Milica Martinovic

Prevalence of and contributing factors for overweight and obesity among Montenegrin schoolchildren.

BACKGROUND Newly emerging Western style economic systems provide new opportunities to study the prevalence and predictors of childhood obesity. We also provide for the first time a national study of childhood obesity using all three international anthropometric criteria. METHODS The sample included 4097 Montenegrin children, 2076 boys (50.7%) and 2021 girls. Anthropometric measurements were performed in school. The questionnaire for parents included questions on 24 potential contributing factors for childhood obesity. Nutritional status was assessed according to World Health Organization, US Center for Disease Prevention and Control and International Obesity Task Force (IOTF) criteria. RESULTS Overall percentage of Montenegrin children who are overweight or obese (IOTF) is 22.9% of which 5.3% are obese (7.0% boys vs. 3.5% girls). We found 10 factors to be independently associated with child obesity. Positive relations [odds ratio (95% confidence interval)] were found with maternal obesity [2.05 (1.68-2.51)], paternal obesity [1.67 (1.32-2.10)], paternal employment [1.40 (1.12-1.74)], maternal smoking [1.32 (1.08-1.61)], obesity at birth [1.33 (1.04-1.70)] and computer game playing [per hour--1.11 (1.00-1.24)]. Negative relations were found with female gender [0.64 (0.53-0.78)], the number of siblings [0.88 (0.78-0.98)], birth order [0.73 (0.64-0.83)] and age [0.92 (0.88-0.98)]. CONCLUSION One out of four Montenegrin children is overweight, with two times more frequent obesity among boys compared with girls. Some previously salient predictors did not appear salient in this sample. To enable worldwide comparability, we propose the use of all three childhood obesity criteria in national studies.

Evaluation of pharmacotherapy of obstructive airway diseases in the Montenegrin outpatient care: comparison with two Scandinavian countries

BackgroundThis study is aimed at evaluating the pharmacotherapy of obstructive airway diseases (OAD) in the Montenegrin outpatient care (MOC) in 2010.MethodsData on the reimbursed drugs which were prescribed during the reference period were obtained from the National Database that was established within the Health Insurance Fund of Montenegro in 2004. We have applied the standard pharmacoepidemiologic methodology with the defined daily dose (DDD) along with the Anatomical Therapeutic Chemical (ATC) classification of drugs. Clinical entities of OAD were classified according to the International Classification of Diseases (ICD-Revision X).ResultsPrescribing and the subsequent use of drugs for OAD (ATC code R03) in 2010 was 18.18 DDD/1000inhabitants/day, much lower than in some developed countries. Fenoterol/ipratropium and salmeterol/fluticasone fixed combinations had the highest utilisation level, accounting for more than 50% of all OAD drugs. About 90% of OAD drugs were prescribed for COPD and asthma.ConclusionsObtained results indicate that there are still large differences in OAD drug utilisation in MOC when compared with developed countries, but also some improvement in pharmacological approach to the pharmacotherapy of OAD in comparison to the earlier period.

Blood pressure among rural Montenegrin children in relation to poverty and gender

BACKGROUND Health inequalities may begin during childhood. The aim of this study was to investigate the main effect of poverty and its interactive effect with gender on childrens blood pressure. METHODS The study was performed in two elementary schools from a rural region near Podgorica, the capital of Montenegro. A questionnaire including questions on family monthly income, childrens physical activity and the consumption of junk food was self-administered by parents of 434 children (223 boys and 211 girls) aged 6-13 years. Childrens poverty level was assessed using the recommendations from the National Study on Poverty in Montenegro. Childrens body weight and height were measured and body mass index-for-gender-and-age percentile was calculated. An oscillometric monitor was used for measurement of childrens resting blood pressure in school. RESULTS A two-factorial analysis of variance with body mass index percentile, physical activity and junk food as covariates showed an interaction of gender and poverty on childrens blood pressure, pointing to synergy between poverty and female gender, with statistical significance for raised diastolic pressure (F = 5.462; P = 0.021). Neither physical activity nor the consumption of junk food explained the interactive effect of poverty and gender on blood pressure. CONCLUSION We show that poverty is linked to elevated blood pressure for girls but not boys, and this effect is statistically significant for diastolic pressure. The results are discussed in the light of gender differences in stress and coping that are endemic to poverty.

Hypertension and correlates among Montenegrin schoolchildren—a cross-sectional study

OBJECTIVES In one of the few national studies of children in a former Eastern bloc country emerging as a Western democracy and the first such study ever in Montenegro, this study establishes the prevalence and correlates of childhood hypertension (CH). STUDY DESIGN A cross-sectional national study. METHODS The study was conducted with 3254 children aged 7-13 years (50.3% male) from 39 elementary schools. We used a structured questionnaire to gather sociodemographic information as well as data on factors potentially related to CH. Childrens nutritional status was assessed using the criteria of the International Obesity Task Force. Waist circumference was also measured. Blood pressure was measured in schools using an oscillometric monitor. CH was defined as an average systolic blood pressure and/or diastolic blood pressure greater than or equal to the 95th percentile for sex, age, and height. RESULTS The prevalence of CH was 10.4% with no differences between boys and girls. Multiple regression revealed that the odds for child hypertension were lowered by 10% for each year of age. On the other hand, rural environment and child obesity raised the odds of hypertension by 38% and 68%, respectively. CONCLUSIONS We found hypertension in one out of ten Montenegrin schoolchildren, with no gender differences. Obesity and rural areas may be unfriendly to childrens blood pressure.

Povezanost retinol-vezujućeg proteina 4 i kardiovaskularnog rizika posredovana je obimom struka kod pretilih/debelih adolescentica

Retinol-binding protein 4 (RBP4) is an emerging risk factor for atherosclerotic disease in adults. However, to our knowledge, there are no studies examining the relationship between RBP4 and cardiovascular risk in young population. Therefore, we aimed to estimate this potential relationship in overweight/obese adolescent girls. Seventy overweight/obese adolescent girls, mean age 17.6±1.20 years, were included. Anthropometric and biochemical parameters were measured. Cardiovascular risk score (CVRS) was calculated by adding points for each risk factor (e.g., sex, high-density lipoprotein cholesterol (HDL-c), non-HDL-c, smoking, blood pressure and fasting glycemia). According to the risk status, we divided adolescent girls into low, medium and high risk groups (-2≤ CVRS ≤1, 2≤ CVRS ≤4 and CVRS ≥5, respectively). We found significantly higher RBP4 in the high risk group as compared with low risk group (p<0.001). However, multiple linear regression analysis showed waist circumference (beta=0.257, p=0.031) to be the only independent predictor of higher cardiovascular risk (adjusted R(2)=0.342, p<0.001). In conclusion, RBP4 may be associated with higher cardiovascular risk in overweight/obese adolescent girls, but this association is mediated by abdominal obesity.

News in the pathophysiology of asthma

Asthma is a complex disorder that displays heterogeneity and variability in its clinical expression both acutely and chronically 1, . This heterogeneity is influenced by multiple factors including age, sex, socioeconomic status, race and/or ethnicity, and gene by environment interactions 3, . Understanding the immunopathology of airways in asthma has been markedly advanced with the use of bronchoscopy and biopsy. irway samples can then be analyzed by using histologic and immunologic methods, and identified features can be evaluated in relationship to clinical features of asthma to more fully understand the contribution of cellular and molecular events to the resulting physiology and response to treatment 5, . It is helpful to arbitrarily consider asthma in terms of the traditional T-helper2 (Th2) inflammatory processes. In the acute inflammatory aspects of asthma, allergenIgE–directed processes are predominant features of airway pathology. Mast cells, Th2 lymphocytes and eosinophils are the predominant histologic features. The cytokine network associated with these processes includes IL-3, IL4, IL-5, IL-9 and IL-13 7, . Mast cells are important contributors to the initiation of asthma with release of acute-phase mediators, including cysteinyl leukotrienes, and also inflammatory cytokines, which serve to perpetuate inflammatory events in the airway . Subpopulations of lymphocytes polarized toward a Th2 profile further sustains the inflammatory process by the release of cytokines, including IL4, IL-5 and IL-13. These factors serve to drive inflammation (e.g., recruitment of eosinophils) and also regulate IgE production . Eosinophils are a characteristic feature of allergic inflammation . Eosinophils that are recruited to the airway in asthmatic subjects by the families of cytokines and chemokines e.g., IL-5, Regulated on Activation, Normal T Cell Expressed and Secreted (RANTES) and eotaxin undergo cell activation through processes not fully identified and release highly inflammatory mediators. Recent years have been marked by rapid progress in understanding cellular and chemical mechanisms in the pathogenesis of asthma and other allergic disorders. Studies published in the Journal of Allergy and Clinical Immunology 9, 10 described advances in our knowledge of signaling molecules and pathways, cytokines and activation and tolerance in asthma and murine models of this disease. Additional studies provided novel information about the induction and regulation of allergic inflammation and the genetic determinants of asthma and responsiveness to asthma therapy.