Contributions of doctors from Serbia to the establishment and initial development of the Faculty of Medicine in Skopje, Republic of Macedonia.

AIM: To analyse and present the milestone activities and actors, with special emphasis on the contribution of doctors from Serbia to the establishment and initial development of the Faculty of Medicine in Skopje, Macedonia, in the period 1947-60 and beyond. METHOD: A retrospective study based on archive materials, encyclopedias and jubilee publications of the Faculty of Medicine and Faculty of Dentistry in Skopje, other relevant sources of information, and a review of the relevant literature. RESULTS: The Faculty of Medicine in Skopje was founded in 1947 and the first meeting of the Teachers' Council of the Faculty was held on March 17, 1947. The first generation of 153 students was enrolled in the autumn of 1947 and the first lecture was delivered on November 3, 1947. More than 20 doctors from Serbia, half of them faculty staff, had joined the initiative of the Government of Macedonia for establishing the Faculty of Medicine in Skopje in 1947. They played leading roles in creating a number of the faculty departments/chairs, establishing 6 institutes and 6 clinics within the newly established Faculty of Medicine in Skopje in 1947 and in the first 10-15 years of its development. CONCLUSION: The Faculty of Medicine in Skopje, founded in 1947, played a crucial role in the education of medical professionals, in improving the poor health status of the population and the overall further development of the health system and provision of health care to the population of Macedonia. The contribution of the doctors from Serbia to the establishment and initial development of the Faculty of Medicine in Skopje, during the period 1947-1960 and beyond, was remarkable and important.

Three periods of health system reforms in the Republic of Macedonia (1991-2011).

AIM: To investigate, describe and classify main health policies and reform activities within the healthcare system undertaken over the past twenty years in R. Macedonia. METHODS: Desk research was conducted on scientific literature and relevant documentation (in English and Macedonian) about healthcare reforms. Relevant documents available at the Ministry of Health, Health Insurance Fund, World Bank and World Health Organization were reviewed. Official data on demographic and health status indicators were collected from the Institute of Public Health and the State Statistical Office. A working hypothesis, that the health system reforms were not continuous, was generated following the shifts in decision-making power over allocation of resources and political influences. RESULTS: Our study identified three periods of health system reforms in Macedonia: post-socialistic, pro-market and manifesto-driven. Throughout these periods poor maintenance, low efficiency and high operational costs increased out-of-pocket expenditures for health services and drugs and reflected on the deterioration of public hospital infrastructure. In parallel, liberal healthcare market regulation initiated commercialization of the healthcare services. Disappointed in the quality of healthcare services provided in the public health sector, many citizens opt to ask for services in private health care facilities, where social health insurance largely does not cover the costs. CONCLUSION: The pace of the reforms is not continuous and the influence of politics is highly visible over the whole period of transition in the Republic of Macedonia. The main problems of the healthcare system in the Republic of Macedonia are politicization of the health sector, high centralization and government control, and poor efficiency of public health institutions. Evaluation framework should be developed to further assess the impact of the health reforms.

Contributions of doctors from Macedonia to the establishment and initial development of the Faculty of Medicine in Skopje, Republic of Macedonia.

AIM: To present an overview of the circumstances, initiatives and milestone activities of the process and actors, with special emphasis on the contribution of doctors from Macedonia to the establishment and initial development of the Faculty of Medicine in Skopje, Macedonia, in the period 1947-60 and beyond. METHOD: A retrospective study based on archive materials, encyclopedias and jubilee publications of the Faculty of Medicine and Faculty of Dentistry in Skopje, other relevant sources of information, and a review of the relevant literature. RESULTS: The Faculty of Medicine in Skopje was founded in 1947 and the first meeting of the Teachers' Council of the Faculty was held on March 17, 1947. The first generation of 153 students was enrolled in the autumn of 1947 and the first lecture was delivered on November 3, 1947. About 15 doctors from Macedonia--faculty staff in the period from 1947-54--had joined the initiative of the Government of Macedonia for establishing the Faculty of Medicine in Skopje, and an additional 22 lecturers from Macedonia, who had been elected in the period from 1955-60, supported its initial development. They played leading roles in the creating and/or development of a number of the faculty departments/chairs, institutes and clinics within the newly established Faculty of Medicine in Skopje in 1947 and in the first 10-15 years of its initial development. CONCLUSION: The Faculty of Medicine in Skopje, founded in 1947, played a crucial role in the education of medical professionals, in improving the poor health status of the population and the overall further development of the health system and provision of health care to the population of Macedonia. The contribution of the doctors from Macedonia to the establishment and initial development of the Faculty of Medicine in Skopje, during the period 1947-60 and beyond, was dominant and essential.

Contributions of doctors from Croatia to the establishment and initial development of the Faculty of Medicine in Skopje, Republic of Macedonia (Historical Note).

AIM: To analyse and present the milestone activities and actors, with special emphasis on the contribution of doctors from Croatia in the establishment and initial development of the Faculty of Medicine in Skopje, Macedonia, in the period 1947-60. METHOD: A retrospective study based on archive materials and jubilee publiccactions of the Faculty of Medicine in Skopje, other relevant sources of information, and a review of the relevant literature. RESULTS: The Faculty of Medicine in Skopje was founded on March 6, 1947 by a Decree of the Government of the Republic of Macedonia, and the first meeting of the Teachers' Council of the Faculty was held on March 17, 1947. The first generation of 153 students was enrolled in the autumn of 1947 and the first lecture was delivered on November 3, 1947. Some 20 doctors from Croatia, a half of them faculty staff, joined the initiative of the Government of Macedonia for establishing the Faculty of Medicine in Skopje in 1947. They played leading roles in creating a number of the faculty departments/chairs, establishing seven institutes and two clinics within the newly established Faculty of Medicine in Skopje in 1947 and in the first ten years of its development. CONCLUSION: Establishing the Faculty of Medicine in Skopje in 1947 was a crucial decision of the Government of Macedonia for improving the poor health status of the population after World War II and for the overall further development of the health system and provision of health care to the population of Macedonia. The contribution of the doctors from Croatia to the establishment and initial development of the Faculty of Medicine in Skopje, Macedonia, during the period 1947-1960, was remarkable and important.

Epidemiological and public health aspects of brucellosis in the Republic of Macedonia.

AIM: To analyze and present epidemiological patterns of human brucellosis cases and the main factors for the appearance and spread of B. melitensis infection among animals and humans in R. Macedonia in the period from 1980 to 2009. METHODS: Retrospective study based on the epidemiological reports and official data on brucellosis cases from the Institute for Public Health in Skopje and other institutions from the health and veterinary sectors in R. Macedonia, and a review of the relevant literature. RESULTS: From 1980 until December 2009, a total of 11,451 brucellosis cases were reported in R. Macedonia, with a mean annual incidence rate of 18.9/100,000. The highest morbidity rate during this period was recorded in 1992 (922 cases and an incidence rate of 47.6/100,000), and the lowest one in 1983 (12 cases and an incidence rate of 0.6/100,000). From the total number of cases reported in R. Macedonia from 1980 to 2009, 66.2% were males and 33.8% were females. Only 7.2% of patients were under the age of 10, and the most of the patients were from the age group 20-39 (31.9%). Seasonal characteristics of the disease were expressed with the highest occurrence in May (15.9%), June (16.3%) and July (15.1%). Within the total number of 3,284 brucellosis cases in the period 2001-2009, 2320 (70.6%) were from rural settlements and 964 (29.4%) from urban areas. 385 of all cases of brucellosis (8.4%) reported in the period 1998-2009 were from the ranks of professional staff. CONCLUSION: Brucellosis was, currently is and will be a significant disease problem and concern in R. Macedonia which should be approached in a more comprehensive and organized way in the coming years. There is a need to establish intersectoral collaboration by joint efforts of all relevant factors in the prevention and eradication of brucellosis, as well as collaboration between all countries in the SEE region.

Gender analysis of sexual behaviour of senior high-school students in Skopje, R. Macedonia - cross-sectional study.

UNLABELLED: (Full text is available at http://www.manu.edu.mk/prilozi). The aim of the study was to assess the gender influence on the main determinants of sexual behaviour of senior high-school students in Skopje, R. Macedonia (prevalence and age of onset of sexual activity, duration of the relationship before and the contraceptive method used during the first sexual intercourse, and number of lifetime sexual partners). METHODS: After ensuring privacy and confidentiality, a cross-sectional study was carried out in Skopje by enrolling 310 high-school students (49.7% males, 49% females, 1.3% unknown) from 5 randomly selected high-schools, from the 4th grade, using a 32-item paper-and-pencil self administered questionnaire. RESULTS: The prevalence of sexual activity was higher among boys than girls (when reaching grade 4 of the study 62.7% of the boys and 26.7% of the girls are sexually active) (p < 0.01). In addition, a significant gender difference was found in the following: the mean age of onset of sexual activity is 16 years for boys and 17 years for girls; concerning the duration of the relationship before the first sexual intercourse 33% of the boys and 2.5% of the girls had experienced one-night stand relationship (p < 0.01); and concerning the number of partners, having four or more sexual partners was reported by 29.8% of the boys and 5% of the girls (p < 0.01). Of those sexually non-active, 62.5% of the boys and 15.5% of the girls did not start with sexual activity because they did not have a chance (p < 0.01); 17.9% of the boys and 79.1% of the girls felt unprepared (p < 0.01). CONCLUSION: The data indicates substantial gender differences in sexual initiation patterns and sexual conduct. Boys and girls are vulnerable at different times in their development and hence need to be reached with different public health interventions for improving their sexual and reproductive health, adapted to local cultural and gender norms. Key words: Macedonia, high-school students, sexual behaviour, gender.

Epidemiological characteristics of the metabolic syndrome in apparently healthy persons.

The risk factors that define the metabolic syndrome lead to an accelerated development of atherosclerosis, cardiovascular diseases in apparently healthy persons. The goal of the research is determining the prevalence of the metabolic syndrome as well as the participation of the risk factors that define this condition in apparently healthy persons. The metabolic syndrome is defined according to the National Cholesterol Education Program Expert Panel. The prevalence of the metabolic syndrome in the examined population, aged 53 +/- 8, is 62 (39.7%). In the group of subjects that have the metabolic syndrome,the largest number of subjects had 3 risk factors and only 5 subjects had 5 risk factors. With the increase of the number of components of the metabolic syndrome, all the observed parameters of the metabolic syndrome also increase, while the level of HDL decreases. In all the examined groups of subjects, the low level of HDL-H is the most present metabolic risk factor, while in the groups of subjects that have the metabolic syndrome the hypertension is the second most present factor, and the waist circumference is the least present factor. According to our research, the prevalence of the metabolic syndrome in apparently healthy persons that have a sedentary life style is 39.7%. In all the subjects the low level of HDL-h is the most present, and in the subjects with the metabolic syndrome compared to subjects that do not have this syndrome the frequency of all the components of the metabolic syndrome is statistically considerably higher.

Tobacco smoking, alcohol and drug consumption among youngsters in the Republic of Macedonia.

OBJECTIVE: To evaluate students attitude and behaviour (16 years old) towards their lifestyle in consumption of tobacco, alcohol and illegal drugs; drugs' availability and the problems related; as well as some social and financial aspects; social relations of students etc. MATERIAL AND METHODS: A survey was conveyed with students from different ethnic groups--16 years old from every school in the country. ESPAD 99 unified questionnaire was used. RESULTS: TOBACCO: 42% persons responded that they have never taken tobacco in their life. 17% has taken a cigarette 1-2 times and 20% have used tobacco over 40 times/occasions (Macedonians 22%, Albanians 11% (12 = 24.92 for p < 0.05). During the last month, 37% youngsters in Macedonia have taken tobacco (in Ireland-41%, Finland 37%, Italy 36%, Croatia 32% and Slovenia 19%). ALCOHOL: 31% persons responded that they have never tried alcohol in their life (Macedonians 20%, Albanians 77% and Turks 76%). Ti is the similar situation for not-taking alcohol during the last year (Macedonians 30%, Albanians 83%, Turks 76%) and in the last month (54% Macedonians, 88% Albanians and 85% Turks). 33% responded they have been drunk at least once in their life 51% Macedonians, 11% Albanians and 14% Turks), and during the last month 20%. Most frequent used alcohol drink is wine (4.4% have used it over 40 times during the last month). Asked if they think they will take alcohol when they will have 25 years, 33% Macedonians, 73% Albanians and 77% Turks responded negative. ILLEGAL DRUGS: Around 1/4 stated that their friends are taking marijuana. 2.5% stated that most of their friends take marijuana. 8% stated that their friend take ecstasy, 3.6% stated that some of their friends take heroin. 5% responded they have taken tranquilizers-sedatives in the period less than 3 weeks. In average, 2.8% respondents wanted to try illegal drug--Serbs- (20.6%), Roma (21%) and Macedonians (14.3%), Albanians (6.5) and Turks (6.9%). 1.28% stated they have smoked heroin 1-2 times. Intravenous heroin used over 40 times 0.4% respondents. Ecstasy tried 1-2 times 0.64%, alcohol + tablets took 2.9% respondents. Alcohol and marijuana in the same time tried 1-2 times in life time 2.37% or in total 4.13%. Asked if they feel themselves lonely, positively responded 28% or 26% Macedonians, 37% Albanians, 35% Turks and 30% Serbs. Asked if they are satisfied with the finance situation in their home 32.4% responded very satisfied. There is significant difference among different ethnic groups (Macedonians 23%, Albanians 71%, Turks 54%, Serbs 27% and Roma 47%). Not satisfactory situation is at 8.36% Macedonians, 0.7% Albanians, 2.3% Turks, 5.9% Serbs and 5.2% Roma. CONCLUSION: 58% persons responded taken tobacco in their life. There are significant differences in alcohol consumption among different ethnic groups--Albanians and Turks take alcohol more rarely than Macedonians, due to the cultural/religious circumstances. Experimenting with drugs is Ok for males-more than females. However, youngsters are pretty lonely (1/3 have stated that they are lonely most of the time). There is a need for realization of health promotional curricula in schools, that will include life skills education and strengthening of personality, self esteem development and care for their own health to prevent drug addiction.

Health insurance system in the Republic of Macedonia.

The current health insurance system of the Republic of Macedonia was introduced by the Health Protection Law, which was adopted in 1991 and modified and supplemented by the amendments in 1993 and 1995. According to this Law, health insurance was established as an obligatory, supplementary obligatory, and voluntary insurance for certain kinds of health care. This report gives an insight into the specificities and practice of all three types of insurance in the Republic of Macedonia. A person can become an insured to the Health Insurance Fund on the basis of 23 modalities. More than 80% of the citizens are eligible to the obligatory health insurance, which provides a broad scope of basic health care rights. Payroll contributions are equal to 8.6% of gross earned wages and more than 70% of health sector revenues are derived from them. Besides some other basic resources and contributions for health financing, co-payments for health care expenses by users were introduced in 1993. Health financing and reform of the health insurance system are of high importance within the ongoing health care reform in the Republic of Macedonia. It is expected that the new Law on health insurance will strengthen the mechanisms for collecting revenues and introduce new methods of co-payment and risk-adjusted reallocation of the funds related to age structure and health status of the population.