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The aim of this cross-sectional study was to compare occupational burnout in two groups of teachers from the district of Bijeljina (Bosnia and Herzegovina) measured with the Serbian version of the Maslach Burnout Inventory survey for workers in human services (MBI-HSS) at the beginning (group 1) and the end of the school year 2018/2019 (group 2) to see if there are seasonal differences. The questionnaire also included standard sociodemographic data and job description (primary and/or secondary school position, length of service, and overtime work). The prevalence of emotional exhaustion and depersonalisation was low in both groups. However, emotional exhaustion and depersonalisation scores significantly shifted to higher values between the beginning and the end of the school year. We also found a statistically significant association between emotional exhaustion and overtime and between depersonalisation and work in a secondary school (p, U ovom je presječnom istraživanju uspoređena prevalencija sindroma izgaranja na poslu u dvjema skupinama nastavnika na području Bijeljine u Bosni i Hercegovini te je procijenjen njegov sezonski karakter. Sindrom izgaranja na poslu mjeren je na početku (skupina I.) i na kraju školske 2018./2019. godine (skupina II.). Za potrebe ovoga istraživanje korištena je srpska inačica Maslachina upitnika izgaranja na poslu za stručnjake pomagačkih zanimanja (izv. Maslach Burnout Inventory Survey for Workers in Human Services, krat. MBI-HSS). Upitnik je uključivao i standardne sociodemografske podatke, kao i podatke o radnomu mjestu (rad u osnovnoj i/ili srednjoj školi, dužina radnog staža i prekovremeni rad). Prevalencija emocionalne iscrpljenosti i depersonalizacije bila je niska u objema skupinama ispitanika na početku mjerenja, ali se na kraju školske godine povećala. Utvrđena je statistički značajna razlika između emocionalne iscrpljenosti i prekovremenoga rada, kao i između depersonalizacije i rada u srednjim školama (p

Mercury (Hg) is one of the most important environmental pollutants with endocrine- disrupting properties. There is little data from epidemiological studies describing the dose- response relationship between toxic metal levels and hormone levels. The aim of this study was to use the nearest neighbor matching analysis to determine the difference in Hg concentration in healthy/sick subjects with thyroid disease and to use Benchmark modeling to determine the dose- response relationship between Hg levels in the blood and thyroid-stimulating hormone (TSH) and thyroid hormones in serum. Blood samples were collected and used for Hg measurement using the ICP-MS method, and separated serum was used for hormone analysis. The study showed the existence of a statistically significant difference in Hg levels measured in healthy and sick subjects and the existence of a dose-response relationship between Hg and all measured hormones, with a narrow interval obtained for the Hg-TSH pair. The results of this research support the use of the Benchmark dose approach for the purpose of analyzing data from human studies, and our further research will be focused on examining the impact of low doses on animal models in order to determine more precise effects of low doses on the organism. Živa (Hg) je jedan od najznačajnijih zagađivača životne sredine sa osobinama endokrinog ometača. Malo je podataka iz epidemioloških studija koji opisuju odnos doza-odgovor između nivoa toksičnih metala i nivoa hormona. Cilj ovog rada bio je da primenom nearest neighbor matching analize utvrdi razliku u koncentraciji Hg kod zdravih/obolelih ispitanika od bolesti štitaste žlezde i da primenom Benchmark modelovanja utvrdi odnos doza-odgovor između nivoa Hg u krvi i tireostimulišućeg hormona (TSH) i tiroidnih hormona u serumu. Uzorci krvi su sakupljeni i korišćeni za merenje Hg uz pomoć ICP-MS metode, a izdvojeni serum korišćen je za analizu hormona. Studija je pokazala postojanje statistički značajne razlike u nivoima Hg koji su izmereni kod zdravih i bolesnih ispitanika i postojanje odnosa doza-odgovor između Hg i svih merenih hormona, pri čemu je uzak interval dobijen za Hg-TSH par. Rezultati ovog istraživanja podržavaju upotrebu Benchmark dose pristupa u svrhu analize podataka iz humanih studija, a naša dalja istraživanja će biti usmerena na ispitivanje uticaja niskih doza na životinjskim modelima, u cilju utvrđivanja preciznijih efekata niskih doza na organizam.

Objectives The aim of this study was to assess the validity and reliability of the Serbian versions of the Copenhagen Burnout Inventory (CBI) and the Study Burnout Inventory (SBI) among fifth-year medical students at 5 universities in Serbia. Material and methods The study included 573 fifthyear medical students at 5 universities in Serbia. The research instrument consisted of SBI and CBI. The reliability of these instruments was assessed using an internal consistency measure (Cronbach's α), an intra-class coefficient (ICC) and factor analysis. Results Cronbach's α for SBI was 0.83, including for exhaustion 0.73, for cynicism 0.70, and for inadequacy 0.48. The test-retest reliability (ICC) was 0.75. Cronbach's α for personal burnout on CBI was 0.89, for the faculty-related burnout 0.86, and for the faculty-members-related burnout 0.92. Cronbach's α for CBI was 0.93. The factor analysis for SBI showed 2 factors and for CBI 3 factors. Conclusions This study revealed that the Serbian versions of both SBI and CBI could be used for the assessment of burnout in this population.

BACKGROUND An infodemic is excess information, including false or misleading information, that spreads in digital and physical environments during a public health emergency. The COVID-19 pandemic has been accompanied by an unprecedented global infodemic that has led to confusion about the benefits of medical and public health interventions, with substantial impact on risk-taking and health-seeking behaviors, eroding trust in health authorities and compromising the effectiveness of public health responses and policies. Standardized measures are needed to quantify the harmful impacts of the infodemic in a systematic and methodologically robust manner, as well as harmonizing highly divergent approaches currently explored for this purpose. This can serve as a foundation for a systematic, evidence-based approach to monitoring, identifying, and mitigating future infodemic harms in emergency preparedness and prevention. OBJECTIVE In this paper, we summarize the Fifth World Health Organization (WHO) Infodemic Management Conference structure, proceedings, outcomes, and proposed actions seeking to identify the interdisciplinary approaches and frameworks needed to enable the measurement of the burden of infodemics. METHODS An iterative human-centered design (HCD) approach and concept mapping were used to facilitate focused discussions and allow for the generation of actionable outcomes and recommendations. The discussions included 86 participants representing diverse scientific disciplines and health authorities from 28 countries across all WHO regions, along with observers from civil society and global public health–implementing partners. A thematic map capturing the concepts matching the key contributing factors to the public health burden of infodemics was used throughout the conference to frame and contextualize discussions. Five key areas for immediate action were identified. RESULTS The 5 key areas for the development of metrics to assess the burden of infodemics and associated interventions included (1) developing standardized definitions and ensuring the adoption thereof; (2) improving the map of concepts influencing the burden of infodemics; (3) conducting a review of evidence, tools, and data sources; (4) setting up a technical working group; and (5) addressing immediate priorities for postpandemic recovery and resilience building. The summary report consolidated group input toward a common vocabulary with standardized terms, concepts, study designs, measures, and tools to estimate the burden of infodemics and the effectiveness of infodemic management interventions. CONCLUSIONS Standardizing measurement is the basis for documenting the burden of infodemics on health systems and population health during emergencies. Investment is needed into the development of practical, affordable, evidence-based, and systematic methods that are legally and ethically balanced for monitoring infodemics; generating diagnostics, infodemic insights, and recommendations; and developing interventions, action-oriented guidance, policies, support options, mechanisms, and tools for infodemic managers and emergency program managers.

Reproductive disorders and infertility have become more common recently among the general population. Toxic metals are known as endocrine disruptors and as they are widespread in nature they may be linked to reproductive problems. This study was conducted as a cross-sectional study and its aim was to examine the dose-response relationship between cadmium, arsenic, mercury, chromium and nickel and serum hormone levels of testosterone (women) and estradiol and progesterone (men) using the Benchmark dose approach (BMD). Blood samples were collected from 218 women and 217 men digested in a microwave, and the levels of the tested metals were determined by atomic absorption spectrophotometry (AAS) or inductively coupled plasma-mass spectrometry (ICP-MS). Dose-response analysis was performed in PROAST software (version 70.1). The model averaging method was used to calculate the Benchmark dose interval (BMDI). A dose-response relationship has been established between all metals and hormones. The narrowest BMDI was found for the As-testosterone and Hg-testosterone. Levels estimated to produce the extra risk of testosterone serum levels disturbances of 10% were lower than median levels measured in the general population. Moreover, this research suggests the possibility of use of the BMD approach in analyzing data pool generated from extensive human-biomonitoring studies.

Background: Cardiovascular diseases ranked first in terms of the number of deaths in Serbia in 2019, with 52,663 deaths. One fifth of those were from ischemic heart disease (IHD), and half of IHD deaths were from acute coronary syndrome (ACS). We present the ACS mortality time trend in Serbia during a 15-year period using the latest available data, excluding the COVID-19 pandemic. Methods: The data on patients who died of ACS in the period from 2005 to 2019 were obtained from the National Statistics Office and processed at the Department of Prevention and Control of Non-communicable Diseases of the Institute of Public Health of Serbia. Number of deaths, crude mortality rates (CR) and age-standardized mortality rates (ASR-E) for the European population were analyzed. Using joinpoint analysis, the time trend in terms of annual percentage change (APC) was analyzed for the female and male population aged 0 to 85+. Age–period–cohort modeling was used to estimate age, cohort and period effects in ACS mortality between 2005 and 2019 for age groups in the range 20 to 90. Results: From 2005 to 2019 there were 90,572 deaths from ACS: 54,202 in men (59.8%), 36,370 in women (40.2%). Over the last 15 years, the number of deaths significantly declined: 46.7% in men, 49.5% in women. The annual percentage change was significant: −4.4% in men, −5.8% in women. Expressed in terms of APC, for the full period, the highest significant decrease in deaths was seen in women aged 65–69, −8.5%, followed by −7.6% for women aged 50–54 and 70–74. In men, the highest decreases were recorded in the age group 50–54, −6.7%, and the age group 55–59, −5.7%. In all districts there was significant decline in deaths in terms of APC for the full period in both genders, except in Zlatibor, Kolubara and Morava, where increases were recorded. In addition, in Bor and Toplica almost no change was observed over the full period for both genders. Conclusions: In the last 15 years, mortality from ACS in Serbia declined in both genders. The reasons are found in better diagnostic and treatment through an organized network for management of ACS patients. However, there are districts where this decline was small and insignificant or was offset in recent years by an increase in deaths. In addition, there is space for improvement in the still-high mortality rates through primary prevention, which at the moment is not organized.

Unselective use of antibiotics to treat children with COVID-19 is one of the major issues during the pandemic in Serbia. Thus far, there has been no evidence about the predictors of multiple antibiotic use in the treatment of children with COVID-19. The purpose of this study was to assess the prevalence of antibiotic use, as well as to examine demographic and clinical factors associated with a greater number of antibiotics and with a longer antibiotic treatment administered to hospitalized children with COVID-19 during the lockdown in Serbia. This study included all children who were hospitalized from 6 March to 31 May 2020 at the only pediatric COVID-19 hospital, and who were confirmed to have SARS-CoV-2 infection. Demographic, clinical, and laboratory data were collected from medical records. The antibiotic treatment included the use of azithromycin, cephalosporin (ceftriaxone), ampicillin-amikacin, and hydroxychloroquine. The overall prevalence of antibiotics use in children hospitalized with COVID-19 regardless of age was 47.2% (43.3% in children aged 1–5 years and 44.4% in those aged 5–17 years). In children aged 1–5 years, not having a family member affected by COVID-19 (B = −1.38, 95% confidence interval [CI] −2.43, −0.34, p = 0.011), having pneumonia on chest X-ray (B = 0.81, 95%CI 0.34, 1.29, p = 0.002), being a boy (B = −0.65, 95%CI −1.17, −0.13, p = 0.018), and having higher C-reactive protein (CRP) values on admission (B = 0.12, 95%CI 0.07, 0.17, p = 0.001) were associated with the administration of a higher number of antibiotics. These factors, along with having fever (B = 3.20, 95%CI 1.03, 5.37, p = 0.006), were associated with a longer duration of antibiotic treatment in children aged 1–5 years. In children aged 5–17 years, having pharyngeal erythema (B = 1.37, 95%CI 0.61, 2.13, p = 0.001), fever (B = 0.43, 95%CI 0.07, 0.79, p = 0.018), and pneumonia on chest X-ray (B = 0.91, 95%CI 0.53, 1.29, p = 0.001), not having rhinorrhea (B = −1.27, 95%CI −2.47, −0.08, p = 0.037), being a girl (B = 0.52, 95%CI 0.08, 0.97, p = 0.021), and having higher CRP values on admission (B = 0.04, 95%CI 0.01, 0.06, p = 0.006) were associated with the administration of a higher number of antibiotics. These factors, not including the absence of rhinorrhea, were associated with a longer duration of antibiotics treatment in children aged 5–17 years. Demographic, epidemiological, clinical, and laboratory parameters were associated with the use of multiple antibiotics and a longer duration of antibiotic treatment both among children aged 1–5 years and those aged 5–17 years.

Exposure to low levels of a toxic metal lead (Pb) affects human health, and its effect as an endocrine disruptor has been reported. However, the precise role of Pb in endocrine health is still unclear because no dose-response relationship has been established for such an effect. The present study aimed to examine blood Pb levels (BLLs) in relation to serum levels of free triiodothyronine (fT3), free thyroxine (fT4), thyroid stimulating hormone (TSH), and insulin in 435 nonoccupationally exposed Serbian subjects (218 women, 217 men, 18–94 years of age, mean age 48). In addition, benchmark dose (BMD) values were calculated for these endocrine endpoints using the PROAST 70.1 software. An explicit dose-response dependency between BLL and TSH, fT3, fT4, testosterone, and insulin serum levels was evident from BMD modelling. The results support the positive association between BLLs and serum insulin levels, with observed dose-response and calculated BMD values of 1.49 and 0.74 μg Pb/dL in males and females, respectively. Collectively, our findings reported potential endocrine-disrupting effects of Pb at the environmental exposure levels experienced by current Serbian population. They also strengthen the notion that the blood Pb threshold level for an endocrine effect is low.

Background & Aim The study describes the experiences and opinions of Serbian physicians regarding workforce management during the COVID‐19 pandemic. Materials & Methods A total of 1553 licensed physicians (65% males; average age 44.0 years) responded to an online survey in September 2020. Differences in the respondents' general data and attitudes regarding workforce management and outbreak preparedness in Serbia were analysed in relation to their engagement during the COVID‐19 pandemic (Pearson χ2 and the independent samples t‐test, p

Chronic subdural hematoma (CSDH) is a common pathology in neurosurgery, especially in the elderly patients, and its incidence is likely to double in the next decade. Considering various features of CSDH and the procedure itself, a sitting position may retain the best characteristics of classic positioning, while offering additional comfort for both the patient and the surgeon. The aim of this study was to describe the technical aspects of this procedure in the sitting position, to evaluate safety and discuss the benefits and shortcomings of this modification. This study included a series of 55 patients surgically treated for CSDH in a sitting position at our department between December 2017 and September 2019, representing all the patients operated on during the study period by a single surgeon. Bilateral hematomas were present in 19 patients. Outcomes, during the 6-month follow-up period, were defined as good (CSDH and symptoms resolved) or poor (lethal outcome or reoccurrence). All complications were noted, with emphasis on pneumocephalus, and complications related to the sitting position: tension pneumocephalus, venous air embolism, and compression nerve injury. Complications previously associated with the sitting position were not noted. The Glasgow Coma Scale and Markwalder Grading Scale scores improved significantly after the surgery (p < 0.001 and p = 0.018). Complications were noted in 17 patients (30.9%), and included 5 cerebrospinal fluid drainages, 3 hematoma reoccurrences, 2 wound infections, and 9 more single-occurring complications. The in-hospital mortality was 5.4% (3 out of 55 patients), while the overall mortality was 16.4% within the 6-month follow-up period. In our series, even the severely ill patients tolerated the position well. No complications associated with the sitting position were noted. Future studies should confirm the safety of this position and evaluate the potential advantages for both the patient and the surgeon.

Introduction: Burnout syndrome occurs as a result of prolonged exposure to emotional and interpersonal stressors in the workplace and is characterised by three dimensions: emotional exhaustion, depersonalization and personal achievements. Research and prevention of this phenomenon are of public health importance due to numerous consequences it leaves on the health of the working population and work organisation, and among teachers, on children as direct users of their services. The research aims to examine the presence of the stress and burnout syndrome at work in teachers in the regions of the Republic of Srpska, as well as to determine the existence of differences between regions. Methods: The research was conducted as a cross-sectional study in the period August-September 2018, in the territory of the Republic of Srpska. The target population was represented by teachers of primary and secondary schools. The response rate in all regions was 75 % or above it. For this research, a special questionnaire was constructed, consisting of sociodemographic data, data on economic characteristics of the respondents, characteristics of the work environment, as well as data on satisfaction with equipment and resources at work, support from family and friends and presence of work-life conflict. In addition to the general questionnaire, the Maslach Burnout Inventory-Human Services Study (MBI-HSS) questionnaire for the assessment of the burnout syndrome at work, and Karasek's questionnaire (Job Content Questionnaire) for the assessment of stress at work were used. Results: A statistically significant difference in the prevalence of occupational stress among teachers between RS regions was found. Also, a statistically significant difference was found between the regions of the Republic of Srpska related to the dimensions of burnout syndrome at work. A high level of emotional exhaustion was more often reported by teachers from the territory of the region of East Sarajevo and Prijedor (8.0 % and 7.7 %) comparing to teachers from other regions. Teachers from the territory of Prijedor more often showed moderate and high levels of depersonalization, as well as a low level of personal achievements comparing to teachers from other regions. Conclusion: This research shows the presence of burnout syndrome in teachers of all the Republic of Srpska regions at the beginning of the school year, as well as statistically significant differences between the regions. This indicates the need for additional research on risk factors by regions to form targeted and thus more effective prevention measures.

Background Healthcare workers (HCWs) are commonly infected by SARS-CoV-2 and represent one of the most vulnerable groups. Adequate prevention strategies are necessary to guarantee HCWs’ safety, as well as to prevent dissemination of the infection among patients. Aims To describe a case series of SARS-CoV-2-positive HCWs in a large public healthcare organization in Milan (Italy) during the most devastating weeks of the epidemic and analyse the sources, symptoms and duration of SARS-CoV-2 infection. Methods This study included 172 SARS-CoV-2-positive HCWs who were infected between the 25th of February and the 7th of April 2020. A nasopharyngeal swab (NPS) and RT-PCR were used to indicate. Results Initially, the most common sources of infection were other positive HCWs (49%). Medical doctors and nursing assistants were most frequently infected, with infection rates of 53/1000 and 50/1000, respectively. COVID-19 departments were less affected than internal medicine, surgery, intensive care, or emergency room. The most commonly reported symptom was mild cough, while loss of smell (anosmia) and loss of taste (ageusia) were reported as moderate and severe by 30–40% of HCWs. The time necessary for 50% of workers to recover from the infection was 23 days, while it took 41 days for 95% of HCWs to become virus-free. Conclusions HCWs are commonly infected due to close contacts with other positive HCWs, and non-COVID departments were most affected. Most HCWs were asymptomatic or subclinical but contact tracing and testing of asymptomatic HCWs help identify and isolate infected workers.

The coronavirus disease (COVID-19) pandemic has an unimaginable impact on the global health workforce. Health workers are deployed as frontline workers to rapidly respond to increasing patient needs. This study aimed to examine the preparedness of healthcare workers during the COVID-19 pandemic to protect their own safety and health. An online survey was conducted among physicians licensed by the Serbian Medical Chamber in September 2020. The Ethics Committee of the Serbian Medical Chamber approved this study (Decision No: 1462/September 15, 2020). The sample consisted of 1,553 physicians who completed the online questionnaire. Almost two thirds (64%) of the physicians worked with COVID-19 patients, and around one third (34%) were deployed to a different work position. Physicians working with COVID-19 patients were younger, less-experienced (mean work experience 14 years vs. 19.5 years) and more commonly non-specialists. Less than 39% of physicians deployed to work with COVID-19 patients had gone through the training on the use of personal protective equipment (PPE), 60% had adequate PPE available daily, and 86% reported using the PPE according to the recommendations. Having proper training regarding the use of PPE and using the PPE according to the recommendations was less common in private compared to public health institutions (31% vs 40% for training, and 89% vs 75% for adequate use, respectively). Workers engaged to work with COVID-19 patients, compared to those who were not engaged, indicated the need for professional changes to respond to the COVID-19 emergency, especially in the areas of workforce planning, education and training, workload measurement and tracking. Younger and less experienced physicians with questionable training and availability of PPE were deployed to work in COVID-19 hospitals and units, and their health and safety was a secondary priority to the primary duty of caring for patients in need. Key messages Younger and less experienced physicians with questionable training and availability of PPE were deployed to work in COVID-19 hospitals and units. Health and safety was a secondary priority to the primary duty of caring for patients in need.

Background Pneumocephalus is a well-known complication in the surgical treatment of chronic subdural hematomas; however, its influence remains controversial. The amount of subdural air may vary, and it may cause worsening of symptoms, increase reoccurrence rates, and worsen the outcomes. Lethal outcome following acute onset of massive pneumocephalus was not previously reported. Case Report An 81-year-old man with bilateral hematomas underwent surgery under local anesthesia. Both hematomas were approached in the same surgery, and the drains were placed subdurally. After initial improvement, severe hypertension developed, followed by vital function and neurologic deterioration. Massive pneumocephalus with subarachnoid and contralateral intracerebral hemorrhage was revealed, causing a severe midsagittal shift. Emergency irrigation to evacuate subdural air was performed. However, there was no improvement. Further computed tomography confirmed subdural air collection, but it also revealed hemorrhage progression and intraventricular propagation. No further surgery was indicated. Conclusion Pneumocephalus is an underestimated but potentially devastating complication. Both intraoperative avoidance and postoperative prevention should be utilized to avoid subdural air ingress, and thus evade potentially fatal complications.

Background In patients with only upper (C5, C6) brachial plexus palsy (BPP), the pooled international data strongly favor nerve transfers over nerve grafts. In patients with complete BPP, some authors favor nerve grafts for the restoration of priority functions whenever there is a viable proximal stump. Objective To evaluate functional recovery in cases of upper and complete BPP where only direct graft repair from viable proximal stumps was performed. Methods The study included 36 patients (24 with complete BPP and 12 with only upper BPP) operated on over a 15-yr period. In all cases, direct graft repair from C5 to the musculocutaneous and the axillary nerve was performed. In cases with complete BPP, additional procedures included either direct graft repair from C6 to the radial nerve and the medial pectoral nerve or the dorsal scapular nerve transfer to the branch for the long head of the triceps. Results The use of C5 proximal stump grafts (in both complete and upper BPP) resulted in satisfactory elbow flexion in 26 patients (72.2%) and satisfactory shoulder abduction in 22 patients (61.1%). The use of C6 proximal stump grafts in patients with complete BPP resulted in satisfactory elbow extension in 5 (50%) and satisfactory shoulder adduction in another 5 (50%) patients. Conclusion Although nerve transfers generally enable better restoration of priority functions, in cases of infraganglionary injuries, especially in shorter defects, it is also necessary to consider direct graft repair, or at least its combination with nerve transfers, as a potentially beneficial treatment modality.

Introduction Absorbed dose assessment from dermal exposure involves multiplying skin contamination by the dermal absorption coefficient, which is usually defined for the standard workday of 8 h. This strategy may suffer from limitations when the duration of exposure is extremely variable, such as in agricultural exposure to pesticides. Objectives The aim of this study was to estimate the dose of mancozeb absorbed by agricultural pesticide applicators in a typical working day considering the real duration of exposure, to compare these estimates with those coming from the use of the Fixed Fractional Approach, and to assess the suitability of the dose estimates in the interpretation of biological monitoring results. Methods In a series of real-life field studies on 29 workers applying mancozeb in vineyards for 38 work days, three sets of data were collected: information regarding work activities for each work day, potential (on clothes) and actual skin exposure using the “patch” methodology, and excretion of ethylenethiourea (ETU) in the 24-h pre-exposure and 24-h post-exposure urine samples. The statistical analyses were done using the R Language and Environment for Statistical Computing. Results Accounting for the duration of exposure led to a substantial reduction in the absorbed dose estimates, compared to the estimates coming from the Fixed Fractional Approach. In particular, absorbed dose by the body, hands' and total absorbed dose were reduced by 50%, 81%, and 80% respectively. The body dose estimated considering both approaches still correlated better with post-exposure 24-h urine ETU levels than the hands’ dose, although more than 90% of the estimated total absorbed dose comes from the hands. Conclusions An accurate estimate of the absorbed dose, carried out considering the real duration of exposure, can result in a higher correlation with a biomarker of occupational exposure, such as urine ETU, or at least yield more accurate results. This can facilitate the interpretation of biological monitoring data in pesticide-exposed agricultural workers despite the absence of biological exposure limits. ETU should be evaluated as a potentially relevant source of exposure due to ethylenebisdithiocarbamates’ (EBDCs) degradation in the formulated product or spray mixture.

Dyes are an important class of pollutants because large amounts are often found in the environment as a result of their extensive industrial use. Traditional wastewater treatment methods often lead to high energy costs, formation of by-products, and the production of sludge. This paper analyzes the possibility of using a new, sustainable approach to water decolorization with reduced consumption of chemicals. In microreactor experiments, reactant molar ratios, volumetric flow rate, and microreactor length and diameter were varied. The obtained results showed that batch decolorization required 250-500 times higher molar ratios to achieve comparable decolorization (70-90%) and at least three times longer residence time. Microreactor experiments demonstrated that higher microreactor lengths and molar ratios influence positively the decolorization process, although satisfactory results are also achieved with medium microreactor lengths and lower molar ratios. Higher fluids velocities contribute to the decolorization process, but the best results were obtained using a medium velocity (in a 5.8m microreactor system) to achieve the highest possible mixing intensity and long enough residence time. Microreactor systems have achieved significantly better decolorization results, considering any combination of microreactor length, molar ratio, diameter, flow rate, and residence time, than a batch system. Thus, a medium length microreactor system, with a low concentration of NaOCl, low flow rate, small diameter, and medium residence time can achieve satisfactory decolorization results, but with a lower consumption of chemicals, energy, equipment, and better environmental impact. Article HighlightsColored wastewater was decolorized using batch and microreactor systems.Various microreactor lengths, diameters, and mixture velocities were tested.Microreactor system required 500 times lower amounts of decolorizing agent.

Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic data suggests that occupational exposure to ergonomic risk factors may cause selected other musculoskeletal diseases, other than back or neck pain (MSD) or osteoarthritis of hip or knee (OA). In this paper, we present a systematic review and meta-analysis of parameters for estimating the number of disability-adjusted life years from MSD or OA that are attributable to occupational exposure to ergonomic risk factors, for the development of the WHO/ILO Joint Estimates. Objectives: We aimed to systematically review and meta-analyse estimates of the effect of occupational exposure to ergonomic risk factors (force exertion, demanding posture, repetitiveness, hand-arm vibration, lifting, kneeling and/or squatting, and climbing) on MSD and OA (two outcomes: prevalence and incidence). Data sources: We developed and published a protocol, applying the Navigation Guide as an organizing systematic review framework where feasible. We searched electronic academic databases for potentially relevant records from published and unpublished studies, including the International Trials Register, Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. Study eligibility and criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (

The use of preventive health services is a long-term health investment due to its potential to help individuals to take care of their health. This study aimed to explore the availability and performance of health services in primary health care (PHC) in the domain of general practice (GP), pediatrics, and gynecology, as well as to analyze the influence of sociodemographic and health determinants on the utilization of preventive health services. This descriptive study used data from the National Health Insurance Fund and the Statistical Office of the Serbia for 2015 and included 149 independent PHC units. The relationship between the utilization of preventive services and sociodemographic and health characteristics of the population was analyzed by bivariate and multivariate linear regression models. The higher health expenditure per capita and noncommunicable diseases mortality rate were, the more preventive health services were provided by a chosen GP. Children with a higher completion rate of primary school (p = 0.024), higher health expenditure (p = 0.017), and higher life expectancy at birth (p = 0.041) had more preventive health services. The fertility rate was positively associated with the number of preventive health services per 1000 women (p = 0.033). Our findings should serve as a starting point for where efforts should be made to achieve better health outcomes.

Background/Aim. Chronic subdural hematoma (CSDH) is one of the most frequent neurosurgical conditions with an overall incidence ranging from 1.72 to 20.6 per 100,000 persons per year. The surgical procedure for CSDH is relatively simple and usually performed in the supine position. Reported reoccurrence rates range from 11.7% to 28%. Postperative pneumocephalus was previously identified as a sole predictor of reoccurrence. The aim of this study was to assess the advantage of the procedure in the sitting position in patients with CSDH and a possible impact on the reoccurrence rate. Methods. The study included 31 patients who underwent awake craniostomy with closed system drainage for CSDH (16 in supine and 15 in sitting position) in our department from December 2016 to March 2018. Results. A total of 22 males and 9 females were included in the study. The overall reoccurrence rate was 19% (22% and 18% in females and males, respectively). The re-occurrence was noted in 5 patients who had undergone surgery in the supine position, and in one case in the sitting position. Our results revealed a lower reoccurrence rate in patients undergoing surgery in the sitting position, although not reaching statistical significance [odds ratio (OR): 0.18, 95% confidence interval: 0.01?1.42, p = 0.172]. Conclusion. Craniostomy in the sitting position under local anesthesia is a safe, simple, and reliable procedure for CSDH treatment. Besides being very comfortable for the patient, according to our initial results, it might also lead to a lower reoccurrence rate, probably due to the better management of the air inflow, and consequent pneumocephalus.

Pesticides are intrinsically toxic, and their manipulated quantity and wide use requires adequate protection to reduce the potential impact on applicators’ health. Before marketing the exposure-related health risk of each active substance is assessed through models, to demonstrate that at least in one application scenario its use does not cause an unacceptable health risk to the exposed workers. This reasonably safe scenario identifies the modalities for an effective and safe use that are coded as “Good Agricultural Practices” (GAP) and summarized in the label's instructions. However, real-life work may be conducted out of the frame of GAP, with a consequent health risk for the exposed workers, which must be assessed and managed. In real-life working conditions, risk assessment is seldom, if at all, performed since the task is linked to economic cost, the limited availability of trained personnel and logistics necessary to reach small, family-based enterprises, which are poorly covered by occupational health services. Additional difficulties are represented by the variability of working patterns, climatic conditions, and the frequent use of mixtures of pesticides. The main tools currently available for the exposure and risk assessment “in the field,” namely, biological and environmental monitoring, show important limits for their use in agriculture. In particular, assessment of dermal contamination involves very complicated and expensive procedures that cannot be carried out on a routine basis. Biological monitoring faces strong limitations, including lack of fully validated biomarkers and biological exposure limits. The exposure estimate and risk estimate done for a specific worker at a specific time during one of his workdays using any of the aforementioned methods represent only one point on a map of exposures and risk for workers applying pesticides. Instead of a point, we are interested in the whole map of exposure and risk. To make risk assessment available to all workers in various working conditions, there is a need of simple, user-friendly, and reliable approaches to estimate the levels of exposure (and of related occupational risk) experienced by the workers during typical, rather than actual, activities. We refer to these typical conditions as exposure and risk profiles. This chapter underlines the variables influencing exposure and exposure assessment in real-life work scenarios, reviews the drawback and difficulties of performing exposure assessment using environmental and/or biological monitoring, introduces the concept of exposure scenarios and risk profiles, reviews the current state of risk profile development and their main characteristics, and presents a way forward to integrate the exposure assessment through the exposure score (or index) and the toxicity score to create a risk assessment scheme or a map of exposure and risk in typical exposure scenarios.

Background In 2010, the American Heart Association introduced a new concept of ideal cardiovascular health (CVH) defined as the simultaneous presence of 7 favorable CVH metrics (smoking, diet, physical activity, body mass index, blood pressure, total cholesterol, and fasting blood glucose). The objective of this study was to conduct a systematic literature review and meta-analysis of studies examining the prevalence of ideal CVH, and each of the ideal CVH metrics as well as the relationship between socio-demographic determinants and ideal CVH. Methods A comprehensive literature search was conducted in Medline and Scopus databases for studies published between 1 January 2010 and 30 June 2020. A total of 50 studies including 2,148,470 participants were analyzed. Associations were estimated using DerSimonian-Laird random-effect models. Heterogeneity was investigated through subgroup analyses, Q-test, and I2 statistics. Results This study showed a low prevalence of ideal CVH defining as 6 and 7 ideal metrics (3.3%). Among seven ideal CVH metrics, smoking was the best metric (71%), while the poorest CVH metric was a healthy diet (5.8%). Gender was a statistically significant moderator of ideal smoking (81% in females and 60% in males) and ideal blood pressure (42% in females and 30% in males). Females and young adults had better CVH status compared to males and older adults. Also, more educated and better-off individuals had a greater number of ideal CVH metrics. Conclusions To the best of our knowledge, this is the first systematic review on the relationship between participants’ socioeconomic status and ideal CVH. The results suggest that the prevalence of ideal CVH and most metrics was unsatisfactory. In order to achieve the improvement of the CVH metrics and the overall ideal CVH, nationwide prevention efforts at the population and individual levels are urgently needed.

International audience; Background: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large network of experts. Evidence from mechanistic and human data suggests that occupational exposure to ergonomic (or physical) risk factors may cause osteoarthritis and other musculoskeletal diseases (excluding rheumatoid arthritis, gout, and back and neck pain). In this paper, we present a systematic review and meta-analysis of the prevalence of occupational exposure to physical ergonomic risk factors for estimating the number of disability-adjusted life years from these diseases that are attributable to exposure to this risk factor, for the development of the WHO/ILO Joint Estimates. Objectives: We aimed to systematically review and meta-analyse estimates of the prevalence of occupational exposure to ergonomic risk factors for osteoarthritis and other musculoskeletal diseases. Data sources: We searched electronic bibliographic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference list of previous systematic reviews and included study records; and consulted additional experts. Study eligibility and criteria: We included working-age (≥15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (andlt;15 years) and unpaid domestic workers. The exposure was defined as any occupational exposure to one or more of: force exertion, demanding posture, repetitive movement, hand-arm vibration, kneeling or squatting, lifting, and/or climbing. We included all study types with an estimate of the prevalence of occupational exposure to ergonomic risk factors. Study appraisal and synthesis methods: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, followed by extraction of data from qualifying studies. We combined prevalence estimates using random-effect meta-analysis. Two or more review authors assessed the risk of bias and the quality of evidence, using the ROB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates. Results: Five studies (three cross-sectional studies and two cohort studies) met the inclusion criteria, comprising 150,895 participants (81,613 females) in 36 countries in two WHO regions (Africa, Europe). The exposure was generally assessed with questionnaire data about self-reported exposure. Estimates of the prevalence of occupational exposure to ergonomic risk factors are presented for all five included studies, disaggregated by country, sex, 5-year age group, industrial sector or occupational group where feasible. The pooled prevalence of any occupational exposure to ergonomic risk factors was 0.76 (95% confidence interval 0.69 to 0.84, 3 studies, 148,433 participants, 35 countries in the WHO Europe region, I2 100%, low quality of evidence). Subgroup analyses found no statistically significant differences in exposure by sex but differences by age group, occupation and country. No evidence was found for publication bias. We assessed this body evidence to be of low quality, based on serious concerns for risk of bias due to exposure assessment only being based on self-report and for indirectness due to evidence from two WHO regions only. Conclusions: Our systematic review and meta-analysis found that occupational exposure to ergonomic risk factors is highly prevalent. The current body of evidence is, however, limited, especially by risk of bias and indirectness. Producing estimates for the burden of disease attributable to occupational exposure to ergonomic risk factors appears evidence-based, and the pooled effect estimates presented in this systematic review may perhaps be used as input data for the WHO/ILO Joint Estimates. Protocol identifier: https://doi.org/10.1016/j.envint.2018.09.053. PROSPERO registration number: CRD42018102631. © 2020 World Health Organization

Pesticides are among the most employed synthetic chemicals, and for which there, is the largest database of chemical and toxicological information that allows establishing health-based exposure limits. Protection of pesticide applicators and of the general population from over-exposure is both an ethical necessity and a contribution to planetary health. So far the exposure occupational and population exposure limits could not be efficiently used for health protection, due to the limitations of current techniques to be employed on a wide scale. Biological monitoring of exposure is a viable technique for occupational protection and for the assessment of chemical risk of the population when measurements can be compared with suitable limit values. This possibility is currently employed only for few metals and organics of industrial interest, but only insufficiently for pesticides. We propose a paradigm to assess exposure and exposure-related risk of pesticides based on the measurement of their metabolites excreted in urine and on the elaboration of results from field exposure studies. Regression models allow forecasting the pesticide excretion associated to a systemic dose of pesticide corresponding to its acceptable occupational exposure limit (AOEL) for agricultural pesticide applicators. For this indicator and its corresponding limit value, we propose the name of equivalent biological exposure limit (EBEL). To demonstrate the proposed procedure and to highlight its utility and current limitations, we report data and elaborations from a previously published study that allows establishing a provisional value for an herbicide. This procedure can be adapted to fill the identified sources of uncertainty and to derive a limit value that corresponds to the ADI-ARfD for the general population. The establishment of limit values according to this strategy allows performing risk assessment in the pesticide workers and in the general population by exploiting the capability of modern analytical approaches to the targeted measurement of trace chemicals in biological specimens.

Introduction: The outbreak of the disease caused by the novel coronavirus, SARS-CoV-2 named COVID-19 has spread throughout the world. The number of registered cases is increasing and almost no country or territory worldwide has been without any COVID-19 patient. The aim of this study was to examine the level of knowledge on the SARS-COv-2 and COVID-19 among medical students and to explore the differences in attitudes, practices and fear of COVID-19 among students with sufficient and students with insufficient knowledge. Methodology: The cross-sectional study among the 1,722 medical students was conducted through an online platform of the Faculty of Medicine, University of Belgrade. The instrument used was a questionnaire with sections on socio-demographic characteristics, knowledge, attitudes and practices towards COVID-19 and the Fear of COVID-19 scale. Results: Total of 1576 (91.50%) students were in the sufficient knowledge group. The multivariate logistic regression analysis showed that there was a significant association between the sufficient knowledge on COVID-19 and female sex (OR = 1.70, 95% CI = 1.18-2.45), age (OR = 1.10, 95% CI = 1.02-1.18), considering the preventive measures enforced in Serbia as good (OR = 2.57, 95% CI = 1.18-5.56), wearing the surgical mask outside of the household in the past 14 days (OR = 1.87, 95% CI = 1.22-2.87) and score on Fear of COVID-19 scale (OR = 0.94, 95% CI = 0.91-0.98). Conclusions: Medical students showed good knowledge of COVID-19 and could be a part of the promotion of health education messages as a part of preventive measures.

Brachial plexus injuries are among the most complex injuries of the peripheral nervous system and among the most devastating injuries overall. In complete lesions, functional priorities include the reinnervation of the musculocutaneous and axillary nerves for proximal functions restoration. Three major nerves - radial, median, and ulnar - and the corresponding muscles remain denervated, which results in subsequent muscle atrophy. This study was aimed at the evaluation of arm volumes in surgically treated patients with brachial plexus injuries, in correlation with the type of palsy, recovery and associated factors.The study included 36 patients with brachial plexus injuries who were surgically treated in our institution over a 15-year-long period. The evaluation of arm and arm segments volumes was carried out using water displacement testing, based on the Archimedes principle.Statistically significant differences were noted between the operated arm and the healthy arm in all of the measured segments (hands, forearms and upper arms), as well as between the patients with complete and upper palsy, and in correlation with the shoulder abduction recovery.Previous studies were mainly focused on the functional outcome and quality of life; although related to both, arm volumes in patients with brachial plexus injuries were not analyzed before. Significant differences between the operated arm and the healthy arm volumes, as well as between the various types of palsy, found in the present study should trigger further prospective research in relation to neurophysiology, useful functional recovery and quality of life.

Chronic subdural hematoma (CSDH) is a common pathology in neurosurgery, especially in the elderly patients, and its incidence is likely to double in the next decade. Considering various features of CSDH and the procedure itself, a sitting position may retain the best characteristics of classic positioning, while offering additional comfort for both the patient and the surgeon. The aim of this study was to describe the technical aspects of this procedure in the sitting position, to evaluate safety and discuss the benefits and shortcomings of this modification.This study included a series of 55 patients surgically treated for CSDH in a sitting position at our department between December 2017 and September 2019, representing all the patients operated on during the study period by a single surgeon. Bilateral hematomas were present in 19 patients. Outcomes, during the 6-month follow-up period, were defined as good (CSDH and symptoms resolved) or poor (lethal outcome or reoccurrence). All complications were noted, with emphasis on pneumocephalus, and complications related to the sitting position: tension pneumocephalus, venous air embolism, and compression nerve injury.Complications previously associated with the sitting position were not noted. The Glasgow Coma Scale and Markwalder Grading Scale scores improved significantly after the surgery (p0.001 and p = 0.018). Complications were noted in 17 patients (30.9%), and included 5 cerebrospinal fluid drainages, 3 hematoma reoccurrences, 2 wound infections, and 9 more single-occurring complications. The in-hospital mortality was 5.4% (3 out of 55 patients), while the overall mortality was 16.4% within the 6-month follow-up period.In our series, even the severely ill patients tolerated the position well. No complications associated with the sitting position were noted. Future studies should confirm the safety of this position and evaluate the potential advantages for both the patient and the surgeon.

Pesticides represent an economical, labor-saving, and efficient tool for pest management, but their intrinsic toxic properties may endanger workers and the general population. Risk assessment is necessary, and biological monitoring represents a potentially valuable tool. Several international agencies propose biological exposure indices (BEI), especially for substances which are commonly absorbed through the skin. Biological monitoring for pesticide exposure and risk assessment seems a natural choice, but biological exposure limits (BEL) for pesticides are lacking. This study aims at establishing equivalent biological exposure limits (EBEL) for pesticides using real-life field data and the Acceptable Operator Exposure Level (AOEL) of mancozeb as the reference. This study included a group of 16 vineyard pesticide applicators from Northern Italy, a subgroup of a more extensive study of 28 applicators. Their exposure was estimated using "patch" and "hand-wash" methodologies, together with biological monitoring of free ethylene-bis-thiourea (ETU) excretion in 24-hour pre- and post-exposure urine samples. Modeling was done using univariate linear regression with ETU excretion as the dependent variable and the estimated absorbed dose as the independent variable. The median skin deposition of mancozeb in our study population was 125 μg, leading to a median absorbed dose of 0.9 μg/kg. The median post-exposure ETU excretion was 3.7 μg. The modeled EBEL for mancozeb was 148 μg of free ETU or 697 μg of total ETU, accounting for around 75% of the maximum theoretical excretion based on a mass balance model. Although preliminary and based on a small population of low-exposed workers, our results demonstrate a procedure to develop strongly needed biological exposure limits for pesticides.

ObjectiveTo study the source, symptoms, and duration of infection, preventive measures, contact tracing and their effects on SARS-CoV-2 epidemic among healthcare workers (HCW) in 2 large hospitals and 40 external healthcare services in Milan (Italy) to propose effective measures to control the COVID-19 epidemic among healthcare workers.DesignEpidemiological observational study.SettingTwo large hospitals and 40 territorial healthcare units, with a total of 5700 workers.Participants143 HCWs with a SARS-CoV-2 positive nasopharyngeal (NF) swab in a population made of 5,700 HCWs.Main outcome measuresClinical data on the history of exposure, contacts inside and outside of the hospital, NF swab dates and results. A daily online self-reported case report form consisting of the morning and evening body temperature and 11 other symptoms (cough, dyspnoea, discomfort, muscle pain, headache, sore throat, vomiting, diarrhoea, anosmia, dysgeusia, conjunctival hyperaemia).ResultsMost workers were tested and found positive due to a close contact with a positive colleague (49%), followed by worker-initiated testing due to symptoms (and unknown contact, 28%), and a SARS-CoV-2 positive member of the family (9.8%). 10% of NF swabs performed in the framework of contact tracing resulted positive, compared to only 2.6% through random testing. The first (index) case caused a cluster of 7 positive HCWs discovered through contact tracing and testing of 250 asymptomatic HCWs. HCWs rarely reported symptoms of a respiratory infection, and up to 90% were asymptomatic or with mild symptoms in the days surrounding the positive NF swab. During the 15-day follow-up period, up to 40% of HCWs reported anosmia and dysgeusia/ageusia as moderate or heavy, more frequently than any other symptom. The time necessary for 95% of HCWs to be considered cured (between the positive and two negative NF swabs) was 30 days.ConclusionHCWs represent the main source of infection in healthcare institutions, 90% are asymptomatic or with symptoms not common in a respiratory infection. The time needed to overcome the infection in 95% of workers was 30 days. Contact tracing allows identifying asymptomatic workers which would spread SARS-CoV-2 in the hospital and is a more successful strategy than random testing.What is already known on this topic?There are more than 3 million SARS-CoV-2 positive cases and more than 200,000 deaths attributed to coronavirus disease (COVID-19) worldwide.Commonly reported symptoms of COVID-19 include fever, cough, dyspnea, sore throat, muscle pain, discomfort, and many prevention strategies are based on identifying these symptoms of infection.The virus can be spread even by asymptomatic patients or patients with mild symptoms, and healthcare workers (HCWs) represent 10% of overall cases and often more than 10% of hospital personnel are commonly infected.HCWs represent both a vulnerable population and an irreplaceable resource in the fight against this epidemic and further analysis is needed to show how and why they get infected and introduce successful prevention measures.What this study adds?The first (index) case in our study was infected by a family member, but due to close contacts with colleagues managed to infect other 7 HCWs. Contrary to a common expectation that HCWs get infected from patients, they regularly get infected by other HCWs.Up to 90% of HCWs were asymptomatic or had only mild symptoms. Random testing for SARS-CoV-2 was not efficient. Active search for suspect cases through contact tracing is the strategy of choice to identify most of the positive HCWs.Most HCWs remained asymptomatic during the 15-day follow-up period, and even in the days prior to the positive NF swab. Anosmia and ageusia/dysgeusia were reported more commonly than classic symptoms of a respiratory infection.Contrary to the recommended quarantine of 14 days, 30 days were necessary for 95% of the workers to be declared cured (two negative NF swabs)

Objectives: The aim of this study was to estimate the prevalence of burnout syndrome in a large sample of primary and secondary school teachers in the Republic of Srpska (Bosnia and Herzegovina) and identify the factors associated with burnout in this population. Methods: This cross-sectional study was conducted in August and September of 2018, on a sample of 952 teachers. Beside socio-demographic information, Bortner scale, Job Content Questionnaire, and Maslach Burnout Inventory were filled in by the study participants. Results: Only 5.1% of teachers reported high levels of emotional exhaustion, 3.8% reported high levels of depersonalization, and 22.3% reported low levels of personal accomplishment. Behavior type, specifically type-A behavior, was associated with higher levels of emotional exhaustion. The most important factors associated with burnout were work&ndash, life characteristics and job-demand-control model of occupational stress. Conclusions: Our study shows a low prevalence of emotional exhaustion and depersonalization in teachers in the Republic of Srpska before the beginning of the new school year. Since similar studies show a high prevalence of burnout at the end of the school year, a potential seasonality of this syndrome should be considered and explored further.

The earliest regulation concerning the handling of poisons in Serbia dates back to 1837, followed closely by the “Law for pharmacies and pharmacists: drugs and poisons storage and sale” in 1865. Eminent Serbian scientists were educated abroad at the end of the 19th and the beginning of the 20th centuries, but formal toxicological education began in 1946 with the founding of the Institute of Toxicology (today Department of Toxicology “Akademik Danilo Soldatovic”) at the Faculty of Pharmacy, University of Belgrade. The Department of Toxicology “Akademik Danilo Soldatovic” at the University of Belgrade – Faculty of Pharmacy has the longest tradition of almost 80 years and is still the main center for education and training in toxicology and health risk assessment. Another important milestone in the development of toxicology in this region was the establishment of the Yugoslav Society of Toxicology in 1969, and after Yugoslavia split up in 1991 the Serbian Society of Toxicology, registered in 2010, continued to organize congresses every 4 years and joined EUROTOX (Federation of European Toxicologists and European Societies of Toxicology) and IUTOX (International Union of Toxicology). Furthermore, this chapter introduces the reader to the history of toxicology in the Republic of Serbia, the beginnings and current status of toxicological education in our country, universities and faculties teaching toxicology, and provides a list of other resources such as books, journals, relevant national legislation, governmental and nongovernmental agencies, databases, centers, institutes, and institutions dealing with poisoning and its prevention.