Smoking habits, knowledge about and attitudes toward smoking among employees in health institutions in Serbia.

BACKGROUND/AIM: According to the number of active smokers, Serbia occupies a high position in Europe, as well as worldwide. More than 47% of adults are smokers according to WHO data, and 33.6% according to the National Health Survey Serbia in 2006. Smoking physicians are setting a bad example to patients, they are uncritical to this habit, rarely ask patients whether they smoke and rarely advise them not to smoke. These facts contribute to the battle for reducing the number of medical workers who smoke, as well as the number of smokers among general population. The aim of the study was to determine the smoking behavior, knowledge and attitudes and cessation advice given to patients by healthcare professionals in Serbia. METHODS: A stratified random cluster sample of 1,383 participants included all types of health institutions in Serbia excluding Kosovo. The self administrated questionnaire was used to collect data about smoking habits, knowledge, attitudes and cessation advice to patients given by health professionals in Serbia. RESULTS: Out of 1,383 participants, 45.60% were smokers, of whom 34.13% were physicians and 51.87% nurses. There were 46.4% male and 45.4% female smokers. The differences in agreement with the statements related to the responsibilities of health care professionals and smoking policy are significant between the "ever" and "never" smokers, and also between physicians and nurses. Twenty-five percent of nurses and 22% of doctors claimed they had received formal training. However, only 35.7% of the healthcare professionals felt very prepared to counsel patients, while 52.7% felt somewhat prepared and 11.6% were not prepared at all. CONCLUSIONS: According to the result of this survey, there are needs for more aggressive nationwide non-smoking campaigns for physicians and medical students. Experiences from countries where physicians smoke less and more effectively carry out smoking cessation practices need to be shared with Serbian physicians in order to improve their smoking behavior and smoking cessation practices.

Lung cancer trends in Southeastern Serbia.

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

Risk factors for health disorders in computer operators in telecom Serbia.

Computer operators are at risk to develop health disorders related to prolonged computer use. We assessed the occupational risk factors for computer-related health disorders and evaluated health conditions of 939 Serbian computer operators. Musculoskeletal (55.8%), ocular (27.3%) and mental disorders (7.1%) were reported most frequently. Risk factors for health disorders, in both male and female populations, were age; overtime work; negative working atmosphere; awkward posture at work; the presence of vibrations, noise, dust and chemical pollution in the workplace. Negative working atmosphere, body mass index > 30, total job tenure and duration of exposed employment were risk factors for developing health disorders only in males, while smoking was a risk factor only in the female population. Our study showed high prevalence of musculoskeletal and ocular disorders in Serbian computer operators. More effective preventive measures are necessary to improve computer operators' health.

Oxidative stress in cataractogenesis.

The aim of our study was to compare levels of antioxidative agent -total SH groups and the final product of lipid peroxidation- malondialdehyde (MDA) in serum, and glutathione (GSH) and MDA in nucleocortical parts of lens after extracapsular extraction of cataract. Patient were (38 with cataract and 38 controls) matched by sex and years of life. Diagnosis of cataract was established by complete ocular examination. All results are expressed as mean ± S.D. A Student's t-test was used to estimate differences between the groups. The level of significance was p<0.05. Total sulfhydryl groups were determined in serum by the method of Ellman as well as GSH content in nucleocortical parts of lenses using the method of Sedlak and Lindsay. Lipid peroxidation, evidenced by formation of thiobarbituric acid reactive substances (TBARS), was determined in nucleocortical parts of the lens and in serum. Our results show a statistical significance in concentration of total SH groups (225.37±82.19µmol/L, controls 311.03±60.37µmol/L p<0.05) and MDA (20.24±8.12, and controls 8.73±2.53µmol/L, p<0,001) in serum among patients with age related cataract and controls. There was no statistical significance in concentration of total SH groups and MDA in serum among patients with different type of age related cataract and in nucleocortical parts of lens. The present study concludes that there is a statistical significance in concentration of total SH groups and MDA in serum among patients with age related cataract and controls, but there were no statistical significance in concentration of GSH and MDA in serum and nucleocortical parts of lens in patient with different type of cataract.

Characteristics of upper urothelial carcinoma in an area of Balkan endemic nephropathy in south Serbia. A fifty-year retrospective study.

AIMS AND BACKGROUND: Upper urinary tract transitional cell carcinoma, a relatively rare tumor, is up to 100 times more frequent in regions with Balkan endemic nephropathy. Characteristics of transitional cell carcinoma in the endemic South Morava Region in Serbia in the previous 50 years were evaluated. PATIENTS: We analyzed 477 cases with pathologically confirmed transitional cell carcinoma who underwent surgery from 1957 to 2006: 91 from endemic, 106 from adjacent and 280 from control settlements. Cases in the study came from 10 endemic villages, 46 adjacent villages, 51 control villages and the city of Nis. RESULTS: The increase in number of transitional cell carcinoma from 1957 was followed by a peak between 1967 and 1978 (yearly incidence 21.9 per 100,000) and a slow decrease thereafter to 7.4 (1997-2006). In the control settlements, the increase was steady. Reduced kidney function at surgery was found in 58% of patients from endemic and in 20% from control settlements. Age at surgery has significantly increased from 52.3 and 51.5 (1957-1966) to 70.9 and 66.1 (1997-2006) for endemic and control settlements, respectively. The female sex was predominant in endemic and adjacent settlements and the male sex in control settlements. Transitional cell carcinoma from endemic settlements was of a lower grade in the period from 1957-1986, but in the period from 1987-2006 they were predominantly high grade. Low tumor stage (pTa-pT1) predominated in transitional cell carcinoma from the endemic and adjacent but not the control settlements in the period from 1957 to 1986. However, in the last 20 years, upper urinary tract transitional cell carcinoma stage increased, the highest in the period from 1997 to 2006 in all settlements studied. Conservative surgery was advocated for transitional cell carcinoma in Balkan endemic nephropathy areas up to 1996. Transitional cell carcinoma are now more malignant and more advanced than before, and a less aggressive approach is used only for absolute indications. CONCLUSIONS: An increased number of transitional cell carcinoma in endemic settlements was observed, markedly decreasing in the last decade. An increasing age and a shorter survival were recorded in patients both from Balkan endemic nephropathy and control settlements. Sporadic cases upper urinary tract transitional cell carcinoma in settlements adjacent to endemic settlements were demonstrated.

Estimated daily intake of cadmium by children living in the city of Nis, Serbia.

Cadmium is widely abundant in the air, water, soils and foodstuffs. Cadmium exposure and accumulation in the body start at a young age. Accumulation occurs in various tissues and organs, especially in the kidney cortex. This study was initiated to examine the total intake of cadmium among preschool children. The study group consisted of 275 children aged 1 to 6 years. Estimation of daily intake of cadmium was calculated using the recommended formula, which takes into consideration all the potential means of children's exposure to cadmium. The average daily cadmium intake in children aged 1 to 3 years was 1.06 microg/kg, while for the children aged 4 to 6 years, the average daily cadmium intake was 1.06 microg/kg. Biomonitoring methods were used to assess the effects of a contaminated environment on the children's health. Our research showed that children take in the highest amount of cadmium from food. It is estimated that by the age of 1-3 years, children have accumulated 1.31 mg of cadmium in the body, while those aged 4-6 years have accumulated 8.80 mg. The persistence in the environment of this metal requires a long-term move toward minimizing human exposure through environmental management and preservation of lower cadmium levels wherever possible.

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.

Decreasing incidence of urothelial cancer in a Balkan endemic nephropathy region in Serbia. A surgery based study from 1969 to 1998.

The incidence of upper urothelial tumors (UUT) and bladder tumors associated to Balkan endemic nephropathy (BEN) in the region of South Morava River in Serbia, in the 30-year period, was studied. A total of 575 urothelial neoplasms during 10-year period (1989-1998) was analyzed and compared to 659 urothelial neoplasms in the period from 1969 to 1988. UUT had 11.2-fold increased incidence in endemic than in nonendemic areas, however, this was far less than in the period from 1969 to 1988, when they were 57.1 times more frequent. Bladder tumors were 2.3 times more frequent in endemic than in nonendemic areas, but 11.9 times in the previous study from 1969 to 1988. Neoplasms from the area of BEN, regardless of their location, were not histologically different from the neoplasms out of endemic areas. Similarly to the previous reports that BEN looks like a disease that disappears, this is demonstrated also for urothelial tumors, which are the most frequent associated diseases.