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There is a dearth of published literature on the organisation of family medicine/general practice undergraduate teaching in the former Yugoslavia.

Background: Similar to other countries, Departments of Family Medicine in the former Yugoslavia had to transition from face-to-face to distance education during COVID-19., Objectives: To elucidate obstacles and facilitators of the transition from face-to-face to distance education., Methods: A cross-sectional, multicentre, qualitative study design was used to analyse nine open-ended questions from an online survey using inductive thematic analysis. The questionnaire was distributed to 21 medical schools, inviting them to involve at least two teachers/students/trainees. Data were collected between December 2021 and March 2022., Results: In 17 medical schools, 23 students, 54 trainees and 40 teachers participated. The following themes were identified: facilitators and barriers of transition, innovations for enhancing distance education, convenience of distance education, classical teaching for better communication, the future of distance education, reaching learning outcomes and experience of online assessment. Innovations referred mainly to new online technologies for interactive education and communication. Distance education allowed for greater flexibility in scheduling and self-directed learning; however, participants felt that classical education allowed better communication and practical learning. Teachers believed knowledge-related learning outcomes could be achieved through distance education but not teaching clinical skills. Participants anticipated a future where a combination of teaching methods is used., Conclusion: The transition to distance education was made possible thanks to its flexible scheduling, innovative tools and possibility of self-directed learning. However, face-to-face education was considered preferable for fostering interpersonal relations and teaching clinical skills. Educators should strive to strike a balance between innovative approaches and the preservation of personal experiences.

Background: The countries of the former Yugoslavia have health and education systems with the same tradition but these have changed over the years. Little is known about how family medicine teaching transitioned from face-to-face to distance education during the COVID-19 pandemic., Objectives: to investigate student/teacher experience in transitioning from face-to-face to distance education., Methods: A cross-sectional, online survey was conducted among 21 medical schools of the former Yugoslavia between December 2021 and March 2022. Under/postgraduate teachers and students who taught/studied family medicine during the academic year 2020/2021 were invited to participate. Of 31 questions for students and 35 for teachers, all but nine open questions were analysed using descriptive statistics., Results: Seventeen of 21 medical schools contributed data involving 117 participants representing all countries of the former Yugoslavia. At the beginning of the pandemic, 30%, 26% and 15% of teachers, students and trainees, respectively, received formal preparation in distance education. Of these, 92% of teachers and 58% of students/trainees felt they were not adequately prepared. Synchronous teaching was the main method used, with a third using hybrid methods. All participants were least confident about online assessment. More than 75% of respondents agreed that lectures could be kept online, not patient consultations or practical skills' classes., Conclusion: Teachers used various old and new methods to provide learning opportunities despite COVID-19 constraints. Effective technology-based strategies are essential to ensure assessment integrity and enhance the learning environment.

Aim: To explore why Croatian mothers request formula for their healthy, term newborn infants during the postnatal hospital stay., Methods: Four focus groups discussions were conducted with a total of 25 women who gave birth to healthy newborn infants, between May and June 2021 in Split, Croatia. A homogenous, non-random purposive sampling technique was used. The semi-structured interview schedule contained 15 open-ended questions. Reflexive thematic analysis was applied., Results: Three themes were generated. The first theme fear of hunger referred to the mothers' fears arising from difficulties in interpreting newborn infant behaviour and finding solace in giving formula. The second theme too little support-too late reflected participants' unrealised expectations of hospital staff. The third theme non-supportive communication addressed mother's need for empathy during the postpartum hospital stay., Conclusion: Croatian mothers want to breastfeed, but often feel unsupported in doing so in the maternity hospital setting. Antenatal education of expectant mothers and training of maternity staff in breastfeeding counselling, with a strong emphasis on communication skills, as well as employment of International Board Certified Lactation Consultants and/or volunteer breastfeeding counsellors, were perceived by participants as a way to decrease mothers' requests for formula for their healthy, newborn infants., (© 2023 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Aim: We determined the prevalence and predictors of formula supplementation for healthy, term newborn infants in hospital., Methods: A cross-sectional study was conducted from 1 June to 21 October 2020 among Croatian women who gave birth to healthy newborn infants of ≥37 weeks gestation and birth weight of ≥2500 g at the University Hospital of Split, Croatia. The mothers completed a questionnaire on hospital infant feeding practices and breastfeeding self-efficacy. Multinomial logistic regression investigated associations between perinatal factors and formula supplementation., Results: We approached 392 mothers, and 355 (90.6%) were included: 286 (80.6%) said their newborn infant received formula in hospital and it was at their request in 173/286 (60.5%) of cases. The adjusted analyses identified factors associated with increased odd ratios (OR) and 95% confidence intervals (CI) for formula supplementation: no previous breastfeeding experience (OR 9.42, 95% CI 3.51-25.28), breastfeeding difficulties in hospital (OR 9.12, 95% CI 3.46-24.09) and older children who received formula during their birth hospitalisation (OR 11.51, 95% CI 4.4-30.1). Mothers were not routinely notified of the risks., Conclusion: An unacceptably high proportion of healthy newborn infants received formula in hospital., (© 2023 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Implementation of the Global Strategy for Infant and Young Child Feeding varies widely among countries. Policymakers would benefit from insights into obstacles and enablers. Our aim was to explore the processes behind the development and implementation of national infant and young child feeding policies and monitoring systems in Europe. A qualitative study design was employed to analyze open text responses from six European countries (Croatia, Germany, Lithuania, Spain, Turkey and Ukraine) using inductive thematic analysis. Countries were selected based on their World Breastfeeding Trends Initiative scores on national policy and monitoring systems. The 33-item online questionnaire was distributed to country representatives and completed by country teams. Key enablers and strengths included strong and continuous government commitment to infant and young child feeding, an operational national breastfeeding authority, a national and active monitoring and evaluation system, implementation of the International Code of Marketing of Breastmilk Substitutes in national legislation, the integration of skilled breastfeeding supporters, the implementation of the Baby-friendly Hospital Initiative, and positive cultural norms and traditions supporting optimal infant and young child feeding. In some countries, UNICEF played a key role in funding and designing policies and monitoring systems. Weak government leadership, the strong influence of the industry, lack of adequate national legislation on the International Code and cultural norms which devalued breastfeeding were particularly noted as obstacles. Government commitment, funding and protection of optimal infant and young child feeding are essential to the implementation of strong national policies and monitoring systems., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

The postpartum period is a time when physical, psychological and social changes occur. Health professional contact in the first month following birth may contribute to a smoother transition, help prevent and manage infant and maternal complications and reduce health systems' expenditure. The aim of this systematic review was to assess the effect of face-to-face health professional contact with postpartum women within the first four weeks following hospital discharge on maternal and infant health outcomes. Fifteen controlled trial reports that included 8332 women were retrieved after searching databases and reference lists of relevant trials and reviews. Although the evidence was of moderate or low quality and the effect size was small, this review suggests that at least one health professional contact within the first 4 weeks postpartum has the potential to reduce the number of women who stop breastfeeding within the first 4-6 weeks postpartum (Risk Ratio 0.86 (95% Confidence Interval 0.75-0.99)) and the number of women who cease exclusive breastfeeding by 4-6 weeks (Risk Ratio 0.84 (95% Confidence Interval 0.71-0.99)) and 6 months (Risk Ratio 0.88 (95% Confidence Interval 0.81-0.96). There was no evidence that one form of health professional contact was superior to any other. There was insufficient evidence to show that health professional contact in the first month postpartum, at a routine or universal level, had an impact on other aspects of maternal and infant health, including non-urgent or urgent use of health services., (Copyright © 2019 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.)

An antenatal/postnatal intervention involving proactive telephone support and written materials was conducted among primiparas. Four hundred women, from the Split-Dalmatia County, Croatia, were randomized between November 2013 and December 2016 into three groups: intervention (IG), active control (ACG) and standard care (SCG). Primary outcome was exclusive breastfeeding (EBF) at 3 months. Secondary outcomes included breastfeeding difficulties, attitudes towards infant feeding, breastfeeding self-efficacy and social support. Practice staff were blinded to group allocation. Of 400 women, 45 (11%) were lost to follow-up, and final analyses were conducted on 129 (IG), 103 (ACG) and 123 (SCG) participants. EBF rates at 3 months were significantly higher for the IG (odds ratio [OR] 4.6, 95% confidence interval [CI], 2.7 to 8.1; EBF 81%) as well as at 6 months (OR 15.7, 95% CI, 9.1 to 27.1; EBF 64%) compared with SCG (EBF 47% at 3 months and 3% at 6 months). Higher rates were also observed for the ACG at 3 months (OR 2.2, 95% CI, 1.3 to 3.8, EBF 68%) and 6 months (OR 2.3, 95% CI, 1.4 to 3.9, EBF 16%). Participants in the IG had the highest increase in positive attitudes towards infant feeding, in comparison to baseline, and significantly higher breastfeeding self-efficacy. Participants in SCG experienced significantly more breastfeeding difficulties, both at 3 and 6 months, in comparison to AC and IGs. Written breastfeeding materials and proactive telephone support among primiparas are an effective means of increasing breastfeeding rates, decreasing breastfeeding difficulties and improving self-efficacy and attitudes towards infant feeding., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: To protect children's right to optimal nutrition, WHO/UNICEF developed a Global Strategy for Infant and Young Child Feeding, endorsed by all 53 WHO/EURO Member States. The World Breastfeeding Trends Initiative (WBTi) is a tool for monitoring implementation of the Global Strategy. It comprises 15 indicators, ten referring to policies and programmes, and five to feeding practices. Each is scored on a scale of 10, giving a total score of 150 for Global Strategy implementation. To date, 18 WHO/EURO Member States - Armenia, Austria, Belgium, Bosnia and Herzegovina, Croatia, France, Georgia, Germany, Italy, Lithuania, North Macedonia, Malta, Moldova, Portugal, Spain, Turkey, Ukraine and United Kingdom - have conducted a WBTi assessment and produced a report., Methods: Between June 2018 and May 2019, all 18 WBTi European reports were carefully read and analysed by a group of national WBTi coordinators. Descriptive data analysis, including inter-country comparisons, was conducted using frequencies and percentages. This paper summarises the findings. The full 88-page report will be published on the WBTi website., Results: Three-quarters of 18 European countries have adequate maternity protection, and two-thirds have breastfeeding initiation rates of 50% or higher. However, 'Preparedness and planning for appropriate and safe Infant and Young Child Feeding (IYCF) in emergencies' is seriously neglected. Breastfeeding duration is far below WHO recommendations, with an average of 8.7 months. Only three European countries have a budget allocated for implementing IYCF policies and plans, and a third currently have no Baby-friendly designated maternity facilities. Bottle feeding is prevalent, despite its inherent risks, monitoring of IYCF practices is inadequate, with most countries not routinely collecting data, and violations of the International Code of Marketing of Breast-milk Substitutes are commonplace., Conclusions: European governments are not doing enough to protect, promote and support sound infant and young child feeding practices. Political commitment at the highest level and adequate funding are required to ensure optimal IYCF for Europe's babies. This report highlights worrying gaps, thereby providing governments, international organisations and other concerned parties with an opportunity to invest in priority areas and, by doing so, hopefully create a better future for our babies.

Background: Cochrane, an organization dedicated to the production and dissemination of high-quality evidence on health, endeavors to reach consumers by developing appropriate summary formats of its systematic reviews. However, the optimal type of presentation of evidence to consumers is still unknown., Objective: The aim of this study was to investigate consumer preferences for different summary formats of Cochrane systematic reviews (CSRs), using both qualitative and quantitative approaches., Methods: Initially, we conducted three focus groups with medical students (n = 7), doctors (n = 4), and patients (n = 9) in 2017 to explore their health information search habits and preferences for CSR summary formats. Based on those findings, we conducted a randomized trial with medical students at the University of Split School of Medicine, Croatia, and with patients from three Dalmatian family practices to determine whether they prefer CSR blogshots (n = 115) or CSR plain language summaries (PLSs; n = 123)., Results: Participants in the focus groups favored brief and explicit CSR summary formats with fewer numbers. Although we found no difference in participants' preferences for a specific summary format in the overall sample, subgroup analysis showed that patients preferred blogshots over PLSs in comparison to medical students (P = 0.003, eta squared effect size η 2  = 0.04)., Conclusion: CSR summaries should be produced in a format that meets the expectations and needs of consumers. Use of blogshots as a summary format could enhance the dissemination of CSRs among patients., Trial Registration: The trial was registered in ClinicalTrials.gov, NCT03542201. Registered on May 31st 2018.

Background: Cochrane systematic review Plain language Summaries (CSR PLSs should serve as a tool for the evidence translation to non-medical population. However, the evidence of optimal type of numerical presentation in CSR PLSs is still scarce. The aim of this study was to investigate readers' comprehension and preferences for different presentation of findings, including framing and numerical data, in Cochrane systematic review Plain Language Summaries (CSR PLSs)., Methods: We conducted a parallel randomized trial and a crossover randomized trial at the School of Medicine and family practice offices in Split, Croatia. The participants were students and consumers. We assessed possible differences in comprehension, measured by four questions on PLS content, of CSR PLSs depending on the positive or negative framing of results (n = 91) (Trial 1) or using percentages or frequencies for the presentation of results (n = 245) (Trial 2). The outcome measures were comprehension of PLS content, perceived effectiveness of the treatment and readiness to use the treatment (all on 1-10 scales)., Results: In Trial 1 we found no difference in readers' perception of the effectiveness of the described treatment, desire that the treatment be offered by their family doctor, readiness to use the treatment, or comprehension when CSR PLS results were presented positively or negatively. In Trial 2 we found no difference in CSR PLS comprehension when results were presented as natural frequencies or percentages (BF 10  = 0.62, Bayesian t-test for independent samples)., Conclusions: Numerical presentation and framing direction of results appear to have no significant impact on understanding of messages in CSR PLSs., Trial Registration: The trials were registered in ClinicalTrials.gov. Protocol registration numbers: Trial 1: NCT03442387; Trial 2: NCT03554252.

Background: In 2011, Tandeter et al. published a list of 15 themes, based on a Delphi survey among representatives of the European Academy of Teachers in General Practice and Family Medicine (EURACT), and suggested this be the 'minimal core curriculum' (MCC) for undergraduate education in family medicine., Objectives: To determine: (1) if medical schools in the former Yugoslavia region are familiar with the MCC; and (2) to what degree it is being taught to medical students., Methods: In July 2015, a questionnaire was distributed to 19 medical schools in the former Yugoslavia region. A copy of the description of the curriculum for GP/FM was requested from participants. Two researchers conducted content analysis of the curricula according to the 15 predefined MCC themes, independently., Results: Thirteen (68%) medical schools responded. Of these, 10 (77%) stated that they were familiar with the MCC. Not a single institution encompassed all 15 MCC themes. The number of themes included by individual medical schools ranged from 6/15 (40%) to 13/15 (87%).The following themes were covered by 12 of 13 (92%) medical schools: Introduction to GP/FM; communication skills; prevention and health promotion; and management of chronic diseases. The three themes most poorly covered were: consulting skills (5/13), management of diseases at an early, undifferentiated stage (2/13) and decision-making based on prevalence and incidence (1/13)., Conclusion: Despite familiarity with EURACT's MCC among medical schools in the former Yugoslavia region, significant variation in curricula content exists, and no curriculum covered all MCC themes.

Background: The primary goal of the Baby-Friendly Hospital Initiative (BFHI) is to create conditions in maternity facilities that enable women to initiate and sustain the practice of breastfeeding exclusively. Research aim: This study aimed to determine hospital practices and breastfeeding rates before and after BFHI implementation and assess compliance with UNICEF/World Health Organization (WHO) standards for seven of the BFHI's Ten Steps to Successful Breastfeeding ( Ten Steps)., Methods: Mothers of healthy, term infants ( N = 1,115) were recruited from the postnatal ward of the University Hospital of Split, Croatia, between February 2008 and July 2011 and followed for 12 months in a repeated-measures, prospective, longitudinal, three-group, nonequivalent, cohort study. Breastfeeding rates, hospital practices-including seven of the Ten Steps-and maternal sociodemographic data were collected., Results: Parts of all seven Ten Steps that were assessed improved significantly post-BFHI. Step 3 ("antenatal education") showed the least improvement, whereas Step 7 ("rooming-in"; 2.6% pre-BFHI vs. 98.5% post-BFHI) and Step 9 ("no pacifiers/teats"; 21.8% pre-BFHI vs. 99.4% post-BFHI) showed the greatest improvement. Six months after Baby-Friendly designation, only Steps 7 and 9 were in full compliance with UNICEF/WHO standards. In-hospital, exclusive-breastfeeding rates rose markedly ( p < .001), but no change occurred in breastfeeding rates at 3, 6, or 12 months., Conclusion: Full implementation of the BFHI was associated with significant improvement in hospital practices and in-hospital, exclusive-breastfeeding rates, but it did not affect breastfeeding rates postdischarge, emphasizing the vital role of community support. Baby-Friendly Hospital Initiative standards declined rapidly post-hospital designation, indicating the need for regular monitoring and reassessment as well as ongoing, effective training for hospital staff.

Breastfeeding is associated with infant and maternal health benefits and considerable potential savings to health services. Despite this, only 37% of infants globally are exclusively breastfed for 6 months. Interventions are needed to improve breastfeeding rates. The aim of this study is to determine whether written breastfeeding information in pregnancy and proactive breastfeeding-focused support phone calls, provided by a health professional educated in breastfeeding management, increase exclusive breastfeeding rates at 3 months compared with general birth-related information with proactive support calls or standard care. This is a single-centre, randomised, controlled, three-arm, superiority study with blind outcome assessment. Eligible participants will include primigravidae with singleton pregnancies who speak Croatian, attending six primary care obstetric practices. We estimate a total sample size of 459, with computer generated stratified randomisation of 153 women per arm. Participants in the intervention and active control groups will receive booklets in pregnancy, phone calls 2 weeks later, and 2, 6 and 10 weeks after birth. The primary outcome will be the proportion of women exclusively breastfeeding at 3 months. Secondary outcomes will compare: infant feeding practices and attitudes, social support, breastfeeding difficulties, breastfeeding self efficacy and utilisation of breastfeeding support services. Follow-up at 6 months will compare exclusive and any breastfeeding and utilised support services. Analysis will be by intention to treat. This trial will contribute to future evidence syntheses identifying the most effective forms of breastfeeding support., (© 2016 John Wiley & Sons Ltd.)

Introduction: In-hospital formula supplementation is a common practice and has been shown to be a strong determinant of shorter exclusive and any breastfeeding., Objective: To investigate the reasons for and circumstances in which in-hospital formula supplementation occurs and whether the stated reasons are medically acceptable., Materials and Methods: This prospective cohort study was conducted among 342 mother-infant pairs from April to July 2011 at the Department of Obstetrics and Gynecology, University Hospital of Split, Croatia. Data were collected based on "every feed" charts and WHO/UNICEF "Questionnaire for Monitoring Baby-Friendly Hospitals". We used WHO/UNICEF Baby-Friendly Hospital Initiative and Academy of Breastfeeding Medicine documents on indications for supplemental feeding., Results: During the first 48 hours and entire hospital stay, 49.5% and 62.8% of infants, respectively, received supplements, given on average 16.68 ± 18.6 hours after delivery. In 94.1% of supplemented infants, healthy newborns were given artificial milk, of which 5.9% of mothers had not been notified. The most common maternal reasons for supplementing were "lack of milk" (49.8%), a "crying baby" (35.5%), "cesarean section" (11.5%), newborn weight loss (10.6%), and sore nipples (10.1%). Of all the given reasons, 24.6% were categorized as being medically acceptable. Primiparas were 1.3 times more likely to supplement in hospital, whereas multiparas were 1.3 times more likely to exclusively breastfeed., Conclusion: In our study, most reasons for formula supplementation of healthy term newborns were not standard acceptable medical reasons, indicating a need for improved maternal support, revision of hospital policies, and training of hospital staff.

The Baby-Friendly Hospital Initiative (BFHI) was launched in Croatia in 1993. By 1998, 15 of 34 maternity facilities were designated "Baby-Friendly." Introduction of hospital bags, violating the International Code of the Marketing of Breastmilk Substitutes, led to a standstill in the BFHI. The aim of this article is to describe the successful reintroduction of the BFHI in Croatia between 2007 and 2015. After hospital bags were abolished in 2007, UNICEF Croatia undertook an assessment of BFHI implementation. All maternity facilities were invited by UNICEF and the Ministry of Health to join the renewed BFHI. UNICEF materials were translated and training for trainers, assessors, coordinators, and hospital staff held. By June 2015, 30 of 32 (94%) maternity facilities, providing care to 89% of newborns, were Baby-Friendly. Nine maternity hospitals have been renovated and 2 new hospitals have been built. Exclusive breastfeeding rates have risen 16% at 0 to 2 months (from 51% in 2007 to 67% in 2014) and 14% at 3 to 5 months (from 32% in 2007 to 46% in 2014). Fourteen "Breastfeeding-Friendly" primary care practices have been designated, 166 breastfeeding support groups are in operation, criteria for Mother-Friendly care are being piloted in 2 maternity facilities, and "Ten Steps in the Neonatal Intensive Care Unit" are being introduced. The BFHI provides an excellent opportunity for revitalizing breastfeeding protection, promotion, and support in all settings. Recognition and support of the BFHI by the Croatian government was crucial for implementing the BFHI, whereas the marketing practices of the breast milk substitutes industry are an ongoing challenge., (© The Author(s) 2016.)

Background: Integrated care is defined as concerted action of healthcare providers ensuring continuity of care within a patient-centered approach, thus contributing to healthcare efficiency and quality. Apart from the WHO/UNICEF Baby-Friendly Initiatives, integrated care has been poorly explored within the context of breastfeeding support. The aim of this study was to investigate the experience of breastfeeding support practitioners, identifying barriers and facilitators towards integrated care., Methods: A 62-item survey was conducted among 900 participants at 3 international breastfeeding conferences. Analysis included uni-and bivariate descriptive statistics, categorizing of mutually exclusive response groups and thematic networks analysis of responses to 18 open-ended items., Results: Three-hundred-and-one participants (33 % response), from 34 predominantly industrialized countries (98 %) on nearly all continents, responded to the survey. Norwegian residents alone, felt sufficiently supported in providing breastfeeding support by other healthcare providers, the work environment, society, the media and their National Breastfeeding Committee (P < 0.05). Out of 11 suggested measures for effective breastfeeding promotion, 96 % of respondents ranked integrated care as the most important. The largest response group identified in open-ended items, as a major barrier to integrated care in breastfeeding support, was "lacking or failing health promotion strategies" (n = 454), followed by "a lack of vertically integrated care" (n =268), described mainly as unsatisfactory cooperation within healthcare. This inconsistency of care also impairs "shared decision-making" on infant feeding for parents, including accessibility of information and support (n = 265). Among other measures, 29 % of respondents recommended incentivizing integrated breastfeeding support within healthcare. Two figures, based on open-ended response evaluations, illustrate participants' ideas of the National Breastfeeding Committees' role in coordinating policies and protagonists towards integrated breastfeeding support, and a family-centered model of integrated care to facilitate successful breastfeeding., Conclusions: According to practitioners in breastfeeding support, integrated care is essential for successful breastfeeding. Quality and accessibility of breastfeeding support should be motivated by healthcare system incentives, to counter the reported lack of consistency of care within and beyond healthcare. To effectively integrate a continuum of breastfeeding support into healthcare and society, a policy consensus and strong political action are indispensable, with coordination by an empowered National Breastfeeding Committee.

Background: Sub-optimum breastfeeding significantly contributes to the global burden of disease. Our aim was to identify risk factors associated with suboptimal breastfeeding in Southern Croatia., Methods: Between February 2008 and August 2009, 773 mother-infant pairs were recruited from University Hospital of Split Maternity Unit. Mothers were interviewed at birth, 3, 6, 12 and 24 months., Results: Ninety-nine percent of mothers initiated breastfeeding but only 2.2% of them exclusively breastfed whilst in hospital. At 24 months, 4.1% of mothers were breastfeeding. Exclusive and any breastfeeding at 3 months was negatively associated with maternal education of 12 years or less, smoking during pregnancy, intention to use a pacifier and in-hospital formula supplementation. In addition, exclusive breastfeeding at 3 months was negatively associated with primiparity, antenatal course non-attendance and not receiving assistance with breastfeeding from hospital staff. Antenatal course non-attendance and discussing infant feeding with a health professional during pregnancy lowered the odds for any breastfeeding at 6 months. At 12 and 24 months, a lower level of education, antenatal course non-attendance and not receiving advice in hospital on feeding frequency was significantly associated with lower odds of breastfeeding. Additionally, intention to use a pacifier was found to be a negative predictor of breastfeeding at 12 months., Conclusions: Important modifiable risk factors found to be significantly associated with suboptimal breastfeeding include smoking during pregnancy, intention to use a pacifier, in-hospital formula supplementation, not receiving advice from hospital staff on normal feeding patterns, not receiving assistance with breastfeeding in hospital and antenatal course non-attendance., (© The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objectives: To determine how GPs manage breastfeeding women with mastitis and how confident they are in treating women with breast conditions that occur during lactation., Design, Participants and Setting: A cross-sectional survey conducted among all Croatian GPs., Key Findings: Sixty-four per cent of the total number of respondents (171/268) had seen a patient with lactational mastitis (LM) in the previous 12 months. Among respondents who recommended medication for the treatment of LM, 93% prescribed an antibiotic (122/131). Fifteen per cent of respondents who gave advice on infant feeding advised alternative feeding methods. Approximately half (47%) felt completely confident when treating LM while more than half (57%) felt partially confident when treating other breast conditions that can occur during lactation., Conclusion: The management of LM among Croatian GPs is not in full compliance with current recommendations. FUTURE IMPLICATIONS: There is a need for further training of Croatian GPs in the management of mastitis.

Unlabelled: In this article we describe Cochrane and its products: Cochrane systematic reviews (CSRs) and other Cochrane evidence. Cochrane is a unique, international, non-profit organisation that offers health care providers, health care consumers and other decision makers unbiased and highly reliable information on health, which is pivotal for conscientious and responsible decision making in overall healthcare. Cochrane offers the highest ranked evidence in Evidence Based Medicine (EBM)--systematic reviews. Currently, CSRs are freely available in BH, and therefore, they ought to be widely used, and understood. We will present the new Cochrane Strategy to 2020, which was the main topic of the 6th Croatian Cochrane Symposium (CroCoS), as well as explore prospects for spreading Cochrane activities to Bosnia and Herzegovina (BH), through collaboration with Cochrane Croatia. BH has no officially organized Cochrane activity, as yet. We hope that this article will raise awareness about Cochrane in BH, help promote its activities, and deepen the existing collaboration with Cochrane Croatia. There are already some changes being introduced concerning Cochrane--at least, in one half, the Federation of BH (FBH). Two documents symbolising official recognition of policy changes towards Cochrane have recently been published in the Official Gazette of FBH., Conclusion: Since founding a BH Cochrane Branch would be costly and difficult to achieve in a complicated environment, such as the one we have, BH could use the good will, experience, knowledge, and translated educational, training and web materials of Cochrane Croatia, particularly given the language similarities, to promote evidence based medicine in BH., (Copyright © 2015 by Academy of Sciences and Arts of Bosnia and Herzegovina.)

Background: Suboptimal breastfeeding practices among infants and young children <24 months of age are associated with elevated risk of pneumonia morbidity and mortality. We conducted a systematic review and meta-analysis to quantify the protective effects of breastfeeding exposure against pneumonia incidence, prevalence, hospitalizations and mortality., Methods: We conducted a systematic literature review of studies assessing the risk of selected pneumonia morbidity and mortality outcomes by varying levels of breastfeeding exposure among infants and young children <24 months of age. We used random effects meta-analyses to generate pooled effect estimates by outcome, age and exposure level., Results: Suboptimal breastfeeding elevated the risk of pneumonia morbidity and mortality outcomes across age groups. In particular, pneumonia mortality was higher among not breastfed compared to exclusively breastfed infants 0-5 months of age (RR: 14.97; 95% CI: 0.67-332.74) and among not breastfed compared to breastfed infants and young children 6-23 months of age (RR: 1.92; 95% CI: 0.79-4.68)., Conclusions: Our results highlight the importance of breastfeeding during the first 23 months of life as a key intervention for reducing pneumonia morbidity and mortality.

Objective: To describe the implementation of the first Objective Structured Clinical Examination (OSCE) conducted at the University of Split School of Medicine., Methodology: Twenty-one clinical skills relevant to general practice were selected and described in a Handbook for students. Assessment sheets were created. After performing an inventory of available resources, teaching models were purchased and practical classes arranged. A Centre for Clinical Competencies was established, where the first OSCE at the University of Split School of Medicine was conducted in March 2011., Results: Attendance by students to the practical classes and the OSCE was 100%. Positive feedback was received by students, who requested extra lessons in clinical skills training. Despite not setting a minimal pass rate, the average OSCE score was 27 out of 30 points., Conclusion: Organization of clinical skills training and assessment was demanding, requiring many hours of preparation and numerous staff involvement but was ultimately very rewarding. Both practical classes and the OSCE were very well received by students, who seemed to be empowered by this experience., (Copyright 2012 by Academy of Sciences and Arts of Bosnia and Herzegovina.)