Analysis of healthcare waste management factors in the provision of healthcare services

UVOD: U radu zdravstvenih ustanova nastaje medicinski otpad, koji se sastoji iz dve komponente, neopasne (75% od ukupne količine) i opasne komponente (25%). U zdravstvenim ustanovava u posledljih deset godina unapređen je rad u postupanju sa medicinskim otpadom, u skladu sa Zakonom o otpadu i Pravilnikom o upravljanju medicinskim otpadom Republike Srbije. Promene u upravljanju sa medicinskim otpadom (UMO) se sastoje iz uvođenja procedura za bezbedno postupanje opasnim medicinskim otpadom od generisanja medicinskog otpada do odlaganja. METOD RADA: Studija predstavlja istraživanje prospektivnog i retrospektivnog tipa na reprezentativnom uzorku zdravstvenih ustanova državnog sektora zdravstva, na teritoriji Republike Srbije bez Kosova i Metohije, koje se međusobno razlikuju u odnosu na vrstu ustanove, nivo zdravstvene zaštite i teritorijalnu pripadnost. Instrumenti istraživanja koji su korišćeni u studiji, su standardizovani upitnici za ispitivanje UMO u sistemima zdravstvene zaštite. Ukupno 116 ustanova je obuhvaćeno istraživanjem i to sa srazmernom zastupljenošću svih vrsta zdravstvenih ustanova (domovi zdravlja, opšte i specijalne bolnice, kliničko-bolnički centri, klinički centri, zavodi i instituti za javno zdravlje, ostale ustanove) iz tri nivoa zdravstvene zaštite. REZULTATI: Izdvojeni su ključni činioci UMO koji utiču na pružanje i kvalitet zdravstvene zaštite u zdravstvenim ustanovama na različitim nivoima zdravstvene zaštite (primarni, sekundarni, tercijarni) i u različitim vrstama zdravstvenih ustanova (dom zdravlja, opšta bolnica, klinički centar, kliničko bolnički centar, institut ili zavod za javno zdravlje) pojedinačno. Ovom studijom utvrđene su razlike među zdravstvenim ustanovama u odnosu na UMO. Činioci za procenu UMO na primarnom nivou zdravstvene zaštite su broj i vrste zdravstvenih usluga, dok na nivou sekundarne i tercijarne zdravstvene zaštite, ključne činioce predstavlja broj kreveta i zauzetost postelja. ZAKLjUČAK: Istraživanjem je utvrđeno da je infektivni medicinski otpad najzastupljeniji tok opasnog medicinskog otpada koji generišu sve vrste zdravstvenih ustanova (oko 95% od ukupne količine opasnog medicinskog otpada). Ukupan broj bolničkih dana, odnosno dužina lečenja u bolničkim zdravstvenim ustanovama, izdvaja se kao najznačajniji prediktor UMO u stacionarnim ustanovama. Studija je izdvojila primenu planova za UMO i imenovanje lica odgovornih za upravljanje otpadom, kao i formiranje tima za UMO u zdravstvenim ustanovama, kao veoma značajne činioce UMO u svim vrstama zdravstvenih ustanova.INTRODUCTION: Healthcare waste is generated within daily activity of healthcare institutions, and it’s composed of two components, non-hazardous healthcare waste (75% of the total quantity) and hazardous components (25%). In the healthcare institutions in the last ten years, the practices concerning healthcare waste management has been improved, in accordance with the Law on Waste Management and with the Rulebook on the management of healthcare waste in the Republic of Serbia. Changes in the management of healthcare waste (HCWM) are based on introduction of procedures for the safe handling of hazardous healthcare waste from the point of its generation to safe disposal. METHOD: The study is a prospective and retrospective type survey on a representative sample of health institutions in the state health sector, on the territory of the Republic of Serbia without Kosovo and Metohija, which differ from one another in relation to the type of institution, the level of health care and territorial affiliation. The research tools used in the study are standardized questionnaires for testing UMO in health care systems. A total of 116 institutions were included in the survey, with proportional representation of all types of health institutions (health centers, general and special hospitals, clinic and hospital centers, clinical centers, institutes and public health institutes, other institutions) from three levels of health care. RESULTS: Study was defined the key factors of HCWM that influence the quality of health care services in health care institutions at different levels of health care (primary, secondary, tertiary) as well as in the different types of health institutions (health center, general hospital, clinical center, clinical hospital center, institute or Public Health Institute). This study has identified the differences between health institutions concerning HCWM. The factors for the HCWM at primary level of health care are the number and types of health services, while at the level of secondary and tertiary health care, the key factors are the number of beds and occupancy of the bed. CONCLUSION: The study found that infectious medical waste is the most frequent stream of hazardous healthcare waste generated in all types of healthcare institutions (about 95% of the total amount of hazardous healthcare waste). The total number of hospital days, that is, the length of treatment in hospital health facilities, is distinguished as the most important predictor of HCWM in stationary healthcare institutions. The study highlighted the implementation of HCWM plans and the appointment of persons responsible for waste management, as well as the establishment of an HCWM team in healthcare institutions, as very important factors of proper HCWM in all types of healthcare institutions

Žene u poduzetništvu- ženski udio u stvaranju gubitka u srednjim i malim poduzećima

The paper explores the ownership structure of small and medium-sized enterprises (SMEs), which fell into a debt crisis due to business failures, in order to indicate the differences between male and female entrepreneurs. We conducted the empirical research on a sample of 186 small and medium-sized loss-making enterprises in the Republic of Serbia. The results obtained by descriptive statistical analysis of the observed sampleshow that the participation of female companies among loss-making enterprises is considerably low. The ratio of companies owned by women and those owned by men was 18.8%: 81.2%. Furthermore, we have recorded a significant difference in the amounts of debt, indicating that female companies have significantly lower debt rates when compared to those owned by men. The findings of this research can be applied as a strategic framework for policymakers to encourage female entrepreneurship.Rad istražuje vlasničku strukturu malih i srednjih poduzeća, koja su upala u dužničku krizu uslijed propusta u poslovanju, kako bi se ukazalo na razlike između muških i ženskih poduzetnika. Empirijsko istraživanje je sprovedeno na uzorku od 186 malih i srednjih poduzeća, koja su poslovala s gubitkom u Republici Srbiji. Na osnovu dobivenih rezultata primjenom deskriptivne statističke analize posmatranog uzorka, dokazano je da je zastupljenost ženskih poduzeća, koja su poslovala s gubitkom veoma niska. Udio poduzeća čiji su vlasnici žene iznosio je samo 18.8%, u usporedbi sa 81.2% poduzeća u vlasništvu muškaraca. Takođe, utvrđeno je da postoji značajna razlika u visini duga, pri čemu je utvrđeno da ženska poduzeća imaju značajno niže stope dugovanja za razliku od poduzeća u vlasništvu muškaraca. Rezultate ovog istraživanja mogu primjeniti kreatori politika kao strateški okvir u cilju poticanja ženskog poduzetništva

Survey of Slaughtered Pigs for Occurrence of Ochratoxin A and Porcine Nephropathy in Serbia

Samples of blood, kidney and liver were randomly selected from slaughtered pigs (n=90) and analyzed for ochratoxin A by HPLC. In addition, in order to obtain information on the occurrence of nephropathy, histological examinations were carried out. Of the 90 liver samples, 26.6% contained OTA in the range of 0.22–14.5 ng/g. The incidence of OTA in serum and kidney were very similar (31%, 33.3%), with a maximum concentration of 220.8 ng/mL, and 52.5 ng/g, respectively. Histopathological examination of kidneys confirmed tubulopathies with edema and cell vacuolization. In addition, hemorrhages and necrosis of proximal kidney tubules’ cells were found

Kompetentnost preduzetnika u uslovima krize

Starting point in this work is the fact that lately, due to the world economic crisis, the quantity of entrepreneur activities stagnate in almost every country. When this problem was analyzed in detail it was found out that the main cause for many firms to be closed is the fact that their owners are not competent enough. It is assumed that the solution to this problem is the model of necessary entrepreneur competence in which there are features and knowledge for the modern entrepreneur to gain and so to survive in the market that is very risky. In addition to this, it is concluded that it is necessary to change the way in which the entrepreneur handles the basic business functions. The most important one is the function of planning which should be innovated the most. It is unavoidable to consider the factor of risk when planning any, middle term or short-term, business plan. The main conclusion is that the classical risk appraisal of future business should be broaden and should include the analysis of how capable the entrepreneur is to react on time and effectively when there are unexpected market changes.Polazište u ovom radu je činjenica da poslednjih godina, usled dejstva svetske ekonomske krize, obim preduzetničke aktivnosti stagnira u gotovo svim zemljama sveta. Podrobnijom analizom ovog problema konstatovano je da je glavni uzrok propadanja velikog broja preduzetničkih firmi u nedovoljnoj kompetentnosti njihovih vlasnika. Stoga je, kao pretpostavka rešenja u radu koncipiran model potrebne preduzetničke kompetentnosti u kome su diferencirano strukturirane osobine i znanja koje savremeni preduzetnik treba da poseduje da bi mogao da opstane na sve rizičnijem tržištu. Pored toga, konstatovano je i da je potrebno u velikoj meri promeniti i pristup preduzetničkom vođenju osnovnih poslovnih funkcija. Pri tome je posebno apostrofirana planska funkcija kao oblast u kojoj treba uneti najviše novina. Tu se pre svega misli na neminovnost uvažavanja faktora rizičnosti kod izrade svakog, bilo srednjoročnog ili kratkoročnog biznis plana. Osnovni zaključak jeste da je neophodno klasičnu ocenu rizičnosti budućeg poslovanja proširiti i analizom sposobnosti samog preduzetnika da blagovremeno i efikasno reaguje na nepredvidive tržišne promene

Pharmacological potential of Thymus serpyllum L. (wild thyme) extracts and essential oil: A review

In traditional medicine Thymus serpyllum L. (wild thyme) herb represents a part of a large number of herbal medicinal formulations such as syrups, tinctures, infusions, teas, and decoctions. In recent years, there is a growing interest in testing the biological properties of wild thyme, because the plant is a high quality raw material, rich in essential oil and pharmacologically active polyphenolic compounds, which can be included in various formulations in the pharmaceutical, cosmetic, food, and chemical industries. Wild thyme extracts and essential oil have shown significant nitric oxide, ABTS and DPPH radicals scavenging potential, ferrous ion chelating property, reducing activity and ability to inhibit peroxidation of deoxyribonucleic acid (DNA), proteins and lipids. Wild thyme extracts exerted antibacterial activity against Bacillus cereus, Enterococcus faecalis, Listeria monocytogenes, Staphylococcus aureus, Escherichia coli, Salmonella enterica, Yersinia enterocolitica, as well as Lactic acid bacteria. Wild thyme essential oil has shown antibacterial potential against E. coli, L. monocytogenes, P. aeruginosa, S. enteritidis, S. aureus, Streptococcus salivariu, S. mutans S. sanguinis, S. pyogenes, E. feacalis, B. cereus, B. subtilis, B. pumilis, Lactobacillus acidophilus, Proteus mirabilis, Klebsiella pneumoniae, Salmonella choleraesuis, and Salmonella poona. T. serpyllum extract possesses antifungal activity against Fusarium solani, F. moniliforme, Aspergillus flavus, Microsporum canis, Alternaria species, Candida albicans, and C. glabarata. The essential oil efficiently inhibited the growth of C. albicans, C. glabrata and Aspergillus fungi. Wild thyme extract significantly and concentration-dependent relaxed spontaneous contractions, acetylcholine-, potassium chloride-, barium chloride- and calcium chloride-induced contractions of isolated rat ileum. The extract significantly reduced the expression of the inducible enzyme cyclooxygenase-2 and inhibited acetylcholinesterase, myeloperoxidase and α-glucosidase activity. T. serpyllum extract has shown cytotoxic activity on human breast cancer cell lines, while essential oil has shown the antitumor potential in human cell lung cancer, colon, cervical, hepatocellular, prostate, and breast adeno-carcinoma

Nutritional habits in children: Research on health-related habits in schoolchildren in the Republic of Serbia in 2017

Introduction. Childhood nutritional habits may have a tremendous influence on long-term health. Nutritional habits developed during childhood may turn into a lifetime habit. Missed meals, skipping breakfast, and increased intake of sweets are related to overweight and obesity. We aimed to research nutritional habits in schoolchildren in Serbia. Method. We used the data from the research "Health-related habits in schoolchildren in Serbia in 2017". We used the standardized international protocol of the World Health Organization for data gathering. We polled 3.933 participants, aged 11, 13, and 15. Results. The habit of having breakfast, on schooldays days, shows statistically significant difference around re-gions, for ages 11 (p = 0,001) and 13 (p = 0,000). At the age of 11 (p = 0,046), the majority of children have breakfast on weekends in Belgrade (92,7%). When fruit consumption is concerned, the regions statistically significantly differ for the age 11 (p = 0,006). The greatest consumption of fruit is found in the region of Vojvodina (37,4%). In Belgrade, 5% of children never eat vegetables. At the age of 15, there is a statistically significant difference (p = 0,046) in vegetable consumption. Most vegetables are consumed in South and East Serbia (25,5%), and Sumadija and West Serbia (27,4%). There is a statistically significant difference (p=0,016), at the age of eleven, in sweets consumption, among regions. There are the least children who never consumed sweets (1,8%) in Vojvodina. Conclusion. Based on analyzed data, we concluded that children aged eleven, thirteen, and fifteen, in the Republic of Serbia, don't eat quite healthy. The results may be useful for the promotion of health-educational programs, which, in turn, may lead to behavioral changes

Phenolics and Flavonoid Content in Selected Seeds from the Serbian Market

Objectives: Edible seeds are usually consumed as common food ingredients. They are considered to have a rich nutrient profile, containing different macro and micronutrients, as well as some biologically active compounds with positive health effects, such as different phenolics. The aim of this work was to determine total phenolics (TPC) and total flavonoid content (TFC) in selected commercial seeds samples from the Serbian market. Methods: Samples of nine seeds were investigated (sesame and black sesame, raw and roasted sunflower, raw and roasted pumpkin, hemp, chia and linseed). The samples of native seeds and those defatted using dichloromethane (maceration and Soxhlet extraction) were extracted with 80% methanol. Obtained hydro-methanol extracts were dried and further analysed using spectrophotometric methods: TPC was determined using Folin–Ciocalteu (FC) reagent and expressed as gallic acid equivalents (GAE), while TFC was measured based on the reaction between flavonoids and aluminium chloride and expressed as catechin equivalents (KE). Results: In general, hydro-methanol extracts of seed samples defatted using Soxhlet extraction had the highest TPC and TFC contents. TPC values ranged from 9.47 g GAE/mg (raw pumpkin seed) to over 170 g GAE/mg (raw sunflower seeds). As for TFC, the highest amount was measured in extracts of defatted raw sunflower seeds (over 150 g KE/mg), while roasted pumpkin and hemp seeds’ extracts were practically devoid of flavonoids. Conclusion: Our results confirmed the fact that certain defatted seeds, which are usually considered as waste products in oil production, could be considered as valuable sources of certain secondary plant metabolites, implicating further investigations on their composition and potential in the development of functional foods.Presented at the 14th European Nutrition Conference FENS 2023, Belgrade, Serbia, 14–17 November 2023

Menopauza kao nezavisni prediktor povišenih vrednosti retinolvezujućeg proteina 4 u serumu

Aim: Retinol-binding protein 4 (RBP4) is a novel adipokine closely related to insulin resistance. However, data on the influence of menopausal status on serum RBP4 are scarce. Therefore, the aim of the current study was to examine whether RBP4 levels are associated with menopausal status per se, independently of insulin resistance. Methods: A total of 30 premenopausal and 100 postmenopausal women non-treated with medications were included in the cross-sectional study. Anthropometric and biochemical parameters, as well as blood pressure (BP) were obtained. The homeostasis model assessment of insulin resistance (HOMA-IR) and estimated glomerular filtration rate (eGFR) were calculated. Results: Postmenopausal women displayed higher RBP4 and an unfavorable cardiometabolic profile, compared to premenopausal ones. Multiple linear regression analysis showed that in addition to high triglycerides level (beta=0.315; p=0.002), decreased eGFR (beta=-0.258; p=0.004) and high systolic BP (beta=0.418; p=0.028), menopause per se is an independent predictor of higher RBP4 levels (beta=0.240; p=0.016), (R2-adjusted=0.310; F=6,522; p lt 0.001). Conclusions: Serum RBP4 levels are dependent of menopausal status, which should be taken into account when examining the role of this adipokine in cardiometabolic diseases' occurrence.Cilj: Retinol-vezujući protein 4 (RBP4) je novi adipokin, usko povezan sa insulinskom rezistencijom. Međutim, nema dovoljno podataka u literaturi o uticaju menopauze na vrednosti ovog proteina u serumu. Zato je cilj ove studije bio da se ispita da li je povezanost menopauze i RBP4 nezavisna ili je posredovana insulinskom rezistencijom. Metode: Ukupno 30 žena u premenopauzi i 100 žena u postmenopauzi, koje nisu na terapiji su uključene u studiju preseka. Mereni su antropometrijski i biohemijski parametri, kao i krvni pritisak (KP), HOMA indeksi, procenjena jačina glomerularne filtracije (JGF) i izračunati su. Rezultati: Kod žena u postmenopauzi zabeležene su veće vrednosti RBP4 i nepovoljniji kardiometabolički profil, u poređenju sa ženama u premenopauzi. Višestruka linearnaregresiona analiza je pokazala da su više vrednosti triglicerida (beta=0,315; p=0,002), smanjena JGF (beta=-0,258; p=0,004), više vrednosti sistolnog KP (beta=0,418; p=0,028), i menopauza (beta=0,240; p=0,016), nezavisni prediktori povišenih vrednosti RBP4 u serumu (R2-adjusted=0,310; F=6,522; p lt 0,001). Zaključak: Menopauza utiče na vrednosti RBP4 u serumu, što treba uzeti u obzir prilikom ispitivanja uloge ovog adipokina u pojavi kardiometaboličkih poremećaja

Korelacija između izloženosti pasivnom pušenju u kućnom okruženju i pojave respiratornih simptoma kod školske dece

Objective. Aim of this paper was to correlate exposure to household second-hand smoke and respiratory symptoms in participating school children, who are attending ten primary schools in Belgrade, Serbia. Method. In order to determine correlation between second-hand smoke exposure at home and respiratory symptoms in primary school pupils, a comparative cross-sectional study has been conducted. The study was conducted in ten primary schools on 735 children, in 44 classrooms in Belgrade, Serbia. A standardized questionnaire was distributed to parents/caregivers, on child's respiratory health, socioeconomic status and parents' lifestyle habits, primarily cigarette smoking. Results. 78% of all exposed children have parents smoking up to 20 cigarettes/day, while more than 22% are exposed to parents' household second-hand smoke of more than 21 cigarettes per day (p lt 0.0001). Respiratory disorders appear in 45.9% of children exposed to domestic second-hand smoke (CI 1.04-1.89), asthmatic symptoms in 33.5% (CI 0.94-1.78), while the least incidence of disorders is reported for continuous cough, which have lasted for 3 months (3.3%, CI 0.44-2.36), wheezing after exercise (4.5%, CI 0.38-1.41) and being awaken by wheezing in last 12 months (7.4%, CI 0.89-3.28). Conclusion. Univariate logistic regression analysis proved that parental smoking exposure is a statistically significant predictor for childhood respiratory symptoms' manifestation.Cilj. Cilj ovog rada je uspostavljanje korelacije između izloženosti pasivnom pušenju u kućnom okruženju i pojave respiratornih simptoma kod dece koja pohađaju deset osnovnih škola u Beogradu, Srbija. Metod. Istraživanje je sprovedeno po tipu komparativne studije preseka, u deset osnovnih škola, na uzorku od 735 dece, u 44 učionice, u Beogradu, Srbija. Roditeljima/starateljima distribuiran je standardizovani upitnik, sa pitanjima o respiratornom zdravlju dece, socio-ekonomskom statusu i navikama roditelja, pre svega o pušenju cigareta. Rezultati. 78% dece koja su izložena duvanskom dimu ima roditelje koji puše do 20 cigareta/dan, dok je više od 22% izloženo duvanskom dimu od popušenih preko 21 cigareta/dan, od strane roditelja (p lt 0,0001). Respiratorni poremećaji prisutni su kod 45,9% dece izložene pasivnom pušenju u kućnom okruženju (CI 1.04-1.89), astmatični simptomi kod 33,5% (CI 0,94-1.,78), dok je najniža incidenca ovih poremećaja prijavljena u slučaju hroničnog kašlja, u trajanju od 3 meseca (3,3%, CI 0,44-2,36), vizinga nakon fizičke aktivnosti (4,5%, CI 0,38-1,41), kao i za slučaj buđenja usled viziga u poslednjih 12 meseci (7,4%, CI 0,89-3,28). Zaključak. Univarijantnom logističkom regresionom analizom dokazano je da je izloženost roditeljskom pušenju duvana statistički značajan prediktor za pojavu respiratornih simptoma kod dece

Indeks telesne mase i insulinska rezistencija kao nezavisni prediktori hipertenzije kod žena u postmenopauzi

Aim: Although previous studies confirmed the association between obesity and hypertension, the underlying pathophysiological mechanism is not well elucidated, specially considering the fact that discordant results exist when examining the independent role of obesity and/or insulin resistance on risk for hypertension onset. Therefore, we aimed to examine if obesity [as measured with body mass index (BMI)] is a predictor for hypertension, independently of insulin resistance [as measured with Homeostasis model assessment of insulin resistance (HOMA-IR)] in the cohort of postmenopausal women. Methods: A total of 150 postmenopausal women non-treated with medications(among them 44.7% hypertensive)were included in cross-sectional study. Anthropometric and biochemical parameters, so as blood pressure were obtained. HOMA-IR was calculated. Results: Multivariate logistic regression analysisrevealed that both, BMI and HOMA-IR were the independent predictors of blood pressure in postmenopausal women (OR=1.240, p=0.035 and OR=2.419, p=0.008, respectively). Rise in BMI for 1 kg/m2 enhanced the probability for higher blood pressure by 24%. Also, elevation in HOMA-IR for 1 unit, rose the probability for higher blood pressure almost 2.5 times. Even 47% of variation in blood pressure could be explained with this Model. Also, this Model correctly classified 76% of postmenopausal women having hypertension. Conclusions: Both, obesity and insulin resistance are the independent predictors of blood pressure in postmenopausal women.Cilj: Premda su ranije studije potvrdile vezu između gojaznosti i hipertenzije, patofiziološki mehanizam ove povezanosti još uvek nije rasvetljen, naročito što postoje oprečni rezultati kada je u pitanju nezavisna uloga gojaznosti i/ili insulinske rezistencije u nastanku hipertenzije. Stoga je cilj studije bio da se ispita da li je gojaznost [merena indeksom telesne mase (ITM)] prediktor za nastanak hipertenzije, nezavisno od insulinske rezistencije [merene HOMA indeksom (HOMA-IR)] u kohorti žena u postmenopauzi. Metode: Ukupno 150 žena u postmenopauzi koje nisu na terapiji (među njima 44,7% sa hipertenzijom) su uključene u studiju preseka. Antropometrijski i biohemijski parametri, kao i krvni pritisak su mereni. HOMA-IR je računat. Rezultati: Multivarijantna logistička regresiona analiza je pokazala da su i ITM (OR=1,240; p=0,035) i HOMA-IR (OR=2,419; p=0,008)nezavisni prediktori krvnog pritiska kod žena u postmenopauzi. Povećanje ITMza1 kg/m2 povećava verovatnoću za pojavu hipertenzije za 24%. Takođe, porast HOMA-IR za 1 jedinicu povećava verovatnoću za pojavu hipertenzije za skoro 2,5 puta. Čak 47% varijacije u vrednosti krvnog pritiska može biti objašnjeno ovim modelom. Takođe, ovaj model je ispravno klasifikovao 76% žena u postmenopauzi koje imaju hipertenziju. Zaključak: I gojaznost, i insulinska rezistencija su nezavisni prediktori krvnog pritiska kod žena u postmenopauzi