Nela Djonovic

Hospital infections in a neurological intensive care unit: incidence, causative agents and risk factors

INTRODUCTION Hospital infections (HIs), which are frequently associated with hospital treatment, increase morbidity, mortality and treatment costs. The aim of this study was to establish the incidence of HIs in a neurological intensive care unit (nICU), and to determine the most prevalent causative agents and risk factors for HIs. METHODOLOGY A cross-sectional study with nested case-control design was conducted between 1 July 2009 and 30 June 2010 at an 18-bed neurological intensive care unit at the Clinical Center Kragujevac, Serbia. RESULTS In total, 537 patients were enrolled in the study, with 6,549 patient-days. There were 89 patients with 101 HIs. The incidence of patients with HIs was 16.57%, and incidence of HIs was 18.81%, while density of HIs was 15.42 per 1,000 patient-days. The most frequent anatomical sites of HIs were urinary tract (73.27%), blood (10.89%), and skin and soft tissues (10.89%). The following risk factors were identified: co-morbidity (OR=3.9; 95% CI=1.9-7.9), surgical intervention in the last 30 days (OR=5.6; 95% CI=1.5-20.4), urinary bladder catheterization longer than seven days (OR=3.8; 95% CI=1.8-8.2), value of Glasgow coma scale ≤ 9 (OR=3.7; 95% CI=1-6.9), and longer hospital stay (OR=1.1; 95% CI=1.1-1.2). CONCLUSIONS Hospitalization in an nICU bears high risk of HIs, especially of urinary tract infections caused by Gram-negative bacteria, in patients with longer hospital stay or co-morbidities, and in those who have had surgical interventions or prolonged use of a urinary bladder catheter. Special attention should be paid to these patients to prevent HIs.

The Analysis of Nutritional Predictors of Anemia Combined with Obesity in Primary School-Age Children

Abstract The consumption and amounts of a variety of food products used in a diet affect the incidence of anemia and different levels of nutritional status among school-age children. The prevalence of food intake comprised of fats, carbohydrates and sodium (salt) is a significant contributing factor to the incidence of excessive weight. Apart from nutrition, a leisure-time physical activity and the time spent in front of the TV or computer may contribute to an increase in anemia and obesity rates. The objective of this paper was to examine nutritional status, dietary habits and anemia among school-age children in the central Serbia region (the city of Kragujevac). It was established that 47.3% of the surveyed children fell into the normal weight group, 24.5% of the children are considered to be at risk of being overweight, 21.4 % of the children are considered as obese, whereas 6.8% of the children fell into the under-weight group. The incidence of anemia was noted in 10.8% of the cases, whereas anemia in obese children was observed in 21.6% of the cases (n=114; during the school year of 2014-2015). The obtained results show a statistically significant correlation between an increase in the consumption of fast food and anemia in children, whereas the amount of time children spend in front of the TV is also associated with the higher percentage of anemia and obesity.

Cardiovascular diseases: Risk factors

Objective. The aim of this study was to investigate the prevalence and impact of certain risk factors for cardiovascular diseases. Methods. Observational cross-sectional study was conducted in the Health Centre of Kragujevac, in 2014. In total, 98 people older than 35 years, with no previous diagnosis of cardiovascular diseases were chosen by simple random method. The respondents were asked to fill out a questionnaire about risk factors including family anamnesis, nutritional habits, and lifestyles. Nutritional status was assessed based on body mass index and visceral obesity was determined by measuring waist circumference. The metabolic profile was evaluated by the values of total cholesterol, triglycerides and glucose. A 10-year risk for fatal cardiovascular disease was determined through SCORE (Systematic Coronary Risk Evaluation) method. Results. Increased body mass index (>25 kg/m2) was detected in 57.1% of the participants. Visceral obesity was determined in 56.1%. In total, 46.2% of the respondents were smokers while 32.7% had low level of physical activity. Chi-squared test indicated significant correlation between female gender and frequent consumption of fruit, vegetable, cereals, milk and dairy products. Increased body mass index and alcohol consumption were more common among males than females. Cardiovascular risk was associated with repeated exposure to mental stress. 89.8% of the respondents had 10-year risk for fatal cardiovascular disease higher than 5%. Conclusion. The results emphasize the need to increase awareness of the risk factors among patients and health care workers at the level of primary health care to take measures of prevention especially for those cardiovascular diseases that are significantly affected by lifestyles and behaviors.

The Factors that Determine Reproductive Health Characteristics of Adolescents in Serbia

Abstract The aim of the work is to assess vulnerability degree of reproductive health in adolescent population in Serbia by analyzing their sexual behavior. The paper is based on data from a National health survey of the population in Serbia in 2013 (without Kosovo and Metohija region), conducted by the Ministry of Health of the Republic of Serbia. For the purposes of this study, the data used are referred to households and population of age 15 and over, so that the final number for analysis is a sample of 1722 respondents aged 15-24. The study included demographic characteristics of respondents (age, gender, settlement type, region) and the characteristics of reproductive health: sexual behavior, use of contraceptive protection, knowledge and attitudes towards HIV, protection of reproductive health. χ2 test was applied for testing differences in frequency of categorical variables. All results with a probability that equals to or is less than 5% (p≤0.05) are considered statistically significant. Among the respondents, there were more than half (53.5%) of sexually active adolescents. The highest percentage of them- 16.6% responded that they had first sexual intercourse at the age of 17. 53.4% of adolescents had sexual intercourse with one partner, 26.4% of respondents had sexual intercourse with two or more partners. The most commonly used contraceptive method was interrupted intercourse (coitus interruptus) with 34.7% of respondents.

Socio-Medical Aspects of Depression among Elderly Adults in Serbia

Abstract Depression is the most frequent mental health problem in older age with serious consequences on personal, interpersonal and social level. The aim of this study was to determine the association of demographic factors, socio-economic factors and health status characteristics, with the presence of depressive symptoms in the elderly persons. The survey was conducted as a part of the national study “Health Survey of the Serbian population” in 2013. Data on the population aged 65 years and over were used for the purposes of this study (3540 respondents). PHQ-8 questionnaire was used to assess the presence of symptoms of depression. The relations between the presence of depressive symptoms, as a dependent variable, and a set of independent variables was examined by univariate and multivariate logistic regressions. Depression (PHQ-8 score≥10) was registered in 10% of the population aged 65 and above, wherein it was statistically significantly higher in women (12.7%) than in men (6.5%). Limitations in performing of daily activities showed to be the strongest predictor of depression in the elderly, while respondents who have had serious limitations had even six times more chanse to develop depression (OR=6.84). Respondents who rated their health as “bad or very bad” for 49.5% more frequently manifested depressive symptoms compared to those who evaluated their health as “very good or good” (OR=3.49). Respondents who have had two or more chronic diseases were three times more likely to have depression (OR=3.1) compared to people without chronic disease.

Public Health and the New Law of Public Health in Republic of Serbia

Abstract The new Law on Public Health was published in the Official Gazette of the Republic of Serbia No. 15 dated 25 February 2016. Comparing to the previous Law, the biggest changes have been made in the domain of monitoring the indicators of the environment and population health. The responsibility of controlling the quality and safety of food was given back to the Ministry of Health. This paper presents the principal regulations regarding the main functions, principals and organizational features of the public health system in Serbia.

Prevalence of Risk Factors Among Women With Osteoporosis

Abstract Osteoporosis is a progressive bone disorder that can be influenced by many different factors. A cross-sectional study has been conducted with the aim to assess the prevalence of risk factors as well as to identify the possible causes of improvement of the disease. Th e study population consisted of 97 women older than 35 who had previously been diagnosed with osteoporosis. Dualenergy X-ray Absorptiometry (DXA) scan was used to determine bone mineral density (BMD) in order to assess the current state of the disease. Th e participants were asked to complete a standardized IOF (International Osteoporosis Foundation) questionnaire. According to BMD measurements, 24.7% of women had normal bone density while 18.6% had T-score lower than -2.5. Th ere was a statistically significant correlation between T-score and the history of previous bone fractures. Besides, a relatively high prevalence of certain risk factors (such as underweight, early menopause, oophorectomy, thyroid and parathyroid disorders etc.) was observed in woman with osteoporosis

Socioeconomic inequalities and non-communicable diseases in Serbia: National health survey

Background/Aim. Non-communicable diseases (NCDs) are a major public health challenge worldwide. Although they are preventable, NCDs are the major global causes of morbidity and mortality, absenteeism, disability and premature death. The aim of this study was to examine socioeconomic inequalities in the prevalence of non-communicable diseases in Serbia. Methods. Data from the 2013 National Health Survey of the population of Serbia was used in this study. There were 13,765 adults interviewed, aged ≥ 20 years. We used multivariate logistic regression analyses with demographic and socioeconomic determinants of health as independent variables and prevalence of non-communicable diseases as a dependent variable. The minimum level of significance was p < 0.05. Results. Hypertension was the most prevalent NCDs (36.1%). The prevalence of multimorbidity was 47.1%. Multivariate logistic regression analysis showed that gender, age, place of residence, employment status and education were associated with the presence of NCDs. The odds ratio (OR) for age was 1.074 [95% confidence interval (CI) : 1.070–1.077). Women were at a higher risk of NCDs by 58.9% when compared to men (OR = 1.589; 95% 95% CI : 1.467–1.726). Respondents who lived in the rural areas were at a higher risk for NCDs by 14.1% compared to those who lived in urban areas (OR = 1.141; 95% CI : 1.047– 1.244). Odds ratio for unemployment was 1.227 (95% CI: 1.118–1.346). Respondents with primary education were at a higher risk for chronic diseases by 47.1% (OR = 1.471; 95% CI : 1.281–1.687) while those with secondary school were at a higher risk by 27.7% (OR = 1.277; 95% CI : 1.142–1.428) compared to respondents who had higher education. When it comes to Wealth Index, univariate logistic regression analysis showed that respondents who belonged to the poor and middle classes were at a higher risk for NCDs (OR = 2.031; 95% CI : 1.819–2.267; OR = 1.473; 95% CI : 1.343– 1.615) compared to respondents who belonged to the rich class. Multivariate logistic regression analysis did not show statistically significant correlations between the Wealth index and NCDs. Conclusion. Socioeconomic inequalities in health status are the major challenge and should be a target of national health policy in Serbia, not only because they represent social injustice but also because solving the health problems of underprivileged groups of the population can influence improvement of health status of the population as a whole.

The influence of certain factors of family nutrition on the occurrence of nutritional anemia among school children

Objective. The aim of our study was to determine the influence of family nutrition and eating habits on potential development of nutritional anemia in school-age children. Methods. The survey was conducted as an observational cross-sectional study in four primary schools in Kragujevac, during the academic year 2014/2015 on 114 respondents. The data of this study were obtained by combining survey research, anthropometric and biochemical measurements. The survey was conducted during regular hours in schools and included pupils in the first and fourth grade of elementary schools and their parents. Results. Processing the collected data showed that the family diet and eating habits can contribute to the occurrence of anemia in children of school age. It was found that the following factors had a statistically significant influence on the manifestation of anemia: the use of nuts, the way of preparing food and the number of daily meals. Conclusion. Adequately preparing food and the number of meals (less than five), pointed out that proper nutrition and eating habits can potentially contribute to the reduction of the development of anemia in school-age children.

Scoliosis in school children aged from 7 to 8 and conditions in primary and secondary schools in Kragujevac

INTRODUCTION Scoliosis, a lateral curvature of the spine, is the most frequent deformity of the spinal column. It is additionally aggravated by the inadequate environmental conditions in schools, such as unadjusted furniture, teaching aids and most of all, school bag and bad lighting. MATERIAL AND METHODS This investigation was carried out during the years 2005 and 2006 on the territory of the city of Kragujevac and included school children attending 22 primary and 8 secondary schools, whose medical records were obtained from school children health centres, the counseling centre for scoliosis at the Orthopedic Department of the Hospital in Kragujevac and the Institute of Public Health in Kragujevac. RESULTS The statistical analysis of these data showed that a significantly higher number of children with scoliosis was detected in 2005, being -chi2 = 11.6, p < 0.01 for primary schools. Scoliosis was more frequent in girls than in boys: in 2005 it was -chi2 = 10.54, p < 0.01 and in 2006 -chi2 = 10.72, p < 0.01 in primary schools, whereas no difference was found in secondary schools in 2005 -chi2 = 4.14, p > 0.05, but in 2006 scoliosis was more frequent in girls -chi2 = 49.51, p < 0.01. CONCLUSION Scoliosis is extremely important in both primary and secondary schools and therefore, it is necessary to intensify preventive systematic examinations of school children.