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Background: Although migraine is among the most common disabling conditions worldwide, it is rarely accurately diagnosed. This study aimed to categorize and compare patients suffering from migraines without aura (MWA) or other types of headaches in primary health care facilities. Material and Methods: We conducted a prospective, cross-sectional, epidemiological, and non-interventional study at 46 primary health care facilities in Bosnia and Herzegovina. The validated Balkan Migraine Screening Questionnaire (BMSQ) was used to classify patients into MWA or non-MWA groups. Results: The study comprised 1,366 patients categorized into MWA (n =896, 65.6 %) and non-MWA (n =470, 34.4 %) groups. Seven hundred thirty-four patients with MWA were newly identified. The patients in the MWA group were significantly younger, at 49.9 ± 13.7 years, compared to the non-MWA group at 52.0 ± 14.4 years (p =0.008). The MWA group documented less alcohol consumption (11.0 % vs 18.7 % for the non-MWA group, p <0.001) and experienced more severe headaches [headache intensity on Visual Analogue Scale (VAS), with a median score of 7, interquartile range (IQR): 6-8 vs 5 (IQR: 4-7) for the non-MWA group, p <0.001)]. The MWA group had a higher proportion of women (80.1 % vs 64.3 % for the non-MWA group, p <0.001). Compared to the non-MWA group, patients in the MWA group experienced more frequent headache attacks (more than six attacks in the preceding six months: 50.6 % vs 28.1 %, p <0.001), needed additional headache treatment (using two or more classes of antiheadache therapy 41.3 % vs 26.4 %, p <0.001), and had a positive family history of migraine (46.9 % vs 23.0 %, p <0.001). The binomial regression model identified two positive predictors (family history of migraines and headache intensity) and one negative predictor (alcohol consumption) for the BMSQ classification of patients into the MWA group. Conclusion: More than half the patients in this study were newly classified as having MWA, indicating a high prevalence of undiagnosed migraine. Categorization of patients with headaches is of crucial importance for appropriate treatment and should be utilized in everyday practice in primary health care settings. HIPPOKRATIA 2023, 27 (2):99-105.

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Trout farms are one of the major sources of pollution of highland streams and rivers, which are very sensitive ecosystems otherwise scarcely influenced by human activities. A trout farm with low annual production was chosen for comparative monitoring of its effects on the macrozoobenthos, epilithic diatom, and potamoplankton communities in the receiving stream. Research was conducted every 2 months during a period of 1 year (one control point and three localities downstream from the farm). The fish farm discharge induced moderate alteration of environmental factors in the receiving watercourse, viz., significant increase of the ionized and un-ionized ammonia fraction, dissolved oxygen concentration, and biological oxygen demand. Species richness and Simpson's diversity index did not change in any of the communities. Correspondent analysis of potamoplankton community composition clearly showed trout farm effects, thereby indicating the need for reevaluation of saprobic valence values for potamoplankton species. The complete lack of influence of the trout farm discharge on the epilithic diatom community is probably due to absence of significant changes of phosphorus concentration in the receiving stream. Effects of the trout farm on the macrozoobenthos community were further characterized by 14 additional indices. The percentages of Chironomidae larvae, shredders, and total collectors; ratio of shredders to collectors; and the family biotic index are suggested as candidates for future multimetric index for measuring of trout farm influence.

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The study evaluated the effects of waterborne pollutants from the Tamis River on gill histology and possible differences in gill reaction patterns between three freshwater fish species, pike Esox lucius L. 1758, pike-perch Sander lucioperca (L. 1758) and wels catfish Silurus glanis L. 1758 from the Tamis River. Gills from analysed fish species showed moderate to intense histopathological alterations. The most frequent progressive alteration was hyperplasia of epithelium, whereas the most frequent regressive alteration was epithelial lifting. Circulatory disturbances were most often manifested in the form of hyperaemia. During comparative analysis, differences in gill indices, reaction and alteration indices, as well as in gill and filament prevalence between analysed species, were observed. Although all analysed fish species did show both progressive and regressive alterations, there was a significant difference in the level of expression of these reaction patterns. Gill index obtained for pike clearly stands out as the lowest. Wels catfish showed the highest progressive reaction index, significantly higher in comparison with the other two species (P < 0.05), while pike-perch showed the highest regressive reaction index, also significantly higher in comparison with the other species (P < 0.001). These results may implicate species-specific gill reactions and thus present a useful tool for better understanding toxic mechanisms of various pollutants.

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INTRODUCTION: A provider-based vaccination strategy that has strong supportive evidence of efficacy at raising immunization coverage level is known as Assessment, Feedback, Incentives, and Exchange. The Maine Immunization Program, and the Maine Chapter of the American Academy of Pediatrics collaborated on the implementation and evaluation of this strategy among private providers. METHODS: Between November 1994 and June 1996, the Maine Immunization Program conducted baseline immunization assessments of all private practices administering childhood vaccines to children 24 to 35 months of age. Coverage level assessments were conducted using the Clinic Assessment Software Application. Follow-up assessments were among the largest practices, delivering 80% of all vaccines. RESULTS: Of the 231 practices, 58 were pediatric and 149 were family practices. The median up-to-date vaccination coverages among all providers for 3 doses of diphtheria-tetanus-pertussis vaccine and 2 doses of oral polio vaccine, and 4 doses of diphtheria-tetanus-pertussis vaccine, 3 doses of oral polio vaccine, and 1 dose of measles-mumps-rubella vaccine at age 12 and 24 months were 90% and 78%, respectively, and did not vary by number of providers in a practice or by specialty. Urban practices had higher coverage than rural practices at 12 months (92% vs 88%). The median up-to-date coverage for 4 doses of diphtheria-tetanus-pertussis vaccine, 3 doses of oral polio vaccine, and 1 dose of measles-mumps-rubella vaccine at 24 months of age improved significantly among those practices assessed 1 year later (from 78% at baseline to 87% at the second assessment). On average, the assessments required 21/2 person-days of effort. CONCLUSIONS: We document the feasibility and impact of a public/private partnership to improve immunization delivery on a statewide basis. IMPLICATIONS: Other states should consider using public/private partnerships to conduct private practice assessments. More cost-effective methods of assessing immunization coverage levels in private practices are needed.

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In this retrospective pilot study we tried to find out whether there were any differences in therapeutic response to electroconvulsive therapy in the patients with diagnosed unipolar affective disorder due to the presence and type of delusions in the clinical course of the disease. The sample consists of 45 inpatient unipolar depressives, 15 male and 30 female, divided into 3 experimental groups: nondelusional depressions, depressions with congruent delusions and depressions with incongruent delusions. Two variables were used to estimate the therapeutic response: number of received ECT treatments and proportion of full remissions. Our results showed significant differences between all the groups for both variables with the best therapeutic response in the group of incongruent delusional depressions and the worst in the group of nondelusional depressions.

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