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The goal of this study was to assess the effectiveness of healthcare spending among the leading Asian economies. We have selected a total of nine Asian nations, based on the strength of their economic output and long-term real GDP growth rates. The OECD members included Japan and the Republic of Korea, while the seven non-OECD nations were China, India, Indonesia, Malaysia, Pakistan, the Philippines, and Thailand. Healthcare systems efficiency was analyzed over the period 1996-2017. To assess the effectiveness of healthcare expenditure of each group of countries, the two-way fixed effects model (country- and year effects) was used. Quality of governance and current health expenditure determine healthcare system performance. Population density and urbanization are positively associated with a healthy life expectancy in the non-OECD Asian countries. In this group, unsafe water drinking has a statistically negative effect on healthy life expectancy. Interestingly, only per capita consumption of carbohydrates is significantly linked with healthy life expectancy. In these non-OECD Asian countries, unsafe water drinking and per capita carbon dioxide emissions increase infant mortality. There is a strong negative association between GDP per capita and infant mortality in both sub-samples, although its impact is far larger in the OECD group. In Japan and South Korea, unemployment is negatively associated with infant mortality. Japan outperforms other countries from the sample in major healthcare performance indicators, while South Korea is ranked second. The only exception is per capita carbon dioxide emissions, which have maximal values in the Republic of Korea and Japan. Non-OECD nations' outcomes were led by China, as the largest economy. This group was characterized with substantial improvement in efficiency of health spending since the middle of the 1990s. Yet, progress was noted with remarkable heterogeneity within the group.

Background Accelerated globalisation has substantially contributed to the rise of emerging markets worldwide. The G7 and Emerging Markets Seven (EM7) behaved in significantly different macroeconomic ways before, during, and after the 2008 Global Crisis. Average real GDP growth rates remained substantially higher among the EM7, while unemployment rates changed their patterns after the crisis. Since 2017, however, approximately one half of the worldwide economic growth is attributable to the EM7, and only a quarter to the G7. This paper aims to analyse the association between the health spending and real GDP growth in the G7 and the EM7 countries. Results In terms of GDP growth, the EM7 exhibited a higher degree of resilience during the 2008 crisis, compared to the G7. Unemployment in the G7 nations was rising significantly, compared to pre-recession levels, but, in the EM7, it remained traditionally high. In the G7, the austerity (measured as a percentage of GDP) significantly decreased the public health expenditure, even more so than in the EM7. Out-of-pocket health expenditure grew at a far more concerning pace in the EM7 compared to the G7 during the crisis, exposing the vulnerability of households living close to the poverty line. Regression analysis demonstrated that, in the G7, real GDP growth had a positive impact on out-of-pocket expenditure, measured as a percentage of current health expenditure, expressed as a percentage of GDP (CHE). In the EM7, it negatively affected CHE, CHE per capita, and out-of-pocket expenditure per capita. Conclusion The EM7 countries demonstrated stronger endurance, withstanding the consequences of the crisis as compared to the G7 economies. Evidence of this was most visible in real growth and unemployment rates, before, during and after the crisis. It influenced health spending patterns in both groups, although they tended to diverge instead of converge in several important areas.

Background: As global populations age, addressing societal attitudes towards older adults becomes increasingly crucial. Ageism negatively impacts both older and younger individuals. Aging simulation has been proposed as a means to challenge ageist attitudes and promote intergenerational solidarity. This study examines the effectiveness of a brief aging simulation in altering adolescents’ perceptions of aging and older adults. Methods: A prospective interventional study was conducted with 63 high school students aged 15–18. Participants completed the Fraboni Scale of Ageism (FSA) before and after intervention. A subset of 20 students was randomly selected to wear an aging simulation suit. Results: Post-intervention FSA scores significantly decreased from 63.50 to 51.00, indicating a reduction in ageist attitudes. Participants showed significant changes in beliefs related to cognitive decline, the prevalence of Alzheimer’s disease, and the perception that older adults are homogeneous. Additionally, 80% of participants reported a positive shift in their attitude toward aging. The simulation experience was rated highly (average score: 9/10). Conclusions: The findings support the effectiveness of aging simulation in reducing ageist attitudes among adolescents. Given the role of adolescence in shaping long-term perceptions, incorporating aging simulations into educational curricula could be a valuable strategy for promoting intergenerational understanding.

Gender differences in anti-doping rule violations (ADRVs) have been noted in international research, yet systematic analyses are rare. This study addresses that gap by providing the first comprehensive evaluation of the doping prevalence by gender in Serbia. A 19-year retrospective quantitative analysis was conducted on data collected by the Anti-Doping Agency of Serbia (ADAS) between 2006 and 2024. In total, 14,919 doping controls were performed, including 10,912 (73.11%) on male athletes and 4007 (26.89%) on female athletes. Across this period, 146 ADRVs were identified, with a clear gender imbalance: 128 (87.32%) cases involved male athletes and 18 (12.68%) female athletes. A Chi-Square test confirmed a significant association between gender and ADRVs, χ (1, N = 14,919) = 15.11, < 0.001, indicating that male athletes were more likely to violate anti-doping rules. Substance profiles also differed: anabolic agents (S1) dominated overall, while stimulants (S6) and cannabinoids (S8) were more frequent in males, and diuretics (S5) and hormone modulators (S4) in females. These findings reveal a pronounced gender disparity in doping behavior and substance choice, providing a foundation for further research and emphasizing the need for gender-sensitive anti-doping education and policy.

Background: Healthcare-associated infections (HAIs), antimicrobial resistance (AMR), and antibiotic use (AU) remain critical challenges in intensive care units (ICUs). Reliable long-term surveillance is essential to inform stewardship programs and infection prevention. Methods: We conducted a seven-year ecological study (2018–2024) of adult patients admitted to the surgical ICU of a Serbian tertiary university hospital. Patients with ICU stays >48 h were included. Data on demographics, HAIs, AU expressed as ‘days of therapy’ (DOT) per 100 patient-days, and resistance profiles of key pathogens were collected. AU was classified by WHO Access, Watch and Reserve categories. Trends were analyzed, and correlations between AU and healthcare-associated Clostridioides difficile infection (HA-CDI) incidence density as well as changes in AMR rates were assessed. Direct expenditures for antibiotic therapy were also calculated. Results: Among 2055 patients, 511 (24.9%) developed at least one HAI. HA-CDI showed a marked upward trend. Overall, AU was stable, but Reserve antibiotics increased significantly (R2 = 0.456), particularly linezolid, colistin, and ceftazidime–avibactam. Resistance to carbapenems and colistin in Klebsiella pneumoniae (K. pneumonia) demonstrated alarming trends. A strong correlation was observed between colistin use and colistin resistance in K. pneumoniae. Antibiotic expenditures peaked in 2023 at more than double pre-COVID levels, mainly driven by Reserve agents. Conclusions: This study reveals a concerning rise in multidrug-resistant pathogens, escalating Reserve antibiotic use, and substantial financial burden. Strengthened antimicrobial stewardship, optimization of Access, restriction of Reserve agents, and investment in infection prevention and surveillance are urgently needed.

According to the World Health Organization, malocclusion type III is third, most important oral health problem. It may be the least prevalent malocclusion, but it is the most noticeable and challenging for orthodontic therapy. With this narrative review, we wanted to give a summation of the most current knowledge about diagnostics, different therapy options, limitations, and additional factors that can influence the therapy of class III malocclusion to help clinicians and researchers focus on the specific approaches. Therapy options were divided into the following groups: orthopedic, orthodontic, and surgical. The SNA, SNB, and ANB angles (cephalometric values) are the best ones to examine improvements in different skeletal improvements, while dentoalveolar improvements were also described, emphasizing the limitation of orthopedic therapy to change the skeletal discrepancy. Eruption-guided appliances and chin cups are more effective in early childhood, mixed dentition, during permanent teeth eruption, with no significant skeletal discrepancy. If a discrepancy exists, a face mask is the first therapy choice. The therapy of an underdeveloped maxilla can be solved with different palate expanders. Bulkiness, lack of long-term results, and duration of therapy make fixed orthodontic appliances with braces and elastic traction favorable nowadays. If the skeletal discrepancy is major, a surgical approach should be considered. One of the main limitations in articles is the combination of different therapy approaches, ages, and dentition preferred for device application, duration of therapy, and lack of information about long-term outcomes. On the other hand, the lack of original articles is noticeable, so further research should be done.

Introduction: Methotrexate (MTX) reduces rheumatoid arthritis activity and ameliorates the long-term functional status in these patients. To achieve this aim, patients need to take their medication regularly. Nevertheless, non-adherence to MTX still remains a considerable issue in the management of rheumatoid arthritis. Objective: This study aimed to estimate the adherence to methotrexate in patients with rheumatoid arthritis and to identify specific non-adherence risk factors. Methods: A cross-sectional study included 111 patients (mean age 56.2 ± 10.6 years, 78.4% female, and mean disease duration 6 years (3–13)). Three adherence self-assessment questionnaires were used: the Compliance-Questionnaire-Rheumatology (CQR19), the Medication Adherence Reports Scale (MARS-5), and the Visual Analogue Scale (VAS). We also collected demographic data, disease and treatment characteristics, and anxiety/depression estimation results (Hospital Anxiety and Depression Scale, HADS). Results: Adherence was identified in 48.6% of patients (COR19), 70.3% of patients (MARS-5), and 82.9% of patients (VAS questionnaire). All three questionnaires displayed a significant positive mutual correlation: CQR19 with MARS-5 and VAS (r = 0.364, r = 0.329, respectively, p < 0.001 for both) and between the VAS and MARS-5 scores (r = 0.496, p < 0.001). A significant positive prediction was shown for urban residence (0.347 (0.134–0.901), p = 0.030) using the MARS-5, female sex (0.264 (0.095–0.730), p = 0.010) according to the CQR19, and for a dose of methotrexate (0.881 (0.783–0.992), p = 0.036) using the VAS, while negative predictions were shown for comorbidity number (3.062 (1.057–8.874), p = 0.039) and depression (1.142 (1.010–1.293), p = 0.035) using the MARS-5 and for older age (1.041 (1.003–1.081), p = 0.034) according to the CQR19. The use of steroids was a significant positive predictor in all three questionnaires and remained an independent predictor for methotrexate adherence in the multivariate logistic regression. Conclusions: We showed non-adherence to methotrexate in a significant number of patients using all three questionnaires. Concomitant steroid therapy emerged as an independent positive predictor for adherence.

Background and objectives: Obesity presents as a multifactorial, pandemic disease that arises as a consequence of unequal energy intake and energy consumption. Obesity adversely affects the quality of life, leading not only to disability, but also to various other disorders. Bariatric surgery is the most effective method for achieving significant and sustained weight loss in individuals with extreme obesity. The aim of this study was to examine how well surgically induced weight loss is maintained after five years of follow-up and its effects on cardiovascular risk factors and outcome. Materials and Methods: This is a retrospective cross-sectional study of 66 patients with morbid obesity, with body mass index (BMI) ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 and obesity-related health conditions, aged 20 to 61 years, mostly women (77.3%) who underwent laparoscopic Roux-en-Y gastric bypass surgery. Results: Average follow-up was 6.42 years (95% CI 6.30–6.54 years) after surgery, with survival rate of 97% in operated individuals. There was a statistically significant reduction of weight and body mass index 6 months and 5 years after surgery in comparison to the initial values (p < 0.001). Of 62 patients who presented weight loss at the end of the follow-up period, 38 were able to maintain the amount of weight loss that was attained 6 months after surgery, while 24 patients regained weight compared to their postoperative weight at 6 months. Two patients reported no weight loss after treatment. Significant weight reduction was associated with better control of diabetes and increased self-reported physical activity at 6 months and 5 years after surgery, as well as with a reduction of the use of anti-diabetic and anti-hypertensive medications. Conclusions: Our research demonstrates a positive long-term impact of bariatric surgery on patients’ health conditions, significant and sustained weight loss, and decrease in BMI, which were associated with a reduction of co-morbidities and risk factors for cardiovascular diseases.

Lesch Alcoholism Typology (LAT) is one of the most widely used clinical typologies of alcohol addiction. Study tested whether introduction of LAT software in clinical practice leaded to improved outcomes and reduced costs. Retrospective matched-pairs case-control cost comparison study was conducted at the Regional Addiction Center of the University Clinic in Serbia involving 250 patients during the four-year period. Mean relapse frequency followed by outpatient detoxification was 0.42 ± 0.90 vs. 0.70 ± 1.66 (LAT/non-LAT; p = 0.267). Adding relapses after inpatient treatment total mean-number of relapses per patient was 0.70 ± 1.74 vs. 0.97 ± 1.89 (LAT/non-LAT; p = 0.201). However, these relapse frequency differentials were not statistically significant. Total hospital costs of Psychiatry clinic based non-LAT addicts' care (€ 54,660) were significantly reduced to € 36,569 after initiation of LAT. Mean total cost per patient was reduced almost by half after initiation of LAT based treatment: € 331 ± 381 vs. € 626 ± 795 (LAT/non-LAT; p = 0.001). Mean cost of single psychiatry clinic admission among non-LAT treatment group was € 320 ± 330 (CI 95% 262-378) and among LAT € 197 ± 165 (CI 95% 168-226) (p = 0.019). Mean LAT software induced net savings on psychiatric care costs were € 144 per patient. Total net savings on hospital care including F10 associated somatic co-morbidities amounted to € 295 per patient. More sensitive diagnostic assessment and sub-type specific pharmacotherapy and psychotherapy following implementation of LAT software lead to significant savings on costs of hospital care.