Abstract Background Translations of instruments for measuring quality of life developed in certain, mostly more developed, parts of the world usually do not cover regionally specific aspects of health-related quality of life, even after transcultural validation. The aim of this study was to develop and validate a reliable questionnaire in Serbian, Croatian, Bosnian, and Montenegrin languages suitable for measuring health-related quality of life in adults. Methods The study was of a cross-sectional type, assessing the reliability and validity of a newly developed questionnaire for measuring health-related quality of life (HRQoL) in adults residing in western Balkan states (WB-HRQoL). It was conducted on a sample of 489 adults from Serbia, Croatia, Bosnia & Herzegovina, and Montenegro, with a mean age of 52.2±14.4 years and a male/female ratio of 195/294 (39.9%/60.1%). Result The definitive version of the WB-HRQoL scale with 19 items showed very good reliability, with Cronbach’s alpha 0.905. The scale was temporally stable, and satisfactory results were obtained for divergent and convergent validity tests. Exploratory factorial analysis brought to the surface four domains of health-related quality of life, namely the physical, psychical, social, and environmental. Conclusion The WB-HRQoL scale is a reliable and valid generic instrument for measuring HRQoL that takes into account the cultural specifics of the western Balkan region.

Background: Patients with chronic diseases, like diabetes need to continuously perform tasks associated with self-management especially with medications they use. It is shown that the patients with diabetes with limited HL and PTHL cannot read medication labels correctly, may misuse their medications, spend much more on therapy and generally have difficulties in understanding printed care instructions and perceiving health advice and warnings. There has been an increasing demand for valid and reliable instruments for HL and PTHL assessment in this population. This review aims to search and critically discuss instruments used to assess HL and PTHL in people with type 2 diabetes and propose their use in different settings. Methods: Authors conducted a comprehensive, electronic search of original studies using a structured approach of the Scopus and PubMed databases, during November and the first 2 weeks of December 2020 to find relevant papers. The review was conducted in accordance with the Cochrane guidelines and the reporting was based on the PRISMA-ScR. The comparison of instruments was made by utilizing a comparison model related to their structure, measurement scope, range, psychometric properties, validation, strengths, and limitations. Results: The final number of included studies was 24, extracting the following identified instruments: Korean Functional Test HL, NVS, FCCHL, HLS-EU-47, TOFLHA, S-TOFHLA, REALM-R, 3-brief SQ, REALM, HLQ and DNT-15. In all, FCCHL and 3-brief SQ are shown with the broadest measurement scopes. They are quick, easy, and inexpensive for administration. FCCHL can be considered the most useful and comprehensive instrument to screen for inadequate HL. The limitation is that the English version is not validated. Three-brief SQ has many advantages in comparison to other instruments, including that it is less likely to cause anxiety and shame. These instruments can be considered the best for measuring functional HL in patients with diabetes mellitus type 2 and other chronic diseases. PTHL instruments (REALM and DNT-15) did not find the best application in this population. Conclusions: The future research should be directed in validation of the FCCHL in English and establishing of the structural validity of this questionnaire. Developing a specific PTHL questionnaire for this population will be of great help in management of their disease.

During their work, pharmacists are faced with a number of ethically difficult situations which include consideration of the values, rights and responsibilities. The overall aim of this study was to analyse the factors that influence the ethical values of pharmacists. We aimed to determine the relationship of these factors and the pharmacists’ perceptions of difficulty and frequency of ethical issues in community pharmacy settings. The research design was cross-sectional and descriptive; the data were gathered from a sample of community pharmacists in Serbia by using validated self-administered survey instrument. In all, 590 pharmacists participated (94.06% females) with working experience from 1 to 39 years (mean 15.17 ± 10.04 years). The majority of respondents stated that the main factor influencing the ethical values of pharmacists is professional ethics, followed by family norms. The most common reasons for addressing ethical issues associated with values are related to the following: importance of cooperation with other healthcare professionals, respect for the rules and regulations, patients` wellbeing, working within one’s competence to limit liability, controlling and monitoring the organizational and occupational framework of pharmacy profession. The respondents in our study identified an ethical imperative for pharmacists in limiting harm to patients and resistance to commercial pressures which might compromise their judgment. The results demonstrate a need for careful examination of the values that could be identified and explored in dilemmas created by commercial environment and dual personality of users (patients, costumers) of community pharmacy service.

Modern use of drugs in the treatment of diseases of children and newborns is increasingly based on off-label use of drugs. The lack of adequate formulations for the pediatric population, the lack of appropriate therapeutic parallels for the treatment of children's diseases and the small number of clinical trials involving the pediatric population have contributed to the mass use of these drugs. The use of these drugs implies extrapolation of doses and indications registered for adults to children, although it is known that the pharmacodynamics and pharmacokinetics of children and adults differ significantly. In the past two decades, many legislative and regulatory initiatives have been taken around the world to improve the use of drugs in children. However, children are still prescribed off-label and unlicensed drugs. The aim of this study was to present a review of the literature in which off-label and unlicensed use in the pediatric population was investigated. Literature was searched through the Google Scholar and Pub Med search engines and using the keywords off label drug, pediatric medicine, use in pediatrics, in the period from May to August 2019. Selected and presented in this article are studies published in the period from 1996 to 2015, which as a subject of research had the use of off-label and unlicensed drugs in the pediatric population. Medicines prescribed for children should be registered for use in the pediatric population and used in accordance with approved indications for children, whenever possible. It is necessary to take measures for more rational use of medicines in pediatrics, which include the collaboration of health workers in order to provide medicines for children that are proven to be effective, high quality and safe to use.

This study investigated the behavior of urban-living students related to the salty snacks consumption, and their contribution to salt daily intake. A cross-sectional survey on 1313 urban-living students (16–25 years, 61.4% university students and 38.6% high school students) used a pre-verified questionnaire created specifically for the study. The logistic regression analysis was performed to investigate the factors influencing snack consumption. The results of salt content and the snack consumption frequency were used to evaluate snack contribution to salt intake. All subjects consumed salty snacks, on average several times per week, more often at home and slightly more during periods of intensive studying, with 42% of the participants reporting to consume two or more packages per snacking occasion. Most of the participants consumed such products between main meals, but 10% of them took snacks immediately after the main meal. More high-school students than university students were in the “high snack group” (p < 0.05). The most frequently consumed salty snacks were those with the highest content of salt. Salt intake from snack products for a majority of participants ranged between 0.4 and 1 g/day. The research revealed younger age, home environment and significant contribution to salt intake as critical points in salty snack consumption among urban-living students important for the better understanding of their dietary habits.

The effective collection and management of personal data of rapidly migrating populations is important for ensuring adequate healthcare and monitoring of a displaced peoples' health status. With developments in ICT data sharing capabilities, electronic personal health records (ePHRs) are increasingly replacing less transportable paper records. ePHRs offer further advantages of improving accuracy and completeness of information and seem tailored for rapidly displaced and mobile populations. Various emerging initiatives in Europe are seeking to develop migrant-centric ePHR responses. This paper highlights their importance and benefits, but also identifies a number of significant ethical, legal and social issues (ELSI) and challenges to their design and implementation, regarding (1) the kind of information that should be stored, (2) who should have access to information, and (3) potential misuse of information. These challenges need to be urgently addressed to make possible the beneficial use of ePHRs for vulnerable migrants in Europe.

Th is article describes the transition of pharmacy in Serbia during the late nineteenth and early twentieth cen-turies, by examining the life and work of the pharmacist Velimir Karić. He was the owner of the fi rst pharmacy in southern Serbia when a concession-based system operated for the opening of new pharmacies. With restrictions on pharmacy openings, confl ict developed between pharmacists holding masters degrees and those who had passed the licence examination. Concessions were originally awarded by a general Chamber of Commerce, but the Serbian Pharmaceutical Society pressed successfully for a separate pharmacy Chamber. Diffi culties in maintaining drug supplies at times of war led to the creation of a Pharmacy Buying Consortium. Central to all these developments was Velimir Karić, who as well as being president of the Serbian Pharmaceutical Society was a national deputy and a philanthropist. Abstract Th e period of resumed British colonial rule in Hong Kong from 1945 until 1984 – when the decision was taken to return sovereignty to China – presented both challenges and opportunities for pharmacy. Th e challenges included a rapidly expanding population, infectious diseases, a rise in drug addiction, and the impact of regional confl icts such as the Korean War. In response, the role of pharmacists became more important in controlling the supply of antibiotics, dangerous drugs and poisons. Changes were made to pharmaceutical legislation; a Pharmacy Board was created, becom-ing the Pharmacy and Poisons Board in 1969. A Pharmacopoeia Ordinance in 1958 resulted in the adoption of the British Pharmacopoeia in Hong Kong. Th is article illustrates how western pharmacy in Hong Kong adapt-ed to the social, economic and political circumstances in which it found itself. Abstract Th e dosage form of tablets was invented by the British artist William Brockedon (1787-1854). He intended to produce dosage forms containing a minimum of excip-ients. Without any experimental proof, it was assumed that ‘compressed pills’ would disintegrate rapidly. First investigations into the disintegration of tablets were done by Silas Burroughs (1846-1895), co-founder of the Burroughs, Wellcome company. He and many succes-sors revealed that tablet disintegration was – contrary to the initial assumption – a critical step for therapeutic success. However, various pharmacopoeial test methods developed slowly from 1907 onwards and remained rather primitive, until the United States Pharmacopoeia XIV in 1950 presented the fi rst detailed test procedure. In the early 1960s, the introduction of physico-chemi-cal knowledge, dating back to 1897, into pharmaceutical sciences led to dissolution testing as a central tool in modern biopharmaceutical considerations. Abstract Consecrated earth or stone powder associated with churches dedicated to medieval saints, often of local signifi cance, has particular importance in certain areas of Belgium and the Netherlands. Sources of supply range from the walls and other parts of the fabric of the church and earth from pilgrimage sites, to specially blessed ordinary building sand. Th e material has been – and often still is – employed in various ways by believers to increase agricultural success, to improve yield in animal husbandry, to preserve the health of live-stock, to discourage vermin, and as a prophylactic and medicinal therapy for a range of conditions, often determined by special association with the saint in question.

Genetic counselling is a complex process that helps people to understand and adopt medical, psychological and genetic aspects of the disease and enable them to make an appropriate decision. In this framework, we revisited all the existing models for decision-making and suggested their use in the process of genetic counselling, which may lead to more equitable and more favourable outcomes. Also, Donabedian's (Structure-Process-Outcome) model for the development of key performance indicators was applied to assess the quality in the process of genetic counselling. Quality indicators at SPO model in the process of genetic counselling were proposed. The social, economic and humanistic outcomes have also been identified. All defined quality indicators together represent a framework for monitoring, evaluation and continuous improvement of the process of genetic counselling. Although the new medical services of genetic counselling tend to be developed as a powerful multidisciplinary field, the implementation of quality management model will certainly help the development of collaborative practice.

Objective. Continued Professional Development (CPD) is one of the most significant precursors to increased competency. Appropriate instruments and support are required for its implementation. This paper demonstrates the attitudes held by pharmacists on the impact of the competency framework on CPD, its acceptance among Serbian pharmacists and potential future application. Furthermore, the motivational impact of the competency framework on CPD as well as the relationship between certain demographic indicators and motivators of CPD are provided. Method. Research on the cross-sectional method throughout 2015-16 included pharmacists working in publicly-owned pharmacies. The survey was anonymous and voluntary. The questionnaires generated for this research contain demographic data on those surveyed and open-ended questions with multiple choice answers and applied a Likert-type scale. Statistical analysis was conducted by applying Microsoft Office 2003 and the Statistical Package for Social Sciences (SPSS) version 22. Results. Among the respondents, the female gender dominated, respondents who had not completed a speciality within their respective field, with an average age of 42 years, and an average of approx. 15 years of service. 26.12% of the respondents had prior experience with the competency framework. Most respondents were of the opinion that these instruments motivated them to actively manage their own PD, to set concrete PD objectives and to review their own competency. Over half intend to apply competency frameworks in future. The statistical Chi-square test indicates it is not possible to determine with certainty that there are differences in terms of motivation in managing PD and in PD goal setting between the groups of variables. Conclusion. The research indicates a positive attitude/opinion of pharmacists towards the competency framework and in recognising these instruments as supportive to CPD.

Background: Medicines dispensing is an error-prone activity, therefore potentially jeopardizing patient safety. This study aimed to assess the community pharmacists’ attitudes towards the causes of dispensing errors and preventive measures, as well as their practice in incidents reporting. Materials and Methods: A cross-sectional survey was performed by distributing an adopted and validated questionnaire to a nationwide sample of community pharmacists in Serbia. The questionnaire included sections related to the participants’ socio-demographic characteristics, their attitudes towards factors causing dispensing errors and corrective actions, as well as their practice in reporting. Statistical analyses were conducted using SPSS Statistics software ver. 21.0. The associations between categorical variables were analyzed using Chi-square test. Results: The study included 1,004 participants, mainly female (94.9%), with the mean age 40.9±9.9 years and mean work experience 14.3±10.0 years. More than a third of the participants (35.4%) indicated an increasing risk of dispensing errors. The main causes included illegible prescriber‘s handwriting (44.3%) and interruptions during dispensing (39.2%), while the major corrective actions were providing pharmacists with education in clinical pharmacy (71%) and reducing the interruptions during dispensing (63.9%). The majority of respondents (85.2%) stated that they routinely reported dispensing incidents. However, even 16.5% of them admitted to having fear sometimes or always. Additionally, only 58.1% of participants would use voluntary dispensing error reporting system. Conclusion: Serbian community pharmacists are aware of the existing risk in medicines dispensing and the corrective actions identified should be put into practice so as to manage them prospectively. Although the results indicate good practice in incidents reporting, conducting tailored educations and building of safety culture is necessary to improve patient safety.

Background and objectives: Pharmacotherapy literacy (PHTL) is an individual’s capacity to obtain, evaluate, calculate, and comprehend basic information about pharmacotherapy and pharmacy-related services necessary to make appropriate medication-related decisions, regardless of the mode of content delivery (e.g., written, oral, visual images and symbols). It is already proven that low PHTL of parents can cause serious problems in the treatment of a pediatric population. We aimed to identify the differences in parental PHTL levels, socio-demographic and health-related characteristics (chronic disease of a child, breastfeeding of a child, annual visits to a pediatrician, parental-self-estimation of health status) between rural and urban areas and to investigate the influence of living in rural areas on a low PHTL level. Materials and methods: Our study was cross-sectional with a validated 14-item instrument (“Parental pharmacotherapy literacy questionnaire—Serbian”), which assessed overall PHTL and its three domains of knowledge, understanding and numerical skills necessary for the safe use of medicines. We analyzed 250 parents of pre-school children (1–7 years old) in rural areas and 182 parents from urban areas in Serbia. Results: Every tenth parent from rural and every fourth parent from urban areas had the highest PHTL level or more than 85% correct answers. However, 51% and 28% of parents in rural and urban areas, respectively, had a low PHTL level (less than 65% correct answers), [Х2(1, n = 432) = 33.2; p < 0.001]. Parents from different areas statistically differed in age, education level, employment, breastfeeding and annual visits to pediatrician rate. Those from rural areas had almost twice the probability of low PHTL levels (ORa = 2.033; p = 0.003) than their urban counterparts, independently of other examined parental characteristics. Conclusions: Parents from rural areas have more difficulties to obtain, evaluate, calculate and comprehend basic information related to pharmacotherapy than parents from urban areas.

Background and objectives: Pharmaceutical literacy skills of parents are crucial for appropriate and safe medication use in pre-school children (ages 1–7 years). A recent study on pharmacotherapy literacy from Serbia showed that one in five parents have difficulty understanding common information about the use of medicines. Because antipyretics are considered to be the most frequently used group of over-the-counter (OTC) medications during the pre-school period, we aimed to: (i) examine parental practice and expectations in antipyretic medication use, and (ii) analyze associations of parental practice and expectations related to socio-economic status and pharmacotherapy literacy. Materials and methods: A cross-sectional survey using a self- report validated specific instrument was conducted with the parents of pre-school children in kindergartens in Belgrade, Serbia. Pharmacotherapy literacy refers to the knowledge and personal skills needed to meet the complex demands of medicine use in both healthcare and non-healthcare settings. A comprehensive literature review, expert-focus group consultation, and pre-testing were employed in 4-item multiple-choice test development to explore practice and expectations related to the use of OTC pediatric antipyretic medicines. Results: The final analytical cohort was comprised of 813 participants, the majority (63.3%) chose a medicine based on a physician’s suggestion and only 15.4% of parents reported they would follow the advice of a pharmacist. More than a half of parents (54.1%) would need advice about antipyretic medicine from a pharmacist, firstly in a simpler language. Parents satisfied with the information given by a pharmacist had higher pharmacotherapy literacy, compared to parents with lower levels (OR–0.718, 95%CI (0.597–0.865), p < 0.001). Men had a higher expectation of pharmacists to explain medicine use in a simpler language (OR–1.630, 95%CI (1.063–2.501), p = 0.025), as well as parents with three or more children (OR–2.527, 95%CI (1.43–4.459), p = 0.001). Parents with higher knowledge about medicine use were less likely to ask for simpler information (OR–0,707; 95%CI (0,583–0,856), p < 0,001). Conclusions: Our main finding is that practice in antipyretic OTC medicine use was associated with levels of parental pharmacotherapy literacy. The expectations of pharmacists were higher among parents with lower levels of pharmacotherapy literacy, who expected more information in a simpler and more precise language. This study highlighted the need for pharmacists to identify risks in parental practice and to provide information about medicines to parents of pre-school children in a simpler and more appropriate way.

Abstract Background Smoking rates in Serbian adults are among the highest in Europe. The objective of this study is to assess the prevalence of smoking and smoking-related behaviours of Belgrade University students depending on their sociodemographic characteristics and faculty group. Methods A cross-sectional study was carried out among 2,608 Belgrade University students (59.6% female) in 2015. A self-administered questionnaire was applied to the opportunity sample to collect the data describing students’ smoking habits and attitudes across all 30 faculties of the university. Results 30.5% of students reported smoking: 26.4% of medical, and 31.1% of non-medical ones. Smoking rate among female students was 31.2% vs. 29.5% among males. Age (p=0.001), relationship (<0.001) and employment status (p=0.002) had statistically significant influence on smoking status, while the differences in smoking status between genders (p=0.141) and medical and non-medical group of students (p=0.066) were not statistically significant. The highest percentage of students started smoking during high school (66.2%). As the most common reason to start smoking, respondents cited peer influence (36.5%). 44.3% of students who smoked unsuccessfully tried to quit smoking. Conclusion To combat high smoking prevalence among a younger population, the formal education of students about the adverse impacts of smoking should be integrated in all active anti-smoking programs. Medical students, as future healthcare professionals, can play an important role in smoking rates reduction among both younger and general populations, if properly trained and educated about smoking prevention and cessation techniques.