Mortality of Malignant Melanoma in Central Serbia, in the Period 1999-2015

INTRODUCTION

Malignant melanoma is one of the rarest forms of skin cancer but it is the most deadly.

OBJECTIVE

The objective of this paper was to analyze the epidemiological characteristics and trends of mortality from malignant melanoma in the population of Central Serbia in the period 1999-2015.

METHODS

The study was designed as a retrospective descriptive epidemiological study. Standardized mortality rates were used in statistical data processing. A linear trend model and regression analysis were used to examine trends in malignant melanoma mortality.

RESULTS

In Serbia, malignant melanoma mortality shows an increasing trend. The overall age-adjusted melanoma death rate was 2.6 per 100,000 with a higher death rate among men (3.03 per 100,000) than among women (2.1 per 100,000). Malignant melanoma mortality rates increase with age in both sexes and are highest in the age group of 75 and older. The highest increase in mortality in men is recorded in the 65-69 age group, with an average percentage increase of 21.33 (95% CI, 8.40 - 51.05), while in women the largest increase in mortality was recorded in the 35-39 age group, with an average percentage increase of 31.4 and in the 70-74 age group, 12.9.

CONCLUSIONS

The trend of increasing mortality from malignant melanoma in Serbia is similar to those in most developed countries. Education and improvement of awareness in the general population and among health professionals are vital to reducing melanoma mortality in the future.

Using the UTAUT model to analyze user intention to accept electronic payment systems in Serbia

This study applies The Unified Theory of Acceptance and Use of Technology (UTAUT) to explain the acceptance of electronic payment systems in Serbia. We used extended model that incorporates several external variables, such as perceived security, trust, privacy, convertibility and financial costs, along with basic UTAUT predictors. The sample comprised of 457 respondents. We applied structural equation modelling to develop the model and draw conclusions. The results showed that performance expectancy, perceived security, trust and social influence had strong positive effects on behavioral intention. Conversely, we found behavioral intention, convertibility and financial costs to be significant drivers of user behavior. We consider the inclusion of convertibility in the model and proving its significance to be the main practical implications of our research, and also suggest to be considered as a factor in models designed for countries with low purchasing power of national currency.

Emerging subdisciplines in ethnology and anthropology of Serbia: research trends at the Faculty of Philosophy, University of Belgrade

This article presents the in-depth analysis of the disciplinary landscape of ethnology and anthropology in Serbia within the institutional contexts of humanities and social sciences. Focusing on the Department of Ethnology and Anthropology at the Faculty of Philosophy, University of Belgrade, it provides insights into the main subdisciplines, fields, and themes of research since 2006, a time when significant publishing activity was invigorated and the Bologna Process reforms were implemented in Serbian universities. Using a theoretical approach to knowledge production as a complex mosaic of complementary research, rather than a hierarchy of different quality works, the article tracks the dynamics of disciplinary (re)orientations in the Department over the past 16 years. This is accompanied by a methodological approach whereby the author does not assume the role of an epistemic arbiter who selects and labels representative work, but instead invites members of the studied Department to exercise the selection processes by filling out a survey that the author composed and distributed. The article is based on information collected through the survey, the Department documentation, as well as the author’s own interpretation of the published works. Related subdisciplines are grouped in larger wholes and presented in counter-alphabetical order of the names given to them. Finally, the concluding part discusses the innovative and dynamic developments of the Department’s faculty research.

Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report

SUMMARY

Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting.

LEARNING POINTS

Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.

Relationship between socioeconomic and nutritional status in the Serbian adult population: a cross-sectional study

BACKGROUND

Socioeconomic status is a well-known risk factor for obesity. The aim of this study was to assess the relationship between socioeconomic and nutritional status in the Serbian adult population.

DESIGN AND SETTING

Cross-sectional study on data from the 2013 National Health Survey performed in Serbia.

METHODS

The study population consisted of adults aged ≥ 20 years. Face-to-face interviews and anthropometric measurements were conducted by trained staff. Associations between body mass index and sociodemographic variables were analyzed using multivariable logistic regression analyses.

RESULTS

Out of 12,461 subjects of both sexes, 36.4% were overweight and 22.4% were obese. The prevalences of overweight and obesity differed significantly between the sexes, regarding all sociodemographic characteristics. Among women, educational attainment was associated with lower risk of being overweight (odds ratio, OR = 0.82; 95% confidence interval, CI: 0.69-0.98 for medium-level and OR = 0.77; CI: 0.62-0.97 for higher education) or obese (OR = 0.68; CI: 0.57-0.82 for medium-level and OR = 0.41; CI: 0.31-0.54 for higher education). In contrast, medium-level (OR = 1.28; CI: 1.08-1.52) and highly educated men (OR = 1.39; CI: 1.11-1.74) were more frequently overweight than were those with low education. Among men, grade I obesity was positively related to the richest wealth index group (OR = 1.27), while the opposite was true for grade II obesity among women (OR = 0.61).

CONCLUSION

This study showed significant socioeconomic inequalities in nutritional status between men and women. Continuous monitoring of socioeconomic patterns relating to weight is important, especially with further exploration of the link between education and obesity.

Are There Striking Differences in Outpatient Use of Antibiotics Between South Backa District, Serbia, and Some Scandinavian Countries?

There is little published information about antibiotic utilization in outpatients in Serbia. The objective of this study was to determine the amount and structure of outpatient antibiotic use in South Backa District (SBD) in Serbia, to assess prescibing quality of antibiotics and to compare with results from Scandinavian countries. Data on the antibiotic use were collected from all private and state-owned pharmacies from January through March 2008 in SBD. Results were expressed as the number of defined daily doses/1,000 inhabitants/day. The drug utilization 90% method was also used. Penicillins were the most frequently used antibiotic subgroup in SBD (35.20%), followed by cephalosporins (19.16%) and macrolides (13.18%). Thirteen drugs accounted for 90% of total antibiotics consumption (DU90% segment). The average cost/DDD within the DU90% segment was 0.95 euros, whereas the average cost/DDD beyond the DU90% segment was 1.89 euros, indicating that less expensive antibiotics were more frequently used. High use of ampicillin, third-generation cefalosporins, co-trimoxazole, and gentamicin, will aggravate the alarming problem of resistance in Serbia. Differences in the amount and structure of antibiotic consumption between SBD and Scandinavian countries indicate the need of updated national guidelines for rational antimicrobial drug use in Serbia.

Openness to experience shortens duration of untreated psychosis in Serbian clinical population

AIM

To determine duration of untreated psychosis (DUP) in patients with schizophrenia-spectrum disorders from Serbia and to analyse factors that potentially contribute to the treatment delay, with focus on personality traits.

METHODS

Fifty seven patients (males 54.4%; age = 29.9 ± 6.0 yrs; age at the illness onset = 24.9 ± 5.1 yrs; IQ = 93.5 ± 12.2) were included. The assessment consisted of Nottingham Onset Schedule (NOS), Premorbid Adjustment Scale (PAS) and NEO Personality Inventory (NEO-PI-R). We used Cox regression model to evaluate relationship between DUP and explanatory variables.

RESULTS

Based on the most restrictive definition, the length of DUP in our sample was 77.8 ± 120.6 weeks (MED = 25.0 weeks). DUP was negatively associated with openness to experience (B = -0.804, P = 0.024).

CONCLUSIONS

We report the first evidence of DUP in Serbia, emphasizing that the personality domains are likely to impact the use of mental health care in persons with psychosis.

Eating habits and body-weights of students of the university of belgrade, serbia: a cross-sectional study

The purpose of this survey was to quantify the prevalence of overweight and obesity among a sample of students in Belgrade University, Serbia and to describe their main eating habits. A total of 1,624 questionnaire responses were analyzed (response rate 97.3%). The students were recruited during mandatory annual check-ups in April-June 2009. All subjects completed the questionnaire; height (in cm) and weight (in km) were measured by two physicians. Results were assessed statistically. Almost every fourth male student was overweight. Strikingly, 15% of female students were underweight. Highly-significant difference was found between average body mass index (BMI) of male and female students (F=317.8, p=0.001). Students' BMI did not correlate with average family income or with the frequency of taking breakfast (p=-0.064, p=0.152 for males and p=0.034, p=0.282 for females respectively). There is a growing demand for global health strategies which would encourage healthy body-image and figure; thus, these initiatives should mobilize the society on a national and international level.

Cancer incidence and mortality in Serbia 1999-2009

BACKGROUND

Despite the increase in cancer incidence in the last years in Serbia, no nation-wide, population-based cancer epidemiology data have been reported. In this study cancer incidence and mortality rates for Serbia are presented using nation-wide data from two population-based cancer registries. These rates are additionally compared to European and global cancer epidemiology estimates. Finally, predictions on Serbian cancer incidence and mortality rates are provided.

METHODS

Cancer incidence and mortality was collected from the cancer registries of Central Serbia and Vojvodina from 1999 to 2009. Using age-specific regression models, we estimated time trends and predictions for cancer incidence and mortality for the following five years (2010-2014). The comparison of Serbian with European and global cancer incidence/mortality rates, adjusted to the world population (ASR-W) was performed using Serbian population-based data and estimates from GLOBOCAN 2008.

RESULTS

Increasing trends in both overall cancer incidence and mortality rates were identified for Serbia. In men, lung cancer showed the highest incidence (ASR-W 2009: 70.8/100,000), followed by colorectal (ASR-W 2009: 39.9/100,000), prostate (ASR-W 2009: 29.1/100,000) and bladder cancer (ASR-W 2009: 16.2/100,000). Breast cancer was the most common form of cancer in women (ASR-W 2009: 70.8/100,000) followed by cervical (ASR-W 2009: 25.5/100,000), colorectal (ASR-W 2009: 21.1/100,000) and lung cancer (ASR-W 2009: 19.4/100,000). Prostate and colorectal cancers have been significantly increasing over the last years in men, while this was also observed for breast cancer incidence and lung cancer mortality in women. In 2008 Serbia had the highest mortality rate from breast cancer (ASR-W 2008: 22.7/100,000), among all European countries while incidence and mortality of cervical, lung and colorectal cancer were well above European estimates.

CONCLUSION

Cancer incidence and mortality in Serbia has been generally increasing over the past years. For a number of cancer sites, incidence and mortality is alarmingly higher than in the majority of European regions. For this increasing trend to be controlled, the management of risk factors that are present among the Serbian population is necessary. Additionally, prevention and early diagnosis are areas where significant improvements could still be made.

Epidemiology of hypertension in Serbia: results of a National Survey

BACKGROUND

We evaluated the prevalence of high blood pressure and the level of awareness, treatment, and control of hypertension in a Serbian population.

METHODS

A cross-sectional study of an adult population was carried out across Serbia in 2006. The study involved 14 204 adults aged 20 years or older. Interviews and measurements of blood pressure were performed at participants' homes.

RESULTS

Overall, 47% of the Serbian adult population had hypertension: 25.3% had stage 1 hypertension and 18.1% had stage 2 hypertension. Only 58.0% of the hypertensive population were aware that they had the disease, and 60.4% were receiving medical treatment. Among those receiving medical treatment, only 20.9% had a blood pressure within the normal range. One in 10 participants with hypertension were not treated because, among other reasons, they thought treatment was unnecessary (55.3%) or they lacked money for medication (19.3%).

CONCLUSIONS

The prevalence of undiagnosed and untreated hypertension is high in the adult population of Serbia. Further action is required to hasten detection and treatment of high blood pressure. Attention should be directed toward educational programs that improve knowledge, attitudes, and awareness of hypertension among adults.

Human giardiasis in Serbia: asymptomatic vs symptomatic infection

Despite the public health importance of giardiasis in all of Europe, reliable data on the incidence and prevalence in Western Balkan Countries (Serbia, Bosnia and Herzegovina, Croatia, Montenegro and FYR Macedonia) are scarce, and the relative contribution of waterborne and food-borne, or person-to-person and/or animal-to-person, transmission of human giardiasis is not yet clear. To provide baseline data for the estimation of the public health risk caused by Giardia, we here review the information available on the epidemiological characteristics of asymptomatic and symptomatic human infection in Serbia. Although asymptomatic cases of Giardia represent a major proportion of the total cases of infection, high rates of Giardia infection were found in both asymptomatic and symptomatic populations. No waterborne outbreaks of giardiasis have been reported, and it thus seems that giardiasis mostly occurs sporadically in our milieu. Under such circumstances, control measures to reduce the high prevalence of giardiasis in Serbia have focused on person-to-person transmission, encouraging proper hygiene, but for more targeted intervention measures, studies to identify other risk factors for asymptomatic and symptomatic infections are needed.

Correlation between fitness and fatness in 6-14-year old Serbian school children

Lack of physical activity and/or physical fitness are some reasons epidemiologists suggest for increase in childhood obesity in the last 20 years, with clear correlation between body composition and physical activity and/or physical fitness yet to be determined. The objectives of the study were to (a) investigate the prevalence of overweight and obesity among Serbian school children and (b) determine the relationship between indicators of physical activity and body fatness in Serbian school children aged 6-14 years. The study subjects included a representative sample of Serbian elementary school children (n = 1,121-754 boys and 367 girls-aged 6.2-14.1 years), all of whom were recruited in the OLIMP (Obesity and Physical Activity among Serbian School Children) study. Anthropometric and physical fitness values, including body mass index (BMI), waist-circumference, body-fat, and aerobic capacity, were measured in all the children. Significant differences were found between male and female children regarding the prevalence of obesity (6.8% vs 8.2%, p < 0.05, boys and girls respectively). Boys had significantly lower body mass, BMI, waist-circumference, sum of six skinfolds, and body-fat compared to their female counterparts (p < 0.05). The highest level of weight, BMI, body-fat, and waist-circumference observed in a 14-year old girl (96.3 kg, 40.5 kg/m2, 54.5%, 91.4 cm respectively) implies the existence of extreme obesity in Serbian school children. The negative relationship between body-fat and maximal oxygen (VO2max) uptake was moderately high (r = -0.76; p < 0.05). The study has shown a high prevalence of adiposity among Serbian school children, with a strong negative relationship between aerobic fitness and body fatness. Data of the study emphasize the necessity to identify children with weight problems and to develop early interventions to improve physical activity in children and prevent the increase of childhood obesity.

Exploring barriers to 'respondent driven sampling' in sex worker and drug-injecting sex worker populations in Eastern Europe

Respondent driven sampling (RDS) has been used in several counties to sample injecting drug users, sex workers (SWs) and men who have sex with men and as a means of collecting behavioural and biological health data. We report on the use of RDS in three separate studies conducted among SWs between 2004 and 2005 in the Russian Federation, Serbia, and Montenegro. Findings suggest that there are limitations associated with the use of RDS in SW populations in these regions. Findings highlight three main factors that merit further investigation as a means of assessing the feasibility and appropriateness of RDS in this high risk population: the network characteristics of SWs; the appropriate level of participant incentives; and lack of service contact. The highly controlled and hidden nature of SW organizations and weak SW social networks in the region can combine to undermine assumptions underpinning the feasibility of RDS approaches and potentially severely limit recruitment. We discuss the implications of these findings for recruitment and the use of monetary and non-monetary incentives in future RDS studies of SW populations in Eastern Europe.