Burnout syndrome among preschool teachers in Serbia.

Pedagogical work, especially with preschool children, is one of the most stressful professions, and the incidence of stress-related illnesses among preschool teachers is higher than in the general population. The aim of this cross-sectional study, conducted between October 2018 and April 2019, was to examine the prevalence of the burnout syndrome in a representative sample of 482 preschool teachers in Serbia and the factors associated with it. For this purpose, the participants completed a questionnaire composed of six sections: the socio-demographic and socio-economic characteristics, health and lifestyle characteristics, workplace and employment characteristics; Copenhagen Burnout Inventory (CBI); Beck Depression Inventory (BDI), and the Zung Self-Rating Anxiety Scale (SAS). The frequency of the total burnout was 27.1 %. The frequency of burnout on the CBI was 25.4 % for personal burnout, 27.0 % for work-related burnout, and 23.4 % for client-related burnout. Multivariate logistic regression analysis with total burnout as an outcome variable showed that being single (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/play tools (OR: 2.71; 95 % CI: 1.21-6.04), having a higher score on the BDI (OR: 1.19; 95 % CI: 1.09-1.29) or SAS (OR: 1.10; 95 % CI: 1.03-1.18) was significantly associated with the total burnout among our participants. Our study shows the worryingly high prevalence of the burnout syndrome among preschool teachers in Serbia and points to its association with mental health issues, depression, and anxiety.

Validity of the Health Personality Assessment among rectal cancer survivors in Serbia.

Understanding health personality traits in rectal cancer survivors could help to optimize recovery and coping mechanisms. The objective of this study was to evaluate psychometric properties of the Health Personality Assessment in Serbian language among rectal cancer survivors. A cross-sectional study was carried out from June to December 2022. The study sample consisted of 76 people who underwent the open lower anterior resection for rectal carcinoma at the Clinic for Digestive Surgery and the Clinic for Emergency Surgery, University of Clinical Center of Serbia (Belgrade, Serbia) and whose ileostomy was closed. Study participants were interviewed over the telephone using the Serbian version of the HPA which was translated according to the internationally accepted methodology for translation and adaptation of questionnaires. The confirmatory factor analysis suggested that the fit indices for 5-factor structure of the HPA were acceptable-to-good: Goodness of fit index = 0.939; Tucker Lewis fit index = 0.989; Comparative fit index = 0.992; Root Mean Square Error of Approximation = 0.019. Cronbach's alpha coefficients for Health Neuroticism, Health Extraversion and Health Agreeableness were>0.7 and for Health Openness and Health Conscientiousness were >0.4. Predictive validity testing suggested that not having complications with the ileostomy and a longer time since ileostomy closure were associated with stronger Health Agreeableness. Also, a longer time since ileostomy closure was associated with stronger Health Conscientiousness. The Serbian version of the HPA showed good construct validity and acceptable internal consistency. This is an important tool in further research of personality and health outcomes among rectal cancer survivors.

"It Bothered Me": The Mental Burden of COVID-19 Media Reports on Community-Dwelling Elderly People.

Background and Objectives: Elderly people may have difficulties understanding the quality and quantity of information about the COVID-19 epidemic, which can put an additional mental strain on their health and well-being. The purpose of this study was to explore the processing of COVID-19 information among older people. Materials and Methods: A qualitative study was carried out in summer 2021. The sampling was based on the snowball method. This approach allowed us to communicate with the next potential participants relatively freely and without reservations. Two female researchers (both MD, PhD) conducted the interviews. All interviews were held in Serbian. The data were analyzed using qualitative content analysis. Results: The interviews were conducted with 13 participants (average age 71 years). The analysis of qualitative content suggested that four topics could be identified: (1) sources of information, (2) information interest and need, (3) reporting of information and (4) suggestions for better reporting. The participants were troubled by the excess of information, repetitive information about death tolls, unqualified people in media discussing the pandemic and inconsistent reporting. These features caused the participants to feel the psychological burden in processing all the pieces of information. Conclusions: The elderly people in Serbia followed mainstream media to get information about COVID-19; however, they perceived a variety of problems with reporting, which made the understanding of the information difficult and psychologically burdensome. These findings should be taken into consideration when delivering health-related information to elderly people.

Mandatory and seasonal vaccination against COVID-19: Attitudes of the vaccinated people in Serbia.

The aim of our study was to examine the position of vaccinated people regarding the proposal for mandatory and seasonal vaccination against COVID-19 in Serbia. A cross-sectional study was conducted in a sample of people who came to receive a third dose of COVID-19 at the Institute of Public Health of Serbia in September and October 2021. Data were collected by means of a sociodemographic questionnaire. The study sample comprised 366 vaccinated adults. Factors associated with the belief that vaccination against COVID-19 should become mandatory were being married, being informed about COVID-19 from TV programmes and medical journals, trust in health professionals, and having friends affected by COVID-19. In addition to these predictors, factors associated with the belief that COVID-19 vaccination should become seasonal were being older, consistently wearing facemasks, and not being employed. The results of this study highlight that trust in information delivery, evidence-based data, and healthcare providers may be a major driver of mandatory and seasonal vaccine uptake. A careful assessment of the epidemiological situation, the capacity of the health system, and the risk-benefit ratio is needed in order to introduce seasonal and/or mandatory vaccination against COVID-19.

Attitudes towards COVID-19 vaccination and intention to get vaccinated in Western Balkans: cross-sectional survey.

BACKGROUND: Introduction of vaccines against COVID-19 has not encountered expected acceptance. The uptake of COVID-19 vaccines in Western Balkans countries is lagging behind the European Union average. The aim of our study was to assess the intention to get vaccinated against COVID-19 in the population of unvaccinated adult citizens of five Western Balkans countries, and to explore factors that influence the vaccination intention. METHODS: Cross-sectional study was conducted in the period from July to October 2021. The questionnaire was shared through online social media. Intention to get vaccinated against COVID-19 was measured by a single item assessing the likelihood of getting vaccinated on a 5-points Likert scale. Linear regressions were conducted with socio-demographic characteristics, presence of chronic diseases and attitudes towards COVID-19 vaccination as independent factors. RESULTS: The largest proportion of unvaccinated respondents willing to get vaccinated in the future was observed in Montenegro and Albania (40.4% in each country), while in the Serbian sample, the willingness to get vaccinated was the lowest (22.6%). Socio-demographic characteristics were not significantly associated with the intention to get vaccinated against COVID-19 in most of the countries. In Albania, Bosnia and Herzegovina, North Macedonia and Serbia the strongest determinant of COVID-19 vaccination intention was the higher sense of social responsibility. CONCLUSIONS: Vaccination interventions and campaigns aiming to improve the COVID-19 vaccine uptake should be focussed on specific set of factors in each country, appealing to social responsibility as most prevalent determinant of vaccination intention in Western Balkans.

Determinants of COVID-19 vaccine hesitancy: questionnaire development and validation.

OBJECTIVES: Vaccine hesitancy presents one of the critical constraints in combating COVID-19 pandemic. The aim of this study was to develop and validate an instrument for measuring factors that contribute to COVID-19 vaccine hesitancy. METHODS: The key constructs in the study instrument were factors that constitute the "3C" model of vaccine hesitancy: Confidence, Complacency and Convenience. Using a cross-sectional, online survey design, the 8-item COVID-19 Vaccine Hesitancy Questionnaire was administered to a sample of 667 adult citizens of Serbia in December 2020. We used confirmatory factor analysis to investigate the model that assumes three latent variables. To ensure that the instrument measures the same constructs in different groups, the measurement invariance examination was conducted. To examine criterion validity, Spearman's correlation was applied to determine the association between the instrument total score and the single-item measuring the likelihood of getting vaccinated against SARS-CoV-2. RESULTS: Confirmatory factor analysis established the three-factor structure, with subscales fitting within the "3C" model of vaccine hesitancy comprising confidence, convenience and complacency. The full scalar invariance was found across gender, and the partial scalar invariance was achieved for the age, region and education level. A higher level of the COVID-19 vaccine hesitancy was associated with the lower likelihood to get vaccinated against the SARS-CoV-2 virus. CONCLUSION: Our scale is brief and consistent, maintaining a good fit across key socio-demographic subgroups. This result implies that the scale could be useful for quick assessment of COVID-19 vaccine hesitancy in various target populations.

Preferences of COVID-19 Vaccines in the General Population in Belgrade, Serbia: A Qualitative Study.

Few countries provided multiple COVID-19 vaccines for their citizens right from the start of mass immunization. In Serbia, four vaccines were available. Circumstances in which people had several options to choose from are unique. The purpose of this study was to identify motivators behind COVID-19 vaccination and the choice of COVID-19 vaccine among people who were immunized against COVID-19. Qualitative interviews with 35 vaccinated people aged > 18 years were conducted in May 2021 at the Institute of Public Health of Serbia, a reference institution for vaccination. Interviews were audio-recorded, transcribed and data were analyzed using qualitative content analysis. Four topics emerged: 1) Decision to receive COVID-19 vaccine; 2) Sources of information about the vaccine; 3) Choice of the COVID-19 vaccine and 4) Anti-vaccination sentiment around the vaccinated people. Participants were classified in two groups: those who were determined to receive the vaccine and those who were hesitant. People who were hesitant decided to receive the vaccine after reviewing the information collected from various sources, especially physicians. Although some participants accepted any vaccine regardless of their characteristics, there were others who had explicit preferences. These preferences stemmed mainly from their beliefs about particular vaccine's efficacy and safety, COVID-19 status (previous infection), living or lifestyle circumstances (residence or travel abroad), doctor's recommendation (underlying health status) or trust in expertise of that particular manufacturer's country of origin. Opting for appropriate vaccine was motivated by reasons specific to various individuals, which enabled them to make choices in line with their preferences and values.

Research priorities to reduce the impact of COVID-19 in low- and middle-income countries.

Background: The COVID-19 pandemic has caused disruptions to the functioning of societies and their health systems. Prior to the pandemic, health systems in low- and middle-income countries (LMIC) were particularly stretched and vulnerable. The International Society of Global Health (ISoGH) sought to systematically identify priorities for health research that would have the potential to reduce the impact of the COVID-19 pandemic in LMICs. Methods: The Child Health and Nutrition Research Initiative (CHNRI) method was used to identify COVID-19-related research priorities. All ISoGH members were invited to participate. Seventy-nine experts in clinical, translational, and population research contributed 192 research questions for consideration. Fifty-two experts then scored those questions based on five pre-defined criteria that were selected for this exercise: 1) feasibility and answerability; 2) potential for burden reduction; 3) potential for a paradigm shift; 4) potential for translation and implementation; and 5) impact on equity. Results: Among the top 10 research priorities, research questions related to vaccination were prominent: health care system access barriers to equitable uptake of COVID-19 vaccination (ranked 1st), determinants of vaccine hesitancy (4th), development and evaluation of effective interventions to decrease vaccine hesitancy (5th), and vaccination impacts on vulnerable population/s (6th). Health care delivery questions also ranked highly, including: effective strategies to manage COVID-19 globally and in LMICs (2nd) and integrating health care for COVID-19 with other essential health services in LMICs (3rd). Additionally, the assessment of COVID-19 patients' needs in rural areas of LMICs was ranked 7th, and studying the leading socioeconomic determinants and consequences of the COVID-19 pandemic in LMICs using multi-faceted approaches was ranked 8th. The remaining questions in the top 10 were: clarifying paediatric case-fatality rates (CFR) in LMICs and identifying effective strategies for community engagement against COVID-19 in different LMIC contexts. Interpretation: Health policy and systems research to inform COVID-19 vaccine uptake and equitable access to care are urgently needed, especially for rural, vulnerable, and/or marginalised populations. This research should occur in parallel with studies that will identify approaches to minimise vaccine hesitancy and effectively integrate care for COVID-19 with other essential health services in LMICs. ISoGH calls on the funders of health research in LMICs to consider the urgency and priority of this research during the COVID-19 pandemic and support studies that could make a positive difference for the populations of LMICs.

Experiences and aftermath of the COVID-19 lockdown among community-dwelling older people in Serbia: A qualitative study.

RATIONALE AND AIM: At the beginning of the COVID-19 pandemic in March 2020, the Serbian government instituted a 24-h curfew for people aged ≥65 years for 2 months. The aim of this study was to examine the experiences and perceptions of curfew for older people in Serbia 15 months after the curfew had ended. METHODS: In-depth interviews were carried out with 23 older adults from urban areas in Serbia. We identified the first three participants, while others were selected using the snowballing method. The interviews were audio-recorded, transcribed and data were analyzed according to guidelines for qualitative studies. RESULTS: Six topics emerged: (1) perception of the curfew announcement; (2) attitude toward the curfew; (3) organization of daily living; (4) mood; (5) frustrations/limitations and 6) making sense of the curfew 15 months after. Older people in this study overall remember not feeling disturbed by the curfew because they perceived it as prevention, especially because this population group is considered to have the highest rate of mortality from COVID-19. Some people remember being extremely frustrated because of the restrictions and considered them unnecessary. Most people remembered that the lack of social interactions and lack of physical activity were the most difficult to cope with. CONCLUSIONS: Although challenging and bothersome, the majority of older people in this study accepted the curfew as an appropriate measure to avoid catching the virus and combat the COVID-19 pandemic.

Drosophila melanogaster as a Model to Study Fragile X-Associated Disorders.

Fragile X syndrome (FXS) is a global neurodevelopmental disorder caused by the expansion of CGG trinucleotide repeats (≥200) in the Fragile X Messenger Ribonucleoprotein 1 (FMR1) gene. FXS is the hallmark of Fragile X-associated disorders (FXD) and the most common monogenic cause of inherited intellectual disability and autism spectrum disorder. There are several animal models used to study FXS. In the FXS model of Drosophila, the only ortholog of FMR1, dfmr1, is mutated so that its protein is missing. This model has several relevant phenotypes, including defects in the circadian output pathway, sleep problems, memory deficits in the conditioned courtship and olfactory conditioning paradigms, deficits in social interaction, and deficits in neuronal development. In addition to FXS, a model of another FXD, Fragile X-associated tremor/ataxia syndrome (FXTAS), has also been established in Drosophila. This review summarizes many years of research on FXD in Drosophila models.

Cross-cultural validation and psychometric testing of the counseling center assessment of psychological symptoms: experience of Serbia.

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

Physicians' Attitudes Toward Adolescent Confidentiality Services: Scale Development and Validation.

INTRODUCTION: Confidentiality is one of the oldest ethical principles in healthcare. However, confidentiality in adolescent healthcare is not a universally-accepted doctrine among scholars. The ethical acceptability of confidential services in adolescents' healthcare is based on perceptions of adolescent maturity and an appreciation of its importance to adolescents' access and utilization of healthcare services. Despite legal policies that promote adolescents' rights, physicians' attitudes toward adolescent confidentiality can be a determining factor in their ultimate decision to protect adolescents' confidentiality. METHOD: A new Attitude towards Adolescent Confidentiality Scale was developed based on the results of a qualitative interview study. This new instrument was administered to a sample of 152 physicians working at school pediatric and gynecology departments in 13 primary healthcare institutions in Belgrade. Principal component analysis was applied to determine the main components of the scale. Reliability was assessed by calculating Cronbach alpha and mean inter-item correlations. RESULTS: Psychometric analysis of the final 19-item version of the scale showed a high level of reliability (Cronbach alpha of 0.83). Principal component analysis showed four components, which present subscales of the instrument: Confidentiality in clinical situation, Iimportance of confidentiality, Adolescent maturity, and Communication with parents. CONCLUSIONS: The instrument showed satisfactory levels of reliability and validity. The results of the scale dissemination may be a valuable tool for needs assessment for future educational interventions and training programs that will raise physicians' awareness of the importance of adolescent confidentiality.

Adolescents' right to confidential health care: knowledge, attitudes and practice of pediatricians and gynecologists in the primary healthcare sector in Belgrade, Serbia.

OBJECTIVES: Confidential counseling is a critical condition of the healthcare quality in adolescent medicine. This study aimed at assessing knowledge, attitudes and practice of primary healthcare pediatricians and gynecologists regarding adolescents' rights to confidentiality. METHODS: A cross-sectional study was conducted in a sample of 152 pediatricians and gynecologists who are employed at 13 primary healthcare centers in Belgrade, Serbia, in 2017-2018. Data were collected by a self-administered questionnaire purposefully constructed for this study. The questionnaire examined knowledge and attitudes toward adolescents' right to confidentiality as well as whether participating physicians practice confidential health care with adolescents. RESULTS: Physicians scored 4 out of 7 on a knowledge scale, but they overall supported adolescents' right to confidential health care (average attitude score was 71 out of 95). On average, physicians scored 21 out of 30 on practice of confidentiality scale. Multivariate analysis showed that better knowledge and stronger positive attitudes toward duty of confidentiality were associated with consistent practice of confidential health care. CONCLUSIONS: Knowledge about adolescents' rights to confidentiality and attitudes toward keeping adolescents' information confidential influence the practice of providing confidential services.

Fragile X-Associated Disorders in Serbia: Baseline Quantitative and Qualitative Survey of Knowledge, Attitudes and Practices Among Medical Professionals.

We conducted a knowledge, attitude, and practice (KAP) survey of fragile X-associated disorders (FXD) in Serbia in order to obtain baseline quantitative and qualitative KAP data on fragile X mental retardation 1 gene (FMR1) pre- and full mutations (PM, FM). The survey's 16-item questionnaire included a knowledge component (12/16), such as self-assessment knowledge (SAK) and factual knowledge (FK, 2/5 questions for PM, FXTAS and FXPOI). Education-directed attitudes in the FXD field and FMR1 DNA testing practices had 4/16 items, including brief case vignettes of FXTAS and FXPOI, respectively. The study's cohort consisted of primary care physicians (referred to as "physicians" in the rest of the text) throughout Serbia (n = 284, aged 26-64 years, 176/284, 62.2% in Belgrade, Serbia) and senior medical students (n = 245, aged 23-30 years; 33.5% males) at the Belgrade School of Medicine. Strikingly, half of the survey respondents indicated "not having any" knowledge for the fragile X gene premutation and FXD. Physicians were more likely to indicate "not having any" knowledge than students (41.2% of physicians vs. 13.1% of students, P < 0.05). Roughly half of the students had "minimal knowledge" (53.5 vs. 30.5% of physicians, P < 0.05). Low FK was common in the cohort, as few physicians had "all correct answers" (7.5 vs. 3.7% of students, P < 0.05; 16.5 vs. 9.5% of students for the 2/5 premutation-related questions). Statistical analyses identified physicians' practice setting and length of clinical experience as predictors of the lack of FK on questions related to FXD. Physicians were more likely than students to indicate "strongly agreed" to expand their knowledge of the gene premutation and FXD (90.9 vs. 66.7% of students, P < 0.01). However, students more frequently indicated that they are willing to recommend DNA testing in their future practices than physicians (93.5 vs. 64.8% of physicians, P < 0.001). In conclusion, there is a major gap in knowledge regarding fragile X gene PM and FXD among the study's participants in Serbia. The study's informative-educational survey serves as an initial step in the process of enhancing the KAP of medical professionals with regards to the fragile X gene premutation and FXD.

Knowledge and attitudes toward vaccination: A survey of Serbian students.

Since vaccination coverage in Serbia has been decreasing and health professionals have been identified as the most important factor in making decisions about immunization, vaccination knowledge and attitudes of students, especially medical students, are of particular interest. A cross-sectional survey was carried out on three groups of 509 Belgrade University students (medical, law and engineering students). The data were collected using an on-line questionnaire posted to student groups and included the Vaccine Knowledge Questionnaire and Attitudes Toward Vaccination Scale. This survey also included questions about demographic characteristics and perceived negative experiences. Multiple linear regression analysis was performed. There was a significant difference in the Vaccine Knowledge score (F=40.48, p<0.01) among the three groups of students. Medical students (N=251, Mean=4.47, SD=1.71) had significantly higher mean knowledge scores than did law (N=128, Mean=2.80, SD=1.56) or engineering students (N=130, Mean=3.98, SD=1.81). Compared with the law (Mean=49.77, SD=10.23) and engineering students (Mean=57.62, SD=12.21), medical students (Mean=59.52, SD=9.62) also had significantly higher attitude scores (F=37.56, p<0.01). These findings demonstrate general positive attitudes of Serbian students toward immunization. However, some knowledge gaps were identified. Multivariate analysis showed that those who had better vaccine knowledge, those who studies medicine, those who attended at university for more years, and those who do not know someone who had a negative experience with vaccines were more likely to have positive attitudes toward vaccination. Considering the growing vaccination hesitance in the general population, this is an important result that indicates that medical students are possible important participants in future public health campaigns. A strong association between vaccine knowledge and attitudes implies recommendations to introduce a specialized vaccination curriculum at both the undergraduate and graduate levels of medical study.