Gorica Maric

The role of gut hormones in appetite regulation (review)

Eating process is an aggregate of complex and different forms of behavior. Its regulation is based on energy homeostasis and appetite control which includes two components: the homeostatic and the hedonistic control. Important signals in appetite regulation are gut-derived hormones. They are produced by enteroendocrine cells in response to nutrient and energy intake, and achieve their effects by influencing brain structures involved in food intake regulation. The key brain structure involved in this process is the hypothalamus. Gut hormones reach the hypothalamus from the circulation or by the vagal nerve via the nucleus of the solitary tract. Among gut peptides, ghrelin is the only orexigenic hormone, leading to an increase in food intake and body weight. All others, such as cholecystokinin, glucagon like peptide-1, oxyntomodulin, peptide tyrosine tyrosine or pancreatic polypeptide, are anorexigenic, leading to decrease in food intake. Also, gut-derived endocannabinoids exert orexigenic effect on appetite. Keeping in mind the growing problem of obesity, the crucial issue when considering gut derived peptides is to understand their mechanisms of acting because of potential role in clinical therapy, and discovering long-lasting gut peptides or their analogues, with no or minimal side effects.

Factors associated with positive attitude towards blood donation among medical students

The aim of this study was to assess attitudes and practice of blood donation among medical students. Medical students were recruited at Medical Faculty, University of Belgrade, Serbia. Of 973 students, 38.4% of freshmen and 41.4% of final year students have donated blood (χ(2) = 0.918, p = 0.186). Blood donors had significantly more positive attitude towards some aspects of blood donation. Being female, residing in a city other than the capital and previous blood donation experience were independent predictors of positive attitude towards being a blood donor to an unknown person. Efforts are required to augment blood donor pool among future physicians.

Gait pattern in patients with different multiple sclerosis phenotypes

BACKGROUND Gait pattern is frequently impaired in multiple sclerosis (MS), however gait characteristics in patients with different MS phenotypes have not been fully elucidated. METHODS We analyzed spatio-temporal gait pattern characteristics in patients with relapsing-remitting (RR, n=52) and primary-progressive (PP, n=18) MS in comparison with age-matched healthy controls (HC, n=40). All subjects performed a standardized simple walking task, a dual motor- motor task, a dual motor-mental task, and a triple combined motor-mental task at a GAITRite electronic walkway of 5.5m active area. We measured: cycle time (CT), stride length (SL), swing time (ST), double support time (DST), gait velocity (GV) and calculated symmetry index (SI) for CT, SL and ST. RESULTS With each task performed, CT and DST in the total MS group were significantly longer while SL was significantly shorter and GV significantly lower than in HC. ST was similar in the total MS patient group and HC. In both MS patients and HC, CT and DST increased and SL and GV decreased over repeated assessments. Dual and triple tasks while walking influenced walking performance in both MS patients and HC. Although patients with PPMS differed significantly from those with RRMS in the majority of gait parameters, the subgroup analysis in patients matched for age and disability (Expanded Disability Status Scale Score -EDSS, 3.0-5.0) showed similar gait performance in RRMS and PPMS patients having the same level of disability, except for CT and ST- symmetry parameters that were more impaired in the PPMS group. The EDSS score correlated significantly with CT, DST, SL and GV, but no significant correlation was found with ST except at the triple combined motor-mental task. CONCLUSION A disturbed gait pattern in MS patients with different MS phenotypes depends on disability and reflects a cognitive-motor interference.

Medical students, do you know how to measure blood pressure correctly?

ObjectiveThe aim of this study was to estimate the level of knowledge of the blood pressure (BP) measurement technique among medical students. Materials and methodsA total of 791 students in the fourth and the final, sixth year were recruited at the Faculty of Medicine, University of Belgrade, before the start of compulsory practical sessions in the classrooms, during the period 2–9 December 2013. Data were collected using questionnaires on the technique of BP measurement according to the existing guidelines. ResultsThe least correct answers among students of both years were related to the fact that the stethoscope membrane should not be placed under the cuff (13.5% fourth year and 19.4% sixth year students). The highest proportion of correct answers (97.5%) in the fourth year was related to the fact that BP should be measured twice during patient examination. By the sixth year, however, most students (96.6%) knew that previous physical activity may cause an increase in the values of BP. With respect to whether or not the students were shown how to measure the BP properly in classes, 54.9% of fourth-year and 52.5% sixth-year students agreed or strongly agreed with this statement (&khgr;2=0.461, P=0.497). No correlation was established between the knowledge score and self-perceived confidence in measuring BP (&rgr;=0.062, P=0.211). ConclusionThe theoretical background of the BP measurement technique varies among students in both years. The correct means of BP measurement should be elaborated thoroughly, with the aim of preventing misconceptions and misdiagnosis of hypertension.

Predictors of hepatitis B vaccination status in healthcare workers in Belgrade, Serbia, December 2015

Despite the availability of a safe and effective vaccine since 1982, overall coverage of hepatitis B vaccination among healthcare workers (HCWs) has not reached a satisfactory level in many countries worldwide. The aim of this study was to estimate the prevalence of hepatitis B vaccination, and to assess the predictors of hepatitis B vaccination status among HCWs in Serbia. Of 380 randomly selected HCWs, 352 (92.6%) were included in the study. The prevalence of hepatitis B vaccination acceptance was 66.2%. The exploratory factor analyses using the vaccination-refusal scale showed that items clustered under ‘threat of disease’ explained the highest proportion (30.4%) of variance among those declining vaccination. The factor analyses model of the potential reasons for receiving the hepatitis B vaccine showed that ‘social influence’ had the highest contribution (47.5%) in explaining variance among those vaccinated. In the multivariate adjusted model the following variables were independent predictors of hepatitis B vaccination status: occupation, duration of work experience, exposure to blood in the previous year, and total hepatitis B-related knowledge score. Our results highlight the need for well-planned national policies, possibly including mandatory hepatitis B immunisation, in the Serbian healthcare environment.

Prevalence of hypertension in a sample of schoolchildren in the Belgrade district.

ObjectiveThe aim of this study was to estimate the prevalence of hypertension in a sample of schoolchildren in the district of Vozdovac (Belgrade). MethodsThis study included 780 pupils from I, III, V and VII classes of a primary school and I and III classes of a high school in the district of Vozdovac (Belgrade). The anthropometric data were obtained from medical records of a regular health survey in 2014–2015. Blood pressure (BP) was measured three times using a mercury sphygmomanometer with a cuff of appropriate size at a 5 min interval. BP values at or above the 95th percentile for age, sex, and height were considered indicative of hypertension. Statistical analysis included descriptive statistics, &khgr;2-test, t-test, and correlation analysis. ResultsOf the participating students, 15.0% were overweight and 6.7% were obese. A significant negative correlation was observed between BMI categories and age (&rgr;=−0.126; P<0.01). The average systolic blood pressure values in boys and girls were 105.0±14.1 (range 80.0–150.0) and 102.5±12.3 (range 80–155) mmHg, respectively. The average diastolic blood pressure values in boys and girls were 67.6±8.8 (range 50–100) and 66.2±7.7 (range 50–95) mmHg, respectively. The prevalence of hypertension was 10.5%. A significant positive association was found between the presence of hypertension and age (&rgr;=0.150, P<0.01) and higher BMI level (&rgr;=0.115, P<0.01). ConclusionIn our sample of schoolchildren, a high prevalence of hypertension was found. Moreover, elevated BP values correlated strongly with age and BMI.

Medical Cannabis in Serbia: The Survey of Knowledge and Attitudes in an Urban Adult Population

ABSTRACT There are some indices in which legalization of medical cannabis in the Republic of Serbia might be considered. The purpose of this research was to assess knowledge and attitudes towards medical cannabis in an urban adult population. This cross-sectional study was conducted in December 2015 and January 2016. A convenience sample of study participants comprised users of the Community Health Center. A total of 360 adults were invited to participate. Data were collected through an anonymous questionnaire. Most participants (77.1%) answered correctly that cancer was indicative of medical cannabis treatment, while the remaining conditions were less frequently recognized. A total of 42% answered correctly that adverse effects of cannabis were hallucinations and dizziness. Persons who previously used cannabis were more knowledgeable on conditions for medical cannabis treatment (ρ = 0.155; p = 0.006). Study respondents expressed positive attitude towards legalization of medical cannabis (median 5 out of 5) and negative towards legalization of recreational cannabis (median 2 out of 5). In conclusion, the adult population in Belgrade had some knowledge of medical cannabis. The overall attitude of our population regarding legalization of medical cannabis was positive, while the attitude towards legalization of cannabis for recreational purposes was negative.

Illict drug use and academia in North Kosovo: Prevalence, patterns, predictors and health-related quality of life

Purpose The purpose of this study were to estimate the prevalence and patterns of illicit drug use in a sample of University students from North Kosovo, to assess factors associated with illicit drug use and to assess health-related quality of life (HRQoL) among students according to illicit drug use. Methods A cross-sectional study was conducted at the Student Public Health Center, where 514 University students were enrolled from April to June 2015 in North Kosovo. Participants completed the general socio-demographic and behavioral questionnaire, Beck Depression Inventory (BDI) and the SF-36 questionnaire for HRQoL assessment. Data on lifetime illicit drug use were self-reported. Results As much as 16.0% of students reported ever illicit drug use. The most frequently used drugs were marijuana (9.3%) and bromazepam (7.6%). Factors associated with ever illicit drug use were: being smoker and alcohol user, having chronic diseases and having higher depressive symptoms score. Ever illicit drug users reported all domains of HRQoL as worse. Conclusion These results could serve as a tool for implementation of preventive strategies and University policies to promote healthy lifestyles and behaviors. Measurement of HRQoL could also be used as indicator of the effect of interventions designed to reduce and/or prevent illicit drug use at institutions of higher education.

Incidence and Mortality Patterns of Acute Myeloid Leukemia in Belgrade, Serbia (1999–2013)

Introduction: To assess incidence and mortality trends of acute myeloid leukemia (AML) in Belgrade (Serbia) in a 15-year period (from 1999 to 2013). Material and Methods: Data were obtained from the Cancer Registry of Serbia, Institute of Public Health of Serbia. Standardized incidence and mortality rates per 100,000 inhabitants were calculated by direct standardization method using World Standard Population. Analysis of raw data indicated single-digit numbers per year and per 5-year age cohorts. Therefore, we merged years of diagnosis to three-year intervals, creating so-called “moving averages”. We also merged study population to 10-year age cohorts. Results: Both incidence and mortality rates increased with age, i.e., the lowest rates were observed in the youngest age groups and the highest rates were observed in oldest age groups. In all age groups, except the youngest (15–24 years), AML incidence was statistically significantly higher in men compared with women. Average age-adjusted incidence was 2.73/100,000 (95% confidence interval (CI) 2.28–3.71). Average age-adjusted mortality was 1.81/100,000 (95% CI 1.30–2.26). Overall, there were no significant changes in incidence trend. Age-adjusted incidence rates had increasing tendency among men aged 65–74 years (B = 0.80, standard error (SE) = 0.11; p = 0.005) and in total population aged 65–74 years (B = 0.41, SE = 0.09; p = 0.023). Increasing tendency in incidence of AML among women was observed in age group >75 years (B = 0.63, SE = 0.14; p = 0.019). No changes of mortality trend were observed. Conclusion: There was no significant change in trends of AML from 1999 to 2013 in the population of Belgrade.

Cross-cultural adaptation and validation of the Functional Assessment of Chronic Illness Therapy – Cervical Dysplasia (FACIT-CD) questionnaire for Serbian women

OBJECTIVES The FACIT-CD (Functional Assessment of Chronic Illness Therapy - Cervical Dysplasia) questionnaire is a disease-specific instrument for assessing the health-related quality of life (HRQoL) in women with cervical dysplasia. Our aim was to perform a cross-cultural adaptation and psychometric evaluation of the FACIT-CD scale in Serbian women with cervical squamous intraepithelial lesions (SIL). STUDY DESIGN Our study included women of reproductive age diagnosed with SIL in a single university-affiliated hospital. A total of 160 participants with histologically confirmed low-grade (LSIL) or high-grade (HSIL) squamous intraepithelial lesions responded to the Serbian version of the FACIT-CD instrument, the Short Form-36v2 questionnaire (SF-36v2), the Beck Anxiety Inventory (BAI), and the Beck Depression Inventory (BDI). Women also participated in an interview regarding their socio-demographic data. We evaluated the validity and reliability of the Serbian version of FACIT-CD. RESULTS The Cronbachs alpha coefficient was 0.710 for the entire sample (0.702 for LSIL and 0.711 for HSIL). We found numerous correlations between the FACIT-CD scores and SF-36v2 scores, as well as between the BAI and BDI scores for both the total score and most of the domain scores. The mean FACIT-CD total score was high (114.47 ± 13.25 out of 136.00 which is the maximum score). There were no significant differences in the mean scores between the LSIL and HSIL groups. CONCLUSIONS Our study demonstrated that the Serbian FACIT-CD has overall good psychometric properties in women with both LSIL and HSIL. We propose the use of the FACIT-CD questionnaire as an indicator for HRQoL in women with cervical dysplasia.