Patients In Serbia Research Articles

Validation of the Montgomery-Åsberg depression rating scale in depressed patients in Serbia

Introduction/Objective. The aim of this study was the validation of the Montgomery?Asberg Depression Rating Scale (MADRS) in patients in Serbia suffering from depression. Methods. Both test and retest situations have been conducted on 162 adult patients with major depressive disorder, and on 110 individuals that have not shown any type of mental disorder (control group). The sample included 58.8% male and 41.2% female participants, age between 20 and 79 years (M = 42.26, SD = 11.53) with no differences between groups in terms of participants? sex and age. The following instruments were used: MADRS, Hamilton Depression Rating Scale, and Brief Psychiatric Rating Scale. Results. MADRS has shown good psychometric characteristics: internal consistency, test-retest reliability, concurrent validity, and its discriminatory validity is adequate. Study also confirmed the onedimensionality of the instrument. Statistically significant differences between the groups, in terms age and education, have been identified, but the effects of the differences were small. Conclusion. The MADRS scale has shown good psychometric characteristics in our study; thus, it may be used for the assessment of depressed states in Serbian patients.

Frequency and effects of seasonal flu vaccines on exacerbations of chronic obstructive pulmonary disease in Serbia

Background/Aim. The influenza virus is often the cause of exacerbations among chronic obstructive pulmonary disease (COPD) patients, especially during the winter season. However, vaccination rates are still below recommended even in developed countries. The aim of the study was to determine the rates and examine the effectiveness of immunization against seasonal influenza in preventing exacerbations among COPD patients in Serbia. Methods. The prospective cohort study of stable COPD outpatients was conducted over three years (between October 1, 2014, and September 30, 2017) at the Polyclinic Department of Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia. The rates and effects of seasonal flu vaccination on COPD exacerbation rates were evaluated using univariate and multivariate logistic regression analysis, taking into account comorbidity, age, and body mass index (BMI). Results. The study included 840 patients. The flu vaccination rate was 37.1%. Exacerbations occurred more frequently in unvaccinated patients [176 (31.9%) vs. 375 (68.1%), p = 0.043]. In elderly vaccinated patients (? 65 years) there were fewer exacerbations compared to unvaccinated patients [89 (56.0%) vs. 188 (69.4%), p = 0.005]. Lower frequency of exacerbations was also observed in vaccinated patients with comorbidities [165 (61.1%) vs. 327 (69.4%), p = 0.021] and low BMI [27 (64.3%) vs. 78 (83.9%), p = 0.011]. Multivariate logistic regression analysis identified BMI < 21 kg/m2 [relative risk (RR): 0.490; 95% confidence interval (CI): 0.318?0.758; p = 0.001] and heart failure (RR: 2.734; 95% CI: 1.121?6.669; p = 0.027) as independent predictors of COPD exacerbations. Conclusion. Immunization for seasonal influenza in Serbia is below recommended rates. Flu vaccination was associated with a significant reduction in COPD exacerbation rates, particularly in elderly patients and patients with heart failure and low BMI.

Incidence and mortality rates of Guillain-Barré syndrome in Serbia.

Guillain-Barré syndrome (GBS) is an acute auto-immune polyradiculoneuropathy. A huge variety of GBS incidence and mortality rates has been noted across the world. The objective of the present multi-centric study was to assess the incidence and mortality rates of GBS during a 10-year period in Serbia. We collected data of adult GBS patients who were hospitalized from 2009 to 2018 in all five tertiary healthcare centers in Serbia. The incidence rates per 100 000 inhabitants with 95% confidence intervals (CI) were calculated and further corrected for the estimated number of patients hospitalized in secondary centers. Mortality rates were also assessed. GBS was considered severe if patients were not able to walk at least 10 m without assistance. Six hundred and forty GBS patients were registered in tertiary centers in a 10-year period. The proportion of severe cases was 75% at nadir, and 52% on discharge. GBS incidence rate in Serbia was 1.1 per 100 000 inhabitants, and estimated incidence if patients from secondary centers included 1.2 per 100 000. Peak incidence was observed during the sixth decade of life. During the acute phase, 5.6% of GBS patients died, while overall 9.7% of them died during 6-month period from disease onset. This study contributes to our knowledge about GBS epidemiology. Results will allow us to improve the diagnosis and treatment of GBS patients in Serbia.

Diagnosis of Pneumocystis jirovecii Pneumonia in Pediatric Patients in Serbia, Greece, and Romania. Current Status and Challenges for Collaboration.

Pneumocystis jirovecii can cause fatal Pneumocystis pneumonia (PcP). Many children have been exposed to the fungus and are colonized in early age, while some individuals at high risk for fungal infections may develop PcP, a disease that is difficult to diagnose. Insufficient laboratory availability, lack of knowledge, and local epidemiology gaps make the problem more serious. Traditionally, the diagnosis is based on microscopic visualization of Pneumocystis in respiratory specimens. The molecular diagnosis is important but not widely used. The aim of this study was to collect initial indicative data from Serbia, Greece, and Romania concerning pediatric patients with suspected PcP in order to: find the key underlying diseases, determine current clinical and laboratory practices, and try to propose an integrative future molecular perspective based on regional collaboration. Data were collected by the search of literature and the use of an online questionnaire, filled by relevant scientists specialized in the field. All three countries presented similar clinical practices in terms of PcP prophylaxis and clinical suspicion. In Serbia and Greece the hematology/oncology diseases are the main risks, while in Romania HIV infection is an additional risk. Molecular diagnosis is available only in Greece. PcP seems to be under-diagnosed and regional collaboration in the field of laboratory diagnosis with an emphasis on molecular approaches may help to cover the gaps and improve the practices.

Long-Term Effectiveness and Cost Effectiveness of Multiple Myeloma Treatment Strategies for Elderly Transplant-Ineligible Patients in Serbia.

IntroductionEvidence on long-term effectiveness and cost effectiveness of treatment sequences for multiple myeloma (MM) is sparse. We used published data and country-specific data to assess the cost effectiveness of four-line treatment sequences for elderly transplant-ineligible patients with MM in Serbia.MethodWe developed a Markov cohort model to compare long-term effectiveness and cost effectiveness of five sequential MM treatment alternatives from the perspective of the national healthcare provider. Effectiveness parameters on progression, mortality and adverse events were extracted from published clinical trials. Costs were based on price lists of the National Health Insurance Fund. We compared life expectancy, costs, and incremental cost-effectiveness ratios among alternative courses of action. The model was analyzed over a lifelong time horizon applying a 3% annual discount rate for effectiveness outcomes and costs. Robustness of the model was tested in multiple deterministic sensitivity analyses.ResultsThe sequences were defined by the frontline treatment: MPT (melphalan-prednisone-thalidomide), MPV (melphalanprednisone-bortezomib), CTD (cyclophosphamide-thalidomide-dexamethasone), VCD (bortezomib-cyclophosphamidedexamethasone) and BP (bendamustine-prednisone). MPV sequence resulted in the highest remaining life expectancy (4.76 life years). Cost-effectiveness analysis resulted in three non-dominated strategies: MPT, VCD, and MPV sequences, with an incremental cost-effectiveness ratio of EUR 35,300 per life-year gained (LYG) for VCD and EUR 47,200/LYG for MPV relative to MPT.ConclusionMPV sequence was the most effective in terms of life expectancy for elderly transplant-ineligible MM patients in Serbia. Bortezomib-based strategies would be recommended for the frontline treatment of patients with MM in Serbia if the willingness-to-pay threshold is around EUR 35,000-60,000/LYG.

Tretman duševno poremećenih osoba u srednjovekovnoj Srbiji

The treatment of mental health patients in Serbia in the Middle ages was the same as in other European countries. Medicine of that time was based on science, the use of magic rituals and witchcraft was banned. Doctors from Serbia, Byzantium and the national doctors had been educated in Salerno and Montpellier, the most developed centers of medicine. They took the exam in front of the government Medical testimony. The development of medicine was followed in the Hodoloski code which was considered the oldest record of folk medicine and the Hilandar medical code which represented a collection of medieval scientific European medicine and Serbian medicine culture (XII-XV). The first Serbian hospital was established in Hilandar in 1199. The founder was Saint Sava who wrote the rules about the work of the hospital. Actually, it was the practice for all medical facilities that were opened later. We know about mental diseases and healing in Serbia from Lives of Saints in monasteries Zica (from 1207) and Decani (1327) and from the biography of Medieval ruler (king) Stephen of Decani. The illustrations of healing some patients with mental diseases were shown on frescoes and in the lives of saints. In Medieval Serbia, there were 49 foreign doctors working (15 in XIV, 30 in XV and 4 in XVI century) and until Turkish conquest Serbia took a very important place in Medieval Europe. Objective of this paper is to show where psychiatric patients were treated in Medieval Serbia, the way they were treated, who treated them, where the hospitals were and what kind of treatment wereapplied.

Validation of Serbian version of chronic obstructive pulmonary disease assessment test

Background/Aim. The Chronic obstructive pulmonary disease (COPD) Assessment Test (CAT) is a simple and reliable tool designed to measure overall COPD related health status and complement physician assessment in routine clinical practice. Objective of this study was to evaluate the validity of the Serbian version of CAT. Methods. Study included 140 outpatients in the stable COPD, recruited from two centres: Clinic for Pulmonology, Clinical Center of Serbia, Belgrade, and Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica. All patients completed pulmonary function testing ? spirometry, the CAT and the modified Medical Research Council (mMRC) dyspnea scale at baseline visit. The CAT test-retest reliability was tested in 20 patients by the same investigator (physician). Results. We demonstrated that Serbian version of CAT had high internal consistency with Cronbach?s alpha 0.88. Test-retest analysis showed good correlation between CAT scores in two time points (Spearman?s ? = 0.681, p < 0.01). In our study the CAT correlated moderately to mMRC scale (? = +0.57), weakly to FEV1 (? -0.214), was positively related to number of exacerbations, but did not showed exact regularity with change in the Global Initiative for Chronic Obstructive lung disease (GOLD) stage. Conclusion. The Serbian version of CAT is a reliable, simple and easy-to-use tool that can be used in everyday clinical practice to assess the health status of COPD patients in Serbia.

ANALYSIS OF PATIENTS’ NONADHERENCE TO STATIN THERAPY FROM CARDIOVASCULAR EVENT TO CARDIOVASCULAR REHABILITATION

Numerous studies have pointed to low adherence to statin, which decreases as time period from acute cardiovascular event elapses. The aim was to analyze the cause of not taking statin by patients who were referred to rehabilitation after coronary event. Study population and methods. The research included the total of 573 patients, average age 60.3, while 305 (53.1%) of them were patients who experienced the first cardiovascular event. The stated research was conducted by means of a questionnaire and implied active participation of the researchers in terms of monitoring the possession and use of medication during rehabilitation. On arrival to rehabilitation, 98 (17.1%) patients did not have statin. They stated that they had never used statins before or that they stopped using them shortly after the event. This subgroup had significantly unfavorable values of lipid parameters (p<0.001), abdominal obesity (p<0.01), physical inactivity (p<0.01), more comorbidities (p<0.001), more prescribed medications on daily level (p<0.05), lower education degree level (p<0.01) and lower monthly income (p<0.001). Independent factors for not taking statin were: female gender, low monthly income and large number of comorbidities (R = 0.291, R2 = 0.85, adjusted R2 = 0.80, std. error of the estimate = 0.36151; p < 0.001). The patients themselves stated that the first reason for not taking statin was lack of financial funds (45.9%), while the second reason was normalization of laboratory results (21.4%). Three months after acute coronary event, 17.1% of patients in Serbia stopped taking statin. Lower adherence to statin closely correlates with female gender, low financial income and multiple comorbidities.

Working status in persons with multiple sclerosis

The ability of people with multiple sclerosis (MS) to maintain their employment is of increasing concern. To assess work status of patients with relapsing-remitting (RR) MS in Serbia and Montenegro and the influence of physical disability, depression, cognitive status and treatment with interferon (IFN)-beta 1a on the work status of MS patients and their quality of life. Multicentre cross-sectional study comprised RRMS patients in Serbia and Montenegro treated with IFN-beta-1a sc (n = 261), and control group consisting of 239 naive RRMS patients, from five university MS centres in our countries. In all patients following were performed: EDSS, MSFC, the Brief International Cognitive Assessment for Multiple Sclerosis, Beck Depression Inventory, Fatigue Impact Scale, MSQoL-54, and online vocational status monitoring tool. In the IFN-beta-treated group, proportion of employed persons was significantly higher (59.4%) in comparison to 49.3% in the untreated group (p = .024). It has been demonstrated that the crucial reason for retirement (disability pension) in RRMS patients was walking problem which was significantly more frequent (p = .002) in the untreated group (20.5%) in comparison to the IFN-beta-treated (10.3%). Via the online vocational status monitoring tool (Serbian version), significant correlation between baseline EDSS and score of the domain related to difficulties at working place (p = .011) has been demonstrated. Cognition, fatigue and depression have been found to predict employment status in persons with MS, independent of physical MS symptoms. It has been clearly demonstrated that work capacity in MS significantly declines with increased physical disability and cognitive impairment.

P1.03-07 Advantages and Setbacks of EGFR Mutation Testing from Liquid Biopsy of Advanced Lung Adenocarcinoma Patients in Serbia

P1.03-07 Advantages and Setbacks of EGFR Mutation Testing from Liquid Biopsy of Advanced Lung Adenocarcinoma Patients in Serbia

Diagnosis and management of chronic obstructive pulmonary disease in Serbia: an expert group position statement.

In recent years, several national chronic obstructive pulmonary disease (COPD) guidelines have been issued. In Serbia, the burden of COPD is high and most of the patients are diagnosed at late stages. Global Initiative for Chronic Obstructive Lung Disease (GOLD) strategy is poorly implemented in real-life practice, as many patients are still prescribed inhaled corticosteroids (ICS)-containing regimens and slow-release theophylline. In this document, we propose an algorithm for treating COPD patients in Serbia based on national experts’ opinion, taking into account global recommendations and recent findings from clinical trials that are tailored according to local needs. We identified four major components of COPD treatment based on country specifics: active case finding and early diagnosis in high-risk population, therapeutic algorithm for initiation and escalation of therapy that is simple and easy to use in real-life practice, de-escalation of ICS in low-risk non-exacerbators, and individual choice of inhaler device based on patients' ability and preferences. With this approach we aim to facilitate implementation of the recommendation, initiate the treatment in early stages, improve cost-effectiveness, reduce possible side effects, and ensure efficient treatment.

Depression/anxiety symptoms in axial spondyloarthritis and psoriatic arthritis patients in Serbia: a pilot study.

To assess prevalence and change of depression/anxiety symptoms in spondyloarthritis patients and feasibility of depression/anxiety questionnaires. 43 Patients with axial spondyloarthritis (axSpA) and 27 patients with psoriatic arthritis (PsA) were consecutively recruited. There were 34 patients on biologics and 36 patients on nonbiologics. Patients were not previously treated for depression. The demographic variables, pain, patient global assessment, laboratory, clinical findings, diseases activity scores, Beck Depression Inventory (BDI) and Depression Anxiety and Stress Scale-short version (DASS-21) were collected. The study visits were at the beginning, after 1month, after 3 and after 6months. In axSpA and PsA patients on biologics, BDI and DASS-21 were significantly lower compared to nonbiologics group during time. The axSpA patients on biologics had significantly lower BDI and depression severity by BDI at each time point and lower DASS-21 after 1, 3 and 6 months. BDI in PsA patients who received biological therapy was significantly lower after 3 and 6 months. In biologics groups, BDI significantly decreased after 3months in axSpA patients and after 1month in PsA patients. In axSpA patients, there was a medium correlation between BDI and axial pain, patient global assessment and disease activity scores. The biological therapy significantly affected the depression/anxiety symptoms in axSpA and PsA during time. BDI moderately correlated with pain and disease activity in axSpA. BDI and DASS-21 are easy to use in daily practice.

HIV prevalence, knowledge and self-perceived risk of HIV infection among tuberculosis patients in Serbia.

The aim of the study was to estimate the seroprevalence of HIV infection among TB patients, knowledge, self-perceived risks and testing practices related to HIV. We performed cross-sectional study from 10 May to 15 July 2011. Cluster sampling method was used to select 27 hospitals where 289 TB patients were consecutively recruited. Descriptive statistics and multivariable logistic regression methods were used to identify the factors associated with correct comprehensive knowledge of HIV/AIDS. HIV prevalence among TB patients was 0.3%. Only 25.2% of the respondents presented comprehensive correct knowledge of HIV/AIDS. The percentage of correct answers to all questions related to knowledge about HIV/AIDS increases with educational status (χ2 = 5.42; p < 0.05) and decreases with the age of respondents (χ2 = 8.53; p > 0.05). The independent predictors of correct comprehensive knowledge were living without partner (OR = 4.45; CI = 1.59-12.95) and self-awareness of HIV risk (OR = 4.43; CI = 1.20-16.52). HIV prevalence among TB patients is higher than among general population in Serbia. The level of comprehensive correct knowledge of HIV/AIDS is low. There is a need for continuous implementation of public health strategy to successfully manage HIV and HIV/TB co-infection in Serbia.

Stavovi i navike pacijenata o korišćenju biljnih lekova

Objective. The aim of study was to examine the factors associated with the use of herbal drugs among patients in Serbia, as well as to assess the attitudes and habits of patients toward the use of herbal drugs. Methods. The study was designed as an observational, cross-sectional study. The research was conducted during February 2018 in six community pharmacies across the municipalities of Despotovac and Ćuprija. Study population consisted of adult volunteers of both genders and over 18 years of age who had purchased drugs in one of the six pharmacies involved in the study. Participants filled out the semi-structured questionnaires which had been specifically designed for purposes of this research. The questionnaire consisted of two parts. The first part comprised five questions relating to socio-demographic characteristics of participants, while the second part of the questionnaire was composed of eight questions concerning the use of herbal products. The study data were analyzed by descriptive and analytical statistics by SPSS statistical program. Results. There were 190 participants in total. The average age of the study subjects was 47.83 ± 15.9 years (the youngest was 18, while the oldest was 87 years old). Some form of herbal product was used by 145 (76.3%) participants. The most common reasons for the use of herbal drugs were common cold (22.6%), improving the digestion (8.9%), stimulation of immune system (7.5%), dermatological problems (7.5%), cough (4.8 %) and rheumatic complaints (4.8%). The most frequently participants gained information on use of herbal drugs from pharmacists (26.9%), from sources provided by Internet (21.0%), from their physicians (11.8%) and from family members and friends (10.8%). Of the total number 67.7% of participants considered herbal drugs to be completely safe for use. Slightly more than half of the study subjects (52.7%) gave information on using the herbal drug to their physicians. The binary logistic regression analyses showed that herbal drugs were more commonly used by younger women, with a higher school or university degree who prefer to use herbal medicines compared to other drugs. Conclusion. The results of our study have shown that herbal drugs had been more commonly used by younger women, with a higher school degree or university degree, and who declared that they preferred to use herbal drugs in relation to other drugs.

Prevalence of Extended Spectrum Beta-Lactamases among Enterobacteriaceae Isolated from Intrahospital Patients in Serbia

Prevalence of Extended Spectrum Beta-Lactamases among Enterobacteriaceae Isolated from Intrahospital Patients in Serbia

Myotonic Dystrophy Type 2 - Data from the Serbian Registry.

Myotonic dystrophy type 2 (DM2) is a multisystem disorder, mostly presented with mild but heterogeneous spectrum of symptoms. The aim of this research was to provide detailed sociodemographic, clinical and laboratory data of a large DM2 cohort from the Serbian registry. In 2008, we started to prospectively enter data of all DM patients. We also retrospectively collected data of patients hospitalized from 1990 until 2008. At the end of 2017, registry comprised 87 (68%) of 128 genetically confirmed DM2 patients in Serbia, i.e. 1.2 registered cases per 100,000 inhabitants. Female subjects were more prevalent (63%). The diagnostic delay was 11.8±11.3 years. The most common first symptoms in our patients were lower limb weakness, handgrip myotonia and limb pain, although some percentage of patients presented with cataracts or extrapyramidal symptoms and signs. Lens opacities were present in 75% of patients. Severe ECG abnormalities were noted in 8% and pacemaker was implanted in 5% of DM2 subjects. Pulmonary restriction was observed in 10% of DM2 patients. Insulin resistance and diabetes mellitus were frequent in our cohort (21% and 17%, respectively). Male subjects more frequently had snoring, baldness, sterility, polyneuropathy, lower HDL and higher glycaemia, while waddling gait and increased muscle reflexes were more common in females. This registry offers a spectrum of different features presented in Serbian DM2 population, which could be at service of earlier diagnosis and better treatment.

Risk factors for multidrug-resistant tuberculosis among tuberculosis patients in Serbia: a case-control study

BackgroundMultidrug resistant (MDR) tuberculosis (TB) represents TB which is simultaneous resistant to at least rifampicin (R) and isoniazid (H). Identifying inadequate therapy as the main cause of this form of the disease and explaining the factors leading to its occurrence, numerous social determinants that affect the risk of developing resistance are highlighted. The objectives of the study was to identify independent factors of MDR-TB among tuberculosis patients.MethodsCase-control study was conducted from 1st September 2009 to 1st June 2014 in 31 healthcare institutions in Serbia where MDR-TB and TB patients were treated. TB patients infected with MDR- M. tuberculosis and non MDR- M. tuberculosis strain were considered as cases and controls, respectively. Cases and controls were matched by the date of hospitalization. The data was collected using structured questionnaire with face to face interview. Bivariate and multivariable logistic regression analysis (MLRA) were used to identify determinants associated with MDR-TB.ResultsA total of 124 respondents, 31 cases and 93 controls were participated in the study. MLRA identified six significant independent risk factors for the occurrence of MDR-TB as follows: monthly income of the family (Odds ratio (OR) = 3.71; 95% Confidence Interval (CI) = 1.22–11.28), defaulting from treatment (OR = 3.33; 95% CI = 1.14–9.09), stigma associated with TB (OR = 2.97; 95% CI = 1.18–7.45), subjective feeling of sadness (OR = 4.05; 95% CI = 1.69–9.70), use of sedatives (OR = 2.79; 95% CI = 1.02–7.65) and chronic obstructive pulmonary disease (OR = 4.51; 95% CI = 1.07–18.96).ConclusionIn order to reduce burden of drug resistance, strategies of controlling MDR-TB in Serbia should emphasize multi-sectorial actions, addressing health care and social needs of TB patients.

Quality of life of laryngectomized patients in Serbia

Introduction/Objective. Total laryngectomy is a very mutilating operation and it leads to drastic changes in life quality. The purpose of this study was to examine factors of importance to the laryngectomized patients? quality of life and to evaluate characteristics of esophageal voice and speech. Methods. The study was conducted at the Clinic of Otorhinolaryngology and Maxillofacial Surgery, at the Clinical Center of Serbia (Belgrade, Serbia), during the period between March 2012?2015. The study included 223 patients diagnosed with laryngeal cancer, who underwent total laryngectomy. The total of 168 laryngectomized patients were provided with phoniatric rehabilitation. Results. The quality of life was significantly better for those laryngectomized patients who did undergo phoniatric rehabilitation. By means of intensive phoniatric rehabilitation the esophageal voice and speech was established in 86.3% of laryngectomized patients registered by objective acoustic analysis. Rehabilitated laryngectomy patients had a significantly lower presence of voice handicap sense (VHI: 19.57 ?} 7.35) and expressed significantly lower symptoms of depression and anxiety (PHQ-9: 3.8 ?} 4.2; GAD-7: 3.4 ?} 4.2). Cronbach?s alpha coefficient was above 0.7 EORTC QLQ-C30 on three levels of Likert scales: the scale of physical and emotional functioning and fatigue; as well as EORTC QLQ-H&N43 questionnaire: the symptoms of head and neck pain, speech, swallowing and eating problems and body image. Conclusion. Significantly improving the quality of life of laryngectomized patients was achieved by a multidisciplinary rehabilitation. Phoniatric rehabilitation carried out in a planned and systematic way is the most efficient rehabilitation of laryngectomized patients.

Analiza primene antidepresiva u Republici Srbiji od 2013. do 2015. godine

Introduction: Depression is a chronic mental disorder that causes changes in mood, thoughts, behavior and physical health. According to the World Health Organization (WHO) 350 million people worldwide are said to suffer from this mental disorder. This explains why antidepressants are widely used. Aim: The aim of this study was to analyze the use of antidepressants in Serbia, Norway and Finland from 2013 to 2015. Methods: The data about the use of antidepressants in Serbia, Norway and Finland in 2013, 2014 and 2015 was taken from the Agency for Drugs and Medical Devices of the Republic of Serbia, the sites of Norwegian Institute of Public Health, and Finish Agency for Drugs Fimea. Results: Large number of depressed patients and smaller number of antidepressants used in Serbia compared to Finland and Norway in 2013, 2014 and 2015 can be explained by a different socioeconomic status and different health system in those three countries. Patients in Serbia are underdiagnosed and undertreated due to a failure of the primary care physicians to identify depressed patients, so that those can be treated by a psychiatrist at the secondary health care level. Sertralin is the first-choice medication in Serbia compared to escitalopram in Norway and Finland. Escitalopram has the highest probability of remission of the investigated antidepressants and is the most effective and cost-effective pharmacological treatment strategy for depression in a primary care setting. Conclusion: The consumption of antidepressants in Serbia increased in 2015 compared to 2013, but was still significantly less in Serbia in 2013, 2014 and 2015 compared to Finland and Norway, pharmacotherapeutically developed countries. Medications consumed the most in all 3 countries in 2013, 2014 and 2015 were selective serotonin reuptake inhibitors. Sertraline was the most widely used antidepressant in Serbia in 2015, while escitalopram was mostly used antidepressant in Norway and Finland.

0052 - The Radiological and Clinical Assessment of a Cohort of AIS Patients in Serbia and Bulgaria

ABSTRACT: Previous studies have established that there is no definitive correlation for all curve types between the progression of a scoliosis and changes in body asymmetry but for many patients the motivation in seeking treatment is the improvement of their appearance rather than to correct an underlying skeletal deformity. Cosmetic concerns, quality of life and the psychosocial impacts of adolescent idiopathic scoliosis remain important factors in any clinical decision-making process. In conjunction with conventional radiologically derived measures, the addition of validated body asymmetry metrics should be included when designing patient specific treatment plans and assessing outcomes. Consolidating radiological diagnoses (Cobb angle, curve type) and clinical assessment data from groups of patients has additional value in the longitudinal assessment of the relative efficacy of differing clinical interventions within physical medicine.