XXX STRUČNI SASTANAK
PREVENTIVNE MEDICINE
TIMOČKE KRAJINE
ZBORNIK REZIMEA
ZAJEČAR 25.04 – 28.04.2017. GODINE
XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE
Impresum
Izdaje i štampa:
Zavod za javno zdravlje "Timok" Zaječar, 2017. godina
Sremska 13, 19000 Zaječar
Za izdavača:
Direktor Zavoda Slađana Ristić
XXX stručni sastanak preventivne medicine timočke krajine
Uređivački kolegijum: prof. dr ZORAN MILOŠEVIĆ, prof. dr DEJAN FILIPOVIĆ, prof. dr MILENA SPASOVSKI, prof. dr JORDAN ALEKSIĆ, prof. dr NEBOJŠA PAUNKOVIĆ, dr PETAR PAUNOVIĆ, docent dr. MIODRAG STOJANOVIĆ.
Tiraž:
(CD-ROM); 12 cm; 100 primeraka
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ВОДА ОД ПРВОГ ДО ПОСЛЕДЊЕГ КУПАЊА Др Стеван М. Станковић, професор емеритус Универзитет у Београду, Географски факултет
Вода је најраширенија материја на Земљи.На први поглед једноставна, јер се састоји од мало водоника и кисеоника, али није баш тако. Воду, онакву какву познајемо у свакодневном животу, готово нико не производи. Вода има бројна својства, која наука још увек истражује, јер се јавља у много облика и користи на безброј начина. Човек се први пут сретне са водом само неколико минута по рођењу, када се обави прво купање. Код старих Словена се то обављало наспољу и хладном водом да се новорођенче кали. Осам дана након тога, новорођенче се крсти. Купа се у води у крстионици, добија име и улази у свет хришћанства у име светог тројства – оца, сина и светога духа. На планети Земљи 2/3 чини вода и 1/3 копно. Океан је дубљи од највише планине.Највише воде има у Светском мору и то 97 %, али се и на сред океана може умрети од жеђи, јер морска вода није за пиће.За једног посетиоца поликлинике потребно је 15 литара воде, као и за ученика у школи. За производљу једног килограма шећера потребно је 100литара воде. За производњу једног килограма пиринча10.000 до 14.000 литара воде. Највише слатке воде има у ледницима и то 69 %. Вода за пиће чини само 3 % од укупне количине воде. Због тога су још стари Асирци говорили: У реку се не сме пљунути. Наука о води је хидрологија која уважава одговарајуће постулате о води као незамењивој материји. Загађена вода узрок је многих болести, од којих неке повремено имају одлике епидемије. Због тога се чини разумљивом изрека Вода има зубе. У старе мудрости убрајамо и следеће: Не пљуј у бунар док не ископаш други; Не мути воду коју пијеш;Вреди као три летње кише;Вода је у пустињи скупља од дијаманта; Вода се жедном не сме продати.Брига о води додељивана је највећим боговима: Зевс је бог воде на копну,Посејдон воде у мору,Кефис у рекама.Нил је дар бога сунца Ра. Количина воде на Земљи је готово увек иста, не може се повећавати, ако је не штитимо прети нам велика опасност.
WATER FROM THE FIRST TO LAST BATH Dr Stevan M.Stanković, profesor emeritus University of Belgrade, Geographic Faculty
Water is the most widely used substanceоn Earth. At first sight simple, because it consists of hydrogen and a little oxygen, but that is not true.Water that we know in everyday life, almost no one produces. Water has a number of properties, which science is still investigating, because it occurs in many forms and benefits in countless ways. Man first encounters water only a few minutes after birth, when the firstbath is done. With the ancient Slavs it was performed outside with cold water to make the newborn strong. Eight days later, the newborn is cristened in water in a font, is named and enters the world of Christianity in the name of the Holy Trinity – Father Son and Holy Spirit. On planet Earth 2/3 make water and 1/3 mainland. Ocean is deeper than the highest mountain. The most water is in the World sea - 97%, but also in the middle of the ocean you can die of thirst, because sea water is not for drinking. For one visitor in a clinic it takes 15 liters of water, as well as for a student in school. For production of one kilogram of sugar it takes 100 liters of water. To produce one kilogram of rice it takes 10,000 to 14,000 liters of water. Most fresh water is in glaciers - 69%. Drinking water makes up only 3% of the total amount of water. Because of that the ancient
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Assyrians used to say: You should not spit in the river.The science of water is hydrology that respects postulates about water as indispensible matter. Contaminated water is the cause of many diseases, some of which occasionally have the qualities of epidemic. The saying therefore seems reasonable, Water has teeth. The old wisdom is also the following: Do not spit into the well until you dig another one; Do not spoil the water you drink; It is worth as three summer showers; Water in the desert is more expensive than diamond; You must not sell water to a thirsty man. Care of water was granted to the greatest Gods: Zeus is the god of water on mainland, Poseidon of water in the sea, Kefis in the rivers. The Nile is a gift of the sun god Ra. The amount of water on Earth is almost always the same, and cannot be increased, if we do not preserve it great danger threatens us.
Drug-Checking: An efficient drug prevention measure in the techno scene
Steve Müller, Rainer Schmid, ‘checkit!’ Prevention Project, Suchthilfe Wien.
Attendants of the (techno-) music scene are associated with a higher extent of use of stimulant drugs (e.g. as ecstasy or amphetamines) than other young adults of same age. This drug use most of the time is associated with relative high risk, because individuals never know exactly, what the identity of the drug is and in which dose they have in hand. To be able to deliver credible harm reduction information to music event visitors, the low –threshold drug prevention project ’checkit!’ had been founded twenty years ago by the government of the city of Vienna, Austria. It consists of delivering of (mainly) drug related prevention information by trained drug counsellors at music event sites and a timely (anonymous) drug-checking service for people willing to consume. People may anonymously present their drugs during the music event at the projects contact point and will obtain a differential result within short time to be discussed with the social workers. Especially in the light of the steadily increasing number of new psychoactive drugs in the last 10 years, this drug prevention project has been becoming more and more demanding. Experience has shown, that is essential in this music scene, to provide credible information on all aspects of drug use to these young adults, so they are prepared to build-up a proper risk competence. In contrary to countries, which do not offer such services, serious health events or even lethal intoxications has remained extremely rare in the Viennese music event scene. And in contrary to general believe, such drug checking and counselling service never leads to an encouragement but to less and less risky drug use by music event visitors: Because, when they learn credibly about the reality on their drugs, they have in hand, they start to become more conscious and cautious in their long-term drug taking behavior!
Implementation of integrated drug checking as a means of coping with risks associated with the rapidly changing drug market in the greater Vienna area
Anton Luf, Medical University Vienna, Clinical Department of Laboratory Medicine, Waehringer Guertel 18-20, 1090 Vienna, Austria
In recent years the number of NPS has steadily increased in the European drug-market resulting in a more and more complex situation for both drug-consumers and experts in the field of addiction prevention (i.e. social workers, psychologists, analytical scientists and clinical experts). In 2015 a
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE total number of 98 new substances were reported to the European monitoring institution EMCDDA equalling the report of almost two new substances every week, resulting in more than 560 new substances being monitored.
This circumstance brings drug-counsellors and analytical scientists in a situation in which thorough research on the analysis of NPS and on possible adverse outcomes has to be carried out for the development and implementation of effective risk- and harm reduction measures and to provide consumers with precise objective information on psychoactive substances. During drug analysis carried out by a fast mobile HPLC-MS system at the Viennese drug checking (DC) facility ‘checkit’ many of these substances were observed.
During the DC process in Vienna it became evident that NPS were more prevalent in drugs bought as classic recreational drugs like MDMA and cocaine rather than in drugs that were purposely bought as NPS. In parallel a new phenomenon has risen in the years 2014 to 2016 in Vienna and all over Europe: the availability of highly dosed ecstasy tablets. In 2015 DC results in Vienna reveal that the average MDMA content of ecstasy tablets has risen to 145 milligrams (mg) per unit, which is more than three times the amount observed in the year 2010 (41 mg). Also the range of MDMA content has widened from 2 to 289 mg in 2015 compared to 10 to 75 mg in 2010. This results in a difficult situation for XTC users to estimate the right dosage without the knowledge of the drugs content.
These two recent developments underline the necessity of comprehensive drug checking services in Europe more than ever, to provide drug consumers with objective information and for drug counsellors, health-care experts and analytical chemists to understand the underlying circumstances and provide appropriate risk- and harm-reduction measures for recreational drug users.
Proteomics as a Tool for Analysis and Clasification of Cerebral Tissue in Early Disease Detection for Brain Tumors and Epilepsy
Goran Mitulović
Proteomics Core Facility and Clinical Instittute for Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, Wien, Austria.
The technological breakthroughs in proteomics, lipidomics, genomics, and transcriptomics offer important and new research opportunities for brain tumor studies. Currently, it is possible to perform a single cell proteomics analysis and targeted proteomics research of posttranslational modifications while combining the results with large scale lipidomics, genomics, and transcriptomics analysis. However, despite significant amount of accumulating genomic and
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE transcriptomic data, the fundamental mechanistic differences of gliomagenesis remain poorly understood. The ultimate goal of recent medical initiatives is the “personalized medicine” or “precision medicine” which would enable tailored therapies based on patient’s proteomic and genomic profile. So far, our understanding of cancer is limited to clinical symptoms and many cancer pathways remain hidden and elusive. Although genetic markers are being applied for detection of predisposition to developing of certain cancer types, it is still not possible to easily apply individually tailored and targeted treatment strategies that can improve the prognosis and the overall survival rate of patients.
As an example, glioblastomas (GBM) are the most common and aggressive primary brain tumors of adults with no curative treatment currently available and thus a very poor prognosis. Researchers have been challenged worldwide for their complex cellular composition and diffuse invasiveness and, especially, for the tumor’s capacity to escape therapies. All this has hampered progress towards an early diagnostics and effective treatment for decades. The tumor consists of heterogeneous cell types and it includes a subset of stem cell-like cells thought to sustain tumor growth. Glioblastoma is characterized by extensive invasion of the brain, neo-angionesis, significant cellular and molecular heterogeneity, and a high proliferative rate. Current treatment involves neurosurgical resection, radiotherapy, and chemotherapy. Despite the broad therapeutic setup, the median survival rate is only about fifteen months. It is critically to uncover the signaling pathways and, in the era of personalized therapy, to find appropriate treatment of the “individual tumor”. Despite advances in analytical platforms, especially in mass spectrometry and the significant success in accessing the information about the human proteome, there are still impeding limitations to achieve comparable coverage of the technologies to be applied (transcriptomics, proteomics, and lipidomics) from any biological sample.
Proteomics, combined with genomics and transcriptomics, provides unique tools and holds great promise for discovery of biomarkers and therapeutic targets that can be applied for improving the prevention and cure of cancer. Therefore, basic science discoveries can be translated into the clinical practice of personalized diagnostics and treatment. Such biomedical studies have been enabled recently owing to the emergence of new next generation sequencing technologies and significant advances in proteomic mass spectrometry (MS) instrumentation.
Beyond the Future off Mass Spectrometry, New Applications for Public Health
Konstantin Halikias
Bruker Austria
Since their discovery, antibiotics have been hugely important in human defense against infectious diseases caused by bacteria. However, the use of antibiotics has also lead to bacterial resistance to 6
XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE antibiotics, which is becoming a global public health problem. In order to develop new treatments for antibiotic-resistant bacteria, we need to understand how these bacteria become resistant in first place. We must understand how the entire bacterial cell works and studies that analyze changes in the protein composition of bacterial cells after antibiotic treatment are the way to discover and understand processes involved in resistance.
In public health, one of the ways for analyzing bacterial proteins is using mass spectrometry (MS) technology. This technology enables scientists and public health professionals to understand more about the mechanism of bacterial infections and about the proteins involved. It is known that the genome includes coding information for every protein and it has also been proved that some proteins that are coded for are not always expressed in the cell. This means that protein production also depends on factors such as the environment in which the bacteria are growing and not only on the information in the genomic code. This information is of particular importance when outbreaks of disease occurs and the infectious ability of some bacteria seems to be highly enhanced.
Public health professionals have become a newly developed type of MS technology to understand more about these changes in bacterial protein production and this information could have significant impact in the process of rapid identification of the cause of many infectious human diseases.
The field for microbial identification has seen an important move forward with Bruker's MALDI Biotyper and soon it will be possible to perform a single cell proteomics analysis and targeted proteomics research of posttranslational modifications while combining the results with large scale lipidomics, genomics, and transcriptomics analysis. Further development in the field of rapid MS detection of viral and bacterial markers and fingertypping will enhance and make the whole process even faster, which is of especial importance in public health.
”Responsible sexual behaviour among adolescents, how to pass the information onto them?”
Assist. Prof. Dubravko Lepušić, PhD, MD
Institution:
1) "Sisters of Charity" Teaching Hospital Zagreb, Croatia
2) Association "Aktiva", Zagreb, Croatia
Introduction: The reasons that make the adolescent population a social group with increased risk are as follows:
-need for sexual experimentation
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-poor knowledge about sexually transmitted diseases
-hedonism as a value
-powerful influence of peer groups
-illusion of invulnerability
Aim: modalities of adolescent education on responsible sexual behaviour
Materials and methods: statistical interview with adolescents through survey
Results: Factors that increase the likelihood of risky sexual behaviour are:
early sexual initiation tendency towards risky activities consumption of alcohol and narcotics not using contraception during the first sexual intercourse negative attitudes towards condom low level of awareness on human sexuality traditional, sexually discriminatory attitudes (especially in men) sense of guilt associated with sexual activity, often connected with strict religious socialization (especially in women) Reproductive health care includes:
education on sexuality and reproduction counselling on family planning and the use of contraception, reproductive health care prevention and treatment of infertility diagnosis and treatment of reproductive system diseases, hormonal disorders and malignant diseases termination of pregnancy with prevention and treatment of consequences prevention of sexual abuse and care for victims The main problems of sexual and reproductive health in adolescents are:
- abortions
- teen pregnancy and births
- contraception
- sexually transmitted diseases
- sexual violence and exploitation
Conclusion: The interest of any society is to have educated people, free from fear of diseases.
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Our own choice is possible only when there is knowledge. Without knowledge, especially in adolescents, that is theoretically impossible. There is no room for political or religious agitation in public schools. Public schools must be temples of knowledge, civil elevation, value-neutral and equal for all
Keywords: adolescents, education, health education
ЉУДСКИ РЕСУРСИ У ЗДРАВСТВЕНОЈ ЗАШТИТИ
Зоран Милошевић, Миодраг Стојановић, Александар Вишњић, Роберта Марковић, Александра Игњатовић, Марија Анђелковић Апостоловић и Сања Милошевић. Медицински факултет Ниш и Институт за јавно здравље Ниш. Србија
Према Закону о здравственој заштити здравствени радници су лица која имају завршен медицински, стоматолошки, односно фармацеутски факултет, као и лица са завршеном другом школом здравствене струке, а која непосредно као професију обављају здравствену делатност у здравственим установама или приватној пракси. Здравствени сарадник јесте лице са средњом, вишом, односно високом стручном спремом које обавља одређене послове здравствене заштите у здравственој установи, односно приватној пракси. За вршење здравствене делатности здравствени радници, односно здравствени сарадници морају за одређене послове имати и одговарајућу специјализацију, односно ужу специјализацију. Здравствени радник, у зависности од степена стручне спреме јесте: доктор медицине, доктор стоматологије, дипломирани фармацеут и дипломирани фармацеут медицински биохемичар - са завршеним одговарајућим факултетом здравствене струке; здравствени радник - са завршеном одговарајућом високом, вишом, односно средњом школом здравствене струке. У организацији здравствене заштите најважнији је сегмент њен први ниво односно примарна здравствена заштите. Усвајањем стратегије здравље за све, све већа пажња је почела да се поклања управо овим докторима медицине. Посебно се подвлачи да пажњу треба усмерити на знање и способности које поседују доктори медицине, и да су добро обучени за руковање технолошким достигнућима. Опредељење Светске здравствене организације да је доктор будућности тзв „доктор са пет звездица“, све више је прихваћено. У току свог школовања мора да овлада многим вештинама међу којима су од значаја и менаџерске вештине. „Доктор медицине са пет звездица“ треба да пружи одговарајућу здравствену заштиту свим људима, одлучује о технологијама које ће применити, унапређује здраве стилове живота, присутан је у заједници и има поверење људи, ради са појединцима и организацијама унутар и ван система здравствене заштите. Процена потребе за здравственим кадровима базира се на четири елемената: захтеви за здравственом заштитом, здравствене потребе, однос кадровских ресурса и популације и захтеви за циљане услуге. Здравствени захтеви се процењују на основу броја и врсте пружених услуга на одређеном подручју. У пракси Фонд за здравствено осигурање прописује својим програмом да се на одређеном подручју из године у годину не може планирати пружање мањег броја услуга у односу на број пружених у предходној години. Број и врста пружених услуга се уз ангажовање доктора медицине специјалисте социјалне медицине могу претворити у кадровске ресурсе, коришћењем емпиријских стандарда јер у највећем броју случајева у
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Србији немамо ваљане и валидне стандарде који прате технолошки развој. Обично је и проблем када се овим послом баве некомпетентни „стручњаци“. Здравствене потребе су категорија која је највише изучена, оне се процењују кроз услуге здравствене заштите које је потребно пружити да би се унапредило и очувало достигнуто здравствено стање становништва. Неопходне здравствене услуге које су у корелацији са здравственим потребама, њихова врста и број резултирају потрбним бројем здравствених радника за њихову реализацију. Становништво на одређеном подручју коме треба пружити здравствене услуге условљава захтеве за кадровским ресурсима преко норматива и стандарда и емпиријских искустава. Данас је то веома отежано, највише зато што се овим питањем бави више институције из разних интереса. Није адекватно сагледана улога социјалне медицине и стручњаци ове области ниси довољно присутни на местима одлучивања о кадровким ресурсима. Реформа примарне здравствене заштите подразумева: Јасно раздвојити нивое здравствене заштите. Оснажити улогу примарне здравствене заштите, као “чувара капије “ према вишим нивоима здравствене заштите (омогућити да примарна здравствена заштита абсорбује преко 80% свих услуга). Померити фокус примарне здравствене заштите са куративе на превентиву. Омогућити равномерно, равноправно и правично коришћење здравствених услуга свим корисницима. Ради остварења наведених циљева према одредбама Закона о здравственој заштити примарну здравствену заштиту у дому здравља грађани остварују преко изабраног лекара. Институција изабраног лекара насумњиво даје допринос менаџменту здравствених кадрова, јер правилом организацијом у Дому здравља биће испуњени принципи који су од значаја за процену потреба за здравственим кадровима. У пружању здравствне заштите је у Србији, према подацима из 2015 године, било 2.9 лекари као и 5.8 сестре на 1 000 становника. У Србији у релативним износима право на здравствену заштиту је финансирано са 12% БДП-а (једине земље које троше више су Француску са 12,5% и Грчке са 13%). То је много више од неких великих земаља као што су Русија и Турска, а у овим земљама се понекад шаљу пацијенти из Србије на лечење. Како објаснити парадокс да, у односу на друге, улажемо више и добију мање? Упоредиве земље као што су Бугарска и Румунија, иако по становнику (како у релативно и апсолутном смислу) троше много мање, имају боље индекса. Систем здравствене заштите Србије показује области које је потребно хитно реформисати. Основна активност у најављиваним реформама система здравствене заштите треба бити стављена на побољшање квалитета здравствених услуга. А квалитет је уско условљен људским ресурсима односно запосленима у здравственом систему. ољшање актуелног стања у сиситему здравствене заштите, што је значајно са аспекта кадрова може се предузети следеће: Увођење јединственог задравственог информационог система који би омогућио смањивање административних кадрова у здравству и растерећење доктора медицине од административних послова што би сасвим сигурно повећало квалтет у пружању здравствене заштите. Стварање законских предуслова за изједначавање приватног и друштвеног сектора у здравству, изменом постојећих закона и доношењем нових. Тиме би било омогућено становништву Србије да једноставније и брже дођу до потребне здравствене услуге. Смањиле би се листе чекања на одређене дијагностичке и терапијске процедуре и врероватно створили услови да грађани могу да бирају доктора медицине. На тај начин би било могуће да запослени у здравству одаберу где желе да пружају здравствену заштиту у
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државној здравственој установи или у приватној. Здравственим радницима би било омогућено да одлуче где ће радити у систему здравствене заштите. Веома важан аспект садашњег система здравстене заштите и запослених у здравству је потреба повећања плата здравственим радницима, награђивање у зависности од квалитета, а не квантитета пружања услуга, уз увођење прецизних критеријума за оцену квалитета рада. Садашњи систем финансирања здравствене заштите је на основу расположивих средстава у Фонду здравственог осигурања, а не на основу реалних потреба за здравственом заштитом и на основу броја и врсте пружених здравствених услуга. У том смислу потребно је увести много пута помињану капитацију у примарној здравственој заштити и плаћање стационарних здравствених установа на основу пружених здравствених услуга. Данас је то још неостварено у нашем здравственом систему. Да би се обезбедила сва Начела здравствене заштите, а посебно Начело приступачности здравствене заштите који су наведени у Закону о здравственој заштити потребно је посебно стимулисање здравстених радника који раде у забаченим и неприступачним деловима Србије. А то практично треба да значи повећан значај и улога примарне здравствене заштите ради универзалне покривености здравстеном заштитом целог становништва у Србији. Из наведених разлога Кадровски план мора уважити територијалну распрострањеност Србије и обавезу руралних Домова здравља да покрију сваки део територије у земљи. На дан 31.12.2015. године у здравственим установама из Плана мреже здравствених установа у Републици Србији је било запослено 107.980 радника. Од тог броја доктора медицине било је 20.450, односно 288 на 100.000 становника. Највећи број лекара у односу на број становника регистрован је у Нишавском округу (396 на 100.000), а најмањи у Сремском округу (188 на 100.000). Наведене вредности су ниже или на нивоу (Сремски округ) вредности у претходној години. Здравствена заштита становништва непосредно се спроводи преко мреже здравствених установа и условљена је развијеношћу организације и технологије рада. Укупан број здравствених установа према Уредби о плану мреже здравствених установа („Сл. гласник РС” бр. 42/06, 119/07, 84/08, 71/09, 85/09, 24/10, 6/12, 37/12, 8/2014 i 92/2015) у 2015. години у Србији износио је 355.
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Графикон: Здравствене установе у Републици Србији
Кључне речи: здравствени радник, примарна здравствена заштита, здравствене потребе, реформа здравствене заштите.
HUMAN RESOURCES IN HEALTH CARE Zoran Milosević, Miodrag Stojanović, Aleksandar Višnjić, Roberta Marković, Aleksandra Ignjatović, Marija Andjelkovic Apostolović and Sanja Milosević. Faculty of Medicine, Niš and Public Health Institute Niš. Serbia According to the Law, health care workers are people who have completed medical, dental, and pharmaceutical faculties, as well as people who have completed another medical professions, and performe health activities in health facilities or private practice. Medical assistant is a person finishing high school, college, or university degree, which carries out certain tasks of health care in a medical institution or private practice. Health workers and health associates need to have appropriate specializations or subspecializations for performing health services. Health care workers, depending on the degree, are: a medical doctor, a dentist, a pharmacist and a pharmacist medical biochemistry as well as health worker – who have finished university, college, high school or medical profession. The World Health Organization consider the future doctor as "five-star doctor". During his education he must learn many skills, especilally managerial skills. "A five-star doctor" should provide an appropriate health care to all people, should decide on the technology to be applied, promote healthy lifestyles, be present in the community and and be a man of trust, also work with individuals and organizations inside and outside the health care system. Assessment of the need for medical personnel is based on four elements: the requirements for health care, medical needs, the ratio of personnel resources to the population and demands for targeted services.
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Health requirements are assessed based on the diferent number and types of services provided in a particular area. The number and type of services provided to the involvement of social medicine specialist can be transformed into human resources, using empirical standards because in most cases we do not have in Serbia proper and valid standards which are following technological developments. Incompetent "experts" usually make a problem is when you are doing this work ". The health needs belongs to one category that is most explored, which are evaluated by health care services and provided in order to improve and maintain the health achievements of the population. Necessary medical services correlated with health needs, their nature and the number are resulting in the necessary number of health workers for their realization. The population in a particular area that needs to provide health services stipulates the requirements for human resources through the norms, standards and empirical experience. Today it is very difficult, mainly because several institutions from various interests are dealing with the same issue. Not adequately perceived role of social medicine and its specialists in this area did not present enough in decision-making about human resources. Primary healthcare reform implies: clear separation levels of health care, strengthening the role of primary health care as a "gatekeeper" to higher levels of care (allow primary care absorbs more than 80% of all services). Direct primary care focus from cure to prevention. Provide uniform, equal and equitable access to health services to all users The citizens are provided health care through the chosen doctor. Institution chosen doctor undoubtedly is contributing to the management of health personnel because ot the proper organization in the health center with principles that are important for assessing the need for medical personnel. According to data from 2015. delivering of health care in Serbia was achieved by 2.9 doctors and 5.8 sisters per 1000 inhabitants. In Serbia, the right to health care is financed with 12% of GDP (the only countries that spend more were France with 12.5% and Greece with 13%). This is much more than some in some large countries such as Russia and Turkey. How to explain the paradox that, in relation to the other countries, we invest more and get less? Comparable to countries such as Bulgaria and Romania, although per capita (both in relative and absolute terms) consume less, have better indexes. Serbian health care system demonstrates the areas that need urgent reform. The main activity of the announced reform of the healthcare system should be placed on improving the quality of health services. A quality is closely conditioned by human resources or staff in the health system. To enhance the current situation in the health care system, which is important from the aspect of personnel the following should be undertaken: The introduction of a uniform general health information system that would enable reducing the administraton and certainly increasing the quality of health care. Creation of legal preconditions for the equalization of private and public health sector, amendments to existing laws and enacting new. This would enable Serbian population to easily and quickly reach the necessary health services. Waiting list will reduce the specific diagnostic and therapeutic procedures and likely to create the conditions for people to choose a medical doctor. In this way it would be possible for employees in the health sector choose where they want to provide health care in the national health care institution or in private. Health workers would be able to decide where they work in the health care system. Very important aspect of the current health care system and employees is the need to increase the salaries of health workers, remuneration, depending on the quality, not the quantity of service delivery, with the introduction of precise criteria for assessing the quality of work. The current
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE system of health care financing is based on the available funds in the health insurance fund, and not based on the real needs for health care and the number and type of health services provided. In this sense, it is necessary to introduce many times-mentioned capitation in primary health care and payment of inpatient health institutions on the basis of health services provided. Today it is still unclaimed in our health care system. In particular, it is necessary to stimulate health care professionals who work in remote and inaccessible parts of Serbia. It would practically mean increasing the role and importance of primary health care services for universal coverage of health care for the entire population in Serbia. For these reasons general plan must take into account the territorial distribution in Serbia and the obligation of rural health centers to cover every part of the territory of the country. 107,980 workers were employed in health care institutions from the Plan network of health institutions in Serbia on the day 31.12.2015. There were 20,450 physicians or 288 per 100,000 inhabitants. The greatest number of doctors in relation to the population were registered in the Nišava district (396 per 100,000) and lowest in Srem (188 per 100,000). Health care of the population is directly conducted through the network of health care institutions and is conditioned by the level of development of the organization and work technology. The total number of health facilities under the Regulation on health institutions network plan ("Off. Gazette of RS" no. 42/06, 119/07, 84/08, 71/09, 85/09, 24/10, 6/12, 37 / 12, 8/2014 and 92/2015) in 2015 in Serbia amounted to 355.
Keywords: health care worker, primary health care, medical needs, the reform of health care.
REPRODUKTIVNO ZDRAVLJE MUŠKARACA - ZNANJE, PONAŠANJE I STAVOVI
Olivera Radulović1,2, Čedomir Šagrić2, Roberta Marković1,2, Ana Stefanović2 Medicinski fakultet Niš1 Institut za javno zdravlje Niš2
Reproduktivno zdravlje po definiciji SZO podrazumeva stanje fizičkog, mentalnog i socijalnog blagostanja svih uzrasnih grupa u odnosu na reproduktivni sistem. Pri tom ono podrazumeva: zadovoljavajući i siguran seksualni život, sposobnost za reprodukciju i slobodu odlučivanja o reprodukciji. Iz toga slede prava muškaraca i žena da budu informisani i da im budu dostupne sigurne, efikasne i prihvatljive metode za planiranje porodice kao i pravo izbora zdravstvene službe koja će ženu voditi kroz trudnoću i porođaj. Bazični elementi za očuvanje reproduktivnog zdravlja su: odgovorno reproduktivno (seksualno) ponašanje, široko korišćenje službi za planiranje porodice, efikasna zdravstvena zaštita majki i materinstva, efikasna kontrola infekcija reproduktivnog trakta (uključujući i polno prenosive bolesti), prevencija steriliteta, eliminacija «nesigurnog» abortusa i tretman maligniteta reproduktivnih organa. Šire, tu spadaju i infekcije HIV virusom, pravilna ishrana, zdravlje dece i odojčadi, zdravlje adolescenata (naročito njihovo seksualno zdavlje), način života i dr. Reproduktivno zdravlje je direkto uslovljeno socijalnim, kulturelnim i faktorima ponašanja. Reproduktivni život mogu činiti prijatni i posticajni dogadjaji i uslovi kao što su zadovoljsto, intimnost i radost koje donose, ljubav, radjanje i podizanje dece i srećan porodični život, ali i oni koji su bolni i ugožavaju zdravlje, kao što su neravnopravnost, zlostavljanje i bolest. Muškarci imaju važnu ulogu u planiranju porodice. Njihova uloga može biti direktna i indirektna.
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Direktna uloga podrazumeva: prihvatanje kontraceptivnih metoda namenjenih muškarcima i stalnu brigu o sopstvenom reproduktivnom zdravlju, uključujući nerizično ponašanje vezano za polno prenosive infekcije. Prihvatanjem velike odgovornosti za korišćenje kontracepcije, muškarci mogu ne samo da smanje transmisiju HIV-a i polno prenosivih infekcija, već i neželjene trudnoće. Indirektna uloga podrazumeva podršku očuvanju reproduktivnog zdravlja žene i podršku u izboru, prihvatanju i korišćenju specifičnih metoda za planiranje porodice. Reproduktivnom zdravlju muškaraca se u prošlosti nije posvećivalo dovoljno pažnje. Razlog tome je veliki morbiditet i mortalitet žena zbog reproduktivnih problema, kao i fizička i socijalna odgovornost žene kada je u pitanju materinstvo. Problemi vezani za reproduktivno zdravlje muškaraca najčešće su vezani za probleme u pubertetu, zloupotrebu psihoaktivnih supstanci, seksualno nasilje i polno prenosive infekcije. Muškarci najčešće nisu dovoljno zainteresovani za reproduktivno zdravlje svojih partnerki. Nemaju dovoljno znanja o seksualnom i reproduktivnom zdravlju. Veliki broj muškaraca ne učestvuje u planiranju porodice sa svojim partnerkama. Muškarci u nekim zemljama imaju široku slobodu kada se radi o predbračnim i vanbračnim seksualnim odnosima, dok ženama to nije dozvoljeno. Takođe postoji značajno protivljenje muškaraca (ili izostanak njihove podrške) da njihove partnerke koriste konracepciju . Značajno veliki broj neželjenih trudnoća, naročito u Istočnoj Evropi i zemljama u razvoju, ukazuje na potrebu porasta učešća i odgovornosti muškaraca kada je u pitanju planiranje porodice i reproduktivno zdravlje. Postojeća istraživanja u ovoj oblasti pokazuju da je učešće muškaraca pozitivno i neophodno, kao i direktan i indirektan uticaj na korišćenje kontracepcije. Muškarci nemaju dovoljno znanja o reproduktivnom zdravlju. Istrazivanje u Nišu obuhvatilo je 532 studenta Univerziteta u Nišu. Sagledano je znanje, ponašanje i stavovi studenata iz sledećih oblasti: seksualno ponašanje, korišćenje kontracepcije, polno prenosive bolesti i socijalne mere od uticaja na planiranje porodice. Rezultati su pokazali da je znanje studenata o kontracepciji je nezadovoljavajuće – 15% nije znalo šta je kontracepcija, a 59% nije znalo koji su plodni dani menstrualnog ciklusa. Mehanizam i primenu pilule nije znalo 28%, a spirale 43% ispitanika, dok 67% nije znalo šta je pilula za sledeće jutro. Samo 44% studenata je znalo da kondom štiti i od neželjene trudnoće i od polno prenosivih infekcija. Studenti su stekli znanje uglavnom od prijatelja i preko medija. Seksualni odnos je doživelo 89% studenata , a 77% njih je koristilo kondom. Prosečna starost supanja u seksualne odnose je bila 16,9 godina, prosečan broj seksualnih partnera – 5,2 a prosečan broj polnih odnosa – 8,7. Većina ispitanika nije razgovarala sa roditeljima o seksualnosti mladih. Studenti su smatrali da mladi treba da dobiju informacije od lekara, roditelja i medija u osnovnoj školi. Oni nisu zadovoljni merama koje država preduzima u cilju stimulacije rađanja. Na Internacionalnoj konferenciji o populaciji i razvoju, 1994. godine, istaknut je značaj učešća muškaraca u unapređenju seksualnog i reproduktivnog zdravlja. Iznad svega, na konferenciji je naglašen razvoj napora koji će povećati uključenost muškaraca u roditeljstvo i mere koje bi mogle dovesti do toga da muškaraci imaju veću odgovornost za svoje seksualno i reproduktivno ponašanje - uključujući planiranje porodice i zdravlje majke i deteta. (odgovorno roditeljstvo, seksualno i reproduktivno ponašanje uključujući planiranje porodice, prevencija neželjene i visoko rizične trudnoće, doprinosu i podeli porodičnih primanja, školovanju, ishrani i zdravlja dece, jednakom vrednovanje dece oba pola). Pozadina ovoga je bila sve veća spoznaja da stavovi, znanja i način reagovanja muškarca utiče ne samo reproduktivno zdravlje njih samih, nego i žena.
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SZO je uradila 59 evaluacija programa koji su radili na tome da se muškaraci i mladići uključe u zdravstvene intervencije u oblasti prevencije seksualnog i reproduktivnog zdravlja, HIV/AIDS-a, seksualnog nasilja, očinstva i zdravlja majki, dece i neonatalnog zdravlja. Dobro osmišljeni programi za muškarce i mladiće su uvjerljiv dokaz za moguću promenu ponašanja i stavova. Muškarci i mladići mogu promeniti stavove i ponašanja u vezi sa seksualnim i reproduktivnim zdravljem, zdravljem majke i deteta, mogu promeniti njihove interakcije sa decom, upotrebu nasilja nad ženama, nasilje nad drugim muškarcima, i njihovo ponašanje vezano za zahteve za zdravljem.Važna je uloga vlada zemalja koje zakonom treba da regulišu obaveze i odgovornost muškaraca u oblasti reproduktivnog zdravlja. Roditelji i škola imaju ulogu u formiranju ispravnih stavova o ravnopravnosti polova i treba da razvijaju razumevanje i odgovornost u svim aspektima sigurnog i harmoničnog porodičnog zivota. Za veće uključivanje muškaraca u rešavanje problema reproduktivnog zdravlja treba : motivisati muškarce preko sportskih događaja, štampanih i elektronskim medija, organizovati seminare i workšopove (radionice), uključiti lidere iz zajednice (muškarce) da promovišu reproduktivno zdravlje, organizovati grupne sesije sa muškarcima i njihovim partnerkama, uključiti političare i verske vođe u promociju reproduktivnog zdravlja, formulisati nacionalnu politiku o ulozi muškarca u reproduktivnom zdravlju, povečati prava muškaraca da učestvuju u odlukama vezanim za reproduktivno zdravlje, sve potrebne informacije i pomoć muškarci treba da dobiju ne samo u servisima, već i kod kuće, na radnom mestu i zajednici.
Servisi za reproduktivno zdravlje mladih treba da budu usmereni ka potrebama muškaraca, sa posebnom pažnjom na seksualnu edukaciju, sociokulturnu orjentaciju i reproduktivno zdravlje. Oni treba da obezbede: promociju korišćenje kondoma, unapređenje komunikacionih veština radi bolje saradnje među partnerima vezano za probleme reproduktivnog zdravlja, edukaciju i informisanost o reproduktivnom zdravlju, organizovanje savetovanja, kako za muškarce posebno, tako i za parove, promociju zdravih stilova reproduktivnog ponašanja u cilju prevencije rizičnog seksualnog ponašanja i polnih infekcija, razvoj programa čije su ciljne grupe muškarci i njihovo sprovođenje na mestu gde oni dominiraju, edukacione programi na mas medijima.
ZAKLJUČAK U cilju očuvanja i unapređenja reproduktivnog zdravlja muškaraca, posebnu pažnju treba posvetiti mladima. Potrebno je razvijati životne veštine u populaciji mladih, uvesti zdravstveno vaspitanje kao predmet u škole i otvoriti savetovališta za planiranje porodice namenjena mladima.
LITERATURA:
1. Bodin M, Stern J, Käll LF, Tydén T, Larsson M. Coherence of pregnancy planning within couples expecting a child. Midwifery 2015 Oct;31(10):973-8.
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2. Hamdan-Mansour AM, Malkawi AO, Sato T, Hamaideh SH, Hanouneh SI. Men's perceptions of and participation in family planning in Aqaba and Ma'an governorates, Jordan. East Mediterr Health J. 2016 Apr 28;22(2):124-32. 3. Dudgeon M, Inhorn M. Men’s influences on women’s reproductive health: medical anthropological perspectives. Social Science and Medicine 2004; 59:1379-1395. 4. Duyvendak JW, Stavenuiter M. Reconciliation of working life and family life. Working fathers, Family Social Work 2015; 10:315-329. 5. Koren A, Giannetti M, Hynes R, Favre M. Integrating Male Reproductive Health Services: One University Clinic's Story. J Sex Marital Ther. 2015 Dec 18:1-9. [Epub ahead of print] PMID:26683806 6. Lamb M, Tamis-Lemonda C. The role of the father. An introduction. In: The role of the father. New York, John Wiley & Sons. 2014 7. Le Guen M, Ventola C, Bohet A, et al. Men's contraceptive practices in France: evidence of male involvement in family planning. Contraception. 2015 Jul;92(1):46-54. 8. Marcell AV, Gibbs SE, Choiriyyah I, et al. National Needs of Family Planning Among US Men Aged 15 to 44 Years. Am J Public Health. 2016 Apr;106(4):733-9. 9. Plantin L. Different classes, different fathers? On fatherhood, economic conditions and class in Sweden. Community, Work & Family 2007; 10:93-110. 10. Radulović O. Socio-medical aspects of family planning in the student population. Doctoral thesis. Faculty of Medicine in Nis, 2009. (in Serbian) 11. WHO. Fatherhood and Health outcomes in Europe. Copenhagen , Denmark 2007. 12. World Health Organization. Department of Reproductive Health and Research. Family Planning. (Cited 2014, October 12); Avaliable from WHO:http://Family_planning_home_page.htm.. 13. World Health Organization. Ensuring human rights in the provision of contraceptive information and services: guidance and recommendations ISBN 987 92 4 1506748, 2014. 14. World Health Organization. Preventing Early Pregnancy and Poor Reproductive Outcomes (2011).
REPRODUCTIVE HEALTH OF MEN - KNOWLEDGE, BEHAVIOR AND ATTITUDES
Olivera Radulović1,2, Čedomir Šagrić2, Roberta Marković1,2, Ana Stefanović2 Medical Faculty of Nis1 Institute of Public Health Nis2
Within the framework of WHO's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health addresses the reproductive processes, functions and system at all stages of life. Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. Implicit in this are the right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant .
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Reproductive health is directly conditioned by social, cultural and behaviour factors. Reproductive life can be made of pleasant and incentive events and conditions, such as satisfaction, intimacy and happiness, which bring love, giving birth and raising children, and happy family life, but also of those painful which endanger health, such as inequality, abusing and illness. Men have an important role in family planning. Their role can be direct or indirect. A direct role involves: the acceptance of contraceptive methods aimed at men and constant care of their own reproductive health, including risk free behavior related to sexually transmitted infections. By taking greater responsibility for their own use of contraception, men can not only can reduce the transmission of HIV and sexually transmitted infections but also lessen the number of unplanned pregnancies. Indirect role means support the preservation of reproductive health of women and support in the selection, acceptance and use of specific methods of family planning. In the past it has not paid sufficient attention to the reproductive health of men in developing countries. The reason is a large morbidity and mortality in women due to reproductive problems, as well as physical and social responsibility of women for motherhood. Problems related to the reproductive health of men are most often related to problems during puberty, substance abuse, sexual violence and sexually transmitted diseases. Men usually are not interested in the reproductive health of their partners. They do not have enough knowledge about sexual and reproductive health. Most men do not participate in family planning with their partners. Men in some countries have a wide margin in the pre-marital and extra-marital sexual relationships, while women it is not allowed. Also there is significant opposition to men (or lack of their support) that their partner use contraception. The still significantly high numbers of unplanned pregnancies, particularly in eastern Europe and developing countries, shows the importance of increasing men’s awareness and responsibility in family planning and reproductive health. All available research in this area shows that male involvement is positive and necessary, as this influences the contraceptive decision-making both directly and indirectly. Men do not have enough knowledge about reproductive health. Research in Nis included 532 students of the University of Nis. It is recognized knowledge, behavior and attitudes of students in the following areas: sexual behavior, contraception, sexually transmitted diseases and social dimensions that affect family planning. The results showed that the students' knowledge about contraception is unsatisfactory - 15% did not know what contraception is, and 59% did not know the fertile days of the menstrual cycle. The mechanism and the use of the pills did not recognize the 28%. The mechanism and application of spiral did not know 43% of boys, while 67% did not know what is a pill for the following morning. Only 44% of students knew that condoms protect against both unwanted pregnancy and of sexually transmitted infections. Students have gained knowledge mainly from friends and through the media. Sexual intercourse had experienced 89% of students and 77% of them used a condom. The average age of entry into first sexual intercourse was 16.9 years, the average number of sexual partners - 5.2 and the average number of sexual relations - 8.7 Most respondents did not talk to parents about youth sexuality. Students felt that young people should receive information from doctors, parents and media in primary school. They are not satisfied with the measures undertaken by the state in order to stimulate the birth.In 1994, the International Conference on Population and Development established the importance of involving men in the challenge of improving sexual and reproductive health. Above all, the Conference emphasized developing efforts that would increase men’s involvement in parenting and measures that could lead to men taking greater responsibility for their sexual and reproductive behaviour –
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE including family planning and maternal and child health (responsible parenthood, sexual and reproductive behavior, including family planning, prevention of unwanted and high-risk pregnancies, contribution and grant of family income, education, nutrition and health of children, equal evaluation of children of both sexes). The background to this was a growing realization that men’s attitudes, knowledge and ways of reacting influenced not only their own but also women’s reproductive health. WHO reviewed 59 evaluation studies of programmes working to engage men and boys in health interventions in the areas of SRH, HIV/AIDS prevention, gender based violence, fatherhood and maternal, child and neonatal health. Well-designed programmes with men and boys show compelling evidence of leading to behaviour and attitude change. Men and boys can and do change attitudes and behaviours related to SRH behaviour, maternal and child health, their interaction with their children, their use of violence against women, questioning violence with other men, and their health-seeking behaviour. Governments of countries play an important role, because the law should regulate the obligation and responsibility of men in reproductive health. Parents and schools have a role in the formation of correct attitudes about gender equality, and they need to develop understanding and responsibility in all aspects of secure and harmonious family life. For greater involvement of men in addressing reproductive health problems it is necessary to: motivate men over sporting events, print and electronic media, organize seminars and Worksops, nclude leaders from the community (men) to promote reproductive health, organize group sessions with men and their female partners, formulate a national policy on the role of men in reproductive health, increase the rights of women to participate in decisions related to reproductive health, all the information and help men should receive not only the services, but also at home, in the workplace and community. Services for the reproductive health for young people should focus on the needs of men, with particular attention to sexual education, socio-cultural orientation and reproductive health. They should provide: promotion of condom use, improving communication skills for better cooperation among partners regarding the issues of reproductive health, education and information on reproductive health, organization of conferences, in particular for men, as well as for couples, promotion of healthy lifestyles reproductive behavior in order to prevent risky sexual behavior and sexually transmitted infections, development programs whose target groups are men and their implementation at the point where they dominate, educational programs in the mass media.
CONCLUSION n order to preserve and improve the reproductive health of men, special attention should be paid to young people. It is necessary to develop life skills among young people, introduce health education as a subject in schools and open services for family planning aimed at young people.
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REFERENCES: 1. Bodin M, Stern J, Käll LF, Tydén T, Larsson M. Coherence of pregnancy planning within couples expecting a child. Midwifery 2015 Oct;31(10):973-8. 2. Hamdan-Mansour AM, Malkawi AO, Sato T, Hamaideh SH, Hanouneh SI. Men's perceptions of and participation in family planning in Aqaba and Ma'an governorates, Jordan. East Mediterr Health J. 2016 Apr 28;22(2):124-32. 3. Dudgeon M, Inhorn M. Men’s influences on women’s reproductive health: medical anthropological perspectives. Social Science and Medicine 2004; 59:1379-1395. 4. Duyvendak JW, Stavenuiter M. Reconciliation of working life and family life. Working fathers, Family Social Work 2015; 10:315-329. 5. Koren A, Giannetti M, Hynes R, Favre M. Integrating Male Reproductive Health Services: One University Clinic's Story. J Sex Marital Ther. 2015 Dec 18:1-9. [Epub ahead of print] PMID:26683806 6. Lamb M, Tamis-Lemonda C. The role of the father. An introduction. In: The role of the a. father. New York, John Wiley & Sons. 2014 7. Le Guen M, Ventola C, Bohet A, et al. Men's contraceptive practices in France: evidence of male involvement in family planning. Contraception. 2015 Jul;92(1):46-54. 8. Marcell AV, Gibbs SE, Choiriyyah I, et al. National Needs of Family Planning Among US Men Aged 15 to 44 Years. Am J Public Health. 2016 Apr;106(4):733-9. 9. Plantin L. Different classes, different fathers? On fatherhood, economic conditions and class in Sweden. Community, Work & Family 2007; 10:93-110. 10. Radulović O. Socio-medical aspects of family planning in the student population. Doctoral thesis. Faculty of Medicine in Nis, 2009. (in Serbian) 11. WHO. Fatherhood and Health outcomes in Europe. Copenhagen , Denmark 2007. 12. World Health Organization. Department of Reproductive Health and Research. Family Planning. (Cited 2014, October 12); Avaliable from WHO:http://Family_planning_home_page.htm.. 13. World Health Organization. Ensuring human rights in the provision of contraceptive information and services: guidance and recommendations ISBN 987 92 4 1506748, 2014. 14. World Health Organization. Preventing Early Pregnancy and Poor Reproductive Outcomes (2011).
Aktuelna saznanja o patogenezi i dijagnostici Legionella pneumophila
Branislava Kocić, Biljana Miljković Selimović, Marina Dinić: Univerzitet u Nišu Medicinski fakultet, Institut za javno zdravlje Niš
Rod Legionella pripada familiji Legionelaceae. Iako je do danas opisano vise od 50 vrsta i vise od 70 serotipova, za više od 70% svih oboljenja izazvanih legionelama odgovorna je Legionella pneumophila serogrupa 1, za 20% druge serogrupe , a samo 5-10% je izazvano drugim vrstama legionela.
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To su Gram-negativni, pleomorfni bacili, aerobni, asporogeni i uglavnom pokretni zahvaljujući prisustvu jedne ili više polarnih flagela.
Legionella pneumophila izaziva dve vrste oboljenja: Legionarsku bolest i Pontijačnu groznicu. Legionarska bolest je težak oblik pneumonije, često praćen i ekstrapulmonalnim manifestacijama koje nastaju širenjem bakterija u organizmu. Pontijačna groznica je oboljenje slično gripu i ima znatno blaži klinički tok. Do infekcije dolazi inhalacijom aerosola koji sadrže bakterije.
Legionele su ubikvitarmi mikroorganizmi koji se nalaze u vodi reka, jezera, potoka, podzemnih voda. Kao otporni mikroorganizmi koji podnose visoke temperature (do 66˚C) i imaju sposobnost adherencije za veštačke materijale (guma, plastika) mogu dospeti u sisteme za snabdevanje vodom, pa čak i formirati biofilmove na ovim površinama. Glavni izvori legionela su klima uređaj, topli i hladni vodovodni sistemi, kule za hlađenje, kondenzori za isparavanje vode, bazeni, termalne vode, oprema za veštačku ventilaciju, fontane, odakle dospevaju putem aerosola do respiratornog trakta ljudi.
Dijagnostika oboljenja izazvanih legionelama se bazira na kultivaciji, detekciji bakterijskih antigena i detekciji bakterijske DNK.
S obzirom na njihovu široku rasprostranjenost u prirodi, veoma važnu ulogu igra laboratorijsko ispitivanje uzoraka iz spoljašnje sredine, naročito u slučajevima izbijanja epidemija. Međunarodna organizacija za standardizaciju ( ISO ) (International Organization for Standardization ) – propisuje metode za izolaciju bakterija roda Legionella iz uzoraka vode za humanu upotrebu.
KLJUČNE REČI: Legionella, Legionarska bolest, ISO 11731-2:2004 Current approach to the pathogenesis and diagnosis of Legionella pneumophila
Branislava Kocić, Biljana Miljković Selimović, Marina Dinić: Univerzity in Niš, School of Medicine, Institute for Public Health, Niš
Genus Legionella belongs to the family Legionelaceae. Until today scientist described more than 50 species and more than 70 serotipes. Legionella pneumophila serogroup 1 caused more than 70% of all diseases; other serogroups of the same species are responsible for more than 20% of diseases, and other species of Legionella caused only 5-10% of diseases.
Legionella are Gram-negative, pleomorphic bacilli, aerobic, asporogenic and mostly motile by one or more polar flagella.
Legionella pneumophila caused two types of diseases: Legionnaires' disease and Pontiac fever. Legionnaires' disease is severe type of pneumonia often followed by extrapulmonale manifestations, which are consequence of bacterial spreading through the body. Pontiac fever is disease similar to the flu and its clinical course is milder. Inhalation of aerosol, which contains bacteria, produces infection.
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Legionella are ubiquitous microorganism, located in water of rivers, ponds, streams, and groundwater. They are resistant to increased temperatures (up to 66˚C) and have ability to adhere for artificial materials (rubber, plastics), they can rich the systems for water supply and even form the biofilms on those surfaces. The main sources for Legionella are air conditioning, worm and cold water supply systems, cooling towers, condenser for water evaporation, swimming pools, thermal water, and equipment for artificial ventilation, fountains. With these sites bacteria with aerosols get into the the respiratory tract of human. Cultivation, detection of bacterial antigens and detection of bacterial DNA are the basis for diagnosis of diseases caused by Legionella. Considering their wide spread in nature, very important role has laboratory investigation samples from environment especially in outbreaks. International Organization for Standardization (ISO) – prescribe some methods for isolation of bacteria of the genus Legionella from water samples for human use.
Key words: Legionella, Legionnaires' disease, ISO 11731-2:2004
Medicinska nutritivna terapija dijabetesa
Medical nutrition therapy in diabetes
Nikolić Maja
Medifcinski fakultet Univerziteta u Nisu, Institut za javno zdravlje
Facultz of medicine Universitz of Nis, Public Health Institute Nis
Diabetes mellitus je bolest koja predstavlja složenu grupu poremećaja različite etiologije, patogeneze, kliničke slike i lečenja. Usvajanje zdravih životnih navika predstavlja neizostavni deo terapije i osnov uspešne prevencije šećerne bolesti, a mediicinska nutritivna terapija (MNT) je obavezni deo lečenja i kontrole dijabetes melitusa. Izazov je prevesti rezultate naučnih istraživanja u vezi MNT dijabetesa u kliničku praksu Cilj našeg rada je revijski prikaz efekata MNT na nivo glikemije, glikolizirani hemoglobin (HbA1c), nivo serumskih lipida I drugih faktora kod odraslih obolelih od dijabetesa. MNT koja se preporučuje obolelima od dijabetesa mora biti individualno prilagođena načinu života, navikama u ishrani i drugim specifičnim zahtevima. Važno je da svi članovi tima, kako lekari, tako i medicinski tehničari poznaju MNT dijabetesa kako bi podržali njenu implementaciju.
Diabetes mellitus is a state of a hronic hyperglycemia caused by the effect of genetic and numerous environmental factors. Regular diet and healthy life style are basic part of therapy and prevention
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE in patients with diabetes mellitus and medical nutrition therapy (MNT) improve patient outcomes. The challenge is to translate research evidence for type 2 diabetes mellitus MNT into health care settings. We review the effect of medical nutrition therapy (MNT) on fasting plasma glucose values, glycated hemoglobin (HbA1c), serum lipid levels, and other factors in adults with diabetes. MNT, as an integral part of the treatment and control of diabetes, has to be individually prescribed according to the life style, eating habits and other specific demands. However, it is important that all team members, including physicians and nurses, be knowledgeable about MNT of diabetes and support its implementation.
STRESNI ŽIVOTNI DOGAĐAJI I RAK DOJKE
Prof. dr Biljana Kocić1,2
1 Univerzitet u Nišu, Medicinski fakultet 2 Institut za javno zdravlje, Niš, Srbija
Uvod: Rak dojke kod je multikauzalno oboljenje. Poznavanje faktora koji doprinose nastanku raka dojke omogućava razvijanje preventivnih i terapijskih strategija.
Cilj: Sagledavanje rezultata naučnih studija, pre svega epidemioloških, koje su istraživale povezanost stresnih životnih događaja i rizika za nastanak raka dojke u žena.
Materijal i metod: Pregled relevantne naučne literature iz ove oblasti.
Rezultati: Nekonzistentni su rezultati epidemioloških studija, koje su se bavile uticajem stresa kao faktora rizika na nastanak raka dojke u humanoj populaciji. Korišćena metodologija i primenjeni instrumenti za merenje stresnih životnih događaja mogu da utiču na rezultate studija.
Zaključak: Neophodno je sprovesti dalja istraživanja u cilju razumevanja efekata stresnih životnih događaja u zavisnosti od vrste i vremena ekspozicije. Konsolidaciji znanja će, u najvećoj meri, doprineti prospektivne kohortne studije.
Ključne reči: rak dojke, epidemiologija, faktori rizika, stresni životni događaji
STRESSFUL LIFE EVENTS AND BREAST CANCER
Prof. dr Biljana Kocić1,2
1 University of Niš, Faculty of Medicine 2 Institute for Public Health, Niš, Serbia
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Introduction: Breast cancer is a multicausal disease. Elucidation of the factors contributing to the incidence of breast cancer is of crucial importance for the development of preventive or therapeutic strategies targeting the disease. Objectives: The aim of this review is to provide a comprehensive overview of the state of scientific evidence, particularly epidemiological, for the association between stressful life events and female breast cancer.
Materials and methods: The scientific literature on the association between stressful life events and breast cancer was reviewed.
Results: Epidemiologic studies, which look at the stress–breast cancer association in human populations, provide inconsistent findings regarding relative contribution of stress to breast cancer risk, probably due to the use of different measures of stress and other study methods. Conclusion: There is a need for understanding the differing physiological effects of types or times of stress exposure. Prospective cohort studies are likely to generate more consistent results. Key words: breast cancer, epidemiology, risk factors, stressful life events
PROSTORNI PLANOVI KAO INSTRUMENT UPRAVLJANJA I ZAŠTITE OD PRIRODNIH NEPOGODA U SRBIJI
Prof. dr Dejan FILIPOVIĆ
Univerzitet u Beogradu - Geografski fakultet
SPATIAL PLANS AS AN INSTRUMENT OF MANAGEMENT AND PROTECTION OF NATURAL DISASTERS OF THE REPUBLIC OF SERBIA
Poznavanje karakteristika prirodnih nepogoda, rizika njihovog nastanka i sagledavanje posledica su neophodna istraživanja koja mogu biti od koristi prostornim planerima, urbanistima i projektantima prilikom izbora lokacija za izgradnju stambenih, industrijskih, infrastrukturnih, vodoprivrednih objekata, kao i pri izradi planova, strategija, elaborata, studija uticaja na životnu sredinu i dr. Rizici od prirodnih nepogoda predstavljaju ograničavajući faktor prostornog razvoja pa im se u izradi strateških i planskih dokumenata prostornog razvoja mora posvetiti posebna pažnja. Republika Srbija je, tek od usvajanja Zakona o vanrednim situacijama, donošenjem Prostornog plana Republike Srbije i izradom Strategije upravljanja u vanrednim situacijama, počela da stvara jasniju i definisanu politiku zaštite od prirodnih nepogoda. Poslednjih nekoliko godina ovaj problem se rešava kroz sektorske studije za pojedine vrste nepogoda ili kao sastavni deo raznih planskih dokumenata. Teritorija Srbije je izložena riziku od prirodnih nepogoda, a stepen ugroženosti je različit u zavisnosti od tipa nepogode i očekivanih potencijalnih šteta, ali je dovoljan da može usloviti različite posledice, ugroziti zdravlje i živote ljudi i prouzrokovati štetu većeg obima na materijalna dobra. U radu se sagledava ugroženost prostora kroz procenu opasnosti od prirodnih nepogoda što ujedno definiše i zone sa ograničenjima na osnovu: seizmičke ugroženosti terena (ugroženost od zemljotresa); inženjersko-geoloških uslova i pogodnosti terena za izgradnju (klizišta i nestabilne padine, ekscesivna
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE erozija, bujični tokovi); klimatskih karakteristika (intenzivne padavine, grad, suša); hidroloških odlika terena (prostori ugroženi poplavama); i najvećeg rizika od izbijanja šumskih požara. Na osnovu Seizmološke karte područje Republike je, za povratni period od 100 godina, locirano u području od VII, VIII i IX stepeni MCS skale, što odgovara dogođenom stanju na ovom području. Poplave i klizišta predstavljaju najčešće prirodne nepogode. Potencijalno plavna područja u Srbiji zahvataju površinu od 1,6 miliona ha. Prema proceni, oko 25% teritorije Republike potencijalno je ugroženo klizištima i odronima. Velike ograničavajuće posledice na korišćenje prirodnih resursa ima erozija tla pri čemu je jačim kategorijama erozije zahvaćeno oko 35% teritorije Srbije. Biće predstavljen metodološki pristup tretmana prirodnih nepogoda u hijerarhiji prostornih planova u Srbiji, sa preporukama u kom pravcu u planerskom smislu razvijati sistem zaštite prostora.
Ključne reči: Prostorno planiranje, prirodne nepogode, sistem, zaštita, upravljanje, Srbija
ОСВРТ НА ДОСАДАШЊЕ АКТИВНОСТИ ЗАВОДА ЗА ЈАВНО ЗДРАВЉЕ „ТИМОК“ ЗАЈЕЧАР НА ПОЉУ ДЕМОГРАФИЈЕ, У КОНТЕКСТУ САВРЕМЕНИХ ДЕМОГРАФСКИХ ИЗАЗОВА У СРБИЈИ
МИЛЕНА СПАСОВСКИ, ГЕОГРАФСКИ ФАКУЛТЕТ УНИВЕРЗИТЕТА У БЕОГРАДУ
ДАНИЦА ШАНТИЋ, ГЕОГРАФСКИ ФАКУЛТЕТ УНИВЕРЗИТЕТА У БЕОГРАДУ
ОЛИЦА РАДОВАНОВИЋ, ЗАВОД ЗА ЈАВНО ЗДРАВЉЕ „ТИМОК“ ЗАЈЕЧАР
Вишедеценијске активности Завода за јавно здравље „Тимок“ у Зајечару у области демографије, развиле су се захваљујући препознавању специфичних демографских процеса у Тимочкој Крајини. Овај простор карактеришу процеси биолошке депопулације и емиграције, те одговор на савремене демографске изазове започиње праћењем и публиковањем радова са обрадом демографских феномена у националним часописима, организовањем скупова и конгреса, као и едукацијом у првом реду младих, репродуктивно способних становника. Тако је деведесетих година 20. века у оквиру Завода започела рад Служба за демографију са едукованим кадром из ове области. На иницијативу и стручну помоћ наведене службе, а поштујући интердисциплинарни приступ и мере локалне самоуправе које се односе на материјалну и нематеријалну помоћ и активност у области демографије, 1997. године је формирана Комисија за заустављање даљег тока депопулације у Зајечару, са Програмом мера и активности за подстицај рађања деце до 2020. године, а 1999. године и Фондација за подстицај рађања деце у општини Зајечар и Фондација за рађање деце у општини Књажевац. Завод је уз стручну помоћ Географског факултета Универзитета у Београду основао Регионални стручни тим за демографију 2001. године, којег су чинили представници свих општина Тимочке крајине.
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Прво саветовање у организацији Завода одржано је 1986. године у Зајечару под називом ''Саветовање о недовољном обнављању становништва Србије'', а потом и две трибине 1998. и 1999. године: ''Депопулација у Србији и Тимочкој крајини, јуче, данас, сутра'' и ''Популациона политика локалне самоуправе''. Почев од 2001. године у оквиру научно-стручног скупа „Еколошка истина“, а потом и ''Стручног састанка превентивне медицине Тимочке крајине'' развија се сесија демографије. Научници и стручњаци са Географског факултета Универзитета у Београду, Инстутута за демографска истраживања, Географског инстистута „Јован Цвијић“, Републичког статистичког завода, Института и Завода за јавно здравље, учествују на овим скуповима, а такође публикују своје радове у часопису Развитак.
На почетку 21. века, Завод започиње дугогодишњу и плодоносну сарадњу са Географским факултетом Универзитета у Београду, на иницијативу прим. др сци. мед. Петра Пауновића. Завод покреће иницијативу и наручилац је Пројекта „Миграције становништва Зајечарског и Борског округа“, као и Пројекта „Фертилитет жена на привременом раду и боравку у иностранству“. Пројекте је подржао тадашњи декан Географског факултета Универзитета у Београду, проф. др Стева Станковић, а поред подршке проф. др Милена Спасовски је и активно учествовала у њиховој реализацији, као и у едукацији анкетара Завода. Пројектом „Миграције становништва Зајечарског и Борског округа“ обухваћено је 46 насеља, 1028 породица и 1093 миграната, а Пројектом „Фертилитет жена на привременом раду и боравку у иностранству“ у 17 насеља обухваћено је 232 жене.
Праћењем досадашњих вишедеценијских активности Завода за јавно здравље „Тимок“ Зајечар у области демографије, утврђује се његово значајно место на иницирању и реализацији мултидисиплинарног приступа изучавању, едукацији и предузетим мерама у контексту савремених демографских изазова у Србији. Евидентно је свеобухватно посматрање депопулације, уз организовање акција друштвене заједнице интердисциплинарног карактера. Савремени неповољни демографски трендови захтевају примену одговарајућих мера популационе политике и других политика на националном нивоу, и као њихов саставни део и мере на регионалном и локалном нивоу, како би се ублажили и успорили негативни демографски трендови и биолошко изумирање. За реализацију ових активности, неопходна је укључивање свих релевантних установа и организација, како би се примењивим одговором на демографске изазове добили дугорочна и сврсисходна решења.
Кључне речи: демографија, Тимочка крајина, Завод за јавно здравље „Тимок“ Зајечар, Географски факултет
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REVIEW OF CURRENT ACTIVITIES OF THE INSTITUTE FOR PUBLIC HEALTH "TIMOK" ZAJECAR IN THE FIELD ОF DEMOGRAPHICS, IN THE CONTEXT OF MODERN DEMOGRAPHIC CHALLENGES IN SERBIA
MILENA SPASOVSKI, GEOGRAPHY, UNIVERSITY OF BELGRADE DANICA ŠANTIĆ, GEOGRAPHY, UNIVERSITY OF BELGRADE Olic RADOVANOVIĆ, Public Health Institute "Timok" Zajecar
Decades-long activities of the Institute for Public Health "Timok" in Zajecar in the field of demography, were developed thanks to the identification of specific demographic processes in the Timok region. This area is characterized by biological processes of depopulation and emigration, so a response to contemporary demographic challenges begins by monitoring and publishing works with processing demographic phenomena in national magazines, organizing meetings and conferences, as well as the education of primarily young people, reproductive-age population. Thus in the nineties of the 20th century within the Institute, Department of Demography started work with the educated personnel in the field. At the initiative of and professional support of this service and respecting the interdisciplinary approach and the measures of local government relating to finantial and non finantial help and activities in the field of demography, in 1997 the Commission for depopulation stopping in Zajecar was formed, with the Program of measures and activities for encouraging birth of children by 2020 and in 1999 also the Foundation to encourage the birth of children in the municipality of Zaječar and the Foundation for the birth of children in the municipality of Knjaževac were formed. The Institute, with the expert help of Faculty of Geography, University of Belgrade established in 2001 a Regional Team of Experts made up of representatives of all the municipalities of the Timok region.
The first consultation organized by the Institute was held in 1986 in Zajecar entitled 'Consultation on insufficient renewal of the population of Serbia' ', followed by two panel discussions in 1998 and 1999,' 'Depopulation in Serbia and the Timok region, yesterday, today, tomorrow '' and '' Population policy of local self-government ''. Beginning in 2001 under the scientific conference "Ecological truth", and then the 'Expert Meeting preventive medicine Timok region' session of demographics was developed. Scientists and experts from the Faculty of Geography of the University of Belgrade, Institute for Demographic Studies, Geography Instistute "Jovan Cvijic", Serbian Statistical Office, the Institute and the Institute of Public Health, participate in these meetings, and also publish their work in the journal Development.
At the beginning of the 21st century, the Department began a long and fruitful cooperation with the Faculty of Geography, University of Belgrade, on the initiative of prim. Dr. sci. med. Peter Paunovic. Institute launches initiative and starts the project "Migration of population in Bor and Zajecar districts" and the project "Fertility of women on temporary work and stay abroad." Projects were supported by the then Dean of the Faculty of Geography, University of Belgrade, prof. Dr. Steva Stanković, prof. Milena Spasovski supported and was actively involved in their
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE implementation, as well as in training of the interviewers of the Institute. The project "Migration of population in Bor and Zajecar districts" included 46 settlements, 1028 and 1093 families of migrants, and the project "Fertility of women on temporary work and residence abroad," in 17 settlements included 232 women. By following the previous decades of activities of the Institute for Public Health "Timok" Zajecar in the field of demography, its prominent place is determined in the initiation and implementation of multidisiplinary approaches to studying, training and measures taken in the context of modern demographic challenges in Serbia. Comprehensive observation of depopulation is evident, with the organization of community actions of interdisciplinary character. Contemporary unfavorable demographic trends require the application of appropriate measures of population policy and other policies at the national level, as an integral part of the measures at regional and local level, in order to mitigate and slow the negative demographic trends and biological extinction. To implement these activities, it is necessary to involve all relevant institutions and organizations, in order to answer demographic challenges and to get long-term and meaningful solutions.
Keywords: demography, Timok region, Department of Public Health "Timok" Zajecar, Faculty of Geography
NEW BRUCELLA SPECIES AND RESERVOIRS– POTENTIAL OF GLOBAL RE- EMERGING ZOONOSIS
Vaso Taleski University „Goce Delchev”, Faculty of Medical Sciences, Sthip, Republic of Macedonia.
Introduction Brucellosis is one of the most common worldwide re-emerging zoonotic disease. Most of the developed countries has been eradicated Brucellosis, but the disease remains prevalent in regions of Africa, the Middle East, Asia, and Central and South America, as well as in the Mediterranean basin. The geographical distribution of brucellosis is constantly changing with new hosts and reservoirs.
Aim To present new Brucella strains and reservoirs.
Material and Methods Review and presentation of recent published data, reported and confirmed new Brucella strains and reservoirs.
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Discussion The genus Brucella comprises several important highly pathogenic species, genetically highly related to each other, which can be divided into the: 1.Classical, terrestrial strains of Brucellae (B. melitensis, B. abortus, B. suis, B. canis, B. ovis, B. neotomae), 2. Marine mammals Brucellae (B. ceti and B. pinnipedialis), and 3. “Atypical”, more recently identified species (B. microti, B. inopinata, B. papionis and B. vulpis). B. melitensis contributes to 98% of all human brucellosis cases. Marine mammals Brucella have never been documented in humans. Within the ‘atypical’ Brucellae, only B. inopinata and the non-classified Brucella strain BO2 were isolated from human infections, but their natural hosts are still unknown. B. microti is the only species known to persist in soil, which is environmental reservoir of particular interest. Most recently, amphibians (frogs) had been recognized as new hosts for Brucella spp. Some frog’s isolates were identified as “atypical” B. inopinata and others as new Brucella members. The worldwide distribution suggests that amphibians are not only occasionally infected, but may represent a new, yet undiscovered and ecologically significant natural host. Very probably, frog’s isolates have a reservoir in soil. In addition, these isolates may represent a link between free-living soil saprophytes and the intracellular pathogenic Brucella.
Conclusions Control of Brucellosis became more complicated due novel reservoirs and hosts. New Brucella species as well as “atypical” Brucella strains have enhanced understanding of the evolution of the genus from a soil-associated motile bacterium to a host-adapted pathogen. Whilst there is no evidence to date that frog’s isolates represent a zoonotic threat, appropriate measures should be taken to avoid unnecessary contact with potentially infected amphibians until the zoonotic potential of this group is better understood.
Key words: brucellosis, atypical, new brucella, reservoirs.
ПРЕВАЛЕНЦА ПУШЕЊА ОСОБЉА ОПШТЕ БОЛНИЦЕ ЛЕСКОВАЦ
Вања Илић
Завод за јавно здравље Лесковац
Увод: Пушење је једно од највећих претњи по јавно здравље. Здравствени стручњаци широм света прихватају чињеницу о постојању епидемије употребе дувана.
Преваленца пушења у Републици Србији је веома висока. Према резултатима испитивања здравља 2006 године, међу највишима у Европи, са 30,7% мушкараца и 22,6% жена активних пушача, да би се 2013.година повећала на 32,6% мушкараца и 26% жена који активно пуше.
Циљ рада је да се истраже пушачке навике особља интензивних одељења Опште Болнице Лесковац, као и осетљивост и подложност негативном утицају дуванског дима, као
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и да се испита неопходност агресивнијег спровођења јавно- здравственог програма ка циљним популацијама.
Методологија рада : Истраживање, као студија пресека, спроведена је међу упошљеницима интензивних одељења Лесковачке Опште Болнице (март 2015. год.). Као инструмент истраживања коришћен је анкетни упитник ИЗЈЗ Србије. За анализу података коришћене су методе дескриптивне статистике.
Резултати рада: Од 100 анкетираних упошљеника интензивних одељења Опште Болнице Лесковац, било је 56% са средњом стручном спремом 36% са високом и 8% са вишом. Преваленца пушача међу лекарима је 27,90%, техничарима 65,12%, нездравственим радницима 6,98%. Просечан број попушених цигарета у току дана је 23 код мушкараца и код жена 19,17. Став о пушењу у здравственој установи: 48,48%, мушкараца се слаже да се потпуно забрани пушење у здравственој установи, док 47,76% жена сматра да пушачи треба да имају право да пуше на радном месту. Најмање је пушача у Коронарној јединици 14,28%, а највише пушача на гинекологији и хирургији 36,84%.
Закључак: Снижавање преваленце пушења је једна од најважнијих мера коју је неопходно применити у циљу унапређења здравља.
PREVALENCE PERSONNEL OF GENERAL HOSPITAL LESKOVAC COMUNITY
Vanja Ilic
Public Health Lescovac
Introduction: The greatest threat for public health in Serbia is defintively smoking. The existence of global tobacco epidemic is now accepted as fact health professionals around the world.
The prevalence of smoking in Serbia is among the high-est in Europe. According to the survey performed in 2006, 30,7% of men and 22,6% of women were active smokers. Hower, the survey performed in 2013 showed that the prevalence of smoking was increase to 32,6% among men and 26% women.
Target labor: The aim of this study was to investigate the smoking of sanitary labor General Hospital Leskovac comunity, of that age are highly sensitive and susceptible to the toxic influence of tobacco smoke, but also to chek the necessity for an aggressive public health programme in the aimed populations.
Method labor: The research, as a cross-sectional study, implement between of sanitary labor General Hospital Lescovac comunity (march 2015.). Instrument of research qvestion-mark Public Health Serbia. Pro analysis reference the use method of descriptive statistics.
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Score labor: Than 100 poll of sanitary labor General Hospital Lescovac, 56% mean school, 36% and 8% academy. Prevalence smoker of doctor 27,90%, nurse 65,12%, worker 6,98%. Mean numeral smoke in day 23 of man, 19,17 of women . State of smoking in General Hospital: 48,48% medical man, no smoking in General Hospital, 47,76% аt working locality specialize region pro smoking in General Hospital. Minimum smoking in cordial one 14,28%, most smoking at gynaecology and operative 36,84%..
Conclusion labor: Reduction in smoking prevalence is therefore one of the most important public health measures that should be implemented to improve the health.
PROCENA RIZIKA ZA NASTANAK MENTALNIH PROBLEMA RADNIKA KAO OSNOV ZA PLANIRANJE PROGRAMA PROMOCIJE ZDRAVLJA
Dubravka Nikolovski, Jasmina Pavlović – Stojanović, Aleksandra Perović, Ljiljana Lazić, Magdalena Bjelica, Jelena Krstić, Snežana Đurić Zavod za javno zdravlje Pančevo
Sažetak
Izgaranje na poslu, anksioznost i depresija su česti problemi zdravstvenih radnika. Cilj rada: procena mentalnog zdravlja zaposlenih radi planiranja programa promocije zdravlja. Metod rada: Istraživanje tipa studije preseka je sprovedeno na 88 (97,8%) zdravstvenih radnika 2016. godine. Kao instrument istraživanja korišćen je „4-dimenzionalni upitnik o simptomima“ - „The Four- Dimensional Symptome Questionnaire“ (4DSQ) namenjen radničkoj populaciji. Rezultati: Ispitivane tegobe pokazuju da se najčešće javljaju izjave za bolove u vratu i brige (58,0%), bolove u leđima (55,7%), glavobolje (42,0%), bolove u mišićima (38,6%) i osećaj napetosti (31,8%). Rezultati procene rizika za nastanak mentalnih problema pokazuju da kod 36 (40,9%) osoba postoji srednji ili visok rizik za pojavu distresa, 25 (28,4%) za pojavu depresije, 17 (19,3%) za pojavu anksioznosti i 49 (55,7%) za pojavu somatizacije. Diskusija i zaključak: Procenat osoba u ispitivanoj populaciji kod kojih postoji srednji ili visok rizik za pojavu distresa i depresije, je znatno viši nego što se zapaža u drugim studijama u svetu. U cilju poboljšanja i održanja zdravlja zaposlenih predlažu se organizovane fizičke aktivnosti u toku radnog vremena koje bi obuhvatile vežbe za vrat, pravilno držanje tela, smanjenje tenzije u leđima, mišićima koji se najčešće koriste pri radu sa kompjuterima, u laboratoriji, pri nošenju tereta na terenu i sl.; ergonomske korekcije radnog mesta; redovne sportsko – rekreativne aktivnosti u lokalnim fitnes centrima u cilju prevencije stresa, korekcije telesne mase i poboljšanja socijalnih odnosa i edukativne radionice u vezi zdravih stilova života. Ključne reči: 4DSQ, mentalno zdravlje, promocija zdravlja, procena rizika, zdravstveni radnici
MENTAL HEALTH RISK ASSESSMENT OF PUBLIC HEALTH WORKERS AS A BASIS FOR PLANNING OF HEALTH PROMOTION PROGRAM
Dubravka Nikolovski, Jasmina Pavlović – Stojanović, Aleksandra Perović, Ljiljana Lazić, Magdalena Bjelica, Jelena Krstić, Snežana Đurić
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The Institute of Public Health Pančevo
Abstract
Burnout, anxiety and depression are common problems of health workers. Objective: To estimate the mental health of public health workers in order to plan health promotion programs. Methods: This cross-sectional study investigated 88 (97.8% of total) public health workers in 2016. The survey instrument was the "The Four-Dimensional Symptom Questionnaire" (4DSQ). It assessed the distress and other mental health problems (anxiety, depression and somatization) of working population. Results: The examinees complain the most frequently (from time to time, often, very often / constant) for neck pain and concern (58.0%), back pain (55.7%), headache (42, 0%), myalgia (38.6%) and a tension (31.8%). The results of the risk assessment for the development of mental health problems show that 36 (40.9%) persons are at intermediate or high risk for distress, 25 (28,4%) for depression, 17 (19.3%) for the occurrence of anxiety and 49 (55.7%) for the occurrence of somatization. Discussion and conclusion: The percentage of people in the studied population who are at intermediate or high risk of distress and depression is much higher than what is observed in other studies in the world. In order to improve and maintain the workplace health it is proposed to organize physical activity during working hours, which would include exercises for the neck, posture, reduce tensions in the back muscles that are most used during the work with computers, in the lab, carrying heavy things; workplace ergonomic corrections; regular sports - recreational activities at local fitness centers in order to prevent stress, correction of body weight and improving social relations as well as healthy lifestyles workshops. Keywords: 4DSQ, mental health, health promotion, risk assessment, public health workers
PODSTICANJE MLADIH NA AKTIVNOSTI U PREVENCIJI BOLESTI ZAVISNOSTI – ZAVISNOST NA „IGNORE“
Ljiljana Lazić, Aleksandra Perović, Jelena Krstić, Dubravka Nikolovski, Mirjana Ostojin, Osman Hamzagić Zavod za javno zdravlje Pančevo
Za održavanje zdravlja nacije od prevashodnog značaja je da se promotivne aktivnosti sprovode među mladima. Bolesti zavisnosti u ovom uzrastu su jako rasprostranjene, javljaju se i novi vidovi zavisnosti, što upućuje na potrebu uvođenja novih preventivnih mehanizama. U okviru projekta Zavisnost na „IGNORE“ Zavod za javno zdravlje Pančevo sproveo je preventivne aktivnosti bolesti zavisnosti: pušenje, alkohol, droga, kocka i zavisnost od interneta.
Cilj: Podizanje svesti mladih o prevenciji bolesti zavisnosti sa akcentom na individualnu odgovornost za sopstveno zdravlje i osnaživanje mladih da se snagom svoje volje odupru bolestima zavisnosti.
Metod: Promotivne aktivnosti u školama, interaktivni rad preko Facebook stranice Zavisnost na „Ignore“, anketiranje učenika, konkurs za kratki film i crtež na istu temu.
Rezultati: Pod pokroviteljstvom Pokrajinskog sekretarijata za omladinu i sport realizovan je projekat u 2016.godini. Realizovano je 27 zdravstvena predavanja i radionica, obuhvaćeno je 653
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE učenika II razreda srednje škole. Organizovan je konkurs za izradu kratkog filma ili postera na temu bolesti zavisnosti. Učestvovalo je 410 učenika sa 293 rada iz škola AP Vojvodine. Kreirana je i ažurirana facebook stranica Zavisnost na „ignore“, koja je kroz interaktivni rad sa mladima promovisala prevenciju bolesti zavisnosti. Stranica je doprla do 60.000 osoba, postavljeno je 343 sadržaja ilustrovanog i video materijala vezanih za bolesti zavisnosti. Sprovedena je anketa o znanju i stavovima učenika na temu bolesti zavisnosti.
Zaključak: Novim vidovima zdravstveno-vaspitnog rada, korišćenjem savremenih tehnologija i učešćem šire zajednice, na pravi način, mogu se postići dobri rezultati za osnaživanje mladih da se snagom svoje volje odupru bolestima zavisnosti.
Ključne reči: bolesti zavisnosti, mladi, prevencija bolesti
ENCOURAGING YOUTH TO ACTIVITIES IN PREVENTION OF ADDICTIONS - ADDICTION ON "IGNORE"
Ljiljana Lazić, Aleksandra Perović, Jelena Krstić, Dubravka Nikolovski, Mirjana Ostojin, Osman Hamzagić Institute of Public Health Pančevo
In aim to maintain the health of the nation is important to promote activities among young people. Addictions at this age are widespread, there are new forms of dependence, and that indicates the need to introduce new preventive mechanisms. The project Addiction on "IGNORE" Institute of Public Health Pancevo carried out preventive activities for several addictions: smoking, alcohol, drugs, gambling and internet addiction.
Objective: To raise awareness of young people about the prevention of addictions with an emphasis on individual responsibility for their own health and to empower resilience of young people against addictions.
Method: Promotional activities in schools, interactive work on Facebook page Addiction on "IGNORE", interviewing students, competition for short film and poster.
Results: Project was implemented in 2016 under the auspices of the Provincial Secretariat for Youth and Sports. There was realized 27 health lectures and workshops for 653 second grades students of high school. There was organized a competition for short films or posters on the theme of addiction. There was 293 students works of 410 students from high schools all over AP Vojvodina. It was created Facebook page Addiction on "IGNORE", that allowed students to interactively participate in prevention of substance abuse and other addictions. The page was reached by 60,000 people, and there was set 343 illustrated content and video materials related to addictions. There were conducted a survey of students knowledge and attitudes on addictions.
Conclusion: Grace the new forms of health-educational work, using modern technology and the participation of the wider community, in the right way, can be achieved good results for the resilience empowerment of young people against addictions.
Keywords: addictions, youth, prevention of disease
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DA LI SU MLADI OTPORNI NA IZAZOVE ZAVISNOSTI?
Aleksandra Perović, Jelena Krstić, Dubravka Nikolovski, Ljiljana Lazić, Mirjana Ostojin, Osman Hamzagić, Jasmina Pavlović- Stojanović, Snežana Đurić
Zavod za javno zdravlje Pančevo
Sažetak
Bolesti zavisnosti koje danas pogađaju mlade nisu samo problemi zloupotrebe psihoaktivnih supstanci, već se sve češće javljaju i kockanje, kao i zavisnost od upotrebe interneta. Cilj istraživanja je bio da se ispita rezilijentnost adolescenata prema izazovima zavisnosti. Metod: korišćen je nestandardizovan upitnik, koji je popunilo 673 mladih online i u pančevačkim školama koje su bile uključene u projekat ”Zavisnost na ignore”. Rezultati: mladi najčešće (47,5%) provode slobodno vreme na internetu. Aktivno trenira 29,6 % mladih, a 23,4 % se ne bavi sportom uopšte. Probleme 64,1% mladih najčešće rešava razgovorom, 19% raspravom, 11,7 % drži to u sebi. U emotivnoj vezi je 23,5 % mladih. U kladionicu često ili ponekad odlazi 17,6% mladih. Da bi mogli da dođu lako do droge u svojoj okolini smatra 51% ispitanika. U kontaktu sa alkoholom je bilo 56,3%, sa cigaretama 33,7%, sa drogom 8,5 %, a 39,5% nikada nije bilo u kontaktu sa psihoaktivnim supstancama. Mladi uglavnom prepoznaju konzumiranje alkohola svaki dan i bilo koje droge kao zavisnost (88,1% i 75,5 %). Odlazak u kladionicu kradom od svoje okoline i korišćenje interneta više od 4 sata dnevno prepoznaje kao zavisnost njih 55%. Malo mladih ispitanika smatra da je povremeno korišćenje marihuane zavisnost (33,5%) kao i konzumiranje alkohola u velikim količinama (22%). Zaključak: Mlade je potrebno dodatno edukovati o zavisnostima i motivisati ih na druge aktivnsoti osim interneta.
Ključne reči: zavisnost, mladi, internet, kockanje, psihoaktivne supstance.
ARE ADOLESCENTS RESILIENT TO ADDICTIONS’ CHALLENGES?
Aleksandra Perović, Jelena Krstić, Dubravka Nikolovski, Ljiljana Lazić, Mirjana Ostojin, Osman Hamzagić, Jasmina Pavlović- Stojanović, Snežana Đurić
The Institute of Public Health Pančevo
Abstract Addictive diseases that affect young people today are not only problems of substance abuse: gambling and internet abuse became more frequent. The aim of this study was to investigate adolescents' resilience to the challenges of addiction. Methods: It was used a non-standardized questionnaire, filled by 673 young people both online and in Pancevo schools which were included in the project "Addiction on ignore." Results: Young people (47.5%) spend their free time on the Internet. Active in sport are 29.6% of young people, and 23.4% are inactive. There are 64.1% adolescents who usually solved problems by talking, arguing 19%, and 11.7% don’t speak about
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE it. In a relationship are 23.5% of young people. The betting visit 17.6% of young people.More than half (51%) consider that drugs are easily available in their neighborhood. Contact with alcohol had 56.3%, with cigarettes 33.7%, with drugs 8.5%, and 39.5% have never been in contact with psychoactive substances. Adolescents recognize that the daily consumption of alcohol and once in a while of any drug is addiction (from 88.1% to 75.5%). Going to the betting sneaking out from its surroundings, and the use of the Internet for more than 4 hours per day recognizes as addiction 55% of them. There are few young respondents who believe that the occasional use of marijuana is addiction (33.5%) as well as alcohol in large amounts (22%). Conclusion: Young people need to be further educated about addictions and motivated to other ongoing activities other than the Internet.
Keywords: addiction, young, internet, gambling, psychoactive substances.
ЗАСТУПЉЕНОСТ ПУШЕЊА - - РЕЗУЛТАТИ ИСТРАЖИВАЊА У СРБИЈИ Надежда Николић, Биљана Килибарда Институт за јавно здравље Србије "Др Милан Јовановић Батут", Београд
Резиме
Употреба дувана је водећи фактор ризика за бројне хроничне незаразне болести и изазива близу шест милиона смртних случајева годишње у свету. У свету пуши око 21% светске популације, а у европском региону око 29% становништва. Праћење учесталости пушења је од великог значаја за имплементацију Оквирном конвенцијом о контроли дувана. Циљ рада је да прикаже и упореди податке из више различитих истраживања о учесталости пушења у Србији последњих 6 година. У питању су: ESPAD истраживање (2011); GYTS (2013); Истраживање здравља становништва Србије (2013); Истраживање о стиловима живота становника Србије (2014); Истраживања о ефектима примене Закона о заштити становништва од изложености дуванском диму (2010,2011,2012,2013,2014,2015,2016). Резултати показују да око трећине одрасле популације у Србији пуши; 12-13% младих је пробало цигарете или пуши; међу одраслима од 45-59 година има 41% пушача; велики проценат пушача је међу незапосленима (44%); у популацији од 18-64 године је скоро сваки десети становник пробао електронску цигарету. Иако приближно половина пушача жели да прекине са пушењем, само око трећине пушача је добило савет здравственог радника да престане да пуши. Више од половине пушача пуши од 11-20 цигарета дневно, а више од 80% пушача наводи да је највећа препрека да престану са пушењем јака навика. Међу младима од 13-15 година око 82% подржава забрану пушења у затвореним просторима, а 67% на отвореним јавним местима. Закон о заштити становништва од изложености дуванском диму из 2010. године је дао одређене позитивне ефекте, али су заступљеност пушења у Србији и изложеност дуванском диму и даље високе. Потребно је планирати ефикасну превенцију пушења засновану на доказима, унапредити реализацију организованог одвикавања од пушења као и унапредити друге мере контроле дувана у Србији.
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Кључне речи: Преваленца пушења, Закон о забрани пушења, превенција, контрола дувана
Prevalence of smoking - -Results across different surveys in Serbia Nadezda Nikolic, Biljana Kilibarda Institute of Public Health of Serbia“Dr Milan Jovanovic Batut“
Abstract
Tobacco use is the leading risk factor for chronic non communicable diseases responsible for around six million of deaths per year. Worldwide, there is 21% of smokers, and in European region of the WHO percentage of smokers is 29%. Monitoring prevalence use is of great importance for the implementation of the Framework Convention of Tobacco Control of the WHO. Aim of the paper is to present and provide comparative analysis of data from several surveys showing data prevalence in Serbia in the last six years. Those surveys are: ESPAD (2011); GYTS(2013); Health Surveys in Serbia (2013); Survey on lifestyles of citizens of Serbia (2014); Survey on Effects of the Law on the protection of the citizens from exposure to tobacco smoke (2010,2011,2012,2013,2014,2015,2016). Results show that one third of the adults population in Serbia smoke; 12-13% of youth have tried cigarettes at least once in the lifetime; among age group 45-59 prevalence of smoking is 41%; the prevalence among unemployed population is (44%); in the population 18-64 every tenth citizen has tried electronic cigarettes. While around 50% wants to stop smoking, only one third of smokers have received advice to quit smoking from health professional. Half of all smokers smoke 11-20 cigarettes per day and more than 80% smokers claim that the strong addiction prevent them from quitting. Among youth 13-15 years old, 82% support smoking ban in closed premises, and 67% in the open space. Law on the protection of citizens from exposure to tobacco smoke adopted in 2010. brought some positive effects, but smoking prevalence is still high in Serbia as well as exposure to tobacco smoke. It is needed to plan and implement effective evidence based smoking prevention, improve smoking cessation services and strengthen implementation of all other tobacco control measures in Serbia.
Key words: Smoking prevalence, smoke free law, smoking prevention, tobacco control
MLADI I ALKOHOL
Mirjana Filipović, Katarina Ristović, Vlatka Stevanović
Zavod za javno zdravlje Užice
Uvod: Alkohol je najčešće prva zavisnost s kojom se mladi susreću, neretko se ne zaustavljajući samo na njemu. Cilj rada: Ispitati navike mladih o upotrebi alkoholnih pića. Metod: Populaciju istraživanja čini 407 učenika Gimnazije „Miodrag Milovanović Lune“ u Užicu. Putem anketnog upitnika ispitivane su navike pijenja alkohola kod učenika 2.- 4. razreda. Za obradu podataka
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE korišćen je SPSS paket. Rezultati: Više od jedne trećine ispitanika (36.4%) ne može da zamisli bilo kakav vid zabave bez alkohola. Zbog preterane upotrebe alkohola 15.7% učenika imalo je probleme sa društvom. Kašnjenje u izvršavanju školskih obaveza zbog alkohola zabeleženo je kod 15.5% učenika, dok je 4.7% ispitanika imalo probleme u zapamćivanju gradiva. Zbog konzumacije alkohola 12% učenika stvorilo je zdravstvene probleme, ili je pogoršalo svoje zdravlje. Samo 11.9% učenika ne konzumira alkohol. Najveći broj (39.8%) koristi alkohol jednom sedmično, dok 4.2% pije svaki dan. Skoro svaki deseti ispitanik izlazi u grad sa namerom da se napije. Svaki peti učenik ne može da kontroliše količinu popijenog alkohola, a 41% je već bilo u fazi teškog pijanstva. Nakon preterane upotrebe alkohola gotovo polovina (48.7%) učenika su puni energije i samopouzdanja, ali ima i onih koji u takvom stanju često provociraju i podsmevaju se drugim ljudima, ili uživaju da ih se drugi plaše. Zaključak: Rezultati istraživanja nesumnjivo ukazuju na neophodnost ozbiljnijeg rada na prevenciji sve veće upotrebe alkohola među mladima.
Ključne reči: alkohol, mladi, prevencija
YOUTH AND ALCOHOL
Mirjana Filipović, Katarina Ristović, Vlatka Stevanović
Public health Institute Užice
Introduction: Alcohol is frequently the first type of addiction that the youth encounter, and they often do not stop at that. Aim of the paper: To examine alcohol drinking habits of the youth. Method: The survey sample consists of 407 students of Grammar School “Miodrag Milovanović Lune” in Užice. We used survey questionnaire to examine the alcohol drinking habits among students of grades 2-4. SPSS package was used for data processing. Results: More than one third of the survey participants (36.4%) could not imagine any form of entertainment without alcohol. 15.7% of students had problems with society because of excessive use of alcohol. 15.5% of students were delayed in fulfilling their school obligations because of alcohol, whereas 4.7% of students experienced problems in memorizing learning materials. Due to alcohol consumption, 12% of students developed health problems or their health deteriorated. Only 11.9% of students do not consume alcohol. Majority (39.8%) use alcohol once a week, whereas 4.2% drink every day. One in ten students goes out with the intention to get drunk. One in five students cannot control the amount of alcohol they consume, and 41% have already been at the stage of severe inebriation. Almost half of students (48.7%) experience surge of energy and confidence after excessive use of alcohol, but there are those who often provoke or ridicule the others or enjoy that the others are afraid of them. Conclusion: The research results are conclusive that there is a need for more serious work aiming at prevention of increasing number of alcohol use among the youth.
Key words: alcohol, youth, prevention
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KAKVA JE PERSPEKTIVA DEMOGRAFSKOG OPORAVKA ZAJEČARSKIH SELA
Magdalena Todorovic Nikolic, "Specijalna bolnica za rehabilitaciju" Gamzigradska banja
Miodrag Todorovic, penzioner, Zajecar
Rezime
Rad prikazuje demografske karakteristike zaječarskih sela sa posebnim osvrtom na ona sela u kojima su prirodne komponente: živorodjeni, prirodni priraštaj i prosečna starost, izuzetno nepovoljne i kojima preti izumiranje.
Suočeni smo sa činjenicom da se seosko stanovništvo grada Zaječara za poslednje četiri decenije smanjilo za više od polovine, da je rađanje dece u 2011.godini u odnosu na 1971. godinu četiri puta manje, da je stopa nataliteta izuzetno niska i kreće se oko 5 a stopa mortaliteta izuzetno visoka i kreće se oko 25 na 1000 stanovnika; da je došlo do pražnjenja seoskih, najviše brdsko-planinskih naselja i da su sela demografski iscrpljena. U njima se decenijama formirala veoma nepovoljna starosna struktura, živi uglavnom staro stanovništvo čija je socijalna, ekonomska i biološka snaga na izmaku (prosečna starost 2011.godine bila je 50,2 godine a indeks starenja 2,89). U nekim naseljima u periodu 2002.-2011. godine rođeno je 1-2 deteta a umrlo na desetine meštana. Kako se decenijama demografska baza seoskog stanovštva sušila, razarala i iščezavala, ukazuje nam na to da je većina seoskih naselja dotakla dno demografske provalije , da za njih nema perspektive demografskog oporavka i da će se za nedugo demografski ugasiti.
Ključne reči: seosko stanovništvo, stopa nataliteta, stopa mortaliteta, starosna struktura.
WHAT ARE THE PROSPECTS OF DEMOGRAFIC RECOVERY ZAJEČAR VILLAGES
Magdalena Todorovic Nikolic, "Specialized hospital for rehabilitation" Gamzigrad Miodrag Todorovic, a pensioner, Zajecar
Summary
This paper presents the demographic characteristics of Zaječar villages with special emphasis on those villages that are natural components: Newborns, natural increase and average age, an awkward and threatened with extinction.
We are faced with the fact that the rural population of the city of Zajecar in the last four decades has decreased by more than half, to the birth of children in 2011. compared to 1971. four times less that the birth rate is very low and is around 5 and the mortality rate is extremely high and is around 25 per 1,000 population; there has been a discharge of village, most mountainous villages and villages that are demographically exhausted. They are decades formed a very unfavorable age structure in which today lives mainly old the population whose social, economic and biological
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE forces at the end (the average age of 2011 was 50.2 years and the index is 2.89); that at some sites in the period 2002 to 2011. born child is 1-2 and killed tens of residents. As the decades, the demographic base of rural population hair, destroying and vanished, shows us that the majority of rural settlements has touched bottom demographic abyss, that they have no prospects of demographic recovery and that, for the long time the village demographic extinguish.
Key words: rural population, birth rate, birth rate, mortality rate, age structure.
MORBIDITET I MORTALITET ŠKOLSKE DJECE I OMLADINE NA PODRUČJU OPŠTINE NEVESINJE OD 2012. DO 2015.GODINE
Radulović Danijela1, Radulović O1,2
¹Medicinski fakultet Foča, Univerzitet Istočno Sarajevo, Republika Srpska
²Medicinski fakultet Niš, Univerzitet Niš, Srbija
Uvod: Kategorija školske djece obuhvata uzrast od 7 do 14 godina, a kategoriji školske omladine pripadaju mladi od 15 do 19 godina. Kvalitet života i zdravlja školske djece i omladine uslovljeni su faktorima porodične sredine i faktorima vezanim za proces školovanja.
Cilj: Cilj rada bio je prikazati morbiditet i mortalitet školske djece i omladine na području opštine Nevesinje od 2012. do 2015. godine.
Metod: Za rad su korišteni podaci Instituta za javno zdravstvo Republike Srpske-Regionalni centar Trebinje i podaci Republičkog zavoda za statistiku Republike Srpske.
Rezultati: U periodu od 2012. do 2015. godine u populaciji školske djece i omladine u opštini Nevesinje najzastupljenije su bile bolesti respiratornog sistema. Najčešća dijagnoza bila je akutne upale ždrijela i krajnika čija je stopa 2012.godine iznosila 663,18 na 1000 djece, a 2015. godine 709,90 na 1000 djece. Na drugom mjestu bila je dijagnoza akutne respiratorne infekcije sa stopom od 633,51 na 1000 djece u 2012.godini i stopom od 672,26 na 1000 djece u 2015.godini. Tokom posmatranog perioda, među tri najzastupljenije dijagnoze nalazila se i neodređena dijagnoza lica koja traže zdravstvene usluge radi pregleda i ispitivanja čija je stopa 2012.godine iznosila 339,56 na 1000 djece, a 2015.godine 349,73. Mortalitet školske djece i omladine u opštini Nevesinje je nizak (stopa 5,5 na 10000 djece).
Zaključak: U cilju smanjenja obolijevnja školske djece i omladine u opštini Nevesinje, neophodno je, između ostalog, intenzivirati zdravstveno-vaspitne aktivnosti na području faktora rizika za respiratorne bolesti. Takođe, u cilju dobijanja kvalitetnijih podataka o zdravstvenom stanju, neophodno je preciznije vođenje medicinske dokumentacije i evidencije.
Ključne riječi: morbiditet, mortalitet, školska djeca, omladina
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MORBIDITY AND MORTALITY OF SCHOOL CHILDREN AND ADOLESCENTS IN THE MUNICIPALITY OF NEVESINJE IN 2012-2015
Radulović Danijela 1, Radulović O 1,2
1Faculty of Medicine Foča, University of East Sarajevo, the Republic of Srpska
2Faculty of Medicine Niš, University of Niš, Serbia
Introduction: The category of school children include children aged 7-14 years, whereas young people aged 15-19 years belong to the category of adolescents. Quality of life and health of school children and adolescents are determined by factors of family environment and factors related to the process of education.
Objective: The main objective was to analize morbidity and mortality of school children and adolescents in the municipality of Nevesinje in 2012-2015.
Method: Data from Public Health Institute of the Republic of Srpska-regional center Trebinje and Institute of Statistics of the Republic of Srpska, were used for this study.
Results: The respiratory diseases were the most prevalent diseases in the population of school children and adolescents in the municipality of Nevesinje in 2012-2015. The most frequent diagnosis was acute tonsillopharyngitis whose rate was 663.18 per 1000 children in 2012 and 709.90 per 1000 children in 2015. Diagnosis of acute nonspecific respiratory infection was in the second place. The rate of this diagnosis was 633.51 per 1000 children in 2012 and 672.26 per 1000 children in 2015. People seeking health services for examination and testing was the third registered diagnosis with the rate of 339.56 per 1000 children in 2012 and 349.73 per 1000 children in 2015. Mortality rate was low (the rate was 5.5 per 10000 children).
Conclusion: In order to improve school children and adolescents′ health, health education about risk factors for respiratory diseases is necessary. Also there is a need for more precise diagnoses to improve the quality of data.
Key words: morbidity, mortality, school children, adolescents
ANALIZA PRVOROTKI U NIŠU 2006.-2015.godine
Mariola Stojanović
Institut za Javno zdravlje Niš
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UVOD: U sadašnjim generacijama je uobičajeno da žene rađaju decu u starijoj dobi. Više faktora mogu da utiču na odluke majki kada se planira njihovo prvo dete. Takvi faktori uključuju obrazovni, socijalni i ekonomski status, ali sve češće i lečenje steriliteta.
CILJ RADA: Analiza socijalne i demografske strukture prvorotki u Nišu u periodu 2006.-2015.god.
IZVOR PODATAKA: Prijava rodjenja - podaci za period 2006.-2015. god.
REZULTATI: Tokom posmatranog desetogodišnjeg perioda prvorotke u Nišu postaju značajno obrazovanije, samostalnije i starije (prosečna starost se povećala za 2.4 godine od 25.2 ± 4.96 u 2006. na 27.6 ± 5.6 u 2015.). Struktura po starosnim kategorijama se takođe menja značajno usled smanjivanja rađanja žena mlađih od 30 godina a povećavanja rađanja kod starijih.
U vanbračnim zajednicama konstantno živi 23-28% porodilja. Starosna struktura vanbračnih zajednica se značajno menja - zapaža se smanjenje udela porodilja mlađih od 20 godina, a raste udeo starijih od 30 godina.
ZAKLJUCAK: Socio-demografska slika naših porodilja početkom 21. veka se definitivno menja. Da li su sve te promene njihov lični izbor?
PRIMIPARAS ANALYSE IN NIS from 2006 to 2015
Mariola Stojanovic
The Institute of Public Health Nis
INTRODUCTION: Nowadays, it is common for women to have children at an older age. Several factors may influence the decision of mothers when planning their first child - educational, social and economic status, and increasingly, the treatment of infertility.
OBJECTIVE: Analysis of social and demographic structure of primiparas in Nis in the period from 2006 to 2015.
SOURCE: Birth reports - data for the period from 2006 to 2015
RESULTS: During the observed period of ten years, the primiparas in Nis have become increasingly more educated, more independent and older (average age increased by 2.4 years from 25.2±4.96 in 2006 to 27.6±5.6 in 2015). Structure of age groups is also changing significantly due to the decrease in women younger than 30 becoming mothers and increase in the older ones who give birth.
23-28% of primiparas constantly live in common-law marriages. The age structure of common-law marriages has changed significantly - the number of mothers younger than 20 is falling and the number of those over 30 is rising.
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CONCLUSION: Socio-demographic picture of our primiparas at the beginning of the 21st century is definitely changing. Are those all changes their personal choice?
Key words: age of primiparas, common-law marriages
ZDRAVLJE I DRUŠTVO
Marina Vojnović , Ana Točević , Ankica Živković
Zavod za javno zdravlje ,,Timok,, Zaječar
REZIME
Uvod ; Životni stil i uslovi u kojima ljudi žive i rade izuzetno utiču na njihovo dravlje i digovečnost.Devet je ključnih odrednica koje utiču na zdravlje : socioekonomski status ; stres ; uslovi odrastanja ;društvena deprivacija ; posao ;nezaposlenost ; društvena podrška ;zavisnost ; hrana.
Cilj rada : Ukazati na znaćaj društvenih cinioca koji utiči na zdravlje i pojavu poremećaja zdravlja kao i podići svest i razmišljanje o tome kako bi pristup javnog zdravlja trebalo da utiče na očuvanje i unapređenje svukupnog zdravlja naročito mentalnog zdravlja.
Metod rada : U radu je prikazana svaka društvena odrednica koja utiče na zdravlje ljudi u pogledu socioekonomskog statusa, stresa, uslova odrastanja ,društvene deprivacije , zaposlenja , društvene podrške , zavisnosti , i ishrane u Republici Srbiji sa posebnim osvrtom na teritoriju zaječarskog i borskog okruga.(Podaci Republičkog Zavoda za statistiku, Analiza zdravstvenog stanja stanovnistva i obrađen upitnik sa korisnicima Narodne kuhinje u Zaječaru )
Rezultati rada : Rezultati rada ukazuju na veliki uticaj društvenih uslova na zdravlje ljudi i poremćaja zdravlja u pogledu lošeg socioekonomskog statusa, siromaštva,psiholoških i socijalnih problema ,nedovoljnne podrške i socijalne isključenosti,nezaposlenosti i stresa kao i socijalne i ekonomske isključenosti , zavisnpsti kao odgovora na socijalni slom i razlika u ishrani .Zaključak :Sosijalni i ekonomski uslovi življenja su od ključnog značaja da li će ljudi očuvati zdravlje ili će se razboleti i svakako su važniji za očuvanje zdravlja cele populacije.
Ključne reči : zdravlje , društvo ,mentalno zdravlje,uslovi života,siromaštvo
HEALTH AND SOCIETY
Marina Vojnović , Ana Točević , Ankica Živković
Institute of public health ,,Timok,, Zaječar
SUMMARY
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Introduction ; Lifestyle choices and conditions wherein people live and work greatly affect their health and longevity. There are nine key determinants that can affect health: socioeconomic status; stress; conditions while growing up; social deprivation; work/jobs; unemployment; social support; addiction; food.
The goal of the paper: Indicate the importance of social factors that can affect health and the occurrence of health disorders as well as to raise awareness and change the mindset about how should the approach of public health affect the preservation and the improvement of overall health, especially mental health.
Methods used: This paper presents every social determinant that affects the health of people in the terms of socioeconomic status, stress, conditions while growing up, social deprivation, employment, social support, addiction, and nutrition in the Republic of Serbia with special emphasis on the territory of Zajecar and Bor district. (The data from the statistical office of the Republic of Serbia, Analysis of the state of health of the population and the questionnaire done with people in the national kitchen in Zajecar)
Results of the paper: The results show a major impact of social conditions on health and health disorders in terms of poor socio-economic status, poverty, psychological and social problems, lack of support and social exclusion, unemployment and stress, as well as social and economic exclusion, addiction as a response to social breakdowns and differences in diet.
Conclusion: Social and economic life conditions are crucial if people will preserve their health or if they'll get sick and are certainly important in the terms of preserving the health of the entire population.
Keywords : health, society, mental health, living conditions, poverty
URGENTNA MEDCINA RAZVOJ OD STARE GRČKE I RIMA DO DANAS
Milos Protić, Nikola Jovanović, Biljana Velić, Ljiljana Jovanović
Zdravstveni centar Zaječar
Uvod: Urgentna medicina ima ulogu prevencije, dijagnoze i lečenja akutnih i hitnih aspekata bolesti i povreda svih uzrasta obolelelih.
Cilj: Prikaz razvoja urgentne medicine od antičkih civilizacija do danas nastale kao odgovor na potrebe čoveka u prevenciji i lečenju od bolesti i povreda opasnih po život i zdravlje.
Metod: Istraživanje baza podataka SZO, Wiley Online Library- Academic Emergency Medicine, PubMed na istoimenim internet portalima.
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Rezultati i diskusija: Urgentna medicina kakva je danas postoji od 60-tih i 70-tih godina 20. veka, dva modela anglo-američki (hirurzi i lekari opšte prakse) i franko-germanski (anesteziolozi, hirurzi i internisti). Dominique Jean Larrey, francuski vojni hirurg, smatra se ocem urgentne medicine, idejom ,,letećih kočija’’- flying carriages, za brzi transport ranjenika do poljskih bolnica u doba Francuske revolucije (1789-1799). Antički Rimljani su osvojivši staru Grčku, preneli u Rim,napredna medicinska dostignuća (Galen i Pedanius Dioscorides). Rimljani su imali svoje vojne lekare- medici ordinarii, niži čin i medicus legionis odnosno medicus cohortis, viši činovi. Rađene su trepanacije, amputacije pod dejstvom opijuma, razvijeni su bili hirurški instrumenti. 1968. se u SAD osniva Američki koledž urgentne medicne, a 90-ih godina 20. veka pa do 2005. u Britaniji je ustanovljeno Britansko udruženje urgentne medicine. Danas postoje odeljenja urgentne medicine (emergency department, SAD).
Zaključak: Urgentna medicina iako mlada disciplina, imala je dug i zavojit razvoj do današnjeg oblika još od početaka civilizacije.
Ključne reči: urgentna medicina , razvoj, istorija, stari Rim
EMERGENCY MEDICINE- DEVELOPMENT OF ANCIENT GREECE AND ROME TO THE PRESENT
Milos Protić, Nikola Jovanović, Biljana Velić, Ljiljana Jovanović
Health Center Zajecar
Introduction: Mortality in the world of atherosclerotic disease, according to WHO for 2015, 54.6 million (54% of ischemic heart disease and stroke), and of polytrauma in traffic of 1.3 million deaths in 2015 (76% of men). Emergency medicine has the role of prevention, diagnosis and treatment of acute and urgent aspects of illness and injury of all ages.
Objective: The aim of this review is to present the development of emergency medicine since ancient civilizations to today arose as a response to human needs in the prevention and treatment of diseases and injuries dangerous to life and health.
Method: Research Database WHO, Wiley Online Library- Academic Emergency Medicine, PubMed on the internet portals
Results and Discussion: Emergency Medicine as it is today has existed since the 60's and 70's of the 20th century, two models of the Anglo-American (surgeons and general practitioners) and ex- Germanic (anesthesiologists, surgeons and internists). Dominique Jean Larrey, a French military surgeon, considered the father of emergency medicine, the idea of flying coach ,, '' - flying carriages, for rapid transport of the wounded to a field hospital at the time of the French Revolution
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(1789-1799). The ancient Romans were winning ancient Greece, conveyed to Rome, advanced medical achievements (Galen and Dioscorides Pedanius). The Romans had their military physicians- medici ordinarii, lower rank and medicus legionis or medicus cohortis senior ranks. They have made trepanation, amputation under the influence of opium, they had developed surgical instruments. 1968 in the United States founded the American College of urgent medicne and 90s of the 20th century up to 2005 in the UK was founded British Association emergency medicine. Today there are departments of emergency medicine (emergency department, USA).
Conclusion: Emergency Medicine although young discipline, had a long and tortuous development to the present form since the beginning of civilization. As well as medicine in general.
Key words: emergency medicine, development, Ancient Rome ,history
KOMUNIKACIJSKE PREPREKE I KONFLIKTI
Ankica Živković Radenković, Jasmina Radosavljević, Olica Radovanović, Snežana Tošić
Zavod za javno zdravlje ,,Timok,,Zaječar
UVOD: Komunikacione veštine određuju kakav ćemo odnos imati sa ljudima uopšte. Koliko smo vešti u građenju odnosa sa drugim ljudima i upravljanju dinamikom ovih odnosa određuje kakav nam je kvalitet života. Zašto ljudi reaguju tako različito na identične poruke? Zašto jedna osoba vidi polu-praznu čašu a neka druga vidi čašu do pola punu? Zašto neka osoba čuje poruku i oseti se energično, uzbuđeno i motivisano dok neka druga na istu poruku uopšte ne reaguje? S obzirom da ne postoje dve osobe koje identično misle ili osećaju, različitosti, razmimoilaženja u mišljenju i konflikti predstavljaju neoizbežan deo svakog odnosa. Kroz konflikte, mi upoznajemo međusobne razlike i tragamo za načinima da se te razlike premoste. Kada su naše potrebe i potrebe drugih u konfliktu možemo reagovati: agresivno, pasivno i asertivno.
METOD: Metod rada je evaluacija postojećih naučnih istraživanja čiji rezultati nam ukazuju na najčešće prepreke u ostvarivanju dobre komunikacije kao i nastanku konflikata kao krajnji rezultat loše komunikacije.
CILJ:Osnovni cilj rada je prikaz modela prevazilaženja prepreka i rešavanje konflikata nastalih kao posledica loše komunikacije pomoću asertivnog načina izražavanja i medijacije kao krajnjeg načina rešavanja sukoba.
REZULTAT: Oko 80% vremena u toku čitavog dana utrošimo na komunikaciju. 70% svake komunikacije na istom jeziku i u istoj kulturi se: pogrešno shvati, pogrešno interpretira, odbije, ne dopadne ili ne čuje. Pasivno ponašanje je veoma često u našem društvu. Više od 80% ljudi neće reći ni reč da se izbori za svoja prava ili da ostvari svoje potrebe.
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ZAKLJUČAK: Osnovno pitanje je da li zaista želite da rešite konflikt s drugim ljudima, ili prosto želite da budete u pravu? Baza rešenja konflikta je u komunikaciji. Iz konflikta skoro uvek možemo da izađemo zadovoljni ili bar poučeni, a ne kako to u većini slučajeva važi – poraženi i ljuti. Asertivnost je nešto što vam u neprijatnim situacijama sa ljudima može mnogo pomoći. Asertivno ponašanje je izuzetno korisno kada želite da se zauzmete za sebe i svoja prava, a pri tom ne povredite druge.
KLJUČNE REČI: Komunikacija, konflikt, asertivnost.
OBSTACLES AND CONFLICTS IN COMMUNICATION
Ankica Živković Radenković, Jasmina Radosavljević, Olica Radovanović, Snežana Tošić
Institute of pubilc health „Тimok“ Zaječar
INTRODUCTION:Our relationship with other people depends on our communication skills. Our quality of life is determinated by our skills in building relationships with other people and managing the dynamics of these relationships. Why do people react differently to the identical messages? Why one person sees a half-empty glass and the other sees the same glass half full? Why somebody hears the message and feels energy, excitement and motivation to react but somebody else doesn’t? There are no two identical persons who think and feel in the same way, and that is why conflicts become unavoidable. People know each other through the conflicts and find out the ways how to overcome the differences. When people have conflicting needs, they may react in three different ways: aggressively, passively or assertively.
METHOD:Method of work is the evaluation the results of existing scientific researches which indicate the most common obstacles in making good communication as well as making conflicts as the final result of bad communication.
AIM:The aim is to show the model of overcoming obstacles and solving conflicts appeared in bad communication with the help of assertive ways of expression and mediation.
RESULTS:During the day we spend about 80% of our time communicating with other people. About 70% of each communication in same language and same culture can be missunderstood, wrongly interpreted, rejected or simply people don’t like something or don’t hear. Passive form of behavior is very common in our culture and more than 80% of people will not say anything to fight for their rights or to satisfy their needs.
CONCLUSION: The main question is: do you realy want to solve conflicts or to be always right? Communication is the key for overcoming conflict. Usualy, one side in conflict may be defeated and feel angriness instead of being satisfied with final solution. Assertiveness is very usefull
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KEY WORDS: communication, conflict, assertiveness.
УНАПРЕЂЕЊЕ КВАЛИТЕТА РАДА ИЗАБРАНОГ ЛЕКАРА У ОБЛАСТИ ПРЕВЕНТИВЕ ОКРУГА БОР И ЗАЈЕЧАР
СНЕЖАНА ТОШИЋ, МИОДРАГ КОСТИЋ, ОЛИЦА РАДОВАНОВИЋ, ЈАСМИНА РАДОСАВЉЕВИЋ
ЗАВОД ЗА ЈАВНО ЗДРАВЉЕ „ ТИМОК „ ЗАЈЕЧАР
СР СРБИЈА
Сажетак:
Увод: Праћење показатеља квалитета рада изабраног лекара опште медицине, педијатрије и гинекологије, у области превентиве, кроз време, представља основ за прађење унапређења квалитета његовог рада усмереног ка очувању и унапређењу здравља, побољшању квалитета живота, повећања удела превентиве у примарној здравственој заштити и директном смањењу трошкова лечења.
Циљ рада је праћење кретања вредности показатеља превентивног рада изабраног лекара опште медицине, педијатрије и гинекологије у периоду 2011-2016. године и пројекција истог у наредних пет година на нивоу округа Бор и Зајечар.
Метод рада: За рад је коришћено важеће „Методолошко упутство за поступак извештавања здравствених установа о показатељима квалитета здравствене заштите“ из 2011. Године.
Јединица посматрања је изабрани лекар опште медицине, педијатрије и гинекологије на нивоу оба округа.
За обраду података коришћена је дескриптивна статистика, а за предвиђање линеарни тред.
Резултати:
Округ Зајечар:
1. Годишња стопа превентивних прегледа изабраног лекара опште медицине за посматрани период бележи смањење oд 3,2% годишње.
2. Годишња стопа превентивних прегледа изабраног педијатра за посматрани период бележи смањење од 9,2% годишње.
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3. Годишња стопа превентивних прегледа изабраног гинеколога за посматрани период бележи смањење 4% годишње.
Округ Бор:
1. Годишња стопа превентивних прегледа изабраног лекара опште медицине за посматрани период бележи раст oд 4,34% годишње.
2. Годишња стопа превентивних прегледа изабраног педијатра за посматрани период бележи смањење од 5,9% годишње.
3. Годишња стопа превентивних прегледа изабраног гинеколога за посматрани период бележи смањење 9% годишње.
Закључак: .
1. У посматраном периоду не постоји значајно унапређење квалитета рада изабраног лекара које се односи на удео превентиве у укупном раду изабраног лекара.
2. У оба округа линеарни тренд је негативан и показује вероватноћу самањења удела превентивних у укупном броју прегледа изабраног лекара.
Кључне речи: показатељи квалитета, превентива, изабрани лекар, округ Бор и округ Зајечар
REFERENCE VALUE AND RELATION OF WORK QUALITY INDICATORS OF CHOSEN GYNECOLOGIST IN THE DISTRICTS OF BOR AND ZAJEČAR IN THE PERIOD 2011-2014
SNEŽANA TOŠIĆ, MIODRAG KOSTIĆ, OLICA RADOVANOVIĆ, JASMINA RADOSAVLJEVIĆ, MARINA VOJNOVIĆ
INSTITUTE OF PUBLIC HEALTH „TIMOK” ZAJEČAR, REPUBLIC OF SERBIA
Summary:
Introduction: Monitoring of the quality of selected gynecologist is the basis for improving the quality of his work directed to preservation and promotion of health, improving quality of life of women, increasing the share of prevention in primary care and reducing the direct costs of medical treatment.
The aim of the work is to compare indicators of the quality of the chosen gynecologist in the period 2011-2014 with a reference value in health centers in the districts of Bor and Zajecar, as
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE well as to compare the work of chosen gynecologist between health institutions in the districts of Bor and Zajecar.
Methods of work: For the quality of the work of chosen gynecologist, the valid "Methodological guidelines for health care institutions reporting procedures on indicators of health care quality" in 2011 were used.
Given that there is no standardized value according to which monitoring of movement of indicators should be done, for each indicator we determined the reference (average) values for each district individually and observation period, according to which indicators were observed.
For statistical analysis, descriptive statistical methods were used.
Results: The monitored parameters and calculated reference values:
1) Percentage of registered beneficiaries who for any reason visited their chosen gynecologist.
The reference value for the district of Bor was 69.00% and 70.00% for the district of Zaječar. In both districts the average number of registered beneficiaries was approximately the same.
2) The ratio of the first examination and re-examination of the chosen gynecologist for medical treatment.
The reference value for the district of Bor was 1,00, and for the district of Zaječar 1.98. In the district of Bor, the first examination was followed by another one, and in the district of Zajecar each first examination was followed by two re-examinations.
3) The ratio of the number of instructions issued by specialist-consultative examination and the total number of visits at the chosen gynecologist.
The reference value for the district of Bor was 8.00, and 3.44 for the district of Zaječar. In the district of Bor, after each examination an average of eight medical referrals were obtained, and in the district of Zaječar it was 3.4 referrals for specialist consultative examination.
4) Percentage of preventive examinations in the total number of examinations of chosen gynecologist.
The reference value for the district of Bor was 44.00% and 40.00% for the district of Zaječar. There was no significant difference between the districts of Bor and Zajecar in the share of preventive examinations on average.
5) Percentage of beneficiaries aged 25-69 covered by the targeted examination for early detection of cervical cancer.
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The reference value for the district of Bor was 30.00% and 27.00% for the district of Zaječar. Approximately the same percentage of the beneficiaries were covered by the targeted examination in both districts.
6) Percentage of beneficiaries aged 45-69 referred for a mammogram by gynecologists in the last 12 months.
The reference value for the district of Bor was 12.00% and 32.00% for the district of Zaječar. A significantly higher percentage of beneficiaries in the district of Zaječar were sent to mammography.
Conclusion: You can not notice the regularity in the movement of the value of these indicators in relation to the calculated reference value in the reporting period.
Reference values for the parameters are different in the districts of Bor and Zaječar.
There is a difference in the work of selected gynecologist in the districts of Bor and Zaječar in relation to the reference values for certain indicators.
Keywords: quality indicators of chosen gynecologist, health institutions of districts of Bor and Zaječar, the reference value
ЉУДСКИ РЕСУРСИ ЗДРАВСТВЕНИХ УСТАНОВА ПРИМАРНЕ ЗДРАВСТВЕНЕ ЗАШТИТЕ ЗАЈЕЧАРСКОГ И БОРСКОГ ОКРУГА
Олица Радовановић1, Снежана Тошић1, Јасмина Радосављевић1, Ивана Ћирић1,
1Завод за јавно здравље¨Тимок¨ Зајечар
Увод: Примарна здравствена заштита представља основни и централни део система здрвствене заштите, који мора задовољити најмање трећину здравствених потреба становништва. Кључан и специфичан ресурс за квалитет, успешност и ефикасност здравствене заштите, је људски ресурс, односно оптимална кадровска сатруктура здравствене установе у односу на број и стручну оспособљеност. Успостављање и одржавање оптималне кадровске структуре представља континуирану равнотежу и усклађивање са сталним променама закона и подзаконских аката и препознатим потребама становништва, поштујући принципе приступачности, правичности, свеобухватности, континуиране и ефикасније здравствене заштите.
Циљ рада: Основни циљ овог рада је да се сагледају људски ресурси здравствених установа примарне здравствене заштите као основ за равномернији развој здравствене службе, реализацију препознатих и прописаних потреба за здравственом заштитом становништа и ефиксније коришћење расположивих ресурса на територији округа Бор и Зајечар.
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Метод рада: Анализом закона, подзаконских аката, базе кадрова и извештаја о извршењу плана рада здравствених установа, прате се људски ресурси свих здравствених установа примарне здравствене заштите округа Зајечар и округа Бор 2016. године.
Резултати: На простору округа Зајечар и округа Бор доминира мањи уговорени број доктора медицине и/или специјалиста одговарајуће гране медицине у односу на прописани број. Уговорени број доктора медицине и/или специјалиста опште медицине је мањи у односу на прописани број за пружање здравствене заштите одраслог становништва, изузев у Дому здравља Бољевац који има три лекара више. Домови здравља округа Бор имају 4 доктора специјалиста педијатрије и 2 доктора специјалиста гинекологије и акушерства више, а округа Зајечар по 1 мање у односу на прописани број. Поштујући Правилник о садржају и обиму права на здравствену заштиту из обавезног здравственог осигурања и о партиципацији за 2016. годину, мањи је број доктора медицине у свим домовима здравља оба округа, изузев у ДЗ Бољевац и ДЗ Књажевац у односу на уговорени, односно у односу на уговорени и нормирани број доктора опште медицине. За пружање здравствене заштите одраслог становништва потребно је обезбедити још око 20 лекара у ДЗ Зајечар и ДЗ Бор. На простору оба округа је потребно обезбедити већи број специјалиста гинекологије и акушерства и специјалиста педијатрије.
Закључак: Неопходно је обезбедити довољан број радника како би се задовољиле препознате потребе становништва дефинисане популационе групе за здравственом заштитом и испоштовале одредбе подзаконских аката. Прописани обим услуга у Правилнику о садржају и обиму права на здравствену заштиту из обавезног здравственог осигурања и о партиципацији за 2016. годину је значајно већи у односу на укупан број извршиоца прописан Правилником о ближим условима за обављање здравствене делатности у здравственим установама и другим облицима обављања здравствене службе, те је неопходно извршити усклађивање подзаконских аката. Изражена демографска депопулација овог простора захтева увођење нових корективних фактора приликом израде критеријума за прописани број извршиоца за пружање здравствене заштите, као и усклађивање корективних фактора са мерама извршења изабраних лекара опште медицине. Значајно је омогућити поштовање одредби Закона о спорту, као и прописаног нивоа пружања стоматолошке здравствене заштите становништву.
Кључне речи: људски ресурси, здравствене установе, примарна здравствена заштита, округ Зајечар и округ Бор, закон и подзаконска акта
HUMAN RESOURCES IN HEALTH FACILITIES OF PRIMARY HEALTH CARE IN ZAJECAR AND BOR DISTRICT
Olica Radovanović1, Snežana Tošić1, Radosavljević Jasmina1, Ivana Ćirić1, 1Department of Public Health Center ¨Timok¨ Zajecar
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Introduction: Primary health care is a fundamental and central part of the health care system, which must meet at least one third of the health needs of the population. A key and specific resource for quality, effectiveness and efficiency of health care, is human resource, i.e. optimal personnel structure of health institutions in relation to the number and professional qualifications. Establish and maintain optimal staffing structure is a continuous balance and alignment with the constant changes in laws and regulations and the identified needs of the population, while respecting the principles of accessibility, fairness, comprehensiveness, continuous and efficient health care.
Objective: The main objective of this paper is to review the human resources of medical institutions of primary health care as the basis for the balanced development of health services, the implementation of the identified needs and local requirements for health protection of the population and more efficient use of available resources on the territory of the district of Bor and Zajecar.
Methods: The analysis of laws, regulations, personnel database and reports on the execution of the plan of medical institutions, monitor human resources of all health care institutions of primary health care district Zajecar and Bor district in 2016.
Results: In the area of the district Zajecar and Bor district there is a smaller number of contracted doctors and / or specialists in the relevant field of medicine in relation to the prescribed number. The agreed number of doctors and / or specialists in general medicine is smaller compared to a prescribed number of health care for the adult population, except in the Health Center Boljevac which has three doctors more. Public health centers in the district of Bor have 4 pediatrician doctors and 2 medical specialists in gynecology and obstetrics more, and the district of Zajecar 1 less than the prescribed number. Respecting Rules on the contents and scope of the right to health care from the compulsory health insurance and the participation for 2016, there is a less number of physicians in all health centers in both districts, with the exception of the Health Centers in Boljevac and Knjaževac in relation to the contract or in relation to agreed and standardized number of doctors in general medicine. Health care for the adult population is necessary to provide another 20 doctors in Health Centres in Zajecar and Bor. In the area of both districts it is necessary to provide a larger number of gynecology and obstetrics and pediatrics specialists.
Conclusion: It is necessary to provide a sufficient number of workers to meet the identified needs of the population of the defined groups on health care and comply with the provisions of the bylaws. The prescribed range of services in the Ordinance on the content and scope of the right to health care from the compulsory health insurance and the participation for 2016 is significantly higher than the total number of performers prescribed by the Regulations on detailed conditions for the provision of health services in health institutions and other forms of performing medical service,
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE and it is necessary to harmonize laws. The demographic depopulation of this area requires the introduction of new corrective factors when developing the criteria for the prescribed number of executors for the provision of health care, as well as harmonization of corrective factors to measures of execution of selected general practitioners. It is important to enable compliance with the provisions of the Law of sport, as well as providing the required level of dental health care to the population.
Keywords: human resources, health centers, primary health care, districts of Zajecar and Bor, law and
Mladi-naša sadašnjost - izazovi savremenog društva Ana Točević, Marina Vojnović Zavod za javno zdravlje “Timok“ Zaječar
UVOD: Mladi su po svojoj prirodi veoma ranjiva društvena kategorija, koja shodno tome predstavlja poseban naučno-istraživački izazov, pogotovo u ovim savremenim uslovima života, koji nameću redefinisanje dosadašnjeg sistema vrednosti i načina života, promovišući drugačiju socijalizaciju u kojoj se bitno menja uloga porodice, škole i vršnjaka. CILJ: Cilj istraživanja je bio da se shvate stavovi i obrasci ponašanja kod mladih s obzirom na istraživane parametre i da se utvrdi moguća razlika između učenika medicinske škole i učenika ostalih srednjih škola. METOD RADA: Prvi deo rada sadrži rezultate istraživanja o pušenju duvana, alkoholu, drogama, kockanju i slobodnom vremenu među učenicima trećeg razreda zaječarskih srednjih škola. Radi se o istraživanju anketnog tipa. Početna hipoteza: Učenici medicinske škole su svesniji posledica koje po njih imaju rizična ponašanja, od učenika ostalih srednjih škola. REZULTATI: Što se tiče pušenja duvana više od 75% učenika svih srednjih škola smatra da više od polovine ukupnog broja učenika puši duvan. Veći je broj redovnih pušača u medicinskoj školi u odnosu na ostale ispitane škole. Što se tiče percepcije učenika o uzimanju sredstava zavisnosti, uopšte nije dobijen ohrabrujuć podatak. Mišljenje ispitanika je da preko 60% učenika uzima sredstva zavisnosti (marihuanu). U medicinskoj školi je nešto veći procenat konzumenata alkoholnih pića. Zabrinjavajući podatak je da izlasci kod preko 70 % ispitanika nisu ograničeni vremenom. Drugi deo rada obuhvata stavove i mišljenja dece zaječarskih osnovnih škola uzrasta od 10 do 13 godina o zadovoljstvu životom u svom gradu. Odgovori su kvalitativno obradjeni kroz par kategorija. U tom pogledu deca su demonstrirala svoju kompetentnost u procenjivanju osnovnih nedostataka i problema gradskog života. Ovaj deo rada je jedan mali pokušaj „da se i njihov glas čuje “ da postanu vidljivi bar na trenutak. ZAKLJUČAK: Mladi ljudi su danas uhvaćeni u mrežu velike ponude razičitih sadržaja koje nudi savremeno društvo. Takođe, menja se vremenska paradigma koja je karakterisala mlade u prethodnom vremenu, odnosno, pomera se “granica njihovog trajanja”. KLJUČNE REČI: mladi, savremeno društvo, stavovi, obrasci ponašanja
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Youth - Our present The challenges of modern society Ana Točević, Marina Vojnović Institute of Public Health “Timok“ Zaječar
INTRODUCTION: Young people are by nature very vulnerable social category, which consequently poses a special challenge when it comes to scientific research, especially in today's modern conditions of life that redefine the former system of values and way of life, promoting a different socialization in which the role of the family, school and peers is substantially changed. GOAL OF THE PAPER: The aim of the research was to understand the attitudes and behavior patterns among young people considering the studied parameters and to determine the possible difference between the medical school students and students of other high schools. METHOD: The first part contains the results of research on tobacco smoking, alcohol, drugs, gambling and free time among third grade students of Zajecar high schools. Survey was used in this research. The initial hypothesis: Students of medical school are more aware of the consequences of risky behaviors than the students of other high schools. RESULTS: When we talk about tobacco smoking, more than 75% of all high school students finds that more than half of the total number of students smoke tobacco. The number of regular smokers is larger in the medical school compared to other schools surveyed. When it comes to the perception of students about taking psychoactive substances, data obtained is not encouraging. The opinion of the respondents is that over 60% of students consume marijuana. The medical school has a slightly higher percentage of alcohol consumers. A disturbing fact is that going out at night in over 70% of respondents is not time restricted. The second part includes the views and opinions of elementary school students aged 10 to 13 on satisfaction with life in their city. Responses were very well processed through a couple of categories. In this regard, children have demonstrated their competence in assessing the underlying shortcomings and problems of city life. This part of the paper is a small attempt "to have their voices heard" and to become visible at least for a moment. CONCLUSION: Young people today are caught in the web of wide array of different contents offered by modern society. Also, the time paradigm is changed that characterized the young in the previous time, i.e., the "boundary of their duration" is changed. KEYWORDS: youth, modern society, attitudes, behavior patterns
ZNAČAJ JODA ZA ZDRAVLJE I ZABLUDE U VEZI SADRŽAJA JODA U ZELENIM ORASIMA
Nebojša Paunković, Džejn Paunković
Poliklinika „Paunković“, Zaječar
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Uvod: Za normalan rast i razvoj ljudskog organizma, jod je jedan od 22 oligoelementa koji je od vitalnog značaja. Jod je oligoelement koji se u našem organizmu ne sintetiše, nego se hranom mora unositi u organizam. Oko 60% joda u ljudskom telu se skladišti u štitnoj žlezdi. Jod ima veoma važnu ulogu u normalnom funkcionisanju štitne žlezde i u optimalnom iskorišćavanju unetih kalorija.
Materijal i metode: U radu koji će biti prezentovan prikazaćemo značajna saznanja o jodu, osnovne osobine ovog elementa, gde se nalazi u prirodi, njegovu ulogu u organizmu, posebno u štitastoj žlezdi.
Diskusija: Zbog malog sadržaja joda u vodi i hrani u većini regiona sveta, nastaju posledice u ljudskom i životinjskom organizmu, prikazaćemo posledice nedostatka joda. U radu koji prezentujemo skrećemo pažnju na značajne aktivnosti koje su preduzete da se ne dogodi da nema dovoljno joda za funkcionisanje ljudskog organizma. Ukazaćemo na značaj jodiranja kuhinjske soli.
Posebno smo obradili koje mesto zauzimaju mladi orasi u ovoj oblasti. Prikazaćemo da li je tačno da oni sadrže jod. Kako i zašto koristi narod ove činjenice, a kako farmaceutska industrija.
Zaključak: Izuzetno je važno sa hranom svakodnevno unositi jod. Bez njega nema normalnog funkcionisanja ljudskog organizma. Narodna saznanja su jako važna i ukazujemo posebno na ulogu i prisustvo joda u mladim orasima, odnosno zablude u vezi toga.
THE MISTAKES CONECTED WITH THE CONTECTS
OF IODINE IN “GREEN” WALNAT
Nebojsa Paunkovic and Jane Paunkovic
Polyclinic “Paunkovic” in Zajechar
In this article we have briefly presented knowledge connected with iodine: date of this discovery and the name of discoverer, the basic characteristic of this element, its contents in nature, and the role in the body, special in thyroid gland.
About of small content of iodine in water and food in most of world region and as a consequence in human and animal organism (endemic appearance of iodine deficit ), we have payed attention on significant human activity concerned to augmentation of food (salt chiefly) by iodine.
At the end we have present the place which have the walnut in this field – is it true that green walnut because have some quality as colored the skin and and cause damage of fingers –
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PREDŠKOLSKE USTANOVE PRIJATELJI PRAVILNE ISHRANE - OD IDEJE DO REALIZACIJE INICIJATIVE
Dragana Stojisavljević1, Miodrag Marjanović1, Ljiljana Stanivuk1, Slađana Šiljak1, Jelena Niškanović,1Janja Bojanić1,
1. Institut za javno zdravstvo Republike Srpske
Uvod: Predškolske i školske ustanove nude mnoge mogućnosti za promociju modela pravilne i uravnotežene ishrane i fizičke aktivnosti i potencijalna su pristupna tačka za uključivanje roditelja i članova zajednice u prevenciju svih oblika malnutricije i hroničnih bolesti, povezanih sa ishranom. Cilj rada je prikazati implementaciju inicijative Svjetske zdravstvene organizacije “Škole/predškolske ustanove prijatelji pravilne ishrane” u Republici Srpskoj. Metod: U radu je korišten deskriptivni metod, a kao izvori podataka korišteni su izvještaji o praćenju i evaluaciji implementacije inicijative “Škole/predškolske ustanove prijatelji pravilne ishrane” u Republici Srpskoj. Rezultati: Implementacija inicijative otpočela je u oktobru mjesecu 2014. godine. Obuhvaćeno je 22,0% (9) predškolskih ustanova u javnom sektoru i 2,0% (1) u privatnom sketoru. Ciljnu populaciju koja je bila uključena u implementaciju inicijative činili su prosvjetni radnici, psiholozi, pedagozi, rukovodioci, predstavnici lokalne zajednice, djeca koja pohađaju predškolsku ustanovu i osobe koje rade na pripremi i distribuciji hrane u predškolskim ustanovama. U toku implementacije razvijeni su instrumenti za održivost inicijative prema modelu SZO i Standardi i normativi ishrane za djecu predškolske dobi. Implementacija je podržana od resornih ministarstava, izrađen je i objavljen novi Zakona o predškolskom vaspitanju i obrazovanju i pravilnik koji definiše oblast ishrane, zdravstvene i socijalne zaštite djece u predškolskim ustanovama. Zaključak: Od pet predškolskih ustanova koje su bile uključene u prvu fazu implementacije inicijative, u periodu od 2014. do 2016., nakon izvršene evaluacije samo jedna predškolska ustanova je stekla priznanje “Predškolska ustanova prijatelj pravilne ishrane”. Četiri ustanove iz druge faze će biti evaluirane u drugoj godini implementacije inicijative. Ključne riječi: predškolske ustanove prijatelji pravilne ishrane, ishrana, promocija zdravlja
NUTRITION FRIENDLY PREESCHOOLS INITIATIVE- FROM IDEA TO REALIZATION
Dragana Stojisavljević1, Miodrag Marjanović1, Ljiljana Stanivuk1, Slađana Šiljak1, Jelena Niškanović,1Janja Bojanić1,
1. Public Health Institute Republic of Srpska
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Introduction: Pre-school and school institutions offer many opportunities to promote healthy dietary and physical activity patterns. They are potential access point for engaging parents and community members in prevention of all forms of malnutrition and nutrition related chronic diseases. Aim of this paper is to present implementation of World Health Organization “Nutrition friendly preschools initiative” in Republic of Srpska. Method: Descriptive method was used, main source of data are reports related with monitoring and evaluation of implementation “Nutrition friendly preschools initiative” in Republic of Srpska. Results: Implementation of initiative started in October 2014. There were included 22,0% (9) preschool institutions in public sector and 2,0% preschool institutions in private sector. Target population of initiative were teachers, psychologists, pedagogues, managers of preschool institutions, representatives of local communities, children who attend preschool institution and professionals who work on preparation and distribution of food in preschools. During implementation there were developed instruments for sustainability of initiative, according to model of WHO, and nutrition normative for preschool children. Implementation was carried out with the support of ministries. Low on preschool education and Regulations on nutrition, health and social protection of children in preschool institutions were developed and launched. Conclusions: Out of five preschool institutions, that were included in first phase of implementation of initiative from period of 2014 to 2016, only one preschool institution gained recognition “Nutrition friendly preschool” after completed evaluation. Other four preschool institutions will be evaluated during second year of initiative implementation. Key words: nutrition friendly preschools, nutrition, health promotion
GENERISANA KOLIČINA I UPRAVLJANJE MEDICINSKIM OTPADOM U REPUBLICI SRBIJI – PREGLED
Radmila Šerovića, Ivana Jelićb*, Mesud Adžemovićb, Dragana Drobnjakb aMinistarstvo poljoprivrede i zaštite životne sredine – Republika Srbija, Beograd, Srbija bFakultet za primenjenu ekologiju – Futura, Singidunum Univerzitet, Beograd, Srbija
APSTRAKT
U poslednje vreme, u svetu se ulažu veliki napori u poboljšanju upravljanja medicinskim otpadom (MO). Zdravstveni i veterinarski sektori proizvode različite vrste otpada, čiji se najveći deo zbrinjava na isti način kao komunalni otpad, dok se manji deo označava kao opasan. U svetu uopšte, postoji ozbiljan nedostatak pouzdanih podataka o generisanju i karakterizaciji svih vrsta otpada, što značajno otežava rešavanje problema njegovim upravljanjem. Tehnologija tretmana i odlaganja otpada trebalo bi da bude usmerena ka smanjenju negativnih posledica po životnu sredinu i ljudsko zdravlje, odnosno prema povećanju održivosti. Cilј ovog istraživanja je procena trenutnog stanja generisanja i upravljanja opasnim medicinskim otpadom u svrhu određivanja potrebnih koraka za unapređenje upravlјanja opasnim medicinskim otpadom u Srbiji. Eksperimentalni podaci dobijeni su anketiranjem, analizom dostupnih podataka, monitoringom, metodom slučajnog uzorka i ekstrapolacijom dobijenih rezultata. Na ovaj način procenjena je dinamika stvaranja MO uz dovoljnu pouzdanost za dalje planiranje njegovim upravljanjem.
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U Srbiji u 2014. godini generisana je 2.931 tona otpada iz zdravstvene zaštite lјudi, odnosno životinja i s tim povezanih istraživanja, gde su 2.682 tone okarakterisane kao opasni otpad. Na osnovu podataka Ministarstva polјoprivrede i zaštite životne sredine u 2014. godini tretirano je ukupno 2.148 tona, uglavnom infektivnog MO. Neodgovarajuće upravlјanje medicinskim otpadom je značajan problem usled nerazdvajanja otpada na licu mesta, odnosno u zdravstvenim ustanovama. Upravljanje MO predstavlja ozbiljan faktor zaštite životne sredine i postaje sve veći javni problem. Sprovedena istraživanja pokazuju da upravljanje MO mora da bude adekvatnije organizovano, sa izričitim kriterijumima, tehnologijama i strogom evidencijom. Ključne reči: medicinski otpad, opasan otpad, upravljanje
GENERATED QUANTITY AND MEDICAL WASTE MANAGEMENT IN THE REPUBLIC OF SERBIA – A REVIEW
Radmila Serovica, Ivana Jelicb*, Mesud Adzemovicb, Dragana Drobnjakb aMinistry of Agriculture and Environmental Protection – Republic of Serbia, Belgrade, Serbia bFaculty of Applied Ecology – Futura, Singidunum University, Belgrade, Serbia
ABSTRACT
Great efforts have, as of lately, been invested in improvement of medical waste (MW) management. Healthcare and veterinary sectors produce different kinds of waste, most of which is being managed in the same way as a municipal waste, while a smaller part of that waste is being marked as hazardous. Generally, there is a worldwide, serious shortage of reliable data on generation and characterization of all waste types, making the solving of waste treatment problem significantly more difficult. Treatment technology and waste disposal should be directed towards reduction of negative consequences to the environment and human health, and/or towards the increase of sustainability. The aim of this research is actual state estimation concerning generation and hazardous medical waste management with the object of determining the necessary steps for improvement of hazardous medical waste management in Serbia. Experimental data are obtained by means of poll, available data analysis, as well as by monitoring, random sample method and by extrapolation of obtained results. In this way, MW generation dynamics has been evaluated with sufficient reliability for further waste management planning. Waste quantity of 2,932 t was generated in Serbia in the year of 2014, originating from human healthcare, and/or animals and related research, while the quantity of 2,682 t was characterized as hazardous waste. According to data obtained from the Ministry of Agriculture and Environmental Protection, waste quantity of 2,148 t was treated in year 2014, consisting mainly of infectious MW. Inappropriate medical waste management is a significant problem due to lack of waste separation on the spot, and/or, within healthcare institutions. MW management presents a serious factor of environmental protection and it becomes an ever growing, public problem. Conducted researches indicate the necessity of more adequately organized MW management, with explicit criteria, technologies and strict record keeping. Keywords: medical waste, hazardous waste, management
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SANITARNO-HIGIJENSKO STANJE OBJEKATA ZA DRUŠTVENU ISHRANU OTVORENOG TIPA U ZLATIBORSKOM OKRUGU VIOLETA PROŠIĆ
ZAVOD ZA JAVNO ZDRAVLJE UŽICE
Objekti za društvenu ishranu otvorenog tipa su funkcionalno povezani, posebno uređeni i opremljeni prostori koji ispunjavaju tehničke i sanitarno-higijenske uslove za obavljanje ugostiteljskih delatnosti. Opšti principi ovih objekata proističu iz velikog epidemiološkog značaja hrane i higijene objekata i neophodnosti prevencije alimentarnih infekcija, toksikoinfekcija i intoksikacija.
Cilj rada je da se na osnovu analize opštih elemenata sanitacije prikaže sanitarno- higijensko stanje i izvrši procena bezbednosti hrane sa mikrobiološkog aspekta, u objekatima za društvenu ishranu otvorenog tipa Zlatiborskog okruga, s obzirom na njihov veliki zdravstveni, ekonomski, socijalni i turistički značaj.
Istraživanja: Rad obuhvata analizu sanitarno-higijenskih parametara u 52 hotela i restorana u Zlatiborskom okrugu u periodu 2014.-2016.godine.
Materijal i metodologija rada: Opšti elementi sanitacije u ugostiteljskim objektima sagledani su lokalnom inspekcijom i obuhvatili su kuhinjski, trpezarijski i magacinski blok. Dinamika uzorkovanja namirnica i briseva regulisana je godišnjim Planom i programom Centra za higijenu. Bakteriološko ispitivanje i ocena ispravnosti namirnica i briseva obavljeni su u skladu sa važećom zakonskom regulativom.
Rezultati: u periodu 2014.-2016.god obavljena je bakteriolška analiza 868 namirnica, 2907 briseva posuđa, pribora i radnih površina i 1120 briseva ruku osoblja zaposlenog u kuhinjskom bloku u ugostiteljskim objektima. 32 namirnice (3,69%), 72 brisa posuđa, pribora, radnih površina (2,48%) i 92 brisa ruku (8,21%) ne zadovoljavaju mikrobiološke kriterijume u odnosu na važeću zakonsku regulativu.
Zaključak: Sanitarno-higijensko stanje u ugostiteljskim objektima u Zlatiborskom okrugu je zadovoljavajuće. Na godišnjem nivou uočava se trend smanjenja broja bakteriološki neispravnih uzoraka namirnica i briseva kao rezultat redovne kontrole i premene predloženih mera.
Ključne reči: objekti za društvenu ishranu, Zlatiborski okrug
SANITARY- HIGIENIC CONDITIONS OF FACILITIES FOR SOCIAL NUTRITION OPEN IN THE ZLATIBOR DISTRICT
VIOLETA PROŠIĆ
INSTITUTE OF PUBLIC HEALTH UZICE
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Facilities for social nutrition open are functionally linked, especially decorated facilities equipped with technical and sanitary devices required for the performance of hospitality activities. General sanitation principles of these objects derive from a large epidemiological importance of food and hygiene facilities and the necessity of preventing foodborne infection, toxic infections and intoxication.
The goal:The aim is that based on the analysis of the general elements of sanitation displayed sanitary-hygienic condition and carry out assessments of food safety from a microbiological point of view, the facilities for social nutrition open Zlatibor District, given their major health, economic, social and tourist importance.
Research:Research includes analysis of sanitary and hygienic parameters in 52 hotels and restaurants in the Zlatibor District in the period 2014 to 2016.
Material and methodology:General elements of sanitation in restaurants were viewed by local inspection in areas of the kitchen, dining and storage block. Bacteriological examination and evaluation of safety of food and smears were performed in accordance with current legislation.
Results:During the period from 2014. to 2016. bacterial analysis was performed on 868 food items, 2907 swabs dishes, utensils and work surfaces and hand swabs of 1120 staff working in the kitchen block in restaurants. Following items did not meet microbiological criteria as per current regulations: 32 food items (3.69%), 72 swabs of dishes, utensils, and work surfaces (2.48%) and 92 hand swabs (8.21%).
Conclusion:The sanitary-hygienic state of the restaurants in the Zlatibor District is satisfactory. At the annual level we can see the trend of reducing the number of defective bacteriological food samples and swabs as a result of regular check-ups and transformations of the proposed measures.
Keywords:Facilities for social nutrition, Zlatibor District
АНАЛИЗА ВОДОСНАБДЕВАЊА У СЕОСКИМ СРЕДИНАМА НА ПОДРУЧЈУ ЈУЖНОБАНАТСКОГ ОКРУГА
С.Ђурић, А. Перовић, Н. Ђуровић, Н. Томић
Завод за јавно здравље Панчево
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Циљ рада је да пружи процену стања водоснабдевања у сеоским срединама на подручју Јужнобанатског округа, узимајући у обзир здравствену исправност воде за пиће и санитарни надзор над водоводима.
Испитиван је квалитет воде за пиће из малих водних система и индивидуалних водних објеката уз санитарни надзор на територији Јужнобанатског округа.
У априлу и мају 2016. године је испитано 36 узорака воде за пиће у сеоским подручјима. Санитарни надзор изворишта и диструбитивне мрежи вршен је помоћу стандардизованих упитника. Анализом физичко-хемисјких параметара неисправно је 29 узорака или 80,6 % због повећане концентрације мангана, амонијака, мутноће, боје, мириса, арсена, нитрата и проводљивости. Закључак: Важно је да се континуирано контролише вода за пиће у сеоским подручјима, да се направе посторојења за пречишћавање воде, да се повећа санитарни надзор и успоставе зоне санитарне заштите постојећих изворишта. Кључне речи: вода за пиће, санитарни надзор, манган, арсен
HEALTH SAFETY OF DRINKING WATER IN RURAL AERAS OF SOUTH BANAT DISTRICT
S.Đurić1, A. Perović1, N. Đurović1, N. Tomić1
1Institute of Public Health Pancevo
Purpose of work is to provide an assessment of the state of water supply in rural areas in the territory of South Banat districts, taking into account the safety of drinking water and sanitary control of water utilities.
The quality of drinking water is tested from small water systems and individual facilities with sanitary control on the territory of South Banat district.
We tested 36 samples of drinking water in rural areas in April and May 2016. Sanitary control of water sources and distrubitivne network was carried out using a standardized questionnaire. Analysis of the chemical-physical parameters incorrect samples are 29 or 80.6% due to the increased manganese concentration, ammonia, turbidity, color, odor, arsenic, nitrates and conductivity.
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Conclusion: It is important to continuously control the drinking water in rural areas, to create water treatment plant, to increase the sanitary control and the establishment of zones of sanitary protection of existing water sources.
Key words: drinking water, sanitary control, manganese, arsenic
ЈАВНО-ЗДРАВСТВЕНИ ЗНАЧАЈ ВОДОСНАБДЕВАЊА У ЗАЈЕЧАРУ ОД 2012 ДО 2016. ГОДИНЕ
Дијана Миљковић, В. Ангелов, М. Величковић, В. Марушић, Н. Јовановић
Завод за јавно здравље "Тимок" Зајечар
Увод: Становништво града Зајечара снабдева се водом за пиће на три начина, са градског водовода, сеоских водовода и из других водних објеката (бунари, дубинске чесме, каптирани извори и др.). Завод за јавно здравље „Тимок“ Зајечар, врши контролу здравствене исправности воде за пиће, сходно одредбама Правилника о хигијенској исправности воде за пиће (Сл. Лист СРЈ, бр. 42/98 и 44/99).
Циљ рада је приказ резултата здравствене исправности воде за пиће у периоду од 2012 до 2016. године у Зајечару.
Материјал и методологија рада: Коришћена дескриптивна метода а извор података су Извештаји о здравственој исправности воде за пиће.
Резултати истраживања: У периоду од 2012 до 2016.године, у Зајечару је извршено узорковање и анализа 3670 узорака воде за пиће, 2656 из градског водовода, од који је 10 (0,37%) било бактериолошки неисправно и 27 (1,01%) физичко-хемијски неисправно. Код сеоских водовода, од укупно 670 узорака, 280 (41,79%) бактериолошки неисправно и 124 (18,50%) физичко-хемијски неисправно, док код других водних објеката, од укупно 344 узорака, 16 (4,65%) било је бактериолошки неисправно и 63 (18,26%) физичко-хемијски неисправно.
Закључак: Здравствено неисправна вода за пиће представља пут преношења заразних болести, стога систематска контрола здравствене исправности воде за пиће је јако битна. Велики значај има код сеоских водовода обзиром да је здравствена неисправност воде велика, како у бактериолошком тако и у физичко-хемијском погледу.
Кључне речи: вода за пиће, здравствена исправност, здравље људи
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THE PUBLIC-HEALTH SIGNIFICANCE OF WATER SUPPLY
IN ZAJECAR FROM 2012 UNTIL 2016.
Dijana Miljkovic, V.Angelov, M.Velickovic, V.Marusic, N.Jovanovic
Institute of Public Health "Timok" Zajecar
Introduction: The population of Zajecar is supplied with drinking water in three ways, from the city water supply system, rural water supply system, and from other water facilities( well, deep fountains, capped water sources, etc.). Institue of Public Health "Timok" Zajecar performs a safety check-up(control) of drinking water, under the provisions of the Regulations of Hygienic Safety of drinking water (Fig. Paper, SRJ, br. 42/98 and 44/99).
The goal of this work is to display the results of hygienic safety of drinking water from 2012 until 2016. in Zajecar.
Materials and the Methodology of this work: A descriptive method as well as the source of data that was used, are the Results of hygienic safety of drinking water.
The results of research: From 2012 until 2016., the sampling and analysis of 3670 samples of drinking water was conducted, here in Zajecar, 2656 from the city water supply system, from which 10(0,37 %) was bacteriologically incorrect, and 27(1,01%) was physically and chemically incorrect.
With rural water supply systems, from total of 670 samples, 280(41,79%) was bacteriologically incorrect, and 124 (18,50%) was physically and chemically incorrect, while with other water facilities, with the total of 344 samples, 16(4, 65%) was bacteriologically incorrect, and 63(18, 26%) was physically and chemically incorrect.
Conclusion: Unhealthy drinking water represents the transmission of infectious diseases, thereforea systematic control of water safety is very important. It has a huge significance for rural water systems, considering that the rural water is not safe at all, in bacteriological, physical and chemical sense.
Key words: drinking water, water safety, the health of people.
INDUSTRIJSKI KONTAMINIRANI LOKALITETI U SRBIJI - RAZLOG ZA BRIGU?
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Prim.mr sci.med. Branislava Matić, Institut za javno zdravlje Srbije "Dr Milan Jovanović Batut"
Dr med. Snežana Dejanović, Institut za javno zdravlje Srbije "Dr Milan Jovanović Batut"
REZIME
UVOD: S obzirom da industrijski pogoni produkuju višestruku kontaminaciju sa kompleksnim zdravstvenim efektima kod izložene populacije, industrijski kontaminirani lokaliteti (IKL) imaju široki javno-zdravstveni značaj. Rudarstvo i metalurgija, kao i petrohemija imaju dominantnu ulogu u ekonomiji Srbije, te su izabrani IKL metaloprerađivačkog kompleksa u Boru, rudnika uglja i termoelektrana, rudnika i topionice antimona u Zajači i petrohemijski kompleks u Pančevu. Prisustvo As i Cd u PM10 ambijentalnog vazduha u blizini IKL bitan su javnozdravstveni problem, jer su teški metali i metaloidi prirodno prisutni u obe rude.
CILJ: Prepoznavanje javno-zdravstvenih pretnji poreklom od industrijske konatminacije.
METODOLOGIJA: Prezentovani su podaci Agencije za životnu sredinu Srbije, Instituta za rudarstvo i metalurgiju iz Bora, Gradskog zavoda za javno zdravlje Beograd. Ove stanice deo su Nacionalne mreže automatskih mernih stanica za kontinuirani monitoring. Humani biomonitoring sproveden je merenjem koncentracija olova u krvi dece koja žive u blizini topionice u Zajači u 2012. i 2013. godini.
RESULTATI: Koncentracije As u PM10 iznad GV u Boru i Lazarevcu, sa blago povećanim vrednostima Cd u Boru. Koncentracija olova u krvi dece koja žive u blizini topionice u Zajači u značajnoj su korelaciji sa blizinom adrese stanovanja u odnosu na topionicu, kod potpuno izložene dece.
ZAKLJUČAK: Iako izmerene koncentracije polutanata ukazuju na neophodnost reagovanja, Srbiji nedostaje zakonski okvir za institucionalizaciju praćenja uticaja izloženosti opasnim materijama iz životne sredine (Hg, As, Pb), posebno osetljivih populacionih grupa.
KLJUČNE REČI: industrijski kontaminirani lokaliteti, javno zdravlje, humani biomonitoring
INDUSTRIALLY CONTAMINATED AREAS IN SERBIA - REASON TO WORRY
Prim. mr sci.med. Branislava Matić, Institute of Public Health of Serbia "Dr Milan Jovanović Batut"
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Dr med. Snežana Dejanović, Institute of Public Health of Serbia "Dr Milan Jovanović Batut"
ABSTRACT
BACKGROUND: Industrially contaminated sites (ICS) are of high concern from Apublic health perspective, since industrial plants may produce a widespread contamination that can result in several health impacts on the population living in their neighbourhood. Due to the dominance of coal and ore mining and metal-processing in the economy of Serbia, we chose ICS of copper industry in Bor, coal mines and power plants, antimony mining-smelting complex in Zajača and a petrochemical plant in Pančevo. Key public health issue is presence of As and Cd in ambient air PM10 close to ICS due to the fact that both ores have high naturally ocurring contents of heavy metals and metaloids.
AIM: Key objective is focusing on recognized public health hazards originating from industrial contamination.
METHODOLOGY: Data originated from Serbian Environmental Protection Agency, Mining and Metallurgy Institute Bor, Belgrade Institute of Public Health, as part of continuous measurement of air quality within National network of automatic stations. Human biomonitoring was performed for blood in lead in children living in Zajača in 2012 and 2013.
RESULTS: Concentrations of As in PM10 are above the limit value in Bor and Lazarevac, with Cd values slightly increased in Bor. Blood lead levels in children exposed to lead from Zajača smelter strongly correlated with the vicinity of home addres from the smelter in totally exposed children.
CONCLUSION: Serbia lacks legal framework for continuous and institutionalized follow-up of population groups vulnerable to hazardous environmental exposure (Hg, As, Pb), although measured concentration indicate urgent need for such activities.
KEYWORDS: industrially contaminated sites, public health, human biomonitoring
МОГУЋНОСТИ И ПЕРСПЕКТИВЕ ПРИМЕНЕ ГЕОИНФОРМАТИКЕ У ЖИВОТНОЈ СРЕДИНИ Никола Јовановић, С. Лазаревић, Р. Јовановић, Д. Миљковић Завод за јавно здравље „Тимок“ Зајечар
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Увод: Са развојем информационих система, у последњих двадесетак година, успоставиле су се многе базе података везане за параметре животне средине. Постигнут је напредак у складиштењу података у електронском облику. Међутим, животна средина као спрега разноврсних научних дисиплина има потребу за систематизацијом података. Актуелно је селективно прикупљање података, зависно од намене. Ово захтева да се у наредном периоду изврши систематизација свих података доступних за квалитетнији и савременији рад.
Циљ: Овим радом се приказује предност повезивања база података параметара животне средине са визуелним приказом на геопростору са циљем пружања информација које су лако доступне широј јавности.
Методологија рада: Метода дескрипције.
Резултати истраживања: Подаци о параметрима животне средине су бројни и разноврсни. Из искуства Завода, исти подаци (о квалитету ваздуха, воде из базена, отпадних вода, воде за пиће итд.) шаљу се у различитом облику на неколико места: у Министарство пољопривреде и заштите животне средине, у Институт за јавно здравље Србије „Батут“, у Агенцију за заштиту животне средине, локалним самоуправама. Збирни извештаји настали систематизовањем достављених података нису увек доступни јавности, објављују се након дугог временског периода због трајања обраде, тешко се проналазе, и немају објашњење међусобног садејства геоморфолошких, хидролошких, климатолошких, демографских, економско-географских и политичко-географских утицаја на живот и здравље људи.
Закључак: Геоинформатика пружа алате да се велика количина података о простору прикаже у визуелном, једноставном и кориснику блиском облику, повезујући податке са територијом настанка. Тако приказани подаци постају лако доступне информације и пружају могућност предвиђања, превентивног и куративног деловања на живот и здравље људи.
Кључне речи: геоинформатика, животна средина, геопростор, подаци, информације
OPPORTUNITIES AND PROSPECTS OF APPLICATION GEOINFORMATICS IN THE ENVIRONMENT
Nikola Jovanovic, S.Lazarevic, R. Jovanovic, D. Miljkovic
Public Health Institute „Timok“ Zajecar
Introduction: During the last twenty years, many databases related to environmental parameters were establishing, as the information systems developed. Storage of data in electronic format reached great progress. However, the environment as a variety of scientific disciplines, has a need
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Aim: The aim is to show the advantage of linking database of environmental parameters with a visual display of the geographic space, in order to get easily accessible information.
Methodology: The method of description.
Research results: Data of environmental parameters are numerous and varied. From the experience of our Institute, same information (about air quality, water from swimming pools, wastewater, drinking water, etc.) are submited in different form to several places: Ministry of Agriculture and Environmental Protection, Institute of Public Health of Serbia "Batut", Agency for Environmental Protection, local governments. Cumulative reports, which are systematization of these data, are not always available to the public. Also, they are publishing after a long period of time due to the long processing, and it is hard to find them. However, they do not contain an explanation of mutual synergies of geomorphological, hydrological, climatological, demographic, economic and geographical impact on human life and health.
Conclusion: Geoinformatics provides tools for displaying large amounts of spatial data in the visual, simple and in the form close for user, linking data with the territory of the occurrence. Thus the present data becomes easily available information, and provide the ability to predict preventive and curative action on human life and health.
Keywords: geomatics, environmental, geospatial data, information
ENDOKRINI DISRUPTORI I ZDRAVLJE DECE
Dr med. Snežana Dejanović, Institut za javno zdravlje Srbije "Dr Milan Jovanović Batut"
Mr sc. med. Branislava Matić, Institut za javno zdravlje Srbije "Dr Milan Jovanović Batut"
Mr sc. med. Zorica Jovanovski, Institut za javno zdravlje Srbije "Dr Milan Jovanović Batut"
REZIME
UVOD: Endokrini disruptori (endocrine disrupting chemicals dalje EDCs,) su egzogene supstance koje ometaju sintezu, oslobađanje, metabolizam, vezivanje, dejstvo i/ili eliminaciju hormona (estrogena, androgenih i tiroidnih hormona) u intaktnom organizmu ili njegovom potomstvu. Izložernost endokrinim disruptorima dcec iz životne i školske sredine je u stalnom porastu
CILJ: Prikaz uticaja endokrinih disruptora na zdravlje dece na osnovu dosadašnjih rezultata biomonitoringa
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METODOLOGIJA: Pregled dostupne stručne i naučne literature o reproduktivnoj toksičnosti endokrinih disruptora (MEDLINE baza podataka, do marta 2017)
REZULTATI: Brojne epidemiološke studije sve više potvrđuju negativni uticaj EDCs na zdravlje, posebno u vulnerabilnim životnim periodima (fetalni rast i razvoj, perinatalni period, detinjstvo i pubertet): povećana učestalost genitalnih malformacija (hipospadija, kriptorhizam), promene u vremenu početka i toka pubertetskog razvoja, poremećaji funkcije tiroidne žlezde, poremećaji neurološkog razvoja, imunološkog i metaboličkog sistema. Utvrđena je povezanost prenatalne ekspozije EDCs, kroz povećane urinarne ftalatne metabolite majki. i niže gestacijske starosti kao i smanjene anogenitalne distanace kod muške novorođenčadi. Povišena vrednost nekih EDCs u majčinom mleku direktno je asocirana sa rizikom od kriptorhizma. Potvrđena je povezanost povišenih nivo urinarnih ftalatnih monoestara i prevremene telarhe kod devojčica kao i pojave prevremenog puberteta kod oba pola. Međutim, rezultati mnogih sprovedenih istraživanja nisu konzistenti te je neophodno sprovođenje dobro dizajniranih studija koje će upotrebom adekvatnih biomarkera, izvršiti i procenu ekspozicije i efekta na zdravlje.
ZAKLJUČAK:. Načini za smanjenje izloženosti edokrinim modulatorima dece u životnom i školskom okruženju, su zakonski regulatorni mehanizmi, sprovođenje sistemskog monitoringa EDCs i humanog biomonitoringa.
KLJUČNE REČI: endokrini disruptori, zdravlje dece, biomonitoring
ENDOCRINE DISRUPTING CHEMICALS AND CHILD HEALTH
Dr med Snežana Dejanović, Institute of Public Health of Serbia "Dr Milan Jovanović Batut"
Mr sc. med. Branislava Matić, Institute of Public Health of Serbia "Dr Milan Jovanović Batut"
Mr sc. med. Zorica Jovanovski, Institute of Public Health of Serbia "Dr Milan Jovanović Batut"
ABSTRACT
BACKGROUND:: Endocrine disrupting chemicals (EDCs) are exogenous substances that interfere with the synthesis, secretion, metabolism, transport, activity and/or elimination of hormones (estrogen, androgen and thyroid hormones) in an intact organism, or its offspring.. Widespread children exposure to EDCs is multi-source and multi-pathway and have increased trends
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AIM: Reviewing the influence and effects of EDCs on child health based on recent reports on human biomonitorig results.
METHODOLOGY: The MEDLINE databases were searched until March 2017 for studies on toxicity of endocrine disrupting chemicals
RESULTS: Numerous epidemiological studies confirmed a negative impact on health of EDCs, in particularly vulnerable life periods (fetal development, perinatal life, childhood and puberty): increased incidence of genital malformations (cryptorchidisms, hypospadias), effects on earlier onset and progression of puberty, disorders of thyroid function, adverse neurological, metabolic and immune effects Prenatal exposure was associated with reduced fetal growth and decreased anogenital distance in male newborns. Increased level of some urinary EDCs metabolites was correlated with premature telarche and both gender pubertas praecox However, results of many studies have been inconsistent and there is need for well-designed studies that measure exposure - response, using adequate biomarkers of exposure and effect.
CONCLUSION: Effective ways to decrease childhood environmental exposure to EDCs and reducing risk should be at the regulatory level, with systematic monitoring of EDCs and human biomonitoring
KEYWORDS: endocrine disruptors, child health, biomonitoring
PRELIMINARNI REZULTATI MONITORINGA ALERGENOG POLENA U SOKOBANJI ZA 2016. GODINU
Milijana Vučković, Dijana Miljković, Srđan Đergović, Radomir Vidanović, Dragan Paunović
Zavod za javno zdravlje “Timok” Zaječar
Uvod: U radu su prikazani rezultati na osnovu jednogodišnjeg monitoringa koncentracije alergenog polena na teritoriji Opštine Sokobanja.
Cilj rada: Prikaz dobijenih rezultata nakon jednogodišnjeg merenja.
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Istraživanje: Istraživanje je vršeno u periodu uzimanja uzoraka za 2016. godinu. Počelo je 01.02.2016. godine, od 5. kalendarske nedelje, i trajalo je do kraja oktobra, do 44. kalendarske nedelje.
Materijal i metodoligija rada: Prikupljeni uzorci “Klopkom za polen” pripremani su i mikroskopirani u laboratoriji Zavoda za javno zdravlje “Timok” Zaječar, gde je vršena kvalitativna i kvantitativna analiza polenovih zrna.
Najvažniji rezultati istraživanja: U jednogodišnjem merenju zastupljene su tri sezone polinacije koje se međusobno preklapaju: sezona drvenastih biljaka, sezona trava i sezona korovskih vrsta. Najveći broj dana 50 sa koncentracijama alergenog polena iznad MDK bio je u sezoni drvenastih biljaka. Kao alergeni polen pojavljuju se: leska, tisa, tuja, čempres, jova, topola, javor, vrba, breza, grab, orah, hrast, bor i bukva. U ovoj grupi najjače alergeno dejstvo ima polen breze, on je bio iznad MDK 23 dana. Polen trave bio je u povećanij koncentraciji 25 dana od sredime maja do sredine jula. Polen ambrozije, kao korovske vrste, bio je u povećanoj koncentraciji 16 dana u drugoj polovini avgusta i prvoj polovini septembra.
Zaključak: Jednogodišnja merenja ne mogu da daju pravu sliku i karakteristike polinacije na godišnjem nivou, koja zavisi od niza ekoloških faktora, koji su promenljivi. Merenja na jednoj teritoriji treba da traju 5 - 10 godina da bi se dobila prava slika o polinaciji na osnovu koje možemo da predvidimo i damo prognozu polenisanja unapred. Obaveštavanje građanstva o prognozi polenisanja ima veliku ulogu u prevenciji.
Ključne reči: Alergeni polen, Sokobanja, zdravlje ljudi
PRELIMINARY RESULTS OF MONITORING POLLEN U SOKOBANJA
FOR THE YEAR 2016
Milijana Vučković, Dijana Miljković, Srđan Đergović, Radomir Vidanović, Dragan Paunović
Institute of Public Health "Timok" Zaječar Introduction: This work presents the results based on the one-year monitoring the concentration of pollen in the municipality of Sokobanja.
Aim: To show results of one year pollen measurement.
Research: The research includes sampling period for 2016. It started 01.02.2016. year ( from fifth calendar week) and lasted until the end of October (44th calendar week).
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The material and the methodology of work: Samples were collected with "Pollen Trap". They were prepared, studied through a microscope and qualitatively and quantitatively analized in the laboratory of the Institute of Public Health "Timok" Zaječar.
The most important results of the research:One year measurement represented three seasons of pollination, which overlap: Season of woody plants, season of herbs and season of weed species. The highest number of days with 50 pollen concentrations, above the MAC was the season of woody plants. As pollen allergens appears: hazel, yew, thuja, cypress, alder, poplar, maple, willow, birch, hornbeam, walnut, oak, pine and beech. In this group,the most allergenic pollen has birch fact, it was above MAC 23 days. Grass pollen was in elevated concentration 25 days, from the middle of May to the middle of July. Ragweed pollen, and weed species, was the increased concentration of 16 days in the second half of August and early September.
Conclusion: One-year measurements may not give a true picture of the characteristics of pollination, which depends on a number of environmental factors that are variable. Measurements in one territory should last 5 - 10 years to get a true picture of pollination, so we can predict and give pollinations advance. Informing the public about the prognosis of pollination plays a major role in prevention.
Keywords: pollen allergens, Sokobanja, health
GORDIUS AQUATICUS U VODI ZA PIĆE I VODI ZA SPORT I REKREACIJU
Dragan Paunović, Milijana Vučković
Zavod za javno zdravlje “Timok” Zaječar
Uvod: Rad je informativnog karaktera. Zasniva se na donešenim uzorcima vrste Gordius aquaticus od strane meštana Timočke krajine. Vrsta je uglavnom indikovana u uzorcima vode za piće gde se kao izvor vodosnabdevanja javlja otvoreno izvorište, otvoreni bazeni po završenoj sezoni kupanja ili bare u jesenjem periodu.
Cilj rada: Upoznavalje auditorijuma sa vrstom Gordius aquaticus, njegovim životnim ciklusom i uticajem na zdravlje ljudi.
Istraživanje: Istraživanja, u smislu ispitivanja zdravstvene bezbednonosti vode za piće i vode iz bazena nisu rađena jer su korisnica odustali od daljih analiza uzoraka.
Materijal i metodoligija rada: Rad se zasniva na uzorcima donetim u Zavod i stručim literaturnim podacima.
Najvažniji rezultati istraživanja: Najvećim delom svog životnog ciklusa Gordius aquaticus parazitira u telu insekta. Jedinka napušta telo domaćina, tako što luči protein koji deluje na nervni sistem domaćina izazivajući potrebu za vodom. Odrasla jedinka, živi u vodi gde dostiže polnu
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Zaključak: Gordius aquaticus se pojavljuje u otvorenim izvorištima koja služe za vodosnabdevanje i kod kojih nije urađena zona sanitarne zaštite. Pojavljivanje vrste u vodi za piće, vodi za sport i rekreaciju nema nikakav rizik po ljudsko zdravlje.
Ključne reči: Gordius aquaticus, voda za piće, zdravlje ljudi
Gordius aquaticus IN DRINKING WATER AND WATER FOR SPORT AND RECREATION
Dragan Paunović, Milijana Vučković
Institute of Public Health "Timok" Zaječar Introduction: This paper is for guidance only. It is based on the several individuals of species Gordius aquaticus which were enacted by the residents of the Timok region. The species is mainly indicated in samples of drinking water with open water source, then in open pools after bathing season or in the ponds in autumn.
The goal of the work: Introducing audience with the kind Gordius aquaticus, its lifecycle and the impact on human health.
Research: Research, as a laboratory testing of drinking water and water from the pool was not practice, because users gave up from further analysis of the samples.
The material and the methodology of work: The work is based on patterns enacted in the Institute, and on data from the literature.
The most important results of research: For most of its life cycle Gordius aquaticus parasitizing in the body of the insect. Moiety leaves the body of the host, by the protein secretion. Protein attacks nervous system of the host, causing the need for water. Adults live in the water where reaches sexual maturity, copulates, lays eggs and dies. Adults have reduced-no food intestinal system. System for excretion, respiratory system and circulatory system does not exist.
Conclusion: Gordius aquaticus appears in open water sources that are used for water supply, which have not sanitary protection zones. The occurrence of the species in drinking water, in water for sports and recreation has no risk to human health.
Keywords: Gordius aquaticus, drinking water, health
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OCENA HEMIJSKOG STATUSA AKUMULACIJE GRLIŠTE
LJUBIŠA DENIĆ, TATJANA DOPUĐA-GLIŠIĆ, MILICA DOMANOVIĆ, BORIS NOVAKOVIĆ, ALEKSANDAR TRAJKOVIĆ, NEBOJŠA VELJKOVIĆ, ZORAN STOJANOVIĆ
AGENCIJA ZA ZAŠTITU ŽIVOTNE SREDINE, MINISTARSTVO POLJOPRIVREDE I ZAŠTITE ŽIVOTNE SREDINE
APSTRAKT
Akumulacija Grlište nastala je pregrađivanjem Grliške reke i namenjena je vodosnadbevanju grada Zaječara i okoline. Shodno Uredbi o utvrđivanju godišnjeg programa monitoringa statusa voda (Sl. glasnik RS, 100/2012), Agencija za zaštitu životne sredine izvršila je ispitivanje akumulacionog jezera Grlište tokom 2012. godine.
Terenska ispitivanja akumulacije Grlište realizovana su tri puta tokom 2012. godine. Prva dva ispitivanja obavljena su u periodu termičke stratifikacije vode, u maju i avgustu, a treće ispitivanje u periodu jesenje cirkulacije.
Cilj ovog rada bio je da se prikaže ocena hemijskog statusa akumulacije Grlište u skladu sa preporukama Uredbe o graničnim vrednostima prioritetnih i prioritetnih hazardnih supstanci koje zagađuju površinske vode i rokovima za njihovo dostizanje (Sl. Glasnik RS, 35/2011).
Hemijski status akumulacije Grlište određen je u skladu sa preporukama Okvirne direktive o vodi (WFD, 2000/60/EC), odnosno proverom da li su prekoračeni standardi kvaliteta životne sredine (SKŽS) (Sl. Glasnik RS, 35/2011). Na osnovu rezultata ispitivanja hemijski status akumulacije Grlište u 2012. godini može se oceniti kao dobar. Nivo pouzdanosti kojim je određen hemijski status akumulacije je srednji, jer je korišćeno manje od 90% indikativnih hemijskih parametara i učestalost monitoringa parametara hemijskog statusa je manja od minimalne učestalosti predviđene za ocenu hemijskog statusa. Statističkom obradom rezultata određene su prosečne i maksimalne izmerene koncentracije prioritetnih i prioritetnih hazardnih supstanci. Dobijene vrednosti ispitanih parametara nisu prelazile standarde kvaliteta životne sredine (SKŽS) za površinske vode, odnosno vrednosti prosečnih godišnjih koncentracija (PGK) i maksimalno dozvoljenih koncentracija (MDK) propisanih zakonskom regulativom (Sl. Glasnik RS, 35/2011).
KLJUČNE REČI: prioritetne i prioritetne hazardne supstance, prosečne godišnje koncentracije (PGK), maksimalno dozvoljene koncentracije (MDK), ocena hemijskog statusa, akumulacija Grlište
CHEMICAL STATUS ASSESSMENT OF THE GRLIŠTE RESERVOIR
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LJUBIŠA DENIĆ, TATJANA DOPUĐA-GLIŠIĆ, MILICA DOMANOVIĆ, BORIS NOVAKOVIĆ, ALEKSANDAR TRAJKOVIĆ, NEBOJŠA VELJKOVIĆ, ZORAN STOJANOVIĆ
THE SERBIAN ENVIRONMENTAL PROTECTION AGENCY, MINISTRY OF AGRICULTURE AND ENVIRONMENTAL PROTECTION
ABSTRAKT
The Grlište Reservoir was formed by damming the Grliška Reka River. It is intended for water supply of the city of Zaječar and its surroundings. Based on the Regulation on the establishment of the annual monitoring programme of water status (Official Gazette of the RS, 100/2012), The Serbian Environmental Protection Agency was conducted an investigation of the Grlište Reservoir during 2012.
Field research of the Grlište Reservoir was realized three times during 2012. The first two examinations were carried out in the period of thermal stratification of water in May and August, whilst the third in the period of autumn circulation in 2012.
The aim of this study was to assess the Grlište Reservoir chemical status in accordance with the recommendations of the Regulation on limit values for priority and priority hazardous substances that pollute surface water and deadlines for their achievement, (Official Gazette of the RS, 35/2011).
Chemical status was determined in accordance with the recommendations of Water Framework Directive (WFD, 2000/60/EC) by checking whether the Environmental Quality Standards (EQS) had been exceeded (Official Gazette of the RS, 35/2011). Based on the obtained results chemical status of the Grlište Reservoir in 2012 could be assessed as good. The confidence level used for determination of chemical status of the Grlište Reservoir was characterized as medium since it was used less than 90% of indicative chemical parameters as well as frequency of monitoring parameters was less than the minimum frequency proposed for chemical status assessment. Considering statistical data processing the average and the maximum concentrations were calculated. The obtained values of priority and priority hazardous substances were not exceeded Environmental Quality Standards (EQS) for surface waters and the Average Annual Concentrations (AAC) and the Maximum Permissible Concentrations (MPC) proposed by national legislation (Official Gazette of the RS, 35/2011).
KEYWORDS: priority and priority hazardous substances, Average Annual Concentrations (AAC), Maximum Permissible Concentrations (MPC), chemical status assessment, the Grlište Reservoir
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OCENA EKOLOŠKOG POTENCIJALA AKUMULACIJE GRLIŠTE
LJUBIŠA DENIĆ, SNEŽANA ČAĐO, ALEKSANDRA ĐURKOVIĆ, BORIS NOVAKOVIĆ, TATJANA DOPUĐA-GLIŠIĆ, MILICA DOMANOVIĆ, NEBOJŠA VELJKOVIĆ, ZORAN STOJANOVIĆ
AGENCIJA ZA ZAŠTITU ŽIVOTNE SREDINE, MINISTARSTVO POLJOPRIVREDE I ZAŠTITE ŽIVOTNE SREDINE
APSTRAKT
Primenom nove nacionalne legislative 2010., 2011. i 2012. godine u oblasti voda, monitoring površinskih voda u Srbiji počeo je da se usklađuje sa zahtevima Okvirne direktive o vodama (WFD, 2000/60/EC). Vodeći se preporučenim kriterijumima WFD, određene su stanice (vodna tela) nadzornog i operativnog monitoringa u Srbiji.
Agencija za zaštitu životne sredine izvršila je ispitivanje bioloških i fizičko-hemijskih elemenata kvaliteta akumulacije Grlište prema Uredbi o utvrđivanju godišnjeg programa monitoringa statusa voda za 2012. godinu (Sl. glasnik RS, 100/2012). Prva dva ispitivanja realizovana su u periodu termičke stratifikacije vode, u maju i avgustu 2012. godine, a treće u periodu jesenje cirkulacije. Od bioloških elemenata kvaliteta, obuhvaćeni su fitoplankton, fitobentos i akvatične makroinvertebrate. U zajednici fitoplanktona, cijanobakterije su konstatovane u akumulaciji u letnjem periodu, kada je gustina njihovih populacija i najveća, ali i tokom jesenjeg perioda imaju značajan udeo u ukupnoj brojnosti fitoplanktona. Za određivanje dijatomnih indeksa korišćen je softverski program OMNIDIA, a za ispitavanje zajednice akvatičnih makroinvertebrata AQEM protokol i softverski program ASTERICS (AQEM, 2002).
Ocena ekološkog potencijala akumulacije Grlište data je na osnovu nacionalne regulative (Službeni glasnik RS, 74/2011). Ekološki potencijal određen je najlošije ocenjenim elementom kvaliteta. Akumulaciju Grlište, na lokalitetu kod brane (A) i na ulazu u akumulaciju (C) u 2012. godini karakteriše slab ekološki potencijal, određen parametrima bioloških elemenata kvaliteta (fitoplanktona i fitobentosa) na lokalitetu kod brane, kao i parametrima relevantnim za zajednicu akvatičnih makroinvertebrata na ulazu u akumulaciju.
KLJUČNE REČI: biološki elementi kvaliteta, fizičko-hemijski elementi kvaliteta, fitoplankton, fitobentos, akvatične makroinvertebrate, ocena ekološkog potencijala, akumulacija Grlište
ECOLOGICAL POTENTIAL ASSESSMENT OF THE GRLIŠTE RESERVOIR
LJUBIŠA DENIĆ, SNEŽANA ČAĐO, ALEKSANDRA ĐURKOVIĆ, BORIS NOVAKOVIĆ, TATJANA DOPUĐA-GLIŠIĆ, MILICA DOMANOVIĆ, NEBOJŠA VELJKOVIĆ, ZORAN STOJANOVIĆ
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THE SERBIAN ENVIRONMENTAL PROTECTION AGENCY, MINISTRY OF AGRICULTURE AND ENVIRONMENTAL PROTECTION
ABSTRACT
By applying new national legislation in 2010, 2011 and 2012 in the field of water policy, the surface water monitoring in Serbia started to harmonize with the requirements of the Water Framework Directive (WFD, 2000/60/EC). Based on the recommended criteria of the WFD, the monitoring stations (waterbodies) of surveillance and operational monitoring in Serbia were selected.
The Serbian Environmental Protection Agency was conducted an investigation of biological and physico-chemical water quality elements in the Grlište Reservoir according to the Regulation on Establishment of Annual Monitoring Programme of Water Status for 2012 (Official Gazette of the RS, 100/2012). The first and the second field research was carried out in a period of thermal stratification of the reservoir in May and August 2012 while the third in a period of autumn circulation. Of the biological quality elements (BQE), phytoplankton, phytobenthos and aquatic macroinvertebrates were examined. In the phytoplankton community, the cyanobacteria were found in the reservoir in summer period, when their population density was high, but also during autumn period the cyanobacteria had a significant percentage participation in the total phytoplankton abundance. For diatom indices calculation the OMNIDIA software was used and for aquatic macroinvertebrate metrics the AQEM protocol and ASTERICS software (AQEM, 2002) respectively.
Ecological potential of the Grlište Reservoir was assessed on the basis of national regulation (Official Gazette of the RS, 74/2011). Ecological potential was determined by the worst assessed quality element. The Grlište Reservoir, at the site of the dam (A) and at the entrance to the reservoir (C) was characterized by poor ecological potential in 2012 determined by the parameters of biological quality elements (phytoplankton and phytobenthos) at the site of the dam as well as the parameters relevant to aquatic macroinvertebrate community at the entrance to the reservoir.
KEYWORDS: biological quality elements (BQE), physico-chemical quality elements, phytoplankton, phytobenthos, aquatic macroinvertebrates, ecological potential assessment, the Grlište Reservoir
HRANJIVE I FIZIOLOŠKE KARAKTERISTIKE PROIZVODA MELVIT
Dr Aneta Georgijev, Timomed doo Knjaževac, dipl.ing Zorica Radosavljević, Timomed Knjaževac, Ljupka Georgijev, Milja Georgijev
Apstrakt
Uvod: Komponente Melvita su supstance sa hranjivim ili fiziološkim efektom. Kombinacijom medasa drugim energetski visoko vrednim namirnicama, u Timomedu doo, nastao je proizvod
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Melvit. Melvitje po Pravilniku o kvalitetu meda i drugih proizvoda pčela (Sl.glasnik RS br. 101/2015) mešavina meda(Livadskog) sa drugim proizvodima pčela (matičnim mlečom i propolisom) i drugim proizvodima (jezgrasto voće). Po Pravilniku o zdravstvenoj ispravnosti dijetetskih proizvoda („Sl.glasnik RS“, br.45/2010, 27/2011,50/2012, 21/2015 i 75/2015) komponente Melvita su supstance sa hranjivim ili fiziološkim efektom. Osnovna komponenta Melvita je livadski med. U Melvitu se nalazi niz nutrijenata koji imaju specifične metaboličke uloge za ljudski organizam. Makronutrienti: ugljenihidrati koji omogućavaju energiju , proteini, masti, esencijalni nutrienti: vitamini, minerali, aminokiseline, masne kiseline, prehrambena vlakna i voda koja potiče iz meda, mleča i semena jezgrastog voća. U Melvitu su prisutne i fitohemikalije koje nisu jake farmakološke aktivnosti.
Cilj: Ispitivanje fizičko-hemijske ispravosti proizvoda „ Melvit “.
Metod: Pravilnik o kvalitetu meda i drugih proizvoda pčela (Sl.glasnik RS br. 101/2015) mešavina meda (Livadskog) sa drugim proizvodima pčela (matičnim mlečom i propolisom) i drugim proizvodima (jezgrasto voće). Pravilnik o zdravstvenoj ispravnosti dijetetskih proizvoda („Sl.glasnik RS“, br.45/2010, 27/2011,50/2012, 21/2015 i 75/2015)
Rezultati I diskusija:Rezultati fizičko-hemijskog ispitivanja potvrđuju da u Melvitu ima 3,25g proteina, ugljenih hidrata 71,06g (redukujući šećeri 64,90g), masti 9,47g od toga zasićene masne kiseline 2,72g i minerala: Cu, Cn, Fe, Mn, K, Na,Ca,Mg,Se,i Mo. Energetska vrednost 100g Melvita je 1614KJ/383Kcal. Melvit kao dodatak ishrani ne može se koristiti kao zamena za raznovrsnu ishranu. Uobičajeno doziranje jedna do dve kesice u toku dana (25-50g) za odrasle i decu stariju od 14 godina. Za decu mlađeg uzrasta maksimalna dnevna doza 25g. Proizvod se ne preporučuje dijabetičarima, osobama alergičnim na pčelinje proizvode, jezfgrasto voće i deci starosti do 12 meseci.
Ključne reči: Melvit, med, hranjivi, energetska, vrednost
Nutritional and physiological characteristics of Melvit product
Dr. Aneta Georgijev, Timomed doo Knjazevac, dipl. ing Zorica Radosavljevic, Timomed Knjazevac, Ljupka Georgijev, Milja Georgijev
ABSTRACT
The combination of honey with other high energy groceries, in Timomed doo, the product Melvit was made. By the Regulation of honey quality and other bee products (Sl. glasnik RS br.101/2015) Melvit represents a mixture of meadow honey with other bee products (Propolis and royal jelly) and other products (nuts). By the Regulation of health quality of dietary products ("SL. vlasnik RS", br.45/2010, 27/2011, 50/2012, 21/2015) and (75/2015) the components of Melvit are substances with nutritional and physiological effect. The basic component of Melvit is meadow
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE honey. In Melvit there is a sequence of nutrients that has specific metabolic effects on human organism. Macronutrients: carbohydrates, which enable energy, proteins, fats, essential nutrients: vitamins, minerals, amino acids, fat acids, dietary fibers and water that comes from honey, jelly and nuts. In Melvit there are phytochemicals that are not pharmacologically strong. The results of physical and chemical researches confirm that in Melvit there are 3.25 g of proteins, carbohydrates (71.06 g, reducing sugars 64.90g), fat 9.47 g, from which fat acids 2.72 g and minerals: Cu, Cn, Fe, K, Na, Ca, Mg, Se and Mo. The energetic value of 100 g of Melvit is: 1614 kJ/383 kcal. Melvit as a food supplement cannot be used as a substitute for rich diet. The usual doses are one or two bags per day (25-50g) for adults and children older than 14. For younger children a maximum dose per day is 25g. The product is not recommended for people dealing with diabetes, people with hayfever, and allergies to nuts and to children not older than 12 months.
Key words: Melvit, honey, nutritional, energetic, value
Значај и улога приступа у саветовалишном раду- искуства кроз приказ случајева
Ненад Ђорђевић
ЗЗЈЗ ,,Тимок" Зајечар
Увод: Саветовалиште за исхрану ЗЗЈЗ ,,Тимок" Зајечар обновљено је и опремљено новом опремом и кадром и ради при Центру за промоцију здравља од средине 2012. године. За последње две године саветовалиште је посетило око 800 особа различите старостне доби, наjчешће из Зајечара, али и из свих других општина Тимочке крајне и њихов број свакодневно има тенденцију раста.
Циљ: Циљ нашег рада је да укаже на значај новог начина приступа корисницима у саветовалишном раду који подразумева: едукацију о правилној исхрани; исхрану без већих одрицања, забрана, притисака и психолошких тензија; активо размишљање о свакодневној исхрани и оброцима, који подразумева правилан избор намирница и оброка, као и њихов број и правилан временски распоред; упражњавање свакодневне физичке активности не само вежбањем, већ и пожељним креативним физичким радом; по потреби, укључивање и осталих чланова породице, рођака и пријатеља као подржаваоца и тд, а ка коначном циљу унапређења здравља и превенцији поремећаја здравља насталих услед неправилне исхране.
Методе: На конкретним примерима наших корисника, са којима практикујемо индивидуални метод рада, кроз параметре које пратимо, показујемо постигнуте резултате на унапређењу њиховог здравља ( БМИ, проценат телесне маси, проценат мишићне масе, ниво висцералне масноће, одређивање базалног метаболизма, тестови интолеранције на храну, одређивање гликемије, триглицерида, холестерола у крви и тд ).
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Резултати рада: Резултати рада указују да је код свих који су потражили савет у нашем саветовалишту, већ при првом контролном прегледу долазило до веома доброг учинка по здарвље, а корисници су се субјективно осећали боље.
Закључак: Добро конципиран и организован саветовалишни рад представља важан сегмент савременог здравства које треба да се базира на унапређењу здравља и превенцији болести.
Кључне речи: саветовалиште, исхрана, приступ, резултати, здравствено васпитање, здравље.
The importance and role of right approach in counciling work — our experiances and case studies
Nenad Đorđević
The Institute for Public Health ,,Timok" Zaječar
Introduction: The nutrition counsiling programme at ,,Timok" institute of Zaječar was recently renewed, equiped with new accessories and experts working at the Center for promotion of health living from the mid 2012. Since the new counsiling programm was formed, about 200 people of different age has visited it, and the number of people visiting the centar has grown ever since. The most of the visitors were from Zaječar, but also from other municipalities of Timočka krajina region.
Aim: The aim of our work was to point out the significance of new approach to the beneficiaries of the counciling work, which covers: education about halthy nutrition; nutrition withought desclaimers, bans, pressures and psihological tensions; active thinking about everyday nutrition and meals, which includes right choice of groceries and meals, their number and adequate time shedule; everyday phisical activity, not only by exercises, but also with creative phisical work; including other members of the family, causins and friends as supporters and other. All of this should lead to the final aim in increasing the health status, prevention of health dissordesr caused by inaprropriate nutrition.
Methods: Using examples of our beneficiaries, whit whom we practice individual working methods, and through parameters which we follow here we pointout the results gained to improve their health (BMI, percent of body fat, percent od muscle weight, the level of visceral fat, basal metabolism, glichemia, triglicerids and holesterol from blood samples, etc.).
Results: The results have shown that all beneficiaries asking for advices in our consulting made a good score after a single control visit, made very good impact score on their health and have subjectively felt better.
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Conclussion: Counciling work with a good concept and organisation is an important segment of modern medical care, which should be based on improvement od health and desease prevention.
Key words: council, nutrition, results, helt
Key words: council, nutrition, approch, results, health
OD NJIVE DO TRPEZE
Jovanović R. 1, Snežana Đ. 1, Aleksandra P. 1
1 Zavod za javno zdravlje Pančevo
UVOD: Bezbednost hrane je jedan od najvažnijih faktora u očuvanju zdravlja ljudi. Bez hrane nema života a bez bezbedne hrane nema zdravlja. Gradska uprava grada Pančeva Sekretarijat za poljoprivredu, selo i ruralni razvoj u saradnji sa Zavodom za javno zdravlje Pančevo realizovao je tokom 2015.godine Projekat Unapređenje kontrole kvaliteta i higijene poljoprivrednih proizvoda.
CILJ RADA: Procena uticaja preventivnih higijesko-sanitarnih mera na unapređenje kontrole kvaliteta i higijene poljoprivrednih proizvoda.
METODOLOGIJA: Projektom je obuhvaćeno 26 domaćinstava koja se bave proizvodnjom hrane životinjskog porekla na teritoriji opštine Pančevo. U tri kampanje je vršena ocena higijensko – sanitarnih uslova za proizvodnju hrane – obilazak domaćinstava i popunjavanje anketnog upitnika, uzimanje uzoraka hrane za mikrobiološku i fizičko – hemijsku analizu, uzimanje uzoraka sa površina (brisevi ruku, pribora i površina) za mikrobiološku analizu, uzimanje uzoraka vode za piće za mikrobiološku analizu i obavljanje sanitarnih pregleda u Zavodu za javno zdravlje Pančevo. REZULTATI ISTRAŽIVANJA: Uslovi u pogledu proizvodnje hrane su uglavnom zadovoljavajući. 18 uzoraka hrane (12.00%) je neispravno, od čega 13 uzoraka mikrobiološki i 5 uzoraka fizičko – hemijski. Uzrok neispravnosti je prisustvo Kvasci i plesni, u jednom uzorku je detektovano prisustvo Staphylococcus kogulaza pozitivnih bakterija, u dva je nađen Bacilus Cereus Najčešći uzrok fizičko – hemijske neispravnosti uzorka bio je niži pH i stepen kiselosti a ovi parametri su povezani sa načinom čuvanja hrane. Rezultati ispitivanja uzoraka sa površina (briseva) pokazali su da je 26.67% uzoraka neispravno (u 10.67% izolovane patogene bakterije). Neispravno je 29.33% uzoraka vode za piće. ZAKLJUČAK: Preduzete preventivne higijensko sanitarne mere dovele su do poboljšanja uslova za proizvodnju hrane što potvrđuje smanjen broj neispravnih uzoraka hrane, briseva KLJUČNE REČI: prevencija, bezbednost hrane.
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FROM FARM TO TABLE
Jovanović R. 1, Snežana Đ. 1, Aleksandra P. 1
1 Department of Public Health Pancevo
INTRODUCTION: Food safety is one of the most important factors in maintaining health. Without food there is no life without safe food has no health. City Administration of Pancevo Secretariat for Agriculture, Village and Rural Development in cooperation with the department of Public Health Pancevo realized during 2015. the project "Quality control improvement and hygiene of agricultural products".
OBJECTIVE: Assessment of the impact of preventive hygienic-sanitary measures on improvement of quality and hygiene of agricultural products.
METHODOLOGY: The project includes 26 households involved in the production of food of animal origin in the municipality of Pancevo. In three campaigns is a result of evaluation of hygienic - sanitary requirements for food - driving households and filling in a questionnaire, sampling food for microbiological and physico - chemical analysis, taking samples from the surface (swabs hands, utensils and surfaces) for microbiological analysis, sampling drinking water for microbiological analysis and sanitary examination at the Department of Public Health Pancevo.
RESEARCH RESULTS: The conditions are largely satisfactory in terms of food production. 18 food samples (12.00%) are incorrect, out of which 13 samples and 5 samples were microbiologically physical - chemical. The cause of contamination is the presence of yeasts and molds in one sample was detected by the presence of Coagulase Positive Staphylococcus, in two samples were found Bacillus Cereus. The most common cause of physico - chemical hazard of the sample was lower pH and a degree of acidity, these parameters are associated with the way of food preservation. Results of testing samples from the surfaces showed that 26.67% of the samples incorrectly (in 10.67% isolated pathogenic bacteria). 29.33% samples of drinking water are incorrect. CONCLUSION: Measures of preventive hygienic sanitary measures have led to improved conditions for food production as evidenced by a reduced number of defective food samples, swabs. KEY WORDS: prevention, food safety.
ZEMLJINO MAGNETNO POLJE I MAGNETNE OSOBINE ĆELIJE KAO FAKTOR RASTA RAZMNOŽAVANJA I ĆELIJSKE DEOBE
Nikola Trifunović, Dejan Krstić
Uvod i cilj:
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Uprkos mnogim radovima o deobi ćelija, nastanku i lečenju raka, starenju ćelija i radu imunološkog sistema, ne postoje jasna objašnjenja. Glavni cilj ovog rada je objašnjenje ovih nepoznanica.
Sve što je u Zemljinom magnetno polju (ZMP) a ima feromagnetne i paramagnetne osobine magnetiše se. Ovim radom pokazuje se da je ZMP faktor koji potstiče podelu ćelija. Takodje prikazuju magnetne osobine organela i supstanci koje su usko povezane sa metabolizmom ćelija.
Rezultati:
U radu se objašnjava kako se sekvence nukleotida u izgradnji DNK i RNK pakuju po magnetnom kodu (genski kod). Objašnjava se funkcionisanje imunog sistema pri sprečavanju raznih oboljenja. Raznovrsnost magnetnih osobina supstanci koje izgradjuju ćelije uz pomoć ZMP omogućavaju polimorfizam i imaju odlučujući doprinos evioluciji živog sveta.
Faktori koji stimulišu deobu ćelija su ZMP, koja i potstiču metabolizam i omogućavaju rad imunološkog sistema. Smanjivanjem magnetnih osobina organela u ćeliji nastaje starenje. Medjumolekulske magnetne sile u ćeliji se kontinuirano menjaju, jer zavise od podele majke ćelije na dve ćeri ćelije. Te magnetne sile se sa brojem podela smanjuju i uz prirodnu arteriosklerozu nastaje starenje ćelije.
Zaključak:
Prirodno ZMP je promotor podele majke ćelije na dve ćeri ćelije. Magnetne osobine organela i supstanci omogućavaju ćelijski metabolizam. ZMP i magnetne karakteristike ćelija omogućavaju evoluciju biosveta.
Deobom ćelija magnetne osobine u jedru svake ćelije se smanjuju što omogućava akumulaciju toksina. Takodje se funkcije organa smanjuju kao i hormonska aktivnost što se manifestuje starenjem. Imunološki sistem funkcioniše najbolje u prirodnom ZMP. Тu leži i mogućnost zaštite čoveka i produženja životnog veka, uz smanjenje koronarnih bolesti, zapaljenskih ciklusa, areroskleroze, dijabetesa i karcinoma. Neophodno je obezbediti stalni boravak čoveka u prirodnom magnetnom polju zemlje, a pogotovo u periodu sna.
Ključne reči: ZMP, magnetne osobine, starenje ćelija.
EARTH'S MAGNETIC FIELD AND MAGNETIC PROPERTIES OF THE CELL AS A FACTOR OF GROWTH, REPRODUCTION AND CELL DIVISION
Nikola Trifunović, Dejan Krstić
Abstract
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Introduction and Aim: In spite of many works on cells division, appearance and treatment of cancer, cells aging and immune system functioning, there are no clear explanations. The main aim of this work is explanation of these unknown subjects.
Everything that is within Earth magnetic field (EMF) and has ferromagnetic and paramagnetic characteristics, gets magnetized. This work shows that EMF is the factor which induces cells division. It also presents organelles and substances magnetic characteristics close connection with cells' metabolism.
Results
The work explains how nucleotides in DNA and RNA construction pack according to a magnetic code (genetic code). Functioning of immune system in various diseases prevention is explained. Variability of substances which build cells by the help of EMF, enables polymorphism and have decisive contribution to the living world evolution.
Factors which stimulate cells division are EMF, stimulating metabolism, too, and enable immune system functioning. Organelles in cells' magnetic characteristics reduction leads to aging. Intermolecular magnetic forces in a cell continually change, because they depend upon mother cell's division into two baby cells. These magnetic forces reduce with number of divisions and, by natural atherosclerosis, cell's aging occurs.
Conclusion
Natural EMF is the promotor of a mother cell division into two baby cells. Organelles and substances magnetic characteristics enable cell metabolism. EMF and cell's magnetic characteristics enable the bio world evolution.
Through cells division magnetic characteristics in each cell nucleus get reduced, enabling toxins accumulation. Organs functioning, also, gets reduced, as well as, hormone activity manifested by aging. Immune system functions most optimally in natural EMF.
There is a possibility of protection of human and longer life expectancy, with a reduction in coronary disease, inflammatory processes, atherosclerosis, diabetes and cancer. It is necessary to ensure permanent staying or as longer staying man in the natural magnetic earth’s field, especially in the period of sleep.
Key Words: EMF, magnetic characteristics, cells aging.
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DOPRINOS ANOMALIJSKOG MAGNETNOG POLJA U NASTANKU MALIGNIH MNPLAZMI
Dejan Krstić, Nikola Trifunović, Dragan Jevdić
Uvod i cilj:
Zemljino magnetno polje (ZMP) je promotor podele majke ćelije na dve ćeri ćelije. Maligne MNplazme (MN) su ćelije koje se dele MNgraničeno i uništavaju organ i organizam. Cilj je da se analizom korelacije merenja magnetnog polja u prostoru kreveta pacijenata sa malignim oboljenjima dodje do zaključaka da li postoji uzročno posledična veza ove dve pojave. Pokazati da je uzročnik MN anomalijsko magnetno polje (AMP) koje je locirano u prostoru kreveta obolelih ljudi. Pokazati da uklanjanjem obolelih iz AMP tj. omogućavanjem boravka u prirodnom ZMP dolazi do ozdravljenja obolelih. Objasniti šta su faktori rizika zvanične medicinske literature. Predložiti poboljšanje terapije oboleelih od MN.
Metodologija rada:
U dužem vremenskom periodu AMP su merena u krevetima 2000 obolelih. Merenje AMP u krevetima obolelih izvedeno je protonskim magnetometrom. Merna mesta su po prikazana po kvadratnoj mreži veličine 10 x 10cm. Izvršena je analiza dobijenih rezultata. Vršeno je uklanjanje obolelih iz AMP i praćeno je zdravstveno stanje boravkom u prirodnom ZMP. Izveden je eksperiment u Psihijatriskoj bolnici sa 40 bolesnika sa pomeranjem pacijenata iy anomalnih magnetnih polja. Analizirana je literatura iz etiopatologije MN.
Rezultati:
Rezultati su prikazani izolinijama na skicama. Utvrdjena je korelacija AMP i lokacije obolelog organa. U radu su prikazani karakteristični primeri obolelih.
Zaključak:
Utvrdjeno je poboljšanje zdravlja kod pacijenata koji su premešteni da žive u prirodnom ZMP. Poznavajući efekte AMP i ZMP zaključeno je da faktori rizika medicinske nauke nisu samo uzroci MN nego i posledica postojanja AMP. Nephodno je poboljšati terapiju obolelih izgradnjom bolnica bez AMP i uvesti hipertermiju u lečenju uznapredovalih MN. Takođe eksperiment u bolnici sugeriše da su AMP obolelih dominantan uzrok MN.
Ključne reči: ZMP,AMP,MN, metastaze.
CONTRIBUTION ANOMALIC MAGNETIC FIELD IN THE DEVELOPMENT OF MALIGNANT NEOPLASMS
Dejan Krstić, Nikola Trifunović, Dragan Jevdić
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Introduction and Aim:
Earth magnetic field (EMF) is the promotor of mother cell division into two baby cells. Malignant Neoplasms (MN) are cells that divide limitlessly and destroy an organ and organism. This study was researching of correlation of measurements of magnetic fields in the bed of patients with malignant diseases and come to the conclusion about relationship of these two phenomena. Aim to show that MN is caused in anomalous magnetic field (AMF) which located in diseased people's beds. Show that moving the diseased people out of AMF, i.e. enable them to live in natural EMF, leads to their recovery. Explaining what are the risk factors in official medicine literature. Suggesting the MN diseased people's therapy improvement.
Work Methodology
AMF are measured in 2000 beds of examinees in long period of time. AMF measurements in the diseased people's beds is performed by protonic magnetometer. Measurements points are per square net 10 x 10 cm. The obtained results were analysed. Moving the diseased people out of AMF is done and their health condition followed during their stay in natural EMF. MN etiopathology literature is studied. An experiment in Psychiatric clinic with 40 patients has taken place and patients are moved from AMF.
Results
Results of measurements are shown with isolines in sketches. Correlation between AMF and diseased organ location is confirmed. In this paper shows characteristically examples of the diseased ones.
Conclusion
Health improvement of the patients located to live in natural EMF is confirmed. Knowing the effects of AMF and EMF, it is concluded that risk factors in medical science are not MN causes, but effects of AMF existence. It is necessary to improve the diseased people's therapy by building hospitals with no AMF and introduce hyperthermia in advanced MN treatment. The experiment in the clinic, also, suggests that AMF are the one significant and probably most important cause of MN.
Key Words: earth magnetic field, malignant neoplasms, anomalous magnetic field, metastases.
ZNAČAJ ULTRAZVUKA U PREVENCIJI UROLOŠKIH OBOLJENJA
Radoš Žikić
Uvod: Ultrazvuk je u vizuelnoj dijagnostici ostvario izvanredne prodore, moglo bi se reći neslućene. Nema sumnje daje ultrasonografija trenutno najrašireniji oblik tzv. "imaging"
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(vizualizujućih) tehnologija. Bezbolna i neinvazivna metoda pregleda koja se može koristiti kod svih uzrasta i može se ponoviti bezbroj puta. Materijal i metode: Pregled ultrazvukom pruža detaljan uvid u položaj, oblik, veličinu i strukturu uro-genitalnih organa: bubrega, uretera, mokraćne bešike, prostate i genitalnih organa kod muškaraca. Iz patologije ovih organa mogu se vizualizirati kongenitalnne anomalije, ciste, kalkuloza, tumori, strana tela i povrede. Diskusija: Ultrazvuk (UZ) je zvuk čija je frekvencija iznad gornje granice čujnosti za naše uvo 20 kHz. To je oblik energije koji nastaje mehaničkim vibracijama. Ove vibracije nastaju kada se sonda aktivira kratkim električnim impulsom koji se u kristalu sonde pretvara u ultrazvučni impuls. Ovako nastali impuls se kreće duž linije posmatranja koji je karakterističan za svako tkivo. Pošto je ljudsko telo nehomogena sredina sastavljena iz različitih tkiva koja različito slabe propušteni snop UZ talasa i različito slabe odjeke koji se vraćaju u sondu. Vraćeni deo talasa se u sondi pretvara u električni impuls koji se nakon obrade u aparatu prikazuje kao slika organa od koje se talasi odbijaju. U radu smo prikazali više pacijenata kojima je blagovremena dijagnostika ultrazvukom pomogla na očuvanju zdravlja. Zaključak: Korišćenje ultrazvuka značajno pomaže u dijagnostici uroloških oboljenja i podizanju kvaliteta zdravstvene zaštite.
Ključne reči: ultrazvuk, uro-genitalni organi, dijagnostika.
ULTRASOUND IN UROLOGICAL DISEASE PREVENTION
Rados Žikić
Summary: Painless and noninvasive examination method that can be used for all ages and can be repeated unlimited number of times. Ultrasonography (US) is a sound with a frequency above the upper limit of audibility for our hearing – 20kHz - a form of energy generated by mechanical vibrations. These vibrations occur when the probe is triggered with a short electrical pulse which is converted into an ultrasonic pulse in the probe crystal transducer. In order to use ultrasound for diagnostic or therapeutic purposes, a beam of ultrasound must be directed into the tissues of the subject over the site of interest. Once the ultrasound enters the body, the ultrasonic energy interacts with the tissues along its path, and different things can happen to them. Only some of it returns back to the probe to help the machine form an image of the organ that is being observed. Such image provides a detailed insight into the position, shape, size and structure of the uro-genital organs: kidney, ureter, bladder, prostate and genital organs in men. Pathology of these organs that can be visualized: congenital abnormalities, cysts, calculi, tumors, foreign bodies and injuries. Keywords: ultrasound, uro-genital organs, Diagnosis
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UČESTALOST VAKCINABILNIH BOLESTI U REPUBLICI SRPSKOJ U ZADNJIH DESET GODINA Janja Bojanić1, Miodrag Marjanović1, Ljubica Jandrić1, Jela Aćimović1, Dragana Stojisavljević1, Ljubica Bojanić1
1Institut za javno zdravstvo Republike Srpske
Uvod: U Republici Srpskoj se u posljednje vrijeme sve više evidentira pad pokrivenosti obaveznom imunizacijom, posebno vakcinacijom protiv morbila, rubeole i parototisa što je za posljedicu imalo epidemije ovih bolesti. Cilj rada je prikazati učestalost vakcinabilnih bolesti i epidemije, na području Republike Srpske u periodu od 2007. do 2016. godine.
Metod: U radu je korišten deskriptivni metod, a za izvore podataka korištene su: prijave zaraznih bolestia, bilteni i izvještaji o kretanju zaraznih bolesti, prijave i odjave epidemija, izvještaji o obuhvatu imunizacijom. Rezultati: Od 2007. do 2016. godine, incidencija vakcinabilnih bolesti se kretala od 40,1%ooo u 2007.godini do 23,6%ooo u 2016.godini, sa najvišom stopom od 433,3%ooo 2012. godine. Najučestalija vakcinabilna bolest, bio je parotitis čija se incidencija kretala od 0,2%ooo u 2007. i 2008.godini. do 397,7%ooo u 2012.godini. Odmah iza su morbili sa najnižom incidencijom od 0,2 %ooo u 2008.god. i najvišom od 172,1%ooo u 2015.god. Najviša stopa incidencije rubeole od 54,7%ooo je zabilježena 2010 godine a najniža od 0,2%ooo u 2007 i 2008 godini. Incidencija tuberkuloze se kretala od 13.1%ooo u 2015.i 2016. godini do 34,2% ooo u 2008. godini. U periodu od 2009-2010 godine registruje se epidemija rubeole sa 1223 oboljelih, zatim od 2009-2010 godine slijedi epidemija parotitisa sa 7813 prijavljenih i epidemija morbila koja je trajala od maja 2014. godine do kraja avgusta 2015. godine, sa 4064 oboljelih. Tetanus, difterija i poliomijelitis su vakcinabilne bolesti koje nisu registrovane.
Zaključak: Epidemije vakcinabilnih bolesti koje su se javile u navedenom periodu su posljedica problema u snabdijevanju, nabavci, isporuci, često i nestašici vakcina u Republici Srpskoj.
Ključne riječi: vakcinabilne bolesti, incidencija , epidemija, obuhvat
FREQUENCY OF VACCINE PREVENTABLE DISEASES IN THE REPUBLIC OF SRPSKA OVER THE LAST DECADE Janja Bojanić1, Miodrag Marjanović1, Ljubica Jandrić1, Jela Aćimović1, Dragana Stojisavljević1, Ljubica Bojanić1
1Public Health Institute of the Republic of Srpska
Introduction: In recent years, it is registered a decline in coverage by mandatory immunization in the Republic of Srpska, especially vaccination against measles, rubella and parototis, which resulted in appearance of an epidemics of these diseases.
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The aim is to show frequencyfrequency of vaccine preventable diseases and outbreaks in the territory of the Republic of Srpska in the period from 2007 to 2016.
Method: Descriptive method was used in this study and data sources were: infectious diseases notifications, monthly bulletins and annual epidemiological reports on communicable diseases, outbreak notifications, immunization coverage reports etc.
Results: From 2007 to 2016, in the Republic of Srpska, the incidence of vaccine preventable diseases ranged from 40,1%ooo in 2007 to 23,6%ooo in 2016, with the highest rate of 433,3%ooo in 2012. In the observed period, the most common vaccine preventable disease was parotitis whose incidence ranged from 0,2%ooo in 2007 and 2008 to 397,7%ooo in 2012. It is followed by measles with the lowest incidence of 0,2 %ooo in 2008 and the highest one of 172,1%ooo in 2015. The highest rubella incidence rate of 54,7%ooo was recorded in 2010 and the lowest one of 0,2%ooo in 2007 and 2008. The incidence of tuberculosis ranged from 13.1%ooo in 2015 and 2016 to 34,2% ooo in 2008. In the period from 2009 to 2010, rubella outbreak was registered with 1223 patients, then from 2009 to 2010, parotitis outbreak with 7813 patients reported and finally measles outbreak that lasted from May 2014 until the end of August 2015, with 4064 patients. Tetanus, diphtheria and polio are vaccine preventable diseases that were not registered in the observed period.
Conclusion: Vaccinable epidemic diseases which have occurred in the said period as a result of problems in supply, procurement, delivery, often shortage of vaccines in the Republic of Srpska.
Key words: vaccine preventable diseases, frequency, outbreak, coverage
MORTALITET OD KARCINOMA DOJKE NA TERITORIJI PIROTSKOG OKRUGA U PERIODU OD 1999. DO 2012. GODINE Slavica Ćirić Pejčić1, Olivera Radulović2 1 Opšta Bolnica Pirot 2 Institut za javno zdravlje Niš
Karcinom dojke je daleko najčešći karcinom kod žena (20% od svih kancera) sa oko 1.6 miliona novoobolelih godišnje u svetu i na drugom mestu je po rasprostranjenosti kada se razmatraju oba pola zajedno. Cilj rada- Sagledavanje umiranja od karcinoma dojke u Pirotskom okrugu i predlog mera za prevenciju raka dojke, kao značajnog socijalno-medicinskog problemа.
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Metod- Primenjena je deskriptivno-epidemiloška studija karcinoma dojke u populaciji žena Pirotskog okruga u periodu od 1999. do 2012. godine. Analiziran je mortalitet od karcinoma dojke po opštinama i dobnim grupama za definisani period. Rezultati rada i diskusija- U Pirotskom okrugu stopa mortaliteta od raka dojke pokazuje blagi trend porasta od 1999. (36,7) do 2012. (39,7/100.000). Prosečna vrednost stope mortalitetaod raka dojke u Pirotskom okrugu za posmatrani period je 34,3/100.000 žena i ona je nešto niža od stope mortaliteta u Cenrtalnoj Srbiji koja je u 2012. godini iznosila 43,4/100.000. I ostale opštine Pirotskog okruga imaju nešto nižu stopu mortaliteta u odnosu na Centralnu Srbiju:opština Dimitrovgrad (40,76/100.000 žena), opština Pirot (36,5/100.000), opština Babušnica (28,67/100.000), i opština Bela Palanka (24,9/100.000). Prosečan uzrasno-specifičan mortaliet od karcinoma dojke u opštinama Pirotskog okruga pokazuje da je rizik umiranja od raka dojke povezan sa starenjem: najveći procenat umrlih žena starijih od 50 godina je bilo u opštini Pirot (88,9%), zatim sledi opština Dimitrovgrad (78,6%), pa Babušnica (78,3%) i najmanji mortaliet je registrovan u Beloj Palanci (72,6%). Najveći procenat umrlih žena mlađih od 50 godina je bio u opštini Bela Palanka (13%), a potom u opštini Pirot (10,6%), zatim u opštini Babušnica (7,4%), i opštini Dimitrovgrad (7%). Zaključak- Neophodne su mere prevencije i što ranije otkrivanje bolesti, redukcija faktora rizika i korišćenje protektivnih faktora. Treba razmisliti o pomeranju skrininga ka mlađim uzrastnim grupama. BREAST CANCER MORTALITY RATE FOR THE TERRITORY OF PIROT MUNICIPALITY BETWEEN YEAR 1999. TO 2012.
Slavica Ciric Pejcic1, Olivera Radulovic2
1 General Hospital Pirot
2 Public Haelth Institute Nis
Breast cancer is by far the most common cancer among woman (20% of all cancers). With 1.6 million newly diagnosed per year in the world it is the second most widespread cancer when both sexes are considered. Work aim: The observation of mortality rate caused by breast cancer in the Pirot municipality and suggestions for prevention of breast cancer as relevant social-medical issue. The method: Application of descriptive-epidemiologist studies of breast cancer for the female population in Pirot municipality for period between 1999. to 2012. Analysing: The mortality from breast cancer considering regions and the age of group samples for chosen time period.
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The results of the work and discussion: In Pirot region the rate of mortality from breast cancer is showing a slight growth from 1999. (36,7) to 2012. (39,7/100.000). The average growth rate for breast cancer mortality rate in the Pirot municipality for observed time period is 34,3/100.000 and it is slightly lower than average mortality rate for central Serbia which was 43,4/1000.000 in the year 2012. The other municipalities in the Pirot region similarly have slightly lower mortality rate comparing to Central Serbia: Dimitrovgrad municipality (40,76/100.000), Pirot municipality (36,5/100.00), Babusnica municipality (28,67/100.000), Bela Palanka municipality (24,9/100.000). The average specific-increase in mortality from breast cancer in regions of Pirot municipality shows that the risk of dying from breast cancer is closely link with the aging factor: the highest percent of woman dying in the age over 50 years old is documented in the Pirot municipialtety (88,9%), followed by Dimitrovgrad municipality (78,6%), Babusnica municipality (78,3%), with the lowest mortality rate being registered in Bela Palanka (72,6%). The highest percent of woman dying under the age of 50 years old is in the municipality of Bela Palanka (13%), followed by Pirot municipality (10,6%), then Babusnica municipality (7,4%) and lastly Dimitrovgrad municipality (7%). The conclusion: It is necessary to apply prevention measures together with early detection of the illness, as well as the reduction of risk factors and the application of protection measures. It is worth considering the further research into lower age groups in the future.
PRAĆENJE I EVALUACIJA PROGRAMA PREVENCIJE I KONTROLE NEZARAZNIH BOLESTI U REPUBLICI SRPSKOJ
Slađana Šiljak, Slađana Vranješ, Dragana Stojisavljević, Janja Bojanić , Miodrag Marjanović
Institut za javno zdravstvo Republike Srpske
Cilj: Utvrditi najčešća patološka stanja dijagnostikovana u sklopu preventivnih pregleda djece.
Metod: U radu je korištena retrospektivna analiza godišnjih izvještaja zdravstvenih ustanova za 2015 godinu.
Od ukupnog broja registrovane djece osnovno školskog uzrasta (38883) pregledano je 22835 ili 58,7%. Čistoća tijela je u najvećem procentu procjenjena kao dobra 95,1% a tjelesno držanje u 87,6% dobro, 8,2% srednje i 4,1% loše. Tjelesna uhranjenost je u najvećem procentu (90,4%) dobra, kao i tjelesna razvijenost (91,3%). Deformiteti kičmenog stuba su u najvećem procentu naznačene skolioze (5,5%) i kifoze (2,3%). Izraženi deformiteti kičmenog stuba su prisutni u manje od 1% slučajeva što ukazuje na potrebu tretmana u okviru sekundarne prevencije. Među ostalim deformitetima kičmenog stuba su izražene deformacije stopala 10,8%. Najčešća smetnja vida je strabizam (1,4%) a alergije su otkrivene prilikom pregleda 3,6% djece. Karijes I stepena je prisutan kod 47,6% slučajeva a II stepena kod 34,8% slučajeva. Ortodontske anomalije su prisutne u 10,6% pregledane djece. Patološki laboratorijski nalazi u vidu anemije su prisutni kod 0,9%, albuminurije 0,5% i pozitivne stolice na parazite 1,2% pregledane djece.
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Zaključak: U više od polovine pregledane djece čistoća tijela, tjelesna uhranjenost i tjelesno držanje su zadovoljavajući. Među najučestalijim deformitetima lokomotornog sistema koji se mogu uspješno prevenirati su deformiteti stopala, skolioze i kifoze. Stomatološka patološka stanja su učestala u približno polovine djece kod kojih je registrovan karijes a svako deseto dijete ima ortodontske anomalije.
Ključne riječi: preventivni pregledi, patološka stanja, djeca
MONITORING AND EVALUATION OF THE NCDs PREVENTION AND CONTROL PROGRAMME IN THE REPUBLIC OF SRPSKA
Slađana Šiljak, Slađana Vranješ, Dragana Stojisavljević, Janja Bojanić, Miodrag Marjanović
Public Health Institute of the Republic of Srpska
Objective: To identify the most common pathological conditions laid down in the framework of preventive examinations of children.
Method: Retrospective analysis of annual reports of health care institutions for 2015 was used in this paper.
Of the total number of primary school children registered (38883), 22835 children or 58.7% were examined.
Body cleanliness is mostly assessed as good in 95.1% of children and body posture as good in 87.6% , medium in 8.2% and bad in 4.1% of children. The nutritional status is mostly good (90.4%) as well as body corpulence (91.3%). Spinal deformities mostly refer to scoliosis (5.5%) and kyphosis (2.3%). Expressed spinal deformities are present in less than 1% of cases indicating the need for treatment in the context of secondary prevention. Expressed foot deformities (10.8%) are among other spinal deformities. The most common visual disorder is strabismus (1.4%). Allergies are detected in 3.6% of children. The first degree caries is present in 47.6% and the second degree caries in 34.8% of cases. Orthodontic anomalies are present in 10.6% of examined children. Pathological laboratory findings are present in 0.9% of anemia, 0.5% of albuminuria and 1.2% of stool samples positive for parasites.
Conclusion: Body cleanliness, body posture and nutritional status are satisfactory in more than half of the children. Among the most common deformities of the locomotor system which can be prevented are foot deformities, scoliosis and kyphosis. Dental pathological conditions are prevalent in approximately half of the children registered with caries and every tenth child has orthodontic anomalies.
Key words: preventive examinations, pathological conditions, children
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РЕЗУЛТАТИ ПРВОГ ЦИКЛУСА ОРГАНИЗОВАНОГ СКРИНИНГА РАКА ГРЛИЋА МАТЕРИЦЕ У РЕПУБЛИЦИ СРБИЈИ
др Бојана Павловић, др Тамара Наумовић, др Верица Јовановић
Aпстракт
Увод:Организовани скрининг рака грлића материце се спроводи према Уредби о Националном програму раног откривања карцинома грлића материце (Сл.гл РС бр.73/13) од краја 2012.године. Програм се од јула 2014.године спроводи у 17 домова здравља-на територији 18 општина у Републици Србији које имају 639.164 жена циљне популације, што је око 33% укупног броја жена циљне популације узраста од 25.-64.године. Циљ овог истраживања је приказ, анализа и евалуација процесних и исходних индикатора из Програма организованог скрининга рака грлића материце за период првог трогодишњег циклуса од 2013. до 2015.године. Материјал и методологија: За прикупљање података коришћени су извештаји из установа које спроводе програм. Процесни и исходни индикатори су приказани у виду апсолутних бројева и изражени у процентима. Резултати: Просечна покривеност позивима за учешће у скринингу (%) износила је 54,6%. Просечан обухват Папаниколау тестом износио је 30%. Просечни одзив жена на тестирање Папаниколау тестом (%) је износио 54,9%. Са позитивним налазом (Папа налаз III, IV и V група) било је 6,4% жена. H-SIL налаз је био код 841 жене, односно 0,44% свих урађених тестова. Закључак: Већа покривеност циљне популације, односно обухват, организованим скринингом рака грлића материце од 75% није достигнут. Процесни индикатори су показали задовољавајуће резултате. Кључне речи: организовани скрининг, рак грлића материце, покривеност позивима, одзив, обухват
RESULTS OF THE FIRST CYCLE OF ORGANIZED CERVICAL CANCER SCREENING PROGRAME IN REPUBLIC OF SERBIA
Dr Bojana Pavlovic, dr Tamara Naumovic, dr Verica Jovanovic
Abstract
Introduction: Decree of National Program of early detection of cervical cancer (CC) (Sl.gl. RS No 73/13) defines methodology of organized CC screening. Target population is women 25 to 64 years. Interval for CC screening is 3 years. Screening test is cervical cytology (Papanicolau test). Program is conducted from July 2014, in 18 municipalities in Republic of Serbia which are inhabited by 639.164 women of the target population, 33% of the total target population in Republic of Serbia.
Aim of this paper is analysis and evaluation of indicators (process and outcome) of the first cycle of the organised CC screening Program, from 2013.-2015.
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Material and methodology: 17 Primary Health Care (PHC) centers conducting the Program submitted their data for analysis of process and outcome indicators. All indicators are in numbers and percentages.
Results: Process indicators: invitation coverage is 54,6%. Coverage by test is 30%. Compliance to invitation is 54,9%. Outcome indicators are: Positive tests (PAP III, IV an V) were at 6,4% of tests. H-SIL was at 0,44% findings. Cervical cancer was confirmed at 113 women.
Conclusion: Outcome indicators confirm that target of 75% coverage is not met yet. Process indicators are in line with expected epidemiological findings.
Key words: organised screening, cervical cancer, coverage by invitation, compliance to invitation, coverage by screening test.
EPIDEMIJA „PETE“ ILI NEKE DRUGE BOLESTI?
Mitić D.1, Marušić P.1, Živković S.1, Đorđević S.1, Savić Mitić Ž.2
1 Zavod za javno zdravlje “Timok” Zaječar
2 Zdravstveni centar Zaječar
Uvod: Erythema infectiosum (infektivni eritem, „peta bolest“) je akutno, lako, nefebrilno virusno oboljenje dečjeg uzrasta. Bolest izaziva Parvovisus B19. Ispoljava se krupnomrljastom ospom koja se pojavljuje u naletima u toku više dana. Karakterističan je upadljivi eritem obraza (išamarano lice), često udruženo sa ospom po telu i ekstremitetima. Ospa menja intenzitet, bledi na hladnoći, a pojačava se u toplom (kupanje) ili pri ekspoziciji suncu. Javlja se sporadično ili epidemijski, posebno kod dece u kolektivima (škole, vrtići). Prenosi se kontaktom sa respiratornim sekretima obolelih. Zaraznost je najveća pre izbijanja ospe, a po izbijanju ospe, verovatno prestaje. Dijagnoza se postavlja na osnovu kliničke slike i epidemioloških podataka, a potvrđuje detekcijom specifičnih IgM antitela protiv Parvovirusa B 19 ili porastom titra IgG antitela. Neophodna je diferencijalna dijagnostika od rubeole, šarlaha i eritema multiforme.
Cilj rada je prikaz epidemiološki obrađene epidemije infektivnog eritema („pete bolesti“) u PU „Đulići“, vrtić „Svitac“ 2016. godine u Zaječaru i ukazati na problematiku u potvrđivanju dijagnoze infektivnog eritema i tumačenju rezultata seroloških ispitivanja.
Materijal i metod rada: U radu smo kao izvor podataka koristili epidemiološke ankete obolelih i roditelja, pojedinačne prijave zaraznih bolesti, podatke dobijene od saradnika za preventivnu zdravstvenu zaštitu dece u PU „Đulići“, ELISA testove krvi obolelih na Parvovirus B19 IgM i IgG antitela i mikrobiološke analize briseva guša. Podaci su analizirani deskriptivnom metodom.
Rezultati: U epidemiji infektivnog eritema u Zaječaru su u periodu od 03.02. do 06.06.2016. godine ukupno obolele 22 osobe (20-oro dece i dve odrasle osobe - vaspitačice). Obolela deca su uzrasta od 2 do 10 godina. Odnos obolelih prema polu je: 14:8 u korist muškog pola. Ukupan broj
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE eksponiranih u vrtiću bio je 111, a stopa oboljenja je 20%. Put prenosa je kontakt i vazdušno- kapljični put. Najčešći simptomi i znaci kod obolelih su bili: osip po koži ekstremiteta i trupa (kod 91% obolelih), crvenilo obraza (kod 82% obolelih), osećaj vrućine i curenje iz nosa (kod 10% obolelih), svrab (5% obolelih). Nestajanje i ponovno pojavljivanje crvenila i osipa registrovano je kod 8 obolelih (36%). Nijedna obolela osoba nije bila hospitalizovana. Ukupno je uzorkovano 13 uzoraka krvi obolelih i testirano ELISA testom na Parvovirus B19 IgM i IgG antitela. Svi uzorci su bili na IgM antitela negativni, a takođe su svi bili visoko pozitivni na IgG antitela (5,8 – 6,9; vrednosti >1,1 su označene kao pozitivne). Nije rađeno ponovno uzorkovanje krvi obolelih zbog komfornosti dece i zato nije praćen titar IgG antitela. Visoki titrovi IgG antitela kod obolelih mogu da znače da su ranije već došli u kontakt sa ovim virusima ili da je u pitanju trenutna infekcija ovim virusima, s obzirom da se prema podacima iz literature seroprevalenca IgG antitela kod dece tog uzrasta 1-5 godina kreće od 5-32% u različitim zemljama. Bez ponovljenog uzorkovanja krvi i određivanja porasta titra IgG antitela ne možemo tvrditi da se radilo o akutnoj infekciji. Uzeti su i brisevi guše obolelih, ukupno 10 briseva, kod 8 je izolovana fiziološka mikroflora, kod dvoje obolelih Streptococcus pyogenes i Moraxella catharalis.
Zaključak: Dijagnozu infektivnog eritema najbolje je postaviti na osnovu kliničke slike i epidemioloških podataka. Serološku potvrdu dijagnoze nije neophodno raditi, pre svega zbog lake kliničke slike obolelih i zbog teškoća koje postoje u tumačenju dobijenih rezultata IgM i IgG antitela na parvovirus B19.
Ključne reči: infektivni eritem, IgM i IgG antitela na parvovirus B19, vrtić, epidemija
Sesija: Epidemiologija javnog zdravlja
Način prezentacije: Usmena prezentacija
OUTBREAK OF "THE FIFTH" DISEASE OR OTHER DISEASE?
Mitić D.1, Marušić P.1, Živković S.1, Đorđević S.1, Savić Mitić Ž.2
1Public Health Institute “Timok” Zaječar
2Health Center Zaječar
Introduction: Erythema infectiosum (infectious erythema, "fifth disease") is an acute, easily, without fever occurring viral disease in childhood. Disease causes Parvovisus B19. It manifests itself with a blotchy or maculopopular rash that appears gusting during several days. A distinctive is conspicuous cheek erythema (slapped - cheek), often associated with a rash on the body and limbs. Rash vary the intensity, fades in the cold, and it increases in hot water (bath), or being exposed to the sun. Occurs sporadically or epidemically, especially among children in collectives (schools, kindergartens). Transmitted by contact with a respiratory secretions of patients. Most contagious before the rash, but after the outbreak of rash, probably stops. Diagnosis is made by
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE clinical features and epidemiologic data, and confirmed by detection of specific IgM antibodies against Parvovirus B 19 or the increase in IgG antibody titer. It is necessary differential diagnosis of rubella, of scarlet fever and erythema multiforme.
Objective: aim of paper is to present the epidemiologically processed outbreaks of infectious erythema ("fifth disease") in PU "Đulići" in kindergarten "Svitac" in 2016 in Zajecar and indicate to the problems in confirming the diagnosis of infectious erythema and interpreting the results of serological tests.
Materials and methods: In this paper we are used as a source epidemiological surveys of patients and parents, individual notification of communicable diseases, the data received from associates for preventive health care of children in PU "Đulići", ELISA tests to the blood of patients on the parvovirus B19 IgM and IgG antibodies and microbiological analysis of smears gullet. Data were analyzed by descriptive method.
Results: In an outbreak of infectious erythema in Zajecar in the period from 03.02. to 06.06.2016. a total the number of diseased are 22 people (20 children and two adults - kindergarten teachers). Sick children are aged from 2 to 10 years. The ratio of patients by gender was 14: 8 in favor of the males. The total number exposed in kindergarten was 111, and the rate of disease was 20%. Way the transfer of was contact and air-droplet. The most frequent symptoms in patients were as follows: skin rash of the limbs and the trunk (in 91% of patients), redness the cheeks (in 82% of patients), feeling of heat and runny nose (in 10% of patients), pruritus (5% of patients). The disappearance and reappearance of redness and rash was observed in 8 patients (36%). None of the diseased person was not hospitalized. A total of 13 blood samples were taken from patients and tested an ELISA assay for parvovirus B19 IgM and IgG antibodies. All the samples were on the IgM antibodies negative, and is also all were highly positive for human IgG antibodies (5.8 - 6.9; values> 1.1 have been marked as positive). Is not done once again sampling the blood of patients due to the comfort children and therefore not accompanied IgG antibody titer. High titers of IgG antibodies in patients may mean that previously came in contact with one of these viruses, or to be the current infection by these viruses, considering that according to the literature seroprevalence of IgG antibodies in children of that age 1-5 years ranges from 5-32% in different countries. Without the repeated sampling of blood and determination of the increase in IgG antibody titer can not claim to that it was an acute infection. A total of 10 swabs of gullet were taken of patients, at 8 were isolated physiological microflora, in two patients were isolated Streptococcus pyogenes and Moraxella catharalis.
Conclusion: The diagnosis of infectious erythema is best to based on clinical and epidemiological data. Serological confirmation of the diagnosis is not necessary to do, primarily because of the easy of the clinical picture patients and because of the difficulties which exist in interpreting of the results obtained of IgM and IgG antibodies against parvovirus B19.
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Keywords: erythema infectiosum, IgM and IgG antibodies against parvovirus B19, kindergarten, the epidemic.
Session: Epidemiology the public health
Method of presentation: Oral presentation
OBOLEVANJE I UMIRANJE OD MALIGNIH TUMORA DOJKE U RASINSKOM OKRUGU U PERIODU 2005-2014
Mirjana Avramović1, Miloš Mihajlović2, Dragoljub Vuksanović1, Snežana Živković3
Zavod za javno zdravlje Kruševac
2 Opšta bolnica Kruševac
3Institut za javno zdravlje Srbije " dr Milan Jovanović Batut "
UVOD: Maligni tumori dojke, predstavljaju vodeći uzrok obolevanja i umiranja od raka kod žena, kako u razvijenim zemljama sveta, tako i u našoj sredini. Karcinomi dojke čine 12% svih tumora, odnosno 25% svih malignih tumora žena. Najveći procenat smrti od raka, kod žena je upravo od raka dojke, čak 18%.
CILJ: Analiza obolevanja i umiranja od malignih tumora dojke u Rasinskom okrugu u periodu od 2005. do 2014. godine.
METOD: U radu je primenjen deskriptivno epidemiološki metod. Kao izvor podataka o obolevanju i umiranju od malignih tumora korišćeni su podaci Registra za rak centralne Srbije u periodu od 2005. do 2014. godine
REZULTATI: Svake godine u posmatranom periodu 147 žena u proseku oboli dok 57 žena umre od raka dojke, na Rasinskom okrugu. Prosečna standardizovana incidencija je je 65,1/100000 dok je prosečan mortalitet 19,1/100000. Tokom analiziranog perioda, standardizovane stope incidencije od malignih tumora dojke su porasle (y=50,03+2,74x), dok je standardizovani mortalitet od malignih tumora dojke u padu (y =19,85-0,14x) . Prosečna stopa incidencije raka dojke u periodu 2012-2014 je porasla za 42% u odnosu na prosečnu stopu incidencije u priodu 2005-2007, dok je mortalitet od raka dojke u istom periodu opao za 10%. Prosečna standardizovana stopa incidencije u 2014 iznosila je 81,4 na 100.000 i tako je Rasinski okrug imao drugu po visini stopu incidencije raka dojke u Srbiji, dok je stopa mortaliteta iznosila 20,1 na 100.000 žena, što je četvrta po visini stopa mortaliteta u Centralnoj Srbiji. U trenutku postavljanja dijagnoze samo 20% tumora dojke bilo je manje veličine od 2cm, 2/3 malignih tumora dojke bilo je prošireno na susedne anatomske strukture, regionalne limfne žlezde ili udaljene organe. Morfološki, 74% malignih
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE tumora dojke, činili su invazivni duktalni karcinomi, a najčešća primarna anatomska lokalizacija tumora je bio spoljašni gornji kvadrant.
ZAKLJUČAK: Da bi se povećala stopa preživljavanja od raka dojke, neophodno je da se žene redovno odazivaju na preventivne skrining preglede kako bi se rak dojke otkrio u najranijem i potpuno izlečivom stadijumu. Rano orkrivanje raka dojke omogućava da se maksimalno produži život oboleloj ženi kao i da se primenom poštednih hirurških procedura obezbedi brži oporavak i bolji kvalitet života.
Ključne reči: Dojka, incidencija, mortalitet, tumor, žene
BREAST CANCER INCIDENCE AND MORTALITY IN RASINA DISTRICT
IN THE PERIOD 2005-2014
Mirjana Avramović1, Miloš Mihajlović2, Dragoljub Vuksanović1, Snežana Živković3
1Center for Public Health of Kruševac
2Hospital of Kruševac
3Institute of Public Health of Serbia " dr Milan Jovanović Batut "
BACKGROUND: Breast cancer is the leading cause of cancer incidence and mortality in female all over the world and also in our country. Breast cancer contributes in 12% of all cancer, but 25% in females. Breast cancer contributes in 18% of all cancer death in females.
AIM: Breast cancer incidence and mortality analysis in Rasina district from 2005-2014.
METHOD: Descriptive epidemiological method. Source of information for cancer incidence and mortality data was Cancer Registry of Central Serbia for the period 2005.-2014.
RESULTS: Every year 147 women were diagnosed with breast cancer and 57 annually died during this period, in Rasina district. Average standardized incidence was 65,1/100.000 and average standardized mortality was 19, 1/100.000. During analyzed period standardized incidence increased (y=50,03+2,74x) and mortality rates decreased mildly, (y =19,85-0,14x). Average standardized incidence for 2012-2014 increased for 42% comparing with standardized incidence 205-207, while standardized mortality rate decreased 10%, in the same period. Average standardized breast cancer incidence of Rasina district in 2014 was the second value in Serbia, while average standardized mortality was the fourth value in Serbia. At the date of diagnose 20% breast cancers only were smaller dimension than 2cm, while 2/3 women had disseminated cancer, from local extended organs, regional lymph nodes to metastasis in one or more organs. Morphologically, 74% of breast cancer was invasive ductal cancer and most frequent anatomical localization of cancer was lateral upper quadrant.
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CONCLUSION: In order to increase breast cancer survival rate, it is necessary for every woman to take part orderly in the National breast cancer screening programme, which provide diagnose the breast cancer in the earliest, completely curable stadium. That allows breast cancer suffering woman to prolong the lifetime as long as possible as well as applying with sparing surgery to supply quicker recovery and far more better quality of life.
Key words: Breast, cancer, incidence, mortality, females
EPIDEMIOLOGIJA HIV/AIDS-A U SEVERNOBAČKOM OKRUGU I RAD SAVETOVALIŠTA ZA DPST U ZAVODU ZA JAVNO ZDRAVLJE SUBOTICA
Dragica Kovačević Berić1, Morana Miković1, Ljiljana Tršić1 1Zavod za javno zdravlje Subotica, Subotica, Republika Srbija Uvod: Prema procenama Svetske zdravstvene organizacije i Agencije UN-a za borbu protiv HIV/AIDS-a u svetu je krajem 2015. godine 37 miliona ljudi imalo HIV/AIDS, što čini povećanje od oko 20 % u odnosu na 2001. godinu. Od samog početka epidemije HIV infekcije značajna pažnja se posvećivala DPST, ali je rad savetovališta za DPST u Subotici započeo tek 2003. godine. Cilj rada: Sagledavanje deskriptivno-epidemioloških podataka i načina transmisije kod osoba sa HIV/AIDS-om u Severnobačkom okrugu. Sagledavanje broja, osnovnih demografskih podataka i oblika rizičnog ponašanja klijenata DPST savetovališta u Subotici. Materijal i metod rada: Korišćeni su podaci iz prijava zaraznih bolesti i godišnjih izveštaja o radu DPST savetovališta. Rezultati: Od početka epidemije do danas, u Severnobačkom okrugu HIV infekcija je registrovana kod 64 osobe, od AIDS-a je obolelo 37 osoba, a 16 obolelih je umrlo. Najviše novootkrivenih infekcija je registrovano 2015. godine (7). Muškarci čine 88,1% inficiranih/obolelih, od čega je jedna trećina uzrasta 30 do 39 godina (34,4%), sledi uzrast 25 do 29 godine (18,9%). Među inficiranim i obolelim osobama u posmatranom periodu, kod 77,2% slučajeva način transmisije je rizični homo/biseksualni, a 22,6% heteroseksualni kontakt. U periodu od 2003. do 2016. godine 2718 osoba je savetovano i testirano na HIV. Među njima, muškarci učestvuju sa 58%. Najveći broj savetovanih i testiranih osoba (22,5%) je starosti 25-29 godina. Kao najčešći razlog dolaska na testiranje je naveden rizičan heteroseksualni odnos, koji je zastupljen sa 52%, a zatim homo/biseksualni kontakt (18%), seksualne radnice/radnici (4%) i intravenska upotreba narkotika (3%).
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Zaključak: Ono što karakteriše epidemiju HIV/AIDS u Severnobačkom okrugu od početka epidemije do danas je kasno otkrivanje infekcija, odnosno otkrivanje u fazi razvijenog AIDS-a, stopa savetovanih i testiranih na HIV i dalje je niska, usled čega je nepoznat stvarni broj osoba koje žive sa HIV-om. Ključne reči: HIV, DPST, rizično ponašanje
EPIDEMIOLOGY OF HIV/AIDS IN THE NORTH BAČKA DISTRICT AND THE WORK OF THE VCCT CCINIC AT THE INSTITUTE OF PUBLIC HEALTH IN SUBOTICA Authors: Dragica Kovacevic Beric¹, Morana Mikovic¹, Ljiljana Trsic1 ¹Public Health Institute Subotica, Subotica, Republic of Serbia Introduction: According to the estimates by the World Health Organization and the Joint United Nations Programme on HIV and AIDS (UNAID) there were 37 million HIV/AIDS positive people in the world at the end of 2015, which makes an increase of about 20% compared to 2001. Since the very beginning of the HIV epidemic, much attention has been paid to VCCT, but the VCCT clinic in Subotica only started working in 2003. Objective: Understanding descriptive and epidemic data and ways of transmission in HIV/AIDS positive people in the North Bačka District. Understanding the figures, basic demographic data and forms or risky behavior of the clients of the VCCT clinic in Subotica. Materials and methodology of work: Data from infectious disease registers and annual work reports of the VCCT clinic have been used. Results: Since the beginning of the epidemic to the present day, there have been 64 recorded HIV positive cases in the North Bačka District, 37 people have contracted HIV and 16 of the ill have died. The highest number of the newfound cases, seven, was recorded in 2015. Men made up 88.1% of the infected/ill, of which number one third was between the ages of 30 and 39 (34.4%), followed by the age group of 25 to 29-year-olds (18.9%). Among the infected and ill in the observed period, in 77.2% of the cases the way of transmission was a risky homo/bisexual contact and in 22.6% of the cases it was a heterosexual contact. In the period from 2003 to 2016, there were 2718 people tested and counselled for HIV. Among them, men’s share was 58%. The highest number of those tested and counselled (22.5%) was aged between 25 and 29. As the most frequent reason for coming
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XXX STRUČNI SASTANAK PREVENTIVNE MEDICINE TIMOČKE KRAJINE to testing they cited a risky heterosexual contact, which was present in 52% of the cases, followed by a homo/bisexual contact (18%), sex workers (4%) and IV use of narcotics (3%). Conclusion: Characteristic of the epidemic of HIV/AIDS in the North Bačka District since the beginning of the epidemic to the present day has been late discovery of the infection, i.e. discovery at the stage of the developed AIDS infection, the figures of the counselled and HIV tested individuals are still low, which leads to the conclusion that the real number of people living with HIV is unknown. Key words: HIV, VCCT, risky behavior REDAK IZOLAT U MIKROBIOLOŠKOJ LABORATORIJI ZJZ ”TIMOK” ZAJEČAR - CHRYSEOBACTERIUM INDOLOGENES
SLAĐANA ĐORĐEVIĆ,GORDANA VASILIJEVIĆ LUČIĆ, BOJANA NIKOLIĆ
CENTAR ZA MIKROBIOLOGIJU
ODELJENJE ZA KLINIČKU MIKROBIOLOGIJU
ZAVOD ZA JAVNO ZDRAVLJE ”TIMOK” ZAJEČAR
Uvod: Chryseobacterium indologenes pripada Gram negativnim, fakultativno anaerobnim , nepokretnim bakterijama oblika bacila. Karakteriše se produkcijom žutog pigmenta –Flexirubina. Može se naći u zemljištu, vodama, na biljkama, priboru za ishranu, na vlažnim radnim površinama, klima uređajima. U bolničkoj sredini se može naći u vodenim sistemima, na medicinskim predmetima, uređajima, kateterima,medicinskim implantatima, hirurškim koncima. Prvi put je izolovan 1983.godine iz trahealnog aspirata pacijenta na veštačkoj ventilaciji. Patogenetski mehanizam delovanja je vezan za formiranje biofilma, pa nije neočekivana multirezistencija ove bakterije na antibiotike I sredstva za dezinfekciju. Poseban značaj ima kod imunokompromitovanih pacijenata, pacijenata sa komorbiditetima, pacijenata na produženoj antibiotskoj terapiji, pacijenata u odeljenjima intenzivne nege, neonatalnim odeljenjima kada se neretko javlja kao udružena infekcija, septikemija, meningitis.
Cilj rada je prikaz retkog izolata u mikrobiološkoj laboratoriji ZJZ ”Timok” Zaječar.
Materijal I metod rada: U radu su prikazana dva uzorka sputuma pacijenata iz bolničke sredine sa uputnom dijagnozom HOBP (Hronična obstruktivna bolest pluća) .Korišćene su standardne mikrobiološke metode za obradu uzoraka, identifikaciju I test osetljivosti.
Rezultati istraživanja: U direktnim mikroskopskim preparatima nađeno je dosta leukocita I Gram negativnih bacila. Na krvnom I endo agaru ispupčene, sjajne, žuto prebojene kolonije. Katalaza,oksidaza,indol reakcije su pozitivne. Konačnu identifikaciju dobili smo korišćenjem API
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20E testa (BioMerieux). Testirani sojevi su osetljivi na Ciprofloxacin, Thrimetoprim/sulfametoxasol, a rezistentni na Meropenem, Imipenem, aminoglikozide, cefalosporine I,II I III generacije. Jedan soj je osetljiv na Piperacillin/tazobactam I Cefepim.
Zaključak: Chryseobacterium indologenes je bakterija sa urođenom otpornošću na veliki broj antibiotika pa može naći svoje mesto na listi prouzrokovača intrahospitalnih infekcija, može pogoršati osnovnu bolest hospitalizovanih, imunokompromitovanih pacijenata , pacijenata u odeljenjima intenzivne nege, neonatološkim odeljenjima . Poštovanje osnovnih principa antisepse I asepse smanjuje mogućnost nastajanja navedenih komplikacija.
Ključne reči: Chryseobacterium, biofilm, septikemija.
RARE ISOLATE FROM THE MICROBIOLOGY LABORATORY PUBLIC HEALTH INSTITUTE "TIMOK" ZAJEČAR - CHRYSEOBACTERIUM INDOLOGENES
SLAĐANA ĐORĐEVIĆ, GORDANA VASILIJEVIĆ LUČIĆ, BOJANA NIKOLIĆ CENTAR ZA MIKROBIOLOGIJU ODELJENJE ZA KLINIČKU MIKROBIOLOGIJU ZAVOD ZA JAVNO ZDRAVLJE “TIMOK” ZAJEČAR Introduction: Chryseobacterium indologenes belongs to Gram-negative, facultative anaerobic, non-motile bacillus. It is characterized by the production of yellow pigment - Flexirubin. It can be found in soil, water, on plants, accessories for feeding on moist surfaces, air conditioning. In the hospital setting, can be found in aquatic systems, in medical items, devices, catheters, medical implants, surgical sutures. It was first isolated in 1983 from a tracheal aspirate a patient on artificial ventilation. The pathogenic mechanism of action is related to the formation of biofilm, but not unexpected multidrug resistance of bacteria to antibiotics and disinfectants. Of particular importance is in immunocompromised patients, patients with co-morbidities, patients on prolonged antibiotic therapy, patients in intensive care units, neonatal unit when it often appears as associated infection, septicemia, meningitis. The aim is to see the rare isolate from the microbiology laboratory PHI "Timok" Zajecar. Material and methods: In the present two sputum samples of patients in a hospital environment with the diagnosis of COPD (chronic obstructive pulmonary disease) .We used standard microbiological methods for the processing of specimens, identification and susceptibility testing. Research results: In direct microscopic slides found a lot of leukocytes and gram-negative bacilli. On blood and endo agar a prominent, bright, yellow painted colonies. Catalase, oxidase and indol reactions are positive. We get the final identification using API 20E test (BioMerieux). The test samples are sensitive to Ciprofloxacin, Thrimetoprim / sulfametoxasol, but are resistant to Meropenem, Imipenem, Aminoglycosides, Cephalosporins I, II and III generation. One strain is susceptible to Piperacillin / tazobactam and Cefepime. Conclusion: Chryseobacterium indologenes the bacteria with intrinsic resistance to a large number of antibiotics but can find its place among the causal agents of nosocomial infections can worsen the disease hospitalized, immunocompromised patients, patients in intensive care units, neonatal departments. Respect for fundamental principles of antisepsis and asepsis reduces the risk of these complications. Keywords: Chryseobacterium, biofilm, septicemia.
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Садржај: Вода од првог до последњег купања, Др Стеван М. Станковић - 3, Drug-Checking: An efficient drug prevention measure in the techno scene, Steve Müller – 4, Implementation of integrated drug checking as a means of coping with risks associated with the rapidly changing drug market in the greater Vienna area, Anton Luf – 4, Proteomics as a Tool for Analysis and Clasification of Cerebral Tissue in Early Disease Detection for Brain Tumors and Epilepsy, Goran Mitulović – 5, Beyond the Future off Mass Spectrometry, New Applications for Public Health, Konstantin Halikias – 6, ”Responsible sexual behaviour among adolescents, how to pass the information onto them?”, Assist. Prof. Dubravko Lepušić, PhD, MD - 7 Људски ресурси у здравственој заштити, Зоран Милошевић – 9, Reproduktivno zdravlje muškaraca - znanje, ponašanje i stavovi, Olivera Radulović – 14 Aktuelna saznanja o patogenezi i dijagnostici Legionella pneumophila, Branislava Kocić – 20, Medicinska nutritivna terapija dijabetesa, Nikolić Maja – 22, Stresni životni događaji i rak dojke, Prof. dr Biljana Kocić – 23, Prostorni planovi kao instrument upravljanja i zaštite od prirodnih nepogoda u Srbiji, Prof. dr Dejan Filipović – 24, Осврт на досадашње активности Завода за јавно здравље „Тимок“ Зајечар на пољу демографије, у контексту савремених демографских изазова у Србији, Милена Спасовски – 25, New brucella species and reservoirs– potential of global re-emerging zoonosis, Vaso Taleski – 28 Преваленца пушења особља опште болнице Лесковац, Вања Илић - 29 Procena rizika za nastanak mentalnih problema radnika kao osnov za planiranje programa promocije zdravlja, Dubravka Nikolovski – 31, Podsticanje mladih na aktivnosti u prevenciji bolesti zavisnosti – zavisnost na „Ignore“, Ljiljana Lazić – 32, Da li su mladi otporni na izazove zavisnosti?, Aleksandra Perović – 34, Заступљеност пушења - - резултати истраживања у Србији, Надежда Николић -35, Mladi i alkohol, Mirjana Filipović – 36,
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Kakva je perspektiva demografskog oporavka Zaječarskih sela, Magdalena Todorovic Nikolic - 38 Morbiditet i mortalitet školske djece i omladine na području opštine Nevesinje od 2012. do 2015.godine, Radulović Danijela – 39, Analiza prvorotki u Nišu 2006.-2015.godine, Mariola Stojanović – 40 Zdravlje i društvo, Marina Vojnović – 42 Urgentna medcina razvoj od stare Grčke i Rima do danas, milos protić – 43, Komunikacijske prepreke i konflikti, Ankica Živković Radenković – 45, Унапређење квалитета рада изабраног лекара у области превентиве округа Бор и Зајечар, Снежана Тошић – 47, Људски ресурси здравствених установа примарне здравствене заштите Зајечарског и Борског округа, Олица Радовановић – 50, Mladi-naša sadašnjost - izazovi savremenog društva, Ana Točević – 53, Značaj joda za zdravlje i zablude u vezi sadržaja joda u zelenim orasima, Nebojša Paunković – 55, Predškolske ustanove prijatelji pravilne ishrane - od ideje do realizacije inicijative, Dragana Stojisavljević – 56, Generisana količina i upravljanje medicinskim otpadom u republici Srbiji – pregled, Radmila Šerović – 57, Sanitarno-higijensko stanje objekata za društvenu ishranu otvorenog tipa u Zlatiborskom okrugu, Violeta Prošić – 59, Анализа водоснабдевања у сеоским срединама на подручју Jужнобанатског округа, С.Ђурић – 61, Јавно-здравствени значај водоснабдевања у Зајечару од 2012 до 2016. Године, Дијана Миљковић – 62, Industrijski kontaminirani lokaliteti u Srbiji - razlog za brigu?, Prim.mr sci.med. Branislava Matić – 64, Могућности и перспективе примене геоинформатике у животној средини, Никола Јовановић – 66, Endokrini disruptori i zdravlje dece, Dr med. Snežana Dejanović – 67,
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Preliminarni rezultati monitoringa alergenog polena u Sokobanji za 2016. godinu, Milijana Vučković – 69, Gordius aquaticus u vodi za piće i vodi za sport i rekreaciju, Dragan Paunović – 71, Ocena hemijskog statusa akumulacije grlište, Ljubiša Denić – 73, Ocena ekološkog potencijala akumulacije Grlište, Ljubiša Denić – 75, Hranjive i fiziološke karakteristike proizvoda melvit, Dr Aneta Georgijev – 76, Значај и улога приступа у саветовалишном раду- искуства кроз приказ случајева, Ненад Ђорђевић - 78 Od njive do trpeze, Jovanović R. – 80, Zemljino magnetno polje i magnetne osobine ćelije kao faktor rasta razmnožavanja i ćelijske deobe, Nikola Trifunović – 81, Doprinos anomalijskog magnetnog polja u nastanku malignih mnplazmi, Dejan Krstić – 84, Značaj ultrazvuka u prevenciji uroloških oboljenja, Radoš Žikić – 85, Učestalost vakcinabilnih bolesti u Republici Srpskoj u zadnjih deset godina, Janja Bojanić – 87, Mortalitet od karcinoma dojke na teritoriji Pirotskog okruga u periodu od 1999. Do 2012. Godine, Slavica Ćirić Pejčić – 88, Praćenje i evaluacija programa prevencije i kontrole nezaraznih bolesti u Republici Srpskoj, Slađana Šiljak – 90 Резултати првог циклуса организованог скрининга рака грлића материце у Републици Србији, др Бојана Павловић – 92 Epidemija „pete“ ili neke druge bolesti?, Mitić D – 93 Obolevanje i umiranje od malignih tumora dojke u Rasinskom okrugu u periodu 2005-2014, Mirjana Avramović – 96 Epidemiologija hiv/aids-a u Severnobačkom okrugu i rad savetovališta za dpst u Zavodu za javno zdravlje Subotica, Dragica Kovačević Berić – 98, Redak izolat u mikrobiološkoj laboratoriji ZJZ ”Timok” Zaječar - chryseobacterium indologenes, Slađana Đorđević – 100.
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