Browsing by Author "Bjegovic-Mikanovic, Vesna (55848108800)"

Aim: An assessment of the training needs and interests of health managers working in the health care facilities of the Kyrgyz Republic was conducted, aiming to tailor and shape future training interventions. Methods: A rapid assessment was organized among directors of health care services in the Kyrgyz Republic, using a web-based questionnaire. Due to the pandemic situation (COVID-19), it was impossible to involve all healthcare facilities as initially planned. Therefore, a convenient sample of 75 directors was drawn with a response rate of 77.3%, or 58 filled-in questionnaires. Results: Among respondents, 60.3% were female and 39.7% male managers, with an average age of 53.5 years. Most of the respondents (89.7%) came to a managerial position by direct appointment, while only 10.3% were appointed through competitive process. More than half of health managers (63.8%) do not have any managerial category, and only 25.7% indicated that they have membership in the Association of Health Administrators of Kyrgyzstan1. All respondents reported the need to develop computer skills. Discussion: There is a high demand in all aspects of the management of health organizations. The respondents are deciding about involvement in management training based on (a) the full range of training' topics, (b) the quality of the training content, and (c) the focus on developing practical skills. The most cited training needs are digital health (E-Health), financing management, planning, and quality control; the interest in distance learning courses is excellent. Almost two-thirds of managers reported that the Ministry of Health and Social Development (MOHSD KR) did not evaluate their work. Conclusion: The main implications derived from this assessment are related to the culture of lifelong learning among the population of Kyrgyz health managers. © 2021 Bjegovic-Mikanovic et al;.

Aim: An assessment of the training needs and interests of health managers working in the health care facilities of the Kyrgyz Republic was conducted, aiming to tailor and shape future training interventions. Methods: A rapid assessment was organized among directors of health care services in the Kyrgyz Republic, using a web-based questionnaire. Due to the pandemic situation (COVID-19), it was impossible to involve all healthcare facilities as initially planned. Therefore, a convenient sample of 75 directors was drawn with a response rate of 77.3%, or 58 filled-in questionnaires. Results: Among respondents, 60.3% were female and 39.7% male managers, with an average age of 53.5 years. Most of the respondents (89.7%) came to a managerial position by direct appointment, while only 10.3% were appointed through competitive process. More than half of health managers (63.8%) do not have any managerial category, and only 25.7% indicated that they have membership in the Association of Health Administrators of Kyrgyzstan1. All respondents reported the need to develop computer skills. Discussion: There is a high demand in all aspects of the management of health organizations. The respondents are deciding about involvement in management training based on (a) the full range of training' topics, (b) the quality of the training content, and (c) the focus on developing practical skills. The most cited training needs are digital health (E-Health), financing management, planning, and quality control; the interest in distance learning courses is excellent. Almost two-thirds of managers reported that the Ministry of Health and Social Development (MOHSD KR) did not evaluate their work. Conclusion: The main implications derived from this assessment are related to the culture of lifelong learning among the population of Kyrgyz health managers. © 2021 Bjegovic-Mikanovic et al;.

Psychological distress in university students represents a rising public health concern. The complexity of this phenomenon calls for a more in-depth scrutiny, in order to address the wide diversity of mental health issues that may arise in this population. The instrument designed for the purpose of measuring the student-specific distress is needed. An appropriate tool is the Counseling Center Assessment of Psychological Symptoms 62 (CCAPS-62), multidimensional scale widely used at many universities. The objective of the present study was to translate, culturally adapt and psychometrically validate CCAPS-62 in Serbian student population. A total of 1326 Belgrade University students were recruited from twelve different faculties. Considering the possible culturally conditioned differences in the quality of distress both exploratory and confirmatory factor analyses were performed. The results of the exploratory factor analysis supported the eight-factor model with the item composition of the factors different to a certain extent from the original version. This measurement model was verified by confirmatory factor analysis. Findings demonstrated good internal consistency for the total scale as well as for the eight subscales applied among Serbian students. Implications are discussed with respect to the cultural context of mental health concerns in student population. © The Author(s) 2021. Published by Oxford University Press. All rights reserved.

Psychological distress in university students represents a rising public health concern. The complexity of this phenomenon calls for a more in-depth scrutiny, in order to address the wide diversity of mental health issues that may arise in this population. The instrument designed for the purpose of measuring the student-specific distress is needed. An appropriate tool is the Counseling Center Assessment of Psychological Symptoms 62 (CCAPS-62), multidimensional scale widely used at many universities. The objective of the present study was to translate, culturally adapt and psychometrically validate CCAPS-62 in Serbian student population. A total of 1326 Belgrade University students were recruited from twelve different faculties. Considering the possible culturally conditioned differences in the quality of distress both exploratory and confirmatory factor analyses were performed. The results of the exploratory factor analysis supported the eight-factor model with the item composition of the factors different to a certain extent from the original version. This measurement model was verified by confirmatory factor analysis. Findings demonstrated good internal consistency for the total scale as well as for the eight subscales applied among Serbian students. Implications are discussed with respect to the cultural context of mental health concerns in student population. © The Author(s) 2021. Published by Oxford University Press. All rights reserved.

Europeanization is assumed to influence health policy in the Western Balkans, but little is known about the actual impact of this process in these countries which constitute a complex geopolitical region of Europe. In this context, we used time trends to explore the Western Balkans health policies during the Europeanization through a cross-country comparative analysis of six countries. We conducted a health policy analysis by adapting the framework for globalization and population health coined by Huynen et al. in 2005. We analyzed 90 progress reports of Albania, Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia and Serbia from 2005 to 2020. In particular, we considered chapter 28 on “Consumer and health protection” and other chapters that contained the words “health” or “population health”. Evidence indicates that Europeanization influences Western Balkans’ policies at different levels. Western Balkan countries revise national legislation in accordance with new European Union acquis as addressed in the progress reports and build cooperation with international institutions. They build national health reforms and reorganize relevant institutions to better address regulations in accordance to Europeanization. However, it is necessary to monitor law implementation so that the current legislation is enforced and further positive impact can be measured on population health. © 2022

Background: Global evaluations of the progress towards the WHO End TB Strategy 2020 interim milestones on mortality (35% reduction) and incidence (20% reduction) have not been age specific. We aimed to assess global, regional, and national-level burdens of and trends in tuberculosis and its risk factors across five separate age groups, from 1990 to 2021, and to report on age-specific progress between 2015 and 2020. Methods: We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) analytical framework to compute age-specific tuberculosis mortality and incidence estimates for 204 countries and territories (1990–2021 inclusive). We quantified tuberculosis mortality among individuals without HIV co-infection using 22 603 site-years of vital registration data, 1718 site-years of verbal autopsy data, 825 site-years of sample-based vital registration data, 680 site-years of mortality surveillance data, and 9 site-years of minimally invasive tissue sample (MITS) diagnoses data as inputs into the Cause of Death Ensemble modelling platform. Age-specific HIV and tuberculosis deaths were established with a population attributable fraction approach. We analysed all available population-based data sources, including prevalence surveys, annual case notifications, tuberculin surveys, and tuberculosis mortality, in DisMod-MR 2.1 to produce internally consistent age-specific estimates of tuberculosis incidence, prevalence, and mortality. We also estimated age-specific tuberculosis mortality without HIV co-infection that is attributable to the independent and combined effects of three risk factors (smoking, alcohol use, and diabetes). As a secondary analysis, we examined the potential impact of the COVID-19 pandemic on tuberculosis mortality without HIV co-infection by comparing expected tuberculosis deaths, modelled with trends in tuberculosis deaths from 2015 to 2019 in vital registration data, with observed tuberculosis deaths in 2020 and 2021 for countries with available cause-specific mortality data. Findings: We estimated 9·40 million (95% uncertainty interval [UI] 8·36 to 10·5) tuberculosis incident cases and 1·35 million (1·23 to 1·52) deaths due to tuberculosis in 2021. At the global level, the all-age tuberculosis incidence rate declined by 6·26% (5·27 to 7·25) between 2015 and 2020 (the WHO End TB strategy evaluation period). 15 of 204 countries achieved a 20% decrease in all-age tuberculosis incidence between 2015 and 2020, eight of which were in western sub-Saharan Africa. When stratified by age, global tuberculosis incidence rates decreased by 16·5% (14·8 to 18·4) in children younger than 5 years, 16·2% (14·2 to 17·9) in those aged 5–14 years, 6·29% (5·05 to 7·70) in those aged 15–49 years, 5·72% (4·02 to 7·39) in those aged 50–69 years, and 8·48% (6·74 to 10·4) in those aged 70 years and older, from 2015 to 2020. Global tuberculosis deaths decreased by 11·9% (5·77 to 17·0) from 2015 to 2020. 17 countries attained a 35% reduction in deaths due to tuberculosis between 2015 and 2020, most of which were in eastern Europe (six countries) and central Europe (four countries). There was variable progress by age: a 35·3% (26·7 to 41·7) decrease in tuberculosis deaths in children younger than 5 years, a 29·5% (25·5 to 34·1) decrease in those aged 5–14 years, a 15·2% (10·0 to 20·2) decrease in those aged 15–49 years, a 7·97% (0·472 to 14·1) decrease in those aged 50–69 years, and a 3·29% (–5·56 to 9·07) decrease in those aged 70 years and older. Removing the combined effects of the three attributable risk factors would have reduced the number of all-age tuberculosis deaths from 1·39 million (1·28 to 1·54) to 1·00 million (0·703 to 1·23) in 2020, representing a 36·5% (21·5 to 54·8) reduction in tuberculosis deaths compared to those observed in 2015. 41 countries were included in our analysis of the impact of the COVID-19 pandemic on tuberculosis deaths without HIV co-infection in 2020, and 20 countries were included in the analysis for 2021. In 2020, 50 900 (95% CI 49 700 to 52 400) deaths were expected across all ages, compared to an observed 45 500 deaths, corresponding to 5340 (4070 to 6920) fewer deaths; in 2021, 39 600 (38 300 to 41 100) deaths were expected across all ages compared to an observed 39 000 deaths, corresponding to 657 (–713 to 2180) fewer deaths. Interpretation: Despite accelerated progress in reducing the global burden of tuberculosis in the past decade, the world did not attain the first interim milestones of the WHO End TB Strategy in 2020. The pace of decline has been unequal with respect to age, with older adults (ie, those aged >50 years) having the slowest progress. As countries refine their national tuberculosis programmes and recalibrate for achieving the 2035 targets, they could consider learning from the strategies of countries that achieved the 2020 milestones, as well as consider targeted interventions to improve outcomes in older age groups. Funding: Bill & Melinda Gates Foundation. © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license

With the growing prevalence and complex pathophysiology of type 2 diabetes, many patients fail to achieve treatment goals despite guidelines and possibilities for treatment individualization. One of the identified root causes of this failure is clinical inertia. We explored this phenomenon, its possible predictors, and groups of patients affected the most, together with offering potential paths for intervention. Our research was a cross-sectional study conducted during 2021 involving 52 physicians and 543 patients of primary healthcare institutions in Belgrade, Serbia. The research instruments were questionnaires based on similar studies, used to collect information related to the factors that contribute to developing clinical inertia originating in both physicians and patients. In 224 patients (41.3%), clinical inertia was identified in patients with poor overall health condition, long diabetes duration, and comorbidities. Studying the changes made to the treatment, most patients (53%) had their treatment adjustment more than a year ago, with 19.3% of patients changing over the previous six months. Moreover, we found significant inertia in the treatment of patients using modern insulin analogues. Referral to secondary healthcare institutions reduced the emergence of inertia. This assessment of primary care physicians and their patients pointed to the high presence of clinical inertia, with an overall health condition, comorbidities, diabetes duration, current treatment, last treatment change, glycosylated hemoglobin and fasting glucose measuring frequency, BMI, patient referral, diet adjustment, and physician education being significant predictors. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

With the growing prevalence and complex pathophysiology of type 2 diabetes, many patients fail to achieve treatment goals despite guidelines and possibilities for treatment individualization. One of the identified root causes of this failure is clinical inertia. We explored this phenomenon, its possible predictors, and groups of patients affected the most, together with offering potential paths for intervention. Our research was a cross-sectional study conducted during 2021 involving 52 physicians and 543 patients of primary healthcare institutions in Belgrade, Serbia. The research instruments were questionnaires based on similar studies, used to collect information related to the factors that contribute to developing clinical inertia originating in both physicians and patients. In 224 patients (41.3%), clinical inertia was identified in patients with poor overall health condition, long diabetes duration, and comorbidities. Studying the changes made to the treatment, most patients (53%) had their treatment adjustment more than a year ago, with 19.3% of patients changing over the previous six months. Moreover, we found significant inertia in the treatment of patients using modern insulin analogues. Referral to secondary healthcare institutions reduced the emergence of inertia. This assessment of primary care physicians and their patients pointed to the high presence of clinical inertia, with an overall health condition, comorbidities, diabetes duration, current treatment, last treatment change, glycosylated hemoglobin and fasting glucose measuring frequency, BMI, patient referral, diet adjustment, and physician education being significant predictors. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Background: European Essential Public Health Operations (EPHOs) supposedly drive improvements in public health outcomes, including Schools and Departments of Public Health (SPHs). Overall, SPHs did not progress significantly in delivering outcomes related to the EPHOs between 2011 (Survey I) and 2015/16 (Survey II). This analysis attempts to identify the positive or negative development of individual SPHs. Methods: The analysis has utilized data obtained from SPHs through questionnaire-based surveys, which contained information about learning outcomes of Master of Public Health (MPH) programs necessary for the implementation of EPHOs. To differentiate the progress of SPHs, we applied cluster analyses for a group of 36 SPHs with complete data sets for both surveys. Results: The statistical analysis identified three clusters for Survey I and Survey II, defined by their medians and position vectors. A comparison shows that between the two surveys, all clusters overlap and thus are not significantly different. Of the individual SPHs, 16 of 36 (44.4%) improved between 2011 and 2015/16 according to the increased magnitude of their position vector, whereas 9 SPHs (25.0%) show significant progress at P<0.05. From the 20 SPHs (55.6%) that decreased their performance, 11 (30.6%) showed a significant reduction in the outcome of Master of Public Health programs at P<0.05. This outcome implies that N=20 or 55.6% of the participating SPHs evidenced substantial changes. Analysis of 11 available nominal variables did not significantly explain the cluster positions in Survey I and II. Conclusions: Overall, there is no significant progress in the performance of SPHs between 2011 and 2015/16. However, detailed cluster analysis can demonstrate considerable progress for one-fifth of participating SPHs, whereas more than half lag. © Journal of Public Health and Emergency. All rights reserved.

Background: Despite effective prevention and control strategies, in countries of the Balkan region, cancers are the second leading cause of mortality, closely following circulatory system diseases. Objective: To describe trends in the burden of breast, cervical, and colon and rectum cancer in the Balkan region and per country between 1990 and 2019, including a forecast to 2030. Methods: We described the 2019 Global Burden of Disease (GBD) estimates for breast, cervical, and colon and rectum cancers in eleven Balkan countries over the period 1990–2019, including incidence, years lived with disability (YLD), years of life lost (YLL), and disability-adjusted life years (DALYs) rates per 100,000 population and accompanied 95% uncertainty interval. With the Autoregressive Integrated Moving Average, we forecasted these rates per country up to 2030. Results: In the Balkan region, the highest incidence and DALYs rates in the study period were for colon and rectum, and breast cancers. Over the study period, the DALYs rates for breast cancer per 100,000 population were the highest in Serbia (reaching 670.84 in 2019) but the lowest in Albania (reaching 271.24 in 2019). In 2019, the highest incidence of breast cancer (85 /100,000) and highest YLD rate (64 /100,000) were observed in Greece. Romania had the highest incidence rates, YLD rates, DALY rates, and YLL rates of cervical cancer, with respective 20.59%, 23.39% 4.00%, and 3.47% increases for the 1990/2019 period, and the highest forecasted burden for cervical cancer in 2030. The highest incidence rates, YLD rates and DALY rates of colon and rectum cancers were continuously recorded in Croatia (an increase of 130.75%, 48.23%, and 63.28%, respectively), while the highest YLL rates were in Bulgaria (an increase of 63.85%). The YLL rates due to colon and rectum cancers are forecasted to progress by 2030 in all Balkan countries. Conclusion: As most of the DALYs burden for breast, cervical, and colon and rectum cancer is due to premature mortality, the numerous country-specific barriers to cancer early detection and quality and care continuum should be a public priority of multi-stakeholder collaboration in the Balkan region. © 2023, BioMed Central Ltd., part of Springer Nature.