Stefan Mandić-Rajčević’s research while affiliated with University of Belgrade and other places

The aim of this study was to assess the association between the use of and trust in sources of information, knowledge about human papillomavirus (HPV) and vaccines against it, perceived lack of information, and the decision to receive the HPV vaccine in undergraduate students in Belgrade. The sample of this cross-sectional study included students aged 18 to 27 who received the second dose of the HPV vaccine or used other services of the general medicine department at the Institute for Students’ Health of Belgrade during the period June–July 2024. The research instrument was a questionnaire consisting of socio-demographic data, information environment (sources of information, trust in sources of information, as well as questions related to perceived lack of information), knowledge about HPV and HPV vaccines, and vaccination status. Participants filled out an online questionnaire created on the RedCap platform of the Faculty of Medicine, University of Belgrade, which they accessed via a QR code. Hierarchical logistic regression was used to assess the association between vaccine status and socio-demographic characteristics, use and trust in information sources, knowledge, and perceived lack of information. Of the 603 participants who filled out the questionnaire completely, 78.6% were vaccinated against HPV. Key factors associated with vaccine uptake were female gender (OR = 2.33, p < 0.05), use of scientific literature (OR = 1.40, p < 0.05) and family as a source of information (OR = 1.37, p < 0.01), less frequent use of regional TV channels (OR = 0.76, p < 0.05), higher level of knowledge (OR = 1.43, p < 0.01), and lower perceived lack of information (OR = 0.50, p < 0.01). These variables explained 41% of variability in vaccine uptake in the multivariate hierarchical logistic regression model. Exposure to and trust in sources of information were significantly associated with knowledge about HPV and HPV vaccination, as well as with the perceived lack of information regarding HPV vaccination, and were the most significant determinants of the decision to accept HPV vaccine in the student population.

In recent years, there has been a significant increase in attention towards the use of pesticides, as evidenced by the introduction of regulations aimed at ensuring their safe and environmentally responsible application. Although this stricter legislative framework offers potential benefits, the challenges faced by farmers, particularly those in small-scale operations, in complying with occupational health and safety (OHS) requirements are considerable. To address this issue, a research project was promoted by the Italian Workers’ Compensation Authority (INAIL) aimed at developing a user-friendly software tool to support farmers in planning pesticide applications in safe conditions. This study summarizes the results of the research, which consisted of three main phases: the definition of the main parameters that characterize the farmers’ exposure based on the analysis of the literature; the development of a risk assessment model that integrates these determinants with data provided by producers for each authorized pesticide; and the development of software tool (called SICURPEST) for a preliminary risk assessment when using pesticides. This tool serves as a preliminary risk assessment method, offering a simplified model for practical use by farmers. Its initial verification was conducted through a case study and the results represent a step towards promoting safer pesticide practices, providing a solid basis for further validation.

Background Health concerns, narratives and misinformation are growing in digital spaces, which makes them also a vulnerability to being hijacked by disinformation. A workshop was held at GlobalFact11, the global factchecking summit, to take a pulse among the participants on their exposure and work with health misinformation, provide a public health perspective on the role of factchecking, and equip participants with building a business case for developing health-related factchecking programmes. Methods A pre-summit survey of IFCN members and summit participants was conducted to better tune the design of the discussion in the workshop. The workshop included interactive polling and a discussion of case-based scenarios and real-world examples. Results A business case for investing into health-claim fact-checking can consider needs of public health organizations from a variety of perspectives. (1) The global health security agenda, and the politicization of health and hijacking in disinformation influence campaigns; (2) Contributing data for public health infodemic insights reports in formats that provide value to fact-checking in public health context; (3) Developing community resilience programmes by combining fact-checking with community-based interventions; (4) Building partnerships with public health organizations (for fact-checking, capacity building, community media and information literacy, research). Conclusions Many fact-checking organizations got involved in public health during the COVID-19 pandemic. However, they want to access more public health expertise, tools, and partnership modalities that would enable them a more sustainable effort in covering health topics, especially beyond infectious disease.

Background Effective infodemic management (IM) requires a multidisciplinary approach and the use of various skills originating from natural, social, and medical sciences. Personnel involved in IM activities have diverse backgrounds from medical doctors and data scientists to communication specialists and journalists. However, the IM framework is rarely introduced into the existing teaching programs, compromising the training of a competent workforce. Objectives Our goal was to identify opportunities for integrating the IM framework into the existing teaching programs at the University of Belgrade. A team of researchers reviewed the curricula of 31 faculty and identified the courses that already covered IM skills or had the potential to include them in their teaching programs. The research was conducted as part of the U.S. Federal Assistance Award within the University Partnership Program between Emory University and the University of Belgrade. Results After conducting independent reviews and reaching a consensus, over 40 different courses and/or teaching programs have been identified to include or could potentially integrate IM skills and competencies. These courses are found across all major academic clusters (natural sciences and mathematics, technology and engineering, medical sciences, social sciences, and humanities). Faculties of medicine, pharmacy, and dentistry lead with the number of courses and interested teaching staff, followed by social sciences (psychology, sociology, political science). Most of the identified courses are related to information, data science, and communications. Conclusions There is a promising opportunity to introduce IM skills into the current teaching programs at the University of Belgrade. Faculties from the medical sciences group have a solid potential to lead such a process. Collaborative efforts are needed to establish comprehensive teaching programs to ensure a competent public health workforce and certification. Key messages • University of Belgrade has the potential to introduce infodemic management skills into its existing teaching programs, respecting the multidisciplinary nature of this discipline. • Medical and social sciences faculties can lead the process of mainstreaming infodemic management in their curricula, ensuring a competent public health workforce and certification.

Background The information environment significantly impacts public health decisions, behaviors, and health security. Misinformation and disinformation can compromise health interventions and undermine public trust, and this phenomenon, known as the infodemic, is increasingly challenging to address and requires innovation and transformation of public health and education of the health workforce. This study aimed to assess the relevance of infodemic management (IM) to different academic fields and training needs to create a competent workforce. Methods As part of the US Federal Assistance Award within the University Partnership Program between Emory University and the University of Belgrade, a mixed-methods study was conducted to evaluate the curricula of all 31 faculties at the University of Belgrade. An online survey was distributed to faculty deans to assess the current educational framework and opinions on IM in various academic fields. This approach provided a multidimensional view of how IM is perceived and integrated across diverse disciplines. Results The survey received 33 responses from different departments at the University of Belgrade. Over 75% of participants identified misinformation as prevalent in their respective fields. More than half of the respondents believe that students are not sufficiently familiar with the concept of the infodemic and its potential consequences, only 9% believe these topics are well covered in the current curriculum, and over 90% agree that additional content on IM is required to update study programs, indicating a gap in our current educational approach. Conclusions Academic circles have acknowledged the issue of misinformation and its negative impact on public health. Current gaps in academic curricula indicate the critical necessity of integrating IM into educational programs. This innovative approach will provide future specialists with the necessary skills to navigate the complexities of the modern information ecosystem. Key messages • Over 75% of surveyed professors identify misinformation and disinformation as prevalent in their professional fields, indicating a widespread impact. • Over half of professors feel academic programs do not sufficiently equip students to navigate the information ecosystem, with over 90% calling for additional infodemiology content.

Issue/problem COVID-19 vaccination rates remained below 50% in Moldova, North Macedonia, and Serbia, especially among vulnerable populations like pregnant women and those with chronic diseases. This was strengthened by a lack of targeted communication and training for healthcare workers, and COVID-19 fatigue. Strategies to increase vaccine demand and confidence are a global priority, especially among vulnerable populations. Description of the solution From May 2022 to April 2024, the USAID MOMENTUM Routine Immunization Transformation and Equity project employed behavior integration to design a social and behavior change strategy, centering on vaccination as a part of a healthy lifestyle. It was implemented through continuing medical education (CME) and community engagement (CE) workshops with vulnerable populations, supplemented by cross-country learning exchanges. The outcomes provide a framework for public health initiatives aimed at boosting vaccine uptake through innovative, behavior-based methods. Results 1,618 healthcare professionals, able to reach 2.5 to 4.8 million patients, received training in immunization, COVID-19 vaccines, and quality health service, and 99% indicated confidence in applying the knowledge. 265 CE workshops, engaging 4,079 patients, increased awareness and addressed concerns related to vaccination. Of 3,223 patients who were followed up, 47% reported setting an appointment with their doctor regarding vaccination, 27% discussed vaccination with their partners, and 7% proceeded to receive the COVID-19 vaccine. Lessons Behavior Integration helped address key barriers to vaccination and informed the design of strategies (i.e. situating COVID-19 vaccination as part of a healthy lifestyle). Establishing trust with healthcare providers and patients through collective engagement improved health behaviors. Focusing on health as a wider priority helped re-establish the significance of vaccination as part of a healthy lifestyle. Key messages • Behavior science and behavior integration helped identify and address barriers, as well as design tailored interventions to improve vaccination demand and confidence. • Collective engagement, focused on integration of COVID-19 vaccination as part of a healthy lifestyle, achieved results through addressing vaccine hesitance from both sides of the equation.

Introduction. The COVID-19 pandemic has significantly impacted global health, with Eastern Europe experiencing notable excess morbidity and mortality and vaccine hesitancy. This study utilized the Behavior Integration (BI) framework to identify barriers and motivators for COVID-19 vaccination and develop strategies to increase vaccine demand and confidence in Moldova, North Macedonia, and Serbia. Methods. A mixed-methods approach was employed, including qualitative interviews and quantitative surveys. The BI framework was used to integrate human behaviors with technical and operational considerations throughout the project. Results. A total of 2742 online surveys were collected in Moldova and Serbia, revealing significant barriers such as vaccine safety concerns (OR = 1.839, 95% CI: 1.328–2.547 in urban Moldova; OR = 1.990, 95% CI: 1.351–2.931 in urban Serbia), logistical challenges, and lack of institutional trust. Conversely, motivators included personal health concerns, recommendations from health care providers, and the desire to travel. The proposed social and behavior change strategy included a continuing medical education course that trained 2403 medical providers, with post-test results showing a 99% improvement in knowledge and confidence in applying the information, and collective engagement workshops for 3260 chronic disease patients and 842 pregnant women, of which 7% were vaccinated against COVID-19. Conclusions. The BI approach effectively identified and addressed vaccination barriers and motivators, leading to tailored strategies that increased vaccine uptake. Continuous stakeholder engagement, adaptive learning processes, and local organizations are crucial for refining program implementation, ensuring sustainability, and promoting public health.

(1) Background: A chronic subdural hematoma (CSDH) is considered an acute life-threatening event that is easily treated surgically, but little is known about the longer-term mortality of these patients. The objective of this study was to evaluate the association of social determinants of health (SDoH) and the long-term mortality of patients with a chronic subdural hematoma. (2) Methods: This retrospective cohort study included 121 (88 male and 33 female) patients with a surgically treated unilateral or bilateral CSDH. Mortality was evaluated at 1, 2, 6, and 12 months after treatment. (3) Results: Most of the patients were >65 and retired, N = 96 (79.3%); of them, the majority presented with a neurological deficit, N = 71 (73.9%). Patients who lived alone more often had a neurological deficit, N = 57 (75.0%), compared to those who lived in communities, N = 25 (55.5%). Mortality at 1, 2, 6, and 12 months after surgery was 10.7%, 17.4%, 19.0%, and 45.5%, respectively, and there was a significant difference in the median age between the survival and deceased groups at 1 month (p < 0.01), 2 months (p < 0.01), and 6 months (p < 0.01) of follow-up, but not in the long-term (12 months) follow-up (p = 0.200). Patients who lived alone had 3.7 times higher odds of dying at the 12-month follow-up (p < 0.01), compared to those who lived in the community. (4) Conclusions: Living alone is related to an increased case fatality risk after CSDH surgery in the Serbian context. Social determinants of health can be associated with CSDH presentation and survival, indicating that further studies should include SDoH to obtain a deeper understanding of the occurrence, presentation, and outcomes of SDoH and propose additional preventive measures.

Concurrent global increase of prevalence of obesity and male fertility implies link between overweight and obesity with male subfertility. This hypothesis is supported by numerous population-based epidemiological studies. Increase in body mass index (BMI) is associated with poor sperm quality in fertile, and more noticeable in infertile men. Nevertheless, some studies disprove damaging effect of BMI on semen quality. To examine the influence of men’s BMI in infertile couples undergoing in vitro fertilization (IVF) on semen analysis parameters and IVF outcomes. Study encompassed all couples who underwent IVF at Gynecology and Obstetrics Clinic Narodni Front in Belgrade during 2018 and 2019. Exclusion criteria were azoospermia, conditions and diseases that could affect the semen analysis parameters (diabetes, malignant diseases treated with radiation and/or chemotherapy, trauma or surgery of the genital organs, mumps or undescended testicles in childhood). Evaluated semen analysis parameters included semen ejaculate volume, sperm pH, sperm count, sperm motility, and sperm morphology. IVF outcomes comprised total number of embryos, number and percentage of obtained good-quality embryos and clinical pregnancy rates. Based on BMI value, participants were divided into a group of underweight (Group 1), normally weight (Group 2), overweight (Group 3), and obese men (Group 4). After applying inclusion and exclusion criteria, 411 men (couples) were included in the analysis. The largest number of men were overweight, while the smallest belonged to the group of underweight participants. There are no significant differences in the semen analysis parameters between study groups. Correlation analysis shown weak and insignificant correlation between BMI and semen analysis parameters. The number and proportion of good quality embryos is significantly lower in overweight and obese study groups compared to normal weight and underweight groups (2.89, 2.91, 2.42, and 2.36, respectively, P = .041). The differences in other IVF outcomes: total number of embryos (3.61, 3.74, 3.21, and 3.37, respectively) and clinical pregnancy rates (41.26%, 43.09%, 42.78%, and 39.95%, respectively) between study groups were not significant ( P > .05). BMI does not significantly affect semen analysis parameters, but a higher BMI is associated with a lower number and proportion of good quality embryos in IVF outcomes.

Introduction Although the overall quality of medicine has improved in recent decades, the functional capacity in many hip fracture patients remains insufficient. The goal of the present study was to identify significant predictors of Instrumental Activities of Daily Living (IADL) measured by the Lawton-Brody scale at 3- and 6-month follow-up in patients with hip fractures admitted to a hospital. Methods This observational cohort study included 191 patients with acute hip fractures. IADL was measured at baseline and after 3 and 6 months using the Lawton-Brody scale. Multivariable logistic regression analysis was carried out using pre-fracture functional status, sociodemographic variables, hand grip strength (HGS), surgical procedure, complications, and length of hospital stay, Short Physical Performance Battery, and Barthel Index (BI) on the fifth postoperative day as potential predictors for IADL after a hip fracture surgery. Results The mean age of the participants was 80.3 ± 6.8 years, and 77.0% of our cohort were women. Multivariate regression analysis revealed that pre-fracture functional status and early functional recovery were independent predictors of IADL after hip fracture surgery. Conclusions Clinicians should take steps to improve functional outcomes by changing how patients are rehabilitated in the first days after hip fracture surgery, especially for the group of patients with a lower functional status before the fracture.