Search

Background Regulation of private health care providers (PHPs) in middle-income countries can be challenging. Mandatory safety and quality standards for PHPs have been in place in the Republic of Srpska since 2012, but not all PHPs have adopted them yet. Adoption rates have differed among different types of providers. We studied three predominant types of PHPs to determine why the rate of adoption of the standards varies among them. Methods This study used a mixed methods approach, which allowed the integration of both quantitative and qualitative data, to develop an explanatory case study. The case study covered three types of private PHPs: pharmacies, dental practices and specialist practices. Primary data were collected through face-to-face semi-structured in-depth interviews and a self-administered postal survey of private health care providers. Our study’s theoretical framework was based on the diffusion of innovation theory. Results The rate of adoption of mandatory standards varied among different types of PHP mainly due to four factors: (1) level of concern about negative financial consequences, such as the risk of fines or of losing contracts with the Health Insurance Fund of the Republic of Srpska; (2) availability of information on the standards and implementation process; (3) level of the relevant professional association’s support for the introduction of standards; and (4) provider’s perceptions of the relevant health chamber’s attitude toward the standards. Opinions conveyed to PHPs by peers slightly negatively influenced adoption of the standards at the attitude-forming stage. Perceived gains in professional status did not have a major influence on the decision to adopt standards. All three types of PHPs perceived the same disadvantages of the introduction of safety and quality standards: associated expense, increased administrative burden and disruption of service provision. Conclusions When introducing mandatory quality and safety standards for PHPs, national health authorities need to: ensure adequate availability of information on the relative advantages of adhering to standards; support the introduction of standards with relevant incentives and penalties; and work in partnership with relevant professional associations and health chambers to get their buy-in for regulation of quality and safety of health services. Electronic supplementary material The online version of this article (10.1186/s12939-018-0806-0) contains supplementary material, which is available to authorized users.

Introduction/Objective. Work motivation and job satisfaction are key issues for organizations nowadays. The aim of this study was to examine whether there is a difference in work motivation and job satisfaction among doctors and nurses in Vojvodina, Serbia. Methods. The study included a sample of 230 doctors and 489 nurses, employed in three health centers. Data collection was performed using a self-administered questionnaire. Results. The doctors, compared to the nurses, were significantly more motivated by the work motivation factors: accomplishing goals of the health center, good work relationships, positive work environment, possibilities for improvement, and independence at work. Compared to nurses, doctors were significantly more satisfied with the level of independence at work. Conclusion. In comparison to nurses, the doctors are more motivated and satisfied with their job.

Introduction. Inter-professional education is the first step towards the effective collaborative practice of future health care workers and one of the prerequisites for the highest quality health care. Therefore, the aim of this study was to assess the readiness for inter-professional education among medical science students. Material and Methods. The research was conducted as a descriptive cross sectional study by surveying 406 students of five study profiles at the Faculty of Medicine at the University of Novi Sad. The Serbian version of The Readiness for Inter-professional Learning Scale and questionnaire on sociodemographic data were used as research instruments. The Readiness for Inter-professional Learning Scale comprises a total of 19 items grouped into two sub-scales: ?team?work, collaboration and shared learning? and ?role and responsibilities?. The methods of descriptive and inferential statistics were used, and statistically significant values were considered significant at the p

The roles of the pharmacist were transformed throughout the history and modern pharmacist as we know now beside providing products and playing in optimization of medicines has a crucial role in ensuring the efficacy and safety of applied drugs. A better life quality, global health and safety is the major goal of the 21st century and to achieve that great span of roles pharmacy profession involves now. The paper highlighted new roles of the pharmacist today in order to better understand the transition of the pharmacy profession.

Aim: To examine different aspects of job satisfaction among nurses in health centres in Belgrade. Methods: The study included 261 nurses, employed in two health centers. For data collecting was used questionnaire which was anonymous. Results: A considerable number of nurses were more satisfied than dissatisfied with interpersonal relationships, monthly income, training opportunities, autonomy in the workplace, and current equipment. Nurses were satisfied with the fulfillment of certain factors of job satisfaction by health institutions in the following order: training opportunities, current equipment, good interpersonal relationships, monthly income, and autonomy in the workplace. Conclusion: Nurses were more satisfied than dissatisfied with their job. The leading factor of job satisfaction of nurses in regard to the level of its fulfillment by the health institution is training opportunities.

Introduction/Objective. Not only do pre-pregnancy overweight or obesity increase the risk of adverse maternal and perinatal outcomes but they also lead to the development of gestational diabetes mellitus. The objective of this study was to estimate the prevalence of pre-pregnancy overweight and obesity in the Republic of Srpska and to investigate its association with hyperglycemia and risk of gestational diabetes mellitus. Methods. A cross-sectional study was carried out during the period from February to October 2012 among 555 pregnant women in gestational period from 24 to 28 weeks. The criterion for exclusion from the sample was previously diagnosed type 1 or type 2 diabetes. Results. Before pregnancy, 20.39% of participants had increased body mass index, while 4.04 % [95% confidence interval (CI); 2.62?6.13] were obese. Gestational diabetes mellitus was diagnosed in 10.91% (95% CI, 8.44?13.98) of them. The increase in body mass index by 1 increased the risk of gestational diabetes mellitus by 1.09 times [odds ratio (OR) = 1.09; 95% CI; 1.02?1.16]. Pregnant women who were overweight had a 4.88 times greater risk (OR = 4.88; 95% CI, 1.23?29.41) of developing gestational diabetes. Conclusion. Every fifth pregnant woman in this study was overweight or obese before pregnancy. The increase in body mass index by 1 increased the risk of gestational diabetes by 1.09 times (OR = 1.09; 95% CI; 1.02?1.16). Counselling is necessary for overweight and obese women planning pregnancy.

The primary objectives were to assess the prevalence of dietary supplement (DS) use and to identify specific demographic and lifestyle characteristics of DS users from Novi Sad, Serbia as well as the most commonly used DS and reasons for their use.Observational, cross-sectional study.Data on demographics, lifestyle and dietary supplement use of 435 adults from Novi Sad, Serbia were collected using an online questionnaire.In total, 435 subjects completed the questionnaire (62.3% women). Prevalence of dietary supplement use in the sample was 42.8%. More women used DS than men (p = 0.002). Higher use of DS was reported among individuals 65+, while the young used DS less (p = 0.001), but the highest proportions of DS users was from the 45-54 age group. DS were used more among those with lower education levels (p 0.001) and no income (p = 0.009). The highest percentages of DS users reported daily intakes of fruits and moderate physical activity, were non-smokers and social drinkers. Main reason for DS use was maintaining general health. The most commonly used DS were minerals and/or vitamins (68.8%).We report a high prevalence of dietary supplement use in Novi Sad. DS use was associated with being a female, being older and having minimal/average income, the latter being opposite of the usual findings. Our results warrant a more detailed examination of the association between income, DS use and healthcare availability in developing countries such as Serbia.

Background/Aim. Motivated and job satisfied health professionals represent a basis of success of modern health institutions. The aim of this study was to investigate whether there was a difference in work motivation and job satisfaction between health workers in urban and rural areas in the region of Central Serbia. Methods. The study included 396 health professionals from urban setting, and 436 from a rural area, employed in four randomly selected health facilities. An anonymous questionnaire was used for data gathering. Statistical analysis was performed using ?2, Student t-test, Spearman's correlation coefficient, and logistic regression analysis. Results. Urban health professionals were significantly more motivated and job satisfied than respondents from rural area. In relation to work motivation factors and job satisfaction of health professionals in urban and rural areas, there were no significant differences in working conditions and current equipment, and in terms of job satisfaction there were no significant differences in relation to income either. Conclusion. In order to increase the level of work motivation and job satisfaction of health workers in rural areas, apart from better income, they should get more assistance and support from their supervisors, and awards for good job performance; interpersonal relationships, promotion and advancement opportunities, managerial performance and cooperation at work should be improved; employment security should be provided, as well as more independence at work, with professional supervision of health workers.

Background/Aim. Data on sodium intake and sources of sodium in the diet in Serbia are limited. The aim of this study was to estimate the sodium intake and identify the sources of sodium in the diet of undergraduate students attending the University of Novi Sad. Methods. Students completed a questionnaire to gather data on their gender, age and university faculty attended, and then a 24 h dietary recall. The sodium intake of the students was calculated using the dietary recall data and data on the sodium content of foods. The contribution of different food groups as well as of specific foodstuffs to the total sodium intake was calculated. Results. The mean estimated sodium intake of the students was 3,938.5 ± 1,708.1 mg/day. The sodium intake of 89.1% of the surveyed students exceeded the guideline for sodium intake, the majority of the sodium coming from processed foods (78.9% of the total sodium intake). The food groups that contributed the most to the total sodium intake of the students were meat and meat products (21.7%) and cereals and cereal-based products (18.6%). Bread and other bakery products were responsible for 13.1% of the total sodium intake. Conclusion. High sodium intake in students of the University of Novi Sad puts them at high risk of developing high blood pressure. The food industry should work towards reformulating products with high sodium content, especially bread and other bakery products. Efforts should be taken to reduce sodium intake among undergraduate students in Novi Sad.

Interview guide for the private healthcare providers that have completed certification. Interview guide used for interviews with pharmacies, specialist practices and dental practices that adopted the safety and quality standards. (DOC 56 kb)

Questionnaire for the private healthcare providers. The questionnaire used in self-administered postal survey of pharmacies, specialist practices and dental practices. (DOC 190 kb)

Interview guide for the private healthcare providers that have not completed certification. Interview guide used for interviews with pharmacies, specialist practices and dental practices that adopted the safety and quality standards. (DOC 74 kb)

Introduction. Children with hearing impairment do not understand speech without specific instructions and cannot meet daily life requirements. Children with hearing and speech impairment have higher DMFT index and poorer oral hygiene than healthy children of the same age. The aim of this study was to determine oral health status and the prevalence of dental caries in children attending The Center for Education and Rehabilitation of Speech and Hearing in Banjaluka. Material and Methods. The study was conducted as a cross-sectional study and it included 66 children of both genders, age 3 to 18 years, with deciduous, mixed and permanent dentition. General information about the respondents, their socioeconomic status, dental hygiene habits and frequency of dental visits were obtained using a questionnaire. Dental examination was performed using a dental mirror, regular and proximal probe on the daylight, in accordance with World Health Organization guidelines. Oral examination included: number of present teeth, presence of caries, restorations, number of extracted teeth. These data was entered in each patient’s dental record. The DMFT index was used for the assessment of dental status. Results. Results showed that the mean DMFT value in the total sample was 7.79. There was no significant difference in the DMFT index between genders (p=0.19). The significant difference was not found between children who live with parents and those who live in foster families (p=0.15). It was observed that the respondents from rural areas had higher DMFT index (8.68) than respondents from urban areas (5.83). The DMFT index increased with age and school age (p

Introduction. Dental status in people with special needs is generally non satisfactory. Children with special needs have difficulties in maintaining oral hygiene, they require special conditions for dental care and because of previous negative experience they often show emotional vulnerability. Development of oral and dental diseases in these subjects is the consequence of insufficient knowledge about the causes of these diseases, poor eating habits, low level of oral hygiene and inadequate number of visits to dentist. The aim of this study was to determine dental status and the prevalence of dental caries in children with special needs in the institution “Zastiti me” in Banjaluka. Material and Methods. The study included 82 children (53 boys and 29 girls) with mixed and permanent dentition age 5-15 years. They were divided into four groups according to their diagnosis. The first group included children with combined disorders of speech development and hearing, in the second group were children who had neurological disorders without mental retardation, third group included children with mild mental retardation and fourth group comprised children with moderate mental retardation. For each patient the number of teeth, the presence of caries and restorations, the number of extracted teeth, the presence of residual roots and the presence and number of fixed restorations were recorded. Results. Mean DMFT of all teeth was 9.77. Detailed analysis showed the greatest number of decayed teeth (83.83%), and filled teeth (9.52%) whereas the least number was for extracted teeth (6.65%). The highest percentage of children (79.27%) did not have any class I composite filling or one amalgam filling class I (82.92%). Only one child had a fixed restoration. Conclusion. The status of teeth in children with special needs in the institution “Zastiti me” in Banjaluka indicated high percentage of carious teeth, small percentage of restorations and extracted teeth, and inadequate oral hygiene.

Introduction: Basic purpose of health claims is consumers' benefit by providing information about healthy eating habits. It is necessary for health claims to be scientifically substantiated and truthful. Health claims should not attribute to food the property of preventing, treating or curing a human disease. Use of health claims should be followed by a statement indicating the importance of a varied and balanced diet and a healthy lifestyle. The objective of this research was to examine the compliance of health claims made on multivitamin and mineral dietary supplements' labels on the Serbian market with national regulation concerning health safety of dietary products.Methods: An assessment of labels of MVMs was done in two privately owned pharmacies in Novi Sad, Serbia in August 2010.Results: In total, 48 MVMs were sampled and 22 health claims were detected. Seven out of 22 health claims were in compliance with the national regulation. The main reason for health claims on foreign MVMs not to be compliant with the regulation in Serbia was inadequate or nonexistent translation of original labels.Conclusion: Detected use of terms such as "prevention", "treatment" and "indications" on vitamin and mineral dietary supplements' labels is both forbidden and misleading to consumers. Coupled with inadequate or nonexistent translation of the labels, it leads to a low level of protection of Serbian consumers. It is necessary to establish an effective monitoring system for dietary supplements' labeling on a national scale in order toprotect consumers and their wellbeing.

Background/Aim. According to the literature that has been published over the last two decades Campylobacter spp i Listeria monocitogens can be identified as causes of numerous diseases derived by consuming food of animal origin. The purpose of this paper was to find out how established national microbiological criteria of the Republic of Serbia on food safety in retailed food of animal origin could contribute to consumer's protection against exposition to foodborne pathogens such as Campylobacter spp. and Listeria monocytogenes. Methods. During a routine microbiological safety control of randomly selected 60 samples of fresh poultry meat, 30 samples of other fresh meat readymade for grilling, 30 samples of sausage products, 37 samples of heattreated meat, 39 samples of toppings for fast food of animal origin and 31 samples of dairy products a national food safety criteria (Escherichia coli, aerobic plate count, Salmonella spp., coagulasa positive Staphylococcus, Proteus spp., sulphitoreducting Clostridia) were applied and, as well as, testing to Campylobacter spp. and Listeria monocitogens. In determination of Campylobacter spp. and Listeria monocytogenes, food quality control methods of the Food and Agriculture Organization (FAO) were applied, while in determination of the other above motioned bacteria, national provisions on microbiological methods were applied who are adjusted to the FAO ones. Results. Related to the national criteria on microbiological food safety, 88 (38.8%) samples, out of the total 227 tested, were rejected. When to these results, the results of laboratory tests on Listeria monocytogens were added, a terminal number of rejected samples were not changed. When to these results, the results of Campylobacter spp. testing were added, 91 (40.1%) out of the 227 samples were unsatisfied. Results of logistic regression model with occurrence of Escherichia coli as dependent variable indicated that Escherichia coli was 4.5 times likely to occur among samples with Campylobacter spp. than among samples without Campylobacter spp. (OR = 4.515, 95% CI: 1.019-20.002). Sensitivity of the fitted model (Hosmer-Lemeshow p = 0.268) was 76.8% and its specificity was 75.0%. At the same time Escherichia coli was confound in all (100%) food samples that were contaminated by Listeria monocytogenes. Conclusion. Statistical analysis indicated that Escherichia coli was completely sensitive to identify all samples contaminated with Listeria monocytogenas and highly sensitive to identify samples contaminated with Campylobacter spp. Nevertheless, 3 (1.3%) of the tested samples were not covered with Escherichia coli.

Introduction. Diet has vital, preventive and therapeutic functions. Medical nutrition therapy is a part of the Standardized Nutrition Care Process integrated in health care systems. Material and methods. An overview of the Nutrition Care Process model and the application of nutrition guidelines based on literature, reports, documents and programmes of international health, food and physical activity authorities was done. Results. The Nutrition Care Process model requires registered dieticians, standardized terminology as well as nutrition diagnosis categorization. It consists of four distinct, but interrelated and connected steps: (a) nutrition assessment, (b) nutrition diagnosis, (c) nutrition intervention, and (d) nutrition monitoring and evaluation. An individual approach is essential for successful medical nutrition therapy. Nutrition guidelines facilitate the process of understanding and application of medical nutrition therapy. Conclusion. The Nutrition Care process provides dietetic professionals information on high-quality client nutrition care. The success of medical nutrition therapy rests not only upon the advice of the dietician, but also upon the client?s compliance.

Introduction. Investigations have brought evidence that salt intake is positively related to systolic blood pressure and that children with higher blood pressure are more susceptible to hypertension in adulthood. In developed countries the main source of salt is processed food. Objective The aim of this paper was to determine total sodium chloride (NaCl) in average daily meal (breakfast, snack and dinner) and in each of three meals children receive in kindergarten. Methods. From kindergarten, in the meal time, 88 samples of daily meals ( breakfast, snacks and dinner) offered to children aged 4-6 years were taken. Standardized laboratory methods were applied to determine proteins, fats, ash and water in order to calculate energy value of meal. The titrimetric method with AgNO3, and K2CrO4 as indicator, was applied in order to determine chloride ion. Content of NaCl was calculated as %NaCl = mlAgNO3 × 0.05844 × 5 × 100/g tested portion. NaCl content in total daily meal and each meal and in 100 kcal of each meal was calculated using descriptive statistical method. Student’s t-test was applied to determine statistical differences of NaCl amount among meals. Results. NaCl content in average daily meal was 5.2±1.7 g (CV 31.7%), in breakfast 1.5±0.6 g (CV 37.5%), in dinner 3.5±1.6 g (CV 46.1%) and in snack 0.3±0.4 g (CV 163.3%). NaCl content per 100 kcal of breakfast was 0.4±0.1 g (CV 29.5%), dinner 0.7±0.2 g (CV 27.8%) and snack 0.13±0.19 g (CV 145.8%). The difference of NaCl content among meals was statistically significant (p

Cancer development is a result of interactions among environmental and hereditary factors (Kim, 2006). The majority of genetic abnormalities, which increase the risk of cancer are not hereditary, but a result of DNA damage occurring during lifetime. The causes of DNA damage include internal (nutrient metabolism, cell hormones) and/or external factors (diet, insufficient physical activity, tobacco use, exposure to chemical agents and radiation) (International Life Sciences Institute [ILSI], 2005; World Cancer Research Fund [WCRF], 2007; Kryston et al., 2011). Epidemiological studies have shown that diet and lifestyle are the most important external factors implicated in the development of malignant diseases (ILSI, 2005; WCRF & AICR, 2007; Go et al., 2003).

Introduction: The role of salt in the diet is very important, however what effect will lead to its entry into the organism depends on the amount of salt ingested. Elevated salt intake is a risk factor for hypertension, heart disease, adversely affects the kidneys, helps the development of osteoporosis. The aim was to examine sodium intake in the student population through an objective assessment of nutrition students and the students' subjective experience of salty foods and salty foods influence on the organism.Methods: The research is cross-sectional study, which is carried out in April 2010 among students at the University of Sarajevo.Results: More than half of students from the FHS considers that the greatest amount of salt into the body, adding salt to food during the meal, 34% considered that it was during the preparation of food by 10% of processed products in the food industry and 4% said that it was the intake of salt, which naturally found in foods. Not in a group of students there who suffer from hypertension, while in their families the disease is present.Conclusions: Subjects eat a quantity of salt that are well above the recommended. This problem must be approached in a more organized educational, health educational and research terms.

Introduction. The Department of Hygiene, Faculty of Medicine, University of Novi Sad, is responsible for undergraduate and graduate courses in the field of preventive medicine. The principal task of physicians in the 21st century is to provide health promotion and disease prevention. In the future, evaluation of physician knowledge and competence will be predominantly based on patients' health conditions. Health and Environment. Human health is a result of long-term interaction between human genome and the environment. Good human health requires permanent control of health conditions as well as control of environmental health hazards. Various environmental factors, such as physical, chemical, biological, social and economic, affect the population health. Air, drinking water and food are fundamental to the existence of life of all living beings on Earth, and therefore they have enormous influence on the health of individuals and populations. Conclusion. The significance of the above mentioned requirements, essential for human health, is the reason why the Department of Hygiene conducted an investigation on the quality of air, food and water (water is a foodstuff as well) in Vojvodina.

The official reporting system in the Province of Vojvodina (PV) indicates that cases of human salmonellosis were partly covered by complete epidemiological investigation including laboratory analysis of the suspected food. Intestinal campylobacteriosis and yersiniosis and four cases of septicemias caused by Listeria monocytogenes were not fully epidemiologically investigated. Actual country legislation on food safety does not include provisions for a routine control of the above mentioned pathogens except for Salmonella. In the PV, there are no other sources of data that contribute to risk assessment of the above food-borne diseases. A pilot investigation, performed in Novi Sad, indicated that 8.17% out of the total number of 257 retail food samples (90 of fresh meat and 167 of ready-to-eat food) had been contaminated with one of the tested bacteria Campylobacter or Salmonella or Listeria monocytogenes. Yersinia enterocolitica was not detected in any of the tested samples. Fresh poultry meat and other fresh meats were the dominant sources of the detected pathogens compared to samples of ready-to-eat food (p0.05). Campylobacter was detected in 18.8% and 10.0% samples of fresh poultry and other fresh meat respectively, which was not statistically significant (p0.05). Salmonella was detected in 3.3% samples of fresh poultry meat. Listeria monocytogenes was detected in 5.0% samples of fresh poultry and in 3.3% samples of other fresh meat, the difference was not statistically significant (p0.05). One sample (0.6%) of ready to eat food was contaminated with Campylobacter and one (0.6%) with Salmonella.

Introduction: Today’s lifestyle is characterized by increased intake of calories with reduced physical activity, which benefits a real epidemic of obesity in the population. The increase in the prevalence of hypertension in the population follows a significant increase in the prevalence of obesity. Parallel to the trend of increasing the number of older population with increased cardiovascular disease. The aim: The aim of our study was to determine the value of body mass index and determine the correlation of obesity and arterial hypertension. Material and methods: The study was conducted in family medicine Clinic of the Primary Health Care Center Zenica. Out of 600 patients of both sexes aged over 18 years, randomly are formed groups of 188 patients with hypertension and 189 patients without hypertension of the same gender and same age. The study included patients with primary or essential hypertension, and excluded patients with secondary hypertension, hypertension due to renal disease, pheochromocytoma, coarctation of the aorta, as a result of taking oral contraceptives, corticosteroids, and cocaine. We used the method of anthropometric measurements (body weight, body height from which is calculated the body mass index) measurement of blood pressure with the statistical data processing at the significance level of p