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To assess the quality of maternal and newborn care (QMNC) in countries of the former Yugoslavia.Women giving birth in a facility in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina between March 1, 2020 and July 1, 2021 answered an online questionnaire including 40 WHO standards-based quality measures.A total of 4817 women were included in the analysis. Significant differences were observed across countries. Among those experiencing labor, 47.4%-62.3% of women perceived a reduction in QMNC due to the COVID-19 pandemic, 40.1%-69.7% experienced difficulties in accessing routine antenatal care, 60.3%-98.1% were not allowed a companion of choice, 17.4%-39.2% reported that health workers were not always using personal protective equipment, and 21.2%-53.8% rated the number of health workers as insufficient. Episiotomy was performed in 30.9%-62.8% of spontaneous vaginal births. Additionally, 22.6%-55.9% of women received inadequate breastfeeding support, 21.5%-62.8% reported not being treated with dignity, 11.0%-30.5% suffered abuse, and 0.7%-26.5% made informal payments. Multivariate analyses confirmed significant differences among countries, with Slovenia showing the highest QMNC index, followed by Croatia, Bosnia-Herzegovina, and Serbia.Differences in QMNC among the countries of the former Yugoslavia during the COVID-19 pandemic were significant. Activities to promote high-quality, evidence-based, respectful care for all mothers and newborns are urgently needed.gov Identifier: NCT04847336.

Objective: To investigate women's perspectives on the quality of maternal and new-born care (QMNC) around the time of childbirth during the COVID-19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean. Methods: Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards- based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021. Results: 2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID-19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a signifi-cantly lower QMNC index for 2020 compared with 2021 (P < 0.001).Conclusion: This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate health-care strategies to improve health care for women and newborns in Latvia are required.

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.

Objective: To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. Methods: Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. Results: A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n= 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 4 87, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. Conclusion: Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.

Objective: To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic. Methods: Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time. Results: Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83– 4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time. Conclusion: Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored.

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic.Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured question- naire with 40 key WHO standards- based quality measures. Four domains of QMNC were assessed: (1) provision of care ; (2) experience of care ; (3) availability of human and physical resources ; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region.Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high- quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%) ; adequate staff profession-alism (94.6%) ; adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center ; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstru- mental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1% ; 19.5% in Lisbon to 28.2% in Algarve).Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.

Objective: To investigate potential associations between individual and country- level factors and medicalization of birth in 15 European countries during the COVID- 19 pandemic. Methods: Online anonymous survey of women who gave birth in 2020– 2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. Results: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P

Objective: To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. Methods: Online anonymous survey of women who gave birth in 2020–2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. Results: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: PConclusion: We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care.

Background Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. Methods Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures. Findings 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers’ number as “insufficient”. Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes. Interpretation Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed. Funding The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. Study registration ClinicalTrials.gov Identifier: NCT04847336 This research was funded by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste Italy.

Radionicu pod nazivom „Kvaliteta zdravstvene zaštite majki i novorođenčadi: Prevođenje istraživanja u političke inicija- tive u europskoj regiji SZO“ organizirao je Suradni centar Svjetske zdravstvene organizacije za zdravlje majke i djeteta IRCCS Burlo Garofolo iz Trsta u suradnji s Talijanskim na- cionalnim institutom za zdravlje (ISS), UNICEF-om u Italiji i Sveučilištem Lancashire (UK). Radionica je održana online 27. listopada. Sudjelovali su govornici iz Hrvatske, Bosne i Hercegovine, Slovenije, Italije, Portugala i Ujedinjenog Kraljevstva, a teme su uključivale kako lokalne inicijative tako i nacionalne odnosno međunarodne inicijative iz navedene oblasti. Cilj događanja je bio podijeliti ključne koncepte te prijedloge za prevođenje istraživanja u zdravstvenu politiku i učinkovite akcije, uključujući promicanje zdravlja u prvih 1000 dana djetetovog života. Predstavilo se nekoliko studija slučaja, na svim razinama (tj. regionalnoj, državnoj, europskoj) koje su provedene u različitim okolnostima i s različitim uspjehom (tj. Bosna i Hercegovina, Hrvatska, Italija, Portugal i UK). Događaj je bio namijenjen onima koji su iz različitih razloga uključeni u prevođenje znanstvenih spoznaja u politike (tj. institucije, volonterski sektor i drugi sudionici) s naglaskom na zdravlje majke i djeteta te kvalitetu skrbi tijekom poroda. Radionica i webinar su samo dio većeg međunarodnog projekat IMAgiNE EURO (Improving Maternal Newborn care u EURO regiji), a koji je započet u rujnu 2020. godine u organizaciji Suradnog centra Svjetske zdravstvene orga- nizacije (SZO) za zdravlje majke i djeteta IRCCS Burlo Garofolo iz Trsta, s mrežom od 20-ak europskih zemalja, a s ciljem poboljšanja kvalitete majčinsko-neonatalne skrbi unutar europske regije SZO-a. U pokušaju da se razumije utjecaj koji je pandemija COVID-19 imala (i ima) na kvalitetu pružene skrbi, prikupljali su se podaci o iskustvima majki i zdravstvenog osoblja u ovom razdoblju. Do danas je projekt IMAgiNE EURO prikupio iskustva više od 24.000 majki koje su rodile u europskoj regiji SZO-a od ožujka 2020. Projekat ima za cilj dokumentirati iskustva zdravstvenog osoblja koje, na prvoj crti bojišnice, pruža skrb za majke i novorođenčad u zdravstvenim ustanovama te se i njihova iskustva evidentiraju. Od 2016. Suradni centar SZO-a za zdravlje majki i dojenčadi IRCCS Burlo Garofolo iz Trsta pridonio je implementaciji Standarda SZO-a za poboljšanje kvalitete majčinsko- neonatalne skrbi u talijanskim strukturama, također razvijajući alate za prikupljanje podataka za procjenu i praćenje razine kvalitete pružene skrbi. Slijedom ovih događaja, organizirana je međunarodna razmjena mišljenja i iskustava u vidu navedenog webinara odnosno radionice. U sklopu lokalnih inicijativa obrađena je tema tj. prikaz slučaja iz Bosne i Hercegovine „Prijevod Standarda SZO na bosanski“ (1) s iskustvima pokušaja provedbe publiciranih standarda iz 2018. SZO-a„Standardi za poboljšanje kvalitete skrbi majki i novorođenčadi u zdravstvenim ustanovama“ u praksu te pouka za ubuduće, pogotovo glede kolaboracije nevladinog sektora s iznimno složenim zdravstvenim sustavom Bosne i Hercegovine. Temu„Obiteljska integrirana skrb u NICU“ prikazala je Maria- na Amorim iz EPIUnit – Instituto de Saúde Pública, Universi- dade do Porto, Portugal) (2). U sklopu nacionalnih i među- narodnih inicijativa predstavljene su teme: „Talijanski sustav nadzora smrtnosti majki“ - Serena Donati (ISS) (3), „Izrada i implementacija europskih standarda za primaljsku jedinicu“ - Lucia Rocca-Ihenacho (Sveučilište u Londonu, UK) (4) i „Po- stojeći okviri za prevođenje istraživačkih dokaza u politiku i praksu“ - Marzia Lazzerini (Suradni centar Svjetske zdravstve- ne organizacije za zdravlje majke i djeteta, IRCCS Burlo Garo- folo, Italija) (5). Ispred Republike Hrvatske govornik je bila Marija Čatipović s Veleučilišta u Bjelovaru na temu „Namjere, stavovi i znanje srednjoškolaca o dojenju u Hrvatskoj: kako poboljšati sta- nje?“ (6), a unaprijed snimljene studije slučaja prezentirali su Anita Pavičić („Kako implementirati Neo-BFHI program na nacionalnoj razini: hrvatsko iskustvo“) (7), Milan Stanojević („Provedba inicijative prijatelj majci i bebi (MBFHI) u četiri hrvatska rodilišta: rezultati pilot projekta“) (8), iz Italije Enrica Pizzi (Talijanski nadzorni sustav za djecu u dobi od 0 do 2 godine za podršku roditeljstvu i promicanje zdravlja u prvih 1000 dana života“) (9), Francesca Beber („Porodna staza – po- svećena primalja“) (10), iz Portugala Carina Rodrigues („Hra- njenje majčinim mlijekom pri otpustu portugalske nedo- noščadi: politika i praksa odjela za intenzivnu njegu novo- rođenčadi čine razliku“) (11), iz Slovenije Zalka Drglin („Inicijativa za brigu o rodilištu“) (12) te iz UK Trixie McAree (Primaljski kontinuitet skrbi: od koncepta do održivog mo- dela skrbi) (13). U zaključku, većina država nailazi na slične probleme pri implementaciji znanstvenih činjenica u praksu s tim da je bilo zanimljivo svjedočiti jedinstvenosti i specifičnosti koje izranjaju kao rezultat različite organizacije zdravstvenih sustava te različitih razina razvoja i svijesti općenito. Prikaz slučaja iz Bosne i Hercegovine „Prijevod Standarda SZO na bosanski“(1) predočio je iskustva prilikom pokušaja implementacije prijevoda publiciranih standarda SZO-a iz 2018. „Standardi za poboljšanje kvalitete skrbi majki i novo- rođenčadi u zdravstvenim ustanovama“. Naime, 2018. godi- ne aktivisti iz nevladinog sektora u području porođajnih prava su na vlastitu inicijativu i bez financijske podrške vladi- nih institucija preveli publikaciju svjetske zdravstvene orga- nizacije „Standards for improving quality of maternal and newborn care in health facilities” na bosanski jezik. Ova pu- blikacija je objavljena 2016. godine i pored izdanja na engle- skom jeziku bili su dostupni prijevodi na ruski i francuski. S obzirom da nije bilo prijevoda ni na hrvatski ni na srpski je- zik, a koji su također službeni jezici Bosne i Hercegovine, od- lučili smo se na prijevod ove publikacije kako bi bila dostup- na vladinim službenicima i medicinskom osoblju Bosne i Hercegovine. S obzirom na raspon od dvije godine od pu- bliciranja do prijevoda smatrali smo da je to dostatan vre- menski okvir koji bi omogućio suvremene i ažurirane podat- ke za implementaciju u zdravstveni sektor. Nakon prijevoda projekat je predstavljen Federalnom ministarstvu zdravstva i Agenciji za kvalitetu i akreditaciju u zdravstvu te je naišao i na njihovo odobrenje. Kada već spominjemo institucije poput Federalnog mini- starstva i Agencije, ne možemo a da se kratko ne osvrnemo na organizaciju zdravstvenog sustava u Bosni i Hercegovini u postdejtonskom razdoblju. Naime, prilikom svim među- narodnih predstavljanja naših projekata, ovakav jedan uvod je neophodan kako bi se stekao kontekst i razumjela slože- nost područja našeg djelovanja. Naime, zdravstveni sustav Jugoslavije je 1970-ih bio poznat kao „Švedska Balkana“ prema riječima Benjamin Warda, američkog zdravstvenog ekonomista. Sada, trideset godina kasnije, prema riječima The Guardian, Bosna i Hercegovina ima najsloženiji politički sustav na svijetu. U kontekstu zdravstva, to znači da imamo trinaest ministarstava zdravstva od kojih nijedno nije na državnoj razini. Dva najveća su Ministarstvo zdravstva Fede- racije Bosne i Hercegovine i Ministarstvo zdravstva Republi- ke Srpske. Iako donosi zakone i strategije u zdravstvu za svo- je područje djelovanja, Ministarstvo zdravstva Federacije dio izvršne vlasti gubi raspačavanjem na razine kantonalnih ministarstava zdravstva. Pri tome ne smijemo zaboraviti da se ide s tendencijom pružanja sve veće autonomije bolnič- kim sustavima pri organizaciji rada i upravljanja što dodatno otežava koncept pozivanja na odgovornost. Dakle, iako se teoretski implementacija projekata bez većih zastoja spušta s viših razina na niže, jako je teško revidirati i poticati pro- mjene s nižih razina ka višima, pogotovo kada se u kalkula- ciju uvrsti i nevladin sektor zainteresiran za domenu rada zdravstvenog sektora, s obzirom da nevladin sektor nije do- voljno ojačao u onoj mjeri u kojoj igra ulogu partnera vladi- nog i privatnog sektora u razvijenim zemljama svijeta. Dakle, prijevodom ove publikacije, nevladin sektor i naše udruženje je pokušalo pokrenuti inicijativu prema višim razinama zdravstva da se službeno implementiraju najnovije smjernice na temu kvalitete zdravstvene skrbi majke i novorođenčadi u Bosni i Hercegovini. U području porođajnih prava, ovo je bila prva inicijativa ove vrste. Inicijative nevladinog sektora vrlo često se prosljeđuju od jedne vladine institucije do druge na različitim razinama i vrlo često nakon dosta vremena i uložene energije, nikad ne bivaju pretočene u praksu. Zamisao je bila da se dio smjernica spomenutih u publikaciji svjetske zdravstvene organizacije pretoči u konkretne korake za rad rodilišta a u formi „Mother Friendly“ akre- ditacijskog sustava te stoga i uključuje Agenciju za kvalitetu i akreditaciju u zdravstvu (AKAZ). Mother Friendly sintagmu je prvi put osmislio FIGO - The International Federation of Gynecology and Obstetrics (Međunarodna federacija gine- kologa i opstetričara), Svjetske zdravstvene organizacije i White Ribbon Alliance (Savez bijelih vrpci) (14). Smatrali smo da su nam šanse za uspjeh na ovaj način najznačajnije s obzirom da je AKAZ već imao sustav za akreditaciju rodilišta kao „Baby Friendly Hospital“ odnosno, „Rodilišta prijatelj djece“. Ovaj projekt je bio dosta uspješan te je 11 od ukupno 13 porodilišta bilo akreditirano i reakreditirano kao Baby Friendly. Stoga se, nakon službenog objavljivanja online publikacije, pokrenula inicijativa te su se okupili predstavnici našeg udruženja, kao nevladinog sektora te predstavnici AKAZ-a, Federalnog ministarstva zdravstva i regionalnog ureda Svjetske zdravstvene organizacije. Iako je sami susret bio obećavajući, ova inicijativa nažalost nije zaživjela. Zašto, u ovom specifičnom kontekstu? Postoji nekoliko razloga iz kojih možemo povući pouku za ubuduće. Prvenstveno, inicijativa je trebala ostati u„rukama“ nevladinog sektora, da se pored publiciranja i objavljivanja, ne predaje u nadi da će druge institucije preuzeti daljnje korake. Zapravo, nijedna ustanova nije dalje preuzela vodeću ulogu ni odgovornost da se aktualizira ono što je na papiru. Mi smo smatrali da kao nevladin sektor nemamo dovoljno ingerencije za to dok su ostali sudionici smatrali da nije na njima odgovornost da to učine. Ideje su ostale, novi susreti nisu organizirani, i kao što to obično biva, akteri vladinih institucija i donositelji odluka su se u međuvremenu smijenili i promijenili. Ono što smo mi naučili iz ovoga je da za nevladin sektor postoji dovoljno prostora da se sve buduće inicijative ove vrste, nakon inicijalnih koraka, pretvore u „watchdog“ aktivnosti koji će biti stalni podsjetnik i korektiv za sve sudionike. Pozitivna korespondencija je održana sa svima koji su bili uključeni te se nadamo da ovom poduhvatu još nije kraj. Svakako da je došlo vrijeme da se uloga nevladinog sektora u Bosni i Hercegovini, kao korektiva društva, još više poveća.

Background: Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking.Methods Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 to March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based quality measures. Findings: 21,027 women were included in the analysis. Among those who experienced labour (N=18,063), 49·9% (37·2%-60·7%) perceived a reduction in QMNC due to the COVID-19 pandemic, 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported health workers not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the number of health workers as “insufficient”. Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Findings were significantly worst among women with elective caesarean (CS) and emergency CS during labour (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes; younger women and those with operative births also had significant lower QMNC Indexes. Interpretation: Findings reveal large inequities in the QMNC across countries of the WHO European Region. Actions to reduce these inequities and promote high-quality, evidence-based, patient-centred respectful care for all mothers and newborns are urgently needed. Trial Registration: Study registration ClinicalTrials.gov Identifier: NCT04847336. Funding: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. Declaration of Interest: None to declare. Ethical Approval: The study was approved by the Institutional Review Board of the coordinating centre: the IRCCS Burlo Garofolo Trieste (IRB-BURLO 05/2020 15.07.2020). The study protocol was also reviewed and approved by the ethical committees of three other countries to comply with local regulations: Portugal (Instituto de Saude Publica da Universidade do Porto, CE20159); Norway (Norwegian Regional Committee for Medical Research Ethics, 2020/213047) and Germany (Bielefeld University ethics committee, 2020-176).

U ovom radu se opisuje i istražuje fenomen „djece ulice“ u Hrvatskoj i svijetu. Nastoji se definirati pojam „djece ulice“, procijeniti broj i uzroke fenomena te pojasniti stigmatizaciju djece ulice. Posebna važnost pridaje se prisutnosti fenomena u svijetu, budući da djeca ulice žive na ulicama nerazvijenih, ali i razvijenih zemalja. Sukladno tome, istražuje se prisutnost fenomena i u Hrvatskoj. Djeca ulice izložena su mnogobrojnim rizicima, a neka od njih i sama se priklanjaju rizičnim ponašanjima. U ovom radu se u tom kontekstu opisuje nasilje, konzumacija opijata, rizično seksualno ponašanje te trgovina djecom. Također, u radu se opisuju načini suočavanja društva s fenomenom te uloga profesije socijalnog rada., This paper is describing and exploring the phenomenon of “street children” in Croatia and the world. The aim is to define the term "street children", to estimate the number and causes, and to explain the stigmatization of street children. Particular importance is attached to the presence of this phenomenon in the world, as street children live on the streets of underdeveloped but also developed countries. Accordingly, the presence of the phenomenon in Croatia is also explored. Street children are exposed to many risks, and some of them choose to behave risky. This paper describes violence, opiate use, risky sexual behavior, and child trafficking. Also, the paper describes the ways in which society copes with the phenomenon and the role of the social work profession.

Paraneoplastic cerebellar degeneration (PCD) is a rare disease that is triggered by an abnormal immune response to a malignant tumor by cross-reaction of antibodies. The low prevalence of this condition has not allowed for large-scale randomized controlled trials. Suspecting a paraneoplastic syndrome followed by rapid diagnosis is crucial before the symptoms irreversibely progress. Indirect immunofluorescence (IIF) with HEp-2 ​cells is currently the most widely used screening technique for the detection of a wide range of nuclear and cytoplasmatic autoantibodies. Here, we present a case of a female Caucasian patient, 61 years of age, who started having sudden symptoms of PCD starting April 2016 that progressed through the course of 10 months before the final diagnosis. Assuming that antinuclear antibodies (ANA) testing could give rise to suspicion of an underlying malignancy but also to an underlying autoimmune etiology of PCD, we followed the ANA patterns of the patient during the course of disease and treatment protocols. A total of four ANA follow ups were done on serum dilution 1:100 and all showed weak positive results on hepatic cells and a mix of similar patterns that, through the course of time, differed slightly on HEp-2 ​cells. Finding positive antinuclear or anticytoplasmic auto-antibodies might guide toward an extensive and useless search for a systemic autoimmune disease ignoring the possibility of searching for paraneoplastic-specific antibodies. An unspecified mix of patterns should not be ignored and might, through further research, show to be more valuable in the ANA screening than is the case now. Weak positive results should not mislead into thinking that there is no overall effect on health, since quite the opposite was the case here. In our example, neither the tumor response to treatment, neurological presentation nor the immunological treatment had a strong effect on the ANA patterns which remained almost identical throughout the course of disease and treatment. Ultrastructural and molecular events in the pathogenesis of the disease could have caused certain minor changes in the pattern but are not of clinical value at the moment and further research is needed.

The paper present a review of the geotechnical characteristics of the terrain at the location of the bridge No. 3 of motorway Zenica – Sarajevo – Mostar - Bijaća, section Počitelj - Zvirovići.Also, given the suggestion of foundation structures for each column, as well as the calculated bearing capacity.

Intake of sugar-containing beverages (SCBs) has been associated with higher body mass index (BMI) in childhood. The potential effect of SCB intake during infancy is unclear. We examined the association of SCB intake at 13 months with BMI development until 6 years and body composition at age 6 years. This study included 2371 Dutch children from a population-based prospective cohort study. SCB intake at 13 months was assessed using a Food Frequency Questionnaire with validation against 24-h recalls and was standardized for total energy. BMI was calculated from repeated weight and height measurements, and age- and sex-specific s.d. scores were calculated. Adiposity was measured using Dual-energy X-ray absorptiometry. In girls, higher SCB intake at 13 months was significantly associated with higher BMI at ages 2, 3, 4 and 6 years (at age 6 years BMI (s.d. score) increase 0.11 (95% confidence interval (CI) +0.00; 0.23), high versus low intake). We observed a tendency towards higher android/gynoid fat ratio in girls with high intake (s.d. increase 0.14 (95% CI −0.02; 0.29), versus low intake) but not with body fat percentage. In boys, there was no association with BMI or body composition, but boys with high SCB intake at 13 months were taller at age 6 years (s.d. increase 0.14 (95% CI +0.00; 0.27), versus low intake). Higher SCB intake at 13 months was associated with higher BMI up to age 6 years in girls but not in boys. Our results imply that the unfavorable effects of SCB intake start early in life and that dietary advice regarding limiting SCB intake should already be given early in life.

The paper present a review of the geotechnical characteristics of the terrain at the location of the bridge No. 1 of motorway Lašva – Donji Vakuf, subsection interchange Lašva – interchange Kaonik.Also, given the suggestion of foundation structures for each column, as well as the calculated bearing capacity

Izvješće sadrži analizu IV. nacionalnog izvješća o provedbi Aarhuške konvencije ; neusklađenost Zakona o zaštiti okoliša i drugih zakona s Aarhuškom konvencijom ; primjere kršenja Arhuške konvencije iz prakse.

U radu su najprije opisani odnosi između Dubrovačke Republike i Osmanskog Carstva kroz povijest. Mnogi arhivski fondovi Državnog arhiva u Dubrovniku svjedoče o tim specifičnim odnosima i čestim kontaktima. Među tim arhivskim fondovima posebno se ističe fond osmanskih spisa nazvan Acta Turcarum koji je nastao isključivo na temelju osmansko-dubrovačkih odnosa. Fond Acta Turcarum prati sudbinu osmansko-dubrovačkih odnosa sve do službenog ukinuća Republike pa i kraće vrijeme poslije. Dopisivanje Dubrovčana s vlastima susjednih zemalja prije dolaska Osmanlija bilo je u nadležnosti tzv. Slavenske kancelarije. Nakon dolaska Osmanlija, u njoj se razvila i Turska kancelarija. S obzirom na pismo i jezik spisa koji su se čuvali u Turskoj kancelariji, njezini službenici su nosili naziv „dragomani“ (prevoditelj za osmanski jezik). Dragomani Turske kancelarije pohranjivali su osmanske spise, prevodili ih na hrvatski ili talijanski jezik te na osmanski jezik prevodili pisma dubrovačke vlade osmanskim dostojanstvenicima. Također su bili odgovorni za pohranu, klasificiranje i inventarizaciju spisa. Vrste osmanskih spisa koje se čuvaju u arhivu uglavnom su sljedeće: sultanski spisi, bujruldije, hudžeti, ilami, arzi, fetve i veći broj pisama. Sultanski spisi sastoje se od većeg broja fermana, manjeg broja berata–povelja te malobrojnih sačuvanih ahdnama i hatt-ı hümayuna. Bilo je raznih pokušaja razvrstavanja i klasificiranja tih spisa te izrade pomagala radi lakšeg snalaženja u opsežnom osmanskom gradivu. Nakon sloma Dubrovačke Republike spisi njezina arhiva imali su uistinu dramatičnu sudbinu kojoj se posebno pogođeni osmanski spisi. Najvjerojatnije nikada ni otprilike nećemo saznati koliko ih je izvorno bilo ni koliko ih je propalo u vrijeme Republike i kasnije. Godine 2002. započeta je digitalizacija i inventarizacija fonda Acta Turcarum, međutim digitalizirano je tek prvih 500 fermana. U radu su spomenuti primjeri digitalizacije u svijetu te mogući prijedlozi za nastavak. Kako je proces digitalizacije dugotrajan, potrebno je uzeti u obzir hoće li se gradivo digitalizirati u instituciji ili izvan nje, uzimajući u obzir prednosti i mane odabranog te koji će se skeneri pri tome koristiti. Ipak, digitalizacija bi bila odlično rješenje za očuvanje tako vrijednog fonda, a i za poboljšanje pristupa samom gradivu zbog čega bi se mogao povećati i broj korisnika, ne samo znanstvenika već i studenata koji bi na lakši način mogli pretraživati ono što ih zanima.

Ćerimagić, Adnan Zsfassung in engl. Sprache Graz, Univ., Dipl.-Arb., 2010