Comparison of Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II and Mini Nutritional Assessment - Short Form in detecting nutritional risk among community-dwelling seniors in Bosnia and Herzegovina.

OBJECTIVE: The aim of the current study is to compare Seniors in the Community: Risk Evaluation for Eating and Nutrition, version II (SCREEN II) and Mini Nutritional Assessment - Short Form (MNA-SF), where each is used to identify nutritional risk prevalence among community-dwelling people aged 65 years and above in Bosnia and Herzegovina. DESIGN: A cross-sectional study. Nutritional risk assessed using the nutritionist's risk rating, anthropometric measurements, functional indicators, cognitive parameters, SCREEN II and MNA-SF. SETTING: The municipalities of Foca, East Sarajevo and Bijeljina, Bosnia and Herzegovina. PARTICIPANTS: Eight hundred twenty-one community-dwelling individuals aged ≥65 years. RESULTS: The prevalence of high nutritional risk per nutritionist's risk rating, SCREEN II and MNA-SF was 26, 60, and 7 %, respectively. With the nutritionist's rating score ≥5 as the criterion, the MNA-SF cut-off point of ≤11 (indicating any possible risk) had poor sensitivity (55·7 %), specificity (46·6 %) and AUC (0·563; P = 0·024). When the criterion of >7 was applied, good sensitivity (95·3 %) and specificity (88·9 %) were obtained for the MNA-SF cut-off score of ≤7. AUC for this comparison was 0·742 (considered fair). Cut-off points of <54 (AUC = 0·816) and <50 (AUC = 0·881) for SCREEN II (indicating moderate to high risk) corresponded with good sensitivity (82·2 %; 80·9 %) and fair specificity (72·1 %; 75·0 %). CONCLUSION: MNA-SF may have a limited role in nutritional risk screening among community-dwelling seniors in Bosnia and Herzegovina. SCREEN II has promising results in regard to validity, but further studies are warranted.

Anxiety and depression in patients with vocal fold nodules, edema and polyps.

PURPOSE: To compare the prevalence and severity of depression and anxiety among patients with vocal fold (VF) nodules, polyps and edema. At the same time the aim was to analyse association between severity of distress and the level of vocal handicap as well as to identify other factors related to severity of depression and anxiety in these patients. METHODS: To all participants were given five questionnaires: (1) questionnaire on socio-demographic and some other characteristics of patient; (2) Beck's Depression Inventory (BDI); (3) State-Trait Anxiety Inventory (STAI) 1 (State Anxiety); (4) STAI 2 (Trait Anxiety); and (5) Voice Handicap Index (VHI)-10. RESULTS: A total of 205 patients were included in this study. Mild-to-severe depression, according to BDI was present in 79 (38.6%) patients. Mild-to-severe state anxiety and trait anxiety were present in 199 (97.1%) and 200 (97.6%) patients, respectively. Only 10 patients had VHI-10 score ≤ 11. Multivariate analyses showed that there were no significant differences in the level of depression and anxiety between patients with VF nodules, polyps and edema. The VHI-10 score was significantly higher in patients with VF edema in comparison with VF nodule patients (p = 0.001), as well as in comparison with VF polyp patients (p = 0.001). CONCLUSION: The present study identified a high prevalence of psychological and vocal distress among patients with vocal disorders. Severity of depression and anxiety did not differ between patients with VF nodules, polyps and edema, and it was not related to the level of vocal handicap.

Comparison of different anthropometric measures in the adult population in Serbia as indicators of obesity: data from the National Health Survey 2013.

OBJECTIVE: The present study aimed to compare different indicators of obesity in the Serbian adult population. DESIGN: Cross-sectional study. A stratified, two-stage, national-representative random sampling approach was used for the selection of the survey sample. Data sources were questionnaires created according to the European Health Interview Survey questionnaire. Measurements of weight, height and waist circumference (WC) were performed using standard procedures. Anthropometric measures included BMI, WC and waist-to-height ratio (WHtR). SETTING: Data for the study were obtained from the 2013 National Health Survey, performed in line with the EUROSTAT recommendations for performance of the European Health Interview Survey. SUBJECTS: Adults aged ≥20 years. RESULTS: According to BMI, out of the whole studied population (12 460 adults of both sexes) 2·4 % were underweight, 36·4 % overweight and 22·4 % obese. Using WC and WHtR as measures of adiposity showed that 22·5 % and 42·8 % of participants were overweight and 39·8 % and 25·3 % were obese, respectively. Men and women differed significantly in all variables observed. Overweight was more frequent in men and obesity in women regardless of adiposity measure used. CONCLUSIONS: In spite of strong correlations between BMI, WC and WHtR, substantial discrepancies between these three measures in the assessment of overweight and obesity were found, especially in some age groups. Which of these anthropometric measures should be used, or whether two or all three of them should be applied, depends on their associations with cardiovascular or some other disease of interest.

Association between C-reactive protein, anthropometric and lipid parameters among healthy normal weight and overweight postmenopausal women in Montenegro.

OBJECTIVE: Although C-reactive protein (CRP) is among the best cardiovascular disease risk predictors, data regarding the association of CRP and menopause are controversial. In this study, we measured CRP by a high-sensitivity method (hsCRP), cholesterol, lipoproteins, and triglycerides in normal and overweight postmenopausal women. METHODS: Body weight, height, waist circumference (WC), hsCRP, total cholesterol, high-density lipoprotein cholesterol (HDL-c), low-density lipoprotein cholesterol (LDL-c), triglycerides, and lipoprotein (a) were measured in 30 normal weight and 60 overweight healthy postmenopausal women. RESULTS: Significantly higher triglyceride and hsCRP levels (P = 0.005 and P < 0.001 respectively), together with lower HDL-c levels (P = 0.001) were found in overweight compared to normal weight women. In the overweight group, positive correlations of hsCRP were observed with age, body mass index and WC (P = 0.016, P = 0.001, and P < 0.001, respectively) and a negative correlation was observed with HDL-c (P = 0.007). In the normal weight group, positive correlations were found for hsCRP with age and WC (P = 0.023 and P = 0.014, respectively). WC was the best predictor of hsCRP level in both groups (P < 0.001). CONCLUSION: Elevated hsCRP levels in conjunction with abnormal lipid profiles may be strongly associated with weight gain in postmenopausal women. Efforts to reduce obesity and inflammation in this group may help correct abnormal levels of hsCRP and lipids.

Quality of life in chronic venous disease patients measured by short Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-14) in Serbia.

BACKGROUND: This was a psychometric validation of the short Chronic Venous Disease Quality of Life Questionnaire (CIVIQ-14) as quality of life (QOL) instrument for chronic venous disease (CVD) patients. METHODS: Patients aged >18 years who had CVD in CEAP C stages C0s to C6 were included in the study. Diagnosis was made by general practitioners according to CVD symptoms and visual examination of the lower extremities. QOL was assessed with the self-administrated CIVIQ-14. The reliability, construct, and convergent validity of the CIVIQ-14 was estimated as well as QOL of CVD patients according to CEAP C stages. RESULTS: The study comprised 2260 subjects who fully completed the CIVIQ-14. CIVIQ-14 had a high level of reliability, construct, and convergent validity, but the structure of its three dimensions (pain [P], physical [PHY], and psychological [PSY]) was suboptimal. After adjustment for age, body mass index, and number of CVD symptoms, CIVIQ -14 global, P, PHY, and PSY scores showed significant progressive reduction of QOL from CEAP class C0s to C6. These differences were present in both sexes. The progressive impairment of the QOL involved primarily the pain and the physical items. For all CEAP C classes, the P and PHY scores were lower than the PSY scores. Global scores for men and women were: 76.7 and 73.9 for C0s; 75.5 and 70.6 for C1; 67.8 and 64.5 for C2; 68.3 and 61.6 for C3; 60.7 and 54.6 for C4; 49.5 and 50.2 for C5; and 41.3 and 46.7 for C6. CONCLUSIONS: CVD in the lower extremities has a substantial effect on both physical and psychologic aspects of QOL, the physical aspects of QOL (P and PHY items) being more important. CIVIQ-14 is valuable in assessing QOL in CVD patients. Further investigations are necessary to confirm the stability of its two dimensions.

Health-related quality of life among patients with symptomatic carotid disease.

OBJECTIVES: To evaluate health-related quality of life (HRQoL) in patients with symptomatic carotid disease (amaurosis fugax, transient ischaemic attack, stroke); to compare it with that of the general population; to explore whether HRQoL depends on the severity of the disease and to investigate the possible association between some demographic and clinical characteristics of patients and HRQoL. METHODS: This cross-sectional study involved 175 patients with symptomatic carotid atherosclerotic disease who were referred for endarterectomy between January 2011 and December 2011. HRQoL was measured using Medical Outcome Survey Short Form 36 (SF-36). RESULTS: In comparison to both referent populations, patients with carotid disease had significantly lower mean SF-36 scores for role-physical (41.6 vs. 61.5 and 67.8), social functioning (65.4 vs. 73.8 and 80.0), role-emotional (48.2 vs. 68.6 and 80.5) and mental health (51.5 vs. 61.9 and 66.0). The SF-36 scores were significantly lower in female patients with carotid disease than in men (for role-physical 32.3 vs. 46.5; for bodily pain 57.0 vs. 73.0; for general health 55.6 vs. 61.5; for vitality 55.4 vs. 60.1; for social functioning 57.1 vs. 69.8 and for role-emotional 37.2 vs. 54.1). Significantly lower SF-36 scores were also found in patient with comorbidity (for physical functioning 68.1 vs. 77.7; for role-physical 35.1 vs. 52.3; for bodily pain 62.6 vs. 75.4; for general health 56.8 vs. 63.8; for social functioning 61.9 vs. 71.0, for role-emotional 41.6 vs. 59.1and for mental health 52.5 vs 49.8). In a multivariable analysis, education, occupation, body mass index, metabolic syndrome and severity of the disease had a weak influence on patients' HRQoL, while age, marital status, smoking, alcohol consumption, physical activity and the degree of carotid stenosis had no effect on patients' HRQoL. The SF-36 scores did not substantially change after adjustment for confounding variables. CONCLUSIONS: Patients with symptomatic carotid disease had poorer HRQoL, especially its mental components, than the general population. The severity of the disease was significantly associated only with the SF-36 role-physical subscale. HRQoL in patients with symptomatic carotid disease was poorer in women than in men, and was not affected by age and other demographic and clinical characteristics of patients.

Body Mass Index and Late Adverse Outcomes after a Carotid Endarterectomy.

A cohort study was conducted to examine the association of an increased body mass index (BMI) with late adverse outcomes after a carotid endarterectomy (CEA). It comprised 1597 CEAs, performed in 1533 patients at the Vascular Surgery Clinic in Belgrade, from 1 January 2012 to 31 December 2017. The follow-up lasted four years after CEA. Data for late myocardial infarction and stroke were available for 1223 CEAs, data for death for 1305 CEAs, and data for restenosis for 1162 CEAs. Logistic and Cox regressions were used in the analysis. The CEAs in patients who were overweight and obese were separately compared with the CEAs in patients with a normal weight. Out of 1223 CEAs, 413 (33.8%) were performed in patients with a normal weight, 583 (47.7%) in patients who were overweight, and 220 (18.0%) in patients who were obese. According to the logistic regression analysis, the compared groups did not significantly differ in the frequency of myocardial infarction, stroke, and death, as late major adverse outcomes (MAOs), or in the frequency of restenosis. According to the Cox and logistic regression analyses, BMI was neither a predictor for late MAOs, analyzed separately or all together, nor for restenosis. In conclusion, being overweight and being obese were not related to the occurrence of late adverse outcomes after a carotid endarterectomy.

Prevalence of the metabolic syndrome in patients with carotid disease according to NHLBI/AHA and IDF criteria: a cross-sectional study.

BACKGROUND: Metabolic syndrome (MetS) has been related to type 2 diabetes and cardiovascular diseases. Different criteria for diagnosis of MetS have been recommended, but there is no agreement about which criteria are best to use. The aim of the present study was to investigate agreement between the National Heart, Lung, and Blood Institute, American Heart Association (NHLBI/AHA) and the International Diabetes Federation (IDF) definitions of MetS in patients with symptomatic carotid disease and to compare the frequency of cardiovascular risk factor in patients with MetS diagnosed by these two sets of criteria. METHODS: The study was a cross-sectional one involving 644 consecutive patients with verified carotid disease who referred to the Vascular Surgery Clinic Dedinje in Belgrade during the period April 2006 - November 2007. Anthropometric parameters blood pressure, fasting plasma glucose and lipoproteins were measured using standard procedures. RESULTS: MetS was present in 67.9% of participants, according to IDF criteria, and in 64.9% of participants, according to the NHLBI/AHA criteria. A total of 119 patients were categorized differently by the two definitions. Out of all participants 10.7% had MetS by IDF criteria only and 7.8% of patients had MetS by NHLBI/AHA criteria only. The overall agreement of IDF and NHLBI/AHA criteria was 81.5% (Kappa 0.59, p < 0.001). In comparison with patients who met only IDF criteria, patients who met only NHLBI/AHA criteria had significantly more frequently cardiovascular risk factors with the exception of obesity which was significantly more frequent in patients with MetS diagnosed by IDF criteria. CONCLUSION: The MetS prevalence in patients with symptomatic carotid disease was high regardless of criteria used for its diagnosis. Since some patients with known cardiovascular risk factors were lost by the use of IDF criteria it seems that NHLBI/AHA definition is more suitable for diagnosis of MetS. Large follow-up studies are needed to test prognostic value of these definitions.

Gender differences in academic stress and burnout among medical students in final years of education.

BACKGROUND: The educational process brings a considerable amount of stress to medical students that can influence mental health status and contribute to further professional burnout. The authors assessed the academic stress influences, mental health status and burnout syndrome, with the intent to find different patterns in female and male medical students. SUBJECTS AND METHODS: The applied cross sectional study was in the form of an anonymous questionnaire which included: socio-demographic data, self-reported health status and influence of studying activities on stress level in 755 medical students who attended two final years. Mental health status was explored by the General Health Questionnaire (GHQ-12), and Maslach Burnout Inventory (MBI). RESULTS: Female students assessed their physical health status and general stress level as worse compared to males (p<0.001). Exams were described as a high stressor in about 50% of all examined students. However, this stressor was significantly more frequent in female students (p<0.001). Female students frequently declared high stressful effects of contacts with patients (p=0.009) and autopsy (p<0.001). The scores of the GHQ-12 questionnaire were above the threshold or high in 51.5% of all students, and also significantly higher in females (p=0.001). High scores were found among 52.6% of all examined students on MBI subscale of Depersonalization, and 33.6% on MBI subscale of Emotional exhaustion without gender difference. CONCLUSION: Measures for prevention of academic distress should be targeted at optimization of the educational process, development of the clinical skills and professionalism, with special concern to female students who manifested high vulnerability.

Body mass index and early outcomes after carotid endarterectomy.

As the existing data on the correlation of adiposity with adverse outcomes of carotid endarterectomy (CEA) are inconsistent, the aim of the present study is to examine the correlation of an increased body mass index with 30-day complications after carotid endarterectomy. The cohort study comprises 1586 CEAs, performed at the Clinic for Vascular Surgery in Belgrade, from 2012-2017. Out of them, 550 CEAs were performed in patients with normal body mass index (18.5-24.9), 750 in overweight (25.0-29.9), and 286 in obese (≥30) patients. The association of overweight and obesity with early outcomes of carotid endarterectomy was assessed using univariate and multivariate logistic regression analysis. Overweight patients, in whom CEAs were performed, were significantly more frequently males, compared to normal weight patients-Odds Ratio (OR) 1.51 (95% confidence interval- 1.19-1.89). Moreover, overweight patients significantly more frequently had non-insulin-dependent diabetes mellitus-OR 1.44 (1.09-1.90), and more frequently used ACEI in hospital discharge therapy-OR 1.41 (1.07-1.84) than normal weight patients. Additionally, the CEAs in them were less frequently followed by bleedings-OR 0.37 (0.16-0.83). Compared to normal weight patients, obese patients were significantly younger-OR 0.98 (0.96-0.99), and with insulin-dependent and non-insulin-dependent diabetes mellitus-OR 1.83 (1.09-3.06) and OR 2.13 (1.50-3.01) respectively. They also more frequently had increased triglyceride levels-OR 1.36 (1.01-1.83), and more frequently used oral anticoagulants in therapy before the surgery-OR 2.16 (1.11-4.19). According to the results obtained, overweight and obesity were not associated with an increased death rate, transient ischemic attack (TIA), stroke, myocardial infarction, or with minor complications, and the need for reoperation after carotid endarterectomy. The only exception was bleeding, which was significantly less frequent after CEA in overweight compared to normal weight patients.

Surgical treatment of ovarian cancer and early detection of venous thromboembolism.

INTRODUCTION: Deep vein thrombosis (DVT) is present in 10.6% patients after operative treatment for ovarian malignancy. We undertook the present study to find the risk factors for venous thromboembolism (VTE) after surgical treatment for ovarian cancer and to clarify the prognostic value of D-dimer and a positive PTP test (Wells score) in these patients. MATERIAL AND METHODS: A total of 31 consecutive patients with histologically confirmed ovarian cancer after surgery, clinically suspicious for DVT were followed from January 2006 to December 2008. All patients were operatively treated at the Clinical Center of Serbia. Study variables included age, cardiovascular disease, FIGO stage, histology, BMI, presence of massive ascites and tumor size, D-dimer level and Wells score. All patients were postoperatively administered anticoagulant therapy. RESULTS: DVT was found in nine of 31 patients (29.0%). High BMI and presence of massive ascites were significantly associated with DVT. D-dimer (DD) levels were high in 27 of out 31 patients (87.1%). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 100, 18.2, 33.3 and 100%. Results of the PTP test (according to Wells score) was positive in 20 out of 31 patients (64.5%). PTP score was not significantly different in patients with or without VTE (p = 0.606). Sensitivity, specificity, PPV and NPV were 66.7, 36.4, 30.0 and 72.7%, respectively. CONCLUSION: Incidence of VTE after gynecological operations for ovarian cancer in our study was similar to other investigators. Obesity and the massive ascites are statistically significant risk factors. Measurement of DD level and ultrasonography could become the standard in predicting VTE in ovarian cancer surgery. The use of Wells score is not satisfying in these patients. Prediction of VTE after gynecological surgery needs further confirmation in randomized controlled trials.

Translation, adaptation and validation of the youth attitude to noise scale (YANS) questionnaire into serbian language.

CONTEXT: Several language variations of YANS have been published. There is a rationale in grouping languages where one variation is usable for several countries. The people of four ex-Yugoslavian countries do speak practically one language whatever its present name. AIM: To make a Serbian version of YANS which would be usable in Serbia, Croatia, Bosnia and Herzegovina and Montenegro. SETTINGS AND DESIGN: Translation and test-retest survey in a secondary school. MATERIAL AND METHODS: The translation process was performed according to the relevant guidelines through a standard procedure: English-Serbian-English-Consensus (people fluent in English)-Pilot assessment (20 students). The survey was performed in a Belgrade high school. Test YANS was completed by 244 students (response rate 98,8%, males 44%). Retest YANS was carried out among 60 randomly chosen students from the primary sample (response rate 96.7%, males 58%). In the statistical analysis we used the Olsen's model of classification as well as previous validation of YANS. A reliability measure for analyzing survey items was Cronbach's alpha. Determination of the mean differences between test and retest with respect to normal distribution of data was performed with the Student's paired t-test. RESULTS: Factor analysis between items grouped into four factors showed no significant association, except for a weak but negative one between two specific factors. The internal reliability (Cronbach's alpha) was 0.721 and assessed as acceptable. The test-retest comparison did not reveal any significant differences. Mean overall YANS score was 2.76, which is higher than on testing in Sweden, very similar to the Brazilian one, and lower than in Belgium and China. CONCLUSION: Serbian version of YANS is a valid and reliable research instrument. It may also be used in Croatia, Bosnia and Herzegovina and Montenegro.

Association of overweight and obesity with cardiovascular risk factors in patients with atherosclerotic diseases.

BACKGROUND: The aim of this study was to compare demographic, clinical and biochemical characteristics, including inflammatory markers, according to the nutritional status of patients with verified atherosclerotic disease. METHODS: This cross-sectional study involved 1045 consecutive patients with verified carotid disease or peripheral arterial disease (PAD). Anthropometric parameters and data on cardiovascular risk factors and therapy for hypertension and hyperlipidemia were collected for all participants. RESULTS: Carotid disease was positively and PAD was negatively associated with body mass index (BMI). Negative association between obesity and PAD was significant only in former smokers, not in current smokers or in patients who never smoked. Overweight and general obesity were significantly related to metabolic syndrome (p < 0.001), lower values of high - density lipoprotein cholesterol (p < 0.001), increased triglycerides (p < 0.001), hyperglycemia (p < 0.001), self-reported diabetes (p < 0.001), hypertension (p < 0.001), high serum uric acid (p < 0.001), increased high sensitivity C-reactive protein (p = 0.020) and former smoking (p = 0.005) after adjustment for age, gender and type of disease. Antihypertensive therapy seems to be less effective in patients who are overweight and obese. CONCLUSIONS: In conclusion, overweight and general obesity were significantly related to several cardiovascular risk factors.

Statistical Challenges in Development of Prognostic Models in Diffuse Large B-Cell Lymphoma: Comparison Between Existing Models - A Systematic Review.

BACKGROUND AND AIM: Based on advances in the diagnosis, classification, and management of diffuse large B-cell lymphoma (DLBCL), a number of new prognostic models have been proposed. The aim of this study was to review and compare different prognostic models of DLBCL based on the statistical methods used to evaluate the performance of each model, as well as to analyze the possible limitations of the methods. METHODS AND RESULTS: A literature search identified 46 articles that proposed 55 different prognostic models for DLBCL by combining different clinical, laboratory, and other parameters of prognostic significance. In addition, six studies used nomograms, which avoid risk categorization, to create prognostic models. Only a minority of studies assessed discrimination and/or calibration to compare existing models built upon different statistical methods in the process of development of a new prognostic model. All models based on nomograms reported the c-index as a measure of discrimination. There was no uniform evaluation of the performance in other prognostic models. We compared these models of DLBCL by calculating differences and ratios of 3-year overall survival probabilities between the high- and the low-risk groups. We found that the highest and lowest ratio between low- and high-risk groups was 6 and 1.31, respectively, while the difference between these groups was 18.9% and 100%, respectively. However, these studies had limited duration of follow-up and the number of patients ranged from 71 to 335. CONCLUSION: There is no universal statistical instrument that could facilitate a comparison of prognostic models in DLBCL. However, when developing a prognostic model, it is recommended to report its discrimination and calibration in order to facilitate comparisons between different models. Furthermore, prognostic models based on nomograms are becoming more appealing owing to individualized disease-related risk estimations. However, they have not been validated yet in other study populations.

Available prognostic models for risk stratification of diffuse large B cell lymphoma patients: a systematic review.

The International Prognostic Index (IPI) has been used for risk stratification for a long time in diffuse large B cell lymphoma (DLBCL). Based on new clinical and biological prognostic markers, many new prognostic models have been described. This review aims to present the progress in development and validation of these prognostic models. A comprehensive literature review was performed to identify studies that proposed a new prognostic model in DLBCL. A total of 38 studies met the inclusion criteria. The IPI, revised IPI (R-IPI), and National Comprehensive Cancer Network (NCCN)-IPI were the most studied prognostic indexes, externally validated and commonly used to compare to other models. Despite an increasing number of prognostic models have been proposed lately, most of them lack external validation. Further studies, that combine biological and clinical markers with prognostic significance, are needed to determine the optimal prognostic tool for more personalized treatment approach to DLBCL patients.

The prevalence of polyvascular disease in patients with carotid artery disease and peripheral artery disease.

BACKGROUND: Cardiovascular disease remains the major cause of mortality in the Western World. AIMS: We aimed to assess the prevalence of polyvascular disease in patients with carotid artery disease and peripheral artery disease (PAD), and to determine the risk profile of patients with polyvascular disease. METHODS: The study included 1045 consecutive patients presenting to our department with carotid disease or PAD. Demographic characteristics, anthropometric parameters, and data on cardiovascular risk factors were collected in all patients. On the basis of medical history, patients were classified into those who had only symptomatic carotid disease or symptomatic PAD and those who had symptomatic polyvascular disease. RESULTS: Carotid disease alone was reported in 366 participants (35%), PAD alone, in 199 (19%), and polyvascular disease, in 480 (46%). Compared with carotid disease, PAD was more often a component of polyvascular disease (P = 0.002) and was combined with a higher number of other atherosclerotic diseases (P = 0.02). Compared with patients with symptomatic atherosclerotic disease in only 1 territory, patients with various types of polyvascular disease more often had hypertension (P from 0.03 to <0.001), dyslipidemia (P <0.001), high­sensitivity C­reactive protein levels of 3 mg/l or higher (P = 0.005), and more often were current smokers (P <0.001) or former smokers (P from 0.03 to 0.001). CONCLUSIONS: We showed a high prevalence of symptomatic polyvascular disease in patients with carotid disease or PAD. The risk profile was worse in patients with polyvascular disease than in those with a disease in a single vascular territory.

The assessment of health-related quality of life in relation to the body mass index value in the urban population of Belgrade.

BACKGROUND: The association between excess body weight, impairment of health and different co-morbidities is well recognized; however, little is known on how excess body weight may affect the quality of life in the general population. Our study investigates the relationship between perceived health-related quality of life (HRQL) and body mass index (BMI) in the urban population of Belgrade. METHODS: The research was conducted during 2005 on a sample of 5,000 subjects, with a response of 63.38%. The study sample was randomly selected and included men and women over 18 years of age, who resided at the same address over a period of 10 years. Data were collected by means of a questionnaire and nutritional status was categorized using the WHO classification. HRQL was measured using the SF-36 generic score. Logistic regression analysis was used to compare HRQL between subjects with normal weight and those with different BMI values; we monitored subject characteristics and potential co-morbidity. RESULTS: The prevalence of overweight males and females was 46.6% and 22.1%, respectively. The prevalence of obesity was 7.5% in males and 8.5% in females.All aspects of health, except mental, were impaired in males who were obese. The physical and mental wellbeing of overweight males was not significantly affected; all score values were similar to those in subjects with normal weight.By contrast, obese and overweight females had lower HRQL in all aspects of physical functioning, as well as in vitality, social functioning and role-emotional. CONCLUSION: The results of our study show that, in the urban population of Belgrade, increased BMI has a much greater impact on physical rather than on mental health, irrespective of subject gender; the effects were particularly pronounced in obese individuals.

Association of socioeconomic status measured by education and risk factors for carotid atherosclerosis: cross-sectional study.

AIM: To investigate the association between socioeconomic status and metabolic syndrome, lifestyle, clinical and biochemical characteristics, and inflammatory markers as risk factors for carotid atherosclerotic disease. METHODS: This cross-sectional study, involving 657 consecutive patients with verified carotid atherosclerotic disease, was performed in Belgrade, Serbia, during the period 2006-2007. Formal education level was used as a proxy for socioeconomic status. Anthropometric parameters and data on cardiovascular risk factors were analyzed in participants with different levels of education--low (< or = primary school), medium (secondary school), and high (university education). In the analysis, univariate and multivariate logistic regressions were used. RESULTS: Multivariate analysis showed that low education was significantly positively associated with female sex (odds ratio [OR], 2.38; 95% confidence interval [CI], 1.45-3.81), increased triglycerides (OR, 1.79; 95% CI, 1.12-2.78), increased high-sensitivity C-reactive protein (hsCRP) (OR, 3.53; 95% CI, 2.17-5.88), and physical inactivity (OR, 4.24; 95% CI, 1.82-9.86) and negatively associated with former smoking (OR, 0.42; 95% CI, 0.23-0.75). Medium education was significantly positively associated with increased triglycerides (OR, 1.73; 95% CI, 1.14-2.62) and increased hsCRP (OR, 2.17; 95% CI, 1.37-3.41), and negatively with age (OR, 0.97; 95% CI, 0.94-0.99). CONCLUSION: Increased triglycerides and hsCRP in people with low and medium education, and high prevalence of metabolic syndrome, its components and inflammatory markers in all study participants, suggest that regular health check-up, especially for those with lower education, may be useful in early detection and treatment of any abnormality that can be associated with cardiovascular disease.

Relationship between socioeconomic and nutritional status in the Serbian adult population: a cross-sectional study.

BACKGROUND: Socioeconomic status is a well-known risk factor for obesity. The aim of this study was to assess the relationship between socioeconomic and nutritional status in the Serbian adult population. DESIGN AND SETTING: Cross-sectional study on data from the 2013 National Health Survey performed in Serbia. METHODS: The study population consisted of adults aged ≥ 20 years. Face-to-face interviews and anthropometric measurements were conducted by trained staff. Associations between body mass index and sociodemographic variables were analyzed using multivariable logistic regression analyses. RESULTS: Out of 12,461 subjects of both sexes, 36.4% were overweight and 22.4% were obese. The prevalences of overweight and obesity differed significantly between the sexes, regarding all sociodemographic characteristics. Among women, educational attainment was associated with lower risk of being overweight (odds ratio, OR = 0.82; 95% confidence interval, CI: 0.69-0.98 for medium-level and OR = 0.77; CI: 0.62-0.97 for higher education) or obese (OR = 0.68; CI: 0.57-0.82 for medium-level and OR = 0.41; CI: 0.31-0.54 for higher education). In contrast, medium-level (OR = 1.28; CI: 1.08-1.52) and highly educated men (OR = 1.39; CI: 1.11-1.74) were more frequently overweight than were those with low education. Among men, grade I obesity was positively related to the richest wealth index group (OR = 1.27), while the opposite was true for grade II obesity among women (OR = 0.61). CONCLUSION: This study showed significant socioeconomic inequalities in nutritional status between men and women. Continuous monitoring of socioeconomic patterns relating to weight is important, especially with further exploration of the link between education and obesity.

Awareness and knowledge of cardiovascular disease risk factors among medical students.

BACKGROUND: The aim of this study was to assess the knowledge and attitude of medical students in relation to cardiovascular disease (CVD) risk factors as well as to assess the impact of medical education on their knowledge and recognition of the importance of implementation of preventive measures. METHODS: This cross-sectional study included 514 students in the second year of studying at the Faculty of Medicine in Belgrade, Serbia (younger students response rate 79.57%) and 511 students in the last year of education (older students response rate 90.21%). For data collection, an anonymous self-administered questionnaire was used, which included two types of questions about CVD risk factors and questions about the student's attitude. RESULTS: Older students knew significantly more about CVD risk factors than students who were at the beginning of their medical studies; however, more than half of the older students did not know the correct answers about CVD risk factors. The only exceptions were questions about "bad" and "good" cholesterol, metabolic syndrome (MSy) and lipid lowering therapy in high risk subjects. Physical inactivity, obesity, type 2 diabetes, smoking and hypertension were not ranked highly enough as important CVD risk factors. Compared groups of students did not significantly differ in attitude scores. The majority of them recognized CVD as the leading cause of death, had normal weight and knew their own blood pressure. CONCLUSION: Knowledge of medical students from Belgrade about CVD risk factors should be improved.