MEDIS – International Journal of Medical Sciences and Research最新文献

{"title":"CORTICOSTEROID-INDUCED EXPRESSION OF MICROBIAL VIRULENCE CAN ENHANCE THE DEVELOPMENT OF HOST INFECTIOUS DISEASE","authors":"Kamelija Madacki-Todorović, Izet Eminovic, Nadira Ibrišimović Mehmedinović, Mirza Ibrišimović","doi":"10.35120/medisij030219m","DOIUrl":"https://doi.org/10.35120/medisij030219m","url":null,"abstract":"Corticosteroids regulate a number of physiological processes and are synthetic analogs of the natural steroid hormones produced by the adrenal cortex. As drugs, corticosteroids are non-inflammatory and are used for the treatment of plethora of conditions which include arthritis, kidney, skin, lungs or thyroid disorders, for the treatment and relief of symptoms of allergies and symptoms of some gastrointestinal disorders. In addition, glucocorticoids can regulate the effects of inflammatory disorders, including sepsis, autoimmune diseases, and allergies. These conditions are potentially fatal. Consequently, this drug class is among the most commonly prescribed globally. One representative of corticosteroid class of drugs is dexamethasone which is used to treat allergies, adrenal problems, arthritis, asthma, diseases of blood or bone marrow, inflammation, kidney diseases, different types of skin conditions, and episodes of multiple sclerosis. Virulence factors help bacteria colonize the host at the level of the cell. In their nature, these factors are secretory, associated with the membrane or present in the cytosol. Secretory factors allow bacterium to circumvent the host immune response, while membrane factors aid bacterium in adhesion to the host cell. Finally, cytosol factors help bacteria adapt metabolically, physiologically, and morphologically to their changing environment. One such factor is aspartyl proteinase, a protein that degrades other proteins and is a virulence factor in many pathogens playing a role in the host invasion process. Another important virulence factor is the ability to form biofilms, which can render bacteria resistant to antimicrobials. Despite the widespread use of corticosteroids, including dexamethasone, little is known about their possible influence on the expression of virulence factors such as aspartyl proteinase. If such a connection is to exist the use of corticosteroids could elicit pathogenesis in certain microbes. In the here-presented study we wanted to investigate the effects of dexamethasone on the growth, expression of aspartyl proteinase and biofilm formation in three E. coli strains that were previously isolated from patients suffering from urinary tract infection. To this aim, we amended the growth media with 0.5 mg/mL dexamethasone. Bacterial growth was measured over the period of 24 hours and the effect of dexamethasone was established at different time points. Administration of 0.5 mg/mL glucocorticoid drug dexamethasone did not significantly affect bacterial growth. However, it resulted in an increase in concentration of secreted E. coli virulence factor aspartyl proteinase, which increased up to 2.6-fold for some E. coli strains. In addition, we noted the increased biofilm formation in to three out of four studied strains. This study indicates dexamethasone as a possible trigger molecule for the expression of virulence factor aspartyl proteinase in E. coli.","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"119 31","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE IMPORTANCE OF ULTRASONOGRAPHY IN THE DETECTION OF CONGENITAL HEART DISEASES IN CHILDREN","authors":"Indira Poplata, Elvedina Hodžić, Nedim Begić, Ljiljana Stijepović","doi":"10.35120/medisij030213p","DOIUrl":"https://doi.org/10.35120/medisij030213p","url":null,"abstract":"Over the last few years, remarkable progress has been made in the field of congenital heart diseases. Improvements considering diagnostic modalities, especially imaging, in surgical and interventional techniques, as well as in postoperative therapy and care, have contributed to a significant reduction in mortality and morbidity. One of the most important applications of medical imaging techniques in children is the detection and treatment of congenital heart anomalies. Objective of this article is to show the importance of ultrasonography in the detection of congenital heart diseases in children. The study was conducted on children with simple and complex congenital heart diseases and was conducted on the Pediatric Clinic, UKCS. The research is descriptive on a representative sample. In our study, 166 children were observed, of which 148 children (77 boys, 71 girls) with simple congenital heart diseases, and 18 children (8 boys, 10 girls) with complex congenital heart diseases. Out of the total number of observed children, 115 had a surgical correction, 97 children with simple congenital heart diseases (45 boys, 52 girls) and 18 children with complex congenital heart diseases (8 boys, 10 girls). The number of children monitored through the Cardiac Counseling Center who didn’t undergo surgical correction was 51, all with simple congenital heart diseases. Out of the total number of observed children who were frequently coming for follow-ups, 28 children had changes on the ECG, and 138 of them had no changes on the ECG, 93 were surgically treated, and 73 of them were on conservative therapy. Based on the results of the research, we conclude that ultrasonography is an important method in the detection and treatment of congenital heart diseases.","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"45 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACTS OF TOBACCO USE AND EXPOSURE TO TOBACCO SMOKE ON HEALTH, SOCIETY, ECONOMY, AND ENVIRONMENT","authors":"Branislav Sančanin, Aleksandra Penjišević","doi":"10.35120/medisij030225s","DOIUrl":"https://doi.org/10.35120/medisij030225s","url":null,"abstract":"Smoking represents a significant global public health challenge and is the primary preventable cause of disease and death. This problem is accentuated by the fact that a substantial 80% of adult smokers worldwide come from low- or middle-income countries. The aim of this paper is twofold: first, to highlight the health impacts associated with tobacco use, and second, to delineate the indirect damage caused to the environment during the life cycle of tobacco products - from production and distribution to consumption and waste generation. The reluctance of some countries to take decisive action, together with intense pressure from tobacco corporations, is hindering progress towards reducing the number of adult smokers and curbing tobacco use among minors. State interventions, supported by strict laws, are necessary to enforce the ban on indoor smoking, the ban on the sale of tobacco to minors, and the establishment of permanent interstate cooperation in the fight against cigarette smuggling. Educational initiatives aimed at raising awareness of the dangers of smoking and tobacco consumption are key to fostering a smoke-free culture. A strong media campaign, supported by state measures, could contribute to faster and more comprehensive targeting of target groups, especially younger age categories.","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"111 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INVESTIGATION OF FACTORS AFFECTING ADHERENCE TO METFORMIN THERAPY IN TYPE 2 DIABETES","authors":"Aldijana Mahmutović, Lana Lekić, Nermina Zaimović Imamović, Amir Kikanović, Ana Pavlović","doi":"10.35120/medisij030243m","DOIUrl":"https://doi.org/10.35120/medisij030243m","url":null,"abstract":"Adherence is the degree to which the patient’s behavior (taking medication, following a diet, and/or changing lifestyle) matches the agreed recommendations of the prescriber. Adherence is influenced by socio-economic factors, factors related to the health system, factors related to the disease, factors related to the patient and factors related to therapy. Many methods have been developed to measure adherence. Methods are divided into direct and indirect. Adherence is usually lower in patients with chronic conditions than in patients with acute conditions. More recent studies show adherence values to oral antidiabetic therapy of 65-85%. Adherence is usually considered optimal when patients take at least 80% of their prescribed medication. The research conducted on the sample made up of middle-aged, non-adherent respondents (35-65), who have been using metformin for a minimum of 6 months in the treatment of type 2 diabetes mellitus showed the influence of different factors on adherence. The factors that showed the greatest influence on the low degree of adherence are: lower education, passive life, low physical activity, smoking, long-term therapy, change of therapy, concomitant therapy, metformin dosing more than 2 times a day, forgetting to take therapy. The average value of blood sugar for all subjects is 10.5 mmol/L, which indicates the ineffectiveness of the prescribed therapy, and which can be directly linked to the determined non-adherence of subjects to metformin therapy.","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"115 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"APPLICATION OF BOTULINUM TOXIN IN CONSERVATIVE TREATMENT OF MASTICATORY MUSCLES DYSFUNCTION","authors":"A. Mijoska, Sasho Jovanovski, B. Naumovski","doi":"10.35120/medisij030201m","DOIUrl":"https://doi.org/10.35120/medisij030201m","url":null,"abstract":"The purpose of this paper is to describe the application of the botulinum toxin in diseases of the temporomandibular system of a muscular type such as masticatory hypertrophy, spasm, bruxism, and tension headaches of idiopathic etiology. The masticatory system is a complex apparatus with great adaptive capacity. Still, when that capacity is exceeded, functional disorders occur followed by a series of symptoms that depend on individual, local, and systemic etiological factors. Occlusal trauma exceeding the physiological limits of the teeth, periodontium, and TMJ leads to a series of functional disorders. Temporomandibular dysfunctions (TMD) are used to describe a large, heterogeneous group of diseases of the temporomandibular joint (TMJ) and its adjacent tissues and organs. Botulinum toxin type A, hemagglutinin complex with 500 IU (DISPORT Ipsen Biopharm, UK) was used for the therapy of muscle disorders like bruxism or night teeth clenching in female patient 26 years old. Depending on the dose that was applied to the targeted muscle, a complete or partial reduction in contraction occurs with reduced function and weakening of the muscle. Two weeks after applying the neuromodulator, the patient reported a reduction in pain and episodes of teeth grinding and clenching. Bilateral hypotrophy of left and right masseter muscles was noticeable after 2 months. We concluded that botulinum toxin could be used as an effective treatment for reducing nocturnal bruxism and myofascial pain in patients with bruxism.","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"118 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DIABETES TYPE 2 AND OBESITY","authors":"N. Kostadinov","doi":"10.35120/medisij030231k","DOIUrl":"https://doi.org/10.35120/medisij030231k","url":null,"abstract":"Diabetes mellitus type 2 is a socially significant disease, which etiologically and pathogenetically is to the greatest extent influenced by body weight. Obesity has become a pandemic of our time. It is most often caused by the imbalance between energy intake and energy expenditure. Excess calories accumulate as fat. In patients with DM type 2, obesity further increases the risk of atherosclerosis, ischemic heart disease, cerebrovascular disease, arterial hypertension, hepatic steatosis, chronic kidney disease, increased mortality. The aim of the present analysis is to determine the frequency of patients with type 2 DM 170 patients with DM type-2 were studied. Of them, 77 with a relative share of 45.% are men, 93 are women, who make up 54.7%. The method of calculating the body mass index, which serves to assess the physical condition of the patients, was applied. After processing the data, it was found that 4.4% of the patients had a normal body weight, 26.5% were overweight, 1st degree obesity - 34.7%, 2nd degree obesity - 20.3% and with obesity of the 3rd degree are 14.1% of the studied patients. Obesity is a serious metabolic disorder that harbors multiple health risk factors that may reduce quality and life expectancy among patients with type-2 DM.","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"39 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"THE EVOLUTION OF NURSING AS A PROFESSION IN HEALTHCARE","authors":"Kushtrim Salihu","doi":"10.35120/medisij030207k","DOIUrl":"https://doi.org/10.35120/medisij030207k","url":null,"abstract":"Currently, nursing stands as a highly coveted profession drawing significant attention. While its roots can be traced back to ancient times, the formal recognition of nursing as a profession, labeled as such, has only emerged in recent decades. Defined as both a science and an art grounded in evidence, nursing is progressively assuming more significant roles within the healthcare and biomedical realms. The profession’s evolution is intricately linked with advancements in science, technology, and research, which have translated into tangible practices within the healthcare system. Offering both undergraduate and graduate nursing programs elevates the level of responsibility among nurses. However, this advancement lacks proper systematization and acknowledgment of educational standards within the healthcare sector. Future challenges encompass meeting the increasing healthcare demands spurred by longer life expectancies and population growth, alongside facilitating professional mobility within EU nations. Factors such as enhanced financial stability and improved working conditions contribute to the outflow of nurses from the region. Proposed solutions include establishing adaptable mobile teams, prioritizing patient education and preventative measures, integrating LED clinics/facilities, and introducing supportive robotic technologies. Nurses play a pivotal role in delivering care and advocating for health equity, emphasizing the necessity of fostering collaborative partnerships for the future sustainability of healthcare systems.","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"119 14","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141124338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COMPARATION OF KINESITHERAPY AND POWERPLATE IN PATIENTS WITH CERVICOARTHROSIS","authors":"Tamara Adjiska, Tose Krstev, Lence Nikolovska","doi":"10.35120/medisij030253a","DOIUrl":"https://doi.org/10.35120/medisij030253a","url":null,"abstract":"Osteoarthritis is a chronic disease of the musculoskeletal system, in which degeneration of the affected tissues is observed. Modern living conditions and immobility create favorable conditions for the spread of the disease. The cervical region of the spine is subjected to significant dynamic and static loads, which often leads to pain and limited mobility. Diagnosing cervical arthrosis at an early stage opens up opportunities for effective and timely complex treatment. Such treatment includes not only medicinal approaches, but also various physical therapies, balneotherapy, as well as massage and kinesitherapy. Improving and maintaining the functional status of patients with cervical arthrosis is essential for their quality of life. This disease is characterized by destruction of articular cartilage, in which the formation of new tissue at the edges of bones and tendons is observed. It has a progressive course and affects a significant part of the population. These changes are part of the aging process of the body and the musculoskeletal system. The patented technology of Power Plate is designed to trigger the body’s innate reflexive reaction to precise vibrations, stimulating muscles in a consistent and regulated fashion, thereby expediting the benefits of training. Power Plate’s efficacy has been substantiated through numerous medical and scientific investigations, alongside practical application in clinical recovery and wellness establishments, sports enhancement hubs, and widespread adoption by a multitude of professional and collegiate sports organizations in the United States, as well as numerous others globally. Vibration is defined as an oscillatory motion involving mechanical forces. Its intensity is influenced by biomechanical parameters such as amplitude, frequency, and the scale of the oscillations. Specifically, amplitude refers to the peak-to-peak displacement measured in millimeters, frequency relates to the rate at which oscillation cycles repeat and is measured in Hertz (Hz), and acceleration reflects the scale of the vibrations. This study aims to compare the efficacy of two therapeutic interventions, kinesitherapy (analytical exercises) and power plate, in enhancing muscle strength and improving cervical range of motion. Eighteen patients were divided into experimental (n=10) and control (n=8) groups. The control group received physical medicine and kinesitherapy, while the experimental group underwent physical medicine and power plate therapy, both for 21 days. Clinical assessments were conducted pre- and post-therapy. Results indicated symptom improvement in both groups, with better outcomes observed in the control group. Furthermore, the control group exhibited more significant improvements in range of motion compared to the experimental group. Kinesitherapy demonstrated greater efficacy than power plate therapy, likely due to its targeted muscle exercises and isotonic/ isometric contraction combination, as opposed to the r","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"34 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141123533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FORCED OSCILLATION TECHNIQUE (FOT) – A NOVEL METHOD FOR THE DETECTION OF EARLY AIRWAY CHANGES","authors":"Plamena Stoimenova, S. Mandadzhieva, Blagoi Marinov","doi":"10.35120/medisij030141s","DOIUrl":"https://doi.org/10.35120/medisij030141s","url":null,"abstract":"According to the World Health Organization in 2019 chronic obstructive pulmonary disease (COPD) was the third leading cause of death worldwide, causing more than 3 million deaths whereas bronchial asthma affected more than 250 million people and caused 455 000 deaths. Both diseases are chronic obstructive conditions which need to be diagnosed early in order to prevent or slow down the complications. Consequently the world requires new effortless methods for diagnosis of airway obstructions, especially for small children and people who cannot perform the spirometry maneuver. The purpose of this report is to describe the objectives of the forced oscillation technique (FOT) and to establish its applications in the clinical practice. Studies and clinical cases regarding pulmonary function testing are summarized and analyzed. They are found in the following databases - PubMed, Google Scholar and Science Direct. Spirometry is the ‘gold standard’ for the diagnosis of airflow obstruction but it requires effort and can be difficult for patients to perform. Forced oscillation technique (FOT) on the other hand is a relatively new method that may hold the key to identifying smoking-related respiratory early alterations and childhood asthma. FOT requires tidal breathing while applying external, small amplitude oscillations in order to determine the response of the respiratory system. Therefore, it is easy for pre-school children to perform. The benefit of FOT should be taken into account for patients who cannot perform spirometry or other pulmonary function ttests. The minimal cooperation of the patient and the easy tidal breathing maneuvers make this method a great option for every pulmonologist. Compared to spirometry this technique may be more sensitive in the detection of disturbances of the peripheral airways and may be effective for the control of therapy at a long term. The Forced oscillation technique has been successfully applied in many pediatric respiratory disorders, such as asthma, cystic fibrosis, and chronic lung disease. Considering these qualities FOT may be used as an alternative of spirometry in heterogenous ventilatory disturbances of the small airways.","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"36 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140077339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DEVELOPING STEPS TO IMPROVE ADHERENCE IN HEALTHCARE PROFESSIONALS DAILY PRACTICE","authors":"L. Lekić, E. Alibegović, Jasna Rahimić, Bojan Pavlović, Aida Hamzić-Mehmedbašić","doi":"10.35120/medisij020427l","DOIUrl":"https://doi.org/10.35120/medisij020427l","url":null,"abstract":"Adherence is a a term that has been prominently used and emphasized recently, representing the connection between a patient and their treatment. Medical adherence has its hierarchical structure, with roots primarily stemming from legislative bodies to the healthcare system, institutions and ultimately healthcare professionals (doctors, nurses, technicians). However, medical adherence faces a significant obstacle in achieving therapy goals and improving treatment outcomes among many patients, especially those with chronic conditions. Social and sociental conditions, as well as the state organization in Bosnia and Herzegovina (BiH), greatly influence the healthcare system and the purchasing power of healthcare service users. Due to significant barriers and challenges regarding adherence, efforts are being made to maintain a system that supports increasing patient adherence levels. Within this research paper, three questionable theses are presented: internal and external education, improvement of the healthcare system and the implementation of systematic data collection on patient adherence. All three questionable thesis recived positive feedback from respondents (200 participants). From the first thesis, 154 respondents voted in favor, for the second thesis, 142 respondents and for the third thesis, 134 respondents agreed with the proposed suggestions. Unfortunately, in BiH insufficinet attention is given to patient adherence and there is no unified strategy to increase adherence levels. Internal and external education would be essential as healthcare workers are not adequately trained, nor are conditions created for its implementation. Increasing the level of adherence can greatly benefit healthcare workers in their daily practice if they have adequate conditions in place. Unfortunately, a significant number of healthcare employees lack the knowledge, experience and a clearly defined strategy on how to increase patient adherence. The complexity of measuring adherence only adds to the intricacy of an already complex problem and the inefficiency and sluggishness of the healthcare system hinder the creation of appropriate activities that should result in increased patient adherence. The patient’s adhrence is influenced by numerous factors for which there is no unique solution or overcoming suggestions. Also, problems in the process of identifying and measuring adherence further complicate the already complex matter and the process of increasing user adherence. Creating a strategy to improve adhrence at the state level in Bosnia and Herzegovina is almost impossible; therefore, the increase in adhrence can only be achived at the level of the patient, healthcare personnel and ideally, at the level of healthcare institutions. Unfortunately, in most cases, conditions and workload do not allow healthcare workers to spend enough time with patients, establish adequate communication and demonstrate that the patient is genuinely important to them. Providing no","PeriodicalId":446210,"journal":{"name":"MEDIS – International Journal of Medical Sciences and Research","volume":"50 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138982523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}