Brankica B. Mladenovic. Knowledge, attitudes and practices regarding use
of contraception among high-school students in Skopje [MSc thesis].
Skopje, Republic of Macedonia: Cathedra of Social Medicine, Center for
Public Health, Faculty of Medicine, University “Ss Cyril and Methodius”;
2007.
Objectives: The purpose of the study was to determine the knowledge,
attitudes and practices regarding use of contraception among high-school
students in Skopje, in order to document data which could be used in
creating interventions for improving adolescent sexual and reproductive
health.
General objectives:
1. To assess the main determinants of high-school students’ sexual conduct.
2. To assess the knowledge regarding contraception by the study population.
3. To assess the practices regarding use of contraception by the study
population.
4. To better describe the level of use of the existing sexual and
reproductive health service
Methods: Data were obtained through a quantitative, cross-sectional
study conducted in March-April 2006, using paper-and-pencil
self-administered questionnaire. The population under study included 310
high-school students from 5 different high-schools from Skopje, from both
genders, from 4-th grade, aged 17-19. The age was selected on purpose as
they were expected to have more sexual experience and accordingly, more
experience in contraception use. All students registered in classes selected
at random were invited to participate in the survey. There were two levels
of sampling: 1) the school and 2) the class. The questionnaire contains 32
questions, divided in three sections: section for general characteristics,
section for sexually active, and section for non-active students.
Results:
1. Sexual conduct
The median age of onset of sexual activity is 16 years for boys and 17 years
for girls. High proportion of students (43.2%) started their sexual activity
when studying in high-school. There was a significant difference of reported
sexual activity between the males and females: when reaching grade 4 of the
study, 63% of the boys and 27% of the girls had already started with sexual
activity. The difference between gender was also demonstrated in the
duration of the relationship before the first sexual intercourse as well as
in the number of partners. The first sexual intercourse is highly unplanned
activity; 59.1% of the boys and 43.9% of the girls reported that their first
sexual intercourse was unplanned. Of those sexually non active, 55% of the
girls and 37.5% will accept sexual relationship for the first time without
using condom. Fifty percent of the girls reported having no consideration
and 20% have no intention to go for counseling on contraception and STI
before the first sexual intercourse.
2. Knowledge about contraception
Students use many different sources/providers of information about
contraception. The most frequently cited sources of information on
contraception were non-professional sources, like TV, radio, Internet and
peers. Medical staff and medical services were less mentioned. The survey
demonstrated an insufficient knowledge of the students about contraception
(except condoms), especially about modern contraceptive methods, including
pills, emergency contraception and the concept of “dual protection”. The
detection of individual perspectives to have the first child and unwanted
effects of non-protected sex such abortions or STIs demonstrated that
students have need for contraception.
3. Use of contraception
Condoms were by far the most frequently used contraceptive method. The use
of modern contraceptives like pills and emergency contraception were
marginal. Data show that there is no significant difference regarding the
level of use and the contraceptive method used between tow genders during
the first sexual intercourse, as well as with the current partner. The
frequently used contraceptive method at the first sexual intercourse were
condoms. Condoms were by far the contraceptive method frequently used at
most recent sexual intercourse. The level of information about contraception
has positive influence on the level of use. Those who have used
contraception during the first sexual intercourse are more likely to use
contraception during the recent intercourse. Students did not discuss about
contraception with the partner before the first intercourse. Prolonged
sexual activity has no influence on contraceptive method used, as well as on
the level of use.
4. Utilization of sexual and reproductive health services
The under-use of sexual and reproductive health facilities for contraceptive
purpose as well as for diagnosis and treatment of STIs was clearly
demonstrated.
The proportion of students who ever visited a doctor or a health facility
for a problem related to sexual and reproductive health is 33/310 (11.6%).
Marginal proportion of students have visited such facility for contraceptive
purpose or only 5% of the sexually active girls; only 1.0% of the student
have made a visit for diagnosis or treatment for STI. Main barriers
identified (lack of information and subjective barriers) demonstrated that
provision of services appeared sufficient but not well adapted to their
needs.
Conclusion
The study shows elements of risky sexual behavior and insufficient knowledge
about contraception. The under-use of modern contraceptive methods, purpose
was clearly demonstrated. Adolescents are entering their reproductive years
ill prepared to protect and safeguard their sexual and reproductive health.
In conclusion, young people need to be guided in their reproductive health
seeking behavior especially in their contraception need and adequately
provided with information about contraceptive methods and the symptoms of
STIs. Medical staff should be additionally educated for working with youth.
Young people should be convinced that such services are “youth friendly”.
Key words: Not available.
Defended: April 5, 2007.
Mentor: Prof. Dr. Mome Spasovski.
Angelina Bachanovic. The regulatory mechanism as public-health instrument
on the system for food safety in the Republic of Macedonia [MSc thesis].
Skopje, Republic of Macedonia: Cathedra of Hygiene, School for Public
Health, Faculty of Medicine, University “Ss Cyril and Methodius”; 2007.
Abstract not available
Key words: Not available.
Defended: April 5, 2007.
Mentor: Prof. Dr. Dragan Gjorgjev.
Gabriela Topuzovska. Quality of life at patients on hemodialysis [MSc
thesis]. Skopje, Republic of Macedonia: Center for Public Health, Faculty of
Medicine, University “Ss Cyril and Methodius”; 2007.
Background. Health related quality of life is a valid marker of
outcome for chronic dialysis therapy. Medical treatments can no longer be
evaluated on basis of survival only, and comparison of quality of life in
relation to different parameters and treatments are required.
Methods. The quality of life was evaluated using disease specific
questionnaires such as KDQOL-Kidney Disease Quality of Life. A wide range of
questionnaires are available witch asses different aspects of an
individual’s health. The study was provide in 7 dialysis centers in Republic
of Macedonia, and was inquired 151 patients.
Results. Analysis of data by demographics collections gender, age and
extensive of dialysis period, showed that quality of was decreased in two
different aspects: burden of kidney disease and role limitation, in all
analyzed groups of patients. With growing on dialysis time we notified going
down on quality of life. The specifics determinants work status, degree of
education and place of living, showed that influence of the disease is
reducing the workers possibilities of the patients, which is confirmed with
data that very big percentage of patients are retied. Degree of educations
is confirming the hypothesis of his influence over quality of life. The
place of living has not influence over the quality of life in this study
population.
Conclusions. This study has elements of lowest quality of life in
patients of hemodyalisis. The obtaining dates of this study for quality of
life in patients of dialysis, showing absents of the process of
reintegration and resocialization of this group of patients in the society.
Key words: hemodialysis; quality of life; chronic kidney disease.
Defended: July 5, 2007.
Mentor: Prof. Dr. Elisaveta Stikova.
Biljana Danilovska - Filipovic. Diabetes mellitus tip II - Public health
challenge of XXI-century [MSc thesis]. Skopje, Republic of Macedonia:
Cathedra of Epidemiology and Biostatistics with Medical Informatics, Faculty
of Medicine, University “Ss Cyril and Methodius”; 2007.
According the WHO data and International Diabetes Federation, in 1995y. in
the world around 135 million people had Diabetes. In 2005 y. in the world
around 194 million people suffered of this disease. Expecting is that this
number will be 366 million people till 2030 y.
Diabetes spread conditions are wareed. Diabetes took epidemiological
characteristics and become to be trend for the human race and we have now
more than 3 million death people in a year in the world, because of the
Diabetes complications.
Goal of our survey is, according of our data, to show the influence of some
risk-factors associated with the survey problem, to make range-list of
risk-factors according the epidemiological potential that they have it.
The survey contain 2 parts. First part is descriptive analysis of relevant
variables in the sick people from Diabetes Type II in R. of Macedonia in the
period 1997-2005 y. Second part, show analytically, the relevant
epidemiological variables, in the survey groups (105 persons are with
Diabetes Type II and 105 persons are without Diabetes Type II). We made
investigations in two groups of persons, with the special designed
non-standard questionnaire, where all relevant data were noted. All dates
were analyzed with adequate statistic methods and the risk-factors were
defined as the factors which took parts in the illness appearance and again
the risk-factors were defined with statistic importance of the variables
which were goal of the investigation. Our survey shows that the existence of
Diabetes Type II is the family of the patient, increases the risk of it for
8 times, overweight and hypertensio arterialis increases the possibility for
Diabetes Type II 4 times, physical inactivity and high values of
triglycerides increases the possibility for 3 times and high values for
cholesterol increases the risk for 2 times. The place of living (city),
social background, poor standard, age and smoking are also risk-factors, but
nationality, religion, marital status, education, occupation and alcohol
consummation, are not valid as a risk-factors for appearance of Diabetes
Mellitus Type II.
Key words: Diabetes Type II; Risk-factors; Prevention.
Defended: July 9, 2007.
Mentor: Prof. Dr. Rozalinda Isjanovska.
Jaroslav Karadzinski. Influence of the medical education on the level of
knowledges, attitudes and skills development for health-promotion activities
related to tobacco use among students of Medical and Dental faculty [MSc
thesis]. Skopje, Republic of Macedonia: Center for Public Health, Faculty of
Medicine, University “Ss Cyril and Methodius”; 2007.
Background. In the New Public Health, the interactions between
behavior and the environment are defined as life style which can be of great
influence on the personal life. One of the greatest behavioral risks
spreading epidemicaly is the tobacco use.
Methods. The study was conducted with a questionnaire distributed to
students from the IV, V and VI th year of the Medical and Dental Faculty,
University of Sst Cyril and Method, Skopje, all together 309 of them. The
research consists of collecting, analyzing and validation of data from
different sources relevant to this study. The methodology was standardized
one from the Global Health Professionals Survey (GHPS), produced by WHO,
Center for Diseases Control (CDC) USA and Canadian Public Health Association
(CPHA), 2005. Statistical analysis was made with SPSS 14 (SPSS Inc,
Chicago). Considering that all variables are categorical (measured with
nominal and ordinal scale) they are presented as number and percentage as
well. Mutual correlation of variables as well as statistical significance of
the association was tested with c2-(Pearson coefficient) and Fisher exact
test for small figures, and Spearman’s Rho for correlation of distinct
variables. All statistical sets were performed applying required statistical
significance level of p<0.05) results regarded as “significant”) and the
results with p>0.05 as “absence of evidence of a difference”.
Results. From the total number of students (n=309), 175 students
(56.6) are form the Medical faculty and 134 (43.4%) from the Dental faculty
Skopje. There is a significant prevalence group (41.4%) of smokers found
among the tested group. 77% of the students tried to smoke in some period of
their life. The greater percentage (44.5) started smoking when there were at
the age between 18-19, High percentage of smokers (77.3%) and non smokers
(83.1%), belive that health professionals should serve as an example to
their patients and that they should routinely consult their patients on
smoking cessation as said by 95.8% of the smokers and 98.6% of non-smokers.
But there is a difference in the knowledge, attitudes and habits, depending
on the smoker status. Significantly (p<0.05) higher is the number of the non
smokers compared to smokers that are in favor of banning the smoking in the
restaurants, discos/bars and public places. More than half of the tasted
students (59% females and 58% males) never discussed about risk factors from
smoking on any of the course on the medical or the dental faculty, or it was
insufficient. Their knowledge about this problem depends on the year of the
study (most of the positive answers - 66% is acquired from the study
population in IVth year of the studies.
Conclusions. The level of the students’ knowledge on the ill effects
of the tobacco smoking should be enhanced through modernization of the
educational study programs. Students attitudes related to the activities
connected with control and use of tobacco products, are positive and
properly directed. The consultation and continuous education concerning this
meter, aimed for the health professionals, i.e. medical and dental faculty
students, should be a long term task.
Key words: Tobacco use; smoking; education; attitudes; students.
Defended: July 11, 2007.
Mentor: Assistant Prof. Dr. Elena Kjosevska.
Aleksandar Stojanov. Evaluation of the diagnostic task and the validity
of the registered data about Hepatitis virosa in the Republic of Macedonia
[MSc thesis]. Skopje, Republic of Macedonia: Cathedra of Epidemiology and
Biostatistics with Medical Informatics, Faculty of Medicine, University “Ss
Cyril and Methodius”; 2007.
Hepatitis virosa is one of the most important health issues around the
world. Hepatitis virosa represent a group of diseases that has gained on
importance in the public health because of its wide presence in the world,
its serious consequences, but also with the possibility of taking measures.
Hepatitis virosa is a clearly defined clinical syndrome containing all kind
of etiology and all sorts of different clinical, epidemiological,
serological and pathological characteristics.
The aim of our research is to analyze the collected data, collected in a
methodic way, as a reliable basis for planning and conducting measures for
disabling the incriminatory causable relationship between the dominant
variables and by conducting them, we can lower the risks of producing
invalid and unreliable data for the Hepatitis virosa in Macedonia.
The research represents an epidemiological field study ant it is done in the
period of one year (2006). The data collecting is done by a specified
question nary, field up by the health institutions through out the state.
The collected data (the registered cases of Hepatitis virosa in the R. of
Macedonia, 1996-2005 and data about epidemiological procedures and the
laboratory methods of differentiation of Hepatitis virosa were analyzed with
the aid of corresponding epidemiological and statistic methods.
In the R. of Macedonia, 1995-2006, in total 13.760 cases were registered
Hepatitis virosa with the average annual incidence of 68,03/100.000
inhabitants. 58% of the case were of the Hepatitis virosa A type, with the
average annual incidence of 35,74/100.000; 12% of the cases were of the
Hepatitis virosa B type, with the annual incidence of 8,36/100.000; 2% of
the cases were Hepatitis virosa of C, D and E type with the annual incidence
of 1,4/100.000 and 33% of the caeses were of an undetermined type of
Hepatitis virosa, with the annual incidence of 22,52/100.000 inhabitants.
The trend of the incidence of the hepatitis virosa A, B, C, D, and E type is
in a constant decrease. The average annual incidence of the Hepatitis A type
is the highest in the region of Skopje (56,06/100.000), of the B type, in
the region of Prilep (15,33/100.000), of the C, D and E type, also in the
region of Prilep (2,99/100.000) and of the undetermined type in the region
of Strumica (88,30/100.000). The mail sex is more common with each type of
Hepatitis virosa. More frequently, patients at the age of 14 are infected
with the A type and the undetermined type; with the type B and the C, D and
E type, are patients at the age between 20-29. The serological
differentiation of the different types of Hepatitis virosa, is being
practiced in the region of Skopje since 1996, and the remaining part of the
country, only 66.9% are being serologically differentiated. In all health
institutions in the Republic, where differentiation of Hepatitis virosa is
being practiced, proper serological methods are used. The performances of
the laboratories with specific serological markers are on a high level in
the region of Skopje. The experts from the laboratories in the remaining
part in the Republic of Macedonia are heaving problems (lack) of the
specific markers of serological differentiation of the Hepatitis virosa.
Hepatitis virosa is a serious health problem and it needs preventive
measures in the sense of decreasing of the incidence of all types of
Hepatitis virosa and removing the causes of it’s appearing, supplying more
reliable and more valid tests for diagnosing and procedures, in the purpose
of improving the quality and the health/life of the general population.
Key words: Hepatitis virosa A; Hepatitis virosa B; Hepatitis
virosa C, D, E; undetermined Hepatitis virosa; incidence health improving.
Defended: November 6, 2007.
Mentor: Prof. Dr. Dragan Danilovski.
Vera Dimitriovska. Public health aspects of the nutrition and lifestyles
in the older persons in the Republic of Macedonia [MSc thesis]. Skopje,
Republic of Macedonia: Faculty of Medicine, University “Ss Cyril and
Methodius”; 2008.
Abstract not available
Key words: Not available.
Defended: June 3, 2008.
Mentor: Prof. Dr. Dragan Gjorgjev.
Radmila Ristovska. Managing with human resources – algorithm for
improving the performance of the doctors in the primary health care [MSc
thesis]. Skopje, Republic of Macedonia: Cathedra of Social Medicine, Center
for Public Health, Faculty of Medicine, University “Ss Cyril and Methodius”;
2008.
Abstract not available.
Key words: Not available.
Defended: November 28, 2008.
Mentor: Prof. Dr. Fimka Tozija.
Elisaveta Jovanova. Rational pharmacotherapy of arterial hypertension at
level on primary health care in the Republic of Macedonia – public health
aspects [MSc thesis]. Skopje, Republic of Macedonia: Cathedra of Social
Medicine, Center for Public Health, Faculty of Medicine, University “Ss
Cyril and Methodius”; 2008.
Objectives
The purpose of the study was to evaluate the knowledge, adherence and
acceptance to practice for the guidelines for management of the hypertension
in primary care physicians, for general practice in the selected towns.
General objectives:
1. To assess physician’s adherence to the current guidelines for diagnosis
and treatment of the hypertension
2. To assess knowledge of the guideline for evidence based medicine
3. To assess the impact of the different factors on the pharmacotherapy for
hypertension
4. To determine the sources of information and continuing medical education
Methods
Data were obtained through a cross-sectional study conducted in
June-August 2007, using self-administered questionnaire. The population
under study included 70 physicians from primary care, general practice, in
three towns (Skopje, Tetovo and Kumanovo). The selection of the towns was
made by the number of citizens, the three biggest in Macedonia. The
questionnaire contains 10 questions, section for years of working live and
specialization, section for diagnosis and treatment of the hypertension, the
factors that have impact on the pharmacotherapy and the sources for the
information and continuing medical education.
Results
1. Guidelines compliance
Only half or 49% of the physicians gave the correct answer about the
threshold of the arterial pressure for diagnosis of hypertension, and the
rest of the physicians had different threshold. The biggest number of the
physicians, or 97% do recommends another tests for new diagnosed patients
with hypertension. About thresholds of arterial pressure for starting
pharmacotherapy in particular clinical case 90% of the physicians had higher
threshold, only 10% had the same like in the guidelines. The right goal
arterial pressure after using pharmacotherapy had only 30% of the doctors,
the rest 70% of them do not had correct goal pressure.
2. Initial pharmacotherapy
Only 20% of the physicians used fabric name of the drug to answer for drug
for initial pharmacotherapy for particular clinical case. There is
significant domination in the proportion for doctors who use monotherapy
(70% of the doctors), comparing the others who use fixed fabric combination
(3%) and the others who use combination of two or more drugs. For this case
86% of the doctors prescribed the right initial pharmacotherapy.
3. Knowledge of the guidelines for evidence based medicine
There was no one physician who didn’t know the meaning of the “evidence
based medicine practice”. Only 19% answered that they know what its mean,
but they don’t use it in everyday practice, and the rest 81% of the doctors
know the meaning and they do it in everyday practice. Most of the
physicians, 96%, know the current guidelines for evidence based medicine ad
use in everyday practice, 3% know but don’t use and only one doctor don’t
know the current guidelines for evidence based medicine.
4.Influence of some factors on the choice for pharmacotherapy for
hypertension
Strong influence on the choice for pharmacotherapy for hypertension have
next factors: positive lists of the drugs (79% of the doctors), the price of
the drug (69% of the whole sample), the way of dosage the drug (51% of the
doctors), own experience and habit for prescribing some drug (64% of the
physicians), guidelines for evidence based medicine (79% of the doctors) and
the name-brand of the pharmaceutical company (41% of all of the doctors).
Neither strong nor weak influence have written promotional materials from
pharmaceutical company (51% of the doctors), and weak influence on the
choice of the pharmacotherapy for hypertension have other promotional
materials from pharmaceutical company (73% of the physicians) and commercial
reasons, according to 67% of all doctors.
5. Sources for continuing medical education
The sources that physicians use for information and continuing medical
education a lot are: medical books (54% of the doctors), congresses,
seminars, symposia organized by the medical associations (82% of the
doctors) and congresses, seminars, symposia organized by the pharmaceutical
companies according to 69% of the doctors. Sources that doctors use neither
lot nor less are: Macedonian medical magazines (53% of the sample) and
promotional materials by the pharmaceutical companies according to 46% of
the physicians. Less used sources are foreign medical magazines (50% of the
doctors) and internet 41% of all physicians.
Conclusion
General conclusion from the study is that primary care physicians from
general practice have modest knowledge of the guidelines from evidence based
medicine from management of hypertension. Pharmacotherapy from hypertension
is not rational yet, the choice for pharmacotherapy, the continuing medical
education and the sources for information are influenced by pharmaceutical
companies.
Key words: Not available.
Defended: November 18, 2008.
Mentor: Prof. Dr. Mome Spasovski.
Goran Sanevski. Public health aspects of pollution in the ambient air in
the urban areas in Republic of Macedonia and the impact on the children’s
health [MSc thesis]. Skopje, Republic of Macedonia: Center for Public
Health, Faculty of Medicine, University “Ss Cyril and Methodius”; 2009.
Abstract not available.
Key words: Not available.
Defended: June 8, 2009.
Mentor: Prof. Dr. Mihail Kochubovski.
Lolita Mitevska. Accreditation of the health institutions in the Republic of
Macedonia – Situation and prospective [MSc thesis]. Skopje, Republic of
Macedonia: Cathedra of Social Medicine, Center for Public Health, Faculty of
Medicine, University “Ss Cyril and Methodius”; 2009.
Abstract not available.
Key words: Not available.
Defended: June 15, 2009.
Mentor: Prof. Dr. Doncho Donev.
Vladanka T. Andreeva. Partnership between NGOs and Public Health
Organisations in the implementation of the National HIV/AIDS Strategy
[MSc thesis]. Skopje, Republic of Macedonia: Cathedra of Social Medicine,
Center for Public Health, Faculty of Medicine, University “Ss Cyril and
Methodius”; 2009.
Introduction: Civil Society has a long history of participation in
health preservation and promoting. In many countries NGO sector has taken
the lead in the HIV response, promoting the human rights based approach.
Global trends are reflected in Macedonia as well, where NGOs are key
advocates for HIV prevention among the vulnerable groups. The main aim of
the study is to analyze and depict the role that the NGOs had in the
implementation of the implementation of the first National HIV/AIDS Strategy
2003-2006, as well as to formulate recommendations for future partnership
between NGOs and the Public Health sector.
Methods: The study was designed as retrospective-prospective
research. In the retrospective part, focused on the period November
2004-October 2007, the role of the NGOs in the implementation of the
National HIV/AIDS Strategy priorities was analyzed. The prospective part of
the research was designed as a Delphi study, and trough application of
questionnaires to a group of 22 experts, expert opinion on the role of the
NGOs in the implementation of the National Strategy, as well as
recommendations for future interaction between NGOs and the public health
sector were gathered.
Findings: Within the framework of the implementation of the first
National HIV/AIDS Strategy activities were conducted in few programme areas,
and six NOGs (HOPS, HERA, MIA, Doverba, EGAL and Izbor) were key partners
targeting most at risk groups (young people, injecting drug users,
commercial sex workers, man who have sex with man, Roma and prisoners). In
the analyzed period, 16,587 young people, 5% of the total young population
in the country, were covered with different peer education sessions; 731,315
condoms in total were distributed, and out of them 250,000 were distributed
to young people; 2,281 client had voluntary counseling and testing; 767
contacts with MSM were established; 173 commercial sex workers and 3,355
clients of sex workers were reached; 3909 injecting drug users were covered
with harm reduction activities, and 1281 injecting drug users had access to
substitution treatment. The experts involved in the Delphi Study were
unanimous in their response that the successful implementation of the first
National HIV/AIDS Strategy was largely due to the partnership established
between the Government and the NGOs. Accountability, creativity, and team
work were just some of the attributes used to portray NGOs contribution. The
role that NGOs had in the HIV/AIDS demystification, as well as the bold and
intensive social mobilization, was emphasized. That helped fight stigma and
discrimination that people living with HIV and their families are facing
with, and improved access to health and social services. Considering the
findings of the SWO analysis, 8 recommendations for future partnership
between the NGOs and public health sector were formulated. The
recommendations were divided in four specific areas: legal framework;
sustainability; coordination and capacity building.
Conclusion: Activities undertaken and results achieved within the
implementation of the National Strategy have proved the necessity to have
NGOs as equal partners to the public health sector. The established
cooperation and coordination between the Government and the NGOs is one of
the main prerequisite for service provision to the most at risk groups.
Future partnership between the NGOs and the Public Health Sector in
Macedonia should be based on the success achieved with the implementation of
the National HIV/AIDS strategy, and principles of joint trust, partnership,
participation and consultations.
Key words: NGOs; Public Health Organizations; most at risk groups;
HIV prevention; good governance; coordination; partnerships.
Defended: June 25, 2009.
Mentor: Prof. Dr. Fimka Tozija.
Aleksandar Mitrevski. Evaluation of the oral healthcare in the Republic
of Macedonia and total expected cost design in providing preventive and
treatment services [MSc thesis]. Skopje, Republic of Macedonia: Center
for Public Health, Faculty of Medicine, University “Ss Cyril and Methodius”;
2009.
Oral healthcare in the developed countries, as America and Europe
has established efficient preventive programs, thus the caries and the
epidemics of the periodontal diseases are stopped. In these countries,
significantly decreased values of the average caries index are registered,
which indicates that oral and dental diseases might be stopped. On the
contrary, in the developing countries, the caries frequency is still high.
The oral health condition in our country is dramatic. The incidences of
dental caries, periodontal diseases and orthodontic anomalies are still very
high. Furthermore, most concerning is the fact that in some areas a trend of
their increase exists, despite the efforts of the society, growing number of
qualified dentists and dental service capacities.
In order to address these problems, the purposes of our investigations were
focused towards:
· Obtaining accurate caries incidence values in predefined age groups;
· Estimation of the expected costs for the conservative treatment of the
dental caries;
· Evaluation of the financial effects from application of preventive dental
procedures performed in two community regions in the Republic of Macedonia
(Skopje and Strumica);
· analysis and evaluation of the economic indexes between the conservative
dental caries treatment and the financial effects of application of
preventive measures.
Our study group consisted of 50 subjects aged 6 and 12 years respectively,
from Skopje-Center and city of Strumica with their suburban areas. The
investigation comprised of determination of the following indexes: DMF-index
and economic evaluation of treatment procedures compared to preventive
measures among the subjects of the study group.
Our results revealed high DMF-index values, particularly when compared to
those in the western European countries.
Analysis of the results of the economic effects of conservative dental
caries treatment compared to caries prevention measures costs are
unfavorable only in the 6 years old children group from Skopje-Center
Community (1:0.63), whilst the other values are positive and range from
1:1.32 in Strumica urban areas with 6-year olds; this analysis was highly
favorable among 12-year old subjects from the rural areas in Skopje
(1:2.93).
The realization of the projected purposes and hypotheses in this study
revealed that the oral health condition of pediatric population in the
Republic of Macedonia is a serious public health problem which might be
resolved by a co-ordinated preventive dental healthcare. The conducted study
also concludes that the minimal finances invested in primary preventive
measures will lead towards better healthcare and huge savings in a short
period of time. The indexes point to the fact that the best possible methods
in solving of this national public health problem public health problem
should be chosen, by preference of the whole population model to the
individual clinical approach to the problem.
This master’s thesis contributes to defining of the activities of the
national policy in the dental preventive program and will be a basis for
massive application of dental preventive measures. It obtains relevant
indexes for the oral health condition in the urban and rural areas; as well
as the economic evaluation indexes of the preventive measures, such as
public health activities in the protection against tooth decay and their
efficiency in comparison to conservative dental caries treatment.
In order to fulfill these aspirations, a thorough understanding and
engagement of the following factors is necessary:
· Taking into consideration the national oral pathology and etiological
factors that have a serious impact on the above mentioned conditions;
· Identification of strategies for prevention of oral diseases;
· Financial policy, organization and professional recruitments;
· Application of adequate methods and measures in order to prevent the
appearance of oral diseases;
· Motivation of the human resources at each level in fulfillment of the
previously mentioned factors.
The final conclusion of this study can be the recommendation of application
of “caries free” politics, which expects further decrease of the DMF index.
The entrance of the existing twenty year’ old “caries free” generation in
the 21st century will probably increase the average number of healthy teeth;
furthermore, most of the population will have a complete dentition.
In order to improve oral and dental health of the population in general, we
have to emphasize the necessity of obligatory conduction of systematic
prevention and treatment. This aim can be achieved by application of a
unique protocol in prevention of oral diseases in the whole country,
supported by financial and other resources for their implementation.
Key words: Not available.
Defended: July 16, 2009.
Mentor: Prof. Dr. Mome Spasovski.
Natasha Mitrevska Teovska. Patient’s attitudes and knowledge about the
protection of personal data in the specialist - consultative services of the
public and the private sector of the health system in the Republic of
Macedonia [MSc thesis]. Skopje, Republic of Macedonia: Center for Public
Health, Faculty of Medicine, University “Ss Cyril and Methodius”; 2009.
Abstract not available.
Key words: Not available.
Defended: July 20, 2009.
Mentor: Prof. Dr. Doncho Donev.
Aneta Kostovska. Attitudes and knowledge about the patients’ rights from
public health aspect [MSc thesis]. Skopje, Republic of Macedonia:
Cathedra of Epidemiology and Biostatistics with Medical Informatics, Faculty
of Medicine, University “Ss Cyril and Methodius”; 2009.
In Republic of Macedonia patients’ rights are regulated by Law for
protection of patients’ rights passed and declared on 2 June 2008.
The aim of the work is to get acquainted with the real situation about the
level of informing, attitudes and acknowledgement of the common population,
health workers and collaborators in R. Macedonia about the patients’ rights
according to Law for protection of patients’ rights.
The work presents a transversal, analytical-descriptive study carried out at
the Faculty of Medicine and University clinics in Skopje, in the period from
01.01 until 31.03.2009. In this research two groups were included, 300
patients (N1) which were chosen by chance from the ambulances of the
University Clinics in Skopje and 300(N2) health workers, chosen by chance
from the same clinics where the patients were asked.
Analysis of the two questioned groups about being informed and acquainted
with the existence of Law for protection of patients’ rights in our country,
showed that health workers and assistants are considerably informed (94%),
as expected and the percentage of the patients who were informed about this
law was also big (82%) or 247 ones.
According to the results got from the questionnaire, patients are different
informed about the different rights according to the law (30%-97%), which
displays a necessity for searching a mechanism for its drawing nearer to
them. Health workers and assistants are largely more informed about certain
rights for patients, but the number of patients who were questioned is also
large. One may conclude that both groups that were questioned are almost
equally informed about the rights of the patients.
The importance of the problem with informing of the population about the Law
for protection of patients’ rights is stressed by the number of activities
and campaigns launched by the Health Ministry.
Key words: law; patients’ rights; informing; attitudes and
knowledge.
Defended: November 20, 2009.
Mentor: Dr sci. Dr .Milka Zdravkovska.
Sonja Panovska. Osteoporosis – a public health problem among the women in
menopause [MSc thesis]. Skopje, Republic of Macedonia: Faculty of
Medicine, University “Ss Cyril and Methodius”; 2009.
Abstract not available.
Key words: Not available.
Defended: December 7, 2009.
Mentor: Prof. Dr. Rosalinda Isjanovska.
Teuta Agai-Demjaha. Effects of unemployment on the health of the
unemployed persons – public health problem and action steps – our experience
[MSc thesis]. Skopje, Republic of Macedonia: Cathedra of Occupational
Medicine, Center for Public Health, University “Ss Cyril and Methodius”;
2009.
Introduction: Today unemployment represents an urgent problem in the
world in general and in Republic of Macedonia in particular. This specific
phenomenon generates serious consequences. More and more data confirm that
unemployment and unstable employment result in health consequences.
Aims: Determining the main health effects of unemployment on physical
and mental health of the unemployed through most frequent registered
“self-reported” health problems; assessment of differences in a lifestyle
(smoking, alcohol consumption, level of physical activity) and life
conditions (home, water supply, nutrition) between the employed and
unemployed, assessment of the impact of different lengths of unemployment on
the health of the unemployed; assessment of the impact of the length of the
previous working experience, working factors and working conditions of the
previous job on the health of unemployed and recommendations for undertaking
appropriate measures and guidelines for the implementation of health
promotion and prevention of the unemployed.
Materials and methods: The research represents a
descriptive-analytical model of an epidemiological cross-sectional study
with a retrospective surveillance approach. During the research 400 people
were interviewed, of which 200 were unemployed and 200 were employed. The
interviewees were selected through random selection, while throughout the
study the following questionnaires have been used: “Unemployment Health
Effect Survey Questionnaire” and “Health Effects of Working and Life
Conditions Survey Questionnaire”. The study has been implemented within the
framework of “Preventive Program for Health and Work Ability Assessment
among the Unemployed in Republic of Macedonia” and trough regular medical
check-ups in the Institute of Occupational Health- WHO Collaborating Center
and Services of Occupational Health in Republic of Macedonia.
Results: According to the collected data concerning the existence of
health problems of the unemployed and employed, statistics show a
significantly higher prevalence of overall health problems among the
unemployed (59.0%) in comparison to the employed (40.5%). Regarding specific
health problems, statistics show a significantly higher prevalence among the
unemployed in comparison to the employed. When it comes to the correlation
of health problems with the employment status, our results show that the
majority of the unemployed (83.0%) believe that their health problems are
related to their unemployment status, while around 40% of the employed
believe that their health problems are related to their employment status.
The correlation to stressful events generated by long-term unemployment was
detected in 88.0% of the unemployed and only in 8.5% of the employed. A
considerably higher number of the unemployed (in comparison to the employed)
correlate the presence of stressful events with other problems. Data from
the two groups show that a relatively high number of the unemployed (38.5%)
believe that they would not be able to do the job for which they have been
trained by the age of 60, while the majority of employed ones (58.5%)
believe otherwise. The correlation between the length of the previous
working experiences and lowered mood and heart problem in unemployed persons
is statistically significant. Professional exposure to bad microclimate
conditions is the most frequently mentioned reason for specific health
problems among the unemployed people with previous working experience.
Conclusion: The prevalence of overall health problems is
significantly higher among the employed. The prevalence of the specific
health is in most cases significantly higher among the unemployed in
comparison to the employed. The majority of the unemployed interviewees link
unemployment with their existing health problems. The prevalence of
stressful events generated by long-term unemployment as well as other
problems is significantly higher among the unemployed in comparison to the
employed. A considerably higher number of the unemployed (in comparison to
the employed) believe that they would not be able to do the same job by the
age of 60. Among the unemployed a significant correlation between the length
of the previous employment and lowered moods and heart problems has been
registered. Professional exposure to bad microclimate conditions is the most
frequently mentioned reason for specific health problems among the
unemployed with previous working experience. There is a need for continued
and planned surveillance and assessment of health problems and working
ability of the unemployed, combined with a logistically and financially
accessible health protection that focuses on the prevention and promotion of
the health of the unemployed population.
Key words: Unemployment; health effects; physical and mental
health; public health; occupational medicine.
Defended: December 29, 2009.
Mentor: Prof. Dr. J. Karadzinska - Bislimovska.
Blashko Kasapinov. Injuries burden in the children and youth in the
Republic of Macedonia – a priority public health problem [MSc thesis].
Skopje, Republic of Macedonia: Cathedra of Social Medicine, Center for
Public Health, Faculty of Medicine, University “Ss Cyril and Methodius”;
2010.
Introduction: Injuries and violence pose a great threat to the health
of people worldwide, especially to children and youth. Eight of fifteen
leading causes of death in young adults aged 15-29 are related to injuries
and violence. When all age groups are considered, injuries are ranked as
third leading cause of death.
Main objective: The main objective of this paper is to determine the
burden, characteristics and risk-factors for injuries in children and youth
aged 0-24, in order to propose and develop preventive programs for
decreasing the injuries burden.
Material and methods: Retrospective analysis of data for children and
youth aged 0-24, collected through transversal cross-sectional study,
designed according to standard methodology by the World Health Organization
for community survey on injuries and violence conducted in April-May 2008 on
the whole territory of republic of Macedonia. Multi-stage sampling technique
was used to select the sample for this survey. Total of 1200 households have
been covered, 4868 questionnaires have been completed, out of which 48
persons with injuries aged 0-24 have been identified, and this sample
represents the survey population. Cross-tabulation and Chi-square tests were
used for statistical significance testing. All statistical tests were
performed applying required statistical significance level of p<0.05
(results regarded as “significant”) and the results with p>0.05 as “absence
of evidence of a difference”.
Results: 59.2% of injured were males, while 40.8% were females;
male-to-female ratio was 1,45:1. The age was in the span form 3 to 24, while
the mean age was 14,04±6,4 more than half of injured were ethnic Albanians,
followed by ethnic Macedonians. The most common place of injury was
street/highway with more than one quarter of cases, followed by injuries at
home and injuries at school, while the injuries most frequently happened
during leisure activities, unspecified activities and sporting activities.
According to the injury mechanism, the majority were result of falls,
followed by injuries sustained by struck/hit from other person or object.
The most common type of injury was sprain/strain, followed by cuts and
fractures.
Recommendations: Injury prevention in children and adolescents should
be comprehensively assessed with application of evidence-based effective
interventions.
Key words: injuries; children and youth; morbidity; mortality;
prevention and control.
Defended: January 11, 2010.
Mentor: Prof. Dr. Fimka Tozija.
Tanja Jovanovska. HCV infection in the prison population in Republic of
Macedonia - public health challenge of the modern society [MSc thesis].
Skopje, Republic of Macedonia: Center for Public Health, Faculty of
Medicine, University “Ss Cyril and Methodius”; 2010.
Abstract not available.
Key words: Not available.
Defended: January 11, 2010.
Mentor: Prof. Dr. Biljana Taushanova.
Bisera Rachic. Public-health aspect of the behavior of adolescent in the
Republic of Macedonia concerning nutrition habits, physical activity,
smoking and alcohol consumption [MSc thesis]. Skopje, Republic of
Macedonia: Center for Public Health, Faculty of Medicine, University “Ss
Cyril and Methodius”; 2010.
Introduction. A big part of the diseases of adolescent population
comes as a result of the risk taking behavior in relation with their
nutrition habits, physical inactivity, use of alcohol and tobacco. The
globalization as a world phenomenon and the social protective factors as
family, school, peers and media influent over adolescent behavior. Healthy
lifestyle and strong emotional relation between parents and children, as
well as peer connection, correspond with good psychosocial welfare, higher
self-confidence, better behavioral and social competence, and certainly is a
reason more for the adoption of healthy life habits. The adolescent risk
behavior connected with dietary habits, physical activity, consumption of
alcohol and tobacco is one of the main reasons for increased prevalence of
chronical non-infective diseases (HND) in the last decades of the 20th and
the beginning of the new century.
The main objective of the survey was to analyze the behavior of adolescent
in the Republic of Macedonia concerning nutrition, physical activity,
smoking and alcohol consumption, as well as its relation with the community
protective factors (parents, peers, media) in order to design preventive
programs for adolescent health promotion by controlling the negative
influence of the society appearances and factors over their health.
Materials and methods. The basic instrument of the actual study is
the questionnaire from the Global research on adolescent health. Actually,
it’s a standard questionnaire from the WHO and CDC which consists of 74
questions, 52 basic and 22 extended and specific questions for our country.
The questionnaire was designed in order to match the age and the sex of the
respondents. The pupils from 7th and 8th grade in primary schools and 1st
and 2nd year in secondary school in the Republic of Macedonia, aged 13-15
years (urban and rural community; 30 schools) were the target population of
the study. The total of examinees was 2116 persons. Statistical data
processing is derived with statistical software SPSS 16.0 and with required
statistical significant where p<0.05 for statistical significant results,
and p>0.05 for leave out significant results.
Results. Results from this survey give complete information about
habits in adolescent behavior when it comes to nutrition, physical activity,
use of tobacco and alcohol, as well as for the impact of the protective
factors such as parents, peers, school and media. This survey indicated that
adolescents in Republic of Macedonia practice rick behavior and face a great
deal of health problems connected with the dietary habits. 3.4% from the
examinees are obese, while 12.7% tend to get obese. This problem is
significantly more evident among boys in comparison with girls older age,
the percentage of pupils with higher weight in urban areas is higher than in
rural ones. Obligatory physical activity in youth is at least 60minutes
daily, 7 days a week. Here it is practiced only by 14.2%and mostly by boys.
Smoking habits also, respect a big problem. This survey indicated that the
trend of girls who smoke regularly is present in Macedonia too. In the last
30 days, girls smoked significantly more (15.1%) than boys (11.4%). Habits
in consumption of alcohol are an important issue as well. The survey showed
that pupils in rural environment start consuming alcohol at very young age,
more precisely when they get 8 or 9 years old. The survey showed that
parents influence as well as their attitudes and behavior about certain
issues has very important role in pupil’s habits (e.g. 7.7% of the
respondents smoked on regular basis, 21% smoked one or more days in last 30
days in situations when parents rarely knew about their children’s spare
time activities; or in families where both parents smoke respondents have
higher addiction to smoking-9.0% from them are regular smoker). The research
indicated that peers have major influence too, there is a significant
statistic difference between male and female responders, and more
specifically peer’s influence is more evident when it comes to girls, and
media also play a very important role on pupil’s behavior and adoption of
new habits.
Conclusion. The survey highlighted risk habits and behaviors among a
great share of students both in urban and rural areas, such as the behavior
connected to the nutrition, physical inactivity, smoking and consumption of
alcohol which endanger their health. Such behaviors are not simply the
actions of individuals but take place in social context, which indicates
that greater engagement of all relevant factors is necessary, starting with
parents, schools, peers and media and their education in order to improve
and raise the awareness of risk taking behavior of adolescents, as well as
its prevention.
Key words: adolescents; nutrition; smoking; physical activity;
alcohol; globalization; family; peers; mediums.
Defended: January 11, 2010.
Mentor: Prof. Dr. Elena Kjosevska.
Snezjana M. Lazarevska. Public health approach on disability with lumbar
pain. [MSc thesis]. Skopje, Republic of Macedonia: Center for Public
Health, Faculty of Medicine, University “Ss Cyril and Methodius”; 2010.
The objectives of this work are: To determine the differences between
results from the disability of patients with lower lumbar pain, depending on
the type of the applied methods; physiotherapy or therapy with medicaments,
and according to age, the index of bodyweight and the malformation of the
spinal column, as well as the connection between the type of the profession
and the level of changes on the spinal column and the influence of the
professional education in the application of ergonomic principles and
practicing previously mastered exercises for the sacrum.
Materials and methods: The research has covered 200 patients with
lower lumbar pain, treated with medicaments and physiotherapy, and according
to the applied therapy, patients were divided in two groups and being tested
both in the beginning and in the end of the treatment. The Oswestry index is
used for the assessment of the disability with lumbar pain. In the cases of
50 respondents a questionnaire was used to determine whether they abide, and
what are the results of the ergonomic advice given previously and the use of
exercises for the sacrum. For statistical data processing, proper
statistical methods and tests were used: Person-X2, Fisher-exact,
Man-Whitney, Kruskal-Walis, Wilcokson, Kolmogorov-Smirnov and
Student-t-test, and the statistics significance was specified for p<0.05.
Results: On average, the respondents are 53,8 years old, and most of
them are female (62%). 34% have a job sitting at a desk, and 48% are
physically inactive. 72% of the respondents have malformations of the spinal
column, and in those cases the use of physiotherapy is 3,5 times more
efficient than the use of medicament therapy X2=14.286 (p<0.5). The T-test
has shown almost double decrease of the index of the patients’ disability in
case where physiotherapy was used (28,80), compared to the decrease of the
index of patients’ disability in cases where medicament therapy was used
(15,72), (p<0.05). Out of 50 people being questioned: 36 (72%) have abided,
whereas 14 (28%) have not abided by the ergonomic advice. 16 patients have
done the exercises, 8 have exercised occasionally, 18 did the exercises only
in the beginning, 3 have not exercised at all, and 5 haven’t done the
exercises, but were physically active. The adherence to the exercises is
associated with the adherence to the ergonomic advice in case of p<0.05. The
X2 -test indicates that there is no statistical significance between
adherence to the ergonomic advice and the reappearance of disorders in
patients (p>0.05). The malformations and the age of the respondents,
statistically are significantly associated with the type of therapy
(physical/medicament) in the unique analysis (p<0.05).
Conclusion: By applying physiotherapy in the early stadium, and by
decreasing the long-term rest, one can accomplish better and faster results
in reducing the disability with lumbar pain.
Key words: lower lumbar pain; disability; malformation; ergonomic
principles.
Defended: December 18, 2010.
Mentor: Prof. Dr. Biljana Taushanova.
Igor Spiroski. Characteristics of the nutritional status of the Roma
children population at primary school age in Republic of Macedonia [MSc
thesis]. Skopje, Republic of Macedonia: Center for Public Health, Faculty of
Medicine, University “Ss Cyril and Methodius”; 2010.
Introduction: Main objective of the research is to assess the
nutritional status of the Roma children population attending first and fifth
grade of primary school in Macedonia in order to detect precursors of
possible health risk at early age.
Material and methods: The research is designed as comparative
epidemiological cross sectional survey using retrospective (case-control
study) and prospective methods. Population group consisted of 229 children
from the first and 272 children from the fifth grade of primary school in
different towns in the Republic of Macedonia. The control group consisted of
283 children attending first grade and 356 children attending fifth grade
but are from different ethnic background, other than Roma. The main
instrument of the survey was the questionnaire. Every participant was
measured for his/hers body height and weight. Height and weight was measured
with the medical instrument having integrated height and weight mater.
Sub-scapular and triceps skin folds were measured with caliper.
Results: There is statistically significant difference of the values
of the body weight among children attending first grade from population
group and control group. Statistically significant difference is also proved
at the height-for-age, weight-for-age and BMI-for-age indexes. The ranges of
standard deviations where there is significant difference, at all three
indexes, are: e”-2SD and <-1SD ; e”-1SD and Median; >+1SD and d”+2SD and
>+2SD and d”+3SD. There is no statistically significant difference of the
values of the anthropometric parameters between the population of Roma
children and the control group attending fifth grade of primary school.
Conclusion: Health risks of the population of Roma children compared
to those of the control group, both in children attending first and fifth
grade, are related to their lower values of the anthropometric indexes i.e.
the ranges of the SD which are placed left of the median. For the z-scores
of SD placed right of the median, there are lower percentage of cases of
Roma children with increased health risk. That counts for all the three
indexes. Social determinants of the Roma population’s principles and
conditions of living, which could be investigated in future researches,
could bring additional light on the problem of impaired nutritional status
in Roma population at this age.
Key words: Roma; children; nutritional status; health risk;
assessment.
Defended: December 21, 2010.
Mentor: Prof. Dr. Dragan Gjorgjev.
Zoran Biban. Public health aspect on the social and economic status of
the nutrition of the population in the Republic of Macedonia [MSc
thesis]. Skopje, Republic of Macedonia: Center for Public Health, Faculty of
Medicine, University “Ss Cyril and Methodius”; 2010.
Introductin: During their mental and physical development, people eat
food that of course affects the same. Some conditions such as being
overweight or on the other hand being extremely skinny, lead to more
efficient development of the diseases as we know them. There could be a
worse combination considering the economical vulnerability of certain
people. This fact itself should lead to achieving higher standards for these
people or in other words getting their lifestyle to a bigger and healthier
level. There is certain continuity in the effects of risk factors for
developing chronical diseases and also opportunities for their prevention.
Poorer countries are in need of different preventive approaches than the
wealthier. Poverty is a major aspect of vulnerability and social exclusion.
The result of the social and economic status of the individual arises into
being a hazard when it comes to the availability, quality and hygienic
status of the food he is eating. The main goal of the research is to
determine the social as well as the economical status of the people when it
comes to the products that they are buying and level of the health
promotional activities in Republic of Macedonia regarding the healthy
nutrition.
Material and methods: The research was designed on the basics of the
health statistics showing mortality and morbidity of people that live in the
Republic of Macedonia regarding chronical diseases connected to healthy
nutrition and the available data on the consumption basket. The project
shows the registered number of deaths and suffering in Macedonia in the
years of 2003 to 2005 and reports on the movement of princes of the consumer
basket for the same period. This research is an analytical study on the
contents of the general statistics and other published materials in the
period of the year 2003 to 2005. Retrospective data cover of the cost of the
consumption basket and its products and product groups, their nutritive
value as well as the annual rate of morbidity and mortality from the food
linked diseases. The prospective part that also is in a function of
promotion of the healthy nutrition included questionnaire survey and
gathering information in order to determine the level of the health
promotional activities here in the Republic of Macedonia. After the content
analysis of materials and data were carried out, a standard statistical
treatment was executed.
Results: Based on data showing the annual consumption of food per a
member of one average household during 2003-2005 that was obtained from
State Statistical Office of Macedonia, an assessment was made of the average
daily dietary intake for the adult population in the state.
The monthly consumption basket (which only includes the minimum food
commodities for a family of four) about 12.000 dears occupies almost 80% of
the average salary. Accordingly, the family would only have 3400 dears
remaining to meet other needs such as health, clothing, footwear, hygiene,
entertainment and other. The data show that an average Macedonian citizen
spends approximately 80 dears per day (only for food and drink), thus
meaning that if an average family had bought 32 kilograms of bread, which
means that each member of the family had eaten about 8 kilograms of bread in
30 days. Regarding data showing annual consumption of food products for an
average member of a household during the of 2003 to the year of 2005 that
was obtained from State Statistical Office of the Republic of Macedonia, an
assessment was made of the average daily dietary intake for the adult
population in the state. Also, according to the State Statistical Office,
during the period 2003-2005, a four-member household was able to fill the
monthly expenditure basket for food and drink. This was achievable with an
average salary.
The total energy intake includes a certain percentage of macro-nutrition:
protein with 14.40%, fat with 35.72% and carbohydrates with 49.18%. It is
evident that the content of fat in the daily meal of 116.8g (35.72%) is much
higher compared to the recommended values for the adult population (an
average of 70g per day or<30% of the total energy). Average daily intake of
protein is 105.98g which is a greater intake for about 40% compared to the
recommended daily requirements. Carbohydrates are included with 361.92g and
are within the limits of the recommended daily needs.
According to analyses in terms of daily vitamin needs it is estimated that
the daily meal for the period 2003-2005, more of these substances are
represented with the exception of some vitamins.
In the year of 2003 to the year of 2005, in the context of promoting healthy
lifestyles and specifically the area of nutrition, the main carrier of the
promotional activity in the health system is the Republican Institute for
Health Protection-Skopje (IJZ) regarding the Program for Health care in
Macedonia.
Conclusions and recommendations:
The population has a reduced purchasing power when in comes to the
availability of food that meets the daily needs of the organism according to
recommended standards. The structures of the products in the consumption
basket deviate from the structure of the recommended healthy, food pyramid.
When it comes to the specific criteria of vulnerability and the groups that
should receive financial help, a winder public debate is needed in order to
discuss the available options and approaches. Any approach that would be
accepted needs to have a broad government support and support anchored from
the many stakeholders.
The health promotion activities in the Republic of Macedonia are a valid
source of information and education needed for people to learn about proper
nutrition. Unfortunately their availability is debatable because of the lack
of indicators that recognize their performance (and there is no tracking
systems for the same).
It is necessary to intensify activities on promoting modern and continues
education of health workers in particular. An introduction on the subject of
knowledge of food hygiene needs to be added to the regular education system,
which cause would indicate it to be a continuing aspect of education for the
wider population.
Key words: nutrition; annual consumption of households;
uninfectius chronicle diseases; promotion; the public health system.
Defended: December 26, 2010.
Mentor: Prof. Dr. Dragan Gjorgjev.
Lejla Rusevska. The influence of the temperature and climate changes in
the population on national level from public health aspect [MSc thesis].
Skopje, Republic of Macedonia: Institute for Public Health, Faculty of
Medicine, University “Ss Cyril and Methodius”; 2010.
Introduction: The balans of incoming short-wave from radiation from
the Sun and the long-wave radiation on the Earth is disbalanced because of
the “greenhouse gases”, that destroy the ozone and consequently leads toward
increasing the air temperatures. Global environmental changes are
attributable to human activities. The average temperature of the Earth’s
surface has been increased for 0.74o C since 1850 and it is expected to
continue increasing from 1.4 to 5.8o C till 2100. These climate changes and
variations will have a great health impact with serious influence on
people’s life and economy in the whole civilization.
Goal: The main goal of the research is to present the public health
aspect of the influence of weather and climate changes on the health of the
population in Republic of Macedonia. The accent is put on the need of taking
specific public health preventive measures in terms of adaptation and
mitigation in the health sector for decreasing the burden of diseases caused
by the expected climate changes.
Materials and methods: The materials of the research are: data for
ambiental air temperature and data for mortality rate in Republic of
Macedonia.
The research is ecological study which is based on the following methods:
1. With descriptive method it is analisyed the data of monthly mortality
distribution from all reasons in Republic of Macedonia for the period of
1994-2007.
2. Computer modeling and use of the method expert judgement. Based on the
results it is predicted the future trend of the climate changes in the
period until 2050. Science-based forecast is made of the expected mortality
in the period of 2024-2037 according the expected temperature and the
results from the climate changes within this period.
Results: Overall it is noticed the increasing trend of the air
temperature in the second half of the 20th century and Macedonia as well. In
terms of rains registered in the 20th century, there are differences on the
regional and local level distribution.
The highest maximal air temperature in the country measured in July 2007 is
45.7oC in Demir Kapija.
Key words: Not available.
Defended: March 31, 2010.
Mentor: Prof. Dr. Mihail Kochubovski.
Sanja Dimovska. Estimation of the prevalence and identification of
knowledge, attitudes and practices for possible risk factors for development
of eating disorders in students aged 13-14 in the Republic of Macedonia
[MSc thesis]. Skopje, Republic of Macedonia: Cathedra of Hygiene, Center for
Public Health, Faculty of Medicine, University “Ss Cyril and Methodius”;
2010.
Background: Eating disorders are one of the most common psychiatric
problems faced by adolescents and are characterized by chronicity and high
rates of recurrence. It affects both females that represent a population
with higher prevalence, but male are not an exception and new studies reveal
that they are similarly affected. Anorexia nervosa is characterized by
starvation, fear of becoming fat, disturbed perception of body shape,
unjustified influenced of shape on self-evaluation, dental of the
seriousness of low body weight and amenorrhea (for females). Bulimia nervosa
is marked by uncontrollable binge eating, compensatory behavior to prevent
weight gain (e.g., vomiting) and absurd influence of shape on
self-evaluation. The diagnostic category of Eating Disorder Not Otherwise
Specified (EDNOS) is more commonly detected than either anorexia or bulimia
nervosa (APA 1994) and eating problems that do not reach diagnostic
threshold are quite common in community surveys. Eating disorders are
characterized by medical complications, psychosocial impairment and
accompanying psychopathology. They have the highest levels of treatment
seeking, inpatient hospitalization, suicide attempts and mortality of common
psychiatric syndromes.
Purpose: The principal goal of the survey was to estimate prevalence
of EDs and to identify knowledge, attitudes, practices and beliefs in
students aged 13-14 in Republic of Macedonia for possible risk factors for
development of EDs, aimed at establishment of baseline data for development
of specific intervention programs for the target groups.
Methodology: Data was collected by self-administered EAT 26
questionnaire, distributed to selected students in class. Data from health
professionals was collected by Questionnaire on knowledge, attitudes and
practices on EDs, involved in treatment of adolescents.
Data was collected from 1293 students in urban and rural areas of 4
municipalities in RM, including the capital Skopje. Total of 40 responses
were received from health professionals involved in treatment of selected
age group.
Results: The survey has been conducted on a sample of 1293
respondents in 4 regions in RM and capital Skopje. Obtained results have
completely proved hypotheses defined in the project proposal. EDs are more
prevalent in female population (52.1%), assessed by sub-scale 1 and 2 of the
EAT-26 instrument. In the total population 334 respondents have classified
as at risk of ED (17.4%); more than a half of them (56%) are Macedonians,
but respondents with EDs are also identified among representatives of other
ethnic groups. Of them, 49.4% have normal BMI, while 37.7% have classified
as underweight. 84.7% respondents with ED have never been treated by health
professional.
Results obtained from the questionnaire for health professionals show that
health professionals are aware of how to recognize the problem with EDs in
school children aged 13-14, but are not using any pharmacologic treatment.
However, results have to be interpreted with caution, given the small
response rate (39.8%).
Key words: Not available.
Defended: June 3, 2010.
Mentor: Prof. Dr. Dragan Djordjev.
Evgenija Kiroska-Petreska. Preparedness of the health laboratories for
quality standard applications [MSc thesis]. Skopje, Republic of
Macedonia: Cathedra of Hygiene, Center for Public Health, Faculty of
Medicine, University “Ss Cyril and Methodius”; 2010.
Tendencies in business system standardisation processes today are owed to
intensive expansion of standards on global levels and relate to different
management systems within an organization (quality, environmental
protection, safety, laboratory testing and other). This study only examines
aspects of quality management in public health laboratories through
application of the ISO 9001:2008; ISO 17025:2005 and ISO 15189:2007
standards. Some results of detailed analyses of those standard and their
application in public health laboratories in the Republic of Macedonia are
also presented. Public health laboratories are shown in relation to the
equipment, spatial area and staff in the QM/QA model laboratories in line
with the quality standards.
The main goal of this master’s study is to determine preparedness of public
health laboratories concerning the conditions (area, equipment, and staff)
and in relation to quality standard application. With a view of
accomplishing this goal, the following has been done:
-identification of the current condition of laboratories in relation to the
area, equipment and staff as well as quality standard application in the
Institute and Public Health Centers in the Republic of Macedonia.
Data from a survey conducted on employees and management in the Public
Health Institute of the Republic of Macedonia and the ten Public Health
Centers throughout Macedonia have been used as materials for the research
with the sample encompassing interviewees with minimum higher education.
This research took three months and an observational-analytical method was
applied.
This research was conducted through a Questionnaire (Appendix 1), which was
actually the basic research instrument The Questionnaire was adapted from
the ISO/IEC 17025:2005 standard and modified for the goals of the study. It
consists of 62 questions related to the fulfillment of the conditions (area,
equipment and staff); questions about the commitment of a management team in
institutions; and questions referring to the management system monitoring.
Total 144 employees completed the Questionnaire which they were given during
the survey (face to face method), with the aim of reducing possible errors.
Statistic processing was conducted through application of standard
descriptive analyses of quality indicators and check of the hypotheses put
forward. Analysis of the relation of quality indicators (answers to
questions in the Questionnaire) is presented through tables and graphs. The
study identified that globally, the preparedness of public health
laboratories in the Republic of Macedonia in relation to conditions (area,
equipment and staff), for quality standard application, is seen as PARTIAL.
The study has shown that the current condition of laboratories in relation
to the area, equipment and staff, as well as quality standard application in
the Institute and the Public Health Centers in the Republic of Macedonia
varies and differs significantly between accredited and non-accredited
public health laboratories.
Analysing the answers to the Questionnaire showed that in the accredited
public health laboratories in the Republic of Macedonia, interviewed
employees in the Public Health Institute of the Republic of Macedonia showed
best knowledge and dedication for quality system maintenance in testing
laboratories.
One can distinguish essential differences in the management staff’s view and
knowledge in relation to introducing quality systems between managers-health
professionals and managers-economists.
Testing Laboratories in the Institute of Public Health of the Republic of
Macedonia and few Public Health Centers have adequate and modern equipment,
in line with the testing methods. Most laboratories in Public Health Centers
have great inadequacy of space in relation to its distribution,
non-permitted access, cleanliness and monitoring the ambiance conditions.
Professional and competent staffs work in the Institute and in all Public
Health Centers, in particular when it comes to the testing activities.
Motivation of staffs instigated by management teams is what is missing. Both
internal and external trainings of staffs are necessary.
Key words: Accreditation; QMS; standards; quality management; ISO
9001:2008; ISO/IEC 17025:2005 and ISO 15189:2007.
Defended: November 22, 2010.
Mentor: Prof. Dr. Dragan Gjorgjev.
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