Trend analyses of breast cancer incidence and mortality in Vojvodina.

PURPOSE: Breast cancer is the most common type of malignant tumor in women and one of the most significant public health problems in the world. The purpose of this work was to determine breast cancer epidemiology in the Autonomous Province of Vojvodina in a 20-year period (1993 to 2012) by determining breast cancer incidence and mortality in female population and analyzing the trend in the specified period. METHODS: The research involved the population of women in Vojvodina in the period from 1993 to 2012. Data were obtained from the Register for malignant neoplasms of Vojvodina. Incidence and mortality trends were analyzed by a joinpoint regression analysis. RESULTS: A total of 20,242 cases of breast cancer were registered in the observed period. Standardized incidence ratio in 2012 was 71.2/100,000. The trend of incidence increased with an average annual percentage of growth of 2.10. A total 10,062 deaths due to breast cancer were documented. Standardized incidence ratio in 2012 was 28.6/100,000. An increase of mortality rate by 1.70% per year was recorded in the period from 1992 to 2006 and a decline in the mortality rate by 1.56% was noticed afterwards. The highest percentage of deaths due to breast cancer was recorded in a group aged 60-69 years (26.7%).

Assessment of climate change impact on the malaria vector Anopheles hyrcanus, West Nile disease, and incidence of melanoma in the Vojvodina Province (Serbia) using data from a regional climate model.

Motivated by the One Health paradigm, we found the expected changes in temperature and UV radiation (UVR) to be a common trigger for enhancing the risk that viruses, vectors, and diseases pose to human and animal health. We compared data from the mosquito field collections and medical studies with regional climate model projections to examine the impact of climate change on the spreading of one malaria vector, the circulation of West Nile virus (WNV), and the incidence of melanoma. We analysed data obtained from ten selected years of standardised mosquito vector sampling with 219 unique location-year combinations, and 10 years of melanoma incidence. Trends in the observed data were compared to the climatic variables obtained by the coupled regional Eta Belgrade University and Princeton Ocean Model for the period 1961-2015 using the A1B scenario, and the expected changes up to 2030 were presented. Spreading and relative abundance of Anopheles hyrcanus was positively correlated with the trend of the mean annual temperature. We anticipated a nearly twofold increase in the number of invaded sites up to 2030. The frequency of WNV detections in Culex pipiens was significantly correlated to overwintering temperature averages and seasonal relative humidity at the sampling sites. Regression model projects a twofold increase in the incidence of WNV positive Cx. pipiens for a rise of 0.5°C in overwintering TOctober-April temperatures. The projected increase of 56% in the number of days with Tmax ≥ 30°C (Hot Days-HD) and UVR doses (up to 1.2%) corresponds to an increasing trend in melanoma incidence. Simulations of the Pannonian countries climate anticipate warmer and drier conditions with possible dominance of temperature and number of HD over other ecological factors. These signal the importance of monitoring the changes to the preparedness of mitigating the risk of vector-borne diseases and melanoma.

Epidemiology of pancreatic cancer in vojvodina province in Serbia.

PURPOSE: Analysis of descriptive epidemiological characteristics of pancreatic cancer in Vojvodina, Serbia. MATERIALS AND METHODS: The study covers population of Vojvodina in the period from 2000 to 2009. The method used for data processing was the descriptive. The data, referring to a specified period of time, were analyzed from chronological and demographic aspects and according to histological diagnosis. RESULTS: In the period from 2000 to 2009, there were 2,108 registered cases of pancreatic cancer of which 1,886 had a fatal outcome. Standardized incidence rates varied between 5.7 and 9.1 per 100,000 population in males and between 4.2 and 5.3 in females. Linear incidence trends in males in the specified period of time, based on crude (r=0.7883, p<0.05) and standardized (r=0,6373, p<0,05) incidence rates, demonstrated increase. Annual percent increase in the crude incidence rate was 4.5% in males, and 2.8% in females. Age-standardized mortality rates varied between 5.2 and 7.5 per 100,000 population in males and 3.6 and 4.7 in females. Linear mortality trends in males in the specified period of time, based on crude (r=0.8795, p<0.05) and standardized (r=0.7669, p<0.05) mortality rates, also demonstrated annual percent increase. CONCLUSIONS: Data analysis shows unfavorable onco-epidemiological situation related to pancreatic cancer in Vojvodina, in aspects of both incidence and mortality. Absence of primary and secondary prevention does not allow medical institutions to successfully fight against this disease.

Effects of treatment adherence on clinical and economic outcomes in patients with psoriasis.

AIM: To compare clinical and cost outcomes of psoriasis in non-biological treatment of adherent and non-adherent patients in a developing Balkans country going through socio-economic transition. METHODS: The study was designed as a retrospective cohort study involving patients with psoriasis adherent and non-adherent to the prescribed treatment regimen. The patients were followed for a period of one year, through four visits with intervals of three months. The adherence to the prescribed regimen was measured at the end of the follow-up period by the medication possession ratio. Clinical outcomes of the treatment were estimated by the Psoriasis Area Severity Index (PASI) at each visit and the treatment costs were collected from patients' files at each visit. RESULTS: The study enrolled 108 patients, 61 (56.5%) were adherent to the prescribed treatment, and 47 (43.5%) were non-adherent. A signiicant decrease of PASI score was noted in the patients adherent to prescribed therapy (p < 0.001). The costs also decreased significantly in the group of adherent patients (p=0.001), and the drop of costs was the highest from the visit 3. The decrease in PASI score and costs were less rapid in non-adherent patients. CONCLUSION: Better treatment adherence leads to faster clinical improvement and a more rapid decrease in costs of treatment, which diminish overall expenditure of the health system and society, leaving room for treatment of other diseases more efficiently. Therefore, health systems of developing countries should support additional research of causes of treatment non-adherence in patients with psoriasis, in order to minimize this fenomenon more efficiently, and make significant savings.

Use of healthcare services 8 years after the war in Kosovo: role of post-traumatic stress disorder and depression.

BACKGROUND: The aim of the present study was to examine the use of health-care services and medication, as well as health risk behaviours such as smoking, in relation with post-traumatic stress disorder (PTSD) and major depressive episode (MDE) in post-war Kosovo. METHODS: A sample of 864 adults was interviewed in 2007 of which 551 took part in a 2001 survey. They were assessed using the PTSD and MDE sections of the Mini International Neuropsychiatric Interview (MINI) and the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Use of health-care services, alcohol and tobacco were also recorded. RESULTS: Respondents were predominantly female (56.6%) with a median age of 36 years and a primary educational level (44.6%). While 11.9% of participants met diagnostic criteria for PTSD, MDE prevalence was 30.6%. Both PTSD and MDE were significantly associated with lower scores on the SF-36 physical component summary. After adjustment for sex, age, education, unemployment, municipality and SF-36 perceived physical health, no significant association was observed between PTSD and medical visits in the past 12 months, hospitalizations in the past 12 months and use of medication in the past 7 days. Results were similar for MDE, except for a significantly higher frequency of medication use that included psychotropic and other drug classes. CONCLUSION: Eight years after the war in Kosovo, poor perceived physical health displayed a long-lasting association with PTSD and MDE and was a major determinant of increased use of health-care services without additional contribution of PTSD per se.

Detection of patent infections of Echinococcus granulosus ("sheep-strain", G1) in naturally infected dogs in Kosovo.

A survey was carried out to assess the occurrence of canine echinococcosis in naturally infected dogs in Kosovo. Using the flotation-ovassay technique, taeniid eggs were found in 23 (7.5%) out of a total of 305 dogs. Eggs from other helminths were detected as well: hookworms 139 (45.5%), Trichuris sp. 87 (28.5%), Toxocara sp. 42 (13.7%), Toxascaris leonina 21 (6.8%) and Dipylidium caninum eight (2.6%). From 21 of the 305 samples (6.9%), taeniids eggs could be collected. Using PCR primers specific for Echinococcus granulosus ("sheep strain", G1), four of these samples (1.3%) resulted positive. The E. granulosus isolates originated from each one stray dog, hunting dog, sheepdog and pet dog. A semi-quantitative analysis showed low to moderate egg counts (2-10 per 1 g faeces) in dogs positive for E. granulosus ("sheep strain", G1) whereas specimens with high (11-20) or very high numbers (> 20) of taeniid eggs were negative in the E. granulosus PCR. Using specific primers for the detection of E. multilocularis, all samples containing taeniid eggs were negative. This is the first report on identification of E. granulosus in dogs from Kosovo where human cystic echinococcosis is a significant medical problem.

Problem of substance misuse and lack of national strategy in Kosovo.

UNLABELLED: The aim of this project was to explore the problem of substance misuse among adolescent town dwellers in Kosovo, as a result of lack of a national strategy related to this problem. DESIGN: 261 students from 4 secondary schools took part in cross sectional survey performed in October 2005. The survey was carried out in Gjilan town in south-east of Kosovo. MAIN RESULTS: From all questioned students, 36% smoked cigarettes every day, 12.6% consumed alcohol occasionally and 1.4% consumed all kind of drugs regularly. Girls consumed more cigarettes, whereas boys consumed more alcohol and other drugs. The prevalence of substance misuse was higher among students in their last year of high school attendance. Students in Gjilan continue to smoke, consume alcohol and drugs despite their knowledge about the adverse health consequences of substance misuse, but in the same time, most of them consider information and counselling the best way of substance misuse prevention. CONCLUSIONS: The prevalence and trends of substance misuse among students in our survey indicates that it is time to start acting. It is assumed that results of survey may be a very useful source of information for policy-makers, government and ministry of health in developing and implementing national strategy that would address the most important issues in connection with addiction among adolescents.

Epidemiological characteristics of malignant ovarian tumors in Vojvodina.

PURPOSE: Ovarian cancer ranks 6th in relation to new cases of malignant diseases among females and 2nd concerning gynecological cancers. The purpose of this study was to determine the epidemiological situation of ovarian cancer in Vojvodina, Serbia. METHODS: In our study, we used a descriptive epidemiological method for the analysis of incidence and mortality of ovarian cancer in Vojvodina, based on the data of the Cancer Registry of Vojvodina. RESULTS: In the period 1987-2006, the average incidence rate of ovarian cancer was 15.28%/100,000 with an average annual increase of 1.15%; the average mortality rate for the same period was 9.24/100,000 with an average annual increase of 0.95%. The values of crude incidence rate (15.28/100,000) and standardized incidence rate (range 7.47 - 12.55/100,000) in Vojvodina correspond to the values in eastern and southern Europe. CONCLUSION: In the observed period of 20 years, the incidence and mortality rate indicate a tendency for increase, which can be characterized as an unfavorable epidemiological situation. New markers are being studied in order to find a solution for ovarian cancer screening.

Screening of chronic diseases and chronic disease risk factors in two rural communities in Kosovo.

BACKGROUND: A cross-sectional study was carried out in Velika Hoca and Orahovac, two rural communities in Kosovo and Metohia, with the aim of assessing the prevalence of chronic diseases and associated risk factors. METHODS: The study involved 423 (180 male) adult inhabitants aged 51 +/- 16 years and included an interview, medical documentation, physical, ultrasound, laboratory examinations and ECG. RESULTS: Hyperlipidemia was the most frequent (70%) risk factor followed by alcohol consumption (47%), hypertension (42%), smoking (36%) and obesity (32%). Ischemic heart disease was diagnosed in 25 patients, hypertensive cardiomyopathy in 17, other cardiomyopathies in 5 and arrhythmia in 20 patients. Nine persons had chronic obstructive pulmonary disease. Previously diagnosed liver cirrhosis occurred in 5 and chronic hepatitis in 8 subjects, while liver steatosis with elevated serum transaminases (22 persons), elevated transaminases with normal ultrasound (20 persons), tumor or suspected tumor (7 persons) were detected in the survey. Gastrointestinal symptoms were the most prevalent but peptic ulcer and gastritis had been previously diagnosed in 64 and 47 patients. Kidney and urinary tract diseases were known for 52 patients (12 with chronic renal failure and 4 on hemodialysis) and 46 more were detected in the study. Among them in 22 patients with markers of kidney disease and unclear diagnosis 12 had a positive family history, 8 low-grade proteinuria, 14 tubular dysfunctions and 7 eGFR (estimated glomerular filtration rate) below 60 ml/min/1.73 m2. CONCLUSION: In the Serbian enclave of Velika HoEa and Orahovac the prevalence of cardiovascular diseases was similar to that of gastrointestinal, liver and kidney diseases. This differs from other parts of Serbia where cardiovascular disorders are the leading cause of disease burden.

High prevalence of kidney disease in two rural communities in Kosovo and Metohia.

A systematic survey was carried out in an enclave in Kosovo and Metohia, with the aim of assessing the prevalence of kidney diseases. The survey involved 423 (180 males) adult inhabitants from two small settlements, Velika Hoca and Orahovac, and included an interview, medical documentation, physical, ultrasound, and laboratory examinations. Persons with any detected disorder indicating kidney disease were invited for additional examination of kidney function. Using urine dipstick test, proteinuria was detected in 19.1% and hemoglobinuria in 4.5% of the examined subjects. Glomerular filtration rate (Modification of Diet in Renal Disease (MDRD) formula) below 60 mL/min/1.73 m(2) was found in 5.2% of subjects. Kidney ultrasound examination detected reduced length of right and left kidneys in 38 and 24 persons, respectively. Cysts were also a frequent finding, but polycystic kidney, hydronephrosis, and kidney stones were found in about 2% each. The analysis of data obtained by the present examination and available medical documentation revealed kidney and urinary tract diseases in 98 persons: 52 patients with already known disease and 46 patients detected in the survey. Out of them in 22 patients diagnosis of kidney disease could not be established during the survey but laboratory analyses indicated that they might suffer from tubulointerstitial disease: 14 had tubular dysfunctions, 8 of them low-grade proteinuria, and 12 had a positive family history for kidney disease. In the enclave of Velika Hoca and Orahovac the prevalence of kidney disease was 7.0% indicating that these communities might be placed among those with a high prevalence of kidney disease in Serbia.

[Survey of diarrhoea survey in Kosovo Mitrovica. August 2001]. / Etude sur les diarrhées à Mitrovicè (Kosovo) en août 2001.

The upsurge of diarrhoea observed in children in Kosovo Mitrovica in the spring of 2001 led to a survey, jointly organized by the city health department, the GISPE association and the medical laboratory at the Val de Grâce Hospital (France). The available retrospective data showed an increase in cases of diarrhoea in which Giardia duodenalis was isolated. During the third week of August 2001, all children with diarrhoea consulting in the hospital south of city (n = 45) had a complete stool analysis. The analyses showed the presence of Giardia cysts and trophozoites in 40% of the cases, and no cases with helminthes or cryptosporidia. Moreover 3 strains of S. sonnei, a microorganism never previously identified, and different pathovars of E. coli in 11 patients were isolated. This "epidemic" appeared to be linked to the poor hygiene conditions that still prevailed 2 years after the events but not directly to the water supply, which was rehabilitated at the end of 1999. It is also necessary to strengthen the capacity of the public laboratories and health-care facilities of the province.

Cancer surveillance in Italian army peacekeeping troops deployed in Bosnia and Kosovo, 1996-2007: preliminary results.

OBJECTIVE: An excess of cancer cases was reported in 2000 among Italian troops involved in peacekeeping operations in Bosnia and Kosovo. A preliminary assessment of cancer risk in this cohort was done for the period 1996-2007, based on cancer surveillance activity, which was started in 2001. METHODS: A retrospective cohort study was done among 27361 Italian Army soldiers deployed in Bosnia, 31052 deployed in Kosovo, and a control group of non-deployed soldiers, whose number varies from 130275 in 1996 to 40967 in 2007. Standardized incidence ratio and 95% confidence intervals (SIR [95% CI]) of the main types of tumours were computed as the ratio of the observed and expected cases. RESULTS: 98 incident cancers were reported among soldiers deployed in Bosnia, 66 in those stationed in Kosovo and 388 in non-deployed personnel. Overall, cancer incidence was lower than expected in all groups. Annual SIR was significantly higher than expected in 2000 for Hodgkin's lymphoma only among troops deployed in Bosnia (4.34 [1.18-11.12]) and non-deployed personnel (3.48 [1.67-6.39]); and in 2001 for thyroid cancer only among troops deployed in Bosnia (5.28 [1.44-13.51]). CONCLUSION: Although further investigation is needed, these preliminary results give no indication of an increased risk of cancer for Italian soldiers who were stationed in Bosnia and Kosovo. The cluster of Hodgkin's lymphoma in 2000 and of thyroid cancer in 2001 were sporadic events, they did not specifically affect deployed personnel and are unlikely to be related to environmental exposures in the Balkans.

Factors associated with pathologic colposcopic and cytologic changes in 500 clinically asymptomatic women.

OBJECTIVE: To determine the role of cytologic and colposcopic diagnosis in the early detection of pathologic cervical changes and the effect of the number of births, a history of abortion, the number of sexual partners, and contraceptive use on pathologic colposcopic and cytologic changes. METHOD: The 500 study participants were seen at the Obstetric-Gynecologic Clinic of Prishtina, Kosovo, in 2006 and 2007. They were assigned to 5 groups of 100 according to number of births, a history of abortion (whether spontaneous or induced), and total number of sexual partners, but the use of contraceptives was also analyzed. All participants underwent cytologic and colposcopic evaluations. RESULTS: Colposcopic atypia was observed in 70 participants (14%) and 77 (15.4%) had other findings. The degree of colposcopic atypia increased with the number of sexual partners, as did the frequency of infections. Most (91.2%) of the women with positive cytologic results were from groups 1 and 2, and the remaining 8.8% of these women were from groups 3, 4, and 5. From 44 patients with positive pathology results, 29 (65.9%) had chronic cervicitis, 13 (29. 5%) had hyperplasia, and 2 (4.5%) had carcinoma in situ. CONCLUSION: Number of births, a history of abortion, number of sexual partners, and contraceptive use directly affected pathologic colposcopic and cytologic changes.

Seroprevalence of HIV, HSV-2, and Treponema pallidum in the Kosovarian population.

The objective of this study was to evaluate the seroprevalence of infection with HIV, herpes simplex virus type 2 (HSV-2), and Treponema pallidum (TP) in a Kosovarian population. A cross-sectional study was performed in Peja, Kosovo, from January to March 2005, among 1285 persons recruited at the Peja Hospital. The seroprevalence of HIV, HSV-2, and TP was evaluated, and the viral correlates for each infection were analysed. No HIV-positive cases were found. The seroprevalence of HSV-2 was 20.2%. The factors significantly associated with HSV-2 infection at the multivariate analysis were: female gender (adjusted OR, 1.73; 95% CI 1.24-2.41) and being married (adjusted OR, 1.46; 95% CI 1.06-2.01). Three persons (0.2%) had a positive serology for TP. The only risk factor associated with TP infection was age = 50 y. Our results show a low seroprevalence of HIV infection and TP, and a high seroprevalence of HSV-2 in Kosovo. These findings suggest the need for appropriate surveillance systems, prevention programmes, and information aimed at controlling the spread of HIV and other sexually transmitted infections in this area. Moreover, the circulation of infections acquired through sexual contact may facilitate an increase in the sexually transmitted HIV epidemic in the near future.

Molecular epidemiology of Acinetobacter baumannii in central intensive care unit in Kosova teaching hospital

Infections caused by bacteria of genus Acinetobacter pose a significant health care challenge worldwide. Information on molecular epidemiological investigation of outbreaks caused by Acinetobacter species in Kosova is lacking. The present investigation was carried out to enlight molecular epidemiology of Acinetobacterbaumannii in the Central Intensive Care Unit (CICU) of a University hospital in Kosova using pulse field gel electrophoresis (PFGE). During March - July 2006, A. baumannii was isolated from 30 patients, of whom 22 were infected and 8 were colonised. Twenty patients had ventilator-associated pneumonia, one patient had meningitis, and two had coinfection with bloodstream infection and surgical site infection. The most common diagnoses upon admission to the ICU were politrauma and cerebral hemorrhage. Bacterial isolates were most frequently recovered from endotracheal aspirate (86.7 percent). First isolation occurred, on average, on day 8 following admission (range 1-26 days). Genotype analysis of A. baumannii isolates identified nine distinct PFGE patterns, with predominance of PFGE clone E represented by isolates from 9 patients. Eight strains were resistant to carbapenems. The genetic relatedness of Acinetobacter baumannii was high, indicating cross-transmission within the ICU setting. These results emphasize the need for measures to prevent nosocomial transmission of A. baumannii in ICU.

[Hospital morbidity and mortality of adolescents in Vojvodina].

INTRODUCTION: The aim of this study was to analyze hospital morbidity and mortality of adolescents in Vojvodina in 2004. MATERIAL AND METHODS: The analyzed data for hospital morbidity were obtained from the Reports on diseases and conditions of hospitalized patients in the Service for stationary-hospital treatment. Hospital mortality was analyzed on the basis of Documentation tables of vital statistics of Republic of Serbia. In order to have better insight into the pathology, the adolescents were divided by sex and age (the younger ones from 10-14 years, and the older ones, from 15-19 years). RESULTS: The hospital morbidity of adolescents in Vojvodina in 2004 was 47/1,000 adolescents, while in 1983 it was 53/1,000 adolescents. The most frequent indications for hospitalization of the adolescents were respiratory, digestive diseases, and injuries, poisoning and consequences of an external factor influences. The overall mortality rate was 39.68/100,000 adolescents and in 1988 44.74/100,000 adolescents. Hospital mortality rate in Vojvodina in 2004 was 16.18/100,000 adolescents and in 1986 11.65/100,000 adolescents. The male adolescents most frequently died in hospitals because of tumors, and female ones because of injuries, poisoning and consequences of external factor influences. DISCUSSION AND CONCLUSION: Morbidity structure was not changed compared to the previous period. Older and female adolescents were more frequently hospitalized. There was a decrease in adolescent mortality for 15.5% compared to the previous 15 years. Hospital mortality rate was higher than before. Older adolescents had three times the death rate of younger. Mortality rates for male adolescents were three times rates for females. Programs for adolescents' health care must be implemented fully, with engagement of whole community services, in order to prevent and cure diseases adequately and to enhance quality of life.

Tobacco use among Kosovar schoolchildren: a cross-sectional study.

One out of ten deaths worldwide among adults is attributable to tobacco use. Most people begin using tobacco before the age of 18. The European Region of WHO faces nearly one third of the worldwide burden of tobacco-related diseases. We aimed to study the prevalence of tobacco use among Kosovar schoolchildren, knowledge and behaviors related to tobacco use and its health impact. A cross-sectional study was performed, using anonymous self-administered questionnaire carried out among 7088 students in 110 schools. The target population group were students aged between 13 and 15 years were enrolled in all the targeted grade levels. The questionnaire consists of two main parts developed especially for the European region. Statistical analysis and the complex sampling design were done by EPI Info 2000 statistical software package. Around one-third (2622=37%) of all students, reported to have smoked cigarettes. One-fifth (20.9%) of ever smokers initiated smoking before the age often. Significantly more boys than girls ever smoked cigarettes (43.5% and 30.4% respectively). Over one-third (37.0%) had ever smoked cigarettes, as compared to over one-half (53.9%) of secondary students. There is a high probability of an increased burden of disease from tobacco in the future decades in Kosova. Special attention should be paid to the cessation needs of current smokers, school-based programs on environmental tobacco smoke, and the health risk of exposure due to smoking by siblings and friends.

Linear trend analysis of patients with cervical cancer treated at the Institute of Oncology Vojvodina in 2001-2007.

PURPOSE: Cervical cancer is the leading cause of death in women with gynecological cancers in Vojvodina. Serbia currently holds the leading place in Europe regarding the incidence of cervical carcinoma and comes second in terms of mortality. METHODS: Data were retrieved from the Register for malignant neoplasms of the Institute of Oncology Vojvodina for the period 2001-2007. The patients were divided in 3 groups according to the stage of disease based on the FIGO classification for cervical cancer. Data were analysed using linear trend and t-test. RESULTS: The linear trend of the number of registered cases in the group of stage I-IIA patients during 7 years showed no significant change in the prevalence of the disease. In the group of women diagnosed with stage IIB no statistical difference regarding either a rising or a decreasing trend was observed. The observed trend in an advanced disease stage (III and IV) showed a slight decrease in the number of patients, but without statistical significance. CONCLUSION: The linear trend of the number of patients with cervical carcinoma during a 7-year period points to the fact that the number of newly detected cases of advanced disease stages did not decrease significantly despite the affordable and simple methods of early detection. This result underlines the importance of implementation of a National screening programme in the general population for early detection of cervical neoplasms. The excellent results of National screening programmes in other European countries lend support to this approach.

[Descriptive-epidemiological characteristics of lung cancer in Serbia].

INTRODUCTION: Lung cancer represents the most common malignant tumour among men, and appears more and more frequently among women in many countries worldwide. The aims of this descriptive epidemiological study were to evaluate the mortality trends of all malignant tumours and lung cancer in Central Serbia from 1990 to 1999, and to estimate the incidence, mortality and the basic demographic characteristics of lung cancer in Central Serbia in 1999. MATERIAL AND METHODS: The source of data concerning cancer cases in 1999 was the Cancer Registry of Central Serbia, while data of the Republic Statistics Institute were used for the analysis of mortality trends for the period 1990-1999. All rates were standardized by the direct method, to the world standard population. Confidence intervals for mortality rates were assessed with 95% level of probability. Linear regression coefficient was determined by Fisher's test. RESULTS: The mortality rates showed rising tendencies for both lung cancer (y = -1876.26 + 0.96x, p = 0.028 for men; y = -654.78 + 0.33x, p = 0.001 for women) and all malignant tumours (y = -4139.88 + 2.15x, p = 0.163 for men; y = -3649.68 + 1.88x, p = 0.016 for women), with statistically significant increase being observed for all trends, except all malignant tumours among men. In the year 1999, lung cancer ranked first among men and third among women, with 29.2% and 10.3% of cancer mortality respectively. The age-specific mortality rates were much higher in men in all age groups. Mortality increased with age and the highest rates were found in the age group 70-74 for both sexes. The highest incidence and mortality rates were reported in Belgrade, Moravicki and Sumadijski district.

[Frequency and risk factors of the use of psychoactive substances among the young].

BACKGROUND/AIM: Socio-economic changes that occured in the wake of dismemberment of former Yugoslavia resulted in the appearance of social pathology, one of which was the increase in the use of psychoactive substances. The overwhole epidemiological research in the use of psychoactive substances has not been conducted so far. The aim of this study was to establish the type and form of the use of psychoactive substances considering sex and age, as well as risk factors for the use of psychoactive substances among the children and adolescents. METHODS: The research was carried out among 1011 elementary school children (seventh and eighth grades) and secondary school children (all four grades) in the area of Belgrade from October 2003 to January 2004. Out of the total number 457 (45.2%) were elementary school pupils and 554 (54.8%) secondary school pupils. There were 524 (51.8%) boys and 487 (48.2%) girls, aged from 12 to 18 years (the average age being 15.3 years). The method used was the European School Survey Project on Alcohol and Other Drugs Questionaire. Chi-square test, Mann-Whitney, Student's t test and Logistic Regression test were used in statistical processing of the data. RESULTS: Totally 14.2% examinees tried psychoactive substances. The most frequent drug used at the first contact was marijuana (10.8%) at the age of 15 tried by 12.7% examinees, inhalants (4.4%), amphetamines (4.1%), sedatives (3.7%), alcohol combined with marijuana (3.9%), then cocaine (2.8%), heroine (2.3%), alcohol combined with sedatives (2.2%), and ecstasy (1.6%), followed by anabolic steroids, heroin, diethilamid lisergic acid (LSD) and magic mushrooms. It was determined that going out in the evening, smoking and binge form drinking were directly connected with the use of psychoactive substances. CONCLUSION: Totally 14.2% of the exameneers used psychoactive substances, mostly marijuana, followed by amphetamines and others. New tendencies of use characterized by the increase in the use are of synthetic substances, simultaneous use of more psychoactive substances and younger age. The risk factors are going out in the evening, smoking, binge drinking and use of synthetic substances among peers. Our research indicates the neccessity of primary prevention.