A Complex Relationship between Quality of Life, Anxiety, and Depression among General Population during Second Year of COVID-19 Pandemic: A Population-Based Study.

Background: The COVID-19 pandemic has had a significant impact on the global economy and public health, disrupting various aspects of daily life. Apart from its direct effects on physical health, it has also significantly affected the overall quality of life and mental health. This study employed a path analysis to explore the complex association among multiple factors associated with quality of life, anxiety, and depression in the general population of the Republic of Srpska during the pandemic's second year. Method: A cross-sectional study was conducted on a nationally representative sample (n = 1382) of the general population (adults aged 20+) during the second year of the COVID-19 pandemic in the Republic of Srpska, Bosnia, and Herzegovina. Assessment tools included the DASS-21 scale for depression, anxiety, and stress, along with the Brief COPE scale, Quality of Life Scale (QOLS), and Oslo Social Support Scale (OSSS-3). Sociodemographic factors and comorbidities were also assessed. Structural equation modeling was used to identify the direct and indirect links of various characteristics to quality of life, anxiety, and depression. Results: This study revealed a considerable prevalence of anxiety and depression symptoms (27.5% and 20.9%, respectively), with quality of life playing a significant mediating role. The constructed path model accounted for 33.1% of moderate to severe depression and 79.5% of anxiety. Negative coping was directly linked to anxiety and indirectly to depression via anxiety, while the absence of positive coping had both direct and indirect paths (through quality of life) on depression. Among variables that directly affected depression, anxiety had the highest effect. However, the bidirectional paths between anxiety and depression were also suggested by the model. Conclusions: Pandemic response strategies should be modified to effectively reduce the adverse effects on public mental health. Further research is necessary to assess the long-term effects of the pandemic on mental health and to analyze the contributing factors of anxiety and depression in the post-COVID period.

Demographic and socioeconomic factors associated with cervical cancer screening among women in Serbia.

Objectives: Effective reduction of cervical cancer incidence and mortality requires strategic measures encompassing the implementation of a cost-effective screening technology. Serbia has made significant strides, introducing organized cervical cancer screening in 2012. However, various impediments to screening implementation persist. The aim of the study was to estimate the socioeconomic factors associated with cervical cancer screening among women in Serbia. Methods: Data from 2019 National Health Survey of the population of Serbia were used in this study. The study is cross sectional survey on a representative sample of the population of Serbia. Present total number of participants analyzed in survey 6,747. Results: In Serbia, 67.2% of women have done a Pap test at any time during their lives, of which 46.1% of women have undergone cervical cancer screening in the past 3 years. About a quarter of women have never undergone a Pap test in their life (24.3%). The probability of never having a Pap test have: the youngest age group (15-24 years) is 1.3 times more likely than the oldest age group (OR = 1.31), unmarried women 0.3 times more often than married women (OR = 0.37), respondents with basic education 0.9 times more often than married women (OR = 0.98), the women of lower socioeconomic status 0.5 times more often than respondents of high socioeconomic status (OR = 0.56). Conclusion: Enhancement of the existing CCS would be the appropriate public health approach to decrease the incidence and mortality of cervical cancer in the Republic of Serbia.

Predicting the survival probability of functional neuroendocrine tumors treated with peptide receptor radionuclide therapy: Serbian experience.

Introduction: Peptide receptor radionuclide therapy (PRRT) is a treatment option for well-differentiated, somatostatin receptor positive, unresectable or/and metastatic neuroendocrine tumors (NETs). Although high disease control rates seen with PRRT a significant number NET patients have a short progression-free interval, and currently, there is a deficiency of effective biomarkers to pre-identify these patients. This study is aimed at determining the prognostic significance of biomarkers on survival of patients with NETs in initial PRRT treatment. Methodology: We retrospectively analyzed 51 patients with NETs treated with PRRT at the Department for nuclear medicine, University Clinical Center Kragujevac, Serbia, with a five-year follow-up. Eligible patients with confirmed inoperable NETs, were retrospectively evaluated hematological, blood-based inflammatory markers, biochemical markers and clinical characteristics on disease progression. In accordance with the progression og the disease, the patients were divided into two groups: progression group (n=18) and a non-progression group (n=33). Clinical data were compared between the two groups. Results: A total of 51 patients (Md=60, age 25-75 years) were treated with PRRT, of whom 29 (56.86%) demonstrated stable disease, 4 (7.84%) demonstrated a partial response, and 14 (27.46%) demonstrated progressive disease and death was recorded in 4 (7.84%) patients. The mean PFS was a 36.22 months (95% CI 30.14-42.29) and the mean OS was 44.68 months (95% CI 37.40-51.97). Univariate logistic regression analysis displayed that age (p<0.05), functional tumors (p<0.05), absolute neutrophil count (p<0.05), neutrophil-lymphocyte ratio-NLR (p<0.05), C-reactive protein-CRP (p<0.05), CRP/Albumin (p<0.05), alanine aminotransferase-ALT (p<0.05), were risk factors for disease progression. Multivariate logistic regression analysis exhibited that functional tumors (p<0.001), age (p<0.05), CRP (p<0.05), and ALT (p<0.05), were independent risk factors for the disease progression in patients with NETs. Tumor functionality was the most powerful prognostic factor. The median PFS (11.86 ± 1.41 vs. 43.38 ± 3.16 months; p=0.001) and OS (21.81 ± 2.70 vs 53.86 ± 3.70, p=0.001) were significantly shorter in patients with functional than non-functional NETs respectively. Conclusion: The study's results suggest that tumor functionality, and certain biomarkers may serve as prognostic survival indicators for patients with NETs undergoing PRRT. The findings can potentially help to identify patients who are at higher risk of disease progression and tailor treatment strategies accordingly.

Attitudes of Primary School Teachers Toward Inclusive Education.

Background: The aims of our study are related to examining the relevance of teachers' attitudes toward the implementation of inclusive education. In addition, its subject is related to the implications on inclusive education policies, limitations of the existing study along with the recommendations for our future research endeavors. Methods: The research is a cross-sectional study type. The sample included 64 primary school teachers in the lower grades of primary school (grades 1-4), selected by using simple random sampling, in three primary schools on the territory of Belgrade, Serbia in 2021 (26, 17, and 21 primary school teachers). The Questionnaire for Teachers, which was used as a research instrument, was taken from the Master's Thesis Studen Rajke, which was part of the project "Education for the Knowledge Society" at the Institute for Educational Research in Belgrade. Dependent variables measured in the study referred to the attitudes of primary school teachers toward inclusive education. Categorical variables are represented as frequencies and the Chi-square test was used to determine if a distribution of observed frequencies differed from the expected frequencies. Results: One in three teachers (32.8%) thought that inclusion was useful for children with disabilities (29.7%), of them thought that schools did not have the conditions for inclusive education, whereas one in four teachers (25.0%) believed that inclusion was not good. No statistically significant differences were found in the attitudes of professors, when observed in terms of their gender, age and length of service. Conclusion: Investing more resources and time in developing and implementing special education policies can promote successful inclusive education.

Lifestyle, Physical Activity, Eating and Hygiene Habits: A Comparative Analysis Before and During the COVID-19 Pandemic in Student Population.

Background: Changing daily habits such as diet, hygiene and physical activity may be some of the consequences of the COVID-19 pandemic. The aim of the study was to analyze the effect of this pandemic on lifestyle, physical activity, eating and hygiene habits among students. Methods: This cross-sectional study involved 171 students from the Faculty of Medical Sciences, University of Kragujevac, Serbia. Data were statistically analyzed using Wilcoxon Signed-Rank test, Marginal homogeneity test and Chi-square test. The differences were considered statistically significant when p ≤ 0.05. Results: In this study, it was observed that the most common physical activity before the pandemic was walking, while during the pandemic was home exercising. Compared to the period before the pandemic, there was no difference in the time spent engaging in daily physical activity (p = 0.334). However, there was a significant increase in sitting time during the pandemic (p = 0.005). Difference was noticed in the use of breakfast, the number of meals, and the type of fat in the diet before and during the pandemic (p = 0.000). During the pandemic, there was an increase in the use of fruits (p = 0.000), vegetables, and nuts (p = 0.001), while the use of fast food and alcohol have decreased. During the COVID-19 pandemic, a significant increase in the use of dietary supplements was observed (40.2%), (p = 0.008). Conclusions: Given that the COVID-19 pandemic is ongoing, certain changes in lifestyle observed in this study should be confirmed in more extensive population studies.

Self-Assessment of Health among the Citizens of Serbia in the Transition Period.

BACKGROUND: The aim of the research was to compare the differences between the self-assessment of the health in the latest National Health Surveys research and in the one before that. METHODS: We used the database of the latest National Health Survey in the Republic of Serbia (2013) and of the one before that (2006), as cross-sectional studies (n=29485). Logistic regression was used to predict the relationship between self-assessment of health and independent predictors. RESULTS: Health condition of the interviewees improved according to their self-assessment. With aging respondents who poorly assessed their health; women assessed their health 1.7 and 1.6 times poorer in the latest research and in the one before that respectively. The odds ratio in patients diagnosed with some disease in the previous 12 months ranged from 2.15 (1.85 - 2.51) to 4.03 (3.22 - 5.05) in the latest research. The strongest predictor was sick leave in the past 12 months with 95% CI = 3.19 (1.87-5.44) in the latest research and 95% CI = 2.27 (1.67-3.08) in the one before that. CONCLUSION: There was an improvement of the health condition of individuals. Female interviewees, less educated, unemployed, the ones who have some disease and who were on a sick leave rated their health as bad.

Differences Regarding Knowledge of Sexually Transmitted Infections, Sexual Habits, and Behavior Between University Students of Medical and Nonmedical Professions in Serbia.

Aim: The aim of this study is to assess the knowledge of sexually transmitted infections (STIs), sexual habits, and behavior among students of medical and nonmedical students in Serbia. Methodology: The cross-sectional study of 1,273 university students of four undergraduate institutions in Serbia, two of medical and two of nonmedical orientation. A standardized questionnaire, prepared in line with the questionnaire of the European health research-the second wave (European Health Interview Survey-EHIS wave 2), according to defined internationally accepted indicators, was used as a survey instrument. Results: Statistically significant difference (p < 0.001) between medical and nonmedical student groups was determined for the following parameters: naming four of five STIs (29.1 vs. 13.4%), knowledge about vaccines against some STIs (26.0 vs. 17.0%), relationship between HPV infection and cervical malignancy (48.2 vs. 16.7%) engaged in the sexual relations (87.9 vs. 76.4%), never used a condom (15.2 vs. 10.4%), underwent gynecological or urological examination (66.7 vs. 44.1%), and tested to one of STIs (10.5 vs. 4.9%). Conclusion: Both student groups have limited knowledge on possible consequences that risky sexual behavior has for reproductive health. Promotion of knowledge about STIs, awareness of all complications, and consequences of these infections certainly affect the reduction of risky behavior.

Clinical usefulness of 99mTc-HYNIC-TOC, 99mTc(V)-DMSA, and 99mTc-MIBI SPECT in the evaluation of pituitary adenomas.

BACKGROUND: The aim of this study was to evaluate the behavioral uptake and ability to diagnose pituitary adenoma (PA) using tumor-seeking radiopharmaceuticals, and to provide a semiquantitative analysis of tracer uptake in the pituitary region. PATIENTS AND METHODS: The study included 33 (13 hormonally active and 20 nonfunctioning) patients with PA and 45 control participants without pituitary involvement. All patients (n=78) underwent single photon emission computed tomography (SPECT) imaging with technetium-99m-labeled hydrazinonicotinyl-tyr-octreotide (Tc-HYNIC-TOC), dimercaptosuccinic acid (Tc(V)-DMSA) and hexakis-2-methoxyisobutylisonitrile (Tc-MIBI). A semiquantitative analysis of abnormal uptake was carried out by drawing identical regions of interest over the pituitary area and the normal brain on one transverse section that shows the lesion most clearly. The pituitary uptake to normal brain uptake (P/B) ratio was calculated in all cases. RESULTS: The result of this study confirms that the SPECT semiquantitative method, with all three tracers, showed statistically significant differences between the PA group and the controls. However, Tc-HYNIC-TOC scintigraphy could have the highest diagnostic yield because of the smallest overlap between the P/B ratios between adenoma versus nonadenoma participants (the receiver operating characteristic curve P/B ratio cut-off value was 13.08). In addition, only Tc-MIBI SPECT have the diagnostic potential to detect secreting PAs, with statistically significant differences between groups (P<0.001), with an receiver operating characteristic curve P/B ratio cut-off value of 16.72. CONCLUSION: A semiquantitative analysis of increased focal tracer uptake in the sellar area showed that Tc-HYNIC-TOC is a highly sensitive and reliable tumor-seeking agent for detecting PA, whereas Tc-MIBI SPECT is a highly sensitive and specific method in differentiating hormone-secreting pituitary tumor.

Epidemiology of Suicidal Behaviour in Shumadia District, Serbia: a Fifteen-year Retrospective Study.

OBJECTIVE: The purpose of this study is to analyze epidemiological characteristics of suicide, as well as to emphasize possible risk factors. METHODS: This is a retrospective study, covering the period of fifteen years (1996-2010), which aims at discovering the relevant factors which have an influence on suicidal behaviour. This research uses the data from the documentation of the Ministry of Internal Affairs of Serbia and Police Department in Kragujevac, hospitalization reports of patients treated at Psychiatric Clinic of the Clinical Centre Kragujevac, as well as the medical records of patients treated at the Health Centre Kragujevac. χ2 test was applied to examine the influence of all selected factors on incidence of suicide and for this purpose SPSS statistical software package was used. RESULTS: The analysis has shown that during the given period average suicide rate reached 11.8 per population of 100,000. The male to female suicide ratio of 3.6:1 obtained through this study suggests that men (78.4%) are more prone to suicide than women (21.6%). The highest number of suicides has been found within the age group of 65-year-olds (31.2%), while for the youngest age group (15-24 years) the lowest prevalence of 8.8% has been determined. In other words, the youngest subjects are 3.5 times less likely to commit suicide than the participants of the oldest age group. During the given period suicide was most often committed by married males and females with primary school education than by employed and retired people. The research has also revealed that most suicides came from urban areas (52.0%) and that the most common method of suicide is hanging (60.8%), followed by suicide by firearms, jumping from height, poisoning, and drowning. CONCLUSION: In order to prevent suicide, it is essential to collect and analyze all information concerning suicide victims.

The prevalence and socioeconomic correlates of depressive and anxiety symptoms in a group of 1,940 Serbian university students.

UNLABELLED: BACKGROUND/AIM. Mental health of university students is under increasing concern worldwide, because they face challenges which predisposes them to depression and anxiety. The aim of this study was to identify demographic and socioeconomic variables associated with depressive and anxiety symptoms among university students. METHODS: This cross-sectional study on 1,940 university students was performed using a questionnaire including demographic and socioeconomic variables, Beck Depression Inventory and Beck Anxiety Inventory. RESULTS: The prevalence of depressive symptoms in students was 23.6%, while the prevalence of anxiety symptoms was 33.5%. The depressive symptoms were significantly related to the study year (p = 0.002), type of faculty (p = 0.014), satisfaction with college major choice (p < 0.001), satisfaction with grade point average (p < 0.001). Female students (odds ratio--OR = 1.791, 95% confidence interval--CI = 1.351-2.374), older students (OR = 1.110, 95% CI = 1.051-1.172), students who reported low family economic situation (OR = 2.091, 95% CI = 1.383-3.162), not owning the room (OR = 1.512, 95%CI = 1.103-2.074), dissatisfaction with graduate education (OR = 1.537, 95% CI = 1.165-2.027) were more likely toshow depressive symptoms. The anxiety symptoms were significantly related to study year (p = 0.034), type of faculty(p < 0.001), family economic situation (p = 0.011), college residence (p = 0.001) satisfaction with the college major choice (p = 0.001), and satisfaction with graduate education(p < 0.001). Female students (OR = 1.901, 95% CI =1.490-2.425), and students who reported parents high expectations of academic success (OR = 1.290, 95% CI =1.022-1.630) were more likely to show anxiety symptoms. CONCLUSION: This is one of the largest study examining mental disorders in a sample of university students in Serbia. These findings underscore the importance of early detections of mental problems and prevention interventions in university students.

Agreement between admission and discharge diagnoses: Analysis by the groups of international classification of diseases, 10th revision.

Background/Aim: Admission diagnosis represents the diagnosis of an illness, injury or condition due to which a patient is referred to hospital to be admitted. Discharge diagnosis represents the main reason of illness or condition due to which a patient is admitted. The aim of this study was to analyze the agreement between admission diagnostic groups and discharge diagnostic groups of patients in the Clinical Center Kragujevac in the period from January 1, 2006 to December 31, 2013 on the basis of the hospitalization report. Methods: From the basic set of reports, 5% of random samples were singled out and they contained 20,422 reports. Out of the given number of reports, 18,173 hospitalization reports were complete and then further analyzed in the paper. Admission diagnostic groups given by the primary care doctor were compared with discharge diagnostic groups filled out by the practicing physician in the hospital ward from which a patient was discharged. The agreement of these two diagnostic groups was an indication of the high-quality performance of the primary care doctor. Agreement analysis was conducted using Cohen's Kappa statistics. Restuls: Agreement analysis showed that the values of the Kappa coefficient for the five leading admission diagnostic groups were in the range of κ = 0.61 to κ = 0.94. The values of the Kappa coefficient for the five most common discharge diagnostic groups were in the range of κ = 0.55 to κ = 0.81. Conclusion: Hospitalization report is a reliable individual report on inpatient care, so it could be used in determining the degree of agreement between admission diagnostic groups and discharge diagnostic groups.

[Pharmacotherapeutical possibilities in mental disorders: current status in Serbia].

The new therapeutical approaches have direct implications on living in order to accomplish remission, stop further progression of illnesses or improve the quality of life. The life expectancy has been increased up to 10 years in the last 55 years, probably owing to the innovative drugs. The innovative drugs application in our everyday clinical practice should be analyzed, related to economical aspects and to the transitional status of a country, but also in the context of fears and misconceptions of therapists. The cost of therapy is not equal to the cost of prescribed drugs, however it also includes direct and indirect costs and medical and nonmedical burden. Countries in our region spend 4-7.3% of the total budget for antipsychotic drugs, while the costs in Serbia are about 1.5%. The new antipsychotics and the new formulations of the available antipsychotics in the treatment of schizophrenia are pharmacoeconomically justified. On the other side, the substance abuse needs other strategies, including new substitution treatments. In our country only methadone maintenance therapy is available. It is necessary to provide adequate legislation to improve the process of drug registration. In the European Union it takes from 0 to 400 days for a drug to be registered, but in Serbia the process last longerthan 3 years. Important laws approved in 2006 and 2009, are only a part of the destigmatiazation of patients with mental disorders. Treatment guidelines also help in resolving these issues. Taking all of the above into consideration, the treatment of mental disorders with innovative drugs is financially justified, but still unreachable for patients in Serbia. The voice of the professionals should be heard in these matters in order to provide the adequate treatment of people with mental health problems.