Browsing by Author "Bjegovic, Vesna (6602428758)"

The Albanian Forum of Public Health (AFPH), an umbrella organization including different public health associations operating in Albania, was established in March 2004 with the support of the European Public Health Association (EUPHA) and the Open Society Institute (OSI). Ever since its establishment the AFPH has been an open arena wherein opinions and options for rational health policies comprising all relevant issues of the New Public Health are discussed, formulated, and documented near the Albanian Ministry of Health. Notwithstanding the laudable mission of the AFPH, there is an emerging need to establish a regional Public Health Forum in south-east Europe as a basic prerequisite for sustainable development of public health in these countries. Most conveniently, this regional umbrella organization should have a supporting Secretariat based in one of the south-east European countries. Nevertheless, there is a clear call for international funding with participation of different agencies and bodies (OSI, EUPHA, Canadian International Development Agency, and the Stability Pact). A regional association in the south-east Europe would enable the organization of annual conferences in the most renowned institutions in the region. Also, a regional collaboration among public health associations would be a suitable start for the development of research in south-east Europe. Furthermore, the existence of a regional public health association would make feasible the establishment of a scientific public health journal for south-east Europe in the English language. © The Author 2006. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

To provide estimates of cardiovascular disease burden to guide future health strategies and interventions and enable improvements in health and performance of the health care system to be monitored. A descriptive study. The study was performed in Serbia without Kosovo and Metohia for the year 2000. Disability-adjusted life years (DALY) was used to provide a comprehensive assessment of premature mortality (years of life lost; YLL) and disability attributable (years lived with disability; YLD) to ischaemic heart disease (IHD) and cerebrovascular diseases, and to estimate the attributable and avoidable burden of these diseases caused by smoking, hypertension, overweight/obesity, physical inactivity, alcohol consumption and an inadequate consumption of fruit and vegetables. IHD was responsible for 150 889 DALY (16.28/1000 population), and cerebrovascular diseases were responsible for 136 090 DALY (14.49/1000 population). There were considerably more YLL for both IHD and stroke than YLD. For both diseases DALY rates increased with ageing in men and women. The risk factors most responsible for IHD and stroke burden were smoking, physical inactivity, hypertension and overweight/obesity. Sex and age differences were present in the burden attributable to various risk factors. Despite limitations the DALY estimates represent a useful measure of the size of the health problem. The DALY and related estimates for cardiovascular disease can be used as a guide for the prevention of IHD and stroke as well as the evaluation of future health gains by reducing population exposure to lifestyle and related risk factors. © 2006, European Society of Cardiology. All rights reserved.

Objective: To describe the prevalence of intimate partner violence and associated factors among married women in Albania. Design: Cross sectional study. Setting: Tirana, the capital city of Albania. Participants: A representative sample of 1039 married women aged 25-65 living in Tirana and recorded in the 2001 census. Methods: Questionnaire on intimate partner violence and social and demographic characteristics of the women and their husbands. Main outcome measure: Women's experience within the past year of being hit, slapped, kicked, or otherwise physically hurt by the husband. Results: More than a third (37%, 384/1039) of women had experienced violence. Risk was greatest among women aged 25-34 (odds ratio 1.47, 95% CI 1.04 to 2.09), women with tertiary education (3.70, 2.04 to 6.67), women in white collar jobs (4.0,1.59 to 10.0), women with least educated husbands (5.01, 2.91 to 8.64), and women married to men raised in rural areas (3.31, 2.29 to 4.80). Women were at higher risk if they were more educated than their husbands (4.76, 2.56 to 9.09). Conclusions: In transitional Albania, the risk of spousal violence is high, and more empowered women are at greater risk.

Objectives: The purpose of this study was to analyze the improvement of managerial skills of hospitals' top managers after a specific management training programme, and to explore possible predictors and relations. Methods: The study was conducted during the years 2006 and 2007 with cohort of 107 managers from 20 Serbian general hospitals. The managers self-assessed the improvement in their managerial skills before and after the training programme. Results: After the training programme, all managers' skills had improved. The biggest improvement was in the following skills: organizing daily activities, motivating and guiding others, supervising the work of others, group discussion, and situation analysis. The least improved were: applying creative techniques, working well with peers, professional self-development, written communication, and operational planning. Identified predictors of improvement were: shorter years of managerial experience, type of manager, type of profession, and recognizing the importance of the managerial skills in oral communication, evidence-based decision making, and supervising the work of others. Conclusions: Specific training programme related to strategic management can increase managerial competencies, which are an important source of competitive advantage for organizations. © 2010 Elsevier Ireland Ltd.

Introduction: Conflicts, social unrest, and disasters can significantly affect the ability of a healthcare system to provide for the needs of its citizens. The collapse of the primary healthcare system in Serbia is a model of the effects that civil unrest can have on the health of a population. However, with improving social and political conditions, focus now can be turned towards the greatly needed development and reorganization of the primary healthcare system in Serbia. Due to the complexity of health-system reform in the post-conflict/post-disaster setting, attempts to restructure health services are fraught with pitfalls that often are unanticipated because of inadequate preliminary assessments. A multimodal assessment involving quantitative and qualitative methodologies may provide a more robust mechanism to identify key programmatic priorities and critical barriers for appropriate and sustainable health-system interventions. The purpose of this study is to describe a multimodal assessment using primary healthcare in post-conflict Serbia as a model.Methods: Integrated quantitative and qualitative methodologies - system characterization and observation, focus group discussions, free-response questionnaires, and Q-methodology - were used to identify needs, problems, and potential barriers to primary healthcare development in Serbia. Participants included primary healthcare providers and administrators from 13 institutions throughout Belgrade.Results: Demographic data indicate a well-established infrastructure of primary health centers and stations. However, focus group discussions and free-response questionnaires reveal significant impediments to delivery of care: (1) Inadequate equipment, supplies, and medications; (2) Poor financial investment; (3) Discouraging worker salaries; (4) Few opportunities for professional development; and (5) Little emphasis on or respect for primary healthcare. Q-methodology of provider perceptions and opinions supports these concerns, shows remarkable consensus among participants, and provides further insights toward system development by grouping respondents into distinctive types.Conclusions: This study identified the critical needs and barriers to development of primary healthcare in Serbia. This combined methodology may serve as a model for future health system assessments in the post-conflict and post-disaster settings. © World Association for Disaster and Emergency Medicine 2003.

Introduction: Conflicts, social unrest, and disasters can significantly affect the ability of a healthcare system to provide for the needs of its citizens. The collapse of the primary healthcare system in Serbia is a model of the effects that civil unrest can have on the health of a population. However, with improving social and political conditions, focus now can be turned towards the greatly needed development and reorganization of the primary healthcare system in Serbia. Due to the complexity of health-system reform in the post-conflict/post-disaster setting, attempts to restructure health services are fraught with pitfalls that often are unanticipated because of inadequate preliminary assessments. A multimodal assessment involving quantitative and qualitative methodologies may provide a more robust mechanism to identify key programmatic priorities and critical barriers for appropriate and sustainable health-system interventions. The purpose of this study is to describe a multimodal assessment using primary healthcare in post-conflict Serbia as a model.Methods: Integrated quantitative and qualitative methodologies - system characterization and observation, focus group discussions, free-response questionnaires, and Q-methodology - were used to identify needs, problems, and potential barriers to primary healthcare development in Serbia. Participants included primary healthcare providers and administrators from 13 institutions throughout Belgrade.Results: Demographic data indicate a well-established infrastructure of primary health centers and stations. However, focus group discussions and free-response questionnaires reveal significant impediments to delivery of care: (1) Inadequate equipment, supplies, and medications; (2) Poor financial investment; (3) Discouraging worker salaries; (4) Few opportunities for professional development; and (5) Little emphasis on or respect for primary healthcare. Q-methodology of provider perceptions and opinions supports these concerns, shows remarkable consensus among participants, and provides further insights toward system development by grouping respondents into distinctive types.Conclusions: This study identified the critical needs and barriers to development of primary healthcare in Serbia. This combined methodology may serve as a model for future health system assessments in the post-conflict and post-disaster settings. © World Association for Disaster and Emergency Medicine 2003.

The modern concept of public health, the New Public Health, carries a great potential for healthy and therefore less aggressive societies. Its core disciplines are health promotion, environmental health, and health care management based on advanced epidemiological methodologies. The main principles of living together in healthy societies can be summarized as four ethical concepts of the New Public Health essential to violence reduction - equity, participation, subsidiarity, and sustainability. The following issues are discussed as violence's determinants: the process of urbanization; type of neighborhood and accommodation, and consequent stigmatization; level of education; employment status; socialization of the family; women's status; alcohol and drug consumption; availability of the firearms; religious, ethnic, and racial prejudices; and poverty. Development of the health systems has to contribute to peace, since aggression, violence, and warfare are among the greatest risks for health and the economic welfare. This contribution can be described as follows: 1) full and indiscriminate access to all necessary services, 2) monitoring of their quality, 3) providing special support to vulnerable groups, and 4) constant scientific and public accountability of the evaluation of the epidemiological outcome. Violence can also destroy solidarity and social cohesion of groups, such as family, team, neighborhood, orany other social organization. Durkheim coined the term "anomie" for a state in which social disruption of the community results in health risks for individuals. Health professionals can make a threefold contribution to peace by 1) analyzing the causal interrelationships of violence phenomena, 2) curbing the determinants of violence according to the professional standards, and 3) training professionals for this increasingly important task. Because tolerance is an essential part of an amended definition of health, monitoring of the early signs of public intolerance is important. The vital interplay between the informed public and efficient administration, however, can only exist in an open society. The link between democracy and health of the people, and between public health and economic welfare is real. The Public Health Collaboration in South Eastern Europe (PH-SEE) evolved just in time to reconnect and strengthen disrupted professional networks in the region as a prerequisite of effective public health action.

It is argued that each country of South Eastern Europe should have its own school of public health. However, a basic prerequisite of modern public health training is the comprehensiveness of the programme and a worldview approach. Most of the countries of South Eastern Europe face the same difficulties to adapt their inherited communist structures of public health training to Western standards. A regional collaboration would facilitate the process of establishing schools of public health in all countries of the region and support the training of public health professionals at all levels. Key Points asterisk inside a circle sign South East Europe includes Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Macedonia, Moldavia, Romania, Serbia and Montenegro, and Slovenia. asterisk inside a circle sign Public health institutions in South East Europe face similar difficulties to adapt their inherited teaching structures to Western standards. asterisk inside a circle sign Public health institutions in South East Europe should make a joint effort towards establishing regional training programmes. asterisk inside a circle sign A regional approach in public health training would enable an efficient use of resources in countries of South East Europe. © European Public Health Association 2005; all rights reserved.

Two recent developments have redirected the course of Public Health in Europe - the Public Health Mandate of the European Commission and the conceptualization of a New Public Health. For the transition, countries in South Eastern Europe, particularly Serbia, provide support to essential public health reforms in four areas: strategic management, public health information, public health legislation, and public health training and research. The roles of the Dubrovnik Pledge (2001) and the Stability Pact, which has international support, have been central. © 2007 Palgrave Macmillan Ltd.

The purpose of this study was to analyse whether the nationwide application of the national Serbian guideline for diabetes mellitus (NSGDM) would save a relevant amount of disability-adjusted life years (DALYs) and/or reduce the medical cost of treating diabetic patients in Serbia, as compared to the present situation. Disability-adjusted life years were calculated for Serbia and the cost-effectiveness was analysed in eight population groups under ideal and present conditions; prevalent and incident cases were each split up for patients with blood glucose that was well controlled and that was uncontrolled. Under ideal conditions, i.e., according to the NSGDM, 8,031 DALYs could be saved with a potential cost reduction at the same time of approximately 19 million Euros. The implementation of the NSGDM in clinical practice bears a great potential to save lives and reduce years lived with lowered quality of life, but in addition it may reduce costs by about a quarter. © 2006 Springer-Verlag.

The purpose of this study was to analyse whether the nationwide application of the national Serbian guideline for diabetes mellitus (NSGDM) would save a relevant amount of disability-adjusted life years (DALYs) and/or reduce the medical cost of treating diabetic patients in Serbia, as compared to the present situation. Disability-adjusted life years were calculated for Serbia and the cost-effectiveness was analysed in eight population groups under ideal and present conditions; prevalent and incident cases were each split up for patients with blood glucose that was well controlled and that was uncontrolled. Under ideal conditions, i.e., according to the NSGDM, 8,031 DALYs could be saved with a potential cost reduction at the same time of approximately 19 million Euros. The implementation of the NSGDM in clinical practice bears a great potential to save lives and reduce years lived with lowered quality of life, but in addition it may reduce costs by about a quarter. © 2006 Springer-Verlag.

The transition countries in the region of South Eastern Europe (SEE) share the historical burden of communism and four centuries of Ottoman dominance. In spite of deep, inherited rifts, they are going to develop multilateral collaboration as expressed in the Dubrovnik Declaration of 2001. Recently, a common public health strategy was drafted and a regional Forum for Public Health agreed upon. This special issue of the Journal of Public Health provides an overview of relevant developments in SEE with reference to new schools of public health and national public health associations. © Springer-Verlag 2006.

Huge population migration, increasing unemployment and poverty and unhealthy lifestyles (stress, smoking, alcohol consumption, etc), among the population in Serbia, are some of the consequences of the political and economic instability in the Balkan region over the last decade (especially in countries of the former Yugoslavia). Data available reveal that, in Serbia, chronic noncommunicable diseases are the dominant cause of death. The National Burden of Disease and Injury Study, done in 2003, showed that cardiovascular diseases, cancers and injuries are responsible for 80% of the total mortality burden in both males and females. The health-care system of Serbia is excessively centralized. The public health services are based on the traditional hygiene and clinical approach and are predominantly organized through a network of Institutes of Public Health which puts insufficient emphasis on analytical and planning tasks and on health promotion (including the prevention of chronic noncommunicable diseases), and too much emphasis on routine reporting and on activities of a technical and laboratory nature in the field of communicable diseases. Today, with the aid of the EU, UNICEF, the World Bank and NGOs, the Ministry of Health is in the process of expanding the capacities and skills of the public health workforce in order to achieve the "New Public Health". Although progress has been made on several important fronts in achieving the transition to the New Public Health, this does not yet extend to the wider community. Policy documents and legislative instruments have been drafted to guide the reorganization and reorientation of the public health services, especially the network of Institutes of Public Health, and the creation of the Centre School of Public Health has secured the future of professional public health training. The authors argue that the reform of the health sector should be placed within the context of the overall reform of public administration in the country. In this respect, much of the journey still lies ahead, but experience within public health can be used to stimulate, motivate and encourage professionals throughout the civil service to grasp the opportunities for positive change with both hands. © Springer-Verlag 2005.

Objectives: Effective hypertension control remains low without much improvement since the 1990s. However, information is limited whether and how social status impacts on hypertension control. Methods: Data from the German Health Survey 1998 are used to explore the role of social status according to educational achievement in treating hypertension, adjusted for key determinants in a logistic regression. Results: Actual as well as population prevalence (≥140 mmHg/≥90 mmHg) is highest in the lowest of the three social classes with 59.4 and 51.9% as compared to 44.5 and 40.5% in the highest. Physician contacts during the previous year were also highest in the lower class with 76.0% as compared to 59.0% in the highest. The logistic regression revealed insignificant odds ratios (OR) of 1.46 for the highest and 1.12 for the middle class for treatment of known hypertension after adjusting for gender (OR for females, 1.38), age (OR for 60-69 years, 13.13), GP visits (OR, 1.43) and living in East Germany (OR, 1.56). Conclusions: German survey data for antihypertensive treatment do not show any significant disadvantage for the lowest social class. © 2011 Swiss School of Public Health.

Objective: To provide an assessment of the mortality burden in Serbia (excluding Kosovo and Metohia). Methods: The study was undertaken using data for Serbia, excluding Kosovo and Metohia, for the year 2000. Years of life lost (YLL), the mortality component of disability-adjusted life years, was determined from the average life expectancy at each age of death while discounting future years by 3% per annum. YLL was calculated using life expectancy at that age based on standard life tables, with life expectancy at birth fixed at 82.5 years for females and 80.0 years for males. Results: Premature mortality was responsible for 814,022 YLL, after discounting future years at 3% per annum and weighting for age. Males lost 462,050 years and females lost 351,972 years. Cardiovascular diseases and cancers dominated the burden of premature mortality. Ischaemic heart disease was the leading single cause of YLL for males, followed by stroke, lung cancer, inflammatory heart disease, self-inflicted injuries, road traffic accidents, colorectal and stomach cancers, and chronic obstructive pulmonary disease. Each contributed over 10,000 YLL. For females, cerebrovascular disease was the leading cause of YLL, followed by ischaemic heart disease, breast and lung cancer, and diabetes mellitus. YLL due to premature death gives greater weight to those conditions that affect younger people. Consequently, a ranking of diseases by YLL differs from a ranking based on unadjusted numbers of deaths. In comparison with data from the Global Burden of Disease study (2000) for the world population and the EURO-A region, the mortality burden in Serbia is closer to that in developed than developing countries. Standardization was performed using the direct method, with the world population used as the standard. Conclusions: The national health priority areas, relevant to the mortality burden, should include cardiovascular diseases, cancers, diabetes mellitus, self-inflicted injuries and road traffic accidents. © 2007 The Royal Institute of Public Health.