Browsing by Author "Milicevic, Milena Santric (57209748201)"

The policy dialog on human resource in health care is one of the central issues of the ongoing health care system reform in the Republic of Serbia. Pharmacists are the third largest health care professional group, after nurses and doctors. This study's objective was to analyze population coverage with pharmacists employed in the public sector of health care system of Serbia during 1961 - 2007, and to project their density by 2017. In this respect, additionally, time-series of annual number of enrolled and graduate pharmacy students were modelled. Time trends of routinely collected national statistical data, concerning the pharmacists, were analyzed by join point regression program, according to grid-search method. During the observed period of time, in Serbia, pharmacist workforce production and deployment trends were generally positive, but with different annual dynamic. Key findings were the slow rise of pharmacist workforce density rates per 100,000 population; the insufficient balance between pharmacists workforce supply side (annual number of enrolled and graduated students) and the public health care sector's ability to absorb annual number of pharmacy graduates. For ten years ahead, density rates of publicly active pharmacist workforce would probably increase for 46%, if no policy interventions were planned to adverse trends of pharmacist workforce production and deployment in public health care sector. The study results may be useful for variety of stakeholders to better understand how and why the supply and deployment of pharmacists were changing; and that the coordination among policy interventions is a crucial successes factor for a health workforce development plan implementation. The repercussions of any changes made to the pharmacy workforce, need to be considered carefully in advance.

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: The coronavirus disease 2019 (COVID-19) pandemic affected antibiotic usage worldwide. However, there is limited data from Serbia. Dispensing of oral antibiotics in Serbian pharmacies was analyzed to calculate monthly and yearly changes between 2018-2021, and to explore immediate and long-term effects of COVID-19 on antibiotic dispensing during this period. Methodology: The number of antibiotic packages dispensed from pharmacies during the study period was analyzed with a Chi-square test to assess the average change in annual dispensing, and an interrupted time-series analysis was used to evaluate the impact of the pandemic on antibiotic dispensing. The data from 2018-2021 were retrieved from the database of a large community pharmacy chain in Serbia. Results: The average number of antibiotic packages dispensed per day and per pharmacy was higher in 2021 compared to 2018 by one package. However, the dispensing of macrolides increased significantly; 17.7% (2018) vs. 22.5% (2021) (p < 0.05). In general, an increase in antibiotic dispensing was detected during COVID-19 for total antibiotics (16.4%), Watch antibiotics (44.8%), third-generation cephalosporins (80.4%), macrolides (45.5%) and azithromycin (83.7%). However, the immediate effect of COVID-19 was a decrease in the dispensing of Watch antibiotics, penicillin, and third-generation cephalosporins (p < 0.05); and a notable long-term COVID-19 effect was an increase in the dispensing of azithromycin (p < 0.05). Conclusions: In spite of a relatively stable trend of total antibiotic dispensing before and during COVID-19 pandemic, the use of Watch antibiotics, third-generation cephalosporins, and macrolides (particularly azithromycin) showed an increasing trend in dispensing that should be optimized. © 2024 Tomic et al.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic affected antibiotic usage worldwide. However, there is limited data from Serbia. Dispensing of oral antibiotics in Serbian pharmacies was analyzed to calculate monthly and yearly changes between 2018-2021, and to explore immediate and long-term effects of COVID-19 on antibiotic dispensing during this period. Methodology: The number of antibiotic packages dispensed from pharmacies during the study period was analyzed with a Chi-square test to assess the average change in annual dispensing, and an interrupted time-series analysis was used to evaluate the impact of the pandemic on antibiotic dispensing. The data from 2018-2021 were retrieved from the database of a large community pharmacy chain in Serbia. Results: The average number of antibiotic packages dispensed per day and per pharmacy was higher in 2021 compared to 2018 by one package. However, the dispensing of macrolides increased significantly; 17.7% (2018) vs. 22.5% (2021) (p < 0.05). In general, an increase in antibiotic dispensing was detected during COVID-19 for total antibiotics (16.4%), Watch antibiotics (44.8%), third-generation cephalosporins (80.4%), macrolides (45.5%) and azithromycin (83.7%). However, the immediate effect of COVID-19 was a decrease in the dispensing of Watch antibiotics, penicillin, and third-generation cephalosporins (p < 0.05); and a notable long-term COVID-19 effect was an increase in the dispensing of azithromycin (p < 0.05). Conclusions: In spite of a relatively stable trend of total antibiotic dispensing before and during COVID-19 pandemic, the use of Watch antibiotics, third-generation cephalosporins, and macrolides (particularly azithromycin) showed an increasing trend in dispensing that should be optimized. © 2024 Tomic et al.

Background: Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. Methods: We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. Results: We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables. Conclusions: Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability of injury BoD estimates across Europe and beyond. © 2022, The Author(s).

Effective pain management can significantly improve quality of life and outcomes for various types of patients (e.g. elderly, adult, young) and often requires assisted living for a significant number of people worldwide. In order to improve our understanding of patients' response to pain and needs for assisted living we need to develop adequate data processing techniques that would enable us to understand underlying interdependencies. To this purpose in this paper we develop several different algorithms that can predict the need for medically assisted living outcomes using a large database obtained as a part of the national health survey. As a part of the survey the respondents provided detailed information about general health care state, acute and chronic problems as well as personal perception of pain associated with performing two simple talks: walking on the flat surface and walking upstairs. We model the correspondent responses using multinomial random variables and propose structured deep learning models based on maximum likelihood estimation and machine learning for information fusion. For comparison purposes we also implement fully connected deep learning network and use its results as benchmark measurements. We evaluate the performance of the proposed techniques using the national survey data and split them into two parts used for training and testing. Our preliminary results indicate that the proposed models can potentially be useful in forecasting the need for medically assisted living.Clinical relevance - The proposed results can potentially be used to forecast the resources needed to offer long-term medical care to both chronic and acute conditions patients not being able to preform daily tasks independently. © 2020 IEEE.

Effective pain management can significantly improve quality of life and outcomes for various types of patients (e.g. elderly, adult, young) and often requires assisted living for a significant number of people worldwide. In order to improve our understanding of patients' response to pain and needs for assisted living we need to develop adequate data processing techniques that would enable us to understand underlying interdependencies. To this purpose in this paper we develop several different algorithms that can predict the need for medically assisted living outcomes using a large database obtained as a part of the national health survey. As a part of the survey the respondents provided detailed information about general health care state, acute and chronic problems as well as personal perception of pain associated with performing two simple talks: walking on the flat surface and walking upstairs. We model the correspondent responses using multinomial random variables and propose structured deep learning models based on maximum likelihood estimation and machine learning for information fusion. For comparison purposes we also implement fully connected deep learning network and use its results as benchmark measurements. We evaluate the performance of the proposed techniques using the national survey data and split them into two parts used for training and testing. Our preliminary results indicate that the proposed models can potentially be useful in forecasting the need for medically assisted living.Clinical relevance - The proposed results can potentially be used to forecast the resources needed to offer long-term medical care to both chronic and acute conditions patients not being able to preform daily tasks independently. © 2020 IEEE.

We aimed to evaluate the prevalence of sociodemographic factors with the presence and different degrees of walking difficulties in elderly above 65 years, and to analyze association between evaluated variables and the presence and degree of waking difficulties. In the population based study, 3540 individuals age above 65 years from Serbia were recruited. Further predictors were analyzed: gender, age, level of education, marital status, body mass index (BMI), index of well-being and place of residence. We assessed difficulty in walking half a km on level ground without the use of any aid (Group-1); and difficulty in walking up or down 12 steps (Group-2). Walking difficulties were categorized as no difficulty, some difficulty, a lot of difficulty and cannot do at all. For present difficulty significant predictors were: age (Group-1 (OR-3.022)/Group-2 (OR-3.825)), gender (Group-1 (OR-0.337)/Group-2 (OR-0.311)), educational level (Group-1 (OR-0.689)/Group-2 (OR-0.556)) and place of residence (Group-2 (OR-1.523)) while for non-performing the task, significant predictors were: age (Group-1 (OR-1.998)/Group-2 (OR-2.096)), gender (Group-1 (OR-0.629)/Group-2 (OR-0.495)), BMI (Group-1 (OR-1.219)/Group-2 (OR-1.305)), marital status (Group-1 (OR 0.764)/Group-2 (OR-0.769)), educational level (Group-1 (OR-0.679)/Group-2 (OR-0.719)) and index of well-being (Group-2 (OR-0.764)). Understanding of predictors, and their role on functional decline in elderly is of great importance for the development of specific population-based health programs to prevent further functional loss and preserve achieved functional gains. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.

We aimed to evaluate the prevalence of sociodemographic factors with the presence and different degrees of walking difficulties in elderly above 65 years, and to analyze association between evaluated variables and the presence and degree of waking difficulties. In the population based study, 3540 individuals age above 65 years from Serbia were recruited. Further predictors were analyzed: gender, age, level of education, marital status, body mass index (BMI), index of well-being and place of residence. We assessed difficulty in walking half a km on level ground without the use of any aid (Group-1); and difficulty in walking up or down 12 steps (Group-2). Walking difficulties were categorized as no difficulty, some difficulty, a lot of difficulty and cannot do at all. For present difficulty significant predictors were: age (Group-1 (OR-3.022)/Group-2 (OR-3.825)), gender (Group-1 (OR-0.337)/Group-2 (OR-0.311)), educational level (Group-1 (OR-0.689)/Group-2 (OR-0.556)) and place of residence (Group-2 (OR-1.523)) while for non-performing the task, significant predictors were: age (Group-1 (OR-1.998)/Group-2 (OR-2.096)), gender (Group-1 (OR-0.629)/Group-2 (OR-0.495)), BMI (Group-1 (OR-1.219)/Group-2 (OR-1.305)), marital status (Group-1 (OR 0.764)/Group-2 (OR-0.769)), educational level (Group-1 (OR-0.679)/Group-2 (OR-0.719)) and index of well-being (Group-2 (OR-0.764)). Understanding of predictors, and their role on functional decline in elderly is of great importance for the development of specific population-based health programs to prevent further functional loss and preserve achieved functional gains. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.

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.

Introduction: The aim of this paper is to present an experience from the School of Medicine (University of Belgrade, Serbia) in restructuring of study programs to be compliant with Bologna standards and European best practices in public and community health. We devised the new module with the idea to implement both the concept of patient-centered medicine and community-based learning activity, in the pre-clinical phase of medical education. It emphasis importance of social determinants of health, community activities on health promotion, early contacts with patients, developing communication skills and introduction of primary health care settings Method: All participants of overall four generations of this curriculum (students, patients and physicians) were asked to evaluate their participation in the module, using three types of self-administered questionnaires. Results: Overall 1529 students (response rate 74.1%), 1011 patients (response rate 57.2%) and 118 physicians (response rate 69.5%) had participated in this evaluation. One-way analysis of variance (ANOVA) demonstrated significantly higher satisfaction of patient with the participation in the new module (4.48), than the students (3.90) and physicians (4.08) (F=69.882, p = 0.000). Conclusion: The satisfaction of patients enrolled in this module encourages us to continue. Broadening of medical training to primary health care and other "non-medical" community settings enabled students to get insight into the different social determinants of health. However, the instructors need to improve the student's understanding and devotion for this conception.

Background: Injection drug use is a major public health problem. Oral health problems and the appearance of dental disease among injection drug users (IDUs) are caused by their lifestyle. The aim of the present study was to examine the relations between socioeconomic factors, drug use, and oral hygiene habits on the oral health of heroin drug users. Methods. A cross-sectional survey on oral health was carried out as part of UNICEF's research on the biological and behaviours survey among injection drug users in Sarajevo, Banja Luka and Zenica in Bosnia and Herzegovina. A sample of 519 IDUs participated in the survey. Respondent Driven Sampling (RDS) was used to obtain the sample. The data were obtained through face-to-face interviews using a structured questionnaire related to socio-demographic characteristics, duration of drug injection, frequency of drug injection in the last month and oral health. Results: Older participants (OR = 1.06; 95% CI = 1.02 -1.10), part-time employment (OR = 3.57; 95% CI = 1.02 - 12.20) and unemployment (OR = 3.23; 95% CI = 1.23 - 8.33) in comparison to full-time employment as the referent category, and longer duration of drug injection (OR = 1.06; 95% CI = 1.003 - 1.12) were predictors of bad oral health. A higher level of education (OR = 0.56; 95% CI = 0.39 - 0.79), more frequent tooth brushing (OR = 0.59; 95% CI = 0.49 - 0.71), and regular dental checkups (OR = 3.30; 95% CI = 1.42 - 7.67) were predictors of good oral health. Conclusions: Socioeconomic characteristics of IDUs as well as their lifestyles may contribute to oral health problems. Heroin drug users have specific dental needs, and programmes to improve their oral health should be an integral part of strategies to prevent addictions including treatments and harm reduction programmes. © 2013 Supic et al.; licensee BioMed Central Ltd.