Incidence of primary central nervous system tumors among children in Belgrade (Serbia), 1991-2004.

The aim of this survey was to estimate the incidence of primary CNS tumors among children aged 0-14 in Belgrade during the period 1991-2004. Incidence rates were age-adjusted according to the world standard population. The average age-adjusted incidence rates were 3.4/100,000 for boys, 2.4/100,000 for girls, and 2.9/100,000 for both genders. There was a nonsignificant tendency toward increased CNS tumor incidence (y = 2.547 + 0.052 x, p = .549). The age-specific incidence rates were 3.0/100,000 (0-4 years), 2.2/100,000 (5-9 years), and 3.8/100,000 (10-14 years). Among the population aged between 0 and 14, the cumulative probability of acquiring primary CNS tumors was 1 per 1961 for boys and 1 per 2778 for girls. Astrocytoma was the most common pathohistological type of primary CNS tumors accounting for 41.5% of cases.

Trends in mortality from different subtypes of stroke in the population of Belgrade (Serbia).

OBJECTIVE: To estimate trends in mortality due to different stroke subtypes in the population of Belgrade during the period 1989-2003. PATIENTS AND METHODS: Mortality data for stroke were compiled from material of the Municipal Institute of Statistics. Stroke mortality rates were standardized by world standard population. Linear regression coefficient in time trend analysis of mortality rates was assessed by Fisher's test. RESULTS: In Belgrade, 1989-2003, the highest values of mortality rates were for ischemic stroke in both sexes: 50.1/100,000-men, and 39.9/100,000-women. The mortality rate from subarachnoid hemorrhage (SAH) was lower in men (3.9/100,000) compared to women (5.3/100,000). For intracerebral hemorrhage (ICH), the death rate was 3.1 times higher than that for SAH. Stroke due to hemorrhage was a more common cause of death than ischemic stroke for both sexes in all age groups up to 59. In older age, ischemic stroke became the more frequent cause of death. The time trends of stroke mortality rates in the Belgrade population during the period 1989-2003 showed that the most excessive statistically significant increase in death rates was related to ICH in both sexes. The death rates from SAH had increasing tendency in both sexes, especially in women (p=0.017). Upward trends were observed for ischemic stroke mortality rates too, with statistical significance in men (p=0.048). CONCLUSION: Further research is needed to explain the causes of the increasing burden of stroke in Serbia. Since different profiles of risk factors play a role in the etiology of different stroke subtypes, these facts should be taken into account in the creation of both prevention and management strategies.

Stroke mortality in Belgrade, Serbia: age, period, and cohort analyses.

OBJECTIVE: To assess the age, period, and cohort effects on stroke mortality in Belgrade, Serbia, between 1989 and 2003. METHODS: Mortality data for stroke events were obtained from the Municipal Institute of Statistics. The age- and gender-specific mortality rates were calculated for the cohorts of individuals born between 1904-1908 and 1964-1968. RESULTS: In males, the average mortality rate increased from 80.9/100,000 in 1989-1993 to 111.3/100,000 in 1994-1998, and decreased slightly to 101.8/100,000 in 1999-2003. A similar pattern was observed among females. Stroke mortality risk was strongly related to age in both genders. This age effect was present for both genders, independent of the cohort or time period. The majority of the successive generations in Belgrade had an increased risk of death from stroke in the recent cohorts especially among females. CONCLUSIONS: Our results suggest the need to improve efforts in the primary and secondary prevention of stroke.

Prevalence of primary headaches in children from Belgrade, Serbia.

The aim of our study is to estimate the prevalence of migraine and tension-type headaches in 7-12-year-old school children from Belgrade. The sample was drawn from a total of 1259 school children from randomly selected primary schools. The diagnosis was made on the basis of a clinical interview combined with the neurological examination. The prevalence of migraine increases with age from 0.5% at the age of seven, to 6.8% at the age of 12. Female to male ratio inverts with age: males predominate at age 7-9, but females predominate at age 10-12. The estimated prevalence of tension-type headache increases with age from 0.5% in 7-year olds to 2.4% in 12-year olds. Statistically, the onset of migraine occurs significantly earlier than that of tension-type headache. Migraine and tension-type headache are frequent headache types and have different demographic characteristics among children.

Lifestyle factors and multiple sclerosis: A case-control study in Belgrade.

The aim of this case-control study was to assess the risk of developing multiple sclerosis (MS) associated with certain lifestyle factors (cigarette smoking and coffee and alcohol consumption). The study groups consisted of 210 cases with clinically proven and/or laboratory-confirmed MS (Poser's criteria) and an identical number of sex- and age-matched hospital controls. In the MS patients, cigarette smoking was significantly more frequent than in the controls (OR = 1.6, p = 0.021). A dose-response relationship between the risk of MS and both duration (years) of smoking (p = 0.027) and number of cigarettes smoked daily (p = 0.021) was observed. Coffee consumption was significantly more frequent in the MS group (OR = 1.7, p = 0.047), with dose-response relationships. The analysis of alcohol drinking showed a significant association between consumption of hard liquor per day and risk of MS (OR = 6.7, p = 0.026). In multivariate logistic regression analysis, smoking was detected to be a significant independent risk factor for MS (OR = 2.4, p = 0.004).

[Epidemiology of myasthenia gravis].

Myasthenia gravis (MG) is an organ-specific autoimmune disorder characterized by weakness and fatigue of voluntary muscles, and presence of autoantibodies to acetylcholine receptor of postsynaptic muscle membrane. A review of the international literature suggests that there is large variety of MG frequency and distribution. An annual incidence rate of MG is thought to be between 0.25 and 20 per 1,000,000 population. The prevalence of MG in world shows even wider variation, i.e. ranging from 50/1,000,000 in Hong Kong to 200/1,000,000 in Virginia (USA). Among population of Belgrade, an average annual incidence rate during the period 1983-1992 was 7.1/1,000,000, and prevalence on December 31, 1992 was 121.5/1,000,000. The mortality rate of MG is very low with value under 1/1,000,000. Epidemiological studies of MG have indicated trend of increasing MG prevalence with relatively stable incidence. This reflects the impact of effective treatment, improved diagnostic methods and prolonged survival. Due to development of intensive care facilities and immunomodulating treatment, the mortality of MG has significantly decreased. The most common age of MG onset is between 20 and 40 years. In this age group, about 60% of patients are women, while sex ratio at older age is 1:1. Stressful life events, viral infections, pregnancy and delivery may precipitate the development of MG. MG is associated with other autoimmune diseases in about 30% of cases. Although the number of patients with MG continues to rise, it is still a rare disease. Further epidemiological research with a view to establish population registries and to estimate economic impact of disease on population as well as quality of life of patients with MG is needed.

[Epidemiological characteristics of hip fractures in Belgrade from 1990 to 2000].

The objective of this study was to estimate the incidence of hip fractures in Belgrade for the period 1990-2000, and to determine distribution of fractures according to sex, age, and causes of injuries. Data based on medical records of the National Health Service in Belgrade were collected from all orthopedic hospitals and departments in Belgrade. A total number of 8904 hip fractures were included in the analysis, out of which 64.7% occurred in women. During the survey period, the estimated average annual incidence rate of hip fractures was 51.7/100 000 (95% CI= 48.1-55.4); 66.2/100 000 (95% CI= 60.8-72.1) in women and 35.3/100 000 (95% CI= 31.4-40.1) in men, respectively. In the age group > or =50 years, the incidence rates standardized by the 1985 US population were 228 and 96 per 100 000 female and male population, respectively. An exponential increase in the incidence of hip fractures with age was observed in both sexes, especially in women. The number of trochanteric fractures was 4718 (53.0%), compared with 4186 (47.0%) cervical fractures. Observation at three time points, in 1990, 1995, 2000, indicated the pronounced increase of trochanteric fractures in women and less distinctive in men. Fall on the flat ground resulted in 70.3% of hip fractures among persons aged 50 years or older, and traffic accidents were recorded as the major cause in 59.7% of patients under 50 years of age.

[Mortality from endometrial cancer in female population of Belgrade]. / Mortalitet od raka endometrijuma u zenskoj populaciji Beograda.

Data about mortality from malignant tumors of endometrium were analyzed in the Belgrade area during the period 1975-2000. The obtained results showed that the average percentage of endometrial cancer in mortality structure from all the cancers of female population was 2.65%. During the observed 26-years period, malignant tumors of endometrium constituted 17.38% of all the tumors of gynecological localization. The standardized mortality rate in 1975 (population worldwide used as a standard) 7.06/100,000 population, while in 2000 it was 1.78/100,000 population, respectively, which showed almost fourfold mortality decline during the observed period (y=4.72-0.16x). A trend of declining risk of dying from endometrial cancer was present in all the age groups. The obtained results indicated that in the observed period the average mortality rates ranged from 0.14/100,000 population in females aged up to 34 years (y=0.30-0.01x), and reached the highest value in females aged 65-74 years (14.57/100,000; y=23.43-0.66x), and 75 years of age and over (19.62/100,000; y=31.17-0.85x).

Childhood infections as risk factors for multiple sclerosis: Belgrade case-control study.

The aim of this case-control study was to analyze the role of childhood infections and vaccinations in patients with MS in the Belgrade population. The study group comprised 110 cases with definite MS according to Poser's criteria, in whom onset symptoms occurred up to 2 years prior to the interview. An equal number of controls, individually matched by sex, age and area of residence, was recruited from patients with various nonautoimmune neurological disorders. Measles (OR = 2.6, 95%CI 1.4-5.0), chickenpox (OR = 3.0, 95%CI 1.5-6.0), rubella (OR = 2.4, 95%CI 1.2-4.7), whooping cough (OR = 1.9, 95%CI 0.8-4.4), and mumps (OR = 1.8, 95%CI 0.8-4.5), at age < or = 7 years, were more frequently reported by MS cases. The total number of childhood viral infections (including measles, rubella, chickenpox, and mumps) at age < or = 7 years was significantly higher in MS cases than in controls (OR = 1.8, 95%CI 1.4-2.5). Concerning vaccinations, no statistically significant differences were found between groups. According to multivariate analysis, rubella (OR = 2.5, 95%CI 1.4-4.4, p = 0.001) and measles (OR = 2.4, 95%CI 1.3-4.3, p = 0.003) at age < or = 7 years were significantly related to MS.

[Mortality in primary malignant brain tumors in the population of Belgrade]. / Mortalitet kod primarnih malignih tumora mozga u populaciji Beograda.

BACKGROUND: The aim of this investigation was the analysis of primary malignant brain tumors (PMBT)-related mortality in the Belgrade population during the period 1983-2000. METHODS: Mortality data (based on death records) for the period observed, as well as population data, were obtained from the unpublished material of the Municipal Institute of Statistics, Belgrade. The data analysis was adjusted to specific and standardized mortality rates and linear trend, using the world population as a standard. Regression coefficient was determined by Fisher's test. RESULTS: During the period 1983-2000, in the Belgrade population standardized mortality rates from PMBT were 6.29/100,000 (95% CI-confidence interval 5.33-7.24) for males, 4.50/100,000 (95% CI 3.84-5.17) for females, and 5.91/100,000 (95% CI 5.20-6.63) for total population. The age-specific mortality rates increased with age up to the age group 65-74, with the highest value of 21.21/100,000 (95% CI 16.03-26.39), and decreased in persons of 75 and more years of age. CONCLUSION: Mortality rates from PMBT in Belgrade had slightly increasing tendency in male (5.725 + 0.0592x, p = 0.545), and decreasing tendency in female population (y = 4.703-0.0213x, p = 0.756), while statistically significant increasing mortality rate was registered only in the age group 65-74 (y = 435 + 1.7707x, p = 0.0001).

Decreased frequency of the tumor necrosis factor alpha -308 allele in Serbian patients with multiple sclerosis.

Tumor necrosis factor (TNF) alpha has been considered the prototypic cytopathogenic cytokine in multiple sclerosis (MS), but recently this cytokine has been shown to possess significant anti-inflammatory and neuroprotective effects in demyelinating diseases. It has been reported that the TNFalpha -308 polymorphism influences levels of TNFalpha production, and that the rare allele, TNF2, is associated with high TNFalpha production. We investigated the TNFalpha -308 polymorphism in 143 unrelated Serbian patients with MS and 123 ethnically matched, healthy individuals using the allele-specific restriction fragment length polymorphism polymerase chain reaction technique. The frequency of the TNF2 allele was significantly decreased in MS patients (14%) in comparison with controls (24%; p = 0.044). The TNF2 allele had no influence on disease behavior, since it was not associated with the course and severity of MS in this group of patients. The result suggests that in the Serbian population polymorphism at position -308 of TNFalpha or at an adjacent locus might have a role in MS susceptibility.

[Analysis of mortality in cancer of the large intestine in a cohort group in Serbia from 1971 to 1996]. / Analiza mortaliteta od raka debelog creva u kohortama u Repubici Srbiji od 1971. do 1996. godine.

Colorectal cancer is one of the most frequent malignant neoplasms in both sexes within developed countries. In the Republic of Serbia(Serbia), colorectal cancer mortality in 1971 range 5 in females, and 4 in males; it became the second leading malignancy in 1982 in females (after breast cancer), and in 1992 in males (after lung cancer). The objective of this descriptive-epidemiological study was to examine colorectal cancer mortality in Serbian population, particularly the effect of cohort variations on death rates in defined age groups over the period 1971-1996. Mortality rates were calculated from unpublished national vital statistics data of the Institute of Statistics of the Republic of Serbia. To estimate the age effect on colorectal cancer mortality, specific death rates were computed for cohorts born between 1992-96 and 1972-76, and died at subsequent time periods. The mortality rates were adjusted by direct method, using the world standard population. Confidence intervals (CI) for death rates were assessed with 95% level of probability. In time trend analysis of mortality, Fisher's test was used as a significance test for linear regression coefficient. In the study period (1971-1996), a share of all digestive tumours in cancer mortality has decreased from 42.0% to 32.3%. However, the mortality risk of colorectal cancer and its share in cancer mortality have increased. For example, in men, the share of colorectal cancer in digestive cancer mortality increased from 20.7% (1971) to 32.8% (1996) and in overall cancer mortality from 7.5% to 10.5%. In women, the share of colorectal cancer in digestive cancer mortality increased from 23.0% (1971) to 35.6% (1996), and in overall cancer mortality from 8.5% to 11.6%. The average colorectal cancer age-adjusted death rates (1971-1996) were 11.2 per 100,000 men (95% CI: 10.1-12.3), and 8.3 per 100,000 women (95% CI: 7.7-8.9). The secular linear mortality trends showed significant increase both in males (y = 11.2 + 0.2x; p = 0.000), and females (y = 8.3 + 0.1x; p = 0.000). The highest rise in age-specific death rates, according to linear mortality trends, was observed in males over 65 years (7.8% annually), and females between 60 and 69 years (5.9% annually). In cohort analysis of age-specific rates in males, younger birth cohorts were compared with older ones. The increasing colorectal cancer mortality risk has been observed for ages over 40, with statistical significance in age groups over 45. In ages between 45 and 59, and over 60, the youngest birth cohorts were at 2 and 2.5-fold higher cancer mortality risk than birth cohorts of the oldest generations. For example, the age specific colorectal cancer death rates in a 70-74 year group were 2.5-fold higher in men born between 1922 and 1926 (139.3/100,000) than in cohorts born 25 years earlier (58.7/100,000). In cohort analysis of age-specific rates in females, changes in the age under 50 were not so expressive. In all age groups over 50, women of younger generations were at 2-fold higher cancer mortality risk than the oldest ones. The age specific colorectal cancer death rates in a 65-69 year group were doubled in women born between 1927 and 1931 (61.0/100,000), than in cohorts born 25 years earlier (30.5/100,000). According to the present mortality trends, the further increase in colorectal cancer death rates, especially in the ages over 40, should be expected in future generations. Consistent increase in mortality risk in all younger birth cohorts of older ages, as well as in successive five-year age groups of the observed generations, could reflect the continuous increase in colorectal cancer incidence attributed to predominantly environmental exposures.

Survival of multiple sclerosis patients in the Belgrade population.

The aim of this study was to estimate survival rates of multiple sclerosis (MS) patients in the Belgrade population, Yugoslavia, and furthermore, to determine the prognostic value of some demographic and clinical variables for survival. The cumulative survival probability was calculated by the Kaplan-Meier method. The prognostic value of different variables was assessed by univariate and multivariate analyses using the Cox regression model. In the Belgrade population, the cumulative 25-year survival probability of MS patients and the mean survival time from MS onset were 73.2% and 38 years, respectively. The univariate analysis showed that survival was significantly related to sex, age at onset, course of disease and monoregional initial symptoms. A multivariate model demonstrated that a relapsing-remitting course of MS and monoregional onset were predictors of a better prognosis. The presence of motor symptoms at the onset was found to be an independent predictor of a poorer outcome of MS.