Multivariate analysis of prognostic factors in male breast cancer in Serbia.

BACKGROUND: The aim of this study was to analyze the demographic and clinical characteristics of male breast cancer patients in Serbia, and furthermore to determine overall survival and predictive factors for prognosis. MATERIALS AND METHODS: In the period of 1996-2006 histopathological diagnosis of breast cancer was made in 84 males at the Institute for Oncology and Radiology of Serbia. For statistical analyses the Kaplan-Meier method, long-rank test and Cox proportional hazards regression model were used. RESULTS: The mean age at diagnosis with breast cancer was 64.3±10.5 years with a range from 35-84 years. Nearly 80% of the tumors showed ductal histology. About 44% had early tumor stages (I and II) whereas 46.4% and 9.5% of the male exhibited stages III and IV, respectively. Only 7.1% of male patients were grade one. One-fifth of all patients had tumors measuring ≤2 cm, and 14.3% larger than 5 cm. Lymph node metastasis was recorded in 40.4% patients and 47% relapse. Estrogen and progesterone receptor expression was positive in 66.7% and 58.3%, respectively. Among 14.3% of individuals tumor was HER2 positive. About two-thirds of all male patients had radical mastectomy (66.7%). Adjuvant hormonal (tamoxifene), systematic chemotherapy (CMF or FAC) and adjuvant radiotherapy were given to 59.5%, 35.7% and 29.8% patients respectively. Overall survival rates at five and ten years for male breast cancer were 55.0% and 43.9%, respectively. According to the multivariate Cox regression predictive model, a lower initial disease stage, a lower tumor grade, application of adjuvant hormone therapy and no relapse occurrence were significant independent predictors for good overall survival. CONCLUSIONS: Results of the treatment would be better if disease is discovered earlier and therefore health education and screening are an imperative in solving this problem.

Risk factors for the development of arterial hypertension.

AIM: To examine risk factors for the development of primary arterial hypertension which is a significant health and public health problem throughout the world. METHODS: This anamnestic study, conducted at the Primary Health Centre "Stari Grad" in Belgrade during 2006, included 63 new cases of arterial hypertension and 63 subjects who formed the control group. Patients and control group were individually matched to each other by sex, age (+/- 3 years) and place of residence. The survey instrument was a questionnaire based on socio-demographic characteristics of respondents (gender, age, residence, education level, occupation, marital status, socio-economic status) and habits (smoking, alcohol consumption, physical activity). Data analysis was performed by applying descriptive statistics (relative numbers) and inferential statistics (χ2 test). RESULTS: There were significant differences in the level of education (p = 0,012) and current smoking status (p=0.017) between the group of patients with arterial hypertension and the control group. The subjects in the control group showed significantly longer consumption of schnapps (p=0.033) and beer (p=0.040) (more than 20 years). There was a significant difference in excessive body weight, and obesity measured by body mass index (p=0.006) and waist circumference (p=0.014) between these groups of patients. CONCLUSION: Risk factors associated with arterial hypertension were low education, long smoking period, excessive body weight and obesity. These results indicate the necessity of introducing programs which should be imperative in future prevention of arterial hypertension.

Comparison of male and female breast cancer incidence and mortality trends in Central Serbia.

BACKGROUND: To compare breast cancer incidence and mortality trends in Central Serbia between males and females in the period 1999-2009. MATERIALS AND METHODS: In this descriptive study, mortality data were obtained from the National Statistics Institute and morbidity data were derived from Institute of Public Health of Serbia for the period of interest. RESULTS: Breast cancer is a leading cancer in the female population of Central Serbia, whereas in male population it is not on the list of 10 leading localizations, concerning both incidence as well as mortality. In the period 1999-2009 the average standardized incidence rates of breast cancer were 60.5/100,000 in women and 1.4/100,000 in men, while average standardized mortality rates were 20.4/100,000 and 0.4/100,000. The average standardized incidence and mortality rates were about 45 times higher in females than males. Male breast cancer comprises approximately 2.1% of all breast cancer cases. The average age-specific mortality and incidence rates increased with age in both sexes. In the observed period standardized mortality rates of breast cancer increased significantly only in men (y=0.320+0.021?, p=0.044). CONCLUSIONS: The increase of breast cancer incidence in both sexes and mortality in men, indicate an urgent need for Serbian health professionals to apply existing cancer control and preventive measures. Male breast cancer is more present than in other world regions, with an outstanding increase of mortality, which demands a timely identification (screening) and adequate treatment. A national policy including mammography should be considered in the light of the newest findings.

Risks for first nonfatal myocardial infarction in Belgrade.

The aim of this study was to investigate which one among possible risk factors are independently related to first nonfatal myocardial infarction (MI) in Belgrade population. Case-control study was conducted in Belgrade during the period 2005-2006. Case group comprised 100 subjects 35-80 years old who were hospitalized because of first nonfatal MI at the coronary care unit in Urgent Center, Belgrade. Control group consisted of 100 persons chosen among patients treated during the same period at the Institute of Rheumatology, Institute for Gastroenterology, and Clinic for Orthopedics, Belgrade, Serbia. Cases and controls were individually matched by sex, age (+/- 2 years) and place of residence (urban/rural communities of Belgrade). According to the multivariate analysis risk factors for MI occurrence were "good" socioeconomic conditions (OR = 2.76), total alcohol consumption (OR = 2.62) and consumption of brandy (OR = 6.73), stressful life events taken together (OR = 3.13) and stress because of close relative Ns death (OR = 3.35), great financial problems (OR = 31.64) and small financial problems (OR = 8.47), hypertension (OR = 2.39), MI among all relatives (OR = 3.66), MI in father (OR = 6.24), and low level of high density lipoprotein cholesterol (OR = 152.41). Amateur sport activity in the past was negatively associated with MI development. The results obtained are mainly in accordance with other studies results and can be of help in development of strategy for coronary heart disease prevention in Serbia.

The stressful life events and Parkinson's disease: a case-control study.

A case-control study was conducted in order to investigate the possible link between stressful life events and Parkinson's disease (PD). A group of 110 consecutive newly diagnosed PD cases treated at the Institute of Neurology, Faculty of Medicine, Belgrade University, was compared with a control group comprising 220 subjects with degenerative joint disease and some diseases of the digestive tract. The case and control subjects were matched by sex, age (±2 years) and place of residence (urban/rural). According to conditional multivariate logistic regression analysis, PD was found to be significantly related to retirement (odds ratio--OR 18.73, 95% confidence interval--95%CI 1.9-175.4), birth of own child (OR 66.22, 95%CI 8.3-526.3) and air raids (OR 5.66, 95%CI 2.4-13.5). The risk of PD significantly increased with the number of stressful events. The results of the present study support the hypothesis that stress may play a role in the development of PD.

Cigarette smoking, coffee intake and alcohol consumption preceding Parkinson's disease: a case-control study.

OBJECTIVE: A case-control study was performed in Belgrade in order to investigate the association between Parkinson's disease (PD) and smoking, coffee and alcohol consumption. METHODS: During the period 2001-2005, 110 new PD cases and 220 hospital controls were interviewed. Cases and controls were matched by sex, age and place of residence (urban/rural). For the analysis of data conditional univariate and multivariate logistic regression methods were used. RESULTS: With PD were associated, independently from each other, current smoking [odds ratio (OR) = 0.44; 95% confidence interval (CI) = 0.23-0.82], alcohol consumption (OR = 4.78; 95% CI = 2.67-8.55) and coffee consumption (OR = 2.54; 95% CI = 1.36-4.75). In ever smokers the risk for PD significantly decreased with the increasing number of cigarettes smoked and with increasing duration of smoking. The risk for PD significantly increased with the increasing quantity of alcohol consumption. PD risk was significantly higher in subjects whose average daily consumption of coffee was 1 and 2-3 cups, and it was lower (but not significantly) in those whose daily coffee consumption was 4+ cups. Cases and controls did not differ in duration of alcohol and coffee consumption. The results of multivariate analyses did not substantially change after adjustment on family history positive on PD. CONCLUSION: The findings of this study support the hypotheses of inverse association of smoking with PD, but an inverse association with coffee was not confirmed. PD was found to be positively associated with coffee and alcohol consumption.

Some risk factors for the development of type 2 diabetes in men and women of Belgrade population.

INTRODUCTION: In the last two decades there has been an increase in the prevalence of type 2 diabetes in both developed and in developing countries. OBJECTIVE: To determine whether personal habits like smoking, alcohol and coffee consumption or physical inactivity are different between genders in patients with type 2 diabetes. METHODS: The study was conducted in Belgrade, during the period 2007-2008, and included newly diagnosed patients with type 2 diabetes. We included 80 men and 99 women diagnosed with diabetes mellitus type 2, referred to the Primary Health Care Centre "Savski venac". A questionnaire was used to collect data on demographic and anthropometric characteristics, as well as data on healthy habits. The chi2 test and two-tailed t-test were used for data analysis. RESULTS: The men were significantly more engaged in industry and crafts, while the women worked significantly more frequently in administrative jobs. The men were married significantly more frequently than the women (p < 0.05) and had a higher level of education (p < 0.05). Regarding to the level of implementation of nutritional and physical activity, there were no significant differences between the genders (p > 0.05). The women consumed coffee significantly more frequently than the men (p < 0.05), but drank less alcohol (p < 0.05). The men were former smokers significantly more frequently (p < 0.05) than the women. CONCLUSION: These results indicate the role of certain personal habits in the development of type 2 diabetes.

Environmental factors and Parkinson's disease: a case-control study in Belgrade, Serbia.

A case-control study was performed in Belgrade in order to investigate the association between Parkinson's disease (PD) and some environmental factors. During the period 2001-2005, 110 new PD cases and 220 hospital controls were interviewed. Cases and controls were matched by sex, age (+/-2 years), and place of residence (urban/rural). According to multivariate conditional logistic regression analysis, PD was positively asssociated with exposure to insecticides (odds ratio (OR) 3.22, 95% confidence interval (95% CI) 1.32-7.87), dyes (OR 25.33; 95% CI, 2.89-222.0), and naphtha and its derivates (OR 9.53; 95% CI, 1.04-86.96), and with gardening (OR 5.51; 95% CI, 3.04-10.01), well water drinking (OR 2.62; 95% CI, 1.40-4.90), and spring water drinking (OR 2.19; 95% CI, 1.15-4.16). Negative association was found for service-sector working (OR 0.15; 95% CI, 0.04-0.59). The results obtained did not changed after adjustment for smoking. The findings of the present study support the role of environmental factors in the occurence of PD.

[Shigellosis--epidemiological situation in Montenegro in period 1996-2005].

UNLABELLED: INTRODUCTION Shigellosis is the most common cause of diarrhoea in the world. It is estimated to cause 165 million cases per a year, and two third of all diseases and most of the deaths are among children under 10 years of age. The aim of this descriptive epidemiologic study was to analyze the incidence of shigellosis in Montenegro during the period 1996-2005 and to find out which species of Shigella were dominant in this region. MATERIAL AND METHODS: In the analysis of the data we used crude, age-specific and standardized incidence rates calculated by direct method using world population by Segi as standard. RESULTS: During the study period the average participation of shigellosis among all cases of intestinal diseases expressed in percentage was 1.2%. The average standardized incidence rate for shigellosis was 7.18/100.000 in male population and 6.3/100.000 in female population. During the period 1996-2005 the number of Shigella cases decreased both in male and female population. Most of the cases were among children aged 0-14, and then in the age group 15-24 years. The most common species were S. sonnei (46.1%), then S. flexnery (25.4%), S. boydi (10.9%) and S. dysenteriae (3.6%). DISCUSSION: Today shigellosis is still a big health problem in most countries because of high mortality rate among children, the presence of multi-resistant species to antibiotics, easy transmission from one person to another and lack of preventive measures, especially vaccine. CONCLUSION: In order to decrease the incidence of shigellosis it is necessary to apply appropriate preventive measures as well as to improve vaccine against this disease.

[Oesophageal-cancer-derived death in the population of Belgrade in a period 1989-2006].

BACKGROUND/AIM: Oesophageal cancer is the sixth most common cause of death from all malignant tumors in the world (fifth in men, eighth in women). This cancer was estimated to account for about 529 000 new cases and about 442 000 deaths in the year 2007. In the year 2002 the highest standardized mortality rates (per 100 000 habitants) of oesophageal carcinoma were noticed in the East Asia (men/women: 18.8/7.7) and East Africa (18.6/7.8), while the lowest were noticed in the Middle Africa (1.4/0.2) and West Africa (1.3/0.5). The aim of this descriptive epidemiologic study was to analyze epidemiologic situation of oesophageal cancer in Belgrade population during the period 1989-2006, using mortality data. METHODS: Mortality data were collected from the City Organization for Statistics. In data analysis we used mortality rates which were standardized directly using those of the world population as the standard, and proportions. A denominator for mortality rates was calculated using the Belgrade population which was an average of the two latest register years (1991 and 2002). In order to analyze trend mortality from oesophageal cancer we used linear trend. RESULTS: In Belgrade deaths from oesophageal cancer accounted for about 5.2% of all malignant tumors of intestinal system in male population, and 2.4% in female population. This cancer is, according to standardized mortality rates (per 100 000 habitants), on the fifth place in Belgrade population behind colorectal, stomach, pancreatic, liver and cholecystic cancer. During the period 1989-2006 in Belgrade 44 persons died from oesophageal carcinoma on the average each year, mainly men (75%), and the rest were women (25%). In male population during the same period we noticed a significant increase in trend mortality (y = 1.61 + 0.06x, p = 0.001), while in female population the increase of mortality was not significant. The male/female oesophageal cancer mortality ratio was 3:1. Mortality rates for oesophageal cancer rise with age in both sexes and they are highest in the age group of 70 and more years. Significant increase in mortality from oesophageal cancer was noticed in age groups 20-29 and over 70 in male population, and age group 40-49 in female population. CONCLUSION: Increasing trend in oesophageal mortality suggests the necessity for improving measures of primary prevention including education about risk factors for this carcinoma (smoking, alcohol consumption, hot food and drinks), early diagnosis, and treatment.

[Mortality from heart attack in Belgrade population during the period 1990-2004].

INTRODUCTION: In most countries, cardiovascular diseases are the leading disorders, with ischemic heart diseases being the leading cause of death. According to WHO data, every year about 17 million people die of cardiovascular diseases, which is 30% of all deaths. Ischemic heart diseases contribute from one-third to one-half of all deaths due to cardiovascular diseases. Three point eight million men and 3.4 million women in the world die every year from ischemic heart diseases, and in Europe about 2 million. The highest mortality rate from ischemic heart diseases occurs in India, China and Russia. OBJECTIVE: The aim of this descriptive epidemiological study was to determine heart attack mortality in Belgrade population during the period 1990-2004. METHOD: In the study, we conducted investigation of Belgrade population during the period 1990-2004. Mortality data were obtained from the city institution for statistics. The mortality rates were calculated based on the total Belgrade population obtained from the mean values for the last two register years (1991 and 2002). The mortality rates were standardized using the direct method of standardization according to the world (Segi) standard population. RESULTS: In the Belgrade population during the period 1990-2004, the participation of mortality rate due to heart attack among deaths from cardiovascular diseases was 17% in males and 10% in females. In Belgrade male population, mean standardized mortality rates (per 100,000 habitants) were 50.5 for heart attack, 8.3 for chronic ischemic heart diseases and 4.6 for angina pectoris, while in females the rates were 30.8, 6.7 and 4.2, respectively. Mortality from ischemic heart diseases and from heart attack was higher in males than in females. During the studied 15-year period, on average 755 males and 483 females died due to heart attack every year. Mean standardized mortality rates per 100,000 habitants were 50.0 in male and 31.1 in female population. Males died 1.6 times more frequently from heart attack than females. During the studied period, mean standardized mortality rates from heart attack, in the population aged over 30 increased with age both in male and female population. However, males tended to die from heart attack at an earlier age than females, with death rates for males approximately the same as those for women who were 10 years older. CONCLUSION: In Belgrade during the period from 1990-2004, we found that there was an increasing trend in mortality rate due to cardiovascular diseases, while the trend of mortality rate from heart attack was constant with insignificant oscillations.

Stressful life events and psychological dysfunctions before the onset of type 1 diabetes mellitus.

AIM: To test the hypothesis that stressful life events and psychological dysfunction increase the risk for development of type 1 diabetes mellitus (DM1). METHOD: A case-control study comprising 105 children with DM1 and 210 controls matched by age +/- 1 year), sex and place of residence. Conditional univariate and multivariate logistic regressions were used to analyze the data. RESULTS: After adjustment for possible confounders, the following factors were positively related to DM1: parents' job-related issues changed or lost job (odds ratio [OR] 11.5, 95% confidence interval [CI] 1.6-81.8); other severe life events--severe accident, hospitalization or death of close friend, quarrels between parents, war in republics of former Yugoslavia, near-drowning in a pool, falling down, unhurt participant of an accident (OR 68.5, 95% CI 13.5-349.0); other minor life events--conflicts with parents/teacher/neighbors, lost in town, physical attack, failure in competition, penalty, examination, death of pet, presence at lightning strike, thrown out of dwelling (OR 32.7, 95% CI 6.3-169.6); and learning problems (OR 17.5, 95% CI 4.3-71.6). CONCLUSION: These results support the hypothesis that stressful life events and psychological dysfunctions are associated with DM1.

[Mortality rate of gastric cancer in the population of Belgrade for 1990-2002 period].

BACKGROUND: Worldwide, gastric cancer is the fourth leading cause of diseases, and the second leading cause of cancer deaths. AIM: To analyze the differences between men and women in mortality rate of gastric cancer in Belgrade from 1990-2002. METHODS: Mortality rates standardized directly to the "World population", and regression analysis were used. RESULTS: In Belgrade population, 29.2% out the total number of deaths attributable to cancer were caused by gastric cancer. Gastric cancer was the second most common cause of death among digestive tract cancers. In women, in the period between 1990 and 1993, an average annual decline of mortality was 9.0% (95% confidence interval (CI) = 5.9-13.1), and between 1994 and 2002, an average annual increase was 10.3% (CI = 8.4-12.6). Mortality rate series of gastric cancer in men did not fit any of the usual trend functions. The male/female gastric cancer mortality ratio was 1.7 : 1. Mortality rates for gastric cancer rose with age in both sexes and they were higest in the age group of 70 and more years. From 1990-2002, in both sexes aged 70 years and more, mortality from gastric cancer rose by 67.2% (CI = 58.0-76.4) in men and by 69.6% (CI = 60.6-78.6) in women. During the same period, the death rates in men decreased by 75.9 % (CI = 67.5-84.4) in the age group of 30-39 years, and by 48.1% (CI = 38.4-57.9) in women aged 50-59 years. In both sexes mortality rate series of all other age groups did not fit any of the usual trend functions. CONCLUSIONS: The increase in mortality rate of gastric in women over the past few years, showed the necessity of instituting primary and secondary preventive measures.