The aim of the current study is to compare Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (SCREEN II) and Mini Nutritional Assessment - Short Form (MNA-SF), where each ...is used to identify nutritional risk prevalence among community-dwelling people aged 65 years and above in Bosnia and Herzegovina.
A cross-sectional study. Nutritional risk assessed using the nutritionist's risk rating, anthropometric measurements, functional indicators, cognitive parameters, SCREEN II and MNA-SF.
The municipalities of Foca, East Sarajevo and Bijeljina, Bosnia and Herzegovina.
Eight hundred twenty-one community-dwelling individuals aged ≥65 years.
The prevalence of high nutritional risk per nutritionist's risk rating, SCREEN II and MNA-SF was 26, 60, and 7 %, respectively. With the nutritionist's rating score ≥5 as the criterion, the MNA-SF cut-off point of ≤11 (indicating any possible risk) had poor sensitivity (55·7 %), specificity (46·6 %) and AUC (0·563; P = 0·024). When the criterion of >7 was applied, good sensitivity (95·3 %) and specificity (88·9 %) were obtained for the MNA-SF cut-off score of ≤7. AUC for this comparison was 0·742 (considered fair). Cut-off points of <54 (AUC = 0·816) and <50 (AUC = 0·881) for SCREEN II (indicating moderate to high risk) corresponded with good sensitivity (82·2 %; 80·9 %) and fair specificity (72·1 %; 75·0 %).
MNA-SF may have a limited role in nutritional risk screening among community-dwelling seniors in Bosnia and Herzegovina. SCREEN II has promising results in regard to validity, but further studies are warranted.
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.
Public health represents a field full of unresolved issues which are often raised by highly complex and mutually related events. Due to this, the more frequent use of qualitative scientific research ...is required. Qualitative research is primarily focused on the world view of an individual or a group, enabling them to form attitudes and practise related to certain research questions. As its final goal is to comprehend some aspects of social life, qualitative study analyzes words instead of numbers, which makes the interpretation of results complicated. In several simple steps, this paper will allow us to understand qualitative research methodology by providing basic insight into research question formulation, sample selection and methods of data collection and analysis.
Objective. The aim of this study was to investigate the differences in pre-hospital care of patients with acute myocardial infarction between emergency medical services and family medicine. Patients ...and methods. This retrospective descriptive study included patients treated for acute myocardial infarction at the University Clinical Centre of Banja Luka, in the period from 1st January to 31st December 2011. The patients were divided into two groups: patients who received a hospital referral from the family medicine service and those who received one from the emergency medical service. Results. The majority of patients (54.8%) received pre-hospital care from emergency medical services, while in 24.8% of cases the care was provided by family medicine physicians. The analysis showed that the time that passed from the onset of symptoms to the visit to the health institution of first medical contact was shorter in the emergency medical service (p<0.001). The average time from the onset of symptoms to arrival at the family practice was 24 hours, and to the emergency service 2 hours. The patients who established their first medical contact with the emergency service reported more severe symptoms than the ones who visited a family practice over the same period of time. Conclusion. The severity of symptoms affected the patients’ decisions to seek help in a timely manner and to choose the facility of first medical contact. Interventions to decrease delay must focus on improving public awareness of acute myocardial infarction symptoms and increasing their knowledge of the benefits of early medical contact and treatment. Continuing education of family practitioners in this field is required.
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.
The aim of the study was to determine the ability of ferritin, haemoglobin, albumin and total cholesterol to identify nutritional risk and malnutrition among elderly primary care patients.
The ...cross-sectional study included 446 elderly adults over 65 years of age from four areas of Bosnia and Herzegovina. In addition to anthropometric, functional, cognitive and biochemical indicators, nutritional status was evaluated using 24-hour recall of meals, the Mini Nutritional Assessment (MNA), and Seniors in the Community: Risk Evaluation for Eating and Nutrition, Version II (SCREEN II).
Malnourished/at-risk study respondents had lower mean levels of haemoglobin (P=0.001) and total cholesterol (P<0.001), compared to those with normal nutritional status. Albumin levels significantly differed regarding nutritional status (P=0.004), but not nutritional risk level (P=0.521). Significant differences in serum ferritin levels were not found between malnourished and normally nourished study respondents (P=0.779) Determinants of albumin level were eating more than three meals a day (P<0.001), fewer than two portions of fruit and vegetables a day (P=0.024), drinking one glass of wine (P<0.001) and reporting functional independence (P=0.011). The AUC curves for serum ferritin, albumin and total cholesterol levels in men and women, as well as for haemoglobin levels in women, were poor to fair (AUC<0.800).
Although ferritin, haemoglobin, albumin and total cholesterol may be useful biomarkers of nutritional status, their accuracy in diagnosing malnutrition and nutritional risk among elderly primary health care patients is limited.
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.
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/Aim. Diabetic polyneuropathy (DPN) is the most common microvascular complication of diabetes mellitus (DM), which may be present at the time of disease detection. Screening for DPN is ...performed for the patients with type 2 diabetes at the time of diagnosis and for type 1 diabetes 5 years after diagnosis. The primary aim of this study was to determine the prevalence of DNP among family medicine patients with DM aged 18 to 70 years using nylon monofilament. Methods. The cross-sectional study estimated the prevalence of DPN among primary care patients with DM in Banja Luka, Republic of Srpska, Bosnia and Herzegovina. Semmes-Weinstein nylon 10 g monofilament was used to detect DPN. Age, gender, duration of DM, type of therapy, symptoms, glycosylated hemoglobin (HbA1c), and risk factors (hypertension, smoking, dyslipidemia, obesity, physical inactivity) were analyzed. Data collection took place from June 1st, 2017 to May 31st, 2018. Results. The study included 228 patients, 132 (57.9%) men and 96 (42.1%) women. There was a statistically significant difference in the presence of all symptoms of DPN (tingling, burning, light burning, and stinging) among patients with different duration of DM (p < 0.01). Multivariate logistic regression revealed that patients who had hypertension odds ratio (OR) = 26.2; 95% confidence interval (CI): 4.070?168.488; p = 0.001, used oral anti-diabetic therapy (OR = 12.3; 95% CI: 1.300?116.309; p = 0.029), had tingling (OR = 5.2; 95% CI: 1.431?18.571; p = 0.012) and a longer duration of diabetes (OR = 4.27; 95% CI: 1.983?9.175; p = 0.000) were more likely to have DPN. Conclusion. The prevalence of DPN in family medicine patients with DM using nylon monofilament was 24.2%. Determinants of DNP were the presence of symptoms of tingling, duration of diabetes, hypertension, and the use of oral antidiabetic therapy alone.
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