Differences in nutritional status and level of physical activity among adolescents living in urban and rural areas of Montenegro - national study.

BACKGROUND: Nutritional status and physical activity are important factors for adolescent health. These factors may vary by the place of residence. This study aims to assess the nutritional status and physical activity levels, as well as their variations by the place of residence. METHODS: The sample consisted of 1503 adolescents (46.3% male; 53.7% female), with a mean age of 15.7 ± 0.7 years. Nutritional status was assessed using Body Mass Index (BMI), Waist-to-Height Ratio (WHtR), and Body Fat Percentage (BF). Physical activity levels were assessed using the PAQ-C questionnaire. Differences in nutritional status among adolescents living in urban and rural areas were analyzed using Chi-square test (p ≤ 0.05), while differences in physical activity levels were analyzed using an independent samples t-test (p ≤ 0.05). RESULTS: In terms of BMI, 14.7% of males were overweight and 10.1% were obese, while 12% of female adolescents were overweight and 3.1% were obese. There were no differences in nutritional status among adolescents living in urban and rural areas (BMI, WHtR, BF). Male adolescents in rural areas had significantly higher physical activity levels compared to urban areas (p = 0.032). They showed higher activity scores during a spare time (p = 0.002), physical education classes (p = 0.002), little breaks (p = 0.007), and lunchtime (p = 0.034). Female adolescents showed significance only in spare time activity (p = 0.020). CONCLUSION: The differences in nutritional status among adolescents living in urban and rural areas were not found. However, male adolescents living in urban areas showed lower physical activity levels than their rural counterparts. Strategies should be implemented to promote physical activity among adolescents in urban areas, and attention should be given to the further urbanization process to create improved conditions for engaging in physical activity.

Trends in oesophageal cancer mortality in Montenegro, 1990-2018.

BACKGROUND: Oesophageal cancer (OC) is a significant public health issue, despite the decreasing trends in OC mortality rates observed globally in the past decades. The objective of our study is to analyze the pattern of OC mortality in Montenegro between 1990 and 2018 and contribute to the development of a national long-term strategy for the prevention and control of this malignancy. METHODS: The data on OC death cases in Montenegro between 1990 and 2018 were collected. The mortality rates were standardized according to the World Standard Population. The Joinpoint, Linear and Poisson regressions were applied to analyze the OC mortality trend. RESULTS: Joinpoint regression analysis showed an increase in death rates for men and the overall level which were not statistically significant. However, the number of cases increases significantly with an average annual percentage change (AAPC) increase of 2.6% for the overall level [AAPC (95% CI)=2.6 (1.0-4.2); P = 0.002] at the expense of the increase in men, which on average was 2.6% annually [AAPC (95%CI) = 2.6 (1.2-4.1); P = 0.001]. The age groups 55-64 and 65-74 have the highest percentage of deaths cases from OC with 30.6% and 31.4%, respectively. CONCLUSION: Montenegro has witnessed a recent increase in the number of deaths from OC, although the mortality rates remain stable. National strategies to further reduce mortality rates for OC are necessary. Individuals aged 55-64 and 65-74 need specific attention during the ongoing monitoring of this cancer.

Health policy developments in the Western Balkan Countries 2000-19: towards European Health and Health Care Policies.

BACKGROUND: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia have committed to becoming European Union (EU) member states. This, among others, implies that candidate/potential candidate states adopt legally authorized EU policies, including health. The study aims to identify the main country-specific health policy areas critical to the EU accession health policy dimension and present the change in associated selected health indicators from 2000 to 2019. METHODS: The study draws on published reports and analyses of official statistics over time and cross-country. Health care policy adherence to the European Commission's recommended country-specific health actions was classified into five health policy areas: financing, payment, organization, regulation and persuasion. Key health policy areas for Western Balkan countries (WBCs) were identified. Health progress or lack thereof in catching up to the EU15 population health, health expenditure and the number of health professionals are measured. RESULTS: The European Commission prioritized financing and regulation for all WBCs in the five policy areas. Nine of the 18 analyzed selected health indicators showed divergence, and the other nine converged towards the EU15 averages. WBCs continue to face diverse public health challenges in improving life expectancy at birth, death rates caused by circulatory system diseases, malignant neoplasms, traffic accidents, psychoactive substance use, tuberculosis incidence, tobacco smoking prevalence and public-sector health expenditure. CONCLUSIONS: By 2019, there is limited evidence of WBCs catching up to the average EU15 health levels and health care policies. Closer attention towards EU health and health care policies would be favourable.

Parenting for Lifelong Health for Young Children in Montenegro: Preliminary Outcomes, Dissemination, and Broader Embedding of the Program.

The quality of parenting program implementation significantly affects the extent to which a program is delivered effectively as well as the likelihood of it becoming embedded in everyday services. The group based Parenting for Lifelong Health for Young Children (PLH-YC) program for parents of children aged 2-9 years was developed specifically for implementation in low- and middle-income contexts, has been tested in five randomized trials, and incorporates a number of strategies to encourage fidelity of delivery. This paper reports on the introduction of PLH-YC to Montenegro, including initial work to engage government agencies and service providers, adapt the program and, following initial evidence of effectiveness, implement strategies to promote effective delivery and embed the program. Following program adaptation and initial facilitator training, eight groups were run, supported with resources and supervision and independently evaluated. The successful pilot led to program training accreditation by national professional agencies and a series of steps to successfully further embed it into routine settings in Montenegro, including by recognizing the program in national policy documents. This led to further facilitator trainings, now numbering 97 facilitators and the certification of ten coaches and two trainers. By the end of 2023, 1278 parents, across 13 municipalities (half of all municipalities in Montenegro) and a range of service providers, have received the program. The paper describes the project phases and key fidelity components that underpinned the successful introduction and embedding of the program in Montenegro. The plan has resulted in Montenegro having its own domestic resources to continue to implement the program effectively and further plan for widespread dissemination.

Evaluation of Risk Factors for the Occurrence of Limb Fractures in Children Due to Unintentional Injury in Podgorica, Montenegro, Mediterranean.

Background and Objectives: Limb injuries in childhood are very common, with most of them being unintentional and often accompanied by soft tissue injuries. The aim of our study was to determine the risk factors that contribute to the occurrence of limb fractures as the most common type of accidental injury to children in our conditions. Materials and Methods: This study was designed as a prospective clinical analysis of predictive factors with a "nested" case-control study. It included all patients under the age of 18 who were diagnosed with unintentional limb injury and limb fracture due to accidental injury, at the Clinical Center of Montenegro, Podgorica, in the period of 7 January 2020-30 June 2021. Results: The gender of the child and the occurrence of the fracture are not related, and a statistically significant relationship was found between the occurrence of the fracture and the place of residence, the child's age, body mass index (BMI), the affected limb, the method of injury, and the mental state of the parents of the injured child, as well as their economic status. It was proved that the older the child was, the lower the chance of injury, while multivariate analysis proved that BMI could be a predictor of accidental fracture. The most common method of accidental limb fractures in children was a fall from a height. Conclusions: The analysis of factors that influence the occurrence of children's injuries is of great importance for public health. Such and similar research can enable a better understanding of the factors that influence accidental injuries, and therefore influence the prevention of these injuries by organizing various educational materials at the primary healthcare level or at the school level, for both children and parents.

Antimicrobial veterinary drug sale pattern in correlation with critically important antimicrobials for human use: A five-year study in Montenegro.

Antimicrobial resistance (AMR) poses a significant threat in veterinary medicine due to the excessive and inappropriate use of antimicrobial agents, compromising the effectiveness of these drugs. To combat AMR, the collection of data on the consumption of antibiotics is paramount, as there is a well-established connection between antibiotic use and AMR in both humans and food-producing animals. Hence, the current study aimed to generate measurable data concerning the sales patterns of antimicrobial drugs used in animal treatment in Montenegro over a five-year period (from 2017 to 2021). Furthermore, the study aimed to compare these sales figures with the overall sales of antimicrobial veterinary medicine products (AMVMPs) during the same period, with particular emphasis on the utilization of critically important antimicrobials (CIAs) for human use. Data on AMVMPs consumption from 2017 to 2021 were expressed in euros and were sourced from the Institute for Medicines and Medical Devices of Montenegro (CInMED) annual reports, complying with the regulatory framework of the Law on Medicines in this country. Research results indicate that the sales of AMVMPs increased from 2017 to peak in 2019, followed by a stable decline of 21.79% in 2021. However, the portion of selected CIAs AMVMPs in total sales experienced a minor decline from 2017 to 2019, followed by a noticeable 6.11% increase from 2019 to 2021. In order to address AMR challenges, these findings emphasize the importance of enhancing surveillance and monitoring of veterinary antimicrobial use, as well as CIAs for human use.

Psychological research and practice in former Yugoslavia and its successors.

This paper presents a brief history of Yugoslav psychology and a review of the current state of psychological research and practice in the former Yugoslav countries. Bibliometric mapping was used to explore the knowledge domain and international visibility of psychological research in Bosnia and Herzegovina, Croatia, North Macedonia, Montenegro, Serbia, and Slovenia. Judging by the number of papers visible in Scopus, psychological research activity in these countries is similar to the other former communist countries. In a relative sense, it is even higher in Slovenia and Croatia. However, psychologists still rely heavily on national journals indexed in Scopus when publishing their papers. Regarding psychological practice, former Yugoslav countries are facing challenges that are more or less typical for all small countries in the global scientific and economic market. Keeping in mind all the obstacles and traumas in the past decades, it should be considered a success that psychology in the former Yugoslav countries is now a fully established profession and a recognized scientific discipline.

Measles outbreak, Montenegro January-July 2018: Lessons learned.

In 2017, the Regional Verification Commission for Measles and Rubella Elimination (RVC) of the World Health Organization confirmed that measles elimination was sustained in Montenegro, and the previous endemic transmission remained interrupted. However, the RVC was extremely concerned over the continuing low vaccination coverage reported for this country. In this study, we describe the most recent measles epidemic in Montenegro using the epidemiological data collected from January 1 to July 31, 2018. The outbreak is largely attributable to a dangerous accumulation of susceptible subjects across the country and represents a high-risk factor for re-establishing endemic transmission in the Balkan area. This study showed how a vaccine-preventable communicable disease outbreak can have a dramatic impact and severe consequences on regional public health system performance in terms of the sanitary spending point of view. A detailed update is provided on the epidemiological situation in this Central European area, not available until now.

Effectiveness of tax policy changes in Montenegro: smoking behaviour by socio-economic status.

BACKGROUND: The main goal of this study was to examine the responsiveness of smoking prevalence and cigarette consumption to price and income changes by income groups and the effectiveness of tax policy changes to reduce cigarette consumption in Montenegro. DATA AND METHODS: A two-part model was applied to estimate smoking participation, smoking intensity price and income elasticity. The first part of the model applies logit regression, while the second uses Deaton's model to improve the validity and objectivity of conditional (smoking intensity) elasticity results. A generalised linear model (GLM) was applied to verify robustness. The reason for this is that Deaton's model is commonly used in the analysis of Household Budget Survey (HBS) data, especially when households do not report the market price. Moreover, using this model, it is possible to capture the shading of quality to price change. The analysis used HBS data (2006-2017). RESULTS: The estimates indicate that tobacco pricing policies had a much higher impact on smoking prevalence in the low-income group (price elasticity of -0.595) relative to the high-income group (price elasticity of -0.344). The same conclusion could be drawn for the smoking intensity elasticity: the high-income group was the least affected by changes in price (price elasticity of -0.258). At the same time, the most affected was the low-income group, with price elasticity of -0.424. Poorer households spent a larger share of their budget on cigarettes. The simulation results confirm that increases in the specific excise taxes of 58.3% on tobacco would reduce total cigarette consumption by 11.25% while increasing the collection of government revenue by 8.07%. CONCLUSION: Smoking prevalence and consumption are very responsive to price and income changes, with considerable differences in elasticities between income groups. The taxation policy has a positive impact on changing patterns of consumption and public revenues across each income group. Low-income and middle-income households would benefit the most, while on the other hand, the highest revenue collection was generated from the wealthiest group. Our results align with results obtained so far for other low-income and middle-income countries. This paper contributes to the analysis of the smoking prevalence and cigarette consumption responsiveness to price and income changes, which was conducted for the first time in Montenegro.

Use of the intradermal leishmanin test (Montenegro skin test) for feline visceral leishmaniosis: Detection of cellular immunity.

This study evaluated the humoral and cellular response in 100 cats living in an endemic area of visceral leishmaniosis (VL) using the Montenegro Skin Test (MST) and serological diagnosis and compared the MST with other diagnostic techniques. Sixty 60%, (60/100) cats were positive for MST and the diameter of positive skin reactions ranged from 5 to 9 mm. By serological methods, 74% (74/100) and 34% (34/100) had antibodies against Leishmania spp. by Immunofluorescence Antibody Test (IFAT) and Indirect Enzyme-Linked Immunosorbent Assay (ELISA), respectively. Comparing tests, the observed profiles were (1) IFAT (+)/MST (-) = 27 cats, (2) IFAT(-)/MST(+) = 13 cats, (3) IFAT(+)/MST(+) = 47 cats, (4) ELISA(+)/MST(-) = 12 cats, (5) ELISA(-)/MST(+) = 38 cats and (6) ELISA(+)/MST(+) = 22 cats. Through the combination of serological diagnosis and MST, a positivity frequency of 87% (87/100) by IFAT + MST and 72% (72/100) by ELISA + MST was identified in this cat population. Five cats (5%) were positive for Leishmania donovani complex DNA by molecular analysis, and two cats (2%) had Leishmania spp. amastigotes in lymph node smears. Therefore, the agreement between tests was classified as poor for all tests by Kappa index. The IFAT (+)/MST (+) response was the most frequent considering all cats (47%; 47/100); nonetheless, the most frequent immune expression in Polymerase Chain Reaction (PCR)-positive cats was the IFAT (+)/MST (-) profile (80%; 4/5). Five sick and PCR-positive cats, negative for Feline Immunodeficiency Virus (FIV) and Feline Leukemia Virus (FeLV), that PCR sequencing matched 100% with L. donovani complex, all but one were MST negative. These results suggest that cats develop a significant cellular response against infection by parasites of the L. donovani complex, and most PCR and parasitological positive cats may be unable to develop a significant cellular response.

Prevalence and clinical implications of the HPV16 infection in oral cancer in Montenegro - Evidence to support the immunization program.

Oral squamous cell carcinoma (OSCC) makes 85-95% of all malignances in the oral cavity. Increasing evidence shows that the Human Papillomaviruses (HPVs) are preferentially associated with some oropharyngeal and OSCCs, namely the genotype 16. The aim of the present study was to determine the prevalence and clinical implications of HPV16 infection in oral squamous cell carcinoma in population of Montenegro.This study included 60 patients with OSCC (localized on the lower lip, tongue or/and floor of the mouth), surgically treated at the Clinical Centre of Montenegro from 2012 to 2018. Surgically obtained formalin-fixed and paraffin-embedded specimens were used for histopathological analysis and HPV16 genome detection using standard Polymerase Chain Reaction (primers for detection of E6 gene). Each individual was further followed up for the period of three years and for different clinico-pathological characteristics, including disease free interval (DFI).The prevalence of HPV16 infection in OSCCs was 23.3% and the infection was significantly more common in female patients (P = 0.038). No significant correlation was detectable between HPV16 infection and the patients' age (P = 0.302), tumor site (P = 0.125), tumor grade (P = 0.363) and disease stage (P = 0.995). Observing the total sample the DFI was not significantly different for HPV16-positive versus HPV16-negative patients (P = 0.427), but a gender-based difference in DFI was observed, with the significantly shorter DFI (Log Rank test, P = 0.003) in HPV16 positive female patients compared to male patients (P = 0.003).The results obtained in this study provide scientific evidence for the development of national HPV vaccination program in Montenegro.

The Impact of Type of Brandy on the Volatile Aroma Compounds and Sensory Properties of Grape Brandy in Montenegro.

This paper presents the results of a study that examined the impact of grape variety on the volatile aroma compounds and sensory properties of standard and Muscat grape brandy produced in the Podgorica sub-region (Montenegro) in vintages 2011, 2012, and 2013. The brandies were prepared by the distillation of crushed grapes, from the autochthonous varieties of Vranac and Kratosija, and Muscat grapes, in a traditional copper alembic, under the same conditions. The gas chromatographic-mass spectrometric (GC/MS) method of 82 volatile aroma compounds that belong to the group (alcohols, volatile acids, volatile esters, terpenes, volatile aldehydes, acetals, ethers, ketones, and alkanes) and an evaluation of the sensory properties of brandies were carried out to determine the typical characteristics of the examined brandies. Alcohols, fatty acid esters, and terpene compound contents were significantly more abundant in all Muscat grape brandies compared to the brandies from the Vranac and Kratosija wine varieties (Standard brandy). Research results revealed that variety had a significant impact on the volatile aroma compound and sensory properties of brandy. The varietal effect was also confirmed, by multivariate analysis, based on the aroma volatile composition, which showed a grouping by type of grape brandy (varietal origin). Sensory analyses showed that all the brandies belonged to the category of high-quality brandies.

Heavy metal assessment in agricultural soils and vegetables in the vicinity of industrial pollutants in the Pljevlja municipality (Montenegro): ecological and health risk approach.

This paper aims to assess ecological and health risks associated with heavy metal (As, Hg, Cd, Pb, Cu, Zn, Cr) content in agricultural soils and vegetables (potato tuber, beetroot, onion bulb, carrot root) collected near the lead and zinc mine (MLZ), coal-fired power station (CFPS) and coal mine (CM) located in Pljevlja municipality (Montenegro). The ecological risk of soil was estimated using the ecological risk index (RI) and pollution load index (PLI). The health risk was evaluated through different soil exposure pathways (ingestion, inhalation, dermal contact) and vegetable consumption. The pollution indices RI and PLI indicated the highest contamination in MLZ study area followed by CM and CFPS areas. RI values revealed considerable contamination in MLZ and CM study areas, while CFPS area is moderately contaminated by heavy metals. According to PLI, soil in MLZ and CM areas is classified as polluted, while the soil in the vicinity of CFPS is classified as unpolluted. Non-carcinogenic and carcinogenic health risks through soil exposure were identified for both children and adults, in all investigated areas. Dermal contact was identified as the main contributor to carcinogenic risk. Dermal contact was also identified as the main exposure pathway for non-carcinogenic risk in MLZ area, while for CFPS and CM areas, ingestion was the main exposure route. As for vegetables, only Cu and Zn were detected in all examined vegetables. Non-cancerogenic health risk of edible vegetable consumption was found for children in all study areas, while there was no health risk for adults.

Optimal outcome factors in maternity and newborn care for inpatient (hospital maternity ward-HMW) and outpatient deliveries (outhospital maternity clinics -OMC).

BACKGROUND AND OBJECTIVES: The aim of the study was to use the United States Optimality Index (OI-US) to assess the feasibility of its application in making decisions for more optimal methods of delivery and for more optimal postpartum and neonatal outcomes. Numerous worldwide associations support the option of women giving birth at maternity outpatient clinics and also at home. What ought to be met is the assessments of requirements and what could be characterized as the birth potential constitute the basis for making the right decision regarding childbirth. MATERIALS AND METHODS: The study is based on a prospective follow-up of pregnant women and new mothers (100 participants) who were monitored and gave birth at the hospital maternity ward (HMW) and pregnant women and new mothers (100 participants) who were monitored and gave birth at the outhospital maternity clinics (OMC). Selected patients were classified according to the criteria of low and medium-risk and each of the parameters of the OI and the total OI were compared. RESULTS: The results of this study confirm the benefits of intrapartum and neonatal outcome, when delivery was carried out in an outpatient setting. The median OI of intrapartum components was significantly higher in the outpatient setting compared to the hospital maternity ward (97 range from 24 to 100 vs 91 range from 3 to 100). The median OI of neonatal components was significantly higher in the outpatient compared to the inpatient delivery. (99 range from 97 to 100 vs 96 range from 74 to 100). Certain components from the intrapartum and neonatal period highly contribute to the significantly better total OI in the outpatient conditions in relation to hospital conditions. CONCLUSION: Outpatient care and delivery provide multiple benefits for both the mother and the newborn.

Connection between Religiosity and Attitudes towards Sexuality in Montenegro.

The aim of the study was to examine the relationship between religiosity and liberal versus conservative attitudes about sex. The study involved 1287 residents of Montenegro over the age of 18, of which 848 women and 439 men. They completed the scale for examining the liberality of attitudes about sex, which the authors of the article compiled for the purposes of this research. Respondents declared their religiosity as believers, agnostics or atheists, so there were 957 believers, 171 atheists and 159 agnostics in the sample. We found that agnostics are the most liberal in terms of attitudes about sex, then atheists and then believers. In addition to religiosity, we examined the connection of attitudes about sex with gender, age, and education level. More educated respondents proved to be more liberal than less educated ones. The women in our sample proved to be more conservative than the men. We did not confirm the assumption that younger respondents would be more liberal than older ones, which can be partly explained by the numerical inequality of age groups. The knowledge we have gained in this study can be of great use primarily as guidelines for further research work, and can also be implemented in various educational programs.

Screening of dysphagia in relapsing-remitting multiple sclerosis patients in Montenegro.

OBJECTIVES: To perform screening of dysphagia in Montenegrin multiple sclerosis (MS) patients. Dysphagia is often neglected problem in patients with MS. METHODS: We included 104 patients with relapsing-remitting MS who completed 3 questionnaires: dysphagia in multiple sclerosis (DYMUS), eating assessment tool-10 (EAT-10) and swallowing disturbance questionnaire (SDQ). Our study was performed in the clinic for neurology of the Clinical Center of Montenegro (Podgorica, Montenegro) and Polyclinic Neuron (Bijelo Polje, Montenegro) between November 2020 and December 2020. RESULTS: Self-reported prevalence of this symptom in our group was simmilar to previously reported results. We did not find correlation between DYMUS and expanded disability status scale (EDSS), as it was reported before. Time spent from disease onset to diagnosis is strongly correlated with reported SDQ results. The population of dysphagia-patients is statistically significantly older compared to the non-dysphagia patients, and statistically higher mean values in this population of our subjects were proven on all 3 questionnaires used. CONCLUSION: The importance of this issue is not just because it warns of potientially malnutrion in MS patients, but also important factor in therapy choosing algorithm in the era of orally used immunomodulatory drugs.

A new tool for identifying risk of repeated intimate partner violence adjusted for the population of Montenegro: a cohort study.

Current estimates suggest that approximately 20% of women and 11% of men have been victims of intimate partner violence. Risk identification tools for repeated domestic violence currently exist and have typically been designed by police and judicial authorities, based on the criminal history of the perpetrator. A follow-up cohort study of 238 cases of intimate partner violence (judicially processed and officially judged as DV according to Montenegrin Criminal Act) was conducted by reviewing randomly selected court files. The results showed that certain perpetrator characteristics (unemployment, lack of regret, other violent criminal history, and history of being beaten by a family member) and victim characteristics (nonqualified education and predictions of future harm) were associated with reassault. Relationship characteristics such as different ethnicity, poor socioeconomic status, difference in incomes, living in a rental property, alcohol and drug use, and unprocessed previous history of physical violence were also associated with repeated violence. A risk identification tool for repeated intimate violence was computed based on the significant variables, with a sensitivity of 85% and a specificity of 89%. This study demonstrates a new tool for repeated intimate partner violence prediction in patriarchal societies, widespread in Eastern Europe and the Middle East. The majority of factors associated with reassault in this sample have been shown to be predictive for repeated intimate partner violence in previous studies. The applicability of our tool in egalitarian societies should be investigated in order to see whether the combination of these factors is universal or specific to patriarchal societies.

Accelerating progress on effective tobacco tax policies in Montenegro.

BACKGROUND: The objective of this study is to estimate the sensitivity of cigarette quantity demanded to price and income changes in Montenegro. DATA AND METHODS: The sensitivity of cigarette quantity demanded to price and income changes was estimated using micro and macro analysis. Micro analysis implied the use of Deaton's model on Household Budget Survey data (2006-2017). In macro analysis, conventional static demand model is applied using error correction and autoregressive distributed lag time series methodology on annual time series aggregated data (2001-2017). RESULTS: The same results were obtained using micro and macro analysis which contributes to the objectivity of the conducted research. Results derived from the Deaton's model indicate a negative price elasticity of cigarettes in the range between -0.62 and -0.80 (conditional and unconditional), while in macro model estimated price elasticity is in that range and equals -0.68. Simulation results confirm the efficiency of excise tax policy changes, having an evident decrease in consumption and increase of public revenues. CONCLUSION: Analysis of the tobacco market and regulatory environment suggests that the increase of excise and other taxes on tobacco have an important direct impact on the reduction of cigarettes and other tobacco products consumption. Our estimates of long and short-run price elasticity show that direct impact is strong and very much in accordance with the results obtained so far for other low-income and middle-income countries. This paper gives a contribution to the analysis of price elasticity of demand for cigarettes, which was for the first time conducted in Montenegro.

Montenegro makes important strides towards achievement of the SDGs.

In 2018, Montenegro took an important step towards ratification of the Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. A multisectoral national consultation provided a forum where national stakeholders could assist in related decision-making. The Protocol is the first and only multilateral legal agreement linking sustainable water management and the prevention, control and reduction of water-related diseases in the pan-European region. It was adopted in 1999 at the Third Ministerial Conference on Environment and Health in London and entered into force in 2005 as legally binding for the ratifying countries. To date, 26 countries have ratified it, covering about 60% of the population of the pan-European region. Montenegro is on the way to becoming the next country to ratify it and has used it as an instrument to strengthen national action towards progressively reaching regional and global WASH-related commitments, specifically in relation to SDG 3 (good health and well-being), SDG 6 (clean water and sanitation) and the Ostrava Declaration on Environment and Health (2017).

No research for the decisionally-impaired mentally ill: a view from Montenegro.

BACKGROUND: Many of the important elements of a valid informed consent - comprehension, voluntariness, and capacity - can be compromised or unmet in the context of psychiatric research. The inability to protect their own interests puts mentally ill subjects at an increased likelihood of being wronged or harmed and makes them particularly vulnerable in the context of clinical research. Therefore, they are due extra protection. Sometimes, these additional safeguards can significantly limit the possibilities for research involving subjects deemed unable to consent due to their mental illness. Montenegro, a middle-income country in Southern-Eastern Europe, goes so far in their policy to protect these subjects from harms of research, as to ban all biomedical research on mentally ill persons who are unable to provide consent. MAIN BODY: Mental health research is often neglected and very low on the list of health research priorities, especially in low- and middle-income countries. Despite the fact that mental health disorders are among leading causes of disability, the need for evidence-based services and interventions for those affected remains unmet. To exclude all members of a certain group of subjects seems extremely restrictive and unnecessary. Such a policy is discriminatory and unethical, because it inflicts further harms and exclusion of those patients from participation in society. This unjust exclusion policy obstructs research of certain psychiatric disorders and implies that new treatments for conditions that directly affect these incapacitated subjects will not be developed. CONCLUSIONS: Scientific and clinical development must not be precluded by overly restrictive, discriminatory and unjust practices, such as the normative ban on research on decisionally-impaired mentally ill subjects. Rather, there should be a regulative framework that ensures that those who cannot consent for themselves are respected and protected in research, the anticipated benefits maximized, risks minimized, their autonomy recognized and extended. These patient-subjects must be appropriately included unless there is a clear and compelling rationale and justification that inclusion is inappropriate with respect to the health of the participants or the purpose of the research.