Vladimir Vasic

Buprenorphine Enhances and Prolongs the Postoperative Analgesic Effect of Bupivacaine in Patients Receiving Infragluteal Sciatic Nerve Block

Background:Results from previous studies have shown favorable effects from the addition of buprenorphine to local anesthetics used for interscalene or axillary perivascular brachial plexus blocks. The main objective of the current study was to determine whether addition of buprenorphine could enhance bupivacaine analgesia after infragluteal sciatic nerve block. Methods:One hundred and three consenting adult patients for elective foot and ankle outpatient surgeries were prospectively assigned randomly, in double-blind fashion, to one of three groups. Group 1 received 0.5% bupivacaine with epinephrine 1:200,000 for infragluteal sciatic block plus 1 ml normal saline intramuscularly. Group 2 received bupivacaine sciatic block along with intramuscular buprenorphine (0.3 mg). Group 3 received bupivacaine plus buprenorphine for infragluteal sciatic block and 1 ml normal saline intramuscularly. Results:Although patients receiving buprenorphine either for sciatic block or intramuscularly had less pain in the postanesthesia care unit compared with patients receiving only bupivacaine, the individual pair-wise comparison of the analysis of variance model showed no statistical difference. However, only buprenorphine added to bupivacaine for sciatic block prolonged postoperative analgesia. Patients receiving a combination of buprenorphine and bupivacaine for sciatic block had lower numeric rating pain scores and received less opioid medication at home than patients in the other two groups. Conclusions:The results show that buprenorphine may enhance and prolong the analgesic effect of bupivacaine when used for sciatic nerve blocks in patients undergoing foot and ankle surgery under general anesthesia but does not do so to the extent shown in previous studies using brachial plexus models with mepivacaine and tetracaine.

Expression of Th1 and Th17 cytokines and transcription factors in multiple sclerosis patients: does baseline T-bet mRNA predict the response to interferon-beta treatment?

We studied the effect of one-year interferon (IFN)-beta treatment on the in vivo mRNA expression of IFN-gamma, interleukin (IL)-17, T-bet and RoR-gammat, on peripheral blood mononuclear cells (PBMC) from 36 multiple sclerosis (MS) patients. In the total MS group, IFN-beta induced decrease in mRNA levels of IFN-gamma and T-bet (p<0.0001), while the levels of IL-17 and RoR-gammat remained similar. In both responders and non-responders, IFN-beta induced significant decrease of IFN-gamma (p<0.0001 and p=0.011, respectively), while decrease in T-bet was detected only in responders (p<0.0001). Higher pre-treatment T-bet allowed prediction of the clinical response in the first year (beta=0.601, p=0.036). Our preliminary findings suggest that T-bet expression might be a potential prognostic marker of treatment response to IFN-beta in MS.

Maternal satisfaction with organized perinatal care in Serbian public hospitals

BackgroundUnderstanding 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.MethodsOur 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.ResultsWe 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.ConclusionsOur 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.

Physician and nurse supply in Serbia using time-series data

BackgroundUnemployment among health professionals in Serbia has risen in the recent past and continues to increase. This highlights the need to understand how to change policies to meet real and projected needs. This study identified variables that were significantly related to physician and nurse employment rates in the public healthcare sector in Serbia from 1961 to 2008 and used these to develop parameters to model physician and nurse supply in the public healthcare sector through to 2015.MethodsThe relationships among six variables used for planning physician and nurse employment in public healthcare sector in Serbia were identified for two periods: 1961 to 1982 and 1983 to 2008. Those variables included: the annual total national population; gross domestic product adjusted to 1994 prices; inpatient care discharges; outpatient care visits; students enrolled in the first year of medical studies at public universities; and the annual number of graduated physicians. Based on historic trends, physician supply and nurse supply in the public healthcare sector by 2015 (with corresponding 95% confidence level) have been modeled using Autoregressive Integrated Moving Average (ARIMA) / Transfer function (TF) models.ResultsThe ARIMA/TF modeling yielded stable and significant forecasts of physician supply (stationary R2 squared = 0.71) and nurse supply (stationary R2 squared = 0.92) in the public healthcare sector in Serbia through to 2015. The most significant predictors for physician employment were the population and GDP. The supply of nursing staff was, in turn, related to the number of physicians. Physician and nurse rates per 100,000 population increased by 13%. The model predicts a seven-year mismatch between the supply of graduates and vacancies in the public healthcare sector is forecasted at 8,698 physicians - a net surplus.ConclusionThe ARIMA model can be used to project trends, especially those that identify significant mismatches between forecasted supply of physicians and vacancies and can be used to guide decision-making for enrollment planning for the medical schools in Serbia. Serbia needs an inter-sectoral strategy for HRH development that is more coherent with healthcare objectives and more accountable in terms of professional mobility.

Training hospital managers for strategic planning and management: a prospective study

BackgroundTraining is the systematic acquisition of skills, rules, concepts, or attitudes and is one of the most important components in any organization’s strategy. There is increasing demand for formal and informal training programs especially for physicians in leadership positions. This study determined the learning outcomes after a specific training program for hospital management teams.MethodsThe study was conducted during 2006 and 2007 at the Centre School of Public Health and Management, Faculty of Medicine, University of Belgrade and included 107 participants involved in the management in 20 Serbian general hospitals. The management teams were multidisciplinary, consisting of five members on average: the director of the general hospital, the deputy directors, the head nurse, and the chiefs of support services. The managers attended a training program, which comprised four modules addressing specific topics. Three reviewers independently evaluated the level of management skills at the beginning and 12 months after the training program. Principal component analysis and subsequent stepwise multiple linear regression analysis were performed to determine predictors of learning outcomes.ResultsThe quality of the SWOT (strengths, weaknesses, opportunities and threats) analyses performed by the trainees improved with differences between 0.35 and 0.49 on a Likert scale (p < 0.001). Principal component analysis explained 81% of the variance affecting their quality of strategic planning. Following the training program, the external environment, strategic positioning, and quality of care were predictors of learning outcomes. The four regression models used showed that the training program had positive effects (p < 0.001) on the ability to formulate a Strategic Plan comprising the hospital mission, vision, strategic objectives, and action plan.ConclusionThis study provided evidence that training for strategic planning and management enhanced the strategic decision-making of hospital management teams, which is a requirement for hospitals in an increasingly competitive, complex and challenging context. For the first time, half of state general hospitals involved in team training have formulated the development of an official strategic plan. The positive effects of the formal training program justify additional investment in future education and training.

Weekly variation of hospital admissions for stroke in Nis (Serbia)

OBJECTIVES Weekly variability in stroke occurrence could be related to the change in behaviors of patients or medical personnel that occur during certain periods of the week. The aim of the present study was to examine the weekly variation in hospital admissions for stroke in Nis (Serbia), as well as to investigate how the demographic factors influenced these changes. PATIENTS AND METHODS The main data source for this study was the Nis Stroke Registry. During the study period (1996-2007) a total of 9675 stroke patients were registered. According to stroke subtypes, all registered patients were divided into three groups: patients with subarachnoid hemorrhage (SAH) (438 or 4.5%), patients with intracerebral hemorrhage (ICH) (1576 or 16.3%) and patients with ischemic stroke (IS) (6946 or 71.8%). Analyses were conducted separately for SAH, ICH and IS. Each stroke type was stratified by gender, age group and education level. RESULTS We have showed that there is a significant weekly variability in the number of SAH (p=0.028) and IS (p<0.001) admissions, with the minimum number of admissions on Sundays (39.27 and 14.04% less than expected), and the maximum one on Tuesdays (21.46% more than expected) and Wednesdays (10.96% more than expected), respectively. We have also registered more SAH (p=0.015) and IS (p<0.001) admissions on weekdays than on weekend days. CONCLUSION Results of this hospital-based study confirm that there is a pattern in the variation of the number of stroke admissions on the weekly level. Reasons for the weekly variation of hospital admissions for stroke cannot be determined from the present study.

Hospitalizations due to spontaneous intracerebral hemorrhage in the region of Nis (Serbia): 11-year time-series analysis

BACKGROUND The study of seasonal variability of intracerebral hemorrhage (ICH) occurrence may contribute to a better understanding of the nature of this disease and open up new perspectives in its prevention. The aim of this study was to test seasonal patterns in the number of admissions of ICH patients and determine which months have maximal and minimal number of admissions. METHODS The main data source for this study was a hospital-based registry at the Clinic of Neurology in Nis, Serbia. During the studied period (1997-2007) a total of 1569 ICH patients were registered. Time series, consisting of the monthly number of hospitalized patients, for the 128 months of the study duration, has been successfully modeled using the multiplicative Auto Regressive Integrated Moving Average (ARIMA) model. RESULTS Using the maximum likelihood method, utilizing Melrads algorithm, the parameters of this ARIMA model have been calculated: constant (estimate 12.068, p<0.001), auto regressive-AR(1) (estimate 0.866, p<0.001), moving average-MA(1) (estimate 0.775, p<0.001), seasonal moving average-SMA(12) (estimate -0.198, p=0.036). ARIMA modeling has been successful and showed that there is a clear seasonal pattern in the data analyzed. CONCLUSION Based on the seasonal multiplicative ARIMA model and the seasonal time series decomposition, we showed that, in the period covered by the study, the peak of admissions occurred in March, and the trough of admissions was found in August.

Self-perceived health and psychological well-being among Serbian schoolchildren and adolescents: data from National Health Survey

The purpose was to determinate possible factors associated with psychosocial health through self-perceived health and psychological well-being among Serbian schoolchildren and adolescents. A cross-sectional study. The study is based on the 2006 National Health Survey of the population of Serbia. A total of 2,721 schoolchildren and adolescents were included. Face-to-face questionnaire and self-administered questionnaire were used for collection of data. For the assessment of psychosocial health we created two indicators (varibles): Self perceived health (using the categorical principal components), and Psychological well-being (using reliability analisys). Data were analyzed using descriptive statistics, Pearson’s correlation coeficient and categorical regression. Self-perceived health was found to have a positive association with gender, age, objective and subjective socioeconomic status. Psychological well-being was associated with gender, age, social support, objective and subjective socioeconomic status. Age group was strongly associated with self-perceived health and psychological well-being. Older respondents and female perceived their health to be better than others. Male and respondents in age group 7–11 had higher levels of psychological well-being. Results show that both demographic and socioeconomic variables have an important influence on schoolchildren and adolescent self-perceived health and psychological well-being.

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.

AUPOV morphological versus molecular markers for maize inbred lines variability determination

7 CHILEAN JOURNAL OF AGRICULTURAL RESEARCH 76(1) JANUARY-MARCH 2016 4 OCTOBER DECEMBER 2016 In maize (Zea mays L.) breeding programs, it is very important to define a genetic distance of inbred lines and to establish criteria and biometric methods for the satisfactory germplasm classification. A total of 29 inbred lines from Maize Research Institute “Zemun Polje” (MRIZP) breeding program, Belgrade, Serbia, were used to compare similarities obtained by morphological (according to UPOV Union Internationale pour la Protection des Obtentions Végétales) and molecular (simple sequence repeats, SSR) markers. The aim was to assess discriminative power of applied markers in the separation of related lines, and to determine the possibility of their application in choosing parental lines for breeding programs. Application of different marker types resulted in adequate separation of inbreds into divergent groups, which facilitates the choice of parental lines. However, there were still many inconsistencies between the field and laboratory results. The quality of information from morphological markers was improved by the application of the appropriate descriptor, measurement scale and the biometric method. According to the correspondence analysis, increased number of SSR markers will enable more reliable results. Regression analysis of morphological visual assessment (MVG) and SSR similarity of individual inbreds pointed out that in some cases morphological, and in others molecular markers more accurately reflected known pedigree information of tested maize lines. In the early generations of maize inbred lines testing, we propose utilization of information resulting from morphological markers, according to UPOV descriptor. However, application of adequate number of molecular (SSR) markers has an economic justification on a smaller number of elite lines in the later generations of line testing.