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The major bioactive component of black pepper (Piper nigrum) is piperine which has demonstrated beneficial therapeutic properties. The purpose of this research was to investigate the effects of different irradiation doses on the content of piperine in black pepper. Samples were irradiated with 60Co γ-rays (at absorbed doses of 0.5, 1, 3, 5, 7, 10, and 12 kGy). Thin-layer chromatography (TLC) and UV–Vis spectrophotometry methods were used for measuring the piperine content in the samples. TLC was performed using three mobile phases (1. toluene:ethyl acetate, 7:3 v/v; 2. acetone:n-hexane, 6:4 v/v; 3. toluene:methanol, 8.5:1.5 v/v) and the retention factor (R f) value for piperine was equal to 0.66, 0.94, and 0.67, respectively. The content of piperine in γ-irradiated samples of black pepper was found to be between 0.04 and 1.05% w/w from the spectrophotometry analyses. Irradiation slightly decreased the piperine content of black pepper. It was found that piperine crude yield from black pepper was from 1.10 (the unirradiated sample) to 1.69, 1.07, 0.60, 0.90, 0.30, 1.20, 0.80% for irradiated samples, respectively. Microbiological analyses were performed with standard plate count method, which resulted in a decreasing number of the total cell count of microbial cells with increasing the radiation dose. Treatment with irradiation reduced the population of bacteria by 4 logs.

Special high-protein foods suitable for diabetics must be treated to ensure the complete absence of microorganisms and bacteria. It is also important to achieve that this treatment does not change the nutritional value of the product. Among the new decontamination technologies, low-energy electron-beam treatment has proven to be an effective technique for inactivating bacteria with minimal impact on food quality. The paper aims to analyze the influence of low-energy electron-beam irradiation on the microbiological properties and nutritional value of high-protein foods.

Background/Aim. The risk assessment of heat illness and fatigue development is essential in military service. The aim of our study was to investigate the relationship between heat storage and various psychophysiological parameters of heat stress, as well as potential peripheral markers of fatigue in soldiers performing exertional heat stress tests. Methods. Fifteen young, healthy, and unacclimatized men underwent an exertional heat stress test (EHST) with the submaximal workload in warm conditions (WBGT 29°C) in a climatic chamber. Every 10 min, the following parameters of thermotolerance were measured or calculated: core temperature (Tc), mean skin (Tsk) and body temperature (Tb), heart rate (HR), heat storage (HS), physiological strain index (PSI), as well as peripheral markers of fatigue [blood concentrations of ammonia, urea nitrogen (BUN), lactate dehydrogenase (LDH), cortisol and prolactin] and subjective parameters: thermal sensation (TS) and rate of perceived exertion (RPE). Results. Tolerance time varied from 45 to 75 min (mean 63 ± 7.7 min). Average values of Tc, Tb, and HR constantly increased during EHST, while Tsk reached the plateau after 10 min. Concentrations of all investigated peripheral markers of fatigue were significantly higher after EHST compared to baseline levels (31.47 ± 7.29 vs. 11.8 ± 1.11 μmol/L for ammonia; 5.92 ± 0.73 vs. 4.69 ± 0.74 mmol/L for BUN, 187.27 ±2 8.49 vs.152.7 3± 23.39 U/L for LDH, 743.43 ± 206.19 vs. 558.79 ± 113.34 mmol/L for cortisol, and 418.08 ± 157.14 vs. 138.79 ± 92.83 μIU/mL for prolactin). Conclusions. This study demonstrates the relationship between heat storage and Tc, HR, TS, and RPE, but also with PSI. Concentrations of cortisol and especially prolactin showed a significant correlation with parameters of thermotolerance.

This work sets out the methodology and presents the calculation results of the amount of carbon dioxide emitted into the atmosphere of the BelAz dump truck at the Open Pit "Turija" BCM Banovići d.d., based on the fuel consumption monitoring data. Properly determined fuel consumption enables the calculation of the amount of carbon dioxide emitted and preventive measures, as well as the choice of its reduction strategy. Data collection took six months, then the data were analyzed, and thus the results were given for all dump trucks by months.

Lyophilization or freeze-drying is the technique of removing ice or other frozen solvents from a material through sublimation and the removal of bound water molecules through the process of desorption. Drying occurs in an absolute vacuum at temperatures from −40°C to −50°C. This technique is often used for the conservation of fruits, especially berries. During this process, the water changes from frozen to gaseous, with no thawing. Due to low temperatures and the high vacuum, most microorganisms are rendered inactive during the lyophilization process. However, if there is a necessity to destroy all microorganisms from treated food, subsequent irradiation with gamma rays is an appropriate method. This paper investigated the influence of different doses of gamma radiation on lyophilized berries’ microbiological characteristics. It was shown that the radiation dose of 7 kGy is sufficient to eliminate the total number of microorganisms (excluding molds) to the extent that the number falls below the permitted limit according t o the law on the microbiological safety of foodstuffs of the Republic of Serbia, and 5 kGy is enough for molds to be rendered inactive. It was also concluded that gamma irradiation does not affect the nutritional value of lyophilized berries.

The Kolubara river pollutes the coastal land in the river basin and makes it unsuitable for agricultural activities in that area. Also, contaminated land poses a risk to the environment. Different methods can be used for soil decontamination. These methods include biological treatment/bioremediation, chemical oxidation, soil stabilization, physical methods, such as soil leaching, or treatment with high-energy ionizing radiation. Gamma irradiation of soil is a well-known method of inhibiting microbial activity. This paper investigated the influence of different doses and dose rates of gamma irradiation on microorganisms' decontamination of coastal soil, in the Kolubara river basin. The irradiation effects on reducing the total number of microorganisms and removing mold and pathogenic bacteria from soil samples were examined. Gamma radiation affects the soil's organic matter, causing the formation of free reactive radicals, which act as reducing and oxidizing agents, cleaving C-C bonds, and depolymerizing carbohydrates. It was found that a dose of 3 kGy of gamma radiation, neutralizes all pathogenic bacteria, a dose of 5 kGy deactivates mold in soil samples, and a dose of 10 kGy is optimal to kill all microorganisms in the samples and sterilize exposed soil. The research showed that the dose rate does not significantly affect microbiological decontamination of soil using gamma irradiation. The content of heavy metals in soil was determined, and the obtained values were compared with the remediation limit values prescribed by the regulations. It was concluded that the content of heavy metals in the analyzed soil samples is below the limit of remediation values. The only exception is the slightly increased copper content in one sample. The result of this research is the conclusion that the coastal land from the Kolubara basin can be decontaminated by gamma radiation treatment. This advanced soil treatment technology is available in Serbia because there is an industrial plant for gamma radiation treatment within the Vinča Institute.

This paper sets out the methodology and presents the results of calculation the efficiency of transport system in separation of the OP "Dimnjače", based on the data of monitoring the operating time and downtime/failure. Properly determined state of operation of the transport system, allows preventive measures and selection of maintenance strategy. Data collection lasted a year, and the data were analyzed, and thus the results are given by month for the transport system as a whole.

This work sets out the methodology and presents the calculation results of fuel consumption of the BelAz dump trucks at the Open Pit "Turija" of the Brown Coal Mine Banovići itd. based on monitoring data. Properly determined fuel consumption allows the preventive measures and selection of strategy to reduce it. Data collection took six months, the data were analyzed, and thus the results by month of all dump trucks were presented.

The distribution of the absorbed dose within the irradiated product is a complex function of the product density and homogeneity, the position and shape of the radiation source, as well as the design of the irradiator. In this paper, detailed mapping of absorbed radiation doses in products of different density: gauze, plastic, and soil, is performed. Positions of minimum and maximum absorbed radiation dose were determined, and the homogeneity of irradiation of products was calculated using the ethanol-monochlorobenzene oscillotitrator dosimetry system.

Background: Of all breast cancers 20-25% are HER2 positive. Overexpression of HER2 protein on the surface of the malignant cell leads to excessive cell proliferation through different signaling pathways. Trastuzumab is a human monoclonal antibody that binds to domain IV of HER2 receptor and blocks signaling pathway for proliferation. The result is an improved prognosis for HER 2 positive breast cancer patients, even when compared to patients with other types of breast cancers. Methods: The study presents 74 women patients with early HER2 positive breast cancer who were previously operated (either radicaly or using breast conserving surgery), and received adjuvant chemoand radiotherapy. Fourty four patients received adjuvant trastuzumab for one year, and 30 patients did not (control group). Observed time to relapse of the disease was 60 months. Results: There was a significant difference in survival in favor of the group that received trastuzumab (p

Background/Aim. Hyperbaric oxygen therapy (HBOT) is a method which increases oxygen solubility in plasma up to 20 times. This effect is very important in the treatment of circulatory disorders, which reduces oxygenation and leads to increased production of inflammatory mediators and free oxygen radicals. The aim of this study was to examine the impact of HBOT on the oxidative stress parameters in the patients with systemic lupus erythematosus (SLE). Methods. This prospective study included 18 females with SLE [American College of Rheumatology (ACR) criteria], average age 52.2 ± 8.82 years, treated with HBOT for 60 min/day, with average partial oxygen pressure of 2.2 atmospheres absolute (ATA), during 10 days, in combination with appropriate medication therapy for SLE. The following parameters were determined in the serum: C-reactive protein (CRP), hemoglobin, creatinine, albumin, complement 3 (C3), antinuclear antibodies (ANA), glomerular filtration rate (GFR) using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. In the urine, parameters of oxidative stress were spectrofotometrically determined: levels of superoxide anion radical (O2 •–), hydrogen peroxide (H2O2), nitrites (NO2-) and concentration of thiobarbituric acid reactive substances (TBARS). In hemolysate, the parameters of antioxidant protection: superoxide dismutase (SOD), catalase (CAT) and reduced gluthatione (GSH), were measured. The samples for the analysis were collected three times: before HBOT (initial values), after 10 days of HBOT and 1 month after beginning the treatment in relation to the initial value. Results. We noticed a statistically significant (p < 0.05) decrease in a level of O2 •–, both after 10 days and after 1 month of HBOT (8.26 ± 13.62; 8.39 ± 4.94; 11.92 ± 6.86 nmol/mL, respectively). Values of other parameters of oxidative stress such as NO2-, TBARS and H2O2- showed no significant difference during the monitored period. Regarding the parameters of antioxidant the protection, we revealed slightly higher value of GSH after treatment (initial value: 66.34 ± 16.31; after 10 days of HBOT 79.43 ± 36.77; after 1 month of HBOT69.72 ± 22.32 μmol/mL red blood cells) which was held after a month, but it was not statistically significant. Activity of SOD and CAT, before and after HBOT, did not change significantly. Conclusion. Our results suggested the potential beneficial effects of HBOT on redox status in the patients with SLE by decreasing the levels of O2•–.

The purpose of this paper is to present basic characteristics and highlight the differences between post hoc tests, as well as to show their application on concrete data of the research conducted. The said tests are applied on data obtained in the research which found evidence of 240 Serbian hotel ratings, given by their 71,700 guests. Each guest rated: cleanliness, comfort, location, facilities, staff, value for money, and free Wi-Fi in the hotel. A difference in ratings in relation to hotel category was observed and explained using several post hoc tests. The use of those tests is made much easier with the development of numerous statistical software packages. Therefore, clearly differentiating each of the tests allows one to select the most appropriate test in the research process, according to the type of data and research objectives. The paper presents the tests used when one-way analysis of variance, which is a method frequently used in statistical processing of experimental data, finds evidence of the existence of statistically significant differences in values of arithmetic mean in groups of data observed. The task of post hoc tests is to determine which group of data leads to the difference observed. Tests thus presented here are: the Fisher LSD, the Tukey HSD, the Bonferroni , the Newman-Keuls, the Dunnett and the Scheffe test.

Introduction. Polycystic kidney disease is a hereditary kidney disease characterized by the occurrence of cysts (fluid-filled enlargements) in cortex or medula of the kidney, and is inherited in an autosomal dominant or autosomal recessive manner. In addition to multiple cysts in kidneys, there may be many extra-renal manifestations (cysts of the liver, pancreas, lungs, heart, etc.), among which the most serious one is intracranial aneurysms. Case report. A 57-year-old female patient with polycystic kidney disease and stage IV renal failure was hospitalized at our clinic due to decreased renal function, the development of urinary tract infections, headaches and unregulated blood pressure despite the usual treatment. This patient also had a number of associated diseases: obesity, diabetes mellitus (the insulindependent type), hypothyroidism, and depression syndrome. After better regulation of blood pressure, resolved urinary tract infections and improved renal function, there were still persistent headaches (resulting in the excessive use of analgesics). With adequate preparation, multislice computed tomography (MSCT) angiography of blood vessels of the head was performed. As a result, we diagnosed the saccular intracranial aneurysm (IA) with anterior localization. Regarding the symptoms, age and comorbidity, digital subtraction angiography (DSA) was performed, and showed saccular IA (5.2 mm × 4 mm), with wide neck affecting both middle cerebral artery branches (MCA). During the procedure the stent was placed, which filled the aneurysm with spirals, cutting it off from circulation. After the successful procedure and without further complications, the patient no longer had headaches and blood pressure was maintained within the required limits with stable parameters of chronic renal failure. Conclusion. The case of the patient with polycystic kidney disease, stage IV chronic renal failure, with a number of comorbidities (headache, obesity, hypertension, diabetes mellitus, hypothyroidism) and diagnosed with symptomatic intracranial aneurysm was successfully solved with a multidisciplinary approach, emphasizing the importance of teamwork in daily practice.

Ethanol-chlorobenzene/oscillotitrator dosimetry system is widely used in controlling the irradiation process in gamma facilities. The ethanol-chlorobenzene dosimetry system provides a reliable means of measuring absorbed dose. It is based on a process of radiolytic formation of hydrochloric acid in aqueous ethanolic solutions of chlorobenzene by ionizing radiation. The irradiation temperature dependence of dosimeter response is a complex function of dose and temperature for each concentration of chlorobenzene. At different temperature the mobility of conducting species from hydrochloric acid is changed leading to different oscillotitrator deflections during high-frequency conductometric readout. In this paper, we examined the influence of temperature on the calculation of the radiation dose. We showed that the temperature significantly influenced the measurement results, and that the calibration curve has to be formed at the irradiation temperature in order to obtain precise values of the absorbed dose.

The purpose of the present study was to examine self-perceived stress of health professions students at the Faculty of Medicine Foča, and to explore its association with anxiety, depression and health-related quality of life.

Objective: The primary objective is to analyze the impact of the physicianpatient relationship on the outcomes of hypertension treatment. Method: The study included 8 family physicians and 240 patients with arterial hypertension, selected according to specific criteria. Physicians were divided into two groups. Group 1 consisted of physicians who have had completed training in communications, while group 2 was comprised of those with no training in medical communications. Each physician was accompanied by a group of thirty patients with hypertension. The interaction between physician and patient was evaluated using the Bales interaction process analysis. During the 12 months, the functional parameters, blood pressure, patient compliance and patient satisfaction were monitored. Results: Statistically significant differences were found between two groups of physicians in all 12 categories of Bales Interaction Analysis. Physicians from group 1 were showing more empathy, humor, understanding, interest for patient background and their opinion compared to group 2 physicians. The mean systolic blood pressure level of the patients treated by physicians which belonged to group 1 decreased from 155.25 to 137.16 mmHg and diastolic from 94.20 to 79.3 mmHg. Statistically significant improvements in work performance, activities of daily living, psychological function, social activity, compliance and patient's satisfaction were also found in group 1 after 12 months. Conclusion: The study showed that physician-patient relationship significantly affects treatment outcomes in patients with arterial hypertension. Communication with patients can be improved by introducing interaction elements that are not exclusively related to the causes and characteristics of diseases, giving the relevant information and increasing intelligibility of this information during the encounter.

Healthy nutrition in childhood is of major importance for maintenance of health in adults. Early detection of nutritional status impairments in children is directed toward prevention of chronic non-contageous diseases. Obesity in children is reported as the most important public health problem in pediatrics in developed countries. The aim of this study was to established the frequency of overweight and obesity, as well as blood pressure levels in population of 4-years aged children. This study enrolled 125 children aged 4 years. The survey was conducted during their regular systematic exams. Nutritional status was estimated from standard antrhropometric measurements. Data regarding nutritional habits, as well as physical activity were collected from parents, using questionnaire. 67,2% of children were normally nourished, 19,2% were overweight, 10,4% were obese, and 3.2% undernourished. Average values of body weight on birth were similar, regardless of nutritional status and gender, as well as actual BMIs o parents. Sedentary activities were the most frequent in overweight children of both gender, which is statistically significant when compared to normally nourished (2,61 ▫ 1,36 h vs 1,91 ▫ 0,98 h; p

Introduction. Effective treatments for osteoarthritis are available, yet little is known about the quality of primary care in the Republic of Srpska for this disabling condition. Objective. The main objective of this study was to analyze the overall quality of osteoarthritis treatment in a family medicine setting, as well as to explore whether the achievement of quality indicators was associated with particular patient characteristics and severity of osteoarthritis. Methods. The cross-sectional study included 120 patients with confirmed hand, knee, and hip osteoarthritis, recruited at seven family practices in the town of Ugljevik, Republic of Srpska, Bosnia and Herzegovina. Data were extracted from a patient questionnaire on quality indicators, as well as from their electronic and paper records, to assess care against 14 indicators. The included quality indicators were based on the Arthritis Foundation’s Quality Indicator set for Osteoarthritis. Summary achievement rates for hip, knee, or hand osteoarthritis, as well as for the total sample, were calculated. Results. The mean achievement rate for all 14 quality indicators obtained from medical records was 74%, and 77% obtained from patient interview. The quality indicators concerning referral for weight reduction (23%) and pharmacological treatment (24%) had the lowest achievement rates, whereas the highest achievement rates were related to physical examination (100%), pain and functional assessment (100%), and education (90.8%). Patients physical functioning was significantly associated with the quality indicator achievement rate (p = 0.001). Conclusion. Pharmacological therapy and the referral of osteoarthritis patients in need of weight reduction seem to have the greatest potential for improvement in primary health care.

This paper will demonstrate the methodology and results of analysis the stationary phenomena upon gravitational pipeline transport of brine from the Salt Mine Tuzla to the ultimate consumer. Moreover, it will provide the analysis of reciprocal effects of flow, change in diameter, speed of hydraulic ascent, loss of pressure and density of brine.

Introduction. Oxygen is an essential element of life in aerobic organisms. However, if not controlled, inhalation of oxygen under increased pressure in conditions of hyperbaric oxygen therapy can lead to serious damage and even death. Case report. We presented a 20-year-old male who had begun exhibiting symptoms of epilepsy during diving test in a hyperbaric chamber while inhaling 100% oxygen. He was immediately taken off oxygen mask and started breathing air and began rapid decompression. He lost consciousness, began foaming at the mouth, and had a series of tonic spasms. The patient was previously completely healthy and not on any medications. He was admitted for emergency treatment in our hospital, where he was treated for epilepsy. On admission, he complained of muscle and joint pain, and had erythematous changes on the forehead, neck and chest. All these changes occurred after leaving the hyperbaric chamber. Bloodwork revealed leukocytosis with neutrophil (Leukocytosis 16.0 ´ 109/L (reference values 4.00-11.00 ´ 109/L), Neutrophili 13 ´ 109/L (reference values 1.9-8.0 ´ 109/L), with elevated enzymes aspartate aminotransferase (AST) 56 U/L (reference values 0-37 U/L), alanin aminotransferase (ALT) 59 U /L, (reference values 25-65 U/L), creatine kinase (CK) 649 U/L, (reference values 32-300 U /L), lactate dehydrogenase (LDH) 398 U/L (reference values 85- 227 U/L). Because of pain and his condition we began treatment in a hyperbaric chamber at a pressure of 2.0 ATA for 70 minutes, resulting in a reduction of symptoms and objective recovery of the patient. Within 24 h, repeated laboratory tests showed a reduction of leukocytosis (13 ´ 109/L and neutrophils (7.81 ´ 109/L), and the gradual reduction of the enzymes AST (47 U/L), ALT (50 U/L, CK (409 U/L), LDH (325 U/L). Since head CT and EEG were normal, epilepsy diagnosis was ruled out. This fact, along with medical tests, facilitated the differential diagnosis and confirmed that this was a case of neurotoxic effects of oxygen while the patient was in a hyperbaric chamber, not epileptic seizures. Conclusion. This case report suggests that in patients with symptoms of epileptic seizures while undergoing treatment in a hyperbaric chamber, it is always important to think of neurotoxic effects of pure oxygen which occurs at higher pressures and with a longer inhalation of 100% oxygen. In these patients, reexposure to hyperbaric conditions leads to recovery. This effect is important in daily inhalation of 100% oxygen under hyperbaric conditions which is why the use of pure oxygen is controlled and diving is allowed in shallow depths and for a limited time.

Numerous researches have shown the existence of influence of specialized Web 2.0 portals on hotel business. One of most famous portals of that kind is TripAdvisor. The goal of this work is to determine the degree and mode of representation of hotels in Serbia on TripAdvisor portal. The results of the conducted research show that in past years the number of hotels from Serbia represented on this portal has increased significantly. At the end of 2012 there have been registered 3.288 comments which evaluated the service quality of 165 hotels from Serbia. The average vote, on five-degree scale, calculated at the level of all represented hotels at the end of 2012 was 3,92. Considering that Belgrade represents the primarily business, administrative and touristic center of Serbia, on the Belgrade's hotels specimen there has been analyzed the connection between business performances of hotels expressed through indicator TREVPAR and their image on TripAdvisor expressed through average vote determined based on user's comments, as well as in relation with TripAdvisor Popularity Index (TPI). The results show the high degree of correlation between analyzed features on the specimen of Belgrade's hotels, in range of hotels of second (4*) and third category (3*). Having in mind the results of conducted research it is obvious that the hotels managers from Serbia should adopt and implement the corresponding procedures of monitoring and adequate reactions on contents on TripAdvisor, considering their influence on behavior of modern consumer in hotels.

This work presents a methodology of data collecting and processing from the load and fuel control system SKZiT, installed on BelAZ 75131 trucks, owned by the Brown Coal Mine "Banovici" in Banovici. There is also a methodology of display the achieved operating parameters. Transport of coal and overburden is performed by these trucks. Total of eleven trucks has processors. Conclusions about working time, length of crossed routes, quantity of transported load, achieved cycles, etc. Can be presented by data processing.

Background: Research involves the systematic collection and analysis of data to enhance understanding of a particular phenomenon. Participation in medical research is crucial for advancing healthcare practices. However, there has been limited focus on understanding the factors that motivate medical students to engage in research. Additionally, in the era of e-learning, the easy accessibility of online resources has contributed to a widespread 'copy-paste culture' among digital-native students, which is recognized in academia as plagiarism. Existing studies suggest that a contributing factor to the increasing prevalence of plagiarism is students' limited understanding of this act. The purpose of this study was to assess medical students' attitudes toward research and plagiarism, and to evaluate the psychometric properties of the Attitudes Toward Research (ATR) and Attitudes Toward Plagiarism (ATP) questionnaires., Methods: This was a multicenter study conducted among medical undergraduate and postgraduate students attending the three medical universities who were involved in research. Students' attitudes toward research and plagiarism were assessed using the ATR and ATP questionnaires. The research instruments underwent translation and cultural adaptation in accordance with internationally accepted methodology. The psychometric properties of the ATR and ATP, including validity and reliability, were assessed. Confirmatory factor analysis was used to test the model's fit to the data., Results: The ATR and ATP questionnaires were completed by 793 medical students who were involved in research (647 undergraduates and 146 PhD students). Cronbach's alpha coefficients of 0.917 and 0.822 indicated excellent and good scale reliability for the ATR and ATP questionnaires, respectively. The five-and three- factor structures of ATR and ATP have been validated with maximum likelihood confirmatory analysis, and the results demonstrated an adequate level of model fit (TLI = 0.930, CFI = 0.942 and TLI = 0.924, CFI = 0.943, respectively). Medical students showed a high degree of positive attitudes toward research and favorable scores across all three domains of attitudes toward plagiarism. In multivariate regression models, age was found to be positively associated with favorable attitudes of research usefulness, positive attitudes, relevance to life subscales and total ATR scale (p < 0.001), while PhD study level was related to research anxiety (p < 0.001) and favorable attitudes across all three ATP domains (p < 0.001)., Conclusion: Medical students who were involved in research showed a high degree of favorable attitudes toward research and plagiarism. Adjusting medical school curricula to include research courses would broaden the students' interest in scientific research and maximize their impact on the full preservation of research ethics and integrity., Competing Interests: Declarations Ethical approval and consent to participate The University of Belgrade Faculty of Medicine’s Ethics Committee approved the study (Ethical Code: 25/VII-10). Written informed consent was obtained from all participants in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background/Objectives : The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire is a widely employed self-report tool for assessing upper extremity function. The aim of this study was to assess the psychometric properties of the Serbian version of the DASH by determining its criterion and construct validity, as well as internal consistency. Methods : This cross-sectional study was conducted among patients with hand and wrist disabilities at the Institute for Orthopedics "Banjica", Serbia. The psychometric properties of the Serbian version of the DASH were analyzed through an examination of its factorial structure and internal consistency. The DASH consists of 30 items, 24 of which assess function, 21 of which focus on physical function and three on social/role function. The remaining six items evaluate symptoms related to pain, tingling/numbness, weakness, and stiffness. Results : A total of 297 patients were included in the study. The mean age was 47.4 ± 16.8 years, with 50.5% males. Three models were assessed to determine the reliability and validity of the questionnaire across different domains. Model 1 examined a single-factor structure. In Model 2, the items were divided into two domains: Physical Function and Psychosocial/Symptoms. In Model 3, items were subdivided into three domains: Physical Function, Symptoms, and Psychosocial. All models demonstrated an excellent internal consistency with a Cronbach's alpha > 0.9 for most domains. The values for the fit indices Tucker-Lewis index (TLI) and Comparative-Fit Index (CFI) were above their cut-off criteria of 0.9, while the Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR) were below the suggested value of 0.06, indicating an excellent level of models fit. Standardized factor loadings were statistically significant ( p < 0.05). Conclusions : The present study provided the evidence for the appropriate metric properties of the Serbian version of the DASH. Results support both the unidimensional and multidimensional structures of the DASH.

Background : The COVID-19 pandemic has had a significant impact on the global economy and public health, disrupting various aspects of daily life. Apart from its direct effects on physical health, it has also significantly affected the overall quality of life and mental health. This study employed a path analysis to explore the complex association among multiple factors associated with quality of life, anxiety, and depression in the general population of the Republic of Srpska during the pandemic's second year. Method : A cross-sectional study was conducted on a nationally representative sample ( n = 1382) of the general population (adults aged 20+) during the second year of the COVID-19 pandemic in the Republic of Srpska, Bosnia, and Herzegovina. Assessment tools included the DASS-21 scale for depression, anxiety, and stress, along with the Brief COPE scale, Quality of Life Scale (QOLS), and Oslo Social Support Scale (OSSS-3). Sociodemographic factors and comorbidities were also assessed. Structural equation modeling was used to identify the direct and indirect links of various characteristics to quality of life, anxiety, and depression. Results : This study revealed a considerable prevalence of anxiety and depression symptoms (27.5% and 20.9%, respectively), with quality of life playing a significant mediating role. The constructed path model accounted for 33.1% of moderate to severe depression and 79.5% of anxiety. Negative coping was directly linked to anxiety and indirectly to depression via anxiety, while the absence of positive coping had both direct and indirect paths (through quality of life) on depression. Among variables that directly affected depression, anxiety had the highest effect. However, the bidirectional paths between anxiety and depression were also suggested by the model. Conclusions : Pandemic response strategies should be modified to effectively reduce the adverse effects on public mental health. Further research is necessary to assess the long-term effects of the pandemic on mental health and to analyze the contributing factors of anxiety and depression in the post-COVID period.

Background/Objectives : Due to their high frequency, common risk factors, and similar pathogenic mechanisms, musculoskeletal disorders (MSDs) are more likely to occur with other chronic illnesses, making them a "component disorder" of multimorbidity. Our objective was to assess the prevalence of multimorbidity and to identify the most common clusters of diagnosis within multimorbidity states, with the primary hypothesis that the most common clusters of multimorbidity are MSDs. Methods : The current study employed data from a population-based 2019 European Health Interview Survey (EHIS). Multimorbidity was defined as a ≥2 diagnosis from the list of 17 chronic non-communicable diseases, and to define clusters, the statistical method of hierarchical cluster analysis (HCA) was performed. Results : Out of 13,178 respondents, multimorbidity was present among 4398 (33.4%). The HCA method yielded six multimorbidity clusters representing the most common diagnoses. The primary multimorbidity cluster, which was prevalent among both genders, age groups, incomes per capita, and statistical regions, consisted of three diagnoses: (1) lower spine deformity or other chronic back problem (back pain), (2) cervical deformity or other chronic problem with the cervical spine, and (3) osteoarthritis. Conclusions : Given the influence of musculoskeletal disorders on multimorbidity, it is imperative to implement appropriate measures to assist patients in relieving the physical discomfort and pain they endure. Public health information, programs, and campaigns should be utilized to promote a healthy lifestyle. Policymakers should prioritize the prevention of MSDs by encouraging increased physical activity and a healthy diet, as well as focusing on improving functional abilities.

Background: The continued rise in healthcare expenditures has not produced commensurate improvements in patient outcomes, leading US healthcare stakeholders to emphasize value-based care. Transition to such a model requires all team members to adopt a new strategic and organizational framework., Objective: To describe and report a strategy for the implementation of a novel patient-centered value-based "optimal surgical care" (OSC) framework, with validation and cost analysis in kidney surgery., Design, Setting, and Participants: An observational study of care episodes at a single institution from 2014 to 2019 was conducted., Outcome Measurements and Statistical Analysis: Multidisciplinary teams defined OSC by core and procedure-specific metrics using a combination of provider-based ("bottom-up") and "clinical leadership"-based ("top-down") strategies. Baseline OSC rates across were established, while identifying proportions of OSC achieved by coefficient of variation (CV) in total direct costs. Multivariable linear regression comparing cost between OSC and non-OSC encounters was performed, adjusting for patient characteristics., Results and Limitations: An analysis of 30 261 perioperative care episodes was performed. Following the implementation of an OSC framework, there was an increase in OSC rates across all procedure buckets using core (25%) and procedure-specific (26%) metrics. Among the tumors tested, kidney cancer surgical episodes held the highest OSC rate improvement (67%) with lowest variability in cost (CV 0.5). OSC was associated with significant total cost savings across all tumor types after adjusting for inflation (p < 0.05). Compared with non-OSC episodes, a significant reduction in the cost ratio of OSC was noted for renal surgery (p < 0.01), with estimated costs savings of $2445.87 per OSC encounter., Conclusions: Institutional change directing efforts toward optimizing surgical care and emphasizing value rather than focusing solely on expense reduction is associated with improved outcomes, while potentially reducing costs. The strategy for implementation requires serial performance analyses, engaging and educating providers, and continuous ongoing adjustments to achieve durable results., Patient Summary: In this study, we report our strategy and outcomes for transitioning to a value-based healthcare model using a novel "optimal surgical care" framework at a National Cancer Institute-designated comprehensive cancer center. We observed an increase in optimal surgical care episodes across all specialties after 5 yr, with a potential associated reduction in cost expenditure. We conclude that the key to a successful and sustained transition is the implementation strategy, focusing on continual review and provider engagement., (Published by Elsevier B.V.)

The accurate management of testicular germ cell tumors (TGCTs) depends on identifying the individual histological tumor components. Currently available data on protein expression in TGCTs are limited. The human protein atlas (HPA) is a comprehensive resource presenting the expression and localization of proteins across tissue types and diseases. In this study, we have compared the data from the HPA with our in-house immunohistochemistry on core TGCT diagnostic genes to test reliability and potential biomarker genes. We have compared the protein expression of 15 genes in TGCT patients and non-neoplastic testicles with the data from the HPA. Protein expression was converted into diagnostic positivity. Our study discovered discrepancies in three of the six core TGCT diagnostic genes, POU5F1 , KIT and SOX17 in HPA. DPPA3 , CALCA and TDGF1 were presented as potential novel TGCT biomarkers. MGMT was confirmed while RASSF1 and PRSS21 were identified as biomarkers of healthy testicular tissue. Finally, SALL4 , SOX17 , RASSF1 and PRSS21 dysregulation in the surrounding testicular tissue with complete preserved spermatogenesis of TGCT patients was detected, a potential early sign of neoplastic transformation. We highlight the importance of a multidisciplinary collaborative approach to fully understand the protein landscape of human testis and its pathologies.

Child sexual abuse (CSA) affects all cultures and sociodemographic sections. As health professionals, pediatricians are often the first line of defense when it comes to CSA identification and reporting. Our previous study examined encounters, competence, beliefs, and reporting regarding CSA among pediatricians in countries of the former Yugoslavia, Serbia, and Montenegro. Following up on this work, we expanded our research to another neighboring country, the Republic of Srpska (RS). Sixty pediatricians were surveyed in 2020, comprising 30% of all practicing pediatricians in the Republic of Srpska. Compared to their colleagues from Serbia and Montenegro, RS pediatricians revealed an increased perception that children are often abused by someone they do know well, were more confident in their abilities to detect CSA, reported a higher number of CSA cases, and were more interested in further trainings on the subject of CSA. Despite this, the level of underreporting remained high (40%). To our knowledge, this is the first study to both assess and compare CSA-related attitudes in this part of the world. Key differences between RS, other two neighboring countries as well as from other countries worldwide are likely to stem from the level of pediatricians' training and education, as well as from the socio-cultural and legislation context. Although encouraging, our data indicate a need for further research in the countries of the former Yugoslavia.