Health In Serbia Research Articles

Impacts of tobacco tax increases on tax revenues and public health in Serbia – a simulation model

Impacts of tobacco tax increases on tax revenues and public health in Serbia – a simulation model

Identifying infodemic sources of exposure, its effects, response capacities and needs in Serbia

Abstract Background Serbia has secured adequate quantities of COVID-19 vaccines and ensured continuous access and delivery. However, vaccine uptake has remained a major public health issue due to the infodemic - an overwhelming amount of information, making it difficult for the population to make the right decisions regarding their health. This study aimed to identify the sources of exposure to the infodemic, its effects, existing capacities, and the needs of public health practitioners in Serbia. Methods Infodemic management (IM) training and discussions were organized for public health (PH) professionals, civil society organizations (CSOs), and academia in three different regional Institutes of Public Health in Serbia. After learning about the basic terms in IM, the participants discussed infodemic topics in small groups using the “gallery walk” method. Facilitators wrote down their answers and moderated the discussion. Results Overall, 57 PH practitioners participated in the lessons, discussions, and the “gallery walk”. Participants identified media, including social media, public figures, healthcare personnel and community members as the main sources of infodemic exposure. The most recognized topics were infectious diseases, natural disasters, immunization, nutrition, and environmental issues. Participants identified the reduced trust in health authorities, lower compliance with health recommendations, and lack of satisfaction in both patients and healthcare workers as possible effects of the infodemic. Most participants underlined the lack of support regarding the production of high-quality health information and science communication. Conclusions The PH community in Serbia has identified infodemic and infodemic management as a priority in the future and has already conducted activities that are part of the Framework for managing infodemics. Their work could be supported by organizing a network for the exchange of materials, knowledge, and experience. Key messages • PH professionals identified media, public figures, healthcare personnel, and community members as sources of infodemic exposure. • The main infodemic effects are reduced trust in health authorities, lower compliance with health recommendations, and lack of satisfaction in patients and healthcare workers.

CONTEMPORARY TENDENCIES IN THE FIELD OF OCCUPATIONAL SAFETY AND HEALTH IN SERBIA

Every year, the employment rate in Serbia increases, and along with it, the number of injuries at work. Investing in security represents a cost for employers, while it slows down the dynamics of work for employees, which is why it is often marginalized. This paper provides an analysis of regulations in the field of occupational safety and health in Serbia and a comparative analysis of data on the number of occupational injuries in Serbia and a number of European countries, as well as examples of good practice, as a recommendation for the improvement of preventive occupational health and safety measures.

Mental health in serbia - transitional context or are we going towards reform

Mental health in serbia - transitional context or are we going towards reform

Preferences of COVID-19 Vaccines in the General Population in Belgrade, Serbia: A Qualitative Study

Few countries provided multiple COVID-19 vaccines for their citizens right from the start of mass immunization. In Serbia, four vaccines were available. Circumstances in which people had several options to choose from are unique. The purpose of this study was to identify motivators behind COVID-19 vaccination and the choice of COVID-19 vaccine among people who were immunized against COVID-19. Qualitative interviews with 35 vaccinated people aged > 18 years were conducted in May 2021 at the Institute of Public Health of Serbia, a reference institution for vaccination. Interviews were audio-recorded, transcribed and data were analyzed using qualitative content analysis. Four topics emerged: 1) Decision to receive COVID-19 vaccine; 2) Sources of information about the vaccine; 3) Choice of the COVID-19 vaccine and 4) Anti-vaccination sentiment around the vaccinated people. Participants were classified in two groups: those who were determined to receive the vaccine and those who were hesitant. People who were hesitant decided to receive the vaccine after reviewing the information collected from various sources, especially physicians. Although some participants accepted any vaccine regardless of their characteristics, there were others who had explicit preferences. These preferences stemmed mainly from their beliefs about particular vaccine’s efficacy and safety, COVID-19 status (previous infection), living or lifestyle circumstances (residence or travel abroad), doctor’s recommendation (underlying health status) or trust in expertise of that particular manufacturer’s country of origin. Opting for appropriate vaccine was motivated by reasons specific to various individuals, which enabled them to make choices in line with their preferences and values.

Canned meat products for members of the Serbian armed forces: Na, K, Ca, and Mg content and health risks/benefits

Macroelements such as Na, K, Ca, and Mg play a significant physiological role, and their inadequate intake has been linked to severe diseases, such as high blood pressure. Data on risk assessment for human health in Serbia, from the intake of these macroelements through the consumption of canned food, are minimal. Therefore, the content of Na, K, Ca, and Mg in five types of canned meat that members of the Serbian Armed Forces regularly use was examined. Macroelements were determined by inductively coupled plasma mass spectrometry in cans of beef goulash, pork ragout, spam, liver pate, and meatballs in tomato sauce, which were stored from one month to six years. The sodium content was significantly higher than the potassium content in all types of food, so the Na/K ratio below 1, desirable for good health, was not found in any of the analyzed products. Also, a significant number of samples had an unfavorable Ca/Mg ratio above 1. However, due to the low consumption of canned food by members of the Serbian Armed Forces, its contribution to the average daily intake of macroelements is almost negligible. The concentration of macroelements decreased with the shelf life, while a significant source of Ka and Mg, among analyzed ingredients, was ground red pepper.

Women’s health in Serbia - past, present, and future

Cardiovascular and reproductive health of women have been going hand in hand since the dawn of time, yet links have been poorly studied. Still, once basis of their connections started to be established, it depended on local regional abilities and level of progressive thinking to afford women comprehensive care beyond the ?bikini medicine?. Further research identified different associations rendering more conditions sex-specific and launching therefore a slow, yet initial turn around in clinical trials? concept as the majority of global cardiovascular guidelines rely on the results of research conducted on a very modest percentage of women and even less on the women of color. Currently, the concept of women?s heart centers varies depending on the local demographics? guided needs, available logistics driven by budgeting and societal support of a broad-minded thinking environment, free of bias for everyone: from young adults questioning their gender identity, via women of reproductive age both struggling to conceive or keep working part time when healthy and line of work permits it during pregnancy, up to aging and the elderly. Using ?Investigate-Educate-Advocate-Legislate? as the four pillars of advancing cardiovascular care of women, we aimed to summarize standing of women?s health in Serbia, present ongoing projects and propose actionable solutions for the future.

Načini informisanja roditelja dece sa celijačnom bolešću o samoj bolesti i bezglutenskoj ishrani

Introduction: Celiac disease is an autoimmune disease caused by an inadequate immune response in contact with gluten in genetically predisposed individuals. Barriers to maintaining a strict gluten-free diet arise due to several factors, the most common of which are: inadequate information, insufficient education about the disease, food contamination. Aim of the research: To determine the ways of informing parents about the celiac disease that has been diagnosed in their children, as well as to learn about the necessary procedures to improve information about gluten-free diet. Subjects and method: The study included a sample of 116 parents whose children are diagnosed with celiac disease and who are on a gluten-free diet. The place of research is the Institute for Maternal and Child Health of Serbia "Dr Vukan Cupic" in New Belgrade and the University Children's Clinic in Belgrade. The research instrument used is the Questionnaire on Parents' Awareness of Celiac Disease, which was created for the purposes of this research. Results with discussion: The results of the study show that 47.14% of parents of children with celiac disease ask for information about the proper nutrition of their children and gluten-free foods from the doctor of the institution where the child was diagnosed with the disease. In order to better understand the diagnosis of celiac disease in their child, 53.01% of parents most often chose to talk to the doctor who treats the child. Conclusion: Information on proper nutrition of children and gluten-free foods, as well as specific information on celiac disease, is requested from the doctor of the institution where the disease was diagnosed in the child and where they go for check-ups. Many complications caused by unrecognized celiac disease could be prevented by timely diagnosis and proper posture of the child, which contributes to good and adequate information.

Disease burden of edentulism – Dental Clinic of Vojvodina, Serbia, 2008-2019

Abstract Background Although there is a decline in the global prevalence of edentulism over the past decade, the tendency is opposite in Serbia. The aim of this study was to estimate the disease burden of edentulism at the Dental Clinic of Vojvodina, tertiary referral public health institution of the northern province of Serbia. Methods Disease burden was expressed in disability-adjusted life years (DALYs). Prevalence (P) was calculated on the database of all patients from 2008 to 2019 at the Dental Clinic of Vojvodina using IBM SPSS Statistics. The number of diagnosed cases rehabilitated by complete dentures was an indicator of edentate people. A total sample of 76287 patients was examined, including 1620 patients restored with complete dentures (44.94% male, 55.06% female). Disability weight (DW) for severe tooth loss was taken from the “Disability weight for the Global Burden of Disease 2013 study”. The prevalence-based years lived with disability (YLD) were calculated as YLD = P x DW. Due to the non-fatal outcome of edentulism, DALY estimates were based on YLDs only (YLL=0). Results For the observed period, the total disease burden (per 1000) was 1.42 DALYs (0.64 for men and 0.78 for women). During observed years, DALYs increased (from 1.66 in 2008 to 1.73 in 2019), in association with population aging, and insufficient support from public health insurance for oral prevention and treatments. For both sexes, DALYs increased gradually with age. The results for age-stratified DALYs (per 1000) were: 0.005 (age 0-24), 0.049 (age 25-34), 0.55 (age 35-44), 2.66 (age 45-54), 4.41 (age 55-64), 7.89 (age 65-74), 8.04 (age 75-84) and 9.05 (age 85-94). Conclusions Considering the calculated disease burden, edentulism has been posing an increasing challenge for the health system in Serbia over the past decade. The quantified burden could contribute to the improvement of evidence-informed policymaking in public oral health in Serbia. Acknowledgment Supported by “Burden-EU” COST Action Key messages The calculated DALYs show an increase in burden of edentulism in Vojvodina, Serbia. DALYs calculations could improve the insufficient monitoring of oral health status in Serbia.

Suicidalnost tokom zdravstvene krize - prikazi slučajeva

Introduction: Suicide represents a major health problem of great importance for public health in Serbia. In the whole world in last decades, the number of committed suicides is constantly increasing. The most dramatic increase is the number of committed suicides among adolescents, but also among the elderly, over 65 years of age. Serbia ranks 13th in Europe in terms of the number of suicide(13.6/100.000 inhabitants) and Vojvodina is at the top place as region in Serbia (15.3/100.000 inhabitants). It is alarming that suicide attempts are 10-15 times more frequent, as well as that a large number of people who have committed suicide in the last month have reported in medical institutions with various problems. Situations and conditions that increase suicide risk are mental disorders and chronic physical illness, as well as life crises, which include pandemic. Also of great importance is positive heredity, as well as previous suicide attempts. Usually, during crisis, number of suicide attempts and committed suicides decline, but after crisis there is lot of evidence that symptoms of anxious and depressive disorders increase and number of suicide attempts and committed suicides is growing up. Case reports: In presented case reports the rigger for a suicide attempt was the current situation during the covid-19 epidemic. One of the leading reasons for the increase in number of attempted and committed suicides is the unrecognition and lack of treatment of mental disorder symptoms. Most frequently symptoms of depression and severe anxiety result in a suicide attempt. Early recognition and treatment either with psycho and/or pharmacotherapy in a significant percentage can reduce the number of attempted and committed suicides. Conclusion: In current pandemic and in next period, it is necessary for medical staff to look after various, but mostly depressive and anxious symptoms in patients, that frequently result in suicide attempt, if stay unrecognized and untreated. That is the best way to prevent suicide and to improve mental health, as it is very important for national interests.

Surface waters as a potential source of Giardia and Cryptosporidium in Serbia

Giardiasis and cryptosporidiosis are recognized by the WHO as important emerging diseases of the 21st century. Symptoms are similar and include diarrhoea and vomiting, which may be severe, even life-threatening, for the immunocompromised and children under five years of age. Between 2013 and 2017, the Institute for Public Health in Serbia recorded 10 waterborne epidemics that manifested as gastrointestinal disease. Routine testing for enteropathogenic bacteria and viruses did not identify the aetiological agents of these outbreaks. As water is not examined for the presence of protozoa in Serbia, we performed a pilot study to analyse samples from four major rivers and their tributaries using a newly implemented methodology for detection of Giardia and Cryptosporidium, based on the ISO 15553:2006 standard. Using immunofluorescence microscopy, Giardia was detected in 10 out of the 31 samples, Cryptosporidium in five, while two samples were positive for both. Presence of G. duodenalis gDNA was confirmed by amplification of the β-giardin gene in eight samples, of which one and two, respectively, were identified by RFLP as potentially zoonotic assemblages A and B. The results suggest that surface water in Serbia may be a potential source of infection and call for more in-depth studies using sophisticated molecular tools.

Dynamics of Health Care Financing and Spending in Serbia in the XXI Century.

Serbia is an upper-middle income Eastern European economy. It has inherited system of health provision and financing, which is a mixture of Soviet Semashko and German Bismarck models. So far, literature evidence on long-term trends in health spending remains scarce on this region. Observational descriptive approach was utilized relying on nationwide aggregate data reported by the Republic Health Insurance Fund (RHIF) and the Government of Serbia to the WHO office. Consecutively, the WHO Global Health Expenditure Database1 was used. Long-term trends were extrapolated on existing data and underlying differences were analyzed and explained. The insight was provided across two distinctively different periods within 2000–2016. The first period lasted from 2000 till 2008 (the beginning of global recession triggered by Lehman Brothers' bankruptcy). This was a period of strong upward growth in ability to invest in health care. Spending grew significantly in terms of GDP share, national and per capita reported expenditures. During the second period (2009–2016), after the beginning of worldwide economic crisis, Serbia was affected in a way that its health expenditure growth in PPP terms slowed down effectively fluctuating around plateau values from 2014 to 2016. Serbia health spending showed promising signs of steady growth in its ability to invest in health care. Consolidation marked most of the past decade with certain growth rates in recent years (2017–2019), which were not captured in these official records. The future national strategy should be devised to take into account accelerated population aging as major driver of health spending.

The Link Between HIV Knowledge and Prophylaxis to Health Professionals.

BACKGROUND:Healthcare workers have a high risk of professional exposure, especially in developing countries.AIM:This paper aims to determine whether there is a link between knowledge and HIV prophylaxis on HIV prevention in Albanian healthcare system employees.MATERIAL AND METHODS:This study was attended by professionals of the Albanian health care system who also attended second cycle studies at the Faculty of Medical Sciences (FMS) at the University of Medicine, Tirana. The study was conducted through a standard questionnaire with 24 questions, previously created by the Vojvodina Institute of Public Health in Serbia.RESULTS:A group of 219 respondents participated in the study, of which 83.3% were women and 16.7% males. The risk of HIV transmission from syringe injection is > 75%, for 55.9% of the respondents. This result is statistically significant compared to other categories (p < 0.01). There is an increase in awareness of the use of gloves before manipulation and use of syringes, with increased work experience (p = 0.01). The use of specific containers for the elimination of syringes after manipulation is a more common practice by the most experienced professionals at work and results in a significant change (p = 0.02).CONCLUSION:This study showed that there is not enough information from health professionals about potentially infectious fluids for HIV transmission. Younger professionals are less informed about HIV transmission and prophylaxis. These data indicate that there is a need for deepening of university curricula about the risks and exposure to biologically infectious fluids.

Liderstvo u sistemu zdravsta u Srbiji

Background/Aim. To discuss current challenges and future perspectives in order to initiate a debate on the introduction of leadership in Serbia's health care system. The ultimate goal of the review is to provide a ground work on which future standardized training and credentialing curriculum could be based on. The PubMed and Web of Science databases were searched in December 2017 and January 2018 for scientific papers written in English using the keywords: health systems, management, leadership, medical education. Health care issues have been the subject of intense scientific discussions around the world for the past two decades. Most attention is drawn to the efforts of interested countries to find the most effective way of managing complex health care systems. There is evidence that management is important and that in successful management, the effects are correlated with management practices and promoted values. The situation where heads of health care teams of large clinical systems in Serbia are physicians, requires more attention to be paid to managerial and leadership skills. Clinical quality depends on employee team work, therefore leadership and management skills are necessary at all levels. The development of leadership competencies must be an integral part of the training and eductation of doctors in Serbia. There is currently a great necessity of a standardized curriculum to be developed and applyed with training and certification of current and future leaders.

Socioeconomic inequalities in oral health in Serbia: evidence from a cross-sectional study

Socioeconomic inequalities in oral health in Serbia: evidence from a cross-sectional study

Odnos javnog mnjenja u srbiji prema štetnim posledicama osiromašenog uranijuma i posledicama bombardovanja SRJ 1999. godine

The bombing of Yugoslavia in 1999 has raised controversial questions concerning its legitimacy, justification, efficacy, and its impact on the health of Serbia's citizens. A striking lack of a clear and unambiguous common scientific attitude concerning the impact and harm of employing DU weapons, together with the absence of a clear political and legal attitude of international and national institutions, have been stirring up public opinion for decades, magnifying the ambiguity in dealing with this extremely important issue. It is obvious that, without sufficient and reliable research into the long-term impact of bombing with DU munitions, it will be very difficult to shape a grounded and plausible international policy concerning the usage of depleted uranium weapons. Moreover, it will provoke conflicts and increase 'the public fog' making it impossible to present an objective scope of damage and prove or refute the argument that DU weapons should be banned. In the case of the Federal Republic of Yugoslavia, almost 20 years after the bombing, the Serbian government established a Commission aimed at estimating the overall impact of DU 'bombing' of Serbia. During these two decades, the chances of a thorough and continual monitoring of the citizens and areas which had been exposed to DU were missed, in spite of the fact that the bombing of the FRY was the first case in which NATO had been forced to publicly confirm their usage of DU munitions. The paper addresses the following question: How is public opinion built in the absence of reliable data? The theoretical background in this approach is based on the theories of public opinion which assume that "individuals turned to the media to help themselves define social reality." (Moy & Bosch, 2013). This means that public opinion, particularly public opinion on controversial issues which are not presented in a transparent and objective way, is built on stereotypes framed by political assumptions and affinities, without making a clear distinction between facts and preferences. The paper presents the results of an online survey conducted on the sample of 534 Serbian citizens, in which we tried to use the above-mentioned approach as a hypothesis and to operationalize and prove it. The results show that attitudes toward the harmful effects of DU munitions depend greatly on the respondents' political affinities for the East or the West and their views on how the Kosovo crisis should be resolved. It also correlates significantly to their positive/negative identification with the Serbian national identity.

Drug-induced Extrapyramidal Symptoms Scale (DIEPSS) Serbian Language version: Inter-rater and Test-retest Reliability

Drug-induced Extrapyramidal Symptoms Scale (DIEPSS) is developed in the era of second-generation antipsychotics and is suitable for evaluation of the low incidence of extrapyramidal symptoms occurring in the treatment of atypical antipsychotics, as well as the relationship between personal and social functioning. The study was carried out at the Institute of Mental Health in Serbia in 2015 Study used the 127 DIEPSS video clips material, recorded from 1987 till 2015. Four raters performed the assessment simultaneously, individually rating one assigned item immediately after seeing the video clip. For the purpose of evaluating test-retest reliability the second assessment of the same material was performed nine months after the first assessment. Inter-rater reliability was high for each individual item, with ICCs ranging from 0.769 to 0.949. The inter-rater reliability was highest for akathisia item and lowest for dyskinesia. The test-retest reliability was high for each individual item, with ICC ranging from 0.713 to 0.935. The test-retest reliability was highest for bradykinesia item and lowest for dystonia. The Serbian version of DIEPSS has high level of inter-rater and test-retest reliability. High values of concordance rates (ICC > 0.7) for each evaluated individual item suggest that items of DIEPSS are well defined.

Laboratory Medicine Management: Leadership Skills for Effective Laboratory.

SummaryForum of the European Societies of Clinical Chemistry (FESCC) decided that the FESCC Symposium for Balkan Region would be held each year in Belgrade and organized by the Society of Medical Biochemists of Serbia and Montenegro (SMBSM). Professor Victor Blaton, at the time President of the FESCC, supported the organization of the Symposium. Purpose of these Symposia has been to educate clinical biochemists from Balkan region to improve management, leadership skills for effective laboratories. As a result of these decision twelve symposia have been organized thus far very successfully. Here the most important Symposium topics will be reviewed. Also, the 13th EFLM Symposium for Balkan Region under the title »Laboratory Medicine Management: Leadership Skills for Effective Laboratory« (Belgrade, September 2017) is organized by EFLM and SMBS under the Auspices of the International Federation of Clinical Chemistry (IFCC), Ministry of Education, Science and Technological Development of Serbia and Ministry of Health of Serbia with participation of the European and domestic specialists in field of Laboratory Medicine.

Original article. The cost of individual health care in Serbia according to the international classification of diseases in the period 2010–2015

Summary Introduction There is growing interest in the world for estimating the cost for the treatment of a disease. This value can be used to determine to which extent a particular disease or group of diseases burden society in terms of the global crisis (Segel 2006). In 2000, Organization for Economic Countries Development (OECD) established a System of Health Accounts (SHA), and provided methodological guide for calculating the cost of treating the disease. The aim of this study was to determine the cost of individual health care in the Republic of Serbia according to the major International Classification of Diseases (ICD) for the period 2010-2015. Material and Methods A retrospective and comparative analysis of health statistics from the database of the Institute of Public Health of Serbia (IPHS) and financial information provided by the National Health Insurance Fund (NHIF) in the period 2010-2015 was performed. Financial information and data on hospital services, outpatient, home health care, auxiliary health care services, drug consumption and consumer goods in healthcare were analyzed using SHA methodology. Results showed that during observation period the maximum cost of individual health care in Serbia by main classification ICD was achieved in 2015 and it was 194,128,864,011 RSD (€1,580,853,941; $1,764,807,854) and the minimal cost was achieved in 2010, 151,333,139,835 RSD (€1,434,464,541; $1,908,843,843). Conclusion The cost of individual health care in the Republic of Serbia in the period 2010-2015 increased by thirty percent. The highest amount was allocated to treat people with diseases of the circulatory system.

The assessment of soil availability and wheat grain status of zinc and iron in Serbia: Implications for human nutrition

The deficiency of zinc (Zn) and iron (Fe) is a global issue causing not only considerable yield losses of food crops but also serious health problems. We have analysed Zn and Fe concentrations in the grains of two bread wheat cultivars along native gradient of micronutrient availability throughout Serbia. Although only 13% of the soil samples were Zn deficient and none was Fe deficient, the levels of these micronutrients in grain were rather low (median values of 21mgkg−1 for Zn and 36mgkg−1 for Fe), and even less adequate in white flour. Moreover, excessive P fertilization of calcareous soils in the major wheat growing areas strongly correlated with lower grain concentration of Zn. Our results imply that a latent Zn deficiency in wheat grain poses a high risk for grain quality relevant to human health in Serbia, where wheat bread is a staple food.