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The WHO recommends a risk management approach to ensure safe drinking-water and sanitation, so-called Water Safety Planning and Sanitation Safety Planning. However, applying these risk management approaches separately in small-scale drinking-water supply and sanitation systems might be challenging for rural communities with limited human, financial, and administrative resources. An integrated approach seems a better option. In this study, an integrated water and sanitation safety planning (iWSSP) approach was developed together with guidance and training material for the practical application of this novel approach. The integrated approach was piloted in three small systems in rural Serbia to identify benefits and suggestions for improvement which can be used for potential future scaling-up. Implementing iWSSP at the pilot sites contributed to a better understanding of both drinking-water supply and sanitation systems. It also resulted in increased awareness, knowledge, and understanding among staff of drinking-water supply and sanitation services. Key experts, including external facilitators, played a crucial role in the implementation of iWSSP. Future scaling-up of the integrated approach could be enabled if more guidance, easy-to-use training materials and templates become available which can be adapted and updated as needed.
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Población Rural , Agua , Humanos , Saneamiento , Serbia , Gestión de RiesgosRESUMEN
BACKGROUND: After Action Reviews (AAR) with a One Health perspective were performed in Slovenia, Italy, Serbia and Greece following a severe West Nile virus (WNV) transmission season in 2018. A protocol combining traditional techniques and organizational process analysis was developed and then implemented in each country. RESULTS: In 2018, response to the unusually intense transmission season of WNV in Slovenia, Italy, Serbia and Greece took place through routine response mechanisms. None of the four countries declared a national or subnational emergency. We found a very strong consensus on the strengths identified in responding to this event. All countries indicated the availability of One Health Plans for surveillance and response; very high laboratory diagnostic capacity in the human, veterinary and entomology sectors and strong inter-sectoral collaboration with strong commitment of engaged institutions as critical in the management of the event. Finally, countries implementing One Health surveillance for WNV (in terms of early warning and early activation of prevention measures) consistently reported a positive impact on their activities, in particular when combining mosquito and bird surveillance with surveillance of cases in humans and equids. Recurring priority areas for improvement included: increasing knowledge on vector-control measures, ensuring the sustainability of vector monitoring and surveillance, and improving capacity to manage media pressure. CONCLUSIONS: The AARs presented here demonstrate the benefit of cross-sectoral and cross-disciplinary approaches to preparedness for West Nile virus outbreaks in Europe. In the coming years, priorities include fostering and strengthening arrangements that: enable coordinated One Health surveillance and response during WNV transmission seasons; ensure adequate laboratory capacities; strengthen risk communication; and fund longer-term research to address the knowledge gaps identified in this study.
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Fiebre del Nilo Occidental/epidemiología , Animales , Culicidae/virología , Brotes de Enfermedades , Grecia , Humanos , Italia/epidemiología , Mosquitos Vectores , Estaciones del Año , Serbia/epidemiología , Eslovenia/epidemiología , Virus del Nilo OccidentalRESUMEN
An amendment to this paper has been published and can be accessed via the original article.
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Background: West Nile virus (WNV) is an emerging mosquito-borne pathogen in Serbia, where it has been detected as a cause of infection in humans since 2012. We analyzed and modelled WNV transmission patterns in the country between 2012 and 2023. Methods: We applied a previously developed modelling approach to quantify epidemiological parameters of interest and to identify the most important environmental drivers of the force of infection (FOI) by means of statistical analysis in the human population in the country. Results: During the study period, 1,387 human cases were recorded, with substantial heterogeneity across years. We found that spring temperature is of paramount importance for WNV transmission, as FOI magnitude and peak timing are positively associated with it. Furthermore, FOI is also estimated to be greater in regions with a larger fraction of older adult people, who are at higher risk to develop severe infections. Conclusion: Our results highlight that temperature plays a key role in shaping WNV outbreak magnitude in Serbia, confirming the association between spring climatic conditions and WNV human transmission risk and thus pointing out the importance of this factor as a potential early warning predictor for timely application of preventive and control measures.
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Brotes de Enfermedades , Estaciones del Año , Fiebre del Nilo Occidental , Virus del Nilo Occidental , Serbia/epidemiología , Humanos , Fiebre del Nilo Occidental/epidemiología , Fiebre del Nilo Occidental/transmisión , Brotes de Enfermedades/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Temperatura , Femenino , Anciano , Masculino , Adolescente , Animales , Adulto Joven , NiñoRESUMEN
Due to the continued detrimental effects of tobacco use, a growing number of countries are embracing the idea of tobacco endgame, meaning ending the tobacco epidemic instead of controlling it. This narrative review aims to synthesize and update the evidence from earlier scientific reviews on effective tobacco endgame measures, as well as to assess their integration to current national strategies among European countries with official tobacco endgame goals. The synthesis of the prior scientific literature found most evidence on product-focused and some evidence for supply-focused policies. Little evidence was detected for user- and institutional-focused measures. An update for the tobacco-free generation measure showed uncertainty in reducing smoking prevalence, especially for adolescents' reactions to age-restrictive laws. All the countries that established a tobacco endgame strategy have included product standards in their measures, predominantly based on European Union regulations on conventional tobacco products, yet standards above this level and considering other products were also common. Cessation measures were given strong emphasis in strategies, yet none of the countries linked these to specific endgame measures. Despite commonly mentioning vulnerable groups, such as youth and pregnant women, adoption of measures to reduce tobacco use among these groups was scarce. Lastly, the decline in tobacco use seems to be modest, implying challenges in meeting the endgame goals. To meet these goals, European countries should reinforce the implementation of known effective tobacco control measures such as tax increases. Furthermore, new innovative strategies and measures to meet the objective of an endgame should be explored.
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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.
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INTRODUCTION: To assess the feasibility of developing World Health Organization (WHO) European Region countries' goals and measures in line with tobacco endgame objectives, information on the current tobacco control context and capacity is needed. The aim of this study was to assess the implementation of the Framework Convention on Tobacco Control (WHO FCTC) and MPOWER measures in the region. METHODS: In this cross-sectional study we used data from the WHO FCTC implementation reports and MPOWER from 2020 in 53 WHO European Region countries. Six domains (i.e. capacity, taxation and price policies, other national key regulations, public awareness raising and communication, tobacco use cessation, and monitoring) were formed. Subsequently, available indicators under these domains were scored and the level of implementation was computed for each country. Mann-Whitney tests were carried out to compare the scores between the group of countries with and without official endgame goals. RESULTS: Overall, implementation of the WHO FCTC with the selected indicators at the country level ranged from 28% to 86%, and of MPOWER from 31% to 96%. Full implementation was achieved by 28% of WHO FCTC Parties in the region in taxation and price policies, 12% in public awareness raising and communication, and 42% in monitoring. In capacity, tobacco use cessation and other national key regulations, none of the Parties in the region reached full implementation. Overall median WHO FCTC scores were significantly higher in countries with official endgame goals than in those without (p<0.001). CONCLUSIONS: There is unequal implementation of both WHO FCTC and MPOWER measures among WHO European Region countries. MPOWER and WHO FCTC provide all the measures for the necessary first steps, followed by innovative measures, to accomplish tobacco endgame goals.
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To raise awareness about health inequalities, a well-functioning health inequality monitoring system (HIMS) is crucial. Drawing on work conducted under the Joint Action Health Equity Europe, the aim of this paper is to illustrate the strengths and weaknesses in current health inequality monitoring based on lessons learned from 12 European countries and to discuss what can be done to strengthen their capacities. Fifty-five statements were used to collect information about the status of the capacities at different steps of the monitoring process. The results indicate that the preconditions for monitoring vary greatly between countries. The availability and quality of data are generally regarded as strong, as is the ability to disaggregate data by age and gender. Regarded as poorer is the ability to disaggregate data by socioeconomic factors, such as education and income, or by other measures of social position, such as ethnicity. Few countries have a proper health inequality monitoring strategy in place and, where in place, it is often regarded as poorly up to date with policymakers' needs. These findings suggest that non-data-related issues might be overlooked aspects of health inequality monitoring. Structures for stakeholder involvement and communication that attracts attention from policymakers are examples of aspects that deserve more effort.
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Equidad en Salud , Europa (Continente) , Disparidades en el Estado de Salud , Humanos , Renta , Factores SocioeconómicosRESUMEN
Recruitment and retention of public health workers (PHWs) is crucial for the optimal functioning of the public health system at a time of budget cuts and the threat of a pandemic. Individual and job-related variables were examined by univariate and multivariate logistic regression to identify predictors of the intention to leave a job during the COVID-19 outbreak among Serbian PHWs in 25 institutes of public health (n = 1663 respondents, of which 73.1% were female). A total of 20.3% of PHWs intended to leave their current job within the next five years. Males and persons aged younger than 55 years who had additional practice were more likely to report an intention to leave their job than females, those older than 54 years and those without additional work. While uncertainty and fear of infection during the COVID-19 pandemic were almost perceived as job attractiveness, other job-related characteristics were identified as significant barriers to maintaining the sufficient capacity of qualified PHWs in the future. Authorities need to address these factors, including the following: the feeling of tension, stress or pressure, and unavailability of information during the COVID-19 pandemic, as well as dissatisfaction with respect, valuation, and the job in general.
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COVID-19 , Intención , Anciano , Estudios Transversales , Femenino , Humanos , Satisfacción en el Trabajo , Masculino , Pandemias , Salud Pública , SARS-CoV-2 , Encuestas y CuestionariosRESUMEN
The study provides evidence on the individual and family factors as potential predictors (odds ratio-OR and 95% CI) of cyber-violence among school-aged children (11-17 years old) from 64 schools participating in the 2017 Serbian Study on health behavior in school-age children (HBSC). The standardized international HBSC research protocol was used. The study population was the nationally representative sample of 3267 students of V and VII grades of primary and I grade of secondary schools in Serbia. Potential predictors for the probability of occurrence vs. non-occurrence of cyberbullying exposure at least once and multiple times were identified among 24 explanatory variables, including the individual characteristics and family context. The cyberbullying exposure was more prevalent among girls than among boys of school-age, i.e., over one in seven girls and one in ten boys were exposed to cyberbullying. Over one in seven students at age 13 years and almost every seventh student at grade I of the gymnasium were exposed to cyberbullying. There were more students exposed to at least one cyberbullying than to multiple cyberbullying. Potential predictors of exposure to cyberbullying are gender, opinion of the family's affluence status, fathers' employment, communication with father, and family support. The study compensates for the evidence of cyberbullying in Serbia, which could help raise awareness, inform national and international stakeholders in the region and enable their efforts and strengthen cooperation in ending cyberbullying. This study's findings could inform the development of an intervention program aimed at families and various professionals involved in protecting and improving school-age children's health and well-being.
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Acoso Escolar , Víctimas de Crimen , Ciberacoso , Adolescente , Niño , Composición Familiar , Femenino , Humanos , Masculino , Instituciones Académicas , Serbia/epidemiologíaRESUMEN
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.
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Personal de Salud , Satisfacción en el Trabajo , Adulto , Estudios Transversales , Femenino , Hospitales Generales , Humanos , Masculino , Persona de Mediana Edad , Personal de Hospital , Atención Primaria de Salud , SerbiaRESUMEN
Institute of Public Health of Serbia (IPHS) is developing new function related to better monitoring of alcohol related diseases and injuries, actions focusing on alcohol as a lifestyle related factor using integrated strategic approaches for both population and individual risk reduction. In that regard the long term objective of the IPHS is to study, monitor, promote and safeguard public health--from the point of view of mental health and alcohol abuse--by means of research, development and the provision of expert services. Starting point in the aforementioned need for the capacity building in the area of mental health and alcohol abuse is the Program of education of general practitioners (GPs) in primary health care settings for identification and diagnosis of alcoholism. This is because GPs have the widest contact with the general population. Their education related to recognition of alcohol abuse and appropriate diagnostic tools application is first, but very important step in providing direction of the health service and other sectors for problem solving and would bring the largest benefit for the whole population. In the year 2010 National program against alcohol abuse and alcoholism will be developed. Program of education of GPs is very important complementary activity which outcome will have great impact on the National program implementation.
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Alcoholismo/diagnóstico , Educación Médica Continua , Medicina General/educación , Atención Primaria de Salud , Alcoholismo/complicaciones , Alcoholismo/epidemiología , HumanosRESUMEN
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.
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Personal Administrativo , Atención a la Salud , Administración de los Servicios de Salud , Administración de los Servicios de Salud/estadística & datos numéricos , Serbia , Recursos HumanosRESUMEN
A key component of any healthcare reform process is to ensure that the services are delivered by the right numbers of staff with appropriate skills and training. In 2007, public health institutions in Serbia had 2% more employees than before the economic transition. Nevertheless, the trend of the total number of employees in the Serbian health care system still preserved a mild rising trend. The most prominent changes in the structure of human resources were effectuated in the total numbers of physicians, nurses and administrative and technical staff. Development of medical science and practice in Serbia is characterized by more intensive processes of specializations, resulting in increased number of specialists among medical doctors. Health care provided in in-patient institutions still employs most of the doctors. The number of unemployed physicians, dentists and pharmacists has been rising since 2000. Another aspect that explains the rise of unemployed, university educated human resources is the rising number of graduated physicians, dentist and pharmacists. Health care policy makers may recognize the need for more integrated planning of human resources in health care, in particular, making management of human resources responsive to system needs and design, instead of vice versa.
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Atención a la Salud , Desarrollo de Personal , Humanos , Serbia , Desarrollo de Personal/estadística & datos numéricos , Factores de Tiempo , Recursos HumanosRESUMEN
Planning and adjusting health capacities to meet the needs of refugees is a constant issue for transit and destination countries following the 2015/2016 Western Balkans refugee crisis. Understanding this crisis is important for taking the right steps in the future. The study informs about the prediction of the refugees' health needs and demands for services in correspondence to political decision-making during 2015/2016 Western Balkan Refugee Crisis. Time series analysis, linear regression, and correlation analyses modelled the weekly flux of arrivals of more than half a million refugees to Serbia and the European Union, changes in the utilization of health care services, and disease diagnoses. With strategic planning, in the event of a recurrence of the refugee crises, the demand for health care services in the transit country could increase by 63 (95% CI: 21-105) for every additional 1000 refugees.
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BACKGROUND: In the Mediterranean and Black Sea Region, arbovirus infections are emerging infectious diseases. Their surveillance can benefit from one health inter-sectoral collaboration; however, no standardized methodology exists to study One Health surveillance. METHODS: We designed a situation analysis study to document how integration of laboratory/clinical human, animal and entomological surveillance of arboviruses was being implemented in the Region. We applied a framework designed to assess three levels of integration: policy/institutional, data collection/data analysis and dissemination. We tested the use of Business Process Modelling Notation (BPMN) to graphically present evidence of inter-sectoral integration. RESULTS: Serbia, Tunisia and Georgia participated in the study. West Nile Virus surveillance was analysed in Serbia and Tunisia, Crimea-Congo Haemorrhagic Fever surveillance in Georgia. Our framework enabled a standardized analysis of One Health surveillance integration, and BPMN was easily understandable and conducive to detailed discussions among different actors/institutions. In all countries, we observed integration across sectors and levels except in data collection and data analysis. Data collection was interoperable only in Georgia without integrated analysis. In all countries, surveillance was mainly oriented towards outbreak response, triggered by an index human case. DISCUSSION: The three surveillance systems we observed prove that integrated surveillance can be operationalized with a diverse spectrum of options. However, in all countries, the integrated use of data for early warning and inter-sectoral priority setting is pioneeristic. We also noted that early warning before human case occurrence is recurrently not operationally prioritized.
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Infecciones por Arbovirus/veterinaria , Salud Única , Animales , Infecciones por Arbovirus/epidemiología , Infecciones por Arbovirus/virología , Mar Negro , Enfermedades Transmisibles Emergentes , Georgia (República)/epidemiología , Humanos , Región Mediterránea , Vigilancia de la Población , Serbia/epidemiología , Túnez/epidemiologíaRESUMEN
This analysis of the Serbian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the Serbian population has improved over the last decade. Life expectancy at birth increased slightly in recent years, but it remains, for example, around 5 years below the average across European Union countries. Some favourable trends have been observed in health status and morbidity rates, including a decrease in the incidence of tuberculosis, but population ageing means that chronic conditions and long-standing disability are increasing. The state exercises a strong governance role in Serbia's social health insurance system. Recent efforts have increased centralization by transferring ownership of buildings and equipment to the national level. The health insurance system provides coverage for almost the entire population (98%). Even though the system is comprehensive and universal, with free access to publicly provided health services, there are inequities in access to primary care and certain population groups (such as the most socially and economically disadvantaged, the uninsured, and the Roma) often experience problems in accessing care. The uneven distribution of health professionals across the country and shortages in some specialities also exacerbate accessibility problems. High out-of-pocket payments, amounting to over 40% of total expenditure on health, contribute to relatively high levels of self-reported unmet need for medical care. Health care provision is characterized by the role of the "chosen doctor" in primary health care centres, who acts as a gatekeeper in the system. Recent public health efforts have focused on improving access to preventive health services, in particular, for vulnerable groups. Health system reforms since 2012 have focused on improving infrastructure and technology, and on implementing an integrated health information system. However, the country lacks a transparent and comprehensive system for assessing the benefits of health care investments and determining how to pay for them.
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Atención a la Salud/organización & administración , Programas de Gobierno/organización & administración , Reforma de la Atención de Salud/organización & administración , Política de Salud , Financiación de la Atención de la Salud , Administración en Salud Pública , Calidad de la Atención de Salud/organización & administración , Humanos , SerbiaRESUMEN
Highly monodisperse silicon nanoparticles (1.57 +/- 0.21 nm) are synthesized with a covalently attached alkyl monolayer on a gram scale. Infrared spectroscopy shows that these silicon nanoparticles contain only a few oxygen atoms per nanoparticle. XPS spectra clearly show the presence of unoxidized Si and attached alkyl chains. Owing to the relatively efficient synthesis (yields approximately 100-fold higher than of those previously reported) the molar extinction coefficient epsilon can be measured: epsilon(max) = 1.7 x 10(-4) M(-1)cm(-1), only a factor of 4 lower than that of CdS and CdSe nanoparticles of that size. The quantum yield of emission ranges from 0.12 (C(10)H(21)-capping) to 0.23 (C(16)H(33)-capping). UV/Vis absorption and emission spectroscopy show clear vibrational progressions (974 +/- 14 cm(-1); up to five vibrational bands visible at room temperature), resembling bulk SiC phonons, which support the monodispersity observed by TEM. This was also confirmed by time-resolved fluorescence anisotropy measurements, which display a strictly monoexponential decay that can only be indicative of monodisperse, ball-shaped nanoparticles.
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Nanopartículas/química , Óptica y Fotónica , Óxidos/química , Silicio/química , Absorción , Hexanos/química , Nanopartículas/ultraestructura , Tamaño de la Partícula , Espectroscopía Infrarroja por Transformada de Fourier , TemperaturaRESUMEN
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.