Relationship between socioeconomic and nutritional status in the Serbian adult population: a cross-sectional study

ABSTRACT BACKGROUND: Socioeconomic status is a well-known risk factor for obesity. The aim of this study was to assess the relationship between socioeconomic and nutritional status in the Serbian adult population. DESIGN AND SETTING: Cross-sectional study on data from the 2013 National Health Survey performed in Serbia. METHODS: The study population consisted of adults aged ≥ 20 years. Face-to-face interviews and anthropometric measurements were conducted by trained staff. Associations between body mass index and sociodemographic variables were analyzed using multivariable logistic regression analyses. RESULTS: Out of 12,461 subjects of both sexes, 36.4% were overweight and 22.4% were obese. The prevalences of overweight and obesity differed significantly between the sexes, regarding all sociodemographic characteristics. Among women, educational attainment was associated with lower risk of being overweight (odds ratio, OR = 0.82; 95% confidence interval, CI: 0.69-0.98 for medium-level and OR = 0.77; CI: 0.62-0.97 for higher education) or obese (OR = 0.68; CI: 0.57-0.82 for medium-level and OR = 0.41; CI: 0.31-0.54 for higher education). In contrast, medium-level (OR = 1.28; CI: 1.08-1.52) and highly educated men (OR = 1.39; CI: 1.11-1.74) were more frequently overweight than were those with low education. Among men, grade I obesity was positively related to the richest wealth index group (OR = 1.27), while the opposite was true for grade II obesity among women (OR = 0.61). CONCLUSION: This study showed significant socioeconomic inequalities in nutritional status between men and women. Continuous monitoring of socioeconomic patterns relating to weight is important, especially with further exploration of the link between education and obesity.

Changes in morphological characteristics during the period 2005 ­ 2014 in a sample of Serbian 7 - year-old children / Cambios en las características morfológicas durante el período 2005 - 2014 en una muestra de niños serbios de 7 años de edad

Morphological characteristics of children commonly imply the processes of growth and development. Information on children's growth in height and their body weight is often used as the indicator of the children's health and nutritional status. As the parameters are changeable both temporally and spatially, it is important to provide their continual assessment. The aim of the study is to investigate the changes in morphological characteristics in a sample of Serbian 7-year-old children in the period 2005 ­ 2014. The data was gathered from medical documentation recorded in the period 2005-2014 in the local health-care centre "Dr Dusan Savic­ Doda" in Beocin, which is situated in the central part of the province Vojvodina, the north-west part of Serbia. Most of the population consists of Serbs (69.7 %), and the second largest group are Roma (9 %) who came to this region in the 1990s as refugees from Kosovo. The categorization of the participants was based on their decimal age ranging from 6.50 to 7.49 years. Body height and weight were measured, and nutritional status categories were set in relation to the cut off values of body mass index (BMI) of the age of 7 (kg/m2) as proposed by IOTF- International Obesity Task Force. The study has pointed to an increasing trend in height and a decrease of BMI. Analysing the period of ten years, the height, weight and BMI in seven-year-olds living on the territory on Beocin municipality have proven to be slightly lower than in the children of the same age in other parts of Vojvodina and Serbia. The obtained results point to the need of further investigations of children living in this region in order to provide a better insight into the changes of the morphological parameters.

Las características morfológicas de los niños suelen implicar los procesos de crecimiento y desarrollo. La información sobre el crecimiento de los niños en altura y peso corporal se utiliza a menudo como el indicador de su salud y de su estado nutricional. Como los parámetros son cambiantes tanto temporalmente como espacialmente, es importante realizar una evaluación continua. El objetivo del estudio fue investigar los cambios en las características morfológicas en una muestra de niños serbios de 7 años en el período 2005-2014. Los datos se obtuvieron de la documentación médica registrada en el período 2005-2014 en el Centro de Atención de Salud "Dr Dusan Savic - Doda" en Beocin, situado en la region central de la provincia Vojvodina, al Noroeste de Serbia. La mayor parte de la población se compone de serbios (69,7 %) y el segundo grupo más grande son los romaníes (9 %) que llegaron a esta región en la década de 1990 como refugiados de Kosovo. Los participantes fueron clasificados en base a su edad decimal de 6,50 a 7,49 años. Se midió la estatura y el peso corporal y se establecieron las categorías de estado nutricional en relación con los valores de corte del índice de masa corporal (IMC) de 7 años de edad (kg / m2), según lo propuesto por IOTF International Obesity Task Force. El estudio ha señalado una tendencia creciente en altura y una disminución del IMC. Analizando el período de diez años, la altura, el peso y el IMC en niños de siete años que viven en el territorio del municipio de Beocin han demostrado ser ligeramente más bajos que en los niños de la misma edad en otras areas de Vojvodina y Serbia. Los resultados obtenidos apuntan a la necesidad de nuevas investigaciones de los niños que viven en esta región con el fin de proporcionar una mejor visión de los cambios en los parámetros morfológicos.

Analysis of risk factors and clinical manifestations associated with Clostridium difficile disease in Serbian hospitalized patients

Abstract Clostridium difficile is the leading cause of infectious diarrhoea in hospitalized patients. The aim of this study was to determine the risk factors important for the development of hospital-acquired Clostridium difficile-associated disease and clinical manifestations of Clostridium difficile-associated disease. The clinical trial group included 37 hospitalized patients who were selected according to the inclusion criteria. A control group of 74 hospitalized patients was individually matched with cases based on hospital, age (within 4 years), sex and month of admission.Clostridium difficile-associated disease most commonly manifested as diarrhoea (56.76%) and colitis (32%), while in 8.11% of patients, it was diagnosed as pseudomembranous colitis, and in one patient, it was diagnosed as fulminant colitis. Statistically significant associations (p < 0.05) were found with the presence of chronic renal failure, chronic obstructive pulmonary disease, cerebrovascular accident (stroke) and haemodialysis. In this study, it was confirmed that all the groups of antibiotics, except for tetracycline and trimethoprim-sulfamethoxazole, were statistically significant risk factors for Clostridium difficile-associated disease (p < 0.05). However, it was difficult to determine the individual role of antibiotics in the development of Clostridium difficile-associated disease. Univariate logistic regression also found that applying antibiotic therapy, the duration of antibiotic therapy, administration of two or more antibiotics to treat infections, administering laxatives and the total number of days spent in the hospital significantly affected the onset of Clostridium difficile-associated disease (p < 0.05), and associations were confirmed using the multivariate model for the application of antibiotic therapy (p = 0.001), duration of antibiotic treatment (p = 0.01), use of laxatives (p = 0.01) and total number of days spent in the hospital (p = 0.001). In this study of patients with hospital-acquired diarrhoea, several risk factors for the development of Clostridium difficile-associated disease were identified.

Characteristics of gonorrhea and syphilis cases among the Roma ethnic group in Belgrade, Serbia

Abstract Background The Roma ethnic group is the largest and most marginalized minority in Europe, believed to be vulnerable to sexually transmitted infections. Aim The purpose of the study was to investigate frequency and characteristics of gonorrhea and syphilis among the Roma population in Belgrade. Methods Data from the City Institute for Skin and Venereal Diseases to which all gonorrhea and syphilis cases are referred were analyzed. Results During the period of 2010–2014 sexually transmitted infections were more frequent among Roma than in rest of Belgrade population. Average percentages of Roma among all reported subjects with syphilis and those with gonorrhea were 9.6% and 13.5%, respectively, while the percentage of Roma in the total Belgrade population was about 1.6%. Roma with syphilis and gonorrhea were more frequently men (75%), most frequently aged 20–29 years (43.4%), never married (64.5%), with elementary school or less (59.2%), unemployed (80.3%), and heterosexual (89.5%). Among Roma 10.5% were sex workers and 68.4% did not know the source of their infection. Significant differences between Roma cases and other cases in Belgrade in all characteristics observed were in agreement with differences between Roma population and the total population of Serbia. Conclusion The present study confirmed the vulnerability of the Roma population to sexually transmitted infections.

Administering the Sarcoidosis Health Questionnaire to sarcoidosis patients in Serbia / Aplicação do Sarcoidosis Health Questionnaire em pacientes com sarcoidose na Sérvia

Objective: The aim of this study was to use a Serbian-language version of the disease-specific, self-report Sarcoidosis Health Questionnaire (SHQ), which was designed and originally validated in the United States, to assess health status in sarcoidosis patients in Serbia, as well as validating the instrument for use in the country. Methods: This was a cross-sectional study of 346 patients with biopsy-confirmed sarcoidosis. To evaluate the health status of the patients, we used the SHQ, which was translated into Serbian for the purposes of this study. We compared SHQ scores by patient gender and age, as well as by disease duration and treatment. Lower SHQ scores indicate poorer health status. Results: The SHQ scores demonstrated differences in health status among subgroups of the sarcoidosis patients evaluated. Health status was found to be significantly poorer among female patients and older patients, as well as among those with chronic sarcoidosis or extrapulmonary manifestations of the disease. Monotherapy with methotrexate was found to be associated with better health status than was monotherapy with prednisone or combination therapy with prednisone and methotrexate. Conclusions: The SHQ is a reliable, disease-specific, self-report instrument. Although originally designed for use in the United States, the SHQ could be a useful tool for the assessment of health status in various non-English-speaking populations of sarcoidosis patients.

Objetivo: O objetivo deste estudo foi utilizar uma versão no idioma sérvio do Sarcoidosis Health Questionnaire (SHQ), um questionário de autorrelato doença-específico, concebido e originalmente validado nos EUA, para verificar o estado de saúde de pacientes com sarcoidose na Sérvia, além de validar o instrumento para uso no país. Métodos: Estudo transversal com 346 pacientes com sarcoidose confirmada por biópsia. Para avaliar o estado de saúde dos pacientes, utilizamos o SHQ, o qual foi traduzido para o sérvio para os propósitos deste estudo. Comparamos os escores do SHQ por gênero, idade, duração da doença e tratamento. Escores do SHQ mais baixos indicam pior estado de saúde. Resultados: Os escores do SHQ demonstraram diferenças no estado de saúde entre os subgrupos de pacientes avaliados. O estado de saúde foi significativamente pior entre as mulheres e pacientes mais velhos, assim como entre aqueles com sarcoidose crônica ou com manifestações extrapulmonares da doença. A monoterapia com metotrexato associou-se com melhor estado de saúde do que a monoterapia com prednisona ou a terapia combinada com prednisona e metotrexato. Conclusões: O SHQ é um instrumento de autorrelato doença-específico confiável. Embora originalmente concebido para uso nos EUA, o SHQ pode ser uma ferramenta útil na avaliação do estado de saúde de populações de pacientes com sarcoidose em vários países de língua não inglesa.

Healthy Eating Habits among the Population of Serbia: Gender and Age Differences.

The purpose of the study is to examine healthy eating habits of the population of Serbia through three dimensions: knowledge, problems, and feelings as well as to determine whether there are any differences between genders and among different age-groups. The research instrument was an Eating Habits Questionnaire (EHQ) which consisted of 35 items. There were 382 respondents involved in the study. The reliability and factor structure of the questionnaire were verified by using factor analysis. The results of MANOVA showed that there is a significant difference in the habits concerning healthy eating between men and women [F (3,378)=4.26, p=0.006; Wilks’ Lambda=0.97]. When the results for the dependent variables (knowledge, problems, and feelings) were considered separately, it was determined that there is no significant difference between men and women, which confirms the results of the t-test. The effect of age on the three dimensions of healthy eating habits was examined within three age-groups, by using ANOVA. The results showed that knowledge about healthy eating increases with age [F (2,379)=6.14, p=0.002] as well as positive feelings which occur as a result of healthy eating [F (2,379)=3.66, p=0.027]. Unlike ANOVA, MANOVA showed difference among the age-groups only when it came to the ‘knowledge’ variable. This study is important as it shows the current state of awareness on healthy eating habits in the researched populace and may be the basis for further research in this field in Serbia.

Eating Habits and Body-weights of Students of the University of Belgrade, Serbia: A Cross-sectional Study.

The purpose of this survey was to quantify the prevalence of overweight and obesity among a sample of students in Belgrade University, Serbia and to describe their main eating habits. A total of 1,624 questionnaire responses were analyzed (response rate 97.3%). The students were recruited during mandatory annual check-ups in April-June 2009. All subjects completed the questionnaire; height (in cm) and weight (in km) were measured by two physicians. Results were assessed statistically. Almost every fourth male student was overweight. Strikingly, 15% of female students were underweight. Highly-significant difference was found between average body mass index (BMI) of male and female students (F=317.8, p=0.001). Students’ BMI did not correlate with average family income or with the frequency of taking breakfast (p=-0.064, p=0.152 for males and ρ=0.034, p=0.282 for females respectively). There is a growing demand for global health strategies which would encourage healthy body-image and figure; thus, these initiatives should mobilize the society on a national and international level.

Body height and its estimation utilizing arm span measurements in Serbian adults / Altura corporal y su estimación utilizando mediciones de envergadura en adultos serbios

Anthropologists recognized the tallness of nations in the Dinaric Alps long time ago. As the modern Serbians fall more into the Dinaric racial classification than any other does, the purpose of this study was to examine the body height in Serbian adults as well as the relationship between arm span as an alternative to estimating the body height, which vary in different ethnic and racial groups. The nature and scope of this study analyzes 394 students (318 men, aged 20.13±1.47 and 76 women, aged 19.59±1.46) from the University of Novi Sad to be subjects. The anthropometric measurements were taken according to the protocol of the ISAK. Means and standard deviations were obtained. A comparison of means of body heights and arm spans within each gender group and between genders were carried out using a t-test. The relationships between body height and arm span were determined using simple correlation coefficients and their 95% confidence interval. Then a linear regression analysis was performed to examine the extent to which the arm span can reliably predict body height. The results have shown that male Serbians are 181.96±6.74 cm tall and have an arm span of 184.78±8.41 cm, while female Serbians are 166.82±5.88 cm tall and have an arm span of 164.67±8.09 cm. Compared to other studies, the results of this study have shown that both genders make Serbian population one of the tallest nations on the earth. Moreover, the arm span reliably predicts body height in both genders. However, the estimation equations, which were obtained in Serbians, are substantially different alike in other populations, since arm span was close to body heights: in men 2.82±4.89 cm more than the body height and in women 2.15±4.68 cm less than the body height. This confirms the necessity for developing separate height models for each population.

Los antropólogos estimaron la altura de las naciones en los Alpes Dináricos hace mucho tiempo. Como los Serbios modernos caen en la clasificación racial de Dináricos, el propósito de este estudio fue examinar la altura corporal en adultos serbios, así como la relación con la longitud de la envergadura de brazo a brazo como una alternativa a la estimación de la altura corporal, que varía en los diferentes grupos étnicos y raciales. Se analizó a 394 estudiantes (318 hombres y 76 mujeres, con edades entre 20,13±1,47 años y 19,59±1,46 años, respectivamente) de la Universidad de Novi Sad. Las medidas antropométricas fueron tomadas de acuerdo con el protocolo de ISAK, obteniendo Medias y DE. La comparación de la media de altura corporal y envergadura dentro de cada grupo y entre sexos se realizó con la prueba t. Las relaciones entre estatura y envergaduras se determinaron mediante coeficientes de correlación simple, con un intervalo de confianza del 95%. También se realizó un análisis de regresión lineal para examinar el grado en que la envergadura puede prever con exactitud la altura corporal. Los resultados mostraron que los hombres Serbios tienen una altura de 181,96±6,74 cm, y una envergadura de 184,78±8,41 cm, mientras que las mujeres una altura de 166,82±5,88 cm y una envergadura de 164,67±8,09 cm. En comparación con otros estudios, estos resultados demuestran que para ambos sexos, la población Serbia es una de las más altas. Por otra parte, la envergadura predice confiablemente la altura corporal en ambos sexos. Sin embargo, las ecuaciones de estimación obtenidas en esta población son sustancialmente diferentes a otras poblaciones, ya que la envergadura fue cercana a la altura corporal: en hombres 2,82±4,89 cm mayor a la altura corporal y en mujeres 2,15±4,68 cm menor a ésta. Esto confirma la necesidad de desarrollar diferentes modelos de para determinar la altura en cada población.

Skeletal Manifestations of Hydatid Disease in Serbia: Demographic Distribution, Site Involvement, Radiological Findings, and Complications

Although Serbia is recognized as an endemic country for echinococcosis, no information about precise incidence in humans has been available. The aim of this study was to investigate the skeletal manifestations of hydatid disease in Serbia. This retrospective study was conducted by reviewing the medical database of Institute for Pathology (Faculty of Medicine in Belgrade), a reference institution for bone pathology in Serbia. We reported a total of 41 patients with bone cystic echinococcosis (CE) during the study period. The mean age of 41 patients was 40.9+/-18.8 years. In 39% of patients, the fracture line was the only visible radiological sign, followed by cyst and tumefaction. The spine was the most commonly involved skeletal site (55.8%), followed by the femur (18.6%), pelvis (13.9%), humerus (7.0%), rib (2.3%), and tibia (2.3%). Pain was the symptom in 41.5% of patients, while some patients demonstrated complications such as paraplegia (22.0%), pathologic fracture (48.8%), and scoliosis (9.8%). The pathological fracture most frequently affected the spine (75.0%) followed by the femur (20.0%) and tibia (5.0%). However, 19.5% of patients didn't develop any complication or symptom. In this study, we showed that bone CE is not uncommon in Serbian population. As reported in the literature, therapy of bone CE is controversial and its results are poor. In order to improve the therapy outcome, early diagnosis, before symptoms and complications occur, can be contributive.

Trend of Antibiotic Resistance in Children with First Acute Pyelonephritis.

There have been many recent reports of increasing antimicrobial resistance among uropathogens. In this study, we reviewed medical records of children (<18 yr age) with first acute pyelonephritis admitted to our Institution between January 2005 to December 2009. 411 children (189 girls) were studied and increasing trend in bacterial resistance toward co-trimoxazole, 2nd and 3rd generation cephalosporins and gentamicin were observed.

Correlation between Fitness and Fatness in 6-14-year Old Serbian School Children.

Lack of physical activity and/or physical fitness are some reasons epidemiologists suggest for increase in childhood obesity in the last 20 years, with clear correlation between body composition and physical activity and/or physical fitness yet to be determined. The objectives of the study were to (a) investigate the prevalence of overweight and obesity among Serbian school children and (b) determine the relationship between indicators of physical activity and body fatness in Serbian school children aged 6-14 years. The study subjects included a representative sample of Serbian elementary school children (n=1,121—754 boys and 367 girls—aged 6.2-14.1 years), all of whom were recruited in the OLIMP (Obesity and Physical Activity among Serbian School Children) study. Anthropometric and physical fitness values, including body mass index (BMI), waist-circumference, body-fat, and aerobic capacity, were measured in all the children. Significant differences were found between male and female children regarding the prevalence of obesity (6.8% vs 8.2%, p<0.05, boys and girls respectively). Boys had significantly lower body mass, BMI, waist-circumference, sum of six skinfolds, and body-fat compared to their female counterparts (p<0.05). The highest level of weight, BMI, body-fat, and waist-circumference observed in a 14-year old girl (96.3 kg, 40.5 kg/m2, 54.5%, 91.4 cm respectively) implies the existence of extreme obesity in Serbian school children. The negative relationship between body-fat and maximal oxygen (VO2max) uptake was moderately high (r=-0.76; p<0.05). The study has shown a high prevalence of adiposity among Serbian school children, with a strong negative relationship between aerobic fitness and body fatness. Data of the study emphasize the necessity to identify children with weight problems and to develop early interventions to improve physical activity in children and prevent the increase of childhood obesity.

Toxoplasmose como assunto de saúde pública na Sérvia: [revisão] / Toxoplasmosis as a public health issue in Serbia: [review]

Aims: To review the significance of toxoplasmosis as a public health issue in Serbia, and analyze the current strategies to alleviate the burden of the disease. Source of data: Relevant clinical and epidemiological reports from Serbia published since 1975. Summary of findings: Despite 50 years of continuous work on Toxoplasma gondii and toxoplasmosis in Serbia, exact data on the frequency of acute clinical disease, acute infections in pregnancy and congenital infection in the offspring are still lacking, due to the vague legal provision that toxoplasmosis is subject to reporting ?in case of epidemiological indications?. What, however, is clear is that the major Toxoplasma-induced public health issue in Serbia, like elsewhere in Europe, is congenital toxoplasmosis. Continuous monitoring of particular patient groups showed a dramatic decrease in the prevalence of infection over the past two decades, and a consequently increased proportion of women susceptible to infection in pregnancy, suggesting a potential increase in the incidence of congenital toxoplasmosis. Studies of risk factors for infection transmission have provided data to guide national health education campaigns. Conclusions: It is expected that the recent appointment of the National Reference Laboratory for Toxoplasmosis as the focal point for the collection of data from the primary level, will provide the means for accurate assessment of the measure of the problem, which is a prerequisite of an evidence-based nation-wide prevention program. In the mean time, health education of all pregnant women, focused at risk factors of major local significance, is advocated as a sound and financially sustainable option to reduce congenital toxoplasmosis.