Vojnosanitetski Pregled Military Medical and Pharmaceutical Review, 2015
Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose ... more Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0.001) respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively). Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001) as well as under the projected DRG payment system (β = 0.737, p < 0.001). The same predictor was crucial for the difference in the current payment method and the pro- jected DRG payment methods (β = 0.501, p < 0.001). Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.
Like many developing countries, Serbia is facing a growing burden of chronic diseases. Within suc... more Like many developing countries, Serbia is facing a growing burden of chronic diseases. Within such public health issue, multi-morbidity requires a special attention. This study investigated the prevalence of multi-morbidity in the Serbia population and assessed the co-occurrence of chronic diseases by age and gender. We analyzed data from the 2013 National Health Survey, which included 13,103 individuals ≥ 20 years old. Multi-morbidity patterns were identified by exploratory factor analysis of data on self-reported chronic diseases, as well as data on measured body weight and height. The analysis was stratified by age and gender. Multi-morbidity was present in nearly one-third of respondents (26.9%) and existed in all age groups, with the highest prevalence among individuals aged 65 years and older (47.2% of men and 65.0% of women). Six patterns of multi-morbidity were identified: non-communicable, cardio-metabolic, respiratory, cardiovascular, aggregate, and mechanical/mental/metabolic. The non-communicable pattern was observed in both genders but only in the 20-44 years age group, while the aggregate pattern occurred only in middle-aged men. Cardio-metabolic and respiratory patterns were present in all age groups. Cardiovascular and mechanical/mental/metabolic patterns showed similar presentation in both men and women. Multi-morbidity is a common occurrence among adults in Serbia, especially in the elderly. While several patterns may be explained by underlying pathophysiologies, some require further investigation and follow-up. Recognizing the complexity of multi-morbidity in Serbia is of great importance from both clinical and preventive perspectives given that it affects one-third of the population and may require adjustment of the healthcare system to address the needs of affected individuals.
Aim: This paper deals with public health training, research and practice in order to identify the... more Aim: This paper deals with public health training, research and practice in order to identify the future perspectives and requirements of public health in Serbia. Method: The methods used for data collection and analysis were: (1) Review of the existing written reports, the relevant legislation and other documents, and (2) Internet searches accessing the websites of ministries of health, education, science and technology of the Republic of Serbia as well as websites covering thematic areas in European and global education, research and development. Use has been made also of the results of the European Union projects done in the field of public health in Serbia, particularly Tempus programme: “Postgraduate Studies in Public Health Sciences”. Results: A wider public health concept includes especially cost-effective health management and bottom-up health promotion, two areas which have a special relevance for Serbia. The most important role in the field of change in public health of Se...
Cilj ovo rada je da se, koristeći izneseni logični okvir za faze uspostavljanja javnozdravstvene ... more Cilj ovo rada je da se, koristeći izneseni logični okvir za faze uspostavljanja javnozdravstvene politike, analizira situacija javnozdravstvene politike u Srbiji, prevashodno na nacionalnom nivou. Naročita pažnja se fokusira na Milenijumske ciljeve razvoja kao i na segmente javnozdravstvene politike koji se odnose na pristupanje Evropskoj uniji. Metod Osnovni metodi korišćeni u ovoj analizi odnose se na pretraživanje veb stranica i pregled dokumenata politike uopšte i javnozdravstvene politike, uz analizu njihovog sadržaja. Identifikovani su osnovni dokumenti politike kao i situacija u oblasti njihove implementacije, počevši od veb stranica Ministarstva zdravlja Republike Srbije, (http://www.zdravlje.gov.rs). Preko veb stranica Vlade Srbije prikupljeni su drugi neophodni dokumenti povezani sa zdravljem u ostalim oblastima radi poređenja dostignuća. Analizirani su i podaci iz elektronskih baza Instituta za javno zdravlje Republike Srbije i Zavoda za statistiku Republike Srbije. Usled...
Background: In the etiology of cervical cancer not only HPV infection is important, but also othe... more Background: In the etiology of cervical cancer not only HPV infection is important, but also other factors such as demographic influences andsexual and reproductive health attitudes, as well as others related to preventive measure usage (or non usage). The aim of this study was to examine factors associated with cervical dysplasia in asymptomatic women who were examined by routine cytology and cervical biopsy for early detection of cervical cancer. Materials and Methods: Socio-demographic and other characteristics were obtained from medical files of 85 examinees with pathologic cytologic findings (Pap test) and histopathologic (HP) findings after biopsy. Results: ccording to the Pap test result, a greater probability for development of cervical dysplasia was noted with examinees having a larger number of sexual partners (OR= 5.01, 95% CI 1.04-24.10), and those who are afraid of the Pap finding. Risk factors for development of cervical dysplasia according to the bioptic finding were ...
FOREWORD This first edition of a Guide for Distance Learning has been developed, based on the ASP... more FOREWORD This first edition of a Guide for Distance Learning has been developed, based on the ASPHER Survey on Schools and Departments of Public Health (SDPH) 2011/2012. Institutions from all corners of Europe contributed with their experience in the new and rapidly developing field of Blended Learning. There are many different and partly overlapping terms like Distance Learning (used here as an umbrella term), e-learning, on-line teaching/learning, Problem Oriented Learning, Problem Based Learning, Continuing Professional Development etc. used by our authors in different ways. One additional term is emerging recently “Continuing Online Training”, which perhaps captures best the new philosophy of Lifelong Learning and is one of the essential pre-conditions for its broad acceptance, i.e. the availability of training modules on-line. Knowledge and skills once acquired are rapidly outdated and have to be updated and developed each year throughout the lifecycle. If we look at the Europe...
Introduction: The aim of this paper is to present an experience from the School of Medicine (Univ... more Introduction: The aim of this paper is to present an experience from the School of Medicine (University of Belgrade, Serbia) in restructuring of study programs to be compliant with Bologna standards and European best practices in public and community health. We devised the new module with the idea to implement both the concept of patient-centered medicine and community-based learning activity, in the pre-clinical phase of medical education. It emphasis importance of social determinants of health, community activities on health promotion, early contacts with patients, developing communication skills and introduction of primary health care settings Method: All participants of overall four generations of this curriculum (students, patients and physicians) were asked to evaluate their participation in the module, using three types of self-administered questionnaires. Results: Overall 1529 students (response rate 74.1%), 1011 patients (response rate 57.2%) and 118 physicians (response ra...
Asian Pacific journal of cancer prevention : APJCP, 2015
Serbia is one of the countries with highest incidence and mortality rates for cervical cancer in ... more Serbia is one of the countries with highest incidence and mortality rates for cervical cancer in Central and South Eastern Europe. Introducing a risk index could provide a powerful means for targeting groups at high likelihood of having an abnormal cervical smear and increase efficiency of screening. The aim of the present study was to create and assess validity ofa index for prediction of an abnormal Pap test result. The study population was drawn from patients attending Departments for Women's Health in two primary health care centers in Serbia. Out of 525 respondents 350 were randomly selected and data obtained from them were used as the index creation dataset. Data obtained from the remaining 175 were used as an index validation data set. Age at first intercourse under 18, more than 4 sexual partners, history of STD and multiparity were attributed statistical weights 16, 15, 14 and 13, respectively. The distribution of index scores in index-creation data set showed that most...
Tuberculosis (TB) remains an important health problem in the Roma population in Serbia. Recent st... more Tuberculosis (TB) remains an important health problem in the Roma population in Serbia. Recent studies have highlighted the importance of increasing awareness of TB and reducing the associated stigmas to reduce the incidence of TB and enable earlier diagnosis and effective treatment. This study investigated the knowledge and beliefs about transmission, symptoms and treatment of TB as well as attitudes towards patients with TB among the Roma population in Belgrade. The focus-group method was considered to be appropriate for investigating knowledge and beliefs about TB. A total of 24 Roma people aged 19-55 years participated in three focus-group discussions. All participants knew that TB was a pulmonary disease and could be contagious. Saliva was the most commonly mentioned mode of transmission. Some individuals thought, albeit hesitantly, that TB could be transmitted by shaking hands with an infected individual. Of factors contributing to TB, participants mentioned bad living conditi...
Prevention of AIDS is very complex and requires, apart from basic knowledge about modes of transm... more Prevention of AIDS is very complex and requires, apart from basic knowledge about modes of transmission and protection, individual awareness of personal risk of infection and modification of one's risky behavior. Perception of risk has been suggested as an important element of sexual behavior change among people who engage in behaviors that place them at risk of HIV infection. This study investigates perceived risk of an HIV infection among inhabitants of municipality of Palilula. The purpose of this study was to determine the relative accuracy of risk assessment, especially for those with high-risk sexual behavior and to assess the factors related to self perception of developing AIDS. The survey was conducted as a household survey in Belgrade municipality "Palilula". The design of the survey was based on a two-stage stratified random sample. The population of Palilula municipality was divided in two stratums and 840 households were selected from each stratum. All mem...
The term of project management is commonly used to describe the work of a team that is handling a... more The term of project management is commonly used to describe the work of a team that is handling a special program. In this type of management, a form of leadership which creates environment, enables fast movement of participants through different work phases achieving the common aims, is used [1-4]. The "Healthy School" Project, launched in almost all European countries, has been taking place in Yugoslavia since the end of 1991 [5]. The project developed within the country designed as a health promotion-education intervention study in primary schools. The network of 13 schools on 11 locations representing typical economic, cultural and social environments, was established to cover the country. Although the proposed methodological approach from WHO was followed [6], the specific situation in the country (economic crisis, break down of Yugoslav Federation, the war and international blockade) distated the particular modification. The management of the Healthy School Project i...
The incidence of cervical cancer in Central Serbia has the higher rate as compared with that in o... more The incidence of cervical cancer in Central Serbia has the higher rate as compared with that in other European countries. Considering mortality rate for cervical cancer, the standardized rate in Serbia is 10.1 per 10,000 females, which is the second highest one after that in Romania with 13.0. The aim of this study was to examine application of preventive measures for cervical cancer in women both from rural and urban areas in Serbia and if they are associated with sociodemographic characteristics and sexual behaviour. We analyzed secondary data of the 2006 National Health Survey of the population of Serbia focused on characteristics of adult females aged 25 to 65 years (5.314 in total) taking into consideration that programme of the organized screening will include female population aged over 25 years. Respondents from rural areas have gynecological examination less than once a year in comparison with those from urban areas (OR = 0.60, 95% CI 0.54-0.68). Less women from rural areas did Pap test during the last 12 months in comparison with respondents from urban areas (OR = 0.55, 95% Cl 0.48-0.64). Respondents from urban areas less often do the Pap test on doctor's advice in comparison with those from rural one (OR = 0.55, 95% CI 0.42-0.62). This study shows that women in rural areas rarely implement preventive gynecological measures againt cervical cancer in comparison with those in urban areas. Implementation of preventive measures among rural women is conditioned by lower levels of education and lower socioeconomic status.
Complete atrioventricular block is a serious disorder, since patients may be asymptomatic. Howeve... more Complete atrioventricular block is a serious disorder, since patients may be asymptomatic. However, it is an important risk for sudden cardiac death. A 48-year old male patient was admitted to the coronary care unit, due to recurring substernal chest pain. It was followed by fatigue, weakness and confusion, it lasted more than half an hour and occurred twice. Loss of consciousness did not occur. The patient had a tick bite two months earlier. Physical examination was unremarkable, except for low heart rate (50/minute) electrocardiogram showed a complete atrioventricular block with narrow QRS complexes and good ventricular function. Elevation of ST segment was observed in the inferior ECG leads, with reciprocal ST depression in precordial leads; it was highly suspicious for acute myocardial infarction, but markers of myocardial necrosis (Troponin, Creatine kinase-MB) were normal. The chest pain recurred without evolutive changes in the electrocardiogram or increase in markers of myocardial necrosis. Tests for Lyme disease were negative, too. The cause of atrioventricular conduction disturbance was found by transthoracic echocardiography. A giant tumor was found in the right atrium and right ventricle. Further examinations excluded its secondary cause and the patient was sent to surgery. The tumor was inoperable and bled excessively. Although permanent pacing was performed, the patient died suddenly after dismisal. We can conclude that a giant primary tumor of the heart can be asymptomatic for a long time causing complete atrioventricular block, and in this case it clinically presented as acute myocardial infarction. Echocardiographic examination was the main diagnostic tool in our case.
ABSTRACT Hip fracture has epidemic character in the world, including Serbia, which is significant... more ABSTRACT Hip fracture has epidemic character in the world, including Serbia, which is significant for its medical and social consequences on the one hand and economic on the other, taking into account the increasing number of elderly in Serbia. Socio-medical aspects of hip or femur fracture were researched on the territory of Belgrade, within two groups of patients, younger (age 20–64) compared to elderly (age 65+).
Vojnosanitetski Pregled Military Medical and Pharmaceutical Review, 2015
Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose ... more Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0.001) respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively). Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001) as well as under the projected DRG payment system (β = 0.737, p < 0.001). The same predictor was crucial for the difference in the current payment method and the pro- jected DRG payment methods (β = 0.501, p < 0.001). Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.
Like many developing countries, Serbia is facing a growing burden of chronic diseases. Within suc... more Like many developing countries, Serbia is facing a growing burden of chronic diseases. Within such public health issue, multi-morbidity requires a special attention. This study investigated the prevalence of multi-morbidity in the Serbia population and assessed the co-occurrence of chronic diseases by age and gender. We analyzed data from the 2013 National Health Survey, which included 13,103 individuals ≥ 20 years old. Multi-morbidity patterns were identified by exploratory factor analysis of data on self-reported chronic diseases, as well as data on measured body weight and height. The analysis was stratified by age and gender. Multi-morbidity was present in nearly one-third of respondents (26.9%) and existed in all age groups, with the highest prevalence among individuals aged 65 years and older (47.2% of men and 65.0% of women). Six patterns of multi-morbidity were identified: non-communicable, cardio-metabolic, respiratory, cardiovascular, aggregate, and mechanical/mental/metabolic. The non-communicable pattern was observed in both genders but only in the 20-44 years age group, while the aggregate pattern occurred only in middle-aged men. Cardio-metabolic and respiratory patterns were present in all age groups. Cardiovascular and mechanical/mental/metabolic patterns showed similar presentation in both men and women. Multi-morbidity is a common occurrence among adults in Serbia, especially in the elderly. While several patterns may be explained by underlying pathophysiologies, some require further investigation and follow-up. Recognizing the complexity of multi-morbidity in Serbia is of great importance from both clinical and preventive perspectives given that it affects one-third of the population and may require adjustment of the healthcare system to address the needs of affected individuals.
Aim: This paper deals with public health training, research and practice in order to identify the... more Aim: This paper deals with public health training, research and practice in order to identify the future perspectives and requirements of public health in Serbia. Method: The methods used for data collection and analysis were: (1) Review of the existing written reports, the relevant legislation and other documents, and (2) Internet searches accessing the websites of ministries of health, education, science and technology of the Republic of Serbia as well as websites covering thematic areas in European and global education, research and development. Use has been made also of the results of the European Union projects done in the field of public health in Serbia, particularly Tempus programme: “Postgraduate Studies in Public Health Sciences”. Results: A wider public health concept includes especially cost-effective health management and bottom-up health promotion, two areas which have a special relevance for Serbia. The most important role in the field of change in public health of Se...
Cilj ovo rada je da se, koristeći izneseni logični okvir za faze uspostavljanja javnozdravstvene ... more Cilj ovo rada je da se, koristeći izneseni logični okvir za faze uspostavljanja javnozdravstvene politike, analizira situacija javnozdravstvene politike u Srbiji, prevashodno na nacionalnom nivou. Naročita pažnja se fokusira na Milenijumske ciljeve razvoja kao i na segmente javnozdravstvene politike koji se odnose na pristupanje Evropskoj uniji. Metod Osnovni metodi korišćeni u ovoj analizi odnose se na pretraživanje veb stranica i pregled dokumenata politike uopšte i javnozdravstvene politike, uz analizu njihovog sadržaja. Identifikovani su osnovni dokumenti politike kao i situacija u oblasti njihove implementacije, počevši od veb stranica Ministarstva zdravlja Republike Srbije, (http://www.zdravlje.gov.rs). Preko veb stranica Vlade Srbije prikupljeni su drugi neophodni dokumenti povezani sa zdravljem u ostalim oblastima radi poređenja dostignuća. Analizirani su i podaci iz elektronskih baza Instituta za javno zdravlje Republike Srbije i Zavoda za statistiku Republike Srbije. Usled...
Background: In the etiology of cervical cancer not only HPV infection is important, but also othe... more Background: In the etiology of cervical cancer not only HPV infection is important, but also other factors such as demographic influences andsexual and reproductive health attitudes, as well as others related to preventive measure usage (or non usage). The aim of this study was to examine factors associated with cervical dysplasia in asymptomatic women who were examined by routine cytology and cervical biopsy for early detection of cervical cancer. Materials and Methods: Socio-demographic and other characteristics were obtained from medical files of 85 examinees with pathologic cytologic findings (Pap test) and histopathologic (HP) findings after biopsy. Results: ccording to the Pap test result, a greater probability for development of cervical dysplasia was noted with examinees having a larger number of sexual partners (OR= 5.01, 95% CI 1.04-24.10), and those who are afraid of the Pap finding. Risk factors for development of cervical dysplasia according to the bioptic finding were ...
FOREWORD This first edition of a Guide for Distance Learning has been developed, based on the ASP... more FOREWORD This first edition of a Guide for Distance Learning has been developed, based on the ASPHER Survey on Schools and Departments of Public Health (SDPH) 2011/2012. Institutions from all corners of Europe contributed with their experience in the new and rapidly developing field of Blended Learning. There are many different and partly overlapping terms like Distance Learning (used here as an umbrella term), e-learning, on-line teaching/learning, Problem Oriented Learning, Problem Based Learning, Continuing Professional Development etc. used by our authors in different ways. One additional term is emerging recently “Continuing Online Training”, which perhaps captures best the new philosophy of Lifelong Learning and is one of the essential pre-conditions for its broad acceptance, i.e. the availability of training modules on-line. Knowledge and skills once acquired are rapidly outdated and have to be updated and developed each year throughout the lifecycle. If we look at the Europe...
Introduction: The aim of this paper is to present an experience from the School of Medicine (Univ... more Introduction: The aim of this paper is to present an experience from the School of Medicine (University of Belgrade, Serbia) in restructuring of study programs to be compliant with Bologna standards and European best practices in public and community health. We devised the new module with the idea to implement both the concept of patient-centered medicine and community-based learning activity, in the pre-clinical phase of medical education. It emphasis importance of social determinants of health, community activities on health promotion, early contacts with patients, developing communication skills and introduction of primary health care settings Method: All participants of overall four generations of this curriculum (students, patients and physicians) were asked to evaluate their participation in the module, using three types of self-administered questionnaires. Results: Overall 1529 students (response rate 74.1%), 1011 patients (response rate 57.2%) and 118 physicians (response ra...
Asian Pacific journal of cancer prevention : APJCP, 2015
Serbia is one of the countries with highest incidence and mortality rates for cervical cancer in ... more Serbia is one of the countries with highest incidence and mortality rates for cervical cancer in Central and South Eastern Europe. Introducing a risk index could provide a powerful means for targeting groups at high likelihood of having an abnormal cervical smear and increase efficiency of screening. The aim of the present study was to create and assess validity ofa index for prediction of an abnormal Pap test result. The study population was drawn from patients attending Departments for Women's Health in two primary health care centers in Serbia. Out of 525 respondents 350 were randomly selected and data obtained from them were used as the index creation dataset. Data obtained from the remaining 175 were used as an index validation data set. Age at first intercourse under 18, more than 4 sexual partners, history of STD and multiparity were attributed statistical weights 16, 15, 14 and 13, respectively. The distribution of index scores in index-creation data set showed that most...
Tuberculosis (TB) remains an important health problem in the Roma population in Serbia. Recent st... more Tuberculosis (TB) remains an important health problem in the Roma population in Serbia. Recent studies have highlighted the importance of increasing awareness of TB and reducing the associated stigmas to reduce the incidence of TB and enable earlier diagnosis and effective treatment. This study investigated the knowledge and beliefs about transmission, symptoms and treatment of TB as well as attitudes towards patients with TB among the Roma population in Belgrade. The focus-group method was considered to be appropriate for investigating knowledge and beliefs about TB. A total of 24 Roma people aged 19-55 years participated in three focus-group discussions. All participants knew that TB was a pulmonary disease and could be contagious. Saliva was the most commonly mentioned mode of transmission. Some individuals thought, albeit hesitantly, that TB could be transmitted by shaking hands with an infected individual. Of factors contributing to TB, participants mentioned bad living conditi...
Prevention of AIDS is very complex and requires, apart from basic knowledge about modes of transm... more Prevention of AIDS is very complex and requires, apart from basic knowledge about modes of transmission and protection, individual awareness of personal risk of infection and modification of one's risky behavior. Perception of risk has been suggested as an important element of sexual behavior change among people who engage in behaviors that place them at risk of HIV infection. This study investigates perceived risk of an HIV infection among inhabitants of municipality of Palilula. The purpose of this study was to determine the relative accuracy of risk assessment, especially for those with high-risk sexual behavior and to assess the factors related to self perception of developing AIDS. The survey was conducted as a household survey in Belgrade municipality "Palilula". The design of the survey was based on a two-stage stratified random sample. The population of Palilula municipality was divided in two stratums and 840 households were selected from each stratum. All mem...
The term of project management is commonly used to describe the work of a team that is handling a... more The term of project management is commonly used to describe the work of a team that is handling a special program. In this type of management, a form of leadership which creates environment, enables fast movement of participants through different work phases achieving the common aims, is used [1-4]. The "Healthy School" Project, launched in almost all European countries, has been taking place in Yugoslavia since the end of 1991 [5]. The project developed within the country designed as a health promotion-education intervention study in primary schools. The network of 13 schools on 11 locations representing typical economic, cultural and social environments, was established to cover the country. Although the proposed methodological approach from WHO was followed [6], the specific situation in the country (economic crisis, break down of Yugoslav Federation, the war and international blockade) distated the particular modification. The management of the Healthy School Project i...
The incidence of cervical cancer in Central Serbia has the higher rate as compared with that in o... more The incidence of cervical cancer in Central Serbia has the higher rate as compared with that in other European countries. Considering mortality rate for cervical cancer, the standardized rate in Serbia is 10.1 per 10,000 females, which is the second highest one after that in Romania with 13.0. The aim of this study was to examine application of preventive measures for cervical cancer in women both from rural and urban areas in Serbia and if they are associated with sociodemographic characteristics and sexual behaviour. We analyzed secondary data of the 2006 National Health Survey of the population of Serbia focused on characteristics of adult females aged 25 to 65 years (5.314 in total) taking into consideration that programme of the organized screening will include female population aged over 25 years. Respondents from rural areas have gynecological examination less than once a year in comparison with those from urban areas (OR = 0.60, 95% CI 0.54-0.68). Less women from rural areas did Pap test during the last 12 months in comparison with respondents from urban areas (OR = 0.55, 95% Cl 0.48-0.64). Respondents from urban areas less often do the Pap test on doctor's advice in comparison with those from rural one (OR = 0.55, 95% CI 0.42-0.62). This study shows that women in rural areas rarely implement preventive gynecological measures againt cervical cancer in comparison with those in urban areas. Implementation of preventive measures among rural women is conditioned by lower levels of education and lower socioeconomic status.
Complete atrioventricular block is a serious disorder, since patients may be asymptomatic. Howeve... more Complete atrioventricular block is a serious disorder, since patients may be asymptomatic. However, it is an important risk for sudden cardiac death. A 48-year old male patient was admitted to the coronary care unit, due to recurring substernal chest pain. It was followed by fatigue, weakness and confusion, it lasted more than half an hour and occurred twice. Loss of consciousness did not occur. The patient had a tick bite two months earlier. Physical examination was unremarkable, except for low heart rate (50/minute) electrocardiogram showed a complete atrioventricular block with narrow QRS complexes and good ventricular function. Elevation of ST segment was observed in the inferior ECG leads, with reciprocal ST depression in precordial leads; it was highly suspicious for acute myocardial infarction, but markers of myocardial necrosis (Troponin, Creatine kinase-MB) were normal. The chest pain recurred without evolutive changes in the electrocardiogram or increase in markers of myocardial necrosis. Tests for Lyme disease were negative, too. The cause of atrioventricular conduction disturbance was found by transthoracic echocardiography. A giant tumor was found in the right atrium and right ventricle. Further examinations excluded its secondary cause and the patient was sent to surgery. The tumor was inoperable and bled excessively. Although permanent pacing was performed, the patient died suddenly after dismisal. We can conclude that a giant primary tumor of the heart can be asymptomatic for a long time causing complete atrioventricular block, and in this case it clinically presented as acute myocardial infarction. Echocardiographic examination was the main diagnostic tool in our case.
ABSTRACT Hip fracture has epidemic character in the world, including Serbia, which is significant... more ABSTRACT Hip fracture has epidemic character in the world, including Serbia, which is significant for its medical and social consequences on the one hand and economic on the other, taking into account the increasing number of elderly in Serbia. Socio-medical aspects of hip or femur fracture were researched on the territory of Belgrade, within two groups of patients, younger (age 20–64) compared to elderly (age 65+).
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