Experiences from integrating water and sanitation safety planning in small systems in rural Serbia.

The WHO recommends a risk management approach to ensure safe drinking-water and sanitation, so-called Water Safety Planning and Sanitation Safety Planning. However, applying these risk management approaches separately in small-scale drinking-water supply and sanitation systems might be challenging for rural communities with limited human, financial, and administrative resources. An integrated approach seems a better option. In this study, an integrated water and sanitation safety planning (iWSSP) approach was developed together with guidance and training material for the practical application of this novel approach. The integrated approach was piloted in three small systems in rural Serbia to identify benefits and suggestions for improvement which can be used for potential future scaling-up. Implementing iWSSP at the pilot sites contributed to a better understanding of both drinking-water supply and sanitation systems. It also resulted in increased awareness, knowledge, and understanding among staff of drinking-water supply and sanitation services. Key experts, including external facilitators, played a crucial role in the implementation of iWSSP. Future scaling-up of the integrated approach could be enabled if more guidance, easy-to-use training materials and templates become available which can be adapted and updated as needed.

Safety Assessment of Herbal Food Supplements: Elemental Profiling and Associated Risk.

Increased usage of herbal food supplements by both the paediatric and adult populations prompted a health risk assessment study. The elemental profiles of 52 supplements collected in Serbia were obtained using ICP-MS. The calculated contribution to permitted daily exposure was in compliance with the guidelines for elemental impurities: up to 46.8% for Pb (infants), 67.2% for Cu (toddlers), 6.8% for As (preschool children), and 8.0% for Hg (adolescents). Hazard quotients indicated high exposure of toddlers to Cu (100.9%) and Zn (112.7%), although by only one supplement, for which hazard indices ranged from 229 to 105% (aligning from toddlers to adolescents). Based on the margin of exposure, As and Pb were not of safety concern. Conversely, the proportion of supplements exceeding the acceptable level of lifetime cancer risk due to As exposure varied from 41.9% in adolescents to 54.3% in adults. Simultaneous use of multiple supplements over a prolonged period of time could further deepen health concerns.

Water, sanitation, and hygiene services in health care facilities in the Autonomous Province of Vojvodina, Serbia.

Provision of safe water, sanitation, and hygiene (WASH) services in health care facilities is a priority at the global, national, and local levels. To inform improvements planning, conditions of WASH, waste management, and environmental cleaning were assessed in 81 facilities in the Autonomous Province of Vojvodina, Serbia, as part of a nationally representative survey in 2019. The survey included on-site checks, structured interviews, and drinking-water quality analysis. WHO/UNICEF indicators for WASH service levels and an advanced service level defined at the national level were applied. The results showed that all investigated facilities provided basic water services; 94% of facilities provided basic hygiene and waste management services; 58 and 2%, respectively, provided basic cleaning and sanitation services. Only 1% of investigated facilities met the basic level for all five WASH dimensions. Advanced service levels were only met for hygiene, waste management, and/or cleaning in 15-38% of facilities. In 33% of health care facilities, drinking-water quality was not in compliance with the national standards. The results revealed that there is a need for increased awareness and efforts to ensure basic provisions for sanitation, environmental cleaning, and drinking-water safety.

Short-term health effects of air quality changes during the COVID­19 pandemic in the City of Novi Sad, the Republic of Serbia.

OBJECTIVES: The objective of this research is to determine the change in outdoor air quality during the COVID­19 related state of emergency resulting in a lockdown and the potential health benefits for the urban population. MATERIAL AND METHODS: During 53 days of the COVID­19 related state of emergency with a lockdown (March 15-May 6, 2020) in the Republic of Serbia, as well as in the corresponding periods of 2018 and 2019, data on the daily sulfur dioxide (SO2), nitrogen dioxide (NO2), ground-level ozone (O3) and particulate matter (PM10 and PM2.5) concentrations were analyzed. The total mortality data were analyzed to estimate the impact of the COVID­19 related lockdown measures on the burden of health in a given population, attributed to the outdoor air quality in the City of Novi Sad, using AirQ+ software. RESULTS: The average daily concentrations of PM2.5, NO2, PM10 and SO2 were reduced by 35%, 34%, 23% and 18%, respectively. In contrast, the average daily concentration of O3 increased by 8%, even if the primary precursors were reducing, thus representing a challenge for air quality management. In the City of Novi Sad, a reduction in the average daily PM2.5 concentration of 11.23 µg/m³ was significant, which resulted in a quantified number of avoided deaths. CONCLUSIONS: Air pollution in the City of Novi Sad had a chance to be improved due to some preventive measures related to the infectious disease (the COVID­19 related lockdown), which in turn was the mitigation measure to air pollution with positive public health effects. The confirmed positive effects of the improved air quality on public health could also include raising collective resistance to mass non-communicable and infectious diseases such as COVID­19 and reducing economic costs. Int J Occup Med Environ Health. 2021;34(2):223-37.

Impact of climate conditions on hospital admissions for subcategories of cardiovascular diseases.

BACKGROUND: The aim of this study has been to examine the association between climate conditions (CC) and hospital admissions for the subcategories of cardiovascular diseases (CVD), according to patients' age. MATERIAL AND METHODS: From January 2010 through December 2011, the daily number of hospital admissions for angina pectoris (AP), essential hypertension (EH), acute myocardial infarction (AMI) and ischemic heart diseases (IHD) for adults (19-64 years old) and the elderly (≥ 65 years old), as well as for the CC (N = 728 days) was collected for multivariate Poisson regression analysis, confounding with season and weekends. The results were expressed by using the relative risk with the corresponding 95% confidence interval. RESULTS: The risk for the AMI among the adults and the elderly is significantly higher for 41.8% and 38.9%, respectively on the days with lower ambient temperature and lesser for 32.7% and 29.8%, respectively on the days with lower air pressure values. The risk for the IHD among the elderly is significantly higher on the days with lower ambient temperature and lower relative humidity for 50.6% and 37.4%, respectively. CONCLUSIONS: Our findings explain how the CC and subcategories of CVD are associated, which could be used for adequate public awareness of the risk for hospitalization due to climate conditions. Med Pr 2017;68(2):189-197.

Testing for viral material in water of public bathing areas of the Danube during summer, Vojvodina, Serbia, 2014.

From August to September 2014 a water quality study was conducted on five popular public Danube beaches in Vojvodina, Serbia. To assess the safety of Danube water for bathing, physical, chemical, bacteriological tests were performed. While many parameters for monitoring the quality of water are regulated by law, there are neither national nor international legislations addressing the presence of viruses in recreational waters. In this study, we performed analyses that surpassed national requirements, and investigated if adenovirus, enterovirus or rotavirus genetic material was present in samples of recreational water collected for quality monitoring. Of 90 water samples obtained during the study, enterovirus material was not found in any sample, but adenovirus and rotavirus genetic materials were respectively detected in 60 and 31 samples. Statistical analyses showed a significant correlation between adenovirus DNA and total coliforms in the water. Even when water samples were adequate for recreational use, adenoviruses were detected in 75% (57/76) of such samples. Our results indicate that implementation of viral indicators in recreational water might be helpful to better assess public health safety. This might be particularly relevant in areas where urban wastewater treatment is insufficient and surface waters affected by wastewater are used for recreation.

Salt Content in Ready-to-Eat Food and Bottled Spring and Mineral Water Retailed in Novi Sad.

INTRODUCTION: Salt intake above 5 g/person/day is a strong independent risk factor for hypertension, stroke and cardiovascular diseases. Published studies indicate that the main source of salt in human diet is processed ready-to-eat food, contributing with 65-85% to daily salt intake. OBJECTIVE: The aim of this paper was to present data on salt content of ready-to-eat food retailed in Novi Sad, Serbia, and contribution of the salt contained in 100 g of food to the recommended daily intake of salt for healthy and persons with cardiovascular disease (CVD) risk. METHODS: In 1,069 samples of ready-to-eat food, salt (sodium chloride) content was calculated based on chloride ion determined by titrimetric method, while in 54 samples of bottled water sodium content was determined using flame-photometry. Food items in each food group were categorized as low, medium or high salt. Average salt content of each food group was expressed as a percentage of recommended daily intake for healthy and for persons with CVD risk. RESULTS: Average salt content (g/100 g) ranged from 0.36 ± 0.48 (breakfast cereals) to 2.32 ± 1.02 (grilled meat). The vast majority of the samples of sandwiches (91.7%), pizza (80.7%), salami (73.9%), sausages (72.9%), grilled meat (70.0%) and hard cheese (69.6%) had a high salt profile. Average amount of salt contained in 100 g of food participated with levels ranging from 7.2% (breakfast cereals) to 46.4% (grilled meat) and from 9.6% to 61.8% in the recommended daily intake for healthy adult and person with CVD risk, respectively. Average sodium content in 100 ml of bottled spring and mineral water was 0.33 ± 0.30 mg and 33 ± 44 mg, respectively. CONCLUSION: Ready-to-eat food retailed in Novi Sad has high hidden salt content, which could be considered as an important contributor to relatively high salt consumption of its inhabitants.

Cardiovascular diseases and air pollution in Novi Sad, Serbia.

OBJECTIVES: A large body of evidence has documented that air pollutants have adverse effect on human health as well as on the environment. The aim of this study was to determine whether there was an association between outdoor concentrations of sulfur dioxide (SO2) and nitrogen dioxide (NO2) and a daily number of hospital admissions due to cardiovascular diseases (CVD) in Novi Sad, Serbia among patients aged above 18. MATERIAL AND METHODS: The investigation was carried out during over a 3-year period (from January 1, 2007 to December 31, 2009) in the area of Novi Sad. The number (N = 10 469) of daily CVD (ICD-10: I00-I99) hospital admissions was collected according to patients' addresses. Daily mean levels of NO2 and SO2, measured in the ambient air of Novi Sad via a network of fixed samplers, have been used to put forward outdoor air pollution. Associations between air pollutants and hospital admissions were firstly analyzed by the use of the linear regression in a single polluted model, and then trough a single and multi-polluted adjusted generalized linear Poisson model. RESULTS: The single polluted model (without confounding factors) indicated that there was a linear increase in the number of hospital admissions due to CVD in relation to the linear increase in concentrations of SO2 (p = 0.015; 95% confidence interval (95% CI): 0.144-1.329, R(2) = 0.005) and NO2 (p = 0.007; 95% CI: 0.214-1.361, R(2) = 0.007). However, the single and multi-polluted adjusted models revealed that only NO2 was associated with the CVD (p = 0.016, relative risk (RR) = 1.049, 95% CI: 1.009-1.091 and p = 0.022, RR = 1.047, 95% CI: 1.007-1.089, respectively). CONCLUSIONS: This study shows a significant positive association between hospital admissions due to CVD and outdoor NO2 concentrations in the area of Novi Sad, Serbia.

Analysis of salt content in meals in kindergarten facilities in Novi Sad.

INTRODUCTION: Investigations have brought evidence that salt intake is positively related to systolic blood pressure and that children with higher blood pressure are more susceptible to hypertension in adulthood. In developed countries the main source of salt is processed food. OBJECTIVE: The aim of this paper was to determine total sodium chloride (NaCl) in average daily meal (breakfast, snack and dinner) and in each of three meals children receive in kindergarten. METHODS: From kindergarten, in the meal time, 88 samples of daily meals (breakfast, snacks and dinner) offered to children aged 4-6 years were taken. Standardized laboratory methods were applied to determine proteins, fats, ash and water in order to calculate energy value of meal. The titrimetric method with AgNO3, and K2CrO4 as indicator, was applied in order to determine chloride ion. Content of NaCl was calculated as %NaCl = mlAgNO3 x 0.05844 x 5 x 100/g tested portion. NaCl content in total daily meal and each meal and in 100 kcal of each meal was calculated using descriptive statistical method. Student's t-test was applied to determine statistical differences of NaCl amount among meals. RESULTS: NaCl content in average daily meal was 5.2 +/- 1.7 g (CV 31.7%), in breakfast 1.5 +/- 0.6 g (CV 37.5%), in dinner 3.5 +/- 1.6 g (CV 46.1%) and in snack 0.3 +/- 0.4 g (CV 163.3%). NaCl content per 100 kcal of breakfast was 0.4 +/- 0.1 g (CV 29.5%), dinner 0.7 +/- 0.2 g (CV 27.8%) and snack 0.13 +/- 0.19 g (CV 145.8%). The difference of NaCl content among meals was statistically significant (p < 0.01). CONCLUSION: Children in kindergarten, through three meals, received NaCl in a quantity that exceeded internationally established population nutrient goal for daily salt intake. The main source of NaCl was dinner, a meal that is cooked at place.

How a routine checking of Escherichia coli in retailed food of animal origin can protect consumers against exposition to Campylobacter spp. and Listeria monocytogenes?

BACKGROUND/AIM: According to the literature that has been published over the last two decades Campylobacter spp i Listeria monocitogens can be identified as causes of numerous diseases derived by consuming food of animal origin. The purpose of this paper was to find out how established national microbiological criteria of the Republic of Serbia on food safety in retailed food of animal origin could contribute to consumer's protection against exposition to foodborne pathogens such as Campylobacter spp. and Listeria monocytogenes. METHODS: During a routine microbiological safety control of randomly selected 60 samples of fresh poultry meat, 30 samples of other fresh meat readymade for grilling, 30 samples of sausage products, 37 samples of heat-treated meat, 39 samples of toppings for fast food of animal origin and 31 samples of dairy products a national food safety criteria (Escherichia coli, aerobic plate count, Salmonella spp., coagulasa positive Staphylococcus, Proteus spp., sulphito-reducting Clostridia) were applied and, as well as, testing to Campylobacter spp. and Listeria monocitogens. In determination of Campylobacter spp. and Listeria monocytogenes, food quality control methods of the Food and Agriculture Organization (FAO) were applied, while in determination of the other above motioned bacteria, national provisions on microbiological methods were applied who are adjusted to the FAO ones. RESULTS: Related to the national criteria on microbiological food safety, 88 (38.8%) samples, out of the total 227 tested, were rejected. When to these results, the results of laboratory tests on Listeria monocytogens were added, a terminal number of rejected samples were not changed. When to these results, the results of Campylobacter spp. testing were added, 91 (40.1%) out of the 227 samples were unsatisfied. Results of logistic regression model with occurrence of Escherichia coli as dependent variable indicated that Escherichia coli was 4.5 times likely to occur among samples with Campylobacter spp. than among samples without Campylobacter spp. (OR = 4.515, 95% CI: 1.019-20.002). Sensitivity of the fitted model (Hosmer-Lemeshowp = 0.268) was 76.8% and its specificity was 75.0%. At the same time Escherichia coli was confound in all (100%) food samples that were contaminated by Listeria monocytogenes. CONCLUSION: Statistical analysis indicated that Escherichia coli was completely sensitive to identify all samples contaminated with Listeria monocytogenas and highly sensitive to identify samples contaminated with Campylobacter spp. Nevertheless, 3 (1.3%) of the tested samples were not covered with Escherichia coli.

[Health and environment].

INTRODUCTION: The Department of Hygiene, Faculty of Medicine, University of Novi Sad, is responsible for undergraduate and graduate courses in the field of preventive medicine. The principal task of physicians in the 21st century is to provide health promotion and desease prevention. In the future, evaluation of physician knowledge and competence will be predominantly based on patients' health conditions. HEALTH AND ENVIRONMENT: Human health is a result of long-term interaction between human genome and the environment. Good human health requires permanent control of health conditions as well as control of environmental health hazards. Various environmental factors, such as physical, chemical, biological, social and economic, affect the population health. Air, drinking water and food are fundamental to the existence of life of all living beings on Earth, and therefore they have enormous influence on the health of individuals and populations. CONCLUSION: The significance of the above mentioned requirements, essential for human health, is the reason why the Department of Hygiene conducted an investigation on the quality of air, food and water (water is a foodstuff as well) in Vojvodina.