Temporal Changes in Incidence Rates of the Most Common Gynecological Cancers in the Female Population in Central Serbia.

Background and Objectives: There were 1,335,503 newly diagnosed cases of the most common gynecological cancers in women (cervical, uterine and ovarian cancer) worldwide in 2020. The main objective of this paper was to assess temporal changes in incidence rates of the most common gynecological cancers and to determine the age group with the greatest increase in incidence in the Serbian female population in the period 2003-2018. Material and Methods: Trends and annual percentage change (APC) of the incidence rate with corresponding 95% confidence intervals (CI) were calculated by Joinpoint regression analysis. The trend was considered to be significantly increasing (positive change) or decreasing (negative change) when the p-value was below 0.05 (p < 0.05). Results: The total number of newly registered cancer cases from 2003 to 2018 was 35,799. There was a significant increase of age standardized rate (ASR) for all cancer incidences in women from 2012 to 2018 with APC 6.9% (95% CI from 0.9 to 13.3, p = 0.028) and for uterine cancer during the 2014-2018 period with APC of 16.8% (95% CI: from 4.0 to 31.1, p = 0.014), as well as for ovarian cancer incidence in the 2012-2018 period with APC of 12.1% (95% CI: from 6.7 to 17.8, p < 0.001). A non-significant decrease of ASRs of incidence for cervical cancer was determined from 2003 to 2015 with APC of -0.22% (95% CI: from -3.4 to 3.1, p = 0.887) and a non-significant increase of ASRs incidence from 2015 to 2018 with APC of 14.21% (95% CI: from -13.3 to 50.5, p = 0.311). The most common gynecological cancers were present in all age groups and only ovarian cancer was registered in the youngest age group (0-4 years). Cervical cancer showed a typical increase after the age of 30, with peak incidence in women aged 40-44 and 65-69 years. The increased incidence trend regarding age for cervical cancer (y = 1.3966x + 0.3765, R2 = 0.3395), uterine cancer (y = 1.7963x - 5.4688, R2 = 0.5063) and ovarian cancer (y = 1.0791x - 0.8245, R2 = 0.5317) is statistically significant. Conclusion: Based on our presented results, a significant increase of incidence trend for the most common gynecological cancers in the Serbian female population from 2012 to 2018 was determined. There has been a significant increase in the incidence of uterine cancer from 2014 up to 2018, as well as for ovarian cancer from 2012 up to 2018, while cervical cancer showed a non-significant decrease of incidence trend from 2003 until 2015 and then a non-significant increase. In women below 20 years of age, ovarian cancer was significantly more prevalent, while cervical cancer was significantly more prevalent in the age groups 20-39 and 40-59 years. In the age group of 60-79, uterine cancer had a significantly higher incidence than the other two cancers. Measures of primary prevention, such as vaccination of children against Human Papilloma Virus and screening measures of secondary prevention, for the female population aged 25 to 64 years of age are needed, as well as educating females about healthy lifestyles via media and social networks to help prevent the most common gynecological cancers.

Trends of Stomach Cancer in Central Serbia.

Somach cancer is the third most common cause of cancer-related deaths worldwide. The objective of the paper was to analyze the incidence and mortality trends of stomach cancer in Central Serbia in the period between 1999-2017. Materials and Methods: trends and annual percentage change (APC) of the incidence and mortality rate with corresponding 95% confidence intervals (CI) were calculated by joinpoint regression analyses. The optimal number of Joinpoints was identified using the Monte Carlo permutation method. The trend was considered to be significantly increasing (positive change) or decreasing (negative change) when the p-value was below 0.05 (p < 0.05). Results: the total number of new cases was 16,914 (10,873 males and 6041 females) and the total number of mortality cases was 14,790 (9348 in and 5442 in females). Almost one third (30.8%) of new cases were registered in the 60-69-year age group, and new cases were significantly more frequent in males than in females (30.8% vs. 29.02%, p < 0.001). Joinpoint regression analysis showed a significant decrease of incidence trend in females during the 2000-2015 period with APC of -2.13% (95% CI: -3.8 to -0.5, p < 0.001). An insignificant decrease in incidence trend was in males with APC of -0.72% (95% CI: -2.3 to 0.9, p = 0.30). According to the joinpoint analysis, a significant decrease of mortality trends both in males during 2000-2015 with APC of -2.21% (95% CI: -1.6 to -7.5, p ≤ 0.001 and in females, during the same period, with APC of -1.75% (95% CI: -2.9 to -0.6, p < 0.001) was registered. From 2015 to 2017, a significant increase of mortality was registered with APC of 44.5% (95% CI: from 24.2 to -68.1, p ≤ 0.001) in females and in males with APC of 53.15% (95% CI: 13.5 to -106.6, p ≤ 0.001). Conclusion: a significant decrease of stomach cancer incidence trend in females and insignificant decrease of incidence trend in males were determined in Central Serbia. Based on presented results, the mortality trend decreased significantly both in males and in females during 2000-2015, and from 2015 to 2017 we recorded a significant increase in mortality in both sexes. We found significantly more new cases in women than in men in the age group of 40-49, and the mortality of stomach cancer was significantly more frequent among females compared to males in the age groups 30-39, as well as in the 50-59 age group. There is a need for improving recording and registration of new cases of stomach cancer, especially in females. Urgent primary and secondary preventive measures are needed-introducing stomach cancer screening and early detection of premalignant changes. Urgent primary and secondary preventive measures are needed.

Knowledge about Cervical Cancer and Awareness of Human Papillomavirus (HPV) and HPV Vaccine among Female Students from Serbia.

Background and objectives: Persistent infection with carcinogenic human papillomavirus (HPV) is the leading cause of cervical cancer. The study explored students' knowledge about cervical cancer and awareness of human papillomavirus and the HPV vaccine. Materials and Methods: A questionnaire-based survey was carried out among 1616 first-year female college students at the University of Nis. It examined socio-demographic characteristics, measured the score of knowledge about cervical cancer, assessed awareness regarding HPV and the HPV vaccine and inquired about the source of information about cervical cancer and HPV. Results: The average cervical cancer knowledge score was 16.35 ± 7.92 (min 0, max 30), with medical professional education, parents' education level, place of residence and relationship status having significant effects on the score. The awareness about HPV and the HPV vaccine was low, with only 14.2% of students having heard about both HPV and its vaccine. The most commonly reported sources of information were the media, while the most competent one was organized health education. Conclusions: Health promotion campaigns and educational programs are necessary in order to reduce cervical cancer burden and should be directed particularly towards those who have demonstrated low cervical cancer knowledge and low awareness regarding HPV and its vaccine.

Incidence and mortality trends of ovarian cancer in central Serbia.

PURPOSE: Ovarian cancer (OC) is the most fatal cancer in females. The objective of this paper was to determine the incidence and mortality trends of OC in central Serbia from 1999 to 2003. METHODS: Data about all new cases and deaths of OC were obtained from the Serbian Cancer Registry. Data were analyzed for the central of Serbia which encompasses the territory of Serbia without its northern and southern regions. Data of the female population were obtained from the population censuses in the years 1991, 2002 and 2011. World population was used as a standard. Trend and annual percentage change (APC) of the incidence and mortality rate with corresponding 95% confidence intervals (CI) were calculated by performing jointpoint regression. RESULTS: Jointpoint analysis showed increased incidence trend of annual standardized rate (ASR) for OC from 1999 to 2013 with APC 0.3% (95%CI: 0.3, 0.8). Significantly increased trend in OC mortality was recorded continuously from 1999 to 2007 with APC 2.25% (95% CI: 0.9, 3.6). Decreased mortality trend was observed in the period 2010- 2013 with APC -7.34% (95%CI:-15.8, 2.0). The majority of the new cases of OC were aged 40-74 (78.7%). OC was the sixth most common cancer of all cancers in females and the sixth most common cause of cancer death in females. CONCLUSIONS: During 1999-2013 there was an increasing trend of incidence of OC. In 1999-2007 there was a significant increasing mortality trend and non-significant decrease of the trend from 2010 to 2013 in central Serbia. The incidence and mortality rates of OC in central Serbia were higher than the corresponding rates in neighboring countries.

Lung cancer trends in Southeastern Serbia.

The aim of the study was to assess recent changes in lung cancer incidence and mortality trends in the male and female population in Southeastern Serbia, in the period 1999-2008. Data used for analyses were provided by the Cancer Registry of the Institute for Public Health, Nis. Incidence and mortality trends were based on crude and age-standardized incidence and mortality rates for the period 1999-2008. Standardized rates were calculated by the direct method of standardization (per 100,000), using the world population as the standard. Statistical significance was checked on the basis of correlation coefficient (r) for probability (p) on the level of 0.05. A total of 3,128 new cases and 2,327 deaths from lung cancer were registered (males/females ratio is 4:1). In males, the crude (107.94) and the age-standardized incidence rate (59.88) were four-fold higher than in females (27.10 and 14.21). In males, the crude mortality rate was four-fold higher than in females (80.61 vs. 19.87), while the age-standardized mortality rate was four and a half higher than in females (43.78 vs. 9.54). Lung cancer incidence trend, based on crude and age-standardized incidence rates, in females was increasing while in males was decreasing. Lung cancer mortality trends, based on crude and age-standardized incidence rates, were increasing in both sexes. Registration of unfavourable incidence and mortality trends of lung cancer indicate failure in primary and secondary prevention in the past. It is thus of vital importance to provide much intensive and comprehensive activities for primary and secondary prevention of lung cancer in the future, including education and rigorous tobacco control as well.

[The influence of overweight on the quality of life of health workers].

INTRODUCTION: The number of people who are considered to be either overweight or obese continues to increase, worldwide. The aim of the paper was to determine the influence of overweight on the quality of life of health workers. MATERIAL AND METHODS: The study of prevalence was used We observed 108 health workers both men and women from the Institute for Public Health in the City of Nis. The questionnaire Obesity Related Well-Being 97 (ORWELL97) was applied in all health workers. RESULTS: A hundred and five health workers filled in the ORWELL97 questionnaire. There were 40% of men and 60% of women; 72% of them were married and 28% of them were single; 68% were from the urban area and 32% were from the rural area. The average age was 29.5 (SD=3.2) and the average value of BMI was 25.4 (SD=4,0). There were 54 (48.6%) health workers having normal weight and there were 51 (5.4%) who were considered overweight. No one was obese among them. The difference between the average sum of scores in the group of health workers who had normal weight and the group of health workers who were overweight was not statistically significant (t=1.1 and p<0.05). Nor was the difference statistically significant for the average sum of scores of subquestion O (t=3.6 and p<0.05), and subquestion R (t=2.9 and p<0.05). BMI showed a weak positive correlation with both occurence and relevance of symptoms. A weak positive correlation of BMI was found with average sum of scores in the first, second and third groups of questions in ORWELL 97 questionnaire. CONCLUSION: According to the presented results, health workers who were overweight did not have lower quality of life than health workers who had normal weight.

[Association of stressful life events with acute myocardial infarction in population in the city of Nis within the period from 1998-2000].

BACKGROUND/AIM: Stressful life events present a very important category of psychosocial stress. A few studies have showed that a psychosocial stress represents a very important risk factor for acute myocardial infarction (AMI), but measures of stress may not be suitable for different countries, cultures and ethnic groups. The aim of this study was to investigate the relation of stressful life events with AMI in the period of 1998-2000 in the population of the city of Nis. METHODS: A case-control study included 100 patients with the first MI (in the period 1998-2000) and 100 healthy subjects, matched with respect to sex and age (+/- 2 years) from the city of Nis. The data of stressful life events were obtained by the Scaling of life events by Paykel ES, modified by the authors consistent with the examined population and the period of investigation. The Yates chi2 test, odds ratio - OR and their 99% interval of confidence were used as statistical procedures. RESULTS: The results showed that stressful life events in the period of investigation were very important risk factors for AMI with a statistically significant level (p = 0.000). Huge financial problems (OR = 202.36, Ci = 24.82-4387.58), violation of law (OR = 168.00, Ci = 10.66-6658.96) and serious illness of family members (OR = 159.60, Ci = 19.05- 3514.81) were the highest risk for AMI. The patients who reported that his/her son or other member of family had been gone to the army (or mobilization) before the illness onset, had 138 times higher risk of AMI (Ci = 14.98-3222.47, chi2 = 40.95, p = 0.000), while the patients who had mobilized themselves had 84 times higher risk (Ci = 7.00-2363.06, chi2= 23.87, p = 0.000). Effect of several stressful life events lead to significantly increased risk of AMI andthat significance is larger as the number of life events is more frequent (one life event: OR = 28.41, Ci = 3.73-593.52; chi2 = 17.40, p = 0.000; ? 4: OR = 336.00, Ci = 28.31-9760.28, chi2 = 50,43, p = 0,000). CONCLUSION: These findings indicate that stressful life events are associated with AMI and that they are very important for further epidemiological investigation of the triggering mechanisms and should improve preventive strategies of this serious disorder.