Mirjana Jovanovic

Radiology Services Costs and Utilization Patterns Estimates in Southeastern Europe—A Retrospective Analysis from Serbia

OBJECTIVEnAssessment of costs matrix and patterns of prescribing of radiology diagnostic, radiation therapy, nuclear medicine, and interventional radiology services. Another aim of the study was insight into drivers of inappropriate resource allocation.nnnMETHODSnAn in-depth, retrospective bottom-up trend analysis of services consumption patterns and expenses was conducted from the perspective of third-party payer, for 205,576 inpatients of a large tertiary care university hospital in Serbia (1,293 beds) from 2007 to 2010.nnnRESULTSnA total of 20,117 patients in 2007, 17,436 in 2008, 19,996 in 2009, and 17,579 in 2010 were radiologically examined, who consumed services valued at €2,713,573.99 in 2007, €4,529,387.36 in 2008, €5,388,585.15 in -2009, and €5,556,341.35 in 2010.nnnCONCLUSIONSnThe macroeconomic crisis worldwide and consecutive health policy measures caused a drop in health care services diversity offered in some areas in the period 2008 to 2009. In spite of this, in total it increased during the time span observed. The total cost of services increased because of a rise in overall consumption and population morbidity. An average radiologically examined patient got one frontal chest graph, each 7th patient got an abdomen ultrasound examination, each 19th patient got a computed tomography endocranium check, and each 25th patient got a head nuclear magnetic resonance. Findings confirm irrational prescribing of diagnostic procedures and necessities of cutting costs. The consumption patterns noticed should provide an important momentum for policymakers to intervene and ensure higher adherence to guidelines by clinicians.

Inpatient Detoxification Procedure and Facilities: Financing Considerations from an Eastern European Perspective

Eastern Europe and the Balkans region report high rates of alcohol abuse and addiction (OECD, 2009). Alcohol detoxification procedures in the countries of the European Union (EU) tend to be conducted at the primary care level or at specialized units associated with the psychiatric clinics. These facilities provide medical treatment to help achieve and maintain abstinence, often through initial 24-h psychiatric supervision. In the EU, these patients often already have an awareness of the reality of addiction and show a will to decisively tackle it (Hayashida, 1998). By visiting these facilities, they attempt and often succeed in preventing an abstinence crisis when they end a period of heavy drinking. Treatment protocols are intended to reduce and eliminate most symptoms of withdrawal (Beshai, 1990). Serbian everyday experience, however, seems to be radically different from that of the EU. At first, we point out that we are observing a typical middle-income Eastern European transitional economy, in a society that is primarily Caucasian, secular, and with a low fertility rate, and is in many ways similar to Western European countries (OECD, 2009). Nevertheless, the Serbian economy has suffered from a high rate of unemployment and a declining standard of living since the onset of the current recession, both of which have proved to be significantly correlated with the country’s rate of alcohol consumption (Ettner, 1997). To take an example, The University Clinical Center Kragujevac is the oldest hospital in Serbia, located in the heart of the country. Intoxicated patients are brought to the psychiatric clinic either after being arrested by public security services on civil order violation charges, as suspected traffic accident perpetrators, or after being found in a state of severe alcoholic intoxication in a public place. Another possible scenario is of the patients to whom serious injuries have been ruled out but who are still conscious and are transported by emergency care vehicles. In cases where a mental disturbance with life-threatening symptoms is observed, the patient will be taken to the Emergency Medicine Clinic.

Serbian and Austrian Alcohol-Dependent Patients: A Comparison of Two Samples Regarding Therapeutically Relevant Clinical Features

AIMSnTo support the Serbian Expert Board in setting up reimbursement for modern pharmacotherapeutic support, we compared a Serbian sample of alcohol-dependent patients with an Austrian sample, in order to detect differences that might inhibit the introduction of anti-craving medications in Serbia.nnnMETHODSnOne hundred and twenty-seven (116 males) alcohol-dependent patients in Serbia and 136 in Austria (78 males) were enrolled consecutively from January 2011 to March 2012 and were assessed using the Lesch alcoholism typology instrument (LAT).nnnRESULTSnAge of onset was slightly higher in the Austrian sample (28.5 vs. 30.0; P = 0.10). The Serbian sample showed a higher rate of anxiety disorders than the Austrian sample (89.8 vs. 26.5%, P ≤ 0.0001). Suicidal tendencies, independent of alcohol intake or withdrawal syndrome, were higher in the Austrian sample (1.6 vs. 13.2% P ≤ 0.0001). There was no difference between the two samples in Lesch-Type IV (26 vs 28); there was a slight excess in the Serbian sample of Type I (15 vs. 10). In Austria, significantly more Type II patients (32 vs. 52) had been included, while the Serbian sample comprised significantly more Type III patients.nnnCONCLUSIONSnAustrian and Serbian patients are quite similar, without any showing any factor that would detract from the potential value of modern anti-craving medications in Serbia. The differences in anxiety disorders might be due to the 1990s war and should be investigated further.

Accessibility and Affordability of Alcohol Dependency Medical Care in Serbia

CONTEMPORARY HOT ISSUES ON ALCOHOL DEPENDENCY IN SERBIA Alcoholic beverages are traditional to the Balkans region since the Antiquity. Consumption of domestic honey-made spirits and wine was wide spread among the Serbs even in the early medieval history before spreading of Christianity (1). Today, it remains a deeply rooted custom while prevalence of full scale dependency and associated disorders in Serbia are slightly less frequent than European average (3.4 vs. 4.0% and 5.2 vs. 7.5%, respectively) Alcohol dependence in cited WHO sources was confirmed according to ICD-10 criteria. (2). Although hosting one of the oldest medical societies across European region, Serbia still lacks systematic morbidity and mortality registries for a variety of leading prosperity diseases including alcoholrelated disorders (3). Nevertheless some national estimates on standardized death rates attributed to alcohol-related causes and alcohol consumption are available thus allowing the insight into trends of change since late 1990s. Likewise, elsewhere in the European community, traffic accidents caused by alcohol consumption posed a substantial challenge to the road safety (4). Undisputed relationship between alcohol blood concentration and severity of acquired traffic injuries was proven in national forensic studies on cases with fatal outcome (5). Afterward, national policies have been adopted with more severe legislation framework and punitive measures compared to previous real socialism legacy (6). Unfortunately, like many other public health strategies, this one actually had quite limited effect to alcohol attributed traffic accident mortality in consecutive years (7). According to the forensic observation of a local sample of deceased with mortal injuries, craniocerebral trauma remains the most typical clinical pattern (8). Among direct alcohol effects on mortality are classified as mental disorders with suicidal tendency (9) as well as poisoning with ethanol, methanol, and unspecified alcoholic compounds, which were attributed a total of 248 fatal outcomes in 2012. Indirect alcohol effects on mortality present far more extensive burden for the health system. Diseases such as alcoholcaused degeneration of nervous system, alcoholic cardiomyopathy, alcoholic liver disease, and alcohol-induced chronic pancreatitis caused a total of 430 deaths in 2012 according to latest official release (10). Observing the landscape of age-stratified direct alcohol-related deaths due to overdoses, one could notice heavy domination of 45–79 years age group. According to the criminal justice procedure in Serbia, there are some 106 beds of Special Prison Hospital in Belgrade reserved for mandatory treatment of offenders who committed crimes in alcoholic condition. Such treatments are either been conducted in the penitentiary institution itself or elsewhere, in a specialized medical facility. Quite a peculiar issue is non-fatal alcohol overdoses whose treatment lies within responsibility of the National Poison Control Center of the Military Medical Academy being the reference institution in the country for diagnostics and treatment of intoxications. This facility reported 2078 patients admitted because of acute ethylalcohol intoxications or almost 50% of all cases in 2012 (11). Broad portion of similar clinical cases, with or without suicidal intention, are being admitted to the emergency wards of other tertiary university clinics across the countries. So far illicit psychoactive substances cause several fold less overdoses than alcohol although drugscaused mortality belongs to far younger adolescent age group (12). One promising trend among the youth is slightly decreasing prevalence of those who have ever used alcohol from 75.6% in 2008 to 64.3% level in 2012 (13). Risky attitudes of adolescents toward the alcohol use contributed substantially to the current morbidity (14). Recent pan-European trends expose binge drinking habits and co-assumption of diverse novel psychoactive substances, which contribute to the challenging nature of alcohol addiction treatment (15).

LAT Software Induced Savings on Medical Costs of Alcohol Addicts' Care - Results from a Matched-Pairs Case-Control Study

Lesch Alcoholism Typology (LAT) is one of the most widely used clinical typologies of alcohol addiction. Study tested whether introduction of LAT software in clinical practice leaded to improved outcomes and reduced costs. Retrospective matched-pairs case-control cost comparison study was conducted at the Regional Addiction Center of the University Clinic in Serbia involving 250 patients during the four-year period. Mean relapse frequency followed by outpatient detoxification was 0.42±0.90 vs. 0.70±1.66 (LAT/non-LAT; pu200a=u200a0.267). Adding relapses after inpatient treatment total mean-number of relapses per patient was 0.70±1.74 vs. 0.97±1.89 (LAT/non-LAT; pu200a=u200a0.201). However, these relapse frequency differentials were not statistically significant. Total hospital costs of Psychiatry clinic based non-LAT addicts care (€54,660) were significantly reduced to €36,569 after initiation of LAT. Mean total cost per patient was reduced almost by half after initiation of LAT based treatment: €331±381 vs. €626±795 (LAT/non-LAT; pu200a=u200a0.001). Mean cost of single psychiatry clinic admission among non-LAT treatment group was €320±330 (CI 95% 262–378) and among LAT €197±165 (CI 95% 168–226) (pu200a=u200a0.019). Mean LAT software induced net savings on psychiatric care costs were €144 per patient. Total net savings on hospital care including F10 associated somatic co-morbidities amounted to €295 per patient. More sensitive diagnostic assessment and sub-type specific pharmacotherapy and psychotherapy following implementation of LAT software lead to significant savings on costs of hospital care.

When cure becomes an illness-abuse of addictive prescription medicines.

Citation: Jakovljevic M, Lazarevic M, Jurisevic M and Jovanovic MR (2015) When cure becomes an illness—abuse of addictive prescription medicines. Substance Addiction as Societal Phenomenon—the Case of Serbia Psychoactive substance addiction presents a challenging public health issue worldwide particularly targeting vulnerable adolescent population (Babor et al., 2007). The illegal market turnover of the controlled substances is very difficult to trace and intervene timely among the young in the early stage of illness (Inciardi et al., 2007). Contrary to this one, legally regulated pharmaceuticals pose another dangerous threat that is more accessible to the authorities. In order to combat substance dependence the national strategies should specially emphasize prescription medicines with proven potential of abuse and addiction (Compton and Volkow, 2006). Serbia as the largest Western Balkans market and a typical Eastern European transitional health system might serve as an appropriate example of medicines abuse in the EU borderlands (Jakovljevic, 2013). The results of local research in 2008, showed that 15.1% of first grade high school students, at least once had used, some psychoactive substance (excluding nicotine and alcohol), while 7.6% of them used sedatives, which was the most common [European School Survey Project on Alcohol and Other Drugs (ESSPAD), 2008]. The national survey on life styles of citizens in Serbia in 2014 about substance use and gambling addiction reported that in the past 12 months 22.4% of the respondents used sedatives, anxiolytics or hypnotics drugs (13.9% of males and 30.9% of females) and in the last 30 days 14.6% of respondents (8% of males and 21.2% of females) used these drugs with higher preponderance among older population. In the last 12 months 5.1% of the respondents used opioids for pain treatment (4.1% of males and 6.1% of females) and in the last 30 days 2.2% of respondents (1.6% of males and 2.8% of females) used these drugs. A large number of respondents said that they had purchased these drugs in the pharmacies prescribed by their physicians –85.3% of the population 18–64 years of age used hypnotics and sedatives, and 70.3% of the population used opioid drugs (Kilibarda et al., 2014). Various studies have shown that drug addiction disorders are related to personality disorders, anxiety disorders and a considerably higher suicide rate (Regier et al., 1990). Further consequences of drug addiction are: education (Yamada et al., 1993) and employment underachievement, reduced work productivity, poor health, higher rates of human immunodeficiency virus (HIV) …

Community-based study of health-related quality of life in spinal cord injury, muscular dystrophy, multiple sclerosis, and cerebral palsy.

Purpose: To assess health-related quality of life (HRQOL) in adults with spinal cord injury (SCI), muscular dystrophy (MD), multiple sclerosis (MS), and cerebral palsy (CP). Methods: This is a multicenter, community-based, cross-sectional study of adults diagnosed with CP (94), MD (99), MS (98), SCI (99), and healthy adults (105). The WHOQOL-BREF and WHOQOL-DIS questionnaire were used. Results: Significant differences in physical functioning between adults with CP and SCI and adults with MS (pu2009=u20090.003 and p < 0.001, respectively), as well as between adults with SCI and MD (pu2009=u20090.001) were found. Univariate tests revealed significant psychological functioning differences between adults with SCI and MD (pu2009=u20090.02) and SCI and MS (pu2009=u20090.001). There was a significant difference in physical functioning between controls and adults with SCI (pu2009=u20090.049) and a significant difference in psychological functioning between controls and adults with MS (pu2009=u20090.039). No statistically significant differences were found between the groups in social and environmental domains. Conclusions: Physical and physiological functioning were affected to various degrees in the studied neurodisabilities, while all groups reported similar levels of functioning and well-being in social and environmental domains. Implications for Rehabilitation Health-related quality of life (HRQOL) in adults with neurodisabilities living in a community differs from HRQOL in these individuals sampled in clinical and/or rehabilitation settings. Psychosocial aspects of HRQOL relevant to physical disability were similarly affected across those groups. Physical and physiological domains in HRQOL were affected to various degrees among adults with neurodisabilities living in a community. Levels of functioning and well-being in social and environment domains of HRQOL are similar among adults with neurodisabilities living in a community. Community-based study of health-related quality of life in spinal cord injury, muscular dystrophy, multiple sclerosis, and cerebral palsy.

Parameters of Calcium Metabolism Fluctuated during Initiation or Changing of Antipsychotic Drugs.

Objective Serum parameters of calcium homeostasis were measured based on previously published evidence linking osteoporotic fractures and/or bone/mineral loss with antipsychotics. Methods Prospective, four-week, time-series trial was conducted and study population consisted of patients of both genders, aged 35-85 years, admitted within the routine practice, with acute psychotic symptoms, to whom an antipsychotic drug was either introduced or substituted. Serial measurements of serum calcium, phosphorous, magnesium, 25(OH)D, parathyroid hormone, calcitonin, osteocalcin and C-telopeptide were made from patient venous blood samples. Results Calcium serum concentrations significantly decreased from baseline to the fourth week (2.42±0.12 vs. 2.33±0.16 mmol/L, p=0.022, n=25). The mean of all calcemia changes from the baseline was -2.6±5.7% (-24.1 to 7.7) with more decreases than increases (78 vs. 49, p=0.010) and more patents having negative sum of calcemia changes from baseline (n=28) than positive ones (n=10) (p=0.004). There were simultaneous falls of calcium and magnesium from baseline (63/15 vs. 23/26, p<0.001; OR=4.75, 95% CI 2.14-10.51), phosphorous (45/33 vs. 9/40, p<0.001; 6.06, 2.59-14.20) and 25(OH)D concentrations (57/21 vs. 13/35, p<0.001; 7.31, 3.25-16.42), respectively. Calcemia positively correlated with magnesemia, phosphatemia and 25(OH)D values. Parathyroid hormone and C-telopeptide showed only subtle oscillations of their absolute concentrations or changes from baseline; calcitonin and osteocalcin did not change. Adjustment of final calcemia trend (depletion/accumulation) for relevant risk factors, generally, did not change the results. Conclusion In patients with psychotic disorders and several risks for bone metabolism disturbances antipsychotic treatment was associated with the decrease of calcemia and changes in levels of the associated ions.

Regulatory issues surrounding audit of electronic cigarette charge composition

A 29-year-old patient who was treated with buprenorphine for 2 years without recurrence attends regular psychiatric controls that include screening for psychoactive substances. During one of the visits, when he was accompanied by his parents, a test for psychoactive substances was positive for opiates. The patient denied that he used illegal substances, and his parents claimed so as well. During this period, the patient lived fairly in isolation, with themembers of his family. The only new substance that he used was a new cartridge for e-cigarette. The cartridge was bought at the market in another place, at a pretty low price. Since the father used the same cartridge, he offered to take the test on PAS. The test was positive for opiates (father had never used psychoactive substances in his life). This inspired us to do the following experiment: we poured the content of the cartridge into a glass with water, and the test was again positive for opiates. In this case, neither the outcome of the test of our patient and/or his father nor naive experiment (with the help of immunochromatographic test for the simultaneous qualitative detection of drugs and their metabolites in the urine) or experimental method that is highly dubious was important, but the questions (i.e., more questions) that open after these clinical experiences. The questions posed are: does any authority regularly control the composition of e-cigarettes, and if so, which one, under what circumstances, and whether it is regulated by law? Let us start from the known premise: electronic cigarettes (e-cigarettes) are battery-powered devices that allow nicotine intake with chemicals that have different tastes by inhalation, and they are substitutes for smoking ordinary cigarettes. It is known that there are over 250 different brands of e-cigarettes currently on the market. It is estimated that the number of users of e-cigarettes in the world is rapidly growing. In Europe, there are about 7million users of e-cigarettes. In France, there are about 1.5million e-cigarette users, while, for example, in the UK, the number of e-cigarette users has tripled since 2012 (from 700,000 to over 2million) (1). The tobacco industry is investing a huge sum of money into the development of e-cigarettes, and according to the researchers fromHSPH’s Center for Global Tobacco Control (CGTC), Department of Social andBehavioral Sciences, it is very important to identify the subpopulation thatwill probably use them more than others and determine the implications for public health. This research has shown that millions of people – including many young people and smokers who want to stop smoking – try e-cigarettes. This also points to the fact that the importance of determining the potential harm (or benefit) is being underestimated (2). Each e-cigarette contains the following components: batteries (mainly lithium ion) that can be automatic or manual; electronic atomizer spray (responsible for controlling the operation of the device and the release of nicotine vapor during inhalation); and tank in which the liquid for e-cigarette is poured (newer versions have atomizer and tank in one unit, and such a device is called clearomizer). The first e-cigarette appeared on the market in China in 2004, and since then, it is marketed as a healthier alternative to smoking.

Legal Framework and Retirement Policies in Serbia from 1990 to 2016 – Gendered Perspective

Retirement policy is an unavoidable factor for the economic and social stability of the state. In our country, Serbia, the total number of pensioners in 2015 was almost 1.8 million, which is higher in comparison to the time period from 2002 to 2014. According to increased number of pensioners, pension reforms are a crucial step of economic stability for less developed country, such as Serbia. The first step in this question in Serbia was made in 2001, and this change was referred to the raise in the retirement age. Next step was made in 2003 and involved wider ranges of changes than the previous step. Another change in this field was followed by 2005, and it was related to age limit for retirement, which was supposed to increase for 6u2009months each year during the period from 2008 to 2011, while another change was a gradual pension adjustment. The last step in this road of pension reforms in Serbia has become with adopted Law on Pension and Disability Insurance that entered into force in January 2015, when age limit for retirement was extended for both genders, whereby it is clear that the aim of this measure is to equalize years of service for genders by 2023 and age limit by 2032 when 65u2009years will be the age limit.