Milena M Santric Milicevic

• MD, M.Sc., Ph. D., Sci. med.
• Professor at University of Belgrade

Background and Objective: Active aging is influenced by various factors, including chronic diseases, multimorbidity, functional limitations, and disabilities. The presence of these factors might lead to greater dependence on caregivers and could present potential barriers to community engagement. Physical functioning might be considered as one of t...

Background/Aims: This study was conducted with the aim of assessing the mental well-being of general practitioners (GPs) amidst the COVID-19 pandemic in Serbia. These findings are intended to provide valuable insights to primary care stakeholders about the potential need for support interventions. Materials and Methods: In the context of the intern...

Primary healthcare played a crucial role during the COVID-19 pandemic by preventing, timely diagnosing, and referring severe cases to hospitals, as well as monitoring and counseling patients via telemedicine. We used a cross-sectional approach to analyze the severity outcomes of 174,540 COVID-19 cases treated in primary care in Almaty between 2021...

Background Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by in...

Background The adoption of healthy self-care practices has proven necessary for professional life, as they often serve as a shield against stressors in the workplace. The COVID-19 pandemic created a high strain on general practitioners (GPs), contributing to increased workload, burnout, and anxiety. The present study aimed to identify self-care pra...

Background/Objectives: A properly functioning musculoskeletal system is imperative for human well-being at every stage of life, including at an older age. This study’s aim was to assess the relationship between sociodemographic and physical functioning variables and the presence of individual musculoskeletal disorders (MSDs), MSD comorbidity, and m...

Background Cardiovascular diseases are ranked as the number one cause of death in Serbia, and one-fifth of them present ischemic heart disease (IHD). However, the physicians certifying the cause of death have either not been adequately involved in how to complete a death certificate according to the current International Statistical Classification...

Background The healthcare workforce crisis strongly affects the primary healthcare sector, worsening the work conditions of healthcare workers and hampering service delivery and health system resilience. This study introduces a health system and governance approach to identify transformative capacities in health system contexts. Methods A qualitat...

Background Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Enhanced Surveillance), we conducted a study to describe health progress in 19 former socialist economies (FSEs) in Europe from 1990 to 2019. Our metric of choice was age and sex-standardized rates per 100,000 population of total...

Background During the COVID-19 pandemic in Serbia, state-owned primary health centres’ general practitioners (GPs) served as the first point of care for adults (the population aged 19 years and older) and gatekeepers of the health system. The study highlights changes in the overall availability, accessibility, and workload of GPs during the pandemi...

Background Accurate data on the causes of death (CoDs) is the foundation for analyzing the health situation and developing health policy in various countries. The percentage of garbage codes (GCs) indicates the quality of the CoDs data. Within the Western Balkan Strategic Partnership Project (Work Package 4: Use of Population Health Metrics for Imp...

Introduction Monitoring the pharmacotherapy adherence in society is crucial for identifying occurance and causes of potential inadequate use of drugs and inform providers about the need for better customer counceling. It is necessary component of the strategic planning of the quality of healthcare services. This population- based study aimed to ass...

Background. Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by i...

Introduction: The coronavirus disease 2019 (COVID-19) pandemic affected antibiotic usage worldwide. However, there is limited data from Serbia. Dispensing of oral antibiotics in Serbian pharmacies was analyzed to calculate monthly and yearly changes between 2018-2021, and to explore immediate and long-term effects of COVID-19 on antibiotic dispensi...

The mental health of healthcare workers, especially the nursing staff in intensive care units, is crucial for the optimal functioning of healthcare systems during medical emergencies. This study implements a cross-sectional design to investigate the associations between nurses’ personal characteristics, workplace challenges, and job satisfaction wi...

Aim: The study aimed to identify factors associated with pro-integration attitudes to the European Union (EU) among Serbian medical freshmen to promote integration. Methods: In the period from 2010 to 2021, within the scope of the distance learning module "Medicine & Society", a total of 1333 freshmen of the Faculty of Medicine of the University of...

Background: Laboratory management has long struggled with staffing challenges, and a uniform staffing formula for medical laboratories remains elusive because of the varied and complex nature of the tasks that laboratory professionals perform, laboratory staff qualifications, skills, competencies, and additional activities. In Serbia, the laborator...

In the Republic of Serbia, the health care system includes various health institutions, higher education institutions that train personnel in this field, private practices and other organizations that deal with health activities. Within this system, medical and non-medical personnel are employed. The medical staff includes health professionals with...

Background: The turnover intention (TI) among public health professionals (PHPs) may lead to substantial workforce losses and negatively affect the public health system's performance. The rate of TI varies among different countries and types of public health workers. Most research has consistently confirmed that job satisfaction significantly influ...

Introduction: Due to historical, economic, and social factors, Angola in Southern Africa faces significant public health challenges. The country's health system was severely affected by civil war, leading to damaged infrastructure and limited human resources. Other challenges include widespread poverty, lack of access to healthcare in rural areas,...

Background: The field of health promotion aspires to move beyond the conventional biomedical approach and consider a broader range of social and environmental interventions. This shift acknowledges the crucial influence of social and economic determinants on health and emphasizes the interconnectedness of the health of individuals, animals, and eco...

The rapidly evolving landscape of public health challenges requires national public health associations (NPHA) to take leadership and play a multifaceted role (1). NPHAs usually serve as primary non-governmental advocates for population health and manage complex intersections of policy, education, and community engagement to address both traditiona...

Introduction

Background General practitioners - GPs are at risk of greater exposure to multiple stressors during emergencies. To help primary care crisis preparedness planning, we rapidly assessed GPs’ mental well-being during the COVID-19 pandemic using a cross-sectional design, and after examining the 9-item Mayo Clinic Well-being Index (MWBI) correlation wit...

Background Severe cases of COVID-19 require hospital treatment due to the risk of developing a life-threatening condition. Monitoring and reporting indicators of severe forms of COVID-19 in the population can warn health authorities of its increasing presence and the growing demand for hospital treatment and measures to protect persons at risk. By...

Background Valid estimates of the national disease burden often lack during crises. They need to be improved to help assess the effectiveness and efficiency of the national public health system. To determine the magnitude of acute COVID-19 in Belgrade in 2020 and 2021, we estimated the total, age and sex-disaggregated Years Lived with Disability (Y...

Introduction The COVID-19 pandemic has had an extensive impact on public health worldwide. However, in many countries burden of disease indicators for COVID-19 have not yet been calculated or used for monitoring. The present study protocol describes an approach developed in the project “The Burden of Disease due to COVID-19. Towards a harmonization...

Background Despite effective prevention and control strategies, in countries of the Balkan region, cancers are the second leading cause of mortality, closely following circulatory system diseases. Objective To describe trends in the burden of breast, cervical, and colon and rectum cancer in the Balkan region and per country between 1990 and 2019,...

Primary care services are key to population health and for the efficient and equitable organisation of national health systems. This is why they are often financed through public funds. Primary care doctors are instrumental for the delivery of preventive services, continuity of care, and for the referral of patients through the system. These cadres...

Background: In Europe, Serbia occupies a high position in antibiotic utilization and antimicrobial resistance (AMR). Aim: The aim was to analyse utilization trends of meropenem, ceftazidime, aminoglycosides, piperacillin/tazobactam and fluoroquinolones (2006-2020), and the reported AMR in Pseudomonas aeruginosa (2013-2020) in Serbia and to compa...

Background and objectives: During the COVID-19 pandemic, Serbia has faced devastating losses related to increased mortality rates among men and women of all ages. With 14 registered cases of maternal death in 2021, it became obvious that pregnant women are faced with a serious threat that jeopardises their life as well as the life of their unborn...

Objective Light-to-moderate daily coffee consumption (dCC) has been associated with favourable cardiovascular outcomes. The frequency and amount of dCC as well as beliefs related to dCC impact on cardiovascular health (CVH) may vary in different populations. The aim of this study was to assess the frequency and amount of dCC and beliefs related to...

Background and objectives: During the COVID-19 pandemic, a possible overlap of obesity and COVID-19 infection has raised concerns among patients and healthcare professionals about protecting pregnant women from developing a severe infection and unwanted pregnancy outcomes. The aim of this study was to evaluate the associations of body mass index w...

This study examined the association between social characteristics, substance use, and psychological distress in a national representative sample of adults in Serbia. It was a secondary analysis of the National Survey on Lifestyles in Serbia: Substance Abuse and Gambling 2018. The study included a total of 2000 participants aged 18 to 65 from the g...

During the last three years, since the emergence of the COVID-19 pandemic, a significant number of scientific publications have focused on resolving susceptibility to the infection, as well as the course of the disease and potential long-term complications. COVID-19 is widely considered as a multisystem disease and a variety of socioeconomic, medic...

The COVID‑19 pandemic disproportionately affected vulnerable populations’ access to health care. By proactively reaching out to them, general practices attempted to prevent the underutilization of their services. This paper examined the association between practice and country characteristics and the organization of outreach work in general practic...

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and...

This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and...

During the last two and a half years, clinical manifestations, disease severity, and pregnancy outcomes have differed among pregnant patients with SARS-CoV-2 infection. These changes were preceded by the presence of new variants of SARS-CoV-2, known in the literature as variants of concern. The aim of this study is to describe the differences betwe...

Background Alcohol use is recognized as an important risk factor for more than 200 different diseases and injuries. In the Diagnostic statistic Manual- 5 (DSM-5) it is defined as ‘impaired control over alcohol consumption with chronic, heavy and often escalating pattern of alcohol use despite significant detrimental consequences to their overall he...

Background The health and development of school-age children is a contemporary topic of various health policies and programs, which has become even more of a focus in critical situations such as the COVID-19 pandemic. The study aims to assess the prevalence of school-age children's participation in fights and bullying in Serbia, and to examine the...

Background During the COVID-19 pandemic surges, healthcare stakeholders were concerned with the sufficiency of available health workforce capacity. In this study we examined the changes in the supply and demand of physicians, nurses and care workers in Serbia over the period 2011-2021. Methods The National Employment Service (NES) data on total nu...

Background Depressive disorders are one of the leading causes of disability and are significant contributor to total Global Burden of Disease (GBD). Globally, according to the 2019 GBD study, the 1.85% of all Disability adjusted life years (DALYs) was associated with depression. The aim of this study was to describe the age-standardized DALYs in te...

Background Analysis of years of life lost (YLL) due to premature deaths during the COVID-19 pandemic can direct decision-makers towards specific public health recommendations in order to improve health and lives of people. Our study aimed to examine the existence of age- and sex-specific patterns of the three most common causes of premature death i...

Background Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD st...

The aim of this study was to examine the prevalence and association of school-age children’s participation in bullying, focusing on their health characteristics, risk factors, and leisure activities. We performed a secondary analysis of the original data of the 2017 HBSC study to examine participation in bullying once and multiple times among schoo...

Objectives: Breast cancer is the leading cause of cancer mortality among women in Serbia and accounts for 22.8% of total cancer mortality in 2018. This study assessed the knowledge and barriers to early detection of breast cancer in women. Methods: In March 2019, at the Primary Healthcare Centre Kikinda, Serbia, a 22-item questionnaire was distr...

Infection prevention and control (IPC) is an evidence-based approach used to reduce the risk of infection transmission within the healthcare environment. Effective IPC practices ensure safe and quality healthcare. The COVID-19 pandemic highlighted the need for enhanced IPC measures and the World Health Organization (WHO) emphasized the need for str...

Emerging literature is highlighting the huge toll of the COVID-19 pandemic on frontline health workers. However, prior to the crisis, the wellbeing of this group was already of concern. The aim of this paper is to describe the frequency of distress and wellbeing, measured by the expanded 9-item Mayo Clinic Wellbeing Index (eWBI), among general prac...

The aim was to explore the factors associated with the financial burden (FB) of medical care, dental care, and medicines among older-aged people in Slovenia, Serbia, and Croatia using EU-SILC 2017. The highest frequency of FB of medical care and medicines was in Croatia (50% and 69.1%, respectively) and of dental care in Slovenia (48.5%). The multi...

Background The clinical laboratory services, as an essential part of health care, require appropriate staff capacity to assure satisfaction and improve outcomes for both patients and clinical staff. This study aimed to apply the Workload Indicators of Staffing Need (WISN) method for estimating required laboratory staff requirements for the high-vol...

Participating in physical fighting and bullying can be a cause of severe injury and death among school-age children. Research evidence can support school and health actors’ efforts to improve school-age children’s development and health capacity for life. The study aims to assess the prevalence of school-age children’s participation in fights and b...

Introduction: Diagnosis related group migration (DRG) is a phenomenon in coding hospitalizations that indicates that a patient has been transferred from one group to a different, more costly group, after an episode of hospital treatment, solely because of complications or comorbidities that occurred during hospital treatment or medical intervention...

A particularly important issue in healthcare settings is public health professionals' intention to leave their job, which may exacerbate both existing and forecasted public health workforce shortages and jeopardize the health system's performance. The rate of intention to leave a job varies across countries and among different profiles of health wo...

Introduction: Organizational commitment is defined as 'psychological relationship of an individual with an organization'. The aims of this study were to analyze organizational affective and normative commitment of young healthcare providers, factors that determine their perception of organizational support, as well as to identify possibilities to p...

The COVID-19 pandemic is a major challenge for clinical-biochemical laboratories. Laboratory managers face demands to maintain the productivity and quality of laboratory diagnostics, while protecting laboratory staff from a new pathogen that the medical public has only just begun to reveal. This paper describes the experiences of the Center for Med...

(1) Background: The COVID-19 pandemic tested the public health system’s readiness for crises and highlighted the importance of knowing the demand for blood products and the maintenance of the blood supply chain. The aim of this study was to evaluate blood product usage in a series of patients that were hospitalized due to COVID-19 and to analyze th...

Background: The clinical laboratory services, as an essential part of health care, require appropriate staff capacity to assure satisfaction and improve outcomes for both patients and clinical staff. This study aimed to apply the Workload Indicators of Staffing Need (WISN) method for estimating required laboratory staff requirements for the high-vo...

The coronavirus disease (COVID-19) pandemic has an unimaginable impact on the global health workforce. Health workers are deployed as frontline workers to rapidly respond to increasing patient needs. This study aimed to examine the preparedness of healthcare workers during the COVID-19 pandemic to protect their own safety and health. An online surv...

Recruitment and retention of public health workers (PHWs) is crucial for the optimal functioning of the public health system at a time of budget cuts and the threat of a pandemic. Individual and job-related variables were examined by univariate and multivariate logistic regression to identify predictors of the intention to leave a job during the CO...

The study provides evidence on the individual and family factors as potential predictors (odds ratio—OR and 95% CI) of cyber-violence among school-aged children (11–17 years old) from 64 schools participating in the 2017 Serbian Study on health behavior in school-age children (HBSC). The standardized international HBSC research protocol was used. T...

Introduction: The outbreak of the disease caused by the novel coronavirus, SARS-CoV-2 named COVID-19 has spread throughout the world. The number of registered cases is increasing and almost no country or territory worldwide has been without any COVID-19 patient. The aim of this study was to examine the level of knowledge on the SARS-COv-2 and COVI...

Background & Aim The study describes the experiences and opinions of Serbian physicians regarding workforce management during the COVID‐19 pandemic. Materials & Methods A total of 1553 licensed physicians (65% males; average age 44.0 years) responded to an online survey in September 2020. Differences in the respondents' general data and attitudes...

The progression of the COVID-19 pandemic has urged the medical and scientific community to attempt to model and predict the transmission of SARS-CoV-2. Fo-recasting the possible course of the COVID-19 pandemic has helped us to better understand the nuances in the effects of the adopted policy measures and has directed us towards future actions whic...

Introduction: Mortality data are the most reliable indicators of the number of lives that a community has lost due to COVID-19 and represent the minimum data necessary for public health decision-making. Aim: The aim of the study is to describe the basic characteristics of population mortality from COVID-19 in Belgrade in 2020. Methods: The unit of...

Planning and adjusting health capacities to meet the needs of refugees is a constant issue for transit and destination countries following the 2015/2016 Western Balkans refugee crisis. Understanding this crisis is important for taking the right steps in the future. The study informs about the prediction of the refugees’ health needs and demands for...

Background: With the growing increase in the older proportion of the world population, there is also an increase in specific age-related chronic diseases and conditions, including pain. We aimed to evaluate the association of sociodemographic factors with the presence and different degrees of pain intensity in people aged 65 years and older. Meth...

The free movement of people is a cornerstone of an open and integrated Europe. Yet the labor migration of Europeans from lower-income countries in southern and eastern Europe to higher-income countries in northern and western Europe has had significant impact on the workforce— including the loss of skilled health professionals in their most product...

Background Breast cancer is the third highest incidence of cancer globally. It is the leading cause of cancer-associated mortality among females in the world. In Serbia, the incidence rate of breast cancer in 2015 was 61.0/100000 and breast cancer attributed to 18.9% of total cancer mortality among females. The aim of this study was to examine the...

Background Access to health care is a key health policy issue faced by countries in the WHO European Region and Serbia is not an exception. There is increasing concern that financial and economic crisis may have delay progress regarding the performance of the Serbian health system. While substantial development has been experienced by the Serbian h...

Background Various studies have shown the ebb of the political spectrum when determining entry into the European Union. The objective of this study was to determine the key differences between the European Union (EU) and the current EU-candidate countries through the lens of the financial burden of the public healthcare system. Methods The most co...

Background Nursing competencies are paramount to the quality of care outcomes and patient satisfaction. Serbia is lagging behind developed countries in the number of highly educated nurses. The study objective was to examine how well hospital nurses' competency fit for purpose (fit the needs of patients) and fit for practice (fit the needs of job r...

It would seem that today, for many individuals the most important thing is to have a good profile picture on online social networks. Accordingly, there is a serious possibility that addiction to social networking sites (SNS) can lead to psychosocial and behavioral disorders, and other negative consequences on health-related issues. So, the aim of t...

Background Some rich countries are actively recruiting labour from abroad for lack of health workforce. A high-level tendency for emigration among health care personnel in Serbia has attracted the attention of policymakers. In the search for evidence that can support the interventions to manage the outflow of the health workforce, the objective of...

Background Understanding the importance of educational accreditation standards for health and health workforce policymaking is needed more than ever given the growing circulation of physicians, cross-border care and population needs. The World Health Organization National Health Workforce Accounts (WHO/NHWA) for education and training could support...

Background Understanding the importance of educational accreditation standards for health workforce policymaking is needed more than ever, given the growth of physicians' shortage, circulation, cross-border care. The World Health Organization National Health Workforce Accounts (WHO-NHWA) for education and training could support medical education ac...

Objectives This study aimed at identifying the needs for the health workforce in 16 public health laboratories in the Serbian capital by assessing the workforce stock, workload activities, activity standards, and workload pressure. Methods A review of laboratory records and regulations, interviews with key respondents, and observing work processes...

Effective pain management can significantly improve quality of life and outcomes for various types of patients (e.g. elderly, adult, young) and often requires assisted living for a significant number of people worldwide. In order to improve our understanding of patients' response to pain and needs for assisted living we need to develop adequate dat...

Background: Previous studies among the Serbian population concluded that the trend of self-medication with tranquillizers and sleeping pills requires deeper study. The objective is to identify gender differences in socio-demographic, health, and health service predictors of self-medication with tranquillizers and sleeping pills in a Serbian popula...

Background This study assessed the prevalence of unmet health needs of the elderly and the associated factors regarding socioeconomic, health and functional status. Methods A secondary analysis of the 2013 National Health Survey data was conducted on a representative sample of 3540 persons aged sixty-five and older (the lowest response rate was 99...

Background Pre-school teachers are faced with work-related stress and are at increased risk of development of burnout syndrome. The aim of this study was to evaluate the reliability of the Serbian version of Copenhagen burnout inventory (CBI) on a National Representative Sample of preschool teachers in Serbia. Methods This was a cross-sectional st...

Background Physical activity level decreases during the transition from late adolescence to young adulthood. Social media are nowadays widely used and part of many people’s daily routines and the interventions on these websites have the possibilities to be integrated into those routines without becoming a burden. The aim of this study was to assess...

Background Changes in the health insurance law in 2005 led to the changes in the organization of the provision of dental health care in Serbia. Prior to this law, dental health care was available for every resident covered by mandatory health insurance without additional out-of-pocket payments. Now the dental health care is available only for child...

Background Rationalization, freezing of salaries and additional taxation of salaries above a certain amount have marked the reform of the public health sector in Serbia in 2014/15. Health managers bear responsibility for success in reform activities, and improvement of subordinates’ job satisfaction and health care quality with constrained resource...

This analysis of the Serbian health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. The health of the Serbian population has improved over the last decade. Life expectancy at birth increased slightly in recent years, but it remains, for example...

The study identifies the prevalence of violence victimization and the perpetration among youths, and explores the determinants and predictors using a socio-ecological model. The data of 36 variables from a representative sample of 1722 persons, ages 15–24 years, from the National Health Survey of Serbia in 2013, were analyzed by a multivariate logi...

Background: seizures and their consequences contribute to the burden of epilepsy because they can cause health loss (premature mortality and residual disability). Data on the burden of epilepsy are needed for health-care planning and resource allocation. The aim of this study was to quantify health loss due to epilepsy by age, sex, year, and locati...

Summary Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide i...

Objectives: The aim of our study was to evaluate the association of health factors with the presence and different degrees of pain in elderly above 65 years of life. Methods: The population-based study included 3540 individuals above 65 years of age of life from twofold stratified household sample representative for Serbia, during 2013 (the aver...

Supplement to: GBD 2016 Neurology Collaborators. Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol 2019; published online March 14. http://dx.doi.org/10.1016/S1474-4422(18)30499-X.

Summary Background Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic, comparable method of quantifying health loss by disease, age, sex, year, and location to provide inf...

OBJECTIVES To use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016. DESIGN Systematic analysis. MAIN OUTCOME MEASURES Crude and age standardis...