Tatjana Gazibara

Health in middle-aged and elderly women: a conceptual framework for ‘healthy menopause’

Middle-aged and elderly women constitute a large and growing proportion of the population. The peri and postmenopausal period constitutes a challenging transition time for womens health, and menopausal health is a crucial aspect in healthy and successful aging. Currently, no framework for the concept of healthy menopause exists, despite its recognized importance. Therefore, we aimed to: (i) characterize healthy menopause; (ii) identify aspects that contribute to it; and (iii) explore potential approaches to measure it. We propose healthy menopause as a dynamic state, following the permanent loss of ovarian function, which is characterized by self-perceived satisfactory physical, psychological and social functioning, incorporating disease and disability, allowing the attainment of a womans desired ability to adapt and capacity to self-manage. The concept of healthy menopause applies to all women from the moment they enter the menopausal transition, up until they reach early and late postmenopause and includes women with spontaneous, iatrogenic, and premature menopause. This conceptualization can be considered as a further step in the maintenance and improvement of health in menopausal women from different perspectives, foremost the womans own perspective, followed by the clinical, public health, and societal perspectives, and can be seen as a further step in delineating lines for future research. Furthermore, it could facilitate the improvement of adequate preventive and treatment strategies, guide scientific efforts, and aid education and communication to health care practitioners and the general public, allowing women the achievement of their potential and the fulfillment of their fundamental role in society.

Circumstances of falls and fall-related injuries among patients with Parkinson's disease in an outpatient setting

Falls represent continuing, disabling and costly problem in Parkinsons disease (PD). The study was carried out at the Neurology Clinic in Belgrade from August 2011 to December 2012. As many as 180 community dwelling persons with PD aged 22-83 years who sustained a fall in past 6 months were included. Characteristics of the most recent fall were obtained through detailed interviews. Inclusion criteria were: Mini Mental State Examination (MMSE)≥24, ability to walk independently for at least 10 m and ability to statically stand for at least 90 s. Exclusion criteria were: presence of other neurologic as well as psychiatric, visual, audio-vestibular and orthopedic impairments. Falls more frequently took place outside (57.2%) and in the morning (53.9%). As much as 38.9% of persons with PD sustained an injury. Soft-tissue contusion was the most common injury (71.8%) both after indoor and outdoor falls. Fractures accounted for 5% of all fall-related injuries. All the fractures were either arm, clavicle or rib fractures. Tripping was identified as risk factor for outdoor falls (OR=7.90; 95% confidence interval [95% CI] 3.21-19.39; p=0.001). In contrast, lower extremity weakness (OR=0.20; 95% CI 0.05-0.72; p=0.015) and internal sense of sudden loss of balance (OR=0.19; 95% CI 0.05-0.73; p=0.015) were risk factors for indoor falls. To accomplish long-term results, development of particular prevention programs for persons with PD who fall at home vs. outdoors is recommended.

Associations of maternal and fetal 25-hydroxyvitamin D levels with childhood lung function and asthma: the Generation R Study

Exposure to low levels of vitamin D in fetal life might be a risk factor for childhood asthma.

Parental knowledge, attitudes, and behaviors towards children with epilepsy in Belgrade (Serbia).

OBJECTIVE The aim of our study was to assess knowledge, attitudes, and behaviors of parents whose children were diagnosed with epilepsy. METHODS This cross-sectional study included 213 consecutive parents who accompanied their children, diagnosed with epilepsy, at regular checkups in the outpatient department of the Child and Adolescent Neurology and Psychiatry Clinic in Belgrade. Data were obtained through a questionnaire before completion of the childs neurological checkup, while clinical parameters of children with epilepsy were taken from medical records. RESULTS Almost all respondents knew that epilepsy is not an infectious disease (99.5%), while the least proportion of parents (31.9%) knew that epilepsy is not, for the most part, hereditary. Parents felt that their family and friends should know that their child is suffering from epilepsy (average score: 4.3 out of 5). Also, parents felt the most confident in taking care of their child during seizures (4.7 out of 5), while they felt the least confident in letting their child go on school trips for several days (3.4 out of 5). Parental longer schooling (i.e., higher education level) was an independent predictor of higher epilepsy knowledge. Taking less number of medications was an independent predictor of more supportive parental behavior towards children with epilepsy. CONCLUSION Some epilepsy-related issues still require improvement in parental knowledge. Ensuring education and support at community and school levels for both parents and children with epilepsy should be the principal goal of health-care service.

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.

Fall frequency and risk factors in patients with Parkinson's disease in Belgrade, Serbia: A cross‐sectional study

The aim of the present study was to estimate fall frequency as well as demographic and clinical factors related to falling in a cohort of Serbian patients with Parkinsons disease (PD).

Validation and cross-cultural adaptation of the Falls Efficacy Scale in patients with Parkinson's disease in Serbia.

The aim of the present study was to assess the validity and reliability of the Falls Efficacy Scale (FES) in Parkinsons disease (PD) patients in Serbia.

Incidence and prediction of falls in Parkinson’s disease: a prospective cohort study

Falls represent continuing, disabling and costly problem in Parkinson’s disease (PD) [1]. In a long-term prospective study of PD patients, after 20 years of follow-up, at least one fall occurred in 81 % of participants of whom 23 % sustained a fracture [2]. Fall-related burden in PD has substantial impact on activity limitations, participation restrictions, social isolation or premature mortality [3]. Various studies have indicated that age, longer disease duration, advanced stages of the disease, poor balance, freezing of gait, lower extremity weakness, fear of falling and depression, were independently associated with falling in PD [1]. However, precise quantification of risk for falling in PD is still missing. Previous studies dealing with the risk factors for falls in PD expressed incidence by means of incidence proportions [1]. At the same time, the concept of person-time at risk of falling, that includes individual contribution of observed time during which falls occurred, has been missing. In our previous cross-sectional study, we identified selfperceived disability level measured by the Self-Assessment Disability Scale (SADS) and the Unified Parkinson’s Disease Rating Scale (UPDRS) score of C69 to be independently associated with falling in PD [4]. The aim of this prospective cohort study was to quantify incidence rates and individual risk for falls among persons with PD. From August 15, 2011 to December 15, 2012, 300 consecutive patients with PD were recruited at regular check-ups at the Department of Movement Disorders, Neurology Clinic CCS in Belgrade. The diagnosis of PD was made in accordance with the United Kingdom Parkinson’s Disease Society Brain Bank criteria [5]. Inclusion criteria were: (a) the Mini Mental State Examinations score of C24, (b) ability to walk independently for at least 10 m and (c) ability to stand for at least 90 s. Exclusion criteria comprised the presence of other neurologic, psychiatric, visual, audio-vestibular and orthopedic disorders. The study was approved by the Ethical Committee of Faculty of Medicine of the University of Belgrade. A fall was defined as any occasion on which the patients found themselves unintentionally on the floor, ground or any other lower surface regardless of cause of fall or whether they sustained an injury. At baseline assessment persons with PD were asked whether or not they sustained a fall in the past 6 months. Those who denied falling in past 6-month period were followed during the following year (n = 120) (Fig. 1). Demographic and clinical data were acquired though detailed interviews with patients, as well as from their medical charts. Dosages of levodopa were calculated based upon the systematic review of levodopa dose equivalency reporting in PD. Subjects were evaluated with the new version of the UPDRS, divided in 4 subscores: UPDRS I (non-motor aspects of PD), II (activities of daily living), III (motor examinations) and IV (motor complications). The staging of PD was obtained by the Hoehn and Yahr (HY) system. The Falls Efficacy Scale (FES) was applied to estimate fear of falling and the SADS to quantify the level of difficulty while performing activities of daily living [6, 7]. Additionally, the New Freezing of Gait (NFOG) & Vladimir S. Kostic vladimir.s.kostic@gmail.com

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.

MSQoL-54 predicts change in fatigue after inpatient rehabilitation for people with multiple sclerosis

Purpose: The aim of our study was to investigate the impact of a short-term inpatient rehabilitation program on fatigue in patients with multiple sclerosis (MS) and to assess whether the scales of Multiple Sclerosis Quality of Life 54 (MSQoL-54) could predict change in fatigue after rehabilitation. Method: Included in the study were 151 moderately disabled MS patients admitted for 3 weeks of inpatient rehabilitation. Fatigue (Fatigue Severity Scale; FSS) was assessed at baseline and after treatment, and quality of life (MSQoL-54), disability (Expanded Disability Status Scale; EDSS) and depression (Beck Depression Inventory; BDI) were estimated at baseline. Results: Sixty-four percentage of the subjects showed fatigue. Both EDSS (r = 0.720, p = 0.001) and BDI (r = 0.655, p = 0.001) scores showed statistically significant positive correlation with FSS scores. Significant negative correlation was demonstrated between FSS and both, Physical Health Composite (PHC) and Mental Health Composite (MHC) scores of MSQoL-54 (r = −0.770, p = 0.001, and r = −0.646, p = 0.001, respectively). The mean FSS score significantly decreased by 0.19 ± 0.29 points in the fatigue group, immediately after rehabilitation. The multiple regression analyses with change of FSS as dependent variable and baseline scores of MSQoL-54 as independent variables showed statistically significant relation between change in fatigue and baseline PHC score (p = 0.034). Conclusions: Inpatient rehabilitation decreased MS patients’ fatigue. Change in fatigue was predicted with certain domains of QoL at baseline. Implications for Rehabilitation The rehabilitation programmes which comprise physiotherapy (physical input) and verbal interactions with people with multiple sclerosis (MS) (non-physical input) improve fatigue in this study. Predictive value of certain quality of life domains on change in fatigue status could suggest that the way in which people interpret their symptoms, may have a significant impact on the effect of rehabilitation interventions for fatigue in MS. The assessment of the baseline quality of life may be useful in decision-making before undergoing rehabilitation therapy and could help in the process of guiding individualized rehabilitation programmes in this cohort.