Olivera Milovanovic

Growing Burden of Non-Communicable Diseases in the Emerging Health Markets: The Case of BRICS

The blooming of incidence and prevalence of “prosperity diseases” among the broad layers of modern day populations is rather novel phenomenon in demographic history of the human race (1). Illnesses such as obesity (2), diabetes mellitus, hypertension, cerebrovascular and cardiovascular consequences of atherosclerosis, renal insufficiency, mental disorders, and even cancer are closely related to the increased longevity of most contemporary societies (3). In previous centuries, they were mostly reserved for elite social groups enjoying rather luxurious life style. Vast majority of citizens of the time were living in rural communities on the verge of poverty. Their structure of morbidity even in Europe until late 19th century was dominated by burden of infectious diseases and injury while neonatal and maternal mortality rates were huge. Industrial revolution led to the growth of living standards, invention of vaccines, and antibiotics, and ultimately development of organized publicly funded health systems. The prominent European health policy makers in the 19th century properly believed that effective public health measures will diminish huge burden of infectious diseases. Consecutively, they expected that overall costs of medical care provision should decrease substantially and ultimately reach plateau level. This second step turned out to be a great miscalculation and a surprise. Like no time in written past, people began living longer and healthier lives. But it happened at the cost. Simultaneously, from many industrialized nations, evidence were accumulating of accelerated occurrence of non-communicable diseases. Accomplishment of evidence-based medicine succeeded to control many of these initially incurable diseases, thereby transforming them into life time disorders as in the typical cases of diabetes and terminal renal insufficiency. Acute bacterial infections, dominating morbidity in the old days, were usually successfully treated within few weeks. Unlike these, chronic illnesses were bringing long-term burden for both the patients and the society. Malignant disorders with its complex treatment strategies present particularly demanding medical conditions. Cancer leaves permanent footprint in a life of a patient in terms of poor survival rates, decreased life quality, and working ability.

The New and Old Europe: East-West Split in Pharmaceutical Spending

HIGHLIGHTS Since the geopolitical developments of 1989, former centrally planned economies of Eastern Europe followed distinctively different pathways in national pharmaceutical expenditure evolution as compared to their free market Western European counterparts. Long term spending on pharmaceuticals expressed as percentage of total health expenditure was falling in free market economies as of 1989. Back in early 1990s it was at higher levels in transitional Eastern European countries and actually continued to grow further. Public financing share of total pharmaceutical expenditure was steadily falling in most Central and Eastern European countries over the recent few decades. Opposed scenario were EU-15 countries which successfully increased their public funding of prescription medicines for the sake of their citizens. Pace of annual increase in per capita spending on medicines in PPP terms, was at least 20% faster in Eastern Europe compared to their Western counterparts. During the same years, CEE region was expanding their pharmaceuticals share of health spending in eight fold faster annual rate compared to the EU 15. Private and out-of-pocket expenditure became dominant in former socialist countries. Affordability issues coupled with growing income inequality in transitional economies will present a serious challenge to equitable provision and sustainable financing of pharmaceuticals in the long run.

Disability, Work Absenteeism, Sickness Benefits, and Cancer in Selected European OECD Countries-Forecasts to 2020

Background Disability either due to illness, aging, or both causes remains an essential contributor shaping European labor markets. Ability of modern day welfare states to compensate an impaired work ability and absenteeism arising from incapacity is very diverse. The aims of this study were to establish and explain intercountry differences among selected European OECD countries and to provide forecasts of future work absenteeism and expenditures on wage replacement benefits. Methods Two major public registries, European health for all database and Organization for Economic Co-operation and Development database (OECD Health Data), were coupled to form a joint database on 12 core indicators. These were related to disability, work absenteeism, and sickness benefits in European OECD countries. Time horizon 1989–2013 was observed. Forecasting analysis was done on mean values of all data for each single variable for all observed countries in a single year. Trends were predicted on a selected time horizon based on the mean value, in our case, 7 years up to 2020. For this purpose, ARIMA prediction model was applied, and its significance was assessed using Ljung–Box Q test. Results Our forecasts based on ARIMA modeling of available data indicate that up to 2020, most European countries will experience downfall of absenteeism from work due to illness. The number of citizens receiving social/disability benefits and the number being compensated due to health-related absence from work will decline. As opposed to these trends, cancer morbidity may become the top ranked disability driver as hospital discharge diagnoses. Concerning development is the anticipated bold growth of hospital discharge frequencies due to cancer across the region. This effectively means that part of these savings on social support expenditure shall effectively be spent to combat strong cancer morbidity as the major driver of disability. Conclusion We have clearly growing work load for the national health systems attributable to the clinical oncology acting as the major disability contributor. This effectively means that large share of these savings on public expenditure shall effectively be spent to combat strong cancer morbidity. On another side, we have all signs of falling societal responsibility toward the citizens suffering from diverse kinds of incapacity or impaired working ability and independence. Citizens suffering from any of these causes are likely to experience progressively less social support and publicly funded care and work support compared to the golden welfare era of previous decades.

Health Spending Follows Pace of Population Aging: Challenges Lying Ahead of the Largest Western Balkan Market

Humanity has almost won its battle with many infectious diseases, thus increasing longevity, but is now confronted with challenges arising from population aging (1). A blessing turned into a curse as modern societies began struggling with prosperity diseases proliferation (2). Such obstacles are notable in the largest Western Balkan country (1). One-fifth of the Serbian population is aged 65, where that age group holds 8% globally (3). Serbia has a negative population growth and descending fertility rates, which places its population among the oldest in Europe (4). Following these trends, it is estimated that population older than 75 will make up amajority in the next two decades forming a T shaped age pyramid (5). Within the broader South East European region, population aging trend is clearly present for decades and shows clear signs of acceleration (6). This phenomenon originated from tumultuous changes in terms of political and economic stability affecting the Balkans in past decades. During the civil war in the 1990s, there has been an exodus of refugees from former parts of Yugoslavia to Serbia. This influx of people accounted for 5% of the total Serbian population count, but left no positive mark on the overall fertility rates due to similar reproductive behavior of internally displaced people (7). Destitution caused by sanctions placed by the Security Council of the UN forced indigenous people to embark on massive emigrations toward richer and more viable economies. Additional impacts on renewal of demographic potential were “brain drain” consisting of almost 50% of skilled emigrants younger than 40 (8). Difficulties in finding a partner of the opposite sex are also noteworthy. Even though the ratio of men and women is even at reproductive age, the proportion of each gender in rural and urban settings is significantly off-balance (9). Also, the age for womenwhen couples decide on having their first child has shifted from 25 in 2001 to 27 in 2011 (5).

Cross-sectional survey on complementary and alternative medicine awareness among health care professionals and students using CHBQ questionnaire in a Balkan country

ObjectiveTo conduct a study on attitudes, knowledge, and use of complementary and alternative medicine (CAM) therapies in Serbia. Available data about CAM therapies in the region are scarce, opinions lacking from health sector. Balkan region countries had a delay in issuing national policies on CAM therapies.MethodsThe questionnaire used was based on previously validated CAM Health Belief Questionnaire (CHBQ), formulated as 5-item Likert type scale, adjusted for local environment. Health care students and professionals were evaluated. The questionnaire comprehended 10 closed questions on attitudes, knowledge and use of CAM therapies. This survey was conducted in eight cities of Serbia, January 2010–July 2011. A total of 797 participants was included. The second group of participants was 145 healthcare professionals (50 academic staff, 64 clinical staff, 19 pharmacists, 6 other clinical branch specialists and 6 nurses). Data were collected by an interview. Examinees could acquire maximum of 70 points, 35 representing neutral attitude.ResultsStudents of dentistry (54.65±6.07) were better informed on CAM therapies than medicine students (50.26±7.92). Pharmacy students (51.16±7.10) accepted low-scientific CAM. Pharmacists scored better than university professors (55.12±6.55 vs. 50.29±9.50). Primary health care professionals had better awareness than pharmacists in dispensing pharmacies. Both groups of participants preferred use of vitamins over any other CAM therapy.ConclusionThese pioneering efforts in the region exposed weaknesses in CAM attitudes of current and future health care professionals. Nevertheless, awareness on alternative medicine treatment choices is growing among Balkan prescribers. Supportive legal framework would facilitate dissemination of CAM medical practices.

Vitamin D Deficiency and its Importance - A Global Problem of Today, Realistic or Not?

Abstract Vitamin D, also known as the “sun vitamin” in the literature, has been examined for many years and still arouses researchers’ interest due to the pleiotropic effects achieved in the human body. Because of the influence on mineral homeostasis, the initially observed effects of vitamin D on the prevention and treatment of rickets, have now been extended to a large number of diseases with different aetiologies such as cardiovascular, autoimmune, endocrine, infectious, neurological, malignant and other diseases. Due to the large number of experimental studies in animals and humans, we have exact information about the role of vitamin D in many of these conditions. Reaching an adequate level of 25(OH)D in the human body is a basic requirement for the realization of these effects; 25(OH)D is a metabolic product that reflects the vitamin D status but that does not have any biological activity. The biological activities of vitamin D can occur only after the formation of a second metabolic product, 1,25(OH)2D, in the kidneys. The three main sources of acquiring vitamin D are through food, skin and supplementation. Food is not a rich source of vitamin D; it is clear that the most important influences to achieve an optimal vitamin D status in the human body are vitamin D synthesis at the skin and adequate supplementation intake. An alarming fact is that vitamin D deficiency is detected in an increasing number of people from one day to another in the general world population and that this condition has pandemic dimensions. Introducing the beneficial effects and sources of vitamin D to the general population and to medical experts with adequate supplementation regime can decrease the number of people who are vitamin D deficient.

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 6 months 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 65 years will be the age limit.

Population pharmacokinetics of 25-hydroxyvitamin D in healthy young adults.

OBJECTIVES The aim of our study was to develop a population pharmacokinetic (PPK) model for 25-hydroxyvitamin D clearance in a healthy young adult population in Serbia. METHODS Study sample consisted of 70 healthy young students of the Faculty of Medical Science, University of Kragujevac, Serbia, with a mean age and body mass index of 22.39 ± 1.82 years and 21.31 ± 2.69 kgm-2, respectively. Non-linear mixed-effect modeling (NONMEM) software was used for data analysis. A validation set of 16 participants was used to estimate the predictive performance of the pharmacokinetic model. RESULTS In the base model (without covariates), we had parameter estimates of 0.01 L/h for apparent clearance, 0.25 L for apparent volume of distribution, while value of minimum objective function (MOF) was 383.468. The full regression model was established by estimating the effects of 12 covariates. Mean intake of vitamin D from foods (DD) and value of phosphate in serum (PHO) were covariates included in the final model, while others were excluded in this process. The estimated value in the final MOF model was 274.555. The final regression model formula was: clearance (CL) (L/h) = 0.0711 + 0.738 x DD + 0.618 x PHO. CONCLUSIONS The PPK model obtained determined clearance of 25-hydroxyvitamin D in a healthy young adult population in Serbia. Mean intake of vitamin D from foods and serum phosphate level are the most important covariates that influence value of 25-hydroxyvitamin D clearance in healthy young adults.

CUTANEOUS TOLERANCE OF SEA BUCKTHORN OIL EMULSION

Introduction: Sea buckthorn oil ( Hippophae rhamnoides L.) is medically used both externally and internally, but the external application is unsutable due to its liquid, lipophylic and highly colored nature. These difficulties could be overbriged by formulation of semisolid emulsion with sea buckthorn oil. Previous research on this formulation showed that it has higher wound healing potential then sea buckthorn oil, possesing enhanced structure of liquid crystals, stability and suitability for topical use. Aim: The aim of this investigation was to complete characterization of proposed emulsion, by testing its potential for causing skin irritation. Methods: The emulsion was prepared by standard emulsifying techniques using a combination of surfactants that form an enhanced structure of liquid crystals. Amount of 40% of sea buckthorn oil was incorporated. Since results of previous research on this formulation show wound healing effect on an animal model, we also tested skin tolerance of it on animal skin model. Evaluation was done by Draize test which measures level of skin changes of rabbit skin. Results: There was absence of edema or erythema type of irritation after 2h, 24h, 48h, 72h and 7 days of application of semisolid emuslion with sea buckthorn oil. Conclusion: This study confirmed that combination of the proposed ingredients is adequate and the concentrations of surfactants used to form stable emulsion were appropriate also for skin application. The proposed formulation of emulsion with sea buckthorn oil exerted percutaneous tolerance and could be safely applied on the skin. Key words: sea buckthorn oil, emulsion, topical use, irritation

Cutaneous Effects of Sea Buckthorn Oil Emulsion

Abstract Sea buckthorn oil (Hippophae rhamnoides L.) is medically used both externally and internally, but the external application is unsuitable due to its liquid, lipophilic and highly coloured nature. These difficulties could be overcome by a formulation of semisolid emulsion with sea buckthorn oil. Previous research on this formulation showed that it has higher wound healing potential than sea buckthorn oil, possessing an enhanced structure of liquid crystals, stability and suitability for topical use. The aim of this investigation was to completely characterizise a proposed emulsion by testing skin effects, such as moisturising potential, skin pH and potential to cause skin irritation. The emulsion was prepared by standard emulsifying techniques using a combination of surfactants that form an enhanced structure of liquid crystals. Approximately 40% of sea buckthorn oil was incorporated. The moisturising potential and skin pH were tested on the healthy skin of volunteers. Skin tolerance was tested on a rabbit skin model and evaluated by the Draize test. The tested emulsion containing sea buckthorn oil did not cause a significant change in skin pH, while it significantly increased skin hydration. Th ere was an absence of edema or erythema type of irritation after 2 h, 24 h, 48 h, 72 h and 7 days of application of the emulsion with sea buckthorn oil. The tested formulation shows good moisturizising effects and does not cause human or animal skin irritation. Th e study confi ms that the combination of the proposed ingredients in a sea buckthorn oil emulsion is adequate and could be safe for skin application Sažetak Ulje pasjeg trna (Hippophae rhamnoides L.) se u medicinske svrhe upotrebljava kako za eksternu tako i za internu primenu, pri čemu je eksterna primena nepogodna usled njegove tečne konzistencije, lipofi lne prirode i intenzivne obojenosti. Navedeni nedostaci bi se mogli prevazići formulacijom polučvrstih emulzija sa uljem pasjeg trna. Prethodna ispitivanja ove formulacije su pokazala da poseduje znatno veći potencijal za zarastanje rana u odnosu na ulje pasjeg trna, unapređenu strukturu tečnih kristala, stabilnost i pogodnost za lokalnu primenu. Sprovedeno istraživanje imalo je za cilj da upotpuni karakterizaciju predložene formulacije, testirajući efekte na koži- hidrirajući potencijal, pH kože i potencijal za izazivanje kožnih iritacija. Emulzija je pripremljena standardnim tehnikama emulgovanja, korišćenjem kombinacije surfaktanata kojima se formira poboljšana struktura tečnih kristala pri čemu je ulje pasjeg trna je bilo inkorporirano u količini od 40%. Hidrirajući potencijal i pH kože su bili testirani na koži zdravih volontera. Tolerancija kože je testirana na modelu zečje kože i procenjivana pomoću Draize-ovog testa. Ispitivana emulzija sa uljem pasjeg trna nije pokazala značajne promene pH kože, dok je pokazan značajan hidrirajući efekat. Nisu se javile kožne iritacije, tipa edema ili eritema, nakon 2h, 24h, 48h, 72h i 7 dana od aplikacije emulzije sa uljem pasjeg trna. Evaluirana formulacija ne izaziva iritaciju ni humane ni životinjske kože i pokazuje dobar hidrirajući efekat. Studija potvrđuje da je kombinacija preloženih sastojaka u emulziji sa uljem pasjeg trna adekvatna i može se bezbedno primenjivati na koži.