bluuebunny/crossref_metadata_2025 huggingface dataset:
First six months of measles outbreak in the Republic of Srpska in 2024
Authors: Rodić-Vukmir Nina , Jelen Marina , Ćulum Nikola
Published: October 2024

Background: Surveillance is an essential component of measles and rubella elimination. Persistent low routine vaccination is the most critical driver of the measles outbreaks. MMR coverage in the Republic of Srpska in the last years is significantly below 95% (in 2023 1. dose - 62,07 and 2. dose - 76,03%). Methods and Objectives: The aim of this descriptive study is to analyse the data on measles patients in the first six months of the outbreak that has started in 2024 in the Republic of Srpska. Information on each reported measles patient was obtained via the infectious disease notification form. Based on the measles case definition, each patient was reported as possible, probable or confirmed case according to the European Center for Disease Control (ECDC) definitions. Each sample is tested both for measles and rubella according to the recommendations. Results: Since the beginning of 2024, a total of 256 measles cases have been registered, of which 104 are possible (40.63%), 87 are probable (33.98%) and 65 are confirmed (25.39%). Gender distribution is almost equally represented. The majority of patients belong to the age group 1-4 (41.41%) and 5-9 (28.91%). The largest number of patients was reported in cities where outbreaks was reported, namely Bijeljina (72.66%), Banja Luka (10.16%) and Istočno Novo Sarajevo (5.47%). Of total, 41 cases (16.02%) were hospitalized, of which 51% were unvaccinated or the vaccination status was unknown (29.27%). A total of 24 cases had complications, of which 70.83% were unvaccinated and 12.50% had unknown vaccination status. Conclusions: The appearance of measles in the Republic of Srpska was expected given the low coverage of the MMR vaccine. Measles was registered 13 times more often in the unvaccinated, while complications occurred 17 times more often in the unvaccinated. There is an urgent need to improve vaccination coverage rates with both doses of the MMR vaccine.
Investigation of a Salmonella enterica outbreak in a nursery in Tirana, Albania: Epidemiology, implications, and control measures
Authors: Ramaj Arlinda , Mersini Kujtim , Konomi Fiona , Gjergji Elona , Ymeraj Jasmena , Bino Silvia
Published: October 2024

Background: Salmonella is a major cause of diarrheal diseases, transmitted through contaminated food and the faecal-oral route. We report an outbreak of Salmonella enterica in a nursery in Tirana, Albania. Methods and Objectives: On October 25, 2023, the Local Health Care Unit was informed of a confirmed case of Salmonella enterica in a hospitalized child who attended a nursery in Tirana, with 120 children aged 6-36 months and 33 staff. We conducted a cohort study, interviewing parents and staff to assess demographics, symptomatology, and risk factors. Microbiological testing of stool and environmental samples were also performed. The investigation aimed to identify the outbreak source, determine transmission methods, and identify control measures to halt spread and safeguard nursery attendees' health. We calculated attack rates and relative risks according to gender, age and nursery class. Confirmed case definition was anyone tested positive for Salmonella enterica (stool sample), and probable case definition was having symptoms consistent with Salmonella. Results: We collected data from 110 nursery attendants, 82 children and 28 staff members (72% response rate). Twenty-two cases (four confirmed and 18 probable), were identified. The overall attack rate was 20%. Males were 3.9 times (95% CI=1.74-8.75) more likely to be a case. The median age of children affected was 29 months (IQR=14-33) and those older than 24 months were less likely to be a case (RR=0.45, CI=0.22-0.93). The median duration of illness was 4.5 days. Eleven (50%) cases had visited general practitioners, and two (9.1%) were admitted to hospital. All environmental cultures, taken from the kitchen's utensils and surfaces, diaper changing tables, and hands of staff were negative for Salmonella, but positive for E.coli. Through interviews and observation, we found that nursery staff did not follow hygienic measures. Following our investigation, a mandatory two-week closure of the nursery was implemented to halt transmission and introduce corrective actions to improve conditions. Conclusions: Although environmental laboratory samples were negative for salmonella and therefore we could not prove the source, we suspect that poor hygiene practices among staff likely caused outbreak extension through faecal-oral routes. The presence of E.coli in the environmental samples supports this hypothesis.
Surveillance of hospital-acquired infections at the Niš University Clinical Center: Analysis of isolates with multidrug-resistant bacteria
Authors: Novak Sonja , Popović Nadežda , Milenković Nikola , Lukić Nataša , Stanojević Bojan
Published: October 2024

Background: It is important for healthcare facilities to have robust infection control measures in place to minimize the risk of hospital-acquired infections (HAI) and protect patient safety. By analyzing multidrug resistant bacteria, healthcare professionals can make informed decisions about antibiotic therapy, implement appropriate infection control measures to prevent the spread of resistant strains, and contribute to the development of new antimicrobial agents. The aim of the study was to investigate the microbial isolates in humane materials and compare findings with number of registered hospital-acquired infections, evaluating current preventive measures and making ground for new ones. Methods and Objectives: Retrospective study was employed in evaluating UKC Niš Surveillance Data Base with all patients' microbial isolates during the hospitalization at University Clinical centre (UKC) Niš between January 2022 and December 2023. Results: Out of 35,072 patients in 2022, 3,622 (10.3%) isolates were with multi drug resistance bacteria while 195 (5,38%) were registered as HAI. Out of 59,428 patients in 2023, 3,840 (6.46%) isolates were with multi drug resistance bacteria while 378 (9,8%) were registered as HAI. The most frequent isolated bacteria were Acinetobacter spp. (15.9%) from wound (35.94%) in 2022, and Klebsiella spp. (18.85%) from urine (35.36%) in 2023. Multi drug resistant microbes were most common found in category of ≥55 years old patients and predominantly in males (both 2022 and 2023). A comparative analysis of the 2022 and 2023 HAI UKC Nis distribution by organizational units showed that in 2022, the clinic for anesthesia (51), pediatrics (29) and nephrology (15) reported the highest number of HAI, while in 2023, the anesthesia clinic (106), physical medicine (36) and pulmonology (28) reported the highest number. Significant number of registered HAI was ''from the other healthcare institution''. Conclusions: Strong surveillance of isolates of multidrug-resistant microbes, monitoring, evaluation and adaptation of preventive measures to clinical specific characteristics are key in fighting the HAI.
Dashboard for MMR vaccination coverage in Montenegro as the innovative communication tool
Authors: Obradović Aleksandar , Raičević Marija , Laušević Dragan , Dujović Branko
Published: October 2024

Background: Despite being included in the mandatory vaccination calendar and used for over three decades, MMR vaccine coverage has significantly declined in Montenegro over the last decade, especially the first dose, which is often delayed until preschool age. This was exacerbated by the COVID-19 pandemic, however, the pandemic accelerated digital innovations in public health, leading to a greater presence of dashboards as a primary communication tool for public health authorities, aimed at timely and comprehensive information sharing. Consequently, the Institute for Public Health of Montenegro (IPHMNE) developed a dashboard for MMR immunization coverage in early 2024 available at: https://www.ijzcg.me/me/male-boginje-morbili. Methods and Objectives: Data for the MMR vaccination dashboard are derived as a CSV file from the IPHMNE National immunization registry, within an integrated health informatics system. Exported data are converted to a MySQL database through an extract-transform-load phase, serving as the data source. Visuals for the dashboard are created using Microsoft Power Bi Desktop. The dashboard is updated weekly and it provides vaccine coverage by different birth cohorts, genders, and municipalities, as well as timeliness of vaccination. Results: Since the MMR vaccination dashboard's publication in April 2024, IPHMNE has referred to it in all public statements regarding the current epidemiological situation related to measles. This approach allows IPHMNE to communicate the importance of vaccination in preventing measles outbreaks more comprehensively and highlights fractions of the population at increased risk due to lack of vaccination. This has led to a more than 80% reduction in requests about current MMR vaccination coverage, as the information is publicly available to both professional and general audiences. Conclusions: Dashboards for data visualization are an effective way to utilize information technology to improve communication on different public health topics. They ensure timely and accurate information dissemination and reduce the need for information-sharing requests by providing updated data access to all interested parties.
HPV vaccine application in the cities of Vlora and Fier
Authors: Kokalla Erlini , Subashi Brunilda , Ismailaj Evgjeni , Fetahu Lejdi , Rakipaj Majlinda , Taraj Deona , Brokaj Stiliana
Published: October 2024

Background: Cervical cancer is the second most common type of cancer among women in Albania. This cancer has great potential for prevention, with health interventions resulting in the gain of several healthy years of life. One of the most effective methods of preventing cervical cancer is to vaccinate girls before starting sexual activity. That's why the application of HPV vaccine is a crucial intervention of public health for preventing and controlling the cervical cancer and also other HPV infections. In Albania, the vaccine against HPV has become part of the children's vaccination calendar, free of charge, since November 2022. The application of this vaccine aims to include all girls born since January 2009, thus targeting girls at the age of 13. Methods and Objectives: This study aims to assess the HPV vaccination coverage rates in the cities of Vlora and Fier throughout 2023. It is an epidemiological cross-sectional study utilizing data obtained from the databases of The Regional Directorate of the Health Care Services Operator. Results: The analysis of data from 2023 shows that 537 girls in Vlora were scheduled for HPV vaccination, with 297 receiving it. In Fier, out of 887 girls scheduled, 501 were vaccinated. The vaccination coverage for the HPV vaccine reaches the value of 55% for the city of Vlora and 56% for the Fier. Conclusions: This study concludes that the HPV vaccine uptake is not at high levels, highlighting the importance of conducting further research to identify factors that hinder the implementation of the HPV vaccination program.
Diabetes mellitus: Can health care burden be reduced by new follow up forms
Authors: Selea-Živojinović Anujka , Fog Heen
Published: October 2024

Background: Diabetes mellitus is one of the fastest growing health care problems, especially in the developing countries. It is projected that there would be 635 mil people with diabetes by 2035. The disease is chronic and progressive. The treatment an follow up require a multidisciplinary team and a continuous effort from the healthcare team but also from the patient. Modern treatment of chronic disease sets the patient and his experience of wellbeing in focus. The development of new medicines and integration of technology and artificial intelligence in diabetes care gives new challenges to the patient and health care team, but also new possibilities. The last COVID pandemics has also confirmed the efficacy of digital consultations. Methods: We give a short description presentation of patient managed outpatient clinic. The number of outpatient clinics in Norway (neurology, rheumatology, diabetes) have now started to use patient managed outpatient clinics. Chronic patients that are followed up at the clinic (every 3/6/12 month) are included in the patient register. Instead of getting an physical appointment, the patients get first a questionnaire formed by the specialist health care team (symptoms, medication use, wellbeing etc). The questionnaire is sent back digitally. The specialist nurse than goes through the answers. The answers at coded in traffic light color. Depending on the score, it is possible to time the appointment and choose the type of appointment (physical, digital) or postpone the appointment: The patient has also the possibility to refer to the healthcare team when there is a need for consultation. Results: There is not systemic statistic for the effect of patient managed outpatient clinics. Preliminary local results, however, show that up to 70% of planned consultations can be modified. The new outpatient clinic is very well accepted from the patentswith preliminary high response to the questionnaire and satisfaction with the possibility of digital consultations. Conclusion: Patient managed diabetes outpatient clinics are a promising improvement in diabetes care. It responds better to patient needs. It reduces the burden on diabetes healthcare team. It helps the team to better prioritize the task. It probably reduces the economic burden of diabetes follow up, though that is not so easy to confirm due to the costs of modern medicines and diabetes technology that is being part of the treatment. The patient managed outpatient clinic can be of help in the developing healthcare systems and can be engaged in the prevention of diabetes.
Health council at the local self-government unit: Report 2022 for Serbia
Authors: Živković-Šulović Mirjana
Published: October 2024

Background: Creating resilient, adaptable communities and supportive environments is one of the goals of the "Health 2020" police framework developed by the World Health Organization. The Health Council (Council) is responsible for social care for public health (PH) at the level of local self-government units (LGUs) in accordance with the Law on PH. Methods and Objectives: The goal of the research is to examine the capacity of Counsil in the community and to evaluate the cooperation with PH institutes (PHI), as well as other partners and actors related to PH in the community. The survey questionnaire "Report on the activities of participants in the PH System - Health Council at the LGUs" with six parts was used (January 2023). Using descriptive statistical analysis, the distributions of answers to the questions were determine for first two part of questionnaire - Social care for the PH of the LGUs in the field of physical, mental and social health, promotion and prevention. Results: The survey covered 130 (89,6%) of 145 LGUs. The Council has 90.7% of LGUs. PHI representatives participate in the work of 74.5% of the Council. The PH Plan was adopted by 39.3% of LGUs. PHIs made Analysis of the health status of municpality for 40% LGUs. Health risk assessment study have 10.7% LGUs. Campaigns for promoting healthy lifestyles support 78.7% of LGUs. Preventive examinations, immunization and prevention of violence are most often supported (52.5; 45.1; 37.7; %). LGUs most often participate by providing media support, space and the participation of LGU representatives (63.1; 60.7; 54.1; %). The most common partners of LGUs in campaigns are health centers, the Red Cross, PHIs and civil organizations (75.6; 64.4; 51.9; 38.5;%; ). LGUs funded a total of 794 PH programs in the community from all areas of PH, of which 475 (59.8%) were from social care for PH in the areas of physical, mental and social health, prevention and promotion of healthy lifestyles. Conclusions: To apply evidence-based recommendations to improve all areas of public health to be implemented in policy-making and action at the local level, monitoring of existing measures and activities in accordance with evidence-based recommendations or political areas of action is necessary.
Maternal characteristics and perinatal care costs
Authors: Marković Radomir , Grbić Dragana
Published: October 2024

Background: The inherent complexity of managing pregnancies and their outcomes presents a significant challenge for the obstetric team and places considerable strain on hospital resources. Tertiary-level maternity wards frequently encounter difficulties in securing adequate financing and optimizing the use of limited resources, all while facing rising demand for healthcare services due to complicated pregnancies and deliveries. Methods and Objectives: The aim of this study was to examine the association between characteristics of women and the expenses of their delivery in University Gynaecology Obstetrics Clinic Narodni Front. We analysed health record and hospital bill data of 6949 women collected in a cross-sectional study conducted in 2019. Both parametric and non-parametric tests were used to examine these associations. Results: The extremely high expenses had women older than 35 years (p<0,01), primiparas (p<0,01), women with premature childbirth (less than 37 gestational weeks of pregnancy) (p<0,001), those who concieved via IVF (p<0,001) and women with multiple pregnancy (p<0,001). Women with "near miss" conditions like severe bleeding during and after delivery (p<0,001), severe preeclapsia or eclapmsia (p<0,001), systemic infection or sepses (p<0,001), uterine rupture (p<0,001), hysterectomy (p<0,001), and with perinatal coomorbidities (p<0,001) incurred notably higher costs compared to those without these conditions. Furthermore, women with extremely high expenses were significantly more likely to be categorized in DRG groups for both complicated and uncomplicated C-sections. Conclusion: Maternal characteristics can significantly impact the cost of perinatal care. Further analysis is needed to develop effective payment strategies for tertiary-level hospitals and enhance the quality of perinatal care, thereby safeguarding women's health.
Access to medicines in the Republic of Serbia
Authors: Atanasijević Dragana
Published: October 2024

Background: According to World Health Organization one-third of the total population lack access to essential medicines. Also, the biggest driver of catastrophic health spending is usually medicine. Eff orts to reduce fi nancial hardship should prioritize improving drug aff ordability. In the Republic of Serbia, the right to medicines includes the right to medicines from the List of medicines at the expense of compulsory health insurance funds. Extraordinarily, the insured person can be provided with a medicine that is not on the List of Medicines. Methods and Objectives: Th e paper uses a descriptive analysis of the available data (data source National Health Insurance Fund (NHIF)) related to exercising the right to medicines on diff erent grounds, including a comparative analysis of the obtained results by time intervals. Th e aim of the paper is to review the scope and content of the realized rights to medicines in the Republic of Serbia. Results: In the latest revision of the List of medicines there were 2859 medicines under 759 diff erent INN across the various sections of the List. Moreover, in the year 2023, based on the opinion of three doctors of the appropriate specialty, medicines with marketing authorisation but not on the List of reimbursed medicines received a total of 16,559 insured persons, and 16,550 insured persons received medicines with no marketing authorisation in the Republic of Serbia. Th e numbers exceeded the number of treated with medicines that are not on the List even during the peak period (2021) the COVID 19 epidemic (Graph 1). In addition, there are also broad rights that enable insured persons to be provided with medicines of proven effi cacy, which are not on the List of medicine, as well as various ways in which medicines for the treatment of rare diseases (orphan drugs) are made available. Conclusions: Access to medicines is defi ned by the generally wide scope of the right to medicines, which are provided not only from compulsory insurance funds, with the basic aim of satisfying the specifi c priorities defi ned by the Health Care Plan.
Transforming mental health services in primary health care in Slovenia
Authors: Bujko Ana , Pribaković Brinovec
Published: October 2024

Background: Strengthening mental health, preventing development of mental health disorders and accessible mental health services for all are crucial tasks of health system, both from individual and societal point of view. In year 2015 the mission of the World Health Organization, Regional office for Europe, to Slovenia recommended i.a. (a) strengthening mental health services in primary care for improved accessibility; (b) improved access to community treatment of persons with severe mental health disorders; (c) strategic workforce planning in mental health and increased number of clinical psychologists; (d) improved access to psychotherapy. Based on these recommendations the first strategic document on mental health was adopted in 2018, The National Mental Health Programme 2018-2028. Methods and Objectives: Eight strategic objectives of the National Programme address implementation of policies in supporting mental health, intersectoral cooperation, implementation of evidence-based programmes and interventions, suicide prevention, alcohol related mental health disorders, community-based services, integration of social care and health care programmes, shortages of workforce. Results: Between 2018 and 2023 several mental health promotion programmes were introduced (e.g. Incredible Years, Cool Kids, This Is Me / To Sem Jaz). School counselling services and programmes for vulnerable adolescents and young adults were strengthened. Strategy for deinstitutionalization of long-term social care facilities was adopted. There are already 22 multidisciplinary Children and Adolescents Mental Health Centres and 18 Adults Mental Health Centres operating in primary health care, out of 30 and 25 respectively. Adults Mental Health Centres also provide community services for persons with severe mental health disorders according to the FACT (Flexible Assertive Community treatment) model. Out-patient and hospital programmes for non-chemical dependencies were introduced. Conclusions: Mental health is high on political agenda in Slovenia since 2018. Major investments in health care, social care and education system increased access to mental health programmes and services.
Pharmacoepidemiological analysis of the consumption of nasal decongestants in the Republic of Srpska
Authors: Bojanić Ljubica , Đermanović Mirjana
Published: October 2024

Background: Nasal decongestants are drugs that are used to prevent excessive nasal secretions, and to facilitate breathing in case of a cold, allergy or other disorders of the upper respiratory tract. They are most often used locally in the form of sprays, nasal drops or inhalation products, but they can also be used oraly in the form of tablets or capsules, alone or in combination with other medicines. Monitoring the consumption of medicines is important for the analysis and improvement of its rational use, and the aim of this paper is to analyze the outpatient consumption of nasal decongestants for local administration, in the Republic of Srpska during the period from 2020 to 2022. Methods and Objectives: The data were obtained from the Annually Drug Consumption Report of the Public Health Institute of the Republic of Srpska, and are expressed in defined daily doses per 1000 inhabitants per day (DID), in accordance with the recommendations and classifications of the World Health Organization. Results: Among the drugs for the treatment of the respiratory tract, nasal preparations (drugs for the treatment of diseases of the nasal mucosa) are in second place, right after the drugs for the treatment of obstructive lung diseases. Among the nasal preparations, the sympathomimetics xylometazoline and oxymetazoline, and the combination of xylometazoline with dexpanthenol, are used the most, similarly to other countries in the region. Conclusions: During the observed period, a slight increase in the consumption of nasal preparations was observed, and it is necessary to continue monitoring the trend of consumption and work on improving cooperation between doctors, pharmacists and patients in order to rationalize therapy and raise knowledge and awareness about the correct use of nasal decongestants in accordance with modern therapeutic guidelines.
Medicine shortage: Serbian experience
Authors: Jaćović-Knežević Nataša , Atanasijević Dragana
Published: October 2024

Background: The unavailability of medicines continues to be on the rise in Europe and it has a tremendous impact on patients. Medicine shortages occur across all healthcare settings and involve both essential life-saving medicines and very commonly used medicines. Medicine shortage means a situation in which the supply of a medicinal product that is authorized and placed on the market in a Member State does not meet demand for that medicinal product at a national level, whatever the cause (Regulation (EU) 2022/123). Medicine shortages can result from different economic, manufacturing, or regulatory causes. In our country has been performed an assessment of the regulatory framework to increase preparedness for the forthcoming situation. By changing several regulations import proponent for centralized public procurement become Institute of Public Health of Serbia (IPHS). Methods and Objectives: We have analyzed Health Technology Assessment Department's data of import proposal for missing medicines from September 2023. to July 2024. in order to ensure a continuous supply of medicines and provide quality health care. Results: In accordance with the changes, so far 23 medicines have been imported this way. The largest number of them belong anti-infective medicines (benzylpenicillin, tobramycin, rifampicin, acyclovir), then medicines with an effect on the nervous system - antipsychotics: fluphenazine, Lithium and disulfiram used in alcohol dependence. Respiratory system medicines including fluticasone and adrenergics in combination with anticholinergics (salbutamol and ipratropium bromide). Also, zoledronic acid as drug affecting bone structure and mineralization and pemetrexed as antineoplastic agent were imported, as well as antihemorrhagics drugs tranexamic acid and phytomenadione. Conclusions: The main causes of medicine shortages are diverse and multi-factorial, so the analysis is important for adequate supply that enables continuous performing of healthcare, defining priorities and calculating the impact on National health insurance fund (NHIF) resources.
Evaluation of natural spring water quality as environmental indicator in Belgrade 2022-2023
Authors: Avramović Dušan , Ristanović-Ponjavić Ivana
Published: October 2024

Background: The quality of untreated, ground water from public taps with natural spring water is related to surrounding environment heavily influenced by human activities in urban and suburban areas of the city. Methods and Objectives: We evaluated natural springs water quality as environmental indicators in Belgrade in 2022-2023. We included 985 water samples from 34 objects of public taps with ground water, and performed physico-chemical, microbiological, biological and parasitological analysis in accordance with Regulation on Hygienic Standards of Drinking Water (Official Gazette of the FRY", no. 42/98 and 44/99 and "Official Gazette of the RS", no. 28/19). Results: The results of our study show frequent microbiological contamination, followed by elevated presence of biological and parasitological indicators, and different physico-chemical parameters reflecting characteristics of the public spring nearby surrounding environment. Conclusions: The quality of natural ground water indicates the potential contamination of the spring surrounding environment in urban and suburban areas of the city.
Monitoring of arsenic content in arterial wells in Srem and Northern Mačva from 2017 to 2024
Authors: Ljubičić Žaklina
Published: October 2024

Background: Arsenic is one of the risk factors responsible for the occurrence of various diseases and has been proven to be a human carcinogen (IARC, Group 1). Exposure to arsenic through drinking water can lead to hyperpigmentation and keratoses (content less than 50 µg/L), as well as skin cancer, and is associated with an increased risk of lung, liver and bladder cancer, Inorganic arsenic can also increase the risk of type 2 diabetes mellitus. Determining the content of arsenic in drinking water on the territory of Srem and Mačva has been carried out for two decades, and since 2017, continuous monitoring of the content of arsenic in artesian wells has been carried out in all settlements in Srem and the northern part of Mačva. Methods and Objectives: The content of arsenic is determined by the method of atomic absorption spectrometry (hydride technique). Results: The total number of artesian wells in which arsenic content is analyzed in the settlements of Srem and Mačva is 67. The total annual number of samples at the mentioned locations is 268. Of the total number of locations of artesian wells, 18% have arsenic content in water above the maximum allowed value of 10 µg/L. Conclusions: It is necessary to stop the exposure of the population to water from locations with elevated arsenic values and to continue monitoring the content of arsenic in drinking water. The recommendation for the next period is that, in addition to monitoring the arsenic content in drinking water, trends in the population's illness in places with high arsenic content should also be monitored.
Public health indicators of THE PEP In Serbia: Linkages to active mobility
Authors: Matić Branislava , Dejanović Snežana
Published: October 2024

Background: The Transport, Health and Environment Pan-European Programme (THE PEP) is the first and only international programme (UNECE) designed to integrate environmental and health aspects into transport, mobility and urban planning policies. Serbian health sector has joined THE PEP team in 2014. with an assignment to introduce topic of active and sustainable mobility into the public health agenda. Methods and Objectives: In order to update THE PEP process with data from Serbia on the issue of healthy and active youth mobility, we used those available from the activities of the IPHS: "Health Behaviour in School-aged children" (2018 and 2022 surveys). Our aim was to present indicators of youth active mobility provided by the public health sector, as contribution of Serbia in THE PEP process. Results: There is a mild increase in obesity trend in boys in a 2022 survey, compared to the one in 2018 with 24.8% vs 21.8%; girls were more malnurished than boys in both surveys: 15.4% vs. 8.3% in 2018 and 14.1% vs.9.6% in 2022. Comparing percentage of pupils practicing physical activity 60 min/day in three age groups (grades fifth and seventh of primary school and first of gymnasium) in both girls and boys it has declined lineary with age, in both surveys. Percentage of students physically active outside regular school hours ≥ 3 times per week shows a clear decrease in girls in all three age groups (from 80.4% to 71.4% and finally 58.7% in gymnasium) in both surveys, while being physically active out of school is more ballanced in boys ranging from 83.1 - 80.4%. Conclusions: In order to enhance healthy youth active mobility different sectors should get involved, through promoting healthy life styles from pre-school and school age, building up capacities for better traffic safety of children, continuous air quality monitoring, with a definite aim to provide growing up of healthy adults free of NCDs.
The role of risk and crisis communication in managing deliberate release incidents
Authors: Iliopoulos Dimitrios , Dellis Georgios
Published: October 2024

Background: The objective of WP7 of JA TERROR is to promote the implementation of Risk and Crisis Communication at all stages of risk management, on both national and EU level. During a crisis or emergency, communication to the public may include media releases, website content, talking points for spokespersons, interviews, social media posts, public service announcements and advertising. It is important to determine which populations are at greater risk and use the most appropriate methods to reach both them and the public. In addition to providing accurate and timely information, informative material for the public must also address and deal with misconceptions, misinformation and rumours. Communication planning must be an integral part of Generic Plans, including the development of country-level technical guidance as well as public information and training. Methods and Objectives: The main objective of the document is to provide practical information on how to manage the flow of risk and crisis communication among stakeholders and the public in the event of a biological or chemical terror attack. The guidance tool is evidence-based as it based on best practices and after-action reviews from the COVID-19 pandemic Results: The recommendations derived in this guideline are given from a health sector perspective but should be applicable to all sectors with the responsibility to public health in the event of a biological or chemical terror attack, for example, both for the health, security, and civil protection sectors. They have been defined, grouped and presented per each phase in the emergency management cycle and should be considered in developing, updating, or revising the national, sector, and facility emergency management plans. Conclusions: • Rapid, open, and coordinated communication with the public can determine to what degree terrorists will succeed with their intentions. Therefore, risk communication should be considered as a foundation for national security. • Social media is a leading channel for communication that should be used in a dialogical way • Disinformation should be monitored and handled.
The role of public health in emergency situations
Authors: Knepr-Šegina Maja
Published: October 2024

Public health has always been one of the key links in dealing with emergency situations. When we say emergency, the first thought is usually an accident that happened and involves the emergency services. However, if we look at the bigger picture, many situations can be considered urgent and almost always involve multiple services and sectors. In such cases, cooperation between sectors involved in a emergency situation is extremely important. The strengthening of intersectoral cooperation and communication was one of the incentives for launching the JA TERROR project at the European Union level. A terrorist attack or, more broadly, any incident involving chemicals or a biological agent can occur at any time, anywhere. In addition, we all witnessed a pandemic that affected us all equally and revealed where we are strong but also where, unfortunately, we are not. The very launch of JA TRRORA in 2019 seemed to be a foreshadowing of what is to come. Croatia is one of the many countries involved in the work of all work packages of the project, and the Croatian Institute of Public Health is the project holder for Croatia. Our main goal was to strengthen cooperation and communication between the sectors of public health, security and civil protection. By working within several technical packages, together with colleagues from other countries, we have obtained detailed information on the areas that require additional work in order to enhance and make the cooperation between the sectors as effecitve as possible. By organizing workshops at the national and international level, participants from various sectors had the opportunity to exchange experiences and jointly identify the main problems in communication and cooperation. The purpose of the project and everything that comes from it is to give advice, instructions and suggestions on how to establish the best possible cooperation and communication between the sectors, but also towards the public.
The right to a healthy city: From residents' needs to better planning
Authors: Biesaga Mikołaj , Domaradzka Anna , Roszczyńska-Kurasińska Magdalena , Domaradzka Ewa
Published: October 2024

This paper will focus on presenting the results of international research and projects carried out in the field of public health and residents' wellbeing. Those results will be presented within the framework of the right to the city perspective (Domaradzka et al., 2022), which emphasizes the importance of residents' participation in shaping a healthy future for our cities. We will discuss the right to healthy living in the city (Corburn, 2009), designing for health through nature-based solutions (Frantzeskaki, 2019) and local potential for problem-solving for residents in the area of health and quality of life. We start with theorizing health as one of the fundamental rights and a prerequisite of political rights and wellbeing of urban citizens. We then focus on discerning health-related needs of different groups of urban residents and summarize findings concerning physical and mental health relation with different qualities of urban environment. In this context, we introduce new 'planning for health' methodologies - based on Blue Green Solutions - developed within euPOLIS and HEART projects funded by the European Commission (Bozovic et al., 2017). Both projects focus on the impact of green and blue spaces on people's health and wellbeing, in a wider context of community livability (Wagner Caves, 2012). To conclude, we propose a livability model based on social, economic, environmental and health-related indicators, which allows us to coprehensively evaluate the impact of nature-based interventions in our pilot cities.
Strengthening International Health regulations (IHR) implementation through peer-to-peer learning among National IHR Focal Points (NFP): The twinning project
Authors: Janiec Janusz , Cheng Ka
Published: October 2024

Background: Strengthening IHR NFP capacities is essential for enhancing the global response to public health emergencies, enabling more efficient information sharing, coordination, and implementation of the IHR. Peer-to-peer experience exchange was prioritized by NFPs during workshops, online discussions, and survey addressing NFPs' needs. The World Health Organization Regional Office for Europe (WHO EURO) promoted this approach by facilitating twinning between IHR NFP teams paired on common interests, similarities or challenges. The twinning NFP pairs were established during the pre-twinning workshops in 2023 and 2024. Topics for discussion were selected prior to the visits during online meetings. The usefulness and format of twinning among participants of twinning visits from Montenegro, Poland and Serbia were being evaluated. Methods and Objectives: Three face-to-face meetings (1 - 1.5 days) organized by NFPs in Warsaw, Podgorica and Belgrade (April - June 2024) were separately evaluated using the same, structured and tested evaluation form, which consist of 15 questions with 6 on usefulness, 5 on format, 4 on general impression and future twinning plans (all scaled or free text). Results: Participants from visiting NFP teams and collaborating surveillance experts completed 23 evaluation forms, in total. The overall general impression of each visit ranged between 9.4 and 9.6 on a scale to 10 (10 being the most positive). Questions on usefulness and format scored 4.4 and above on a scale to 5 (5 being the highest positive). The free text fields contained mainly positive comments. All participants would like to have one or two twinnings per year in the future. There were no major differences among the meetings evaluations. Conclusions: Although preparation and logistics may be challenging, the face-to-face twinning proved to be useful. The gained knowledge is expected to improve NFP's capacities and networking, and participants plan to conduct more twinning in the future. This peer learning approach is also beneficial for other IHR critical capacities (such as surveillance or laboratory work) in WHO Member States and could contribute to cross-border information exchange, improving national capacities through positive benchmarking from the twinning countries.
Antibiotic resistance pattern of extended-spectrum betalactamase: Producing Escherichia coli from urine samples
Authors: Nikolovska Jasmina , Krstevska-Kelepurovska Elena , Delova Angela , Popovska-Kljuseva Svetlana , Shurbevska-Boneva Biljana
Published: October 2024

Background: Urinary tract infections are among the most common bacterial infections in clinical practice. The strains of Extended-spectrum beta-lactamase (ESBL) producing Escherichia coli, represent serious therapy problem and significant concern. Objectives and Methods: To determine the presence and antibiotic resistance pattern of ESBL producing E. coli in urine samples in the period of 3 years (2021-2023). Urine samples sent in the Department of Microbiology at the Center for Public Health Bitola, were inoculated on Chromogenic media (CPS agar, bioMerieux). Double-disk synergy (DDS) test and Automatized Vitek 2 system were used for detection of ESBL-producing strains. Antimicrobial susceptibility was examined by standard disk diffusion method and MIC concentrations with Automatized Vitek 2 system. Results: Out of the total number of E. coli 1201 in 2021, 1443 in 2022 and 1776 in 2023, ESBL positive were 56 (4.66%), 134 (9.28%) and 90 (5.06%) respectively. All 280 ESBL-producing isolates, showed high percentage of resistance against all cephalosporins as follows: 100% to cefuroxime, 100% to ceftriaxone, 86.34% to ceftazidime and 69.91% to cefepime. While low level of resistance was observed against fosfomycin (2.34%) and nitrofurantoin (4.39%), and no resistance to carbapenems. Conclusions: The results indicate the need of constant monitoring of the percentage of antibiotic resistance of uropathogen bacteria in order to make the correct choice of effective antibiotics which rapidly and efficiently will treat and prevent recurrent urinary infections.
HPV genotyping at the City Institute for Public Health Belgrade from January 2023 to July 2024
Authors: Glišović Ana , Relić Tijana , Mihajlović Nikola
Published: October 2024

Introduction: Human papillomavirus (HPV) infection is an indispensable factor in the carcinogenesis of the cervical epithelium. Persistent infection with high-risk HPV genotypes poses a particular risk. According to the World Health Organization (WHO) guidelines, molecular biological assays that detect the presence of HPV DNA and determine the viral genotype in cervical samples are diagnostically superior for early infection detection compared to conventional cytological Pap smears. Objectives and Methods: To present the results of HPV genotyping from endocervical swab samples at the City Institute for Public Health Belgrade. In this study, we employed the Sansure Biotech diagnostic kit for HPV genotyping. Using Real-Time Polymerase Chain Reaction (rtPCR) methodology (utilizing specific primer pairs and specific fluorescent probes), this kit detects 15 high-risk HPV genotypes (HPV 16, 18, 31, 33, 35, 39, 45, 51, 52, 53, 56, 58, 59, 66, 68). The research included test subjects whose clinical indications warranted the reason for testing. Results: From January 2023 to July 2024, a total of 292 HPV genotyping tests were conducted; 96 (32.9%) were positive for high-risk genotypes. The most frequently detected genotype was HPV16 (30.2%), while HPV18, HPV52, HPV53 and HPV68 were equally represented (approximately 20%). Other genotypes included in the test panel were detected sporadically. According to the International Classification of Diseases (ICD-10), the most common referral diagnosis for testing was N72 - inflammation of the cervix (63%), with high-risk genotypes confirmed in 35% of these cases. Conclusion: HPV genotyping confirms the importance of applying molecular biological techniques in the early diagnosis of HPV infection and the prevention of cervical epithelial carcinogenesis. This method also becomes a significant tool in improving cervical cancer screening strategies in the future.
Surveillance of antimicrobial resistance genes from wastewater: A literature review
Authors: Petrova Aleksandra , Kocubovski Mihail , Boshevska Golubinka , Buzharova Teodora , Gjorgjievska Ivana , Shahini Azizi
Published: October 2024

Aim: The environment acts as a reservoir for antibiotic resistance bacteria (ARB) and plays a role in the spread of antimicrobial resistance genes (ARGs). The aim of the study is to present the problem of ARB in the environment through a literature review. Background: The overuse of antibiotics in the agricultural, veterinary and medical sectors is contributing to the global epidemic increase in antimicrobial resistance. Wastewater treatment is a double-edged sword that can act as either a pathway for ARB spread or as a barrier to reduce the environmental release of anthropogenic ARB. Methods: Systematically searches of the literature in the electronic databases PubMed to identify studies that have compared findings from Waste Water Surveillance (WWS) and ARGs and their analysis is performed. The search was limited to peer-reviewed published articles on English language without restriction on the publication year combining the keywords "Wastewater surveillance" and "Antimicrobial resistance genes" using "AND". Results: Literature searches initially identified 34 entries which 21 abstracts met the inclusion criteria. After review of the articles, 3 scientific papers were dediated to the detection of multidrug-resistant bacteria and antimicrobial resistance genes analysis with conventional microbiological tests or tests such as Polymerase Chain Reaction (PCR) and sequencing with methagrenomic analysis published between 2023-2024 year. Conclusions: Evidence shows that wastewater are significant reservoirs and dissemination pathways. The active surveillance of ARB using an integrated one-health approach can help to reduce the emergence and spread of ARB, reduce the associated economic impact, and guide antimicrobial stewardship programs.