Determinants of job satisfaction of healthcare professionals in public hospitals in Belgrade, Serbia--Cross-sectional analysis.

INTRODUCTION: The quality of health care significantly depends on the satisfaction of the employees. OBJECTIVE: The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. METHOD: Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade's hospitals. Statistical analysis was performed using the Student's t-test, χ² test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. RESULTS: This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals'dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. CONCLUSION: There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.

Prognostic factors and survival of ALS patients from Belgrade, Serbia.

Our aim was to assess the incidence, survival and its prognostic factors in ALS patients from the area of the City of Belgrade, Serbia. A retrospective analysis included 325 probable or definite ALS cases from all five Belgrade neurology departments in the period 1992-2009. Each patient was regularly followed up during the disease until death or until 31 December 2009. Results showed that the average annual ALS incidence rate was 1.11 per 100,000 inhabitants. Male predominance was registered, except for patients with ALS onset after the age of 80 years. Mean survival from the first symptoms was 4.4 ± 0.2 years. Cumulative probability of survival was 71% for two years, 24% for five years, and 17% for seven years. Patients with diagnostic delay longer than 1.6 years had a 1.4-times better chance for survival (p <0.01). Spinal-onset patients on riluzole therapy had 1.8-times better survival (p < 0.01). Patients with early-onset ALS and higher ALSFRS-R score at initial evaluation also had somewhat better survival (p < 0.05). In conclusion, the average annual ALS incidence rate was 1.11 per 100,000 inhabitants. Longer survival was observed in patients with early onset, longer diagnostic delay, less functional impairment at the time of diagnosis, and riluzole treatment.

Is hyperlipidemia correlated with longer survival in patients with amyotrophic lateral sclerosis?

Amyotrophic lateral sclerosis (ALS) is the most serious form of degenerative motor neuron disease in adults, whose relentless course leads to death within 2-5 years, generally due to respiratory failure. Apart from the age and site of onset, no other factors have consistently demonstrated to be related to the ALS outcome. The aim of the study was to investigate the influence of fasting serum lipid levels (cholesterol and triglycerides) and the body mass index (BMI) at the time of diagnosis on survival in ALS patients. The study included 82 patients with ALS residing in the Belgrade area who were diagnosed with ALS over a time period of 4 years (2006-2009). Survival was assessed by the Kaplan-Meier method. In this retrospective study, 39 (47.56%) patients had normal values of lipids and 43 (52.43%) patients had hyperlipidemia. The mean survival time from the onset of symptoms for patients with normal lipidemia was 4.21 ± 0.5 years, while the mean survival time from the onset of symptoms for patients with hyperlipidemia was 5.0 ± 0.67 years (P = 0.36). We also did not register a significant difference in survival in relation to gender, the site or age of onset, even though we noticed a longer survival in patients with hyperlipidemia in all of the examined groups, especially in the group of younger patients, with the onset of the disease before the age of 45 years. If we take into account the fact that BMI is pathophysiologically associated with cholesterol and triglyceride serum levels, the results in our study complement each other showing that patients with a higher BMI, registered in 28.8% of the cases, do not live longer. Our findings show that hyperlipidemia, which we found in 52.43% of our ALS patients, at the time of diagnosis, is not related to significantly longer survival.

[Assessment of health care quality in the tertiary level pediatric hospitals in Serbia].

BACKGROUND/AIM: It is necessary to improve the quality of health care for children. Assessment data would provide new insights into better treatment outcomes. The aim of this descriptive study was to estimate and to compare applied quality indicators in five pediatric in-patient tertiary level institutions in Serbia during the period from January 1st to December 31st 2008. METHODS: Quality data and indicators were collected in the Institute for Public Health of Serbia "Dr. Milan Jovanovid Batut". Descriptive statistics and chi-square test were used for data analysis. RESULTS: The average length of stay (ALOS) in pediatric departments was 7.51 + 1.30 days (5.88-8.91 days). In the same period, ALOS in pediatric surgery departments was 5.85 +/- 1.50 days (3.58-7.57 days). The average number of nurses per occupied bed was 0.76 +/- 0.20 and 1.09 +/- 0.36 in pediatric and in pediatric surgery departments, respectively. The number of operated patients per surgeon was in the range 51.0-160.5. The annual case fatality rate in pediatric departments was estimated to 0.72% +/- 0.20%, whereas in pediatric surgery departments it was 0.34% +/- 0.25%. The autopsy rate was estimated to 0.00%-63.16% in pediatric departments, and 37.14%-80.00% in pediatric surgery departments. There was statistically significant difference among the five hospitals regarding the following indicators of quality of work: total annual mortality rate of patients, autopsy rate, number of rate of patients, autopsy rate, number of patients referred to other institutions, both in pediatric and pediatric surgery departments. CONCLUSION: There is a significant difference among the five hospitals regarding indicators of quality of work. Obligatory set of quality indicators on the basis of legislative acts are the indicators of general quality of work in hospital. It is necessary to establish specific pediatric quality indicators and to define national standards related to these indicators.