Infection control capacity building in European countries with limited resources: issues and priorities.

We report the results of a panel investigation aimed at assessing the critical aspects regarding healthcare-associated infections in European countries with limited resources and pinpointing the highest priority issues that need to be addressed for effective infection control. Questionnaires were designed and information collected from national EUNETIPS representatives in Bulgaria, Hungary, Kosovo, Romania, and Serbia. Based on the data collected, we concluded that rigorous implementation of existing law, standardized training, and political commitment constitute a common relevant background and provide the lessons to be learnt for aligning healthcare systems in this area with internationally recommended standards of infection control.

Trends in the incidence of hip fractures.

UNLABELLED: Hip fracture incidence in the capital city of Serbia was assessed over a period of 10 years (2000-2009). Crude annual incidence rates increased significantly for all ages and both sexes (p = 0.002). Age-adjusted rates also showed a steady increase. The mean rate of annual change for age-adjusted rates was 8.6 % (95 %CI 7.5-9.7) in males, 8.0 % (95 %CI 7.4-8.6) in females, and 8.2 % (95 %CI 7.7-8.7) in the total population. INTRODUCTION: The aim of this study was to estimate the incidence rate and trend of hip fractures in the population of Belgrade, the capital of Serbia. METHODS: Data sources were the official statistics of the Public Health Institute in Belgrade. The patient's age, gender, residence, hospital admission, and diagnosis were registered for each hospital admission. Population estimates were based on census data from 2002 and on published estimates for the intercensus years. The annual incidence (crude) rates and age- and sex-specific incidence rates were calculated with 95 % confidence intervals (CI) and age-adjusted incidence rates for persons over the age of 50 years were computed. RESULTS: A significantly increasing trend of crude incidence rates for all ages was observed in males (p = 0.002), females (p = 0.001), and overall (p = 0.002). The proportion of trochanteric fractures rose significantly with age in women (p < 0.0001), whereas it decreased nonsignificantly in men ≥70 years (p = 0.44). The age-adjusted incidence rates (per 100,000 in subjects ≥50 years old) showed a steady increase. The mean rate of annual change for age-adjusted rates was 8.6 % (95 %CI 7.5-9.7) in males, 8.0 % (95 %CI 7.4-8.6) in females, and 8.2 % (95 %CI 7.7-8.7) in the total population. CONCLUSION: Hip fracture incidence continues to increase. In view of the rapid aging of the population, it is necessary to implement a comprehensive preventive policy in our community.

The impact of postoperative pain on early ambulation after hip fracture.

Hip fractures are the most serious consequence of falling in older people with osteoporosis. Early ambulation is one of the main goals of inpatient rehabilitation aimed at reducing negative effects of immobilization, and promoting functional recovery. Recognizing the role of different factors that are associated with time to ambulation time after hip fracture surgery may help decrease morbidity and mortality rates. The aim of this study was to examine the impact of postoperative pain time to ambulation following hip fracture surgery. A total of 96 patients who consecutively presented at the Clinic for Orthopaedic Surgery and Traumatology, Clinical Center Serbia during a 6 month period were included in the study. Subjects were assessed regarding socioedemographic characteristics, prefracture functional status, cognitive status, general health status, fracture type, type of anaesthesia, and waiting time for surgery. The VAS scale (0-100) was used to measure pain intensity on the first postoperative day. Our results revealed that patients, whose time to ambulation was = 48 h postoperatively were of worse physical health, and had significantly higher VAS score on the first postoperative day. Unrelieved pain in geriatric hip fracture patients is associated with delayed ambulation. Future research should confirm the posi-tive effects of aggressive pain management programs on early functional outcome in elderly patients who sustain hip fractures.

The challenge of osteo-articular tuberculosis in the twenty-first century: a 15-year population-based study.

SETTING: Serbia, an intermediate tuberculosis (TB) incidence country in socio-economic transition. OBJECTIVE: To examine the epidemiological and clinical pattern of osteo-articular TB (OATB) in Serbia over 15 years. DESIGN: This retrospective observational study included OATB cases diagnosed between 1 January 1993 and 31 December 2007, according to the National Referral Institute of Lung Diseases and TB in Belgrade and the Central TB Register. Population estimates with extrapolations were based on 1991 and 2002 census data. RESULTS: The 295 OATB cases represented 10.9% (range 5.3-20.2) of all extra-pulmonary TB cases notified in Serbia over the period. One tenth of these were relapses. The incidence rate showed a significant increasing trend (y = 0.1167 + 0.0175x, R(2) = 0.3196), with an average age-specific incidence rate of 0.26 per 100 000 population. The peak number of cases was in the 45-64 year age group for both men and women. The average male:female ratio was 0.85. The outcome was favourable for 279 of the 295 patients (94.6%). In addition to a standardised chemotherapy regimen, 25.4% patients underwent surgery. CONCLUSION: The increasing time trend of OATB is caused by increased morbidity, a higher TB detection rate and better notification. Although rare in children, OATB remains a challenge in clinical practice.

[Satisfaction survey of Serbian oncologists after experience in French hospitals]. / Enquête de satisfaction des cancérologues serbes en stage d'observation en France.

UNLABELLED: Serbian oncologists benefited of a short training in French structures as observer between 2003 and 2007. To this day, there has been yet no study on the professional feedback of this kind of training for foreigner doctors. Our aim was to evaluate the satisfaction of the participants and thereafter to analyse their needs. MATERIAL AND METHODS: Survey by auto questionnaires sent to the participants oncologists. RESULTS: On 60 oncologists, 40 answered. On all the oncologists interviewed, 90% thought that the knowledge was easily accessible and is still useful. Sixty per cent said they introduced new protocols; 92.3% wished they could have another training. Compared to their own practise in Serbia, 97% think there is a employee in charge of administrative questions that set the doctors free to do something else. DISCUSSION: To optimise these training's, basic knowledge of French and well-targeted expectations are essential. To improve professional practise of oncologists, the answers go to a best internal communication and the establishment of a politic of education for doctors and the rest of the personal in oncology services.

The risk of occupational tuberculosis in Serbian health care workers.

SETTING: Health care workers in the Clinical Center of Serbia. OBJECTIVE: To evaluate tuberculosis (TB) incidence by job category comparing the rates of TB in health care workers (HCWs) working in pulmonary departments, other (non-pulmonary) departments, and in the general population in Serbia. DESIGN: Prospective cohort study from 1992 to 2004. Assessment of the relationship between employment in different departments and TB incidence was expressed by relative risk (RR), which was calculated using the annual TB incidence in the population of Serbia as the baseline rate. RESULTS: A total of 24 HCWs developed active TB in the study period. The mean incidence rate was 413.2 per 100000 persons (RR = 12.2) for hospital staff in the pulmonary department and 20.3/100000 (RR = 0.6) for other departments. Nurses and technicians were at 7.8 times higher risk of developing TB than doctors. The mean working period before the onset of illness was 15.1 years (95%CI 5.1-25.1) for HCWs in pulmonary departments and 8.1 years (95%CI 4.6-11.6) in non-pulmonary departments (P = 0.006). CONCLUSION: This study indicates that HCWs were at an increased risk of TB, most likely from nosocomial transmission in high-risk departments.

Clinical and epidemiological evaluation of tuberculosis in Serbia, 1990-2004.

SETTING: Republic of Serbia, excluding Kosovo. OBJECTIVE: To estimate the clinical and epidemiological pattern of tuberculosis (TB) in Serbia during the period 1990-2004. DESIGN: A retrospective analysis of clinical and epidemiological data on TB patients registered in annual TB reports. RESULTS: During the 15-year period, TB incidence levelled off in Serbia. The slightly decreasing trend occurred in both total pulmonary TB (PTB) and laboratory confirmed PTB (PTB+) incidence (P > 0.05), while the trend of extra-pulmonary TB (EPTB) incidence increased slightly (P > 0.05). During the same period, TB mortality showed a significantly decreasing trend (P < 0.05). The mean annual proportion of PTB+ cases among newly reported PTB cases was 62.7%. The mean proportion of EPTB cases among total TB cases was 6.1%. The mean percentage of cases with resistance to at least one anti-tuberculosis drug was 4.8%. CONCLUSION: Thanks to the good organisation and efficient work of anti-tuberculosis dispensaries in Serbia, as well as to the low incidence of AIDS and low frequency of Mycobacterium tuberculosis resistant strains, TB incidence did not increase during the period observed and TB mortality significantly decreased, despite markedly deteriorated socio-economic conditions during the 1990s.

Prevalence of hospital-acquired infections in a home care setting.

The aim of this point-prevalence study was to determine the prevalence of hospital-acquired infections (HAIs) by site of infection and the associated risk factors in a 'hospital at home' setting in Paris. All patients undergoing a care procedure with a risk of infection and who had been in home care for more than 48 h on the day of the survey (5 June 2000) were enrolled. A standard questionnaire was completed by nurses, midwives and family doctors. Overall, 6.1% of patients had at least one HAI [95% confidence intervals (CI): 3.7-8.5%] and there were 6.3 infections per 100 patients (infections/infected patients ratio: 1.04). The most common site of infection was the urinary tract (50.0%), followed by the skin (37.9%). Infection rates were 3.2% and 2.4%, respectively. Escherichia coli (29.4%), Staphylococcus aureus (29.4%) and Enterococcus spp. (17.6%) were the predominant micro-organisms. In multivariate analysis, the most significant independent risk factor was the presence of a urinary catheter (odds ratio=15.9, 95%CI: 6.3-40.1, P<0.0001). In conclusion, this prevalence study has provided a better understanding of the types of patient receiving 'hospital at home' care, an insight into risk factors for HAIs in home care, and a basis for improving surveillance and prevention.

Family history and risk of type 1 diabetes mellitus.

The aim of the study was to evaluate association of type 1 diabetes in children and adolescents with positive family history of type 1 diabetes, type 2 diabetes, and thyroid, adrenal, rheumatic, allergic, celiac and some other diseases. A case-control study was conducted in Belgrade. The case group comprised 105 subjects < or = 16 years old who were for the first time hospitalized because of type 1 diabetes during the period 1994-1997. For each case, two controls were chosen among children and adolescents treated for skin diseases. Cases and controls were individually matched by age (+/- one year), sex and place of residence (all were from Belgrade). In the statistical analyses we used chi(2)-test, Fisher's exact test and univariate and multivariate logistic regressions. According to multivariate logistic regression analysis, risk of type 1 diabetes was significantly associated with a positive family history for type 1 diabetes (OR = 4.04; 95% CI, 2.31-7.07), allergic diseases (OR = 3.32; 95% CI, 1.63-6.76), celiac and Crohn's diseases (OR = 11.02; 95% CI, 1.14-106.89) and other diseases (thrombocytopenia, alopecia areata, psoriasis, chronic uveitis and pernicious anemia; OR = 3.63; 95% CI, 1.05-12.48).

Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage.

To investigate persistent carriage of methicillin-resistant Staphylococcus aureus (MRSA), we conducted a prospective 10-month study of MRSA carriage in previous carriers who were readmitted to our hospital. Four screening specimens, 2 from the skin and 2 from the nares, were obtained within 3 days after admission, in addition to diagnostic specimens requested by physicians. Of the 78 patients included in our study, 31 (40%) were persistent carriers of MRSA, with an estimated median time of 8.5 months to MRSA clearance. In the multivariate analysis, the only factor significantly associated with persistent carriage was the presence of a break in the skin at readmission (odds ratio, 4.34; P=.004); however, a trend was found for admission from a chronic-care institution (odds ratio, 3.65; P=.06). Our data confirm that prolonged carriage of MRSA can occur after hospital discharge, support routine screening for MRSA at readmission of previously MRSA-positive patients, and suggest that a particularly high index of suspicion for MRSA carriage should be maintained if these patients have a break in the skin.

Notification of tuberculosis in a university hospital.

The aim of this study was to evaluate completeness of tuberculosis notification in Bichat Claude-Bernard University Hospital and to evaluate whether misclassification of atypical mycobacterial infection could have contributed to the inaccuracy of tuberculosis notification. Data from Microbiology Laboratory of the hospital and statutory notifications were compared. From 1 January 1994 to 31 December 1995, 299 tuberculosis cases were diagnosed in the Microbiology Laboratory and 316 cases were notified as tuberculosis. Notification rate for laboratory-documented tuberculosis was 57.5%, was significantly higher in cases with positive acid fast bacilli smear (75%) than without this feature (45%) and was similar in HIV-positive (59.4%) and HIV-negative (63.5%) patients. Among notified cases, diagnosis was established by laboratory proofs in only 54.4% and by clinical signs in 45.6%. Three cases with positive smear and culture growing atypical mycobacteria were wrongly notified. Notification of laboratory-documented tuberculosis was higher than that observed in a previous study in the same hospital, suggesting that the rise of tuberculosis incidence reported in our country could be partially artificial. Nevertheless, extent of notification remains insufficient and needs to be improved by combining microbiological data with current system of notification.

[Mortality in Serbian males from the most common malignant tumors]. / Smrtnost muskaraca u Srbiji od najcescih malignih tumora.

The frequency and distribution of mortality of men in Serbia caused by the most frequent malignant tumors in the period from 1982. to 1991., were shown. Data were taken from the Republic Statistic Center. For the evaluation of the situation the descriptive epidemiological method was used. In that period men mostly died from lung, stomach, prostate, liver, rectum, pancreas, larynx, colon, brain and urinary bladder cancer. In the same period the mortality increase was observed in lung cancer, rectum, pancreas, colon, urinary bladder, brain, larynx and liver. For the cancer of prostate and stomach the decrease of mortality was noticed.

Brick mortar exposure and chronic lymphocytic leukemia.

A case-control study of 130 patients with chronic lymphocytic leukemia (CLL) and 130 controls matched with respect to sex, age (2 years), type of residence (urban-rural) and area of residence (according to the national per capita income) was carried out. Conditional logistic regression analysis showed that, apart of four risk factors already described in the literature (work in a hazardous industry, hair dye use, family history of leukemia and exposure to electromagnetic radiation), brick mortar exposure was also significantly related to CLL.

Cancer mortality of family members of patients with chronic lymphocytic leukemia.

A case-control study comprised 130 cases affected by chronic lymphocytic leukemia and the same number of individually matched controls, with accidental injuries as a cause of hospitalization. Matching criteria were: sex, age, type of settlement, and area of residence. Both leukemias and all cancers were more frequent among family members of cases, as compared to controls.

[Mortality in the most common malignant tumors in women in Serbia]. / Smrtnost od najcescih malignih tumora zena u Srbiji.

The incidence and mortality rate due to the most common malignant tumors in women in Serbia 1982-1991 were presented. Records from the Republic Institute of Statistics were used as the source of data. Descriptive method was used in epidemiological analysis. Within the period 1982-1991, women in Serbia had died most frequently due to malignant tumors of breast, lung, cervix, rectum, liver, colon, ovary, pancreas and uterine body. Tendency towards increased mortality rate due to the cancer of the breast, cervix, ovary, pancreas, rectum and colon has been registered in this period. Reduced mortality rate was observed in the cancers of uterine body, liver and stomach.

Well water characteristics and the Balkan nephropathy.

A total of 366 inhabitants of a village affected by Balkan nephropathy (BN) have been followed over 12 years. It was shown that depth of the well to the water level, height of the water column, electroconductivity, and NO3 content of the water were not associated with BN. The risk of developing the disease was significantly higher if a well was at a lower altitude and contained a higher concentration of SiO2. Low altitude might have been expected to correlate with the BN frequency; as for silica, however, there are sound indications that it could just be a correlate of a cause rather than a direct determinant of BN.