Valuation and perception of the costs of climate change on health.

BACKGROUND AND AIMS: Climate change affects our societies and lives through our economies, our livelihoods, and our health. Economic losses of climate change are estimated at $23 trillion, largely through externalities due to premature mortality, healthcare expenditure, and health-related work losses. Even if there are established methods to quantify the health economic burden, there is limited information on how people perceive this information. The current study aimed to examine different health cost evaluation methods and observe perceptions of stakeholders in the climate change context. METHOD: The participatory research approach of the World Café with 41 participants was applied to explore four topics associated with valuing the costs of climate change. The data were analyzed following an inductive approach. RESULTS: Despite the willingness-to-pay approach being widely applied, many experts see actual healthcare costs as a more explicit indicator of costs; however, this approach might underestimate actual costs. Participants experienced difficulties accepting and understanding cost estimates that indicated very high externalities as a percentage of gross domestic product. The cost-effectiveness of mitigation and adaptation measures was also challenged by a concern that while the costs of such measures are incurred now, the benefits do not come to fruition until later, for example, when building bike lanes or dams. CONCLUSIONS: Policies should favor environmentally friendly activities such as making cycling more convenient in cities with the health benefits presented in monetary terms, while limiting car driving. Moreover, the public might better understand the costs of climate change via tools that map how solutions influence different sectors and outlining the costs in evaluating the benefits for health and the environment.

Adherence, Disease Control, and Misconceptions Related to the Use of Inhalation Therapy in Patients with Obstructive Pulmonary Diseases: A Cross-Sectional Study.

Background and Objectives: Inadequate treatment of asthma and chronic obstructive pulmonary disease (COPD) might have a negative impact on their progression. Inhalation therapy is the cornerstone of pharmacotherapy for these conditions. However, challenges such as low adherence, negative attitudes, and misconceptions about inhaled medications still persist, impeding effective disease management. This study aimed to evaluate adherence, ascertain the level of disease control in asthma and COPD, explore potential misconceptions surrounding inhalation therapy among patients with obstructive lung diseases and the general population in Vojvodina, and evaluate the reliability of newly developed questionnaires employed in the study. Materials and Methods: This cross-sectional study utilized a battery of questionnaires encompassing sociodemographic data, the Asthma Control Test (ACT), the COPD Assessment Test (CAT), along with two novel questionnaires-one for assessing adherence and another for analyzing attitudes toward inhalation therapy. Statistical analyses were conducted using SPSS software, version 25.0. Results: The average ACT score among patients with asthma was 17.31, while it was 19.09 for the CAT questionnaire among COPD patients. The composite score on the newly developed adherence assessment questionnaire was 2.27, exhibiting a reliability coefficient lower than recommended (α = 0.468). Significant statistical differences emerged among sample subgroups regarding attitudes and misconceptions toward inhalation therapy. The reliability coefficient for this questionnaire was deemed satisfactory (α = 0.767). Conclusions: Adherence rates were notably suboptimal in both subgroups of the studied population. The disease control levels were higher among asthma patients, while they exhibited less prevalent misconceptions regarding inhalation therapy compared to COPD patients and the healthy population.

Environment-lockdown, air pollution and related diseases: could we learn something and make it last?

Although the pandemic has caused substantial losses in economic prosperity and human lives, it has also some positive impacts on the environment. Restricted mobility, complete closure, less traffic and industry have led to improved air quality especially in urban settings. Not only is air pollution an important determinant of chronic diseases, such as heart and lung disorders, but it has also been shown that poor air quality increases the risk of COVID-19. In this article, we review some of the findings on changes in air quality during the pandemic, and its potential effects on health. We need to continue to monitor the effects of change in air quality, due to COVID-19 lockdown or other factors, but also keep all our efforts to improve air quality even faster and more persistent, bringing the pollution levels below what WHO recommends are safe to live with.

Impact of climate conditions on hospital admissions for subcategories of cardiovascular diseases.

BACKGROUND: The aim of this study has been to examine the association between climate conditions (CC) and hospital admissions for the subcategories of cardiovascular diseases (CVD), according to patients' age. MATERIAL AND METHODS: From January 2010 through December 2011, the daily number of hospital admissions for angina pectoris (AP), essential hypertension (EH), acute myocardial infarction (AMI) and ischemic heart diseases (IHD) for adults (19-64 years old) and the elderly (≥ 65 years old), as well as for the CC (N = 728 days) was collected for multivariate Poisson regression analysis, confounding with season and weekends. The results were expressed by using the relative risk with the corresponding 95% confidence interval. RESULTS: The risk for the AMI among the adults and the elderly is significantly higher for 41.8% and 38.9%, respectively on the days with lower ambient temperature and lesser for 32.7% and 29.8%, respectively on the days with lower air pressure values. The risk for the IHD among the elderly is significantly higher on the days with lower ambient temperature and lower relative humidity for 50.6% and 37.4%, respectively. CONCLUSIONS: Our findings explain how the CC and subcategories of CVD are associated, which could be used for adequate public awareness of the risk for hospitalization due to climate conditions. Med Pr 2017;68(2):189-197.

Assessment of health impacts and costs attributable to air pollution in urban areas using two different approaches. A case study in the Western Balkans.

In this study, two different air quality impact assessment methodologies were adopted and combined with a sensitivity analysis to estimate the unit costs. Air pollution health impact (mortality) assessment was carried out using one methodology based on log-linear concentration response functions (CRF) and another relying on the integrated exposure response curve (IER) from the Global Burden of Disease. Morbidity impacts were estimated with the CRF approach only. To assess the inequalities between low and high income countries, an area of low-medium income countries with a critical air pollution situation, was selected. The health impact and related external costs attributable to air pollution in 2019 were assessed in 30 urban areas of the Western Balkans region, one of Europe's air pollution hot spots. The evaluation was based on PM2.5, O3 and NO2 concentrations in background sites from official monitoring networks. In 2019, the cost of mortality attributable to PM2.5 in 26 urban areas was 7.8 and 9.0 billion Euro according to IER and CRF methodologies, respectively. The cost of O3 associated with all-cause mortality estimated with the CRF methodology in 17 urban areas was 1.0 billion Euro while the one attributable to NO2 pollution in 28 urban areas was 1.5 billion Euro. The study results suggest that the economic burden of air pollution in the Western Balkans is higher in terms of GDP than the one observed in EU27 in the same time window. The study concludes that CRF and IER methodologies are coherent, because the discrepancy in the results are explained by the differences in the assessed health outcomes. The two approaches are complementary because the combination of them makes it possible to obtain a wider range of outcomes. In addition, despite the different causes of death considered, the comparison between them is useful for cross-validation.

Coping with the mental health impact of COVID-19: A study protocol for a multinational longitudinal study on coping and resilience during the COVID-19 pandemic.

BACKGROUND: Mental health is challenged due to serious life events such as the COVID-19 pandemic and can differ by the level of resilience. National studies on mental health and resilience of individuals and communities during the pandemic provide heterogeneous results and more data on mental health outcomes and resilience trajectories are needed to better understand the impact of the pandemic on mental health in Europe. METHODS: COPERS (Coping with COVID-19 with Resilience Study) is an observational multinational longitudinal study conducted in eight European countries (Albania, Belgium, Germany, Italy, Lithuania, Romania, Serbia, and Slovenia). Recruitment of participants is based on convenience sampling and data are gathered through an online questionnaire. gathering data on depression, anxiety, stress-related symptoms suicidal ideation and resilience. Resilience is measured with the Brief Resilience Scale and with the Connor-Davidson Resilience Scale. Depression is measured with the Patient Health Questionnaire, Anxiety with the Generalized Anxiety Disorder Scale and stress-related symptoms with the Impact of Event Scale Revised- Suicidal ideation is assessed using item 9 of the PHQ-9. We also consider potential determinants and moderating factors for mental health conditions, including sociodemographic characteristics (e.g., age, gender), social environmental factors (e.g., loneliness, social capital) and coping strategies (e.g., Self-efficacy Belief). DISCUSSION: To the best of our knowledge, this is the first study to multi-nationally and longitudinally determine mental health outcomes and resilience trajectories in Europe during the COVID-19 pandemic. The results of this study will help to determine mental health conditions during the COVID-19 pandemic across Europe. The findings may benefit pandemic preparedness planning and future evidence-based mental health policies.

Additives in Children's Nutrition-A Review of Current Events.

Additives are defined as substances added to food with the aim of preserving and improving safety, freshness, taste, texture, or appearance. While indirect additives can be found in traces in food and come from materials used for packaging, storage, and technological processing of food, direct additives are added to food with a special purpose (canning). The use of additives is justified if it is in accordance with legal regulations and does not pose a health or danger to consumers in the prescribed concentration. However, due to the specificity of the child's metabolic system, there is a greater risk that the negative effects of the additive will manifest. Considering the importance of the potential negative impact of additives on children's health and the increased interest in the control and monitoring of additives in food for children, we have reviewed the latest available literature available through PubMed, Scopus, and Google Scholar. Expert data were taken from publicly available documents published from January 2010 to April 2022 by internationally recognized professional organizations. It was found that the most frequently present additives in the food consumed by children are bisphenols, phthalates, perfluoroalkyl chemicals, perchlorates, pesticides, nitrates and nitrites, artificial food colors, monosodium glutamate, and aspartame. Increasing literacy about the presence and potential risk through continuous education of parents and young people as well as active monitoring of newly registered additives and harmonization of existing legal regulations by competent authorities can significantly prevent the unwanted effects of additives on children's health.

Community pharmacists' challenges regarding adverse drug reaction reporting: a cross-sectional study.

OBJECTIVE: The effectiveness of the national drug safety monitoring program directly depends on the active participation of healthcare professionals in reporting suspected adverse drug reactions (ADRs). The aim of the study was to explore community pharmacists' comprehension of pharmacovigilance, their perspectives toward reporting ADRs and investigate the current practice of ADR reporting among pharmacists in Serbia. METHODS: This descriptive cross-sectional study was performed on a sample of pharmacists in Serbia between November 2019 and March 2020 using a pre-tested questionnaire distributed online. Eligible participants were community pharmacists in Serbia who were willing to participate in the study during the data collection period. Non-parametric statistical tests were performed in the analysis of knowledge, perspectives and ADR reporting. The validity and reliability of the survey were measured by exploratory factor analysis. RESULTS: The median knowledge score was 6 out of 10 (interquartile range 5-7, range 2-10). No significant differences in the knowledge scores of pharmacists were found based on weekly working hours (U = 24,805, p = .374), working experience (χ2 = 4.011, DF = 2, p = .135), being a member of a professional organization (U = 24,312, p = .209), or highest level of pharmacy qualification obtained (χ2 = 3.233, DF = 3, p = .506). Only 28.8% of pharmacists reported ADR at least once a year, while the majority of them have never reported any ADRs. CONCLUSIONS: Despite the community pharmacists' positive attitude toward adverse drug reporting and their role in the process, they show limited knowledge regarding the issue and highly prevalent under-reporting of ADRs. Educational programs are necessary to increase ADRs reporting.

Impact of the Cross-Curricular Education Program on Food Intake, Physical Activity, and Body Mass Index of School Children in a Local Community in Northern Serbia.

INTRODUCTION: The trends in the state of nutrition and physical activity of school-age children in Serbia impose a need to create and evaluate programs to improve their nutrition and physical activity. The purpose of this study was to evaluate the impact of the cross-curricular nutrition and physical activity education program (NPAEP) on food intake, physical activity, and body mass index in first-fourth-grade primary school children. MATERIAL AND METHODS: The study used an experimental pre-test (t1) post-test (t2) design. The sample included 167 participants in t1 and 178 in t2. The differences in food intake, physical activity, and body mass index before and after implementation of the cross-curricular nutrition and physical activity education program were analyzed using the Mann-Whitney U test, the Chi-squared test, and the Wilcoxon signed-rank test. Values p < 0.05 were considered statistically significant. RESULTS: Fruit (t1 = 0.70 ± 0.55; t2 = 1.26 ± 0.65; p < 0.001) and dairy intake (t1 = 1.52; t2 = 1.79; p = 0.005) significantly increased in the intervention group. A significant reduction in time spent watching television (t1 = 78.0; t2 = 56.7; p = 0.005) and playing on the computer (t1 = 32.3; t2 = 25.8; p = 0.047) was achieved in the intervention group. Time spent in organized sports activities significantly increased only in the intervention group (t1 = 21.9; t2 = 30.5; p = 0.046). Body mass index did not change significantly in the intervention group after the implementation of the NPAEP. CONCLUSIONS: The nutrition and physical activity education program contributed to an increase in fruit and dairy intake and time spent in intense physical activities and a reduction in screen time. The presented results justify the application of the NPAEP in improving the nutrition and physical activity of first-fourth-grade primary school children.

Short-term health effects of air quality changes during the COVID­19 pandemic in the City of Novi Sad, the Republic of Serbia.

OBJECTIVES: The objective of this research is to determine the change in outdoor air quality during the COVID­19 related state of emergency resulting in a lockdown and the potential health benefits for the urban population. MATERIAL AND METHODS: During 53 days of the COVID­19 related state of emergency with a lockdown (March 15-May 6, 2020) in the Republic of Serbia, as well as in the corresponding periods of 2018 and 2019, data on the daily sulfur dioxide (SO2), nitrogen dioxide (NO2), ground-level ozone (O3) and particulate matter (PM10 and PM2.5) concentrations were analyzed. The total mortality data were analyzed to estimate the impact of the COVID­19 related lockdown measures on the burden of health in a given population, attributed to the outdoor air quality in the City of Novi Sad, using AirQ+ software. RESULTS: The average daily concentrations of PM2.5, NO2, PM10 and SO2 were reduced by 35%, 34%, 23% and 18%, respectively. In contrast, the average daily concentration of O3 increased by 8%, even if the primary precursors were reducing, thus representing a challenge for air quality management. In the City of Novi Sad, a reduction in the average daily PM2.5 concentration of 11.23 µg/m³ was significant, which resulted in a quantified number of avoided deaths. CONCLUSIONS: Air pollution in the City of Novi Sad had a chance to be improved due to some preventive measures related to the infectious disease (the COVID­19 related lockdown), which in turn was the mitigation measure to air pollution with positive public health effects. The confirmed positive effects of the improved air quality on public health could also include raising collective resistance to mass non-communicable and infectious diseases such as COVID­19 and reducing economic costs. Int J Occup Med Environ Health. 2021;34(2):223-37.

Occurrence of Campylobacter, Salmonella, Yersinia enterocolitica and Listeria monocytogenes in some retail food products in Novi Sad.

The official reporting system in the Province of Vojvodina (PV) indicates that cases of human salmonellosis were partly covered by complete epidemiological investigation including laboratory analysis of the suspected food. Intestinal campylobacteriosis and yersiniosis and four cases of septicemias caused by Listeria monocytogenes were not fully epidemiologically investigated. Actual country legislation on food safety does not include provisions for a routine control of the above mentioned pathogens except for Salmonella. In the PV, there are no other sources of data that contribute to risk assessment of the above food-borne diseases. A pilot investigation, performed in Novi Sad, indicated that 8.17% out of the total number of 257 retail food samples (90 of fresh meat and 167 of ready-to-eat food) had been contaminated with one of the tested bacteria Campylobacter or Salmonella or Listeria monocytogenes. Yersinia enterocolitica was not detected in any of the tested samples. Fresh poultry meat and other fresh meats were the dominant sources of the detected pathogens compared to samples of ready-to-eat food (p < 0.05). Campylobacter was detected in 18.8% and 10.0% samples of fresh poultry and other fresh meat respectively, which was not statistically significant (p > 0.05). Salmonella was detected in 3.3% samples of fresh poultry meat. Listeria monocytogenes was detected in 5.0% samples of fresh poultry and in 3.3% samples of other fresh meat, the difference was not statistically significant (p > 0.05). One sample (0.6%) of ready to eat food was contaminated with Campylobacter and one (0.6%) with Salmonella.

Pneumonia: Features registered in autopsy material.

BACKGROUND: Despite improvements in clinical practice, pneumonia remains one of the leading causes of death worldwide. Pathologic findings from autopsy reports could provide more precise and valid data on characteristics of pneumonia patients. METHODS: We retrospectively reviewed autopsy reports of deceased patients admitted to the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica, Serbia, between 1994 and 2003. The patients were classified into two groups: group 1 (n = 161) comprised patients in whom pneumonia was the main cause of death, while group 2 (n = 165) consisted of patients in whom pneumonia was confirmed at autopsy but had various different causes of death. RESULTS: From 1776 patients who underwent autopsy 326 (18.3%) were diagnosed with pneumonia. The most common underlying diseases were atherosclerosis (29.4%), chronic obstructive pulmonary disease (COPD) (26.7%), and malignancies (20.2%). Pneumonia was the main cause of death in 161 cases (group 1) while in group 2 major causes of death were heart failure (HF) (26.7%), acute myocardial infarction (AMI) (16.4%), and pulmonary embolism (PE) (10.9%). Multilobar involvement (91% vs.27%), pulmonary effusion (29% vs.14%), and lung abscess (23.6% vs.8.5%) were more frequently found in group 1, compared to group 2. CONCLUSION: In patients with pneumonia who underwent autopsy most common underlying diseases were atherosclerosis, COPD, and malignancies, while major causes of death were: progression of pneumonia, HF, AMI, and PE.

Raw milk consumption and health.

Contrary to the safe practices of milk pasteurization or sterilization, which effectively reduce foodborne outbreaks incidence associated with raw milk and dairy products use, outbreaks caused by such products continue to occur. Despite this fact, a worldwide movement advocating for the rights of raw milk and cheese selling and consumption, due to their specific nutritive characteristics, has strengthened significantly in recent years. Traditional agricultural manufacturers from Serbia still sell products related to thermally unprocessed milk, such as cottage cheese and raw cream. In AP Vojvodina during the period of 1981-2010 a total of 179 foodborne outbreaks were reported, where the incriminated cause of the outbreak were milk or diary. In 126 (70.39%) outbreaks, totaling 2276 sick individuals and one casualty, it was confirmed that the incriminated food was from the group of dairy products. In 48 instances (26.82%), bacteriological tests confirmed that milk and dairy products were excluded as the outbreak causes, while in another 5 (2.79%) outbreaks, microbiological analysis of food failed to confirm any relation to the actual epidemiological instances. In some cases, bacteriological testing of incriminated foods was not possible. In the cases of outbreaks associated with the consumption of milk and dairy products, traditional raw milk products were cited as being used. Consumption of unpasteurized milk and cheese represents public health threat. National and international rules ensuring use of safe products for human consumption have to set rules of trade of thermally processed milk and products on the market.

THE ROLE OF NUTRITION IN CARIES PREVENTION AND MAINTENANCE OF ORAL HEALTH DURING PREGNANCY.

INTRODUCTION: Pregnancy may pose an increased risk for the development of caries and other oral health problems. Continuous screening of oral health status, implementing appropriate preventive measures (particularly oral hygiene, healthy diet plans and education) is of paramount importance not only for oral health but also for the general health status of the future mother and her offspring. EFFECTS OF FOOD ON CARIES DEVELOPMENT: Caries prevention through healthy diet implicates the reduction in frequency and amount of intake of cariogenic food, above all ofrefined carbohydrates, i.e. sugars and sweets. Foods known to have caries-prophylactic effects should predominate in healthy diet plans. They mainly include solid foods, which have mechanical effects on teeth cleaning, as well as foods providing sufficient amounts of vitamins (A, C, D) and a variety of elements and compounds (calcium, phosphates, fluorides) favoring the preservation and remineralization of tooth structures. EDUCATION OF PREGNANT WOMEN ON HEALHY DEIT: In accomplishing these goals, education and direct positive communication between the educator and the pregnant woman play a crucial role. Educative approach is always individual and determined by the patient's specific cultural and socioeconomic features and status, as well as her habits, motivation and willingness to accept relevant recommendations. Accomplishing the aforementioned goals requires the appropriate organization and professional competence within the preventive dental service and its close cooperation with the relevant medical institutions and social support in the framework of public health protection. CONCLUSION: Preserving of oral health during pregnancy is predominantly influenced by the following factors: 1) healthy diet, 2) oral hygiene, 3) patients' education, 4) regular control of oral health, 5) appropriate organization of dental services and 6) community engagement.

Cardiovascular diseases and air pollution in Novi Sad, Serbia.

OBJECTIVES: A large body of evidence has documented that air pollutants have adverse effect on human health as well as on the environment. The aim of this study was to determine whether there was an association between outdoor concentrations of sulfur dioxide (SO2) and nitrogen dioxide (NO2) and a daily number of hospital admissions due to cardiovascular diseases (CVD) in Novi Sad, Serbia among patients aged above 18. MATERIAL AND METHODS: The investigation was carried out during over a 3-year period (from January 1, 2007 to December 31, 2009) in the area of Novi Sad. The number (N = 10 469) of daily CVD (ICD-10: I00-I99) hospital admissions was collected according to patients' addresses. Daily mean levels of NO2 and SO2, measured in the ambient air of Novi Sad via a network of fixed samplers, have been used to put forward outdoor air pollution. Associations between air pollutants and hospital admissions were firstly analyzed by the use of the linear regression in a single polluted model, and then trough a single and multi-polluted adjusted generalized linear Poisson model. RESULTS: The single polluted model (without confounding factors) indicated that there was a linear increase in the number of hospital admissions due to CVD in relation to the linear increase in concentrations of SO2 (p = 0.015; 95% confidence interval (95% CI): 0.144-1.329, R(2) = 0.005) and NO2 (p = 0.007; 95% CI: 0.214-1.361, R(2) = 0.007). However, the single and multi-polluted adjusted models revealed that only NO2 was associated with the CVD (p = 0.016, relative risk (RR) = 1.049, 95% CI: 1.009-1.091 and p = 0.022, RR = 1.047, 95% CI: 1.007-1.089, respectively). CONCLUSIONS: This study shows a significant positive association between hospital admissions due to CVD and outdoor NO2 concentrations in the area of Novi Sad, Serbia.

The impact of obesity on early mortality after coronary artery bypass grafting.

BACKGROUND/AIM: It had been suggested that elevated body mass index (BMI) is a beneficial and preventive factor when it comes to the outcome for patients undergoing coronary artery bypass grafting (CABG). At the same time, obesity is strongly associated with coronary artery disease development. The aim of this study was to determine the significance of the obesity paradox in patients referred for CABG and to examine if a relationship exists between obesity and early coronary surgery outcome. METHODS: This study comparised 791 patients who had undergone isolated CABG over one year period (year 2010). The average age of patients was 62.33 +/- 8.12 years and involved 568 (71.8%) male and 223 (28.2%) female patients, while the mean logistic EuroSCORE was 3.42%. The patients were categorized into three distinct groups based on their BMI: I - BMI < 24.9 kg/m2; II - BMI 25-30 kg/m2; III - BMI > 30 kg/m2. Regression analysis was conducted to determine whether BMI was an independent predictor of early mortality after CABG. RESULTS: The majority of the cohort could be categorized as overweight (490/o) or obese (30%). There was no association between BMI and gender (p = 0.398). The overall early mortality was 2.15% (1.85% in the group I, 2.06% in the group II and 2.51% in the group III; p = 0.869). Univariate analysis showed that obesity cannot be regarded as an independent risk factor for early mortality following CABG (odds ratio 1.021, 95% confidence interval 0.910-1.145, p = 0.724). Duration of in-hospital period following the surgery was comparable within the BMI groups (p = 0.502). CONCLUSION: Compared to non-obese patients, overweight and obese individuals have similar early mortality rate following CABG. This study can substantiate the presence of obesity paradox only in terms that elevated BMI patients have comparable outcome with non-obese. Further research is needed to delineate potential underlying mechanisms that set off obesity to protective factor for coronary surgery.