Browsing by Author "Janković, Slavenka (7101906308)"

Background: Psoriasis has a substantial impact on patients' quality of life. Objectives: The aims of this study were to assess the impact of the clinical severity of psoriasis on patients' quality of life and to determine the effects of psoriasis-related stress on patients' everyday life. Methods: The cross-sectional study was conducted at the Institute of Dermatovenereology, Clinical Center of Serbia, Belgrade. The study included 201 patients (124 men and 77 women), aged 18-70 with a diagnosis of psoriasis, hospitalized or treated as outpatients during 2009. For the assessment of patients' quality of life, the psoriasis disability index (PDI) was used. The stress related to psoriasis was measured with the psoriasis life stress inventory (PLSI) and disease severity with the psoriasis area and severity index (PASI). Results: We found moderate correlation between PLSI and all PDI subscales and overall score (correlation coefficients ranged from 0.334 to 0.521). The correlation between PASI and PDI subscales was weak, while we failed to find any significant correlation between PASI and the PLSI. The results of multiple regression analysis indicated that stress, more severe disease, and lower educational level are significant determining factors of a poorer quality of life in patients with psoriasis. Conclusion: Our results support the importance of assessing the quality of life in psoriasis and effects of stress in patients' adjustment to their condition and may have important implications for a psychological stress management approach in the clinical management of psoriasis. © 2014 The International Society of Dermatology.

Aim. To test the discriminative metric properties and specificity of the Serbian version of the Asthma Quality of Life Questionnaire (AQLQ) for assessment of the quality of life in asthma patients. Method. We studied 100 atopic and 60 nonatopic adult asthma patients with different disease severity, who were consecutively recruited from the outpatient and inpatient departments of the Institute of Allergology and Immunology, University Center of Serbia, between March 2000 and June 2002. After linguistic validation, AQLQ was administered, as well as Paykel's scale of stressful life events. Tests of statistical significance and General Linear Model were used to explore the correlation between characteristics of patients, disease, and environment, and AQLQ scores. Reliability of the questionnaire was evaluated by determining its internal consistency with Cronbach's alpha coefficient. Results. A more severe form of the disease (F = 16.05; p < 0.001), life in rural disease areas (t = -2.67; p = 0.008) and changes in weather conditions (t= 3.05; p= 0.003) were significantly associated with worse overall quality of life of the tested asthma patients. Older patients had poorer quality of life in domains of activity limitation (B = -0.024; 95% confidence interval [CI], -0.036 to -0. 011; p < 0.001) and exposure to environmental stimuli (B = -0.022; 95% CI, -0.039 to -0.006; p = 0.008). Higher values of forced expiratory volume in one second (FEV 1 , % predicted) were correlated with better quality of life in overall (B = 0.017; 95% CI, 0.009-0.025; p < 0.001) and other questionnaire domains, except in domain of environmental stimuli. Poorer overall quality of life was recorded in atopic patients sensitive to house dust mites (t = 2,60; p = 0.011). Form (atopic and nonatopic) and duration of disease, as well as stressful life events were not significantly related to asthmatic patients' quality of life. The Cronbach's alpha ranged from 0.72 to 0.93. Conclusion. Disease severity, place of residence, weather conditions, age, and FEV 1 (% predicted) were significantly related to quality of life in our patients. The Serbian version of AQLQ was highly reliable.

Objective: Cardiovascular health (CVH) is a relatively new concept defined by the American Heart Association (AHA). The aim of the present study was to assess whether the indices of CVH were discriminators of socioeconomic status (SES) in the adult population of the Republic of Srpska (RS). Design: Population-based cross-sectional study. Setting: RS, Bosnia and Herzegovina. Participants: The study involved 4165 adults aged ≥18 years (mean age 50.2; 54% women) who participated in the National Health Survey performed from September to November 2010 in the RS. Study variables: Participant's education was a proxy for SES. Potential discriminators of SES were indices of CVH presented according to AHA as: ideal health behaviours index (non-smoking, body mass index <25 kg/m2, physical activity at goal level and healthy diet); ideal health factors index (untreated total cholesterol <200 mg/dL, untreated blood pressure <120/<80 mm Hg, untreated fasting glucose <100 mg/dL and non-smoking); and ideal CVH status (defined as all seven ideal health metrics present) versus intermediate and poor CVH status. Results: Participants with high educational levels had a significantly greater number of ideal CVH metrics, and ideal health factor metrics compared with those with low or medium educational level (OR 0.88 95% CI 0.77 to 0.99 and OR 0.88 95% CI 0.80 to 0.96; OR 0.81 95% CI 0.69 to 0.96 and OR 0.77 95% CI 0.68 to 0.87; respectively). The number of ideal behaviour metrics was not a discriminator of educational groups. Concerning the categories of CVH status the poor CVH was a discriminator for low and medium education compared with those with high education (OR 1.93 95% CI 1.24 to 3.01 and OR 1.54 95% CI 1.08 to 2.19, respectively). Conclusions: Our findings emphasise the large potential for preventing cardiovascular disease, showing a low proportion with a favourable CVH profile, especially among low-educated people. It is necessary to consider prevention strategies aimed at improving CVH in RS, targeting primarily low educational groups.

Background. Almost 50 years ago Balkan Endemic Nephropathy (BEN) was first described in Serbia in the village of Sopic where the first field examination was carried out in 1971. Our aim was to find out whether BEN is still present in this region. Methods. Prevalence data on BEN from a field examination run in 1971 were compared with the results of a cross-sectional study conducted in the same village in 1992. In addition, every new case of the disease diagnosed between 1971 and 1992 was recorded retrospectively. The prospective study included 50 members of five BEN families randomly selected from 28 BEN families registered in the village Šopić in 1992. The objective survey and examination of global and tubular kidney function was carried out in all examined persons once yearly in 1998, 1999, and 2000. Results. The overall prevalence of BEN was 6.4% in 1971 and 8.9% in 1992. In the period of 21 years, 161 new BEN patients were detected in 28 families in which the disease had already been recorded. No new family affected by BEN and none of the new patients in 47 families registered previously as nonaffected were discovered. In the prospective study of five BEN families, three new BEN cases were discovered among 50 members, and two patients fulfilled criteria for BEN-suspected ones. Conclusion. Balkan Endemic Nephropathy (BEN) is still present in the village of Šopić, but the clinical course of the disease became more protracted over time. New cases of BEN appeared only in the affected families. Copyright © 2005 Taylor & Francis Inc.

Aim: To provide a comprehensive assessment of burden of selected cancers in Serbia. Method: We calculated disability adjusted life years (DALY) - the sum of the years of life lost (YLL) from premature mortality and the years lived with disability (YLD) - for cancers of stomach, colon and rectum, lung, breast, and cervical cancer for central Serbia and Vojvodina, Serbia and Montenegro. The obtained values were compared with the corresponding values for European region as estimated by the World Health Organization. The study was conducted between October 2002 and September 2003. The cancer burden was estimated for the year 2000. Results: Observed cancers were responsible for 133 689 DALYs (73 197 for men and 60 482 for women). There were significantly more losses because of premature death than disease disability (95.2% vs 4.8% in men P<0.001, and 93.2% vs 6.8% in females, P<0.001). The cancer burden was dominated by lung cancer in men and breast cancer in women. The cancer burden was very small before the age of 35. Conclusion: DALYs per 1000 population were higher in Serbia than in the European region for all observed cancers except for stomach cancer. The participation of a burden caused by disability in the total burden of selected cancers was lower in Serbia than in other European countries, with the greatest differences in colorectal, breast, and cervical cancers.

Background and Purpose: There are only a few published studies on the relationship between cardiovascular health (CVH) status as proposed by the American Heart Association and the metabolic syndrome (MetS) in persons with cardiovascular disease (CVD). The aim of this study was to assess the prevalence of CVH and MetS and their correlation in the adult population of the Republic of Srpska, Bosnia and Herzegovina, in order to evaluate which set of cardiovascular risk factors (low or medium CVH status and MetS), or the combination of both, is a better predictor for the occurrence of CVD. Methods: We included 3601 adults (aged ≥25 years) from the Republic of Srpska National Health Survey 2010. CVH status was evaluated according to the American Heart Association criteria, whereas MetS was defined using the criteria of the National Cholesterol Education Program's Adult Treatment Panel III. Results: The prevalence of low or medium CVH status and MetS is significantly higher in participants who had experienced CVD than in those free of CVD. Our study showed that predictors for CVD occurrence were presence of MetS (odds ratio 3.61, 95% confidence intervals 2.14-6.07) and presence of both sets of cardiovascular risk factors in the same person (odds ratio 4.23, 95% confidence intervals 1.50-11.93). Conclusion: Our results suggest that presence of both sets of cardiovascular risk factors (low or medium CVH status and MetS) is the strongest predictor of CVD. Identification of individuals with cardiovascular risk factors may provide opportunities to intervene earlier and can help reduce the risk of developing CVD. © 2018 National Stroke Association

Background: The most important instrument of EU support for the reforms of higher education in the European countries with the final goal of joining the European Higher Education (HE) Area by the year 2010 is TEMPUS (Trans-European Mobility Programme for University Studies). So far, Tempus is the only EU programme providing support for the reform of HE in the Western Balkans. Aim The purpose of this paper is to present the new curriculum of the Master of Health Policy and Management programme, which will provide students in Serbia with the up-to-date knowledge and necessary skills to analyse options, define strategies, formulate and implement health policies, and manage solutions for the effective delivery of health services. Methods: With financial support from the European Union's Tempus project, the "Postgraduate Study in Public Health Sciences" core project team from the Centre School of Public Health (C-SPH) School of Medicine (SoM) in Belgrade, supported by European project partners from Dresden, Rome and Krakow, developed a new curriculum-the Master of Health Policy and Management (MHPM) programme. Project activities (courses, workshops and visits to partner institutions) took place in Belgrade, Dresden, Rome and Krakow throughout 2006-2009. Results: The MHPM programme, based on modular principles and a European Credit Transfer System (ECTS) approach (60 ECTSs), was established at the C-SPH SoM and approved by the University of Belgrade. The MHPM programme consists of two tracks: one for health-care services management and the other for public health management. The first generation of MHPM students enrolled at the C-SPH SoM, Belgrade, in September 2008. They successfully passed all obligatory courses. It is envisaged that the first MHPM students will graduate in autumn/winter 2009. Conclusion: We believe that the project will continue to deliver benefits to the project beneficiaries after the Commission's financial assistance has been terminated. The MHPM programme will facilitate health-care administration reform, contribute to strengthening civil society and accelerate the development of democracy and the rule of law through good governance in Serbia. © Springer-Verlag 2009.

Introduction: Atopic dermatitis (AD) is a chronic skin disease that has a significant impact on quality of life (QoL). The aim of this paper was to evaluate if gender affects some aspects of QoL in children with AD. Materials and methods: The cross-sectional study was conducted at the Clinic of Dermatology and Venereology, Clinical Center of Montenegro, between August 2017 and July 2018 and included 200 children aged 5−16 years with AD diagnosis. The severity of disease was measured by the Three Item Severity (TIS) score, while QoL was assessed with the Children’s Dermatology Life Quality Index (CDLQI). Socio-demographic data on children with AD were collected by a short questionnaire. Results: The difference in overall CDLQI between boys and girls was not statistically significant. The domains that were most affected by AD were school/holidays (mean score 2.27 ± 0.65), and symptoms (mean score 2.22 ± 0.70). Swimming/ sports activities, school/holidays, teasing/bullying and sleep disturbance were more affected in girls. Overall CDLQI score and CDLQI subscale scores (except school/holidays and sleep in boys) significantly correlated with TIS. According to multivariate logistic regression analyses statistically significant differences between two genders were not found for age, AD severity, concomitant atopic disease, and family history of atopic disease. Conclusion: Although we did not find differences between the two genders in the overall health related QoL, this study confirmed the tendency for AD to have a more severe impact on girls' lives. These results may influence treatment and counselling of children affected with AD. © 2019, Faculty of Medicine, University of Banja Luka. All rights reserved.

Background and Objectives: Many epidemiological studies have shown a positive association between black carbon (BC) and the exacerbation of allergic rhinitis and allergic asthma. However, none of the studies in Serbia examined this relationship yet. The aim of this study was to examine the associations between BC and emergency department (ED) visits for allergic rhinitis and allergic asthma in the Užice region of Serbia. Materials and Methods: A time-stratified case-crossover design was applied to 523 ED visits for allergic rhinitis and asthma exacerbation that occurred in the Užice region of Serbia between 2012–2014. Data regarding ED visits were routinely collected in the Health Center of Užice. The daily average concentrations of BC were measured by automatic ambient air quality monitoring stations. Odds ratios (ORs) and their corresponding 95% confidence intervals (CIs) were estimated using conditional logistic regression adjusted for the potential confounding influence of weather variables (temperature, humidity, and air pressure). Results: Statistically significant associations were observed between ED visits for allergic rhinitis and 2-day lagged exposure to BC (OR = 3.20; CI = 1.00–10.18; p = 0.049) and allergic asthma and 3-day lagged exposure to BC (OR = 3.23; CI = 1.05–9.95; p = 0.041). Conclusion: Exposure to BC in the Užice region increases the risk of ED visits for allergic rhinitis and asthma, particularly during the heating season. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

Allergic rhinitis is a chronic inflammatory disease of the airways, which can interfere with many aspects of an individual's life and severely diminish the quality of life of the person affected. The objective of this study was to assess the quality of life of patients suffering from allergic rhinitis during and out of pollen season. The study involved 100 patients diagnosed with allergic rhinitis, 48 of who had seasonal, 25 perennial, and 27 who manifested both forms of allergic rhinitis. All study participants were treated at the Institute of Allergology and Immunology, Clinical Centre of Serbia, Belgrade, in the period March-November 2002. A specific quality of life questionnaire for patients with rhinoconjunctivitis was used in the study. During pollen season, itchy eyes (chi2 = 6.34; p = 0.042), red eyes (chi2 = 7.44; p = 0.024), and swollen eyes (chi2 = 6.65; p = 0.036) caused significantly more difficulties for subjects with seasonal and those with both seasonal and perennial rhinitis than for subjects with perennial allergic rhinitis. A highly significant difference in the mean scores of the indoors activity variable during and out of pollen season (F = 347.28; p = 0.000) was noted, that is to say, significant irritation was noted during pollen season among subjects with seasonal and those with both seasonal and perennial allergic rhinitis, however the dynamics of irritation remained the same in both study groups (F = 0.145; p = 0.704). The patients with seasonal and those with both seasonal and perennial allergic rhinitis experienced a significantly poorer quality of life during pollen season than out of it, as well as an inferior quality of life in comparison to patients with perennial allergic rhinitis during pollen season.

Atopic dermatitis (AD) is a chronic relapsing condition that can have considerable effects on the patients' quality of life (QOL). The aim of this study was to measure the health-related QOL in patients with AD, using generic and specific instruments, to compare the scores obtained by different instruments and to verify the relationship between them. We conducted a cross-sectional study of 132 outpatients with AD. To assess the QOL, Short Form 36 (SF-36), Dermatology Life Quality Index (DLQI) and Children's Dermatology Life Quality Index (CDLQI) were administered. In order to assess the disease severity of AD, we used the Eczema Area and Severity Index (EASI) and physician assessment of disease severity. Stressful life events during the last 12 months were assessed with Paykel's Interview for Recent Life Events. Patients with AD had inferior social functioning and mental health scores compared with the general population. The correlations between the DLQI and SF-36 were found for the mental components of the QOL. Increasing disease severity was associated with greater impairment in QOL in both, children and adults. Our study found the influence of the stressful life events on the role emotional of AD patients. These results demonstrate that AD influences health-related QOL, especially in children. This study supports the decision to use both generic and skin-specific instruments to assess the impact of AD on QOL. © 2011 Japanese Dermatological Association.

Introduction: Palmoplantar psoriasis (PPP) is a variant of psoriasis that affects the palms and/or soles. Although PPP is a disabling and therapeutically challenging condition, its epidemiology is poorly defined. Aim: To assess the prevalence of PPP locations (palms, soles or both), and to analyse epidemiological and clinical characteristics of the disease. Material and methods: Two bibliographic databases (MEDLINE and SCOPUS) were used as data sources searched from inception to October 2017. The selection of articles was limited to human subjects and English or French languages. Results: A search resulted in a total of 293 articles, out of which 24 were utilized for the current systematic review and 21 for meta-analysis. All listed studies comprised a total of 2083 patients with PPP, with more males than females. According to the results of meta-analysis, majority of patients had the highest prevalence of both palms and soles involvement (95% CI: 47–67), with an almost equal prevalence showing palmar (21%; 95% CI: 13–30) or plantar (20%; 95% CI: 12–29) involvement. The most prevalent type of PPP was plaque/hyperkeratotic, followed by the pustular type. Conclusions: Almost three-fifths (59%) of all PPP patients had involvement of both palms and soles, while exclusive palmar or plantar involvement was seen in 21% and 20% of patients, respectively. Future research should be performed to elucidate basic epidemiological and clinical characteristics of PPP, which would be helpful for proper consideration of this condition. © 2019 Termedia Publishing House Ltd.. All rights reserved.

Background and objectives: While most previous surveys on the clinico-epidemiological features of autoimmune bullous diseases (AIBDs) have predominantly focused on a single disease entity or just one disease group, there have been only few studies examining the incidence of various AIBDs. In the present study, we set out to determine the spectrum of AIBDs, to estimate the incidence of the most common AIBDs, and to examine their temporal trends in Central Serbia over a period of 20 years. Methods: We retrospectively recruited 1,161 new AIBD cases diagnosed in Central Serbia during the period from January 1991 to December 2010. The diagnosis was based on strict clinical, histological, and immunohistological evaluation. Results: The incidence rates were: 4.35 per million population/year (pmp/year) for pemphigus, 4.47 pmp/year for pemphigoid, 1.42 pmp/year for dermatitis herpetiformis (DH), 0.25 pmp/year for linear IgA disease, and 0.08 pmp/year for epidermolysis bullosa acquisita. In the period observed, age-adjusted incidence rates significantly increased for pemphigus and particularly for pemphigoid, whereas they decreased, albeit not significantly, for DH. Conclusions: For the first time, our study evaluates the incidence rates of the entire spectrum of AIBDs in Serbia, and examines their temporal trends over a 20-year period. To the best of our knowledge, our finding of similar incidence rates for pemphigus and pemphigoid has previously not been reported. © 2016 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

Objectives: To examine demographic, socio-economic, and health status inequalities in the utilization of health care services (UHCS) in the Republic of Srpska (RS), Bosnia and Herzegovina. Methods: Data were retrieved from the 2010 National Health Survey for the RS adult population (n = 4128). A complex sample design was taken into account for statistical analysis. Results: As compared to men, a higher percentage of women visited a family physician (FP), urgent care department, dentist and private doctor. Higher educated women and those worse-off (OR 1.17) more frequently visited FP. Hospitalization (OR 4.56 for males; OR 9.17 for females), visit to urgent care department (OR 3.19 for males; OR 2.42 for females) and visits to FP in females (OR 1.46) were associated with poor self-perceived health. No inequalities by wealth index were found for the utilization of FP, hospitalization, urgent care and dentist among persons with poor self-perceived health status. Conclusions: The present study confirmed demographic, socio-economic and health status inequalities in the UHCS in RS. These findings have significant implications for health policy makers that seek to provide equal care for all people living in RS. © 2017, Swiss School of Public Health (SSPH+).

Balkan endemic nephropathy (BEN) presents an unsolved puzzle despite fifty years of its investigation. Academy of Medical Sciences of the Serbian Medical Society organized a round table discussion on current unsolved problems related to BEN. The present paper summarizes presentations, discussion and conclusions of this meeting. During the last fifty years, the course of BEN prolonged and it shifted towards the older age in all endemic foci. Data on the incidence of BEN have been controversial and frequently based on the data on the number of BEN patients starting haemodialysis treatment. In Serbia, BEN patients present 6.5% of haemodialysis population and this percentage differs among different centres ranging from 5% (Leskovac) to 46% (Lazarevac). Maintenance of high prevalence of BEN patients on regular haemodialysis indicates that BEN is not an expiring disease. In addition, recent data have shown more frequent microalbuminuria and low-molecular weight proteinuria in children from endemic than from nonendemic families. Aetiology of BEN is still unknown despite numerous investigations of environmental and genetic factors. Today, there is a very current hypothesis on the aetiological role of aristolochic acid but the role of viruses, geochemical factors and genetic factors must not be neglected. Morphological features of BEN are nonspecific and characterized by acellular interstitial fibrosis, tubular atrophy and changes on preand postglomerular vessels. New immunohistochemical and molecular biology methods offer a new approach to BEN investigation. Association of BEN with high incidence of upperurothelial tumours is well-known. Recent studies have shown significant changes of demographic characteristics of patients suffering upper-urothelial tumours, their prevalence in different endemic foci and characteristics of tumours. Further studies of BEN should be directed to determination of incidence and prevalence of disease in different endemic foci, investigations of different insufficiently examined aetiological factors as well as pathomorphological features of the disease by the use of modern methods.

Aim This manuscript deals with public health training, research and practice in order to identify the future perspectives and requirements of master's programmes in public health sciences in Serbia. Methods: A wide array of documents and websites was analysed. The methods used for data collection were: (1) review of the existing written reports, the relevant legislation and other documents, and (2) Internet searches accessing the websites of the Ministries of Health, Education, Science and Technology of the Republic of Serbia as well as websites covering thematic areas in European and global education, research and development. Use has also been made of the results of the European Union projects done in the field of public health in Serbia, particularly the Tempus programme "Postgraduate Studies in Public Health Sciences". Results: The most important role in the field of change in public health in Serbia is played by the School of Public Health (SPH) and the Institutes of Public Health (IPH). Although at the managerial level the need for change has been perceived, in general there is not a shared, clear vision of what the change should be and how this should happen. The reorganisation of the IPH in Serbia is greatly needed given their poor present performance and the expectations of the government to reach EU standards and to increase the health status of the Serbian population. The main obstacles are seen to be inappropriate legislation, lack of financial resources and insufficiently trained staff. Three areas with priority for future development have been identified: (1) doctoral programmes in public health and in health policy and management, (2) expansion of continuing and life-long learning in good governance and public health management, and (3) increasing the research base in public health and management. Conclusion: The need for a better trained workforce in the fields of public health, health management and health promotion is clearly recognised by public health professionals in Serbia. Therefore, the educational infrastructure should be amended by doctoral programmes and life-long learning schemes, based on intensified public health research. © Springer-Verlag 2009.

Aims: The aim of this study was to determine non-occupational risk factors for bladder cancer in Serbia. Methods and design: A hospital-based, case-control study included 130 newly diagnosed bladder cancer patients and the same number of individually matched controls with respect to sex, age (± 2 years) and type of residence (rural or urban), from the Clinical Center of Serbia in Belgrade and from the Clinical Center in Kragujevac in central Serbia. The study took place from June 1997 to March 1999. Results: According to multivariate logistic regression analysis, there was an association between: frequency of daily urination (OR = 0.18; 95% CI = 0.08-0.39); consumption of liver (OR = 13.81; 95% CI = 2.49-76.69), canned meat (OR = 8.38; 95% CI = 1.74-40.36), fruit juices (OR = 0.08; 95% CI = 0.01-0.56); the highest tertile of pork (OR = 4.55; 95% CI = 1.30-15.93), cabbage (OR = 0.25; 95% CI = 0.06-1.01) and vinegar (OR = 4.41; 95% CI = 1.18-16.50) intake and risk for bladder cancer. Conclusions: Consumption of liver, canned meat, pork (h vs I tertile) and vinegar (m vs I tertile) was indicated as a risk factor for bladder cancer, whereas frequent daily urination, consumption of fruit juices and cabbage (h vs I tertile) were indicated as protective factors.

Aims: The aim of this study was to determine non-occupational risk factors for bladder cancer in Serbia. Methods and design: A hospital-based, case-control study included 130 newly diagnosed bladder cancer patients and the same number of individually matched controls with respect to sex, age (± 2 years) and type of residence (rural or urban), from the Clinical Center of Serbia in Belgrade and from the Clinical Center in Kragujevac in central Serbia. The study took place from June 1997 to March 1999. Results: According to multivariate logistic regression analysis, there was an association between: frequency of daily urination (OR = 0.18; 95% CI = 0.08-0.39); consumption of liver (OR = 13.81; 95% CI = 2.49-76.69), canned meat (OR = 8.38; 95% CI = 1.74-40.36), fruit juices (OR = 0.08; 95% CI = 0.01-0.56); the highest tertile of pork (OR = 4.55; 95% CI = 1.30-15.93), cabbage (OR = 0.25; 95% CI = 0.06-1.01) and vinegar (OR = 4.41; 95% CI = 1.18-16.50) intake and risk for bladder cancer. Conclusions: Consumption of liver, canned meat, pork (h vs I tertile) and vinegar (m vs I tertile) was indicated as a risk factor for bladder cancer, whereas frequent daily urination, consumption of fruit juices and cabbage (h vs I tertile) were indicated as protective factors.

Background: Nosocomial bloodstream infections (BSI) create a serious health problem in hospitals all over the world. The objectives of our study were to explore putative disease markers and potential risk factors with nosocomial BSI in patients in intensive care units (ICU) and non-ICU patients and to determine risk factors associated with increased 28-day mortality rate in patients with nosocomial BSI acquired in combined medical-surgical ICU. However, the major purposes of this report were to identify epidemiologic differences between nosocomial BSI acquired in ICU and non-ICU, as well as analyses outcomes for patients with nosocomial BSI acquired in ICU. Methods: A 1-year prospective cohort study was performed to determine the incidence of nosocomial BSI in hospitalized patients. Patient characteristics, risk factors related to health care, and source of infection of patients with BSI acquired in non-ICU were compared with those patient with BSI acquired in ICU. Also, nested case-control study of patients to nosocomial BSI acquired in ICU was performed to evaluate outcome. Patients were identified by active surveillance and positive blood culture during the study period. Results: The incidence of nosocomial BSI was 2.2 per 1000 admission in non-ICU patients and 17.4 per 1000 admission in ICU patients. The 28-day crude mortality rate was 69% in ICU patients. A multivariate model showed that nasogastric tube (RR, 25.1; 95% CI: 3.845-163.85; P = .001), mechanical ventilation (RR, 13.04; 95% CI: 1.974-96.136; P = .008), and H2 blockers (RR, 12.16; 95% CI: 1.748-84.623; P = .012) were more prevalent among patients with BSI acquired in ICU, and aggressive procedures (RR, 8.65; 95% CI: 1.70-44.00; P = .009) were more prevalent among patients with BSI acquired in non-ICU patients. Risk factors independently associated with increased 28-day mortality rate in ICU patients were mechanical ventilation (OR, 8.63; 95% CI: 1.5-49.8; P = .016) and SAPS II >40 (OR, 6.0; 95% CI: 1.0-35.7; P = .049). The most common isolated nosocomial BSI pathogens (in both groups of patients) were coagulase-negative staphylococci (21%), Staphylococcus aureus (14%), and Klebsiella species (13%). Klebsiella species was the only organism independently influencing the poor outcome of nosocomial BSI in ICU patients (OR, 4.3; 95% CI: 1.2-15.3; P = .022). Conclusions: Our results show epidemiologic differences between non-ICU and ICU BSI. Also, this study suggests that severity of underlying host conditions, mechanical ventilation, and microbial agents (Klebsiella species) affect the outcome of NBI in patients in ICU. Copyright © 2005 by the Association for Professionals in Infection Control and Epidemiology, Inc.

This study aimed to assess possible differences in health services utilization among people living with noncommunicable diseases (NCDs) in the Republic of Srpska (RS), Bosnia and Herzegovina, with special reference to NCD multimorbidity. In addition, the relationship between self-perceived health and health care utilization was assessed. Data were retrieved from the 2010 National Health Survey. A cross-sectional study design was used. A total of 4,673 persons aged 18 years and older were identified in the households, of which 4,128 were interviewed. Logistic regression analyses were used to estimate the effects of NCDs on health care utilization in RS. Respondents with NCD multimorbidity more frequently visited family physicians (odds ratio [OR], 2.74; 95% confidence interval [CI], 2.34 − 3.19), dentists (OR, 1.57; CI, 1.28 − 1.92), private doctors (OR, 2.14; CI, 1.74 − 2.64), and urgent care departments (OR, 2.30; CI, 1.75 − 3.03) than their counterparts without NCDs. They also had more hospital admissions (OR, 2.03; CI, 1.56 − 2.64). This is the first study to address the relationship between health care utilization and NCDs in the population of RS. Further research is needed to explore how best to organize health care to meet the needs of people in RS with NCDs, especially with NCD multimorbidity. © The Author(s) 2018.