Communication is the foundation of every interpersonal relationship. Good communication leads to better relationships and trust, fosters improved interactions with colleagues, and has a positive impact on the workplace atmosphere. The aim of this study is to determine how the communication skills of management staff influence work processes. The primary task of this study is to examine the communication styles of responsible individuals in the healthcare process and their relationships with subordinates or executors in the healthcare process. The study is descriptive and comparative. An author-designed questionnaire, created based on a review of professional and scientific literature and experiences from everyday clinical practice, was used as the research instrument.The results showed that out of the total number of respondents, 33.3% reported being completely satisfied with interpersonal communication, 57.0% partially satisfied, and only 24 or 9.6% were not satisfied. It can be concluded that the good communication skills of managers positively impact staff productivity.

Introduction: Providing adequate healthcare for premature infants is an important issue in perinatal medicine. The aim of this study is to assess the level of the perinatal healthcare institution (PHI) where the newborns were delivered and the possibilities of transporting them to the cantons of the Federation of Bosnia and Herzegovina. The authors also aimed to examine the overall survival of low birth-weight infants (LBWI) in the Federation of Bosnia and Herzegovina and to compare the survival of newborns according to the PHI where they were born and the PHI where they were treated. Materials and methods: This cross-sectional study included newborns of both sexes that were born in the maternity wards in 10 cantons of the Federation of Bosnia and Herzegovina with a gestational age between 22 and 42 weeks, and a birth weight less than 2500 g. Result: From the PHI of the first and second level, 159 newborns were referred to the third level. A total of 159/669 (23.7%) were referred from a second level PHI to a third level PHI, and 127/669 (l8.9%) LBWI were definitely taken care of. A total of 513/669 (76.8%) LBWI were definitely taken care of in the third level PHI. Out of a total of 159 LBWI referred from other PHI, only 31 (19.5%) LBWI were transported in less than 4 h, and 128 (80.5%) newborns were admitted to the third level PHI within 4 h of birth (P<0.0001). In second level PHI, most LBWI died in the first 12 h after birth, while in third level PHI, 69.2% of LBWI died after 1 week of life. Conclusion: Based on world experience and assessment of the situation in Federation of Bosnia and Herzegovina, it is necessary to take measures to improve perinatal care and its regional organization.

In Australia, there is a high burden of acute rheumatic fever (ARF) among Aboriginal and Torres Strait Islander peoples. Clinical diagnostic criteria can result in a diagnosis of ‘definite’, ‘probable’ or ‘possible’ ARF and outcomes range from recovery to severe rheumatic heart disease (RHD). We compared outcomes by ARF diagnosis, where the main outcome was defined as disease progression from: possible to probable ARF, definite ARF or RHD; probable to definite ARF or RHD; or definite ARF to definite ARF recurrence or RHD. Data were extracted from the Northern Territory RHD register for Indigenous Australians with an initial diagnosis of ARF during the 5.5-year study period (01/01/2013–30/06/2019). Descriptive statistics were used to describe cohort characteristics, probability of survival, and cumulative incidence risk of disease progression. Cox proportional hazards regression was used to determine whether time to disease progression differed according to ARF diagnosis. Sub-analyses on RHD outcome, clinical manifestations, and antibiotic adherence were also performed. In total there were 913 cases with an initial ARF diagnosis. Of these, 92 (13%) experienced disease progression. The probability of disease progression significantly differed between ARF diagnoses (p = 0.0043; log rank test). Cumulative incidence risk of disease progression at 5.5 years was 33.6% (95% CI 23.6–46.2) for definite, 13.5% (95% CI 8.8–20.6) for probable and 11.4% (95% CI 6.0–21.3) for possible ARF. Disease progression was 2.19 times more likely in those with definite ARF than those with possible ARF (p = 0.026). Progression to RHD was reported in 52/732 (7%) of ARF cases with normal baseline echocardiography. There was a significantly higher risk of progression from no RHD to RHD if the initial diagnosis was definite compared to possible ARF (p<0.001). These data provide a useful way to stratify risk and guide prognosis for people diagnosed with ARF and can help inform practice.

Introduction This paper aims to examine the frequency and significance of diagnostic comorbidity of psychiatric disorders and somatic diseases in a sample of patients with depression as well as present current psychopharmacological treatment of the patients in the sample. Methods The subjects in this study sample were 489 patients from the four Western Balkan countries with current primary diagnosis of major depression according to ICD 10. Comorbid psychiatric disorders and non-psychiatric illnesses were noted according to ICD 10 criteria during the diagnostic interview and analysed later. Additionally, the pharmacological treatment (existing and newly introduced) for each patient was noted and analysed later. Results At least one comorbid psychiatric disorder was present in 72.5% of patients. The most frequent were anxiety disorders (53.6%), specifically generalized anxiety disorder (20.2%); non-organic sleep disorders (50.7%), specifically insomnia (48.4%); and sexual dysfunctions (21.4%), specifically lack of sexual desire (20.2%). Comorbidity with any non-psychiatric illness was present in 80.3% of patients. The most frequent were circulatory system diseases (55.9%), specifically hypertension (45.9%); endocrine, nutritional and metabolic disorders (51.3%), specifically hyperlipidaemia (24.0%); and other non-psychiatric disorders (60.7%), specifically low back pain (22.7%). All patients received pharmacological treatment with different medications. Most patients received monotherapy or combination therapy of antidepressants, anxiolytics, antipsychotics and antiepileptics. The most frequently used antidepressants were escitalopram, sertraline, and duloxetine. The most frequently used anxiolytics were alprazolam and diazepam, the most used antiepileptic was pregabalin, and the most used antipsychotics were olanzapine, quetiapine, and aripiprazole. Conclusion The results of the study confirm the results of previous research studies about the high prevalence of psychiatric and non-psychiatric comorbidities in patients with depression that were conducted in the past. It would be important if future studies could prove the importance of those comorbidities on clinical severity, choice of treatment, and its outcome in patients with depression.

Background Assessments of subclinical connective tissue disorders depend on complex approaches, emphasizing the need for more accessible methods applicable to clinical routine. Therefore, we aimed to establish a reliable approach assessing cervical vessel tortuosity, which is known to be associated with such disorders. Methods Magnetic resonance angiography (MRA) images of ReSect study participants [single-center prospective cohort of spontaneous cervical artery dissection (sCeAD) patients] were used. Each patient underwent the same magnetic resonance imaging (MRI) protocol. The segmentation procedure was done using MATrix LABoratory 9.4 [up-sampling of raw MRA images, distance metric (DM) calculation], ITK-SNAP [region of interest (ROI) determination, vessel segmentation] and Vascular Modelling ToolKit (centerline determination). To assess inter-user variability and validity, we (I) had two blinded independent users segment all arteries and we (II) compared the results of our method to visual appraisal of vessel tortuosity done by two blinded expert neuro-radiologists. Results A total of 526 extracranial cervical arteries were available for analysis. The inter-user variability of our method users was below 0.5% throughout. Overall, our method outperformed the visual tortuosity appraisal, as the visual grading underestimated the DM in 38.8% subjects when tasked to assess overall cervical artery tortuosity (both vertebral and internal carotid arteries) and in 16.6% and 33.3% respectively if tasked to grade anterior or posterior circulation separately. Conclusions We present a reliable method to assess cervical artery tortuosity derived from MRA images applicable in clinical routine and future research investigating the potential correlation of sCeAD and connective tissue disorder.

Abstract The total heavy metal concentration (Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Zn) in green tea leaves and metals leached into tea infusions of pure water with the addition of ascorbic acid and lemon juice at various temperatures (70, 80, and 100 °C) and steeping times (3, 5, and 7 min), were determined. Metal concentrations were analyzed by atomic absorption spectrometry and the flame technique (FAAS). Mean total concentrations of Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Zn were < LOD, <LOD, 0.198, 4.527, 67.51, 333.7, 2.588, <LOD, 10.23 μg/g, respectively. The highest percentage of extraction in different solutions was in the case of Mn (up to 100%). The risk for adults through consumption of tea was mainly contributed by Mn, and non-carcinogenic hazard quotient (HQ) was slightly higher than 1 when infusions were heated to 100 °C. High percentages of Ni were extracted in pure water compared to water with addition, regardless of tea steeping time, followed by Cu in pure water and water with lemon juice. Fe was poorly extracted in all applied solutions; the highest percentage of extraction (17.21%) was determined in lemon juice solutions of at 100 °C during a steeping time of 7 min.

Microvascular surgery, plastic and reconstructive hand surgery, and coronary artery bypass surgery call for a microanatomical study of the branching pattern of the superficial palmar arch (SPA). For the anatomical analysis, we used a group of 20 dissected human hands injected with 4% formaldehyde solution and a 10% mixture of melted gelatin and India ink. The morphometric study was performed on 40 human hands of adult persons injected with methyl-methacrylate fluid into the ulnar and radial arteries simultaneously and afterwards corroded in 40% KOH solution for the preparation of corrosion cast specimens. The mean diameter of the SPA, between the second and third common palmar digital arteries, was 1.86 ± 0.08 mm. We identified the persistent median artery (PMA) in 5% of hands. We distinguished the three main groups of the SPAs according to variations in morphology and branching of the arch: Type 1, the long SPA; Type 2, the middle length SPA; and Type 3, the short SPA found in 27.5% of specimens. The communicating branch (CB), a vessel interconnecting the SPA to the closest branch of the radial artery, is classified into two different morphological groups. The third type of incomplete short arterial arch is the most important of the three groups of SPAs. That short SPA is potentially inadequate for restoring circulation after occlusion or radial artery harvesting for coronary artery bypass.

Alopecia areata is an autoimmune form of non‐scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete scalp and body hair loss (alopecia totalis, alopecia universalis). In patients with alopecia areata hair loss significantly impacts the quality of life. Children and adolescents with alopecia areata often experience bullying, including physical aggression. The disease severity evaluation tools used in clinical practice are: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS). A SALT score equal to or greater than 20 constitutes a commonly accepted indication for systemic therapy in alopecia areata. When using the AAS, moderate to severe alopecia areata should be considered a medical indication for systemic treatment. Currently, the only two EMA‐approved medications for alopecia areata are baricitinib (JAK 1/2 inhibitor) for adults and ritlecitinib (JAK 3/TEC inhibitor) for individuals aged 12 and older. Both are EMA‐approved for patients with severe alopecia areata. Other systemic medications used off‐label in alopecia areata include glucocorticosteroids, cyclosporine, methotrexate and azathioprine. Oral minoxidil is considered an adjuvant therapy with limited data confirming its possible efficacy. This consensus statement is to outline a systemic treatment algorithm for alopecia areata, indications for systemic treatment, available therapeutic options, their efficacy and safety, as well as the duration of the therapy.

Background The main goal of the paper is to review the existing state and propose a model solution for the introduction of the waste-to-energy concept in the Republic of Serbia and Bosnia and Herzegovina, as these Balkan countries are a source of high pollution due to the inefficient use of fossil fuels and the operation of coal-fired power plants. Besides, these countries have very low level of waste management, which results in the uncontrolled disposal of a large amount of waste which consists of plastic and microplastic materials which are difficult to decompose in natural ecosystems. Methods Considering the type and objectives of the study, a mixed research method was chosen as a combination of exploratory research, descriptive research, explanatory research, and modeling. Results The main result of the research shows the unfavorable situation in the field of waste management in the Republic of Serbia, as well as in Bosnia and Herzegovina. Both countries have adopted adequate strategies and plans, but waste management is not implemented accordingly, Nevertheless, numerous problems create considerable opportunities for improvement, especially regarding the potential for energy production from waste, which is an important approach to implementing the circular economy model. The study showed that the situation is particularly unfavorable in rural areas. Hence, the research proposes (a) a novel model for waste-to-energy governance and (b) a novel model for waste-to-energy management in rural areas. The research was done, and models were developed based on the examples of the Republic of Serbia, and Bosnia and Herzegovina. However, the results can be used in countries with a similar level of waste management and with a larger share of rural areas. Conclusions The paper emphasizes the importance of a holistic and systemic approach to waste management, with emphasis on using waste-to-energy concept as particularly applicable in the transition to circular economy. This study proposes a model for the integration of waste management (with emphasis on plastic and microplastic) and energy efficiency, presenting a model of approach that can be used in countries that are at the beginning of introducing a circular economy.

Narcissus poeticus L. (Amaryllidaceae), a facultative serpentinophyte, is a highly variable species and particularly important ancestor of cultivated daffodils, but is rarely studied in field populations. This study, based on natural populations in the Balkans, focused on karyotype variability, genome size, ploidy and the presence of B chromosomes. Thirteen native populations from different environmental and soil conditions were collected and analyzed using flow cytometry to estimate nuclear genome size, fluorescence in situ hybridization (FISH) for physical mapping of rDNA, fluorochrome labeling (chromomycin and Hoechst) for heterochromatin organization and silver nitrate staining of nucleoli for determining rRNA gene activity. The organization of rDNA and natural triploids is reported here for the first time. The presence of individuals with B chromosomes (in 9/13 populations) and chromosomal rearrangements was also detected. The observed B chromosome showed three different morphotypes. The most frequent submetacentric type showed four different patterns, mainly with active ribosomal genes. The results obtained show that N. poeticus has a dynamic genome with variable genome size due to the presence of polyploidy, B chromosomes and chromosomal rearrangements. It is hypothesized that the observed changes reflect the response of the genome to different environmental conditions, where individuals with B chromosomes appear to have certain adaptive advantages.