Contamination levels, influencing factors, and risk assessment of polybrominated diphenyl ethers in house dust of northern Serbia.

Polybrominated diphenyl ethers (PBDEs) are a group of compounds that, due to their applications, are considered mainly indoor contaminants. To obtain the first information about the presence of PBDEs in Serbia, dust samples (n = 50) were collected in settlements in the northern Serbian province of Vojvodina. The selected/target congeners (BDE-28, 47, 99, 100, 153, 154, and 183) were extracted from house dust by microwave-assisted extraction technique, and purified extracts were analyzed on a dual-column gas chromatograph with micro-electron capture detectors. A wide range of ΣPBDEs was detected (0.295 to 394 ng g-1 dust), which reflects large differences in contamination among the examined homes. For the majority of samples (72%), ΣPBDEs were lower than 5 ng g-1 indicating that people living in Vojvodina province are exposed to low concentrations of PBDEs present in their households. Based on principal component analysis (PCA), balcony areas and age of the house positively correlate with the PBDE congeners with higher detection frequencies (≥ 50%), namely, with BDE-99, BDE-153, and BDE-183. Statistically significant positive correlation (p < 0.01) was obtained for BDE-99 and the number of household's members. Estimated daily intakes (EDItot) were calculated for ingestion and dermal absorption of dust for two age groups-adults and toddlers. These are the first data on PBDE status in the area of the Western Balkan, and the health risk assessment indicates that PBDE levels obtained in household dust do not pose a risk for human health.

Entropy-weighted water quality index, hydrogeochemistry, and Monte Carlo simulation of source-specific health risks of groundwater in the Morava River plain (Serbia).

Population growth, urbanization, industry, floods, and agriculture globally degrade groundwater in river plains, necessitating action for its quality assessment and management. Hence, a comprehensive methodology, including hydrogeochemical facies (Piper, Gibbs), irrigation indices (SAR, Wilcox), entropy-weighted water quality index (EWQI), positive matrix factorization (PMF), and Monte Carlo simulation of source-specific health risks was used in this study to analyze groundwater in the Morava river plain (Serbia). The results revealed a prevalent Ca-Mg-HCO3 groundwater type, influenced by water-rock interactions. Although groundwater was found suitable for irrigation, only 66.7 % of the samples were considered drinkable. Agricultural activities, natural processes, and municipal wastewater were identified as primary pollution sources. The incremental lifetime cancer risk (ILCR) and hazard index (HI) threshold exceedance for adults and children ranged from 8.5 % to 39 % of the samples, with arsenic identified as the most risk-contributing contaminant. These findings provide valuable insights for researchers studying groundwater vulnerability in river plains.

Moving forward after the COVID-19 pandemic: Lessons learned in primary care from the multi-country PRICOV-19 study.

BACKGROUND: The COVID-19 pandemic has accentuated the indispensable role of primary care. Objectives: Recognising this, the PRICOV-19 study investigated how 5,489 GP practices across 38 countries (Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kosovo*, Latvia, Lithuania, Luxembourg, Malta, Republic of Moldova, Netherlands, North Macedonia, Norway, Poland, Portugal, Romania, Serbia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, and United Kingdom) adapted their care delivery during the pandemic. METHODS: Based on a series of discussions on the results of the PRICOV-19 study group, eight recommendations to enhance primary care's preparedness for future crises were formulated and endorsed by EQuiP and WONCA Europe. RESULTS: The recommendations underscore the importance of recognising and sustaining the substantial strides made in patient safety within GP practices during the pandemic in current daily practices; acknowledging and supporting the pivotal role of GP practices in addressing health inequalities during crises; adopting interprofessional care models to enhance practices' resilience and adaptability to change; supporting training practices; creating healthy working environments; investing in infrastructure that supports adequate and safe care; and increasing funding for research on patient safety and primary care quality to inform evidence-based health policies and fostering international knowledge exchange among healthcare professionals and policymakers. CONCLUSION: Policymakers, primary care associations, and the broader healthcare system are urged to collaboratively take responsibility and increase support for GP practices to enhance their resilience, adaptability, and capacity to deliver safe and equitable healthcare during future crises.

Governments should recognise the critical role of family medicine in addressing inequity and prioritise carers' wellbeing to maintain quality care during crises.Associations for practitioners should lead in crisis management developments and advocate for primary care.PC facilities should participate in health system design to answer challenges posed by crises.

Cumulative risk assessment of dietary exposure of the adult population in Serbia to pesticides that have chronic effects on the thyroid gland through fresh fruits and vegetables.

In contrast to the traditional approach to risk assessment, which focuses on a single chemical, cumulative exposure and risk assessment considers the consequences of exposure to multiple chemical combinations. A cumulative risk assessment of dietary exposure of adult females and adult males to pesticides with chronic effects on the thyroid was conducted by estimation of the Total Margin of Exposure (MOET). Exposure to each active substance was estimated using a second-order Monte Carlo simulation. Input values for the simulation were based on over 2300 conventionally produced fruit and vegetable samples analysed from 2021 to 2023 and consumption data collected using the Food Frequency Questionnaire (FFQ) and 24h recall method. MOET values, for both populations assessed, did not exceed thresholds for regulatory consideration established by risk managers. Considering that MOETs values from consumption of fresh fruits and vegetables were relatively close to the threshold value, total exposure to the pesticides could likely reach risk-associated MOET levels, through the consumption of other food products that may be contaminated.

Dynamic spillover effects of renewable energy efficiency in the European countries.

Renewable energy has gained significant attention due to the growing concern for environmental sustainability and the high reliance on energy imports in European countries. In this study, we use a two- stage approach to assess renewable energy efficiency (REEF) of European countries. Initially, we employ the data envelopment analysis (DEA) method to quantify the efficiency of renewable energy. Subsequently, we investigate the factors influencing REEF between 2005 and 2020. Our findings reveal a generally high level of REEF across European countries, but some countries have become worse in this regard (e.g., France, Ukraine, Russia, Belgium, Germany, Norway, and Serbia). In order to find the causes of these changes, we considered the explanatory variables of gross domestic product (GDP), energy price, renewable energy consumption, information and communications technology (ICT), and industrial value added in a spatial system generalized method of moments (spatial SYS-GMM) model. The findings provide confirmation of the spatial spillover effects of REEF within European countries. The strongest positive effect is related to energy prices. In simpler terms, as energy prices rise, the efficiency of renewable energy has increased in European countries. Additionally, ICT and renewable energy consumption have positive impacts, too. But GDP and industrial value added, have decreasing effects. Based on these findings, we put forth several policy suggestions aimed at enhancing the efficiency of renewable energy in European countries.

An EKC-based modelling of CO2 emissions, economic growth, electricity consumption and trade openness in Serbia.

Understanding the complex interactions between the economy and the environment is crucial for promoting sustainable development and mitigating the negative impact of human activities on the Planet. The importance of this issue for Serbia is evident as the country strives to balance economic growth and environmental protection to ensure a sustainable and resilient future. Therefore, the main objective of this study is to investigate and model the relationship between CO2 emissions, economic growth, electricity consumption, and trade openness in Serbia. Initially, an Autoregressive Distributed Lag (ARDL) model is used to characterize the Environmental Kuznets Curve (EKC) using data from the period from 1995 to 2019, followed by the construction of a bootstrap logistic regression model to predict environmental quality in Serbia. Long-term estimates of the model confirm an inverted U-shaped relationship, where all three variables exert a statistically significant influence on CO2 emissions. In the short run, however, a causal relationship is only observed between electricity consumption and CO2 emissions. The logistic regression results show that all three factors significantly influence environmental quality. The study proposes policy recommendations for Serbia, such as promoting sustainable economic growth, implementing long-term programs to reduce CO2 emissions, reviewing trade policies to prioritize sustainable practices, and investing in renewable energy sources to reduce emissions.

Experiences from integrating water and sanitation safety planning in small systems in rural Serbia.

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.

Scabies outbreak management in refugee/migrant camps in Europe 2014-2017: a retrospective qualitative interview study of healthcare staff experiences and perspectives.

OBJECTIVES: Provide insights into the experiences and perspectives of healthcare staff who treated scabies or managed outbreaks in formal and informal refugee/migrant camps in Europe 2014-2017. DESIGN: Retrospective qualitative study using semistructured telephone interviews and framework analysis. Recruitment was done primarily through online networks of healthcare staff involved in medical care in refugee/migrant settings. SETTING: Formal and informal refugee/migrant camps in Europe 2014-2017. PARTICIPANTS: Twelve participants (four doctors, four nurses, three allied health workers, one medical student) who had worked in camps (six in informal camps, nine in formal ones) across 15 locations within seven European countries (Greece, Serbia, Macedonia, Turkey, France, the Netherlands, Belgium). RESULTS: Participants reported that in camps they had worked, scabies diagnosis was primarily clinical (without dermatoscopy), and treatment and outbreak management varied highly. Seven stated scabicides were provided, while five reported that only symptomatic management was offered. They described camps as difficult places to work, with poor living standards for residents. Key perceived barriers to scabies control were (1) lack of water, sanitation and hygiene, specifically: absent/limited showers (difficult to wash off topical scabicides), and inability to wash clothes and bedding (may have increased transmission/reinfestation); (2) social factors: language, stigma, treatment non-compliance and mobility (interfering with contact tracing and follow-up treatments); (3) healthcare factors: scabicide shortages and diversity, lack of examination privacy and staff inexperience; (4) organisational factors: overcrowding, ineffective interorganisational coordination, and lack of support and maltreatment by state authorities (eg, not providing basic facilities, obstruction of self-care by camp residents and non-governmental organisation (NGO) aid). CONCLUSIONS: We recommend development of accessible scabies guidelines for camps, use of consensus diagnostic criteria and oral ivermectin mass treatments. In addition, as much of the work described was by small, volunteer-staffed NGOs, we in the wider healthcare community should reflect how to better support such initiatives and those they serve.

Transcultural adaptation and validation of the Serbian version of Functional Assessment of Chronic Illness Therapy-Treatment Satisfaction-Patient Satisfaction (FACIT-TS-PS) questionnaire.

OBJECTIVE: Transcultural adaptation and validation of FACIT-TS-PS questionnaire to Serbian language. METHODS: Standard forward and backward translation from English to Serbian language was performed. Pilot testing of FACIT-TS-PS was conducted on 12 patients with a confirmed diagnosis of malignant tumor. The study included 154 patients with malignant disease. The Questionnaire of Patient Satisfaction was used as a validated tool to evaluate concurrent validity of FACIT-TS-PS questionnaire. Reproducibility was tested on 30 subjects who answered the questionnaire for the second time two weeks later. RESULTS: Three FACIT-TS-PS subscales (Physician Communication, Treatment Staff Communication and Nurse Communication) demonstrated satisfactory construct validity using Cronbach's alpha, the remaining two subscales (Technical Competence and Confidence & Trust) showed high ceiling effect. Treatment Staff Communication subscale showed large floor effect. Concurrent validity was demonstrated by correlation with the two dimensions of the Questionnaire of Patient Satisfaction. Satisfactory reproducibility was demonstrated on 30 patients who filled the questionnaire for the second time two weeks after initial interview. CONCLUSION: The Serbian version of FACIT-TS-PS with the omission of Treatment Staff Communication subscale could be used as a valid instrument to assess patient and treatment satisfaction in chronically ill patients in the Serbian population. Omission of Treatment Staff Communication subscale is necessary because it contains questions not relevant for patients in Serbian healthcare system.

Assessment of antibiotic use patterns in bovine mastitis treatment in the dairy sector in Serbia.

The dairy sector is essential for the world's food systems, playing a vital role in agricultural production. Yet, mastitis, an inflammation of the mammary gland, affects a considerable portion of the dairy cow population annually, leading to reduced productivity and sustainability. Insight into therapeutic protocols is essential for a better understanding of the situation on farms with the aim of developing new or harmonizing existing protocols in the mastitis treatment. This study conducted on dairy farm in Serbia aimed to explore the most commonly used antibiotics during bovine mastitis treatment and their association with daily milk yield. Data from 100 lactating cows, including therapeutic protocols, lactation numbers, mastitis episodes, milk yield, and antibiotic usage, were obtained from a computerized database and statistically analysed. The results demonstrated a high prevalence of narrow-spectrum antibiotics usage, with the majority of cows treated with combination therapy. The route of antibiotic application did not significantly impact daily milk yield, while treatment duration had no discernible effect. Nonetheless, specific antibiotics were associated with milk yield variations, suggesting the need for careful antibiotic selection and management in mastitis therapy. These findings emphasize the importance of prudent antibiotic use to safeguard animal health and long-term milk production sustainability.

Socioeconomic inequalities in the use of dental health care among the adult population in Serbia.

Objectives: The aim of this paper is to assess the association of demografic and socioeconomic determinants with utilization of dental services among Serbian adults. Materials and methods: The study is a part of the population health research of Serbia, conducted in the period from October to December 2019 by the Institute of Statistics of the Republic of Serbia in cooperation with the Institute of Public Health of Serbia "Dr. Milan JovanovicBatut" and the Ministry of Health of the Republic of Serbia. The research was conducted as a descriptive, cross-sectional analytical study on a representative sample of the population of Serbia. For the purposes of this study, data on the adult population aged 20 years and older were used. Results: Men were approximately 1.8 times more likely than women to not utilize dental healthcare services (OR = 1.81). The likelihood of not utilizing dental healthcare protection rises with increasing age, reaching its peak within the 65-74 age range (OR = 0.441), after which it declines. Individuals who have experienced marital dissolution due to divorce or the death of a spouse exhibit a higher probability of not utilizing health protection (OR = 1.868). As the level of education and wealth diminishes, the probability of abstaining from health protection increases by 5.8 times among respondents with an elementary school education (OR = 5.852) and 1.7 times among the most economically disadvantaged respondents (OR = 1.745). Regarding inactivity, respondents who are not employed have a 2.6-fold higher likelihood of not utilizing oral health care compared to employed respondents (OR = 2.610). Conclusion: The results suggest that individual sociodemographic factors influence utilization of dental services by Serbian adults and confirmed the existence of socioeconomic disparities.

Comparative assessment of erythrocyte sphingolipid levels as potential cardiovascular health markers in women from Libya and Serbia: a small-scale study.

Aim: Cardiovascular diseases (CVDs) represent the major cause of morbidity and mortality worldwide including Libya, where they account for 43% of all deaths. Sphingolipids are involved in the pathology of numerous diseases including cardiovascular diseases and are proposed as potential biomarkers of cardiovascular health that could be more effective compared to traditional clinical biomarkers. The aim of this study was to determine the sphingolipid content in the erythrocyte membrane of Libyan migrant and Serbian resident women. In addition, to examine if sphingolipid levels could be used as a novel indicator of cardiovascular risk, we evaluated possible correlations with some well-established biomarkers of cardiovascular health.Materials and Methods: A total of 13 Libyan and 15 Serbian healthy women participated in the study. The high-performance version thin-layer chromatography (HPTLC) using the image analysis tool JustTLC was applied for quantification of erythrocytes' sphingolipids.Results: Lower mean values of erythrocytes' sphingolipids and cholesterol concentrations were found in the group of Libyan emigrants compared to Serbian resident women. Besides, in this group of apparently healthy women (n = 28), the sphingolipid content of erythrocytes was inversely related to the Omega-3 index (r =-0.492, p = 0.008) and directly linked to vitamin D status (r = 0.433, p = 0.021) and membrane cholesterol levels (r = 0.474, p = 0.011).Conclusion: The erythrocytes' sphingolipid levels should be measured/assessed as an additional biomarker of CV health, by applying a simple and routine method. Still, further investigation in a larger population-specific context is warranted.

Environmental sensitivity assessment and land degradation in southeastern Serbia: application of modified MEDALUS model.

This paper aims to improve the methodology and results accuracy of MEDALUS model for assessing land degradation sensitivity through the application of different data detail levels and by introducing the application of Ellenberg indices in metrics related to vegetation drought sensitivity assessment. For that purpose, the MEDALUS model was applied at 2 levels of detail. Level I (municipality level) implied the use of available large-scale databases and level II (watershed) contains more detailed information about vegetation used in the calculation of the VQI and MQI factors (Fig. S6). The comparison was made using data based on CORINE Land Cover (2012) and forest inventory data, complemented with object-based classification. Results showed that data based on forest inventory data with the application of Ellenberg's indices and object-based classification have one class more, critical (C1 and C2) and that the percentage distribution of classes is different in both quantitative (area size of class sensitivity) and qualitative (aggregation and dispersion of sensitivity classes). The use of data from Forest Management Plans and the application of Ellenberg's indices affect the quality of the results and find its application in the model, especially if these results are used for monitoring and land area management on fine scales. Remote sensed data images (Sentinel-2B) were introduced into the methodology as a very important environmental monitoring tool and model results validation.

Untreated wastewater impact and environmental risk assessment of artificial sweeteners in river water and sediments of the Danube River Basin in Serbia.

Artificial sweeteners are receiving increasing attention as newly recognized emerging contaminants that mainly reach the aquatic environment through the discharge of municipal wastewater containing large amount of these compounds. In this study, the impact of raw untreated wastewater discharges on the levels and the water/sediment distribution of artificial sweeteners in the Danube River and its largest tributaries in Serbia was evaluated, and a comprehensive assessment of environmental risks for freshwater and benthic organisms was performed. Acesulfame and sucralose were detected in all river water samples (100%), while saccharin (59%) and cyclamate (12%) were less frequently found, indicating long-term continuous sewage-derived pollution. Aspartame (100%) and neotame (60%) were the only artificial sweeteners recorded in the sediment samples due to their preference to sorb to particulate matter in the water/sediment system. In terms of ecotoxicological risk, a low risk for aquatic organisms was determined at the detected levels of saccharin in river water, while a high to medium risk was found for benthic biota at the concentrations of neotame and aspartame detected in sediments. The largest contribution to the pollution of the Danube River Basin with artificial sweeteners, and consequently the highest environmental risk, was determined in the two largest cities, the capital Belgrade and Novi Sad, which raises the issue of transboundary pollution.

Second order probabilistic assessment of chronic dietary exposure to aflatoxin M1 in Serbia.

Considering the genotoxic and cancerogenic nature of aflatoxin M1 (AFM1), its presence in milk and dairy products may pose health risks for consumers. The chronic exposure was calculated using a two-dimensional (second order) Monte Carlo model. Results of 13 722 milk and dairy product samples analysed in the 2015-2022 period were used. Milk and dairy products intake information was collected with a Food Frequency Questionnaire (FFQ) validated by a 24-h recall-based method. Risk characterization was done by calculation of the Margin of Exposure (MOE) and by calculation of AFM1 induced number of hepatocellular carcinoma (HCC) cases. Mean AFM1 Estimated Daily Intake (EDI) was highest in children at 0.336 (CI: 0.294-0.385) ng kg-1 bw day-1, followed by adolescents with 0.183 (CI: 0.164-0.204), then adult females with 0.161 (CI: 0.146-0.179) and finally adult males with lowest EDI of 0.126 (CI: 0.115-0.139) ng kg-1 bw day-1. MOE values based on mean EDI for all population groups were above risk associated threshold and the number of possible HCC cases was in the range of 0.0002-0.0021 cases per year for 105 individuals. The results suggest low health risks due to AFM1 exposure for the whole population. Still, this risk is not non-existent, especially for children as they have a higher ratio of the population exposed to risk associated AFM1 levels, with MOE values below risk indicating threshold starting at 77.5th percentile.

Communication partner training for healthcare workers engaging with people with aphasia: Enacting Sustainable Development Goal 17 in Austria, Egypt, Greece, India and Serbia.

PURPOSE: This commentary describes how a grassroot-led partnership initiated by members of the organisations World Federation of NeuroRehabilitation and Collaboration of Aphasia Trialists is addressing the marginalisation of people with aphasia, through education and knowledge exchange related to communication partner training of health professionals. RESULT: A partnership between academics and healthcare professionals across Austria, Denmark, Egypt, Ireland, Greece, India, Serbia and the United Kingdom was established in 2020. Through bimonthly online sessions in 2021-2022 a Danish communication partner training program was introduced while six teams adapted and translated the training and its materials to their local contexts. CONCLUSION: A collaborative partnership enabled multiple translations of an existing communication partner training program for healthcare professionals working with people with aphasia to support a sustainable delivery model that is linguistic and culturally sensitive. This commentary paper focusses on Sustainable Development Goal (SDG) 17 and also addresses SDG 10.

Carcinogenic and human health risk assessment of children's and adults' exposure to toxic metal(oid)s from air PM10 in critical sites of the Republic of Serbia.

With global urbanization and industrialization, air pollution has become an inevitable problem. Among air pollutants, toxic metals bound to particulate matter (PM) have a high hazardous potential, contributing to the development of several diseases, including various types of cancer. Due to PM pollution, Serbia is considered to be among the most polluted countries in Europe. Therefore, the objective of the study was to assess and characterize the non-carcinogenic and carcinogenic risks of children's and adults' exposure to metal(oid)s (Pb, Cd, Ni, and As) bound to PM10 in five of the most polluted areas in the Republic of Serbia (Subotica, Smederevo, Bor, Valjevo, and Kraljevo). Non-carcinogenic (HQ and HI) and carcinogenic risk (CR) were calculated using USEPA methodology. Our results show that PM10 concentrations exceeded the annual limit of 40 µg/m3 at four out of five monitoring sites (ranging from 44.33 to 63.25 µg/m3). Results obtained from Bor monitoring station show that safe limits were exceeded for both children and adults, indicating an unacceptable risk (> 1) obtained for inhalation exposure to the As (HQ = 6.14) and Cd (HQ = 1.17), while total HI was 7.43, which characterized the risk as unacceptable. For the same station, the CR value was 1.44E-04 (> 1 × 10-4). In other sites, the risks were acceptable. The characterized risk from exposure to the toxic elements via PM10 in critical locations in Serbia contributes to improving air quality by requiring regulatory organs to take new actions and adopt new measures to reduce air pollution.

Cross-Cultural Adaptation and Validation of the Serbian Version of the Brief Assessment of Cognition in Schizophrenia Scale.

The Brief Assessment of Cognition in Schizophrenia (BACS) scale was developed for the assessment of cognitive function in patients with schizophrenia. The objective of this study was to cross-culturally adapt and validate the BACS in to the Serbian language. The study was conducted at the Laza Lazarevic Clinic for Mental Disorders and the Clinic for Psychiatry of the University Clinical Center of Serbia from March 2021 to January 2022. The study enrolled 61 inpatients diagnosed with schizophrenia and 61 healthy controls matched for age and sex. Compared with the healthy control group, the schizophrenia patient group had worse cognitive function in all dimensions measured using BACS (p < 0.001 for all measures). The mean standardized composite BACS score was z = -2.46, and symbol coding (z = -2.54) was the most deficient function. Principal component analysis suggests a two-factor structure, where the first factor consisted of loading the measures of verbal and working memory, attention, speed of information processing, and executive function, while the second factor regarded the loading of motor speed. Cronbach's alpha coefficient demonstrated an excellent level of internal consistency (0.798). These outcomes suggest that the Serbian BACS neurocognitive battery's psychometric properties are satisfactory, with good overall discriminant validity and high internal consistency. The Serbian BACS appears to be a quick and reliable neuropsychological instrument for evaluating global cognition in schizophrenia patients in Serbia.