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PubMed1985

Risk factors for coronary heart disease in rural Hungary.

This is a ten-year study of a cohort of 1088 Hungarian men aged 40-59 at entry, with a 99% baseline response rate and complete ascertainment of cases and follow-up. The methods were state of the art for the period the survey was performed, with quality control for standard procedure and training. Zero, five- and ten-year examinations were carried out and standard risk factors measured and analysed in relation to the ten-year experience, ie, age, blood cholesterol, blood pressure, smoking, body mass, vital capacity, and skinfolds. Risk factor levels were high relative to the Mediterranean and Oriental populations in the Seven Countries Study. The five-year coronary heart disease rates were intermediate between the low rates in Yugoslavia and Greece and high rates in Finland. Ten-year events were significantly and linearly related to quintile values of serum cholesterol and of 3, 4, 6, and 9 risk factors in the Walker-Duncan logistic model. Discrimination was not substantially improved beyond three factors apart from age. The maximal prediction concentrated 62% of events in the upper 20% of multifactor risk, and up to 80% in the upper 40% of risk. The authors conclude, from this separate but comparable study to the Seven Countries Study, that the results are not greatly different from that study or from the US Pooling Project. Unique features of the study, and its results, are the eastern European population, the absence of a strong CHD relationship with smoking, and the strong independent relationship with body mass.

Adult↗

PubMed2005

Long-term risk of tuberculosis among immigrants in Norway.

BACKGROUND: Two-thirds of the tuberculosis (TB) cases in Norway were discovered among immigrants. Some cases were discovered at arrival, but many develop the disease several years post-migration. Knowledge about how long after migration to Norway TB were discovered will enable us to better target preventive measures including preventive therapy. This study examines the long-term risk of TB among immigrants in Norway. METHODS: All non-Nordic immigrants who arrived in Norway between 1986 and 2002, as registered by the Norwegian Directorate of Immigration, were followed-up. Their TB status was determined from the National Tuberculosis Registry. Observation period for TB cases was calculated from the date of arrival in Norway to TB registration. For persons without TB, it was calculated from the date of arrival in Norway to the date of emigration from Norway, date of death, or until end of follow-up (December 31, 2002). RESULTS: For immigrants from Africa and Asia, the TB rates were 190 and 80 per 100,000 person-years (PY), respectively, at 7 years post-migration. For immigrants from Somalia, Pakistan, Vietnam, and the former Yugoslavia, the rates were 520, 160, 210, and 40 per 100 000 PY respectively, at 7 years post-migration. These rates were 7 to 90 times higher than the crude TB incidence for Norway. This increased risk applies to both genders, pulmonary and extra-pulmonary sites. CONCLUSION: These results indicate the need for health personnel to be aware that immigrants remain at high risk of TB many years post-migration. Screening for TB on arrival should be strengthened, and preventive therapy for those with recent TB infection should be considered.

Adult↗

PubMed1997

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.

Birth Weight↗

PubMed1998

Analysis of tuberculosis transmission between nationalities in the Netherlands in the period 1993-1995 using DNA fingerprinting.

Immigration from high prevalence areas may contribute to an increased risk of tuberculosis in Europe. This study aimed at quantifying transmission of tuberculosis between and within nationalities among residents of the Netherlands. DNA "fingerprints," on the basis of restriction fragment length polymorphism using marker IS6110, were made of all Mycobacterium tuberculosis isolates in the Netherlands from January 1993 through June 1995. Clusters were defined as groups of patients that had isolates with identical fingerprints. It was assumed that the probability of a patient being the source of a cluster was proportional to the incidence rate of potential sources times the probability that a potential source would give rise to a cluster. The transmission index was defined as the average number of secondary cases of infectious tuberculosis caused directly or indirectly through recent transmission by a single potential source case and was used to estimate the effective reproductive rate associated with recent transmission, ReFAST. Among a total of 623 Dutch tuberculosis cases, 17% (95% confidence interval 9-25%) of cases were attributable to recent transmission from a non-Dutch source. The transmission index varied strongly by nationality, and was highest among the Surinamese (1.3), Moroccan (0.8), and Turkish (0.8) populations; ReFAST was 0.26. Aggregation of tuberculosis cases of given nationalities within clusters was most pronounced among recent immigrants from Somalia and (ex-)Yugoslavia. The authors conclude that differences in transmission between subpopulations can be quantified and may be used to evaluate and direct tuberculosis control.

Adolescent↗

PubMed2001

Curricular and extracurricular activities of medical students during war, Zagreb University School of Medicine, 1991-1995.

War, as a major human disaster, affects many aspects of life, including medical education. This report describes curricular and extracurricular activities of the students at the Zagreb University School of Medicine during the wars in Croatia and neighboring Bosnia and Herzegovina. Although condensed versions of the curricula were prepared in case of a major breakdown in civilian life, the school maintained the continuity and quality of its curriculum throughout the war. Students engaged in extracurricular activities related to medical aspects of the war, including organization of resuscitation and first aid courses, collecting medical documentation on war victims, humanitarian help to refugees, and peace-promoting activities. Some students joined mobile surgical teams on the battlefronts. After army service, most of them returned to the school and successfully continued with their studies. The school also accepted guest-students from other new states emerged from former Yugoslavia. The authors found that the students' engagement in extracurricular activities related to medicine was enormously beneficial both to the psychological well-being of the students and to the region's peace-building efforts.

Bosnia and Herzegovina↗

PubMed1996

Teaching critical care in Europe: analysis of a survey.

OBJECTIVE: To analyze the status of the teaching of critical care at the postgraduate and undergraduate levels in Europe. DATA SOURCES: Two types of questionnaires were sent in order to collect data. The first questionnaire was sent to the heads of the intensive care units (ICUs) of at least five of the major hospitals in each western country of the European Region of the World Health Organization and to the people responsible for specialist training in the Eastern countries. Countries in the former USSR and former Yugoslavia were excluded; 50 questionnaires (of 105) were returned. The second questionnaire was sent to the 374 medical schools in the European Region; 253 were returned although only 185 were selected for this article. RESULTS: Postgraduate and undergraduate training differ widely in terms of the content of, and disciplines in charge of, the teaching of critical care. Even countries of the World Health Organization's European Region, where critical care is a recognized clinical specialty, do not have an academic discipline of critical care. This lack of an established academic discipline of critical care contributes to the diversity in teaching critical care in medical schools in the countries we studied. Postgraduate training is more formally regulated, and objectives and guidelines have been established in many countries. The topics in medical schools that correspond to critical care medicine do not encompass a distinct body of knowledge and are distributed among more traditional disciplines, most frequently internal medicine, anesthesiology, and surgery. The critical care medicine experience afforded to undergraduates varies widely between and within countries. The repetition of critical care conditions for which patients receive critical care in several disciplines, as described by the responses, leads us to wonder whether these conditions are really included in the curriculum. CONCLUSIONS: The standardization of curriculum content on critical care medicine, the clear definition of competence (the combination of knowledge, attitudes, skills, and judgment necessary to practice) in medical schools, and better coordinated postgraduate training are needed to clarify an educational approach in the field. Practitioners of critical care medicine will have to participate actively on curriculum committees. The recognition of critical care medicine as a specialty or subspecialty and as an academic discipline will facilitate the achievement of a comprehensive critical care education program.

Critical Care↗

PubMed2002

Estimates of radiological risk from depleted uranium weapons in war scenarios.

Several weapons used during the recent conflict in Yugoslavia contain depleted uranium, including missiles and armor-piercing incendiary rounds. Health concern is related to the use of these weapons, because of the heavy-metal toxicity and radioactivity of uranium. Although chemical toxicity is considered the more important source of health risk related to uranium, radiation exposure has been allegedly related to cancers among veterans of the Balkan conflict, and uranium munitions are a possible source of contamination in the environment. Actual measurements of radioactive contamination are needed to assess the risk. In this paper, a computer simulation is proposed to estimate radiological risk related to different exposure scenarios. Dose caused by inhalation of radioactive aerosols and ground contamination induced by Tomahawk missile impact are simulated using a Gaussian plume model (HOTSPOT code). Environmental contamination and committed dose to the population resident in contaminated areas are predicted by a food-web model (RESRAD code). Small values of committed effective dose equivalent appear to be associated with missile impacts (50-y CEDE < 5 mSv), or population exposure by water-independent pathways (50-y CEDE < 80 mSv). The greatest hazard is related to the water contamination in conditions of effective leaching of uranium in the groundwater (50-y CEDE < 400 mSv). Even in this worst case scenario, the chemical toxicity largely predominates over radiological risk. These computer simulations suggest that little radiological risk is associated to the use of depleted uranium weapons.

Computer Simulation↗

PubMed1995

Identifying and responding to the needs of refugees: a global nursing concern.

Worldwide catastrophic events such as civil war have forced 1 in every 130 people in the world to flee her or his home and become a refugee or displaced person. The article draws upon contemporary refugee experiences from Afghanistan, the Sudan, and the former Yugoslavia to introduce the role of nursing during the refugee journey from flight to asylum seeking. It is hoped that the article will provide nurses with a beginning awareness of the nurse's role in the care and comfort of refugees and displaced people. Central to this role is the gathering of humanitarian, sociocultural, and personal information to enable extensive networking and relationship building with refugees for ongoing empowerment and increased problem-solving capabilities.

Data Collection↗

PubMed1993

Sociodemographic and disease-related correlates of depressive morbidity among diabetic patients in Zagreb, Croatia.

The magnitude of depressive morbidity as well as its significant sociodemographic and disease-related correlates were investigated in a sample of 180 adult diabetic patients attending an outpatient clinic in Zagreb, Croatia (formerly Yugoslavia) in 1989. Results using the Zung Self-Rating Depression Scale yielded a prevalence rate of 60.5% with 10% manifesting severe levels of depressive symptoms. Significant correlates of higher symptoms included older age, female gender, unmarried status, less education, the presence of diabetic complications, longer duration of the disease, more demanding diabetic regimens, and poorer adherence to the regimen. The lowest coefficient was for level of glycosylated hemoglobin (r = .04), indicating a weak relationship between diabetic control and depressive symptoms. Findings are discussed in relation to other epidemiological surveys of depression and to the deteriorating economic and political situation in Croatia. The implications of untreated depression for diabetic self-care are discussed.

Adolescent↗

PubMed1996

Early plasma amino acid pool alterations in patients with military gunshot/missile wounds.

Plasma amino acid profiles in patients during the early period (first 18 hours) following military gunshot/missile wounds were investigated. Patients (n = 29) were casualties from the war in the former Yugoslavia with injury severity scores ranging from 4 to 18. They were divided into three groups: soft tissue (muscle) damage, wounds with fractures, and vital structures injured. Controls were normal blood donors (n = 17). Free amino acids were analyzed in venous plasma. Increased concentrations of phenylalanine and glutamine associated with increased molar phenylalanine/tyrosine ratio in plasma indicated increased net protein catabolism in the peripheral tissues, regardless of the type of injured tissues. Decreased plasma arginine, ornithine and citrulline levels, accompanied with increased molar glutamine/valine ratio, suggested disturbance in urea cycle activity, although urea level was not altered. We concluded that early changes in plasma amino acid pool characteristics after wounds were of systemic origin, not related to the type of injured tissues.

Adolescent↗

PubMedDate not supplied

Public health capacity building in southeastern Europe: a partnership between the Open Society Institute and the US Centers for Disease Control and Prevention.

The political disintegration of former Yugoslavia inaugurated in 1991 resulted in the decentralization of health systems in the federation's successor nation-states. Efforts by the Open Society Institute improved public health planning and management needs consequent to health sector changes. Beginning in Croatia in 2001, the Institute developed ongoing collaborations between Andrija Stampar School of Public Health and the US Centers for Disease Control and Prevention. In 2003 and 2004, it expanded its project to include the republics of Macedonia and of Serbia and Montenegro.

Academies and Institutes↗

PubMed1994

Restriction fragment length polymorphism analysis of reverse transcription-PCR products reveals the existence of two major strain groups of beet necrotic yellow vein virus.

Beet necrotic yellow vein virus (BNYVV)-infected sugarbeets were obtained from many parts of Europe and also from some sites in Asia and the U.S.A. Reverse transcription (RT)-PCR products of more than 1 kbp were obtained for four different regions of the viral genome which may be particularly important with respect to the pathogenic properties of the virus, i.e. for the coat protein and the 42K protein-encoding regions on RNA 2 and for major parts of RNAs 3 and 4. Restriction fragment length polymorphism (RFLP) patterns obtained with these PCR products revealed the existence of two major strain groups of BNYVV, named type A and type B. The A type was detected in Greece, the former Yugoslavia, Slovakia, parts of Austria, Italy, Spain, parts of France, Belgium, The Netherlands and England as well as in Asia (Turkey, Kazachstan, China and Japan) and the U.S.A. The B type occurs in Germany and parts of France. Mixed infections were detected at the borderline regions between areas of the A and B types. Comparisons of published and newly determined nucleotide sequences of the respective parts of the BNYVV genome indicate that the percentage of nucleotide differences between the A and the B type is approximately 3% for the respective regions of RNAs 2 and 3 and approximately 1.5% for RNA 4. Nucleotide sequences appear to be remarkably stable within each of the two strain groups. The majority of the nucleotide differences between the A and B types occur in the third triplet position. The amino acid changes in the coat protein area are outside the four previously determined antigenic regions that are accessible on the surface of the virus particles and are involved in the formation of continuous and presumably also discontinuous epitopes. This may explain why serological differences between the two strain groups have not been found.

Base Sequence↗

PubMed1976

Trace-element concentrations in human hair measured by proton-induced x-ray emission.

Proton-induced x-ray spectroscopy has been used to measure trace elements concentration ratios for 10 elements relative to Zn on a group of the population in the harbor city of Rijeka, Yugoslavia. The average biologic levels of elemental ratios for the inhabitants of this region have been established. The presence of pollutants has been confirmed by studying the variation of elemental concentration ratios along single samples of hair.

Arsenic↗

PubMed2005

Incident, accident, catastrophe: cyanide on the Danube.

It has been described as the worst disaster since Chernobyl. In January 2000, a retaining wall failed at the Aurul gold processing plant in Romania, releasing a wave of cyanide and heavy metals that moved quickly from one river to the next through Romania, Hungary, the Federal Republic of Yugoslavia and Bulgaria, killing tens of thousands of fish and other forms of wildlife and poisoning drinking-water supplies. This paper examines how and why the chemical spill at Baia Mare occurred and how responses to it emerged from circumstances at the global, local and immediate levels. The spill demonstrates the importance of the flow of information in framing and interpreting disasters, suggesting that such an event can go unnoticed or be viewed as catastrophic, depending on the political, historical and personal struggles that lead to its publicity. The paper offers a framework for understanding why the spill was alternately perceived as an incident, an accident and a catastrophe based on changing perceptions of culpability.

Accidents↗

PubMed1989

Geographical differences of gastric ulcer healing rate in patients treated with ranitidine or placebo.

The literature was searched for clinical trials evaluating the use of 300 mg ranitidine daily in the acute treatment of gastric ulcer. All available trials were examined, and the results compared between countries to determine the extent of any geographical variation in ulcer healing rates. Published placebo studies in gastric ulcer were also reviewed for comparison. Sixty-six publications were inspected to determine the trial design, country of origin, gastric ulcer healing rates, determined endoscopically, and details of patient demography. Overall worldwide healing rates for ranitidine treatment were 63% at week 4 and 86% at week 8 (n = 2349 and 2256 respectively), compared with 34% at week 4 and 52% at week 8 for placebo (n = 790 and 231 respectively). Statistically significant differences were found between the healing rates for individual countries at week 4 (P less than 0.001) and week 8 (P less than 0.001). However, after exclusion of the results from Japan (35%, n = 278) and Yugoslavia (97%, n = 32) at week 4, and from Japan (80%, n = 467) and France (65%, n = 52) at week 8, the healing rates from the remaining countries were not statistically different from one another. The limited data available in relation to age, sex and smoking habits, or placebo healing rates contributed little to explaining these aberrant results. It is concluded that there is variation in gastric ulcer healing rates between countries, but only results from Japan seem to be out of line with the rest of the world.

Cimetidine↗

PubMed1990

Two novel polyadenylation mutations leading to beta(+)-thalassemia.

In an ongoing effort to identify point mutations causing beta-thalassaemia, we have found two previously unreported mutations which are located in the Poly A site of the beta-globin gene. The screening programme used amplified DNA and dot-blot hybridization with several 32P-labelled oligonucleotide probes. DNA samples which remained unidentified by this methodology were subjected to sequencing with 32P-labelled primers and modified T7 DNA polymerase. The newly discovered mutations were confirmed by the dot-blot hybridization technique. One type concerned an AATAAA----AATGAA mutation in the polyadenylation site and was found in one family from Yugoslavia (including one patient with the C----T mutation at codon 29 in trans), one from Bulgaria (the patient had the G----A mutation at IVS-I-110 in trans), and one from Greece (this patient had the C----G mutation at IVS-II-745 in trans). Haematological data for three simple heterozygotes suggested a rather mild beta(+)-thalassemia. The second type involved an AATAAA----AATAGA mutation and was found in one family from Malaysia. The propositus had the beta E mutation on the other chromosome, was originally diagnosed as mild Hb E-beta(+)-thalassaemia, and had Hb A and Hb E percentages which were nearly the same.

Adult↗

PubMed2006

Genetic differentiation of the marbled white butterfly, Melanargia galathea, accounts for glacial distribution patterns and postglacial range expansion in southeastern Europe.

Isolation of Mediterranean species in the southern European peninsulas during the cold glacial phases often resulted in differentiation of several genetic lineages confined to the respective peninsulas. However, whilst there is good genetic evidence for multiple refugia in Iberia, there are only limited data available for the Balkans. Therefore, we wish to examine the hypothesis of a strong genetic structuring within southeastern Europe for the existence of multiple Balkan differentiation centres and/or several leading edges. As a model we use the marbled white butterfly, Melanargia galathea. We studied 18 allozyme loci of 564 individuals from 16 populations distributed over a large part of southeastern Europe. The single populations showed moderately high genetic diversity and no northward decline of genetic diversity was detected. The overall genetic differentiation between populations was considerable (F(ST) 7.0%). Cluster analysis discriminated three genetic groups: (i) a western flank in the former Yugoslavia, parts of eastern Austria and Hungary; (ii) an eastern flank with populations from Bulgaria and Romania (south of the southern Carpathians and eastern Carpathians); and (iii) the eastern Carpathian Basin. Hierarchical variance analysis distributed 53% of the variance among populations between these three groups. One sample from the Greek-Bulgarian border clustered within the eastern flank, but showed some tendency towards the eastern Carpathian Basin populations. Two populations from Carinthia clustered together with the eastern Carpathian Basin ones and a population from Styria showed an intermediate genetic composition between the three groups. Most probably, the eastern and the western flank groups are due to postglacial range expansion from the northeastern and the northwestern edges of the glacial differentiation centre (so-called leading edges). The eastern Carpathian Basin group may have resulted from postglacial expansion from northern Greece through valley systems of the central Balkan peninsula, maybe even expanding westwards north of the Balkan mountains reaching some parts of eastern Austria (e.g. Carinthia). Therefore, the Balkanic refugium of M. galathea may or may not have been continuous along the coastal areas of the Mediterranean, but must have been strongly genetically structured.

Animal Migration↗

PubMed1996

Promotion of children's early psychosocial development through primary health care services.

The paper presents the study design of the development and organisation of an EU/WHO multicentre study on the promotion of children's early psychosocial development through primary health care services. The aim of the programme is to develop training for primary health care workers (PHCWs) that improves their ability to assess factors relevant to psychosocial development and gives them preventive approaches to foster that development, building on families' strengths. The focus is on the period from conception to the end of the second year of the child's' life. Two main components are the training of the PHCWs and the semi-structured interviews that guide the workers in practice. The training has content and structure that is feasible within primary health care resources working in collaboration with mental health services. The programme is evaluated in terms of (a) the impact of training on both the PHCWs' knowledge and attitudes with regard to infant behaviour and development, and on practice as assessed by the delivery of the semi-structured interview; and (b) the effect of the intervention on maternal well-being, infant language development and behavior, home environment and mother-infant interaction. The programme is taking place in Cyprus, Greece, the Federal Republic of Yugoslavia, Portugal, Slovenia and Turkey.

Child Development↗