Climate change is definitely one of the greatest challenges of human development in the 21st century. Climate change is expected to increase the risk of communicable diseases in Europe. This impact will depend not only on local climatic conditions, but on other factors, such as current infrastructure, public health services, biodiversity specificity, etc. The population in Bosnia and Herzegovina, Croatia and Serbia has been severely affected by the floods caused by cyclone Tamara in 2014. The basic mode of transmission of the disease caused by the West Nile virus is the bite of the infected mosquito. The West Nile virus is not transmitted among humans through contact, nor can it be transmitted from infected birds to humans without mosquito bite. The aim of the study was to analyze and present the trend of this disease in the period 2014-2018 and to show the connection between the spatial occurrence of cases and location of the flooded area in 2014 in the Republic of Srpska. Using the descriptive method, the demographic data of the patients were analysed, the most common clinical form of the disease and the incidence of the disease in the period 2014-2018 was analysed. The cases were mapped and we analysed the connection of the case and location that was flooded. The incidence ranged from 0.79 in 2014 to 0.43 in 2018. Patients were of all age groups and both sexes, most commonly cases from rural areas (78%). The most common clinical form of the disease is shown, which were symptoms of the central nervous system infection. Out of the total number of patients, 94% were from flooded areas. All reported cases have been diagnosed at the Institute of Microbiology at the University Clinical Center of Republika Srpska and were reported as probable cases in accordance with the international case definition of communicable diseases. However, it is crucial to implement internationally endorsed procedures as a clinical alghoritm for the confirmation of the case in accordance with the laboratory criteria for the case definition. The occurrence, frequency and spatial distribution of cases indicates a possible connection with the floods in 2014.

Objectives: Increased C. difficile infection rates were observed during the last decade, as well as the onset of complicated forms of the disease. The primary objective of this study was to report the first outbreak of C. difficile in a Serbian hospital, aiming to determine clinical and environmental factors associated with the outbreak. The secondary objective was to describe outbreak control measures taken.Design: The retrospective cohort study conducted from 18 April to 22 May 2013 in Serbian healthcare. Ninety-five patients hospitalized at the Department for orthopedic surgery during the CDI outbreak.Results: Prophylactic antibiotic therapy was identified among 93.3% patients with and 87.9% without C. difficile infection. The multivariate logistic regression analysis has shown that the independent risk factors for C. difficile infection incidence are the age beyond 70 (OR = 4.5; 95%CI = 1.1-18.2; p = .031) and the length of antibiotic therapy (OR = 1.5; 95%CI = 1.1-2.1; p = .017).Conclusion: The length of antibiotic prophylaxis is linked with the incidence. Orthopedic departments have a risk of C. difficileinfection. Infection control measure, antimicrobial stewardship programs and compliance to guidelines for the prescribing of antibiotics play important role in the prevention of C. difficile infection burden.

INTRODUCTION: Internet addiction is a topic that is widely debated in scientific circles and the media. Students spend a lot of time in content-related activities online, neglecting common activities such as socializing, business obligations, learning, home affairs, etc., and have difficulty interrupting internet activities, even when they themselves recognize it is time for it. AIM: The aim of this research was to investigate Internet addiction among students of the Medical Care, Faculty of Medicine in Foca. MATERIAL AND METHODS: The research was conducted at the Medical Faculty in Foca in the period from 07.11. until 09.11.2016. year with health care students. The selected study design is a cross section study. The study covered 60 students, the first, second and third year of studies that were present on the days of the study and volunteered to participate in the research. RESULTS: The survey involved 60 respondents, of whom 21 are men (35%) and 39 women (65%), ages 18 to 24 years old. All of our respondents are Internet users. The largest percentage of respondents (66.7%) use the internet for 2 to 4 hours. The largest number of respondents first accessed the Internet at the age of 13 (21.7%). Most respondents use Facebook as a social network 56 (93.3%), while the least number of Twitter users. CONCLUSION: All of our respondents are Internet users, and the largest percentage of respondents (66.7%) use the internet for 2 to 4 hours. The largest number of respondents first accessed the Internet at the age of 13 (21.7%).

Objective: The primary aim of this study was to examine whether the perception of the patient’s disease and adherence to treatment process influence treatment outcomes of heart failure. The secondary aim was to analyze whether there were differences in perception and adherence in patients with heart failure in relation to anemia. Method. A cross-sectional study was carried out in 2015. One group consisted of 100 patients with heart failure and sideropenic anemia. The other group consisted of 100 patients without anemia. The standardized questionnaire was used to collect demographic data, the Brief Illness Perception Questionnaire to measure the patients’ perception of the disease and modified Clinician rating scale to assess patient’ s adherence. Results: The majority of respondents in the first group were women 63%, while in the second group there were 58% male and 42% female respondents. Respondents from the first group had statistically significantly lower adherence compared to respondents from the second group (χ2 = 23.28; p=0.05). A significant difference was found between the groups of subjects in comparison to the perception of disease control (χ2=18.03; p=0.05). Conclusion: The illness perception and treatment adherence have a significant impact on treatment outcomes of heart failure. Comorbidities, such as anemia, contribute to the patients’ perception of their disease and influence their adherence. Кey words: heart failure, sideropenic anemia, illness perception, adherence doi:10.5937/opmed1902029D

According to the World Health Organization, quality communication is one of the five skills that individuals need for a healthy and happy life, and the knowledge and skills of quality communication are a prerequisite for quality action for many professions. In order for healthcare professionals to tailor health communication to each patient individually and to provide high quality healthcare, it is essential that they have an insight into the health literacy status of their users. Given the large percentage of the illiterate population around the world, it is necessary to conduct health literacy research in some of our adapted measuring instruments in our country as well.

Aim To synthesize evidence about the influence of individual antimicrobial stewardship programs (ASP) related to the prevention of Clostridium difficile (C. difficile) infection on primary and secondary outcomes. Methods Relevant databases such as Medline, PUBMED, COCHRANE library and EBSCO were searched from 1 April to 27 April 2017. Additional studies were reached by the manual search for original articles in relevant journals. We included all randomized controlled, quasi-experimental and observational studies, published in the English language from 2007 onward, that evaluated effectiveness of ASP in preventing and controlling C. difficile associated disease (CDAD) among adult inpatients. Results Implementation of ASP interventions was associated with CDAD incidence reduction in 62.5% studies, but no significant differences were reported for the duration of hospitalization, readmission and mortality rate. Improvements in prescribing patterns (decreased antimicrobial use or increased rational use) and microbial outcomes (decreased rates of selected antimicrobial-resistant bacteria) were reported. Evidence on the effects of ASP is mainly limited to the results of studies low in methodological quality with great heterogeneity of outcomes, interventions, and units in which CDAD incidence data were reported. Conclusion Despite the low strength of evidence of reviewed studies, consistency of findings suggest the positive impact of antimicrobial stewardship programs on the prevention and control of nosocomial CDAD. The significance of this problem imposes randomized control trial use as the best instrument to provide highquality evidence. Further studies need to systematically analyse changes in all antibiotic use and its outcomes.

OBJECTIVES Interprofessional teamwork is best attained through education that promotes mutual trust and effective communication. The primary aim of the study was to evaluate the impact of interprofessional learning on knowledge about diabetes. METHODS The cross-sectional study included students of medicine, dentistry and nursing at the Faculty of Medicine Foča, Bosnia and Herzegovina. The students were randomly allocated into one of two groups. Group 1 attended an interprofessional course on diabetes while group 2 was divided into three subgroups and each of the subgroups attended an uniprofessional diabetes course. The measuring instrument used in the course in order to assess the participants' knowledge about diabetic care was a test containing multiple-choice questions about diabetes. The Interprofessional Questionnaire was used to explore the attitudes, views, values and beliefs of students regarding interprofessional education (IPE). RESULTS No statistically significant difference in total score on the test was found between the groups at baseline, but at follow-up the difference was highly statistically significant (F=10.87; p=0.002). The students from Group 1 had better results (21.82 points), compared to Group 2 (18.77 points). The statistically significant difference was observed in mean values (t=-3.997; p=0.001), between Groups 1 and 2; the students from Group 1 obtained 20.42 points, which is considered to indicate a respectively positive self-assessment of communication and teamwork skills. However, Group 2 indicated a negative self-assessment of communication and teamwork skills. CONCLUSION The findings suggest that IPE activities may provide health profession students with valuable collaborative learning opportunities.

Introduction: Hospital-acquired infections (HAI) and surgical site infections (SSI) are a global public health problem. The aim of the study was to determine the incidence of SSIs at the Surgical Clinics of the University Clinical Centre Banja Luka and to identify risk factors for the development of SSIs. Methods: In order to determine the frequency of SSIs through the incidence compared to the patients operated at the Surgical Clinics of the University Clinical Centre Banja Luka, we conducted a prospective cohort study which encompassed 11.216 operated patients, in the period from November 11th, 2014 to September 30th, 2015. In order to identify risk factors for the development of SSIs, a nested case-control study of risk factors for SSIs was conducted. The study group consisted of patients who were diagnosed with SSIs in the period of monitoring, while the control group was consisted of patients without SSIs who corresponded with the study group in age and sex. Results: The highest values of incidence of SSIs were observed at the Department of Anesthesia and Intensive Care (2.65%), Department of Orthopaedic Surgery (2.48%) and the Department of Vascular Surgery (2.15%), and the lowest ones at the Department of Urology (0.59%). Among the cases of SSIs, deep infections of the surgical site were the most represented (82.7%). Multivariate logistic regression was used to identify the following independent risk factors: length of pore-operative stay in hospital (p=0.000; OR=1.062; 95% CI=1.037-1.087), reintervention (p=0.000; OR=22.409; 95% CI=6.361-79.071) and cotrticosteroids (p=0.023; OR=4.141; 95%CI=1.221-14.047). Conclusion: The incidence of SSIs at the Surgical Clinics of the University Clinical Centre Banja Luka is at the level of hospitals in developed countries. There are a number of risk factors for SSIs, which may be prevented.

BACKGROUND/AIM Active surveillance is an important component of surgical site infection (SSI) reduction strategy. The aim of this study was to analyze and compare SSI surveillance data in orthopedic patients in the Military Medical Academy (MMA), Belgrade. METHODS A 4-year prospective cohort study was performed to identify the incidence rate and risk factors for SSI in orthopedic patients in the MMA, Belgrade. We collected data regarding patients characteristics, health care and micro-organisms isolated in SSI. The National Nosocomial Infection Surveillance (NNIS) risk index was subsequently calculated for each patient. The Centers for Disease Control and Prevention criteria were used for the diagnosis of SSI. RESULTS Assessment of 3,867 patients after different orthopedic operations revealed SSI in 109 patients. The overall incidence rate of SSI was 2.8% with the decrease from 4.6% in 2007 to 1.6% in 2010. Using NNIS risk index for surgical procedures there were: 53.7% (2,077) patients with risk 0--the incidence rate of 1.4%; 38.9% (1,506) patients with risk 1--the incidence rate of 3.1%; 7.3% (281) patients with risk 2--the incidence rate of 11.7%; 0.1% (3) patients with risk 3--without infection within the risk. Multivariate logistic regression analysis identified 6 independent risk factors associated with SSI: contaninated or dirty wounds, smoking, preoperative infection, NNIS risk index, body mass index and the length of hospital stay. CONCLUSION The results of our study are valuable confirmation of relations between risk factors and SSI in orthopedic patients. A decreasing incidence rate of SSI (from 4.6% to 1.6%) during a 4-year active surveillance approved its implementation as an important component of SSI reduction strategy.

Introduction: Mumps is a systemic viral infection characterized by swelling of salivary glands, especially the parotid ones. Gonads, meninges, pancreas and other organs may also be affected. Aims of the study: The aim of this study was to analyze the epidemiological characteristics of mumps meningitis in the last epidemic of mumps in the Republic of Srpska, and to analyze the frequency of mumps meningitis and vaccination status in patients who were supposed to be vaccinated against mumps in the war and early post-war period, and also in those patients who were supposed to be vaccinated before or after this period. Patients and Methods: The study included 175 patients divided in the experimental group (140 patients with mumps meningitis) and the control group (35 patients with serous meningitis of other etiology, probably enteroviral). We compared epidemiological characteristics of these patients and additionally we analyzed the differences in these characteristics in patients with different vaccination status. Results: The mean age of patients in the experimental group was 20.0 years (18.0-24.5; IQ), and in the control group 7.0 years (5.0-14.0; IQ) (p <0.001). Patients born between 1985 and 1996 more frequently suffered from meningitis (p <0.001) caused with mumps virus than other patients in the experimental group. There was no statistically significant difference in sex distribution between patients in the experimental and control group (p = 0.746), nor between patients in the experimental group with previously different vaccination status (p = 0.371). Most patients in the experimental group didn’t have data of their immunization status. The subsequent are those patients who received only one dose of vaccine, followed by unvaccinated patients and those who were vaccinated correctly. Conclusion: The epidemic of mumps during 2011 and 2012 is a consequence of maintaining the virus in non-vaccinated population (mainly because of the omissions made during the war and early post-war period) and insufficient duration of protection after vaccination, especially in vaccination with one dose of vaccine.