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.

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.

Education and training in public health: is there progress in the European region?

BACKGROUND: The Association of Schools of Public Health in the European Region (ASPHER) is confronted with challenges to improve education for public health professionals. In this article, we attempt to answer the question: Did ASPHER members improve their organization and programmes to enable their graduates to acquire the competences to tackle the diverse areas of public health defined in the Ten Essential Public Health Operations (EPHOs)? METHODS: ASPHER run two surveys among its membership: In 2011, 66 Schools and Departments of Public Health (SDPHs) took part (82.5%), while in 2015-16, 78 SDPHs (81.3%). The performance of graduates was estimated using a Likert scale. RESULTS: In 2015-16, the SDPHs delivered 169 academic programmes (2.2 on average per SDPH). Among the SDPHs participating in both surveys, significant differences could not be determined, neither for the organization (except increasingly using social media) nor for teaching areas. The performance of graduates did not show significant differences except for the deterioration of EPHO-8 ('assuring sustainable organizational structures and financing'). However, the qualitative data revealed progressive dynamics regarding innovations in the organizational set-up, digitalization, teaching/training, introduction of new modules and research. CONCLUSIONS: The results generated do not allow us to state that the innovative elements introduced after the first survey in 2011 have had a clear impact reflected in the second survey carried out in 2015-16, but perhaps this is due to the need for a broader follow-up in order to objectify the potential consequences derived from the boost generated by the changes introduced.

Alcohol use, psychological distress, and subjective well-being among young adult university students: A cross-national study between Serbia and Italy.

Few studies have cross-nationally tested the mediators of the relationship between alcohol use and subjective well-being among university students. This study examined how self-reported psychological distress symptoms mediate the association between alcohol use (drinking frequency and binge-drinking frequency) and subjective well-being among 637 Serbian and 705 Italian university students. Psychological distress mediated the negative relationship between binge-drinking frequency and subjective well-being among Serbians (partial mediation) and Italians (full mediation). Drinking frequency was not associated with psychological distress or subjective well-being. Binge drinking may negatively affect subjective well-being among university students by enhancing symptoms of psychological distress.

A Gap Analysis of Mother, New-born, and Child Health in West Africa with Reference to the Sustainable Development Goals 2030.

The Economic Community of West African States (ECOWAS) comprises 15-member states with an estimated population of 350 million. This account relates the present status of maternal, neonatal, and under-five-mortality to the Sustainable Development Goals (SDG) targets set for 2030. For each SDG indicator, progress observed was compared with that needed to meet the target (assuming linear progression). The time gap was calculated as the difference between the time remaining to the target year (2030) and the estimated time needed to achieve the target. The highest maternal mortality ratio is found in Sierra Leone (1360 in 2015), followed by Nigeria (814) and Liberia (725). Whereas Sierra Leone and Nigeria keep high positions also for the neonatal and under-five mortality rate, Liberia ranks clearly better than the ECOWAS average. Globally skilled health professionals' density is 25 per 10,000 population and in Nigeria close to it with 20.1 whereas Guinea takes the last position with 1.4. The gap analysis shows that ECOWAS countries have a realistic chance to likely reach the SDG targets in 2030 with a delay of less than 4 years regarding maternal, neonatal, and under-five-mortality although their skilled health professionals' density is considerably lower than for the entire African region.

Correlates of self-rated health in Southern Europe: evidences from national representative samples in Italy and Serbia.

Background: Self-rated health (SRH) is a widely adopted tool to compare health across countries. Our aim was to examine SRH differences between Italy and Serbia and to observe the role of predictors of SRH referring to health behaviors within and between both countries. Methods: We used cross-sectional population-based data from Italian and Serbian national health surveys carried out in 2013. Post hoc cross-standardization was undertaken to ensure that the information from both data sets was comparable. Results: Univariate and multivariate multinomial logistic regressions showed that Serbians reported bad-SRH significantly more often than Italians. Moreover, consistently across national groups, younger participants, males, higher educated participants and participants with lower body mass index (BMI) had more chances than older, lower educated and higher BMI participants, respectively, to report better SRH. Finally, smoking and drinking behaviors did not correlate with SRH, while the frequency of fruits and vegetables intake was differently associated with SRH across countries. Conclusion: Health assessments based on SRH in Italian and Serbian national surveys are directly comparable and show similar relationships with socio-demographic correlates and BMI. However, the effect of health behaviors on SRH may differ according to national and cultural contexts.

The role of mother's education in the nutritional status of children in Serbia.

OBJECTIVE: The present study aimed to identify the role of mother's education in the nutritional status of children aged 2-5 years in Serbia. DESIGN: Nationally representative population-based study. Age- and gender-specific BMI percentiles of children were analysed. In accordance with the WHO growth reference, children with BMI less than the 5th percentile were considered undernourished. Logistic regression was used to calculate the association between mother's education and other socio-economic determinants as possible confounders. SETTING: UNICEF's fourth Multiple Indicator Cluster Survey, conducted in both Roma and non-Roma settlements in Serbia. SUBJECTS: Children (n 2603) aged 2-5 years (mean age 3·05 years). RESULTS: Less than 5 % of children aged 2-5 years were undernourished. There were significantly more undernourished children among the Roma population, in the capital of Serbia and among those whose mothers were less educated. There were statistically significant differences according to mother's education in all socio-economic characteristics (ethnicity, area, region of living and wealth index). Mother's level of education proved to be the most important factor for child's nutritional status; place of living (region) was also associated. CONCLUSIONS: Mother's education is the most significant predictor of children's undernutrition. It confirms that investment in females' education will bring benefits and progress not only for women and their children, but also for society as a whole.

Does workplace violence exist in primary health care? Evidence from Serbia.

BACKGROUND: Violence in the workplace is a serious social and public health problem. The objective of this study was to estimate the prevalence of workplace violence and to identify potential predictors of workplace violence at Serbian Primary Health Care (PHC) centres. METHODS: A cross-sectional study was conducted between October 2012 and July 2013. The sample consisted of medical and non-medical staff employed at PHC centres in Belgrade, Serbia. Among 1757 currently presented at work, 1526 returned the questionnaires. The data were collected by questionnaire Workplace Violence in the Health Sector-Country Case Studies, developed by the ILO/ICN/WHO/PSI. Binary logistic regression was conducted to assess the association between exposure to workplace violence and sociodemographic and work-related characteristics. RESULTS: The prevalence of workplace violence, was 803 (52.6%), with 147 (18.3%), exposed to physical violence. Multiple logistic regression models indicated that the following work-related characteristics were positive associated of workplace violence with working between 18:00 and 07:00 h [odds ratio (OR): 1.37, 95% confidence interval (CI): 1.08-1.73], nurses as a professional group (OR: 1.91, 95% CI: 1.16-3.17), working with preschool children (OR: 0.56, 95% CI: 0.34-0.91). There was negative association of workplace violence with encouragement to report violence (OR: 0.61, 95% CI: 0.49-0.76) and the number of staff in the same work setting (OR: 0.73, 95% CI: 0.56-0.96). CONCLUSIONS: More than half of employees in Belgrade PHC centres were exposed to different types of workplace violence. There is a need for interventions to protect health workers and provide safer workplace environments.

Training hospital managers for strategic planning and management: a prospective study.

BACKGROUND: Training is the systematic acquisition of skills, rules, concepts, or attitudes and is one of the most important components in any organization's strategy. There is increasing demand for formal and informal training programs especially for physicians in leadership positions. This study determined the learning outcomes after a specific training program for hospital management teams. METHODS: The study was conducted during 2006 and 2007 at the Centre School of Public Health and Management, Faculty of Medicine, University of Belgrade and included 107 participants involved in the management in 20 Serbian general hospitals. The management teams were multidisciplinary, consisting of five members on average: the director of the general hospital, the deputy directors, the head nurse, and the chiefs of support services. The managers attended a training program, which comprised four modules addressing specific topics. Three reviewers independently evaluated the level of management skills at the beginning and 12 months after the training program. Principal component analysis and subsequent stepwise multiple linear regression analysis were performed to determine predictors of learning outcomes. RESULTS: The quality of the SWOT (strengths, weaknesses, opportunities and threats) analyses performed by the trainees improved with differences between 0.35 and 0.49 on a Likert scale (p < 0.001). Principal component analysis explained 81% of the variance affecting their quality of strategic planning. Following the training program, the external environment, strategic positioning, and quality of care were predictors of learning outcomes. The four regression models used showed that the training program had positive effects (p < 0.001) on the ability to formulate a Strategic Plan comprising the hospital mission, vision, strategic objectives, and action plan. CONCLUSION: This study provided evidence that training for strategic planning and management enhanced the strategic decision-making of hospital management teams, which is a requirement for hospitals in an increasingly competitive, complex and challenging context. For the first time, half of state general hospitals involved in team training have formulated the development of an official strategic plan. The positive effects of the formal training program justify additional investment in future education and training.

Cross-cultural adaptation and validation of the Serbian version of the ICS SF male questionnaire.

INTRODUCTION: The objective of this study was to cross-culturally adapt and validate ICS male SF questionnaire to Serbian language. MATERIALS AND METHODS: This study included 91 male patients with lower urinary tract symptoms and 24 men with similar age and with confirmed absence of LUTS. ICS male SF questionnaire was translated from English to Serbian language and then back-translated to English. RESULTS: Internal consistency was high in both dimensions, voiding (Cronbach's alpha = 0.916) and incontinence (Cronbach's alpha = 0.763). Comparison of the average scores between patients and controls revealed significant differences in both dimensions: voiding (med = 8 versus med = 0; P < 0.001) and incontinence (med = 3 versus med = 0; P < 0.001). Interclass correlation revealed high testretest validity in both dimensions, voiding ICC = 0.992 (P < 0.001) and incontinece ICC = 0.989 (P < 0.001). Correlation analysis revealed high agreement between ICS male SF voiding dimension and IPSS questionnaire (ρ = 0.943; P < 0.001). CONCLUSION: The Serbian version of male ICS SF questionnaire showed acceptable reliability and validity. The ICS male SF questionnaire could be used in routine practice as an easy and comprehensive tool for assessment of LUTS.

In search for a public health leadership competency framework to support leadership curriculum-a consensus study.

BACKGROUND: Competency-based education is increasingly popular, especially in the area of continuing professional development. Many competency frameworks have been developed; however, few address leadership competencies for European public health professionals. The aim of this study was to develop a public health leadership competency framework to inform a leadership curriculum for public health professionals. The framework was developed as part of the Leaders for European Public Health project-supported by the EU Lifelong Learning Programme. METHODS: The study was carried out in three phases: a literature review, consensus development panel and Delphi survey. The public health leadership competency framework was initially developed from a literature review. A preliminary list of competencies was submitted to a panel of experts. Two consensus development panels were held to evaluate and make changes to the initial draft competency framework. Then two rounds of a Delphi survey were carried out in an effort to reach consensus. Both surveys were presented through Survey Monkey to members of the Association of the Schools of Public Health in the European Region Working Group on Innovation in Public Health Teaching and Education. RESULTS: The framework was developed consisting of 52 competencies organized into eight domains: Systems Thinking; Political Leadership; Collaborative Leadership: Building and Leading Interdisciplinary Teams; Leadership and Communication; Leading Change; Emotional Intelligence and Leadership in Team-based Organizations; Leadership, Organizational Learning and Development and Ethics and Professionalism. CONCLUSION: The framework can serve as a useful tool in identifying gaps in knowledge and skills, and shaping competency-based continuing professional development leadership curricula for public health professionals in Europe.

Evaluation of a health literacy screening tool in primary care patients: evidence from Serbia.

Improving health literacy skills is important for patient comprehension of health-related topics and their ability to attend to their medical problems. Promoting health literacy is a pivotal policy for maintaining and promoting health. The objective of the present study was to translate the Test of Functional Health Literacy in Adults (TOFHLA; long and short versions) into Serbian and evaluate the translated and cross-culturally adapted questionnaires in Serbian primary care patients. The translated TOFHLA questionnaires were administered to 120 patients. Additionally, a self-completed questionnaire was used. Both descriptive and inferential statistics were measured. The mean score for the TOFHLA was 73.49 (median, 78; SD = 17.94; range, 0-100) and the mean score for the Short Test of Functional Health Literacy in Adults (STOFHLA) was 29.28 (median, 32; SD = 6.16; range, 0-36). Sex, age, education, self-perceived health and presence of any chronic disease were associated with health literacy scores. The internal consistency (Cronbach's alpha) was 0.73 for the TOFHLA numeracy subset, 0.95 for reading comprehension, 0.94 for the TOFHLA and 0.90 for the STOFHLA. The Pearson correlation between the TOFHLA and STOFHLA was 0.89. The area under the curve of these two tests was 0.79 (95% CI, 0.602-0.817). The Serbian translated versions of the TOHFLA questionnaires offer valid measures of functional health literacy. There were no differences between the reliability and validity of the short and long TOFHLA forms.

Rights and responsibilities: Women leadership for health in Kyrgyzstan.

The World Health Organization (WHO) is committed to empowering countries by implementing a gender, equity, and human rights approach in the health sector. The objective of this gender and inclusion analysis is to assess potential gender disparities of health sector management in the Kyrgyz Republic. The employed mixed-method approach takes advantage of data triangulation. Besides information from the literature and policy documents available at the international and national levels, the analysis includes interviews and data from the self-assessment of health services managers in the Kyrgyz Republic. A convenience sample of 75 health managers was taken and after up to three reminders a commendable response rate of 80% was achieved which resulted the final sample size of N = 60. A factor analysis using quartimax orthogonal rotation was applied to investigate the correlation between Teaching Qualification, Digitalization, Training Usefulness, Computer Workplace, and Gender Equality. In 2021, the Kyrgyz Republic adopted a new Constitution, which provides a sound legal framework to support gender equality and promote women's empowerment. However, according to a survey, only 42.9% of the respondents felt that equal rights and opportunities were integrated into their job descriptions. Similarly, only 40.7% believed that their institutions' written documents reflected a commitment to equal rights and opportunities for both genders. Two factors were identified as influencing gender equality: (1) personal and (2) technical aspects. Regarding personal aspects, gender equality, teaching qualification, and training usefulness were found to be significant. Regarding technical aspects, the computer workplace was related. In recent years, the Kyrgyz Republic has been developing a culture of gender equality. Political will is essential to promote and make organizational change possible. It is important to create a written mid-term policy that affirms a commitment to gender equality in organizational behavior, structures, staff, and management board compositions. Healthcare institutions need to prepare strategic and operational plans that incorporate gender equality principles.

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.

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.

Europeanization of health policy in post-communist European societies: Comparison of six Western Balkan countries.

Europeanization is assumed to influence health policy in the Western Balkans, but little is known about the actual impact of this process in these countries which constitute a complex geopolitical region of Europe. In this context, we used time trends to explore the Western Balkans health policies during the Europeanization through a cross-country comparative analysis of six countries. We conducted a health policy analysis by adapting the framework for globalization and population health coined by Huynen et al. in 2005. We analyzed 90 progress reports of Albania, Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia and Serbia from 2005 to 2020. In particular, we considered chapter 28 on "Consumer and health protection" and other chapters that contained the words "health" or "population health". Evidence indicates that Europeanization influences Western Balkans' policies at different levels. Western Balkan countries revise national legislation in accordance with new European Union acquis as addressed in the progress reports and build cooperation with international institutions. They build national health reforms and reorganize relevant institutions to better address regulations in accordance to Europeanization. However, it is necessary to monitor law implementation so that the current legislation is enforced and further positive impact can be measured on population health.

Predictors of Clinical Inertia and Type 2 Diabetes: Assessment of Primary Care Physicians and Their Patients.

With the growing prevalence and complex pathophysiology of type 2 diabetes, many patients fail to achieve treatment goals despite guidelines and possibilities for treatment individualization. One of the identified root causes of this failure is clinical inertia. We explored this phenomenon, its possible predictors, and groups of patients affected the most, together with offering potential paths for intervention. Our research was a cross-sectional study conducted during 2021 involving 52 physicians and 543 patients of primary healthcare institutions in Belgrade, Serbia. The research instruments were questionnaires based on similar studies, used to collect information related to the factors that contribute to developing clinical inertia originating in both physicians and patients. In 224 patients (41.3%), clinical inertia was identified in patients with poor overall health condition, long diabetes duration, and comorbidities. Studying the changes made to the treatment, most patients (53%) had their treatment adjustment more than a year ago, with 19.3% of patients changing over the previous six months. Moreover, we found significant inertia in the treatment of patients using modern insulin analogues. Referral to secondary healthcare institutions reduced the emergence of inertia. This assessment of primary care physicians and their patients pointed to the high presence of clinical inertia, with an overall health condition, comorbidities, diabetes duration, current treatment, last treatment change, glycosylated hemoglobin and fasting glucose measuring frequency, BMI, patient referral, diet adjustment, and physician education being significant predictors.

Implementation of the Workload Indicators of Staffing Need (WISN) Method in Determining Staff Requirements in Public Health Laboratories in Serbia.

OBJECTIVES: This study aimed at identifying the needs for the health workforce in 16 public health laboratories in the Serbian capital by assessing the workforce stock, workload activities, activity standards, and workload pressure. METHODS: A review of laboratory records and regulations, interviews with key respondents, and observing work processes provided data for the World Health Organization method for determining staffing needs based on workload indicators (Workload Indicators of Staffing Need, WISN). RESULTS: A total of 99 laboratory workers spend almost 70% of their available working time in undertaking core activities. Core activities per sample can take from 0.25 to 180 min. Laboratory workers are under moderate or high workload pressure (the WISN ratio from 0.86 to 0.50). The WISN difference indicates a shortage of 22.22% of laboratory analysts and 20.63% of laboratory technicians. To balance the staffing to workload, these laboratories need an additional 8 FTE analysts and 13 FTE technicians. They could also consider selectively reducing workload pressure by automating some of the additional activities while maintaining the competence of laboratory workers and opportunities for professional development. CONCLUSIONS: Staffing policy should account for work processes, activity standards, and workload pressure to determine necessary staffing to meet the need for laboratory services in the local context.

Competencies gap of management teams in primary health care.

BACKGROUND: Health workforce competencies are considered crucial for attaining high-quality health care in the current market principles approach to the provision of health services. This study explored the competencies and the perceived competence gap of management personnel in public primary healthcare. METHODS: During 2007 and 2008, 14 management teams of Belgrade primary health-care centres were questioned before and after management training in six competency categories. Competency mean differences (95% confidence interval) by gender, educational level, experience and position were analysed by Leven, Snedecor or Welch statistics, and Student's t-test for comparison of two independent samples. Mixed Model Analysis clarified possible interactions of the managers' baseline characteristics and competency task ratings. Differences between team ratings were analysed by analysis of variance (ANOVA) or the Kruskal-Wallis test. The General Linear Model Repeated Measures Analysis determined interactions and competency gap changes. Differences were statistically significant at P ≤ 0.05. RESULTS: Female managers developed higher competency levels after training in communication skills and problem solving. Top managers rated assessing performance of higher importance, while chief nurses emphasized the importance of leading. Before training, the estimated competency gap was generally the highest in assessing performance (6.29), followed by team building (5.81) and planning and priority setting (5.70). Five months after training, the highest gap remained in assessing performance, although it was reduced considerably to 3.18 (P < 0.0005). CONCLUSIONS: Managers rated core competencies as highly important. The reduction in competency gaps can be significant through training. However, assessing performance remained a relatively high weakness among managers.

Corrigendum: Surprising Differences in the Practice of Exclusive Breastfeeding in Non-Roma and Roma Population in Serbia.

[This corrects the article DOI: 10.3389/fpubh.2020.00277.].