Maja Nikolić

Swimming and persons with mild persistant asthma.

The aim of our study was to analyze the effect of recreational swimming on lung function and bronchial hyperresponsiveness (BHR) in patients with mild persistent asthma. This study included 65 patients with mild persistent asthma, who were divided into two groups: experimental group A (n = 45) and control group B (n = 20). Patients from both groups were treated with low doses of inhaled corticosteroids (ICS) and short-acting β2 agonists salbutamol as needed. Our program for patients in group A was combined asthma education with swimming (twice a week on a 1-h basis for the following 6 months). At the end of the study, in Group A, we found a statistically significant increase of lung function parameters FEV1 (forced expiratory volume in 1 sec) (3.55 vs. 3.65) (p < 0.01), FVC (forced vital capacity) (4.27 vs. 4.37) (p < 0.05), PEF (peak expiratory flow) (7.08 vs. 7.46) (p < 0.01), and statistically significant decrease of BHR (PD20 0.58 vs. 2.01) (p < 0.001). In Group B, there was a statistically significant improvement of FEV1 3.29 vs. 3.33 (p < 0.05) and although FVC, FEV1/FVC, and PEF were improved, it was not significant. When Groups A and B were compared at the end of the study, there was a statistically significant difference of FVC (4.01 vs. 4.37), FEV1 (3.33 vs. 3.55), PEF (6.79 vs.7.46), and variability (p <0.001), and statistically significantly decreased BHR in Group A (2.01 vs. 1.75) (p < 0.001). Engagement of patients with mild persistent asthma in recreational swimming in nonchlorinated pools, combined with regular medical treatment and education, leads to better improvement of their parameters of lung function and also to more significant decrease of their airway hyperresponsiveness compared to patients treated with traditional medicine

Report: Treatment of medical waste in Nisava and Toplica districts, Serbia.

If there are no clearly defined management procedures, medical waste may represent a source of serious health hazards. Medical waste management was evaluated at the three hospitals in the Nisava and Toplica district, in Serbia. All the stages of existing waste management (segregation, collection, storage, transportation and disposal of waste) were examined by interviewing the personnel involved in the management of waste. The generated waste was a mixture of hazardous and non-hazardous waste. The study found that waste management performance in this district was poor and that there were problems in every stage of management. The results indicate that the waste generation rate was 1.92 kg bed— 1 day—1 and consisted of 98.7% general waste and 1.3% sharps. Inappropriate segregation practices were the biggest problem and led to increased quantities of general waste. There were no specific regulations for the segregation of the medical waste. None of the surveyed hospitals have a system to refine wastewater and there were no training courses about hospital waste management.

Relationship between burnout, quality of life, and work ability index--directions in prevention.

The aim of our study was (1) to test the possibilities of standardized questionnaires for burnout, quality of life, and work ability in Serbia by investigating interactions of these phenomena in food manufacturing workers in Serbia; and (2) to determine possible preventive measures. The study enrolled 489 food manufacturing workers in the region of Niš (Serbia) during the period from January 2008 to February 2009. We included three standardized questionnaires: for burnout (CBI), quality of life (ComQoL-A5), and the work ability index (WAI) in the Serbian language. The results of our study indicate high scores in personal (60.0) and work burnout (67.9), lower scores for objective (66.2%SM) and subjective quality of life in enrolled subjects (69.2%SM), and an excellent work ability index in most workers (65.8%). The questionnaires tested are reliable instruments in the Serbian region. Burnout, quality of life, and work ability are significantly interrelated categories in food manufacturing workers. There is a high degree of work burnout that has not yet been accompanied with significant impairment of quality of living and work ability in exposed workers. That is why a salutogenic approach in the prevention of this phenomenon, by health-promotion programs in the workplace, would be the method of choice for burnout improvement.

THE INFLUENCE OF MARITAL STATUS ON EPIDEMIOLOGICAL CHARACTERISTICS OF SUICIDES IN THE SOUTHEASTERN PART OF SERBIA

BACKGROUND The support of close persons is a protective factor in the suicide epidemiology. The aim of this paper is to determine if there are differences between epidemiological characteristics of the suicides committed by married people in relation to singles. METHODS In order to determine epidemiological characteristics of suicide among married and single people in the southeastern Serbia 628 suicides committed from 1995 to 2002 among persons 20 years of age and over were analysed. To compare suicide rates between married and single persons chi2 test was performed. RESULTS From 628 registered suicides, 188 were performed by women, and 440 by men. The average annual suicide rate among males was 24.1 per 100,000 and among females it was 9.9. The highest rates were among widowed (139.0) and divorced men (63.2). The highest risk factor for suicide was to be widowed (men: RR=8.35; women: RR=2.75). The suicide trend among women, both married and single has been declining, whilst among males it has been on significant increase. Seasonality of suicides, weekly and daily distribution had a small influence on the epidemiological characteristics of suicides. Married women committed more suicides by poisoning than single women (p=0.02). In both groups, the most frequent way is hanging. CONCLUSION Though marital status plays important role in an increasing rates of suicide, time and the way of its happening, this role is not decisive. Single people are very vulnerable and the time and way of suicide show that their reasons are more serious than among married ones.

Long-term ambient air pollution exposure and risk of high blood pressure among citizens in Nis, Serbia.

Abstract Epidemiological studies suggest that long-term exposure to air pollution increases the risk for high blood pressure (BP). The aim of our study is to evaluate any effects in BP in citizens exposed to long-term ambient air pollution. The subjects are 1136 citizens, aged 18–70 years, living for more than 5 years in the same home in the areas with a different level of air pollution. The air concentrations of black smoke and sulfur dioxide were determined in the period from 2001 to 2011. We measured systolic and diastolic BP and heart rate. Multivariate methods were used in the analysis. Alcohol consumption had the greatest influence on the incidence of hypertension as a risk factor (RR: 3.461; 95% CI: 1.72–6.93) and age had the least (RR: 1.23; 95% CI: 1.183–1.92). Exposure to air pollution increases risk for developing hypertension 2.5 times (95% CI: 1.46–4.49). Physical activity has proved to be statistically significant protective factor for the development of hypertension. Long-term exposure to low levels of main air pollutants is significantly associated with elevated risk of hypertension.

Air quality monitoring in NIS (SERBIA) and health impact assessment

The aim of this study is to indicate the significance of air quality monitoring and to determine the air quality fields for the assessment of air pollution health effects, with special attention to risk population. Radial basis function network was used for air quality index mapping. Between 1991 and 2005, on the territory of Nis, several epidemiological studies were performed on risk groups (pre-school children, school children, pregnant women and persons older than 65). The total number of subjects was 5837. The exposed group comprised individuals living in the areas with unhealthy AQI, while the control group comprised individuals living in city areas with good or moderate AQI. It was determined that even relatively low levels of air pollution had impact on respiratory system and the occurrence of anaemia, allergy and skin symptoms.

[Effects of air pollution on children's health in Nis and Niska Banja].

BACKGROUND Epidemiological studies point out that air pollution in the cities was a major risk for health of the exposed population. In particular, the effects of air pollutants were adverse to the respiratory tract. In Nis and Niska Banja, the concetrations of pollutants were mainly below the threshold values. However, according to the literature, even these concentrations could exert negative effects, especially the health of the most sensitive group, such as the preschool children. The aim of our study was to evaluate the effects of the current levels of air pollutants in the city of Nis on respiratory symptoms and diseases. METHODS A pilot, cohort, retrospective study included 1 385 children of 1-5 years of age from the zones with statistically significant concentrations of air pollutants, in the period after the birth of the children. The prevalence of respiratory symptoms and diseases was determined on the basis of a modified WHO standard questionnaire completed by the parents. RESULTS It was revealed that in the more polluted of the studed zones, the prevalence of some respiratory symptoms (cough with cold and phlegm), and the lower respiratory tract diseases was significantly higher. CONCLUSION The results of our study showed that the current concentrations of air pollutants in Nis and Niska Banja could represent the important etiological factor for the development of respiratory symptoms and diseases. Our study showed that in the children of up to 5 years of age, the frequency of respiratory symptoms and diseases was significantly higher in more polluted than in less polluted environments.

Use of family planning methods by women in the municipality of Nis (Serbia)

The use of family planning methods reduces maternal mortality, prevents unwanted and high-risk pregnancies, the need for (un)safe abortion and protects from sexually transmitted diseases. The objective of the study was to assess the use of family planning methods by women in the municipality of Nis. We applied an observational cohort study that included 1,584 women age 15–49 who lived in the municipality of Nis. Data was collected through the opinion poll examination, which took place in the municipality of Nis from February to September 2002. We found 81.9% of interviewees having sexual relations protect themselves from unwanted pregnancy permanently or occasionally; 18.1% do not. Of interviewees who do not use protection and have sexual relations, 28.1% think it harms health and 27.7% think it is unsafe. Among women who use contraceptive protection, 57.9% use traditional (unsafe) methods while 42.1% use modern methods. Interviewees who use contraception mostly choose a particular method of their own accord without consultation (52.9%); 58.2% estimate their method of contraception as partly safe, 6.8% as unsafe and 35% as completely safe. As to the reason for contraception use, 40.4% state they already have their preferred number of children, 22.4% use contraception for health reasons, 17% because they are not married, 7.6% because of poor economic condition, and other reasons are present in significantly lesser percentages. Of the interviewees, 29.3% had intentionally interrupted pregnancies. The use of family planning methods is unsatisfactory. Therefore, it is necessary to promptly begin promoting protection of reproductive health and the use of modern family planning methods as a part of the nurturing of healthy lifestyles.

Indoor exposure to chemical and biological agents and health efects in primary school children

The aim of this study has been to estimate effects of indoor air pollutants on children’s health. An anamnestic retrospective study was done on 1074 children aged between 7 and 11 years old who lived in Nis (Serbia). An original questionnaire was used in an interview between training physicians and children’s parents. Interview data were processed by using Microsoft Excel and Epiinfo 6. The investigation determined that children who were more often exposed to combustion by-products had respiratory and nonspecific symptoms. Parental smoking was strongly associated with wheezing, bronchitis, headache and fatigue. There was no association between health and keeping pets, apart from partial nasal congestion. Presence of insects (e.g., cockroaches) and rats in households was a significant risk factor for all symptoms and diseases estimated except for asthma and pneumonia. Homes abundant in textiles were the cause of nasal congestion, wheezing and fatigue in children. Old mattresses were associated with respiratory symptoms, bronchitis, and nonspecific symptoms. It has been concluded that indoor air quality plays a major role in children’s health. Sources of indoor air pollution are present in every home. Being aware of the risks associated with indoor air quality problems, consequently, leads to their mitigation.

Correlation between risk factors, functional recovery, and the health-related quality of life of stroke survivors

Introduction/objective: It has been estimated that 50% of strokes are preventable through the control of modifiable risk factors. The objective of the paper was to determine the correlation between the risk factors, functional status, and the health-related quality of life (HRQOL) of stroke survivors. Method: The prospective cohort study was used. The study included 136 patients 30–79 years old. Functional recovery was assessed using the Barthel index (BI) and the Modified Rankin Scale (mRS). The HRQOL was evaluated by the generic Short Form 36 (SF-36) questionnaire. BI and mRS were determined at admission at the rehabilitation, one, three and six months after the stroke. The SF-36 was filled out at the same time. The analysis of the repeated measure variance (Repeated Measures ANOVA) was applied, as well as the correlation analysis and Spearman’s coefficient of rank correlation. Results: A total number of 136 patients [66 (48.5%) male and 70 (51.5%) female] completed the questionnaire. The average age of stroke survivors was 63.72 ± 8.73. At admission, mRS was 4.75 ± 0.55, and six months after the stroke onset it decreased to 2.60 ± 1.08. The average value of BI at admission was 25 ± 24.66, and within six months it increased to 83.75 ± 18.59 (p = 0.001). The ANOVA showed that the values of mRS significantly decreased (p < 0.001) and the values of BI significantly increased (ANOVA: p < 0.001). All domains of the SF-36 questionnaire, except for the pain domain, significantly increased (p < 0.001). The physical function (r = 0.238; p < 0. 01), physical role (r = 0.199; p < 0.05), and emotional role (r = 0.237; p < 0.01) were significantly lower among alcohol addicts (r = 0.199; p < 0.05). Mental health (r = 0.244; p < 0.01) and social relationships domains were significantly lower among smokers (r = 0.272; p < 0.01). The general health (r = -0.290; p < 001) and health condition change domains were significantly lower among smokers (r = 0.225; p < 0.01). Conclusion: The most important risk factor which was negatively correlated with the HRQOL was smoking. The patients who were smokers and alcohol addicts had a significantly smaller increase of the HRQOL domains compared to other patent groups. Six months after the stroke, all domains of the HRQOL significantly increased. The significant improvement of patients’ functional status was positively correlated to the increase of their HRQOL.