Aim To investigate the prevalence of burnout syndrome among health care workers in the Federation of Bosnia and Herzegovina (FBiH) during the coronavirus disease 2019 (COVID-19) pandemic. Methods This cross-sectional study was conducted in May and June 2021 using an online survey based on Copenhagen Burnout Inventory. The questionnaire underwent forward and backward translation, preliminary pilot testing, and was assessed for reliability and validity. Personal burnout, work-related burnout, and patient-related burnout were assessed. The survey was sent to the members of the Union of Physicians and Dentists in FBIH, who were asked to forward the link to their medical technicians and nurses. Results A total of 77% of participants experienced some form of burnout. As many as 32% experienced all three forms of burnout. Those actively involved in tackling the COVID-19 pandemic more often experienced burnout. In personal and work-related burnout domains, higher level of burnout was reported among female respondents. Higher work-related and patient-related burnout was reported by physicians compared with medical technicians/nurses. Higher level of patient-related burnout was reported in health care workers aged 30-39 and 50-59 years, among respondents working in primary care, and among physicians. Conclusion The majority of health care workers showed moderate or high levels of personal and work-related burnout, with a lower level of patient-related burnout. There is a need for further research into the causes of burnout, as well as for the implementation of organizational interventions aimed to minimize workplace burnout.

Abstract Introduction Road traffic injuries (RTI) are among the ten leading causes of death worldwide, and they are the leading cause of death among young adults aged 15-29 years. In Federation of Bosnia and Herzegovina (FBiH), with population of 2,1 million, around 380 people die every year and additional 11.000 get seriously injured in RTI. Aim The aim of this study was to investigate the incidence and fatality rate of RTI in FBiH in the period of 2006 until the end of 2020. Methods Data source of RTI (ICD-X) incidence and fatality rate was Statistical book for Federation of Bosnia and Herzegovina, which includes all injuries and deaths reported through Ministry of internal affairs. Fatality rate was calculated as number of confirmed deaths in total number of reported RTI. To compare frequencies of reported deaths Chi square test was used. YLD were calculated based on information on injury that was caused in road traffic accidents. Results In the last 15 years, in FBiH, total 39,455 injuries related to road traffic were reported. According to the official data, over the period 2006-2020 the peak of fatality rate (8.52% deaths among all cases with RTI) was in 2016, while it had a statistically significant decline in 2018: 6.51%; 2019: 6.35%; and 2020: 6.32% (x2=7728,584; p < 0,0001). It is estimated that young adults (in the age group 30 to 39 years) injured in the road traffic accidents have 197.01 patient-years of total 881.17 years to live with disabilities just based on serious RTI in 2020. Conclusions RTI pose a significant burden on the health of the population in FBiH. After implementing strict laws in the year 2017, and 2018, a significant decrease of RTI was registered, including the number of deaths due to RTI (fatality rate). This abstract is support and sponsorship by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe. Key messages • RTI are significant burden for health of population in FBH. Strict laws and stronger punishments and fees are decreasing number of RTI. • This abstract is support and sponsorship by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe.

Abstract Background Mortality data are essential for monitoring population health and is one of the most important data for evaluation and comparison of health status at the local, national, and international level. Objective: We analysed all-cause mortality data in the Federation of Bosnia and Herzegovina (FBiH) for the period 2016-2021 and compared it with mortality occurred during the COVID-19 pandemic, in 2020 and 2021. Methods Using data on all-cause deaths for the period 2016-2021, obtained from the Institute for Statistics of the Federation of Bosnia and Herzegovina, we compared annual number of deaths (all-ages) and death rates during the 2020 and 2021 to pre-pandemic years. Results In 2016 the reported number of death was 21,146, in 2017 was 21,942, in 2018 was 21,691, and in 2019 was 22,024, and during the pandemic period in 2020 and 2021, 26,026 and 29,086 deaths were reported respectively. In 2020, 4,115 more deaths has been reported (15,8%), and in 2021 more 6,438 death (22,1%) compared with period 2016-2019. In FBiH in 2021, the death rate per 100,000 inhabitants was 1,341.2 and it is recorded an increase compared to 2020 when it had a value of 1,208.3 while in 2016 the value was 951.7. Conclusions A large proportion of increased mortality during pandemic was probably caused directly by COVID-19. However, the pandemic also resulted in deaths that would otherwise not have occurred (indirect deaths) due lack of access to medical services when hospitals were overwhelmed and changes in health seeking behaviour. An in-depth investigation of the underlying causes of the high excess mortality should be conducted to inform changes in the health care system and efforts to prevent severe COVID-19 through vaccination of vulnerable groups should be a priority. *This abstract is support by ‘BoCO-19 - The Burden of Disease due to COVID-19'. Project is coordinated/led by Robert Koch Institute and supported by the WHO Regional Office for Europe. Key messages • During the two years of the COVID-19 pandemic, population in FBiH had a significant increase in all-cause mortality. • The direct standardized death rate for all causes and age groups per 100,000 inhabitants in 2020 for FBiH was 818.0 and it is slightly higher compared to the EU average.

Metabolic syndrome (Met Sy) as a highly debatable cluster of traditional risk factors is known to promote cardiometabolic-related morbidity and mortality, but its precise mechanisms remain to be determined. We sought to determine influence of MetSy on heart failure (HF) morbidity and mortality in the Seven Countries' Study as one of the oldest epidemiological studies. The Seven Countries Study encompassed 12,763 participants from 3 continents who were all healthy men of over 40 years at baseline and who underwent regular check ups every 5 years throughout over a 4 decades' span. Morbidity and mortality was adjudicated according to valid ICD and LPH coding. Using the IDF definition of the Metabolic Syndrome, 9,09% of participants were identified (Figure 1). HF was confirmed in 220 patients (16.4% alive at 40y follow up visit), while 8.2% died of HF as well in the same time-frame (Tables 1 & 2). Presence of MetSy has been shown to significantly influence HF mortality (Figures 2) with lowest survival of 22% for 300 months of follow up for patients with both MetSy and HF (Log rank test=4.405, p<0.0001). Metabolic syndrome treatment remains in the realm of risk factors' control that now we know influence both ischemic heart disease and heart failure of other origins. Historically, just emerging biomarkers' and targeted imaging weren't available to determine such at the time of HF diagnosis. Also, the sample consisted of men only, mainly Caucasian and a modest proportion of Asian and African-American now known to carry ethnic-specific burden of cardiovascular disease. All of the above, emphasizes the importance of more diversity, equity and inclusion-dedicated long term both observational, as well as interventional research. Type of funding sources: None.

Chronic kidney disease (CKD) is a significant cause of morbidity and mortality among patients infected with human immunodeficiency virus (HIV). The Central and East Europe (CEE) region consists of countries with highly diversified HIV epidemics, health care systems and socioeconomic status. The aim of the present study was to describe variations in CKD burden and care between countries. The Euroguidelines in the CEE Network Group includes 19 countries and was initiated to improve the standard of care for HIV infection in the region. Information on kidney care in HIV-positive patients was collected through online surveys sent to all members of the Network Group. Almost all centres use regular screening for CKD in all HIV (+) patients. Basic diagnostic tests for kidney function are available in the majority of centres. The most commonly used method for eGFR calculation is the Cockcroft–Gault equation. Nephrology consultation is available in all centres. The median frequency of CKD was 5% and the main cause was comorbidity. Haemodialysis was the only modality of treatment for kidney failure available in all ECEE countries. Only 39% of centres declared that all treatment options are available for HIV+ patients. The most commonly indicated barrier in kidney care was patients’ noncompliance. In the CEE region, people living with HIV have full access to screening for kidney disease but there are important limitations in treatment. The choice of dialysis modality and access to kidney transplantation are limited. The main burden of kidney disease is unrelated to HIV infection. Patient care can be significantly improved by addressing noncompliance.

Premature ventricular contraction (PVC) is a frequent kind of arrhythmia that affects around 1% of the general population. While PVC most frequently impairs ventricular function in structurally normal heart, retrograde ventriculo‐atrial conduction can occur in people with PVC. These retrograde atrial activations may mimic pulmonary vein‐derived atrial ectopies. As a result, PVC may raise the risk of atrial fibrillation (AF) by retrograde ventriculo‐atrial conduction. The Four‐Dimensional Automated Left Atrial Quantification (4D Auto LAQ) tool is a left atrial analytical approach that utilizes three‐dimensional volume data to quantify the volume, as well as LA longitudinal and circumferential strains. The purpose of this study was to determine if clinical diagnosis of PVC is connected with abnormal LA function as determined by LA strain evaluation utilizing a 4D Auto LAQ compared to the healthy population.

Premature ventricular complex (PVC) is common in general population. The atrial conduction time (ACT) represents the interval between electrocardiographic P wave and atrial mechanical contraction, and the prolongation of ACT called atrial electromechanical delay (EMD). In the present study, we investigated atrial conduction parameters through echocardiography in patients with frequent PVC. The study involved 54 patients with PVC and 54 healthy volunteers as a control group. A comprehensive echocardiographic examination was done. The time difference between the onset of the p wave and septal Am wave was the PA septal, the time difference between the onset of the p wave and the lateral Am wave was the PA lateral, and the time difference between the onset of the p wave and the tricuspid annulus Am wave was the PA tricuspid. The interatrial EMD was the time difference between the PA lateral and the PA tricuspid, the left atrial (LA) intraatrial delay was the time difference between the PA lateral and the PA septal and the right atrial (RA) intraatrial delay was the time difference between the PA septal and the PA tricuspid. LA anterior-posterior dimension and LA maximum volume were significantly larger in the patient group. Left intraatrial EMD, right intraatrial EMD, and interatrial EMD were significantly longer in the patient group. PA lateral, PA septal, PA tricuspid durations were significantly prolonged in the patient group. Atrial conduction times were prolonged in patients with frequent PVC. Type of funding sources: None.

Abstract Background Analysis of years of life lost (YLL) due to premature deaths during the COVID-19 pandemic can direct decision-makers towards specific public health recommendations in order to improve health and lives of people. Our study aimed to examine the existence of age- and sex-specific patterns of the three most common causes of premature death in Belgrade during the first year of the COVID-19 epidemic. Methods Mortality data disaggregated by age, sex and cause of death, as well as the estimated number of inhabitants and remaining life-expectancy by age-groups for Belgrade was provided by the Statistical Office of the Republic of Serbia. YLLs were calculated using the methods of the Global Burden of Disease Study, without garbage code redistribution. Mortality rates were standardized according to the European Standard Population. We acknowledge the support from the COST Action 18218 - European Burden of Disease Network. Results In 2020 in Belgrade, according to the share in all-cause YLLs, cardiovascular diseases ranked first (36.2%), followed by neoplasms (25.7%) and COVID-19 (11.1%). However, on average, COVID-19 generated higher number of YLLs per death case (11.9) than cardiovascular diseases (9.2), but fewer than neoplasms (13.9). In total of 31,943 YLLs due to COVID-19, men had 1.7 times more YLLs than women. By age groups, the highest YLL share due to COVID-19 was among men aged 45-49 (16%) and 70-74 (16%) and among women aged 20-25 (33%) and 25-29. years (29%). In men, COVID-19 YLL rate was 2,488 per 100,000 and was higher after standardization (2,714). In women, COVID-19 YLL rate was 1346 per 100,000 and was lower after standardization (1,245). Conclusions In Belgrade, COVID-19 was the third cause of premature mortality in 2020. The difference between COVID-19 YLL rates in men and women were even more prominent after standardization. Future research is needed to determine the synergistic impact of COVID-19 and other causes of premature death. Key messages • In 2020, COVID-19 was among the top three causes of premature mortality among male and female contingents of the Belgrade population. • Assessing the causes of premature mortality is important for determining community health priorities.