INTRODUCTION: In 2015, smoking prevalence in Republic of Macedonia was 36% in men and 21% in women We aim to assess the effectiveness and cost-effectiveness of two methods of motivating smokers to quit smoking compared with very brief advice (VBA) alone. Тo date, there are no studies investigating smoking cessation treatment in Republic of Macedonia. METHODS/DESIGN: RCT with process evaluation and cost-effectiveness analysis within 31 general practices in Republic of Macedonia recruiting smokers currently smoking >10 cigarettes per day, aged >35 years, attending primary care practices for any reason, regardless of motivation to quit smoking. Respondents will be randomized into one of three groups: (1) VBA and assessment and communication of lung age; (2) VBA and additional assessment and communication of exhaled carbon monoxide (CO) levels; or (3) control group – VBA. All participants who attempt to quit smoking will be offered behavioral support based on the UK standard program for smoking cessation. Primary outcome: Proportion of smokers who are quit at 4 weeks (7-day point prevalence, confirmed by salivary cotinine level). Secondary outcomes: Proportion who have attempted to quit smoking or have quit smoking, a proportion that has reduced the number of cigarettes and motivation to quit smoking; cost-effectiveness analysis calculating cost per quality-adjusted life year. We will evaluate the fidelity to the intervention and will explore patients’ and GPs’ experience and the acceptability of the study intervention by interview. DISCUSSION: The study will evaluate the effectiveness of combining feedback about lung age or exhaled CO levels with VBA and support for smoking cessation in primary care compared to giving VBA and support alone. It will explore how willing primary care physicians are to perform such interventions and the acceptability and effectiveness of such interventions to patients in Republic of Macedonia. TRIAL REGISTRATION: The study is registered on the ISRCTN registry (ISRCTN54228638).

is an open access, peer-reviewed online journal that encompasses all aspects of tobacco use, prevention and cessation that can promote a tobacco free society. The aim of the journal is to foster, promote and disseminate research involving tobacco use, prevention, policy implementation at a regional, national or international level, disease development-progression related to tobacco use, tobacco use impact from the cellular to the international level and finally the treatment of tobacco attributable disease through smoking cessation.

Macedonia is one of the leading countries in Europe with the highest use of tobacco, or 2540 cigarettes per person over 15 years of age, which is twice the world average. The aims of this study were to analyze and assess the organization and efficiency of the smoking cessation support centres, established as part of the Public Health Centres within the country.A descriptive study was conducted using a questionnaire designed for the purposes of this study and sent to each counselling centre. A review of the reports of smoking cessation services from the official publication of the Institute of Public Health was performed. The SWOT analysis method was used for synthesis and analysis of the data.The smoking cessation centers in Macedonia are organized and operate according to the protocol of the Institute of Public Health of the Republic of North Macedonia as a main coordinator. Since 2014, 828 smokers have used the services of the centre, which are consisted of assessment of dependence and readiness to quit smoking, very brief advice, counselling individual or group support therapy and pharmacotherapy provided by educated medical specialists in social medicine and public health. Additionally, the centres organize health promotion campaigns and health education programs for the general public, schools and health professionals.There is a need to strengthen the work performance and effectiveness of the smoking cessation centers. Smoking cessation interventions should be recognized as essential health interventions covered by health insurance, and promotion of these services and referral from primary care will increase the utilization rate, which will lead in tobacco use decline in the country.

Background Disease reporting and data collection are key tools for the health care systems in order to identify opportunities to address burden of diseases. The country’s diabetes patients register was the first registry to be integrated with the e-health system in North Macedonia in 2017. We aimed to estimate type 2 diabetes mellitus prevalence and effectiveness of diabetes control as one of the proposed national priorities in tackling the non-communicable diseases. Methods Cross-sectional descriptive study was conducted on patients entered in the National Diabetes Register in 2017/2018. Patients’ socio-demographic and anthropometric characteristics in association with diabetes’ complications and outcomes were determined by Pearson correlation coefficient (P < 0.0001, 95% CI). Results This study identified a total of 35541 patients with a diagnosis of diabetes, out of which 32888 with type 2. This corresponds to a prevalence rate of 1583.9 per 100,000 population. The prevalence increased with age (65+) and was higher among females than males (56.8% vs. 43.2%). Over 80% of type 2 patients were overweight out of which 34.5% obese (BMI>30kg/m2). Diabetic retinopathy is reported as first diagnosed complication in diabetic patients, followed by neuropathies and vascular complications. Patient’s low level of education and higher BMI were associated with increased number of early and late-onset complications. Conclusions Evidence accumulating suggests high burden of complications in type 2 diabetic patients, indicating that the patients understanding of diabetes care, treatment adherence and healthy lifestyle are important topics to be address by health professionals in order to avoid complications and premature deaths in people with diabetes. Key messages Integrated reporting of non-communicable diseases and risk factors is needed to complete current information gaps, from completeness of data to quality and comparability. The action plan for chronic diseases should specifically address diabetes control, as most of the patients with diabetes have high prevalence of comorbidities, complications and unfortunate outcomes.