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BACKGROUND We evaluated the prevalence of high blood pressure and the level of awareness, treatment, and control of hypertension in a Serbian population. METHODS A cross-sectional study of an adult population was carried out across Serbia in 2006. The study involved 14 204 adults aged 20 years or older. Interviews and measurements of blood pressure were performed at participants' homes. RESULTS Overall, 47% of the Serbian adult population had hypertension: 25.3% had stage 1 hypertension and 18.1% had stage 2 hypertension. Only 58.0% of the hypertensive population were aware that they had the disease, and 60.4% were receiving medical treatment. Among those receiving medical treatment, only 20.9% had a blood pressure within the normal range. One in 10 participants with hypertension were not treated because, among other reasons, they thought treatment was unnecessary (55.3%) or they lacked money for medication (19.3%). CONCLUSIONS The prevalence of undiagnosed and untreated hypertension is high in the adult population of Serbia. Further action is required to hasten detection and treatment of high blood pressure. Attention should be directed toward educational programs that improve knowledge, attitudes, and awareness of hypertension among adults.

WHO policy “Health for all” defines ten global goals and one of them is relating to health care quality: “Improvement of comprehensive high quality health care”. There are numerous definitions of health care and WHO defines it as “the level where delivered health care achieves the best results establishing the balance between the risk and benefit within specified economic conditions”. Basic dimensions of quality are equality, relevance, accessibility, acceptability, effectiveness and efficiency. Motives for establishing the system of quality in health care are professional, socio-economical, patients’ satisfaction, and the final and the most important at the same time – improvement of population health. Modern concept of quality means implementation of TQM (Total Quality Management) and CQI (Continuous Quality Improvement) that represent managing strategies whose main steps are managing consciousness, strategic planning, management implementation and training of employees. Principles are that patients’ needs, opinions and experience are the important information in permanent improvement of quality, that it has to be integrated part of everyday work, that all employees in the system of health care have professional responsibility according to permanent improvement of quality and particular responsibility have managers at all levels in health institution, that permanent improvement of quality means positive approach to work and that all activities should be based on data and information not on assumptions. Significant parameter of quality is also patients’ satisfaction, which is defined by WHO as “the level when the health system has satisfied patients’ expectations”. One of the approaches in management and explicit measuring of quality is also accreditation and its purpose is improvement of quality, gaining of information and responsibility., Programmes for Training on Research in Public Health for South Eastern Europe, Programmes for Training on Research in Public Health for South Eastern Europe. Vol. 5: Management in Health Care Practice: A Handbook for Teachers, Researchers and Health Professionals

Depresija je jedan od najčešćih mentalnih poremećaja u opštoj populaciji širom sveta i prema podacima Svetske zdravstvene organizacije se nalazi na trećem mestu globalnog opterećenja bolestima. Cilj ovog istraživanja je bio da se utvrdi prevalencija depresije u populaciji odraslog stanovništva Vojvodine, da se identifikuju kategorije stanovništva pod najvećim rizikom i da se utvrdi povezanost depresije sa determinantama zdravlja, zdravstvenim stanjem i korišćenjem zdravstvene zaštite. Istraživanje je sprovedeno kao studija preseka na reprezentativnom uzorku stanovništva Vojvodine starosti 15 i više godina, kao deo nacionalne studije „Istraživanje zdravlja stanovništva Srbije“ koju je sprovelo Ministarstvo zdravlja Republike Srbije 2013. godine. Kao instrument istraživanja su korišćeni upitnici konstruisani u skladu sa upitnikom Evropskog istraživanja zdravlja. Prisustvo depresivnih simptoma je analizirano primenom PHQ-8 upitnika (Patient Health Questionnaire-8) a vrednost PHQ-8 skora 10 i više je ukazivala na prisustvo depresivne epizode (depresije). Istraživanjem je obuhvaćeno 3550 ispitanika prosečne starosti 50,2 godine. Prevalencija depresije je iznosila 4,8%. Primenom multivarijantne regresije je utvrđeno da žene imaju za 40% veću šansu za depresiju u odnosu na muškarce (OR=1,4), a kao prediktori depresije su se pokazali i starija životna dob, razvod/razlaz ili udovstvo, niži nivo obrazovanja, nezaposlenost, ekonomska neaktivnost i niži materijalni status. Osobe koje su u mesecu koji je prethodio istraživanju bile izložene stresu su imale oko sedam puta veću šansu za depresiju (OR=6,8), a kod ispitanika sa lošom socijalnom podrškom šansa za depresiju je bila oko četiri puta veća nego kod ispitanika sa jakom socijalnom podrškom (OR=3,7). Multimorbiditet je bio značajno prisutniji među ispitanicima sa depresijom, a šansa za prisustvo dve ili više hroničnih bolesti je kod njih bila skoro pet puta veća (OR=4,6) u odnosu na ispitanike koji nisu imali depresivne simptome. Depresija se pokazala i kao značajan prediktor češćeg korišćenja usluga zdravstvene zaštite. Dobijeni rezultati su potvrdili javnozdravstveni značaj depresije i istovremeno obezbedili podatke koji se mogu koristiti kao osnova za buduća prospektivna istraživanja, kao i za kreiranje programa za prevenciju i kontrolu depresivnih poremećaja i unapređenje mentalnog zdravlja., Depression is one of the most common mental disorders in the general population worldwide and according to the World Health Organization it is the third leading cause of the global burden of disease. The aim of this study was to determine the prevalence of depression in the adult population of Vojvodina, to identify groups at the greatest risk of depression and to determine the relationship of depression with health determinants, health status and use of health care services. The research was carried out as a cross-sectional study on a representative sample of the population of Vojvodina, aged 15 and over as part of the National Health Survey of Serbia which was conducted by the Ministry of Health of the Republic of Serbia in 2013. Data was gathered by using questionnaires designed in accordance to the European Health Interview Survey. The presence of depressive symptoms was analyzed using the PHQ-8 questionnaire (Patient Health Questionnaire-8) and the score of 10 or above indicated a presence of a depressive episode (depression). The study included 3550 examinees with an average age of 50.2 years. The prevalence of depression was 4.8%. Multivariate regression showed that women had a 40% greater chance to suffer from depression as compared to men (OR=1.4). Also, factors such as older age, divorce/separation or widowhood, lower level of education, economic inactivity and poor financial situation were predictors of depression. People who were exposed to stress in the month prior to the survey had about seven times greater odds of depression (OR=6.8), and in patients with poor social support the chance of depression was about four times higher than among those with a strong social support (OR=3.7). Multimorbidity was significantly more prevalent among respondents with depression and they had five times higher odds of the presence of two or more chronic diseases (OR=4.6) in comparison with those who did not show depressive symptoms. Depression has been revealed as a significant predictor of more frequent use of health care services. The results confirmed the importance of depression to public health and also provided the data that can be used as a basis for future prospective studies, as well as for the development of the programs for the prevention and control of depressive disorders and mental health improvement.

Klaster analiza ima dugu istoriju i mada seprimenjuje u mnogim oblastima i dalje ostajuznačajni izazovi. U disertaciji je prikazan uvodu neglatki optimizacioni pristup uklasterovanju, sa osvrtom na problemklasterovanja velikih skupova podataka.Međutim, ovi optimizacioni algoritmi boljefunkcionišu u radu sa neprekidnim podacima.Jedan od glavnih izazova u klaster analizi jerad sa velikim skupovima podataka sakategorijalnim i kombinovanim (numerički ikategorijalni) tipovima promenljivih. Rad savelikim brojem instanci (objekata) i velikimbrojem dimenzija (promenljivih), možepredstavljati problem u klaster analizi, zbogvremenske složenosti. Jedan od načinarešavanja ovog problema je redukovanje brojainstanci, bez gubitka informacija.Prvi cilj disertacije je bio upoređivanjerezultata klasterovanja na celom skupu iprostim slučajnim uzorcima sa kategorijalnim ikombinovanim podacima, za različite veličineuzorka i različit broj klastera. Nije utvrđenaznačajna razlika (p>0.05) u rezultatimaklasterovanja na uzorcima obima0.03m,0.05m,0.1m,0.3m (gde je m obimposmatranog skupa) i celom skupu.Drugi cilj disertacije je bio konstrukcijaefikasnog postupka klasterovanja velikihskupova podataka sa kategorijalnim ikombinovanim tipovima promenljivih.Predloženi postupak se sastoji iz sledećihkoraka: 1. klasterovanje na prostim slučajnimuzorcima određene kardinalnosti; 2.određivanje najboljeg klasterskog rešenja nauzorku, primenom odgovarajućeg kriterijumavalidnosti; 3. dobijeni centri klastera iz ovoguzorka služe za klasterovanje ostatka skupa.Treći cilj disertacije predstavlja primenuklaster analize u definisanju klasterabihejvioralnih faktora rizika u populacijiodraslog stanovništva Srbije, kao i analizusociodemografskih karakteristika dobijenihklastera. Klaster analiza je primenjena navelikom reprezentativnom uzorku odraslogstanovništva Srbije, starosti 20 i više godina.Izdvojeno je pet jasno odvojenih klastera sakarakterističnim kombinacijama bihejvioralnihfaktora rizika: Bez rizičnih faktora, Štetnaupotreba alkohola i druge rizične navike,Nepravilna ishrana i druge rizične navike,Nedovoljna fizička aktivnost, Pušenje. Rezultatimultinomnog logističkog regresionog modelaukazuju da ispitanici koji nisu u braku, lošijegsu materijalnog stanja, nižeg obrazovanja i živeu Vojvodini imaju veću šansu za prisustvovišestrukih bihejvioralnih faktora rizika., The cluster analysis has a long history and alarge number of clustering techniques havebeen developed in many areas, however,significant challenges still remain. In thisthesis we have provided a introduction tononsmooth optimization approach to clusteringwith reference to clustering large datasets.Nevertheless, these optimization clusteringalgorithms work much better when a datasetcontains only vectors with continuous features.One of the main challenges is clustering of largedatasets with categorical and mixed (numericaland categorical) data. Clustering deals with alarge number of instances (objects) and a largenumber of dimensions (variables) can beproblematic because of time complexity. One ofthe ways to solve this problem is by reducingthe number of instances, without the loss ofinformation.The first aim of this thesis was to comparethe results of cluster algorithms on the wholedataset and on simple random samples withcategorical and mixed data, in terms of validity,for different number of clusters and fordifferent sample sizes. There were nosignificant differences (p>0.05) between theobtained results on the samples of the size of0.03m,0.05m,0.1m,0.3m (where m is the size ofthe dataset) and the whole dataset.The second aim of this thesis was todevelop an efficient clustering procedure forlarge datasets with categorical and mixed(numeric and categorical) values. The proposedprocedure consists of the following steps: 1.clustering on simple random samples of a givencardinality; 2. finding the best cluster solutionon a sample (by appropriate validity measure);3. using cluster centers from this sample forclustering of the remaining data.The third aim of this thesis was toexamine clustering of four lifestyle risk factorsand to examine the variation across differentsocio-demographic groups in a Serbian adultpopulation. Cluster analysis was carried out ona large representative sample of Serbian adultsaged 20 and over. We identified fivehomogenous health behaviour clusters withspecific combination of risk factors: 'No RiskBehaviours', 'Drinkers with Risk Behaviours','Unhealthy diet with Risk Behaviours','Smoking'. Results of multinomial logisticregression indicated that single adults, lesseducated, with low socio-economic status andliving in the region of Vojvodina are most likelyto be a part of the clusters with a high-riskprofile.

Uvod: Najveći doprinos nejednakostima u zdravlju, koje postoje kako unutar, tako i između zemalja širom sveta, pripisuje se socijalno-ekonomskim determinantama zdravlja. Što je socijalno-ekonomsko stanje ljudi gore, to je veća verovatnoća da sopstveno zdravlje procenjuju kao lošije uz češće prisustvo zdravstvenih simptoma i hroničnih stanja. Cilj ove disertacije bio je da se ispita povezanost demografskih i socijalno-ekonomskih determinanti sa obolevanjem stanovništva, da se konstruišu indeksi obolevanja uz procenu njihove pouzdanosti i validnosti, i da se izvrši analiza i poređenje socijalno-ekonomskih nejednakosti u zdravlju u 2000. i 2006. godini. Metod: U ovoj studiji korišćeni su podaci iz dva nacionalna ispitivanja zdravstvenog stanja stanovnika Republike Srbije, sprovedenih 2000. i 2006. godine po tipu studije preseka na reprezentativnom uzorku odraslih osoba uzrasta 20 i više godina (9921 u prvom i 14.522 u drugom ispitivanju). Kao instrument ispitivanja zdravlja stanovnika korišćeni su upitnici. Rezultati: Kao najučestaliji prediktori obolevanja stanovništva izdvojile su se sledeće varijable: pol, godine starosti, obrazovanje, radni status i materijalno stanje domaćinstva. Ispitanici sa nižim obrazovanjem (UO=2,69 u 2000. godini; UO=3,08 u 2006. godini), nezaposleni (UO=1,24 u 2000. godini; UO=1,53 u 2006. godini), neaktivno stanovništvo (UO=1,58 u 2000. godini; UO=1,96 u 2006. godini) i oni sa lošijim materijalnim stanjem domaćinstva (UO=4,34 u 2000. godini; UO=5,03 u 2006. godini) češće procenjuju svoje zdravlje kao loše. Vrednosti korišćenih indeksa obolevanja su veće u istraživanju iz 2000. godine, što ukazuje na bolje zdravstveno stanje stanovništva u 2006. godini... Introduction: The greatest contribution to inequalities in health both within and between countries is attributable to the socioeconomic determinants of health. The lower the socioeconomic status, the higher the probability of reporting a poor self-perceived health and the higher the prevalence of health problems and cronic conditions. The aim of this doctoral dissertation was to examine the associations between demographic, socioeconomic determinants and morbidity of the population, to construct morbidity indices with assessment of their reliability and validity, and to analyze and compare socioeconomic inequalities in health between 2000 and 2006. Methods: Data from the 2000 and the 2006 National Health Surveys for Serbia were used, conducted as cross-sectional studies on a representative sample of adults aged 20 years and over (9921 in the first survey and 14,522 in the second survey). The information on population health was obtained from the questionnaires. Results: The most frequent predictors of morbidity of the population are: gender, age, education, employment status and financial situation of the household. Respondents with lower education (OR=2,69 in year 2000; OR=3,08 in year 2006), unemployed (OR=1,24 in year 2000; OR=1,53 in year 2006), inactive (OR=1,58 in year 2000; OR=1,96 in year 2006) and those with worse financial situation of the household (OR=4,34 in year 2000; OR=5,03 in year 2006) were more likely to report poor self-perceived health. The values of used morbidity indices were higher in 2000 National Health Survey, which implies better health status of the population in 2006...

Istraživanje predstavlja studiju preseka na reprezentativnom uzorku od 672 deteta starosti od 7 do 19 godina u Vojvodini. Kao instrument istraživanja korišćeni su upitnici kojima su dobijeni podaci o demografskim i socijalno-ekonomskim karakteristikama, samoproceni zdravlja, zadovoljstvu životom, higijenskim navikama, navikama o ishrani, fizičkoj aktivnosti i slobodnom vremenu, mentalnom zdravlju, zastupljenosti rizika po zdravlje i korišćenju zdravstvene službe. Objektivni nalaz dobijen je merenjem telesne mase i visine, određivanjem indeksa telesne mase i merenjem krvnog pritiska. Osnovni ciljevi ovog rada bili su da se dobije ocena zdravstvenog stanja i utvrde vodeći zdravstveni rizici kao i razlike u odnosu na demografske i socijalne karakteristike, da se utvrde promene u zdravstvenom stanju školske dece i omladine u odnosu na retrospektivni deo istraživanja i da se testira validnost instrumenta. Rezultati su pokazali da 40,2% dece živi u domaćinstvima koja pripadaju grupi siromašnih, imaju jednog brata/sestru, 88% živi sa oba roditelja, a dve trećine ima svoju sobu. Redovne higijenske navike češće imaju devojčice, stariji uzast i deca iz bogatijih domaćinstava. Ishrana je neadekvatna kako sa aspekta redovnosti, tako i unosa pojedinih namirnica, nedovoljan je unos mleka i mlečnih proizvoda, voća i povrća i ribe, a prekomeran unos namirnica koje su izvor tzv. „praznih kalorija“, dok je 17% dece sa prekomernom telesnom masom i gojazno. Slobodno vreme karakterišu sedenterne aktivnosti i nedovoljna fizička aktivnost. Ponašanje u saobraćaju je rizično, većina ne koristi zaštitne mere. Povredu je imalo oko 15% dece, petina je bila izložena nekom obliku fizičkog ili psihičkog nasilja. Većina ocenjuje svoje zdravlje kao dobro, dve trećine svoju telesnu masu kao normalnu a tri četvrtine svoju fizičku aktivnost kao dobru. Higijenu i mogućnost rekreacije u školi petina ocenjuje kao lošu a svako deseto dete bezbesnost u školi kao lošu. Informacije o zdravlju najčešće dobijaju od roditelja. Zdravlje stavljaju na prvo mesto na lestvici životnih vrednosti i imaju visok nivo zadovoljstva životom. Većina ima dobru komunikaciju sa majkom a tri četvrtine sa ocem. Petina oseća napetost, stres i ima emocionalne probleme, lošije vrednosti na skali psihološkog distresa ima svaka šesta a na skali vitalnosti skoro svaka druga mlada osoba. Pušenje i konzumacija alkohola su visoko zastupljeni, a svaka deseta mlada osoba probala je neku od psihoaktivnih supstanci. Korišćenje zdravstvene zaštite je zadovoljavajuće osim u sferi reproduktivnog zdravlja adolescentinja, seksualno ponašanje karakteriše rano stupanje u seksualni odnos i nedovoljna zaštita. U odnosu na retrospektivni deo istraživanja značajne razlike dobijene su u higijenskim navikama, ishrani, fizičkoj aktivnosti i sedenternim aktivnostima, procentu gojaznih, oceni svog zdravlja, zadovoljstvu životom, mentalnom zdravlju, izloženosti duvanskom dimu, konzumaciji alkohola, poznavanju psihoaktivnih supstanci, seksualnom ponašanju, reproduktivnom zdravlju i korišćenju zdravstvene službe., The research represents a cross-sectional study of the representative sample of 672 schoolchildren 7-19 of age in Vojvodina. Instrument was specially constructed questionnaire providing data about demographic and socio-economic characteristics, self assessment of the health, life satisfaction, hygiene, nutrition, physical activity, leisure time, mental health, social support, presence of risk factors, and use of health care. Anthropometric measures included body mass, height, blood pressure measurement and calculating body mass index. The aim of the study was to assess health status of the children, identify health risks and determine demographic and socio-economic differences, as well as to determine differences in relation to the retrospective part of the study, and to determine validity of the instrument. Results showed that 40 percents of children live in households with low level of socio-economic status (SES), 88 percents live with both parents, have 1 sibling, and two thirds have their own room. Good hygiene practice is more likely present in girls, older age and children with better SES. Nutrition habits are inadequate regarding regularity and different food intake, there is low consumption of milk and dairy products, fruits, vegetables and fish, high intake of sweets, snacks and sweet beverages, and there is 17 percents of overweight and obese children. Leisure time is characterized with sedentary activities and lack of physical activity. Road traffic behavior is risky with inadequate safety measures. Injury had 15 percents of children, and the fifth was object of physical and psychological violence. Most of the children assessed their health as good and very good, two thirds their body mass as normal and three quarters their physical activity as good. School hygiene and recreational conditions were poorly rated by fifth of the children, and one in ten assessed school safety as bed. Health information are mostly provided by parents. Health is highly rated among life values and life satisfaction is high. Most of them easy communicate with their mothers and three quoters with their fathers. Every fifth child is having emotional problems, anxiety and stress, lower values on Psychological Distress Scale has every sixth child and on Vitality Scale every second child. Prevalence of smoking and alcohol consumption is high, one in ten adolescents experimented or consumed drugs. Health care use is satisfying except in the sphere of reproductive health of female adolescents. Sexual behavior is characterized with early onset of sexual intercourse and inadequate protection against pregnancy and STD. Differences regarding retrospective part of the study exist in hygiene practice, nutrition, physical activity, sedentary activities, prevalence of overweight and obesity, self assessment of health, life satisfaction, mental health, exposure to tobacco, alcohol consumption, knowledge about drugs, sexual behavior and health care use.

Determination of smoking prevalence within the representative sample of pregnant women in Vojvodina is facilitating insight into dispersion of the most frequent behavioral risk factor in one of the most vulnerable population categories, as well as consideration of influence of smoking to pregnancy outcome. The survey was performed on representative sample of three months cohort, 726 pregnant women in Vojvodina, by stratified two-stage random cluster sampling with an aim to assess: prevalence and intensity of smoking immediately before cognition of pregnancy, at each trimester during the pregnancy and at 3 and 6 months after delivery, exposure to environmental smoke at home, rate and reasons for smoking cessation up to 6 months after delivery and pregnancy outcome by infants` birth weight, body height and circumference of the head analysis. Three questionairres were used as survey instruments, composed with consideration of survey protocols used for attainment of smoking prevalence with pregnant women in earlier studies, pilot-study results and form for transcript of variables from the Newborn Infant Record. It is determined that smoking prevalence during pregnancy is high (40.9 percents smoked at some point during the pregnancy), as well as exposure to tobacco smoke at home (56.2 percents lives in a home with at least one smoker whilst 83.5 percents allowes smoking at home). More than one third of pregnant women (39.2 percents) attemped to quit smoking after the delivery, majority immediately after the birth (85.3 percents), but over 55 percents continued to smoke afer only one week. Almost one quarter of pregnant women (24.4 percents) that quit smoking during the pregnancy is still abstaining three months after the birth, and nearly one fifth of examinees (19.3 percents) is successful even six months after giving birth which could be considered as definite efficacy of cessation. Smoking in pregnancy was significantly influential to infants` birth weight, body height and circumference of the head. Infants whose mothers smoked immediately before the pregnancy, and during the course of pregnancy, had lower birth weight compared to infants of nonsmoking mothers (for 95.3 g i.e. 86.3 g), while body height was smaller for 0.59 cm, i.e. 0.54 cm. Arrear in birth weight and birth height was more expressed in infants whose mothers smoked constantly during the course of pregnancy and more than 20 cigarettes per day in average than in mothers smoking less frequently and less intensively. Circumference of the newborns` head was affected by frequency and quantity of consumed cigarettes. Infants whose mothers smoked constantly during the pregnancy and more than 20 cigarettes per day in average had smaller circumference of the head for approximately 1 cm compared to infants delivered by mothers who smoked occasionally and less cigarettes. The results impose an obligation for establishing population-specific aims for decrement of smoking prevalence among pregnant and post-partum women. Vulnerability of this population group draws attention to urgency of action(s).

Determination of smoking prevalence within the representative sample of pregnant women in Vojvodina is facilitating insight into dispersion of the most frequent behavioral risk factor in one of the most vulnerable population categories, as well as consideration of influence of smoking to pregnancy outcome. The survey was performed on representative sample of three months cohort, 726 pregnant women in Vojvodina, by stratified two-stage random cluster sampling with an aim to assess: prevalence and intensity of smoking immediately before cognition of pregnancy, at each trimester during the pregnancy and at 3 and 6 months after delivery, exposure to environmental smoke at home, rate and reasons for smoking cessation up to 6 months after delivery and pregnancy outcome by infants` birth weight, body height and circumference of the head analysis. Three questionairres were used as survey instruments, composed with consideration of survey protocols used for attainment of smoking prevalence with pregnant women in earlier studies, pilot-study results and form for transcript of variables from the Newborn Infant Record. It is determined that smoking prevalence during pregnancy is high (40.9 percents smoked at some point during the pregnancy), as well as exposure to tobacco smoke at home (56.2 percents lives in a home with at least one smoker whilst 83.5 percents allowes smoking at home). More than one third of pregnant women (39.2 percents) attemped to quit smoking after the delivery, majority immediately after the birth (85.3 percents), but over 55 percents continued to smoke afer only one week. Almost one quarter of pregnant women (24.4 percents) that quit smoking during the pregnancy is still abstaining three months after the birth, and nearly one fifth of examinees (19.3 percents) is successful even six months after giving birth which could be considered as definite efficacy of cessation. Smoking in pregnancy was significantly influential to infants` birth weight, body height and circumference of the head. Infants whose mothers smoked immediately before the pregnancy, and during the course of pregnancy, had lower birth weight compared to infants of nonsmoking mothers (for 95.3 g i.e. 86.3 g), while body height was smaller for 0.59 cm, i.e. 0.54 cm. Arrear in birth weight and birth height was more expressed in infants whose mothers smoked constantly during the course of pregnancy and more than 20 cigarettes per day in average than in mothers smoking less frequently and less intensively. Circumference of the newborns` head was affected by frequency and quantity of consumed cigarettes. Infants whose mothers smoked constantly during the pregnancy and more than 20 cigarettes per day in average had smaller circumference of the head for approximately 1 cm compared to infants delivered by mothers who smoked occasionally and less cigarettes. The results impose an obligation for establishing population-specific aims for decrement of smoking prevalence among pregnant and post-partum women. Vulnerability of this population group draws attention to urgency of action(s).

Achieving and maintaining good health and prosperity requires a clear and harmonized environment. Studying the environment to protect human health aims to determine the type of pollutants and to monitor their impact on humans. Pollutants include the chemical, physical and microbiological pollutants. It is believed that the best way of studying the interaction between the population and the environment is the method that allows selection of representative, easily measurable and routinely controlled environmental indicators and health status. The World Health Organization recommends "DPSEEA" (Driving Force, Pressure, State, Exposure, Effect and Action) system. "DPSEEA" describes a closed circuit system of interdependent factors of the environment and human health which can be defined as a cause _ effect model. Application of "DPSEEA" system to assess the influence factors of the environment on human health is defined by studying the air quality of the environment, water and sanitation, noise and health, housing, traffic accidents, chemical accidents, and radiation. The use of complex indicators by "DPSEEA" system in our country so far has been used to assess the environmental situation, but not for systematic assessment of the impact factors of the environment on human health. AIM: Aims of the research are based on determining the type of microbiological, physical and chemical hazards in the environment of Novi Sad, exposure of the population and assess the impact of identified hazards to human health, as well as determining the significance of the application of environmental factors as indicators of impacts on human health. METHODOLOGY: Identifying hazards present in the environment of the City of Novi Sad (air quality, drinking water quality, noise) in 2006 were carried out based on the statutory methodology for sampling, microbiological, physical and chemical analysis and preparation of expert opinions on the hazards present in the environment. There were sampled, analyzed and professionally studied 9936 air samples, 6474 samples of drinking water and 648 individual measurements of daily levels of noise. Determination of population-level exposure to environmental noise survey was conducted by applied poll concerning subjective population experience of noise and subjective assessment of noise impact on human health, based on 1079 valid completed questionnaires. Assessment of exposure to microbial, physical and chemical hazards from the environment and determine the impact of identified hazards from the environment on human health is determined in accordance with the "DPSEEA" methodology by using the 15 indicators. To assess the impact of air, water and noise on human health following indicators have been considered: Air_Exl, Air_El, Air_E2, Air_E3, WatSan_S2,WatSan_S3, WatSan_Exl, WatSan_Ex2, WatSan_Ex3, WatSan_Ex4, WatSan_El,WatSan_E2, WatSan_E3, Noise_El and Noise_E2. The questionnaire of the population of the subjective experience of noise and subjective assessment of noise impact on human health was conducted with the help of specially composed questionnaire, based on national surveys conducted. RESULTS: Out of the 15 indicators of "DPSEEA" system in our research 87 percents is considered accessible, 67 percents quality and 73 percents usable. Monitoring of air quality in the City of Novi Sad in 2006 indicates that average annual concentrations of sulfur dioxide (0.05). Reducing the average population exposure to suspended particles in 10 µg/m3 in the City of NoviSad, reducing the expected total number of deaths from 131 to 115, the expected number of deaths from cardiopulmonary disease (MKB 10:JOO-99 and MKB 1 0:120-25) in people aged above 30 with 42 to 37 and expected number of deaths from respiratory diseases (MKB 1 0:JOO-99) of children under five years from 0.036 to 0.03, statistically significant Cp>0.05). Increase the total suspended particles (TSP) In air of the City of Novi Sad for 10 µg/m causes the Increase rate of total mortality in 0.047 without statistical significance (p=0.29299) and increased rates of mortality from cardiopulmonary disease (MKB 10:JOO-99 and MKB 10:120-25) of people aged above 30 to 0.016, with no statistical significance . The decrease of total suspended particles (TSP) in air of the City of Novi Sad for 10 µg/m3 induced reduction of total mortality rate of 0.051 with no statistical significance (p=0.26355) and the reduction of mortality from cardiopulmonary disease (MKB 10:JOO-99 and MKB 1 0:120-25) of people aged above 30 years to 0.016 with no statistical significance (p=OA04055). By monitoring the presence of microbiological and physical-chemical hazards in treated drinking water from the water plant and water system of central water supply infrastructure and sewerage in the City of Novi Sad in 2006 showed the absence of microbiological and physical-chemical hazards in 94.50 percents (p

Health related quality of life of the elderly is the most important aspect of quality of life concept in general, and it,s measurement has an important place in health care practice and scientific work. The aim of this study was te determine physical, social and emotional dimension of health related quality of life among elderly, using modified McMaster Health Index questionare, as well as to construct valid instrument for health related quality of life assessment among elderly for our theritory. Cross sectional study was performed during 1998-2000. through poll, on the Novi Sad population sample aged 60 and above (n=373). Initial questionare was used for the purpose of analysis of certain health domains, and by using correlation analysis to extract items for six scales: physical functioning, selfacare, social usefulness, emotions about life, social functioning and self perception. Transformed score (range 0-100) was calculated for each scale separatly and for total health related quality of life index (QOL-OLD) as well as percentage influence of each scale on QOL-OLD index. Health related quality of life index (QOL-OLD) present summar numeric value calculated from all six domains. For each scale and for QOL-OLD validity and reliability eas determined using Cronbach alpha value. Analysis extracted six scales which influence quality of life among elderly, and results showed that physical health, covered with physical functioning scale and selfcare scale, has dominant influence (39,3) in creating global QOL-OLD index. Each domain and QOL-OLD index was analyzed considering some socio-demographic determinants which shoewd impact on single domains and total QOL-OLD index. Extracting items from initial modified McMaster Health Index Questionnaire enabled construction of shortend and valid questionnaire for assessment health related quality of life among elderly in the population but also for individuals of same age.