Personal stethoscope disinfection practices and bacterial contamination: A cross-sectional study at the University Hospital Emergency Department in Belgrade, Serbia.

BACKGROUND: A significant reduction in bacterial growth on stethoscope membranes has been noticed after performing daily disinfection. Nevertheless, disinfection is rarely performed. We aimed to assess self-reported stethoscope disinfection practices among medical doctors, detect bacterial contamination on personal stethoscopes, and estimate the effectiveness of 70% ethanol as a stethoscope disinfecting agent. METHODS: To determine stethoscope disinfection practices, participants filled out a questionnaire (N = 47), followed by providing stethoscopes for bacterial analysis. Differences in bacterial contamination were observed through the self-reported frequency and method of stethoscope disinfection. The effect of disinfecting with 70% ethanol was evaluated by comparing the presence of bacterial growth before and after disinfection. RESULTS: The presence of bacterial growth was found in 78.7% of the stethoscope samples, with the median (interquartile range) number of colony-forming units at 25 (10-105). The frequency of disinfection greatly impacted the number of colony-forming units, and the method affected the presence of bacterial growth. Disinfection of stethoscope membranes using 70% ethanol resulted in a compelling 97.3% reduction of bacterial growth. CONCLUSIONS: Adequate stethoscope disinfection is highly efficient in reducing bacterial contamination and as such should be considered a critical step in hygienic practices.

Precautionary Allergen Labelling in Serbia: Market Audit and Consumers' Perception.

Background: Precautionary allergen labels (PAL) should be used to indicate the possibility of allergen presence in the food. This study aimed to determine the prevalence and types of precautionary labeling statements on different pre-packaged food products in retail stores in Belgrade, Serbia, as well as to assess consumers' attitudes and behavior towards PAL statements. Methods: This was a descriptive study. The following characteristics of 1404 pre-packaged foods were analyzed: prevalence of PAL, listed food allergens on PAL, and the types of the advisory terminology. In the group of 275 participants (94 with food allergies, and 181 persons who purchasing food for a household member with food allergy) reading practice of PAL, purchasing practice based on PAL, and the opinion about PAL statements credibility were evaluated. Results: Overall, 33.9% of products had precautionary statements for one or more allergens. "Tree nuts" were the most common allergens listed in the PAL. The most common type of PAL was "May contain traces of x [allergen]" (52.7%). The PAL was always read by half of the participants. Less than half (43.3%) of the participants incorrectly believed that PAL is regulated by national law. A quarter of participants thought that the PAL statements are trustworthy. Conclusion: PAL statements frequently are not user-friendly and are not providing sufficient protection for food allergic patients. To gain buyers' confidence, protect health and provide security, the necessity for the strategies that would regulate PAL by the law exists.

Dietary Habits of Older Adults in Serbia: Findings From the National Health Survey.

Objectives: Adults aged 65 years and older comprise one fifth of the Serbian population. Many of them have multiple, often diet-related comorbidities. We aimed to investigate their dietary habits by comparing them with younger adults' and to determine the relation of the differing ones to demographic, socioeconomic and health factors. Methods: We performed a secondary analysis of 2013 Serbian National Health Survey data on 14,082 adults. Binary logistic regression was used to determine dietary habits associated with older age (≥65 years) compared to younger age (18-64 years) and to assess their independent predictors in older adults. Results: Older adults more often reported everyday breakfast (OR = 2.085, 95%CI = 1.622-2.680) and brown/wholegrain bread consumption (OR = 1.681, 95% CI = 1.537-1.839), while using margarine (OR = 0.578, 95%CI = 0.397-0.839), discretionary salt (sometimes: OR = 0.648, 95%CI = 0.596-0.705, almost always: OR = 0.522, 95%CI = 0.445-0.614) and consuming fish (two or more times a week: OR = 0.465, 95%CI = 0.383-0.566) less frequently than younger adults. This was mainly positively related to urban environment, affluence, higher education and poor health. Conclusion: Using nationally representative data, we found that older adults reported healthier dietary habits compared to younger adults, which requires timely public health action.

Nutrition and Health Claims Spectra of Pre-Packaged Foods on Serbian Supermarket Shelves: A Repeated Cross-Sectional Study.

Nutrition and health claims (NHCs) are a powerful tool that influence consumers' final decision on the choice of food products. The purposes of this repeated cross-sectional study were to (i) assess the prevalence of pre-packaged food products containing nutrition and health claims among different food categories, (ii) to determine the type of NHCs labelled on the examined food products, and (iii) to evaluate the trend in the use of NHCs in comparison to the 2012 survey. The survey was conducted immediately before the full enforcement of the new national legislation on NHCs in 2020. It comprised 3141 pre-packaged food products from 10 product categories. In total, 21.2% of food products contained any claim (19.4% contained any nutrition claim; 8.2% contained any health claim). In comparison to the 2012 survey, we observed a rising trend in the presence of NHCs; the use of nutrition claims on food products increased three times and the use of health claims increased 1.3 times in the 2020 survey. Bearing in mind that NHCs are a powerful tool guiding consumers' food purchase decisions, NHCs should be supported by precise legislation and strict surveillance by the public health authorities.

Dietary Factors and Tinnitus among Adolescents.

The number of people suffering from constant tinnitus is ever-increasing and has spread to all age groups, including adolescents. The etiology of tinnitus is multifactorial, but dietary factors have been rarely investigated. The purpose of this study is to examine the relationship between dietary factors and constant tinnitus among adolescents from an urban environment. A population-oriented cross-sectional study was carried out during the 2019/2020 school year in 12 Belgrade secondary schools. There were 1287 school children aged from 15 to 19 years who participated in the study. There were 1003 respondents who completed a questionnaire on tinnitus (response rate 77.9%; 31% male). We used the standardized Tinnitus Screener questionnaire and a food frequency questionnaire specially designed for this study and adapted to Serbian adolescents. A logistic regression analysis revealed a strong negative correlation between fresh vegetables and fruits and tinnitus presence. On the other hand, the risk of constant tinnitus increased with the increased intake of white bread, carbonated beverages, and fast food. In conclusion, we show that fresh fruit and vegetable intakes may be negatively related to tinnitus frequency, while sweetened sodas, fast food, and white bread may raise the odds for tinnitus.

Quality of life after peripheral bypass surgery: a 1 year follow-up.

OBJECTIVES: The aim of the study was to assess quality of life (QoL) in patients with peripheral arterial disease (PAD) after aortobifemoral bypass. METHODS: QoL assessments were completed by 78 patients, 61 (78.2 %) men and 17 (21.8 %) women. QoL was measured, using Medical Outcome Survey Short Form 36 (SF-36), before surgery and 1 year later. RESULTS: QoL significantly improved after revascularization in about two-third of patients with PAD. Improvement was present in all the SF-36 subscales with the exception of the score for mental health which significantly decreased after operation. Mean SF-36 scores, which were for almost all subscales significantly decreased in patients with PAD in comparison with reference populations, after operation reached or exceeded values of the populations with which they were compared. CONCLUSIONS: In the present study 1 year after revascularization QoL in patients with PAD was significantly improved in comparison with QoL before operation. Long-term follow-up is needed in order to assess duration of this beneficial effect of bypass surgery.

Nutrition labelling of pre-packaged foods in Belgrade, Serbia: current situation.

OBJECTIVE: To determine the presence of nutrition labels on pre-packaged food products, as well as to analyse the types of presentation. DESIGN: This was a descriptive study. The following characteristics were analysed: (i) presence and placement of the nutrition declaration (either as front-of-pack (FOP) or back-of-pack (BOP)); (ii) content of the presented information; (iii) presence of nutrition and health claims; and (iv) legibility of the written information. Settings Three different types of retailers in Belgrade, Serbia. SUBJECTS: A total of 2138 pre-packaged food products from ten categories. RESULTS: A nutrition declaration was found on 65.9% of all tested products. It was displayed on the back of the packaging of 62.7% of products and on the front of the packaging of 19.1% of products. BOP was the most commonly observed in breakfast cereals, soft drinks, milk and instant soups (in total over 90%), and the least common in meat products (21.5%). FOP was predominantly displayed on breakfast cereals (65.0%) and the least frequently on milk products (2.4%). The 'Big 4' (energy value, protein, carbohydrate and fat contents) and the 'Big 4 with additional information' figured on 40.9% of products. The 'Big 8' ('Big 4' plus sugar, saturated fat, fibre and sodium contents) and the 'Big 8 with additional information' were present less frequently (20.5%). Nutrition claims and health claims appeared on very few products (6.6% and 6.3%, respectively). The proportion of products with insufficient legibility was 31.5%. CONCLUSIONS: Nutrition labelling in Belgrade, Serbia is not satisfactory. Mandatory regulations may be the best way to improve the current situation.

[Stress and mental health among medical students].

INTRODUCTION: Medical studies bring many stressful activities to students. Prolonged stress can make adverse effects to mental health and lead to further professional burnout. OBJECTIVE: The aim of this study was to assess the association of stress impact and adverse effects of medical studies with psychological distress among medical students. METHODS: The cross sectional study was conducted on 367 fourth-year medical students of the Faculty of Medicine in Belgrade, by means of the anonymous questionnaire, containing: socio-demographic data, self-reported health status and stressful influences of studying activities. Mental health status was estimated by General Health Questionnaire (GHQ-12). RESULTS: More than 50% of students perceive frequent feeling of psychic tension, and one third has problems with insomnia. Nearly one-half of students assessed their general stress level as moderate or high. Exams were estimated as high stressor in 63.1% of all students. Stressful effects of communication with teaching staff were reported by one quarter of the examinees. The scores of GHQ-12 were above the threshold in 55.6% of all students. Mental health problems among students were most significantly associated with stressful experience during exams and contacts with teaching staff. CONCLUSION: Academic stress makes great influence on mental health of medical students. Reduction of stress effects should be directed to optimization of the examination process and improvement of communication skills.

Ultrasound diagnosis of gallbladder polyps.

The most frequent benign gallbladder polyps are cholesterol polyps. Next in frequency were adenomas, which may have malignant potential. The aim of this study was to assess the possibility of ultrasonography in the diagnosis and differential diagnosis of cholesterol polyps compared to adenomas. Patients were examined during the period from October 2006. to December 2008. In Department of Ultrasound, Clinic for Gastroenterology and Hepatology, Belgrade. The group of 54 patients analyzed consisted of 30 women (56%) and 24 men (44%). Most (59%) had solitary polyps. In 92.6% of patients the size of polyps was below 10 mm. 74% of respondents were over 50 years. Ultrasonography is the method of choice and gold standard in diagnosis of gallbladder polyps. Based on echoic properties cholesterol polyps can not be distinguished from adenomas. Malignant alteration of polyps also could not be detected. Appropriate ultrasonographic characteristics such as size of polyps, appearance of a broad base that sits on the wall, concomitant lithiasis findings and patient age may be indicative for malignancy.

Dietary habits as a risk factor of gallstone disease in Serbia.

Gallstone formation is a multifactorial disease, caused by the interaction of genetic and enviromental factors. In order to prevent gallbladder stone disease, it is useful to detect modifable risk factors, which contribute to its development. The aim of this study is to analyze the potential relationship between nutrition and the development of gallstone disease, and to establish the possibility for its prevention. The study examined 114 patients; 55 of them suffered from gallstone disease, while 59 were healthy controls who were age- and sex- matched. Diagnosis of gallbladder stone disease was made by ultrasonography. Diet was established using a 24-hour dietary recall method. In the multivariate model, high energy intake (OR = 9.720, p < 0.001) and overnight fasting period (12 hours and longer) (OR = 4.285, p = 0.005) were the most important predictors of gallstone disease, after adjustment for Body Mass Index. These factors can be altered in order to prevent gallstone disease.

New International Classification of Functioning, Disability and Health.

The WHO International Classification of Functioning, Disability and Health (ICF) provides a coherent view of health from a biological, individual and social perspective. This view may be defined both as multi- and interdisciplinary management of one's functioning and health. This new classification is currently being assessed in multiple centres in 32 countries, on 12 health conditions. The Institute of Hygiene and Medical Ecology, School of Medicine, University of Belgrade, is one of them, serving as the centre where the classification is being tested in obese population. The objective of this paper is to provide information needed for further development and practical application of this classification in various health conditions. The new language of ICF is an exciting landmark event for preventive medicine and rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multiprofessional communication and improve communication between patients and health professionals.

[Factors mediating the depression in the adult obese outpatients].

INTRODUCTION: The prevalence of obesity is rising to epidemic proportions at the alarming rate in both developed and underdeveloped countries around the world. Current prevalence data from individual national studies suggest that the obesity prevalence in the European countries ranges from 10% to 20% for men, and 10% to 25% for women. Health consequences of obesity imply both a number of fatal and non-fatal health problems (out of which the most common are cardiovascular problems, non-insulin dependent diabetes mellitus, cancers), and also a wide spectrum of psychological consequences from diminished self-esteem to clinical depression. Causal relationship between obesity and many chronic diseases is evidence-based. At the same time, there are marked differences in research data regarding causal obesity-depression relationship. Several studies have found no direct association between obesity and depression, while in others the prevalence of depression in obese patients was up to 50%. Gender, obesity grade, socioeconomic status and asking for professional help are named as moderators and mediators of this relationship. Among recommended screening methods, BDI-II is the most frequently used in the adult outpatient departments. OBJECTIVE: The aim of the study was to determine possible risk factors of depression in adult obese patients treated for obesity. Gender, obesity and education level as well as marital status were analyzed as possible moderators of depression-obesity relationship. METHOD: The research included 267 patients, 38.0 +/- 14.6 years of age, who referred to the Outpatient Nutrition Department for dietetic consultation or nutritional medical therapy. Nutritional status was assessed by BMI (kg/m2), calculated from measured values of body weight and height according to WHO recommendations. An estimate of the existence and/or depression level was investigated by Beck Depression Inventory--self-administered questionnaire recommended for use in Serbian population. RESULTS: The results revealed higher average BDI score values in obese patients (F(267,1) = 6.014, p = 0.015) in comparison to their non-obese counterparts. In addition, the percentage of depressive obese patients was significantly higher (55.1%, chi2(267.1) = 22.64, p < 0.001). There was significant correlation of BMI and BDI scores (r = 0.246, p < 0.001). The number of women with depression was significantly higher in comparison to men (chi2(267.1) = 4.261, p = 0.039). Women also had higher average BDI score (p = 0.003). MANOVA showed that BDI score was influenced by gender (F(267.1) = 8.936, p = 0.030) and nutritional status (F(267.1) = 6.115, p = 0.014), but combined effect of the above-mentioned moderators was not significant. CONCLUSION: Depression is ten times more frequent in obese patients undergoing the obesity treatment vs. general population and, therefore, screening for depression is needed. Special attention should be paid to women and more obese patients due to higher incidence of depression in these groups.

[Max Josef von Pettenkofer--founder of modern hygiene (1818-1901)].

Max Josef von Pettenkofer was one of the leading personalities in the world of medicine in the 19th century. He was the founder of the modern science of hygiene. In his experimental work, he was involved in the research of problems dealing with the relationship between human beings and the environment, including such topics as soil and air pollution, water supply, sewage water management, room ventilation and heating, as well as the function of clothing and the cleanliness of homes and streets. Pettenkofer also studied the onset, the course, and the consequences of infectious diseases, such as cholera and typhus. He realised the great economic value of public health and emphasised that personal preventive measures should be supplemented with the improvement of factors in communal and work environments. His efforts lead to hygiene becoming a part of medical studies in 1865. The Institute for Hygiene at the School of Medicine in Munich was established in 1879. It was constructed according to his drawings and was considered to be the most modern institute for hygiene in the world. Since hygiene was a subject on the school curriculum in the German Empire in 1882, Pettenkofer became the Chairman of Hygiene in Berlin in 1885. Research institutions established by Pettenkofer and the fact that many of his students became professors of hygiene speak about the importance of his work. One of his students was professor Milan Jovanovic Batut, founder of the Institute for Hygiene at the School of Medicine in Belgrade.