Milena Vasic

Early reports indicated that Serbia was among the best-performing European countries in dealing with COVID-19 health issues based on relatively small COVID-19 mortality. This success can be partly attributed to the government's rapid response and implementation of restrictive measures to curb the spread of the virus. It can also be noted that the high level of solidarity among citizens contributed to the effective containment of the pandemic, with many adhering to experts' prescribed measures and recommendations. Serbia has become an example of good practice in the fight against COVID-19, resulting in positive assessments by international organizations and experts. However, Mortality from the virus alone is insufficient to describe the pandemic's health effects, unlike excess mortality from all causes. This paper aims to estimate excess mortality in Serbia during 2020-2022 and to compare estimated mortality with the reported COVID-19 deaths. Excess was calculated using a negative binomial regression with historical 2015-2019 data. Estimation provides a P-score as a percentage difference between the reported and expected number of deaths. Mortality excess in Serbia was 15,437 in 2020 and 35,836 in 2021, with 224 and 524 per 100,000 population rates and P-scores of 15% and 36%, respectively. Three prominent waves of excess were observed: the winter of 2020 and the spring and last quarter of 2021. The highest monthly excess was noticed in December 2020, with a rate of 113 per 100,000 and a P-score of 84%. The ratios of reported COVID-19 deaths to calculated excess mortality were 20% in 2020 and 27% in 2021. The excess mortality dramatically increases with age. Serbia faced high levels of mortality excess in 2020 and 2021, particularly among older people. During 2022, there was a decrease in mortality trends compared to pandemic years. That year 109,203 died with a rate of 1,639 per 100,000. The excess in 2022 was 7733 (116 per 100,000) with a P-score of 8%.

This case report synthesises the exchanges of a scientific workshop examining the intersection of Blue-Green (B-G) spaces, public health and socio-economic dynamics within the urban sphere. Convened in Belgrade as part of a broader Congress on public health challenges, the session interrogated the manifold ways in which proximity to and engagement with natural environments shape physical well-being, psychological resilience, housing market dynamics and social cohesion. The discourse revealed discernible patterns of utilisation, with habitual users integrating these verdant and aquatic landscapes into their daily rhythms, while those engaging less frequently exhibited a markedly different range of motivations. Notably, disparities in healthcare reliance emerged, suggesting that sustained exposure to such environments may bear salutary effects on public health burdens. The dialogue also shed light on the economic ramifications of B-G spaces, not merely as aesthetic appendages to the built environment but as substantive determinants of residential desirability and urban valuation. While reaffirming established paradigms on the positive impact of natural spaces on human health, the workshop underscored multi-layered gaps in empirical understanding -particularly regarding the long-term physiological and psychosocial dividends of such environments and the optimal modalities of their incorporation into urban design. These findings highlight the imperative for evidence-led policymaking that enshrines nature as a structural component of urban development.

Introduction: Comprehensive legislation covering the use of all types of tobacco and nicotine products to provide a smoke- and aerosol-free environment (SAFE) should be part of strategies aimed at phasing out tobacco use. There is a need to identify challenges and opportunities for advancing...

Background: Risk and crisis communication is very challenging and even more so in a terrorist attack caused by biological or chemical agents due to its unpredictable emergency scenario and health consequences. Under the EU framework for improving preparedness and strengthening the response capacities to health emergencies of biological, chemical, environmental, and unknown origin, the project "Joint Action to Strengthen Health Preparedness and Response to Biological and Chemical Terror Attacks" (JA TERROR) aims, amongst others, to address gaps in health preparedness to response to biological and chemical terror attacks by cross-sectoral work. Promoting the implementation of risk and crisis communication in all stages of risk management is a focus of the WP7. This article aims to present identified challenges in risk communication in a biological or chemical terror attack. Objective and Methods: A literature review of scientific findings about risk and crisis communication about biological or chemical terror attacks after 2000 and before October 2023 in peer-reviewed journals and English-language publications was performed. Exchange knowledge and lessons learned through project meetings and workshops Results: Overall findings singled out the following risk communication challenges: nature of the threat (differing threat types, unpredictable, global threat), resources (lack of experts and competence, lack of training, lack of experience), cooperation (roles and responsibilities), public perception (psychological reactions, fear, panic, misinformation, etc.), preparedness communication, and communication and providing information during a crisis. In-depth analysis for identification of challenges from the angle of emergency management phases pointed to those Conclusions: The list of identified challenges is not exhausted here, but their sorting out through the emergency management cycle is to highlight and point to those that should be recognised on time and considered for appropriate and time actions to be taken.

Background: Joint Action on Strengthened International Health Regulations and Preparedness in the EU (SHARP JA) was implemented from 2019 to 2023. Work package 8 of this project dealt with training and local exercises, and exchange of working practices. Methods and Objectives: The objective of this paper is to present the trainings conducted during the SHARP JA with the aim to strengthen implementation of international health regulations (IHR) for serious cross-border health threats in the JA partner countries. Method of this paper was a review of published and unpublished reports and training materials developed under the WP8 activities. Results: The following trainings were conducted - IHR Basic Online-Training, In(tra)-Action Reviews (IAR) in an Online Setting, Online Tabletop exercise on Risk communication - "Vaccination Exercise", International Tabletop Exercise Points of Entry - Control Measures, Contact Tracing, Public Health Disaster Recovery Training, Workshop on Public Health Surveillance - lessons learned from COVID-19/Public Health Emergencies Detection and Surveillance, Training on the EU Common Ship Sanitation Database - Digital tool for supporting International Health Regulations implementation at Points of Entry, Chemical Safety and Chemical Threats. In total, 21 workshops/ trainings, 3 national exercises, and 2 study visits were organised in online and on-site settings with total number of 943 participants from 31 countries. The target audience for the trainings were the public health professionals from different sectors, actively involved in the implementation of IHR core capacities, risk communication experts, field epidemiologists from different sectors, laboratory experts, representatives of local, intermediate and national level authorities, National focal points for the IHR, persons working at a competent authority at a country central level (Ministry of Health, National Public Health Institute or other) dealing with chemical safety, etc. Conclusions: WP8 conducted online and on-site basic and advanced trainings that contributed to strengthening the competencies of public health professionals in the JA-SHARP partner countries.

Background: Adequate water, sanitation, and hygiene (WASH) services are crucial for life, health, well-being and prosperity. WASH is a priority area in public health programming in Serbia and also targeted in the National targets set under the UNECE/WHO Protocol on Water and Health in 2015, after its ratification in 2013. Together with Germany and its German Environment Agency (UBA), the Serbian Ministry of Health and the Institute of Public Health of Serbia (IPHS) co-lead the Protocol's programme area of work "Small scale water supply and sanitation systems", jointly collaborating and conducting activities that support improvements in this area. Methods and Objectives: This workshop aims to present the results in the last decade for accomplishing Serbian Protocol's targets, covering a wide spectrum of WASH topics in different settings (schools, healthcare facilities, small water supply, and sanitation systems) and aspects (drinking-water quality, equity, etc.), with special focus on integrated water and sanitation safety planning project. The methodological approach considers an overview of all WASH projects performed in the last 10-year period that were coordinated and led by the IPHS or participated as a project partner. Results: In the last decade, nine WASH projects were identified (four situation analyses of sanitary-hygienic conditions, one self-assessment of equitable access to water and sanitation, one on integrated water and sanitation safety planning, and three on education and training materials). Integrating drinking-water and sanitation was found to be feasible, ensuring that both systems were addressed together and equally prioritised in templates. Conclusions: Public health professionals within the network of the institutes of public health in Serbia in collaboration with and support of international experts and multidisciplinary participation and approach played a crucial role in performing and accomplishing significant work done under the Protocol.

Background and aim: Adolescence is a nutritionally vulnerable life phase. Poor eating habits formed during adolescence can lead to obesity and diet-related diseases in later years. The adoption of healthy eating habits is of particular importance, not only because of the direct impact on growth and development at this age, but also because of the impact on health in adulthood. A change in dietary habits in adolescence is marked by a higher intake of soft drinks, sweets, and salty snacks, with a decrease in the intake of vegetables, fruits, and milk and dairy products. The aim of this study was to show current trends in the eating habits of Serbian adolescents. Method: This study comprised a secondary analysis of data collected from 11-15-year-old students who participated in two cross-sectional Health Behaviour in School-aged Children Surveys (HBSC), conducted in Serbia in 2018 and 2022. Data on breakfast consumption and the intake of fruit, vegetables, soft drinks, and sweets were analyzed. Results: About two thirds of students (67.7%) in 2022 were eating breakfast every day during the working week, significantly more than in 2018 (58.8%), with no gender differences. The number of students who never eat breakfast during the working week is increasing (7.5% in 2018, 9.9% in 2022), with the highest numbers in the oldest age group. When it comes to the intake of fruit and vegetables, students do not meet the recommendations: in 2022, less than half of the students consumed fruit and vegetables once a day or more (39.6% fruit, 39.7% vegetables), while the frequency of a daily intake of fruits and vegetables decreased with age. The results show a decrease in daily consumption in comparison to 2018. Less than one fifth of students in 2022 consumed soft drinks daily (18.8%), boys more often than girls (21.5% vs. 16.4%), significantly less than in 2018 (22.4%). The consumption of soft drinks increases with age. More than a third of adolescents in 2022 ate sweets once a day or more often (34.8%), girls more often than boys (38.7% vs. 30.3%). This consumption has not changed since 2018. Conclusions: The findings of this study indicate a need for a more intensive nutrition-related health education of adolescents in order to improve their eating habits.

Background and Aim: Exposure to food marketing not only increases food consumption but also has a significant impact on food choices in children and adolescents. At the same time, prevalence of overweight and obese individuals in this age group is constantly increasing, reaching epidemic...

Background and Objective: In the scope of the Joint Action on Strengthened International HeAlth Regulations and Preparedness in the EU (SHARP JA), WP8 is focusing on trainings, local exercises and exchange of working practices. Training needs assessment pointed out that recovery management is...