How older adults experience the age-friendliness of Skopje: Results of the validation of the AFCCQ for use in North Macedonia and a representative survey.

Hundreds of cities and communities in the world have joined the WHO's Global Network for Age-Friendly Cities and Communities since 2010. In order to do quantitative assessments of the age-friendliness of cities, the Age-Friendly Cities and Communities Questionnaire (AFCCQ) was developed for the Dutch municipality of The Hague. The purpose of this study was first to translate and test the validity and reliability of the AFCCQ for use in North Macedonia and second to explore perceptions on age-friendliness of the bicultural and bilingual City of Skopje. The AFCCQ proved valid for use in North Macedonia. Overall, older adults in Skopje experience the age-friendliness of the city as neutral (in seven out of nine domains). The best score ("slightly satisfied") was found in the domain of Housing domain, which was rated positive in all ten municipalities. The lowest total score ("slightly dissatisfied") was found in the domain of Outdoor spaces and buildings scoring, which received negative scores in eight out ten municipalities. In five out of nine domains differences were observed between the Albanian and Macedonian communities. The Albanian sample has slightly higher scores in two domains: 1) Housing and 2) Civic Participation and Employment, while the Macedonian sample scored higher in three domains: 1) Communication and Information; 2) Outdoor Spaces and Buildings and 3) Transportation. A hierarchical cluster analysis further revealed the presence of six distinct age-friendly typologies that can be used for a better understanding of subpopulations in the city and draft policies and action programs on the city level.

Examining the perceptions of needs, services and abilities of Czech and North Macedonian caregivers of children with autism and trainers.

Effective practices for supporting families with autistic children ensure a match between their needs and the expectations and competencies of the clinician. Applied behavior analysis (ABA) services are a common provision for serving autistic individuals. However, in regions where ABA is in its infancy, like the Czech Republic and North Macedonia, culturally relevant resources, regulations for practice, and standardized coursework are missing. In their absence, it is necessary to investigate the degree to which practitioners in the regions are meeting the behavioral needs of families. Assessing this match can set the stage for establishing more stable and effective services in the areas, as well as neighboring countries with similar historical foundations. Therefore, a survey was conducted to examine the perceptions of caregivers and trainers (those who self-identified as providing support to families with autistic children). A total of 233 caregivers and 204 trainers participated. Analysis of the survey responses verified the lack of behavioral knowledge on the part of the trainers, the apparent lack of access to ABA services for families in both regions, a potential misalignment between family needs and training targets, and the disparities between the two countries. The information evaluated here can be used to guide preservice training, dissemination efforts, and regulations surrounding behavioral practices.

Cases of Crimean-Congo haemorrhagic fever in North Macedonia, July to August 2023.

The last report of Crimean-Congo haemorrhagic fever (CCHF) in North Macedonia was more than 50 years ago in the northwest. We report on a fatal CCHF case following a Hyalomma tick bite in the east of the country in July 2023. Tracing of 67 contacts identified CCHF in one healthcare worker (HCW) providing care for the patient. Monitoring of contacts is concluded (including further 11 HCW contacts), thus far 28 days after the death of the case no additional cases were identified.

Developing modern primary care nursing in North Macedonia.

BACKGROUND: Nurses have the potential to make a real impact on the health and well-being of people and populations and contribute to the realisation of delivery of Universal Health Coverage. However, in many parts of the world, the education and practice of nursing and nurses' position in health care and society are restricted by a range of social, cultural, economic and political factors. In North Macedonia, the Ministry of Health in partnership with the WHO Country Office launched a primary healthcare strategy supporting the development of nurses in primary care to fulfil their full scope of service. AIMS: To present information on the education, practice and position of nursing, in particular primary care nursing, in North Macedonia and to describe the ongoing initiatives to support the further development of nursing. APPROACH: Background documents reviewed, and visits to healthcare settings, organisations, interviews with individuals and groups and workshops undertaken in 2019-2020. FINDINGS: Three key areas of development were identified: education of nurses, their service delivery and practice in primary care, and their position in health care and society, all underpinned by the need for workforce planning. The findings formed the basis of a 10-year plan: Making Change Happen: The Nursing and Midwifery Development Roadmap. DEVELOPMENTS: To support the proposed primary care pilots, during the 2020/2021 COVID-19 pandemic, an on-line modular programme for primary care nurses was developed and delivered with the support of members drawn from The National Working Group for Moving Primary Care Nursing Forward in North Macedonia. Further work is planned to develop initial nurse education and to pilot changes in primary care. CONCLUSIONS: The launch of the primary healthcare strategy stimulated initiatives to improve the education, position and practice of primary care nursing. The COVID-19 pandemic required flexibility and changes to the original plans.

Psychometric Properties of the 14 Items Oral Health Impact Profile Questionnaire Translated into the Macedonian language.

Objective: Due to the consideration that oral/dental health is an important part of general health, well-being, and an individual's quality of life, the need for appropriate instruments assessing oral health-related quality of life is emphasized. This study aimed to evaluate the psychometric properties of the Oral health-related quality of life questionnaire consisting of 14 questions among the Macedonian language-speaking adults (OHIP-MAC 14). Material and methods: A total of 270 adults participated in the study. The reliability of the questionnaire was examined by testing the internal consistency and reproducibility (test-retest). The responsiveness of the instrument was tested by computing the pre-intervention and post-intervention OHIP-14 scores using the paired t-test followed by the determination of the effect-size. The two aspects of the construct validity were evaluated: concurrent validity and discriminative validity. Results: A concurrent validity analysis confirmed that the instrument performed well. Discriminative validity also confirmed good psychometric properties (P<0.01). The ICC statistics and the Cronbach alpha coefficients indicated the appropriate reliability of the instrument for the included groups of participants. The responsiveness of the questionnaire was also acceptable (P<0.01) demonstrating the large effect-size of 1.43. Conclusion: The OHIP 14 MAC showed acceptable psychometric properties and can be recommended as a valuable instrument in assessments of the Oral health-related quality of life in the Republic of North Macedonia.

Molecular Screening of Haemogregarine Hemoparasites (Apicomplexa: Adeleorina: Haemogregarinidae) in Populations of Native and Introduced Pond Turtles in Eastern Europe.

Haemogregarines (Apicomplexa: Adeleorina) are the most common and widespread reptilian blood parasites. Haemogregarina stepanowi was the first haemogregarine described from a reptile, the European pond turtle Emys orbicularis, and initial assessments indicated it was widespread across different pond turtle host species across much of Europe, the Middle East and North Africa. However, recent molecular assessments have indicated the presence of multiple genetically distinct forms in North Africa and the Iberian Peninsula, and extensive mixed infections which may be associated with a negative impact on the hosts. Here, we screened two native species, E. orbicularis and Mauremys rivulata, and the introduced Trachemys scripta from Serbia and North Macedonia for haemogregarines by amplifying and sequencing part of the 18S rRNA gene of these parasites, and used a standard DNA barcoding approach to identify leeches, the final host, attached to pond turtles. Our results again demonstrate the occurrence of considerable diversity of parasites in the analysed pond turtle species, and that T. scripta are likely infected by local haemogregarine parasites, and not those that are found in its native range. Leeches were identified as Placobdella costata, part of a lineage from Northern Europe. Mixed infections within pond turtles were again common. Current haemogregarine taxonomy does not reflect the genetic diversity identified, and a full taxonomic reassessment is needed.

Accumulation and distribution of heavy metals in soil and food crops in the Pb-Zn mine environ. Case study: Region of Probistip, North Macedonia.

The aim of the study was to investigate the exploration and distribution of various chemical elements in soils and vegetables from gardens in the region of Probistip, North Macedonia. This region was exposed to heavy metals pollution from Pb-Zn mining and flotation tailings landfill near the town of Probistip for 70 years. A total of 38 samples of various crops and vegetable products from 19 gardens were analyzed. The analyzes were carried out by ICP-AES (Al, Ba, Ca, Cr, Cu, Fe, K, Li, Mg, Mn, Na, Ni, P, Pb, Sr, V, and Zn) and by ICP-MS (As, Cd, Co, Cr, and Pb). It was found that the content of some potentially toxic elements (As, Cd, Cu, Pb, and Zn) in the soil samples from the gardens, exceeded the target values. From these results, it is clear that the contamination of the soils in this area is due to mining activities and the distribution of flotation wastes from the nearby flotation dump. It was also found that the contaminated soils lead to elevated levels of these elements in some vegetables from the gardens, especially those near the Zletovska River and the flotation waste landfill, exceeding the nationally permissible food content.

Erratum: Data mining approach: What determines the wellbeing of women in Montenegro, North Macedonia, and Serbia?

[This corrects the article DOI: 10.3389/fpubh.2022.873845.].

No social distancing from food: How the COVID-19 pandemic shaped student food-related activities in the Western Balkans.

BACKGROUND: The COVID-19 pandemic has influenced food preparation and consumption habits, as well as food wastage. The pandemic also affected the lives of university students worldwide; their learning and living environments changed, influencing their eating habits. AIM: The purpose of this study was to evaluate the repercussions of the COVID-19 pandemic on students' food-related activities in four countries in the Western Balkans: Bosnia and Herzegovina, Serbia, North Macedonia, and Montenegro. METHODS: The research draws upon an online survey gathered through the SurveyMonkey platform in four Balkan countries-viz. Bosnia and Herzegovina, Serbia, North Macedonia, and Montenegro-and used a structured questionnaire. The information was collected during the second wave of COVID-19 in October-November 2020. A total of 1658 valid responses were received. Descriptive statistics and nonparametric tests were used to analyze the survey findings. RESULTS: The research results suggest that the pandemic influenced students' food purchase habits, diets, and food-related behaviors and practices such as food preparation, cooking, and food waste management at the household level. In particular, students have been eating healthier and shopping less frequently during the pandemic. Meanwhile, the pandemic improved their attitude toward food wastage. CONCLUSION: This study is the first to examine how students in the Balkan region perceive the impact of the COVID-19 pandemic on their eating habits, laying the groundwork for future studies into the disease's consequences. This and other studies will assist in preparing students and education institutions for future calamities and pandemics. The findings will also help develop evidence-based postpandemic recovery options targeting youth and students in the Western Balkans.

Thoughts, Attitudes and Experiences of Parents of Children with Disabilities in the Republic of North Macedonia About Comprehensive Sexuality Education.

When it comes to sexuality education, people with disabilities are often left out of the conversation. Many believe that these people are asexual, sexually inactive, that they do not need sexual education, that they cannot and should not have sexual relations and cannot/should not have love relationships and start a family. The main purpose of the research is to determinate thoughts, attitudes, knowledge and personal experience of the parents of children with disabilities regarding comprehensive sexuality education of their children. The data were collected through a survey of 54 respondents, parents of persons/children with disabilities from different regions in the Republic of N. Macedonia. Data were analyzed using the SPSS program and Chi square and Fisher exact test. From the data, it can be concluded that the majority of parents covered by this research are not familiar with the most appropriate age at which sexual education should begin. Around 57% of parents completely agreed with the statement that sex education should be part of the educational program in schools and only 38.9% of parents believe that their child should study all subjects. Children with disabilities need developmentally appropriate sex education to stay safe and healthy and to achieve self-determination.

Erratum: Data mining approach: What determines the wellbeing of women in Montenegro, North Macedonia, and Serbia?

[This corrects the article DOI: 10.3389/fpubh.2022.873845.].

Mediterranean spotted fever-like illness caused by Rickettsia sibirica mongolitimonae, North Macedonia, June 2022.

Mediterranean spotted fever-like illness (MSF-like illness) is a tick-borne disease caused by Rickettsia sibirica mongolitimonae first reported in France more than 25 years ago. Until today, more than 50 cases of MSF-like illness have been reported in different regions of Europe and Africa, highlighting variable clinical manifestation. Here we report a case of MSF-like illness following a bite from a Hyalomma tick in the Skopje region of North Macedonia.

Network analysis of live pig movements in North Macedonia: Pathways for disease spread.

Globalization of trade, and the interconnectivity of animal production systems, continues to challenge efforts to control disease. A better understanding of trade networks supports development of more effective strategies for mitigation for transboundary diseases like African swine fever (ASF), classical swine fever (CSF), and foot-and-mouth disease (FMD). North Macedonia, bordered to the north and east by countries with ongoing ASF outbreaks, recently reported its first incursion of ASF. This study aimed to describe the distribution of pigs and pig farms in North Macedonia, and to characterize the live pig movement network. Network analyses on movement data from 2017 to 2019 were performed for each year separately, and consistently described weakly connected components with a few primary hubs that most nodes shipped to. In 2019, the network demonstrated a marked decrease in betweenness and increase in communities. Most shipments occurred within 50 km, with movements <6 km being the most common (22.5%). Nodes with the highest indegree and outdegree were consistent across years, despite a large turnover among smallholder farms. Movements to slaughterhouses predominated (85.6%), with movements between farms (5.4%) and movements to market (5.8%) playing a lesser role. This description of North Macedonia's live pig movement network should enable implementation of more efficient and cost-effective mitigation efforts strategies in country, and inform targeted educational outreach, and provide data for future disease modeling, in the region.

Prevalence of Overweight and Obesity in Children: Variation in Different Ethnicities, Age, and Sex in North Macedonia.

Childhood obesity is assuredly one of the most important health challenges of the 21st century, particularly regarding long-term metabolic complications. In the last four decades, there has been a tenfold increase in childhood and adolescence obesity. This cross-sectional study aimed to show the prevalence of overweight and obesity compared by age, sex, and ethnicity in n=1034 healthy male and female children, aged 6-13 years in North Macedonia. Out of the total 1034 children included in the study, 589 (57.0%) were observed with normal weight, 202 (19.5%) children were obese, 140 (13.5%) children were overweight and, 103 (10.0%) children underweight. The study presents an insight that 33% of primary school children are at >85th percentile overweight; or at ≥95th percentile with increased weight due to obesity. The data show that boys have a higher prevalence of obesity and overweight with 37.1%, compared to girls with 29.1%. Also, all age groups demonstrate an exponential increase of the prevalence of overweight: in 6-7 years (5.8%); 8-9 years (12%); 10-11 years (15%); and, 12-13 years old with 19.5%. A jump of prevalence of overweight and obesity between the age groups of 6-7 years, and 8-9 years was observed (17.9% to 25.4% obese and 5.8% to 12.0% overweight). The onset of puberty may be the possible cause. According to the Global Atlas of Childhood Obesity, North Macedonia is graded with a risk index of 7/11; i.e. it is expected that in the next decade until 2030 the obesity rate will rise to 52.5% for children aged 5-19 years old. It is with utmost importance to emphasize that continuous monitoring of children's nutritional status and their risk of obesity is essential, as to further prevent obesity and overweight in the pediatric population.

Moss biomonitoring of air pollution with potentially toxic elements in the Kumanovo Region, North Macedonia.

A study was carried out to investigate air deposition and to explore the natural distribution and contamination with potentially toxic elements (PTEs) in the Kumanovo Region, North Macedonia, by using moss samples as biomonitors for air pollution. The distribution of 51 elements was detected in 42 moss samples collected from this area. Moss samples were analyzed following microwave digestion by inductively coupled plasma-atomic emission spectrometry (ICP-AES) and inductively coupled plasma-mass spectrometry (ICP-MS). It was found that the atmospheric deposition for some PTEs in the moss samples in specific parts of the study area is influenced by anthropogenic and urban activities. R-mode factor analysis was used to identify and characterize element associations, and six associations of elements were determined. Four factors were separated from the group of macroelements determined by ICP-AES: Factor 1 (Al, Cr, Fe, Li, Ni, V, and Zn), F2 (K, Mg, and P), F3 (Ba and Sr), and F4 (Cd, Pb, and Zn); and two associations were separated from the group of trace elements determined by ICP-MS: Factor 1 (As, Co, Cs, Ga, Ge, Sc, Ti, Y, Zr, and rare earth elements-REEs) and Factor 2 (Bi, Br, Hg, I, Sb, Sn, and W).

Data Mining Approach: What Determines the Wellbeing of Women in Montenegro, North Macedonia, and Serbia?

Background: Women's happiness and life satisfaction, often summarized as subjective wellbeing, are of great value for most individuals and are associated with various determinants. The countries of the Western Balkan are of particular interest after the political changes in the nineties. Are the women satisfied with their lives today? Methods: We use the most recent datasets of the Multiple Indicator Cluster Surveys (MICS) for women 15-49 years old and with comparable data coverage for three countries of the Western Balkan belonging to the former Yugoslavia, namely Montenegro, North Macedonia, and Serbia. After sorting out variables of limited relevance or quality (missing values >50%), the remaining 32 variables followed a descriptive analysis. Four potential determinants of subjective wellbeing (SWB), an integration of happiness and satisfaction with life, entered an interactive Classification and Regression Tree (iC&RT) to account for their mostly bivariate format: age, education, region, and wealth. Results: The iC&RT analysis determines the influence of 4 independent variables (age, education, region, and wealth) on overall happiness, satisfaction with life, and subjective wellbeing, resulting in a high overall SWB of 88.9% for Montenegro, 82.1% for North Macedonia, and 83% for Serbia. The high relevance of younger age, higher education, and wealth, as critical determinants of a high SWB, and the lesser role of regions except for Serbia is confirmed. The spread of SWB in defined population subgroups ranges from 80.5-92.6% for Montenegro, 64.2-86.8% for North Macedonia, and 75.8-87.4% for Serbia. Conclusions: The three selected South-Eastern European countries of the former Yugoslavia (Montenegro, North Macedonia, Serbia) represent high levels of subjective wellbeing of women and a narrow range between the lowest and highest population groups. Women in Montenegro take a top position regarding their subjective wellbeing.

Evaluation of the economic impact of classical and African swine fever epidemics using OutCosT, a new spreadsheet-based tool.

African swine fever (ASF) and classical swine fever (CSF) are two major transboundary animal diseases of swine with important socioeconomic consequences at farm, subnational and national level. The objective of this study was to evaluate the direct cost of outbreaks and their control at country/regional level in four countries: namely CSF in Colombia in 2015-2016, the retrospective cost of ASF in the Philippines in 2019 and in a province of Vietnam in 2020 and a hypothetical ASF scenario in one region in North Macedonia, using the newly developed Outbreak Costing Tool (OutCosT). The tool calculates the costs of 106 different items, broken down by up to four types of farms, and by who assumes the cost (whether veterinary services, farmers or other stakeholders). The total cost of CSF in Colombia was US$ 3.8 million, of which 88% represented the cost of the vaccination campaign. For ASF, there were wide differences between countries: US$ 8,26,911 in Lao Cai (Vietnam), US$ 33,19,666 in North Macedonia and over US$ 58 million in the Philippines. While in the Philippines and Vietnam, 96-98% of the cost occurred in the affected farms, the highest expenditure in North Macedonia scenario was the movement control of the neighbouring and at-risk farms (77%). These important differences between countries depend on the spread of the disease, but also on the production systems affected and the measures applied. Apart from the financial cost, these diseases have other negative impacts, especially in the livelihoods of smallholder farms. The OutCosT tool also allows users to evaluate qualitatively other important aspects related to the epidemics, such as the impact on human health, the environment, animal welfare, socioeconomic vulnerability, trading and political response. OutCosT, which is a FAO corporate tool (available online at: https://www.fao.org/fileadmin/user_upload/faoweb/animal-health/OutCosT_PIG.xlsx), can be an important tool to support country authorities to rapidly respond to a swine disease outbreak by estimating the associated costs and for advocacy purposes to mobilize resources at national or international levels.

State Aid Causing Distinct Incentives? Quasi-Experimental Measurement of the Effects of Grants on Private Enterprises in North Macedonia.

The objective of this study is to measure the effects of state aid distributed to private enterprises in North Macedonia on the enterprises' efficiency. We examine the governmental Plan for Economic Growth (PEG) pursued through the Financial Support of Investment Law (FSIL) and the Fund for Innovation and Technological Development (FITD). We rely on a rigorous impact evaluation method, whereby comparison groups are sourced from the pool of rejected applicants for the two programs. We pursue conditional matching on firms' observables and then apply the difference-in-differences method to isolate the effect of the subsidy. FSIL State Aid showed largely ineffective, with producing hardly any difference in sales, investment, wages, or profits among recipients, except employment. These results demonstrate the absence of the incentive effect as it relates to FSIL state aid. On the other hand, the FITD State Aid showed to be considerably effective, as the recipients were found to have increased their sales revenue and their investment in technology and profits, corroborating the presence of the incentive effect as it relates to FITD state aid. Notwithstanding the legitimacy of the policy objective to equalize domestic and foreign firms in terms of their access to state aid, these findings document partial failure of the PEG to do so due to its structural problems.JEL classification: H25, C90.

Essential Workers' COVID-19 Vaccine Hesitancy, Misinformation, and Informational Needs in the Republic of North Macedonia.

The COVID-19 pandemic has resulted in over 5.2 million deaths. Vaccine hesitancy remains a public health challenge, especially in Eastern Europe. Our study used a sample of essential workers living in the Republic of North Macedonia to: (1) Describe rates of vaccine hesitancy and risk perception of COVID-19; (2) Explore predictors of vaccine hesitancy; and (3) Describe the informational needs of hesitant and non-hesitant workers. A phone survey was administered in North Macedonia from 4−16 May 2021. Logistic regression explored associations of COVID-19 vaccine hesitancy with sociodemographic characteristics, non-COVID-19 vaccine hesitancy, previous diagnosis of COVID-19, and individual risk perception of contracting COVID-19. Chi-squared analyses compared differences in informational needs by hesitancy status. Of 1003 individuals, 44% were very likely to get the vaccine, and 56% reported some level of hesitancy. Older age, Albanian ethnicity, increased education, previous COVID-19 diagnosis, acceptance of other vaccines, and increased risk perception of COVID-19 infection were negatively associated with vaccine hesitancy. Results indicated significant differences in top informational needs by hesitancy status. The top informational needs of the hesitant were the freedom to choose to be vaccinated without consequences (57% vs. 42%, p < 0.01) and that all main international agencies recommended the vaccine (35% vs. 24%, p < 0.01).

Social distance and stigma towards persons with serious mental illness among medical students in five European Central Asia countries.

The study investigated behavioral measures of social distance (i.e., desired proximity between self and others in social contexts) as an index of stigma against those with mental illness among medical students in the Republic of North Macedonia, Turkey, Azerbaijan, Kazakhstan, and Poland, using the Reported and Intended Behavior Scale (RIBS), a standardized, self-administered behavioral measure based on the Star Social Distance Scale. The students' responses to standardized clinical vignettes on schizophrenia, and depression with suicidal ideation, were also assessed. A total of 257 North Macedonian (females, 31.5%; 1-4 grades, 189; 5-6 grades, 68); 268 Turkish (females, 43.3%; 1-4 grades, 90; 5-6 grades, 178); 450 Kazakh (females, 28.4%, 71.6%; 1-4 grades, 312; 5-6 grades, 138); 512 Azerbaijani (females, 24%; 1-4 grades, 468; 5-6 grades, 44; females, 24%), and 317 Polish (females, 59.0%; 1-4 grades, 208; 5-6 grades, 109) students were surveyed. The responses on the RIBS social distance behavior measures did not improve with advancing medical school grade, but students across all sites viewed schizophrenia and depression as real medical illnesses. The results support the development of enhanced range of integrated training opportunities for medical student to socially interact with persons with mental illness sharing their experiences with them.