Blood pressure levels in 7 to 14-year-old Belgrade children.

The objective of the work was to study blood pressure and some anthropometric characteristics in children. The study design included the prevalence study at Belgrade, Serbia and Montenegro. The study comprised 1651 subjects (809 boys and 842 girls) aged 7-14 years, that is, 2.6% of all relevant population. The average levels of systolic and diastolic blood pressures (SBP and DBP) were 113.4/70.3 mmHg in boys and 114.6/71.1 mmHg in girls. High SBP was present in 4.7% of boys and in 5.3% of girls. High DBP was found in 5.6% of boys and in 4.8% of girls. According to multivariate regression analysis, in boys SBP and DBP were significantly associated with age, body mass index (BMI) and subscapular skinfold, SBP was also associated with body weight, and DBP with triceps skinfold. In girls, SBP was significantly related to BMI, suprailiac skinfold and body height, and DBP was significantly associated with BMI, suprailiac and subscapular skinfolds. The results of the present study support the opinion that BMI is a significant predictor of blood pressure in children and point out to suprailiac skinfold in girls as a possible predictor of blood pressure.

Case-control study of multiple myeloma with special reference to diet as risk factor.

The case-control study was conducted in Belgrade (Yugoslavia) during the period 1994-1998. The objective of the study was to investigate factors related to the occurrence of multiple myeloma (MM). The study group consisted of 100 newly diagnosed MM patients and the same number of matched hospital controls. In the analysis conditional univariate and multivariate logistic regression were applied. According to multivariate analysis the following factors were significantly related to MM: smoking > or =25 cigarettes per day (Odds ratio--OR=6.7, 95% confidence interval--95% CI=1.3-34.3); having more than two brothers (OR=2.7, 95% CI=1.3-5.3), rheumatoid arthritis in personal history (OR=4.2, 95% CI=1.2-14.8), and frequent (4-7 times per week vs. lower frequency) consumption of yogurt (OR=3.1, 95% CI=1.6-6.0) and vegetables (OR=0.4, 95% CI=0.1-1.0).

Smoking as risk factor for cervical cancer.

In a matched case-control study which comprised 33 cases with cervical carcinoma in situ, 67 cases with invasive cervical cancer, and 100 hospital controls, ever-smoking was found to be significantly related to cervical cancer (Odds ratio = 5.9, 95% confidence interval = 1.2-29.3) after adjustment for a variety of confounding variables.

Risk factors for basal cell carcinoma.

The aim of this study was to assess the risk factors for basal cell carcinoma (BCC). A case-control study, carried out in two towns in Yugoslavia, comprised 200 BCC cases and 399 controls. For statistical analysis, univariate and multivariate logistic regressions were used. The risk factors found for BCC were: freckling before the age 15, seven or more weeks per year spent at the seaside during holidays (lifetime average), outdoor work during summer-time, occupational exposure to organic and non-organic dissolvents and organophosphatic compounds, use of tar for cosmetic purposes, and previous BCC in personal history. Subjects who tended to burn and not to tan after sun exposure also showed a significantly higher risk for BCC. Brown eyes and history of acne had a protective effect. This study confirmed the role of both constitutional and environmental factors in the development of BCC.

Mortality trends of malignant tumours of digestive organs in Belgrade, Yugoslavia, 1975-1997.

AIM: To analyse mortality trends of malignant digestive tract tumours. MATERIAL AND METHODS: Population of Belgrade (Yugoslavia) in the period 1975-1997. Mortality rates were standardized by direct method using world population as the standard. For time series, exponential trends were calculated by the use of three-year moving average rates. RESULTS: In males, the highest mortality rate was for stomach cancer: 14. 6 per 100,000 (average for the period 1975-1997), followed by cancer of liver and cancer of colon: 8.4/100,000, cancer of rectum: 8.1/100,000, cancer of pancreas: 7.3/100,000, oesophageal cancer: 2.8/100,000 and gallbladder cancer: 2.0/100,000. In males, upward mortality trends for carcinomas of colon, rectum, pancreas, oesophagus, gallbladder and bile ducts were observed. The mortality rates series for stomach cancer and liver cancer did not fit any usual trend function. In females, the highest mortality rate was also for stomach cancer 7.7 per 100,000, then for cancer of colon: 6.0/100,000, cancer of rectum: 5.3/100,000, cancer of liver: 4.4/100,000, cancer of pancreas: 4.4/100,000, gallbladder cancer 3.4/100,000 and oesophageal cancer: 0.8/100,000. In females, upward mortality trends were observed for colon and rectal cancer, cancer of pancreas, and gallbladder and bile duct cancer. Downward mortality trends were present for stomach cancer and liver cancer. Mortality rates series for oesophageal cancer did not fit any usual trend function. CONCLUSIONS: In the majority of digestive tracts cancers, an upward mortality trend was observed which is in keeping with the mortality trends of these malignant tumours in many other countries.

[Trends in mortality in Serbia, excluding the provinces, 1973-1994]. / Trend mortaliteta u Srbiji bez pokrajina, 1973-1994. godine.

The war and break up of former Yugoslavia began in 1991. In May 1992 the United Nations imposed economic sanctions on Serbia and Montenegro which were suspended only in November 1995. The purpose of this study was to assess the effects of the war and UN sanctions on health of the population of Serbia without the provinces of Vojvodina and Kosovo. The period 1973-1994 was studied. Mortality data were derived from unpublished and published materials of the Federal Institute of Statistics [1]. Refugees, who, because of civil war, came to Serbia and Montenegro from other parts of former Yugoslavia, were not counted as a part of the population when mortality rates were calculated. Mortality rates were standardized directly using the "European population" as the standard [2]. The least square method was used to fit mortality rates to different trend curves. Linear trend was used whenever it significantly (p < 0.05) demonstrated the existing mortality rates. To measure the possible effect of the war and sanctions (WAS) on mortality between 1991 and 1994, dummy variable (variable WAS) consisting of 0's and 1's was made to signify the passage from the period before and the period after the beginning of the war and sanctions [3]. Over the period 1991-1994, characterized by the war and UN sanctions, in women aged 25-34, 35-44 and 75-84, total mortality was significantly higher than expected on the basis of the trend for the preceding period (p = 0.006, p = 0.000 and p = 0.015 respectively). The opposite effect was found in the age group 85+ (p = 0.012)/Table 2. Of major causes of death, in age group 25-34, mortality from endocrine diseases increased more rapidly in both sexes (p = 0.000) and mortality from urogenital diseases in women decreased more slowly than expected (p = 0.006). On the other hand, in age group 85+ mortality was significantly lower for cardiovascular diseases in both sexes (p = 0.035 and p = 0.006), for respiratory diseases in men (p = 0.011) and for neoplasms in women (p = 0.006)/Table 4. In addition, in the years 1991 and 1992 the increase in mortality from injuries and poisoning was evident in men aged 15-24, 25-34 and 85+ years (Graph 5). Our results show that over the period 1991-1994 changes in mortality were present in some age groups and were caused by certain groups of diseases. In men, besides mortality of infectious disease which decreased more slowly during 1991-1993 than expected, [4], the main departures were found in the mortality from injuries and poisoning and in mortality from endocrine diseases. The excess of death due to injuries and poisoning in the age group 15-34 can be explained as a direct consequence of the war. There were no military operations on the territory of Serbia, but young men from Serbia were nevertheless engaged in the war in other republics of former Yugoslavia. The outstanding increase in mortality caused by injuries and poisoning in men aged 85+ has two explanations. The first is the fact that suicide rate which was on an average of 86 per 100,000 over the period 1984-1990 rose to 140 per 100,000 during the period 1991-1993. In the year 1994 it fell to 92 per 100,000. Since there were no great differences in percent distribution of suicides among all deaths caused by injuries and poisoning in the two periods (27% in 1984-1990 and 20% in 1991-1993), it is clear that the rise of suicidal rate cannot be the only explanation for increased mortality from injuries and poisoning. In a situation when medical services were badly overextended (lack of medical equipment and proper maintenance of the existing equipment, lack of drugs and other medical inputs, a large number of wounded coming from Bosnia as well as numerous refugees) [5, 6], priority had to be given to younger age groups. Higher mortality due to endocrine diseases in men and women aged 25-34 years and higher mortality due to urogenital diseases in women of the same ages can be most probably attributed to poor medical supplies. Although formally excluded from the international economic blockade medical supplies were in practice badly affected by the fact that the dinar was rendered almost worthless and the Ministry of Health could no longer pay the medical inputs. In addition, bureaucratic hurdles of getting clearance from the UN added months of delay and made foreign companies unwilling to trade [5, 7]. The supply and distribution of drugs within the country was also irregular because communication lines were cut and local companies were not prepared to risk distributing drugs that nobody could pay for [7]. Higher than expected mortality in women aged 25-44 over the period 1991-1994 could be probably explained by their higher vulnerability (period of fertility) and the fact that the main burden of family survival was on them, so they had no time to think and to take care of their health. (ABSTRACT TRUNCATED)

[Prevalence of risk factors for cardiovascular diseases in aged persons]. / Prevalencija faktora rizika od kardiovaskularnih bolesti kod starih osoba.

The prevalence study comprised randomly selected sample of 131 females and 109 males aged 70 years and over in the urban area of Kragujevac community. The purpose of this study was to assess the prevalence of cardiovascular diseases, as well as the prevalence of factors important for the onset of cardiovascular diseases. Ischaemic heart disease was found in 36.6% of females, and in 25.7% of males. Six patients (two males--1.8% and five females--3.1% were with cerebrovascular disorders. The majority of the participants in the study (70.6% of males and 80.9% of females) were hypertensive. The mean value of systolic blood pressure was 166.2 mmHg, and the mean value of diastolic blood pressure was 93.3 mmHg. The mean values systolic and diastolic blood pressure values, serum level of total cholesterol, high density and low density cholesterol and glucose were relatively high and higher in women than in men. Serum triglycerides were the same for both sexes--1.5 mmol/l. The majority of patients included in the study had normal body mass index and frequently were the low-fat diet and physically active. Only 13.2% were active smokers. It could be concluded that some of main risk factors for cardiovascular diseases were not frequent in this population of the elderly.

Prevalence of rheumatoid arthritis in Belgrade, Yugoslavia.

OBJECTIVE: To determine the prevalence of chronic arthritis with special reference to rheumatoid arthritis. METHOD: A cross-sectional study was performed during the years 1990 and 1991 in a randomly selected sample of the urban population of Belgrade. RESULTS: Out of 2184 participants, > or = 20 yr old, surveyed by questionnaire, 756 (34.6%) reported peripheral joint complaints. Of those with complaints, 621 (82.1%) agreed to undergo detailed examination. Arthritis was diagnosed in four men (one had rheumatoid arthritis and three had spondylarthropathy with peripheral arthritis) and 11 women (three had rheumatoid arthritis, one had B27-positive polyarthritis and seven had undifferentiated chronic arthritis). The prevalence of chronic arthritis in the adult population was 0.69% (0.35% for men and 1.05% for women). The prevalence for rheumatoid arthritis was 0.18% (0.09% for men and 0.29% for women). Re-examination of 15 individuals with chronic arthritis 3 yr later showed changes in diagnosis only in those patients who at baseline examination had undifferentiated chronic arthritis. CONCLUSION: According to the results obtained, the urban population of Belgrade is among populations with a low prevalence of rheumatoid arthritis.

[Survival analysis in patients with cutaneous malignant melanoma]. / Analiza prezivljavanja bolesnika s malignim melanomom koze.

INTRODUCTION: Cutaneous malignant melanoma (MM) takes only 3% of all malignant tumours of the skin, but for reason of its increased frequency and pronounced tendency to rapid growth and metastases, it causes 60% of total lethal outcomes due to malignant tumours of the skin [1]. Primary MM is a diagnostic problem because of the great variety of its clinical features. Asymmetric configuration, irregular border, speckled color(r)diameter of more than 6 mm, and elevation of the surface, suggest suspicion of malignant alteration, but even then misdiagnosis is possible. For the final diagnosis of MM histopathological confirmation is necessary. The method to use is the extensive excisional biopsy of the lesion and its borders [2]. Histopathological diagnosis is based on microscopic findings which include: histogenetic type of MM, tumour thickness according to Breslow, level of invasion according to Clark, presence of ulceration, grade of lymphocyte infiltration, mitote rate, type of cells, presence of melanin in cells [2, 3]. PATIENTS AND METHODS: A five-year survival of patients with cutaneous malignant melanoma (MM) was studied according to sex, age and distinct features of the tumour: site, type of initial therapy, stage of the disease, time from the first signs of the disease to diagnosis of MM, histological findings (histogenetic type, Breslow's tumour thickness, Clark's level of invasion, presence of ulceration, degree of lymphocyte infiltration, number of mitoses, type of cells, intensity of pigmentation) and presence of metastases. The retrospective study included 336 patients with cutaneous MM. There were 185 female (55.1%) and 151 male patients (44.9%), aged 14-83 years, mean age 48.8 years, who were treated at the institute of Oncology and Radiology in Belgrade from 1978 to 1990. The mean follow-up was 60 months (1-144 months). Melanoma in situ had 16 (4.1%) patients. Stage I had 45 patients (14.1%), stage II 163 (48.5%), stage III 83 (24.7%) and stage IV 29 (8.6%) patients. Acral location on hands and feet had 40 (11.9%) patients, on head and neck 36 (10.7%), on the trunk 146 (43.5%) and on the extremities (except hands and feet) 114 (33.9%) patients. Nodular melanoma (NM) was the most frequent histogenetic type revealed in 150 (44.6%) patients, superficial spreading melanoma (SSM) in 105 (31.1%) patients, acral melanoma (AM) in 39 (11.5%) and lentigo malignant melanoma (LMM) in 32 (9.4%) patients (Table 1). Five-year survival rate was calculated according to Kaplan-Meier's method and significance of the difference between some categories was tested by Long-Rank's test; the significance less than 0.05 was accepted. RESULTS: Statistically highly significant differences in a five-year survival (p < 0.01) were related to sex p = 0.0005, age p = 0.0017, tumour site p = 0.0025, initial therapy p = 0.0036, stage of MM p = 0.0000, histological features of the tumour p = 0.0000 and presence of metastases p = 0.0000. A better five-year survival prognosis was found in female patients (64.5%) compared to male patients 44.5%, aged 27-46 years (87.3%) compared to patients younger than 26 years (43.5%); patients with melanoma on the extremities (except hands and feet) had a better five-year survival (66.7%) compared to patients younger than 26 years (43.5%); patients with melanoma on the extremities (except hands and feet) had a better five-year survival (65.7%) compared to patients with melanoma on the trunk or acral melanoma (47.3%). Higher survival was recorded in the group of patients with the tumour 1.5-3 mm thick, in whom the tumours was excised and regional nodes dissected as the primary therapy (66.9%) compared to those who underwent excision of the tumor only (48.8%). A five-year survival of patients with MM in situ was 100% for those in stage I; 85% in stage II; 42% in stage III, 16% and 0% in stage IV. The patients in whom the diagnosis of MM was established within 10 months after the first signs of the disease had significa

Infectious diseases mortality in central Serbia.

STUDY OBJECTIVE: To determine the influence and the effect of the war in the former Yugoslavia and of the United Nations economic sanctions on mortality from infectious diseases. DESIGN: This was a descriptive study analysing mortality data time series. SETTING: Central Serbia, Yugoslavia. PARTICIPANTS: The population of central Serbia was the subject of the study (about six million inhabitants). MEASUREMENTS: Mortality rates were standardised directly, using the "European population" as the standard. Regression analysis and analysis of covariance were undertaken. MAIN RESULTS: During the period 1973-93, mortality from infectious diseases showed a decreasing trend. From 1987-90, and infectious diseases was significantly higher than expected on the basis of the trend for the preceding period (p = 0.020 and p = 0.00). In addition, there was a statistically significant departure from the preceding trend (p = 0.036) in men between 1991 and 1993 (the period of the war and UN sanctions)--the main effect being in younger age groups. CONCLUSION: The economic crisis in the former Yugoslavia during the 1980s followed by the outbreak of the war and the damaging effects of UN economic sanctions had a distinctly adverse effect on mortality from infectious diseases.

Effect of caffeine intake during pregnancy on birth weight.

The aim of this study was to examine the effect of caffeine consumption during pregnancy on birth weight and its possible interaction with smoking. The sample included 1,011 women who were interviewed during their first 3 days after delivery in one of the hospitals of Belgrade, Yugoslavia. A significant reduction in birth weight was found to be associated with an average caffeine intake of > or = 71 mg per day, after adjustment for gestational age, infant sex, parity, and maternal height and weight, but only in infants born to nonsmoking mothers.

Malignant tumors in families of thyroid cancer patients.

A case-control study comprised 177 patients with various types of thyroid cancer and the same number of hospital controls individually matched by age, sex and place of residence. Malignant tumors were more frequent among first and second degree relatives of cases as compared to controls. The odds ratio (95% confidence interval) was 2.43 (1.33-4.44) and 5.33 (1.77-16.01) respectively. The most frequent were cancers of uterus and stomach with odds ratio of 6.00 (1.61-22.36) and 9.00 (1.64-49.35). Thyroid cancer was present only in first-degree relatives of two cases and none of controls.

[Epidemiological characteristics of cancer of the pancreas in Serbia (without provinces)]. / Epidemioloske odlike raka pankreasa u Srbiji bez pokrajina.

Over the period from 1980 to 1993 the average age standardized mortality rate of cancer of the pancreas was 4.51 per 100000 of population (8.83% per hundred thousand in men and 3.37% per hundred thousand in women). Mortality rates were very low below the age of 34-0.09% per hundred thousand (0.14% per hundred thousand in men and 0.04% per hundred thousand in women). With aging rates showed steady increase, and they were the highest in the age group of 75 and more years--37.21% per hundred thousand (42.60% per hundred thousand in men and 33.60% per hundred thousand in women). During the period observed mortality of cancer of the pancreas showed an increasing trend (y = 3.50 + 0.11x), present in both sexes (y = 4.49 + 0.14x in men and y = 2.73 + 0.07x in women) and in all age groups exept in women aged 0-34 and 35-44 in whom a slightly decreasing trend was found.

Risk factors for laryngeal cancer.

This case-control study comprised 100 histologically verified laryngeal cancer patients and 100 hospital controls matched with cases by sex, age and place of residence. The following variables were tested for their association with cancer of the larynx: marital status, educational level, hard liquor consumption, cigarette smoking, unfavorable working conditions, sudden and frequent temperature changes at work, cold housing, loud speech at work, frequent hoarseness, frequent and persistent cough, persistently swollen neck glands, tonsillectomy and laryngeal surgery. According to conditional logistic regression analysis, significant association with laryngeal cancer was found for unfavourable working conditions for more than 10 years (OR = 4.36; 95% CI = 1.92-9.91), hard liquor consumption for more than 5 years (OR = 2.59; 95% CI = 1.14-5.87), cigarette smoking for more than 10 years (OR = 7.29; 95% CI = 2.41-22.09), tonsillectomy (OR = 4.80; 95% CI = 1.61-14.30) and frequent and persistent cough prior to disease (OR = 8.17; 95% CI = 1.72-38.76).

[Epidemiologic characteristics of malignant tumors of the digestive tract in Serbia 1969-1990]. / Epidemioloske karakteristike malignih tumora digestivnog trakta u Srbiji za period 1969-1990. godine.

The epidemiological situation of the chosen malignant tumors of digestive tract for the period 1969 - 1990, was analyzed in Serbia without autonomous provinces, based on the data of mortality rate. During this observed 22-year period the average standardized mortality rate (%000) was lowest for the oesophageal cancer (men - 2.2; women - 0.6) and gall bladder cancer (1:1.8) and highest for the stomach cancer (14.3:7.1). Men in relation to women died more of oesophageal cancer (3.7 times), stomach (2 times), colon (1.2 times), rectum (1.4 times) and pancreas (1.7 times). In both male and female population the highest average specific mortality rates were observed for persons over the age of 75 for all observed malignancies of digestive system. The standardized mortality rates for both sexes for the period 1969-1990 demonstrated the trend of increase for the cancers of oesophagus, colon, rectum, gall bladder, and pancreas, and the decrease for the stomach cancer.

[Epidemiologic characteristics of hemorrhagic fever with renal syndrome in Serbia 1979-1992]. / Neke epidemioloske karakteristike hemoragijske groznice sa bubreznim sindromom u Srbiji u periodu od 1979. do 1992.

Data on the incidence and deaths of hemorrhagic fever with kidney syndrome (HFKS) in Serbia 1979-1992 were analyzed. Mostly sporadic cases of illness were registered, but for two years it was epidemy in 1986., with 34 and in 1989., with 42 ill. The morbidity rate was between 0.01 and 0.72 /10000 (on average 0.16 /0000). Most often men (72.7%) between 20-39 years old, industrial workers (33.3%) got affected, whose place of living was in the rural environment. The lethality rate was high--7.6%, in epidemies 11.8%, and during sporadic occurrence 1.8%. The ill were registered during the whole year, but the characteristic season of illness was May--September with 76.3% of the total number of the ill. The topographic distribution of the ill showed that the greatest number of the ill with HFKS (45.8%) occurred in three counties in Serbia--in Ivanjica, Cacak and Lucani.

Malignant tumors in family members of colorectal cancer patients.

A case-control study comprised 286 colorectal cancer (CRC) patients and the same number of hospital controls individually matched by age, sex and place of residence. Both CRC and other malignant tumors were more frequent among first and second degree relatives of cases as compared to controls. The odds ratio (and 95% confidence interval) for CRC was 6.67 (2.34-19.01) and for cancers of other sites 1.6 (0.97-2.62).

[Epidemiologic-anamnestic study of stomach cancer in relation to nutrition]. / Epidemiolosko-anamnesticka studija raka zeluca u odnosu na ishranu.

Correlation between the disease and nutritional habits was evaluated in this epidemiologic-anamnestic study. It included 80 patients with the confirmed diagnosis of stomach cancer and the same number of controls selected from five hospitals in Belgrade. Both groups were matched by the sex, age and living place. McNemar's test was used for testing differences in exposure to the hypothetic factors. Based on the analysis of various food intake frequency it could be concluded that nutrition of patients with stomach cancer was, in comparison with the one taken by the control group, poorer in animal proteins, vegetables and citrus fruits, and rich in cereals processed in the form of various pastas and sweets, delicatessen, canned food as well as fruit rich in unsaturated fatty acids (nuts).