Publications by authors named "Bojana Matejic"

28 Publications

  • Page 1 of 1

"Today one partner, tomorrow another one, and no one is suspicious that you are gay": a qualitative study of understanding HIV related risk behaviour among MSM in Bosnia and Herzegovina.

J Homosex 2021 Jul 19:1-18. Epub 2021 Jul 19.

Faculty of Medicine University of Belgrade, Institute of Social Medicine and Centre - School of Public Health, University of Belgrade, Belgrade, Serbia.

Men who have Sex with Men (MSM) are often exposed to stigma and discrimination, especially in developing countries. Discrimination might have an impact on their sexual behavior. The proportion of MSM among HIV positive persons is rising in Bosnia and Herzegovina (B&H). The aim of this qualitative study was to understand the country context and HIV-related risk behaviors among MSM in B&H. We found that MSM in B&H have a dominant fear of expressing their sexual orientation in the homophobic societal environment, including their own family. Disclosures are often connected with escalated family violence, followed by the silence and ignorance. The fear of being connected to one particular partner and being labeled as a gay lead to the need of "masking" their sexual orientation, and having sexual intercourse with non-steady sexual partners. Although most MSM were aware of the risk of HIV and other STIs, the fear of rejection and remaining alone, shapes their decisions to agree to have sex without condoms.
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http://dx.doi.org/10.1080/00918369.2021.1943280DOI Listing
July 2021

Knowledge, attitudes and practices and fear of COVID-19 among medical students in Serbia.

J Infect Dev Ctries 2021 06 30;15(6):773-779. Epub 2021 Jun 30.

Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Introduction: The outbreak of the disease caused by the novel coronavirus, SARS-CoV-2 named COVID-19 has spread throughout the world. The number of registered cases is increasing and almost no country or territory worldwide has been without any COVID-19 patient. The aim of this study was to examine the level of knowledge on the SARS-COv-2 and COVID-19 among medical students and to explore the differences in attitudes, practices and fear of COVID-19 among students with sufficient and students with insufficient knowledge.

Methodology: The cross-sectional study among the 1,722 medical students was conducted through an online platform of the Faculty of Medicine, University of Belgrade. The instrument used was a questionnaire with sections on socio-demographic characteristics, knowledge, attitudes and practices towards COVID-19 and the Fear of COVID-19 scale.

Results: Total of 1576 (91.50%) students were in the sufficient knowledge group. The multivariate logistic regression analysis showed that there was a significant association between the sufficient knowledge on COVID-19 and female sex (OR = 1.70, 95% CI = 1.18-2.45), age (OR = 1.10, 95% CI = 1.02-1.18), considering the preventive measures enforced in Serbia as good (OR = 2.57, 95% CI = 1.18-5.56), wearing the surgical mask outside of the household in the past 14 days (OR = 1.87, 95% CI = 1.22-2.87) and score on Fear of COVID-19 scale (OR = 0.94, 95% CI = 0.91-0.98).

Conclusions: Medical students showed good knowledge of COVID-19 and could be a part of the promotion of health education messages as a part of preventive measures.
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http://dx.doi.org/10.3855/jidc.14298DOI Listing
June 2021

Corrigendum: Surprising Differences in the Practice of Exclusive Breastfeeding in Non-Roma and Roma Population in Serbia.

Front Public Health 2021 10;9:652891. Epub 2021 Feb 10.

Institute of Social Medicine, Medical Faculty University of Belgrade, Belgrade, Serbia.

[This corrects the article DOI: 10.3389/fpubh.2020.00277.].
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http://dx.doi.org/10.3389/fpubh.2021.652891DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902922PMC
February 2021

Physicians' Attitudes Toward Adolescent Confidentiality Services: Scale Development and Validation.

Zdr Varst 2020 Jun 6;59(2):99-107. Epub 2020 Apr 6.

University of Belgrade, Faculty of Medicine, dr Subotića starijeg 8, 11000 Belgrade, Serbia.

Introduction: Confidentiality is one of the oldest ethical principles in healthcare. However, confidentiality in adolescent healthcare is not a universally-accepted doctrine among scholars. The ethical acceptability of confidential services in adolescents' healthcare is based on perceptions of adolescent maturity and an appreciation of its importance to adolescents' access and utilization of healthcare services. Despite legal policies that promote adolescents' rights, physicians' attitudes toward adolescent confidentiality can be a determining factor in their ultimate decision to protect adolescents' confidentiality.

Method: A new Attitude towards Adolescent Confidentiality Scale was developed based on the results of a qualitative interview study. This new instrument was administered to a sample of 152 physicians working at school pediatric and gynecology departments in 13 primary healthcare institutions in Belgrade. Principal component analysis was applied to determine the main components of the scale. Reliability was assessed by calculating Cronbach alpha and mean inter-item correlations.

Results: Psychometric analysis of the final 19-item version of the scale showed a high level of reliability (Cronbach alpha of 0.83). Principal component analysis showed four components, which present subscales of the instrument: Confidentiality in clinical situation, Iimportance of confidentiality, Adolescent maturity, and Communication with parents.

Conclusions: The instrument showed satisfactory levels of reliability and validity. The results of the scale dissemination may be a valuable tool for needs assessment for future educational interventions and training programs that will raise physicians' awareness of the importance of adolescent confidentiality.
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http://dx.doi.org/10.2478/sjph-2020-0013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478075PMC
June 2020

Adolescents' right to confidential health care: knowledge, attitudes and practice of pediatricians and gynecologists in the primary healthcare sector in Belgrade, Serbia.

Int J Public Health 2020 Nov 19;65(8):1235-1246. Epub 2020 Aug 19.

Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Objectives: Confidential counseling is a critical condition of the healthcare quality in adolescent medicine. This study aimed at assessing knowledge, attitudes and practice of primary healthcare pediatricians and gynecologists regarding adolescents' rights to confidentiality.

Methods: A cross-sectional study was conducted in a sample of 152 pediatricians and gynecologists who are employed at 13 primary healthcare centers in Belgrade, Serbia, in 2017-2018. Data were collected by a self-administered questionnaire purposefully constructed for this study. The questionnaire examined knowledge and attitudes toward adolescents' right to confidentiality as well as whether participating physicians practice confidential health care with adolescents.

Results: Physicians scored 4 out of 7 on a knowledge scale, but they overall supported adolescents' right to confidential health care (average attitude score was 71 out of 95). On average, physicians scored 21 out of 30 on practice of confidentiality scale. Multivariate analysis showed that better knowledge and stronger positive attitudes toward duty of confidentiality were associated with consistent practice of confidential health care.

Conclusions: Knowledge about adolescents' rights to confidentiality and attitudes toward keeping adolescents' information confidential influence the practice of providing confidential services.
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http://dx.doi.org/10.1007/s00038-020-01454-8DOI Listing
November 2020

Surprising Differences in the Practice of Exclusive Breastfeeding in Non-Roma and Roma Population in Serbia.

Front Public Health 2020 30;8:277. Epub 2020 Jun 30.

Institute of Social Medicine, Medical Faculty University of Belgrade, Belgrade, Serbia.

Exclusive breastfeeding is essential for early childhood development, although the use of adaptive milk formulas instead of breastfeeding is widespread nowadays. This study aimed to examine the prevalence of exclusively breastfed infants under the age of 6 months in non-Roma and Roma population and factors associated with this practice. This study is a secondary analysis of the Serbian Multiple Indicator Cluster Survey investigating non-Roma and Roma infants under the age of 6 months. The study included mothers of 321 non-Roma and 164 Roma infants younger than 6 months. Univariate and multivariate logistic regression served to analyze factors associated with the practice of exclusive breastfeeding in both populations. The prevalence of exclusive breastfeeding was almost the same among mothers in both non-Roma and Roma population (13.3 vs. 13%, = 0.910). Exclusive breastfeeding was significantly more often ( < 0.001) among wealthier women, women whose newborns were over 2,500 g on birth, multipara, and women who had not established menstrual cycle among both populations. Living outside the capital significantly diminishes the chance for exclusively breastfed infants in the non-Roma community (Vojvodina: OR 0.16, CI 95% 0.03-0.92; eastern Serbia: OR 0.02, CI 95% 0.01-0.35) as well as living in the rural area (urban: OR 10.35, CI 95% 1.94-55.28). Unexpectedly, in the non-Roma population, not staying in the same room with the newborn in the maternity ward increases the chance for the baby to be exclusively breastfed (OR 7.19, CI 95% 1.80-28.68). The same pattern has been observed in Roma population. Non-Roma mothers multipara are more likely to exclusively breastfeed their children than primipara (OR 7.78, CI 95% 1.09-20.93), while among Roma mothers, the inverse association has been found although not significant (OR 0.42, CI 95% 0.14-1.23). Attending a childbirth preparation program more than 18 times increases the chances of infants being exclusively breastfed (OR 18.65, CI 95% 1.34-53.67). In the Roma population, there was no single woman that attended a childbirth preparation program. The pattern of exclusive breastfeeding significantly differs between non-Roma and Roma populations. Preventive work should have focus on strengthening support to mothers and medical staff in maternity wards.
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http://dx.doi.org/10.3389/fpubh.2020.00277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342049PMC
May 2021

Burnout in Anesthesiology Providers: Shedding Light on a Global Problem.

Anesth Analg 2020 02;130(2):307-309

Department of Anaesthesiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.

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http://dx.doi.org/10.1213/ANE.0000000000004542DOI Listing
February 2020

Serbian primary care physicians' perspectives on adolescents' right to confidentiality in sexual and reproductive healthcare-a qualitative interview study.

Fam Pract 2019 05;36(3):317-324

Department of Humanities, Faculty of Medicine, University of Belgrade, Serbia.

Background: In prominent international documents and professional position papers, confidentiality was recognized as a necessary condition for effective reproductive healthcare of adolescents. Although legally guaranteed, it is questionable if the right to confidentiality of adolescents is respected in healthcare practice in Serbia.

Objectives: To assess primary care physicians' perspectives on the legal right of minors to confidentiality in sexual and reproductive healthcare, as well as their experiences in practice.

Methods: Qualitative, semi-structured face-to-face interviews with 12 primary care pediatricians and gynecologists at several municipalities of the city of Belgrade were performed. Interview transcripts were analyzed using qualitative content analysis method.

Results: Most interviewees were aware of their legal obligations and support the general idea of granting adolescents the right to confidentiality. They recognized that the lack of confidentiality assurances prevents adolescents' access to sensitive care. However, physicians expressed concerns regarding medical situations when parents should be notified, which was reflected in their inconsistent respect of said right in actual practice. Several organizational obstacles were emphasized by interviewees, including insufficient number of physicians, time constraints, poor access to gynecological services and vague definitions of legal provisions.

Conclusion: If the aim is for adolescents' right to confidentiality to be consistently respected in practice, primary care physicians need to be systematically educated about legal provisions and given comprehensive clinical guidelines. The general positive attitude towards confidentiality expressed by the primary care physicians implies that a possibility exists to engage them as main advocates for improvements in access to the necessary health care.
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http://dx.doi.org/10.1093/fampra/cmy067DOI Listing
May 2019

'The Devil has entered you': A qualitative study of Men Who Have Sex With Men (MSM) and the stigma and discrimination they experience from healthcare professionals and the general community in Bosnia and Herzegovina.

PLoS One 2017 7;12(6):e0179101. Epub 2017 Jun 7.

Institute of Social medicine, Faculty of Medicine, University of Belgrade, Serbia.

Men who have sex with men (MSM) are often exposed to unequal treatment in societies worldwide as well as to various forms of stigma and discrimination in healthcare services. Bosnia and Herzegovina (B&H) is a postconflict developing country located in Southeast Europe and the Western Balkans, where little is known about the experiences of MSM regarding their communities and interactions with healthcare services. The aim of this study was to explore the types of experiences MSM face and to assess the level of stigma and discrimination they are exposed to in this setting. We conducted twelve in-depth face-to-face interviews with MSM who were 16 to 45 years old and residing in B&H. The main findings indicated that they all experienced various levels of stigma, discrimination, prejudice and inequities in treatment and attitudes from different segments of society, including the health care sector, that prevented them from fully developing their human and health potential. Additionally, these experiences were adversely related to opportunities to receive good quality health care services due to the insufficiently educated and old-fashioned health professionals who sometimes believed in black magic practices. The findings present numerous opportunities for educational trainings and structural reform to create a society that provides and guarantees equal opportunities for all.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179101PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5462409PMC
September 2017

Gynecologists' Knowledge, Attitudes, and Intentions Toward Human Papillomavirus Vaccination in Serbia.

J Low Genit Tract Dis 2017 Jan;21(1):9-11

1 Institute of Social Medicine, Faculty of Medicine, University of Belgrade; and 2 Primary Health Center "Dr Simo Milosevic," Belgrade, Serbia.

Objectives: The aims of this study were to estimate the level of knowledge, attitudes, and intentions about human papillomavirus (HPV) infection and HPV vaccine among gynecologists and to explore predictors of gynecologists' intention to recommend the HPV vaccine.

Method: This research was conducted between April and June 2014 among all gynecologists working at women's health departments in all primary health centers in Belgrade, the capital of Serbia, using a specially designed questionnaire.

Results: The response rate was 88.2%. The knowledge of gynecologists was estimated as average. The most frequently reported obstacles to HPV vaccination was the financial concern (59.8%). More than two thirds of the gynecologists were willing to recommend the vaccine (68.4%). The factors associated with the gynecologists' intention to recommend the vaccine included their positive attitudes toward boys' vaccination (odds ratio [OR], 8.96; 95% confidence interval [CI], 2.85-28.16), negative attitudes toward frequent changes the recommendations (OR, 0.31; 95% CI, 0.10-0.93), and beliefs that the vaccine application would decrease condom usage (OR, 0.31; 95% CI, 0.06-0.68).

Conclusions: The findings provide an important insight into the current point of view of the gynecologists, which confirms that the better the knowledge of HPV and vaccine, the higher the likelihood of recommending it.
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http://dx.doi.org/10.1097/LGT.0000000000000262DOI Listing
January 2017

High rate of burnout among anaesthesiologists in Belgrade teaching hospitals: Results of a cross-sectional survey.

Eur J Anaesthesiol 2016 Mar;33(3):187-94

From the Center for Anesthesiology and Resuscitation, Emergency Center, Clinical Center of Serbia (MM, NP); Institute of Social Medicine, School of Medicine, University of Belgrade, Serbia (BM); Department of Statistics and Mathematics, Faculty of Economics, University of Belgrade, Serbia (VV); Icahn School of Medicine at Mount Sinai, New York, USA (EF); and University Children's Hospital, School of Medicine, University of Belgrade, Serbia (DS).

Background: Decisions by anaesthesiologists directly impact the treatment, safety, recovery and quality of life of patients. Physical or mental collapse due to overwork or stress (burnout) in anaesthesiologists may, therefore, be expected to negatively affect patients, departments, healthcare facilities and families.

Objectives: To evaluate the prevalence of burnout among anaesthesiologists in Belgrade public teaching hospitals.

Design: A cross-sectional survey.

Setting: Anaesthesiologists in 10 Belgrade teaching hospitals.

Main Outcome Measures: Burnout was assessed using Maslach Burnout Inventory-Human Services Survey.

Results: The response rate was 76.2% (205/272) with the majority of respondents women (70.7%). The prevalence of total burnout among anaesthesiologists in Belgrade teaching hospitals was 6.34%. Measured level of burnout as assessed by high emotional exhaustion, high depersonalisation and low personal accomplishment was 52.7, 12.2 and 28.8%, respectively. More than a quarter of the studied population responded in each category with symptoms of moderate burnout. We detected that sex, additional academic education, marital status and working conditions were risk factors for emotional exhaustion and depersonalisation. Ageing increased the likelihood of burnout by 21.3% with each additional year. Shorter professional experience and increased educational accomplishment increased the risk of total burnout by 272%.

Conclusion: Burnout rates in Belgrade teaching hospitals among anaesthesiologists are higher than in foreign hospitals. Emotional and/or physical breakdowns can have serious effects when these individuals care for patients in extremely stressed situations that may occur perioperatively. Causes for burnout should be examined more closely and means implemented to reverse this process.
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http://dx.doi.org/10.1097/EJA.0000000000000383DOI Listing
March 2016

Psychometric Properties of the Serbian Version of the Maslach Burnout Inventory-Human Services Survey: A Validation Study among Anesthesiologists from Belgrade Teaching Hospitals.

ScientificWorldJournal 2015 21;2015:903597. Epub 2015 May 21.

Department of Human Relations, University of Oklahoma, Oklahoma City, OK 73019, USA.

We report findings from a validation study of the translated and culturally adapted Serbian version of Maslach Burnout Inventory-Human Services Survey (MBI-HSS), for a sample of anesthesiologists working in the tertiary healthcare. The results showed the sufficient overall reliability (Cronbach's α = 0.72) of the scores (items 1-22). The results of Bartlett's test of sphericity (χ(2) = 1983.75, df = 231, p < 0.001) and Kaiser-Meyer-Olkin measure of sampling adequacy (0.866) provided solid justification for factor analysis. In order to increase sensitivity of this questionnaire, we performed unfitted factor analysis model (eigenvalue greater than 1) which enabled us to extract the most suitable factor structure for our study instrument. The exploratory factor analysis model revealed five factors with eigenvalues greater than 1.0, explaining 62.0% of cumulative variance. Velicer's MAP test has supported five-factor model with the smallest average squared correlation of 0,184. This study indicated that Serbian version of the MBI-HSS is a reliable and valid instrument to measure burnout among a population of anesthesiologists. Results confirmed strong psychometric characteristics of the study instrument, with recommendations for interpretation of two new factors that may be unique to the Serbian version of the MBI-HSS.
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http://dx.doi.org/10.1155/2015/903597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454751PMC
July 2016

Development of a risk index for prediction of abnormal pap test results in Serbia.

Asian Pac J Cancer Prev 2015 ;16(8):3527-31

University of Belgrade, Faculty of Medicine, Institute for Social Medicine, Serbia E-mail :

Background: 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.

Materials And Methods: 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.

Results: 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 respondents had a score 0 (54.9%). In the index-creation dataset mean index score was 10.3 (SD-13.8), and in the validation dataset the mean was 9.1 (SD=13.2).

Conclusions: The advantage of such scoring system is that it is simple, consisting of only four elements, so it could be applied to identify women with high risk for cervical cancer that would be referred for further examination.
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http://dx.doi.org/10.7314/apjcp.2015.16.8.3527DOI Listing
January 2016

Factors influencing the recommendation of the human papillomavirus vaccine by Serbian pediatricians.

J Pediatr Adolesc Gynecol 2015 Feb;28(1):12-18

Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Serbia.

Objectives: This research was undertaken to investigate the knowledge and attitudes regarding Human Papillomavirus infection and the Human Papillomavirus (HPV) vaccine among pediatricians who work in primary health care and to determine their intention to recommend the HPV vaccine as an important measure for the primary prevention of cervical cancer. We assessed the factors associated with the intention to recommend the vaccine.

Study Design: This cross-sectional study was conducted in March and April 2012. This research included all pediatricians who worked with school children in public primary health care institutions in Belgrade. A research instrument questionnaire had been designed for this study.

Results: The response rate was 78.7%. The knowledge of pediatricians related to HPV infection and the HPV vaccine was estimated as poor. However, pediatricians recognized the need for additional education in this field. The most-frequently reported barrier to HPV vaccination was the financial concern (68.2%). Alternatively, according to the pediatricians, the most common parental barrier to vaccination was the lack of information on the vaccine (67.2%). Nearly two-thirds of the pediatricians were willing to recommend the vaccine (60.2%). The factors associated with the pediatricians' intention to recommend the vaccine included the parents' attitudes.

Conclusion: The majority of pediatricians accept the HPV vaccine and recommend it to their patients. It is necessary to improve cooperation between parents and pediatricians to increase immunization coverage and develop national consulting strategies with a focus on the prevention of HPV infection.
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http://dx.doi.org/10.1016/j.jpag.2014.01.107DOI Listing
February 2015

First- and fifth-year medical students' intention for emigration and practice abroad: a case study of Serbia.

Health Policy 2014 Nov 7;118(2):173-83. Epub 2014 Oct 7.

Cecil G. Sheps Center for Health Services Research, University of North Carolina, 725 M.L. King Blvd CB 7590, Chapel Hill, NC 27599-7590, USA.

Health worker migration is causing profound health, safety, social, economic and political challenges to countries without special policies for health professionals' mobility. This study describes the prevalence of migration intentions among medical undergraduates, identifies underlying factors related to migration intention and describes subsequent actions in Serbia. Data were captured by survey of 938 medical students from Belgrade University (94% response rate), representing two thirds of matching students in Serbia stated their intentions, reasons and obstacles regarding work abroad. Statistical analyses included descriptive statistics and a sequential multivariate logistic regression. Based on descriptive and inferential statistics we were able to predict the profile of first and fifth year medical students who intend or have plans to work abroad. This study contributes to our understanding of the causes and correlates of intent to migrate and could serve to raise awareness and point to the valuable policy options to manage migration.
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http://dx.doi.org/10.1016/j.healthpol.2014.09.018DOI Listing
November 2014

Early sexual initiation and risk factors in Serbian adolescents: data from the National Health Survey.

Eur J Contracept Reprod Health Care 2014 Jun 8;19(3):211-9. Epub 2014 Apr 8.

* Department of Humanities.

Objectives: To identify factors associated with sexual initiation before the age of 17 among Serbian adolescents and to assess whether the latter is associated with other risky behaviours, such as tobacco, alcohol and illicit drug use, and fighting.

Methods: The study was an analysis of data gathered by the 2006 Serbian National Population Health Survey in which information concerning adolescents was obtained by means of questionnaires. Data were analysed using descriptive statistics and a logistic regression model.

Results: A total of 474 adolescents aged 15 and 16 completed the survey. Multivariate logistic regression analysis showed that male respondents reporting sexual initiation were significantly more likely to smoke daily and to have experienced two or more episodes of drunkenness in the past. Female respondents reporting sexual initiation were significantly more likely to live with both parents, to feel insecure in school, to smoke daily and to drink more than once a week.

Conclusions: A strong association was found between adolescent sexual initiation and substance abuse. Although a causal relationship is evidently not established, one might contemplate including measures lowering the frequency and intensity of substance abuse in health prevention programmes and interventions aiming at reducing the risks associated with sexual initiation.
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http://dx.doi.org/10.3109/13625187.2014.897320DOI Listing
June 2014

[Assessment of required resources for implementation of national breast cancer screening program in Serbia].

Srp Arh Celok Lek 2014 Jan-Feb;142(1-2):59-66

Introduction: High values of standardized mortality and morbidity rates of standardized cancer mortality in Serbia, especially colorectal, cervical and breast cancer led to creation of national programs for their early detection and engagement of the international support for their implementation.

Objective: Assessment of required resources (time, personnel, financial) to implement the National program for screening of breast cancer in the Republic of Serbia.

Methods: Three possible scenarios have been prepared (optimistic, realistic and pessimistic) based on the expected coverage by screening of women aged 45 to 69 years, and time, personnel and financial feasibility estimates were made for a two-year screening cycle.

Results: Time aspect of feasibility even under conditions of "relaxation" of the assumption on the number of working days during the year did not question feasibility of any of the scenarios. Personnel feasibility is only possible in the pessimistic scenario, while the financial feasibility only makes sense in optimistic scenario as the least unfavorable solution due to economies of scale.

Conclusion: Establishment of the initial base of skilled radiologists and radiology technicians and the system for their continuous medical education as well as allocation of specific MoH budget line for screening program expenditures, along with donated mammographs and good organization and coordination, may provide unobstructed implementation of the National program for early detection of breast cancer in the Republic of Serbia.
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http://dx.doi.org/10.2298/sarh1402059mDOI Listing
October 2015

Maternal satisfaction with organized perinatal care in Serbian public hospitals.

BMC Pregnancy Childbirth 2014 Jan 13;14:14. Epub 2014 Jan 13.

Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Dr Subotica 15, 11 000 Belgrade, Serbia.

Background: Understanding the experiences and expectations of women across the continuum of antenatal, perinatal, and postnatal care is important to assess the quality of maternal care and to determine problematic areas which could be improved. The objective of this study was to identify the factors associated with maternal satisfaction with hospital-based perinatal care in Serbia.

Methods: Our survey was conducted from January 2009 to January 2010 using a 28-item, self-administered questionnaire. The sample consisted of 50% of women who expected childbirths during the study period from all 76 public institutions with obstetric departments in Serbia. The following three composite outcome variables were constructed: satisfaction with technical and professional aspects of care; communication and interpersonal aspects of care; and environmental factors.

Results: We analyzed 34,431 completed questionnaires (84.2% of the study sample). The highest and lowest average satisfaction scores (4.43 and 3.25, respectively) referred to the overall participation of midwives during delivery and the quality of food served in the hospital, respectively. Younger mothers and multiparas were less concerned with the environmental conditions (OR = 0.55, p = 0.006; OR = 1.82, p = 0.004). Final model indicated that mothers informed of patients' rights, pregnancy and delivery through the Maternal Counseling Service were more likely to be satisfied with all three outcome variables. The highest value of the Pearson's coefficient of correlation was between the overall satisfaction score and satisfaction with communication and interpersonal aspects of care.

Conclusions: Our study illuminated the importance of interpersonal aspects of care and education for maternal satisfaction. Improvement of the environmental conditions in hospitals, the WHO program, Baby-friendly Hospital, and above all providing all pregnant women with antenatal education, are recommendations which would more strongly affect the perceptions of quality and satisfaction with perinatal care in Serbian public hospitals by women.
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http://dx.doi.org/10.1186/1471-2393-14-14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3916080PMC
January 2014

[Ethics and reproductive health: the issue of HPV vaccination].

Srp Arh Celok Lek 2013 Jan-Feb;141(1-2):127-30

The ethics of reproductive health covers a wide field of different issues, from the ethical dimensions of assisted reproduction, life of newborns with disabilities to the never-ending debate on the ethical aspects of abortion. Furthermore, increasing attention is paid to the ethical dimensions of using stem cells taken from human embryos, the creation of cloned embryos of patients for possible self-healing, and the increasingly present issue of reproductive cloning. Development of vaccines against human papillomavirus (HPV) has introduced new ethical aspects related to reproductive health and the need for a consensus of clinical and public-healthcare population. Today immunization with HPV vaccine is a measure for the primary prevention of cervical cancer and it provides effective protection against certain types of viruses included in the vaccine. The most often mentioned issues of discussions on ethical concerns about HPV vaccination are the recommended age of girls who should be informed and vaccinated (12-14 years), attitudes and fears of parents concerning discussion with their preadolescent daughters on issues important for their future sexual behavior, dilemma on the vaccination of boys and the role of the chosen pediatrician in providing information on the vaccination. In Serbia, two HPV vaccines have been registered but the vaccination is not compulsory. Up-till-now there has been no researches on the attitudes of physicians and parents about HPV vaccination. Nevertheless, it is very important to initiate education of general and medical public about the fact that the availability of vaccine, even if we disregard all aforementioned dilemmas, does not lead to the neglect of other preventive strategies against cervical cancer, primarily screening. The National Program for Cervical Cancer Prevention involves organized screening, i.e. regular cytological examinations of the cervical smear of all women aged 25-69 years, every three years, regardless of the vaccination status.
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http://dx.doi.org/10.2298/sarh1302127mDOI Listing
September 2013

Patterns of infant mortality from 1993 to 2007 in Belgrade (Serbia).

Matern Child Health J 2013 May;17(4):624-31

Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Visegradska 26A, 11000 Belgrade, Serbia.

The population of the Republic of Serbia has been exposed to radical changes in living standards and employment status and inequalities in utilization of health-care services. Given that infant mortality rates (IMR) reflect general community health, we evaluated the trends and mortality structure of Belgrade's infant population for a 15-year period (1993-2007). Data were collected from published and unpublished materials of the Municipal Institute of Statistics in Belgrade. Records were based on official notifications of live-born infants and death certificates. A linear regression equation was used to estimate mortality trends over time, while an F test was performed to assess the significance of the linear regression coefficient. The average IMR was 11.3 [95% confidence interval (CI) 9.4, 13.2] per 1,000 live births for both sexes with a higher average rate observed for male infants. Throughout the whole period, a statistically significant declining trend (y = 17.072 - 0.721x, p = 0.001) was noted. The most common causes of death were conditions occurring during the perinatal period, with an average annual mortality rate of 7.7 [95% CI 6.4, 8.9] per 1,000, arising mainly from respiratory distress of the newborns. Regarding congenital anomalies, deformations of the heart and aortic and mitral valves were most frequently found. A statistically significant inverse correlation was observed between average net salary and IMR for each sex separately (for males r = -0.727, p = 0.002, for females r = -0.721, p = 0.002) and for both sexes jointly (r = -0.759, p = 0.001). A decline in infant mortality in Belgrade has been observed. However, further promotion of health-related activities, as well as continuous surveillance of IMR, is required.
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http://dx.doi.org/10.1007/s10995-012-1039-2DOI Listing
May 2013

Trends and patterns of ovarian cancer mortality in Belgrade, Serbia: a joinpoint regression analysis.

Int J Gynecol Cancer 2011 Aug;21(6):1018-23

Institutes of Epidemiology and Social Medicine, University of Belgrade, Belgrade, Serbia.

Objective: Ovarian cancer (OC) represents the leading cause of gynecological cancer deaths. The aim of our study was to estimate the patterns and trends in OC mortality in the population of Belgrade (Serbia) during the period 1976 to 2007.

Methods: Mortality data (official death certificates) for OC have been gathered from the Municipal Institute of Statistics in Belgrade. Mortality rates with corresponding 95% confidence intervals were adjusted by the European standard population. Trends in age-adjusted and age-specific mortality rates were calculated using joinpoint regression, according to the method of Kim et al. An annual percent of changes in mortality rates for each line segment was estimated by fitting a regression line to the natural logarithm of the rates using calendar years as a regressor variable.

Results: The average age-adjusted OC mortality rate during the period 1976-2007 was 5.4/100,000 (95% confidence interval, 4.8-6.1). For total women population, no joinpoint is found, whereas significantly increasing mortality trend was observed during the whole study period (+3.6% annually; P < 0.001). In the group age 55 to 64 years, one joinpoint was detected with a significant increase in OC mortality trend between 1976 and 1990 (+9.8% annually; P < 0.001) and with nonsignificant decreasing tendency between 1990 and 2007 (-1.0% annually; P = 0.773). In the two oldest age groups, statistically significantly increasing tendency in OC mortality was evident during the overall calendar period with no apparent change in linear trends.

Conclusions: Mortality due to the OC in Belgrade has continued to increase, suggesting that this malignancy is becoming an increasing public health problem in our country.
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http://dx.doi.org/10.1097/IGC.0b013e31821dc8d1DOI Listing
August 2011

Determinants of preventive health behavior in relation to cervical cancer screening among the female population of Belgrade.

Health Educ Res 2011 Apr 26;26(2):201-11. Epub 2011 Jan 26.

Institute of social medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Identifying the factors that deter or stimulate the women to participate in screening activities is very important in order to design effective education and motivation strategies, particularly in the countries without an organized system. The study employed a case-control design. The participants were recruited in four primary health care institutions in Belgrade over a month. The study group comprised all women aged 18-70 years, who demonstrated an initiative for a PAP- smear. The controls were women with no Pap smears within the last 4 years, matched by age (±2 years), education and marital status with the study group participants. The study instrument was the 62-item self-administered questionnaire. According to multivariate analysis, adherence to cervical cancer screening practices is significantly related to better financial status [odds ratio (OR) = 10.8, P = 0.001], no gender preference for a gynecologist (OR = 3.1, P = 0.015), consultations with a gynecologist (OR = 4.7, P = 0.029), conversation with the women with cervical cancer about that disease (OR = 2.8, P = 0.029) and higher media exposure to information about cervical cancer prevention (OR = 5.0, P = 0.004). Open communication, social networks and improving social-economic status of women in our society are the most prominent factors, most of which are mainly outside the health services' domain and require multisectoral collaboration to improve women's reproductive health.
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http://dx.doi.org/10.1093/her/cyq081DOI Listing
April 2011

An approach to assess trends of pharmacist workforce production and density rate in Serbia.

Cah Sociol Demogr Med 2010 Jul-Sep;50(3):299-317

Institute of Social Medicine, School of Medicine, Belgrade University, Belgrade, Serbia.

The policy dialog on human resource in health care is one of the central issues of the ongoing health care system reform in the Republic of Serbia. Pharmacists are the third largest health care professional group, after nurses and doctors. This study's objective was to analyze population coverage with pharmacists employed in the public sector of health care system of Serbia during 1961 - 2007, and to project their density by 2017. In this respect, additionally, time-series of annual number of enrolled and graduate pharmacy students were modelled. Time trends of routinely collected national statistical data, concerning the pharmacists, were analyzed by join point regression program, according to grid-search method. During the observed period of time, in Serbia, pharmacist workforce production and deployment trends were generally positive, but with different annual dynamic. Key findings were the slow rise of pharmacist workforce density rates per 100,000 population; the insufficient balance between pharmacists workforce supply side (annual number of enrolled and graduated students) and the public health care sector's ability to absorb annual number of pharmacy graduates. For ten years ahead, density rates of publicly active pharmacist workforce would probably increase for 46%, if no policy interventions were planned to adverse trends of pharmacist workforce production and deployment in public health care sector. The study results may be useful for variety of stakeholders to better understand how and why the supply and deployment of pharmacists were changing; and that the coordination among policy interventions is a crucial successes factor for a health workforce development plan implementation. The repercussions of any changes made to the pharmacy workforce, need to be considered carefully in advance.
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January 2011

Do we have primary health care reform? The story of the Republic of Serbia.

Health Policy 2010 Jul 23;96(2):160-9. Epub 2010 Feb 23.

Institute of Social Medicine, School of Medicine Belgrade University, Dr Subotića 15, 11 000 Belgrade, Serbia.

Objective: To provide insight of national activities and international assistance in PHC reform and to assess their effects on technical and allocative efficiency as well as financial sustainability of primary health care in the Republic of Serbia.

Materials And Methods: Analytical framework of the study consisted of gathering and reviewing of relevant political documents, international assistance project documentation, and analysis of routinely collected national statistical data based on the evaluation model of three groups of criteria: allocative, technical efficiency and financial sustainability in the public sector of Serbia from 2000 to 2007. Time trends were analyzed by Poisson regression models using average annual percentage changes--AAPC, and the percent of targeted change achieved by progress quotient--PQ.

Results: Allocative efficiency of the PHC during period of 8 years was improved, but technical efficiency was almost unchanged for all service, except for preschool health care. Financial sustainability was also improved measured by indirect indicators of health expenditure.

Conclusions: Results of this study indicated that we are on the right track with PHC reform, and international support is in accordance with the reform goals. Our approach has been and will remain incremental, gradualist and multi-faceted.
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http://dx.doi.org/10.1016/j.healthpol.2010.01.015DOI Listing
July 2010

Health professionals' perceptions of intimate partner violence against women in Serbia: opportunities and barriers for response improvement.

Patient Educ Couns 2010 Jul 22;80(1):88-93. Epub 2009 Oct 22.

University of Belgrade, School of Medicine, Institute of Social Medicine, Belgrade, Serbia.

Objective: The aim of this study was to determine the perceptions and attitudes of health professionals toward violence against women in intimate relationships, and to discuss them as opportunities and barriers for improving health professionals' response.

Methods: Six focus groups were conducted with 71 health professionals employed in the public primary health care centers in Belgrade (Serbia). The data were analyzed according to the direct approach of the qualitative content analysis.

Results: Findings suggest that the majority of health professionals perceive IPV as an unjustifiable act. They showed an understanding for women; see their role as providing support to women and collaborating with other institutions. They are willing to help, but do not know how. However, some health professionals appeared to be judgmental in terms of what preceded violence, and would insist on extracting a woman's disclosure that violence had occurred. As barriers, they emphasized the lack of training and specific education on IPV, a weak support network, and overall social insecurity.

Conclusion: There is a gap between health professionals' willingness to help and resources needed, along with prejudice and interrogative attitudes. Barriers appeared at individual, organizational and societal levels.

Practice Implications: Proper education and protocols are priorities in strengthening health professionals' response to IPV.
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http://dx.doi.org/10.1016/j.pec.2009.09.028DOI Listing
July 2010

Communications about cervical cancer between women and gynecologists in Serbia.

Int J Public Health 2008 ;53(5):245-51

Institute of Social Medicine, School of Medicine, University of Belgrade, Dr Suboti a 15 (Silos), 11000, Belgrade, Serbia.

Objective: The age-standardized incidence rate of cervical cancer in Serbia is 27.2 per 100,000 women, i. e., twice as high as in western European countries. This paper explores the communication which occurs between women and gynecologists in Serbia in relation to cervical cancer screening.

Methods: Our study was conducted in two phases: a qualitative phase (focus group discussions and in-depth interviews with women) and a quantitative phase (community-based survey). This paper reports the findings from both phases, and in particular, the in-depth interviews with 22 women with different socio-economic backgrounds residing in the capital city and a regional town. To illustrate women's experiences and attitudes, we used interview excerpts.

Results: Our findings indicate that there is poor communication between women and gynecologists and an absence of proper counseling. Women's lack of knowledge about reproductive health issues, poor attitudes of gynecologists, and personal barriers that women experience in accessing health care render preventive practices a low priority both for women and gynecologists.

Conclusion: We recommend different educational and organizational strategies that may improve the counseling skills of gynecologists and ultimately reduce the prevalence of cervical cancer in Serbia.
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http://dx.doi.org/10.1007/s00038-008-7102-5DOI Listing
March 2009

Awareness of cervical cancer screening among women in Serbia.

Gynecol Oncol 2005 Dec 19;99(3 Suppl 1):S222-5. Epub 2005 Sep 19.

Institute of Obstetrics and Gynecology, Clinical Center of Serbia, The University of Belgrade, Visegradska 26, 11000 Beograd, Serbia and Montenegro.

Background: The success of cervical cancer screening programs in North America and Western Europe has led to their expansion into other regions of the world. As these services become available on a large scale in other countries, it is imperative to understand the background conditions that may present challenges to their effectiveness there.

Methods: Women were recruited from two different areas in Central Serbia. Both focus group discussions and survey instruments were used to gauge participants' knowledge and attitudes about cervical cancer screening issues.

Results: Results were mostly similar to comparable studies performed in other regions. Education and economic status were not highly related to knowledge about cervical screening. The population sampled showed a broad lack of knowledge about the necessity of screening and shared attitudinal barriers with women in other regions.

Conclusion: The success of public awareness campaigns elsewhere suggests that a media-centered approach could have good results in Serbia. The lack of media attention noted in the study focus groups supports this conclusion.
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http://dx.doi.org/10.1016/j.ygyno.2005.07.092DOI Listing
December 2005

Barriers to cervical cancer screening: a qualitative study with women in Serbia.

Soc Sci Med 2005 Dec 13;61(12):2528-35. Epub 2005 Jun 13.

Department of Public Health, Key Centre for Women's Health in Society, School of Population Health, The University of Melbourne, Victoria 3010, Australia.

Serbia employs opportunistic approaches to cervical cancer screening, leading to inequitable health care access. To better understand the health care needs of women, we investigated their knowledge of and perceived barriers to cervical cancer screening. Data reported in the paper arise from nine focus group discussions with 62 women from diverse socio-economic backgrounds. They were recruited in two cities with contrasting social settings, Belgrade, the Serbian capital, and a regional town, Smederevo. Thematic analysis identified that the interplay of social and personal barriers influenced women's poor presentation for screening. Inadequate public health education, lack of patient-friendly health services, socio-cultural health beliefs, gender roles, and personal difficulties were the most salient barriers to screening. We suggest how within the context of opportunistic screening patient education may be employed. The introduction of compulsory cervical cancer screening, suggested by some participants, is also discussed.
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http://dx.doi.org/10.1016/j.socscimed.2005.05.001DOI Listing
December 2005
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