Mortality trend of cutaneous melanoma in Montenegro from 1990-2018.

OBJECTIVE: Every year, melanoma claims over 20,000 lives in Europe. In Montenegro, as in Europe, numerous campaigns have been initiated to raise public awareness about the importance of melanoma prevention and its early detection. Thus, accompanying current diagnostic and therapeutic protocols, new methods of melanoma diagnosis and treatment have been implemented. Studying the trend enables the identification of the groups most burdened by mortality and assesses whether there has been a change in trends based on interventions aiming to reduce mortality. The objective of this study is to evaluate the mortality trend from cutaneous melanoma in Montenegro for the period 1990-2018. MATERIALS AND METHODS: We have utilized national data on the causes of death from melanoma, code 179 from the ninth and C43 from the tenth revision of the International Classification of Diseases, categorized by gender and age groups. The study utilized various regression techniques, including Joinpoint regression in the Joinpoint Program, Poisson regression, and linear regression in the SPSS 26th Program, to describe the trend. RESULTS: In Montenegro, during the period from 1990 to 2018, a total of 281 individuals died (51.6% male and 48.4% female). This ranks as the 13th leading cancer in terms of mortality among all cancers. The average age-standardized rate was 1.1 deaths per 100,000 (1.2 for males and 1.0 for females).  The number of death cases has been increasing on average by 3.3% annually [average annual percentage change (AAPC) (95% CI) = 3.3 (1.7-4.9); p<0.001] on an overall level and by 5.4% annually among males [AAPC (95% CI) = 5.4 (3.6-7.3); p<0.001] due to the rises in the age groups 55-64 years and 65-74 years with an average annual percent change of respectively 3.2% [AAPC (95% CI) = 3.2 (0.8-5.8); p=0.012] and 5.4% [AAPC (95% CI) = 5.4 (2.7-8.1); p<0.001] overall level, and 4.8% [AAPC (95% CI) = 4.8 (2.4-7.3); p<0.001] and 7.5% [AAPC (95% CI) = 7.5 (4.9-10.2); p<0.001] among males. For females, an increase of 1.1% was recorded, which was not statistically significant [AAPC (95% CI) = 1.1 (-0.8-3.0); p=0.255]. Furthermore, there was a noted increase in the rates at an overall level [ß (95% CI) = 0.027 (0.008-0.046); p=0.007] and in the age group 65-74 years [ß (95% CI) = 0.249 (0.090-0.407); p=0.003], as well as among males at an overall level [ß (95% CI) = 0.052 (0.025-0.079); p<0.001] and for age groups 45-54 years [ß (95% CI) = 0.102 (0.011-0.193); p=0.030] and 65-74 [ß (95% CI) = 0.410 (0.144-0.676); p=0.004]. In contrast, the rates for females remained constant. The three age groups most burdened by melanoma skin cancer mortality are 65-74 years (23.5%), 55-64 years (21.7%) and 75-84 years  (19.2%). CONCLUSIONS: The results of regression analyses indicate a significant rise in both the number of death cases and mortality rates overall, specifically among males in Montenegro. In females, however, the increase in the number of death cases and rates is not statistically significant. Preventive campaign activities should be redirected towards the most vulnerable groups in terms of mortality, namely males and the elderly population.

Effects of palivizumab prophylaxis on respiratory syncytial virus (RSV) infections in Montenegro.

BACKGROUND: Respiratory syncytial virus (RSV) is one of the most common pathogens causing severe lower respiratory tract disease in infancy and childhood. In newborns, young infants, and in infants with co-morbidities, the risk of severe infection is increased. Current protection against severe RSV infection is immunoprophylaxis with the monoclonal antibody palivizumab. The study aimed to assess the effects of palivizumab prophylaxis in the Republic of Montenegro in comparison to the pre-prophylaxis period. METHODS: The study was conducted in prospective/retrospective single center format in Montenegro in the Clinical Center of Podgorica, for the period 2009-2019. RESULTS: A total of 104 high-risk infants in the palivizumab prophylaxis program (2014-2019 RSV seasons) and 168 high-risk children without palivizumab prophylaxis (2009-2013 RSV seasons) were enrolled. A total of 51 children (49.0%) received prophylaxis for prematurity, 33 (31.7%) for bronchopulmonary dysplasia (BPD), 13 (12.5%) for hemodynamically significant heart disease/defect (HSCHD), and 7 (6.8%) for "miscellaneous" indications. In the control group most children had prematurity (101, 60.1%), followed by BPD (59, 35.1%), HSCHD (3, 1.8%), and "miscellaneous" (5, 3.4%) conditions. Readmission to the pediatric intensive care units (PICU) due to RSV infection was significantly lower in prophylaxis group (0.0 vs 16.1%, p<0.001). No lethal outcomes were observed in high-risk children with palivizumab prophylaxis compared to 2.4% in the control group. CONCLUSIONS: The introduction of RSV immunoprophylaxis as well as other new protective treatment strategies for high-risk newborns led to significant improvements in infant and childcare in Montenegro. This is the first report on palivizumab prophylaxis in Montenegro, demonstrating the effectiveness and safety of palivizumab use in clinical settings.

Health policy developments in the Western Balkan Countries 2000-19: towards European Health and Health Care Policies.

BACKGROUND: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia have committed to becoming European Union (EU) member states. This, among others, implies that candidate/potential candidate states adopt legally authorized EU policies, including health. The study aims to identify the main country-specific health policy areas critical to the EU accession health policy dimension and present the change in associated selected health indicators from 2000 to 2019. METHODS: The study draws on published reports and analyses of official statistics over time and cross-country. Health care policy adherence to the European Commission's recommended country-specific health actions was classified into five health policy areas: financing, payment, organization, regulation and persuasion. Key health policy areas for Western Balkan countries (WBCs) were identified. Health progress or lack thereof in catching up to the EU15 population health, health expenditure and the number of health professionals are measured. RESULTS: The European Commission prioritized financing and regulation for all WBCs in the five policy areas. Nine of the 18 analyzed selected health indicators showed divergence, and the other nine converged towards the EU15 averages. WBCs continue to face diverse public health challenges in improving life expectancy at birth, death rates caused by circulatory system diseases, malignant neoplasms, traffic accidents, psychoactive substance use, tuberculosis incidence, tobacco smoking prevalence and public-sector health expenditure. CONCLUSIONS: By 2019, there is limited evidence of WBCs catching up to the average EU15 health levels and health care policies. Closer attention towards EU health and health care policies would be favourable.

Time trends in liver cancer mortality rates in Montenegro from 1990 to 2018.

OBJECTIVE: Liver cancer is the third most common cause of cancer-related deaths worldwide. Hepatitis B and C infections are the main factors affecting mortality. During recent years, Montenegro conducted activities on eradication of viral hepatitis according to the global strategy for the primary prevention of liver cancer mortality. The objective of this study was to assess the liver cancer mortality trend in Montenegro for the period of 1990-2018 using regression techniques. METHODS: liver cancer mortality data in Montenegro from 1990 to 2018 were collected. Mortality rates were age standardized to the World Standard Population. The joinpoint, linear and Poisson regressions were used to assess liver cancer mortality trends both overall and gender specific. RESULTS: The mortality trend was constant, with no significant increase or decrease in mortality rates both at the overall level and by gender. The number of cases, however, increases significantly at the overall level by an average of 1.4% per year [average annual percentage change (AAPC) (95% confidence interval, CI): 1.4 (0.5-2.3); P  = 0.004] and in women by 1.9% per year [AAPC (95% CI): 1.9 (0.8-3.1); P  = 0.002]. In men, there was no change in the number of cases. The three age groups most burdened by mortality from liver cancer were 65-74 (34.9%), 75-84 (26.6%) and 55-64 (25.8%). CONCLUSION: The consistent implementation of prevention measures and hepatitis virus infection treatment has played a role in partially favorable liver cancer mortality trends in Montenegro. It is crucial to closely monitor guidelines for this cancer and give particular attention to the elderly population as the most affected.

Prevalence and clinical implications of the HPV16 infection in oral cancer in Montenegro - Evidence to support the immunization program.

Oral squamous cell carcinoma (OSCC) makes 85-95% of all malignances in the oral cavity. Increasing evidence shows that the Human Papillomaviruses (HPVs) are preferentially associated with some oropharyngeal and OSCCs, namely the genotype 16. The aim of the present study was to determine the prevalence and clinical implications of HPV16 infection in oral squamous cell carcinoma in population of Montenegro.This study included 60 patients with OSCC (localized on the lower lip, tongue or/and floor of the mouth), surgically treated at the Clinical Centre of Montenegro from 2012 to 2018. Surgically obtained formalin-fixed and paraffin-embedded specimens were used for histopathological analysis and HPV16 genome detection using standard Polymerase Chain Reaction (primers for detection of E6 gene). Each individual was further followed up for the period of three years and for different clinico-pathological characteristics, including disease free interval (DFI).The prevalence of HPV16 infection in OSCCs was 23.3% and the infection was significantly more common in female patients (P = 0.038). No significant correlation was detectable between HPV16 infection and the patients' age (P = 0.302), tumor site (P = 0.125), tumor grade (P = 0.363) and disease stage (P = 0.995). Observing the total sample the DFI was not significantly different for HPV16-positive versus HPV16-negative patients (P = 0.427), but a gender-based difference in DFI was observed, with the significantly shorter DFI (Log Rank test, P = 0.003) in HPV16 positive female patients compared to male patients (P = 0.003).The results obtained in this study provide scientific evidence for the development of national HPV vaccination program in Montenegro.

Trend of breast cancer mortality in Montenegro, 1990-2018 - Joinpoint regression.

OBJECTIVE: In this study, we analyzed breast cancer mortality data overall and by age groups in women in Montenegro, to determine if there were any changes in trend for period 1990-2018. MATERIALS AND METHODS: The study gathered data on breast cancer mortality in Montenegro obtained from Vital Registration System. Annual data on breast cancer mortality were extracted for period 1990-2018 and analyzed using World Standard Population age-standardized and age-specific rates and Joinpoint regression. RESULTS: In 2018 in Montenegro, breast cancer accounted for 4.64% of all deaths in women and for 19.78% of all cancer deaths in women. In terms of total cancer mortality, it ranked first among women. Age-standardized rates ranged from 11.41/100,000 in 1990 to 20.46/100,000 in 2016. Joinpoint regression showed no one joinpoint for the entire population of all women and age groups. In the observed period, breast cancer mortality rates significantly increased in the women in Montenegro [average annual percentage change (AAPC) = 1.44%; 95% confidence interval (CI): 0.9-2.0]. The most affected age group was 55-64 years. CONCLUSIONS: There is a growing breast cancer mortality trend in Montenegro. It is necessary to create specific programs for urgent action, in order to reduce this undesirable trend. At the same time, support from the competent institutions is needed for increasing screening coverage and better prevention of breast cancer in the target population.

Effectiveness of tax policy changes in Montenegro: smoking behaviour by socio-economic status.

BACKGROUND: The main goal of this study was to examine the responsiveness of smoking prevalence and cigarette consumption to price and income changes by income groups and the effectiveness of tax policy changes to reduce cigarette consumption in Montenegro. DATA AND METHODS: A two-part model was applied to estimate smoking participation, smoking intensity price and income elasticity. The first part of the model applies logit regression, while the second uses Deaton's model to improve the validity and objectivity of conditional (smoking intensity) elasticity results. A generalised linear model (GLM) was applied to verify robustness. The reason for this is that Deaton's model is commonly used in the analysis of Household Budget Survey (HBS) data, especially when households do not report the market price. Moreover, using this model, it is possible to capture the shading of quality to price change. The analysis used HBS data (2006-2017). RESULTS: The estimates indicate that tobacco pricing policies had a much higher impact on smoking prevalence in the low-income group (price elasticity of -0.595) relative to the high-income group (price elasticity of -0.344). The same conclusion could be drawn for the smoking intensity elasticity: the high-income group was the least affected by changes in price (price elasticity of -0.258). At the same time, the most affected was the low-income group, with price elasticity of -0.424. Poorer households spent a larger share of their budget on cigarettes. The simulation results confirm that increases in the specific excise taxes of 58.3% on tobacco would reduce total cigarette consumption by 11.25% while increasing the collection of government revenue by 8.07%. CONCLUSION: Smoking prevalence and consumption are very responsive to price and income changes, with considerable differences in elasticities between income groups. The taxation policy has a positive impact on changing patterns of consumption and public revenues across each income group. Low-income and middle-income households would benefit the most, while on the other hand, the highest revenue collection was generated from the wealthiest group. Our results align with results obtained so far for other low-income and middle-income countries. This paper contributes to the analysis of the smoking prevalence and cigarette consumption responsiveness to price and income changes, which was conducted for the first time in Montenegro.

HPV TYPING AS A SCREENING PROGRAM FOR PREVENTION AND EARLY DETECTION OF CERVICAL CANCER IN DIFFERENT MONTENEGRO REGIONS.

The objective of our research was to compare the results of human papillomavirus (HPV) typing and occurrence of the most important risk factors for cervical cancer obtained in the towns of northern, central and southern regions of Montenegro, in subjects between 30 and 35 years of age, in accordance with the new screening program introduced by the Ministry of Health of Montenegro in 2018. The study included 400 patients aged 30-35 years from Rozaje, Berane, Budva and Podgorica, 100 from each town, who underwent HPV typing in accordance with the latest screening program for early detection and prevention of cervical cancer, approved by the Ministry of Health of Montenegro in 2018. The material was obtained and sampled at the Health Clinics in Rozaje, Berane, Podgorica and Budva. Specially designed brushes were used to take swabs from the cervices, which were then sampled in separate collection tubes that contained a liquid transport medium. The samples were then sent for further analysis to the Institute of Public Health of Montenegro where HPV typing was performed using the real-time polymerase chain reaction method. The results were encrypted and obtained electronically. The data obtained from the questionnaires each subject filled out in accordance with this program were analyzed and the subjects willingly agreed to partake in the screening program. Nearly one-quarter of subjects had a positive HPV finding. The group of HPV positive women included significantly more women from Podgorica (χ2-test=26.455, p<0.001), women with very good living conditions (χ2-test=12.264, p<0.001), women who smoked cigarettes (χ2-test=5.074, p=0.024), women who had the first sexual intercourse between the ages of 17 and 20 (χ2-test=5.874, p=0.015), and women who did not have permanent partners (χ2-test=6.061, p=0.014). Among the observed socio-demographic characteristics and sexual behaviors of our subjects that proved to be non-significant variables in their HPV statuses we excluded the length of smoking habit (χ2-test=0.638, p=0.424) and protected sexual intercourse (χ2-test=2.628, p=0.105). By implementing the screening program and HPV typing, we came to a conclusion that the problem of cervical cancer could be solved or at least mitigated by raising awareness of the causes and incidence of cervical cancer, as well as by being well informed on its curability, predictability and protection during intercourse, which would contribute to positive changes.

Lung cancer mortality in Montenegro, 1990 to 2015.

AIM: To analyze the trend of lung cancer mortality in Montenegro from 1990 to 2015. METHODS: Data on lung cancer mortality were collected from death certificates obtained from the Statistical Office of Montenegro for the period 1990-2009 and the Institute for Public Health for the period 2010-2015. Population data were obtained from the Statistical Office of Montenegro. Rates were age-standardized to the World Standard Population, and mortality trends were analyzed with the joinpoint regression. RESULTS: In 2015, lung cancer accounted for 5.44% of all deaths and 22.92% of all cancer deaths. It was the leading cause of all cancer deaths and the third-leading cause of all deaths. A joinpoint was observed in 2004 in women and in the entire population, and in 2005 in men. The overall mortality rates increased from 1990 to 2004 by an average of 3.91% per year and decreased from 2004 to 2015 by an average of 1.95%; which in the entire observed period resulted in an average increase of 1.3% per year. A particularly strong growth rate was observed in women, even 7.14% in the period from 1990 to 2004. CONCLUSION: The observed increase in lung cancer mortality warrants improved tobacco control.

Potential health impact of strong tobacco control policies in 11 South Eastern WHO European Region countries.

Background: While some WHO European Region countries are global tobacco control leaders, the South Eastern region of Europe has the highest tobacco smoking prevalence globally and a relatively low level of overall implementation of the WHO Framework Convention on Tobacco Control (WHO FCTC). An abridged version of SimSmoke has been developed to project the health impact of implementing tobacco control policies in line with the WHO FCTC. Methods: Data on population size, smoking prevalence, policy-specific effect sizes and formulas were applied in 11 South Eastern WHO European Region countries [Albania, Bosnia and Herzegovina (the Federation of Bosnia and Herzegovina and the Republika Srpska), Bulgaria, Croatia, Israel, Montenegro, Republic of Moldova, Romania, Serbia, Slovenia and the former Yugoslav Republic of Macedonia] to project the relative reduction in smoking prevalence, number of smokers and number of smoking-attributable deaths resulting from implementing individual and/or combined six WHO FCTC measures. Results: For all countries, an increase in excise cigarette taxes to 75% of price yields the largest relative reduction in smoking prevalence (range 8-28%). The projections show that within 15 years smoking prevalence can be reduced by at least 30% in all countries when all six tobacco control measures are fully implemented in line with the WHO FCTC. Conclusion: The projections show that large health effects can be achieved and the results can be used as an advocacy tool towards acceleration of the enforcement of tobacco control laws in WHO European Region countries.

Predisposing Factors Responsible for the Occurrence of Bacterial Purulent Meningoencephalitis

Bacterial purulent meningoencephalitis (BPME) is a life-threatening infectious disease caused by various pyogenic bacteria. The disease is defined as the inflammatory process of leptomeninges (visceral layer, pia mater and arachnoid membrane) and brain parenchyma with exudates in the subarachnoid space and surrounding brain structures. The aim of the study was to define the predisposing factors responsible for the occurrence of BPME, as well as the possible correlation between the presence of predisposing factors and patient demographic characteristics, etiology and outcome of the disease. This retrospective-prospective study included 90 patients with BPME confirmed by clinical, neuroradiological and laboratory findings. Multivariate logistic regression models were fitted to analyze the impact of the predisposing factors on the disease outcomes. Predisposing factors that were related to BPME were found in 61% of patients. Cranial trauma as the leading factor was recorded in 23.3% of patients, followed by previous neurological disease in 14.4% of patients, while 13 patients were exposed to previous chemotherapy or long-term corticosteroid therapy. Cardiovascular diseases were reported in 12.2% and diabetes in 7.8% of patients. The existence of cardiovascular diseases significantly influenced unfavorable outcome of the disease, i.e. "deceased" in comparison to "cured" (OR=8.418; 95% CI=1.007-76.270), independently of age and gender. None of the examined predisposing factors was significantly related to the "recovered with sequels" outcome as compared with "cured" outcome. Older age and presence of cardiovascular disease as a predisposing factor significantly increased the odds of the BPME unfavorable outcome "deceased" as compared to "cured" outcome.

Seroprevalencia de la infección por dengue en los municipios de Armenia, Calarcá, La Tebaida y Montenegro en el departamento del Quindío, 2014 / Seroprevalence of dengue infection in the municipalities of Armenia, Calarcá, La Tebaida and Montenegro in Quindío, 2014

Resumen Introducción: El dengue representa un grave problema de salud pública para Colombia y, en el departamento del Quindío, afecta el 90 % de los municipios. Se necesitan estudios actualizados sobre la seroprevalencia en la población general para reforzar las acciones de salud pública. Objetivo: Determinar la seroprevalencia de la infección por dengue en barrios con alta incidencia de dengue en cuatro municipios del departamento del Quindío: Armenia, Calarcá, La Tebaida y Montenegro, en 2014. Materiales y métodos: Se hizo un estudio de prevalencia mediante muestreo probabilístico estratificado y bietápico. Se hizo una encuesta a 658 sujetos residentes del área urbana de los municipios seleccionados y se les tomó una muestra de sangre por venopunción para determinar anticuerpos IgG e IgM contra el virus del dengue. Resultados: La seroprevalencia de anticuerpos IgG en el Quindío fue de 89,4 %; en Armenia fue de 88,7 %, en Calarcá, de 81,5 %, en Montenegro, de 91,8 %, y en La Tebaida, de 97,8 %. La seroprevalencia de anticuerpos IgM en Quindío fue de 14,2 %; en Armenia, de 11,5 %, en Calarcá, de 13,0 %, en Montenegro, de 13,1%, y en La Tebaida, de 28,9 %. Conclusiones: Se evidenció una alta prevalencia de anticuerpos IgG e IgM en los cuatro municipios. En todos los grupos de edad se encontraron personas seropositivas para IgM, lo cual indicaría infección reciente. La seropositividad simultánea para IgM e IgG (12,9 %) puede indicar infección secundaria por otro serotipo del virus o una infección en los tres meses anteriores. Es necesario impulsar estrategias multisectoriales para el control de la transmisión del dengue en el Quindío.

Abstract Introduction: Dengue is a serious public health problem in Colombia; it is prevalent in 90% of the municipalities in Quindío. Studies on its seroprevalence are required to address public health interventions. Objective: To establish the seroprevalence of dengue infection in neighborhoods with high incidence in the municipalities of Armenia, Calarcá, La Tebaida and Montenegro, Quindío, in 2014. Materials and methods: We conducted a probabilistic, stratified, two-stage prevalence study. We interviewed 658 residents in the urban area of the selected municipalities. After they signed the informed consent, we took a blood sample to determine dengue IgG and IgM antibodies. Results: Seroprevalence of IgG in Quindío was 89,4%; in Armenia it was 88,7%, in Calarcá, 81,5%, in Montenegro, 91,8% and in La Tebaida 97,8%. IgM was 14, 2% in Quindío; in Armenia it was 11,5%, in Calarcá, 13,0%, in Montenegro, 13,1% and in La Tebaida, 28,9%. Conclusions: We found a high prevalence of both IgG and IgM in the four municipalities. We had positive results for IgM in all age groups, which suggests recent infection. We also found simultaneous seropositivity for IgG and IgM (12.9%), which may indicate infection by another serotype or presence of infection in the past three months. A multisectoral approach is necessary for dengue control in Quindío.

The association between pro-arrhythmic agents and aortic stenosis in young adults: is it sufficient to clarify the sudden unexpected deaths?

Most young patients with mild-to-moderate aortic stenosis show no symptoms, and sudden death appears only occasionally. We hypothesised that malignant ventricular arrhythmias could be responsible for the high incidence of sudden death in such patients. If multiple factors such as asymptomatic aortic stenosis in association with arrhythmia-provoking agents are involved, could it be sufficient to account for sudden unexpected death? In this study, eight cases of sudden death in young adults, with ages ranging from 22 to 36 years, who had never reported any symptoms that could be related to aortic stenosis, were investigated. Full autopsies were performed, and congenital aortic stenosis in all eight cases was confirmed. DNA testing for channelopathies was negative. Comprehensive toxicological analyses found an electrolyte imbalance, or non-toxic concentrations of amitriptyline, terfenadine, caffeine, and ethanol. Collectively, these results suggest that congenital asymptomatic aortic stenosis without cardiac hypertrophy in young adults is not sufficient to cause sudden death merely on its own; rather, an additional provoking factor is necessary. According to our findings, the provoking factor may be a state of physical or emotional stress, a state of electrolyte imbalance, or even taking a therapeutic dose of a particular drug.

Children's health risk assessment based on the content of toxic metals Pb, Cd, Cu and Zn in urban soil samples of Podgorica, Montenegro.

BACKGROUND/AIM: Due to their low tolerance to pollutants and hand-to-mouth pathways the health risk is very high in children's population. The aim of this study was to evaluate risk to children's health based on the content of heavy metals in urban soil samples from Podgorica, Montenegro. This study included the investigation of several toxic metals such as Pb, Cd, Cu and Zn in soil samples from public parks and playgrounds. METHODS: Sampling was conducted in a period October-November, 2012. Based on cluster analysis, soil samples were divided into two groups related to similarity of metal content at examinated locations: the group I--near by recreational or residential areas of the city, and the group II--near traffic roads. Concentration of toxic metals, in urban soil samples were determined by a graphite furnace atomic absorption spectrometry (Pb and Cd) and by inductively coupled plasma optical emission spectrometry technique after microwave digestion. Due to exposure to urban soil, non-cancerogenic index hazardous index (HI) for children was estimated using 95th percentile values of total metal concentration. The value of the total (ingestion, dermal and inhalation) HI is calculated for maximum, minimum and the average concentration of metals for children. RESULTS: Mean concentrations of Pb, Cd, Cu and Zn in the surface layer of the studied urban soils were 85.91 mg/kg, 2.8 mg/kg and 52.9 mg/kg and 112.5 mg/kg, respectively. Samples from group II showed higher metal content compared to group I. Urbanization and traffic are the main sources of pollution of the urban soils of Podgorica. Most of the samples (93.5%) had a high Pb content, 12.9% of the samples had a higher content of Cd, while Cu and Zn were within the limits prescribed by national legislation. At one location the level of security for lead is HI = 0.8 and very closed to maximum acceptable value of 1. It is probably the result of intensive traffic near by. CONCLUSION: All metals investigated showed relatively higher concentrations at sites that were close to industrial places and high ways. The mean concentrations of Pb and Zn and maximum concentrations of Pb, Cd, and Zn were higher than presented values in the National Regulation.

Colorectal cancer screening in a low-incidence area: general invitation versus family risk targeting: a comparative study from Montenegro.

OBJECTIVES: Colorectal cancer (CRC) is one of the most common malignancies worldwide. The aim of this study was to compare the outcomes of two different screening approaches in a small country (Montenegro, 650,000 inhabitants) with a CRC incidence lower than the European average. METHODS: Two structured invitation programs were compared with respect to compliance and neoplasia yield: (i) program A focused on first-degree relatives of CRC patients diagnosed in two hospitals (n=206), inviting them for colonoscopy; (ii) program B was an invitation program for fecal occult blood testing, followed by colonoscopy if positive, conducted in University Hospital, Podgorica, Montenegro, on 2760 randomly selected average-risk persons, age 50-74 years, living in a single municipality. RESULTS: Of 710 first-degree relatives of 206 CRC patients approached, 540 presented for colonoscopy (76.05% uptake). Overall, 31 were diagnosed with a cancer, 58 with advanced adenoma, and 151 with adenoma in general. In the general screening program, of 2760 individuals invited, 920 underwent fecal immunochemical test (33.3% uptake) and colonoscopy was performed in all 95 positive cases (10.3%); six cancers was found in five patients (one patient had two cancers), 19 patients were diagnosed with advanced adenoma, and 26 with any adenomas. The risk-targeted screening program had a significantly higher yield for cancers in both per invited (31/710 vs. 5/2760, P<0.001) and per eligible person analysis (31/540 vs. 5/920, P<0.001). CONCLUSION: In a low-incidence country with limited resources, it may be advisable to start with CRC screening targeted to risk groups.

Prevalence of and contributing factors for overweight and obesity among Montenegrin schoolchildren.

BACKGROUND: Newly emerging Western style economic systems provide new opportunities to study the prevalence and predictors of childhood obesity. We also provide for the first time a national study of childhood obesity using all three international anthropometric criteria. METHODS: The sample included 4097 Montenegrin children, 2076 boys (50.7%) and 2021 girls. Anthropometric measurements were performed in school. The questionnaire for parents included questions on 24 potential contributing factors for childhood obesity. Nutritional status was assessed according to World Health Organization, US Center for Disease Prevention and Control and International Obesity Task Force (IOTF) criteria. RESULTS: Overall percentage of Montenegrin children who are overweight or obese (IOTF) is 22.9% of which 5.3% are obese (7.0% boys vs. 3.5% girls). We found 10 factors to be independently associated with child obesity. Positive relations [odds ratio (95% confidence interval)] were found with maternal obesity [2.05 (1.68-2.51)], paternal obesity [1.67 (1.32-2.10)], paternal employment [1.40 (1.12-1.74)], maternal smoking [1.32 (1.08-1.61)], obesity at birth [1.33 (1.04-1.70)] and computer game playing [per hour--1.11 (1.00-1.24)]. Negative relations were found with female gender [0.64 (0.53-0.78)], the number of siblings [0.88 (0.78-0.98)], birth order [0.73 (0.64-0.83)] and age [0.92 (0.88-0.98)]. CONCLUSION: One out of four Montenegrin children is overweight, with two times more frequent obesity among boys compared with girls. Some previously salient predictors did not appear salient in this sample. To enable worldwide comparability, we propose the use of all three childhood obesity criteria in national studies.

Changing trends in incidence of lung cancer by histological type in Montenegro.

INTRODUCTION: Lung cancer is one of the most common malignant neoplasms, as well as the most common cause of death cancer. Most lung cancers are squamous cell carcinomas, small cell carcinomas or adenocarcinomas. OBJECTIVE: Examining changes in trends of lung cancer incidence in Montenegro by histological type during a 15-year period, from 1997 to 2011. METHODS: During the study period, histopathological confirmation was obtained for all primary lung cancer cases in the only hospital for lung diseases in the country. Based on the data from medical records, patients were classified by time period, sex, age groups and smoking history. Descriptive method was used. RESULTS: Ratio between incidences of adenocarcinoma and squamous cell carcinoma changes in males, with a significant increase in the incidence rate of adenocarcinoma and drop in the rate of squamous cell carcinoma (p < 0.001). In addition, statistically significant (p < 0.05) decrease in the incidence of NSCLC (non-small cell lung cancer) and an increase in the incidence of SCLC (small cell lung cancer) was found. A statistically significant increase in linear trend in the incidence of small cell carcinoma was noted in females (p < 0.005). CONCLUSION: Incidence rates of adenocarcinoma and small cell carcinoma have increased during the study period.

Severe combined immunodeficiency in Serbia and Montenegro between years 1986 and 2010: a single-center experience.

Severe combined immunodeficiency (SCID), including the 'variant' Omenn syndrome (OS), represent a heterogeneous group of monogenic disorders characterized by defect in differentiation of T- and/or B lymphocytes and susceptibility to infections since birth. In the period of 25 years, between January 1986 and December 2010, a total of 21 patients (15 SCID, 6 OS) were diagnosed in Mother & Child Health Institute of Serbia, a tertiary-care teaching University hospital and a national referral center for patients affected with primary immunodeficiency (PID). The diagnoses were based on anamnestic data, clinical findings, and immunological and genetic analysis. The median age at the onset of the first infection was the 2nd month of life. Seven (33 %) patients had positive family history for SCID. Out of five male infants with T-B+NK- SCID phenotype, mutation analysis revealed interleukin-2 (common) gamma-chain receptor (IL2RG) mutations in 3 with positive X-linked family history, and Janus-kinase (JAK)-3 gene defects in the other two. Six patients had T-B-NK+ SCID phenotype and further 6 features of OS, 11 of which had recombinase-activating gene (RAG1or RAG2) and 1 Artemis gene mutations. One child with T+B+NK+ SCID phenotype as well had proven RAG mutation. One child each with T-B+NK+ SCID phenotype, CD8 lymphopenia and unknown phenotype remained without known underlying genetic defect. Of the eight patients who underwent hematopoetic stem cell transplant (HSCT) 5 survived, the other 13 died between 2 days and 12 months after diagnosis was made. Early diagnosis of SCID, before onset of severe infections, offers possibility for HSCT and cure. Education of primary-care pediatricians, in particular including awareness of the risk of using live vaccines and non-irradiated blood products, should improve prognosis of SCID in our setting.

Effect of delays on survival in patients with lung carcinoma in Montenegro.

Lung cancer is a global medical problem with a rising incidence and 5-year survival of 5%-10%. The aim of this study was to investigate whether waiting times and delays in diagnosis and treatment of patients with lung carcinoma have any bearing on prognosis and survi- val. The study was performed in the Brezovik Special Hospital for Lung Diseases and Tuberculosis. The study included all cases with the diagnosis of lung carcinoma in the Republic of Montenegro in 2009, a total of 206 patients, with follow up until the end of 2010. Median age was 66, median Karnofsky score 80, and male to female ratio 5:1. Diagnostic procedure was bronchoscopy in 89% of patients. Histologic type was small cell lung cancer in 25.7% and non small cell lung cancer in 74.3% of cases. Surgery was the main treatment for 24.4% of patients. Median delay from first symptoms to diagnosis of lung cancer was 10.35 weeks, mean 8 weeks (median patient's delay was 6.20 weeks, doctor's delay at primary health care 2.07 weeks and in pulmonology services 2.37 weeks). Median survival time for all patients was 39.27 weeks, mean 34. There was no statistically significant diffe- rence between patient's delay/doctor's delay/total delay and stage of lung carcinoma at the time of diagnosis, treatment choice and survival. Our results indicate that longer delay is not associated with poorer prognosis of lung carcinoma. The possible ways of reducing mortality of lung cancer include prevention by decreasing smoking prevalence and improved therapeutic options.