[Show abstract][Hide abstract]ABSTRACT: The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was developed and proven efficient for the rapid detection of a major depressive episode in people with epilepsy. This study describes the development, validation, and psychometric properties of the NDDI-E Serbian version. A consecutive sample of 103 patients with epilepsy was assessed using the Beck Depression Inventory (BDI) and the NDDI-E. All patients had no major difficulties in understanding or answering the questions of the Serbian version. Cronbach's alpha coefficient was 0.763. Receiver operating characteristic analysis showed an area under the curve of 0.943 (95% CI; 0.826 to 0.951), a cutoff score of ≥14, a sensitivity of 72.2%, a specificity of 95.2%, a positive predictive value of 81.3%, and a negative predictive value of 94.3%. The NDDI-E Serbian version scores were significantly and positively correlated with those of the BDI (p<0.001). The NDDI-E Serbian version constitutes a concise and consistent depression screening instrument for patients with epilepsy.
[Show abstract][Hide abstract]ABSTRACT: Purpose:
The number of elderly patients with end-stage kidney disease is on the rise. Nonalcoholic fatty liver disease (NAFLD) is characterized by parenchymal fat accumulation in patients without information about alcohol abuse. The aim of our study was to determine correlation between NAFLD and cardiovascular diseases in elderly hemodialysis patients.
The examination was organized as observational and cross-sectional study in elderly patients on hemodialysis. An abdominal ultrasound examination was made in order to define NAFLD. Intima-media thickness of the carotid arteries was quantified by Doppler ultrasound. Biochemical parameters, gender, anthropometric characteristics, duration, adequacy of hemodialysis, blood pressure, smoking and cardiovascular disease were determined. Respondents were divided into a group with NAFLD (37/72 patients, 51 %) and group without NAFLD (35/72 patients, 49 %).
Patients with NAFLD have significantly more cardiovascular disease (p = 0.017) as well as significantly higher values of intima-media thickness of the carotid arteries (p = 0.03) in correlation with patients without NAFLD. Patients without NAFLD have a statistically lower triglyceride (p = 0.04), aspartate aminotransferase (p = 0.006), alanine aminotransferase (p = 0.013) and gamma-glutamyl transpeptidase (p = 0.029) compared to patients with NAFLD. Patients with cardiovascular disease have a higher risk of NAFLD; likewise, patients with NAFLD have a three times higher chance for developing cardiovascular diseases (OR 3.01).
Elderly patients on hemodialysis with cardiovascular disease have a higher risk of NAFLD; likewise, patients with NAFLD have a three times higher chance for developing cardiovascular diseases.
No preview · Article · Feb 2016 · International Urology and Nephrology
[Show abstract][Hide abstract]ABSTRACT: Background: The global burden of mental disorders is
rising. In Serbia, anxiety is the leading cause of disability-adjusted
life years. Serbia has no mental health survey
at the population level. The information on prevalence of
mental disorders and related socioeconomic inequalities
are valuable for mental care improvement.
Aims: То explore the prevalence of mental health
disorders and socioeconomic inequalities in mental
health of adult Serbian population, and to explore
whether age years and employment status interact
with mental health in urban and rural settlements.
Study Design: Cross-sectional study.
Methods: This study is an additional analysis of Serbian
Health Survey 2006 that was carried out with standardized
household questionnaires at the representative
sample of 7673 randomly selected households – 15563
adults. The response rate was 93%. A multivariate logistic
regression modeling highlighted the predictors of
the 5 item Mental Health Inventory (MHI-5), and of
chronic anxiety or depression within eight independent
variables (age, gender, type of settlement, marital status
and self-perceived health, education, employment
status and Wealth Index). The significance level in
descriptive statistics, chi square analysis and bivariate
and multivariate logistic regressions was set at p<0.05.
Results: Chronic anxiety or depression was seen in
4.9% of the respondents, and poor MHI-5 in 47% of
respondents. Low education (Odds Ratios 1.32; 95%
confidence intervals=1.16-1.51), unemployment (1.36;
1.18-1.56), single status (1.34; 1.23-1.45), and Wealth
Index middle class (1.20; 1.08-1.32) or poor (1.33;
1.21-1.47) were significantly related with poor MHI-5.
Unemployed persons in urban settlements had higher
odds for poormMHI-5 than unemployed in rural areas
(0.73; 0.59-0.89). Single (1.50; 1.26-1.78), unemployed
(1.39; 1.07-1.80) and inactive respondents
(1.42; 1.10-1.83) had a higher odds of chronic anxiety
or depression than married individuals, or those with
partner, and employed persons. Those with perceived
good health status had lower odds for poor MHI-5,
chronic anxiety or depression than those whose general
health was average and poor.
Conclusion: Almost half of the population assessed
their mental health as poor and 5% had diagnosed chronic
anxiety or depression. Multi-sectoral socioeconomic
and female-sensitive policies should be wisely tailored
to reduce mental health inequalities contributed by differences
in age, education, employment, marriage and
the wealth status of the adult population.
Keywords: Anxiety, depression, subjective health, socioeconomic
Full-text · Article · Feb 2016 · Balkan Medical Journal
[Show abstract][Hide abstract]ABSTRACT: Background:
Although recent studies report on the benefits of blended learning in improving medical student education, there is still no empirical evidence on the relative effectiveness of blended over traditional learning approaches in medical statistics. We implemented blended along with on-site (i.e. face-to-face) learning to further assess the potential value of web-based learning in medical statistics.
This was a prospective study conducted with third year medical undergraduate students attending the Faculty of Medicine, University of Belgrade, who passed (440 of 545) the final exam of the obligatory introductory statistics course during 2013-14. Student statistics achievements were stratified based on the two methods of education delivery: blended learning and on-site learning. Blended learning included a combination of face-to-face and distance learning methodologies integrated into a single course.
Mean exam scores for the blended learning student group were higher than for the on-site student group for both final statistics score (89.36±6.60 vs. 86.06±8.48; p = 0.001) and knowledge test score (7.88±1.30 vs. 7.51±1.36; p = 0.023) with a medium effect size. There were no differences in sex or study duration between the groups. Current grade point average (GPA) was higher in the blended group. In a multivariable regression model, current GPA and knowledge test scores were associated with the final statistics score after adjusting for study duration and learning modality (p<0.001).
This study provides empirical evidence to support educator decisions to implement different learning environments for teaching medical statistics to undergraduate medical students. Blended and on-site training formats led to similar knowledge acquisition; however, students with higher GPA preferred the technology assisted learning format. Implementation of blended learning approaches can be considered an attractive, cost-effective, and efficient alternative to traditional classroom training in medical statistics.
[Show abstract][Hide abstract]ABSTRACT: Background: There are many factors that affect smoking behavior. Objective: The aim of our study was to identify the most important risk factors related to smoking in the sample population of students at the University of Belgrade with a special emphasize on the family role. Methods: The cross-sectional study was conducted in a population of 2,000 students of the Belgrade University. Four faculties (Medicine, Geography, Economics, and Electrical Engineering) from which the students participating in this research were chosen by the method of random choice, conducted in the period April–June 2010. Results: Independent risk factors for smoking in students, assessed by multivariate logistic regression analysis, included: repeating a year (odds ratio (OR) = 1.67, p < .001), the number of hours spent in the rooms where others smoke (OR = 2.86, p < .001), brother smoker (OR = 1.88, p < .001), sister smoker (OR = 2.33, p < .001), knowledge about the association between smoking and lung cancer (OR = 0.31, p < .001), and depression (OR = 1.02, p = .013). Conclusion: Bearing in mind the influence of siblings, prevention, and intervention efforts should be focused more on family members than on the broader social environment. The results also indicate the need to develop a conscience on a healthy life style and to educate people to enhance and improve their health control.
No preview · Article · Jan 2016 · Substance Use & Misuse
[Show abstract][Hide abstract]ABSTRACT: Purpose:
Magnesium insufficiency is a pro-atherogenic factor involved in endothelial dysfunction, atherosclerosis, and vascular calcification. Our aim was to examine the role of magnesium in the development of arteriovenous fistula complications in hemodialysis.
This was a retrospective clinical investigation of data from 88 patients who were divided into two groups: those with and without arteriovenous fistula complications. We examined the influence of sex, demographics, and clinical and laboratory parameters. The existence of fistula stenosis was determined by measuring Doppler flow, while B-mode ultrasound was used to detect plaques and evaluate the carotid artery intima-media thickness.
Patients with arteriovenous fistula complications had significantly higher leukocyte counts (p = 0.03), platelet counts (p = 0.03), phosphate concentrations (p = 0.044), and alkaline phosphatase concentrations (p = 0.04). Patients without complications had significantly greater blood flow through the arteriovenous fistula (p < 0.0005), higher magnesium concentrations (p = 0.004), and a lower carotid artery intima-media thickness (p = 0.037). The magnesium level was inversely correlated with leukocyte (p = 0.028) and platelet (p = 0.016) counts. The magnesium concentration was significantly lower in patients with carotid artery plaques (p = 0.03). Multiple linear regression, using magnesium as the dependent variable in patients with arteriovenous fistula complications, indicated statistically significant correlations with platelet (p = 0.005) and leukocyte (p = 0.027) counts and carotid plaques (p = 0.045).
Hypomagnesemia is a significant pro-atherogenic factor and an important predictor of arteriovenous fistula complications.
No preview · Article · Jan 2016 · International Urology and Nephrology
[Show abstract][Hide abstract]ABSTRACT: Background/Aim. Immune system disorder, including inflammation, takes a significant place when considering still unclear etiology of schizophrenia. The aim of this study was to determine the blood levels of nonspecific inflammation markers in the first episode of schizophrenia and their relation to the therapy response. Methods. In this study we determined the blood levels of nonspecific inflammation markers: white blood cells count (WBC), C-reactive protein (CRP), erythrocytes sedimentation rate (ESR) and the elements of differential white blood cell counts (or the leukocyte formula): granulocytes (Gra), lymphocytes (Lym) and monocytes (Mon), in the first episode of schizofrenia, in 78 patients hospitalized at the Clinic for Psychiatric Disorders “Dr Laza Lazarević” in Belgrade. The levels were measured at admission to the clinic, as well as after 4 weeks of antipsychotic treatment. The Positive and negative syndrome scale for schizophrenia (PANSS) was applied to measure the severity of psychopathology and response to the treatment. Results. During the first episode of schizophrenia, before initiation of antipsychotic treatment, the frequency of abnormal values was high (≥ 25% of the patients) for the following non-specific inflammation markers: WBC, CRP, ESR and Gra, in the leukocyte formula, but dropped after 4 weeks of antipsychotic treatment at the level of high statistical significance for WBC and Gra (p < 0.001). The ESR remained unchanged in as many as 50% of the patients even after 4-week antipsychotic treatment, at the level of statistical significance in the non-responders compared to the responders (p = 0.045). Conclusion. The obtained results indicate that in the first episode of schizophrenia the blood levels of non-specific inflammation markers (WBS, CRP, ESR and Gra from the leukocyte formula) were high in the subpopulation of patients with the tendency towards normalization of inflammation parameters after a 4-week antipsychotic treatment.
Full-text · Article · Dec 2015 · Vojnosanitetski pregled. Military-medical and pharmaceutical review
[Show abstract][Hide abstract]ABSTRACT: Background:
Correlations between instruments measuring the same construct reflect their concurrent validity. Little is known about changes in correlations between such instruments employed in studies with repeated assessment. The aim of this meta-analysis was to examine the changes in correlations between depression instruments in the course of longitudinal studies.
A literature search was conducted using MEDLINE and PsycINFO for the period from 1960 to 2013. The total number of collected articles was 3723, of which 61 were included. Three meta-analyses were performed for the changes in correlations between each pair of the three depression scales: Hamilton Rating Scale for Depression (HAMD), Montgomery-Asberg Depression Rating Scale (MADRS) and Beck Depression Inventory (BDI). The effect size in these meta-analyses was obtained by the z-transformation of correlation coefficients.
Correlations between depression scales increased over time in 52 studies. Significant changes in correlation coefficients were found for correlations between HAMD and BDI (p<0.001) and for correlations between HAMD and MADRS (p<0.001). An increase in correlations between the scales was associated with a decrease in depression scores and increase in their variability.
Univariable and multivariable meta-regression models were not obtained in all three meta-analyses because of the lack of data.
A finding that correlations between depression instruments tended to increase over time has significant implications for assessment of the concurrent validity of these instruments. In longitudinal designs it is important to estimate correlations between depression scales over time because different thresholds for scale correlations indicate acceptable concurrent validity at different times.
Full-text · Article · Nov 2015 · Journal of Affective Disorders
[Show abstract][Hide abstract]ABSTRACT: Background
Violence in the workplace is a serious social and public health problem in developing and transition countries. The objective of this study was to examine the prevalence and predictors of combination types of workplace violence and measures to ensure safe work environment for employees in Primary Health Care (PHC) centres.
This study was designed as a cross-sectional study and conducted between October 2012 and July 2013 at PHC centres in Belgrade, Serbia. The sample was formed by multi-stage sampling. Out of all sixteen PHC centres in Belgrade, five of them were randomly selected. The final analysis included only employees who confirmed the presence of any type of violence, 803 employees, (122 men – 15.2% and 680 women – 84.7%). The general response rate was 86.8% (1526/1757). The data were collected by questionnaire Workplace Violence in the Health Sector Country Case Studies Research instruments developed by ILO/ICN/WHO/PSI.
The exposure to combination type of violence was 388 (48.3%). One-third of respondents 294 (36.6%) experienced two types of violence, commonly to verbal violence and mobbing. The multivariable - adjusted model showed that working between 18.00 – 7.00 h (95% CI = 1.06-2.15), being witness of incidents of workplace violence (95% CI = 2.02-4.09), changed shifts or rotas (95% CI = 2.40-8.39), and reduced periods of working alone (95% CI = 1.45-34.42) were significant predictors of combined type of workplace violence. There was an inverse association of combined type of workplace violence with being moved from another place to the place where currently work (95% CI = 0.48−0.98), being encouraged to report workplace violence (95% CI = 0.49−0.94) and the number of staff in the same work setting (95% CI = 0.28−0.66)
Collecting data on workplace violence and identifying specific risk factors could have a positive impact on strengthening security measures and control strategies for workplace violence.
Workplace violence is highly prevalent among the employees and almost half of them reported combination type of violence
The existing protection measures in the workplace are not enough, it is necessary to provide a better work organisation and to encourage the reporting of violence by application of written procedures
[Show abstract][Hide abstract]ABSTRACT: To test the validity and reliability of the Serbian version of the interviewer-administered format of the National Eye Institute Visual Functioning Questionnaire (NEI VFQ-25).
The Serbian version of NEI VFQ-25 was translated in accordance with standard methods that have been adopted internationally. In order to assess the reliability and validity of the translated NEI VFQ-25, we used a sample of 105 patients with four different chronic ocular diseases. Cronbach’s alpha coefficient was used to assess internal consistency for each subscale. To assess test–retest reliability, intraclass correlation coefficients were used. The test–retest data were obtained from clinically stable patients with age-related cataracts, in surveys performed 2 weeks apart. Rasch analysis was also applied as a modern methods of psychometric assessment of the questionnaire.
Four groups of patients were studied and the most prevalent were patients with cataract 40 (38.1 %), followed by diabetic retinopathy 31 (29.5 %), age related macular degeneration 22 (21.0 %) and glaucoma 12 (11.4 %). The overall index score on the NEI VFQ-25 ranged from 65.3 to 67.8 with a mean of 67.4 ± 15.0. Cronbach’s alpha coefficient (index of internal consistency reliability) ranged from 0.643 to 0.889 for the subscales. Evaluation of the validity of the Serbian version of NEI VFQ-25 is presented in the multi-trait–multi-method matrix and all items passed the convergent and discriminant validity tests. Rasch analysis showed a good measurement precision, but also demonstrated misfitting items and multidimensionality of the questionnaire.
Although traditional validation method indicates that the Serbian version of NEI VFQ-25 is a valid and reliable instrument for the assessment of vision specific QoL in Serbian populations aged 40 years or older, Rasch analysis revealed a substantial weakness of the questionnaire that should be taken into consideration when interpreting the results.
Preview · Article · Sep 2015 · Health and Quality of Life Outcomes
[Show abstract][Hide abstract]ABSTRACT: In the present study, BCR sequential extraction procedure was introduced to assess mobility of heavy metals (HMs) in agricultural soils along the Ibar River Valley in the historically industrial region. Furthermore, the potato samples grown on these soils were estimated for their bioaccumulation ability. The concentrations of Pb, Zn, Cd, Ni, Cr, and Cu in soil and plant samples were determined by the ICP-OES method. The results indicated that industrial Pb/Zn production over the years significantly increased not only the total concentrations of HMs in the soil, but also their mobile and potentially bioavailable amounts. The order of the bioconcentration capacity in potato samples were Cu>Zn>Cd>Pb>Ni>Cr.
[Show abstract][Hide abstract]ABSTRACT: Purpose: SCI are one of the leading causes of disabilities around the world. Length of stay in patients with spinal cord injury depends on many medical and non-medical factors, especially of health-care system and social environment. Material and Method: The study included 529 patients with spinal cord injuries admitted in Clinic for rehabilitation Dr M. Zotovic, Belgrade, Serbia, from January 2000 to December 2009. The factors influencing length of stay in our study were: age, gender, neurological level and completeness of injury, etiology of injury, methods of treatment, secondary complications and associated injuries. Length of stay in this study was defined from the date of admission to the date of discharge from rehabilitation. Results: Median length of rehabilitation is 134 days (range, 28.0-533.0). The average age of survey respondents was 46.1±16.8 years. In this study 382 (72.2%) of patients were male and 147 (27.8%) were female. There were 180 (34.0%) tetraplegic and 349 (66%) paraplegic patients. In the multivariate Cox regression model, statistically significant predictors of length of stay were: neurological level of injury (p=0.014), completeness of the lesion (p=0.048), ASIA scale (p<0.001), age (p=0.043), urinary tract infection (p<0.001) and spasticity (p=0.042) as complications during rehabilitation. Conclusion: Reducing the length of stay would significantly decrease the overall financial costs for patients with spinal cord injury. Construction of the specialized centers for rehabilitation of patients with spinal cord injury and better coordination between primary care and rehabilitation centers would contribute to it.
No preview · Article · Jun 2015 · Physikalische Medizin Rehabilitationsmedizin Kurortmedizin
[Show abstract][Hide abstract]ABSTRACT: Background
Laryngomalacia (LM) is the most common congenital anomaly of larynx that causes stridor in children. We evaluated the efficacy of epiglottic suture and laser epiglottopexy for treatment of infants with severe LM.Methods
Surgical intervention was performed in 19 patients with severe LM, after the diagnosis was established using flexible laryngotracheobronchoscopy. Five patients had isolated type 1 LM, and fourteen patients had combination of type 1 and 3 LM. The indication for surgical treatment was the presence of LM with at least one of the following: malnutrition (Z score BMI < -2SD), dysphagia or symptoms of gastroesophageal reflux with mean oxygen saturation (SaO2) below 92%, with oxygen desaturation index (ODI) > 3.ResultsEpiglottic suture was performed in 11 patients, and laser epiglottopexy in 8, with mean age of 3.95 ± 2.4 months. The rate that the patient would be operated was 2.2 times greater in patients with more severe anomaly (combination of type 1 and 3 LM). On six months follow-up patient's symptoms gradually improved, as well as nutritional status, with increase of mean BMI Z score from -3.7 to -0.9 (p < 0.01). The mean preoperative SaO2 was 89.4 ± 4.3% with mean ODI of 5.8. On six months follow up mean SaO2 was 96.7 ± 1.1%, with mean ODI of 1.2 (p < 0.01).Conclusions
Epiglottic suture and laser epiglottopexy are efficient surgical techniques that lead to significant improvement of symptoms, oxygenation and nutritional status in patients with LM. This article is protected by copyright. All rights reserved.
No preview · Article · May 2015 · Pediatrics International
[Show abstract][Hide abstract]ABSTRACT: Introduction By the year 2020, if current trends for demographic and epidemiological transition continue, the burden of depression will have increased to 5.7% of the total burden of disease, thus becoming the second leading cause of disability-adjusted life year (DALY) lost. Early detection of people at risk of developing any mental disorder is extremely important in the prevention of all mental disorders. Objective The objective of the study was to determine depression predictors among adult residents in four Kosovo and Metohia municipalities predominantly inhabited by Serbian population. Methods This cross-sectional study included the representative sample of adults in Leposavić, North Kosovska Mitrovica, Gnjilane and Priština and was performed in October/November of 2009. The sample was selected from the list of citizens older than 18, received in the above mentioned municipalities. The Goldberg General Health Questionnaire (GHQ-28) was used as a research instrument. The methods of statistical analysis included descriptive statistics, simple and multiple logistic regression analysis, and analysis of variance, with a significance level of 0.05. Results Problems with depression have been significantly associated with female sex (OR=2.24), older age (OR=1.01), lower levels of education (OR=0.50), unemployment (OR=1.09), poor financial situation (OR=0.45), abuse (OR=0.08) and assessment of the future political and security situation as a highly risky one (OR=3.01). Conclusion To determine risk groups being in greater risk to suffer from depression is important for planning, enhancing, promoting and implementing the prevention strategies for this disease.
Full-text · Article · Jan 2015 · Srpski arhiv za celokupno lekarstvo