BACKGROUND Tumor marker CA 125 is found in normal mesothelial lung cells and normal bronchial epithelial cells. If destruction of these cells occurs due to inflammation or tumour, CA 125 will be released, and increased in the serum. SUBJECTS AND METHODS From November 2008 to May 2009 a study analysing CA 125 levels in serum samples from patients who are hospitalized at the Pulmology Department of University Hospital Mostar. Standard laboratory tests, X-ray, sputum examination to BK, and tumour marker CA 125 were performed in all patients. Patients were divided into 5 groups. Comparing clinical and laboratory findings of patients and statistical processing of collected data, conclusions were drown about the role of tumor markers Ca 125 in the diagnosis of pulmonary tuberculosis. RESULTS This analysis is performed on 220 patients, forty with pulmonary tuberculosis. Of the total number of patients included, there is 60% of the negative findings of tumor marker Ca 125 which is statistically significant (P<0.05). Further analysis of Ca 125 shows that there is 75% of positive findings in active pulmonary tuberculosis, which is a statistically significant difference (P=0.002). Within the group of patients with lung carcinoma, half of the patients showed positive finding of tumor marker CA 125. Statistical analysis showed that sensitivity of CA 125 was 75%, specificity was (68%) and positive predictive value was 12% in patients with active tuberculosis. CONCLUSIONS The result of this study showed that the increase in serum tumor marker CA 125 is present in active pulmonary tuberculosis as well as in patients with lung cancer.

The continuous progress of science has a very positive effect on health care. Health care in its broader sense has greatly progressed in past decades, and the education of health care professions requires more continuous learning, teaching materials and course duration. It becomes clear that continuous education is not only important for good quality doctors, but all participants of health care are gaining more burdens and their work becomes more complex. There is an increased necessity for team work, division of tasks and specialization. In this battle for health, the Faculty of Health Studies becomes a necessity and has an obligation in education of various health personnel due to acquiring practical and theoretical skills, as well as abilities in providing the best possible health care. The path of knowledge is long and difficult. It has been present at our faculty for 17 years and we carry it out through a variety of undergraduate and graduate programs, and as of this years through our postgraduate program. Besides the education of health care workers we wanted to offer to our current and former students, and their educators the possibility of publishing their work, so in 2015 we launched our electronic journal, "Health Bulletin", whose publisher is the Faculty of Health Studies. In the process of continuous battle for health, prevention and treatment, the role of highly educated health care worker is of increasing importance and he certainly becomes an indispensable link in this process. The goal of our faculty is to educate the best possible health care workers, who will in addition to high quality practical work gradually take over our teaching responsibilities at the university.

Public health is an important area of health care that reflects the readiness of the state and society to provide the welfare of all citizens through the promotion of health and the preservation of a healthy environment - factors that directly affect the health of the population. The field of public health is very broad and its concept is changing over time, being defined in a narrower and wider sense. In short, public health is a science and practice that aims at ensuring the conditions in which people can preserve and improve their health and prevent health damage. The third millennium brings its specifics, needs and priorities according to challenges public health is faced by in the twenty-first century: the economic crisis, rising inequality, population aging, rising rates of chronic diseases, migration, urbanization, ecosystem change, climate change, etc. The role of public health is to protect, improve health, prevent diseases and injuries. Such a public health approach implies a multisectoral work focusing on "wider health determinants", and within this activity experts from various medical and non-medical profiles, whose field of public health is concerned, can be found. The development of inter-departmental co-operation skills contributes to a better understanding of health professionals and professionals of other profiles, and facilitates common, synergistic actions in addressing public health problems in the community. Symposium on Public Health Achievements and Challenges organized by the University of Mostar Faculty of Health Studies is just another indication of the obligation, the need and the desire for professional and scientific contribution to the fight for better health. Our faculty has so far organized other numerous symposia, and the aim of this symposium is to present public health achievements and challenges in our surrounding in order to protect, improve health, prevent diseases and injuries in a modern way.

INTRODUCTION In recent decades, there is more and more scientific research and evidence that religiosity has a positive impact on quality of life and mental health. The aim this study is to evaluate the impact of religiosity on the quality of life and psychological symptoms of chronic mental patients. SUBJECTS AND METHODS The test group was consisted of 100 chronic mental patients at the Clinic for Psychiatry UCH Mostar, and control group was consisted of 80 somatic patients surveyed from the Infirmary of family medicine of the Health Center Mostar. The survey was conducted by the social and demographic questionnaire, a questionnaire on the quality of life of the World Health Organization WHOQOL-BREF, the questionnaire on religiosity and self-assessment questionnaire for psychological symptoms SCL-90th. RESULTS For the socio-demographic data we obtained results that chronic mental patients as opposed to chronic somatic patients have significantly higher percent of an average lifestyle habits. There is statistically significant difference in the place of residence, chronic mental patients live in the city as opposed to somatic who live in the countryside. On the question of religiosity we received information that the chronic mental patients in relation to chronic somatic patients significantly more attend public religious gatherings, but however, chronic somatic patients compared to chronic mental significantly more use religiosity for better financial position, social comfort. In self evaluation of psychological symptoms we received information that the chronic mental patients as opposed to chronic somatic patients had significantly more psychotic features. To test the quality of life between the two groups, we received the information that chronic mental patients have significantly better physical and mental health, social relationships and caring for the environment as opposed to chronic somatic patients. CONCLUSIONS Quality of life was significantly better in the chronic mental patients. Also, chronic mental patients significantly more attend public religious gatherings, while chronic somatic patients significantly more use religiosity for a better financial position, social comfort. Finally, chronic mental patients had a significantly more pronounced psychotic features.

BACKGROUND The aim of the present study was to explore the differences in serum CRP, IL-6, TNF-α, ACTH and cortisol among patients with major depressive disorder with or without metabolic syndrome (MS) compared to a healthy control group. SUBJECTS AND METHODS The MDD study group consisted of 80 patients (mean age of 50.03±9.55 years). The control group was recruited from the hospital personnel and it consisted of 40 examinees (mean age of 47.20±7.99 years). All patients who participated in the study were diagnosed with depressive disorder using MINI questionnaire, and Hamilton rating scale for depression. Diagnosis of the metabolic syndrome was set by NCEP ATP III criteria. RESULTS Examinees with depression but without MS had significantly more cortisol concentration when compared to the control group. CRP was significantly higher in the MDD group when compared to the control group and in MDD+MS group when compared to the control group. IL6 serum levels were significantly higher in the MDD group when compared to the healthy control group, and in MDD+MS group when compared to the healthy control group. ACTH had significant independent predictive values for abdominal obesity. Levels of TNF-α were statistically significant independent predictors for hyperglycaemia. Statistically significant predictive values for MDD were found for cortisol, and IL-6. CONCLUSION Results shown here emphasise the importance of neuroendocrine and inflammatory factors in pathogenesis of depressive disorder and MS. Further prospective research is necessary to clarify possible causal relationship between depression and MS. It is necessary to investigate the possibility of a joint biological mechanism in pathogenesis of these two disorders with the special attention given to the disturbances in the immune system.

ACTIVITY OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS AND INFLAMMATORY MEDIATORS IN MAJOR DEPRESSIVE DISORDER WITH OR WITHOUT METABOLIC SYNDROME Marko Martinac, Dragan Babić, Milenko Bevanda, Ivan Vasilj, Danijela Bevanda Glibo, Dalibor Karlović & Miro Jakovljević Mostar Center for Mental Health, Mostar Health Center, Mostar, Bosnia and Herzegovina Clinical Department of Psychiatry, Mostar University Hospital, Mostar, Bosnia and Herzegovina Clinical Department of Internal Medicine, Mostar University Hospital, Mostar, Bosnia and Herzegovina Clinical Department of Psychiatry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia University of Mostar, School of Medicine, Mostar, Bosnia and Herzegovina Clinical Department of Psychiatry, University Hospital Center Zagreb, Zagreb, Croatia

IntroductionMore severe mental illnesses, like depression, are connected with various cardiovasCular risk factors, like hypertension, obesity, atherogenic dyslipidemia, hyperglycemia, smoking and alcohol and other psychoactive substances abuse. Patients suffering from the depressive disorder display alterations of circadian rhythm, sleep disturbances, changes of autonomic nervous system, hypothalamus-hypophysis-adrenal gland axis (HHN) hyperactivity and changes of immunologic system. On the other hand, the somatic diseases, like obesity, hyperlipidemia, hypertension and diabetes mellitus type II are lately ever more often accepted as significant comorbid states in patients with more severe mental diseases. There is ever more data showing that the severe mental illnesses also affect the somatic health and only lately, these states are evaluated in the context of metabolic syndrome. Pathogenesis of metabolic syndrome, similar to pathogenesis of depression, is complex and insufficiently investigated. However, it is considered that the interactions of chronic stress, psychological trauma, hypercortisolism and disturbed immunologic functions contribute to the development of these disturbances [1-6].Metabolic syndrome (MS) is a complex multisystem disturbance, consisting of several components, namely: abdominal obesity, lipid metabolism dysfunction, hypertension and glucose metabolism dysfunction [7]. Besides that, the syndrome is connected with pro-inflammatory and pro-thrombotic state, resulting from the secretory activity of fat tissue, characterized by an increased level of inflammation mediators, endothelial dysfunction, hyperfibrinogenaemia, increased aggregation of thrombocytes, increased concentration of plasminogen activation inhibitors, increased levels of uric acid and microalbuminuria. MS represents the greatest risk for diabetes and cardiovascular diseases. MS was described in patients with polycystic ovaries syndrome, non-alcoholic steatosis of the liver, microalbuminuria and chronic renal failure [7-10].Depression is a complex disease, connected with alterations of sleep, appetite, body weight and level of physical activity, all of which can represent risk factors for the development of metabolic disturbances. In depressive patients, various physiological mechanisms can influence the development of metabolic syndrome, such as disturbed regulation of HHN axis and noradrenergic system, as well as various psycho-social factors, such as gender, age, smoking, stress levels, nutrition and level of physical activity [11-14]. It is possible that MS represents a connection between depression on one and KVB and diabetes on the other side. It is considered that chronic stress causes depression and consequently harmful lifestyle, which can lead to MS and consequently, development of KVB [15]. Disturbed regulation of HHN axis is typically connected to chronic stress and numerous studies had described such connection between depression and high levels of cortysole [16-18]. On the other hand, increased levels of cortysole are connected with components of metabolic syndrome, such as the abdominal obesity and glucose intolerance, so depression can indirectly influence the metabolism of glucose and the risk of diabetes development [19,20]. Besides that, psycho-social variables, such as depressive mood, can result in changes of levels of pro-inflammatory cytokines, which are also important components for the development of metabolic syndrome [21].Based on the research so far, we may say that the depressive patients show a greater incidence of cardiovascular diseases, hypertension and diabetes compared to the other psychiatric patients and the general population [22-39]. Symptoms of a depressive disturbance are frequently observed among the patients with MS and fatigue is a frequent symptom in states with a chronic activation of non-specific immunity, such as MS [3943].The aim of this study was to determine the psychosocial and clinical features of depressive patients diagnosed with MS. …

BACKGROUND Young people and nursing students are prone to stress and psychological consequences of it. The aim of the current study was to assess the associations between psychopathology and religiosity in the group of nursing university students. SUBJECTS AND METHODS The study included 100 nursing students of the Faculty of Health Studies in Mostar. The participants were assessed with the SLC-90-R and Dimensions of Religiosity Questionnaire. Sociodemographic data were also collected. RESULTS All SCL-90-R subscales negatively correlated with religiosity showing that the strength of religiosity was associated with better mental health of nursing students. Twenty two percent of potential cases of mental disorder were detected based on the GSI cut-off score. Religiosity was a significant predictor of mental disorder in logistic regression based on the GSI. The year of the study and quality of family relations were associated with students' religiosity. Gender, socioeconomic status and parents' education were associated with higher psychopathology scores. CONCLUSION Religiosity showed to be important factor of resilience for nursing students. Further studies are needed.

Since war activities, the previously mixed population of Mostar, Bosnia and Herzegovina, live in segregated parts of the town based on ethnicity. The aim of this study was to examine differences in health risks and health status between populations of the two parts of the town. Health status of 300 randomly selected primary care patients was evaluated by practicing family physicians in two main primary care centers in West and East Mostar. Each group consisted of 150 patients. Data were collected between December 2013 and May 2014. Patients were evaluated for smoking habit, alcohol consumption, body mass index, blood pressure and laboratory measurement of fasting glycemia. Family physicians provided diagnosis of chronic noninfectious diseases (hypertension, diabetes mellitus, cardiovascular disease, malignant disease, depression, and alcoholism). The two groups differed according to age, income, employment status, and rate of alcoholism and hypertension. Alcoholism (OR= 4.105; 95% CI 2.012-8.374) and hypertension (OR=1.972; 95% CI 1.253-3.976) were associated with inhabitants of West Mostar, adjusted for age, employment and income status on logistic regression. In conclusion, ethnic differences between inhabitants of the two parts of the town might influence health outcomes. These are preliminary data and additional studies with larger samples and more specific questions considering nutrition and cultural issues are needed to detect the potential differences between the groups.

Approximately 94.000 persons were killed or disappeared and about 1.8 million people were forced to flee from their homes during the war in Bosnia and Herzegovina, from April 1992 to December 1995. The Dayton Peace Agreement, signed on November 21, 1995, ended the war. Life and health conditions of the population in B&H characterized with severe disorders caused by severe war and post-war traumatic events. The aim of this work is to establish the connection between breast cancer in women and stress caused by traumatic experiences during the war in B&H. We performed this study of pairs at the Clinic for Oncology, University Clinical Hospital Mostar, from November 2008 to March 2009. Two hundred women from Herzegovina region participated in this research. The study group consisted of 100 women with diagnosed breast cancer. The control group consisted of 100 women without breast cancer diagnosis, of the same age and living in the same area. We have found that women with breast cancer had statistically considerably more war traumatic experiences and thus more stress than the women in control group (p=0.000). The following conclusions are also noteworthy: 39% of women in the study group were under the ages of 50, when diagnosed breast cancer. Only one woman got psychosocially care within breast cancer treatment. High middle age of physiological loss of period (≥50), longer fertile period, as well as the smoking habit are breast cancer risk factors statistically more present. Women with breast cancer have experienced more stress due to significantly more war traumatic experiences, so that war-related stress considered a risk factor.

Aim: To determine the rural–urban differences in primary care practice, hospital inpatient care and total services. Methods: This cross-sectional study used data from Zenica-Doboj Canton in Federation of Bosnia and Herzegovina (FBiH). The overall sample size for the study was 1,995. Individual interviews were conducted in one randomly selected day of the week, except Monday and Friday, on the basis of EUROPEP (European Task Force on Patient Evaluations of General Practice Care) standardized questionnaire. Results: Out of total number (n=1 995), 47.9% was urban population and median of age was 42 years for both populations. The most of urban residents (81.4%) had finished high school or higher education compared with rural residents (58.5%) (p < 0.001). There are significant differences in employment status between rural and urban population (p < 0.001). Rural residents are more likely to travel more than 15 minutes to see their health facilities compared with urban residents (61.7% vs. 24.4%, respectively). Median of distance (kilometers) from residence location to the nearest hospital was statistically significantly higher in rural Me = 8.0 (5.0 do 14.5) km compared to urban population Me = 1.5 (1.0 to 3.0) km (p < 0.001). The rural population was more likely to buy drugs for medical treatment (p < 0.001) and parenteral injections in primary care practice (p < 0.001). Conclusion: There are significant differences in the overall health care assessment of rural populations as compared to urban populations.

INTRODUCTION Persons serving a prison sentence are identified as a population exposed to a higher risk of HIV/STIs due to a high incidence of risk behaviour, especially intravenous drug misuse. To show results of research on prevalence of HIV/STIs in relation to spread of risk behaviour and other risk factors. SUBJECTS AND METHODS Cross-sectional study on a sample of 620 respondents in 10 prisons. A specially structured questionnaire was applied as a research instrument, together with blood sample taking for laboratory analysis of HIV, HBV, HCV and syphilis. RESULTS Majority of respondents show insufficient knowledge about HIV/AIDS, ways of transmission prevention, especially knowledge on ways of HIV transmission. Every sixth respondent has experience of intravenous drug use, of which 58% exchanged drug injection equipment. Every fifth respondent with a tattoo had their tattoo done in prison. Below 2% of respondents quote being victims of sexual abuse, and having wilful anal sexual intercourse in prison. Test results in this research: HIV (0), HBV (1.5%), HCV (14.3%) syphilis (0.5%). CONCLUSION Intravenous drug use presents the strongest risk factor for HCV, and therefore for HIV/ STIs. Other risk factors - tattooing with kit exchange, sexual risk intercourse, abuse, insufficient knowledge and information about HIV/AIDS, ways of transmission and way of protection, and lack of access to measures of prevention and "Harm reduction" programme.

BACKGROUND A cross-sectional study in the Primary Care Medical Centre Mostar and Regional Medical Center "Safet Mujić" was conducted. Family physicians randomly surveyed, examined, and analyzed laboratory tests from 300 subjects divided into three age groups from 20-39, 40-54 and 55-65 years, totally 100 subjects. Data for age, sex, smoking status, alcohol consumption, body mass index, blood pressure, blood glucose, triglycerides and cholesterol, and the presence of chronic non-communicable diseases, including diagnosis of depression and the presence of stress were entered in medical records. RESULTS Levels of cholesterol were significantly higher in rural population as well as among students, and high triglyceride levels most frequently were presented in the student population. A group of farmers had a significantly higher prevalence of hypertension, DM and CVD compared to other investigated groups. The largest number of smokers and people who drink alcohol was present in group with the highest incomes, while obesity was significantly expressed in people with lower incomes. The group of examinees with the highest incomes had the greatest exposure to stress. CONCLUSIONS Socioeconomic processes have an impact on risk behavior of the adult population, and the presence of a number of chronic diseases that are accompanied with increased laboratory blood glucose, cholesterol and triglycerides levels.

BACKGROUND Although the connection between body and soul is written in the Bible, research papers haven't given much attention to it until the past few decades. Recently, both here and abroad, there have been more studies that investigate the prevalence of various somatic disorders in psychiatric patients, including metabolic syndrome. OBJECTIVE The objective of this study was to establish the prevalence of metabolic syndrome and it's components in patients with posttraumatic stress disorder (PTSD). SUBJECTS AND METHODS Metabolic syndrome and its components were investigated in 60 patients with chronic PTSD conditioned by the war and in 60 patients treated for somatic problems by their family physician in Mostar. RESULTS The prevalence of metabolic syndrome was statistically significantly higher in patients with PTSD (48.3%) than in the control group (25%) (P=0.008) and the number of its individual components (test group 2.38±1.30 compared to control group 1.72±1.24) (P=0.005). PTSD patients diagnosed with metabolic syndrome had significantly more frequent hyperglycemia (P=0.010) and abdominal obesity (P=0.044) compared to the control group. CONCLUSION The prevalence of metabolic syndrome increased in patients with PTSD compared to the control group.