The burden of breast, cervical, and colon and rectum cancer in the Balkan countries, 1990-2019 and forecast to 2030

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.

Psychological Distress in the Republic of Serbia, the Association of Social Characteristics and Substance Use on a National Representative Sample of Serbia

This study examined the association between social characteristics, substance use, and psychological distress in a national representative sample of adults in Serbia. It was a secondary analysis of the National Survey on Lifestyles in Serbia: Substance Abuse and Gambling 2018. The study included a total of 2000 participants aged 18 to 65 from the general population in Serbia. Psychological distress was examined using the Kessler 6 questionnaire. There were a total of 945 male participants (47.3%) and 1055 (52.8%) female participants. The average age was 37.83 ± 13.61 years. The prevalence of a high risk of psychological distress was 5.2% (103/2000), while the prevalence of moderate risk of psychological distress was 15.2% (303/2000). Multivariate logistic regression analysis showed that being male, having poor self-rated health, having poor subjective financial status, binge drinking in the past year, and lifetime use of any illicit drug were associated with a higher likelihood of having a high risk of psychological distress. One in six adults in Serbia has a high risk of psychological distress, while one in twenty has a moderate risk. The findings of this study urge targeted actions to protect and improve the health of people in psychological distress and drug and alcohol users.

Revisiting type II diabetes mellitus in pregnancy and pregnancy outcomes such as in thyroidology: do you mind?

OBJECTIVE

There is an increase in the prevalence of pre-gestational diabetes in the past decades, mainly due to the increase in the prevalence of obesity in the general population and consequently type 2 diabetes among women of reproductive age.

METHODS

This study purposed to describe the delivery characteristics, pregnancy complications, and outcomes among women in Serbia with the pre-gestational type 2 diabetes in the past decade, as well as their pregnancy complications, deliveries, and neonatal outcomes. The study included data from all the pregnant women with pre-gestational type 2 diabetes in Belgrade, Serbia during the period between 2010 and 2020. The final sample consisted of 138 patients.

RESULTS

More than half, i.e., 70 (50.7%) had a vaginal delivery, while 48 (34.8%) had elective and 20 (14.5%) had emergency caesarean sections. Throughout the period, there was 1 patient with preeclampsia (0.7%), 5 with pregnancy-induced hypertension (3.6%), 7 had newborns with small for gestational age (5.1%), 28 with macrosomia (20.3%), 12 (8.7%) had preterm births, and one-fifth, i.e., 28 (20.3%) of the newborns had Apgar score under 8.

CONCLUSION

The present study revealed that women with type 2 diabetes in pregnancy have a significant burden of pregnancy complications, related to pregnancy, delivery, and newborns.

Burden of alcohol use disorder in Balkan countries

Background

Alcohol use is recognized as an important risk factor for more than 200 different diseases and injuries. In the Diagnostic statistic Manual- 5 (DSM-5) it is defined as ‘impaired control over alcohol consumption with chronic, heavy and often escalating pattern of alcohol use despite significant detrimental consequences to their overall health, the lives of their family members and friends and society in general’. The aim of this study was to describe the disability adjusted life years (DALY) associated with the alcohol use disorder in the Balkan countries in the period between 1990 and 2019.

Methods

The study included the data on age-standardized DALY rate per 100,000 for alcohol use disorder in the period between 1990 and 2019 for ten Balkan countries (Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Greece, Montenegro, North Macedonia, Romania, Serbia and Slovenia) from the Institute of Health Metrics and Evaluation. We acknowledge the support from the COST Action 18218 - European Burden of Disease Network.

Results

The highest age-standardized DALY rate in 1990 was in Romania 484.03 per 100,000 (95% CI: 394.68-594.99), while the highest age-standardized DALY rate per 100,000 in 2019 was in Slovenia 427.75 (95% CI: 332.28-543.83). Along with Slovenia, only country that recorded the increase in the age-standardized DALY rates in the period between 1990 and 2019 was Albania, but the increase was only marginal (DALY per 100,000 increased from 174.24, 95% CI: 115.07-244.76 to 187.92, 95% CI: 127.26-262.41). The lowest burden measured in age-standardized DALY rates per 100,000 in 1990 was in Albania, and in 2019 was in Greece- 174.68, 95% CI: 113.66-251.34.

Conclusions

In the majority of the Balkan countries the age-standardized DALY rates per 100,000 for alcohol use disorder decreased in the observed period. The increase is observed for Slovenia and Albania, with the more apparent increase in Slovenia.

Key messages

Factors Associated with PA Level during the COVID-19 Outbreak in Serbia

OBJECTIVE

The novel coronavirus (SARS-CoV-2) has had an influence on almost the entire world and has become a major public health problem. Many countries have introduced measures that restrict the movement of the population and that may negatively influence the physical activity (PA) levels. The aim of this study was to examine the factors associated with changes in PA in Serbia during the COVID-19 outbreak.

METHODS

The cross-sectional study was conducted from the 9th through the 13th of April 2020. A total of 340 people, all contacted using Viber, were invited to participate in the study. The study instrument was a questionnaire that gathered information regarding social characteristics, PA during the outbreak, PA before the outbreak, and fear of COVID-19.

RESULTS

A total of 50 participants (14.7%) had low levels of PA in the 7 days prior to the study, while 133 (39.1%) had moderate and 106 (31.2%) had high levels of PA. The participants with high levels of PA had significantly higher energy expenditures before than after the COVID-19 outbreak (P < .001). There were no significant differences between the participants with different levels of PA in the scores on the Fear of COVID-19 scale (low: 13.4 ± 5.2; moderate: 12.6 ± 4.4; high: 13.8 ± 5.5; P = .204).

CONCLUSION

One-sixth of the participants had low PA levels, and as restrictive measures are still in place in many countries, the lack of PA in high proportions of the general population may cause significant public health concerns.

Trends of the Prevalence of Pre-gestational Diabetes in 2030 and 2050 in Belgrade Cohort

The aim of this study was to analyze the trends in diabetes in pregnancy in Belgrade, Serbia for the period of the past decade and forecast the number of women with pre-gestational diabetes for the years 2030 and 2050. The study included the data on all pregnant women with diabetes from the registry of the deliveries in Belgrade, by the City Institute of Public Health of Belgrade, Serbia for the period between 2010 and 2020 and the published data on the deliveries on the territory of Belgrade. During the examined period the total number of live births in Belgrade was 196,987, and the prevalence of diabetes in pregnancy was 3.4%, with the total prevalence of pre-gestational diabetes of 0.7% and overall prevalence of GDM of 2.7%. The average age of women in our study was significantly lower in 2010 compared to 2020. The forecasted prevalence of pre-gestational diabetes among all pregnant women for 2030 is 2% and 4% for 2050 in our cohort. Our study showed that the prevalence of pre-gestational diabetes has increased both among all pregnant women and among women with diabetes in pregnancy in the past decade in Belgrade, Serbia and that it is expected to increase further in the next decades and to further double by 2050.

Maternal and Fetal Outcomes among Pregnant Women with Diabetes

The aim of this study was to examine the differences in pregnancy complications, delivery characteristics, and neonatal outcomes between women with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and gestational diabetes mellitus (GDM). This study included all pregnant women with diabetes in pregnancy in Belgrade, Serbia, between 2010 and 2020. The total sample consisted of 6737 patients. In total, 1318 (19.6%) patients had T1DM, 138 (2.0%) had T2DM, and 5281 patients (78.4%) had GDM. Multivariate logistic regression with the type of diabetes as an outcome variable showed that patients with T1DM had a lower likelihood of vaginal delivery (OR: 0.73, 95% CI: 0.64–0.83), gestational hypertension (OR: 0.47, 95% CI: 0.36–0.62), higher likelihood of chronic hypertension (OR: 1.88, 95% CI: 1.55–2.29),and a higher likelihood ofgestational age at delivery before 37 weeks (OR: 1.38, 95% CI: 1.18–1.63) compared to women with GDM. Multivariate logistic regression showed that patients with T2DM had a lower likelihood ofgestational hypertension compared to women with GDM (OR: 0.37, 95% CI: 0.15–0.92).Our results indicate that the highest percentage of diabetes in pregnancy is GDM, and the existence of differences in pregnancy complications, childbirth characteristics, and neonatal outcomes are predominantly between women with GDM and women with T1DM.

Financial Burden of Medical Care, Dental Care, and Medicines among Older-Aged Population in Slovenia, Serbia, and Croatia

The aim was to explore the factors associated with the financial burden (FB) of medical care, dental care, and medicines among older-aged people in Slovenia, Serbia, and Croatia using EU-SILC 2017. The highest frequency of FB of medical care and medicines was in Croatia (50% and 69.1%, respectively) and of dental care in Slovenia (48.5%). The multivariate logistic regression analysis with FB as an outcome variable showed that the FB of medical care was associated with being married (OR: 1.54), reporting not severe (OR: 1.51) and severe limitations in daily activities (OR: 2.05), having higher education (OR: 2.03), and heavy burden of housing costs (OR: 0.51) in Slovenia, with very bad self-perceived health (OR: 5.23), having the slight (OR: 0.69) or heavy (OR: 0.47) burden of housing costs, making ends meet fairly easily or with some difficulty (OR: 3.58) or with difficulty or great difficulty (OR: 6.80) in Serbia, and with being married (OR: 1.43), having heavy burden of housing costs (OR: 0.62), and making ends meet fairly easily or with some difficulty (OR: 2.08) or with difficulty or great difficulty (OR: 2.52) in Croatia. The older-aged have the FB of healthcare, especially the poorest or those with health problems.

The Relationship between Individual and Family Characteristics and Cyberbullying Exposure in a Nationally Representative Sample of School-Aged Children Living in Serbia

The study provides evidence on the individual and family factors as potential predictors (odds ratio—OR and 95% CI) of cyber-violence among school-aged children (11–17 years old) from 64 schools participating in the 2017 Serbian Study on health behavior in school-age children (HBSC). The standardized international HBSC research protocol was used. The study population was the nationally representative sample of 3267 students of V and VII grades of primary and I grade of secondary schools in Serbia. Potential predictors for the probability of occurrence vs. non-occurrence of cyberbullying exposure at least once and multiple times were identified among 24 explanatory variables, including the individual characteristics and family context. The cyberbullying exposure was more prevalent among girls than among boys of school-age, i.e., over one in seven girls and one in ten boys were exposed to cyberbullying. Over one in seven students at age 13 years and almost every seventh student at grade I of the gymnasium were exposed to cyberbullying. There were more students exposed to at least one cyberbullying than to multiple cyberbullying. Potential predictors of exposure to cyberbullying are gender, opinion of the family’s affluence status, fathers’ employment, communication with father, and family support. The study compensates for the evidence of cyberbullying in Serbia, which could help raise awareness, inform national and international stakeholders in the region and enable their efforts and strengthen cooperation in ending cyberbullying. This study’s findings could inform the development of an intervention program aimed at families and various professionals involved in protecting and improving school-age children’s health and well-being.

Knowledge, attitudes and practices and fear of COVID-19 among medical students in Serbia

INTRODUCTION

The outbreak of the disease caused by the novel coronavirus, SARS-CoV-2 named COVID-19 has spread throughout the world. The number of registered cases is increasing and almost no country or territory worldwide has been without any COVID-19 patient. The aim of this study was to examine the level of knowledge on the SARS-COv-2 and COVID-19 among medical students and to explore the differences in attitudes, practices and fear of COVID-19 among students with sufficient and students with insufficient knowledge.

METHODOLOGY

The cross-sectional study among the 1,722 medical students was conducted through an online platform of the Faculty of Medicine, University of Belgrade. The instrument used was a questionnaire with sections on socio-demographic characteristics, knowledge, attitudes and practices towards COVID-19 and the Fear of COVID-19 scale.

RESULTS

Total of 1576 (91.50%) students were in the sufficient knowledge group. The multivariate logistic regression analysis showed that there was a significant association between the sufficient knowledge on COVID-19 and female sex (OR = 1.70, 95% CI = 1.18-2.45), age (OR = 1.10, 95% CI = 1.02-1.18), considering the preventive measures enforced in Serbia as good (OR = 2.57, 95% CI = 1.18-5.56), wearing the surgical mask outside of the household in the past 14 days (OR = 1.87, 95% CI = 1.22-2.87) and score on Fear of COVID-19 scale (OR = 0.94, 95% CI = 0.91-0.98).

CONCLUSIONS

Medical students showed good knowledge of COVID-19 and could be a part of the promotion of health education messages as a part of preventive measures.

The Validity and Reliability of the Copenhagen Burnout Inventory for Examination of Burnout among Preschool Teachers in Serbia

Introduction: Burnout syndrome is being increasingly recognized as a factor that affects the health status and is being examined among different professional groups. Consequently, there is a need for a reliable and valid instrument for its examination. Teachers are emerging as a professional group of interest in the area of burnout research, so the aim of this study was to assess the validity and reliability of the Serbian version of Copenhagen burnout inventory among teachers at preschool institutions in Serbia. Materials and Methods: This research was conducted as a cross-sectional study between October 2018 and April 2019 on a nationally representative sample of preschool teachers in Serbia. The internal consistency of the scale was assessed using Cronbach’s alpha, and the construct validity was examined using exploratory (EFA) and confirmatory factor analyses (CFA). Results: The average score on total burnout was 39.1 ± 17.0, while the average score per scales on the Copenhagen burnout inventory was: 41.3 ± 18.7 for personal burnout, 41.2 ± 15.9 for work-related burnout, and 34.7 ± 22.0 for client-related burnout. The Cronbach’s alpha for the entire scale was 0.936, the Cronbach’s alpha for the personal burnout scale was 0.906, and the Cronbach’s alpha for the work-related burnout scale was 0.765, while the Cronbach’s alpha for the client-related burnout scale was 0.901. The EFA for the CBI showed three factors. The factor loadings varied from 0.575 to 0.859. The three factors explained 67.17% of the variance. Conclusions: Our study showed that the three-factor Serbian version of the Copenhagen burnout inventory can be used for the assessment of burnout syndrome among teachers.

Validation of the Study Burnout Inventory and the Copenhagen Burnout Inventory for the use among medical students

OBJECTIVES

The aim of this study was to assess the validity and reliability of the Serbian versions of the Copenhagen Burnout Inventory (CBI) and the Study Burnout Inventory (SBI) among fifth-year medical students at 5 universities in Serbia.

MATERIAL AND METHODS

The study included 573 fifthyear medical students at 5 universities in Serbia. The research instrument consisted of SBI and CBI. The reliability of these instruments was assessed using an internal consistency measure (Cronbach's α), an intra-class coefficient (ICC) and factor analysis.

RESULTS

Cronbach's α for SBI was 0.83, including for exhaustion 0.73, for cynicism 0.70, and for inadequacy 0.48. The test-retest reliability (ICC) was 0.75. Cronbach's α for personal burnout on CBI was 0.89, for the faculty-related burnout 0.86, and for the faculty-members-related burnout 0.92. Cronbach's α for CBI was 0.93. The factor analysis for SBI showed 2 factors and for CBI 3 factors.

CONCLUSIONS

This study revealed that the Serbian versions of both SBI and CBI could be used for the assessment of burnout in this population.

Sports betting in Serbia- National survey on lifestyles in Serbia: substance abuse and gambling

Background

Sports betting has been one of the gambling games which are strongly associated with problem gambling. The aim of our study was to examine the association of social (socio-demographic and socio-economic) and lifestyle characteristics of sports bettors in Serbia.

Methods

The cross-sectional study was the secondary analysis of the data from the National Survey on lifestyles in Serbia: substance abuse and gambling, conducted during 2014. The questionnaire consisted of 158 items. The first part was on socio-demographic characteristics. The second was on lifestyle characteristics with Beverage Specific Quantity Frequency - BSQF Instrument developed during Standardized measurement of Alcohol-related troubles-SMART project, Kessler psychological distress scale, Problem Gambling Severity Index (PGSI), use of illicit drugs, and prescription/ non-medical prescription drug use. The sports betting was assessed with yes/ no question: 'Have you played sports betting in the past 30 days?'

Results

The 10% of participants reported sports betting in the past 30 days. The sports betting was associated with being male (OR:11.22, 95% CI: 7.62-16.53), aged 18-44 (OR: 2.33, 95% CI: 1.78-3.07), living in urban areas (OR: 1.79, 95%CI: 1.41-2.28), being single (OR: 1.35, 95 % CI: 1.06-1.72), having secondary education (OR: 1.47, 95% CI: 1.09-1.98), being unemployed (OR: 2.71, 95% CI:1.35-5.45), employed (OR: 3.00, 95 % CI: 1.53-5.90), or student (OR: 3.86, 95% CI: 1.83-8.17), binge-drinking (OR: 1.94, 95% CI: 1.39-2.71), non-medical prescription drug use (OR: 1.78, 95% CI: 1.22-2.59) and low/ moderate (OR: 12.82, 95% CI: 8.50-19.33), and problem gambling (OR: 43.38, 95% CI: 11.75-160.11).

Conclusions

The association of sports betting with risk behaviors among young males should be a concern for public health authorities.

Key messages

The prevalence of the past 30 days betting in Serbia is 10%. Sports betting is associated with risk behaviors.

What is the health-related burden of EU-Candidate Countries? A snapshot of public health indicators

Background

Various studies have shown the ebb of the political spectrum when determining entry into the European Union. The objective of this study was to determine the key differences between the European Union (EU) and the current EU-candidate countries through the lens of the financial burden of the public healthcare system.

Methods

The most complete and available EUROSTAT data describing health-related burden (13 indicators) for current EU- candidate countries (Serbia, Turkey, the Republic of North Macedonia and Montenegro) were evaluated and compared.

Results

Total health expenditures (Purchasing Parity Power) per capita in EU candidate countries is almost one-third of that in the EU. General government health expenditure for all four countries was below the EU average with Montenegro spending the highest and North Macedonia spending the least. Turkey, with a significantly higher gross domestic product (GDP), allocated the smallest percentage of its GDP on health (4.31%), while Serbia the highest percentage (8.55%), both being below the EU average (10%). The private health expenditure for all of the countries was higher than the EU average, with Serbia's proportion being double that of the EU average. Assessing the burden of disease for these countries, Serbia has the highest disability-adjusted life years (DALY) rate per 100,000 (25,468.38), while the average DALY rate of the other three countries was 23,656.33 and the EU average was 16,390. Turkey and North Macedonia tying for the highest infant mortality rate, three times the EU average. Of the candidate countries, Serbia contains the highest density of physicians and nurses and Turkey, the lowest.

Conclusions

The process of entry to the EU is a varied experience for each country since attaining benchmark standards affects the time needed to achieve them. This study on a selected number of public health indicators contributes to the evidence on the current health-related burden of EU-candidate countries.

Key messages

All EU candidate countries have a much higher burden of disease and a much lower health workforce and health expenditure than the EU average. The challenge for countries in the accession process is to reach a level of quality and achievement in health care in the EU.

Burden of breast cancer in Serbia 2007-2017

Background

Breast cancer is the third highest incidence of cancer globally. It is the leading cause of cancer-associated mortality among females in the world. In Serbia, the incidence rate of breast cancer in 2015 was 61.0/100000 and breast cancer attributed to 18.9% of total cancer mortality among females. The aim of this study was to examine the incidence rate, years lived with disability (YLD) and disability-adjusted life-years (DALY) in Serbia in the ten-year period, from 2007 to 2017.

Methods

We analyzed data from the global burden of disease study (GBD) 2017. The data for the breast cancer incidence, prevalence, YLD, DALY counts and DALY rates per 100,000 were used for analyses.

Results

The prevalence of breast cancer in Serbia (in thousands) in 2017 was 44.6 (95% CI: 39.9-50.6), the incidence (in thousands) was 5.6 (95% CI: 5.0-6.4), YLD (in thousands) in 2017 was 3.5 (95% CI: 2.5-4.9). In the period between 2007 and 2017, YLD counts increased by 11.7%, while the age-standardized rates increased by 5.8%. Total all age DALY counts for both sexes were 51.8 (95% CI: 49- 55.3) in 2007 and 51.5 (95% CI: 45.7-58.3) in 2017. Age-standardized DALY rates per 100,000 decreased from 388.8 (95% CI: 368.3-415.7) in 2007 to 366.3 (95% CI: 323.8-415.4) in 2017.

Conclusions

The data from the GBD study show that the total YLD counts in Serbia increased by more than 10% in the past decade. However, the total DALY counts did not change significantly and the age-standardized DALY rate per 100,000 decreased in the period between 2007 and 2017.

Key messages

The total years-lived with disability as a consequence of the breast cancer increased for 10% in Serbia between 2007 and 2017. The decrease in age-standardized DALYs may reflect aging and depopulation effects in Serbia.

Burnout syndrome among health care workers in the tertiary psychiatric facility in Serbia

Background

Recent studies reported there is a high prevalence of burnout syndrome in healthcare workers and particularly among mental health professionals. The aim of this study was to examine the burnout syndrome in the tertiary level psychiatric hospital and potential factors associated with it.

Methods

This study was conducted as a cross sectional study, during September 2017 in Clinic for psychiatric disorders “Dr Laza Lazarevic” Belgrade, Serbia. The study included 159 health care professionals. Instrument used consisted of section on socio-demographic characteristics, linguistically adapted Serbian versions of Maslach Burnout Inventory - General Survey (MBI-GS) with three subscales (emotional exhaustion-EE, depersonalization- DP, low personal accomplishment-PA) and Beck's Depression Inventory (BDI).

Results

The mean age of the participants was 42.46±10.2 years (the youngest participant was 20 years old, and the oldest was 65 years old). In the overall sample, almost 70% of respondents were educated nurse-technicians. The physicians had the highest values on the EE and DP scale and the lowest values on PA scale: physicians- EE scale: 24.86 ± 15.27, DP scale: 4.29 ± 5.77, PA scale: 37.19 ± 9.77 vs. nurses: EE scale: 17.70 ± 13.58, DP scale: 4.07 ± 6.15, PA scale: 32.56 ± 16.62 vs. health associates: EE scale: 15.54 ± 5.85, DP scale: 3.18 ± 3.43, PA scale: 37.00 ± 6.53. The score on EE-subscale was associated with the years of age (ß=0.310, p = 0.037) and score on Beck's depression inventory (ß=0.828, p &lt; 0.001). The score on DP scale was associated with the score on Beck depression inventory (ß=0.339, p &lt; 0.001). The score on PA scale was associated with the score on Beck depression inventory (ß=0.363, p &lt; 0.001).

Conclusions

Physicians are the category of employees in psychiatry with the highest severity of burnout syndrome at work, and the degree of development of this syndrome depends on age and degree of depression.

Key messages

Physicians are the most vulnerable to the burnout syndrome among health care workers at psychiatry. All three domains of burnout are associated with the scores on Beck depression inventory.

The reliability of the Study burnout inventory among Medical students

Background

The burnout syndrome is increasingly recognized as the factor compromising the mental health of health-care workers. The demands of higher education were reported to influence the development of burnout syndrome among students. Medical students are a significant population as both future health care workers and students with high academic demands. The burnout among medical students has been studied using different questionnaires. The aim of this study was to assess the psychometric characteristics of the Study Burnout inventory for the assessment of burnout among medical students.

Methods

The cross-sectional study was conducted during December of 2019 among the fifth year Medical students at the five Universities in Serbia (University of Belgrade, Novi Sad, Kragujevac, Nis, and Kosovska Mitrovica). The questionnaire used was the Study Burnout Inventory, nine-item scale, measuring three dimensions of burnout (exhaustion from studying- EXH; cynicism toward the meaningfulness of studying-CYN; the sense of inadequacy as a student-INAD). Answers were given on a six-point Lickert scale. The assessment of psychometric characteristics of the questionnaire was done using the reliability analysis (Cronbach alpha-α) and test-retest reliability (intra-class coefficient-ICC). Sensitivity and specificity were assessed using the Receiver operation curves (ROC) compared to the total burnout assessed by the Copenhagen burnout inventory.

Results

A total of 493 students filled-in the questionnaire. The mean score was 28.95±8.87/54. The Cronbach alpha for the total scale was α = 0.839, for the EXH scale was α = 0.724, for the CYN scale was α = 0.767, and for the INAD scale was α = 0.431. The test-retest reliability was ICC=0.750. The total area under the curve was 0.756 (95% CI: 0.711-0.800).

Conclusions

The Study Burnout Inventory has good reliability and can be used for rapid assessment of burnout among Medical students, as this scale is short and convenient for the participants.

Key messages

The Study burnout inventory has a good reliability as a total scale. This short scale is convenient for the participants and can be used for assessment of burnout.

Anxiety among the Medical students at five Universities in Serbia

Background

Medical education is both academically and emotionally demanding. The demands of medical school can influence the development of anxiety among medical students. The aim of this study was to assess the prevalence of anxiety and factors associated with it among the fifth year medical students at the five universities in Serbia.

Methods

The cross-sectional study was conducted during December of 2019 and included a total of 493 students at the five Universities in Serbia (Belgrade, Novi Sad, Kragujevac, Nis, and Kosovska Mitrovica). The questionnaire used was developed based on the questionnaires from similar research and included the sections on social characteristics, lifestyle characteristics, study engagement, Beck depression inventory, Copenhagen burnout inventory, and Zung anxiety scale. Based on the score on Zung anxiety scale students were classified in two groups: with anxiety (scores ≥45) and without anxiety (scores 20-44).

Results

The mean Zung anxiety scale score was 35.39±8.31 (minimum=20, maximum=69). A total of 64/493 students (13%) was in the group with anxiety. The multivariate logistic regression analysis with the anxiety as an outcome variable showed that anxiety was associated with female sex (OR: 4.20, 95% CI: 1.41-12.50), higher scores on Beck depression inventory (OR: 1.18, 95% CI: 1.12-1.26), and total burnout (OR: 3.98, 95% CI: 1.66-9.54).

Conclusions

This study shows that students with anxiety have a higher likelihood of higher scores on Beck depression inventory and a higher likelihood of having burnout syndrome. The clustering of mental health problems, along with the high prevalence of anxiety among medical students is alarming.

Key messages

One in eight medical students in Serbia has scores on Zung anxiety scale indicative of at least mild anxiety. The anxiety was associated with female gender, higher score on Beck depression inventory and total burnout.

How accessible is the Serbian health system? Main barriers and challenges ahead

Background

Access to health care is a key health policy issue faced by countries in the WHO European Region and Serbia is not an exception. There is increasing concern that financial and economic crisis may have delay progress regarding the performance of the Serbian health system. While substantial development has been experienced by the Serbian health system since 2000, we analyse whether barriers to health care access exist in the country and the underlying causes.

Methods

We combine quantitative and qualitative methods to assess the accessibility of the Serbian health system. We use the latest data available both at national (e.g. National Health Survey) and European (EUSILC) level to understand whether barriers to access exist and the underlying causes. On the qualitative side, we analyse the different policies implemented by the Serbian government to improve the accessibility of the health system in the last decade, identifying the challenges ahead for the country.

Results

We find that, in 2018, 5.8% of the Serbian population reported unmet need for medical care due to costs, travel distances or waiting lists, well above the EU28 average and much higher than in neighbouring countries. Financial constraints are reported to be the main reason for unmet needs for medical care. Long waiting times also impede the accessibility of health services in Serbia.

Conclusions

Serbia has a comprehensive universal health system with free access to health care, however, some vulnerable groups, such as those living in poverty or Roma people in settlements, have more barriers in accessing health care. It is expected that Serbia will continue to develop policies focused on reducing barriers to accessing health care and improving the efficiency of the health system, supported by international organisations and in the context of the EU accession negotiations.

Key messages

Some vulnerable groups have more barriers in accessing adequate care in Serbia. National initiatives are in place to increase access to the health system but there is scope for further work.

Burnout among preschool teachers in Serbia

Background

Pedagogical work has been one of the most stressful professions, especially work with pre-school children. Working with each age group has particular challenges, in which educators participate in the development of healthy lifestyles in children, their physical activity habits and their identity as social beings. The incidence of stress-related illnesses is more common among teachers than in the general population. The aim of this study was to examine the prevalence of burnout syndrome among preschool teachers in Serbia and factors associated with it.

Methods

The cross-sectional study was conducted between October 2018 and April 2019 and included National representative sample of 482 pre-school teachers in Serbia. The study instrument consisted of four sections: the socio-demographic, lifestyle and workplace characteristics; Copenhagen Burnout inventory; Beck Depression Inventory, and Zung Anxiety Scale.

Results

The average score on total burnout was 39.1±17.0, while the average score per scales on Copenhagen burnout inventory were: 41.3±18.7 for personal burnout, 41.2±15.9 for work-related burnout and 34.7±22.0 for client related burnout. The frequency of total burnout was 27.1%. Multivariate logistic regression analysis with total burnout as an outcome variable showed that being singe (OR: 0.18, 95% CI: 0.05-0.58), having poor (OR: 6.05, 95% CI: 1.05-34.91), or average (OR: 3.60, 95% CI: 1.57-8.25) self-rated health, not having didactic tools (OR: 2.71, 95% CI: 1.21-6.04), having higher score on Beck depression inventory (OR: 1.19, 95% CI: 1.09-1.29) or Zung anxiety scale (OR: 1.10, 95% CI: 1.03-1.18) was significantly associated with total burnout among our participants.

Conclusions

Our study showed the worryingly high prevalence of burnout among preschool teachers in Serbia. The results indicate its association with mental health problems, depression and anxiety, and yield for preventive action.

Key messages

There is a worryingly high prevalence of burnout among preschool teachers in Serbia. Total burnout was associated with mental health problems.

Factors Associated with the Leisure-Time Physical Activity (LTPA) during the First Trimester of the Pregnancy: The Cross-Sectional Study among Pregnant Women in Serbia

Background: The benefits of physical activity during pregnancy include lower maternal weight gain, a lower likelihood of gestational diabetes, low back pain, preeclampsia, preterm delivery, caesarian delivery, and macrosomia. This study aimed to examine the factors associated with insufficient leisure-time physical activity (LTPA) during the first trimester. Methods: A cross-sectional study was conducted at the Clinic for Obstetrics and Gynecology of Clinical Center of Serbia, Belgrade, between January and June of 2018. The final analyses included 162/175 pregnant women. The questionnaire was used to obtain social characteristics, pregnancy, and lifestyle characteristics (Pregnancy Risk Assessment Monitoring System-PRAMS), pre-pregnancy LTPA (International Physical Activity Questionnaire-IPAQ), and LTPA during the first trimester (Pregnancy Physical Activity Questionnaire-PPAQ). Women were classified into two groups of sufficient and insufficient LTPA during the first trimester based on the recommendations of the World Health Organization. Multivariate logistic regression analysis was applied. Results: A total of 27.2% of the women had insufficient LTPA during pregnancy. Insufficient LTPA during pregnancy was associated with <12 years of education (OR: 2.3, 95% CI: 1.05-5.04), self-rated financial status as poor (OR: 0.34, 95% CI: 0.14-0.79), and hours spent walking before pregnancy (OR: 0.87, 95% CI: 0.77-0.99). Conclusions: Our results can help direct health care professionals advice for women who are planning pregnancy towards walking as it seems to be sustained during pregnancy.

Alignment of Perceived Competencies and Perceived Job Tasks among Primary Care Managers

In this study we aimed to explore how managers in primary health care (PHC) organizations assess their managerial knowledge and skills, as well as the importance of these competencies for their job, and to identify whether there is an alignment between these two perceptions; therefore, whether there is a need for management competency improvement. With this study, we tried to address a high demand for information about health managers, especially in health systems in low- and middle-income countries. In a sample of 58 primary health care centers (n = 106 managers) in Serbia, we used a basic managerial competency matrix consisting of the following six competencies—communication, team-building, planning and priority-setting, performance assessment, problem-solving, and leading. Managerial perception of the importance of their job tasks differs by educational level and managerial position. The best alignment between the importance of knowledge and skills was for communication and leading. The study pointed out that managers were aware of the necessity to improve their level of managerial competencies, particularly in the domains of planning and priority-setting, performance assessment, and problem solving. The study highlights the need for formal managerial education for managers in PHC settings and commitment to continuously evaluate and improve management competencies in order to better manage PHC.

Potential predictors of unmet health needs among the elderly: a population-based study in Serbia

Background

This study assessed the prevalence of unmet health needs of the elderly and the associated factors regarding socioeconomic, health and functional status.

Methods

A secondary analysis of the 2013 National Health Survey data was conducted on a representative sample of 3540 persons aged sixty-five and older (the lowest response rate was 99.7%). Participants characteristics such as socioeconomic status, health self-perception, diagnosed chronic disease, physical functional limitations, performing essential daily activities in the home and daily personal care were explored with logistic regression analysis (Odds Ratio - OR and 95% Confidence Interval) in relation to five aspects of unmet health needs.

Results

15.8% participants had unmet health needs due to the long waiting times, 16.1%, had unmet needs for medical care, 17.7% for dental care, 15.2% for drugs prescription and 96.9% participants for mental health care. Common predictors exist for medical, dental drug prescription and due to long waiting times unmet needs including older age years, middle education, rural residence, lower wealth index, single persons, with average or bad self-perceived health, chronic disease and difficult daily performance of personal care and of home activities. Unmet mental health needs by 61% less likely had participants with average wealth index, while a greater likelihood had participants with average and bad self-perceived health by 3.7 times and 8.4 times (p = 0.035, p = 0.001) respectively, by 6.2 times those with difficulties (p &lt; 0.001) and by 5.9 times unable (p = 0.045) to perform daily activities of personal care and by 1.7 times those with difficulties (p = 0.037) to perform home activities.

Conclusions

Unmet health needs reported less than 20% of the elderly but almost all have unmet mental health needs. Unmet health needs are associated with negative health outcomes, age, low education level, single persons, rural settings, poorer households, and limited daily activities.

Key messages

Unmet mental health needs of the elderly are an extremely important problem for the health system and healthy ageing in Serbia. A strong association of unmet health needs of old, low educated elderly without partners, from rural settings and poor households with health and functional outcomes, requires responsive policies.

Facebook Intervention To Improve Physical Activity Level Among Youth

Background

Physical activity level decreases during the transition from late adolescence to young adulthood. Social media are nowadays widely used and part of many people’s daily routines and the interventions on these websites have the possibilities to be integrated into those routines without becoming a burden. The aim of this study was to assess physical activity level among medical students and to assess the possibilities of using social media intervention with an aim to improve physical activity among them.

Methods

Prospective study was conducted during October of 2016 at the Faculty of Medicine, University of Belgrade, Serbia. The study included 375 first and fifth-year students. At the baseline, students filled in the questionnaire regarding social and lifestyle characteristics as well as their physical activity. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). After completing the questionnaire, students were asked to join a Facebook discussion group. The intervention consisted of motivation for physical activity through motivational pictures, texts, and discussions. The second assessment was done after one month. Based on the reported physical activity level students were divided into two groups: sufficient (&gt;600MET-minutes/week) and insufficient physical activity (≤600 MET-minutes/week).

Results

Total of 85.4% of students were sufficiently active at the baseline, while 90.4% were sufficiently active after one month. Multivariate logistic regression analysis showed that students who were part of the Facebook group (OR: 3.51, 95% CI: 1.46-8.43) and students who had sufficient physical activity at the baseline (OR: 5.44, 95% CI: 2.44-12.13) had a higher likelihood to be sufficiently active after one month.

Conclusions

Social media can be used for interventions targeting lifestyle change among young adults and activities on these websites can be adjusted to meet the needs of the target population.

Key messages

Intervention on social media could lead to lifestyle change. Interventions on social media could be adjusted to fit the target population.

Unmet dental health care needs among adults in Serbia, Survey on Income and Living Conditions 2017

Background

Changes in the health insurance law in 2005 led to the changes in the organization of the provision of dental health care in Serbia. Prior to this law, dental health care was available for every resident covered by mandatory health insurance without additional out-of-pocket payments. Now the dental health care is available only for children under the age of 18, students under the age of 26, pregnant women and for emergency dental care. The aim of this study was to assess the prevalence of unmet dental health care needs among adults and to assess the factors associated with unmet dental health care needs.

Methods

The study was the secondary analysis of the data from the Survey on income and Living conditions in Serbia, conducted during 2017. Multivariate logistic regression analysis was used to assess the association of unmet dental health care needs and socio-demographic and socio-economic factors.

Results

Total of 1718/12437 (12.1%) adults reported unmet dental health care needs. The main reason reported was not being able to afford it (1014/1718, 59.0%), along with the fear of doctors or hospitals (260/1718, 15.5%). Multivariate logistic regression analysis showed the association of unmet dental health care needs and being employed (OR: 1.50, 95% CI: 1.24-1.80), unemployed (OR: 1.96, 95% CI: 1.65-2.33), having primary (OR: 1.47, 95% CI: 1.16-1.86), or secondary education (OR: 1.43, 95% CI: 1.21-1.69), being divorced (OR: 1.47, 95% CI: 1.17-1.85), having good (OR:1.44, 95% CI: 1.20- 1.74), average (OR: 2.36, 95% CI: 1.91-2.92), poor (OR: 2.29, 95%CI: 1.77-2.97), or very poor general health (OR: 2.42, 95% CI: 1.68-3.48), having limitation in daily activities (OR: 0.66, 95% CI: 0.60-0.77) and being materially deprived (OR: 1.67, 95% CI: 1.46-1.90).

Conclusions

The prevalence of unmet dental health care needs in high among adults in Serbia. There is an association between social characteristics and health status with unmet dental health care needs in Serbia.

Key messages

There is a high prevalence of unmet dental health care needs in Serbia. Unmet dental health care needs are associated with social characteristics and health status.

Copenhagen Burnout Inventory On A National Representative Sample Of Pre-School Teachers

Background

Pre-school teachers are faced with work-related stress and are at increased risk of development of burnout syndrome. The aim of this study was to evaluate the reliability of the Serbian version of Copenhagen burnout inventory (CBI) on a National Representative Sample of preschool teachers in Serbia.

Methods

This was a cross-sectional study conducted between October 2018 and April 2019 which included 456 preschool teachers in Serbia. The instrument contained questions on socio-demographic, socio-economic characteristics, lifestyle characteristics, workplace environment and Serbian version of CBI. Univariate linear regression, multiple linear regression, Cronbach alpha coefficients were performed.

Results

Cronbach alpha of three domains of CBI were: personal burnout-0.907, work-related burnout-0.878, client-related burnout- 0.903. Multiple linear regression analysis showed that having a tenured contract (ß=3.46, p = 0.04), working in shifts (ß=7.94, p = 0.01), and having worse self-perceived health status (ß=-8.88, p = 0.01) were significantly associated with personal burnout. Working in shifts (ß=-4.67, p-0.012) and having worse self-perceived health status (ß=-7.82, p &lt; 0.001) were significantly associated with work-related burnout. Age (ß=0.53, p &lt; 0.001), living in urban areas (ß=-6.55, p = 0.015), alcohol consumption (ß=5.09, p = 0.016), number of children teacher work with (ß0.407, p = 0.005), having teaching equipment (ß=-4.46, p = 0.033), and having worse self-perceived health status (ß=-7.17, p &lt; 0.0001) were significantly associated with client-related burnout.

Conclusions

CBI is a valid instrument for the assessment of burnout among preschool teachers in Serbia. Many workplace-related factors, which could be subject of preventive measures, are associated with domains of burnout in this population.

Key messages

Workplace-related factors are associated with burnout among preschool teachers in Serbia. CBI is valid instrument for assessment of burnout among preschool teachers.

Work-pressure, job-satisfaction and turnover intentions among health managers in Serbia

Background

Rationalization, freezing of salaries and additional taxation of salaries above a certain amount have marked the reform of the public health sector in Serbia in 2014/15. Health managers bear responsibility for success in reform activities, and improvement of subordinates’ job satisfaction and health care quality with constrained resources. This study explored factors associated with work-pressure, turnover intentions and job satisfaction among health managers in 323 public health institutions in Serbia.

Methods

Data of the 2015 job satisfaction survey of the Ministry of Health and the Serbian Public Health Institute were used to carry out a secondary analysis. Logistic regression was applied, including factors such as age, gender, occupation (doctors, nurses, other health workers, healthcare associates and non-medical managers), workplace, work-conditions’ satisfaction, general job satisfaction, and turnover intention in relation to work-pressure of 7818 health managers (response rate was 91.5%).

Results

Almost 39.5% of the health managers experienced high/very high work-pressure (p &lt; 0.001), 51.2% were dissatisfied (p &lt; 0.001), and 23.7% had turnover intention outside the health sector/country (p &lt; 0.001). High/very high work-pressure positively correlated with health managers of secondary (Odds Ratio-OR =1.37, p &lt; 0.001) and tertiary care institution (OR = 1.72, p &lt; 0.001), female sex (OR = 1.19, p = 0.004), younger than 55 years of age (OR = 1.26, p &lt; 0.001), and nurses (OR = 1.13, p = 0.024). Other factors showing positive correlations include job dissatisfaction in general (p &lt; 0.001) and with all workplace conditions (p &lt; 0.001), as well as turnover intentions (p &lt; 0.001).

Conclusions

Work pressure of health managers seems to be perceived highest in the group of younger female nurse executives in hospital care. Their dissatisfaction with the job in general and with the working conditions, as well as turnover intentions positively correlate with the increase of work pressure.

Key messages

Improving working conditions and job satisfaction is key to reduce work pressure of health managers. Young female nurse managers perceive highest levels of work pressure, and need reinforcement at work.

Two step cluster analysis of burnout among preschool teachers

Background

The burnout is influenced by a variety of personal, work-related and client-related factors, which are included in different domains of Copenhagen burnout inventory (CBI). The aim of this study was to examine if there are different groups of preschool teachers which differ in scores on different domains of CBI.

Methods

This was the analysis of the data from the survey on burnout on a National representative sample of 456 preschool teachers in Serbia. The study was conducted between October of 2018 and January 2019. The study instrument contained questions on socio-demographic characteristics, workplace environment characteristics, and Copenhagen burnout inventory. We used two-step cluster analysis in SPSS to segment the participants based on age and average scores on personal, work-related and client related domains of CBI.

Results

Our participants clustered in three distinguished groups: participants aged 35.31 years, who worked in shifts, with personal burnout average of 29.46, work-related burnout average of 24.06 and client related burnout average of 19.46; participants aged 44.09 years, who worked in shifts, personal domain scores of 55.24, work-related burnout scores of 51.72, and client-related burnout scores of 51.13; and participants aged 43.01 years, who did not work in shifts, with personal burnout scores of 36.47, work-related burnout scores of 31.95, and client-related burnout scores of 32.08.

Conclusions

Participants clustered in three different groups, and the group with the highest average age and with the shift work had higher scores on all three domains compared to other groups.

Key messages

Preschool teachers clustered in three groups with different scores on domains on burnout. The group with the highest average age had the highest scores on all three domains of burnout.

Serbia: Health System Review

This analysis of the Serbian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the Serbian population has improved over the last decade. Life expectancy at birth increased slightly in recent years, but it remains, for example, around 5 years below the average across European Union countries. Some favourable trends have been observed in health status and morbidity rates, including a decrease in the incidence of tuberculosis, but population ageing means that chronic conditions and long-standing disability are increasing. The state exercises a strong governance role in Serbia's social health insurance system. Recent efforts have increased centralization by transferring ownership of buildings and equipment to the national level. The health insurance system provides coverage for almost the entire population (98%). Even though the system is comprehensive and universal, with free access to publicly provided health services, there are inequities in access to primary care and certain population groups (such as the most socially and economically disadvantaged, the uninsured, and the Roma) often experience problems in accessing care. The uneven distribution of health professionals across the country and shortages in some specialities also exacerbate accessibility problems. High out-of-pocket payments, amounting to over 40% of total expenditure on health, contribute to relatively high levels of self-reported unmet need for medical care. Health care provision is characterized by the role of the "chosen doctor" in primary health care centres, who acts as a gatekeeper in the system. Recent public health efforts have focused on improving access to preventive health services, in particular, for vulnerable groups. Health system reforms since 2012 have focused on improving infrastructure and technology, and on implementing an integrated health information system. However, the country lacks a transparent and comprehensive system for assessing the benefits of health care investments and determining how to pay for them.

Prevalence and Predictors of Violence Victimization and Violent Behavior among Youths: A Population-Based Study in Serbia

The study identifies the prevalence of violence victimization and the perpetration among youths, and explores the determinants and predictors using a socio-ecological model. The data of 36 variables from a representative sample of 1722 persons, ages 15–24 years, from the National Health Survey of Serbia in 2013, were analyzed by a multivariate logistic regression modeling. The study shows that 13.4% of youths experienced multi-victimization, while 10.4% were perpetrators of violence. Up to one-third of the victims were violence perpetrators. A small percentage of victims seek family and community support. Predictors of violence among youths were: male sex, households with fewer members, urban settlements, violence perpetration, self-assessed health as poor, lack of close friends and perception that it was difficult to obtain the assistance needed. Predictors of youth violence highlighted the need to improve health education, social support and community regulations, as well as strengthen the promotion of gender equality and a healthy environment.

The needs of patients with rare disease in Serbia. Why do we need National Strategy for rare disease?

The patients with rare diseases in Serbia face the difficulties in procurement of medications as the Health insurance fund does not cover reimbursement for some medications, they face difficulties in receiving proper diagnosis which makes their position specific and complex. In an attempt to provide more support for the patients with rare diseases, their families and caregivers the helpline for rare diseases was established in October 2015. The aim of this research was to identify, examine and systematise needs of helpline users and forms of assistance provided by the team from the free helpline. The research was designed as a cross-sectional study and was conducted between October 2015 and December 2016. The electronic database of National Organization for rare disease in Serbia helpline users was used as a data source. The user was the person who contacted helpline (patient, relative, friend, physician, etc). The "need" refers to the reasons for addressing the helpline. Helpline users had 549 needs in total; about healthcare-236 (42.98%), social care-113 (20.58%), psychological support-56 (10.20%) and other-144 (26.22%). Services were provided by the lawyer-130 (23.70%), social worker-71 (12.93%), Psychologist-56 (10.20%) and by all employees-292 (53.19%). The most common need for legal assistance among needs on healthcare was on legal aspects of access to and reimbursement of expenses for medications (32/74%-43.24%) and procedures for reimbursement of treatment abroad (11/74%-14.86%). The problems of patients with rare diseases and their families result primarily from the lack of relevant information and knowledge, as well as the non-recognition of rare diseases in the laws and regulations of health and social care. Some problems can simply be solved by legal changes and by a better organisation and do not require additional funding. Only by adopting and implementing the National Strategy and Action Plan for Rare Diseases, the greatest number of problems and needs of people with rare diseases can be systematised and solved.

Can social media intervention improve physical activity of medical students?

OBJECTIVES

Physical activity level decreases during young adulthood. As social media are nowadays widely used and are included into many people's daily routines, the interventions on these websites have the possibilities to be integrated into those routines without becoming a burden. The aim of this study was to assess physical activity level among first- and fifth-year medical students and social media intervention with the aim to improve physical activity among them.

STUDY DESIGN

Prospective longitudinal study was conducted during October of 2016 at the Faculty of Medicine, University of Belgrade, Serbia. The study included 375 first- and fifth-year students.

METHODS

At the baseline, students filled in the questionnaire and were asked to join a Facebook discussion group. The intervention consisted of motivation for physical activity through motivational pictures, texts, and discussions. The second assessment was carried out after one month. Based on the reported physical activity level, students were divided into groups: sufficient (>600 metabolic equivalent [MET]-minutes/week) and insufficient physical activity (≤600 MET-minutes/week).

RESULTS

Total of 85.4% of students were sufficiently active at the baseline, whereas 90.4% were sufficiently active after one month. Multivariate logistic regression analysis showed that students who were part of the Facebook group (odds ratio [OR]: 3.51, 95% confidence interval [CI]: 1.46-8.43) and students who had sufficient physical activity at the baseline (OR: 5.44, 95% CI: 2.44-12.13) had a higher likelihood to be sufficiently active after one month.

CONCLUSION

Social media are shown to be valuable in health-promoting interventions and can be used for interventions targeting lifestyle change among young adults.

The association between social characteristics, alcoholic beverage preferences, and binge drinking in a Serbian adult population

Aim

To determine the association of sociodemographic characteristics and type of alcoholic beverage consumed during binge drinking in Serbia.

Method

We conducted a secondary analysis of data from the 2014 national survey on Serbian lifestyles focusing on substance abuse and gambling. The sample consisted of 5385 individuals. The respondents were divided into non-binge drinkers and binge drinkers, according to the quantity of alcohol consumed during one occasion. Binge drinkers reported consuming more than 60 g of pure alcohol (7.5 units of alcohol) during one occasion at least once during the previous year.

Results

The prevalence of binge drinking in the past year among 2676 female and 2709 male participants aged 18-64 years was 28.4%. The multivariate logistic regression model showed that binge drinkers were more likely to be male (95% CI 3.58-4.94), single (95% CI 1.01-1.53), to be former (95% CI 1.06-1.62) or current smokers (95% CI 1.57-2.19), and to consume more than one type of alcoholic beverage (95% CI 2.04-3.44). There was a negative association of binge drinking with age (95% CI 0.98-0.99), living outside Northern Serbia-Vojvodina region, and drinking only spirits (95% CI 0.39-0.93).

Conclusion

Focusing on the positive association of sociodemographic factors and binge drinking could help policy makers create public health interventions against alcohol misuse. These interventions should be directed to males, smokers, and those who consume more than one type of alcoholic beverage.

Association between non-communicable disease multimorbidity and health care utilization in a middle-income country: population-based study

OBJECTIVE

The objective was to analyze possible inequalities by gender in the utilization of health services (general practitioner [GP] and hospital), among people with non-communicable diseases (NCDs) in the Republic of Serbia, with special reference to multimorbidity. In addition, we examined the prevalence patterns of NCDs by sociodemographic characteristics of the population.

STUDY DESIGN

This study is a population-based, cross-sectional survey.

METHODS

A secondary analysis from the 2013 Serbian National Health Survey included 13,765 adults aged ≥20 years. Multivariable logistic and linear regression analyses were performed to assess the association between NCDs and health care utilization.

RESULTS

Multimorbidity was present in 30.2% of the total sample. An increased number of NCDs was associated with a higher utilization of both primary (odds ratio [OR] for having any GP visit is 3.17 in males and 3.14 in females; unstandardized coefficient [B] for number of GP visits is 0.33 for both gender) and secondary health care services (OR for having any hospitalization is 2.45 in males and 1.97 in females; B for number of overnight stays in hospital is 1.62 in males and 0.97 in females) in Serbia.

CONCLUSIONS

Our study provided strong evidence that an increased number of NCDs was significantly associated with a higher utilization of health care services in Serbia. There is a need for wise, decisive, and integrated care interventions for effective management of NCDs and their risk factors. Further research is necessary with special emphasis on the role of the health system in satisfying needs of such patients.

Do health care workforce, population, and service provision significantly contribute to the total health expenditure? An econometric analysis of Serbia

BACKGROUND

In times of austerity, the availability of econometric health knowledge assists policy-makers in understanding and balancing health expenditure with health care plans within fiscal constraints. The objective of this study is to explore whether the health workforce supply of the public health care sector, population number, and utilization of inpatient care significantly contribute to total health expenditure.

METHODS

The dependent variable is the total health expenditure (THE) in Serbia from the years 2003 to 2011. The independent variables are the number of health workers employed in the public health care sector, population number, and inpatient care discharges per 100 population. The statistical analyses include the quadratic interpolation method, natural logarithm and differentiation, and multiple linear regression analyses. The level of significance is set at P < 0.05.

RESULTS

The regression model captures 90 % of all variations of observed dependent variables (adjusted R square), and the model is significant (P < 0.001). Total health expenditure increased by 1.21 standard deviations, with an increase in health workforce growth rate by 1 standard deviation. Furthermore, this rate decreased by 1.12 standard deviations, with an increase in (negative) population growth rate by 1 standard deviation. Finally, the growth rate increased by 0.38 standard deviation, with an increase of the growth rate of inpatient care discharges per 100 population by 1 standard deviation (P < 0.001).

CONCLUSIONS

Study results demonstrate that the government has been making an effort to control strongly health budget growth. Exploring causality relationships between health expenditure and health workforce is important for countries that are trying to consolidate their public health finances and achieve universal health coverage at the same time.