Factors associated with overweight and obesity in preschool children.

Aim To determine factors associated with overweight/obesity in preschool children. Methods This cross-sectional study was carried out in paediatric outpatient departments of the Public Institution Primary Health Care Centre of Canton Sarajevo, Bosnia and Herzegovina. The study included 300 preschool children who were divided into two groups: normal weight (n=150) and overweight/obese (n=150). Children were weighed and measured and body mass index was calculated. Data concerning potential childhood overweight/obesity risk factors (sociodemographic characteristics of child and mother, physical activity and sedentary behaviour of the child) were collected using a designed questionnaire filled in by the mothers. Logistic regression analysis was used to estimate the association between potential risk factors and overweight/obesity in preschool children. Results Male gender of the children (p=0.043) and maternal overweight (p=0.000) were positively associated with child overweight/obesity. Male children were 1.6 times more likely to be overweight/obese than female (95% CI: 1.01-2.53). Children of overweight mothers were 3.34 times more likely to be overweight/ obese than children with mothers of normal weight (95% CI: 1.77- 6.28). Physical activity <60 minutes/day ) (p=0.014), screen time >180 minutes/day (p=0.020), regular snacking while watching television, using computer/tablet/ mobile phones (p=0.000) were associated with overweight/obesity status of the preschool children. Conclusion Public health programs that aim to reduce overweight/ obesity in preschool children should mainly help mothers understand the serious risk of childhood obesity and the importance of them creating a healthy lifestyle in childhood.

Preventive health services utilization in patients treated by family physicians.

Aim To explore preventive health service utilization in patients treated by family physicians and the factors associated with their use. Methods This cross-sectional study was carried out in family medicine outpatient departments of the Primary Health Care Canter of Canton Sarajevo, Bosnia and Herzegovina. The study included 300 patients (150 males and 150 females). A questionnaire for the evaluation of patients' socio-demographic characteristics, health profile and use of preventive health services was used. Results Females visited family physicians significantly more often than males (p=0.001). About 51.2% of males reported undergoing a prostate examination within the past 2 years, 77% of females had an examination of the breast within the past 2 years, 9.8% of males and 10.5% of females had received influenza immunization in past 12 months. A number of visits to family physicians in the last twelve months was significantly associated with having had a prostate examination (digital rectal examination and/or prostate-specific antigen testing) (B=1.413, SE=0.171; p=0.043) and an examination of the breast (clinical breast examination and/or mammography) (B=1.817, SE=0.307; p=0.041). Advancement in age was positively associated with influenza immunization (B=2.901, SE=0.026; p=0.000). Conclusion A visit to family physicians was an important step along the causal pathway to receiving preventive services (a prostate examination, an examination of breast). Adults aged 18-64 years were not well protected against influenza and comprehensive strategies are needed.

The relationship between education and self-reported mental and physical health.

Aim To investigate the relationship between educational level and self-reported physical and mental health in the population of Sarajevo Canton. Methods This cross-sectional study was carriedout in family medicine outpatient departments of the Primary Health Care Centre of Sarajevo Canton, Bosnia and Herzegovina. The study included 300 respondents who were divided into lower- and higher-education groups (≤12 years and >12 years of education, respectively). The SF-36 questionnaire for self-assessment of mental and physical health and a questionnaire for the evaluation of socio-demographic characteristics were used. Results The mean values for the mental component summary (MCS) were significantly lower in the lower education (56.86±23.02) than in the higher education group (65.08±20.91) (p=0.001). The mean values for the physical component summary (PCS) were significantly lower in the lower education (61.77 ±21.60) than in the higher education group (74.26 ±17.89) (p=0.000). On average, females had significantly lower scores than males on both the PCS (p=0.00) and the MCS (p=0.00). There was significant relationship of low education with self-reported poor mental (B=6.547, SE=2.481; p=0.009) and physical health (B=10.870, SE=2.248; p=0.024). Increased age was associated with poorer PCS and better MCS. Conclusion Educational level is a strong determinant of perceived health. The importance of education should be emphasized to children as vitally important for their future health.

Depressive Symptoms Among Sarajevo University Students: Prevalence and Socio-Demographic Correlations.

OBJECTIVES: The aim of this research was to detect the presence of depressive symptoms among the student population at a Faculty of Medicine, as well to determine the correlation between the socio-demographic characteristics and students' lifestyle and depressive symptoms. SUBJECTS AND METHODS: Of 800 students enrolled and asked to participate, 412 responded to the survey. The study included students from all 6 years of studies. The degree of depressive symptoms was measured by a 21-item revised form of the Beck Depression Inventory (BDI). We built bivariate logistic regression models to study whether age, gender, housing accommodation, year of medical training, and school success status (Grade Point Average - GPA) were associated with depressive symptoms. The results are reported as odds ratios (OR) with 95% confidence intervals (CI). RESULTS: The study revealed that almost one third of students reported BDI >16 (30.1%). The present study did not find any association between BDI scores and study year or age difference, but we found that there was an association between housing accommodation and depressive symptoms. Students who lived with their parents had lower BDI scores than those who lived in a dormitory. The results of this study showed there is a negative correlation between physical activity and depressive symptoms in students, as well as that there is a positive correlation between depressive symptoms and substance abuse. CONCLUSION: Overall, our study confirms that the factors associated with an increase in medical students' depressive symptoms are housing accommodation, a lack of physical activity and substance abuse. Regarding failing a year of study at the medical school, as well as gender and age differences, we did not find any significant difference between students with higher compared to those with lower depressive symptoms.

Socioeconomic and demographic factors associated with abdominal obesity in women of childbearing age.

Aim To determine socioeconomic and demographic factors associated with abdominal obesity in women of childbearing age. Methods This cross-sectional study was carried out in family medicine outpatient departments of the Primary Health Care Centre of Canton Sarajevo, Bosnia and Herzegovina. The study included 300 respondents who were divided into two groups: non-abdominal obesity (n=150) and abdominal obesity (n=150). Abdominal obesity was estimated measuring waist circumference. Data concerning socioeconomic and demographic factors (age, marital status, "live alone", place of residence, formal education level, self-perceived financial status) were collected using a designed questionnaire. Logistic regression analysis was used to estimate the association between socioeconomic, demographic factors and abdominal obesity. Results Abdominal obesity was significantly associated with the life in the urban area (OR=2.174, 95%CI=1.362-3.471), university education (OR=9.881, 95%CI=3.222-30.301) and slightly better financial status than average (OR=2.412, 95%CI=1.302-4.470). Marital status (OR=0.190, 95%CI=0.104-0.347) and no living alone (OR=0.357, 95%CI=0.165-0.773) protect from abdominal obesity. Respondents aged between 20-29 years represent a particularly vulnerable group in terms of abdominal obesity (OR=1.030, 95%CI=0.097-10.946). Conclusion The strongest associations have been found between abdominal obesity and education. Public health programs that aim to reduce abdominal obesity in women of childbearing age should mainly focus on women with university education.

Impact of self-rated health among elderly on visits tofamily physicians.

Aim To evaluate animpact of eight dimensions of self-rated health measured by the SF-36 questionnaire on visits to family physicians among people older than 65. Methods This cross-sectional study was carried out in family medicine outpatient departments of the Public Institution Primary Health Care Center of Canton Sarajevo, Bosnia and Herzegovina. The study included 200 respondents divided into two age groups:18-65 (n=100) and older than 65 (n=100). The SF-36 questionnaire for self-assessment of health status and a questionnaire for the evaluation of socio-demographic characteristics of respondents and health care utilization were used. Results In the group of respondents aged 18-65 the dimension that was related to physical functioning was assessed as best(79.1±25.6), while the dimension concerning the vitality was assessed as the worst (56.1±19.9). In the group of respondents older than 65 the dimension related to social functioning was assessed as best (65.4±24.9), and the dimensions related to general health was assessed as worst (47.7±20.4). Family physicians were visited by significantly more respondents older than 65 than those from the age group 18-65 (94% vs.74%) (p= 0.000). Scores on the scales of general health (p=0.021) and social functioning (p=0.024) in respondents older than 65 had a significant impact on visits to family physicians. Conclusion Poor self-rated general health and better social functioning are important predictors of visiting family physicians by elderly persons.

Association between high levels of stress and risky health behavior.

AIM: To determine the amount of stress to which young and adult persons were exposed during the last twelve months and relationship between stress levels and risky health behavior. METHODS: The study was conducted from November 2011 until January 2012 in the Sarajevo Canton. The study included 700 respondents divided into two groups: 350 young people aged 15- 27 years and 350 adults aged over 27 years. As an instrument for data collection a questionnaire was used to provide information on demographic characteristics of respondents and habits, as well as Holmes and Rahe stress scale to determine the level of stress. RESULTS: The average value of the stress scale score was 302.56±149.75 for the total sample, 331.7±165.7 for youth and 273.5±125.6 for adults. Respondents from the group of young people in the last twelve months had an average of 3.6 highly stressful events and 1.9 in the group of adults. In the group of young people there were more respondents with inadequate nutrition (p=0.023) and more smokers (p=0.128). In the group of adults more people were overweight (p=0.001) and had reduced physical activity (p=0.006). Both study groups had an equal number of respondents who consumed alcohol. People with high levels of stress consumed alcohol significantly more (p=0.03) and smoked (p=0.02) compared to those with low levels of stress. CONCLUSION: The respondents of both groups were exposed to large amount of stress that was associated with smoking and alcohol consumption. There is a need to design appropriate strategies for coping with stress and their implementation in lifestyle.

Tuberculosis related stigma and delay in seeking care after the onset of symptoms associated with tuberculosis.

AIM: To determine association between tuberculosis (TB) related stigma and delay in seeking a treatment after the onset of symptoms associated with tuberculosis. METHODS: This prospective study was carried out in the "Podhrastovi" University Clinic of Lung Diseases and Tuberculosis and Health facilities for lung diseases and tuberculosis in the Sarajevo area. The sample consisted of 300 tuberculosis patients. Between patients who consider TB a stigmatizing disease and patients who did not consider TB a stigmatizing disease distribution of patient delay was compared. RESULTS: Of the total of 300 patients 79 (26.3%) considered TB a socially stigmatizing disease. Among them 43 (54.4%) were females and 36 (45.6%) males. Among patients in the age group 18-24 years, nine (50%) considered TB a socially stigmatizing disease compared to seven (12.3%) among patients in the age group 65-75 years. Among patients with university degree, nine (64.3%) and among patients that had no education, one (9.1%) declared TB as a socially stigmatizing disease. The average time interval from the appearance of first symptoms of tuberculosis until the first visit to a health care facility for those who consider TB a stigmatizing disease was 6.41 weeks and for those who did not consider it a stigmatizing disease the average time interval was 4.99 weeks. CONCLUSION: Study results revealed high stigma-generating attitudes towards tuberculosis. Perceived TB related stigma had no strong impact on patient delay in seeking care for TB symptoms.

The presence of health-risk behaviour in Roma family.

Roma people in B&H are a marginalised population group. Their health condition; is considerably worse than the condition of other population groups. The health problems of Roma people correlate with inadequate living and dwelling conditions. Roma children are facing the impossibility of being health care beneficiaries, because their parents are unemployed. The objective of this survey was to examine the family surrounding of children in age up to 8 years, including the social conditions under which they live and the presence of health risk behaviour. The research presents a descriptive cross-section study. We interviewed 1100 non-Roma parents and children and 383 Roma parents and children (in the communities of domicile Roma people) in B&H Federation. The results obtained indicate that only 17,8 % of Roma parents are secondary-school leavers, while remaining percentage covers those with incomplete primary school or without education at all, against 63,6% of non-Roma parents who have secondary education. The parents consider themselves good providers for their children (59,3% of Roma parents and 75% of non-Roma parents often play with their children). The Roma parents seek for medical attention for their children only in the cases when urgent health problems occur, such as fever/increased body temperature (one-half of the interviewed parents) or diarrhoea (31,9%). Physical punishment of children occurs more frequently in Roma families (23,7% - this is only the top of an iceberg) then in non-Roma families (11,4%). The parents usually beat children by using their hands or punish them by flogging. The domestic violence is accepted amongst Roma people and it has most sever impact on children, who suffer emotionally and physically. In the future, it will be necessary to create the kind of family environment that would enable improvement of health condition and decrease the behaviour that endangers the health of children.

[Group methods for smoking cessation]. / Grupna metoda odvikavanja od pusenja.

UNLABELLED: Tobacco smoking is unique public health problem. Tobacco is unique among preventable causes of diseases because: it is always dangerous, it is highly addictive to many consumers, it is actively and energetically promoted, often by one of the world largest and most powerful industries, it use harms not only those who consume it, but also other people who are exposed to their smoke. Those importance characteristics help to make tobacco a particularly difficult public problem, requiring action, including a workshop for addiction of smoking. THE PURPOSE: Of work was to present results of workshop for addiction of smoking. METHOD: We worked in group using Macfarland and Folkenberg method in quitting of tobacco smoking. The group had 9-12 participants (in total were 100 participants). Person documentation of participant includes family and life anamnesis, physical examination, capacity of lungs, weight and height. RESULTS: The most of health problems are registered in those people who where smoking at least 15 years, and most commend illness are cardiovascular systems 66,7 % and respiratory system 40 %. In first 10 day the symptoms of stopping using cigarettes where, in 92 % had wish for cigarettes, in 76 % had headache, in 68 % physical disorders and fall of concentration, 64 % of them had appetite disorder. CONCLUSION: Group work has been shown to be the effective way to stop smoking, but it depends a getting the patients to join and stay in-group.

Evaluation of efficiency practical issues in the management of childhood asthma.

Asthma is the most common chronic illness in children and adolescents. The pediatric "Asthma School" has been established to improve the health and quality of life of children with asthma through education and support. The purpose of work is evaluation of efficiency education adolescents, children and parents in prevention, adequate use medications and control of asthma. It was operational investigation. The study was enrolled 70 participants from 7 cities in FBiH, which were attended "Asthma School". Evaluations of efficiency of education program have been done through questionnaires using 5-point scale. Observing variables were: attitude about quality of education and level of knowledge about asthma at the end of the educational round. "Asthma School" attended 62 parents and 8 adolescents. The age of children was 6-14 years. The most of participants were with middle school education (64.3%). Successfulness of seminar was score with highest point of scale by 79%. Access to health information was important for patients in adequate treating illness (80.6%) and in prevention of asthma (15%). There was a significant improvement for 38,4% in the basic knowledge of asthma among participants, from 2.7 before to 3.8 after education. Among 20 children that have learned proper technique breathing there was not register worsening symptoms of asthma by 83.4%. There was a significant improvement in the condition of patient, following by greater value PEF (72.3% participants). The results implicate necessity of continuity such action in order to make life of young asthma patient.

Evolution of Quit & Win program carried through 2002 year in FB&H.

UNLABELLED: World Health Organization (WHO) in cooperation with National Public Health Institute of Finland carried through Quit & Win program 2002. People from all over the world try to abstain from smoking or using tobacco products for a four-week period, from 2-29 May. FB&H took part in this campaign. Quit & Win-2002 program was an optional contest for health professionals. The purpose of this paper is to present the participant's characteristic towards age, gender, education, tobacco consumption and previous attempts to quit. RESULTS: the research encompassed 81 health professionals. Among them 71% were women. The highest participation rates on average where found in the 45-54 year group (29.7%). The most of participants were health professionals with middle school education (81%). Only 5% of the participants were physicians. The great number of health professionals (47.5%) smoked between 1-9 years. Research shows that 61% of participants were passionate smokers who smoked more than 14 cigarettes a day. Out of 81 participants 42 medical workers has never tried to stop smoking. Research shows that smoking habit is very spread among medical workers and it follows the general state in population. It's surprising because we expect that health worker must be role model of the healthy life.