HEALTH CARE

LONG-TERM TREND OF BLADDER CANCER MORTALITY IN SERBIA, 1991-2024: A JOINPOINT REGRESSION ANALYSIS

2025-12-07T21:39:16+01:00

Introduction/Aim: Bladder cancer is among the main urological diseases. Bladder cancer mortality trends vary significantly worldwide. This research sought to assess temporal trends in deaths due to bladder cancer in Serbia.

Methods: This was a population-based descriptive epidemiological study. Bladder cancer mortality data were obtained from an official database. Direct standardization with the World standard population was used to compute the age-standardized rates (ASRs) per 100,000. Joinpoint regression analysis was employed to assess temporal trends in bladder cancer mortality using the average annual percentage change (AAPC) alongside its 95% confidence interval (95% CI) over the 1991-2024 period.

Results: During the period 1991-2024, almost 20,000 deaths due to bladder cancer (about 15,000 among men and 5,000 among women) occurred in Serbia. Average annual ASR of mortality from bladder cancer was notably higher among males than females (5.94 versus 3.87 per 100,000, respectively). Significant increases in bladder cancer mortality trends were recorded for both males (AAPC=0.6%; 95% CI=0.4 to 0.9) and females (AAPC=1.3%; 95% CI=1.0 to 1.5). The male and female trends were not parallel, as the final selected model rejected parallelism (p = 0.008). A significant increase in bladder cancer mortality in women was recorded in middle age (age groups 55 to 69 years), while in men a more pronounced increase was observed in older people (age groups 70 and older).

Conclusion: An increase in bladder cancer mortality during more than three decades in Serbia implies that further analytical research is needed.

FUNCTIONAL PROFILE AND ASSOCIATED IMPAIRMENTS IN SCHOOL-AGED CHILDREN WITH CEREBRAL PALSY IN SERBIA

2025-12-07T21:39:17+01:00

Introduction/Aim: Cerebral palsy is a permanent and heterogeneous condition that requires continuous, comprehensive support from multiple service providers, including healthcare professionals. Information on functional characteristics of individuals with cerebral palsy is necessary for effective service planning and counselling families in a clinical context. However, no national database or register is available in Serbia. This descriptive and exploratory study aimed to examine functional characteristics and frequency of associated impairments in a sample of school-aged children with cerebral palsy in Serbia.

Methods: A convenience sample of 117 children and adolescents with cerebral palsy (56.4% male), aged 7–18 years (M = 13.23, SD = 3.36), was analysed. Data on cerebral palsy type, gross motor function, fine manual and bimanual abilities, intellectual functioning, sensory impairments (visual, hearing), epilepsy, and general health problems were extracted from available medical, educational, and psychological records. Descriptive statistics were used for analysis.

Results: Spastic cerebral palsy was the most common type (65.8%), frequently accompanied by intellectual disability (67.5%), visual impairment (33.3%), and epilepsy (24.7%). Nearly two-thirds (64.1%) of participants had two or more associated impairments. The majority exhibited limitations in ambulation, manual performance, and fine motor skills.

Conclusion: The basic functional characteristics and frequency of associated impairments were generally in line with national and international reports, with some differences observed in comorbidity patterns. The high prevalence of multiple health and developmental challenges underscores the urgent need for a national cerebral palsy registry in Serbia.

EVALUATION OF PLANNING AND CONSUMPTION OF MEDICAL RESOURCES IN PRIMARY HEALTH CARE IN SERBIA

2025-12-07T21:39:17+01:00

Introduction/Aim: Efficient planning and consumption of medicines, medical and sanitary supplies, and laboratory reagents within the framework of Serbia's primary health care directly affect therapy availability, service quality, and the rational use of budgetary resources. Although a formal framework for centralized procurement exists, practice reveals significant discrepancies in criteria, procedures, and institutional approaches. The aim of this study was to examine how health care institutions plan their needs, what decision-making criteria they use, and the role of the Republic Health Insurance Fund (RHIF) in the evaluation and implementation of these plans.

Methods: A quantitative study was conducted among 136 primary health care institutions and 26 RHIF branches, using a questionnaire designed in accordance with valid regulations and professional methodological guidelines. Data were analyzed in the Excel environment, using a binary matrix and thematic classification of responses.

Results: Most institutions (84.6%) rely on historical consumption and RHIF guidelines, while only 8.8% use economic criteria. A multicriteria approach is used by just 5.1% of institutions. Internal evaluation is absent in 26.5% of cases, and information systems are mostly used for administrative purposes. A pattern of planning without analytical verification was observed, along with frequent shifting of responsibility to RHIF, which stated in its response that it did not perform evaluations nor apply analytical tools.

Conclusion: Although the planning system formally meets regulatory requirements, it lacks an analytical foundation and functional evaluation. Establishing a standardized model based on clinical, economic, and epidemiological indicators, along with an active evaluative role of RHIF and two-way institutional feedback, represents a key step toward more rational and equitable management of health care resources.

INCIDENTAL FINDING OF CONTRALATERAL BREAST CANCER IN CONTRALATERAL PROPHYLACTIC MASTECTOMY SPECIMEN: A CASE REPORT

2025-12-07T21:39:17+01:00

Introduction/Aim: Prophylactic mastectomy may be performed in women with high genetic or familial risk, or unilaterally alongside therapeutic mastectomy. Although malignancy is not expected in prophylactic specimens, incidental contralateral breast cancer (CBC) may alter management and prognosis. The aim of this study is to present a clinical case of the incidental finding of contralateral breast carcinoma (CBC) in a tissue specimen obtained through contralateral prophylactic mastectomy (CPM) in a 46-year-old patient who had been initially diagnosed with ductal carcinoma in situ (DCIS) in the opposite breast.

Case report: We report a 46-year-old woman initially diagnosed with ductal carcinoma in situ (DCIS) of the right breast. After declining adjuvant radiotherapy, she opted for bilateral nipple-sparing mastectomy with direct-to-implant reconstruction. Histopathology confirmed DCIS with a focal invasive component in the right breast and unexpectedly revealed three microscopic focuses of DCIS in the contralateral breast, alongside fibrocystic changes and atypical ductal hyperplasia.

Discussion: The annual incidence of CBC is estimated at 0.5-0.75%. Examination of contralateral prophylactic mastectomy (CPM) specimens may uncover high-risk lesions (ADH, ALH, LCIS) or, rarely, invasive carcinoma. Such findings highlight the diagnostic potential of CPM and the importance of multidisciplinary evaluation when selecting candidates for risk-reducing surgery.

Conclusion: Although CPM does not consistently improve overall survival, it can contribute to individualized risk reduction, simplified surveillance, and reduced anxiety in selected patients. This case underscores its diagnostic value in detecting occult contralateral malignancy and reinforces the need for personalized surgical planning within a multidisciplinary framework.

PREOPERATIVE, INTRAOPERATIVE AND POSTOPERATIVE PREDICTORS ASSOCIATED WITH COMPLICATIONS AND SURVIVAL OF PATIENTS AFTER COLORECTAL RESECTION

2025-12-07T21:39:17+01:00

Colorectal cancer is the third most commonly diagnosed form of all cancers, and the second deadliest cancer worldwide. The International Agency for Research on Cancer (IARC) estimates that the global burden of colorectal cancer on society will increase by 60%, representing more than 2.2 million new cases and 1.1 million deaths by the year 2030. The aim of this review paper is to show which predictors, at hat point in the course of the disease, and in what way they influence the occurrence of postoperative complications and the survival of patients with colorectal cancer. Elevated levels of inflammatory markers, poor nutritional status, a higher category of the ASA (American Society of Anesthesiologists) physical status classification, and poor lifestyle habits represent significant independent predictors of poor survival and increase the risk of developing postoperative complications after resection. Intraoperatively, longer duration of the operation and significant blood loss during surgery contribute to poor outcomes. Postoperative complications (anastomotic leakage, postoperative bleeding, intra-abdominal abscess, stoma complications, general complications) independently increase the risk of mortality after surgery.

VOICE DISORDERS IN TRANSGENDER PERSONS: ETIOLOGY, CLINICAL PICTURE AND THERAPEUTIC APPROACHES

2025-12-07T21:39:17+01:00

Voice disorders in transgender people represent a significant challenge in the process of gender affirmation, because the voice directly affects the perception of gender identity and psychosocial well-being. The aim of this paper is to provide a comprehensive overview of the etiology, clinical picture and therapeutic approaches of voice disorders in transgender people. Hormonal, anatomical and psychosocial factors influencing voice changes, typical symptoms and acoustic characteristics, as well as various treatment methods, including vocal therapy, phonosurgery and a multidisciplinary approach, were analyzed. Hormone therapy in trans men leads to significant voice changes, while in trans women it is often not enough to achieve the desired gender perception, and additional vocal therapy or phonosurgery is needed. Vocal therapy, when necessary, phonosurgery are effective methods for voice correction, and a multidisciplinary approach enables optimal outcomes and improvement of quality of life. However, the lack of standardized protocols and longitudinal studies highlights the need for further research and individualization of therapy. In conclusion, successful intervention in voice disorders in transgender persons requires the integration of medical, speech therapy and psychological methods, with the aim of achieving voice function that is consistent with gender identity and supporting psychosocial well-being.

PREVENTION OF ISCHEMIC HEART DISEASE

2025-12-07T21:39:18+01:00

Ischemic heart disease (IHD) is the leading cause of death globally, while in Serbia, it is responsible for more than 45% of all deaths, which is significantly above the average in the European Union. It occurs as a result of atherosclerosis of coronary arteries, and the main risk factors include smoking, hypertension, dyslipidemia, diabetes, obesity, physical inactivity, unhealthy diet and stress. Prevention as the foundation of public health and health policies of each country includes a range of measures and activities aimed at preserving and improving health, preventing the occurrence of diseases and complications, as well as reducing mortality and disability in the population at the primordial, primary, secondary and tertiary level. Key measures include the adoption of healthy lifestyle habits: balanced Mediterranean diet, regular physical activity (at least 150 minutes of moderate exercise per week), maintaining a healthy weight and quitting smoking. Controlling biological risk factors, such as hypertension, diabetes and high cholesterol, is also essential. A screening program within primary prevention plays an important role in the early detection of individuals at increased risk for IHD. Secondary prevention includes adequate treatment and measures to prevent further complications in patients who already suffer from IHD. This includes pharmacological therapy (antiaggregation drugs, beta-blockers, statins), invasive procedures such as coronary interventions or bypass surgery, as well as changing unhealthy habits. Tertiary prevention is aimed at patient rehabilitation, the reduction of complications and the improvement of the quality of life. Although recommendations for prevention are clearly defined, their implementation emerged as a challenge in Serbia. Better coordination, continuous education of the population and improvement of the health care system, especially in the field of post-hospital rehabilitation, are necessary. A comprehensive, integrated approach that includes public health and medical interventions is crucial for the long-term reduction of the burden of IHD in Serbia.