Redesigning diabetes care delivery in Serbia, using JA CHRODIS Recommendations and criteria.

INTRODUCTION: Managing non-communicable diseases (NCDs) requires redesigning health care delivery to achieve better coordination of services at all levels of health care. The aim of this study was improving prevention and strengthening high quality of care for NCDs by using type 2 diabetes as a model disease. METHODS: The mix method approach served to analyse the impact of the intervention processes. Source of information were routine health statistics, interviews and observation. Key Performance Indicators in defined Improvement Areas assisted in the quality of diabetes care assessment. RESULTS AND DISCUSSION: During the study the National Diabetes Centre (NDC) was established. The NDC experts organized numerous educational events, 316 physicians and nurses have participated. New electronic data base was implemented in 20 pilot Primary Health Care Centres (PHCCs) with 38,833 electronic diabetes records. CONCLUSIONS: The intervention led to establishment of the NDC, strengthening competences of health care professionals and to the renewal of the Diabetes Care Units in PHCCs included in the study.

Prevalence and factors associated with self-reported kidney disease among Serbian adults: Results of 2013 National Health Survey.

BACKGROUND: Data from developing countries on the rates of kidney disease are scarce. The study aimed to estimate population-based prevalence of self-reported kidney disease (SRKD) in Serbia, describe co-occurrence of chronic diseases/conditions/functional limitations in respondents with SRKD and explore association between SRKD and possible risk factors. METHODS: We performed a secondary analysis of 2013 National Health Survey data. Data on a total of 14,587 respondents aged 15 years or older were analyzed using means of descriptive statistics, principal component analysis and logistic regression analysis. RESULTS: Out of all study respondents, 5.6% (95%CI 5.2-6.0) reported presence of kidney disease. Prevalence of all analyzed morbidities and functional limitations was higher in respondents with SRKD, and they had 8 times higher likelihood of being diagnosed with cirrhosis, 6.3 times higher likelihood of being diagnosed with urinary incontinence, more than 3 times higher likelihood of being diagnosed with degenerative disorder of bone and joint system. For cardiovascular diseases we obtained odds ratios (ORs) from 2.27 (95%CI 2.32-3.44) for heart attack to 2.95 (95%CI 2.43-3.57) for coronary heart disease. Number of co-occurrence patterns of kidney and other chronic diseases/conditions varied depending on inclusion of obesity in models. Logistic regression analysis showed that age explained most part of variability in the prevalence of SRKD and in the prevalence of two morbidities in respondents with SRKD, whereas the presence of three or more morbidities were associated with female gender, aging and low education level. CONCLUSIONS: Our study provided evidence that the presence of kidney disease was significantly associated with socio-demographic, lifestyle characteristics and a number of morbidities in Serbia. There is a need for integrated care and public health interventions, tackling management of NCDs and their risk factors. Detailed well-designed studies, as part of cost-effective preventive approach, are needed for chronic kidney disease screening.

[Etiology of growth hormone deficiency in children and adolescents].

INTRODUCTION: Growth hormone deficiency (GHD) can be isolated or associated with deficiency of other pituitary gland hormones. According to age at diagnosis, causes of GHD are divided into congenital or acquired, and according to etiology into recognized and unknown. OBJECTIVE: We analyzed etiology and prevalence of GHD, demographic data at birth, age, body height (BH) and bone age at diagnosis as well as the frequency of other pituitary hormone deficiencies. METHODS: The study involved 164 patients (109 male).The main criterion for the diagnosis of GHD was inadequate response of GH after two stimulation tests.The patients were classified into three groups: idiopathic, congenital and acquired GHD. RESULTS: Idiopathic GHD was confirmed in 57.9% of patients, congenital in 11.6% and acquired in 30.5%. The mean age at diagnosis of GHD was 10.1 +/- 4.5 years.The patients with congenital GHD had most severe growth retardation (-3.4 +/- 1.4 SDS), while the patients with idiopathic GHD showed most prominent bone delay (-3.6 +/- 2.3 SDS).The prevalence of multiple pituitary hormone deficiency was 56.1%, in the group with congenital GHD 73.7%, acquired GHD 54.0% and idiopathic GHD 53.7%.The frequency of thyrotropin deficiency ranged from 88.2-100%, of adrenocorticotrophin 57.1-68.8% and of gonadotrophins deficiency 57.1-63.0%, while deficiency of antidiuretic hormone was 2.0-25.0%. CONCLUSION: Although regular BH measurements enable early recognition of growth retardation, patients' mean age and degree of growth retardation indicate that GHD is still diagnosed relatively late. A high incidence of other pituitary hormone deficiencies requires a detailed investigation of the etiology of disorders and evaluation of all pituitary functions in each child with confirmed GHD.