Prevalence and associated factors of overweight and obesity among medical students from the Western Balkans (South-East Europe Region).

Being overweight and obese is associated with an elevated risk of developing noncommunicable diseases, which are the leading causes of mortality worldwide. It is a warning that global prevalence of overweight among university students ranges from 20 to 40%, which presents a significant public health problem. To date, there was no research conducted on medical students regarding the prevalence and associated factors of overweight and obesity in the countries of the Western Balkans (Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia, and Serbia). The aim of this study was to determine the prevalence and potential demographic, socioeconomic, and health-related behavioral factors associated with overweight and obesity of medical students from Western Balkans. A cross-sectional study was conducted, surveying 2452 students from 14 medical faculties from 5 countries in the region. The prevalence of overweight was 12% and obesity was 2.3% among medical students from Western Balkans. Male gender and smoking status are significant positive predictors of overweight and obesity. Daily level of physical activity up to 1 h per day, going to preventive check-ups once a year or as a part of annual dormitory check-ups are associated with lower odds of being overweight and obese. By creating adequate public health educational programs, students can be influenced to acquire proper health-related lifestyle habits, which would lead to reducing the prevalence of overweight and obesity among the student population, as well as risk of developing noncommunicable diseases and improving the overall health of the population.

Motives and Barriers for Regular Physical Activity among Medical Students from the Western Balkans (South-East Europe Region).

Regular physical activity (PA) has multiple beneficial effects on students' health, effectively reducing the risk of various non-communicable diseases. Various factors play a role in an individual's motivation to engage in and maintain regular PA. So far, no research dealing with the motives and barriers for regular PA among medical students has been conducted in the countries of the Western Balkans. The aim of this study was to identify the motives and barriers related to regular PA and compare them with different demographic, socioeconomic, and individual lifestyle factors among Western Balkans medical students. The research was conducted in a form of a cross-sectional study. It included 2452 medical students from 14 faculties in five countries (Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia, and Serbia). The most commonly reported motive of medical students for regular PA is to feel better, followed by stress reduction, to look better, the desire to lose weight, and to control chronic disease. PA improvement motives are more frequently associated with the female gender, more advanced years of study, a normal weight, above average household income, and a non-smoking status. Faculty obligations are the most common barrier for regular PA among medical students, followed by other barriers, such as financial situation, current life situation, and health conditions. Barriers are more frequently reported by male students who are overweight or obese, who have a below average income, and are smokers. It is necessary for public health authorities to examine and take into account the perceived motives and barriers when forming activities and policies that aim at increasing the level of PA, in order to enhance the health of the student population.

Nutritional Knowledge, Confidence, Attitudes towards Nutritional Care and Nutrition Counselling Practice among General Practitioners.

Nutritional care represents any practice provided by a health professional, aimed to improve the patient's health outcomes by influencing patient's dietary habits. Clearly, dietitians are the ones supposed to provide top-quality nutrition care, but their services are often inaccessible to many for various reasons. This obliges general practitioners (GPs) in primary health care to provide nutritional counselling to their patients to a certain extent. Preconditions to successful nutritional counselling are GPs with adequate nutritional knowledge, positive attitudes towards nutrition and nutritional care, self-confident and competent in nutritional counselling. Therefore, the aim of this review is to summarise currently available information on nutritional knowledge, confidence and attitudes towards nutritional care and nutrition counselling practice of GPs, as well as barriers towards provision of nutritional counselling. GPs do not consistently obtain satisfying results in nutrition knowledge assessments and their self-confidence in nutrition counselling skills varies. Studies suggest that nutritional counselling practice still has not met its full potential, and GPs frequently report various barriers that impair nutritional counselling practice. Thus, health policies that help overcome barriers and create stimulating environment for GPs to implement nutrition counselling strategies efficiently are the key to improving quality and quantity of nutritional counselling.

Prevalence and Associated Factors of Physical Activity among Medical Students from the Western Balkans.

The student population includes young adults who need nutrition and regular physical activity (PA) for mental, cognitive, and physical development. It is estimated that, globally, only 25-40% of the university student population is involved in regular PA. To date, no research has been conducted in the Western Balkans to address the PA of medical students. The aim of this study was to investigate the prevalence and factors influencing PA among medical students from the Western Balkans. A cross-sectional study included 2452 students from 14 medical faculties in five countries (Slovenia, Croatia, Bosnia and Herzegovina, North Macedonia and Serbia). There were significantly more students who engaged than those who did not engage in some type of regular (daily) PA. Gender, overweight or obesity, and household income are significantly associated with students' PA. Students who are more often involved in regular daily PA and have higher daily PA levels are more likely to be males whose household income is above average. In order to improve the health of the student population, the public health authorities need to continuously investigate the PA of students and introduce appropriate activities to increase their level of PA.

Cigarette Smoking among Medical Students from the Western Balkan.

University student's smoking is a significant public health problem. It is estimated that, globally, every fifth medical student is a smoker. So far, no research dealing with cigarette smoking among medical students has been conducted in the countries of the Western Balkans. The aim of this study was to examine the prevalence and risk factors of cigarette smoking among Western Balkans medical students. A cross-sectional study was conducted among 2452 students from 14 medical faculties in the Western Balkans (Republic of Slovenia, Republic of Croatia, Bosnia and Herzegovina, Republic of North Macedonia and Republic of Serbia). The data were gathered through an online survey. There were significantly more non-smokers than smokers among medical students. Only gender and parents smoking status were statistically significantly associated with students smoking status. The smokers were more often male students, who lived in urban areas prior their studies, and whose parents were both smokers. With the aim of monitoring and enhancing student population health, it is necessary for public health activists and health officials to continually survey the students' smoking status in order to recognize the smoking influencing factors, and form and take on appropriate activities to improve the prevention of cigarette smoking among students, as well as motivate those who smoke to give up smoking, which would contribute to improving the health of the student population.

Introduction of safety and quality standards for private health care providers: a case-study from the Republic of Srpska, Bosnia and Herzegovina.

BACKGROUND: Regulation of private health care providers (PHPs) in middle-income countries can be challenging. Mandatory safety and quality standards for PHPs have been in place in the Republic of Srpska since 2012, but not all PHPs have adopted them yet. Adoption rates have differed among different types of providers. We studied three predominant types of PHPs to determine why the rate of adoption of the standards varies among them. METHODS: This study used a mixed methods approach, which allowed the integration of both quantitative and qualitative data, to develop an explanatory case study. The case study covered three types of private PHPs: pharmacies, dental practices and specialist practices. Primary data were collected through face-to-face semi-structured in-depth interviews and a self-administered postal survey of private health care providers. Our study's theoretical framework was based on the diffusion of innovation theory. RESULTS: The rate of adoption of mandatory standards varied among different types of PHP mainly due to four factors: (1) level of concern about negative financial consequences, such as the risk of fines or of losing contracts with the Health Insurance Fund of the Republic of Srpska; (2) availability of information on the standards and implementation process; (3) level of the relevant professional association's support for the introduction of standards; and (4) provider's perceptions of the relevant health chamber's attitude toward the standards. Opinions conveyed to PHPs by peers slightly negatively influenced adoption of the standards at the attitude-forming stage. Perceived gains in professional status did not have a major influence on the decision to adopt standards. All three types of PHPs perceived the same disadvantages of the introduction of safety and quality standards: associated expense, increased administrative burden and disruption of service provision. CONCLUSIONS: When introducing mandatory quality and safety standards for PHPs, national health authorities need to: ensure adequate availability of information on the relative advantages of adhering to standards; support the introduction of standards with relevant incentives and penalties; and work in partnership with relevant professional associations and health chambers to get their buy-in for regulation of quality and safety of health services.

Work motivation and job satisfaction of health workers in urban and rural areas.

Background/Aim: Motivated and job satisfied health professionals represent a basis of success of modern health institutions. The aim of this study was to investigate whether there was a difference in work motivation and job satisfaction between health workers in urban and rural areas in the region of Central Serbia. Methods: The study included 396 health professionals from urban setting, and 436 from a rural area, employed in four randomly selected health facilities. An anonymous questionnaire was used for data gathering. Statistical analysis was performed using χ2, Student t-test, Spearman's correlation coefficient, and logistic regression analysis. Results: Urban health professionals were significantly more motivated and job satisfied than respondents from rural area. In relation to work motivation factors and job satisfaction of health professionals in urban and rural areas, there were no significant differences in working conditions and current equipment, and in terms of job satisfaction there were no significant differences in relation to income either. Conclusion: In order to increase the level of work motivation and job satisfaction of health workers in rural areas, apart from better income, they should get more assistance and support from their supervisors, and awards for good job performance; interpersonal relationships, promotion and advancement opportunities, managerial performance and cooperation at work should be improved; employment security should be provided, as well as more independence at work, with professional supervision of health workers.

Determinants of fruit, vegetable, and dairy consumption in a sample of schoolchildren, northern Serbia, 2012.

INTRODUCTION: Insufficient intake of fresh fruits, vegetables, and dairy products among children is a serious nutrition-related concern. The aim of our study was to determine behavioral and environmental factors that influence fruit, vegetable, and dairy consumption among Serbian schoolchildren. METHODS: We used 24-hour recall to measure fruit, vegetable, and dairy intake of schoolchildren (N = 212) aged 8 to 11 years from 2 elementary schools in a local community in Serbia. We evaluated potential determinants of intake by using a 48-item questionnaire that asked about children's behaviors, perceptions of others' expectations and behaviors, reinforcement of children's behaviors, and availability of fruits, vegetables, and dairy at home and school. Children completed written questionnaires during 1 school class under teacher supervision. Binary logistic regression was used to analyze determinants of fruit, vegetable, and dairy intake. RESULTS: Negative predictors of fruit intake were expectations from teacher and parents (P <.001) to eat fruit and availability of fruit in school. Vegetable intake was positively related to paternal modeling behavior (P <.001) and availability of vegetables at home (P = .04). Dairy intake was positively influenced by parental reinforcement (P = .03). CONCLUSION: Various personal and environmental factors are associated with children's intake of fruits, vegetables, and dairy. Interventions to promote fruit, vegetable, and dairy consumption in Serbian schoolchildren should focus on modeling and reinforcement by parents and teachers and increasing availability at school and at home.

Obesity as a risk factor for artherial hypertension.

INTRODUCTION: Today's lifestyle is characterized by increased intake of calories with reduced physical activity, which benefits a real epidemic of obesity in the population. The increase in the prevalence of hypertension in the population follows a significant increase in the prevalence of obesity. Parallel to the trend of increasing the number of older population with increased cardiovascular disease. THE AIM: The aim of our study was to determine the value of body mass index and determine the correlation of obesity and arterial hypertension. MATERIAL AND METHODS: The study was conducted in family medicine Clinic of the Primary Health Care Center Zenica. Out of 600 patients of both sexes aged over 18 years, randomly are formed groups of 188 patients with hypertension and 189 patients without hypertension of the same gender and same age. The study included patients with primary or essential hypertension, and excluded patients with secondary hypertension, hypertension due to renal disease, pheochromocytoma, coarctation of the aorta, as a result of taking oral contraceptives, corticosteroids, and cocaine. We used the method of anthropometric measurements (body weight, body height from which is calculated the body mass index) measurement of blood pressure with the statistical data processing at the significance level of p <0.05. RESULTS AND DISCUSSION: The increased value of BMI in the sample with hypertension are present in much higher percentage (87.23%), compared to the tested sample without hypertension (60.10%). In patients with hypertension, the highest percentage (51.06%) of the respondents has the BMI in range between 25 and 30, then BMI in the range between 30 and 35 (25%). BMI of 35-40 have 6.38% of patients, and 3.72 patients BMI over 40. In patients without hypertension was significantly smaller percentage of respondents in the previous group (39.15%) with a BMI in the range 25-30, then BMI in the range between 30 and 35 (18.51%). BMI of 35-40 had 3.17% of respondents, and 1.05% of patients had BMI over 40. Correlation between groups of patients with and without hypertension compared to the value of BMI indicate the presence of strong positive correlation (Rho = 0.737). Correlation between groups of subjects with hypertension and without hypertension compared to triglycerides was statistically significant (Rho = 0.123).

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.

[Medical nutrition therapy planning].

INTRODUCTION: Diet has vital, preventive and therapeutic functions. Medical nutrition therapy is a part of the Standardized Nutrition Care Process integrated in health care systems. MATERIAL AND METHODS: An overview of the Nutrition Care Process model and the application of nutrition guidelines based on literature, reports, documents and programmes of international health, food and physical activity authorities was done. RESULTS: The Nutrition Care Process model requires registered dieticians, standardized terminology as well as nutrition diagnosis categorization. It consists of four distinct, but interrelated and connected steps: (a) nutrition assessment, (b) nutrition diagnosis, (c) nutrition intervention, and (d) nutrition monitoring and evaluation. An individual approach is essential for successful medical nutrition therapy. Nutrition guidelines facilitate the process of understanding and application of medical nutrition therapy. CONCLUSION: The Nutrition Care process provides dietetic professionals information on high-quality client nutrition care. The success of medical nutrition therapy rests not only upon the advice of the dietician, but also upon the client's compliance.

[Medical nutrition prevention and medical nutrition therapy of lipid metabolism disorder].

High energetic density of nutrition, insufficient physical activity and smoking are the most common causes of obesity and lipid metabolism disorders (hyperlipoproteinemia and dyslipoproteinemia). Hyperlipoproteinemia and dislipoproteinemia are mass noncommunicable diseases and at the same time they are main causes of atherosclerotic cardiovascular diseases and cerebrovascular diseases, metabolic syndrome, hepatic diseases and some localization of malignant diseases. Cardiovascular diseases and malignant diseases are the leading causes of mortality in the world. Global Strategy on Diet, Physical Activity and Health Nutrition and The Second European Action Plan for Food and Nutrition Policy represent the World Health Organisation approach in prevention of risks of development, and treatment of mass noncommunicable diseases, first of all for hyperlipoproteinemia, cardiovascular diseases and cerebrovascular diseases. According to the previously mentioned health programmes, medical nutrition therapy of hyperlipoproteinemia and dislipoproteinemia should be applied on whole population and individual level as well. Medical nutrition therapy is managed on individual level. Eminent international organizations, such as the European Society of Atherosclerosis and the American Heart Association, give priority to medical nutrition prevention and medical nutrition therapy in their guides for prevention and therapy of hyperlipoproteinemia, cardiovascular diseases and cerebrovascular diseases.

[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.

Occurrence of Campylobacter, Salmonella, Yersinia enterocolitica and Listeria monocytogenes in some retail food products in Novi Sad.

The official reporting system in the Province of Vojvodina (PV) indicates that cases of human salmonellosis were partly covered by complete epidemiological investigation including laboratory analysis of the suspected food. Intestinal campylobacteriosis and yersiniosis and four cases of septicemias caused by Listeria monocytogenes were not fully epidemiologically investigated. Actual country legislation on food safety does not include provisions for a routine control of the above mentioned pathogens except for Salmonella. In the PV, there are no other sources of data that contribute to risk assessment of the above food-borne diseases. A pilot investigation, performed in Novi Sad, indicated that 8.17% out of the total number of 257 retail food samples (90 of fresh meat and 167 of ready-to-eat food) had been contaminated with one of the tested bacteria Campylobacter or Salmonella or Listeria monocytogenes. Yersinia enterocolitica was not detected in any of the tested samples. Fresh poultry meat and other fresh meats were the dominant sources of the detected pathogens compared to samples of ready-to-eat food (p < 0.05). Campylobacter was detected in 18.8% and 10.0% samples of fresh poultry and other fresh meat respectively, which was not statistically significant (p > 0.05). Salmonella was detected in 3.3% samples of fresh poultry meat. Listeria monocytogenes was detected in 5.0% samples of fresh poultry and in 3.3% samples of other fresh meat, the difference was not statistically significant (p > 0.05). One sample (0.6%) of ready to eat food was contaminated with Campylobacter and one (0.6%) with Salmonella.