Body mass index and primary chronic venous disease--a cross-sectional study.

OBJECTIVES: This study aims to investigate whether overweight and obesity are related to the clinical (C) category of clinical, etiologic, anatomic and pathophysiologic (CEAP) classification of chronic venous disease (CVD). DESIGN: A cross-sectional study. MATERIALS AND METHODS: The study was conducted in Serbia, in the year 2011. Men and women aged >18 years, consecutively coming to venous specialists because of venous problems in the legs, were included in the study. Patients demographic, anthropometric and clinical data were collected. For the analysis, univariate and multivariate logistic regressions were used. RESULTS: The study comprised 1116 subjects with primary CVD, 384 (34.4%) men and 732 (65.6%) women. Among them 464 (41.6%) were normal-weight patients (body mass index (BMI) < 25.0 kg m(-2)), 476 (42.7%) were overweight (BMI = 25.0-29.9 kg m(-2)) and 176 (15.8%) were obese (BMI ≥ 30.0 kg m(-2)). According to multivariate analysis, the CEAP C category of CVD was significantly more advanced in overweight and obese patients, the association being more pronounced in obese. Compared groups did not differ in the presence of venous reflux. In univariate analysis, venous obstruction was related to overweight and obesity but this association did not substantially affect the relationship between obesity and CEAP C categories of CVD. CONCLUSION: The CEAP C categories of CVD were significantly related to overweight and obesity, and this association was independent of age, sex and some other postulated risk factors.

Adaptation and validation of a telephone questionnaire--Serbian version for case detection of rheumatoid arthritis and spondyloarthropathy (multicentric Eular study).

OBJECTIVE: To adapt and validate a telephone questionnaire for case detection of rheumatoid arthritis (RA) and spondyloarthropathies (SpA) in the Serbian population. METHODS: A questionnaire, developed by the French Society of Rheumatology and successfully tested in France, was adapted to the Serbian language using a cross-cultural adaptation process. It was validated in 150 patients: 50 with RA, 50 with SpA and 50 with degenerative rheumatic disorders. They were recruited from Institute of Rheumatology in Belgrade, hospital registry, years 2001 and 2002. The questionnaire validity was assessed in reference to clinical diagnosis and ACR 1987 and ESSG 1991 classification criteria. A logistic regression model was used for RA-control and SpA-control comparison to identify the set of items that best discriminates these groups. RESULTS: Cross-cultural adaptation of the Questionnaire was successfully achieved, verifying its equivalence with the original (semantic, idiomatic, experiential, conceptual). According to the logistic regression, two items selected for RA provided 92.1% agreement when using either clinical diagnosis or ACR classification criteria as a standard. SpA-control comparison included five items providing 96.8% agreement with clinical diagnosis and four items providing 94.1% agreement with ESSG criteria. Results of the present study are similar to those found in the French study. CONCLUSION: Validation results of the telephone questionnaire, translated and adapted to the Serbian language, confirm that it can be used as a detection tool for RA and SpA cases in the population of Serbia, whose diagnoses would have to be further confirmed.

Relationship Between Pain and CEAP C Categories of Chronic Venous Disease.

In this study, we investigated whether the occurrence and intensity of leg pain are related to C class of the clinical, etiological, anatomical, and pathophysiological (CEAP) classification for chronic venous disease (CVeD). This cross-sectional study, conducted in Serbia, included 2841 patients: 2027 (71.3%) women and 814 (28.7%) men with CVeD diagnosed by general practitioners. For the first time, the Numeric Rating Scale of 0 to 5 units was used to assess the intensity of pain. For the analysis, univariate and multivariate logistic and linear regressions were applied. Pain in the legs was reported by 90.5% of the patients. The occurrence of pain significantly (P < .001) increased with increasing C class. Of the patients who reported pain in the legs, 42.0% had moderate pain, 23.7% had moderate to severe pain, 22.8% had light pain, 11.2% had severe pain, and 0.3% had very severe pain. Severity of pain differed significantly (P < .001) according to C class. Light and moderate pain gradually decreased and severe pain gradually increased from C0 to C6 class. These associations remained significant after adjustment for age, body mass index, and family history of CVeD.

Diet and prostate cancer: a case-control study.

A case-control study, performed in two towns of Serbia (Yugoslavia) from 1990 to 1994, comprised 101 patients with histologically confirmed prostate cancer and 202 hospital controls individually matched by age (+/-2 years), hospital admittance and place of residence. Dietary information was obtained by using a standard questionnaire. After adjustment for possible confounders, risk factors for prostate cancer appeared to be the highest tertile of protein (odds ratio (OR) = 13.54, 95% confidence interval (CI) = 2.38-77.13), saturated fatty acid (OR = 3.63, 95% CI = 1.03-12.79), fibre (OR = 4.02, 95% CI = 1.38-11.73), and vitamin B12 intake (OR = 2.07, 95% CI = 1.08-3.97); a protective effect was found for the highest tertile of alpha-tocopherol (OR = 0.15, 95% CI = 0.05-0.53), calcium (OR = 0.37, 95% CI = 0.14-0.99) and iron intake (OR = 0.34, 95% CI = 0.12-0.95). There were significant (P < 0.05) linear trends in the odds ratios for alpha-tocopherol, vitamin B12, calcium and iron. According to logistic regression step by step analysis, risk factors for prostate cancer were dietary intake of retinol equivalent (OR = 1.64, 95% CI = 1.01-2.67) and vitamin B12 (OR = 1.87, 95% CI = 1.15-3.05), and a protective effect was found for dietary intake of iron (OR = 0.40, 95% CI = 0.27-0.58).

Cardiovascular disease mortality in Belgrade: trends from 1975-89.

STUDY OBJECTIVE: To determine trends in cardiovascular disease mortality. DESIGN: This was a descriptive study analysing mortality data. SETTING: Belgrade, Yugoslavia. PARTICIPANTS: The population of Belgrade in the age group 30-69 years was studied (about 760,000 inhabitants). MEASUREMENTS: Mortality rates were standardised directly using those of the "European population" as the standard, and regression analysis was undertaken. MAIN RESULTS: Between 1975 and 1989 "all causes" mortality increased by 27% (95% confidence interval 18.5, 35.9) in men and by 19% (11.6, 27.1) in women. The increase in cardiovascular disease mortality was 7% (1.7, 11.5) for men and 4% (0.2, 7.8) for women. Mortality from ischaemic heart disease fell in both sexes by 32% (23.0, 41.0), but mortality from other heart diseases rose by 31% (22.0, 40.2) in men and 25% (16.2, 33.0) in women. In men the death rate for cerebrovascular disease increased by 37% (27.8, 46.8), but in women the rate fell by 0.4% (-0.8, 1.6). Mortality from the observed causes of death was higher in men than in women. CONCLUSION: Cardiovascular mortality trends in Belgrade are similar to those in most eastern European countries. If the distribution of cigarette smoking and a "rich" diet in the Belgrade population is taken into account, a considerable decline in cardiovascular mortality trends cannot be expected in the near future.

Infectious diseases mortality in central Serbia.

STUDY OBJECTIVE: To determine the influence and the effect of the war in the former Yugoslavia and of the United Nations economic sanctions on mortality from infectious diseases. DESIGN: This was a descriptive study analysing mortality data time series. SETTING: Central Serbia, Yugoslavia. PARTICIPANTS: The population of central Serbia was the subject of the study (about six million inhabitants). MEASUREMENTS: Mortality rates were standardised directly, using the "European population" as the standard. Regression analysis and analysis of covariance were undertaken. MAIN RESULTS: During the period 1973-93, mortality from infectious diseases showed a decreasing trend. From 1987-90, and infectious diseases was significantly higher than expected on the basis of the trend for the preceding period (p = 0.020 and p = 0.00). In addition, there was a statistically significant departure from the preceding trend (p = 0.036) in men between 1991 and 1993 (the period of the war and UN sanctions)--the main effect being in younger age groups. CONCLUSION: The economic crisis in the former Yugoslavia during the 1980s followed by the outbreak of the war and the damaging effects of UN economic sanctions had a distinctly adverse effect on mortality from infectious diseases.

Case-control study of risk factors in laryngeal cancer.

A case-control study with 100 cases and 100 controls was conducted to test hypothetical risk factors in laryngeal cancer. McNemar's test helped to select 25 variables, 12 of which were indicated by the conditional logistic regression analysis as independently associated with laryngeal cancer. The association was proved to be statistically significant in the case of seven risk factors; smoking more than 10 cigarettes per day (RR = 18.17; 95% CI 1.95-169.76), predominantly tinned food and meat product diet (RR = 2.65; 95% CI 1.02-6.88), long-term work exposure to low temperatures and building, fabric and metal dust (RR = 4.53; 95% CI 1.80-11.37), extended stay in closed space filled with cigarette smoke (RR = 2.67; 95% CI 1.08-6.60), recurrent hoarseness persisting for more than 1 month (RR = 12.68; 95% CI 3.28-49.03), swollen neck lymph nodes over a number of years (RR = 12.81; 95% CI 1.57-104.29). It was inferred that these seven tested variables could represent risk factors in laryngeal cancer.

Risk factors for thyroid cancer.

Case-control study comprised 100 histologically verified thyroid cancer patients (23 men, 77 women) and 100 hospital controls matched with cases by sex, age and place of residence. Various risk factors were studied to determine whether they were associated with the occurrence of thyroid cancer. According to the conditional logistic regression analysis, 6 were significantly related to the disease: Cigarette smoking (RR = 7.12 95% CI = 1.53-32.99), family history of any malignant tumors (RR = 5.84 95% CI = 1.76-19.44), history of goiter or thyroid nodules (RR = 27.69 95% CI = 3.11-246.14), long-term occupational exposure to chemicals (RR = 10.07 95% CI = 3.85-26.35), history of second primary tumors (RR = 15.49 95% CI = 3.46-69.30), and diagnostic X-rays exposure (RR = 7.56 95% CI = 2.85-20.07).

Case-control study of multiple myeloma with special reference to diet as risk factor.

The case-control study was conducted in Belgrade (Yugoslavia) during the period 1994-1998. The objective of the study was to investigate factors related to the occurrence of multiple myeloma (MM). The study group consisted of 100 newly diagnosed MM patients and the same number of matched hospital controls. In the analysis conditional univariate and multivariate logistic regression were applied. According to multivariate analysis the following factors were significantly related to MM: smoking > or =25 cigarettes per day (Odds ratio--OR=6.7, 95% confidence interval--95% CI=1.3-34.3); having more than two brothers (OR=2.7, 95% CI=1.3-5.3), rheumatoid arthritis in personal history (OR=4.2, 95% CI=1.2-14.8), and frequent (4-7 times per week vs. lower frequency) consumption of yogurt (OR=3.1, 95% CI=1.6-6.0) and vegetables (OR=0.4, 95% CI=0.1-1.0).

Stressful life events and type 2 diabetes.

OBJECTIVES: The purpose of this study is to compare cases with type 2 diabetes and their controls for the frequency of stressful life events and social support before the occurrence of the disease. METHODS: The study of cases and their controls was undertaken in Belgrade. A case group comprised 179 subjects in whom type 2 diabetes was for the first time diagnosed in the 'Savski Venac' Medical Center during the period 2005-2007 year. The diagnosis was made by a specialist of internal medicine according to criteria of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. For each case two controls were chosen among patients with trauma (fracture, reposition, internal/external fixation) who were treated at the 'Banjica' Institute for Orthopedic-Surgical Diseases during the same period. Cases and controls were matched by sex, age (±2 years) and place of residence (Belgrade). Data were collected on demographic characteristics, habits, personal history, stressful life events, social support and family medical history. RESULTS: According to multivariate analysis low social support in personal history, such as relatives/friends help and financial assistance in solving problems, and bad management of monthly income were significantly positively related to type 2 diabetes. However, significantly more controls than cases had no financial insurance in case of urgent need CONCLUSION: Examine psychosocial factors play a role in the development of type 2 diabetes.

Risk factors for chronic venous disease.

OBJECTIVE: Chronic venous disease (CVD) is a common problem in developing and developed countries. METHODS: A cross-sectional study, conducted in two major towns in Serbia, comprised 3225 subjects over 18 years old, enrolled in the survey consecutively by general practitioners (GPs) within their normal framework. Diagnosis of CVD was made by GPs on the basis of symptoms and visual examination. Data on potential risk factors were collected by the use of a questionnaire. RESULTS: The prevalence of CVD was significantly higher in women (73.7%) than in men (70.1%), although severe forms of CVD were significantly more frequent in men. Risk factors for CVD were age, body mass index ≥ 25.00 kg/m(2), family history of CVD, history of blood clots in veins and ever-smoking in both sexes, and menopause, increased number of child births and physical inactivity in women. CONCLUSION: The results obtained suggest the possibility of CVD prevention by modification of some behavioural risk factors.

Risk factors for laryngeal cancer.

This case-control study comprised 100 histologically verified laryngeal cancer patients and 100 hospital controls matched with cases by sex, age and place of residence. The following variables were tested for their association with cancer of the larynx: marital status, educational level, hard liquor consumption, cigarette smoking, unfavorable working conditions, sudden and frequent temperature changes at work, cold housing, loud speech at work, frequent hoarseness, frequent and persistent cough, persistently swollen neck glands, tonsillectomy and laryngeal surgery. According to conditional logistic regression analysis, significant association with laryngeal cancer was found for unfavourable working conditions for more than 10 years (OR = 4.36; 95% CI = 1.92-9.91), hard liquor consumption for more than 5 years (OR = 2.59; 95% CI = 1.14-5.87), cigarette smoking for more than 10 years (OR = 7.29; 95% CI = 2.41-22.09), tonsillectomy (OR = 4.80; 95% CI = 1.61-14.30) and frequent and persistent cough prior to disease (OR = 8.17; 95% CI = 1.72-38.76).

Malignant tumors in families of thyroid cancer patients.

A case-control study comprised 177 patients with various types of thyroid cancer and the same number of hospital controls individually matched by age, sex and place of residence. Malignant tumors were more frequent among first and second degree relatives of cases as compared to controls. The odds ratio (95% confidence interval) was 2.43 (1.33-4.44) and 5.33 (1.77-16.01) respectively. The most frequent were cancers of uterus and stomach with odds ratio of 6.00 (1.61-22.36) and 9.00 (1.64-49.35). Thyroid cancer was present only in first-degree relatives of two cases and none of controls.

Effect of caffeine intake during pregnancy on birth weight.

The aim of this study was to examine the effect of caffeine consumption during pregnancy on birth weight and its possible interaction with smoking. The sample included 1,011 women who were interviewed during their first 3 days after delivery in one of the hospitals of Belgrade, Yugoslavia. A significant reduction in birth weight was found to be associated with an average caffeine intake of > or = 71 mg per day, after adjustment for gestational age, infant sex, parity, and maternal height and weight, but only in infants born to nonsmoking mothers.

Risk factors for basal cell carcinoma.

The aim of this study was to assess the risk factors for basal cell carcinoma (BCC). A case-control study, carried out in two towns in Yugoslavia, comprised 200 BCC cases and 399 controls. For statistical analysis, univariate and multivariate logistic regressions were used. The risk factors found for BCC were: freckling before the age 15, seven or more weeks per year spent at the seaside during holidays (lifetime average), outdoor work during summer-time, occupational exposure to organic and non-organic dissolvents and organophosphatic compounds, use of tar for cosmetic purposes, and previous BCC in personal history. Subjects who tended to burn and not to tan after sun exposure also showed a significantly higher risk for BCC. Brown eyes and history of acne had a protective effect. This study confirmed the role of both constitutional and environmental factors in the development of BCC.