The significance of different methods for detection of gastroesophageal reflux in children

Symptom-based diagnosis of gastroesophageal reflux disease (GERD) is not specific due to high prevalence of disorders that can mimic GERD. Conventional pH monitoring, combined pH-MII (multiple intraluminal impedance) monitoring and esophagogastroduodenoscopy are diagnostic methods most frequently used in children. Combined pH-MII monitoring is the most accurate diagnostic method for detecting GERD in children, which tends to become the gold standard. In infants and probably in children with extraesophageal symptoms, MII gives the greatest contribution to the validity of pH-MII monitoring. High prevalence of functional heartburn, in children older than 8 years, suggests the importance of pH-MII monitoring in this age group as well. The majority of studies showed age differences in the chemical composition of refluxate. Weakly acid reflux is more common in infants and is often associated with symptoms, whereas acid reflux is more common in older children and adolescent. Sensitivity of endoscopy is very low compared to pH-MII monitoring as a reference test. Although endoscopy is the method of choice for the confirmation of reflux esophagitis, pH-MII parameters are promising indicators of mucosal integrity, but further studies are needed. The major problem with pH-MII monitoring is a lack of normative data for children. Therefore, the standardization is mandatory. For the present pH-MII monitoring has limited impact on treatment due to the absence of effective therapy for weakly acid reflux, suggesting that further studies should be directed in this direction

Craniocervical Dystonia Questionnaire (CDQ-24): Validation and Cross-Cultural Adaptation in Serbian Patients

The purpose of this study was to investigate the validation of the translated and culturally adapted CDQ-24 questionnaire on a group of Serbian patients. The study was comprised of 100 consecutive patients with idiopathic cervical dystonia (CD) and blepharospasm (BSP) who were evaluated at the Institute of Neurology, Clinical Centre of Serbia in Belgrade between March and June 2007. The linguistic validation of CDQ-24 involved 3 steps, according to an internationally accepted methodology. Most of the patients with CD and BSP accepted the CDQ-24 questionnaire. The internal consistency reliability ranged from 0.81 to 0.97. The mean total score of the CDQ-24 was 35.6±23.5. Patients with BSP had better HRQoL scores in the Pain subscale (p=0.025) compared with CD patients. However, patients with CD had better HRQoL sores in the Activities of Daily Living subscale (p=0.028) compared with BSP patients. Statistically significant positive correlations were registered between the Dystonia Movement Scale score and almost all CDQ-24 scales. The Serbian version of CDQ-24 should be recommended for HRQoL evaluation among patients with CD and BSP as an important outcome measure

Cross-cultural adaptation and validation of the disease specific questionnaire oqlq in Serbian patients with malocclusions

Introduction. Dentofacial disorders may potentially significantly affect the quality of life. Objectives of this study were to validate translated and culturally adapted Orthognatic Quality of Life Questionnaire (OQLQ) on a cohort of Serbian patients with malocclusions. Methods. The questionnaire was validated in 111 consecutive patients with malocclusions, seen between December 2014 and February 2015 at the Clinic of Orthodontics, Faculty of Dental Medicine, University of Belgrade. Clinical validity was assessed comparing the mean scores for the four subscales of the OQLQ and mean PAR pre-treatment score. In order to assess whether the allocation of items in the subscales corresponds to their distribution in the original questionnaire, an exploratory factor analysis (principal component analysis with varimax rotation) was conducted. Results. The results of the internal consistency analysis demonstrated good relationships between the items; Cronbach's alpha coefficients for the four subscales were highly significant (p lt 0.001) (0.88-0.91). All items were significantly correlated between baseline and the retest (6 weeks after). The correlations between the PAR and all four domains of the OQLQ were all significant (p lt 0.01). The loading weights obtained in the exploratory factor analysis showed that this model revealed four factors with eigenvalue greater than 1, explaining the 64.0% of the cumulative variance. The majority of the items (86.4%) in the Serbian version of the OQLQ presented the highest loading weight in the subscales assigned by the OQLQ developer. Conclusions. The psychometric properties of the OQLQ (Serbian version) have exceptional internal consistency and reproducibility as an instrument for evaluation of dental malocclusions. Additionally, this questionnaire may be useful as a supplementary outcome measure in persons with malocclusions

Stavovi studenata prve godine u odnosu na šestu godinu medicine u Srbiji prema studiju i poslijediplomskoj karijeri

Self-perceived stress during undergraduate medical training could influence forthcoming career choices. The aim of this study was to explore the attitudes and potential differences between 1st and 6th year students regarding aspects of medical training and career plans. As many as 570 students in 1st and 400 in 6th year of studies at the Faculty of Medicine, University of Belgrade, were recruited on December 2-9, 2013. Data were acquired through a self-administered questionnaire. Students in both years rated “Helping other people” as the most important reason to study medicine. Freshmen rated statistically significantly higher ‘good incomes’ and ‘social status’ as reasons to study medicine (p=0.003 and p=0.037, respectively). The most desirable fields of specialization were surgery and internal medicine (36.4% and 18.7% for 1st year, and 26.3% and 36.6% for 6th year, respectively). Significantly more freshmen would prefer working abroad (χ2=3.891, p=0.029). In terms of careers abroad, students in both years expressed the highest interest in working in western and northern Europe. Desires for specialty training among medical students follow the pattern of the most frequent disciplines in the Serbian physician population, with gender differences comparable to other populations. A certain percentage of students would likely emigrate.Stres tijekom studija medicine mogao bi utjecati na predstojeće izbore u karijeri. Svrha ovog rada bila je istražiti stavove i potencijalne razlike između studenata prve i šeste godine medicine u vezi studija i daljnjih planova u karijeri. Ukupno 570 studenata prve i 400 studenata šeste godine studija na Medicinskom fakultetu Sveučilišta u Beogradu bili su regrutirani za studiju u razdoblju od 2. do 9. prosinca 2013. godine. Podaci su dobiveni putem anonimnog upitnika. Studenti u obje godine ocijenili su “Pomaganje drugim ljudima” kao najvažniji razlog za studij medicine. Brucoši su statistički značajno više ocijenili razloge “dobri prihodi” i “ socijalni status” za studij medicine (p=0,003 odnosno p=0,037). Najpoželjnije specijalizacije bile su kirurgija i interna medicina (36,4% odnosno 18,7% za prvu godinu i 26,3% odnosno 36,6% za šestu godinu). Statistički značajno više brucoša radije bi radili u inozemstvu (χ2=3,891, p=0,029). Studenti koji bi radili u inozemstvu izrazili su najveći interes za rad u zapadnoj i sjevernoj Europi. Želje za specijalizacijom među studentima medicine slijede obrazac najčešćih disciplina među srpskim liječnicima, s rodnim razlikama kakve su prisutne i u drugim populacijama. Određeni postotak studenata vjerojatno će emigrirati

Ready to work or not quite? Self-perception of practical skills among medical students from Serbia ahead of graduation

Aim To assess final year medical students’ self-perception of their practical skills. Methods The study was conducted at the Faculty of Medicine in Belgrade during compulsory practical sessions in the period December 2-9, 2013 and 390 students agreed to participate (response rate 77.8%). The questionnaire included questions on demographic characteristics, 21 questions on students’ self-perception of their practical skills, and 1 question on students’ self-perceived readiness to start working with patients. Results Cronbach’s α for the entire scale was 0.891. Students felt most confident about measuring arterial pulse and blood pressure and taking patients’ history (average score 10 for all three skills) and least confident about placing a urinary catheter (average score 1) and suturing a wound (average score 2). They rated their readiness to work with patients with 5.0 out of 10.0 points. The total score did not correlate with students’ average mark (Spearman’s ρ = 0.039; P = 0.460) and the average mark did not correlate with the self-perceived readiness to work with patients (Spearman’s ρ = -0.048; P = 0.365). Conclusion Our study suggests that medical students lack confidence to perform various clinical procedures, particularly those related to surgical interventions. To improve students’ confidence, clinical curriculum should include either more hours of practical work or ensure closer supervision of practical training in wards

Understanding vaccination communication between health workers and parents: a Tailoring Immunization Programmes (TIP) qualitative study in Serbia

Vaccine communication between health workers and parents affects parental acceptance, so understanding this is particularly important when vaccination rates drop. This paper presents the findings of a qualitative research study conducted in Serbia as part of a Tailoring Immunization Programmes (TIP) project. The aims were to explore the process of vaccination communication between health workers and parents (accepting, indecisive, delaying, refusing), and identify barriers and drivers to effective communication. In-depth interviews with 14 health workers were supplemented and qualified by observations of 40 consultations, using thematic analysis. Study sites were two community health centers in two Belgrade municipalities where a significant drop in childhood vaccination rates had occurred. Key findings were: (1) communication mainly took place between pediatricians and parents, while nurses focused on administering vaccines. (2) Health workers were confident in their skills to communicate and address concerns of accepting and indecisive parents, successfully applying specific strategies. (3) When interacting with delaying and refusing parents, they sometimes agreed to delay vaccination to maintain relationships, confident that most parents would vaccinate in due course. (4) Some refusing parents asked questions grounded in a socio-political agenda regarding vaccines or vaccination. Such questions exceeded the domain of health workers’ expertise, which affected the communication between them. (5) Health workers’ behavior in consultations was sometimes affected by parents’ (dis) trust in their recommendations about vaccination. The study revealed that health workers in Serbia require additional skills and techniques to respond to parents who refuse and wish to delay vaccination, to secure timely vaccination

Validation and cross-cultural adaptation of the COMPASS-31 in Croatian and Serbian patients with multiple sclerosis

Aim To validate and cross-culturally adapt Croatian and Serbian versions of composite autonomic symptom score- 31 (COMPASS-31) for the detection of dysautonomia in patients with multiple sclerosis (MS). Methods A total of 179 patients, 67 with clinically isolated syndrome (CIS) and 112 with MS, completed the COMPASS- 31 at two MS centers in Zagreb and Belgrade between April 1 and October 31, 2016. Demographic and clinical data including age, gender, MS phenotypes, and the Expanded Disability Status Scale (EDSS) score were collected. Results The Cronbach’s alpha coefficient of COMPASS-31 total score was 0.844 for the Croatian MS sample and 0.779 for the Serbian MS sample. A joint analysis yielded Cronbach’s alpha coefficients ranging from 0.394 to 0.796, with values in four domains higher than 0.700. In Croatian and Serbian samples and the total study sample, the Cronbach’s alpha coefficient of COMPASS-31 was 0.785. Reproducibility measured by intra-class correlation coefficient (ICC) was acceptable (ICC = 0.795). With regard to the clinical validity, significant correlation was found between EDSS and the COMPASS-31 total score (P < 0.001). Furthermore, significant differences between MS phenotypes were detected for bladder and gastrointestinal domains and for the COMPASS-31 total score (P < 0.001, P = 0.005, and P = 0.027, respectively). Finally, significant differences between MS phenotypes in patients with score >0, which implies the existence of at least one of the symptoms investigated in each domain, were detected for secretomotor and bladder domains (P = 0.015 and P < 0.001, respectively). Conclusion COMPASS-31 represents a valid and acceptable self-assessment instrument for the detection of dysautonomia in MS patient

Risk factors for epithelial ovarian cancer in the female population of Belgrade, Serbia: A case-control study

Background/Aim. Ovarian cancer (OC) comprises 3% of all cancers, but it is the fifth most common cause of cancer death in women. The aim of this case-control study was to determine the risk factors for OC in the female population of Belgrade, Serbia. Methods. A total of 80 consecutive patients were enrolled in the study between 2006 and 2008 in two national referral centers for OC in Serbia. The control subjects were recruited during the regular gynecological check-ups in the Public Health Center of the corresponding municipalities. All the study participants were interviewed during their visits to the above mentioned institutions by two physicians using the same questionnaire. In order to analyze the influence of specific exposure to the risk of the disease, we categorized variables according to the cut-off values. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated separately for each variable using univariate conditional logistic regression analysis. Results. There were no statistically significant differences in educational level, years of schooling, occupational and employment status between patients with OC and women in the control group. Oral contraceptives use and other contraceptive methods (condoms, mechanical contraceptive devices) were highly statistically significantly more frequent among women in the control group (OR = 0.2, 95% CI 0.1-0.7, p = 0.005; OR = 0.1, 95% CI 0.01-0.5, p = 0.001, respectively). The patients with OC practiced sports for 6.3 ± 2.1 years, and controls for 11.8 ± 9.9 years. Sport and recreation activities were statistically significantly protective (OR = 0.2, p = 0.011; OR = 0.4, p = 0.019). Tea consumption on daily basis had a highly statistically significant protective effect (OR = 0.3, p = 0.001). Conclusions. Oral contraceptives use and physical activity were independent protective factors for OC in this study

Chronic diseases among University students: Prevalence, patterns and impact on health-related quality of life

Background/Aim. Around 30% of university students have chronic diseases and/or special care needs. As future taskforce in various job sectors will be drawn from current university student population, it is essential that their healthrelated problems are recognized and properly managed. The aims of this study were to estimate the prevalence and patterns of chronic diseases in the university student population and to assess their health-related quality of life (HRQoL). Methods. A total of 1,624 Belgrade University students were recruited from April to June 2009 at the Student Public Health Center. The students filled in sociodemographic and behavioral questionnaire, the Beck Depression Inventory (BDI) and the SF-36 questionnaire. Data on chronic diseases were self-reported and thereafter validated in medical records. The impact of chronic diseases on HRQoL was evaluated through series of linear regression models. Results. The prevalence of chronic diseases was 16.5%. The most common chronic diseases were asthma and chronic bronchitis (4.2% and 3.1%, respectively). All SF-36 domains, both composite and total scores were lower compared to healthy students (p < 0.001). Females with chronic diseases reported all eight HRQoL domains as worse, whilst males with chronic diseases reported some HRQoL domains as worse. After adjustment, having chronic diseases remained significantly associated with worse HRQoL [beta (β) -5.69; 95% confidence interval (CI) -8.09, -3.28]. Conclusion. To meet the needs of university students, the health care service should provide support in prevention and treatment of chronic diseases. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175087

Five-factor model personality profiles: the differences between alcohol and opiate addiction among females

Background: The prevalence of female alcohol and substance abusers has markedly increased. The main objective of this research was to explore personality profiles among females who had alcohol and opiate dependence. Aim: The aim of the study is to analyse if there is differences in personality profiles of females addicted to alcohol and opiates. We hypothesized that there might be significant differences in personality profiles among subgroups of women who present with alcohol and opiate use disorders. Subjects and methods: Of 157 consecutive women with diagnosis of alcohol/opiate addiction, 62 fulfilled following inclusion criteria: age 19-45 years, abstinence from alcohol and opiates for at least 10 days prior to enrollment. Alcohol-dependent group consisted of 30 females, while opiate-dependent group consisted of 32 females. The control group involved 30 age-matched randomly chosen healthy women. The data were collected using the Revised NEO Personality Inventory (NEO-PI-R). The multiple stepwise discriminant analysis was used to determine relations between personality traits and the probability of belonging to one of the study groups. Results: Significant differences in the NEO-PI-R scores were observed between groups for all main personality traits except for Openness to Experience. Compared with controls, substance-dependent women scored significantly higher on Neuroticism and lower on Conscientiousness. Opiate-dependent females scored the highest on Neuroticism and on Extraversion and lowest on Agreeableness and on Conscientiousness. Alcohol-dependent females scored higher on Conscientiousness and lower on Neuroticism compared to opiate-dependent women. Conclusions: The results of our study confirmed significant characteristics in personality profiles among females with alcohol and opiate dependence, as well as the difference between these two groups of substance abusers and their healthy controls. The distinct personality characteristics among different groups of substance addicted women should be taken into account when creating the most effective program of prevention and therapeutic approaches in this specific cohort