Epidemiology of Q Fever in Southeast Europe for a 20-Year Period (2002-2021).

This study aimed to assess epidemiological trends of Q fever in six countries of Southeast Europe by analysing surveillance data for 2002-2021 period. In this descriptive analysis, we collected and analysed data on confirmed human Q fever cases, obtained from the national Public Health Institutes of Bosnia and Herzegovina, Croatia, Greece, Montenegro, North Macedonia and Serbia. Overall, 2714 Q fever cases were registered during the 20-year period. The crude average annual notification rate was 0.82 (± 2.06) (95% CI: 0.47-1.16) per 100,000 inhabitants, ranged from 0.06 (± 0.04) (95% CI: 0.04-0.08) /100,000 in Greece to 2.78 (± 4.80) (95% CI: 0.53-5.02) /100,000 in the Republic of Srpska (entity of Bosnia and Herzegovina). Significant declining trends of Q fever age standardized rates were registered in Croatia, the Federation of Bosnia and Herzegovina, North Macedonia and Serbia, with an average annual change of -30.15%; -17.13%; -28.33% and - 24.77%, respectively. An unequal spatial distribution was observed. The highest average age-specific notification rate was reported in the 20-59 age group (0.84 (± 0.40) (95% CI: 0.65-1.02) /100,000). Most cases (53.69%) were reported during the spring. Q fever remains a significant public health threat in this part of Europe. The findings of this study revealed the endemic maintenance of this disease in the including countries, with large regional and subnational disparities in notification rates. A downward trend was found in Q fever notification rates across the study countries with the average notification rate higher than in the EU/EEA, during the same period.

Colorectal cancer mortality trend analysis in Montenegro from 1990 to 2018.

Colorectal cancer (CRC) is the second leading cause of cancer-related death in Europe. This study aimed to investigate CRC mortality trends in Montenegro from 1990 to 2018 and critically review the impact of preventive activities on cancer suppression in this country. We used the national CRC mortality data categorized by sex and age. Mortality rates were age-standardized according to the World Standard Population. The trends were described using regression techniques. In the period from 1990 to 2018, there was a significant increase in CRC mortality (P < .05). The death rates and the number of deaths from CRC were constantly increasing for both the overall level and gender, with the mean annual percentage change for the rates respectively average annual percent change (95% confidence interval-CI): 2.6% (1.9-3.2), 2.6% (1.8-3.5); 2.3% (1.3-3.3), and for the number of cases, respectively: 4.2% (3.5-4.9), 4.3% (3.3-5.3), 4.3% (3.2-5.5). The most affected age groups were 65 to 74 years (33%), followed by those aged 75 to 84 years (25%) and the age group 55 to 64 (22%). In Montenegro, CRC mortality trends are increasing among both men and women over the age of 45. Additional research on the risk factors and mechanisms that contribute to the unfavorable trends in CRC mortality in Montenegro is necessary.

Effects of palivizumab prophylaxis on respiratory syncytial virus (RSV) infections in Montenegro.

BACKGROUND: Respiratory syncytial virus (RSV) is one of the most common pathogens causing severe lower respiratory tract disease in infancy and childhood. In newborns, young infants, and in infants with co-morbidities, the risk of severe infection is increased. Current protection against severe RSV infection is immunoprophylaxis with the monoclonal antibody palivizumab. The study aimed to assess the effects of palivizumab prophylaxis in the Republic of Montenegro in comparison to the pre-prophylaxis period. METHODS: The study was conducted in prospective/retrospective single center format in Montenegro in the Clinical Center of Podgorica, for the period 2009-2019. RESULTS: A total of 104 high-risk infants in the palivizumab prophylaxis program (2014-2019 RSV seasons) and 168 high-risk children without palivizumab prophylaxis (2009-2013 RSV seasons) were enrolled. A total of 51 children (49.0%) received prophylaxis for prematurity, 33 (31.7%) for bronchopulmonary dysplasia (BPD), 13 (12.5%) for hemodynamically significant heart disease/defect (HSCHD), and 7 (6.8%) for "miscellaneous" indications. In the control group most children had prematurity (101, 60.1%), followed by BPD (59, 35.1%), HSCHD (3, 1.8%), and "miscellaneous" (5, 3.4%) conditions. Readmission to the pediatric intensive care units (PICU) due to RSV infection was significantly lower in prophylaxis group (0.0 vs 16.1%, p<0.001). No lethal outcomes were observed in high-risk children with palivizumab prophylaxis compared to 2.4% in the control group. CONCLUSIONS: The introduction of RSV immunoprophylaxis as well as other new protective treatment strategies for high-risk newborns led to significant improvements in infant and childcare in Montenegro. This is the first report on palivizumab prophylaxis in Montenegro, demonstrating the effectiveness and safety of palivizumab use in clinical settings.

Mortality trend of cutaneous melanoma in Montenegro from 1990-2018.

OBJECTIVE: Every year, melanoma claims over 20,000 lives in Europe. In Montenegro, as in Europe, numerous campaigns have been initiated to raise public awareness about the importance of melanoma prevention and its early detection. Thus, accompanying current diagnostic and therapeutic protocols, new methods of melanoma diagnosis and treatment have been implemented. Studying the trend enables the identification of the groups most burdened by mortality and assesses whether there has been a change in trends based on interventions aiming to reduce mortality. The objective of this study is to evaluate the mortality trend from cutaneous melanoma in Montenegro for the period 1990-2018. MATERIALS AND METHODS: We have utilized national data on the causes of death from melanoma, code 179 from the ninth and C43 from the tenth revision of the International Classification of Diseases, categorized by gender and age groups. The study utilized various regression techniques, including Joinpoint regression in the Joinpoint Program, Poisson regression, and linear regression in the SPSS 26th Program, to describe the trend. RESULTS: In Montenegro, during the period from 1990 to 2018, a total of 281 individuals died (51.6% male and 48.4% female). This ranks as the 13th leading cancer in terms of mortality among all cancers. The average age-standardized rate was 1.1 deaths per 100,000 (1.2 for males and 1.0 for females).  The number of death cases has been increasing on average by 3.3% annually [average annual percentage change (AAPC) (95% CI) = 3.3 (1.7-4.9); p<0.001] on an overall level and by 5.4% annually among males [AAPC (95% CI) = 5.4 (3.6-7.3); p<0.001] due to the rises in the age groups 55-64 years and 65-74 years with an average annual percent change of respectively 3.2% [AAPC (95% CI) = 3.2 (0.8-5.8); p=0.012] and 5.4% [AAPC (95% CI) = 5.4 (2.7-8.1); p<0.001] overall level, and 4.8% [AAPC (95% CI) = 4.8 (2.4-7.3); p<0.001] and 7.5% [AAPC (95% CI) = 7.5 (4.9-10.2); p<0.001] among males. For females, an increase of 1.1% was recorded, which was not statistically significant [AAPC (95% CI) = 1.1 (-0.8-3.0); p=0.255]. Furthermore, there was a noted increase in the rates at an overall level [ß (95% CI) = 0.027 (0.008-0.046); p=0.007] and in the age group 65-74 years [ß (95% CI) = 0.249 (0.090-0.407); p=0.003], as well as among males at an overall level [ß (95% CI) = 0.052 (0.025-0.079); p<0.001] and for age groups 45-54 years [ß (95% CI) = 0.102 (0.011-0.193); p=0.030] and 65-74 [ß (95% CI) = 0.410 (0.144-0.676); p=0.004]. In contrast, the rates for females remained constant. The three age groups most burdened by melanoma skin cancer mortality are 65-74 years (23.5%), 55-64 years (21.7%) and 75-84 years  (19.2%). CONCLUSIONS: The results of regression analyses indicate a significant rise in both the number of death cases and mortality rates overall, specifically among males in Montenegro. In females, however, the increase in the number of death cases and rates is not statistically significant. Preventive campaign activities should be redirected towards the most vulnerable groups in terms of mortality, namely males and the elderly population.

Trends in oesophageal cancer mortality in Montenegro, 1990-2018.

BACKGROUND: Oesophageal cancer (OC) is a significant public health issue, despite the decreasing trends in OC mortality rates observed globally in the past decades. The objective of our study is to analyze the pattern of OC mortality in Montenegro between 1990 and 2018 and contribute to the development of a national long-term strategy for the prevention and control of this malignancy. METHODS: The data on OC death cases in Montenegro between 1990 and 2018 were collected. The mortality rates were standardized according to the World Standard Population. The Joinpoint, Linear and Poisson regressions were applied to analyze the OC mortality trend. RESULTS: Joinpoint regression analysis showed an increase in death rates for men and the overall level which were not statistically significant. However, the number of cases increases significantly with an average annual percentage change (AAPC) increase of 2.6% for the overall level [AAPC (95% CI)=2.6 (1.0-4.2); P = 0.002] at the expense of the increase in men, which on average was 2.6% annually [AAPC (95%CI) = 2.6 (1.2-4.1); P = 0.001]. The age groups 55-64 and 65-74 have the highest percentage of deaths cases from OC with 30.6% and 31.4%, respectively. CONCLUSION: Montenegro has witnessed a recent increase in the number of deaths from OC, although the mortality rates remain stable. National strategies to further reduce mortality rates for OC are necessary. Individuals aged 55-64 and 65-74 need specific attention during the ongoing monitoring of this cancer.

Health policy developments in the Western Balkan Countries 2000-19: towards European Health and Health Care Policies.

BACKGROUND: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia have committed to becoming European Union (EU) member states. This, among others, implies that candidate/potential candidate states adopt legally authorized EU policies, including health. The study aims to identify the main country-specific health policy areas critical to the EU accession health policy dimension and present the change in associated selected health indicators from 2000 to 2019. METHODS: The study draws on published reports and analyses of official statistics over time and cross-country. Health care policy adherence to the European Commission's recommended country-specific health actions was classified into five health policy areas: financing, payment, organization, regulation and persuasion. Key health policy areas for Western Balkan countries (WBCs) were identified. Health progress or lack thereof in catching up to the EU15 population health, health expenditure and the number of health professionals are measured. RESULTS: The European Commission prioritized financing and regulation for all WBCs in the five policy areas. Nine of the 18 analyzed selected health indicators showed divergence, and the other nine converged towards the EU15 averages. WBCs continue to face diverse public health challenges in improving life expectancy at birth, death rates caused by circulatory system diseases, malignant neoplasms, traffic accidents, psychoactive substance use, tuberculosis incidence, tobacco smoking prevalence and public-sector health expenditure. CONCLUSIONS: By 2019, there is limited evidence of WBCs catching up to the average EU15 health levels and health care policies. Closer attention towards EU health and health care policies would be favourable.

Time trends in liver cancer mortality rates in Montenegro from 1990 to 2018.

OBJECTIVE: Liver cancer is the third most common cause of cancer-related deaths worldwide. Hepatitis B and C infections are the main factors affecting mortality. During recent years, Montenegro conducted activities on eradication of viral hepatitis according to the global strategy for the primary prevention of liver cancer mortality. The objective of this study was to assess the liver cancer mortality trend in Montenegro for the period of 1990-2018 using regression techniques. METHODS: liver cancer mortality data in Montenegro from 1990 to 2018 were collected. Mortality rates were age standardized to the World Standard Population. The joinpoint, linear and Poisson regressions were used to assess liver cancer mortality trends both overall and gender specific. RESULTS: The mortality trend was constant, with no significant increase or decrease in mortality rates both at the overall level and by gender. The number of cases, however, increases significantly at the overall level by an average of 1.4% per year [average annual percentage change (AAPC) (95% confidence interval, CI): 1.4 (0.5-2.3); P  = 0.004] and in women by 1.9% per year [AAPC (95% CI): 1.9 (0.8-3.1); P  = 0.002]. In men, there was no change in the number of cases. The three age groups most burdened by mortality from liver cancer were 65-74 (34.9%), 75-84 (26.6%) and 55-64 (25.8%). CONCLUSION: The consistent implementation of prevention measures and hepatitis virus infection treatment has played a role in partially favorable liver cancer mortality trends in Montenegro. It is crucial to closely monitor guidelines for this cancer and give particular attention to the elderly population as the most affected.

Trends in Gastric Cancer Mortality in Montenegro, 1990-2018: Joinpoint Regression.

INTRODUCTION: Gastric cancer (GC) remains a significant global public health problem, despite the decreasing trends in GC mortality rates in the last 5 decades. Our study aimed to examine the pattern of GC mortality in Montenegro between 1990 and 2018 and to contribute to the future by designing a national long-term strategy for the control and prevention of GC. METHODS: Gastric cancer mortality data in Montenegro from 1990 to 2018 were collected. Mortality rates were age-standardized to the World Standard Population for estimating both the overall and gender-specific trends. The joinpoint regression model was used to assess GC mortality and identified significant changes in the linear time trend. Linear and Poisson regressions were also applied for additional trend analyses. RESULTS: Joinpoint regression reveals a statistically significant decrease in the age-standardized rate for the overall level, on average by 1.4% per year (AAPC [95% IP] = -1.4 [-2.4 to -0.4]; p = 0.007), which was due to a decrease in the age-standardized rate in men with an average annual change of -1.8% (AAPC [95% IP] = -1.8 [-2.9 to -0.6]; p = 0.003), while in women the rates were stable (p = 0.565). The results for age groups indicate that a decline was registered at the overall level, and among men, as a consequence of the trend of decreasing age-specific rates for the age group 55-64 on average annually by 2% among men (AAPC [95% IP] = -2 [-3.8 to -0.1]; p = 0.035), and for the overall level (AAPC [95% IP] = -2 [-3.7 to -0.3]; p = 0.026). CONCLUSION: Our findings indicate a noteworthy decline in age-standardized overall GC mortality rates among men in Montenegro, while rates for women have remained constant. National strategies to further reduce mortality rates for GC are necessary.

Evaluation of Risk Factors for the Occurrence of Limb Fractures in Children Due to Unintentional Injury in Podgorica, Montenegro, Mediterranean.

Background and Objectives: Limb injuries in childhood are very common, with most of them being unintentional and often accompanied by soft tissue injuries. The aim of our study was to determine the risk factors that contribute to the occurrence of limb fractures as the most common type of accidental injury to children in our conditions. Materials and Methods: This study was designed as a prospective clinical analysis of predictive factors with a "nested" case-control study. It included all patients under the age of 18 who were diagnosed with unintentional limb injury and limb fracture due to accidental injury, at the Clinical Center of Montenegro, Podgorica, in the period of 7 January 2020-30 June 2021. Results: The gender of the child and the occurrence of the fracture are not related, and a statistically significant relationship was found between the occurrence of the fracture and the place of residence, the child's age, body mass index (BMI), the affected limb, the method of injury, and the mental state of the parents of the injured child, as well as their economic status. It was proved that the older the child was, the lower the chance of injury, while multivariate analysis proved that BMI could be a predictor of accidental fracture. The most common method of accidental limb fractures in children was a fall from a height. Conclusions: The analysis of factors that influence the occurrence of children's injuries is of great importance for public health. Such and similar research can enable a better understanding of the factors that influence accidental injuries, and therefore influence the prevention of these injuries by organizing various educational materials at the primary healthcare level or at the school level, for both children and parents.

Burnout syndrome among employees in a clinical center in Montenegro during COVID-19.

OBJECTIVE: Burnout syndrome occurs as a result of the influence of stressors in the workplace. The chronic disproportion between the demands placed on the worker and the resources available to fulfill the demands makes a significant contribution to the development of this syndrome. The occurrence of burnout syndrome has been shown to occur in a wide range of jobs, and it is taking on epidemic proportions among healthcare workers. So far, there have been no large-scale studies dealing with burnout syndrome in healthcare workers in Montenegro. SUBJECTS AND METHODS: The research was conducted as a cross-sectional study. All full-time employees of the Clinical Center of Montenegro who participated in the treatment of patients with COVID-19 during 2020 and 2021 were included in the research. Questionnaires used in the research were: a general questionnaire for collecting socio-demographic data, a questionnaire for the assessment of burnout syndrome at work - Maslach Burnout Inventory and a COVID-19 stress scale. RESULTS: The prevalence of burnout syndrome was 16.8% among employees who were engaged around COVID-19 patients. Predictors of burnout syndrome identified were occupation (nurses/technicians have a 2.8 times higher chance of burnout syndrome than doctors as a reference category), confirmed COVID-19 infection (subjects with confirmed COVID-19 infection have more than 2 times higher chance for burnout syndrome), higher CSS scores (subjects with high CSS score have a 3% higher chance of developing burnout syndrome). CONCLUSIONS: In order to reduce losses due to reduced productivity of employees and prevent long-term detrimental consequences on the mental health of employees, evidence-based preventive measures are needed.

The prevalence of overweight and obesity: a measurement-based analysis of 6-9-year-old school children from Montenegro.

Introduction: This study aimed to conduct a measurement-based analysis of overweight and obesity prevalence among 6-9-year-old children in Montenegro. Methods: The population of this cross-sectional study included 1993 (1059 boys and 934 girls) primary-school children. The sample of anthropometric variables includes body height, body weight and body mass index, as well as nutrition status that were presented based on BMI standardized categories: underweight, normal weight, overweight, and obesity. The descriptive statistics described the means for each variable, while post hoc tests and ANOVA were applied to explore differences between the proposed means. Results: The results indicate the overweight (including obesity) prevalence was 28% (15% of overweight and 13% of obese children), while boys have a higher overweight prevalence rate than girls. In addition, the tendency of higher prevalence rates to differ by age in both sexes is observed. This study also confirmed that overweight and obesity are affected by geographical regions but not by the level of urbanization in Montenegro. Discussion: The innovation of this study is reflected in the fact that the overweight and obesity prevalence rates among 6-9-year-old children are within an acceptable range in Montenegro, since it does not deviate from the European average, but further interventions and continuous monitoring are necessary, due to the specific nature of this issue.

Climate Variables Related to the Incidence of Human Leishmaniosis in Montenegro in Southeastern Europe during Seven Decades (1945-2014).

Leishmaniosis (or leishmaniasis) is a neglected parasitosis most commonly transmitted by the sandfly bite. Changes in temperature, precipitation, and humidity can greatly affect the vectors and reservoir hosts. This study aimed to determine the association between temperature, air humidity, and weather conditions with the incidence of leishmaniasis in Montenegro during a seven-decade period (1945-2014) and to statistically compare and correlate the obtained data. In the studied period, there were 165 registered cases of leishmaniosis, 96.4%, in the coastal and central region of Montenegro, with an average incidence rate of 0.45/100.000. The visceral form of leishmaniosis predominated (99% of the cases), with only one case of cutaneous disease. Climate factors (average temperature, air humidity, and precipitation) had an impact on the occurrence of leishmaniosis in Montenegro. Air temperature elevated by 1 °C in all regions of Montenegro was significantly correlated with an increased incidence of leishmaniosis, by 0.150 (0.013 to 0.287; p < 0.05). In order to improve prevention and control of this disease, it is also necessary to investigate other factors with a possible impact on the number of cases of this neglected parasitosis.

Trends in nationwide incidence of pediatric type 1 diabetes in Montenegro during the last 30 years.

Significant and unexplained variations in type 1 diabetes (T1D) incidence through the years were observed all around the world. The update on this disorder's incidence is crucial for adequate healthcare resource planning and monitoring of the disease. The aim of this study was to give an update on the current incidence of pediatric T1D in Montenegro and to analyze incidence changes over time and how the exposure to different factors might have affected it. This retrospective cohort study included a total of 582 patients younger than 15 years who were newly diagnosed with T1D during the past 30 years. The average age at diagnosis was 8.4 ± 3.91 years. The mean annual incidence of T1D in the Montenegro population during the whole study period of 30 years was 15.2/100,000 person-years. Slightly higher incidence rates were observed in male compared to female individuals, and the incidence increased with age, with the highest incidence in the 10-14 age group. If the model is observed as one without jointpoints, the annual percentage change (APC) for the total population is 3.1 (1.8-4.4); for male individuals, 3.8 (2.1-5.5); and for female individuals, 2.1 (0.6-3.5). In 2020, the first year of the coronavirus disease of 2019 (COVID-19) pandemic, in comparison to 2019, the incidence rate increased from 19.7/100,000 to 21.5/100,000, with the highest increase in the age group of 5-9 years. This is the first nationwide report on a 30-year period of T1D incidence trend in Montenegro. It suggests that T1D incidence among Montenegrin children is rising again and that there is a short-term influence of COVID-19 on new-onset T1D.

Prevalence and clinical implications of the HPV16 infection in oral cancer in Montenegro - Evidence to support the immunization program.

Oral squamous cell carcinoma (OSCC) makes 85-95% of all malignances in the oral cavity. Increasing evidence shows that the Human Papillomaviruses (HPVs) are preferentially associated with some oropharyngeal and OSCCs, namely the genotype 16. The aim of the present study was to determine the prevalence and clinical implications of HPV16 infection in oral squamous cell carcinoma in population of Montenegro.This study included 60 patients with OSCC (localized on the lower lip, tongue or/and floor of the mouth), surgically treated at the Clinical Centre of Montenegro from 2012 to 2018. Surgically obtained formalin-fixed and paraffin-embedded specimens were used for histopathological analysis and HPV16 genome detection using standard Polymerase Chain Reaction (primers for detection of E6 gene). Each individual was further followed up for the period of three years and for different clinico-pathological characteristics, including disease free interval (DFI).The prevalence of HPV16 infection in OSCCs was 23.3% and the infection was significantly more common in female patients (P = 0.038). No significant correlation was detectable between HPV16 infection and the patients' age (P = 0.302), tumor site (P = 0.125), tumor grade (P = 0.363) and disease stage (P = 0.995). Observing the total sample the DFI was not significantly different for HPV16-positive versus HPV16-negative patients (P = 0.427), but a gender-based difference in DFI was observed, with the significantly shorter DFI (Log Rank test, P = 0.003) in HPV16 positive female patients compared to male patients (P = 0.003).The results obtained in this study provide scientific evidence for the development of national HPV vaccination program in Montenegro.

Comparative analysis of the use of non-steroidal anti-inflammatory drugs in Montenegro, Finland and Croatia in the period 2010-2019.

OBJECTIVE: Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used drugs. However, numerous studies have shown that non-selective cyclooxygenase (COX) inhibitors can also significantly increase the risk of cardiovascular side effects. Diclofenac has the highest risk, while naproxen has the lowest risk of developing these complications. The aim of the study was to analyze the structure and amount of NSAIDs consumed in Montenegro, Finland and Croatia in the last 10 years. MATERIALS AND METHODS: In our study, we used 90% drug use (DU90) and ATC/DDD methodology. Drug consumption is shown in DDD/1000 inhabitants/day, and drug prices per DDD in Euros (€). Pearson's correlation test was used to examine the correlation between the number of drugs consumed and their price. RESULTS: Diclofenac consumption is 3 to 4 times higher in Montenegro compared to Croatia, and 9 to 10 times higher than in Finland. The average price of diclofenac in Montenegro was around € 0.07 per DDD, in Finland around € 0.26 per DDD and in Croatia € 0.19 per DDD. In Montenegro, the Pearson correlation test did not show a statistically significant association between high diclofenac consumption and its DDD price but showed a positive strong correlation between DDD price growth and naproxen consumption growth. CONCLUSIONS: The situation in Montenegro regarding the consumption of diclofenac is unfavorable and it is necessary to change the attitude and awareness of doctors and patients about the use of diclofenac. It is also necessary to replace diclofenac with naproxen, which is a slightly more expensive but safer drug.

Data Mining Approach: What Determines the Wellbeing of Women in Montenegro, North Macedonia, and Serbia?

Background: Women's happiness and life satisfaction, often summarized as subjective wellbeing, are of great value for most individuals and are associated with various determinants. The countries of the Western Balkan are of particular interest after the political changes in the nineties. Are the women satisfied with their lives today? Methods: We use the most recent datasets of the Multiple Indicator Cluster Surveys (MICS) for women 15-49 years old and with comparable data coverage for three countries of the Western Balkan belonging to the former Yugoslavia, namely Montenegro, North Macedonia, and Serbia. After sorting out variables of limited relevance or quality (missing values >50%), the remaining 32 variables followed a descriptive analysis. Four potential determinants of subjective wellbeing (SWB), an integration of happiness and satisfaction with life, entered an interactive Classification and Regression Tree (iC&RT) to account for their mostly bivariate format: age, education, region, and wealth. Results: The iC&RT analysis determines the influence of 4 independent variables (age, education, region, and wealth) on overall happiness, satisfaction with life, and subjective wellbeing, resulting in a high overall SWB of 88.9% for Montenegro, 82.1% for North Macedonia, and 83% for Serbia. The high relevance of younger age, higher education, and wealth, as critical determinants of a high SWB, and the lesser role of regions except for Serbia is confirmed. The spread of SWB in defined population subgroups ranges from 80.5-92.6% for Montenegro, 64.2-86.8% for North Macedonia, and 75.8-87.4% for Serbia. Conclusions: The three selected South-Eastern European countries of the former Yugoslavia (Montenegro, North Macedonia, Serbia) represent high levels of subjective wellbeing of women and a narrow range between the lowest and highest population groups. Women in Montenegro take a top position regarding their subjective wellbeing.

Trend of breast cancer mortality in Montenegro, 1990-2018 - Joinpoint regression.

OBJECTIVE: In this study, we analyzed breast cancer mortality data overall and by age groups in women in Montenegro, to determine if there were any changes in trend for period 1990-2018. MATERIALS AND METHODS: The study gathered data on breast cancer mortality in Montenegro obtained from Vital Registration System. Annual data on breast cancer mortality were extracted for period 1990-2018 and analyzed using World Standard Population age-standardized and age-specific rates and Joinpoint regression. RESULTS: In 2018 in Montenegro, breast cancer accounted for 4.64% of all deaths in women and for 19.78% of all cancer deaths in women. In terms of total cancer mortality, it ranked first among women. Age-standardized rates ranged from 11.41/100,000 in 1990 to 20.46/100,000 in 2016. Joinpoint regression showed no one joinpoint for the entire population of all women and age groups. In the observed period, breast cancer mortality rates significantly increased in the women in Montenegro [average annual percentage change (AAPC) = 1.44%; 95% confidence interval (CI): 0.9-2.0]. The most affected age group was 55-64 years. CONCLUSIONS: There is a growing breast cancer mortality trend in Montenegro. It is necessary to create specific programs for urgent action, in order to reduce this undesirable trend. At the same time, support from the competent institutions is needed for increasing screening coverage and better prevention of breast cancer in the target population.

Effectiveness of tax policy changes in Montenegro: smoking behaviour by socio-economic status.

BACKGROUND: The main goal of this study was to examine the responsiveness of smoking prevalence and cigarette consumption to price and income changes by income groups and the effectiveness of tax policy changes to reduce cigarette consumption in Montenegro. DATA AND METHODS: A two-part model was applied to estimate smoking participation, smoking intensity price and income elasticity. The first part of the model applies logit regression, while the second uses Deaton's model to improve the validity and objectivity of conditional (smoking intensity) elasticity results. A generalised linear model (GLM) was applied to verify robustness. The reason for this is that Deaton's model is commonly used in the analysis of Household Budget Survey (HBS) data, especially when households do not report the market price. Moreover, using this model, it is possible to capture the shading of quality to price change. The analysis used HBS data (2006-2017). RESULTS: The estimates indicate that tobacco pricing policies had a much higher impact on smoking prevalence in the low-income group (price elasticity of -0.595) relative to the high-income group (price elasticity of -0.344). The same conclusion could be drawn for the smoking intensity elasticity: the high-income group was the least affected by changes in price (price elasticity of -0.258). At the same time, the most affected was the low-income group, with price elasticity of -0.424. Poorer households spent a larger share of their budget on cigarettes. The simulation results confirm that increases in the specific excise taxes of 58.3% on tobacco would reduce total cigarette consumption by 11.25% while increasing the collection of government revenue by 8.07%. CONCLUSION: Smoking prevalence and consumption are very responsive to price and income changes, with considerable differences in elasticities between income groups. The taxation policy has a positive impact on changing patterns of consumption and public revenues across each income group. Low-income and middle-income households would benefit the most, while on the other hand, the highest revenue collection was generated from the wealthiest group. Our results align with results obtained so far for other low-income and middle-income countries. This paper contributes to the analysis of the smoking prevalence and cigarette consumption responsiveness to price and income changes, which was conducted for the first time in Montenegro.

Managing COVID-19 in four small countries: Initial response to the pandemic in San Marino, Montenegro, Malta and Cyprus.

The aim of this paper is to compare the impact of the COVID-19 pandemic on four small countries in the southern half of Europe with similar public health systems: San Marino, Montenegro, Malta and Cyprus, the latter two being island states. There are advantages and disadvantages in being a small nation amidst this crisis. The centralized public health administration means that small countries are faster at adapting as they learn and evolve on a weekly basis. However, small countries tend to be dependent on their bigger neighbours, and the networks they belong to, for trade, food, medical supplies as well as policies. The risk threshold taken by a small country for the transition strategy has to be less than that taken by a bigger country because if things go wrong in a border region, there is less resilience in a small country, with immediate impact on the whole country. The blow to the tourism industry, which plays a main role especially in small countries, negatively impacted the economy, and it has been a feat to reach a balance between allowing the flow of inbound tourists and keeping the local infection rates under control.

Measles outbreak, Montenegro January-July 2018: Lessons learned.

In 2017, the Regional Verification Commission for Measles and Rubella Elimination (RVC) of the World Health Organization confirmed that measles elimination was sustained in Montenegro, and the previous endemic transmission remained interrupted. However, the RVC was extremely concerned over the continuing low vaccination coverage reported for this country. In this study, we describe the most recent measles epidemic in Montenegro using the epidemiological data collected from January 1 to July 31, 2018. The outbreak is largely attributable to a dangerous accumulation of susceptible subjects across the country and represents a high-risk factor for re-establishing endemic transmission in the Balkan area. This study showed how a vaccine-preventable communicable disease outbreak can have a dramatic impact and severe consequences on regional public health system performance in terms of the sanitary spending point of view. A detailed update is provided on the epidemiological situation in this Central European area, not available until now.