Browsing by Author "Simić, Snežana (57526929000)"

Introduction European School Survey Project on Alcohol and Other Drugs (ESPAD), the largest international research project, was conducted for the first time in Serbia in 2008. Objective The objective was to analyze data obtained by ESPAD research on alcohol use among secondary school first grade students, and particularly the difference in the use of alcohol by gender, type of school students attend, their place of residence and the territory among secondary school students in Serbia in 2008. Methods Attitudes and practice related to alcohol use of 6,553 secondary school first grade students were analyzed. A standardized, internationally approved questionnaire, structured and designed for self-filling was used on a stratified, one-stage sample of students. The data received from the ESPAD research were processed by χ2 test to test the significance of differences between the observed characteristics, with the conclusion level of p<0.01. Results Over three-quarters of students can easily buy beer or wine. More than one half can buy spirits and alcopops. 89.1% of students drank alcoholic beverages at least once in a lifetime and 78.2% in the last year. At least once in a lifetime 42.2% of students were drunk and 29.7% in the last year. At least once in the last month 32.0% of students had five or more drinks in a row. Boys consumed alcohol more frequently and got drunk more often than girls (p<0.01). Conclusion This research emphasizes the need for creating a prevention of alcohol use and alcohol abuse program among adolescents and more consistent application of the existing regulations aiming to decrease alcohol use among adolescents in Serbia.

Background/Aim. Mental health disorders lead to disorder of effective functioning of people and deterioration of quality of life. Early detection of individuals at risk of mental health disorders is extremely important from the aspect of mental health disorders prevention. The aim of the research was to determine the frequency of mental health problems among adult residents of northern Kosovska Mitrovica and to examine the association between frequency of mental health problems and socio-demographic and other characteristics of the population obtained by the questionnaire. Methods. The cross-sectional study on the representative sample of adult residents of northern Kosovska Mitrovica was performed in October 2009. To obtain information about the characteristics of mental health the Goldberg's General Health Questionnaire (GHQ-28) was used. For performing survey at site the method of rapid epidemiological assessment was chosen. Statistical analysis included the methods of descriptive statistics, multivariate regression analysis and calculation of the Cronbach's alpha coefficient of internal consistency of the questionnaire. Results. Mental health problems (total score) were present in almost half of the respondents (49.2%). Psychosomatic problems were present in more than half of the respondents (55.4%), while anxiety and insomnia were present in almost half of the respondents (49.2%). Social dysfunction had more than three fifths of the respondents (63.1%) and depression more than a quarter of the respondents (28.5%). More positive responses in the questionnaire were statistically significantly associated with older age, poor financial situation, abuse and assessing of the current political-security situation as high risk. The value of Cronbach's alpha coefficient was 0.705. Conclusions. Almost half of the respondents (49.2%) of North Kosovska Mitrovica had mental health problems. Mental health problems were associated with older age, poor financial situation, abuse and considering the current politicalsecurity situation as high-risk factor.

In this study the existing forms and amounts of cost-sharing in the Republic of Serbia (Yugoslavia) are analyzed. The level of cost-sharing is ranked according to the number and type of services involved and the relative importance with which they are viewed within the overall health-care policy of Yugoslavia. The “self-managing community of interest of health care,” administratively coincident with the district, is taken as the unit of observation. Until recently, these bodies independently decided whether to introduce cost-sharing as well as the rate of cost-sharing. Therefore, the implementation of this health-policy measure differed among the districts generating inequality within health-care system. The results of simple and multiple correlation indicate that poorer districts with fewer health resources and lower levels of consumption introduced cost-sharing for more services, attempting to provide additional resources for financing of the health-care system. The multiple linear-regression model shows that population/physidan ratio and the use of primary care physicians’ services are the significant indicators of health-care expenditures in this territory. Considering the current economic situation in Yugoslavia and the level of development of the health-care system, the results of this cross-sectional study imply that cost-containment in health care can be achieved in a more equitable and effective manner by controlling supply of health services than by limiting demands. © Lippincott-Raven Publishers.

Background: The aim of this study was to examine the relationships between demographic and socioeconomic characteristics and engaging in multiple risk behaviours among adolescents in Republic of Serbia. Methods: This study presents a cross sectional study of 683 adolescents aged 15 to 19 attending high school. The database from the 2006 National Health Survey was used. As a measure of demographic and socio-economic characteristics: Age, type of settlement, family structure, having one's own room, school success and the household wealth index were used. Multivariate logistic regression model was performed. Results: Boys were more than twice as likely to engage in multiple risk behaviours than girls. Adolescents who were older (OR = 5.82, 95% CI = 3.21-10.54, boys; OR = 3.76, 95% CI =1.77-7.99, girls) and adolescents who achieved low or moderate (OR = 1.82, 95% CI = 1.02-3.26, boys; OR = 3.36, 95% CI =1.51-7.44, girls) school success had significantly higher risk than younger ones and those with high school success. Also, boys who came from a richer class households (OR = 3.14, 95% CI =1.02-9.66) and girls from incomplete family (OR = 5.07, 95% CI = 2.06-12.50) had higher risk than boys from the poorest households and girls from complete family. Conclusions: Further preventive interventions in Serbia should be gender and age specific, oriented towards older adolescents, those who have low or moderate school success, boys from richer class households and girls who live in incomplete families. © 2015 Boricic et al.

Introduction: In anaesthesiology, economic aspects have been insufficiently studied. Objective: The aim of this paper was the assessment of rational choice of the anaesthesiological services based on the analysis of the scope, distribution, trend and cost. Methods: The costs of anaesthesiological services were counted based on "unit" prices from the Republic Health Insurance Fund. Data were analysed by methods of descriptive statistics and statistical significance was tested by Student's t-test and χ2-test. Results The number of general anaesthesia was higher and average time of general anaesthesia was shorter, without statistical significance (t-test, p=0.436) during 2006 compared to the previous year. Local anaesthesia was significantly higher (χ2-test, p=0.001) in relation to planned operation in emergency surgery. The analysis of total anaesthesiological procedures revealed that a number of procedures significantly increased in ENT and MFH surgery, and ophthalmology, while some reduction was observed in general surgery, orthopaedics and trauma surgery and cardiovascular surgery (χ2-test, p=0.000). The number of analgesia was higher than other procedures (χ2-test, p=0.000). The structure of the cost was 24% in neurosurgery, 16% in digestive (general) surgery,14% in gynaecology and obstetrics,13% in cardiovascular surgery and 9% in emergency room. Anaesthesiological services costs were the highest in neurosurgery, due to the length anaesthesia, and digestive surgery due to the total number of general anaesthesia performed. Conclusion: It is important to implement pharmacoeconomic studies in all departments, and to separate the anaesthesia services for emergency and planned operations. Disproportions between the number of anaesthesia, surgery interventions and the number of patients in surgical departments gives reason to design relation database.

Background: The most important instrument of EU support for the reforms of higher education in the European countries with the final goal of joining the European Higher Education (HE) Area by the year 2010 is TEMPUS (Trans-European Mobility Programme for University Studies). So far, Tempus is the only EU programme providing support for the reform of HE in the Western Balkans. Aim The purpose of this paper is to present the new curriculum of the Master of Health Policy and Management programme, which will provide students in Serbia with the up-to-date knowledge and necessary skills to analyse options, define strategies, formulate and implement health policies, and manage solutions for the effective delivery of health services. Methods: With financial support from the European Union's Tempus project, the "Postgraduate Study in Public Health Sciences" core project team from the Centre School of Public Health (C-SPH) School of Medicine (SoM) in Belgrade, supported by European project partners from Dresden, Rome and Krakow, developed a new curriculum-the Master of Health Policy and Management (MHPM) programme. Project activities (courses, workshops and visits to partner institutions) took place in Belgrade, Dresden, Rome and Krakow throughout 2006-2009. Results: The MHPM programme, based on modular principles and a European Credit Transfer System (ECTS) approach (60 ECTSs), was established at the C-SPH SoM and approved by the University of Belgrade. The MHPM programme consists of two tracks: one for health-care services management and the other for public health management. The first generation of MHPM students enrolled at the C-SPH SoM, Belgrade, in September 2008. They successfully passed all obligatory courses. It is envisaged that the first MHPM students will graduate in autumn/winter 2009. Conclusion: We believe that the project will continue to deliver benefits to the project beneficiaries after the Commission's financial assistance has been terminated. The MHPM programme will facilitate health-care administration reform, contribute to strengthening civil society and accelerate the development of democracy and the rule of law through good governance in Serbia. © Springer-Verlag 2009.

Objective: To provide insight of national activities and international assistance in PHC reform and to assess their effects on technical and allocative efficiency as well as financial sustainability of primary health care in the Republic of Serbia. Materials and methods: Analytical framework of the study consisted of gathering and reviewing of relevant political documents, international assistance project documentation, and analysis of routinely collected national statistical data based on the evaluation model of three groups of criteria: allocative, technical efficiency and financial sustainability in the public sector of Serbia from 2000 to 2007. Time trends were analyzed by Poisson regression models using average annual percentage changes - AAPC, and the percent of targeted change achieved by progress quotient - PQ. Results: Allocative efficiency of the PHC during period of 8 years was improved, but technical efficiency was almost unchanged for all service, except for preschool health care. Financial sustainability was also improved measured by indirect indicators of health expenditure. Conclusions: Results of this study indicated that we are on the right track with PHC reform, and international support is in accordance with the reform goals. Our approach has been and will remain incremental, gradualist and multi-faceted. © 2010 Elsevier Ireland Ltd.

Introduction: For health assessment, beside the data of routine health statistics, it is necessary to include and data obtained by a health survey of the citizens. Objective: The aim of this study was to establish how northern Kosovska Mitrovica adults assess their health and which diseases are most common among the population, as well as to investigate differences in relation to demographic and socioeconomic characteristics, the characteristics of social interaction and health behaviour and habits. Methods: The research was conducted as a cross-sectional study conducted on the representative sample of adult citizens in northern Kosovska Mitrovica in 2006. Two hundred-eighteen respondents were included in the survey. In the research we used a questionnaire identical to the Health Survey conducted in Serbia in 2006. The significance of differences in responses about self-rated health and chronic diseases in relation to the characteristics of respondents' responses were determined by X2-test with the significance level of 0.05. Results: Over half of the respondents (54.7%) assessed their health condition as good or very good. There was a significant difference in self-rated health in relation to the respondents' age (X2=202.036; p=0.000), education (X2=72.412; p=0.000), social support (X2=12.416; p=0.015), smoking (X2=11.675; p=0.020) and physical activity (X2=61.842; p=0.000). The leading health problems among the respondents were high blood pressure, rheumatologic diseases of joints, ulcer of the duodenal or gastric ulcer, gall bladder disease and high blood fat. Conclusion: Adult residents of northern Kosovska Mitrovica assessed their health as better than the residents of Serbia without Kosovo and Metohia. The diseases in which stress plays the major role among etiological factors are in the leading position. The obtained data on the population level of specific areas represent the basis in the planning of health education and health promotion activities.

Objective: This study aimed to identify whom women in Serbia approach for help in case of intimate partner violence (IPV), their reasons for seeking help and their satisfaction with the received help. Methods: A cross-sectional, population-based household survey of a random sample of women aged 15-49 years was conducted in Belgrade (WHO Multi-country Study on Women's Health and Domestic Violence against Women). A standard questionnaire was administered by trained interviewers through face-to-face interviews. Results: The questionnaire was completed by 1456 women and 1196 of them ever had an intimate partner. Almost one in four ever-partnered women reported experiencing either physical and/or sexual violence, at least once in their life. Among these abused women, ~22% had ever sought help from formal institutions. Police and health services were most commonly approached (12% and 10% of abused women, respectively). Satisfaction with services was highest for health services and legal advice and lowest for police and social services. Women sought help especially when violence had a severe impact on them or when they saw that their children suffered. Women who did not seek help stated that they believed that the violence was bearable or had ended. Other reasons for not seeking help were fear of undesirable consequences of seeking help and lack of trust in institutions. Conclusions: From the abused women's perspective, health care services are the institutions with the highest potential to help women in cases of IPV. Developing a comprehensive health sector response is of critical importance to ensure appropriate care and referral. © The Author 2011. Published by Oxford University Press. All rights reserved.

Background: The aim of this study was to analyse demographic, socio-economic and health status inequalities by gender in the utilization of health services in Serbia. Methods: Data from 2006 National Health Survey for Serbia were used. A total of 14 522 persons from six geographical regions of Serbia aged ≥20 years were completely interviewed. Logistic regression analyses were used to study the effects of demographic (age, gender, marital status and type of settlement), socio-economic (education and Wealth Index) and health status (self-perceived health) variables on the utilization of health services [visits to general practitioner (GP), private doctor, dentist and hospitalization]. All analyses were carried out separately for males and females. Results: As compared with women (reference category), a lower percentage of men visited a GP [odds ratio (OR) = 0.61; 95 confidence interval (95 CI) = 0.57-0.65], private doctor (OR = 0.62; 95 CI = 0.57-0.67) and dentist (OR = 0.81; 95 CI = 0.76-0.87), but there were no gender differences in hospitalization. Both males and females who belong to disadvantaged classes were less likely to have visited a GP, a private doctor or a dentist in 12 months before the interview, regardless of their health status. No inequalities by social class were observed for the hospitalization among persons with poor self-perceived health status, i.e. those in most need. Conclusions: This study has shown that demographic, socio-economic and health status inequalities in the utilization of health services exist in Serbia. Wise health policy with equitable utilization of health services, regardless these inequalities should be a priority in shaping Serbian health care system reform. © 2009 The Author. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

This study aimed to (1) analyse the utilization of tests in 15 laboratories associated with primary health care centres in Belgrade between 1985 and 1992 and (2) assess differences and similarities concerning technologies and costs between two comparable laboratories.The number of tests performed at primary health care laboratories in Belgrade has decreased since 1987 with a drastic fall in 1992, corresponding with crisis and war in the country. The comparative analysis of costs between the two laboratories showed significant differences in the way laboratory technicians spent their time and a marked difference in direct and indirect costs between the two laboratories. © 1994 Elsevier Science Ltd.

Aim This manuscript deals with public health training, research and practice in order to identify the future perspectives and requirements of master's programmes in public health sciences in Serbia. Methods: A wide array of documents and websites was analysed. The methods used for data collection were: (1) review of the existing written reports, the relevant legislation and other documents, and (2) Internet searches accessing the websites of the Ministries of Health, Education, Science and Technology of the Republic of Serbia as well as websites covering thematic areas in European and global education, research and development. Use has also been made of the results of the European Union projects done in the field of public health in Serbia, particularly the Tempus programme "Postgraduate Studies in Public Health Sciences". Results: The most important role in the field of change in public health in Serbia is played by the School of Public Health (SPH) and the Institutes of Public Health (IPH). Although at the managerial level the need for change has been perceived, in general there is not a shared, clear vision of what the change should be and how this should happen. The reorganisation of the IPH in Serbia is greatly needed given their poor present performance and the expectations of the government to reach EU standards and to increase the health status of the Serbian population. The main obstacles are seen to be inappropriate legislation, lack of financial resources and insufficiently trained staff. Three areas with priority for future development have been identified: (1) doctoral programmes in public health and in health policy and management, (2) expansion of continuing and life-long learning in good governance and public health management, and (3) increasing the research base in public health and management. Conclusion: The need for a better trained workforce in the fields of public health, health management and health promotion is clearly recognised by public health professionals in Serbia. Therefore, the educational infrastructure should be amended by doctoral programmes and life-long learning schemes, based on intensified public health research. © Springer-Verlag 2009.

Objectives Middle-and low-income countries rarely have national surveillance data on smoking in pregnancy. This nationwide population- representative survey investigated pre-and post-partum smoking and their predictors in Serbia. Methods Using stratified two-stage random cluster sampling, 2,721 women in 66 health care centres were interviewed at 3 and 6 months post-partum. Results 37.2% of women smoked at some point in pregnancy (average 8.8 cigarettes/per day). Smoking at pregnancy onset and during pregnancy was associated with smoking by others in the home and lower education and family socio-economic status. Almost a quarter of women (23.2%) who quit smoking during pregnancy did not relapse 6 months post-partum. Older women, primiparae, university students and white-collar workers were more likely to successfully quit smoking. More than a half of women were exposed to SHS in their homes (57.6%) and 84.6% allowed smoking in their homes. Conclusion Smoking during pregnancy in Serbia was two-to threefold higher than in the most affluent western countries. Target groups for action are women with lower education and socio-economic status, as well as health professionals and family members who smoke. © 2012 Swiss School of Public Health.

Introduction: The pandemic of obesity in adolescents is one of the challenges of public health. Aim: The aim of this study was to examine the association of overweight with demographic, socioeconomic and lifestyle factors among Serbian adolescents. Method: A cross-sectional study of 2139 adolescents aged 10 to 19 years was carried out. Data used in this study were from the 2006 Health Survey. In accordance with the international sex- and age-specific Body Mass Index cut-off points, all participants were classified as being normal weight or overweight, including obese. The association between the risk factors and overweight were examined using a multivariate logistic regression model. Results: The study showed that 28.9% of boys and 17.0% of girls were overweight, while 14.5% of boys and 8.1% of girls were obese. Boys were more likely to be overweight/obese, compared with girls. Being younger (p< 0.01 for 14 to 15 years) and (p< 0.01, for 16 to 19 years), engaging in physical activities that last less than 7 hours a week, in such a manner that they breathe quickly and become sweaty, (p < 0.01) and skipping breakfast (p< 0.05) were risk factors significantly associated with overweight among adolescents. No significant association was found with wealth index. Conclusion: These findings should be an integral part of further preventive interventions, especially oriented towards younger adolescents, who are physically inactive, have a habit of skipping breakfast and are boys.

Background evaluation is a systematic process that facilitates measurement of the extent to which a student has attained the educational objective.Objectives the article objectives were to describe the teaching evaluation approach of the Master of Health Policy and Management program developed at Centre School of Public Health, the School of Medicine, Belgrade University.Methods the evaluation strategy for the Master of Health Policy and Management program (which has not been completed yet) for four obligatory courses involves two simple components: Evaluation of student performance and student evaluation of the teaching process.The teaching evaluation was based on a questionnaire with a total of 11 questions.External evaluation was conducted by an individual expert who visited one course.Results the average final score for four courses was very high, somewhat higher than 86 points (of a maximum of 100) with a standard deviation of 9.76 points. However, the average final score per course differed significantly (F=6.46, p=0.001). Overall the average student's rating by questionnaire of all courses was 4.38 (of a maximum of 5),whereas the average marks for assessment of the specific characteristics of the course ranged from 3.65 (understandable teaching material and handouts) to 4.68 (the level of preparation by lecturers/instructors). Specific courses differed significantly in the overall rating (F=10.81, p=0.000).Conclusion The average rating of teachers and instructors was high, as was the average final score of students.However, students rated teaching slightly better than teachers evaluated their knowledge and skills. © Springer-Verlag 2010.

The basic purpose of this study was to analyze the diffusion of computer-based information technology into the health care institutions of the Republic of Serbia in the year 1994, and to compare the results with a similar investigation in 1992 in order to determine the state and progress of its development. The instrument of investigation was a questionnaire with 24 questions, distributed to all the independent health institutions in Serbia (total 238). The overall response rate was 40.8%. Of the number of responding health institutions, 92.8% own computers which are in use, six PCs on average, and on average use two application softwares, obligatory one for accounting and billing. In conclusion, health care institutions in the Republic of Serbia are unsatisfactorily equipped with information technology and without the developed institutional information system, except on the level of the project. So, careful planning, selection, implementation and management with national coordination will be needed to ensure the appropriate use of technology and information systems in health care.

The basic purpose of this study was to analyze the diffusion of computer-based information technology into the health care institutions of the Republic of Serbia in the year 1994, and to compare the results with a similar investigation in 1992 in order to determine the state and progress of its development. The instrument of investigation was a questionnaire with 24 questions, distributed to all the independent health institutions in Serbia (total 238). The overall response rate was 40.8%. Of the number of responding health institutions, 92.8% own computers which are in use, six PCs on average, and on average use two application softwares, obligatory one for accounting and billing. In conclusion, health care institutions in the Republic of Serbia are unsatisfactorily equipped with information technology and without the developed institutional information system, except on the level of the project. So, careful planning, selection, implementation and management with national coordination will be needed to ensure the appropriate use of technology and information systems in health care.

In a nationwide study of Serbian births, in 2008, we estimated the influence of maternal prenatal smoking and environmental tobacco smoke (ETS) exposure on birth outcomes. Using stratified two-stage random cluster sampling, 2,721 women were interviewed in-person (response rates 98.1 %), and 2,613 singleton live births were included. Date of birth, gender, birthweight, birth height and head circumference were copied from the official hospital Birth Certificate. Six exposure categories were defined according to mother's smoking history and exposure to ETS. We calculated adjusted mean values and group differences by analysis of covariance, and adjusted odds ratios for the low birthweight (LBW < 2,500 g). Compared to the reference category (non-smoking, non-exposed to ETS) we observed birthweight reductions in infants whose mothers smoked continuously during the pregnancy and were exposed to ETS (-162.6 g) and whose mothers were not exposed to ETS (-173 g) (p = 0.000, and p = 0.003, respectively), as well as reduction in birth length (-1.01 and -1.06 cm; p = 0.003 and p = 0.000, respectively). Reduction in birthweight and birth length related to exposure categories was not linear. Adjusted OR for LBW was almost tripled for mothers who smoked over the entire pregnancy and were non-exposed to ETS (aOR 2.85; 95 % CI 1.46-5.08), and who were exposed to ETS (aOR 2.68; 95 % CI 1.15-6.25). Our results showed strong effects of smoking throughout the pregnancy on reduced birthweight, birth length and head circumference, and increased risk for LBW. We were not able to detect an effect for ETS exposure alone. © 2012 Springer Science+Business Media New York.