Trends and patterns of antibiotics use in Serbia from 2006 to 2021: Pre-COVID-19 period versus COVID-19 pandemic

BACKGROUND

Global rise in antibiotic utilization has been strongly associated with the resistance of bacteria to antibiotics. The COVID-19 saw an increase in the use of antibiotics in some countries. The aim of this study was to evaluate antibiotic utilization from 2006 to 2021 in the Republic of Serbia.

METHODS

Data on antibiotic use were retrieved from the national annual reports on the official website of the Medicines and Medical Devices Agency of Serbia during the period 2006 to 2021. To evaluate trends in the use of antibiotics in Serbia, linear, and joint regression analyses were performed.

RESULTS

The analysis of the antibiotics use over a sixteen-year period included a total of 50 antibiotics. A significant increase during the COVID-19 pandemic was observed for glycylcyclines that is, new-generation tetracyclines (tigecycline), third-generation cephalosporins (ceftazidime, ceftriaxone, and cefixime), respiratory fluoroquinolones (levofloxacin and moxifloxacin), carbapenems (ertapenem), and oxazolidinones (linezolid) utilization. Moreover, an almost negligible use of new β-lactam/β-lactamase inhibitors during the prepandemic period increased significantly during the COVID-19 pandemic period.

CONCLUSIONS

A significant increasing trend in the use of specific antibiotics classified as the "Watch" and "Reserve" antibiotics during the pandemic period was observed.

Personality traits and attitude towards euthanasia among medical students in Serbia

OBJECTIVE

Various factors may influence the attitudes of medical students towards euthanasia, including personal values, beliefs, and personality traits. The objective of this study was to examine the attitudes of 2nd and 5th year medical students about euthanasia and the relationship between these attitudes and students' personality traits.

METHODS

Medical students from the Universities of Kragujevac and Belgrade, Serbia, participated in this study. A questionnaire was administered assessing attitudes toward euthanasia and student personality traits (honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness using the HEXACO-60).

RESULTS

More than 50% of students in the second year and 60% of students in the fifth year were supportive of euthanasia. Students in the 5th year were 2.5 times more likely to express a concern that euthanasia needs to be clearly regulated by law compared to students in the second year. Adjusted analyses indicated that lower levels of honesty-humility and emotionality were positively correlated with students' belief that euthanasia should be legalized.

CONCLUSION

Many medical students in Serbia have a positive attitude towards euthanasia. It is important to consider the possible influences of culture, religion, and the law on attitudes towards euthanasia. Undergraduate medical training should include more hours dedicated to palliative care and end-of-life topics to raise awareness of patients' preferences in this regard.

Characteristics associated with non-initiation and non-completion of human papillomavirus vaccination among Danish girls: a nationwide register-based cohort study

AIM

The aim was to identify maternal and paternal socioeconomic and demographic characteristics for non-initiation and non-completion of the human papillomavirus (HPV) vaccination among Danish girls including time-trends.

METHODS

This nationwide register-based cohort study included all girls residing in Denmark who were offered free-of-charge HPV vaccination as a part of the childhood vaccination program between 2009 and 2018 (birth cohorts 1996-2005). The study samples included 296,461 daughter-mother dyads and 291,025 daughter-father dyads. Data from the Danish Vaccination Register were linked with socioeconomic and demographic data from Statistics Denmark. HPV vaccination status was classified as 'non-initiation' for girls who received no HPV vaccine and as 'non-completion' for girls who initiated the HPV vaccination program but did not receive all the scheduled HPV vaccines. Data were analyzed using logistic regression models.

RESULTS

Non-initiation of HPV vaccination was 13.7%, and non-completion was 24.2% among girls who initiated the HPV vaccination program. Girls of parents who were descendants of immigrants (adjusted odds ratio: 1.50; 95% confidence interval: 1.35-1.68), were at least 35-years old at time of birth, had basic or no education, had a low income, were not in the labor market, and were unmarried had the highest non-initiation and non-completion odds. The associations between socioeconomic and demographic characteristics and HPV vaccination uptake were similar for mothers and fathers.

CONCLUSIONS

Despite free-of-charge availability to HPV vaccination in Denmark, we found disparities in non-initiation and non-completion of HPV vaccination among Danish girls by both mothers' and fathers' socioeconomic and demographic characteristics.

COVID-19-related stress response among adult females: Relevance of sociodemographics, health-related behaviors and COVID-19 contact

Women were more affected than men during the COVID-19 pandemic. This study aimed to investigate COVID-19-related stress response in adult women and its association with the relevant socioeconomic, lifestyle and COVID-19-related factors. This research was carried out in eight randomly chosen cities from September 2020 to October 2021. To examine stress, we distributed the COVID Stress Scales (CSS) and the Perceived Stress Scale (PSS). Women also fulfilled a general socio-epidemiologic questionnaire. The study included 1,264 women. Most women were healthy, highly educated, employed, married, nonsmokers who consumed alcohol. The average total CSS score suggested a relatively low COVID-19 related stress), while 1.7% of women had CSS ≥ 100. The mean PSS was around the mid-point value of the scale. Older women, who were not in a relationship, didn't smoke, didn't drink alcohol, but used immune boosters, had chronic illnesses and reported losing money during the pandemic had higher CSS scores. A higher level of stress was also experienced by women exposed to the intense reporting about COVID-19, had contact with COVID-19 positive people or took care of COVID-19 positive family members. In this sample of predominantly highly educated women few women experienced very high stress level, probably due to the study timing (after the initial wave) when the pandemic saw attenuated stress levels. To relieve women from stress, structural organization and planning in terms of health care delivery, offsetting economic losses, controlled information dissemination and psychological support for women are needed.

Associations of night eating with depressive symptoms among health sciences students living in a postconflict region

Populations affected by war may experience food insecurity, which could predispose them to eating disorders. A cross-sectional study was conducted among health sciences students in Northern Kosovo from November 2018 to March 2019. Data were collected using the sociodemographic Night Eating Questionnaire (NEQ), the Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI). The study sample comprised 534 students. The prevalence of students who had at least mild depression (BDI ≥ 10) was 20.6%. More frequent night eating was consistently associated with a higher EDI score in the total sample as well as in the subgroup of students whose EDI score was ≥ 10. In addition, having poorer sleep quality and having more anxiety symptoms were associated with having stronger depressive symptoms. In a population of health sciences students who live in a post-conflict region, night eating is associated with having stronger depressive symptoms.

Preferences of COVID-19 Vaccines in the General Population in Belgrade, Serbia: A Qualitative Study

Few countries provided multiple COVID-19 vaccines for their citizens right from the start of mass immunization. In Serbia, four vaccines were available. Circumstances in which people had several options to choose from are unique. The purpose of this study was to identify motivators behind COVID-19 vaccination and the choice of COVID-19 vaccine among people who were immunized against COVID-19. Qualitative interviews with 35 vaccinated people aged > 18 years were conducted in May 2021 at the Institute of Public Health of Serbia, a reference institution for vaccination. Interviews were audio-recorded, transcribed and data were analyzed using qualitative content analysis. Four topics emerged: 1) Decision to receive COVID-19 vaccine; 2) Sources of information about the vaccine; 3) Choice of the COVID-19 vaccine and 4) Anti-vaccination sentiment around the vaccinated people. Participants were classified in two groups: those who were determined to receive the vaccine and those who were hesitant. People who were hesitant decided to receive the vaccine after reviewing the information collected from various sources, especially physicians. Although some participants accepted any vaccine regardless of their characteristics, there were others who had explicit preferences. These preferences stemmed mainly from their beliefs about particular vaccine's efficacy and safety, COVID-19 status (previous infection), living or lifestyle circumstances (residence or travel abroad), doctor's recommendation (underlying health status) or trust in expertise of that particular manufacturer's country of origin. Opting for appropriate vaccine was motivated by reasons specific to various individuals, which enabled them to make choices in line with their preferences and values.

Longitudinal evaluation of health-related quality of life after removal of high-risk melanoma in a setting where adjuvant therapy is not available

To evaluate health-related quality of life (HRQoL) of people with a high-risk skin melanoma after completion of the primary surgical treatment over time, as well as, to identify factors associated with better HRQoL at the beginning and at the end of follow-up. The study included subjects with histopathologically confirmed high-risk skin melanoma in clinical stages IIC, IIIA, IIIB, and IIIC, in whom clinical and radiographic signs of the disease were not confirmed after primary surgical treatment. The HRQoL was evaluated using Short Form-36 (SF-36) after completion of primary surgical treatment (start of follow-up) and after 6 to 12 months (end of follow-up). A total of 71 people completed SF-36 at both points in time. There were no significant differences between the initial and the follow-up total HRQoL score (t = 1.118; p = 0.267). At the start of follow-up, having fewer depressive symptoms, better functional status and lower vitamin D serum levels were associated with a better total HRQoL score. At the end of follow-up, having lower Breslow depth and being employed at the start of follow-up, having fewer depressive symptoms and lower C-reactive protein (CRP) serum levels at follow-up, and not developing metastases over follow-up were associated with a higher total HRQoL scores. The HRQoL of people with high-risk melanoma did not change in the year following the complete removal of the tumor. However, presence of depressive symptoms and metastases seem to have the strongest impact on poorer quality of life after surgery.

Comprehensive qualitative evaluation of the first ever full-time online course for medical students in one middle-income country

The measures to control the COVID-19 pandemic in the academic 2020/2021 included full-time online courses for medical students in Serbia for the first time since the faculty was founded in 1920. The purpose of this study was to examine the attitudes and opinions about the full-time online course among medical students and their teachers. A qualitative study was carried out in the autumn of 2021. In-depth interviews were conducted with 38 participants (27 students in the 4th study year and 11 teachers who teach in the 3rd study year) about their experiences in the past academic year. To select study participants, purposive sampling was employed. The interviews were audio-recorded and transcribed verbatim. Qualitative content analysis was applied. Five topics emerged: 1) Theoretical online learning, 2) Practical online learning, 3) Motivation, 4) Technical aspects of online learning and 5) Evaluation of knowledge. Overall, students' attitudes toward theoretical classes were mostly negative, but the attitudes of teachers were mostly positive. However, the attitudes of both students and teachers toward practical online classes were mostly negative. Students were, in general, less motivated to follow online classes compared to conventional courses, even though the teachers felt that they had to put more effort into making a suitable online course. Most participants considered that the online classes had a negative impact on their knowledge and practical skills, but their academic achievement was not inferior compared to previous years. The full-time online course should include conventional on-site teaching. The relevance of acquiring practical skills is strongly emphasized.

Risk Perception About HIV Among University Students in One of the Last Hotspots for HIV Transmission in Europe

BACKGROUND

HIV testing in the Northern Kosovo province is challenging, because the infrastructure is being rebuilt after the ethnic conflict. The purpose of this research was to examine self-perceived risk for acquiring HIV infection and factors associated with risk assessment among university students.

METHODS

Students completed a questionnaire on socio-demographic data, knowledge about HIV prevention and transmission, attitudes toward people living with (PLHIV) and self-perceived risk for HIV infection. The self-perceived risk was categorized as low, unknown and high.

RESULTS

The majority of students (72.5%) assessed their risk as low, 8.5% assessed their risk as high and 19.1% did not know their risk. Compared to low self-perceived risk, high self-perceived HIV risk was associated with being male, having lower knowledge about HIV prevention, less strong Segregation and protection attitude toward PLHIV, stronger Ignorance and indifference attitude toward PLHIV and positive opinion about gays/lesbians. Students who perceived own risk for acquiring HIV as high had lower knowledge about HIV transmission and prevention. However, those who were previously tested for HIV, despite their poorer knowledge about HIV prevention, assess their HIV-related risk as low.

CONCLUSIONS

Students assessed their risk of HIV infection mostly as low. Still, lower knowledge of HIV prevention has been consistently associated with a high and unknown risk of HIV. Moreover, being ignorant and indifferent about PLHIV was associated with increased self-perceived HIV risk. These findings highlight the need for continuous specialized HIV-related education to reduce fear and stigma of PLHIV and HIV testing as well as risky behaviors.

"It Bothered Me": The Mental Burden of COVID-19 Media Reports on Community-Dwelling Elderly People

Background and Objectives: Elderly people may have difficulties understanding the quality and quantity of information about the COVID-19 epidemic, which can put an additional mental strain on their health and well-being. The purpose of this study was to explore the processing of COVID-19 information among older people. Materials and Methods: A qualitative study was carried out in summer 2021. The sampling was based on the snowball method. This approach allowed us to communicate with the next potential participants relatively freely and without reservations. Two female researchers (both MD, PhD) conducted the interviews. All interviews were held in Serbian. The data were analyzed using qualitative content analysis. Results: The interviews were conducted with 13 participants (average age 71 years). The analysis of qualitative content suggested that four topics could be identified: (1) sources of information, (2) information interest and need, (3) reporting of information and (4) suggestions for better reporting. The participants were troubled by the excess of information, repetitive information about death tolls, unqualified people in media discussing the pandemic and inconsistent reporting. These features caused the participants to feel the psychological burden in processing all the pieces of information. Conclusions: The elderly people in Serbia followed mainstream media to get information about COVID-19; however, they perceived a variety of problems with reporting, which made the understanding of the information difficult and psychologically burdensome. These findings should be taken into consideration when delivering health-related information to elderly people.

Linguistic adaptation and psychometric properties of the health literacy questionnaire in serbian language among people with chronic diseases

OBJECTIVE

To translate the Health Literacy Questionnaire (HLQ) to Serbian language and examine its psychometric characteristics.

METHODS

This cross-sectional study was conducted among 295 people with chronic diseases from the Foča region (Republic of Srpska, Bosnia and Herzegovina). The HLQ was translated according to the translation integrity procedure. Construct validity was tested using confirmatory factor analysis (CFA) using the maximum likelihood estimator and reliability was estimated using the α and ω coefficients.

RESULTS

Minor linguistic differences in 17 items were observed between the original and the initial forward translation and were corrected. The parameters of one-factor CFA on domains 3 and 8 fitted well. The parameters of the CFA for domains 1, 2, 4, 5, 6, 7 and 9 were acceptable after modification using residuals' correlation. The α and ω coefficients for all domains were good to excellent (>0.80).

CONCLUSION

Each domain of the HLQ in Serbian has acceptable construct validity and overall good reliability. This study adds to the growing evidence that the HLQ is a useful tool to provide in-depth multidimensional information on health literacy to improve researchers and policymakers understanding of the health literacy strengths, needs and preferences across cultures and languages.

An Analysis of Early Results after Valve Replacement in Isolated Aortic Valve Stenosis by Using Sutureless vs. Stented Bioprostheses: A Single-Center Middle-Income Country Experience

Background and Objectives: There is a lack of data about the survival of patients after the implantation of sutureless relative to stented bioprostheses in middle-income settings. The objective of this study was to compare the survival of people with isolated severe aortic stenosis after the implantation of sutureless and stented bioprostheses in a tertiary referral center in Serbia. Materials and Methods: This retrospective cohort study included all people treated for isolated severe aortic stenosis with sutureless and stented bioprostheses from 1 January 2018 to 1 July 2021 at the Institute for Cardiovascular Diseases "Dedinje". Demographic, clinical, perioperative and postoperative data were extracted from the medical records. The follow-up lasted for a median of 2 years. Results: The study sample comprised a total of 238 people with a stented (conventional) bioprosthesis and 101 people with a sutureless bioprosthesis (Perceval). Over the follow-up, 13.9% of people who received the conventional and 10.9% of people who received the Perceval valve died (p = 0.400). No difference in the overall survival was observed (p = 0.797). The multivariate Cox proportional hazard model suggested that being older, having a higher preoperative EuroScore II, having a stroke over the follow-up period and having valve-related complications were independently associated with all-cause mortality over a median of 2 years after the bioprosthesis implantation. Conclusions: This research conducted in a middle-income country supports previous findings in high-income countries regarding the survival of people with sutureless and stented valves. Survival after bioprosthesis implantation should be monitored long-term to ensure optimum postoperative outcomes.

Associations of personality traits with night eating among students in health sciences who live in a post-conflict setting

The intake of food later in the evening can have harmful health consequences. Some researchers suggest that having certain personality characteristics may be associated with the onset of eating disorders. There is a lack of studies on personality traits and night eating in a complex socio-political setting. The purpose of this study was to examine the association between personality traits and more intense night eating among students in northern Kosovo. A cross-section study was conducted in a population of health science students at the University in Kosovska Mitrovica. Students completed a socio-demographic questionnaire, Night Eating Questionnaire (NEQ), HEXACO-60 personality inventory, Beck's Depression Inventory (BDI) and Beck's Anxiety Inventory (BAI). The independent variables (exposures) were the six domains of the HEXACO-60 (Honesty-Humility, Emotionality, Extraversion, Agreeableness, Conscientiousness and Openness to Experience). The study outcome was the NEQ score. The study sample consisted of 534 students. The prevalence of night eating syndrome was 3.0%. The multivariate linear regression model suggested that stronger Extraversion and Openness to Experience were associated with more frequent night eating. Additionally, later bedtime, poorer sleep quality and higher scores on BDI and BAI were associated with more frequent night eating across all six models of models of personality traits. In a population of health science students who live in a complex socio-political environment, extraversion and openness to experience traits were associated with more frequent night eating. These findings could help researchers and clinicians tailor specific behavioral therapies to match the personality traits of people with night eating issues.

Understanding attitudes and willingness to volunteer in COVID-19 hospitals in a setting where medical students were not deployed

OBJECTIVE

To examine the attitude and willingness of medical students in Serbia to volunteer in COVID-19 hospitals.

METHODS

This study was conducted in late 2021 among 326 students in latter 3 study years. Data were collected using an anonymous online questionnaire focusing on demographic characteristics, epidemiology-related factors surrounding participants, self-assessed personality traits and a validated scale about attitudes toward volunteering.

RESULTS

A total of 58.1 % of medical students were willing to volunteer in COVID-19 hospitals. Having higher grades, having parents with lower education level and having volunteered previously were characteristics associated with a stronger positive attitude toward volunteering. Having higher grades, having parents with lower education level, living with people aged > 65 years and having had COVID-19 infection was associated with the willingness to volunteer. The adjusted multivariate regression model suggested that higher levels of self-perceived consciousness, extraversion and openness to experience were independently associated with stronger positive attitudes toward volunteering. A similar model showed that openness to experience remained independently associated with the willingness to volunteer in COVID-19 hospitals.

CONCLUSION

A number of individual factors may be involved in the decision to volunteer in COVID-19 hospitals. Promotion of volunteering in medical schools could be influential for future health emergencies (Tab. 6, Ref. 32). Text in PDF www.elis.sk Keywords: COVID-19, students, volunteering, hospital.

Association of health literacy with physical and mental health in people with chronic diseases

OBJECTIVE

to explore the association of health literacy domains with physical and mental quality of life in people with selected chronic diseases.

METHODS

Community-dwelling people with selected chronic diseases planned for immunization against influenza in 2017/2018 were included in the study. All non-vaccinated people and the corresponding number of randomly selected vaccinated people matched on town of residence were included. Data were collected by means of socio-demographic questionnaire, Health Literacy Questionnaire (HLQ) and Short Form-36 (SF-36). The Physical and Mental Composite Scores as well as their domains were observed as the study outcomes.

RESULTS

A total of 295 people were studied. The adjusted logistic regression showed that Physical and Mental composite scores were associated with all HLQ domains except 5) Appraisal of health information. Better Physical Functioning was associated with higher scores on 1) Feeling understood and supported by healthcare providers, 6) Ability to actively engage with healthcare providers, 7) Navigating the healthcare system and 8) Ability to find good health information. Better scores on Vitality, Social Functioning, Role Emotional and Mental Health were associated with higher scores on all HLQ domains except 5) Appraisal of health information.

CONCLUSION

Health literacy is important for physical and mental quality of life among people with chronic diseases. Health care providers and other stakeholders should continuously work to improve health literacy of their patients.

Associations of health literacy with missed free influenza immunization in people with chronic diseases

There is a gap in understanding specific features of health literacy that might be associated with adherence to influenza immunization. The aim of this study was to examine the association of health literacy with avoidance of influenza immunization and beliefs about the influenza vaccine among people with chronic diseases. Selection of study participants was based on a case-control study design in a population of people with chronic illnesses living in the Foča region (Republic of Srpska, Bosnia and Herzegovina) and who were entitled to receive a free influenza shot in season 2017/2018. The cases represented all non-vaccinated people (a total of 146) and the controls were vaccinated people (a total of 149) matched according to town of residence. Participants were interviewed in person from April to December 2018 using a socio-demographic questionnaire, Health Literacy Questionnaire (HLQ) and Health Belief Model Applied to Influenza (HBMAI). Better score on 'Feeling understood and supported by healthcare providers', 'Social support for health' and 'Ability to actively engage with healthcare providers' was associated with more perceived benefits of influenza immunization in men, but not in women. Perceiving more Barriers to influenza immunization was associated with lower scores on 'Feeling understood and supported by healthcare providers', 'Have sufficient information to manage health', 'Social support for health' and 'Ability to actively engage with healthcare providers' in both men and women. Health literacy may be associated with the perception of susceptibility to influenza, benefits and barriers to influenza immunization and motivations to receive influenza vaccine.

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.

Patterns of smoking and menopause-specific quality of life: smoking duration matters more

Evidence about the association of quantity of cigarettes smoked and duration of smoking with quality of life in menopause is sparse. The purpose of this study was to examine the association between smoking patterns and menopause-specific quality of life. This cross-sectional study included 513 consecutive midlife women at two primary health care centers in Belgrade, Serbia. Collection of data was carried out from February 2014 to January 2015, using three questionnaires: socio-epidemiologic questionnaire, Menopause-specific Quality of Life questionnaire (MENQOL) and Beck's Depression Inventory (BDI). Women reported their smoking status (smoker, former smoker, non-smoker), the length of time spent smoking and quantity of cigarettes smoked per day. There was no difference in proportions of ever smokers compared to never smokers. However, there were more women who were current nonsmokers than current smokers. A linear regression model, adjusted for residency district, relationship status, educational level, employment, drinking alcohol, having exercise, age and BDI, showed that longer duration of smoking, but not number of cigarettes smoked per day, was associated with worse Physical domain and total MENQOL score. Receiver Operating Characteristic analysis showed that menopausal symptoms as measured by total MENQOL score were significantly less bothersome for women who smoked less than 10 years and significantly more intense in women who smoked 21 to 30 years. Midlife women should be encouraged to quit smoking as soon as possible, preferably before menopause. Strategies to prevent and quit smoking should be prioritized at all levels of health care delivery for women.Supplemental data for this article is available online at.

Compliance and approach to voluntary HIV testing in a high-risk region for HIV transmission in Europe

Background: The Kosovo province is being considered as a high-risk region for the spread of HIV. Objective: To estimate the prevalence and factors associated with HIV testing in a sample of university students from the Serbian northern Kosovo province. Material and Methods: A questionnaire examining socio-demographic characteristics, HIV–related knowledge, attitudes towards people living with HIV (PLHIV) and HIV testing was used in data collection. A total of 1,017 students from the University of Priština temporarily seated in Kosovska Mitrovica completed the questionnaire. Results: Only 5.4% of students have previously been tested for HIV, even though the majority (70.9%) had a positive approach to HIV testing. Factors associated with having been tested for HIV were being male and younger, having interest in HIV testing and having previous contact with PLHIV. Being more knowledgeable about HIV and having stronger positive attitude towards PLHIV, being older, receiving information about HIV through friends and special educational programs, using condom at last sexual intercourse, having positive opinion on gays/lesbians and previous contact with PLHIV were associated with positive approach to HIV testing. Conclusion: Having a positive approach to HIV testing does not suggest that students would take the HIV test. However, students who have low HIV-related knowledge, negative approach or lack of interest in HIV testing (believing that there is no need to take it) would likely never take the HIV test. Increasing HIV-related knowledge, acceptance of PLHIV and access to testing facilities should be public health priorities to raise HIV testing rates. Keywords: HIV testing; attitude; knowledge; University students.

Factors Associated with the Antibiotic Treatment of Children Hospitalized for COVID-19 during the Lockdown in Serbia

Unselective use of antibiotics to treat children with COVID-19 is one of the major issues during the pandemic in Serbia. Thus far, there has been no evidence about the predictors of multiple antibiotic use in the treatment of children with COVID-19. The purpose of this study was to assess the prevalence of antibiotic use, as well as to examine demographic and clinical factors associated with a greater number of antibiotics and with a longer antibiotic treatment administered to hospitalized children with COVID-19 during the lockdown in Serbia. This study included all children who were hospitalized from 6 March to 31 May 2020 at the only pediatric COVID-19 hospital, and who were confirmed to have SARS-CoV-2 infection. Demographic, clinical, and laboratory data were collected from medical records. The antibiotic treatment included the use of azithromycin, cephalosporin (ceftriaxone), ampicillin-amikacin, and hydroxychloroquine. The overall prevalence of antibiotics use in children hospitalized with COVID-19 regardless of age was 47.2% (43.3% in children aged 1-5 years and 44.4% in those aged 5-17 years). In children aged 1-5 years, not having a family member affected by COVID-19 (B = -1.38, 95% confidence interval [CI] -2.43, -0.34, p = 0.011), having pneumonia on chest X-ray (B = 0.81, 95%CI 0.34, 1.29, p = 0.002), being a boy (B = -0.65, 95%CI -1.17, -0.13, p = 0.018), and having higher C-reactive protein (CRP) values on admission (B = 0.12, 95%CI 0.07, 0.17, p = 0.001) were associated with the administration of a higher number of antibiotics. These factors, along with having fever (B = 3.20, 95%CI 1.03, 5.37, p = 0.006), were associated with a longer duration of antibiotic treatment in children aged 1-5 years. In children aged 5-17 years, having pharyngeal erythema (B = 1.37, 95%CI 0.61, 2.13, p = 0.001), fever (B = 0.43, 95%CI 0.07, 0.79, p = 0.018), and pneumonia on chest X-ray (B = 0.91, 95%CI 0.53, 1.29, p = 0.001), not having rhinorrhea (B = -1.27, 95%CI -2.47, -0.08, p = 0.037), being a girl (B = 0.52, 95%CI 0.08, 0.97, p = 0.021), and having higher CRP values on admission (B = 0.04, 95%CI 0.01, 0.06, p = 0.006) were associated with the administration of a higher number of antibiotics. These factors, not including the absence of rhinorrhea, were associated with a longer duration of antibiotics treatment in children aged 5-17 years. Demographic, epidemiological, clinical, and laboratory parameters were associated with the use of multiple antibiotics and a longer duration of antibiotic treatment both among children aged 1-5 years and those aged 5-17 years.

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.

Validity of the Health Belief Model Applied to Influenza among people with chronic diseases: Is it time to develop a new knowledge domain?

There is a lack of comprehensive instruments for the assessment of compliance with influenza immunization. The purpose of this study was to examine psychometric characteristics of the Health Belief Model Applied to Influenza (HBMAI) among people with chronic diseases. We selected people residing in four municipalities of the Foča region (Republic of Srpska—Bosnia and Herzegovina) who were listed in the official records to receive the recommended influenza immunization in 2017/2018. Participants were interviewed using the HBMAI questionnaire at their homes. The HBMAI is composed of 45 items classified in 7 domains (Susceptibility, Seriousness, Benefits, Barriers, Knowledge, Health Motivation and Cue to Action). The confirmatory factor analysis (CFA) suggested that the Serbian HBMAI did not fit the original structure. The parallel analysis suggested that HBMAI in Serbian had 6 domains, instead of the original 7. The domain of "Knowledge" was removed. The domains of "Barriers", "Health Motivation" and "Cue to Action" preserved their original structure. The domains of "Susceptibility", "Seriousness" and "Benefits" were partially modified. The parameters on the CFA for the new modified HBMAI in Serbian were acceptable (goodness of fit index [GFI] = 0.946, comparative fit index [CFI] = 0.967, Tucker-Lewis index [TLI] = 0.963, root mean square error of approximation [RMSEA] = 0.044 and standardized root mean square residual [SRMR] = 0.078). This modified HBMAI version with 6 domains, not including the Knowledge domain, is recommended for use in research about influenza among people with chronic diseases in Serbian language.

Experiences and aftermath of the COVID-19 lockdown among community-dwelling older people in Serbia: A qualitative study

RATIONALE AND AIM

At the beginning of the COVID-19 pandemic in March 2020, the Serbian government instituted a 24-h curfew for people aged ≥65 years for 2 months. The aim of this study was to examine the experiences and perceptions of curfew for older people in Serbia 15 months after the curfew had ended.

METHODS

In-depth interviews were carried out with 23 older adults from urban areas in Serbia. We identified the first three participants, while others were selected using the snowballing method. The interviews were audio-recorded, transcribed and data were analyzed according to guidelines for qualitative studies.

RESULTS

Six topics emerged: (1) perception of the curfew announcement; (2) attitude toward the curfew; (3) organization of daily living; (4) mood; (5) frustrations/limitations and 6) making sense of the curfew 15 months after. Older people in this study overall remember not feeling disturbed by the curfew because they perceived it as prevention, especially because this population group is considered to have the highest rate of mortality from COVID-19. Some people remember being extremely frustrated because of the restrictions and considered them unnecessary. Most people remembered that the lack of social interactions and lack of physical activity were the most difficult to cope with.

CONCLUSIONS

Although challenging and bothersome, the majority of older people in this study accepted the curfew as an appropriate measure to avoid catching the virus and combat the COVID-19 pandemic.

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.

Beliefs about influenza and avoidance of free influenza immunization among people with chronic diseases

OBJECTIVE

People with chronic diseases may have poor influenza-related outcomes. The study objective was to examine the association between the dimensions of the Health Belief model and noncompliance with influenza immunization.

METHOD

study participants were community-dwelliing individuals from the Foča region (Republic of Srpska, Bosnia and Herzegovina) listed to receive free influenza immunization for the season 2017/2018 due to chronic diseases. After vaccination season was completed, we included all nonvaccinated people and the corresponding number of vaccinated people. The data collection lasted from April to December 2018 using a sociodemographic questionnaire and modified Health Belief model Applied to Influenza.

RESULTS

The study sample consisted of 295 people of which 149 (50.5%) were immunized against influenza in the past season. Adjusted logistic regression model suggested that people who scored lower on domains of Seriousness (odds ratio [OR] = .79, 95% confidence interval [CI] [.69, .91]), Benefits (OR = .83, 95% CI [.76, .91]) and Cue to action (OR = .79, 95% CI [.73, .86]), but higher the Barriers domain (OR = 1.10, 95% CI [1.03, 1.17]), were less likely to receive vaccination in the past season. People who did not receive recommendation from a health care worker and who were never vaccinated against influenza did not comply with influenza vaccination across all models (p < .01).

CONCLUSION

Perceiving influenza as less serious, less beneficial, having fewer cues to action, and perceiving more barriers to influenza vaccination were associated with skipping influenza immunization. Not receiving health care worker recommendation and never being vaccinated against influenza were also associated with avoidance of vaccination. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Severity of COVID-19 Symptoms among University of Belgrade Students during the July-September 2021 Pandemic Wave: Implications for Vaccination

OBJECTIVE

The aim of this study was to identify the intensity of COVID-19 symptoms during the pandemic wave during July-September 2021 and to identify factors associated with having moderate and severe symptoms of COVID-19 among affected students in the University of Belgrade.

MATERIAL AND METHODS

This study was carried out at the Institute for Students' Health (ISH) in Belgrade, Serbia. The ISH is the referral institution for health care delivery at primary and secondary levels. This analysis includes students who presented from July 1 until September 30, 2021, when the latest pandemic wave of COVID-19 was observed among university students. Data were extracted from students' electronic medical records. Three levels of COVID-19 symptom intensity were defined: mild, moderate, and severe.

RESULTS

Of students seeking medical care at the ISH who were diagnosed with COVID-19, 27.3% had mild disease and the majority, 59.3%, had moderate disease, and 13.4% had severe symptoms. Of all students, 124 (21.8%) were fully vaccinated with 2 doses of Sinopharm (81, 60.9%), Pfizer-BioNTech (38, 28.6%), Sputnik V (7, 5.3%), or the Oxford-AstraZeneca vaccine (7, 5.3%). The multiple multinomial regression model suggests that students who were vaccinated against COVID-19 were 78% less likely to develop moderate symptoms and 96% less likely to develop severe symptoms of COVID-19.

CONCLUSION

Students who are vaccinated against COVID-19 are at lower risk of developing moderate and severe symptoms of the disease.

Bereavement Among Adult Siblings: An Examination of Health Services Utilization and Mental Health Outcomes

We aimed to examine the association of young and middle-aged sibling bereavement with use of health services and risk of developing mental health disorders over 24 months before and after sibling's death. All persons aged 18-56 years who died of illness/natural causes between 2009 and 2016 were identified in the Danish Register of Causes of Death. The study sample included 31,842 bereaved siblings and 31,842 age- and sex-matched controls. Overall, the largest effect was observed for increased use of psychological services: For women, the peak was observed 4-6 months after the death (odds ratio (OR) = 3.31, 95% confidence interval (CI): 2.85, 3.85) and for men in the first 3 months after the death (OR = 2.63, 95% CI: 2.06, 3.36). The peak of being diagnosed in a hospital setting with any mental disorder for women was observed in the period 13-15 months after sibling death (OR = 1.52, 95% CI: 1.11, 2.07) and for men in the first 3 months after the death (OR = 1.75, 95% CI: 1.32, 2.32). Young and middle-aged adults who experienced the death of a sibling are more likely to use health services and are at risk of poorer mental health outcomes. During the bereavement process, young and middle-aged siblings are especially in need of mental health support, such as professional psychological counseling.

Alcohol drinking patterns and occurrence of genital warts among Danish adolescents

BACKGROUND

Under the influence of alcohol adolescents are more prone to engage in unprotected sex, which increases the risk of acquiring genital warts. The study aim was to examine whether alcohol consumption among adolescents is associated with acquiring genital warts.

METHODS

Health behavior data were extracted from the Danish National Youth Study 2014. Complete data were available for 63,648 students. Number of binge drinking episodes in the past 30 days, frequency of drinking on weekends and total number of drinks consumed during 7-day week were collected by a questionnaire. Information on genital warts for the period between filling the questionnaire in 2014 and December 31, 2018 was retrieved from the Danish National Prescription Register and Danish National Patient Register.

RESULTS

Adjusted analysis showed that, compared to students who did not drink alcohol, increasing frequency of binge drinking in the past 30 days was independently associated with greater hazard of acquiring genital warts (1-3 times hazard ratio [HR]: 1.36, 95 % confidence interval [CI]: 1.09-1.69; 4-6 times HR: 1.55, 95 % CI: 1.22-1.96; >6 times HR: 1.84, 95 % CI 1.39-2.45). Compared to students who did not drink alcohol, consistent alcohol drinking every weekend was associated with greater risk of developing genital warts (HR: 1.62, 95 % CI: 1.20-2.17). Total weekly number of alcohol drinks consumed was not associated with occurrence of genital warts.

CONCLUSION

Increased alcohol intake was associated with occurrence of genital warts over 4 year of follow-up. There is an urgent need for change of excessive alcohol intake tendencies among adolescents.

Validity and reliability of the Serbian COVID Stress Scales

This study aimed to generate a linguistic equivalent of the COVID Stress Scales (CSS) in the Serbian language and examine its psychometric characteristics. Data were collected from September to December 2020 among the general population of three cities in Republic of Serbia and Republic of Srpska, countries where the Serbian language is spoken. Participants completed a socio-demographic questionnaire, followed by the CSS and Perceived Stress Scale (PSS). The CSS was validated using the standard methodology (i.e., forward and backward translations, pilot testing). The reliability of the Serbian CSS was assessed using Cronbach’s alpha and McDonald’s omega coefficients and convergent validity was evaluated by correlating the CSS with PSS. Confirmatory factor analysis was performed to examine the construct validity of the Serbian CSS. This study included 961 persons (52.8% males and 47.2% females). The Cronbach’s alpha coefficient of the Serbian CSS was 0.964 and McDonald’s omega was 0.964. The Serbian CSS with 36 items and a six-factorial structure showed a measurement model with a satisfactory fit for our population (CMIN/DF = 4.391; GFI = 0.991; RMSEA = 0.025). The CSS total and all domain scores significantly positively correlated with PSS total score. The Serbian version of the CSS is a valid and reliable questionnaire that can be used in assessing COVID-19-related distress experienced by Serbian speaking people during the COVID-19 pandemic as well as future epidemics and pandemics.

Enhancing COVID-19 vaccination coverage using financial incentives: arguments to help health providers counterbalance erroneous claims

Financial reimbursements after receiving the coronavirus disease 2019 (COVID-19) vaccine have been criticized in the literature. This strategy has been described as payment to receive the vaccines, undue inducement, and unethical. We are aware that healthcare workers who work in primary healthcare, prevention, and public health may encounter similar reasons from people who refuse vaccination against COVID-19. For this reason, we are compelled to clarify these claims and provide arguments for all healthcare workers who might be challenged by such reasoning. In this critical review, we discuss why the claims against financial incentives that have been presented in the literature are erroneous.

HEXACO-60 Personality Trait Inventory: Psychometric characteristics in a sample of medical students from Serbia

The 60-item HEXACO (HEXACO-60) Personality Trait Inventory may be strategically more important for researchers compared to the 100-item HEXACO. The aim of this study was to assess the psychometric properties of the 60-item HEXACO questionnaire in the Serbian language. This cross-sectional study, conducted at three of five Faculties of Medicine during the summer semester of the 2016/2017 academic year, included 617 students. Relevant data were collected by an anonymous questionnaire. Cronbach's α and McDonald's ω coefficients for the total scale were .71 and .72, respectively. Apart from Agreeableness, all other domains showed an adequate level of internal consistency (both Cronbach's α and McDonald's ω coefficients were >.70). Random data eigenvalues obtained on the parallel analysis had higher values than initial exploratory factor analysis eigenvalues up to the sixth factor. Accordingly, it was concluded that six factors should be extracted from the Serbian HEXACO-60. These factors corresponded in item distribution with the original ones. Based on the confirmatory factor analysis, using both 60 items and 24 facets, overall goodness of fit of the Serbian HEXACO-60 was acceptable. Moreover, there were no domains with completely invalid indices, as there were at least two indices that were acceptable for each domain. The Serbian version of the HEXACO-60 has acceptable psychometric properties. This shorter version with 60 items may be more suitable for brief surveys or when the time allocated to fill in a questionnaire is limited.

Trend in mandatory immunisation coverage: linear and joinpoint regression approach, Serbia, 2000 to 2017

Background

Analyses of temporal trends in immunisation coverage may help to identify problems in immunisation activities at specific points in time. These data are essential for further planning, meeting recommended indicators, monitoring, management and advocacy.

Aim

This study examined the trends of mandatory vaccination coverage in the period 2000–2017 in Serbia.

Methods

Data on completed immunisations were retrieved from annual national reports of the Institute of Public Health of Serbia during the period 2000–2017. To assess the trends of immunisation coverage, both linear and joinpoint regression analyses were performed. A probability p < 0.05 was considered significant.

Results

Over the period 2000–2017 linear regression analysis showed a significant decline in coverage with the primary vaccination against poliomyelitis, diphtheria, tetanus, pertussis and measles, mumps, rubella (MMR) (p ≤ 0.01). In the same period, coverage of all subsequent revaccinations significantly decreased, namely, first revaccination for pertussis (p < 0.01); first, second and third revaccination against diphtheria, tetanus and poliomyelitis (p < 0.01); and second dose against MMR before enrolment in elementary school (p < 0.05). Although linear regression analysis did not show change in vaccination coverage trend against tuberculosis (Bacillus Calmette–Guérin; BCG), hepatitis B (HepB3) in infants and diseases caused by Haemophilus influenzae type b (Hib3), the joinpoint regression analysis showed that the coverage declined for BCG after 2006, HepB3 after 2010 and Hib3 after 2008.

Conclusion

To achieve and keep optimum immunisation coverage, it is necessary to address barriers to immunisation, such as the availability of all vaccines and vaccine-hesitancy among parents and healthcare workers in Serbia.

Positive attitudes towards persons living with HIV in North Kosovo: The university students' perspective

HIV-related stigma could delay the identification and treatment of persons living with HIV (PLHIV), particularly in regions affected by ethnic conflicts. The aims of this study were to assess attitudes towards PLHIV and examine factors associated with stronger positive attitudes towards PLHIV among university students in the Serbian province of Kosovo. A cross-sectional study was conducted at the University of Pristina temporarily settled in Kosovska Mitrovica during the academic year 2013-2014. A total of 1,017 first- and fourth-year students completed an anonymous questionnaire about socio-demographic characteristics, PLHIV, high-risk groups for acquiring HIV and health behaviour. The main outcome measure was the Attitude Score (ATS), calculated as a sum of points awarded for all attitude-related items. The majority of students (84%) expressed positive attitudes towards PLHIV, while others were indecisive. Most students held negative opinions about persons who use drugs (64%), homosexual persons of both genders (50%) and sex workers (42%). Being female (odds ratio [OR] = 1.49, 95% confidence interval [CI] 1.05-2.09) and older (OR = 1.13, 95% CI 1.03-1.24), not doing paid work while studying (OR = 3.35, 95% CI = 1.63-6.84), studying health-related disciplines (β = -0.113, 95% CI = -0.085 to -2.747), having stronger positive attitudes towards homosexual persons of both genders (OR = 0.77, 95% CI = 0.64-0.94) and not using illicit drugs (β = 2.08, 95% CI = 1.03-4.20) were associated with stronger positive attitudes towards PLHIV. Social inclusion of PLHIV and individuals at high risk for acquiring HIV could help reduce the HIV-related stigma.

Functional assessment of cancer therapy questionnaire for melanoma in the Serbian population: A factor analytic approach

The aim of this study was to examine the psychometric properties of the Functional Assessment Cancer Therapy—Melanoma (FACT-M) questionnaire in the Serbian language. The FACT-M was translated into Serbian using the standard methodology after obtaining the licence from the Functional Assessment of Chronic Illness Therapy (FACIT) translation project team. This version of FACT-M was distributed to a cohort of consecutive patients with histologically confirmed high-risk skin melanoma treated at the tertiary referral center. To examine construct validity of the FACT-M in Serbian, we performed exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The FACT-General (FACT-G) did not fit the original 4-domain structure. Instead, we accepted a 7-domain structure which, aside from physical, emotional, social and functional well-being, had domains of ‘friends’ support’, ‘illness acceptance’ and ‘fear of death’. Melanoma scale (MS) and Melanoma surgery scale (MSS) did not fit the original one-dimensional structure. The MS was observed to have 4 domains: ‘pain’, ‘skin problems’, ‘abdominal metastases’ and ‘other problems’. The MSS was observed to have 2 domains: ‘having symptoms’ and ‘no symptoms’. It is suggested that the FACT-M questionnaire is analyzed using the newly extracted domains to examine quality of life of people with high-risk melanoma in Serbia.

Quality of life in children with atopic dermatitis: A one-year prospective cohort study

BACKGROUND

Literature on the quality of life trends across time in children with atopic dermatitis are scarce.

AIMS

To assess factors associated with quality of life of children with atopic dermatitis after a one-year follow-up and to examine the factors contributing to greater improvement in the atopic dermatitis-related quality of life over one year.

METHODS

Our cohort consisted of 98 children who were treated for atopic dermatitis at the clinic of dermatovenereology. Data collection included atopic dermatitis scoring using the SCORing Atopic Dermatitis (SCORAD) index, Children's Dermatology Life Quality Index (CDLQI) for children aged > four years and Infants' Dermatitis Quality of Life Index (IDLQI) for children aged 0-4 years. Categorization of the impairment of quality of life score due to atopic dermatitis was as follows: mild (score from 0 to 6), moderate (score from 7 to 12) and severe (score from 13 to 30). The cohort was followed for one year after which a total of 80 children were reassessed.

RESULTS

Improvements of both CDLQI and IDLQI were observed in children whose impairment of quality of life due to atopic dermatitis after one year was 'mild'. This was not observed in children whose atopic dermatitis caused either 'moderate' or 'severe impairment' of their quality of life. Adjusted analysis showed that lower initial SCORAD and greater improvement in SCORAD after the one-year follow-up were associated with a better quality of life at follow-up.

LIMITATIONS

The size of our cohort was relatively small. Study participants were recruited from the largest urban and medical referral center in Serbia. Persons from suburban or rural regions may have had different perceptions of atopic dermatitis-related quality of life.

CONCLUSION

Children with less severe atopic dermatitis were more likely to improve their atopic dermatitis-related quality of life. Lower SCORAD was associated with both better quality of life initially and greater improvement in quality of life after one year of follow-up.

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.

What differs former, light and heavy smokers? Evidence from a post-conflict setting

BACKGROUND

Evidence suggests that people who live in regions affected by the armed conflict are more likely to smoke.

OBJECTIVE

The purpose of this study was to assess factors associated with smoking status in a sample of students in the northern Kosovo province.

MATERIALS AND METHODS

A total of 514 students enrolled in University in Kosovska Mitrovica, Kosovo, were recruited between April to June 2015 at Student Public Health Center during mandatory health checks. Participants filled in socio-demographic and behavioral questionnaire and Beck Depression Inventory (BDI). Based on responses about smoking, students were categorized in non-smokers, former smokers, light smokers (1-13 cigarettes/day) and heavy smokers (> 13 cigarettes/day).

RESULTS

Of 514 students, 116 (22.6%) classified themselves as smokers. Higher education level of fathers (Odds ratio [OR]=2.89, 95% confidence interval [CI] 1.30-6.44, p=0.009), not living with smokers (OR=0.42, 95%CI 0.15-0.97, p=0.017) and longer exposure to second hand smoke (OR=1.07, 95%CI 1.01-1.13, p=0.036) was associated with former smoking. Studying medical and natural sciences (OR=2.07, 95%CI 1.05-4.18, p=0.040), consuming alcohol (OR=2.98, 95%CI 1.19-10.03, p=0.020), living with smokers (OR=2.88, 95%CI 1.49-5.56, p=0.002), longer exposure to second hand smoke (OR=1.06, 95%CI 1.01-1.11, p=0.019) and having a more intense depressive symptoms (OR=1.08, 95%CI 1.03-1.13, p=0.002) was associated with light smoking. Being male (OR=0.22, 95%CI 0.07-0.41, p=0.001), older (OR=1.47, 95%CI 1.21-1.78, p=0.001), living with smokers (OR=3.78, 95%CI 1.69-8.07, p=0.001), longer daily exposure to second-hand smoke (OR=1.10, 95%CI 1.04-1.16, p=0.001), and having more severe depressive symptoms (OR=1.12, 95%CI 1.07-1.18, p=0.001) were associated with heavy smoking.

CONCLUSION

Smoking prevention and cessation programs should include the entire community, because exposure to environmental second hand smoke may facilitate initiation and more intense smoking. Screening of student smokers for depression should be prioritized in the process of rebuilding the framework for primary and secondary prevention in the post-conflict period.

Mental health aspect of quality of life in the menopausal transition

PURPOSE

To evaluate factors associated with mental health quality of life (QOL), such as depressed mood, anxiety, poor memory and sleep, among midlife women according to the menopausal status.

MATERIAL AND METHODS

Participants were 500 women aged 40-65 years. Data were collected using socio-demographic questionnaire, Women's Health Questionnaire (domains of depressed mood-DEP, anxiety-ANX, memory-MEM and sleep-SLE) and Short Form-36 (Mental Composite Score) for assessment of health-related QOL. Factors associated with poorer DEP, ANX, MEM and SLE were examined using adjusted linear regression models.

RESULTS

In premenopausal women, lower household monthly income (p = .046) was associated with higher level of DEP; higher body mass index (p = .045) was associated with higher ANX; having gynecological illnesses (p = .017) and menopause-related symptoms (p = .039) were associated with poorer MEM; being married (p = .036), drinking alcohol (p = .036) and having more physical activity (p = .041) was associated with better SLE. In postmenopausal women, worse DEP was more likely among women residing in city outskirts (p = .009), who are not married (p = .038) and with sedentary occupations (p = .049); lower education level (p = .030) was associated with more ANX; lower education level (p = .045) and having menopause-related symptoms (p = .044) were associated with poorer MEM; not engaging in regular recreation (p = .031) was associated with better SLE.

CONCLUSIONS

To improve QOL, pre- and postmenopausal women should not only be supported in the management of menopause-specific symptoms. Women should also receive recommendations as to the behavioral and personal changes when approaching the midlife period.

Factors associated with seasonal influenza immunization in people with chronic diseases

Annually, at a global level, 3 to 5 million people present severe clinical forms of seasonal influenza and up to 650 000 people die of influenza-related complications. People with chronic diseases, such as cardiovascular, pulmonary, renal, hepatic, neurologic, hematologic and metabolic diseases or those reciveing immunosuppressive therapy, constitute a high-risk population group for the development of influenza-related complications, more severe clinical course and poorer health-related outcomes. Due to all of the above, people with chronic diseases are of high priority to receive the influenza vaccine. Immunization represents the key strategy to prevent influenza both in terms of effectiveness and health care costs. Based on the World Health Organization (WHO) recommendations, adequate seasonal influenza immunization coverage among people with chronic diseases is set at 75%. However, few countries achieve this threshold. Understanding predictive factors of vaccination, at different levels of health care delivery (such as individuals, service providers, health policy), is essential to secure acceptance of influenza immunization and achieve the recommended level of vaccination coverage. In this mini review, all the available evidence regarding seasonal influenza vaccination coverage is summarized, alongside factors associated with vaccine uptake in people with chronic diseases as a whole, as well as according to specific diseases such as: cardiovascular and pulmonary disorders, diabetes and cancer. Based on the reviewed empirical evidence, a wide spectrum of factors associated with immunization against influneza was found in people who have chronic diseases. Although diverse, these factors can be systematized into 4 distinctive groups: socio-demographic characteristics, individual attitudes and beliefs, health promoting behaviors and factors related to the health care system. Further efforts are needed to improve the seasonal influenza vaccination coverage. The immunization strategy needs to include the health care system and the community to support people with chronic diseases to continously accept the influenza vaccine.

New antidepressant utilization pre- and post-bereavement: a population-based study of partners and adult children

PURPOSE

Bereavement is associated with increased morbidity and mortality, but few studies have examined the specific timing of depression onset. This study examines the risk of developing new-onset depression in adult children and partners by month, 1 year before and after death.

METHODS

Using population-based registers in Denmark, we assembled a cohort of 236,000 individuals who died a natural death (2010-2016). Partners and adult children of the deceased were identified and demographic and prescription data were collected. GEE logistic regression was used to model whether the bereaved received a new antidepressant prescription around the death of their loved one across 24 time intervals (12 months before and after death).

RESULTS

Male and female partners had an increase in receipt of new antidepressant prescriptions in the 11 months after the death of their partner, with a peak increase 2 or 3 months after death. Partners also increased new antidepressant prescription use 2 months before death. Characteristics of the decedents including cause of death were not associated with new antidepressant prescription in the surviving partner. Adult children did not have increased odds of being prescribed new antidepressants at any time.

CONCLUSION

Both male and female partners have increase in new antidepressant utilization before and after the death of their partner. Our work points to the importance of supporting partners not only after the death of their partner, but also in the period before death when families may be actively engaged in caregiving for the seriously ill.

Searching for online health information instead of seeing a physician: a cross-sectional study among high school students in Belgrade, Serbia

OBJECTIVES

Fear of being judged and stigmatized has been reported as barriers for adolescents to timely use healthcare services. The objective of this study was to examine the prevalence and factors associated with online health information seeking instead of seeing a physician among high school students.

METHODS

A cross-sectional questionnaire-based study was carried out in four out of 21 public high schools in Belgrade, from December 2016 to January 2017 (n = 702, 41.9% males, 15-19 years old). The association of socio-demographic characteristics, digital literacy, interest in health topics and the use of online platforms with health information seeking was analysed using multinomial regression models.

RESULTS

More than half of high school students (56.6%) search for online health information instead of seeking a physician. Being male, having lower-grade point average, attending humanities-languages program, older age at first Internet use, better e-health literacy, use of smartphones, interest in sexually transmitted diseases and mental health, use of websites run by physicians and Youtube was associated with online health information seeking instead of in-person visit to a physician.

CONCLUSIONS

Setting up safe and supportive online platform could help adolescents improve health education. Physicians who see adolescent patients should encourage discussions about sensitive health topics.

Human Papillomavirus Vaccination and Physical and Mental Health Complaints Among Female Students in Secondary Education Institutions in Denmark

BACKGROUND

Previous studies have not explored the effect of HPV vaccination on health status at a longer time interval. Similarly, self-reported physical and mental health in recipients of the HPV vaccine has not been studied.

OBJECTIVE

To evaluate whether HPV vaccination was associated with physical and mental health complaints among girls in secondary education institutions.

DESIGN

Prospective cohort study.

PARTICIPANTS

This study used data from girls aged 15-20 years who participated in the Danish National Youth Study (DNYS) 2014. Data on HPV vaccination was retrieved from the Danish Vaccination Register.

MAIN MEASURES

Participants were asked whether they had experienced headaches, stomachache, neck pain, menstrual cramps, sore throat, sadness, irritation, nervousness and sleep problems in the past 6 months.

KEY RESULTS

Of 41,333 girls, 39,145 (94.7%) received at least one dose of HPV vaccine. The most prevalent health complaint among the vaccinated and not vaccinated females was "been irritable" (88.2% and 88.4%, respectively). The lowest proportion of health complaints was stomachache (49.6% in vaccinated and in 50.4% in unvaccinated girls). Regression model, adjusted for socio-demographic characteristics and health behavior, showed that HPV vaccination was associated with a lower likelihood of reporting sore throat (odd ratio [OR] 0.86, 95% confidence interval [CI] 0.78-0.95) and being sad (OR 0.86, 95%CI 0.76-0.97). Similar results were observed when HPV vaccination status was analyzed according to the number of doses received.

CONCLUSION

We conclude that HPV vaccination was not associated with physical and mental health complaints among girls in secondary education institutions in Denmark after a median of 5.3 years since HPV vaccination.

Is exposure to indoor secondhand smoke associated with poor mental health? Results from non-conflict and post-conflict setting

The purpose of this study was to examine the association between exposure to indoor SHS and self-reported HRQoL among healthy non-smoking students at the University of Belgrade, Serbia and Kosovska Mitrovica located in the post-conflict Kosovo province. Students who presented at Student Public Health Center in Belgrade in 2009 and Kosovska Mitrovica in 2015 for mandatory health checks were invited to participate. Data were collected using socio-demographic and behavioral questionnaire, health-related quality of life questionnaire Short Form-36 (SF-36) and Beck Depression Inventory (BDI). A total of 82.3% students in Belgrade sample and 76.0% in Kosovska Mitrovica sample reported daily exposure to indoor SHS. After adjustment for socio-demographic characteristics and behavior, daily exposure to indoor SHS for more than 6 hours was associated with poorer Vitality (β = -5.55, 95% confidence interval [CI] -9.49, -1.61) and Mental Health (β = 5.00, 95% CI-8.94, -1.07) only among students at the University of Belgrade. This study showed that the association between longer daily indoor SHS exposure and poor mental health HRQoL was not consistent in non-conflict and post-conflict setting. This association was not found in a post-conflict setting. Strict no smoking policies are needed in student housing, university campuses and all public spaces.

Towards a Framework for Research Ethics Education for Physicians in Serbia

With growing opportunities for medical doctors to work either in academia and industry, research ethics education for health sciences research, meaning research which includes humans and animals and/or their tissues and cells with the goal to understand underlying mechanisms of disease occurrence and disease treatment, is of paramount importance, especially in regions, such as Serbia, where comprehensive research ethics curricula for physician researchers are lacking. This article addresses the spectrum of research ethics topics that were identified through analysis of the existing research ethics curricula in medical schools, international organizations, Serbian legislative codes and the PubMed database applying the key search terms: ethics, research, biomedical, education, curriculum, program, course and their combinations. Selected topics were classified in eight syllabi based on their similarity: #1 Responsible conduct of research, #2 Justice in human subjects research, #3 Research on human subjects, #4 Vulnerable population groups, #5 Conflict of interest, #6 Research on animals, #7 Research on genes, cells and embryos, and #8 Organization of research ethics. Justifications for each syllabus are discussed based on empirical evidence and local context. Higher education authorities could use this framework to strengthen, adjust or refine research ethics education for physician researchers in Serbia.

Patterns of condom use in a university student population residing in a high-risk area for HIV infection

OBJECTIVE

The study objective was to investigate factors associated with condom use among university students.

METHODS

During the 2013-2014 academic year, 1017 first and fourth year students from the University of Pristina temporarily seated in Kosovska Mitrovica, northern Kosovo, completed a questionnaire on sociodemographic data, HIV-related knowledge, attitudes and risky behaviours.

RESULTS

Condom use during the most recent sexual encounter and with casual partners was reported by just over half of participants. Factors associated with condom use during the most recent sexual encounter were: being male (35.1%), using medical sources of information about HIV (35.7%), having a positive approach to HIV testing (40.1%) and a positive attitude towards sex workers (17.7%), as well as not having had a sexually transmitted infection in the past year (54.2%). Factors associated with more frequent condom use with casual partners were: being single (28.9%), not living in a rented apartment or own home (32.1%), frequenting night clubs at the weekend (35.3%), not using drugs/opioids (54.1%), not being sure whether to keep a contact after learning of their HIV-positive status (10.1%), and having stronger opinions (either positive or negative) on homosexual individuals (15.5% and 32.1%, respectively), sex workers (18.7% and 23.9%, respectively) and drug users (13.2% and 36.5%, respectively).

CONCLUSION

Condom use among students in northern Kosovo was low. Strategies for HIV prevention should be focussed on promoting healthy behaviours, especially among female students and students who live alone while at university. Moreover, sexuality education should be carried out in schools and primary health care centres to provide support and enable young people to negotiate safe sex.