Quality of Life Indicators in Patients Operated on for Breast Cancer in Relation to the Type of Surgery-A Retrospective Cohort Study of Women in Serbia.

Background and objectives: Quality of life (QoL) after breast cancer surgery is an important public health issue. The aim of this study was to determine the relationship between the levels of perceived quality of life in patients operated on for breast cancer in relation to the type of surgery, using the standardized questionnaires. Materials and Methods: We assessed 425 women after surgery for breast cancer. The assessment included the application of the WHOQOL-bref (The World Health Organization Quality of Life-Bref), and FACT-B (Functional Assessment of Cancer Therapy-Breast) questionnaires. The statistical analysis of the data included multiple linear regression and correlation tests. Results: Multiple linear regression analysis found that education, existence of comorbidities, time elapsed since surgery, and type of surgery were significant predictors of overall quality of life. Women's overall quality of life and general health has increased by 0.16 times for each subsequent year of surgery, and by 0.34 times for each subsequent higher education level. Breast-conserving surgery or mastectomy with breast reconstruction were statistically significant (ß = 0.18) compared to total mastectomy. Conclusions: There is a significant difference in the quality of life perceived by patients in whom the breast has been preserved or reconstructed in relation to patients in whom total mastectomy has been performed.

Trends in thyroid cancer incidence and mortality in Central Serbia, 1999-2014.

INTRODUCTION: Thyroid cancer (TC) is the most common malignant disease of the endocrine system. The incidence of the TC has been increasing worldwide, especially in female population. However, mortality from TC is low in both males and females. The objective of the paper was to determine and to analyze incidence and mortality trends of TC in males and females in the central Serbia in the period 1999-2014. METHOD: In this descriptive study data from the Serbian Cancer Registry were used. Crude and age-standardized rates (ASRs) of incidence and mortality were calculated. Trend and annual percentage change (APC) of the incidence and mortality rate with corresponding 95% confidence intervals (CI) were calculated by performing Joinpoint regression analyses. RESULTS: A total number of new cases of TC was 3113. TC was diagnosed in 2343 females and 770 males (female-to-male ratio, 3:1). A total number of fatal cases was 770 (while 504 female and 266 male died from TC, female-to-male ratio, 1.9:1). TC was not common before 30 years of age. The highest incidence was recorded both in males and females aged 50-59. Joinpoint regression analysis showed the statistically significant increase of ASRs of TC incidence in males in 1999-2014 period with APC 6.2% (95% CI: 4.2-8.3, p < 0.001) and there was also significant increase of ASRs of TC incidence in females in the same study period with a APC 6.1% (95% CI: 4.2-8.0, p < 0.001). Joinpoint regression analysis showed an insignificant increase of ASRs of TC mortality in males with APC 2.4% (95% CI: -0.5-5.5, p = 0.1). There was an insignificant decrease of ASRs of TC mortality in females with APC -1.3% (95% CI: -4.4-1.9, p = 0.4). CONCLUSION: The increasing trend of age-standardized incidence rates of TC both in males and females and decreasing trend of age-standardized mortality rates during the observed period were registered. Females had higher age-standardized incidence and mortality rates than males. Female to male ratio of incidence was 3:1 and for mortality 1.9:1. Measures of primary and secondary prevention are needed.

[Influence of demographic and socioeconomic characteristics on the quality of life].

INTRODUCTION: The quality of life is a multidimensional concept, which is best expressed by the subjective well-being. Evaluation of the quality of life is the basis for measuring the well-being, and the determination of factors that determine the quality of life quality is the basis for its improvement. OBJECTIVE: To evaluate and assess the determinants of the perceived quality of life of group distinguishing features which characterize demographic and socioeconomic factors. METHODS: This was a cross-sectional study of a representative sample of the population in Serbia aged over 20 years (9479 examinees). The quality of life was expressed by the perception of well-being (pleasure of life). Data on the examinees (demographic and socioeconomic characteristics) were collected by using a questionnaire for adults of each household. To process, analyze and present the data, we used the methods of parametric descriptive statistics (mean value, standard deviation, coefficient of variation), variance analysis and factor analysis. RESULTS: Although men evaluated the quality of life with a slightly higher grading, there was no statistically significant difference in the evaluation of the quality of life in relation to the examinee's gender (p > 0.005). Among the examinees there was a high statistically significant difference in grading the quality of life depending on age, level of education, marital status and type of job (p < 0.001). In relation to the number of children, there was no statistically significant difference in he grading of the quality of life (p > 0.005). CONCLUSION: The quality of life is influenced by numerous factors that characterize each person (demographic and socioeconomic characteristics of individual). Determining factors of the quality of life are numerous and diverse, and the manner and the strength of their influence are variable.

[Characteristics of reproductive health of women in their generative age].

INTRODUCTION: Any research of reproductive health has to encompass the relevant connotations of this complex term. In order to establish relevant multidimensional characteristics, it is necessary to assess intercorrelations of the characteristics most commonly used to describe it. OBJECTIVE: Our aim was to describe the characteristics of reproductive health and to establish their significance in describing this term. METHODS: Within the study of health of adult inhabitants of Serbia, on the sample of 2,817 women aged 20-49 years, the data on different reproductive health characteristics were collected by way of a structured questionnaire. By way of factorial analysis (principal components method, Kaisser Varimax criterion), representative characteristics (factors) were selected out of a large number of characteristics, describing reproductive health of women in a multidimensional way, interrelationships of the factors were explained, and carriers--the most important individual characteristics--were selected for further analysis. RESULTS: The characteristics of female reproductive health in Serbia are poor, both from the health policy standpoint and in comparison with other countries. Reproductive health describes 7 relevant factors and their carriers (characteristics which best reflect the variability of characteristics involved in a factor). These involve sexual behaviour (self-assessed HIV infection risk), contraception (use of contraceptive devices on one's own initiative), adequate protection of reproductive health (usage of gynaecological services even when healthy), abortions (pregnancy outcome), HIV control (HIV testing usage), postpartal protection (visits of field nurses after being discharged from maternity ward) and reproductive period (doctor visits after being discharged from maternity ward). CONCLUSION: All the characteristics of reproductive health used in various studies are not equally important in the description of this complex phenomenon. Factorial analysis can explain intercorrelations of the studied characteristics and make possible the selection of those most representative.

[Determinants of the most significant characteristics of reproductive health].

INTRODUCTION: Reproductive health of women is determined by females' demographic and socio-economic characteristics, their behaviour, and the complex of environmental factors. OBJECTIVE: The paper examines the predictive impact of personal and environmental characteristics, health and healthcare characteristics regarding the most important aspects of reproductive health. METHODS: From a sample of 2,718 women, aged 20-49 years, we collected information on various characteristics using a structured questionnaire. Based on factorial analysis (principal components method, Kaisser Varimax criterion) we selected representative variables (factors), describing personal (demographic and socio-economic) characteristics of women, their environment (family, household, community), health (attitudes towards health, life-style, health status), healthcare (independent) and the characteristics of reproductive health (dependent variables). The predictors were analyzed by multiple regression and correlation. RESULTS: Sexual behaviour was determined by socio-economic status, personal tidiness, rest, presence of risk factor(s), health evaluation and attitude toward personal responsibility, trust in physicians etc. The predictors of contraception involved satisfaction with one's own health, serious health problems, health evaluation. The presence and number of abortions were determined by personal psychological maturity, rest, risk factors, life-style, health evaluation and its manifestations, and the continuity and timely healthcare.The predictors of adequate protection of reproductive health involved the cultural level of the community, financial standing of the household, satisfaction with one's own life, tidiness and rest, presence of risk factors, health evaluation, attitude towards personal responsibility, and trust in physicians. HIV control was determined by satisfaction with one's own life, physical activity of women, presence of serious health problems, and the content of primary healthcare. Postpartal protection was determined by the cultural level of the community, reasons for dissatisfaction with one's own life, presence of risk factors and deficiencies, and timely contraception. The predictors of reproductive period duration are availability of health care in a community and personal tidiness of women. CONCLUSION: The study confirmed predictive impact of most of the studied characteristics.

Diagnostic value of neurophysiological tests in the diagnosis of brain death--do we need changes in national guidelines?

For a final diagnosis of brain death one needs particular proof that the brain has fully stopped functioning. In this respect, diagnostic tests need to be used to confirm the clinical findings. Since in different countries there are various national guidelines for the determination of brain death, the aim of this study is to point to the diagnostic value of electroencephalography (EEG) and evoked potentials (EP) in verifying brain death. The need is emphasized for the two methods to be used in combination, and, accordingly, for the current national guidelines to be changed in our country and also in other countries round the world.