Background: The COVID-19 pandemic has had a significant impact on the global economy and public health, disrupting various aspects of daily life. Apart from its direct effects on physical health, it has also significantly affected the overall quality of life and mental health. This study employed a path analysis to explore the complex association among multiple factors associated with quality of life, anxiety, and depression in the general population of the Republic of Srpska during the pandemic’s second year. Method: A cross-sectional study was conducted on a nationally representative sample (n = 1382) of the general population (adults aged 20+) during the second year of the COVID-19 pandemic in the Republic of Srpska, Bosnia, and Herzegovina. Assessment tools included the DASS-21 scale for depression, anxiety, and stress, along with the Brief COPE scale, Quality of Life Scale (QOLS), and Oslo Social Support Scale (OSSS-3). Sociodemographic factors and comorbidities were also assessed. Structural equation modeling was used to identify the direct and indirect links of various characteristics to quality of life, anxiety, and depression. Results: This study revealed a considerable prevalence of anxiety and depression symptoms (27.5% and 20.9%, respectively), with quality of life playing a significant mediating role. The constructed path model accounted for 33.1% of moderate to severe depression and 79.5% of anxiety. Negative coping was directly linked to anxiety and indirectly to depression via anxiety, while the absence of positive coping had both direct and indirect paths (through quality of life) on depression. Among variables that directly affected depression, anxiety had the highest effect. However, the bidirectional paths between anxiety and depression were also suggested by the model. Conclusions: Pandemic response strategies should be modified to effectively reduce the adverse effects on public mental health. Further research is necessary to assess the long-term effects of the pandemic on mental health and to analyze the contributing factors of anxiety and depression in the post-COVID period.

Background/Objectives: Health literacy represents the ability to access, understand, appraise, and apply health information for making appropriate health decisions. It is closely linked to education, income, employment, and overall health outcomes. Limited health literacy is associated with poor self-care, inadequate treatment adherence, and increased healthcare utilization. This study aimed to assess the level of health and medication adherence behaviors among primary health care users in Montenegro and examine its association with key demographic and socioeconomic factors. Methods: A cross-sectional, multicenter study was conducted among 202 primary health care users at the Primary Healthcare Center Danilovgrad, Plav and Ulcinj, Montenegro. Data were collected using a demographic questionnaire, the standardized European Health Literacy Questionnaire (HLS-EU-Q-47), and the Attitudes towards Medication Adherence Self-Reported Questionnaire (ADHERE-7). Statistical analyses included descriptive statistics, χ² tests, and univariate and multivariate regression. Results: The mean HLS-EU-Q Index was 33.55 ± 8.05. Significant differences in literacy levels were observed by age (p = 0.022), material status (p = 0.043), and self-rated health (p = 0.020). In multivariate ordinal regression analysis, lower income (<400 €) was associated with lower odds of belonging to a higher health literacy category (OR = 0.22, 95% CI: 0.02–0.92, p = 0.039), while no statistically significant associations were observed for gender, education level, or employment status after adjustment. The mean ADHERE-7 score of the study population was 21.78 ± 5.19. When analyzed in relation to the level of health literacy, the highest mean ADHERE-7 score was observed among participants with excellent health literacy (24.28 ± 4.90). Lower levels of health literacy were associated with lower odds of belonging to higher health literacy categories among participants reporting selected non-adherence behaviors, including missing therapy 3–4 times per week (OR = 0.30), frequently skipping prescribed medication when feeling well (OR = 0.03), and reducing or omitting therapy due to perceived lack of benefit or high costs (OR range: 0.10–0.31). Conclusions: Health literacy among primary care users in Montenegro is moderate, with a substantial proportion exhibiting limited literacy. Low income is a key determinant of limited literacy, and limited health literacy was associated with poorer medication adherence. Targeted educational and policy interventions are needed to improve health literacy and reduce health inequalities.

Introduction: Peptide receptor radionuclide therapy (PRRT) is a treatment option for well-differentiated, somatostatin receptor positive, unresectable or/and metastatic neuroendocrine tumors (NETs). Although high disease control rates seen with PRRT a significant number NET patients have a short progression-free interval, and currently, there is a deficiency of effective biomarkers to pre-identify these patients. This study is aimed at determining the prognostic significance of biomarkers on survival of patients with NETs in initial PRRT treatment.Methodology: We retrospectively analyzed 51 patients with NETs treated with PRRT at the Department for nuclear medicine, University Clinical Center Kragujevac, Serbia, with a five-year follow-up. Eligible patients with confirmed inoperable NETs, were retrospectively evaluated hematological, blood-based inflammatory markers, biochemical markers and clinical characteristics on disease progression. In accordance with the progression og the disease, the patients were divided into two groups: progression group (n=18) and a non-progression group (n=33). Clinical data were compared between the two groups.Results: A total of 51 patients (Md=60, age 25-75 years) were treated with PRRT, of whom 29 (56.86%) demonstrated stable disease, 4 (7.84%) demonstrated a partial response, and 14 (27.46%) demonstrated progressive disease and death was recorded in 4 (7.84%) patients. The mean PFS was a 36.22 months (95% CI 30.14-42.29) and the mean OS was 44.68 months (95% CI 37.40-51.97). Univariate logistic regression analysis displayed that age (p<0.05), functional tumors (p<0.05), absolute neutrophil count (p<0.05), neutrophil-lymphocyte ratio-NLR (p<0.05), C-reactive protein-CRP (p<0.05), CRP/Albumin (p<0.05), alanine aminotransferase-ALT (p<0.05), were risk factors for disease progression. Multivariate logistic regression analysis exhibited that functional tumors (p<0.001), age (p<0.05), CRP (p<0.05), and ALT (p<0.05), were independent risk factors for the disease progression in patients with NETs. Tumor functionality was the most powerful prognostic factor. The median PFS (11.86 ± 1.41 vs. 43.38 ± 3.16 months; p=0.001) and OS (21.81 ± 2.70 vs 53.86 ± 3.70, p=0.001) were significantly shorter in patients with functional than non-functional NETs respectively.Conclusion: The study’s results suggest that tumor functionality, and certain biomarkers may serve as prognostic survival indicators for patients with NETs undergoing PRRT. The findings can potentially help to identify patients who are at higher risk of disease progression and tailor treatment strategies accordingly.

Background: Lower socioeconomic groups were more affected by depressive symptoms among adults of Serbia. In this study, we tested a model that examines association between sociodemographic factors and depressive symptoms among adult population in Serbia. Methods: The study was conducted within the National Health Survey of the Serbian population in 2019. The questionnaires used as instruments in this study were created in accordance with the questionnaires of the European Health Interview Survey –Third Wave. The Patient Health Questionnaire - 8 was used to evaluate the presence of depressive symptoms to the adult population aged 20 years and over. The relations between depression symptoms and a set of independent variables were examined with univariate and multivariate logistic regression analyses. Results: The prevalence of mild depressive symptoms was 6.6%, %, the prevalence of depressive episodes was 2.2%, while 91.2% of respondents had no depressive symptoms. In the univariate regression model, depressive episodes is 1.9 times more frequent in women (OR=1.909), 6.6 times more frequent in persons over 80 years of age (OR=6.610 ), 3.1 times more frequent in divorced or without a partner (OR=3.143 ), 6.6 times more frequent in persons with low education (OR=6.609), 3.3 times more frequent in persons with a poor well-being index (OR=3.373), 3.6 times more frequent in persons inactive (OR=3.649) and 1.9 times more frequent in persons from Vojvodina (OR=1.902). Conclusion: Sociodemographic factors should be considered for policymaking and for the development of new interventions to lower prevalence of depressive symptoms in adults.

Background and Objectives: Diabetes is one of the most common chronic non-communicable diseases and represents a major public health problem. At the global level, the epidemic character of diabetes mellitus can be attributed to an extended life expectancy but also to lifestyle. The aim of this study was to examine the sociodemographic, health, and lifestyle characteristics of adults with type 2 diabetes mellitus in Serbia. Materials and Methods: The research is part of the Serbian Population Health Survey conducted in the period from October to December 2019 by the Republic Statistical Office, in cooperation with the Institute of Public Health of Serbia “Dr Milan Jovanović Batut” and the Ministry of Health of the Republic of Serbia. The research instrument was standardized questionnaires constructed in accordance with the European Health Interview Survey (EHIS—European Health Interview Survey, wave 3) questionnaire, which were adapted to the specifics of our area. The research was conducted as a cross-sectional study on a representative sample of the adult population of Serbia. Results: Among 1138 adults with type 2 diabetes in Serbia (52.8% female; mean age 66.0 ± 11.9 years), overweight and obesity were highly prevalent (40.1% and 34.4%, respectively), with Obesity I predominating. Significant gender differences were observed: female more often reported obesity, multimorbidity, and depressive symptoms, whereas men were more physically active and more frequently overweight. Most participants were physically inactive, consumed breakfast and bread daily, and had low engagement in cycling and sports. Alcohol consumption was significantly higher in men, while dietary habits differed by gender for bread intake. These findings highlight substantial gender- and lifestyle-related disparities among adults with type 2 diabetes in Serbia. Conclusions: Targeted interventions promoting healthy lifestyle, physical activity, psychosocial support, and chronic disease management are urgently needed to address gender- and lifestyle-related disparities in adults with type 2 diabetes in Serbia.