Vesna Bjegovic

Factors associated with spousal physical violence in Albania: cross sectional study.

Abstract Objective To describe the prevalence of intimate partner violence and associated factors among married women in Albania. Design Cross sectional study. Setting Tirana, the capital city of Albania. Participants A representative sample of 1039 married women aged 25-65 living in Tirana and recorded in the 2001 census. Methods Questionnaire on intimate partner violence and social and demographic characteristics of the women and their husbands. Main outcome measure Womens experience within the past year of being hit, slapped, kicked, or otherwise physically hurt by the husband. Results More than a third (37%, 384/1039) of women had experienced violence. Risk was greatest among women aged 25-34 (odds ratio 1.47, 95% CI 1.04 to 2.09), women with tertiary education (3.70, 2.04 to 6.67), women in white collar jobs (4.0, 1.59 to 10.0), women with least educated husbands (5.01, 2.91 to 8.64), and women married to men raised in rural areas (3.31, 2.29 to 4.80). Women were at higher risk if they were more educated than their husbands (4.76, 2.56 to 9.09). Conclusions In transitional Albania, the risk of spousal violence is high, and more empowered women are at greater risk.

Multimodal assessment of the primary healthcare system of Serbia: a model for evaluating post-conflict health systems.

INTRODUCTION Conflicts, social unrest, and disasters can significantly affect the ability of a healthcare system to provide for the needs of its citizens. The collapse of the primary healthcare system in Serbia is a model of the effects that civil unrest can have on the health of a population. However, with improving social and political conditions, focus now can be turned towards the greatly needed development and reorganization of the primary healthcare system in Serbia. Due to the complexity of health-system reform in the post-conflict/post-disaster setting, attempts to restructure health services are fraught with pitfalls that often are unanticipated because of inadequate preliminary assessments. A multimodal assessment involving quantitative and qualitative methodologies may provide a more robust mechanism to identify key programmatic priorities and critical barriers for appropriate and sustainable health-system interventions. The purpose of this study is to describe a multimodal assessment using primary healthcare in post-conflict Serbia as a model. METHODS Integrated quantitative and qualitative methodologies--system characterization and observation, focus group discussions, free-response questionnaires, and Q-methodology--were used to identify needs, problems, and potential barriers to primary healthcare development in Serbia. Participants included primary healthcare providers and administrators from 13 institutions throughout Belgrade. RESULTS Demographic data indicate a well-established infrastructure of primary health centers and stations. However, focus group discussions and free-response questionnaires reveal significant impediments to delivery of care: (1) Inadequate equipment, supplies, and medications; (2) Poor financial investment; (3) Discouraging worker salaries; (4) Few opportunities for professional development; and (5) Little emphasis on or respect for primary healthcare. Q-methodology of provider perceptions and opinions supports these concerns, shows remarkable consensus among participants, and provides further insights toward system development by grouping respondents into distinctive types. CONCLUSIONS This study identified the critical needs and barriers to development of primary healthcare in Serbia. This combined methodology may serve as a model for future health system assessments in the post-conflict and post-disaster settings.

Risk of HIV infection among indoor and street sex workers and their use of health services in Belgrade, Serbia

INTRODUCTION HIV in Serbia is most often transmitted through sexual contact, and therefore numerous prevention activities are geared towards sex workers (SW). OBJECTIVE To analyse the differences in knowledge, attitudes and risky behaviour between indoor and street SW in Belgrade; to examine the accessibility of health services to this vulnerable group. METHODS In this behavioural cross-sectional study, 113 street and 78 indoor SW were included. The sampling method used was snowball samples. Data were gathered through structured questionnaires. RESULTS Around 15% of respondents used drugs intravenously. Around 60% of SW used a condom during the last sexual intercourse with their private partner, and around 90% with a commercial partner. Indoor SW had lower levels of education more often than outdoor SW, and they used marijuana, sedatives and painkillers on a daily basis. A significantly higher number of indoor SW were informed about HIV, HBV and HCV testing, and that the risk for HIV infection is not lower ifa condom is used exclusively for vaginal sex. Indoor SW reported using health services and testing and counselling for HIV, HBV and HCV more frequently than outdoor SW. Outdoor SW had significantly more sex partners in the previous month than indoor SW. Indoor SW recognized more frequently that providing sex services posed a higher risk for HIV infection. CONCLUSION The results of this research study show that even though outdoor SW had higher levels of education than indoor SW, their level of knowledge about HIV transmission was lower and they reported more risky behaviour than indoor SW. Data show that both groups reported not taking care of their health.

The burden of type 2 diabetes in Serbia and the cost-effectiveness of its management

The purpose of this study was to analyse whether the nationwide application of the national Serbian guideline for diabetes mellitus (NSGDM) would save a relevant amount of disability-adjusted life years (DALYs) and/or reduce the medical cost of treating diabetic patients in Serbia, as compared to the present situation. Disability-adjusted life years were calculated for Serbia and the cost-effectiveness was analysed in eight population groups under ideal and present conditions; prevalent and incident cases were each split up for patients with blood glucose that was well controlled and that was uncontrolled. Under ideal conditions, i.e., according to the NSGDM, 8,031 DALYs could be saved with a potential cost reduction at the same time of approximately 19 million Euros. The implementation of the NSGDM in clinical practice bears a great potential to save lives and reduce years lived with lowered quality of life, but in addition it may reduce costs by about a quarter.

The challenge of public health transition in South Eastern Europe

The transition countries in the region of South Eastern Europe (SEE) share the historical burden of communism and four centuries of Ottoman dominance. In spite of deep, inherited rifts, they are going to develop multilateral collaboration as expressed in the Dubrovnik Declaration of 2001. Recently, a common public health strategy was drafted and a regional Forum for Public Health agreed upon. This special issue of the Journal of Public Health provides an overview of relevant developments in SEE with reference to new schools of public health and national public health associations.

Burden of ischaemic heart disease and cerebrovascular diseases in Serbia without Kosovo and Metohia, 2000

Background To provide estimates of cardiovascular disease burden to guide future health strategies and interventions and enable improvements in health and performance of the health care system to be monitored. Design A descriptive study. Methods The study was performed in Serbia without Kosovo and Metohia for the year 2000. Disability-adjusted life years (DALY) was used to provide a comprehensive assessment of premature mortality (years of life lost; YLL) and disability attributable (years lived with disability; YLD) to ischaemic heart disease (IHD) and cerebrovascular diseases, and to estimate the attributable and avoidable burden of these diseases caused by smoking, hypertension, overweight/obesity, physical inactivity, alcohol consumption and an inadequate consumption of fruit and vegetables. Results IHD was responsible for 150 889 DALY (16.28/1000 population), and cerebrovascular diseases were responsible for 136 090 DALY (14.49/1000 population). There were considerably more YLL for both IHD and stroke than YLD. For both diseases DALY rates increased with ageing in men and women. The risk factors most responsible for IHD and stroke burden were smoking, physical inactivity, hypertension and overweight/obesity. Sex and age differences were present in the burden attributable to various risk factors. Conclusion Despite limitations the DALY estimates represent a useful measure of the size of the health problem. The DALY and related estimates for cardiovascular disease can be used as a guide for the prevention of IHD and stroke as well as the evaluation of future health gains by reducing population exposure to lifestyle and related risk factors.

Serbia within the European context: An analysis of premature mortality

BackgroundBased on the global predictions majority of deaths will be collectively caused by cancer, cardiovascular diseases, and traffic accidents over the coming 25 years. In planning future national health policy actions, inter – regional assessments play an important role. The purpose of the study was to analyze similarities and differences in premature mortality between Serbia, EURO A, EURO B, and EURO C regions in 2000.MethodsMortality and premature mortality patterns were analysed according to cause of death, by gender and seven age intervals. The study results are presented in relative (%) and absolute terms (age-specific and age-standardized death rates per 100,000 population, and age-standardized rates of years of life lost – YLL per 1,000). Direct standardization of rates was undertaken using the standard population of Europe. The inter-regional comparison was based on a calculation of differences in YLL structures and with a ratio of age-standardized YLL rates per 1,000. A multivariate generalized linear model was used to explore mortality of Serbia and Europe sub-regions with ln age-specific death rates. The dissimilarity was achieved with a p ≤ 0.05.ResultsAccording to the mortality pattern, Serbia was similar to EURO B, but with a lower average YLL per death case. YLL patterns indicated similarities between Serbia and EURO A, while SRR YLL had similarities between Serbia and EURO B. Compared to all Europe sub-regions, Serbia had a major excess of premature mortality in neoplasms and diabetes mellitus. Serbia had lost more years of life than EURO A due to cardiovascular, genitourinary diseases, and intentional injuries. Yet, Serbia was not as burdened with communicable diseases and injuries as were EURO B and EURO C.ConclusionWith a premature mortality pattern, Serbia is placed in the middle position of the Europe triangle. The main excess of YLL in Serbia was due to cardiovascular, malignant diseases, and diabetes mellitus. The results may be used for assessment of unacceptable social risks resulting from health inequalities. Within intentions to reduce an unfavourable premature mortality gap, it is necessary to reconsider certain local polices and practices as well as financial and human resources incorporated in the prevention of disease and injury burden.

The role of public health services in prevention

Huge population migration, increasing unemployment and poverty and unhealthy lifestyles (stress, smoking, alcohol consumption, etc), among the population in Serbia, are some of the consequences of the political and economic instability in the Balkan region over the last decade (especially in countries of the former Yugoslavia). Data available reveal that, in Serbia, chronic noncommunicable diseases are the dominant cause of death. The National Burden of Disease and Injury Study, done in 2003, showed that cardiovascular diseases, cancers and injuries are responsible for 80% of the total mortality burden in both males and females. The health-care system of Serbia is excessively centralized. The public health services are based on the traditional hygiene and clinical approach and are predominantly organized through a network of Institutes of Public Health which puts insufficient emphasis on analytical and planning tasks and on health promotion (including the prevention of chronic noncommunicable diseases), and too much emphasis on routine reporting and on activities of a technical and laboratory nature in the field of communicable diseases. Today, with the aid of the EU, UNICEF, the World Bank and NGOs, the Ministry of Health is in the process of expanding the capacities and skills of the public health workforce in order to achieve the “New Public Health”. Although progress has been made on several important fronts in achieving the transition to the New Public Health, this does not yet extend to the wider community. Policy documents and legislative instruments have been drafted to guide the reorganization and reorientation of the public health services, especially the network of Institutes of Public Health, and the creation of the Centre School of Public Health has secured the future of professional public health training. The authors argue that the reform of the health sector should be placed within the context of the overall reform of public administration in the country. In this respect, much of the journey still lies ahead, but experience within public health can be used to stimulate, motivate and encourage professionals throughout the civil service to grasp the opportunities for positive change with both hands.

The use and exchange of teaching modules published in the series of handbooks prepared within the frame of the „forum for public health in south-eastern Europe“ network

Abstract Aim: Throughout 2004-2010, the series of 6 books entitled “Handbooks for Teachers, Researchers and Health Professionals” were published within the frame of the public health network established in South Eastern Europe (SEE), covering the total of 249 teaching modules. The aim of the study was to assess the use and exchange of these modules between the authors. Methods: Out of 148 identified authors, 106 took part in the cross-sectional study carried out from July to November 2011 (response rate: 71.6%). The primary endpoints were the utilization (use and/or exchange) of the modules in general, the percentage of utilized modules from all volumes, the percentages of utilized modules of each volume separately, and the percentage of utilized modules from all the volumes at different levels of the educational process. Non-parametric statistical methods were used for analysis (e.g. Mann-Whitney and Friedman tests). Results: Module utilization was reported by 80/106 participants (75.5%). The median value of the percentage of utilized modules from all the volumes was 4.8, being much higher among full-time university staff (9.2; p=0.008) and authors/editors (14.7; p=0.010). The respondents most frequently utilized Volume 1 (median value: 7.7) and Volume 6 (median value: 4.2) modules (p=0.002) as part of undergraduate (median value: 1.4) and postgraduate vocational (median value: 1.4) study programmes (p<0.001). Conclusion: The level of module utilization within the group of their authors is good. However, this is only partial information and not representative of the entire target population of SEE public health teachers. Izvleček Namen: V okviru javnozdravstvene mreže za jugovzhodno Evropo (JVE) je bila v obdobju 2004-2010 objavljena serija šestih knjig z naslovom Priročniki za učitelje, raziskovalce in zdravstvene delavce. Skupno je bilo objavljenih 249 učnih modulov. Namen študije je bil oceniti uporabo in izmenjavo modulov med avtorji. Metode: V presečni raziskavi, ki je bila izvedena v obdobju julij-november 2011, je sodelovalo 106 od 148 vabljenih avtorjev (71,6-odstotna odzivnost). Glavni opazovani pojavi so bili: uporaba/izmenjava modulov na splošno, odstotek uporabljanih/izmenjanih modulov iz vseh knjig, odstotek uporabljanih/izmenjanih modulov za vsako knjigo posebej in odstotek uporabljanih/izmenjanih modulov iz vseh knjig na različnih stopnjah izobraževalnega procesa. Za analizo smo uporabili neparametrične statistične metode (Mann Whitney in Friedmanov test). Rezultati: 80/106 udeležencev (75,5 %) je poročalo, da uporabljajo/izmenjujejo module. Med njimi je bila mediana odstotka uporabljanih/izmenjanih modulov iz vseh knjig 4,8. Le-ta je bila precej višja med polno zaposlenim univerzitetnim osebjem (9,2: p = 0,008) in avtorji/uredniki (14,7; p = 0,010). Ti anketiranci najpogosteje uporabljajo/izmenjujejo module prve (mediana: 7,7) in šeste knjige (mediana: 4,2) (p = 0,002). Najpogosteje jih uporabljajo na dodiplomskih (mediana: 1,4) in podiplomskih strokovnih študijskih programih (mediana: 1,4) (p < 0,001). Zaključki: Uporaba modulov v skupini njihovih avtorjev je dobra, vendar pa je to le delna informacija o uporabi modulov v ciljni populaciji učiteljev javnega zdravja v JVE.

Framework for the strategic and business planning of the Centre – School of Public Health, Belgrade

The science and practice of the New Public Health have a key role in the promotion of people’s health and in the reform of the health system. Serbia experienced many social and economic threats to public health during the 1990s when the health infrastructure both for curative and preventive services gradually deteriorated. Existing skills and knowledge of public health professionals are insufficient in virtually all fields of public health activities. The foundation of the Centre – School of Public Health, within the Medical School of Belgrade University has been a precondition for the improvement of professional training in public health. The objectives are described as (1) education of capable experts in the field of public health, (2) improvement of knowledge in the health sciences, (3) health promotion in cooperation with local communities, (4) training of competent researchers in the field of public health and (5) improvement of the process of decision making and policy formulation. The training programme covers five key areas of education in the domain of public health: (1) public health in Europe, (2) epidemiology and biostatistics, (3) health policy and management, (4) health promotion, health education and social sciences and (5) environment and health. In the first year, 27 students were admitted for the Master of Public Health programme and more than 350 participants attended various short courses for continuing education in public health and health management based on applied learning approach. The next developmental steps focus on sustainability of the programmes for continuing education and research and a wider national and international partnership.