Cost differentials of dental outpatient care across clinical dentistry branches

Background: Dental care presents affordability issues in Central & Eastern European transitional economies due to lack of insurance coverage in most countries of the region and almost complete out-of-pocket payments by citizens.Objective: Real world estimates on cost differentials across clinical dentistry branches, ICD-10 diagnostic groups and groups of dental services.Methods: Prospective case-series cost analysis was conducted from the patient perspective. A six months time horizon was adopted. Sample size was 752 complete episodes of treatment in 250 patients, selected in 2012/2013 throughout several specialist state- and private-owned dental clinics in Serbia. All direct costs of dental care were taken into account and expressed in Euros (€).Results: Mean total costs of dental care were € 46 ± 156 per single dentist visit while total costs incurred by this population sample were € 34,424. Highest unit utilization of services belongs to conservative dentistry (31.9%), oral surgery (19.5%) and radiology (17.4%), while the resource with the highest monetary value belongs to implantology € 828 ± 392, orthodontics € 706 ± 667 and prosthetics € 555 ± 244. The most frequently treated diagnosis was tooth decay (33.8% unit services provided), pulpitis (11.2%) and impacted teeth (8.5%), while most expensive to treat were anomalies of tooth position (€ 648 ± 667), abnormalities of size and form of teeth (€ 508 ± 705) and loss of teeth due to accident, extraction or local periodontal disease (€ 336 ± 339).Conclusion: Although the range of dental costs currently falls behind EU average, Serbia’s emerging economy is likely to expand in the long run while market demand for dental services will grow. Due to threatened financial sustainability of current health insurance patterns in Western Balkans, getting acquainted with true size and structure of dental care costs could essentially support informed decision making in future

Health self-evaluation of complementary and alternative medicine users in Serbia: cross-sectional national study

The aim of the research was to examine the influence of the respondents' health status on the use of complementary and alternative medicine methods. This was a population-based, cross-sectional study. The sample consisted of 550 interviewed persons, from the third National health survey of the residents of Serbia in 2013, who had used complementary and alternative medicine (CAM) services in the preceding 12 months. Just over 2/3 of CAM users had chronic health disorders (p < 0.01), the most commonly diagnosed chronic health disorder among CAM users was hypertension (36.7%). Every seventh and partially every fourth CAM user had been seriously restricted as regards undertaking normal daily activities for the previous 6 months or longer. CAM users were more satisfied with the services they received in private practice (p < 0.01). The two out of three users of CAM services rated their health as good and/or average. CAM users were more satisfied with the services they received in private practice, the highest percentage of them rated their health as good. The analysis of the impact of respondents' health status, the analysis of the correlation between the respondents' self-health assessment and the use of alternative medicine methods, analysis of the impact of socio-demographic characteristics on the use of CAM, along with a comparative analysis of the use of health care services - would significantly contribute to better recognition of CAM by the Ministry of Health

Desetogodišnje ispitivanje depresivnih simptoma kod studenata medicine u Srbiji

The main objective of this study was to examine the rate of three dimensions of depressive symptoms in medical student population in Serbia, and to find out whether this rate had changed over the period of ten years. This cross-sectional study included 615 medical students (F=61% and M=39%), mean age = 23.60 (SD=1.541), who were tested in five non-consecutive surveys between 2002 and 2012. Depressive symptoms were measured by the Beck Depression Inventory (BDI ). The mean BDI score for the entire sample was 6.26}6.175. There was no significant difference in total BDI score among the values obtained during the ten years of testing. The greatest portion of the examined sample (77.24%) had no signs of depressive symptoms, and there was no difference in symptom intensity between medical students and other educational profiles. Similar to previous results, females had higher scores on all depressive dimensions except for one tested year, whereas a weak correlation was found between BDI scores and student age (r=0.104; p=0.010). Since there are still discrepancies among studies that do (not) report that medical students have typical depressive symptoms, potential explanations for the mentioned discrepancies may be found in individual characteristics of the members of the student population. Our suggestions for future studies are that they should include the stress factor, stress coping strategies, estimated life satisfaction, and the impact of these factors on the potential mental disorders.Osnovni cilj studije bio je utvrditi razine triju dimenzija depresivnih simptoma kod studenata medicine u Srbiji, te mijenjaju li se te razine tijekom razdoblja od deset godina. Ova populacijska studija obuhvatila je 615 studenata medicine (M=61%; Ž=39%) srednje dobi od 23,60 (SD=1,541) godina, koji su testirani u pet odvojenih ispitivanja od 2002. Do 2012. godine. Depresivni simptomi procjenjivani su pomoću Beckova inventara depresivnosti (BDI ). Srednji zbir BDI za cjelokupni uzorak iznosio je 6,26}6,175. Nije utvrđena značajna razlika u zbiru BDI tijekom deset godina testiranja. Najveći dio ispitanog uzorka (77,24%) nije pokazao depresivne simptome, a također nije utvrđena ni značajna razlika između studenata medicine i ostalih obrazovnih profila prema intenzitetu ovih simptoma. Slično ostalim studijama, žene su bilježile više vrijednosti na svim dimenzijama depresivnosti (osim jedne ispitivane godine), dok je slaba korelacija utvrđena između zbira BDI i dobi (r=0,104; p=0,010). Pošto i dalje postoje neslaganja između studija koje (ne) pokazuju da studenti medicine imaju izražene simptome depresivnosti, potencijalna objašnjenja ovih nalaza trebalo bi tražiti u individualnim karakteristikama pripadnika ove populacije. Prijedlog za buduća istraživanja je da bi u analizu trebalo uključiti i čimbenik stresa, strategije prevladavanja stresa, zadovoljstvo životom, uzroke akademskog neuspjeha i njihov potencijalni utjecaj na razvoj mentalnih poremećaja

AVAILABLE TREATMENT APPROACHES OF ACUTE INFLUENZA H1N1 INFECTION AND ITS CLINICAL COMPLICATIONS

Human H1N1 pandemic developed from the originally localized Mexican source early in the spring 2009. It seems that the current wave of infections slowly moves towards the southern hemisphere; however, the WHO reports on certain foci in Southeast Asia, Western Africa and tropic islands of the Middle America do not exclude another reccurrence in the northern hemisphere. This drew the attention of epidemiologists due to the fact that the virus owns a very unique capsid which expresses proteins coded by genes originating from the human, swine and avian influenza virus and was not covered by the available seasonal vaccines. Although most of the cases exibit classical clinical presentation of influenza infection, there are special features like significant gastrointestinal symptomatology and vulnerability of the young population. With respectively small but significant portion of patients there have been noticed fulminant course of infection with poor prognosis including sudden development of respiratory failure and consciousness disturbances which require intensive care unit admission. Cytokine storm should be mentioned as one of the key pathogenic events contributing to the overall mortality in substantial portion of patients. If active immunization is assumed to be preventive measure of proven efficacy, clinicians are still in doubt how to treat a complicated course of infection. We should be aware that the first choice essential drugs, for which viral sensitivity has been certainly proved, are neuraminidasis inhibitors. Here we have to distinct between more available oseltamivir and less available zanamivir and peramivir which until now have shown absolute effectiveness in inhibiting viral strains replication in vivo. Success of direct antiviral protocols has also been noticed with inhaled synthetic nucleoside ribavirine applied locally. Bacterial pneumonia superimposed by the overall patient status should be treated in accordance with the available evidence-based guidelines. We should be aware that septic lung infection caused by multiresistant organisms irrespective of intensive treatment remains the main cause of lethal outcomes in serious clinical presentations of H1N1 infection

Estimate of clinical outcomes from the patient perspective is important for clinical decision making

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Could high continuity of care (COC) have a negative impact on subjective health of hypertensive patients? A Japanese perspective

Abstract Background Cardiovascular diseases, such as stroke and ischemic heart disease attributable to hypertension, are major causes of premature death in Japan and worldwide. Nevertheless, a low rate of blood pressure control among hypertensive patients has been observed in most countries. No previous studies have explored the effectiveness of physician visits among hypertensive patients in Japan. Methods To quantify the effects of persistence in physician visits among hypertensive patients, we evaluated the causal effect of physician visits on the health of hypertensive patients. We used 16 waves of nationally representative longitudinal data drawn from the Longitudinal Survey of Middle-aged and Elderly Persons in Japan (2005–2020). To examine the causal effect of physician visits on patients’ health outcomes, we used inverse probability treatment weights and doubly robust estimation and obtained the estimates of the average treatment effects on the treated (ATETs). Results Covariates were well balanced among patients who had physician visits during the past two consecutive years (N = 67,210; 64.9% among hypertensive patients). The estimated ATETs suggest that three consecutive years of physician visits had a negative impact on poor subjective health. Furthermore, patients without habitual exercise tended to not continue physician visits and perceived poor subjective health. Conclusions Although the impact of frequent physician visits on blood pressure stability remains uncertain, regular appointments every 30 days can be effective for individuals with hypertension, particularly if they receive continuous instruction from their family physician. Because it is important for physicians to strengthen hypertensive patients' blood pressure control, promoting consecutive physician visits to hypertensive patients with diabetes, lower educational attainment, or smoking habits is needed

Economics of cancer related medical care: Worldwide estimates and available domestic evidence

Background: The aims of this article were to report findings of domestic research related to assessment of hospital treatment costs of Serbian patients suffering from cancer and show similar study results among foreign trials. The authors also intended to suggest likely strategies to improve local cost containment in future. Cost-of-illness studies of most high-income economies have proven that malignant disorders belong to top five disorders according to their overall financial burden. Methods: Our trial was conducted as an in depth, retrospective, bottom-up, trend analysis of services con­sumption patterns and expenses relative to diagnosis at discharge, from perspective of the third party payer. Discounting rates were calculated according to the average official exchange rates of the National Bank of Serbia in respective years. Financial value of medical goods and services consumed was taken out of current price lists of the National Republic Institute on Health Insurance on a day when particular service was provided. Results: There were 434 patients and 4850 admissions processed in 2007, consuming 48,483,740.49 RSD (€613,562.90) while in 2010 there were 539 patients and 9509 admissions, consuming 68,880,953.27 RSD (€658,832.65). In total, drugs value accounts for only 5%, radiotherapy 54% and the rest of expenditure 41% (consulta­tions, surgery, consumables, nursing care, other). Average overall cost per patient treated was 125,922.34 RSD and per hospital admission, it was 8,297.99 RSD. Cancer-related medical care costs, in domestic currency, increased by almost one third in only four-year time span. Conclusion: Higher awareness of clinicians on cost limitations and necessity of prioritization in funding health care, would provide wiser resource allocation and more care with money available

BIOEQUIVALENCE STUDIES

Development of pharmaceutical technology and occurence of different dosage forms and routes of administration of the same, well-known drugs leaded to greater role of bioequivalence testing. In this review, we would like to emphasize some aspects of bioequivalence testing between brand name and generic drug forms in both in vitro and in vivo conditions. We also consider important to present some examples of negative bioequivalence from marketed products in the past, together with the serious cosequences of their use