Reporting guidelines for burden of disease studies: why and how?

Background

The Disability Adjusted Life Year (DALY) is a frequently used metric to assess burden of disease (BoD). Many independent BoD studies have been performed across Europe, showing wide variations and inconsistencies in the application and reporting of DALY specific methods. The European Burden of Disease Network (burden-eu) aims to develop guidelines for reporting DALY calculation studies which may enhance transparency and comparability of BoD estimates across Europe and beyond.

Methods

A burden-eu working group of experts generated a list of potential reporting items based on existing literature, guidance for developing guidelines and consultations with BoD experts. To pilot the drafted product, we asked BoD experts and non-experts to apply it to existing BoD studies. We received feedback and we revised the guidelines accordingly.

Results

The guide for DALY calculation studies comprises about 25 items that should be reported in BoD studies. We included information about the study setting, data input sources including methods for data corrections, DALY-specific methods (e.g., YLL life table, YLD approach, disability weights etc), data analyses, and data limitations. We also included information on how users can compare their new estimates with previously available BoD estimates.

Conclusions

We introduced a reporting instrument for DALY calculations that can be used to document input data and methodological design choices in BoD studies. The application of such guidelines will enhance usability of BoD estimates for decision-makers as well as global, regional, and national health experts.

Key messages

Burden of breast cancer in Serbia 2007-2017

Background

Breast cancer is the third highest incidence of cancer globally. It is the leading cause of cancer-associated mortality among females in the world. In Serbia, the incidence rate of breast cancer in 2015 was 61.0/100000 and breast cancer attributed to 18.9% of total cancer mortality among females. The aim of this study was to examine the incidence rate, years lived with disability (YLD) and disability-adjusted life-years (DALY) in Serbia in the ten-year period, from 2007 to 2017.

Methods

We analyzed data from the global burden of disease study (GBD) 2017. The data for the breast cancer incidence, prevalence, YLD, DALY counts and DALY rates per 100,000 were used for analyses.

Results

The prevalence of breast cancer in Serbia (in thousands) in 2017 was 44.6 (95% CI: 39.9-50.6), the incidence (in thousands) was 5.6 (95% CI: 5.0-6.4), YLD (in thousands) in 2017 was 3.5 (95% CI: 2.5-4.9). In the period between 2007 and 2017, YLD counts increased by 11.7%, while the age-standardized rates increased by 5.8%. Total all age DALY counts for both sexes were 51.8 (95% CI: 49- 55.3) in 2007 and 51.5 (95% CI: 45.7-58.3) in 2017. Age-standardized DALY rates per 100,000 decreased from 388.8 (95% CI: 368.3-415.7) in 2007 to 366.3 (95% CI: 323.8-415.4) in 2017.

Conclusions

The data from the GBD study show that the total YLD counts in Serbia increased by more than 10% in the past decade. However, the total DALY counts did not change significantly and the age-standardized DALY rate per 100,000 decreased in the period between 2007 and 2017.

Key messages

The total years-lived with disability as a consequence of the breast cancer increased for 10% in Serbia between 2007 and 2017. The decrease in age-standardized DALYs may reflect aging and depopulation effects in Serbia.

How accessible is the Serbian health system? Main barriers and challenges ahead

Background

Access to health care is a key health policy issue faced by countries in the WHO European Region and Serbia is not an exception. There is increasing concern that financial and economic crisis may have delay progress regarding the performance of the Serbian health system. While substantial development has been experienced by the Serbian health system since 2000, we analyse whether barriers to health care access exist in the country and the underlying causes.

Methods

We combine quantitative and qualitative methods to assess the accessibility of the Serbian health system. We use the latest data available both at national (e.g. National Health Survey) and European (EUSILC) level to understand whether barriers to access exist and the underlying causes. On the qualitative side, we analyse the different policies implemented by the Serbian government to improve the accessibility of the health system in the last decade, identifying the challenges ahead for the country.

Results

We find that, in 2018, 5.8% of the Serbian population reported unmet need for medical care due to costs, travel distances or waiting lists, well above the EU28 average and much higher than in neighbouring countries. Financial constraints are reported to be the main reason for unmet needs for medical care. Long waiting times also impede the accessibility of health services in Serbia.

Conclusions

Serbia has a comprehensive universal health system with free access to health care, however, some vulnerable groups, such as those living in poverty or Roma people in settlements, have more barriers in accessing health care. It is expected that Serbia will continue to develop policies focused on reducing barriers to accessing health care and improving the efficiency of the health system, supported by international organisations and in the context of the EU accession negotiations.

Key messages

Some vulnerable groups have more barriers in accessing adequate care in Serbia. National initiatives are in place to increase access to the health system but there is scope for further work.

Facebook Intervention To Improve Physical Activity Level Among Youth

Background

Physical activity level decreases during the transition from late adolescence to young adulthood. Social media are nowadays widely used and part of many people’s daily routines and the interventions on these websites have the possibilities to be integrated into those routines without becoming a burden. The aim of this study was to assess physical activity level among medical students and to assess the possibilities of using social media intervention with an aim to improve physical activity among them.

Methods

Prospective study was conducted during October of 2016 at the Faculty of Medicine, University of Belgrade, Serbia. The study included 375 first and fifth-year students. At the baseline, students filled in the questionnaire regarding social and lifestyle characteristics as well as their physical activity. Physical activity was assessed using the International Physical Activity Questionnaire (IPAQ). After completing the questionnaire, students were asked to join a Facebook discussion group. The intervention consisted of motivation for physical activity through motivational pictures, texts, and discussions. The second assessment was done after one month. Based on the reported physical activity level students were divided into two groups: sufficient (>600MET-minutes/week) and insufficient physical activity (≤600 MET-minutes/week).

Results

Total of 85.4% of students were sufficiently active at the baseline, while 90.4% were sufficiently active after one month. Multivariate logistic regression analysis showed that students who were part of the Facebook group (OR: 3.51, 95% CI: 1.46-8.43) and students who had sufficient physical activity at the baseline (OR: 5.44, 95% CI: 2.44-12.13) had a higher likelihood to be sufficiently active after one month.

Conclusions

Social media can be used for interventions targeting lifestyle change among young adults and activities on these websites can be adjusted to meet the needs of the target population.

Key messages

Intervention on social media could lead to lifestyle change. Interventions on social media could be adjusted to fit the target population.

Unmet dental health care needs among adults in Serbia, Survey on Income and Living Conditions 2017

Background

Changes in the health insurance law in 2005 led to the changes in the organization of the provision of dental health care in Serbia. Prior to this law, dental health care was available for every resident covered by mandatory health insurance without additional out-of-pocket payments. Now the dental health care is available only for children under the age of 18, students under the age of 26, pregnant women and for emergency dental care. The aim of this study was to assess the prevalence of unmet dental health care needs among adults and to assess the factors associated with unmet dental health care needs.

Methods

The study was the secondary analysis of the data from the Survey on income and Living conditions in Serbia, conducted during 2017. Multivariate logistic regression analysis was used to assess the association of unmet dental health care needs and socio-demographic and socio-economic factors.

Results

Total of 1718/12437 (12.1%) adults reported unmet dental health care needs. The main reason reported was not being able to afford it (1014/1718, 59.0%), along with the fear of doctors or hospitals (260/1718, 15.5%). Multivariate logistic regression analysis showed the association of unmet dental health care needs and being employed (OR: 1.50, 95% CI: 1.24-1.80), unemployed (OR: 1.96, 95% CI: 1.65-2.33), having primary (OR: 1.47, 95% CI: 1.16-1.86), or secondary education (OR: 1.43, 95% CI: 1.21-1.69), being divorced (OR: 1.47, 95% CI: 1.17-1.85), having good (OR:1.44, 95% CI: 1.20- 1.74), average (OR: 2.36, 95% CI: 1.91-2.92), poor (OR: 2.29, 95%CI: 1.77-2.97), or very poor general health (OR: 2.42, 95% CI: 1.68-3.48), having limitation in daily activities (OR: 0.66, 95% CI: 0.60-0.77) and being materially deprived (OR: 1.67, 95% CI: 1.46-1.90).

Conclusions

The prevalence of unmet dental health care needs in high among adults in Serbia. There is an association between social characteristics and health status with unmet dental health care needs in Serbia.

Key messages

There is a high prevalence of unmet dental health care needs in Serbia. Unmet dental health care needs are associated with social characteristics and health status.

Copenhagen Burnout Inventory On A National Representative Sample Of Pre-School Teachers

Background

Pre-school teachers are faced with work-related stress and are at increased risk of development of burnout syndrome. The aim of this study was to evaluate the reliability of the Serbian version of Copenhagen burnout inventory (CBI) on a National Representative Sample of preschool teachers in Serbia.

Methods

This was a cross-sectional study conducted between October 2018 and April 2019 which included 456 preschool teachers in Serbia. The instrument contained questions on socio-demographic, socio-economic characteristics, lifestyle characteristics, workplace environment and Serbian version of CBI. Univariate linear regression, multiple linear regression, Cronbach alpha coefficients were performed.

Results

Cronbach alpha of three domains of CBI were: personal burnout-0.907, work-related burnout-0.878, client-related burnout- 0.903. Multiple linear regression analysis showed that having a tenured contract (ß=3.46, p = 0.04), working in shifts (ß=7.94, p = 0.01), and having worse self-perceived health status (ß=-8.88, p = 0.01) were significantly associated with personal burnout. Working in shifts (ß=-4.67, p-0.012) and having worse self-perceived health status (ß=-7.82, p < 0.001) were significantly associated with work-related burnout. Age (ß=0.53, p < 0.001), living in urban areas (ß=-6.55, p = 0.015), alcohol consumption (ß=5.09, p = 0.016), number of children teacher work with (ß0.407, p = 0.005), having teaching equipment (ß=-4.46, p = 0.033), and having worse self-perceived health status (ß=-7.17, p < 0.0001) were significantly associated with client-related burnout.

Conclusions

CBI is a valid instrument for the assessment of burnout among preschool teachers in Serbia. Many workplace-related factors, which could be subject of preventive measures, are associated with domains of burnout in this population.

Key messages

Workplace-related factors are associated with burnout among preschool teachers in Serbia. CBI is valid instrument for assessment of burnout among preschool teachers.

Association between non-communicable disease multimorbidity and health care utilization in a middle-income country: population-based study

OBJECTIVE

The objective was to analyze possible inequalities by gender in the utilization of health services (general practitioner [GP] and hospital), among people with non-communicable diseases (NCDs) in the Republic of Serbia, with special reference to multimorbidity. In addition, we examined the prevalence patterns of NCDs by sociodemographic characteristics of the population.

STUDY DESIGN

This study is a population-based, cross-sectional survey.

METHODS

A secondary analysis from the 2013 Serbian National Health Survey included 13,765 adults aged ≥20 years. Multivariable logistic and linear regression analyses were performed to assess the association between NCDs and health care utilization.

RESULTS

Multimorbidity was present in 30.2% of the total sample. An increased number of NCDs was associated with a higher utilization of both primary (odds ratio [OR] for having any GP visit is 3.17 in males and 3.14 in females; unstandardized coefficient [B] for number of GP visits is 0.33 for both gender) and secondary health care services (OR for having any hospitalization is 2.45 in males and 1.97 in females; B for number of overnight stays in hospital is 1.62 in males and 0.97 in females) in Serbia.

CONCLUSIONS

Our study provided strong evidence that an increased number of NCDs was significantly associated with a higher utilization of health care services in Serbia. There is a need for wise, decisive, and integrated care interventions for effective management of NCDs and their risk factors. Further research is necessary with special emphasis on the role of the health system in satisfying needs of such patients.

Do health care workforce, population, and service provision significantly contribute to the total health expenditure? An econometric analysis of Serbia

BACKGROUND

In times of austerity, the availability of econometric health knowledge assists policy-makers in understanding and balancing health expenditure with health care plans within fiscal constraints. The objective of this study is to explore whether the health workforce supply of the public health care sector, population number, and utilization of inpatient care significantly contribute to total health expenditure.

METHODS

The dependent variable is the total health expenditure (THE) in Serbia from the years 2003 to 2011. The independent variables are the number of health workers employed in the public health care sector, population number, and inpatient care discharges per 100 population. The statistical analyses include the quadratic interpolation method, natural logarithm and differentiation, and multiple linear regression analyses. The level of significance is set at P < 0.05.

RESULTS

The regression model captures 90 % of all variations of observed dependent variables (adjusted R square), and the model is significant (P < 0.001). Total health expenditure increased by 1.21 standard deviations, with an increase in health workforce growth rate by 1 standard deviation. Furthermore, this rate decreased by 1.12 standard deviations, with an increase in (negative) population growth rate by 1 standard deviation. Finally, the growth rate increased by 0.38 standard deviation, with an increase of the growth rate of inpatient care discharges per 100 population by 1 standard deviation (P < 0.001).

CONCLUSIONS

Study results demonstrate that the government has been making an effort to control strongly health budget growth. Exploring causality relationships between health expenditure and health workforce is important for countries that are trying to consolidate their public health finances and achieve universal health coverage at the same time.

Determinants of intention to work abroad of college and specialist nursing graduates in Serbia

BACKGROUND

In a country with a poor economy and limited job opportunities, the outmigration of students is not commonly perceived as a problem but rather is perceived as a solution to the high unemployment facing young health professionals.

OBJECTIVES

Study objectives were to identify the prevalence of intention to work abroad of nursing graduates to point to the predictors of intention to work abroad and predictors of having a firm plan to work in a foreign country.

DESIGN

Descriptive study, a survey.

SETTINGS

College and specialist nursing schools, Serbia.

PARTICIPANTS

719 nursing graduates from the 2012/2013 school year.

METHODS

Voluntarily completed a questionnaire that was designed with regard to similar surveys administered in EU-candidate countries during the pre-accession period. Data were analysed with descriptive and multivariate regression analyses.

RESULTS

Almost 70% (501) of respondents indicated an intention to work abroad. Of the nurses, 13% already had established a firm plan to work abroad. Single graduates and those with a friend or relative living abroad were more likely to consider working abroad than were their counterparts (odds ratios were 2.3 and 1.7, respectively). The likelihood of considering working abroad decreased by 29% when the individuals' financial situation was improved. Factors associated with having a firm plan were previous professional experience in a foreign country, having someone abroad and financial improvement (5.4 times, 4.8 times and 2 times greater likelihood, respectively).

CONCLUSIONS

The high prevalence of intention to work abroad suggests the need to place the issue of the out-migration of nursing graduates on the policy agenda. College and specialty nursing graduates and health technicians are prepared to work abroad in search of a better quality of life, better working conditions and higher salaries.