CYBERBULLYING AMONG ADOLESCENTS AND ONLINE INFORMATION SEEKING ABOUT MENTAL HEALTH.

BACKGROUND: Cyberbullying is a serious problem among adolescents and has an impact on mental health. The purpose of this study was to: 1) translate and validate the Cyberbullying and Online Aggression Survey in the Serbian language; 2) explore factors associated with more intense cyber victimization and cyber offending and 3) examine whether more intense cyber victimization and cyber offending are associated with a higher likelihood of online search for topics on mental health in a sample of high school students. SUBJECTS AND METHODS: A total of 702 students from 4 public high schools participated in this cross-sectional study. Data were collected using a general questionnaire and the Cyberbullying and Online Aggression Survey. Internal consistency of the questionnaire was examined and confirmatory factor analysis was conducted to assess construct validity. The multiple linear regression model examined factors associated with higher levels of cyber offending and cyber victimization. The multiple logistic regression models examined whether cyber offending and cyber victimizations were associated with searching for mental health topics on the Internet. RESULTS: Cronbach's alpha for the Cyberbullying Victimization Scale was 0.813 and for the Cyberbullying Offending Scale was 0.789. Both scales had a one-factorial structure and parameters on the confirmatory factor analysis were appropriate. More than one-half of students (56.2%) reported ever being cyber victimized and 39.9% of students reported ever being cyber offenders. Having lower grades, being younger at first Internet use and more frequent use of the internet were associated with both higher Cyberbullying Victimization and Offending scores. Having higher scores on both Cyberbullying Victimization and Offending scales was associated with higher odds of searching for mental health topics online. CONCLUSION: It is necessary to address cyberbullying in schools to help recognize and modify the behavior of cyber offenders and provide means of support and empowerment to cyber victims.

Familiarity with the internet and health apps, and specific topic needs are amongst the factors that influence how online health information is used for health decisions amongst adolescents.

BACKGROUND: Many adolescents believe that online health information is reliable, particularly when they are familiar with the source of information. OBJECTIVE: To analyse the degree of influence of online health information on high school students' health decisions and examine whether socio-demographic characteristics, digital literacy, use of different websites and interest in specific health topics are associated with a stronger influence of online health information on adolescents' health-related decisions. METHODS: Participants were students from four public high schools in Belgrade, Serbia. Socio-demographic and behavioural questionnaire as well as the e-health literacy scale (eHEALS) were used to collect data. RESULTS: The study sample comprised 702 students. A total of 79.6% of students reported that online health information influenced their health decisions to a certain extent (from 'a little' to 'a lot'). Being a boy, using the internet since younger age, better self-perceived e-health literacy, using health apps, Google, health forums, websites of health institutions, social media and YouTube, being interested in diet/nutrition, sexually transmitted infections and cigarettes were the characteristics associated with a stronger influence of online health information on students' health decisions. CONCLUSION: This study provides clues about how online health-related information can be used to adjust and enhance health promotion amongst adolescents.

Intestinal carriage of vancomycin-resistant Enterococcus spp. among high-risk patients in university hospitals in Serbia: first surveillance report.

BACKGROUND: The screening for intestinal carriage of vancomycin-resistant Enterococcus spp. (VRE) among high risk patients in the Balkan region and molecular epidemiology of VRE is insufficiently investigated, yet it could be of key importance in infection control. The aim of this study was to provide baseline data on VRE intestinal carriage among high-risk patients in Serbian university hospitals, to determine the phenotypic/genotypic profiles of the isolated VRE, to obtain knowledge of local resistance patterns and bridge the gaps in current VRE surveillance. METHODS: The VRE reservoir was investigated using stool samples from 268 inpatients. Characterization of isolated VRE stains consisted of BD Phoenix system, genotypic identification, glycopeptide and quinupristin-dalfopristin (Q-D) resistance probing, virulence gene (esp, hyl, efaA, asa1, gelE, cpd) detection and MLVA. Biofilm formation was evaluated by the microtiter plate method. RESULTS: VRE carriage prevalence among at-risk patients was 28.7%. All VRE strains were vanA positive multidrug-resistant Enterococcus faecium (VRfm), harboring ermB-1 (38.9%), esp (84%), efaA (71.2%), hyl (54.5%), asa1 (23.4%), gelE and cpd (11.6%) each. Ability of biofilm production was detected in 20.8%. Genetic relatedness of the isolates revealed 13 clusters, heterogeneous picture and 25 unique MTs profiles. CONCLUSION: The obtained prevalence of VRE intestinal carriage among high-risk inpatients in Serbia is higher than the European average, with high percentage of multidrug resistance. The emergence of resistance to Q-D is of particular concern. Close monitoring of pattern of resistance and strict adherence to specific guidelines are urgently needed in Serbia.

Patterns of online health information seeking after visiting a physician: perceptions of adolescents from high schools in central Belgrade, Serbia.

BACKGROUND: Browsing webpages that offer health information allows visitors to remain anonymous, particularly when researching sensitive topics. Uncertainty about confidentiality may be a barrier for adolescents to discuss their health in-person with a physician and seek further health information on the Internet after seeing a physician. OBJECTIVE: To explore factors contributing to perceived online health information seeking after visiting a physician in a sample of high school students. METHODS: A cross-sectional study was conducted from December 2016 to January 2017. The study included 702 high school students. Socio-demographic and behavioral questionnaire as well as the electronic health (e-health) literacy scale (eHEALS) were used to collect data. Students described their perceptions of what they commonly do after visiting a physician, which was not connected to a particular clinic at any point in time. RESULTS: A total of 347 students (49.4%) perceived that they search for online health information after visiting a physician. Attending humanities-languages school program, lower education level of parents, being older at first Internet use, stronger influence of online health information on students' behaviour, better e-health literacy, use of smartphones, YouTube, social networks and heath forums were associated with perceived online health information seeking after visiting a physician. CONCLUSION: One-half of high school students in this study perceived that they search for online health information after having visited a physician. Our results suggest that many adolescents might seek additional information about health.

Patterns of drug prescribing in inpatients with first episode of schizophrenia spectrum disorder: The role of guidelines
.

OBJECTIVE: The great discrepancy between clinical guidelines and the routine psychiatric practice in the treatment of schizophrenia is a subject of intensive research, with the aim to promote the rational prescribing of antipsychotics. The aim of this study was to analyze the pattern of drug prescribing in the treatment of inpatients with the first episode of schizophrenia spectrum disorders and the impact of the implementation of the Serbian National Guideline for the Diagnosis and Treatment of Schizophrenia. MATERIALS AND METHODS: This cross-sectional study was conducted at the Clinic for Mental Disorders "Dr Laza Lazarevic" in Belgrade and included a consecutive sample of 675 previously drug-naïve patients with the first episode of schizophrenia spectrum disorders. The data were obtained from the patients' medical records. The analysis of therapy prescribed at discharge included antipsychotics and non-antipsychotic adjuvant therapy. Descriptive statistical methods and methods for testing statistical hypotheses were used to analyze the primary data. RESULTS: The prescribing of second-generation antipsychotics has increased both within antipsychotic monotherapy and within antipsychotic polypharmacy during the period of the study. The use of adjuvant non-antipsychotic pharmacotherapy was very common, but use of benzodiazepines, carbamazepine, and anticholinergic drugs significantly decreased. Long-acting forms of antipsychotics have been rarely used (9.3%). Clozapine was in general underprescribed (10.4%). CONCLUSION: The National Guideline for the Diagnosis and Treatment of Schizophrenia most likely contributed to some positive changes in prescribing patterns during the treatment of the first psychotic episode in daily clinical practice in Serbia. However, antipsychotic polypharmacy and irrational use of adjuvant therapy was still prevalent.

Trends in tuberculosis notification and mortality and factors associated with treatment outcomes in Serbia, 2005 to 2015.

BackgroundPreviously a country with medium tuberculosis (TB) burden, Serbia almost reached a low TB burden during the period 2005 to 2015.AimThe aim of this study was to analyse the trends in notification rates and treatment success rates as well as to identify predictors of treatment outcomes.MethodsWe performed a trend analysis and logistic regression analysis of 17,441 TB cases registered from 2005 to 2015 in all health facilities in Serbia, to identify predictors of treatment success, loss to follow-up and mortality.ResultsFrom 2005 to 2015, TB notification rate and mortality in Serbia decreased but treatment success remained below the global target. Loss to follow-up was associated with retreatment (odds ratio (OR) = 2.38; 95% confidence interval (CI): 2.08-2.77), male sex (OR = 1.57; 95% CI: 1.39-1.79), age younger than 65 years (OR = 1.37; 95% CI: 1.20-1.51), lower education level (OR = 2.57; 95% CI: 1.74-3.80) and pulmonary TB (OR = 1.28; 95% CI: 1.06-1.56). Deaths were more frequent in retreatment cases (OR = 1.39; 95% CI: 1.12-1.61), male patients (OR = 1.34; 95% CI: 1.19-1.52), those 65 years and older (OR = 4.34; 95% CI: 4.00-5.00), those with lower education level (OR = 1.63; 95% CI: 1.14-2.33) and pulmonary TB (OR = 2.24; 95% CI: 1.78-2.83).ConclusionsSpecial interventions should be implemented to address groups at risk of poor treatment outcome.

Influenza surveillance: determining the epidemic threshold for influenza by using the Moving Epidemic Method (MEM), Montenegro, 2010/11 to 2017/18 influenza seasons.

BACKGROUND: In 2009, an improved influenza surveillance system was implemented and weekly reporting to the World Health Organization on influenza-like illness (ILI) began. The goals of the surveillance system are to monitor and analyse the intensity of influenza activity, to provide timely information about circulating strains and to help in establishing preventive and control measures. In addition, the system is useful for comparative analysis of influenza data from Montenegro with other countries. AIM: We aimed to evaluate the performance and usefulness of the Moving Epidemic Method (MEM), for use in the influenza surveillance system in Montenegro. METHODS: Historical ILI data from 2010/11 to 2017/18 influenza seasons were modelled with MEM. Epidemic threshold for Montenegro 2017/18 season was calculated using incidence rates from 2010/11-2016/17 influenza seasons. RESULTS: Pre-epidemic ILI threshold per 100,000 population was 19.23, while the post-epidemic threshold was 17.55. Using MEM, we identified an epidemic of 10 weeks' duration. The sensitivity of the MEM epidemic threshold in Montenegro was 89% and the warning signal specificity was 99%. CONCLUSIONS: Our study marks the first attempt to determine the pre/post-epidemic threshold values for the epidemic period in Montenegro. The findings will allow a more detailed examination of the influenza-related epidemiological situation, timely detection of epidemic and contribute to the development of more efficient measures for disease prevention and control aimed at reducing the influenza-associated morbidity and mortality.

eHealth and adolescents in Serbia: psychometric properties of eHeals questionnaire and contributing factors to better online health literacy.

Internet is important resource of health-related information and health services. Factors associated with higher level of online health (eHealth) literacy among adolescence have been understudied. The aim of this study was to assess psychometric properties of the eHealth Literacy Scale (eHEALS) in Serbian language and to evaluate eHealth literacy among adolescents in Serbia. The study was carried out in four high schools in Belgrade, Serbia in the period December 2016 to January 2017. A total of 702 students comprised the study sample. The eHEALS was translated according to internationally accepted methodology and its psychometric properties were analyzed. The Cronbach's alpha coefficient for the entire eHEALS was 0.849. On exploratory factor analysis we obtained two-factorial structure. Our adolescents reported low confidence in knowing what health resources are available online. High confidence was observed for knowing how to use and how to find health information online. There was no difference in eHEALS score between genders or between school years. After adjustment for gender, type of school program, parental marital status, fathers' education level and household income, being female was associated with higher eHealth literacy (B = 1.12, 95% confidence interval 0.07-2.18; p = 0.036). Serbian version of the eHEALS is a valid instrument in assessment of online health literacy and can be further used in evaluation of eHealth literacy in other population groups in Serbian language. It is advised that some classes in school are dedicated to appraisal and use of online health websites. This could be achieved through peer-education.

Investigation of the Postoperative Complications Rate and Predictors in Patients Undergoing Surgery due to Associated Carotid and Coronary Occlusive Disease.

BACKGROUND: The aim of this study was to evaluate the frequency of postoperative complications in patients who underwent coronary artery bypass grafting (CABG) and simultaneous carotid endarterectomy (CEA) and find predictors of postoperative complications. METHODS: We retrospectively evaluated 86 patients after simultaneous CABG and CEA. Inclusion criteria were: patients with asymptomatic carotid stenosis with a reduction of the carotid lumen diameter of more than 70% detected with Doppler ultrasound and diagnosed with one, two, or three vessel coronary artery disease with coronary stenosis more than 75% and hemodynamic significant stenosis of the left main artery. Exclusion criteria were patients with urgent and previous cardiac surgery and patients with myocardial infarction and stroke in the past one month. We monitored preoperative (ejection fraction, coronarography status), operative (number of grafts, on-pump or off-pump technique) and postoperative (extubation, unit care and hospital stay, bleeding and reoperation) details and complications (myocardial infarction, neurological events, inotropic agents and transfusion requiry, infection, arrhythmic complication, renal failure, mortality). RESULTS: Postoperative complications were observed in 18 (29.9%) patients. Two patients (2.3%) had postoperative stroke and one patient (1.2%) had transient ischemic attack (TIA). Previous stroke was a predictor for increased postoperative neurological events (P < .05). Intrahospital mortality was 8.1%. CONCLUSION: Simultaneous CEA and CABG were performed with low rates of stroke and TIA. Previous stroke was identified as a predictor for increased postoperative neurological complications.

Predictors of health related-quality of life among elderly with disabilities.

AIM: There have been no previous studies of health-related quality of life (HRQOL) among adults aged 65 years and older with disabilities in Serbia. The aim of study was to identify predictors of HRQOL in the context of sociodemographic characteristics, disability aetiology, comorbid diseases, indices of comorbidities, realization of social rights, and domestic violence. METHODS: The cross-sectional study involved 275 consecutive elderly outpatients with disabilities. They were recruited by general practitioners at Primary Health Centers in Belgrade, Serbia, from March to May 2015. Data were acquired through face-to-face interviews and general practitioners' charts, while the generic 36-item Short Form Health Survey was used to assess HRQOL. In statistical analysis, Student's t-test, Z-test, Spearman's correlation test, and both univariate and multivariate linear regression were performed. RESULTS: Multivariate analysis revealed that a higher Functional Comorbidity Index (ß = -0.194, P < 0.01) and not asking for realization of right to assistance and care financial benefits (ß = -0.142, P < 0.05) were predictors of a lower scores Mental Composite Score (F = 9.262; P < 0.001). Not asking for realization of right to assistance and care financial benefits (ß = -0.187, P < 0.01), congestive heart failure (ß = -0.123, P < 0.05), and stroke (ß = -0.120, P < 0.05) were predictors of a lower Physical Composite Score (F = 7.169, P < 0.001). CONCLUSIONS: This study provides valuable data for better understanding the underlying factors associated with the HRQOL of elderly persons with disabilities, and currently, these are the only available data of their kind in Serbia. National authorities could identify predictors of HRQOL as a basic starting point for improving the social welfare and health-care systems. Better prevention and management of clinical factors, increased access to social services, and enhanced delivery of social services will improve the ageing process and HRQOL of this vulnerable population.

Validation of the Neck Disability Index in Serbian Patients With Cervical Radiculopathy.

OBJECTIVE: The purpose of this study was to translate the Neck Disability Index into the Serbian language (NDI-S) and to investigate the validity of this version for use in Serbian population. METHODS: Fifty patients with cervical radiculopathy were enrolled in the study and completed a multidimensional questionnaire, including NDI-S. Inclusion criteria were ages between 18 and 65 years, Serbian speaking, no cognitive or hearing impairment, sharp and radiating neck and upper extremity pain that has lasted less than 12 months, radiculopathy signs evaluated by electromyoneurography and disc herniation, or spondylotic changes of cervical spine visualized on magnetic resonance imaging. Exclusion criteria were malignancy, previous cervical spine discectomy, trauma of the cervical spine and myelopathy, polyneuropathy, fibromyalgia, and psychiatric disorders. Validity was determined by the correlation of the Neck Disability Index, with pain measured by visual analogue scale, characteristics related to pain, and mental status. Also, factor structure of NDI-S was explored through factor analysis. Reliability was assessed through internal consistency (Cronbach's α and item-total correlations). RESULTS: Correlation analysis between pain and NDI-S showed significant values (P < .01). The NDI-S correlated well with patients mental status (r = 0.421, P < .01). Cronbach's α of NDI-S was 0.85, denoting excellent internal consistency of the questionnaire. Item-total correlations were significant and ranged from 0.328 to 0.789. Factor analysis demonstrated a 2-factor structure with an explained variance of 55%. CONCLUSION: The NDI-S is a valid questionnaire to measure neck and arm pain related to disability in Serbian patients with cervical radiculopathy.

Influence of Family Smoking Habits and Passive Smoking on Smoking Status Among Belgrade University Students.

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.

Validation and cross-cultural adaptation of the National Eye Institute Visual Function Questionnaire (NEI VFQ-25) in Serbian patients.

PURPOSE: 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). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Demographic risk factors for suicide and depression among Serbian medical school students.

PURPOSE: The purpose of the study was to identify demographic risk factors associated with depression and suicidality among medical school students in Serbia, as well as to determine the prevalence of symptoms of depression and suicide attempts in the student population. METHOD: This was a cross-sectional study conducted on the sample of 1,296 students recruited from the School of Medicine, University of Belgrade. Following questionnaires were assigned to participating subjects: PHQ-9, Suicide Behaviors Questionnaire, and Social-demographic survey. RESULTS: PHQ-9 scores in our sample ranged from 0 to 27, averaging at 6.21 (SD = 4.96). Symptoms of depression were associated with grade point average, age, relationship status, and gender. Reported history of suicide attempts was associated with PHQ-9 scores, grade point average, relationship status, gender, history of mental illness and drug use. CONCLUSION: Our findings suggest that medical school students in Serbia may be considered an "at-risk" population. Preventative programs in the future should target symptoms of depression and should provide students with adequate mechanisms to cope successfully with school-related pressure. Alternative stress management strategies may also be useful, especially for younger students who seem to be at greater risk for depression and suicide.

Introducing E-learning in Epidemiology Course for Undergraduate Medical Students at the Faculty of Medicine, University of Belgrade: A Pilot Study.

The aim of this study was to determine whether e-learning as a new teaching concept was acceptable for second-year undergraduates and to compare attitudes and exam results of students who followed electronic compared with classroom seminars. The electronic seminars (e-seminars) were developed several months prior to start of the epidemiology course for second-year students at the Faculty of Medicine, University of Belgrade. The students who applied for e-seminars accessed their content during summer semester (February-May) 2014. E-seminars were set according to the existing topics in practical workbook and designed using Moodle, a free, open-source, personal home page web application for producing modular internet-based courses. To evaluate the motives for enrollment and satisfaction with seminars, two surveys (pre- and post-course) were administered. Students' exam grades were registered over 4 exam sessions (June-October 2014) and compared according to seminar program. Out of 516 students in the second year, 60 (11.6 %) applied for e-seminars (mean age 21 years). Students considered the reason "It's easier to do assignments from home" as the strongest motive to participate. When compared to classroom seminars, students in e-seminars had significantly more fun (p = 0.003), thought that e-seminars were better mode to learn epidemiology (p = 0.030) and would recommend them to other colleagues (p = 0.001). There was no significant difference in average grade received at the oral exam in epidemiology (t = 0.071, p = 0.944). E-seminars in undergraduate epidemiology course add a novel, easy-to-follow and amusing mode of learning. Based on this pilot study, e-seminars in epidemiology will be available for next generations of students, while further improvement of e-seminars could include expansion of seminar syllabus and development of discussion fora.

HIV-related knowledge, attitudes and practice among health care workers in Montenegro.

The objective of the present study was to assess HIV-related knowledge, attitudes, and practice of health care workers (HCWs) in Montenegro. A cross-sectional study was conducted in the University Clinical Centre of Montenegro in Podgorica. A self-administered anonymous questionnaire was used for data collecting. Out of 526 HCWs, 422 were included in the survey and response rate was 80%. An insufficient level of knowledge on HIV transmission and the risk after exposure was observed generally, although the knowledge was better in physicians compared to other HCWs categories. A rather high proportion of HCWs showed inappropriate attitude regarding the need of HIV testing of all hospitalized patients (64.7%) and obligation of HIV+ patient to report his/her HIV status (88.9%) in order to practice universal precaution. Additionally, 6.2% HCWs would refuse to treat an HIV+ patient. More than a half (55.7%) of study participants were educated in HIV/AIDS and 15.9% of them were HIV tested. Majority of HCWs (67.5%) always applied universal precautions during their daily work with patients. In spite of applying protective devices, number of accidents was great. A continuous education is necessary to increase the level of knowledge of HCWs about the risk of infection at the workplace. This would potentially influence the modification of their attitudes regarding HIV patients and improve prevention at the workplace. Continuous research regarding the professional risk would provide better health and safety among medical staff.

Patterns of infant mortality from 1993 to 2007 in Belgrade (Serbia).

The population of the Republic of Serbia has been exposed to radical changes in living standards and employment status and inequalities in utilization of health-care services. Given that infant mortality rates (IMR) reflect general community health, we evaluated the trends and mortality structure of Belgrade's infant population for a 15-year period (1993-2007). Data were collected from published and unpublished materials of the Municipal Institute of Statistics in Belgrade. Records were based on official notifications of live-born infants and death certificates. A linear regression equation was used to estimate mortality trends over time, while an F test was performed to assess the significance of the linear regression coefficient. The average IMR was 11.3 [95% confidence interval (CI) 9.4, 13.2] per 1,000 live births for both sexes with a higher average rate observed for male infants. Throughout the whole period, a statistically significant declining trend (y = 17.072 - 0.721x, p = 0.001) was noted. The most common causes of death were conditions occurring during the perinatal period, with an average annual mortality rate of 7.7 [95% CI 6.4, 8.9] per 1,000, arising mainly from respiratory distress of the newborns. Regarding congenital anomalies, deformations of the heart and aortic and mitral valves were most frequently found. A statistically significant inverse correlation was observed between average net salary and IMR for each sex separately (for males r = -0.727, p = 0.002, for females r = -0.721, p = 0.002) and for both sexes jointly (r = -0.759, p = 0.001). A decline in infant mortality in Belgrade has been observed. However, further promotion of health-related activities, as well as continuous surveillance of IMR, is required.

Association of Smoking Patterns with Vision-Related Disability According to Glaucoma Subtypes.

OBJECTIVE: The relationship between smoking and onset of glaucoma has been inconsistent. However, there is a gap in understanding whether tobacco smoking is linked to a worse visual impairment in different glaucoma subtypes. The objective of this study was to examine the association between smoking behavior and vision-related disability in people who have different glaucoma subtypes. METHODS: A total of 283 people with primary open-angle glaucoma (POAG), primary angle closure glaucoma (PACG), normal tension glaucoma (NTG), and pseudo-exfoliative (PEX) were included in this cross-sectional study. The recruitment of study participants was organized in one of two tertiary centers for eye diseases in Belgrade, Serbia, during their regular eye checks. Information about the duration and quantity of smoking was self-reported. Vision-related impairment was quantified using a validated Glaucoma Quality of Life-15 (GQL-15) questionnaire. RESULTS: A series of multiple linear regression models adjusted for age, gender, severity of glaucoma, lifestyle, and mobility, intraocular pressure level, visual parameters, previous and current therapy, and chronic illnesses suggested that a higher quantity of cigarettes smoked per day was associated with poorer vision-related quality of life only among people with NTG subtypes. This association was absent when smoking duration was tested in the adjusted linear regression model. CONCLUSION: A higher number of cigarettes smoked daily was associated with poorer vision-related impairment among people who have NTG, but not other glaucoma subtypes. It is recommended that ophthalmologists and other health-care professionals work to improve their patients' understanding of harmful effects of tobacco smoke and quit smoking.

Socio-Demographic, lifestyle and eye-related factors associated with quality of life Among people with glaucoma in Serbia.

PURPOSE: The purpose of this study was to examine socio-demographic, lifestyle and ophthalmological factors associated with poorer Vision Related Quality of Life (VRQoL) in people with glaucoma. METHODS: This cross-sectional study included 306 consecutive patients with glaucoma who presented for regular check-ups at the referral center in Belgrade (Serbia) from August 2015 to September 2016. The diagnosis of glaucoma was based on the glaucomatous disc cupping and reproducible visual field impairment on one or both eyes. Quality of life was examined using the validated Glaucoma Quality of Life-15 (GQL-15) and the National Eye Institute Visual Function Questionnaire 25 (NEI VFQ 25). RESULTS: A series of adjusted linear regression models showed that glaucoma patients with higher educational attainment, who were employed and still driving had better VRQoL. Worse visual acuity and visual field defect, being in later glaucoma stages, having lower intraocular pressure, having two laser interventions as well as having pseudo-exfoliative glaucoma was associated with worse VRQoL. Intake of fewer medications and having had no trabeculectomies on better eye as well as taking less drops per day on worse eye were associated with better VRQoL. CONCLUSIONS: Several socio-demographic, lifestyle and ocular factors can impact VRQoL in glaucoma patients. Identifying people who are at risk of having worse VRQoL could allow for earlier interventions, such as changes in therapy, undergoing surgery, use of mobility aids etc.

Factors associated with postmenopausal osteoporosis: a case-control study of Belgrade women.

The aim of this study was to investigate factors related to osteoporosis in postmenopausal women in Belgrade. A case-control study was conducted during 2006-2007. The study group consisted of 100 newly diagnosed osteoporosis patients and 100 age-matched controls (± 2 years). The inclusion criteria for the case group were newly diagnosed osteoporosis confirmed by dual-energy X-ray absorptiometry of the lumbar spine and being menopausal (at least 2 years of amenorrhea). The inclusion criteria for the control group were postmenopausal women with confirmed normal bone mineral density of the lumbar spine by dual-energy X-ray absorptiometry. All study participants were interviewed using a structured questionnaire. Univariate and multivariate logistic regression analyses were used. The following factors were significantly independently related to osteoporosis: low body weight (P < 0.001), thin constitution in childhood (P = 0.002), history of previous fracture (P = 0.033), menopause at age <47 years (P < 0.001), family history of fracture (P = 0.005), and less frequent consumption of cheese (P = 0.027) and fish (P = 0.020). The majority of factors identified may be modifiable and could be influenced to prevent postmenopausal osteoporosis.