Anita Grgurevic

A case-control study of myelodysplastic syndromes in Belgrade (Serbia Montenegro)

The objective of the study was to investigate factors related to the occurrence of myelodysplatic syndromes (MDS) in the population of Belgrade (Serbia Montenegro). The case-control study was conducted during the period 2000–2003. The study group consisted of 80 newly diagnosed MDS patients and 160 sex- and age-matched hospital controls with nonmalignant and noninfectious diseases. The disease categories in the control group were circulatory (51 patients, 32%), gastrointestinal (53 patients, 33%), and ophthalmological (56 patients, 35%) disorders. Conditional univariate and multivariate logistic regression analyses were applied. Multivariate analysis showed the following factors to be significantly related to MDS: exposure to chemicals (OR=10.8, 95%CI 3.2–36.2, p=0.0001), viral upper respiratory tract infections (twice a year or more, OR=5.8, 95%CI 2.5–13.6, p=0.0001), exposure to insecticides, pesticides and herbicides (OR=5.2, 95%CI 1.8–15.1, p=0.003), coffee (OR=5.1, 95%CI 1.9–13.7, p=0.001), and alcohol consumption (OR=2.2, 95%CI 1.1–4.6, p=0.033). The findings support the hypotheses that exposure to chemical agents, pesticides, insecticides, and herbicides, certain lifestyle factors (alcohol and coffee consumption), and frequent viral infections may be involved in the etiology of MDS, but these results should be confirmed by further investigations.

Carriage and Genetic Diversity of Methicillin-Resistant Staphylococcus aureus among Patients and Healthcare Workers in a Serbian University Hospital

Objectives There is a paucity of data on methicillin-resistant Staphylococcus aureus (MRSA) epidemiology among Balkan countries. The aim of our study was to determine the prevalence of nasal and pharyngeal carriages and diversity of MRSA among patients and healthcare workers (HCWs) in the major referral centre in Serbia, and to evaluate performance of three different media for MRSA screening. Methods Nasal and pharyngeal swabs were obtained from 195 patients and 105 HCWs in Emergency Department (ED), Surgical Department (SD) and Medical Department (MD). After broth enrichment, samples were inoculated onto MRSA-ID, ORSA and oxacillin-MSA and incubated for 24/48 hours. Characterisation of isolated MRSA strains was determined by MLVA, spa, SCCmec and agr typing, PVL genes detection and antimicrobial susceptibility. Results MRSA carriage prevalence was 11.8% in patients and 7.6% in HCWs. Introduction of pharyngeal swabs in screening procedure increased MRSA carriage rate by over 30%. Variable found to be independently associated with an increased risk for MRSA carriage was ED (odd ratio (OR) = 4.45, 95% confidence interval (CI) 1.78-11.14). A higher risk of multidrug-resistant MRSA carriage was observed among patients (OR = 22; 95% CI 1.92-251.54). CC5-MRSA-SCCmecI was the dominant clone among patients and HCWs in ED and MD, while high genetic diversity of community-associated MRSA (CA-MRSA) was shown in SD especially among HCWs. MRSA-ID was superior to the other tested media with a sensitivity/specificity of 95.2% and 99.6% after 48 hours of incubation. Conclusions These results indicate high MRSA carriage rate in the hospital and emergence of CA-MRSA through HCWs in these settings. MRSA-ID was the optimal available choice for MRSA screening.

Self-Medication Practices and Risk Factors for Self-Medication among Medical Students in Belgrade, Serbia

Introduction Self-medication among future health care professionals can represent a serious threat to professionalism in medicine and it has potential to put at risk public trust into this profession. The aim of this research was to investigate prevalence and risk factors for self-medication among population of medical students, because it was previously shown that their attitudes towards pharmacotherapy could affect the way they could prescribe medication in the future. Material and Methods Research was performed as a cross-sectional study and it included 1296 (84.1%) 1st, 3rd and 6th year students of School of Medicine, University of Belgrade. Students filled out a demographic and self-medication questionnaire created for the purpose of this research and the Physical Health Questionnaire – 9 (PHQ-9). Questions about self-medication were related to the period of the previous year. Results Self-medication was reported by 79.9% students. The most frequently self-prescribed medications were analgesics (55.4%). Independent risk factors for self-medication were possession of home-pharmacies (OR = 5.3, CI 95% 3.89–7.23), lower level of fathers education (OR = 1.6, CI 95% 1.18–2.25), consumption of alcoholic beverages (OR = 1.5, CI 95% 1.13–2.08), less than 1 hour spent in physical activity per week (OR = 1.4, CI 95% 1.00–2.02), female gender (OR = 1.4, CI 95% 1.02–1.89), older age (OR = 1.1, CI 95% 1.07–1.21) and higher PHQ-9 score (OR = 1.09, CI 95% 1.05–1.12). Conclusions Self-medication is an important issue among population of medical students. Prevalence of self-medication could be controlled through regulatory authorities and further education.

Prevalence of Borrelia burgdorferi in Ixodes ricinus Ticks in Belgrade Area

OBJECTIVE Lyme borreliosis is vector-borne zoonosis. The causative agent of Lyme borreliosis is a spirochete of Borrelia burgdorferi (Bb) sensu lato complex, which is transmitted by ticks of the Ixodes ricinus complex. The aim of our paper is to estimate the prevalence of I. ricinus ticks, the level of their infectivity by Bb, and the prevalence of certain genospecies of Bb sensu lato in ixodide ticks inhabiting Belgrade. MATERIALS AND METHODS An estimate of the tick population density was expressed by the value of flag/hour. For isolation and cultivation of Borrelia, selective Barbour-Stonner-Kelly II media was used. Typization of Borrelia was made by applying the species-specific polymerase chain reaction (PCR) and polymerase chain reaction-restriction fragment length polymorphism analysis. In statistical analysis, Chi(2) test was used. RESULTS Values of flag/hour have varied in relation to year observed and type of habitat: The lowest values were recorded in the city parks (17.9). The values were higher in parks-woods (19.7 and 33.4, respectively). The highest values were detected in localities similar to wooded areas (48.0). The estimated average infestation of ticks with Bb was 21.9%, excluding statistically significant differences by years of investigation. We found the dominance of Borrelia afzelii (75%). Bb sensu stricto (22.2%) as well as Borrelia garinii (2.8%) was much less present. Statistically significant difference was established in the prevalence of the above-mentioned genospecies in relation to the examined localities. CONCLUSIONS We have established the prevalence of all three genospecies in the city of Belgrade. Bb sensu lato was found, with the dominance of B. afzelii.

Factors Associated with Postmenopausal Osteoporosis: A Case-Control Study of Belgrade Women

The aim of this study was to investigate factors related to osteoporosis in postmenopausal women in Belgrade. A case-control study was conducted during 2006–2007. The study group consisted of 100 newly diagnosed osteoporosis patients and 100 age-matched controls (±2 years). The inclusion criteria for the case group were newly diagnosed osteoporosis confirmed by dual-energy X-ray absorptiometry of the lumbar spine and being menopausal (at least 2 years of amenorrhea). The inclusion criteria for the control group were postmenopausal women with confirmed normal bone mineral density of the lumbar spine by dual-energy X-ray absorptiometry. All study participants were interviewed using a structured questionnaire. Univariate and multivariate logistic regression analyses were used. The following factors were significantly independently related to osteoporosis: low body weight (P < 0.001), thin constitution in childhood (P = 0.002), history of previous fracture (P = 0.033), menopause at age <47 years (P < 0.001), family history of fracture (P = 0.005), and less frequent consumption of cheese (P = 0.027) and fish (P = 0.020). The majority of factors identified may be modifiable and could be influenced to prevent postmenopausal osteoporosis.

Asthma mortality in Serbia: a 30-year analysis.

INTRODUCTION The asthma mortality pattern differs among countries. No published evidence is currently available on asthma mortality in a European low-middle-income country in socioeconomic transition. We analyzed the trend of asthma mortality rate in Serbia during the period 1980-2009. MATERIALS AND METHODOLOGY a descriptive study; source of data: Republic of Serbia Institute of Statistics Death Registry. We analyzed asthma mortality data in the total population, including gender specific analysis, and in the selected ≥ 5-34 year age group. The International Classification of Diseases codes for asthma 493 (1980-1996) and J45 + J46 (1997-2009) were included. Population estimates were based on 1991 and 2002 census data, with extrapolation. RESULTS The over-all average mortality rate was 7.27 ± 2.14/100,000 inhabitants. The mortality rate peaked in 1981 at 11.3/100,000 but was 4.45/100,000 in the last year of analysis. While both overall mortality rate, as well as gender specific rates, showed clear decreases over the observed 30-year period (average absolute annual decrease of 0.195/100,000 inhabitants, 0.241/100,000 men and 0.149/100,000 women; p < 0.001) with corresponding relative annual decreases of 2.9% for the whole population, 3.0% for men and 2.8% for women, a stable trend of the rate was found in the age group ≥ 5-34 years. Male-to-female ratio was 1.59 ± 0.186, on average and it showed a stable trend over the observed period. CONCLUSION Although the failure of the health care system during the socioeconomic crisis of the 1990s might have transiently affected asthma mortality rates, the overall mortality rate for the disease shows a favorable decreasing trend.

Is Balint training associated with the reduced burnout among primary health care doctors

ABSTRACT The aim of our study was to examine whether the participation in Balint group is associated with the reducing burnout syndrome among primary health care doctors. This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Out of 210 doctors, 70 have completed Balint training for a period of at least 1 year, whereas 140 doctors have never attended this training (the Non-Balint group). The level of burnout among physicians was assessed with the Serbian translation of the original 22-item version of the Maslach Burnout Inventory – Human Services Survey which defines burnout in relation to emotional exhaustion, depersonalization and personal accomplishment. We found that 45.0% of the Non-Balint participants and 7.1% of the Balint-trained participants responded with symptoms of high level of emotional exhaustion, with a statistically significant difference (p < 0.001). In relation to depersonalization, 20% of the Non-Balint subjects were highly depersonalized compared to 4.4% of the Balint-trained subjects, with a statistically significant difference (p < 0.001). Regarding the personal accomplishment, 21.4% of the Non-Balint subjects and 7.1% of the Balint-trained subjects had a perception of low personal accomplishment, with a statistical significance (p < 0.001). In the multiple ordinal logistic model, with emotional exhaustion as a dependent variable, statistically significant predictor was female gender (OR = 2.51; p = 0.021), while Balint training was obtained as a protective factor (OR = 0.12; p < 0.001). Non-specialists were detected as a risk factor for depersonalization (OR = 2.14; p = 0.026) while Balint group was found as a protective factor (OR = 0.10; p < 0.001), according to the multiple ordinal logistic regression analysis. Regarding the reduced personal accomplishment, our results indicated that nonspecialists were at risk for this subdimension (OR = 2.09; p = 0.025), whereas Balint participants were protected (OR = 0.18; p < 0.001). Participation in Balint groups is associated with the reduced burnout syndrome among primary health care doctors

Childhood Tuberculosis In Serbia

The objective of this study was to establish the tuberculosis incidence and mortality in children in Serbia in the period 1992–2002. There were 280 reported cases. The average annual incidence rate was 1.79/100,000 (95% confidence interval, 0.92–3.13). The rate was higher in girls than in boys. Eleven children died. The average annual mortality rate was 0.10/100,000 (95% confidence interval, 0.01–0.56). The mortality rates for both boys and girls were higher in the age group 0–4 years than in older age group.

Predictors of health related-quality of life among elderly with disabilities: Elderly with disabilities

There have been no previous studies of health‐related quality of life (HRQOL) among adults aged 65 years and older with disabilities in Serbia. The aim of study was to identify predictors of HRQOL in the context of sociodemographic characteristics, disability aetiology, comorbid diseases, indices of comorbidities, realization of social rights, and domestic violence.

Validation of the Neck Disability Index in Serbian Patients With Cervical Radiculopathy

Objective: The purpose of this study was to translate the Neck Disability Index into the Serbian language (NDI‐S) and to investigate the validity of this version for use in Serbian population. Methods: Fifty patients with cervical radiculopathy were enrolled in the study and completed a multidimensional questionnaire, including NDI‐S. Inclusion criteria were ages between 18 and 65 years, Serbian speaking, no cognitive or hearing impairment, sharp and radiating neck and upper extremity pain that has lasted less than 12 months, radiculopathy signs evaluated by electromyoneurography and disc herniation, or spondylotic changes of cervical spine visualized on magnetic resonance imaging. Exclusion criteria were malignancy, previous cervical spine discectomy, trauma of the cervical spine and myelopathy, polyneuropathy, fibromyalgia, and psychiatric disorders. Validity was determined by the correlation of the Neck Disability Index, with pain measured by visual analogue scale, characteristics related to pain, and mental status. Also, factor structure of NDI‐S was explored through factor analysis. Reliability was assessed through internal consistency (Cronbachs &agr; and item‐total correlations). Results: Correlation analysis between pain and NDI‐S showed significant values (P < .01). The NDI‐S correlated well with patients mental status (r = 0.421, P < .01). Cronbachs &agr; of NDI‐S was 0.85, denoting excellent internal consistency of the questionnaire. Item‐total correlations were significant and ranged from 0.328 to 0.789. Factor analysis demonstrated a 2‐factor structure with an explained variance of 55%. Conclusion: The NDI‐S is a valid questionnaire to measure neck and arm pain related to disability in Serbian patients with cervical radiculopathy.