HIV-related knowledge, attitudes and practice among health care workers in Montenegro.

The objective of the present study was to assess HIV-related knowledge, attitudes, and practice of health care workers (HCWs) in Montenegro. A cross-sectional study was conducted in the University Clinical Centre of Montenegro in Podgorica. A self-administered anonymous questionnaire was used for data collecting. Out of 526 HCWs, 422 were included in the survey and response rate was 80%. An insufficient level of knowledge on HIV transmission and the risk after exposure was observed generally, although the knowledge was better in physicians compared to other HCWs categories. A rather high proportion of HCWs showed inappropriate attitude regarding the need of HIV testing of all hospitalized patients (64.7%) and obligation of HIV+ patient to report his/her HIV status (88.9%) in order to practice universal precaution. Additionally, 6.2% HCWs would refuse to treat an HIV+ patient. More than a half (55.7%) of study participants were educated in HIV/AIDS and 15.9% of them were HIV tested. Majority of HCWs (67.5%) always applied universal precautions during their daily work with patients. In spite of applying protective devices, number of accidents was great. A continuous education is necessary to increase the level of knowledge of HCWs about the risk of infection at the workplace. This would potentially influence the modification of their attitudes regarding HIV patients and improve prevention at the workplace. Continuous research regarding the professional risk would provide better health and safety among medical staff.

Asthma mortality in Serbia: a 30-year analysis.

INTRODUCTION: The asthma mortality pattern differs among countries. No published evidence is currently available on asthma mortality in a European low-middle-income country in socioeconomic transition. We analyzed the trend of asthma mortality rate in Serbia during the period 1980-2009. MATERIALS AND METHODOLOGY: a descriptive study; source of data: Republic of Serbia Institute of Statistics Death Registry. We analyzed asthma mortality data in the total population, including gender specific analysis, and in the selected ≥ 5-34 year age group. The International Classification of Diseases codes for asthma 493 (1980-1996) and J45 + J46 (1997-2009) were included. Population estimates were based on 1991 and 2002 census data, with extrapolation. RESULTS: The over-all average mortality rate was 7.27 ± 2.14/100,000 inhabitants. The mortality rate peaked in 1981 at 11.3/100,000 but was 4.45/100,000 in the last year of analysis. While both overall mortality rate, as well as gender specific rates, showed clear decreases over the observed 30-year period (average absolute annual decrease of 0.195/100,000 inhabitants, 0.241/100,000 men and 0.149/100,000 women; p < 0.001) with corresponding relative annual decreases of 2.9% for the whole population, 3.0% for men and 2.8% for women, a stable trend of the rate was found in the age group ≥ 5-34 years. Male-to-female ratio was 1.59 ± 0.186, on average and it showed a stable trend over the observed period. CONCLUSION: Although the failure of the health care system during the socioeconomic crisis of the 1990s might have transiently affected asthma mortality rates, the overall mortality rate for the disease shows a favorable decreasing trend.

Factors associated with postmenopausal osteoporosis: a case-control study of Belgrade women.

The aim of this study was to investigate factors related to osteoporosis in postmenopausal women in Belgrade. A case-control study was conducted during 2006-2007. The study group consisted of 100 newly diagnosed osteoporosis patients and 100 age-matched controls (± 2 years). The inclusion criteria for the case group were newly diagnosed osteoporosis confirmed by dual-energy X-ray absorptiometry of the lumbar spine and being menopausal (at least 2 years of amenorrhea). The inclusion criteria for the control group were postmenopausal women with confirmed normal bone mineral density of the lumbar spine by dual-energy X-ray absorptiometry. All study participants were interviewed using a structured questionnaire. Univariate and multivariate logistic regression analyses were used. The following factors were significantly independently related to osteoporosis: low body weight (P < 0.001), thin constitution in childhood (P = 0.002), history of previous fracture (P = 0.033), menopause at age <47 years (P < 0.001), family history of fracture (P = 0.005), and less frequent consumption of cheese (P = 0.027) and fish (P = 0.020). The majority of factors identified may be modifiable and could be influenced to prevent postmenopausal osteoporosis.

Prevalence of Borrelia burgdorferi in Ixodes ricinus ticks in Belgrade area.

OBJECTIVE: Lyme borreliosis is vector-borne zoonosis. The causative agent of Lyme borreliosis is a spirochete of Borrelia burgdorferi (Bb) sensu lato complex, which is transmitted by ticks of the Ixodes ricinus complex. The aim of our paper is to estimate the prevalence of I. ricinus ticks, the level of their infectivity by Bb, and the prevalence of certain genospecies of Bb sensu lato in ixodide ticks inhabiting Belgrade. MATERIALS AND METHODS: An estimate of the tick population density was expressed by the value of flag/hour. For isolation and cultivation of Borrelia, selective Barbour-Stonner-Kelly II media was used. Typization of Borrelia was made by applying the species-specific polymerase chain reaction (PCR) and polymerase chain reaction-restriction fragment length polymorphism analysis. In statistical analysis, Chi(2) test was used. RESULTS: Values of flag/hour have varied in relation to year observed and type of habitat: The lowest values were recorded in the city parks (17.9). The values were higher in parks-woods (19.7 and 33.4, respectively). The highest values were detected in localities similar to wooded areas (48.0). The estimated average infestation of ticks with Bb was 21.9%, excluding statistically significant differences by years of investigation. We found the dominance of Borrelia afzelii (75%). Bb sensu stricto (22.2%) as well as Borrelia garinii (2.8%) was much less present. Statistically significant difference was established in the prevalence of the above-mentioned genospecies in relation to the examined localities. CONCLUSIONS: We have established the prevalence of all three genospecies in the city of Belgrade. Bb sensu lato was found, with the dominance of B. afzelii.

Tuberculosis incidence in elderly in Serbia: key trends in socioeconomic transition.

AIM: To examine tuberculosis incidence rates among the elderly in Central Serbia in 1992-2006 period, which was characterized by socioeconomic crisis and migration of population. METHODS: We analyzed all reported active tuberculosis cases in a 15-year period, especially among patients aged > or =65, according to the Annual Reports of the Institute of Lung Diseases and Tuberculosis in Belgrade and Central Tuberculosis Register. Population estimates with extrapolations were based on 1991 and 2002 census data. RESULTS: Total tuberculosis incidence rates showed a slight but non-significant decreasing trend (P=0.535), and no significant increase was found in patients aged > or =65 years (P=0.064), with an average age-specific incidence rate for the elderly of 64.0 (95% confidence interval, 60.7-67.4). The increase was significant in patients aged > or =70 years (y=49.3549+2.1186x; P=0.001), both in men (y=62.8666+2.3977x; P=0.005) and even more prominently in women (y=39.8240+1.9150x; P<0.001). The proportion of tuberculosis cases in the elderly peaked in 2005, with 35% of all tuberculosis cases. CONCLUSION: High incidence rates and increasing time trend of tuberculosis in the elderly in Central Serbia is a serious problem, especially among those aged 70 years and over, who might present a target group for active case-finding of the disease.

Risk factors for laryngeal cancer in Montenegro.

Laryngeal cancer is the most common head and neck cancer. There might be many risk factors for laryngeal cancer. Smoking, especially cigarette smoking and alcohol are indisputable risk factors. The authors of this paper assessed the presumed risk factors in order to identify possible aetiological agents of the disease.A hospital-based case-control study was conducted. The study group consisted of 108 histologically verified laryngeal cancer patients and 108 hospital controls matched by sex, age (+/-3 years) and place of residence. Laryngeal cancer patients and controls were interviewed during their hospital stay using a structured questionnaire. According to multiple logistic regression analysis six variables were independently related to laryngeal cancer: hard liquor consumption (Odd Ratio/OR/=2.93, Confidence Interval/CI/95% = 1.17 to 7.31), consumption more than 2 alcoholic drinks per day (OR=4.96, CI 95% = 2.04 to 12.04), cigarette smoking for more than 40 years (OR=4.32, CI 95% = 1.69 to 11.06), smoking more than 30 cigarettes per day (OR=4.24, CI 95% = 1.75 to 10.27), coffee consumption more than 5 cups per day (OR=4.52, CI 95% = 1.01 to 20.12) and carbonated beverage consumption (OR=0.38, CI 95%=0.16 to 0.92). The great majority of laryngeal cancers could be prevented by eliminating tobacco smoking and alcohol consumption.

Risk factors for esophageal cancer in Serbia.

AIM: To establish the role of specified risk factors in the etiology of squamous cell carcinoma of esophagus in Serbia. METHODS: The hospital based case-control study included 102 newly diagnosed patients with squamous cell esophageal cancer and the same number of age and sex matched hospital controls. In the analysis of data conditional univariate and multivariate logistic regressions were applied. RESULTS: The factors significantly related to cancer of esophagus were: smoking (OR=2.0, 95%CI 1.0-4.2), daily consumption of hard liquor (OR=7.5, 95%CI 2.8-20.0), low educational level (OR=4.7, 95%CI 2.2-10.0), occupational exposure to chemicals (OR=3.7, 95%CI 1.6-9.0), malignant tumors in family history (OR=3.6, 95%CI 1.6-9.0), consumption of wine (OR=0.1, 95%CI 0.1-0.3,) and non-carbonated beverages (OR=0.3, 95%CI 0.2-0.7). CONCLUSIONS: Hard liquor and tobacco appear to be the important risk factors for development of squamous cell esophageal cancer in Serbia, whereas wine and non-carbonated beverages may play a protective role.

Burden of tuberculosis in Serbia.

The objective of this study is to estimate the burden of tuberculosis (TB) in Serbia in the period 1992-2002 based on incidence, mortality, and disability adjusted life years (DALY). The average age-adjusted TB incidence rate in the period 1992-2002 was 36.7/100,000 in males and 21.4/100,000 in females. During the period observed, TB incidence levelled of after a long period of decreasing trend during the preceding several decades. The incidence showed slightly increasing tendency in males and decreasing one in females. The average age-adjusted mortality rate was 4.1/100,000 in males and 1.3/100,000 in females. Mortality rates significantly decreased in both males (P = .0001) and females (P = .0001). The burden of TB (DALY) was 0.70/1000 for males and 0.26/1000 for females. DALY rates significantly decreased in both males (P = .009) and females (P = .008). TB incidence and mortality as well as DALY rates increased with aging.

Childhood tuberculosis in Serbia.

The objective of this study was to establish the tuberculosis incidence and mortality in children in Serbia in the period 1992-2002. There were 280 reported cases. The average annual incidence rate was 1.79/100,000 (95% confidence interval, 0.92-3.13). The rate was higher in girls than in boys. Eleven children died. The average annual mortality rate was 0.10/100,000 (95% confidence interval, 0.01-0.56). The mortality rates for both boys and girls were higher in the age group 0-4 years than in older age group.