PERCEPTION OF FIRST-YEAR VERSUS SIXTH-YEAR MEDICAL STUDENTS IN SERBIA ON STUDYING MEDICINE AND POSTGRADUATE CAREER.

Self-perceived stress during undergraduate medical training could influence forthcoming career choices. The aim of this study was to explore the attitudes and potential differences between 1st and 6th year students regarding aspects of medical training and career plans. As many as 570 students in 1st and 400 in 6th year of studies at the Faculty of Medicine, University of Belgrade, were recruited on December 2-9, 2013. Data were acquired through a self-administered questionnaire. Students in both years rated "Helping other people" as the most important reason to study medicine. Freshmen rated statistically significantly higher 'good incomes' and 'social status' as reasons to study medicine (p=0.003 and p=0.037, respectively). The most desirable fields of specialization were surgery and internal medicine (36.4% and 18.7% for 1st year, and 26.3% and 36.6% for 6th year, respectively). Significantly more freshmen would prefer working abroad (χ2=3.891, p=0.029). In terms of careers abroad, students in both years expressed the highest interest in working in western and northern Europe. Desires for specialty training among medical students follow the pattern of the most frequent disciplines in the Serbian physician population, with gender differences comparable to other populations. A certain percentage of students would likely emigrate.

Flu vaccination among older persons: study of knowledge and practices.

BACKGROUND: Surveys of older adults' knowledge relative to flu immunization have highlighted its relevance in the improvement of vaccination coverage. The purpose of this study was to estimate the proportion of older persons who have ever been immunized against seasonal flu in the municipality of Vracar (Belgrade, Serbia), assess their knowledge related to flu and flu vaccination, and to determine factors associated with flu immunization. METHODS: In the period November 2012-January 2013, 480 persons aged above 65 years were recruited at the Community Health Center, of which 354 persons were finally included in the study. Data were collected using a questionnaire. To assess the level of knowledge, correct answers were awarded 1 point. The total knowledge score ranged from 0 to 17 and was divided into three levels: poor (0-4 points), moderate (5-8 points), good (9-13 points), and excellent (14-17 points). RESULTS: The proportion of ever vaccinated older persons was 47.7%. Of those, one third (29.1%) had been immunized regularly. Most seniors (61.9%) demonstrated good, whereas one third (29.8%) demonstrated excellent level of knowledge. In terms of reasons for non-compliance, the highest proportion of older persons declined vaccination because "they were in good health" (33.5%) and because "they did not believe that vaccine protects from flu" (31.5%). Independent predictors of being ever immunized against seasonal flu were having higher level of education, being more knowledgeable relative to flu vaccination, and taking more medications. CONCLUSIONS: Our results indicate that health care sector requires well-coordinated promotion campaigns to enhance acceptance of flu vaccination. Organized immunization counseling could provide accurate, evidence-based information in order to transform misbeliefs, prejudice, and negative attitude towards vaccination.

Climacteric women at work: What lurks behind poor occupational quality of life?

Physical and psychological changes during menopausal transition may affect various aspects of everyday functioning including women's work ability and work productivity. Presence of menopausal symptoms has been well-acknowledged to negatively affect quality of life (QOL). However, data on factors associated with occupational QOL among women at this period of life are lacking. The authors' purpose in this study was to evaluate factors affecting occupational QOL in a sample of employed mid-life women who are experiencing menopause. The authors performed a cross-sectional study among 335 employed women aged 40 to 65 years from Serbia. Socio-demographic questionnaire, Utian's Quality of Life Scale, and Beck's Depression Inventory were used in data collection. Women's average monthly household income and educational level were positively correlated, while having uterine prolapse was negatively associated with occupational QOL. Significant regression models assessing impact of gynecological illnesses and menopause-specific symptoms on occupational QOL (direct value and categories-below vs. above mean) showed that having insomnia, uterine prolapse, and genital inflammations may differentiate "good" from "poor" occupational QOL. Uterine prolapse, genital inflammation, and insomnia were associated with worse occupational QOL among working women in menopausal transition.

Factors associated with general and health-related quality of life in menopausal transition among women from Serbia.

This study assessed factors associated with quality of life (QOL) among Serbian peri- and postmenopausal women using two menopause-specific scales. This cross-sectional study included 500 women aged 40-65 years who had a gynecologic check-up in one of two Community Health Centers in Belgrade during February 2014 to January 2015. Women completed: a questionnaire about socio-demographics, habits, and health status; a menopause-specific questionnaire, Utian's Quality of Life Scale (UQOL); and a Women's Health Questionnaire (WHQ) and Beck's Depression Inventory (BDI). Higher education was associated with better occupational UQOL and memory/concentration, but with lower emotional UQOL and more anxiety/fears. City center residency was associated with better occupational and sexual UQOL. Being employed was associated with better occupational UQOL and lower anxiety/fears. Higher income was associated with better emotional UQOL. Not having uterine prolapse, insomnia, or tachycardia was associated with better occupational UQOL and fewer sleep problems. Higher parity was associated with better sexual UQOL. Having regular recreation was associated with better health and sexual UQOL but with more frequent vasomotor symptoms. Leaner women felt more attractive. QOL during the menopausal transition does not entail only somatic symptoms and therefore requires a more comprehensive approach that includes psychosocial underpinnings.

Factors associated with sexual quality of life among midlife women in Serbia.

PURPOSE: To assess factors associated with better sexual quality of life (QOL) in midlife period among women who are and are not sexually active. METHODS: Participants were 500 women aged 40-65 years from Belgrade, Serbia. Data were collected through general questionnaire (regarding socio-demographic characteristics, lifestyle habits, general medical, and gynecological history) in which one item investigated having partnered sexual activity (heterosexual intercourses). The sexual domain of the Utian Quality of Life Scale was used to assess the sexual QOL. The sexual QOL consisted of reflections on the satisfaction with frequency of sexual interactions, as well as sexual and romantic life in general. Higher scores indicated better sexual QOL. RESULTS: Most women were sexually active in midlife (81.6%). The mean sexual QOL score for the overall sample was 9.99 (range 3-15). The level of sexual QOL did not differ between sexually active and non-active women. Factors associated with better sexual QOL in sexually active menopausal women were being married or coupled, being physically active, having more children, having hot flushes, and not having tachycardia. Factors associated with better sexual QOL in sexually inactive menopausal women were drinking alcohol, being physically active, not having insomnia or skin rash. CONCLUSIONS: Sexual QOL among Serbian urban midlife women was good and did not differ between women who were sexually active and those who were not. Further studies are needed to determine in what manner women who are not sexually active in midlife achieve high level of satisfaction with their sexual QOL.

Falls, risk factors and fear of falling among persons older than 65 years of age.

AIM: Falling represents a major public health problem among older persons because it leads to premature mortality, loss of independence, and placement in assisted-living facilities. The purpose of this study was to assess the main features and risks for falls among persons older than 65 years of age as well as to quantify their fear of falling. METHODS: A total of 354 persons older than 65 years of age were recruited at a community health centre. Characteristics of the most recent fall were obtained through detailed interviews with study participants. The Falls Efficacy Scale was used to quantify fear of falling. RESULTS: Frequency of falling was 15.8%. Falls occurred most often while walking (49%). One-half of fallers (49.1%) sustained an injury. Head haematomas and soft tissues contusions were the most common consequences of falls. The average Falls Efficacy Scale score was significantly higher in fallers ( P = 0.001). Multiple logistic regression analysis showed that having a fear of falling (odds ratio = 4.14, 95% confidence interval: 1.22-14.08, P = 0.02) and being a woman (odds ratio = 2.10, 95% confidence interval: 0.97-4.53, P = 0.05) were independent risk factors for falling among older persons. CONCLUSION: The frequency of falls among older people was similar to those in other populations. These results could be used to help select older persons who should be enrolled in fall prevention programmes.

Combined effects of electromagnetic field and low-level laser increase proliferation and alter the morphology of human adipose tissue-derived mesenchymal stem cells.

In recent years, electromagnetic field (EMF) and low-level laser (LLL) have been found to affect various biological processes, the growth and proliferation of cells, and especially that of stem cells. The aim of this study was to investigate the effects of EMF and LLL on proliferation of human adipose tissue-derived mesenchymal stem cells (hAT-MSCs) and thus to examine the impact of these therapeutic physical modalities on stem cell engraftment. hAT-MSCs were isolated from subcutaneous adipose tissue of six persons ranging in age from 21 to 56 years. EMF was applied for a period of 7 days, once a day for 30 min, via a magnetic cushion surface at a frequency of 50 Hz and an intensity of 3 mT. LLL was applied also for 7 days, once a day for 5 min, at radiation energies of 3 J/cm2, with a wavelength of 808 nm, power output of 200 mW, and power density of 0.2 W/cm2. Nonexposed cells (control) were cultivated under the same culture conditions. Seven days after treatment, the cells were examined for cell viability, proliferation, and morphology. We found that after 7 days, the number of EMF-treated hAT-MSCs was significantly higher than the number of the untreated cells, LLL-treated hAT-MSCs were more numerous than EMF-treated cells, and hAT-MSCs that were treated with the combination of EMF and LLL were the most numerous. EMF and/or LLL treatment did not significantly affect hAT-MSC viability by itself. Changes in cell morphology were also observed, in terms of an increase in cell surface area and fractal dimension in hAT-MSCs treated with EMF and the combination of EMF and LLL. In conclusion, EMF and/or LLL treatment accelerated the proliferation of hAT-MSCs without compromising their viability, and therefore, they may be used in stem cell tissue engineering.

Mesenchymal stem cells in regenerative rehabilitation.

[Purpose] Regenerative medicine and rehabilitation contribute in many ways to a specific plan of care based on a patient's medical status. The intrinsic self-renewing, multipotent, regenerative, and immunosuppressive properties of mesenchymal stem cells offer great promise in the treatment of numerous autoimmune, degenerative, and graft-versus-host diseases, as well as tissue injuries. As such, mesenchymal stem cells represent a therapeutic fortune in regenerative medicine. The aim of this review is to discuss possibilities, limitations, and future clinical applications of mesenchymal stem cells. [Subjects and Methods] The authors have identified and discussed clinically and scientifically relevant articles from PubMed that have met the inclusion criteria. [Results] Direct treatment of muscle injuries, stroke, damaged peripheral nerves, and cartilage with mesenchymal stem cells has been demonstrated to be effective, with synergies seen between cellular and physical therapies. Over the past few years, several researchers, including us, have shown that there are certain limitations in the use of mesenchymal stem cells. Aging and spontaneous malignant transformation of mesenchymal stem cells significantly affect the functionality of these cells. [Conclusion] Definitive conclusions cannot be made by these studies because limited numbers of patients were included. Studies clarifying these results are expected in the near future.

Computer and online health information literacy among Belgrade citizens aged 66-89 years.

Computer users over 65 years of age in Serbia are rare. The purpose of this study was to (i) describe main demographic characteristics of computer users older than 65; (ii) evaluate their online health information literacy and (iii) assess factors associated with computer use in this population. Persons above 65 years of age were recruited at the Community Health Center 'Vracar' in Belgrade from November 2012 to January 2013. Data were collected after medical checkups using a questionnaire. Of 480 persons who were invited to participate 354 (73.7%) agreed to participate, while 346 filled in the questionnaire (72.1%). A total of 70 (20.2%) older persons were computer users (23.4% males vs. 17.7% females). Of those, 23.7% explored health-related web sites. The majority of older persons who do not use computers reported that they do not have a reason to use a computer (76.5%), while every third senior (30.4%) did not own a computer. Predictors of computer use were being younger [odds ratio (OR) = 2.14, 95% confidence interval (CI) 1.30-4.04; p = 0.019], having less members of household (OR = 2.97, 95% CI 1.45-6.08; p = 0.003), being more educated (OR = 3.53, 95% CI 1.88-6.63; p = 0.001), having higher income (OR = 2.31, 95% CI 1.17-4.58; p = 0.016) as well as fewer comorbidities (OR = 0.42, 95% CI 0.23-0.79; p = 0.007). Being male was independent predictor of online health information use at the level of marginal significance (OR = 4.43, 95% CI 1.93-21.00; p = 0.061). Frequency of computer and Internet use among older adults in Belgrade is similar to other populations. Patterns of Internet use as well as non-use demonstrate particular socio-cultural characteristics.

Ready to work or not quite? Self-perception of practical skills among medical students from Serbia ahead of graduation.

AIM: To assess final year medical students' self-perception of their practical skills. METHODS: The study was conducted at the Faculty of Medicine in Belgrade during compulsory practical sessions in the period December 2-9, 2013 and 390 students agreed to participate (response rate 77.8%). The questionnaire included questions on demographic characteristics, 21 questions on students' self-perception of their practical skills, and 1 question on students' self-perceived readiness to start working with patients. RESULTS: Cronbach's α for the entire scale was 0.891. Students felt most confident about measuring arterial pulse and blood pressure and taking patients' history (average score 10 for all three skills) and least confident about placing a urinary catheter (average score 1) and suturing a wound (average score 2). They rated their readiness to work with patients with 5.0 out of 10.0 points. The total score did not correlate with students' average mark (Spearman's ρ=0.039; P=0.460) and the average mark did not correlate with the self-perceived readiness to work with patients (Spearman's ρ=-0.048; P=0.365). CONCLUSION: Our study suggests that medical students lack confidence to perform various clinical procedures, particularly those related to surgical interventions. To improve students' confidence, clinical curriculum should include either more hours of practical work or ensure closer supervision of practical training in wards.

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.

Validation of the Menopause Rating Scale in Serbian language.

PURPOSE: The study aim was to translate the Menopause Rating Scale (MRS) to Serbian language and assess its validity and reliability in the population of Serbian menopausal women. METHODS: The study included 200 peri- and postmenopausal women from two Community Health Centers (city center and outskirts) in the Serbian capital-Belgrade. Women filled out general questionnaire (socio-demographics, habits, medical history), the MRS, Short Form-36 questionnaire (SF-36) and Beck's Depression Inventory (BDI). The MRS was translated according to recommended methodology and its psychometric properties (internal consistency, factor analysis, discriminant, construct and criterion validity) were assessed. RESULTS: The Cronbach's alpha coefficient for the whole scale was 0.884 (psychological α = 0.902, somato-vegetative α = 0.761, urogenital α = 0.734). Values of the CI-TC coefficient for Serbian MRS were adequate for 10 items, proving their suitability in the scale. On factor analysis, we obtained the same 3 factors as in the original scale (73.1 % of variance). Communalities of all items were appropriate (>0.4). There was no common method bias. The MRS total score was correlated positively with BDI score (p = 0.001) and negatively with all SF-36 domains (p = 0.001) except General Health. Based on ROC analysis, MRS scores were more consistent for post- than perimenopausal Serbian women. Similar results of two raters (p > 0.05) implied on adequate translation and reliability of MRS. CONCLUSION: Serbian version of MRS demonstrated excellent reliability and validity. The MRS in Serbian language can be used in daily clinical work with menopausal women for assessing their symptoms and quality of life.

Translation and validation of the Utian Quality of Life Scale in Serbian peri- and postmenopausal women.

OBJECTIVE: This study aimed to translate the Utian Quality of Life Scale (UQOL) into the Serbian and to assess its validity and psychometric properties in Serbian peri- and postmenopausal women. METHODS: This survey included 200 perimenopausal and postmenopausal women. Women were approached after their regular gynecological checkup in two community health centers (city center and outskirts) in the capital city Belgrade. The following instruments were used: general questionnaire (sociodemographics, habits, and medical history), UQOL, Short Form-36, and Beck Depression Inventory. The UQOL was translated according to the recommended methodology for translating questionnaires, and its psychometric properties (internal consistency, factor analysis, discriminant validity, construct validity, and criterion validity) were tested. RESULTS: The mean (SD) UQOL total score was 80.5 (13.5). The Cronbach's α coefficient for the entire scale was 0.83 (Occupational, α = 0.76; Health-Related, α = 0.72; Emotional, α = 0.36; Sexual, α = 0.66). All corrected item-total correlation coefficients were greater than 0.40, confirming that all items were appropriate parts of the UQOL. On exploratory factor analysis, we obtained six factors (five items formed two new clusters: Physical Fitness and Professional Recognition) that explained 85.7% of the total variance. The UQOL total score was significantly negatively correlated with Beck Depression Inventory score (P = 0.001) and significantly positively correlated with all Short Form-36 domains (P = 0.001). In addition, significant intercorrelations of UQOL domains also indicated good criterion validity. CONCLUSIONS: The Serbian version of the UQOL demonstrates satisfactory reliability and validity in the assessment of quality of life among peri- and postmenopausal women. The Serbian version of the UQOL is an adequate quality-of-life instrument in the Serbian language that can be applied in the everyday clinical setting.

To be or not to be an organ donor: differences in attitudes between freshmen and senior medical students.

Despite a plethora of studies on overall attitudes related to organ donation in a health care setting, little is known as to whether or not medical students at various levels of undergraduate training have distinctive attitudes towards donation. The purpose of this study was to analyze attitudes of first- and sixth-year students towards organ donation. A total of 988 students in first (573) and the final, sixth, year (415) were recruited at the Faculty of Medicine, University of Belgrade (Serbia), in the period 2-9 December, 2013. Data were collected using an anonymous questionnaire. There were 3.0% of first-year and 3.9% of sixth-year students who were registered donors (p = 0.019). Sixth-year students felt statistically significantly more positive towards signing an organ donor card [odds ratio (OR) 1.45, 95% confidence interval (CI) 1.13-1.88]. Sixth-year students also considered that organ donation was sufficiently promoted, as well as that organ donation should be practiced unless there is a written notice of objection. In addition, sixth-year students had more confidence in local organ transplant institutions. In a multivariate logistic regression analysis significant predictor of positive attitude for signing organ donor card was being blood donor (OR 1.55, 95% CI 1.03-2.35). Undergraduate training and increase in overall medical knowledge seem to contribute in shaping positive attitudes towards being an organ donor. It would be beneficial that strategies for organ donation promotion target local centers for blood donor recruitment. Nevertheless, further promotion of organ donation is necessary to expand the total donor pool.

Pharmacotherapy and over-the-counter drug use among elderly in Belgrade, Serbia.

From November 2012 to January 2013, 480 seniors were recruited at the Pubic Health Center in Belgrade, Serbia. The patients' records were validated by four independent investigators. Data on over-the-counter (OTC) drug use were collected through a questionnaire. Polypharmacy, an intake of ≥5 prescribed medications, reported in 10.4% of seniors, was associated with cardiovascular (odds ratio [OR] = 3.07; 95% confidence interval [CI] = 1.12-8.39) and endocrine diseases (OR = 2.25; 95% CI = 1.05-4.84) as well as with the number of treated chronic conditions (OR = 2.45; 95% CI = 1.75-3.44). The most frequently used OTC drugs were analgesics (metamizole, diclofenac and acetaminophen) and vitamins (vitamin C and vitamin B complex). The number of treated chronic conditions was associated with use of OTC drugs (OR = 1.17; 95% CI = 1.01-1.36). Multiple chronic conditions correlated with multiple OTC drug use (ρ = 0.125, p = 0.019). Our analysis indicated that the prevalence of polypharmacy and OTC drug use in the elderly are comparable to those in industrialized countries.

Oral contraceptives usage patterns: study of knowledge, attitudes and experience in Belgrade female medical students.

PURPOSE: The purpose of this survey was to quantify oral contraceptive pill (OCP) use and to analyze attitudes and knowledge about the pill in a sample of female medical students. METHODS: A cross-sectional study, conducted between November 28 and December 20, 2011, included 464 female participants from the Faculty of Medicine, University of Belgrade. Data were collected before the start of compulsory practical sessions in the classrooms through a 37-item questionnaire and assessed statistically. RESULTS: Prevalence of OCP use was 11.3 %. Highest proportion of the pill use was in the third year (15.4 %). Approximately, 61 % used the pill as a therapy for dysmenorrhea. Difference in knowledge scores was observed between users and non-users (t = 3.596, p < 0.001). Advancing year at the faculty was highly statistically significantly associated with greater knowledge about health effects of the pill (ρ = 0.506, p < 0.001). There was no difference regarding attitude score among users and non-users (t = -0.9, p = 0.369). In the multivariate regression model the knowledge score was the only predictor of pill use. CONCLUSION: The results of our survey indicate that oral contraceptive pill requires further promotion and reproductive health education in a broader context.

What do male medical students know about the pill? study of knowledge and attitudes at the University of Belgrade.

BACKGROUND: Women have been traditionally more involved in birth control than men. The purpose of this survey is to analyze knowledge of and attitudes towards oral contraceptives (OC) use in a population of male medical students of the Faculty of Medicine, Belgrade, Serbia. METHODS: In November/December 2011, a total of 237 male medical students were recruited at the Faculty of Medicine before the start of compulsory practical sessions in their classrooms. Data were obtained through a 26-item questionnaire regarding knowledge of and attitude towards OC use. RESULTS: Less than a half (40.4%) had a partner and 3.2% did not know whether their partner used the pill. Approximately one fifth of the students (28.5%) did not inform themselves about the pill at all. The average knowledge score differed according to the relationship status (Z = -3.414, p = 0.001). The average attitude score did not statistically differ according to the relationship status (Z = -1.384, p = 0.166). An advanced study year was statistically associated with higher knowledge and attitude scores (ρ = 0.575, p < 0.001; ρ = 0.206, p = 0.002, respectively). CONCLUSION: Our students demonstrated a moderate level of comprehension. The results of our study indicate that the use of the OC pill needs further promotion to raise awareness of male involvement in health-related decisions of their partners.