Discrimination and Romani health: a validation study of discrimination scales among Romani women in Macedonia and Serbia.

OBJECTIVES: Scales used to assess discrimination in public health research have rarely been validated outside of high income countries. Our objective was to validate the Experiences of Discrimination (EOD) scale and the Everyday Discrimination Scale (EDS) among 410 Romani women in Macedonia and Serbia. METHODS: Romani female interviewers conducted interviews in 2012-2013. We used a multiple indicator multiple cause approach to test a one-factor model for each scale and to assess differential item functioning (DIF) by age, wealth, country, and education. We also measured associations between the EOD and EDS with smoking in the past year and psychological distress. RESULTS: Three items of the EOD were conceptually irrelevant. Two items of the EDS were not conditionally independent. DIF was found by country for one item in each scale. After excluding these items, all scales exhibited good model fit and were associated with smoking (EOD beta = 0.40, 95% CI = 0.18, 0.63; EDS beta = 0.33, 95% CI = 0.12, 0.54) and psychological distress (EOD beta = 0.26, 95% CI = 0.15, 0.37; EDS beta = 0.26, 95% CI = 0.04, 0.47). CONCLUSIONS: Discrimination scales can be adapted for use among Romani women and are associated with both smoking and psychological distress.

Three periods of health system reforms in the Republic of Macedonia (1991-2011).

AIM: To investigate, describe and classify main health policies and reform activities within the healthcare system undertaken over the past twenty years in R. Macedonia. METHODS: Desk research was conducted on scientific literature and relevant documentation (in English and Macedonian) about healthcare reforms. Relevant documents available at the Ministry of Health, Health Insurance Fund, World Bank and World Health Organization were reviewed. Official data on demographic and health status indicators were collected from the Institute of Public Health and the State Statistical Office. A working hypothesis, that the health system reforms were not continuous, was generated following the shifts in decision-making power over allocation of resources and political influences. RESULTS: Our study identified three periods of health system reforms in Macedonia: post-socialistic, pro-market and manifesto-driven. Throughout these periods poor maintenance, low efficiency and high operational costs increased out-of-pocket expenditures for health services and drugs and reflected on the deterioration of public hospital infrastructure. In parallel, liberal healthcare market regulation initiated commercialization of the healthcare services. Disappointed in the quality of healthcare services provided in the public health sector, many citizens opt to ask for services in private health care facilities, where social health insurance largely does not cover the costs. CONCLUSION: The pace of the reforms is not continuous and the influence of politics is highly visible over the whole period of transition in the Republic of Macedonia. The main problems of the healthcare system in the Republic of Macedonia are politicization of the health sector, high centralization and government control, and poor efficiency of public health institutions. Evaluation framework should be developed to further assess the impact of the health reforms.

Epidemiological and public health aspects of brucellosis in the Republic of Macedonia.

AIM: To analyze and present epidemiological patterns of human brucellosis cases and the main factors for the appearance and spread of B. melitensis infection among animals and humans in R. Macedonia in the period from 1980 to 2009. METHODS: Retrospective study based on the epidemiological reports and official data on brucellosis cases from the Institute for Public Health in Skopje and other institutions from the health and veterinary sectors in R. Macedonia, and a review of the relevant literature. RESULTS: From 1980 until December 2009, a total of 11,451 brucellosis cases were reported in R. Macedonia, with a mean annual incidence rate of 18.9/100,000. The highest morbidity rate during this period was recorded in 1992 (922 cases and an incidence rate of 47.6/100,000), and the lowest one in 1983 (12 cases and an incidence rate of 0.6/100,000). From the total number of cases reported in R. Macedonia from 1980 to 2009, 66.2% were males and 33.8% were females. Only 7.2% of patients were under the age of 10, and the most of the patients were from the age group 20-39 (31.9%). Seasonal characteristics of the disease were expressed with the highest occurrence in May (15.9%), June (16.3%) and July (15.1%). Within the total number of 3,284 brucellosis cases in the period 2001-2009, 2320 (70.6%) were from rural settlements and 964 (29.4%) from urban areas. 385 of all cases of brucellosis (8.4%) reported in the period 1998-2009 were from the ranks of professional staff. CONCLUSION: Brucellosis was, currently is and will be a significant disease problem and concern in R. Macedonia which should be approached in a more comprehensive and organized way in the coming years. There is a need to establish intersectoral collaboration by joint efforts of all relevant factors in the prevention and eradication of brucellosis, as well as collaboration between all countries in the SEE region.

Public health aspects of renal diseases in the Republic of Macedonia 1983-2007.

OBJECTIVE: To present the situation and burden of renal diseases and dialysis in the Republic of Macedonia in the period 1983-2007. METHODOLOGY: A descriptive-statistical method has been applied with retrospective analysis of data for the period 1983-2007. Data from standard reports from ambulatory, dispensary and hospital services in the Republic of Macedonia, mortality statistics for the Republic of Macedonia, data from the World Health Organization and other professional literature and materials have been used. RESULTS AND DISCUSSION: Morbidity data from ambulatory and dispensary services in the period 1997-2007 show that renal diseases have increased by 64.7%, with rates rising from 319.5/10,000 population in 1997 to 514.5/10,000 in 2007. There has also been a rise in hospital health care for renal diseases, which is mainly due to the increase of chronic renal failure patients. Renal failure in-patient morbidity has increased from 3.5/10,000 in 1983 to 8.2/10,000 in 2006. Mortality from urinary system diseases in the period 1983-2007 also increased from 8.2/100,000 in 1983 to 14.0/100,000 in 2007. The vast majority of all mortality cases are due to renal failure. At the same time, chronic renal failure represents a significant economic burden to the society. CONCLUSIONS AND RECOMMENDATIONS: The treatment of urinary system diseases, and especially of chronic renal failure, requires costly diagnostic procedures and treatment and long-term rehabilitation and these cause negative economic effects, long-term absenteeism, disability and premature death. It is necessary to stress the measures for health protection and promotion, as well as all levels of prevention of renal diseases.