Medicine In Serbia Research Articles

Professional Drivers’ Knowledge About the Influence of Medicines that May Impair Driving

Abstract More knowledge about the impact of medication on driving are indicative of a lower likelihood of having a motor vehicle crash. The aim of this study was to investigate knowledge of professional drivers about the influence of driving impairing medicines in Serbia and Bosnia and Herzegovina. This multicenter cross-sectional study was conducted in 6 cities in Serbia and Bosnia and Herzegovina, during first trimester of 2017, with 221 professional drivers, using questionnaire with 35 statements, where participants expressed their agreement according to Likert scale, from completely disagree to completely agree. The average score related to the drivers’ knowledge was 131,58 (range from 49 to 175), 22,6% were unaware that some medicines may influence psychophysical abilities and ability to drive. A high percentage of participants in the study don’t know that a negative impact on the driving ability can be the result of the use of medicines from groups for which it is unexpected to have such effects, medicines that are dispensed without a medical prescription, herbal remedies, dietary supplements and medicines that affects eyesight or hearing. More than half didn’t know that medicines labeled with warning symbols Δ, ▲ and § are not allowed to be used immediately before or during driving. Professional drivers’ knowledge about driving impairing medicines is not satisfactory. Labeling system of these medicines is inadequate. These findings could help to identify drivers, who are at increased risk for using potentially impairing medicines, to inform and educate them, and to prevent driving under the influence of medicines.

MO1042: Challenges of Diagnosing and Treating Urinary Tract Infection Throuh the Centuries

Abstract BACKGROUND AND AIMS Numerous epidemiological studies indicate the great importance of diagnosing and treating urinary tract infections. Whether they are treated by urology specialists as provided by international guides while clinical practice is provided, or they are treated by nephrologists as practiced in Serbia, the end result is bacterial resistance to antibiotics. Patients often request from doctors for “natural” nonpharmacological drugs, especially when it comes to treating uranium infection and calculosis. Therefore, the aim of our work is to investigate the ways of diagnosing and treating urinary tract infections, hematuria and calculosis in the past. METHOD Numerous resources, including MEDLINE, books, magazines, encyclopedias and data bases, were used to collect the information described in this paper. RESULTS The first written records made 6000 years ago about the visual observation of the color and appearance of urine by uroscopy date from Babylon. Painful urination and blood in the urine has been associated with Egyptians in the past, although they attached great importance to hygiene. Since ancient Egypt hematuria has been attributed to schistosoma hematobium today known as schistosomiasis. The eggs of this parasite were found in the urinary tract of a mummy dating from 1189 BC. Later Egyptian medical papers from 1550 BC describe calculosis, cystitis and urinary frequency in people who have been in contact with contaminated water. In 1798, French doctors from the time of Napoleon described Egypt as the only country in which men menstruate. Although only described about 86 plants belonging to 43 species in southeastern Serbia, there are few records on how to treat hematuria, urinary tract infections and calculosis. Herbal medicine in Serbia is recorded in the oldest document from the 14th century (The Hodoch Codex) and the 16th century (The Chilandar Medicinal Codex). The health book “Pelagic's Folk's Teacher” was published in 1879 by Vasa Pelagic. He published folk healing experiences for the first time on over 900 pages and thus gained great popularity. Most of the information was collected by University Professor Dr. Jovan Tucakov, who in his book “Herbal Therapy,” first published in 1973, described the use of herbs to treat various diseases, including urinary tract infections. Almost every family in Serbia owns these books and changes their therapy together with conventional medicines. However, little attention is paid to the side effects of such combinations and the importance of the consequences of the length of treatment. CONCLUSION Today, treating a urinary tract infection is a major challenge due to bacterial resistance to antibiotics. Knowledge that the culture and social habits of the people are one of the important contexts for improving health care and health education of people and not just the application of technological advances.

Razvoj srpske medicine u XIX veku

With the fall of the medieval Serbian state under Turkish rule, every culture, including medicine, died out, and the people resorted to folk medicine and self-taught doctors, i.e. empiricists. Serbs began to get educated in Vienna and Pest, and there were Serbian doctors in Novi Sad already at the beginning of the 18th century. At that time, the first doctors with diplomas appeared in Serbia, but mostly as personal doctors of the Belgrade pasha or Knez Miloš, i.e. his brother Jevrem in Šabac. In the fourth decade of the 19th century, the first military doctors set out, and the newly created four military district commands got their doctors. The Serbian Medical Association started the first medical journal, "Serbian Archives" in 1874. Josif Pancic is writing the first textbook in natural sciences, and Dr. Acim Medovic is writing the first textbook on forensic medicine. Before the First Serbian-Turkish War, the civilian ambulance numbered 69 doctors, 10 medical assistants, 26 pharmacists, and five pharmacy assistants, while the military ambulance had 19 doctors, five medical assistants, one pharmacist, and four pharmacy assistants. Health was initiated but also the establishment of the Ministry of Health and the higher education institution of the Medical Faculty in Belgrade. Guided by the oath, expertise, and experience, the doctors of that time made a significant effort to improve and develop medicine in Serbia in the 19th century.

Sanitetska služba u Srbiji do Prvog svetskog rata

Modern medicine in Serbia began to develop only after the liberation from the Turks in the Second Serbian Uprising of 1815. The first European-educated doctors came to Serbia in 1819, by order of Prince Milos. The military medical service, in charge of systematic treatment and care of wounded and sick Serbian soldiers, was founded in 1835. The first military doctors and chiefs of Serbian medicine were foreigners, Dr. Emerich Lindenmeier (1806-1884) and Dr. Carlo Belloni (1812-1878), who founded military hospitals in Belgrade, Ćuprija and Paraćin. During the Serbian-Turkish wars (1876-1878), Serbia had only 19 military doctors for about 130,000 soldiers, the divisions had only dressing stations for first aid, and there was also a medical ship for the evacuation of the wounded. Foreign doctors were succeeded by Serbian doctors educated in Vienna, Dr. Vladan Djordjevic (Chief of Medical Services 1877-1884), Dr. Mihajlo Mika Markovic (Chief of Medical Services 1886-1903) and Dr. Lazar Gencic (Chief of Medical Services 1909-1915). By 1885 (Serbian-Bulgarian war), the number of military doctors was increased to one doctor per 1,000 soldiers, and each division (5,000 soldiers) received a field hospital with 200 beds and a medical company with 5 doctors and 100 paramedics. Before the Balkan War (1912), 5 permanent military hospitals with surgical wards were opened, and the medical companies of the divisions had 4 doctors and 450 paramedics, and 4 field hospitals for 400 wounded. For the first time, ambulance trains were used for evacuation and treatment of the wounded. The hygienic-epidemiological service was neglected, and dysentery, typhoid fever and malaria were frequent: in 1913, over 5,000 Serbian soldiers died of cholera alone.

A standstill continuing medical education in Serbia 2011-2017

Introduction/Objective. Continuing Medical Education (CME) is a crucial element to keep the level of professionalism in the three key fields of medical education: pre-clinical, clinical, and public health. The profile of CME in Serbia has been analyzed for the 2011?2017 period. Methods. Between 2011 and 2017, 11,557 courses of CME have been submitted for accreditation, described by 26 variables. Due to the predominance of nominal data, we employed a principal component analysis (PCA) using the nonlinear iterative partial least squares algorithm (PCA/PLS) to arrange the 16 variables with complete information in such a way that most influential factors could be displayed and ranked. The analysis was done with TIBCO Statistical Software. Results. The Faculty of Medicine of Belgrade takes the top position among the medical faculties in Serbia with 569 courses or 47.9% (n = 1187; 2011?2017), whereas non-educational institutions with 86.2% of all courses (n = 11,514) are the most dominant providers. Clinical topics dominate the thematic spectrum with 59.7%. Between 2012 and 2017, the total number of courses offered diminished by 16.9%. A PCA of 16 potential determinants of CME reveals that the most relevant ones are duration, credit points, price, and number of lecturers. Conclusion. For the last decade, a standstill or even a regression in the development can be observed. Especially the faculties of medicine in Serbia, as well as other major providers, should reconsider the entire structure of their administrative organization and initiate innovative development.

Jadwiga Olszewska: A Woman Pioneer in Medicine in Serbia and Bosnia and Herzegovina.

This article describes the life and medical activities of Jadwiga Olszewska (1855-1932) in Serbia from 1895-1899, AustroHungarian (AH)-occupied and annexed Bosnia and Herzegovina (BH) from 1899-1918, and the newly founded Kingdom of Yugoslavia, from 1919-1932. In summer 1899, Olszewska replaced Teodora Krajewska as an AH official female physician in Tuzla. Born in Congress Poland, Olszewska had enrolled in 1873 in the medical courses for women in St. Petersburg but had left Russia in 1880 to study medicine in France. She had lived as a student and single parent in Paris since 1883, and she was awarded her Doctorate in Medicine from the University of Paris in 1894. She could not practice medicine in Russian-occupied Poland because of her French diploma, and she could not practice in most Western countries due to her gender. Therefore, she decided to move to Serbia, where she worked as an assistant physician in the district hospitals of Loznica (1895-1897?) and Požarevac (1897-1899). Driven by the need for a higher income to fund her son's education, she engaged her network of Polish compatriots and procured the position of an AH official female physician of Tuzla in 1899, where she performed her duties in an exemplary manner. After the breakdown of the Austro-Hungarian Empire (AHE) in 1918, Olszewska remained in Tuzla and retired as a Yugoslav official physician in 1923. When she died in Tuzla in 1932, local colleagues had to arrange for a proper funeral because Olszewska did not leave any savings due to her insufficient pension. Olszewska's grave never received a tombstone, and it is untraceable today. CONCLUSION: Jadwiga Olszewska (1855-1932) was a woman pioneer of medicine from Poland, who practiced her profession first as an assistant physician in Serbia (1895-1899) and then as an AH and Yugoslavian official female doctor in Tuzla, BH (1899-1923).

Portable medicine chests and supply of medicines in Serbia from the 1830s to the mid-20th century: analysis of medicines list.

The first portable medicine chests appeared in Serbia immediately after liberation from Ottoman rule around 1830. The network of portable medicine chests grew very quickly and became the first effective public health method of supplying medicines and medical items to people living in cities without community pharmacies and to the rural population in villages. According to their purposes, three categories of portable medicine chests could be identified: Portable medicine chests owned by physicians or veterinarians in the cities, portable medicine chests established by the Department of Workers Health Insurance, and portable medicine chests of the Health Cooperatives that operated in the villages This paper analyzes all three types of portable medicine chests. We specifically examine the regulations concerning the management of portable medicine chests, their content, and supply chains of medicines from the third decade of the 19 th century through the first half of the 20th century. We conclude that portable medicine chests represent a specific type of pharmacy in the territory of Serbia that provided very effective medical service. The medicines in these pharmacies were handled and dispensed to patients by physicians not by pharmacists. Patent medicines, compounded medicines, sanitary items and bandage materials were dispensed as well. Future research is needed to ascertain if physicians who owned or worked with the portable medicine chests actually prepared and compounded simple preparations as they were specified in the laws.

Attitudes toward Euthanasia of Students of Law and Medicine in Serbia

The article's abstract is no available.

Dr Avram Farkic (1866-1925), the founder and the owner of the first physical therapy institute in Serbia

Methods of physical medicine, many of which have been empirically applied since the ancient times, have become particularly popular in 19th century Europe. The first examples of the works of Serbian doctors in this area originate from the same period. In 1838 and 1839, Dr. Konstantin Peicic wrote about Prissnitz?s method of hydrotherapy. In 1842, Dr. Dimitrije Radulovic published in Latin his doctoral dissertation concerning medical gymnastics. In the middle of the 19th century, in the Principality of Serbia, hydrotherapy treatments (by Dr. Andrija Ivanovic, 1850) and electrotherapy (by Dr. Jovan Valenta, 1857) w?re applied. Among the pioneers of physical medicine in Serbia, Dr Avram Farkic is a very important figure. In 1896, Farkic founded the first Serbian institute for physiotherapy in Belgrade, and, two years later, the First Institute for Orthopedics, Swedish Gymnastics and Massage. These institutions were merged in 1899. After the death of Dr. Farkic in 1925, the Institute worked under his name until the German bombing of Belgrade on April 6, 1941. The diversity and continuous introduction of modern therapeutic procedures were the main characteristics of the Institute during its 45-year-long existence. Dr. Farkic was also the initiator of the establishment of the Therapy Joint Stock Company, which founded the first institute for physical medicine in Vrnjacka Banja, the Therapy Institute for Treatment by Water and Electricity, in 1911. Until the First World War, it was the most modern spa sanatorium in Serbia. During spa seasons of 1911, 1912, 1913, and 1924, Dr. Farkic himself was the manager and the main physician of the Therapy Institute.

Interprofessional education and collaborative practice: Psychometric analysis of the Readiness for Interprofessional Learning Scale in undergraduate Serbian healthcare student context

BackgroundThere is an implicit expectation for medical sciences students to work together effectively as members of health-care team, and interprofessional education is therefore widely accepted. Students' attitudes, which are affected by various factors, have been recognized as the most important predictors of successful implementation of interprofessional education with the aim of developing collaborative practice. The Readiness for Interprofessional Learning Scale has often been used in studies to measure these perspectives. ObjectivesTo describe the psychometric properties of the Serbian cross-culturally adapted version of the original Readiness for Interprofessional Learning Scale, to assess the attitudes of undergraduate health science students towards interprofessional education and to evaluate whether a professional group and student characteristics have influence on attitudes towards collaborative practice and shared learning. DesignA descriptive/analytical and comparative cross-sectional study. SettingsFaculty of Medicine in Serbia. ParticipantsNursing and medical students after completed first clinical rotations (n = 257). MethodsThe Readiness for Interprofessional Learning Scale for assessing attitudes among students towards interprofessional learning, Professional Identity Questionnaire for Nursing Students for assessing professional identity in nursing students, Professional Nursing Image Survey for assessing attitudes of medical students towards the nursing profession, as well as a socio-demographic questionnaire were the instruments used in this research study. The data were analysed using descriptive and inferential statistics. ResultsExploratory factor analysis on 19 items revealed two-factors accounting for 51.1% of the total variance with the internal reliability α = 0.90. The mean total score of the Readiness for Interprofessional Learning Scale was 73.5 (SD = 11.5) indicating that students are ready for interprofessional learning. Nursing students, female students; students in their first years of studies, and those with previously completed education in the field of health care, have been more ready for interprofessional learning and collaborative practice. In the multiple linear regression analysis, gender and assessing professional nursing skills and abilities were significant predictors of medical students' readiness for interprofessional learning, whereas professional identity was for nursing students. ConclusionThe Serbian version of the Readiness for Interprofessional Learning Scale has proven to be reliable and valid for the “teamwork, collaboration and shared learning” subscale, while the “role and responsibilities” subscale showed lower stability. The results of this study revealed positive students' attitudes towards interprofessional learning, which is important for Serbia, as a candidate country for European Union membership, and thus making our educational system more inclusive for joining the European Higher Education Area.

Medical Biochemistry as Subdiscipline of Laboratory Medicine in Serbia.

SummaryMedical biochemistry is the usual name for clinical biochemistry or clinical chemistry in Serbia, and medical biochemist is the official name for the clinical chemist (or clinical biochemist). This is the largest sub-discipline of the laboratory medicine in Serbia. It includes all aspects of clinical chemistry, and also laboratory hematology with coagulation, immunology, etc. Medical biochemistry laboratories in Serbia and medical biochemists as a profession are part of Health Care System and their activities are regulated through: the Health Care Law and rules issued by the Chamber of Medical Biochemists of Serbia. The first continuous and organized education for Medical Biochemists (Clinical Chemists) in Serbia dates from 1945, when the Department of Medical Biochemistry was established at the Pharmaceutical Faculty in Belgrade. In 1987 at the same Faculty a five years undergraduate study program was established, educating Medical Biochemists under a special program. Since the academic year 2006/2007 the new five year undergraduate (according to Bologna Declaration) and four-year postgraduate program according to EC4 European Syllabus for Postgraduate Training in Clinical Chemistry and Laboratory Medicine has been established. The Ministry of Education and Ministry of Public Health accredited these programs. There are four requirements for practicing medical biochemistry in the Health Care System: University Diploma of the Faculty of Pharmacy (Study of Medical Biochemistry), successful completion of the professional exam at the Ministry of Health after completion of one additional year of obligatory practical training in the medical biochemistry laboratories, membership in the Serbian Chamber of Medical Biochemists and licence for skilled work issued by the Serbian Chamber of Medical Biochemists. In order to present laboratory medical biochemistry practice in Serbia this paper will be focused on the following: Serbian national legislation, healthcare services organization, sub-disciplines of laboratory medicine and medical biochemistry as the most significant, education in medical biochemistry, conditions for professional practice in medical biochemistry, continuous quality improvement, and accreditation. Serbian healthcare is based on fundamental principles of universal health coverage and solidarity between all citizens.

Availability of pediatric-evaluated formulations in Serbia.

OBJECTIVES:The aim of this study is to analyze the availability and coverage by health insurance reimbursement of pediatric formulations labeled for children up to the age of 12 in Serbia. To provide good insight in general availability of pediatric medicines, results were compared with the World Health Organization's (WHO) “Model List of Essential Medicines for Children” and with published evidence.MATERIALS AND METHODS:Sources of information about medicines are the Summary of Product Characteristics, National Health Insurance Fund (NHIF) Drug Lists, WHO Model Lists of Essential Medicines for Children, and Serbia's official drug registry (2013).RESULTS:Out of total number of medicines in Serbia, only 49% (496) were available for children. Of all available drugs for children, 66% were with license and majority were parenteral formulation (57%), followed by drugs for local use (28%) and formulations for oral use (23%). The lowest availability of medicines was for children 0–27 days. From the total number of licensed medicines for children up to 12 years old, NHIF covers 64% of drugs. The availability of the WHO essential medicines for children in Serbia was 51%, from which 92% were licensed for pediatric use.CONCLUSIONS:Our results demonstrated the alarming lack of pediatric suitable formulations in Serbia. Significant differences in the availability of drugs suitable for children exist worldwide. From global health point of view, the differences in the access to children formulations should, therefore, be of the highest priority.

Dragoljub (Bata) Adamov (1927-1996): The first pacemaker implantation in Serbia

It has been over half a century since the implementation of pacemaker therapy in our country and the region. The first successful implantation of a pacemaker in former Yugoslavia and in Serbia took place on September 16, 1965 in ?Dr. Dragisa Misovic? Clinical Hospital Centre, and this operation, with a team of doctors of the institution, was performed by surgeon Dragoljub (Bata) Adamov (1927?1996). The first permanent pacemaker implantation was with epicardial leads with thoracotomy approach. The patient was operated on under general anesthesia, administered by anesthesiologist Predrag Lalevic (1927?), and Dr. Adamov was assisted by Dr. Misa Albrecht (1933?) and Dr. Milan Dragovic (1933?2009). Although pacemaker therapy has since been widely proven and confirmed, it is necessary to remember the pioneers who introduced this kind of therapy to the region, as they deserve a distinguished place in the history of medicine in Serbia.

Traditional and integrative medicine in Serbia

Traditional and integrative medicine in Serbia

History of Medicine in Jagodina District

Summary The first record of scientific medicine in Serbia has been found in the early of 12th century. For centuries lifestyle, nutrition, natural environment, armies passing through, cultural heritage, and prejudice have affected healthcare in Serbia. Until 1820, Serbia has not had any educated doctor. Fourteen district physicians from 1839 and Dr. Karlo Beloni, to the last one, Dr. Selimir Djordjević – have spent part of their professional careers in Jagodina. All of them have had influence on raising health culture of Jagodina and its population and helped to overcome easily and quickly all existing diseases and epidemics. The Jagodina Hospital has been working without interruption for 147 years and represents one of the oldest healthcare institutions in Serbia.

Evolution of the Serbian pharmaceutical market alongside socioeconomic transition

Introduction: South-eastern European socioeconomic transition followed by extensive health systems reforms has completely changed the pharmaceuticals market landscape in the region. Serbia, as the largest Western Balkans market, may serve as an example of such changes. Methods: Descriptive trend analysis of national-level dispensing of medicines in Serbia 2004–2012 was performed. Results: Total public health expenditure in Serbia increased sharply in less than a decade (€1,175,158,679 to €1,847,971,776); public spending on pharmaceuticals doubled (€339,279,304 to €742,013,976). Market growth was primarily driven by statins, novel platelet aggregation inhibitors, monoclonal antibodies and combined preparations indicated in asthma and chronic obstructive pulmonary disease. Conclusion: The pharmaceutical market of Serbia has undergone thorough and complete transformation from within. Serious crisis of medicine supply sustainability is currently shaking Balkan health systems due to increasing public debt worsened by global recession. More responsible reimbursement policy rooted in cost–effectiveness principle is needed in years to come.

Transplantation through the ages

Historical development of transplantation was going slowly in all parts of the world, following technological progress in general. At the crossing of the 18th and 19th century the first big steps in the field of transplantation were made, when Franz Reisinger was the first who transplanted cornea from an animal to an animal. Successful skin transplantations were made at the beginning of the 20th century; at the same time, surgical techniques of vascular anastomoses were developed, enabling technically successful transplantations of whole organs. At the end of the Second World War the first successful cadaveric kidney transplantation was made, and the first transplantation of this organ from a living donor was performed in 1956. A liver was transplanted for the first time in 1963, and a heart in 1967. Since then, transplantation has become a part of routine health care in developed countries, thanks to technological progress and efforts in promoting organ and tissue donation. Development of transplantation medicine in Serbia was a couple of decades late and annual transplantation rate still does not meet the needs of the population. It is expected that the development of this area of medicine in Serbia will be intense in the future.

The availability of reliable information about medicines in Serbia for health professionals summary of product characteristics

The availability of reliable information about medicines in Serbia for health professionals summary of product characteristics

Continuing medical education in Serbia with particular reference to the Faculty of Medicine, Belgrade.

Continuing Medical Education (CME), conceptualised as lifelong learning (LLL) aims at improving human resources and continuing professional development. Various documents of European institutions underline its key importance. This paper therefore tries to analyse the current status of CME and the main deficits in the delivery of LLL courses at medical faculties in Serbia with special consideration of the Faculty of Medicine in Belgrade with detailed financial data available. Data of 2,265 medical courses submitted in 2011 and 2012 for accredita- tion were made available, thereof 403 courses submitted by 4 medical faculties in Serbia (Belgrade, Kragujevac, Nil, Novi Sad). A subset of more detailed information on 88 delivered courses with 5,600 participants has been provided by the Faculty of Medicine, Belgrade. All data were transferred into an Excel file and analysed with XLSTAT 2009. To reduce the complexity and possible redundancy we performed a principal component analysis (PCA). Correlated component regression (CCR) models were used to identify determinants of course participation. During the 2-year period 12.9% of all courses were submitted on pre-clinical and 62.4% on clinical topics, 12.2% on public health, while 61.5% of all took place in Belgrade. The subset of the Faculty of Medicine, Belgrade comprised 3,471 participants registered with 51 courses accredited and delivered in 2011 and 2,129 participants with 37 courses accredited and delivered in 2012. The median number of participants per course for the entire period was 45; the median fee rates for participants were 5,000 dinars in 2011 and 8,000 in 2012, resulting together with donations--in a total income for both years together of 16,126,495.00 dinar or almost 144,000.00 euro. This allowed for a median payment of approximately 90 eur per hour lectured in 2011 and 49 euro in 2012. The 2 factors, D1 (performance) and D2 (attractiveness), identified in the PCA for Medical Faculties in Serbia, explain 71.8% of the variance. Most relevant are the duration of the courses, credit points" and hours per credit point gained by lecturers and participants respectively. In the PCA for Belgrade D1 and D2 explain 40.7% of the total variance. The CCR on the number of participants reveals the highest positive impact from the number of lecturers per course and the expenditure on amenities, the highest negative impact from the total income collected per participant. The faculties of medicine in Serbia should reconsider the entire structure of their organisation of CME, especially to improve the quantity and quality of registration limit the course fee rates per hour and reduce administrative and other costs request lecturing in CME programmes as obligatory for academic promotion and organise a focused marketing.

137Cs and 40K in some traditional herbal teas collected in the mountain regions of Serbia

Herbal teas are an important part of traditional medicine in Serbia. The objective of the present study was to determine the activity concentrations of 40K and 137Cs in herbal tea, using the gamma spectroscopy method. The samples were collected during the period 2011–2012 in three mountain regions in Western and Central Serbia. The activity concentrations of 40K and 137Cs were found to be in the range of 130–1160 and 0.7–124 Bq kg−1, respectively. The average annual effective dose equivalents from ingestion of 40K and 137Cs for an adult person consuming one cup of herbal tea daily were found to be 588.4–5250.2 nSv for 40K and 4.0–706.1 nSv for 137Cs. Our investigation showed that the herbal teas originating from Maljen, Zlatibor and Tara mountains are radiologically safe for human consumption.