Associations of fatty acids composition and estimated desaturase activities in erythrocyte phospholipids with biochemical and clinical indicators of cardiometabolic risk in non-diabetic Serbian women: the role of level of adiposity.

Introduction: Fatty acids (FAs) composition and desaturase activities can be altered in different metabolic conditions, but the adiposity-independent associations with clinical and biochemical indicators of cardiometabolic risk are still unclear. This study aimed to analyze the associations of FAs composition and estimated desaturase activities with anthropometric, clinical, and biochemical cardiometabolic risk indicators in non-diabetic Serbian women, and to investigate if these associations were independent of the level of adiposity and other confounders. Methods: In 76 non-diabetic, otherwise healthy Serbian women, aged 24-68 years, with or without metabolic syndrome or obesity (BMI=23.6±5.6 kg/m2), FA composition in erythrocyte phospholipids was measured by gas-liquid chromatography. Desaturase activities were estimated from product/precursor FAs ratios (D9D:16:1n-7/16:0; D6D:20:3n-6/18:2n-6; D5D:20:4n-6/20:3n-6). Correlations were made with anthropometric, biochemical (serum glucose, triacylglycerols, LDL-C, HDL-C, ALT, AST, and their ratios) and clinical (blood pressure) indicators of cardiometabolic risk. Linear regression models were performed to test the independence of these associations. Results: Estimated desaturase activities and certain FAs were associated with anthropometric, clinical and biochemical indicators of cardiometabolic risk: D9D, D6D, 16:1n-7 and 20:3n-6 were directly associated, while D5D and 18:0 were inversely associated. However, the associations with clinical and biochemical indicators were not independent of the associations with the level of adiposity, since they were lost after controlling for anthropometric indices. After controlling for multiple confounders (age, postmenopausal status, education, smoking, physical activity, dietary macronutrient intakes, use of supplements, alcohol consumption), the level of adiposity was the most significant predictor of desaturase activities and aforementioned FAs levels, and mediated their association with biochemical/clinical indicators. Vice versa, desaturase activities predicted the level of adiposity, but not other components of cardiometabolic risk (if the level of adiposity was accounted). While the associations of anthropometric indices with 16:1n-7, 20:3n-6, 18:0 and D9D and D6D activities were linear, the associations with D5D activity were the inverse U-shaped. The only adiposity-independent association of FAs profiles with the indicators of cardiometabolic risk was a positive association of 20:5n-3 with ALT/AST ratio, which requires further exploration. Discussion: Additional studies are needed to explore the mechanisms of the observed associations.

Occupational and non-occupational risk factors correlating with the severity of clinical manifestations of carpal tunnel syndrome and related work disability among workers who work with a computer.

The contribution of certain occupational and personal factors to the development of carpal tunnel syndrome (CTS) is still uncertain. We investigated which specific occupational and non-occupational factors correlate with the level of clinical manifestations and work disability related to CTS. The study included 190 workers who work with a computer and have diagnosed CTS (100 men, 90 women, aged 20-65 years). Subjective experience of CTS-related impairments was assessed with the Symptom Severity Scale (SSS) and the Functional Status Scale (FSS) of the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ). The objective, neural impairments were tested with electrodiagnostics (EDX), whereas CTS-related work disability data were collected from medical records. We found a high inter-correlation between BCTQ, EDX, and work disability data. These also showed high correlations with certain occupational factors (duration of computer-working in months and hours spent daily in computer-working, certain ergonomic, microclimatic, and other occupational conditions) and non-occupational factors (demographic and lifestyle factors: nutritional status, diet, smoking, alcohol consumption, and physical activity). Despite its limitations, our study has identified occupational and non-occupational risk factors that can aggravate CTS and work disability, but which can also be improved with workplace and lifestyle preventive and corrective measures. More research is needed, though, to establish the possible causal relationships and the independent influence of each of those risk factors.

Vitamin D Status and Its Correlation With Anthropometric and Biochemical Indicators of Cardiometabolic Risk in Serbian Underground Coal Miners in 2016.

The status of vitamin D in underground working coal miners and its association with their cardiometabolic health is rarely studied. This study aimed to examine vitamin D (VitD) status in Serbian underground coal miners and to correlate it with anthropometric and laboratory indicators of cardiometabolic risk. Nutritional data (food frequency questionnaire, FFQ, and two times repeated 24 h recall), anthropometric data (including segmental analysis by bio-impedance analyzer TANITA BC-545N), arterial tension, and biochemical and hematological data of 103 coal miners (aged 22-63 years) were correlated with their late summer (early September) serum 25 (OH)D levels (measured by HPLC). 68.9% of the studied coal miners were overweight/obese, and 48.5% had metabolic syndrome. Their mean VitD nutritional intakes were low: 5.3 ± 3.8 µg/day (FFQ) and 4.9 ± 8 µg/day (24 h recalls), but their mean serum 25 (OH)D levels were surprisingly high (143.7 ± 41.4 nmol/L). Only 2.9% of the coal miners had 25(OH)D levels lower than 75 nmol/L (indicating an insufficient/deficient status), while 63.2% had values above 125 nmol/L (upper optimal limit), and even 10.7% had values above 200 nmol/L. There were no statistical differences in 25 (OH)D levels in the coal miners with or without metabolic syndrome (or overweight/obesity). Interestingly, 25(OH)D levels had significant positive correlations with body mass index (BMI), fat mass (FM), fat mass percentage (FM%), limbs FM%, serum triglycerides, GGT, AST, ALT, and ALT/AST ratio, and had significant negative correlations with serum HDL-cholesterol and age. All these correlations were lost after corrections for age, FM, FM%, and legs FM%. In Serbian coal miners, high levels of early September VitD levels were observed, indicating sufficient non-working-hour sun exposure during the summer period. Furthermore, the unexpected positive correlations of VitD levels with anthropometric and biochemical parameters indicative of obesity, metabolic syndrome, and fatty liver disease were found. More research is needed on the VitD status of coal miners (particularly in the winter period) and its relationship with their cardiometabolic status.

The relationship between occupational stress, health status, and temporary and permanent work disability among security guards in Serbia.

Purpose. This study aimed to examine the influence of occupational stress on health status and work disability among security guards in Serbia. Methods. Three hundred and ninty nine male security guards (aged 25-65 years) were examined during regular medical preventive check-ups at the Institute of Occupational Health. Data on their health status and permanent and temporary work disability were obtained, and correlations with the levels of occupational stress (measured by occupational stress index [OSI] questionnaire) were analysed. Results. A high prevalence of health impairments, including diabetes (38.8%), dyslipidaemia (82.7%), hypertension (69.9%) and metabolic syndrome (77.7%), was found. Highly significant correlations were shown between reported levels of total stress at work (total OSI score) and measured values of glucose, lipids, blood pressure, heart rate, Framingham cardiovascular risk scale, occurrence of diabetes and impaired fasting glucose, dyslipidaemia, hypertension, metabolic syndrome, coronary heart disease, cerebrovascular insults, degenerative eye-fundus changes, and temporary and permanent work disability. All of these correlations remained significant even after adjustments for age, body mass index and smoking status. Regression analysis confirmed the independent effect of occupational stress on the analysed parameters. Conclusions. There is a significant independent impact of occupational stress on development of health impairments and work disability among security guards.

The importance of individual predictors and psychosocial working conditions in assessing the work ability index of people with low vision.

Purpose. This investigation aimed to clarify the importance of individual predictors and psychosocial working conditions in estimating the work ability index (WAI) of people with impaired vision. Materials and methods. This study utilized a quantitative cross-sectional design involving 450 respondents who had low vision with visual acuity in the range of 0.05-0.3 and a control group of 150 respondents with visual acuity in the range of 0.5-0.3. The investigation was conducted using the standardized instruments of the Copenhagen psychosocial questionnaire (COPSOQ) and the WAI. Results. The average WAI score of the respondents with low vision was 30.1 ± 4.1 and that of the control group was 34.7 ± 3.4. Results indicated a positive COPSOQ/WAI correlation in the following domains: work importance; career prospects; rewards/feedback; role and definition; quality of management; social support; job satisfaction; health condition. Negative correlations were indicated in the following domains: quantitative, cognitive and emotional demands; exhaustion; stress. Conclusions. The WAI of people with low vision is both positively and negatively impacted via different intensities associated with complex correlations, including: gender; age; profession; stress propensity; quantitative, qualitative and emotional demands of work; specificity of work, professional education; presence of stressors.

The influence of specific aspects of occupational stress on security guards' health and work ability: detailed extension of a previous study.

In our earlier study of security guards, we showed that higher occupational stress was associated with health impairments (metabolic syndrome, diabetes, hypertension, cardiovascular diseases) and work disability. The aim of this study was to further explore the association of specific occupational stressors with health impairments and work disability parameters in 399 Serbian male security guards (aged 25-65 years). Ridge linear regression analysis revealed that, after controlling for age, body mass index, and smoking status, professional stressors including high demands, strictness, conflict/uncertainty, threat avoidance and underload were significant positive predictors of fasting glucose, triglycerides, total and LDL cholesterol, blood pressure, heart rate, Framingham cardiovascular risk score, and temporary work disability. The security profession is in expansion worldwide, and more studies are needed to establish precise health risk predictors, since such data are generally lacking.

Relationships of work-related psychosocial risks, stress, individual factors and burnout - Questionnaire survey among emergency physicians and nurses.

BACKGROUND: Psychosocial risks represent a great challenge for safety and health protection at work in Europe. The purpose of this study has been to determine the relationships of psychosocial risks arising from work, stress, personal characteristics and burnout among physicians and nurses in the Emergency Medical Service (EMS). MATERIAL AND METHODS: We performed a cross-sectional study based on a questionnaire survey which contained the Copenhagen Psychosocial Questionnaire (COPSOQ) and Copenhagen Burnout Inventory (CBI). RESULTS: A total of 88 physicians and 80 nurses completed the survey. Physicians demonstrated higher emotional (mean (M) ± standard deviation (SD) = 74.57±16.85) and cognitive (M±SD = 75.95±13.74) demands as compared to nurses. Both groups had high sensory demands and responsibilities at work, in spite of the low degree of their autonomy. The meaning of work, commitment to the workplace, and insecurity at work were high for both groups. Among all participants, stressful behavior and reactions were within the limits of low values (< 40) and coping strategies showed high values (> 60). Personal and patient-related burnout was high for both groups, where physicians were significantly affected by work-related burnout. The influence at work, degree of freedom at work, social support, sense of coherence, mental health, and problem-focused coping are negatively related to work-related burnout. CONCLUSIONS: Based on personal factors and coping styles, emergency physicians and nurses are representing a self-selective professional group that meets high work demands, great responsibility, strong commitment and insecurity at work. Burnout of physicians and nurses in the EMS tends to be ignored, although it has severe consequences on their mental and general health. Med Pr 2017;68(2):178-178.

The impact of occupational stress factors on temporary work disability related to arterial hypertension and its complications.

AIM: To determine which specific groups of occupational stress factors influence the duration of temporary work disability related to arterial hypertension and joint complications/co-morbidities. METHODOLOGY: Workers (n = 1398; 1009 in the exposed group, 389 in the control group) with arterial hypertension who worked at one workplace for a minimum of 10 years were divided into 10 subgroups, depending on the presence of joint complications/co-morbidities. The intensity of seven groups of occupational stress factors, the total score of Occupational Stress Index (OSI) and the average number of lost working days during 1 year were analysed. RESULTS: The number of lost working days due to arterial hypertension and joint complications/co-morbidities was significantly higher in the exposed group. In all subgroups of the exposed group there was a high correlation between the number of lost working days and the total OSI score. Specific occupational stress factors were associated with specific complications: High Demands with chronic myocardial infarction, Strictness with cerebral haemorrhage, Conflict/Uncertainty with cerebral infarction, Extrinsic Time Pressure with acute myocardial infarction, and Avoidance/Symbolic Aversiveness with non-insulin-dependent diabetes. CONCLUSION: There are specific groups of occupational stress factors which can influence the duration of work disability associated with certain complications and co-morbidities of arterial hypertension.

Work stress related lipid disorders and arterial hypertension in professional drivers - a cross-sectional study.

BACKGROUND/AIM: Occupational stress is a term used to define ongoing stress that is related to the workplace. The study was conducted to determine association of occupational stress index (OSI) and its aspects with arterial hypertension and lipid disorders using data from a cross-sectional survey of male professional drivers. METHODS: The cross-sectional study was performed in 439 professional drivers divided into groups (city- and intercity bus drivers, truck and taxi drivers). The OSI and OSI aspects (high demands, strictness, underload, extrinsic time pressure, noxious exposure, avoidance and conflict) were calculated using the standardized questionnaire. Determination of serum lipids, blood pressure (BP) and cardiovascular risk factors were done. RESULTS: A significant difference in prevalence of diagnosed hypertension and dyslipidemia was found along with a difference in total OSI and OSI aspects among examined subgroups of drivers. A total OSI was highest in city, high in intercity bus drivers, and the lowest one in truck and taxi drivers (82.79 +/- 3.5, 81.28 +/- 3.7, 73.75 +/- 3.5, 71.61 +/- 4.4, respectively; p < 0.01). Similar pattern showed triglycerides (TG), total cholesterol (TC) and LDL cholesterol and BP, while HDL-cholesterol showed reverse order (p < 0.01). Logistic regression analyses with multiple OSI aspects adjusted for age and years of exposure showed associations of total OSI with arterial hypertension [OR 5.5; 95% CI (2.24-7.95)] and dyslipidemia [OR 1.43 95% CI (1.09-2.80)]. Underload was the most important OSI aspect associated with the arterial hypertension [OR 1.18; 95% CI (1.04-2.58)] and elevated LDL cholesterol [1.26; 95 CI (1.19-2.1)]. A total OSI had a significant association with elevated LDL cholesterol [2.64; 95% CI (1.19-7.7)], triglycerides [OR 3.27; 95% CI (1.20-5.1)] and low HDL cholesterol [OR 3.29; 95% CI (1.8-5.8)] (p < 0.01). CONCLUSION: The study provides the evidence for the significant association of total OSI and underload with lipid disorders and elevated blood pressure in professional drivers, which could be a possible link between job stress and coronary heart disease. Regular periodical examinations and workplace interventions aimed to decrease total OSI and underload are important aspects in primary prevention and additional reduction of cardiovascular risk.

Predicting the biological effects of mobile phone radiation absorbed energy linked to the MRI-obtained structure.

The nature of an electromagnetic field is not the same outside and inside a biological subject. Numerical bioelectromagnetic simulation methods for penetrating electromagnetic fields facilitate the calculation of field components in biological entities. Calculating energy absorbed from known sources, such as mobile phones when placed near the head, is a prerequisite for studying the biological influence of an electromagnetic field. Such research requires approximate anatomical models which are used to calculate the field components and absorbed energy. In order to explore the biological effects in organs and tissues, it is necessary to establish a relationship between an analogous anatomical model and the real structure. We propose a new approach in exploring biological effects through combining two different techniques: 1) numerical electromagnetic simulation, which is used to calculate the field components in a similar anatomical model and 2) Magnetic Resonance Imaging (MRI), which is used to accurately locate sites with increased absorption. By overlapping images obtained by both methods, we can precisely locate the spots with maximum absorption effects. This way, we can detect the site where the most pronounced biological effects are to be expected. This novel approach successfully overcomes the standard limitations of working with analogous anatomical models.

[Effects of occupational stress on working ability of patients suffering from arterial hypertension].

INTRODUCTION: The aim of this research was to quantify the presence of occupational stressors and to analyze their effects on temporary and permanent working ability of workers with arterial hypertension. MATERIAL AND METHODS: The research included 817 workers. The study group consisted of 504 workers with arterial hypertension without other diseases or disorders, whereas the control group was composed of 313 healthy workers. RESULTS: The study group showed a significantly higher level of total occupational stress index as well as of the stress index related to high job demands, conflicts at work place, underload and time limit (p<0.001) compared to the control group. A positive and statistically significant correlation between total occupational stress index and systolic and diastolic blood pressure was found in the study group. The total level of occupational stress over 40 led to a significant increase of systolic and diastolic blood pressure in persons with arterial hypertension. The analysis of temporary working inability determined a statistically significantly higher level of lost workdays per a worker in the study group compared to the controls (p<0.001). The average number of lost workdays per a worker in a year in the study group increased statistically significantly along with the occupational stress index values at their work place (p<0.001). In the study group the number of workers eligible for disability retirement over a period of one year was significantly higher compared to the controls. The number of workers eligible for disability retirement in the exposed group increased statistically significantly along with occupational stress index values at their work place. CONCLUSION: The results show that occupational stress is a significant factor in the development of arterial hypertension and reduction of work ability of exposed workers.

Associations between the occupational stress index and hypertension, type 2 diabetes mellitus, and lipid disorders in middle-aged men and women.

INTRODUCTION: Retrospective and prospective studies show that stress at work is linked to an increased risk of hypertension, diabetes mellitus, and coronary heart disease. However, the nature of the contributory job stressors and biological mechanisms need further elucidation. OBJECTIVES: The study is aimed to determine the associations between aspects of the occupational stress index (OSI) and arterial hypertension, diabetes mellitus (DM) type 2, and lipid disorders in working middle-aged men and women. METHODS: The cross-sectional study involved 989 middle-aged men and women in different occupations. The OSI was calculated by using standardized questionnaires. The total participation rate was 93%. Occupational stressors were divided into seven groups: High Demands, Strictness, Underload, Extrinsic Time Pressure, Noxious Exposure, Avoidance, and Conflict/Uncertainty. Serum lipid levels, glucoregulation, blood pressure, and cardiovascular risk factors were measured. RESULTS: For both women and men, the total OSI score associated significantly with DM (women: odds ratio [OR] 2.4, 95% confidence intervals [CI] 1.67-3.45; men: 1.21, 1.15-1.45), any type of dyslipidemia (women: 1.54, 1.17-2.03; men: 1.31, 1.24-1.39), and arterial hypertension (women: 1.15, 1.10-1.21; men: 1.58, 1.49-1.68). The group as a whole showed associations between total OSI and low high-density lipoprotein (HDL) cholesterol, high total cholesterol, and high triglyceride levels. Of the OSI aspects, Underload associated significantly in both men and women with arterial hypertension (women: 3.48, 1.91-6.31; men: 2.71, 1.96-3.75) and dyslipidemia (women: 3.26, 2.13-4.99; men: 2.11, 1.76-2.52). Underload was also associated with several lipid abnormalities in the group as a whole. It associated with DM in women only (4.7, 2.84-7.81). All remaining OSI aspects also associated significantly and positively with DM in women only. Conversely, in male workers, but not female workers, High Demand, Conflict/Uncertainty, and Extrinsic Time Pressure associated significantly with arterial hypertension. Strictness and Conflict/Uncertainty associated positively with dyslipidemia in women only. Noxious Exposures associated positively with DM and arterial hypertension in women only. CONCLUSIONS: The study provides evidence for the association of work stress with metabolic disorders and hypertension. Total OSI associated significantly with DM type 2, arterial hypertension, and dyslipidemia in both genders. Different OSI aspects associated with these health issues in gender- and occupational-specific patterns. Underload, which represents lack of social communication, simple task preparation, and underestimation of working results, associated most strongly of all OSI aspects with disease in both the sexes.

[The influence of occupational stress on lipid status of road traffic professional vehicle drivers].

INTRODUCTION: Professional stress can damage all organs and systems of exposed workers. The aim of this study was to assess the influence of occupational stress on lipid state of exposed professional drivers in road traffic. MATERIAL AND METHODS: The atherogenic risk in vehicle drivers professionally exposed to stress was assessed by measuring total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol. The examination included a group of 200 vehicle drivers professionally exposed to stress. The occupational stress index was calculated using the standardized questionnaire authorized by Karen Belkic. Serum lipid parameters were examined by standard methods. RESULTS: All lipid parameters increased with the occupational stress index values. Atherogenic risk increased with the values of occupational stress index too. Workers exposed to occupational stress index over the 90 were at the highest atherogenic risk. CONCLUSION: The highest occupational stress index and the highest values of total cholesterol, triglycerides and LDL-cholesterol were recorded in professional bus drivers at inter urban traffic.

[Importance of D-dimer testing in ambulatory detection of atypical and "silent" phlebothrombosis].

BACKGROUND/AIM: Deep venous thrombosis (DVT) is a life-threatening condition, which could be manifested with discrete symptoms (silent DVT). High mortality and disability of patients with DVT indicate the importance of early diagnosis, especially of "silent" DVT. The aim of this paper was to evaluate of reliability of early detection model for diagnosing DVT in ambulatory patients by using clinical probability of DVT presence, D-dimmer test (DD) and ultrasound evaluation (US). METHODS: Ambulatory patients with suspected DVT were classified as "unlikely" and "likely" DVT by the Wells clinical model. The patients were randomly divided into the control and DD group. In the control group (629 patients) only US examination of lower limbs deep vein was done. All patients in the DD group (643 patients), with "unlikely" TDV, had DD, and in the positive patients US examination was done. In the "likely" patients US examination was done and negative US finding indicated DD test. Positive DD test was an indication for US examination after 7 days. The patients with initially excluded DVT were evaluated during 3 months. RESULTS: A total number of 1 272 patients were examined; 117 (9.19%) patients were with DVT--62 (9.640%) in the DD and 55 (8.74%) in the control group. During the follow-up periods in the DD group (with 582 initially excluded DVT) we registered DVT in only one patient (0.17%). It was significantly lower (p < 0.05) compared to the control group where we registered 7 (1.10%) DVT (a group with 581 initially excluded DVT). The applied DD diagnostic strategy for 70.7% (p < 0.001) reduced the need for US examination. CONCLUSION: The applied DD strategy in the diagnostic of DVT reduces the need for US examinations and reduces frequency of false negative results, with direct impact on cost and efficacy of procedures. DD diagnostic model should replace serial US examination in patients with suspect DVT.

Professional risk, knowledge, attitudes and practice of health care personnel in Serbia with regard to HIV and AIDS.

The aim of our investigation was to assess HIV/AIDS-related professional risk, knowledge, attitude and practice of health care workers in Nis. A cross-sectional study of health personnel from Primary Health Centre, Clinical Medical Centre and Dental Clinic in Nis was performed. The data were collected by an anonymous questionnaire. Mantel-Haenszel X2 testing and multiple logistic regression analysis were applied. Results show that 89% of health personnel perceived high professional risk of acquiring HIV infection. The risk perception of acquiring HIV infections was higher among those who were frequently exposed to patients' blood and other body fluids (OR = 10.1 95% CI = 3.1-32.5), and those who had treated HIV-positive patients (OR = 3.0 95% CI = 1.0-8.8). The majority of respondents had insufficient knowledge about the modes of HIV transmission. Nearly two thirds of health personnel agreed that every hospitalized patient should be tested for HIV, and more than four fifths of them agreed that their personal protection was more important than the confidentiality of patient's HIV/AIDS status. Twenty nine percent of health personnel use adequate protection during their daily work with patients. These findings indicated a need for urgent educational and training initiatives of HIV and AIDS for all categories of health care workers.

Serum lipids and glucose disturbances at professional drivers exposed to occupational stressors.

The aim of this study is to find association between some groups of occupational stressors and serum lipids and glucose concentrations in professional drivers in road traffic. The study included 417 male professional drivers (162 inter city bus drivers, 36 suburban bus drivers, 33 city bus drivers, 81 truck drivers, 71 official car drivers and 34 professional taxi drivers). Occupational stressors were identified and total occupational stress index score was measured by standardized questionnaire authorized by Karen Belkic. Occupational stressors were divided into seven groups (underload, high demand, strictness, extrinsic time pressure, noxious exposures, avoidance and conflict). Serum glucose and lipids concentrations (total cholesterol, LDL cholesterol, HDL cholesterol and triacylglycerols) were measured in study group of drivers. Maximal total OSI values were achieved in group of professional truck drivers. The highest values of serum glucose, total cholesterol, LDL cholesterol and triacylglycerols and the lowest values of serum HDL cholesterol were found at professional truck drivers. With the increase of occupational stress index, there is an increase of the serum glucose, total cholesterol, LDL cholesterol and triacylglycerols concentration in the exposed group of drivers. Specific analytes thresholds' level of occupational stress index exists.

Mortality of Roma population in Serbia, 2002-2005.

AIM: To describe and compare mortality and population changes in the Roma and non-Roma population in Serbia in 2002 and 2005. METHODS: The number of cases of death were obtained from the 2002 and 2005 Mortality Database and population data from the Population Census 2002. Standardized sex specific rates of non-traumatic and traumatic mortality in 2002 and 2005 were calculated in relation to the European standard population. We presented population pyramid and aging index for both populations in 2002 and compared sex specific standardized traumatic and non-traumatic mortality rates and the average age of death for 2002 and 2005. The causes of death were coded according to the 10th revision of the International Classification of Diseases (ICD-10) groups, and the proportional mortalities in the year 2002 and 2005 were compared between the Roma and non-Roma population using chi2 test. RESULTS: Standardized mortality rates were higher in the Roma than in the general population. Non-traumatic mortality rate in Roma men in 2002 was 18.2 per 1000 and in slightly decreased to 18.0 per 1000 in 2005; it was significantly higher than in non-Roma men in both years (11.9 per 1000 in 2002 and 12.5 per 1000 in 2005; P<0.001). Standardized non-traumatic mortality rate in Roma women decreased significantly from 16.78 per 1000 in 2002 to 14.89 per 1000 in 2005 (P=0.014), but it was still significantly higher than in non-Roma women (8.46 per 1000 in 2002 and 8.84 per 1000 in 2005; P<0.001). Morbidity structure indicated that the most common causes of death in the Roma population were cardiovascular diseases, neoplasms, and respiratory system diseases. In relation to the general population respiratory system diseases were denoted as main causes of deaths in significantly higher percent (6% vs 3% in 2002 and 7% vs 4% in 2005; P<0.001) and cardiovascular diseases in significantly lower percent (44%:55% in 2002 and 46%:57%; P<0.001). CONCLUSIONS: Our data show that mortality rates in the Roma population are significantly higher than in the general population, and morbidity structure of the most common causes of death significantly different from that of general population.

[External fixation combined with limited internal fixation in the treatment of pilon tibia fractures].

BACKGROUND/AIM: Intraarticular fractures of the tibial plafond (pilon fractures) belong to the group of most severe fractures. They are usually caused by high-energy trauma and frequently associated with a marked soft-tissue damage. Surgical treatment has replaced the traditional nonoperative treatment. The aim of this study was to present the results of the treatment of distal tibial intraarticular fracture by the use of internal fixation, as well as the combination of minimal internal fixation and external fixation. METHODS: The study included 47 patients with pilon tibia fractures who went through at the Clinic for Orthopedics and Traumatology, School of Medicine, Nis (1995-2004). Within the analayzed group there were 33 (70.2%) males and 14 (29.8%) females. The patients mean age was 45.8 years. In the first group, which consisted of 22 patients, open reduction and internal fixation of both the tibia and the fibula was performed in the two separate incisions. The second group consisted of 25 patients managed with external fixation by external fixator "Mitkovic" with limited internal fixation. Besides external fixation, a minimal internal fixation was performed by the use of Kirschner wires and screws. The patients were followed-up inside a 24-months-period. Results. The obtained was a substantially high number of complications after open reduction and internal fixation in the group of patients. There was no difference in a long-term clinical outcome. Postoperative osteitis, as the most severe complication in the management of closed pilon tibia fractures, was not registered in the second group. CONCLUSION: Considering the results obtained in this study, it can be concluded that external fixation by the "Mitkovic" external fixator with the minimal internal fixation is a satisfactory method for the tratment of fractures of the tibial plafond causing less complications than internal fixation.

[Splenic capping in the treatment of severe spleen injuries].

INTRODUCTION: Permanent and lifelong threat of developing fatal sepsis and other severe infections in splenectomized patients is an important reason for promoting splenic preservation. MATERIAL AND METHODS: Experimental preservation of severe spleen injuries (grade IV), with splenic-capping, was performed in 30 dogs, operated using Ketalar anesthesia. Spleen preservation and concomitant treatment of excessive hemorrhage were achieved by highly controlled "conic" compression of injuried spleen parenchyma, additional hemostatic Z-sutures and fibrin tissue adhesion. RESULTS: Satisfactory hemostasis and complete preservation of the spleen parenchyma damage were achieved in 20% by splenic capping splenorraphy, alone. Additional placement of hemostatic sutures was necessary in 30%, and concomitant application of serum thymic factor (STF) FTA (along with sutures) in 50% of patients. The above mentioned techniques were very effective in achieving hemostasis (100%), with no mortality and low rate of postoperative complications--6.7% (1 intrasplenic abscess and 1 adhesive ileus). CONCLUSION: Excellent results and efficacy, splenic capping-splenorraphy is the method of choice in the treatment of severe and multiple transcapsular spleen injuries with involvement of segmental vessels.

[Blood pressure, heart rate and lipids in professional handball and water polo players].

INTRODUCTION: Blood pressure, heart rate and lipoprotein lipids are affected by family history, obesity, diet, smoking and physical activity habits. The aim of this paper was to estimate the values of blood pressure and heart rate in professional handball and water polo players before and after training and submaximal exercise test and to analyze the lipid state in these professional athletes in comparison with people who have never been in sports. MATERIAL AND METHODS: The investigation included 30 professional handball players, 30 professional water polo players and 15 men who have never been in sports (control group). All groups were matched for age, smoking habits, family predisposition to arterial hypertension and dyslipidemia. RESULTS: Between these groups there were statistically significant differences of blood pressure values and heart rate in the state of rest, after exercise test and after the training. There were also statistically significant differences of total cholesterol values, LDL cholesterol, triglycerides, HDL cholesterol, LDL cholesterol/HDL cholesterol ratio and total cholesterol/HDL ratio between these groups. DISCUSSION: Differences between these groups can be explained by various values of body mass index, by activity of lipoprotein lipase in athletes, by body position during the sports activity, by thermoregulatory vasoconstriction in the water, and by effects of hydrostatic pressure and reflex mechanisms during swimming. CONCLUSIONS: Cardiovascular reaction in professional athletes depends on the type of sports activity, body position and medium during training. Professional athletes have a lower atherogenic risk than non-sportsmen. Changes of blood pressure and heart rate after submaximal exercise test are not the same as changes after training.