The methodology of health education programs in schools-Qualitative study.

OBJECTIVE: To assess strengths and weaknesses of the methodology of health education programs, carried out in the period 2010-2020, in schools in Serbia. DESIGN: Qualitative study, a thematic analysis approach. SITE: Representatives of Public Health institutions, Serbian biggest nongovernmental organization, Youth organization, Ministry of education and municipality. PARTICIPANTS: Nine professionals working in the field of Public Health and Health education. METHOD: Focus group gathered nine health and non-health professionals in 2022 year. Focus group was recorded, transcribed verbatim, coded and analyzed by three research team members. A coding template evolved through the analysis, providing the expansion of key concepts. Themes were, one by one, extracted, encoded, classified as the smallest units and interpretive, thematic analysis was applied. RESULTS: Although the Focus group in our study identified among other advantages, support of Health sector to Educational sector as crucial, it emphasized as well following weaknesses: Analyzed health education programs were implemented insufficiently as a separate process in schools, did not have the image of programs shared and integrated into community; Health education needs of schoolchildren, parents, and teachers should be examined prior the education implementation; Well-educated interdisciplinary educators have to be strengthened and supported; Parents participation is necessity; Standards and good practice guidelines are needed, and those developed through Health Promoting Schools program could be practiced. CONCLUSION: It is necessary to support cross-curricular competence, where health education should be integrated into all school subjects, and should go far beyond the school, grow into a culture of community life, which will interconnect all stakeholders in strong Public Health network.

Assessment of the Quality of Cause-of-Death Data in Serbia for 2005-2019 Vital Statistics Performance Index Estimation.

Background: We aimed to evaluate the quality of the cause of death (COD) concerning mortality patterns and completeness of death registration to identify areas for improvement in Serbia. Methods: COD data collected from the mortality register in Serbia from 2005 to 2019 (1540615 deaths) were analyzed with the software Analysis of National Causes of Death for Action. The Vital Statistics Performance Index for Quality (VSPI(Q)) is estimated for the overall COD data quality. Results: The completeness of death certification was higher than 98%. Usable underlying COD was registered in 57%, 24.1% with an unusable and 18.6% with insufficiently specified COD. The VSPI(Q) was 67.2%, denoting medium quality. The typical error was using intermediate COD (24.7% of all deaths), while 13.2% and 8.5% of all garbage codes (GC) belonged to the Very High and High Severity classes. The leading underlying COD is unspecified cardiomyopathy. The analysis revealed that 39.1% of GC has been redistributed to non-communicable diseases, 2.5% to external causes and 1.1% to communicable diseases. Conclusion: In the 15 years' worth of data analyzed, the true underlying COD, in many cases, was ill-defined, indicating that COD data at the national level could be distorted. The additional and continuous professional education of medical students as well as physicians is needed. It should focus on the most common GC among the leading COD and acquiring skills in certifying external causes of death.

Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review.

Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05). The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health. The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population.

A longitudinal study of the association between depression, anxiety and stress symptoms of university students in Serbia with excessive social media use before and during COVID-19 pandemic.

Background: Besides the well known good side of social media, it cannot be denied some of its negative effects. This two-phase study aimed to find out whether the usage of social media during the COVID-19 pandemic showed some significant association with depression and anxiety symptoms, and levels of stress. Methods: The study was based on the survey of 1,476 randomly selected students at the initial phase (December 2019 to February 2020), and 1,400 students of the same cohort at the follow up phase (December 2021-February 2022). The collected data included socio-demographics, social media usage aspects, and the ones concerning levels of depression, stress and anxiety symptoms. Standardized questionnaires - the Bergen Social Media Addiction Scale (BSMAS) was applied to measure the levels of social media addiction, and the Depression Anxiety Stress Scale (DASS 42) was administered to evaluate the symptoms of depression, anxiety and stress. Results: The comparison of responses regarding the six components of online social media addiction, which constitute the BSMAS, between the two phases of the study showed significant difference (p < 0.01) in favor of the follow up phase in the raised scores of all but one component. The probable severe or extremely severe symptoms of depression, anxiety, and stress were notably enhanced during the peak of pandemic, and all three of them were positively correlated with all 6 BSMAS components (p < 0.01). The results also indicate that students, who consumed alcohol beverages and psychoactive substances more frequently in the pandemic, exhibited more noticeable symptoms of depression (p < 0.01, for both associations). Higher levels of anxiety symptoms in students were found to be associated with longer sleep during the night (p < 0.01), increased alcoholic beverages consumption (p < 0.01). Stress levels had the strongest correlations with consuming alcoholic beverages during the pandemic (r = 0.16, p < 0.01). Conclusion: The comparison between two phases of this follow-up study revealed significant changes in the Internet usage characteristics, which may have had an essential influence on the investigated symptoms of depression, anxiety, and stress. However, other factors that may have influenced student's mental health during the COVID-19 pandemic should also be considered.

Cancer of unknown primary - incidence, mortality trend, and mortality-to-incidence ratio is associated with human development index in Central Serbia, 1999-2018: Evidence from the national cancer registry.

OBJECTIVES: The aim was to estimate the trend of incidence, mortality and mortality-to-incidence ratio (MIR) in Central Serbia in 1999-2018 and its possible association with the human development index (HDI). METHODS: In this study, cancer of unknown primary (CUP) was included as C77-C80 codes. Trend analysis was performed in the Joinpoint Regression Programme version 4.8.0.1. HDI combines life expectancy, educational attainment and gross national income. HDI values for Serbia are extracted from the global bank site. RESULTS: Joinpoint regression analysis of the age-standardised incidence rate of CUP showed a significantly increasing trend with annual percent change (APC) of 8.5% (95% confidence interval [CI] 3.0-14.3%) in males and 7.8% (95%CI 2.7-13.2) in females. The age-standardised mortality rate of CUP showed a significantly decreasing trend with APC of -1.7% (95%CI -2.8 to -0.5%) in males and -1.4% (95%CI -2.7 to -0.1%) in females. MIR showed a significantly decreasing trend with APC of -9.3% (95%CI -14.6 - -3.6%) in males and -7.1% (95%CI -10.5% to -4.2%) in females. The linear regression showed significant inverse association among HDI and the MIR of CUP in males (r2 = 0.464, p = 0.002) and in females (r2 = 0.612, p < 0.001). CONCLUSIONS: Decline of MIR was associated with HDI, suggesting that CUP prognosis follows socio-economic status.

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. Int J Occup Med Environ Health. 2021;34(6):737-45.

[Level of job satisfaction among employees working at healthcare facilities in Nisava and Toplica district].

INTRODUCTION: The product of health system and its employees is health service whose quality is related to the satisfaction and motivation of people working in health system. The objective of this study was to assess and compare satisfaction with different aspects of work among different categories of employees in healthcare facilities on primary, secondary and tertiary level of health care in Nisava and Toplica districts. MATERIALS AND METHODS: The study was conducted as a one-day study in 15 healthcare facilities on primary level, in two public hospitals and 27 clinics of Clinical Centre of Nis, using anonymous questionnaire. Out of 3,892 employees, who took part in this study, 2,227 were from primary and 1,665 were from secondary and tertiary level. RESULTS: All employees on primary level are more satisfied with the majority of aspects of job comparing with employees on secondary and tertiary level of health care. Administrative staff is in general more satisfied with all aspects of job comparing with other categories of employees. All employees on secondary and tertiary level are more physically and psychically exhausted than employees on primary level of health care. Health workers on secondary and tertiary level are most psychically exhausted. CONCLUSION: There is a difference in satisfaction with different aspects ofjob in different categories of employees, and on different levels of health, in healthcare facilities in Nisava and Toplica districts. Employees of healthcare facilities on primary level of health care are in general more satisfied than employees on se-condary and tertiary level of health care.

Job satisfaction among health care workers in Serbia.

According to literature review there seems to be a general agreement that job satisfaction among doctors is declining. This study's objective was to identify job satisfaction levels and their causes among health care workers, employed at the public health institutions. A job satisfaction survey of health care workers was therefore carried out in 197 public health centers in the Republic of Serbia, 157 primary health care centers and 40 general hospitals, in 2008. A satisfaction questionnaire, containing 24 items was used to investigate job satisfaction. Respondents (23.259), working in primary health care, indicated an average job satisfaction level of 3.08 +/- 0.67 on a 5-point scale. Respondents (11.302), working in general hospitals, indicated a lower average job satisfaction level of 2.96 +/- 0.63. The reported level of satisfaction was the highest for their opportunities to use their abilities, cooperation with colleagues and fellow workers, and freedom to choose their own methods of work. Doctors, working in primary health care centers, reported higher level of job satisfaction than hospital doctors. Overall, job satisfaction of doctors and nurses is relatively low. Increased pay rate and more adequate equipment, as well as possibilities for education and career improvement, would enhance their job satisfaction.

Health care managers as a crucial component of health care workforce in Serbia.

The aim of the paper was to describe and analyse health services management in Serbia, commencing with present status and projecting, as accurately as possible, future changes over the next years, skills and required competencies of the health management workforce. The study was done as a part of Ministry of Health/EU funded Project "Preparation for Health Management Training Programme in Serbia" by a desk review of current and draft legislation, related projects in the health sector and relevant local and international literature; semi-structured interviews with key local and international stakeholders and a structural analysis of the health management sector. The results of the study have shown that there was a big gap in knowledge and skills regarding Health Management in Serbia and a true need for such type of education.