South Eastern European Journal of Public Health (SEEJPH) <p>The South Eastern European Journal of Public Health (SEEJPH) is an open-access international peer-reviewed journal involving all areas of health sciences and public health. Devoted to the global health SEEJPH welcomes submissions of scientists, researchers, and practitioners from all over the world, but particularly pertinent to southern and eastern countries in transition.</p> Jacobs Verlag en-US South Eastern European Journal of Public Health (SEEJPH) 2197-5248 <p class="hide_copyright_frontend">Authors retain copyright and grant the journal right of first publication in print and online. The work is distributed under the terms of the Creative Commons Attribution License CC-BY (<a class="moz-txt-link-freetext" href=""></a>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> Mortality reduction in the Russian Federation: Significant progress contrary to Western beliefs Genc Burazeri Copyright (c) 2019 Genc Burazeri 2019-10-30 2019-10-30 10.4119/seejph-3130 Successful reduction of premature mortality in the Russian Federation and the countries around the Baltic Sea working together on Health and Social Well-being <p><strong>Context:</strong> The ‘Northern Dimension on Public Health and Social Well-being’ is a platform for dialogue and cooperation of countries around the Baltic Sea, established in 2003, guided by the Sustainable Development Goal 3 on Health and Social Well-being and the Strategy for the Baltic Sea Region of the European Union adopted in 2009. In this paper we determine the overall progress of the Russian Federation and its North West Federal Okrugin in particular, with regard to the reduction of mortality.</p> <p><strong>Methods:</strong> For the purpose of inter-country comparison and progress over time we make use of age-standardised Potential Years of Life Lost (PYLL) applied to quantifiable strategic targets, the Sustainable Development Goal 3 on Health and Social Well-being and the European Union Strategy of the Baltic Sea Region. A gap analysis is performed to determine whether the target achievement is in delay or on track.</p> <p><strong>Results:</strong> With reference to the baseline of 2009 – corresponding to the most relevant recent period 2009-2020 respectively 2009-2030 – the Russian Federation as a whole is on track achieving the two strategic targets in advance by 2.7 years. For the North West Federal Okrug around St. Petersburg and Kaliningrad bordering the Baltic Sea the target achievement is estimated to be 4.8 and 10.8 years in advance of the deadlines 2020 and 2030. In comparison to the Baltic Sea states the Russian Federation takes a middle position after Estonia, Latvia and Finland. The early target achievement is confirmed if the period 2003-2020 respectively 2003-2030 is considered.</p> <p><strong>Conclusion: </strong>Although the region is progressing there may be a slowdown towards 2030. A careful analysis is required to determine to which degree the activities of the Partnership for Health and Social Well-being have contributed to the success and what should be proposed to increase the impact on premature mortality.</p> Valery Chernyavskiy Helmut Wenzel Julia Mikhailova Alla Ivanova Elena Zemlyanova Vesna Bjegovic-Mikanovic Alexander Mikhailov Ulrich Laaser Copyright (c) 2019 Valery Chernyavskiy, Helmut Wenzel, Julia Mikhailova, Alla Ivanova, Elena Zemlyanova, Vesna Bjegovic-Mikanovic, Alexander Mikhailov, Ulrich Laaser 2019-10-30 2019-10-30 10.4119/seejph-3129 Facilitators and barriers to the use of economic evaluations in nutrition and public health <p><strong>Aims</strong>: Interventions targeting diets have the potential to reduce a consistent fraction of the chronic disease burden. Economic evaluations of such interventions can be an important tool in guiding public health practitioners and decision makers at various levels, yet there are still not many economic evaluations in this area. This qualitative study explored facilitators and barriers in conducting and using economic analyses to inform decision makers in the field of public health nutrition.</p> <p><strong>Methods</strong>: Data were collected through written, open-ended questionnaires administered to twenty-three participants (13 from academia and 10 from government) using purposive sampling and analysed through a conventional content analysis.</p> <p><strong>Results</strong>: The analysis revealed two broad categories of barriers, which included: i) “Methodological challenges”, and; ii) “Barriers related to application of economic evaluations.” Two main categories of facilitators were also identified: i) “Facilitators to improving the methodology of economic evaluations”, with subcategories further detailing frameworks and methods to be applied, and; ii) “Facilitators to broaden the use of economic evaluations”, with most subcategories addressing science-into-policy translations. These barriers and facilitators to the use of economic evaluations in public health are perceived differently by researchers and policymakers, the former more focused on implementation aspects, the latter more concerned by methodological gaps.</p> <p><strong>Conclusion</strong>: Public health nutrition policies seldom take into account data from formal economic evaluations. Economic evaluation methodologies can be improved to ensure their broader application to decision making.</p> <p>&nbsp;</p> <p><strong>Conflicts of interest</strong>: None declared.</p> <p>&nbsp;</p> <p><strong>Acknowledgements: </strong>The work of AL is partially supported by a Jean Monnet Erasmus+ grant (574376-EPP-1-2016-1-IT-EPPJMO-MODULE).</p> Alessandra Lafranconi Vera Meusel Sandra Caldeira Suzanne Babich Katarzyna Czabanowska Copyright (c) 2020 Alessandra Lafranconi, Vera Meusel, Sandra Caldeira, Suzanne Babich, Katarzyna Czabanowska 2020-01-13 2020-01-13 10.4119/seejph-3271 Switching emergency contraceptives to non-prescription status and unwanted pregnancy among adult and teenage women: A long-term European comparative study <p><strong>Abstract</strong></p> <p>&nbsp;</p> <p><strong>Aim</strong>: Unwanted pregnancy is an important social issue, not least among teenagers. Emergency contraceptives (EMCs) can prevent from unintended pregnancy, if taken quickly after unprotected sex. This study’s objective was assessing abortion/birth rates among adult and teenage women in Europe before/after an EMC switch to non-prescription status.</p> <p><strong>Methods</strong>: National authorities were consulted for EMC consumption data and abortion/live birth statistics. Rates (n=26 countries) in the year before the switch (= year of reference) were compared with rates before/after the change (up to ±15 years). The focus was laid on the European Union and further countries closely related to the European Union.</p> <p><strong>Results</strong>: All countries with available data (n=12) experienced a substantial increase of EMC consumption after the switch. On average, abortion rates among women aged 15–49 years were 83% higher 15 years before (compared with the year of reference) and 14% lower 15 years after the switch. Correspondingly, teenage abortion rates were 35% higher 15 years before and 40% lower 15 years after the switch. In 2017, no country had higher teen abortion rates than at time of the switch. Teen birth rates continued decreasing at almost the same rate after the switch as before.</p> <p><strong>Conclusion</strong>: An EMC switch to non-prescription status increases EMC use and may contribute reducing unwanted pregnancy among teenage girls.</p> <p>&nbsp;</p> <p><strong>Conflicts of interest</strong>: None declared.</p> <p><strong>&nbsp;</strong></p> <p><strong>&nbsp;</strong></p> <p>&nbsp;</p> Salvatore Italia Peter Schröder-Bäck Helmut Brand Copyright (c) 2020 Salvatore Italia, Peter Schröder-Bäck, Helmut Brand 2020-01-17 2020-01-17 10.4119/seejph-3277 Socio-demographic inequalities in satisfaction with primary health care and utilization of chosen doctors’ services: a cross-sectional study <p><strong>Aim:</strong> The aim of the study was to examine socio-demographic inequalities in user satisfaction with PHC and utilization of chosen doctors’ services.</p> <p><strong>Methods:</strong> This cross-sectional study was conducted in 2016 among 232 respondents who participated in PHC user satisfaction survey in PHC center Valjevo, Serbia. Inclusion criteria were an age of at least 20 years, sufficient skills of Serbian language to fill in questionnaires and consent to participation. Two hundreds and six patients completed an anonymous questionnaire about the user satisfaction with PHC.</p> <p><strong>Results:</strong> The chosen doctor was seven times more often visited by the elderly (OR=7.03) and almost three times more often by the middle-aged (OR=2.66) compared to the youngest category of respondents. Those with low education and poor financial status of the household visited a doctor four (OR=4.14) and almost nine times (OR=8.66) more often, respectively, compared to those with high education and good socioeconomic status. A statistically significant higher level of PHC satisfaction was recorded in the rural population (p&lt;0.001) and among respondents with poor socioeconomic status of the household (p=0.014).</p> <p><strong>Conclusion:</strong> The chosen doctor was more frequently visited by respondents with low education and those with poor socioeconomic status of the household, while a higher degree of satisfaction with PHC was recorded in the rural population as well as in those with poor socioeconomic status of the household.</p> <p>&nbsp;</p> <p><strong>Conflicts of interest</strong>: None declared.</p> <p>&nbsp;</p> Dragana Jovanovic Janko Jankovic Nikola Mirilovic Copyright (c) 2020 Dragana Jovanovic, Janko Jankovic, Nikola Mirilovic 2020-02-11 2020-02-11 10.4119/seejph-3311 The diabetes epidemic in Malta <p><strong>Aim:</strong> The small European Mediterranean island state of Malta is a highly prevalent type 2 diabetes (T2DM) country. Over recent decades drastic environmental, cultural and ethnic changes occurred and it was considered timely to undergo a cross-sectional survey to establish up-to-date prevalence of T2DM, its socio-geographical distribution and ultimately estimating the economic burden of T2DM.</p> <p><strong>Methods:</strong> A health examination survey was conducted (2014-16) including a representative sample of the adult population stratified by 18-70 years, gender and locality <em>(n=</em>3,947; males <em>n=</em>1,997 male<em>).</em> The survey consisted of a socio-demographic questionnaire, various health examination measurements and blood samples for fasting blood glucose (FBG). Prevalence for T2DM (depending on medical history, medication and FBG &gt;7mmol/L) were calculated for the general population as well as for each of the districts making up the Maltese Islands. The economic burden of T2DM for 2017 and projected burden for 2045 were calculated using secondary sources and by incorporating 2% compound interest per annum respectively.</p> <p><strong>Results:</strong> A total response rate of 47.15% was obtained, with a mean age of 48 years for males and 46 years for females. Out of the total adjusted population (<em>n</em>=3,947, male <em>n</em>=1,998), the prevalence of T2DM was of 10.31%, with 6.31% already known to have T2DM while 4% were newly diagnosed. Females were diagnosed with T2DM at an earlier age than the males. No significant geographical T2DM prevalence differences were established. The total annual diabetes health care expenditure was approximately €107,316,517.82 for 2017, while the projected expenditure for 2045 was estimated at €244,136,040.</p> <p><strong>Conclusion:</strong> Malta is a country with a high prevalence of diabetes. The females were observed to be at an earlier risk of developing undiagnosed diabetes compared to males. Although geographical location did not appear to have significant effect on T2DM distribution, this disease contributes to a high economic burden. The expected exponential increase in diabetes prevalence is subsequently expected to affect negatively the healthcare expenditure. This puts forward the recommendation for development of early screening programmes as part of preventive action strategies.</p> <p>&nbsp;</p> <p><strong>Source of funding: </strong>The author is extremely grateful for the strong support forthcoming from the University of Malta (through the Medical School and Research Innovative Development Trust department) and from the Alfred Mizzi Foundation as major sponsors, as well as that of a host of others, including Atlas Health Insurance (Malta). The in-kind support and encouragement of the Parliamentary Secretariat for Health of the Government of Malta is also gratefully acknowledged.</p> <p>&nbsp;</p> <p><strong>Acknowledgment: </strong>A note of appreciation and acknowledgement is forwarded to Professor Julian Mamo, Professor Josanne Vassallo and Professor Neville Calleja for their continuous support and advice during the academic progression.</p> <p>&nbsp;</p> <p><strong>Conflicts of interest: </strong>None declared.</p> Sarah Cuschieri Copyright (c) 2020 Sarah Cuschieri 2020-02-19 2020-02-19 10.4119/seejph-3322 Knowledge and perception about climate change among healthcare professionals and students: A cross-sectional study <p><strong>Aim:</strong> The aim of this study was to assess knowledge on Climate Change (CC) and related consequences among students and professionals of healthcare setting.</p> <p><strong>Methods:</strong> A cross-sectional study involving 364 people was conducted. The survey was performed at Sapienza University (Rome) using questionnaire previously developed and validated by the same research group.</p> <p><strong>Results:</strong> Findings indicate awareness about CC and its effects and correct identification of practices that could help to mitigate its repercussions. The majority of the participants believed that CC had an impact on the health of humans (96.7%), animals (99.5%) and on the environment (99.7%). Results from the multivariate analysis regarding overall knowledge, show an increased odd in professionals (OR=2.08; 95%CI=1.02-4.26), individuals from the North (OR=3.34; 95%CI=1.37-8.15) and from the Center (OR=2.07; 95%CI=1.17-3.66). Regarding factors able to modify Earth's climate, correct answer had higher odds of being chosen by professionals (OR=2.83; 95%CI=1.41–5.70), and from individuals from South/Islands than by the ones from the Center (OR=0.65; 95%CI=0.40-1.06). The main sources of information resulted to be TV and school/university.</p> <p><strong>Conclusions</strong><strong>:</strong> These new evidences could guide policymakers on increasing the awareness of the population about this fundamental subject.</p> <p><strong>Funding: </strong>This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.</p> <p><strong>&nbsp;</strong></p> <p><strong>Author contributions: </strong>Conceptualization, G.L.T. and A.D.C..; Methodology, G.L.T. and A.M..; Formal Analysis, A.D.P.B., C.S., R.A.C., D.B.; Investigation, A.D.P.B., C.S., R.A.C., D.B.; Data Curation, A.D.P.B., C.S.; Writing – Original Draft Preparation, R.A.C., D.B.; Writing – Review &amp; Editing, R.A.C., D.B., A.M..; Supervision, G.L.T..; Project Administration, G.L.T.</p> <p>&nbsp;</p> <p><strong>Conflicts of interest: </strong>None declared</p> Giuseppe La Torre Alice De Paula Baer Cristina Sestili Rosario Andrea Cocchiara Domenico Barbato Alice Mannocci Angela Del Cimmuto Copyright (c) 2020 Giuseppe La Torre, Alice De Paula Baer, Cristina Sestili, Rosario Andrea Cocchiara, Domenico Barbato, Alice Mannocci, Angela Del Cimmuto 2020-03-02 2020-03-02 10.4119/seejph-3347 Migrant Health Policy in European Union (EU) and a non EU country: Current situation and future challenges for improvement <p><strong>Aim:</strong> The influx of refugees, asylum seekers and migrants in Europe is an ongoing reality and migrant health has become very important public health problem. The aim of this paper is to analyze and compare the health profile, migrant situation and migration integration health policy in Spain as a European Union (EU) country and Republic of North Macedonia as a country in process of European Union accession.</p> <p><strong>Methods:</strong> Migration Integration Policy Index (MIPEX) Health strand questionnaire (2015) was applied to compare health policies for migrant integration in both countries.</p> <p><strong>Results:</strong> There are differences between Spain and Macedonia in health care coverage and access to health services for migrants. Spain has health strand total score of 52 and is in the same group with Austria, Ireland, Belgium, Netherlands, Denmark and Sweden. Macedonia has lower health strand total score 38 and is in the same group with Turkey, Cyprus, Slovakia. Targeted migrant health policies are stronger and services more responsive in Spain compared to Macedonia which offers migrants legal entitlements to healthcare, but health services should be more culturally responsive to migrant health needs.</p> <p><strong>Conclusion:</strong> Health migration policy in both countries is closely tied to the general immigration policy.</p> <p>&nbsp;</p> <p><strong>Conflicts of interest:</strong> None declared.</p> Fimka Tozija Tona Lizana Copyright (c) 2020 Fimka Tozija, Tona Lizana 2020-03-16 2020-03-16 10.4119/seejph-3369 Survival: One Health, One Planet, One Future George R. Lueddeke Copyright (c) 2019 George R. Lueddeke 2019-12-16 2019-12-16 10.4119/seejph-3231