Onychomycosis is a fungal infection of the fingernails and/or toenails caused by dermatophytes, yeasts and non-dermatophyte moulds. The epidemiology of onychomycosis in Serbia is yet to be fully established. This epidemiological study was aimed at evaluating the epidemiology of onychomycosis in a sample of the Serbian patients at risk of onychomycosis, to determine the fungal aetiological agents and to identify the possible risk factors. The study population included 374 patients from six centres in Serbia with suspected onychomycosis. Demographic data, data about comorbidities, lifestyle, clinical aspects of onychomycosis, trauma, excessive perspiration and personal and family history of previous onychomycosis were studied. Laboratory confirmation of diagnosis was done by direct microscopy, fungal culture and PCR. Diagnosis of onychomycosis was confirmed in 50.8% of patients, who tested positive to at least one laboratory test (direct microscopy, fungal culture or PCR). Trichophyton rubrum was predominant both on toenails (85.98%) and on fingernails (38.46%). Independent risk factors for onychomycosis were: old age (OR = 2.285; P < 0.001), family history of previous onychomycosis and/or tinea pedis (OR = 2.452; P = 0.005), excessive perspiration (OR = 2.165; P = 0.002) and higher degree of hyperkeratosis (OR = 1.755; P = 0.020). This is a first epidemiological study of onychomycosis from Serbia.

BackgroundRecently, demand for and supply of short-form patient-reported outcome measures (PROMs) have risen throughout the world healthcare. Our contribution to meeting that demand has been translating and culturally adapting the Chronic Otitis Media Questionnaire-12 (COMQ-12) for adults into Serbian and enhancing its psychometric base on the relatively large Serbian COM caseload. Chronic otitis media can seriously affect quality of life progressively and in long-term, and it remains the major source of hearing problems in the developing world.MethodsThe translated questionnaire was given twice to 60 adult patients with chronic otitis media of three types (inactive, active mucosal and active squamous disease) and to 60 healthy volunteers. Both patients and volunteers also filled the generic Short-Form 36 questionnaire (SF-36). Conventional statistical procedures were used in strategically driven development of scoring. Additionally, item responses were scaled by linear mapping against the provisional total score. Generalizability, detailed factor interpretation and supportability of scores were criteria, for the best compromise factor solution.ResultsTest-retest reliability was very high (0.924 to 0.989, depending on score). The a priori content dimensions of the questionnaire were strongly supported by 3-factor exploratory and confirmatory factor analyses for content validity, separating (i) ear symptoms from (ii) hearing problems, from (iii) daily activity restriction plus healthcare uptake. The 3-factor structure was furthermore highly stable on replication. The very large effect sizes when contrasting patients with healthy volunteers, and active with inactive disease established construct validity for the total score. A strong association with disease activity and a moderate one with generic health-related quality of life (HRQoL), the SF-36, supported construct validity for two of three factors extracted (ear symptoms, and impact on daily activities plus healthcare uptake).ConclusionsGiven the minimal psychometric work to date on COMQ-12, this interim sample with 120 data points adds materially to knowledge of its reliability, several forms of validity and the feasibility of profile sub-scores to supplement total scores. The good psychometric properties shown for COMQ-12 justify both its routine clinical use and acquisition of the necessarily larger sample for generality, score optimisation and the evaluation of responsiveness.Electronic supplementary materialThe online version of this article (10.1186/s12955-017-0782-x) contains supplementary material, which is available to authorized users.

Background Low back pain (LBP) is a serious health problem among medical students. We aimed to investigate the prevalence and associated factors for LBP among Serbian medical students. Methods A cross-sectional study was performed among medical students at one University in Serbia. Data was collected by a self-reported questionnaire. Logistic regression was used to determine the factors associated with LBP; results from the analyses were expressed as odds ratios (OR) with 95% confidence intervals (CI). Results The study sample comprised 499 medical students, giving a response rate of 92.9%. The mean age of the participants was 22.0 ± 2.2 years (range 18–34). Overall, 20.8% (104/499) of medical students had LBP at the time of study. Cigarette smoking (OR = 2.5, 95% CI [1.5–4.2], p = 0.001), stress during classes (OR = 1.8, 95% CI [1.1–3.0], p = 0.039), incorrect sleeping position (OR = 1.9, 95% CI [1.2–3.1], p = 0.006) and family history of LBP (OR = 1.6, 95% CI [1.1–2.7], p = 0.047) were independently associated with high prevalence of LBP at the time of the study. Conclusions LBP is a highly prevalent health problem in medical students in Serbia. The association between LBP and cigarette smoking, stress during classes, incorrect sleeping position and LBP in family history has been observed in medical students.

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

ObjectivesOver the last decades, mortality from cerebrovascular diseases (CVDs) has decreased in many countries. The aim of this study was to assess the trends of CVDs mortality in Serbia.MethodsDescriptive epidemiological study. Age-standardised rates (ASRs) for CVDs mortality were assessed by joinpoint regression analysis to identify significant changes in trends and estimate annual per cent changes with 95% CI. The age-period-cohort analysis has been used to describe variations in mortality.ResultsOver this 20-year period, there were 312 847 deaths from CVDs, with the overall average annual ASR of 148.4 per 100 000. The trend of ASRs from CVDs mortality in males in Serbia showed a significant joinpoint: rates insignificantly decreased from 1997 to 2005 by −0.8% per year (95% CI −1.7% to 0.2%) and thereafter rapidly decreased by −5.0% per year (95% CI −5.6% to −4.5%). A joinpoint for females was found in 2006: the mortality trend was first significantly decreasing by −1.0% per year (95% CI −1.9% to −0.0%) and then sharply falling down by −6.0% per year (95% CI −6.8% to −5.3%). Results of age-period-cohort analysis indicated that the relative risk for CVDs mortality showed statistically significant (p<0.05) cohort and period effects, as well as the net drift and local drifts in Serbian population. The trends in mortality for all subtypes of CVDs were similar in both sexes: trends significantly decreased for most subtypes, with the exception of a significant increase for cerebral infarction.ConclusionsAfter a decade of increase, CVDs mortality rates are declining in last decade in Serbia. However, mortality rates from CVDs remain exceedingly high in Serbia. Differences in mortality trends of the stroke subtypes should be taken into account in the creation of both prevention and treatment guidelines.

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

Serbian medical students greatly value and have a positive perception of future parenthood. Appropriate education is needed, however, because of their inadequate knowledge of the age-related decline in female fertility.