Aflatoksin M1 u sirovom mlijeku u regiji Vojvodine

Aflatoxin М1 was in the spotlight of public attention in Serbia and in the region in 2013 due to high level of this mycotoxin found in milk and milk products. Maximum allowed concentration of aflatoxin M1 in milk by EU regulation is 50 ng/kg, while in the Republic of Serbia, allowed concentration by the current regulation is 250 ng/kg. During seven months period, from May to November, samples of raw milk were being taken from six farms, with 60 to 330 cows, from the region of Autonomous Province of Vojvodina, the Republic of Serbia, for the purpose of monitoring the occurrence of aflatoxin M1 in milk and its variation during this period. The highest level of 39.8 ng/kg was found in November, while the mean value for the whole period was 7.9 ng/kg. None of the samples had higher level of this mycotoxin than allowed by EU regulation or by current legislation of the Republic of Serbia. The second group of samples included a total of 38 samples of raw milk, from the period of October and November, were taken from different producers from the region of Vojvodina and analyzed on the occurrence of aflatoxin M1. In this group of samples, the occurrence of aflatoxin M1 was much higher, with the average value of 230 ng/kg. The highest found value was 864 ng/kg. In 13 samples, the aflatoxin M1 content was higher than the allowed by the legislation of the Republic of Serbia, while in 24 (63.2 %) samples determined concentration exceeded the value allowed by EU regulation. Data from this work suggest huge differences in the occurrence of aflatoxin M1 in milk between the producers in this region. Regular monitoring is necessary to avoid situation with the elevated level of aflatoxin M1 in milk. This measure will protect both the consumers and the producers of milk and milk product.Aflatoksin M1 je bio u središtu pozornosti javnosti u Srbiji ali i u regiji u 2013. godini, zbog visoke razine u mlijeku i mliječnim proizvodima. Najveća je dopuštena koncentracija aflatoksina M1 u mlijeku po propisu EU 50 ng/kg, dok je u Republici Srbiji dopuštena koncentracija prema važećem propisu 250 ng/kg. Uzorci sirovog mlijeka prikupljani su sa šest gospodarstava, sa 60 do 330 krava, s područja Autonomne Pokrajine Vojvodine, Republike Srbije, kontinuirano tijekom sedam mjeseci razdoblja (od svibnja do studenog), u svrhu praćenja pojave aflatoksina M1 u mlijeku i njegova promjena u tom razdoblju. Najviša razina 39,82 ng/kg pronađena je u studenome, dok je srednja vrijednost za cijelo razdoblje bila 7,94 ng/kg. Nijedan od svih uzoraka nije imao višu razinu ovog mikotoksina od razine dopuštene propisom EU ili važećem propisu Republike Srbije. Druga skupina uzoraka, ukupno 38 uzoraka sirovog mlijeka, iz razdoblja listopad/ studeni, uzeto je od različitih proizvođača iz regije Vojvodine i analizirano na pojavu aflatoksina M1. U ovoj skupini uzoraka pojava aflatoksina M1 bila je znatno veća, s prosječnom vrijednošću od 230 ng/kg i najvišom utvrđenom od 864 ng/kg. U 13 (34,27 %) uzoraka utvrđena je koncentracija aflatoksina M1 veća od dopuštene po zakonodavstvu Republike Srbije, dok su u 24 (63,16%) uzorka utvrđene koncentracije prelazile vrijednosti dopuštene propisom EU. Podaci ovog rada ukazuju na velike razlike u pojavi aflatoksina M1 u mlijeku između proizvođača u ovoj regiji. Redovito praćenje je potrebno da bi se izbjegle situacije s povišenom razinom aflatoksina M1 u mlijeku, te da se zaštite i potrošači i proizvođači mlijeka i mliječnih proizvoda

Effectiveness of combining feedback about lung age or exhaled carbon monoxide levels with Very Brief Advice (VBA) and support for smoking cessation in primary care compared to giving VBA and support alone – protocol for a randomized controlled trial within the Breathe Well research program

INTRODUCTION: In 2015, smoking prevalence in Republic of Macedonia was 36% in men and 21% in women We aim to assess the effectiveness and cost-effectiveness of two methods of motivating smokers to quit smoking compared with very brief advice (VBA) alone. Тo date, there are no studies investigating smoking cessation treatment in Republic of Macedonia. METHODS/DESIGN: RCT with process evaluation and cost-effectiveness analysis within 31 general practices in Republic of Macedonia recruiting smokers currently smoking >10 cigarettes per day, aged >35 years, attending primary care practices for any reason, regardless of motivation to quit smoking. Respondents will be randomized into one of three groups: (1) VBA and assessment and communication of lung age; (2) VBA and additional assessment and communication of exhaled carbon monoxide (CO) levels; or (3) control group – VBA. All participants who attempt to quit smoking will be offered behavioral support based on the UK standard program for smoking cessation. Primary outcome: Proportion of smokers who are quit at 4 weeks (7-day point prevalence, confirmed by salivary cotinine level). Secondary outcomes: Proportion who have attempted to quit smoking or have quit smoking, a proportion that has reduced the number of cigarettes and motivation to quit smoking; cost-effectiveness analysis calculating cost per quality-adjusted life year. We will evaluate the fidelity to the intervention and will explore patients’ and GPs’ experience and the acceptability of the study intervention by interview. DISCUSSION: The study will evaluate the effectiveness of combining feedback about lung age or exhaled CO levels with VBA and support for smoking cessation in primary care compared to giving VBA and support alone. It will explore how willing primary care physicians are to perform such interventions and the acceptability and effectiveness of such interventions to patients in Republic of Macedonia. TRIAL REGISTRATION: The study is registered on the ISRCTN registry (ISRCTN54228638)

Randomised controlled trial testing effectiveness of feedback about lung age or exhaled CO combined with very brief advice for smoking cessation compared to very brief advice alone in North Macedonia. Findings from the Breathe Well group

Abstract Introduction In 2019, smoking prevalence in North Macedonia was one of the world’s highest at around 46% in adults. However, access to smoking cessation treatment is limited and no co-ordinated smoking cessation programmes are provided in primary care. Methods We conducted a three parallel-armed randomised controlled trial (n = 1368) to investigate effectiveness and cost-effectiveness of lung age (LA) or exhaled carbon monoxide (CO) feedback combined with very brief advice (VBA) to prompt smoking cessation compared with VBA alone, delivered by GPs in primary care in North Macedonia. All participants who decided to attempt to quit smoking were advised about accessing smoking cessation medications and were also offered behavioural support as part of the “ACT” component of VBA. Participants were aged ≥ 35 years, smoked ≥ 10 cigarettes per day, were recruited from 31 GP practices regardless of motivation to quit and were randomised (1:1:1) using a sequence generated before the start of recruitment. The primary outcome was biochemically validated 7-day point prevalence abstinence at 4 weeks (wks). Participants and GPs were not blinded to allocation after randomisation, however outcome assessors were blind to treatment allocation. Results There was no evidence of a difference in biochemically confirmed quitting between intervention and control at 4wks (VBA + LA RR 0.90 (97.5%CI: 0.35, 2.27); VBA + CO RR 1.04 (97.5%CI: 0.44, 2.44)), however the absolute number of quitters was small (VBA + LA 1.6%, VBA + CO 1.8%, VBA 1.8%). A similar lack of effect was observed at 12 and 26wks, apart from in the VBA + LA arm where the point estimate was significant but the confidence intervals were very wide. In both treatment arms, a larger proportion reported a reduction in cigarettes smoked per day at 4wks (VBA + LA 1.30 (1.10, 1.54); VBA + CO 1.23 (1.03, 1.49)) compared with VBA. The point estimates indicated a similar direction of effect at 12wks and 26wks, but differences were not statistically significant. Quantitative process measures indicated high fidelity to the intervention delivery protocols, but low uptake of behavioural and pharmacological support. VBA was the dominant intervention in the health economic analyses. Conclusion Overall, there was no evidence that adding LA or CO to VBA increased quit rates. However, a small effect cannot be ruled out as the proportion quitting was low and therefore estimates were imprecise. There was some evidence that participants in the intervention arms were more likely to reduce the amount smoked, at least in the short term. More research is needed to find effective ways to support quitting in settings like North Macedonia where a strong smoking culture persists. Trial registration The trial was registered at http://www.isrctn.com (ISRCTN54228638) on the 07/09/2018

Clinical pathway of COVID-19 patients in primary health care in 30 European countries : Eurodata study

BackgroundMost COVID-19 patients were treated in primary health care (PHC) in Europe.ObjectivesTo demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe.MethodsDescriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020.ResultsCOVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30).ConclusionIn Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.Peer reviewe

The role of primary health care in long-term care facilities during the COVID-19 pandemic in 30 European countries : a retrospective descriptive study (Eurodata study)

Background and aim:Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic.Methods:Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care.Results:Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom's follow-up was performed mainly by PHC.Conclusion:PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.Peer reviewe

Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study

BACKGROUND: Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES: To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS: Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS: COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION: In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics