COVID-19 Vaccination Outcomes and Antibiotic Crisis and Overuse During the COVID-19 Pandemic in Bosnia and Herzegovina.

Background: COVID-19 has different presentations from mild flu like symptoms such as anosmia, dysgeusia, fever, sore throat, cough, dyspnea, headache, abdominal pain and diarrhoea to severe COVID-19 with the development of acute respiratory syndrome (ARDS), septic shock, metabolic acidosis, coagulation dysfunction, multiorgan failure or even death. Objective: The aim of this research project was to present and highlight the outcomes of the vaccination against COVID-19 and the widespread use of antibiotics during the initial admission and treatment of COVID-19 patients in out of hospital settings. Methods: This observational cross-sectional study was conducted between September 1st and September 24th 2021, during the fourth wave of COVID-19 outbreak in Bosnia and Herzegovina, among the patients admitted to the primary health care COVID-19 centre of Canton Sarajevo in Bosnia and Herzegovina. Results: Patients were mostly female 213 (53.3%), with a mean age of 48.8±18.6, with hypertension 129 (32.3%) or diabetes mellitus 35 (8.7%) as comorbidities and being COVID-19 unvaccinated 236 (59.0%) COVID-19 unvaccinated patients expressed more fever (X 2=9.93, p<0.05), had typical COVID-19 chest X ray presentation (X 2=6.08, p<0.05) and abnormal lung auscultation sounds (X 2=5.43, p<0.05). Out of all patients, 312 (78.0%) have received antibiotics and 3 (0.75%) antivirotics such as favipiravir as therapy for the treatment of COVID-19. The mean duration of the antibiotic regime was 10.2 ± 7.5 days with a minimum of 3 days and maximum of 62 days. The minimum CRP value when antibiotics were prescribed was 0.1 (ref. value <5mg/l). The most prescribed antibiotic was doxycycline 172 (43.0%), followed by ceftriaxone 139 (34.7%) and azithromycin 108 (27.0%). Conclusion: Our study showed that vaccination acts protective for the development of severe COVID-19 forms, as well as that antibiotics were overused among COVID-19 infected. The outcome of such malpractice could lead to antimicrobial resistance which will be seen in further years. Governmental agencies should advise physicians to change these trends.

Mental Health and Substance Abuse Among the Bosnia and Herzegovina Student Population During the COVID-19 Outbreak.

Background: Mental health, substance abuse and suicidal ideation present an emerging healthcare problem during COVID-19 pandemic as a result of socio-epidemiological measures, isolations, work modifications, constant media overload with COVID-19 related news and no effective cure for the disease. Objective: The aim of this study was to analyse substance abuse, suicidal ideation and mental health status among university students during the COVID-19 outbreak in Bosnia and Herzegovina. Methods: This cross-sectional study, was conducted via an online anonymous questionnaire based on a Patient Health Questionnaire-4 and Impact of Event Scale-6 which was distributed to the student population of Bosnia and Herzegovina. Results: In total 827 subjects, the majority of whom were female (636), had a high school degree (431), were unemployed (587), lived in an urban environment (747) and had a median age of 23.0 (21.0,32.0), completed the questionnaire. Being female [(OR=1.643, p=0.040); (OR=1.643, p=0.032)], taking sedatives [(OR=1.519, p<0.001); (OR=1.250, p=0.029)] and having high IES-6 score [(OR=2.190, p<0.001); (OR=2.013, p<0.001)] were independent predictors of developing depressive and anxiety symptoms during the COVID-19 outbreak, respectively. Suicidal ideation was present in 71 subjects, with 11 attempting to commit suicide. Sedative (OR=1.381, p=0.005) or alcohol (OR=1.493, p=0.002) use, unemployment (OR=4.551, p<0.001) and depressive symptoms (OR=7.261, p<0.001) were independent predictor of developing suicidal ideation. Conclusion: Bosnia and Herzegovina students show a significant prevalence of anxiety and depressive symptoms, trauma- and stressor-related disorder related to the pandemic, suicidal ideation and substance abuse during the COVID-19 outbreak, especially in association with gender, occupation and abuse of a specific substance.

Sleep quality and patterns of young West Balkan adults during the third wave of COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: To evaluate the sleep patterns among young West Balkan adults during the third wave of the COVID-19 pandemic. DESIGN AND SETTING: Cross-sectional study conducted using an anonymous online questionnaire based on established sleep questionnaires Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) (February-August 2021). PARTICIPANTS: Young adults of Bosnia and Herzegovina, Croatia and Serbia. RESULTS: Of 1058 subjects, mean age was 28.19±9.29 years; majority were women (81.4%) and students (61.9%). Compared with before the pandemic, 528 subjects (49.9%) reported a change in sleeping patterns during the pandemic, with 47.3% subjects reporting sleeping less. Mean sleeping duration during the COVID-19 pandemic was 7.71±2.14 hours with median sleep latency of 20 (10.0-30.0) min. Only 91 (8.6%) subjects reported consuming sleeping medications. Of all, 574 (54.2%) subjects had ISI score >7, with majority (71.2%) having subthreshold insomnia, and 618 (58.4%) PSQI score ≥5, thus indicating poor sleep quality. Of 656 (62.0%) tested subjects, 464 (43.9%) were COVID-19 positive (both symptomatic and asymptomatic) who were 48.8%, next to women (70%), more likely to have insomnia symptoms; and 66.9% were more likely to have poor sleep quality. Subjects using sleep medication were 44 times, and subjects being positive to ISI 15.36 times more likely to have poor sleep quality. In contrast, being a student was a negative independent predictor for both insomnia symptoms and poor sleep quality, and mental labour and not working were negative independent predictors for insomnia symptoms. CONCLUSIONS: During the third wave of the pandemic, sleep patterns were impaired in about half of young West Balkan adults, with COVID-19-positive subjects and being women as positive independent predictors and being a student as negative independent predictor of impaired sleep pattern. Due to its importance in long-term health outcomes, sleep quality in young adults, especially COVID-19-positive ones, should be thoroughly assessed.

Knowledge, attitudes and practices during the second wave of COVID-19 outbreak: a cross-sectional study from various perspectives.

Aim To investigate knowledge, attitudes and practice towards COVID-19 among selected population. Methods An anonymous online questionnaire based on a Chinese study was distributed via online social media platforms among general population of Bosnia and Herzegovina, Germany, India, Kosovo and Romania. Results In total 1032 subjects, predominately females, 615 (59.6%) with a mean age of 31.23±12.94 years, single, 705 (68.3%), with high school degree or lower, 469 (45.4%), students, 528 (51.1%) and living in an urban environment, 824 (79.8%), have completed the survey. The median knowledge score was 10.0 (range 0-12). Being male (ß: -0.437; p=0.003) and older (ß: -0.028; p<0.001) were associated with lower knowledge scores, while being single (ß: 1.026; p<0.001) and mental labour employee (ß: 0.402; p=0.032) were associated with higher knowledge scores. The vast majority of subjects had not visited crowded places, 630 (61.0%) and wearing masks when they were going out, 928 (89.9%). Being female (OR=0.731; p=0.022), having higher knowledge scores (OR=0.929; p=0.017) and being a mental labour employee (OR=0.713; p=0.031) decreased the exposure to crowded places. High school or lower education level (OR=0.616; p=0.024) decreased the action of wearing a mask in public places, while higher knowledge scores (OR=1.112; p=0.013) increased it. Conclusion Our study suggests that residents of the selected regions have had good knowledge, pessimistic attitudes and relatively appropriate practices towards COVID-19 during the second wave of the outbreak.