Sanja Kocic

Review of Diagnosis-Related Group-Based Financing of Hospital Care.

Since the 1990s, diagnosis-related group (DRG)-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings) and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities.

Cardiac troponin as biochemical marker of perinatal asphyxia and hypoxic myocardial injury

BACKGROUND/AIM Myocardial cell lesion in newborns may be clinically occult. In recent years there has been shown growing interest in the use of cardiac troponin-I (cTnI) in relation to perinatal asphyxia and hypoxic myocardial lesion. The aim of this study was to determine a relationship between high cTnI levels and outcome in critically ill newborns with perinatal asphyxia. METHODS In this study 78 patients were divided into three groups. The group I included 39 newborns (15 term and 24 preterm) with perinatal asphyxia, with no deaths, only full or partial (with some neurological sequels) recovery. The group II included 10 newborns (6 preterm and 4 term), with perinatal asphyxia who died, with critical cardio-respiratory problems and multiorgan dysfunction. The group III included 29 healthy term newborns. A level of cTnI in all three groups was measured within 24-48 hours after delivery. RESULTS A statistically significant higher value of cTnI (0.082 microg/l +/- 0.166) was found in group I than in the group III (healthy newborns). In the group I, 21/39 newborns required respiratory and 16/39 required pressure support. In the group II, the largest average value of cTnI of 0.425 +/- 0.307 was found. All of the newborns in the group II required respiratory and pressure support. In the group III the lowest average value of cTnI (0.0186 microg/L +/- 0.0286) was found. CONCLUSIONS High cTnI levels could be used as markers of perinatal asphyxia and even as predictors of future outcomes and/or mortality.

Sociodemographic Characteristics Of The Over-The-Counter Drug Users In Serbia

RESEARCH ARTICLE Sociodemographic Characteristics Of The Over-The-Counter Drug Users In Serbia Mihailovic Natasa, Snezana Radovanovic, Dragan Vasiljevic, Sanja Kocic and Mihajlo Jakovljevic Department of Social Medicine, Institute of Public Health Kragujevac, Kragujevac, Serbia Department of Social Medicine, University of Kragujevac, Serbia, Faculty of Medical Sciences Department of Hygiene and Ecology, Faculty of Medical Sciences, University of Kragujevac, Serbia Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Serbia

The Impact of Socioeconomic Characteristics and Lifestyles on Vitamin D Deficit in Mentally Ill Patients

Abstract Mental illnesses put patients at high risk for vitamin D deficit. The aim of the research is to examine the impacts of socioeconomic characteristics and lifestyles on vitamin D deficiency in mentally diseased patients. In this crosssectional study we used blood samples from patients who were treated for mental disorders at Specialist-consultative unit of the Health Center and Clinical Center Kragujevac from May-June 2014. The study used a questionnaire for the assessment of vitamin D status. The study included 220 subjects with different types of mental disorders. Normal values of vitamin D were detected in 16% of patients whereas 64% of patients had vitamin D deficiency. The patients with vitamin D deficit were in average 3 years older than that but the difference is not statistically significant (p>0.05). The patients with vitamin D deficiency were primarily female (p=0.003), people with high-school education from urban environment who lived in bad life conditions (p>0.05). Between patients with and without vitamin D deficiency there is no difference in cigarette consumption, in the number of cigarettes per day, in alcohol usage, in coffee consumption and in nutrition. However, the patients without vitamin D deficiency spent more time outside; during the past year were more exposed to sun and during the past seven days spent more than 30 minutes a day exposed to sunlight (p<0.01). These facts indicate that there is a current need for further research in this area.

Socio-Medical Aspects of Depression among Elderly Adults in Serbia

Abstract Depression is the most frequent mental health problem in older age with serious consequences on personal, interpersonal and social level. The aim of this study was to determine the association of demographic factors, socio-economic factors and health status characteristics, with the presence of depressive symptoms in the elderly persons. The survey was conducted as a part of the national study “Health Survey of the Serbian population” in 2013. Data on the population aged 65 years and over were used for the purposes of this study (3540 respondents). PHQ-8 questionnaire was used to assess the presence of symptoms of depression. The relations between the presence of depressive symptoms, as a dependent variable, and a set of independent variables was examined by univariate and multivariate logistic regressions. Depression (PHQ-8 score≥10) was registered in 10% of the population aged 65 and above, wherein it was statistically significantly higher in women (12.7%) than in men (6.5%). Limitations in performing of daily activities showed to be the strongest predictor of depression in the elderly, while respondents who have had serious limitations had even six times more chanse to develop depression (OR=6.84). Respondents who rated their health as “bad or very bad” for 49.5% more frequently manifested depressive symptoms compared to those who evaluated their health as “very good or good” (OR=3.49). Respondents who have had two or more chronic diseases were three times more likely to have depression (OR=3.1) compared to people without chronic disease.

The efficacy of moxifloxacin in patients with bacterial keratitis

Background/Aim. Keratitis is a sociomedical problem of moderately developed countries. including Serbia, too. The incidence of bacterial keratitis in the world is about 20% in relation to all keratitis, but its frequency in Serbia is still not known. Bearing in mind the complications in the front segment of the eye after bacterial keratitis (ulcer, neovascularization, fibrosis) and decline in visual acuity, it was necessary to assess the efficacy of local therapy by moxifloxacin which will shorten the healing time and reduce complications. The aim of the study was to analyze the efficiency of shortening the treatment of bacterial keratitis with moxifloxacin. Methods. The study was designed as prospective, randomized, double-blind study. The study included 30 patients with diagnosed keratitis and locally applied antibiotic moxifloxacin, and 60 patients in a control group, with locally applied artificial tears. All participants were subjected to complete clinical ophthalmologic analysis (2015/16), for a period of 1–15 days after the application of therapies (healing time of corneal pathology). The following was determined in all patients: degree of hyperemia, degree of epithelial defect, level of corneal sensitivity, level of tear secretion and tear quality, degree of conjunctival secretion, degree of neovascularisation and corneal scarring, degree of visual acuity, score of subjective symptomatology and correlation of ophthalmological findings and subjective symptoms. Results. There was a statistically significant difference in times of therapeutic efficacy/clinical response between the study group patients who received moxifloxacin and the control group patients who received arteficial tears. Conclusion. Local application of moxifloxacin had therapeutic effect (total benefit) both in terms of the effective shortening of the healing time and also the reduction of the complications of bacterial keratitis, without unwanted effects.

Possible Uses of Data from Hospital Discharge Reports

Abstract Almost all countries in the world keep some form of hospital discharge report (HDR). Although there are many variations, every report contains such data as patient demographics, the main cause of hospitalization, comorbidities, the length of stay in hospital and outcome. The advantages of using data obtained from HDRs are numerous: The data from HDRs are already collected in a designated centre and thus easily available and relatively cheap; HDRs contain information for many previous years; they are sometimes more reliable than data obtained through any other method; and finally, they provide a large and representative database. HDRs databases can be connected with other databases using a unified patient identification number. The limitations of using data obtained through HDRs are as follows: inconsistencies in defining and coding diagnoses and applied procedures, common underestimations of comorbidity, limited possible applications in specific studies and partial coverage of inpatient institutions. The prediction that in the future, a growing number of diagnostic and treatment procedures will be performed on an outpatient basis will also limit the use of HDRs. When electronic recordkeeping becomes a practice, we may assume that these data will no longer be needed. There is no perfect model for collection and processing data regarding hospitalized patients. HDRs, with their advantages and disadvantages, currently represent the best way to perceive the size, type, quality and efficiency of the health care services provided to patients at the secondary and tertiary level.

The Prevalence of Physical and Psychological Abuse and its Correlation with Depressive and Anxiety Symptoms among Students

Abstract Abuse in younger populations has been an issue of growing concern globally since youth already face various life situations that can heighten the occurrence of depression and anxiety disorders. The aim of this study was to determine the prevalence of physical and psychological abuse and its correlation with depressive and anxiety symptoms among students. This research was conducted as an epidemiological study of a sample of 1,940 university students using a standardized questionnaire by the World Health Organization. The survey, in addition to questions related to the abuse of youth, also included the Beck Depression Inventory and Beck Anxiety Inventory. Based on the results of this study, psychological abuse had a prevalence of 17.1%, while the prevalence of physical abuse was approximately 1.8%. Depressive symptoms were significantly related to physical (p<0.001) and psychological abuse (p<0.005), and anxiety symptoms were also significantly related to both physical (p=0.003) and psychological abuse (p<0.005). The results of this study indicated the importance of the early detection of abuse and depressive and anxiety symptoms among university students, which is essential for mental health promotion and the prevention of mental disorders.

Socioeconomic inequalities and non-communicable diseases in Serbia: National health survey

Background/Aim. Non-communicable diseases (NCDs) are a major public health challenge worldwide. Although they are preventable, NCDs are the major global causes of morbidity and mortality, absenteeism, disability and premature death. The aim of this study was to examine socioeconomic inequalities in the prevalence of non-communicable diseases in Serbia. Methods. Data from the 2013 National Health Survey of the population of Serbia was used in this study. There were 13,765 adults interviewed, aged ≥ 20 years. We used multivariate logistic regression analyses with demographic and socioeconomic determinants of health as independent variables and prevalence of non-communicable diseases as a dependent variable. The minimum level of significance was p < 0.05. Results. Hypertension was the most prevalent NCDs (36.1%). The prevalence of multimorbidity was 47.1%. Multivariate logistic regression analysis showed that gender, age, place of residence, employment status and education were associated with the presence of NCDs. The odds ratio (OR) for age was 1.074 [95% confidence interval (CI) : 1.070–1.077). Women were at a higher risk of NCDs by 58.9% when compared to men (OR = 1.589; 95% 95% CI : 1.467–1.726). Respondents who lived in the rural areas were at a higher risk for NCDs by 14.1% compared to those who lived in urban areas (OR = 1.141; 95% CI : 1.047– 1.244). Odds ratio for unemployment was 1.227 (95% CI: 1.118–1.346). Respondents with primary education were at a higher risk for chronic diseases by 47.1% (OR = 1.471; 95% CI : 1.281–1.687) while those with secondary school were at a higher risk by 27.7% (OR = 1.277; 95% CI : 1.142–1.428) compared to respondents who had higher education. When it comes to Wealth Index, univariate logistic regression analysis showed that respondents who belonged to the poor and middle classes were at a higher risk for NCDs (OR = 2.031; 95% CI : 1.819–2.267; OR = 1.473; 95% CI : 1.343– 1.615) compared to respondents who belonged to the rich class. Multivariate logistic regression analysis did not show statistically significant correlations between the Wealth index and NCDs. Conclusion. Socioeconomic inequalities in health status are the major challenge and should be a target of national health policy in Serbia, not only because they represent social injustice but also because solving the health problems of underprivileged groups of the population can influence improvement of health status of the population as a whole.

Socioeconomic Factors Associated with Psychoactive Substance Abuse by Adolescents in Serbia

Adolescence is a period of transition from childhood to adulthood, characterized by efforts to achieve the objectives related to the expectations of the culture, as well as the requirements of the physical, mental, emotional, and social development. It has its own characteristics in the biological, psychological, and social terms, with a process of identity formation, the development of social, and moral norms of behavior (McCabe et al., 2017). Adolescence is a period of great settings in which experimentation with psychoactive substances is common and can, in some cases, lead to the development of long-term addictive behavior (Jeannin et al., 2013). Psychoactive substances include licit, illicit, and prescribed psychoactive medications. Alcohol and cigarette are among the licit and controlled drugs, while marijuana, cocaine, heroin, lysergic diethylamide (LSD), crack, and ecstasy are illicit drugs (Kassa et al., 2014). The use of psychoactive substances in adolescents is often associated with a socioeconomic factors, such as gender, age, type, race, ethnicity, family, and social structures, socioeconomic status of the family (Gebreslassie et al., 2013). Significant risk factors for psychoactive substances use among adolescents were poor parental involvement in the child’s education, conflictual family relationships, and drug abuse by the parents, friends, and neighbors (Kpozehouen et al., 2015; Pisarska et al., 2016). Also, parental alcoholism, parental divorce before age 18, and parental death before age 18 increased the odds of abuse psychoactive substances (Vaughan et al., 2017). Socioeconomic environment in which young people were raised as children predicts their behavior in young adulthood. Understanding this relationship, is an important step in identifying persons at risk (Tobler et al., 2000). In order to identify the risk factors and protective factors associated with psychoactive substances abuse among young people, it is very important tomeasure how socioeconomic factors influence the attitudes and behavior of young toward the use of psychoactive substances (Carter et al., 2010; Patrick et al., 2012).