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Preliminary report on a joint U.S.-Yugoslavia five-year comprehensive health education research project carried out in Yugoslavia.

A five-year effort has been planned to test the efficacy of health education integrated in primary care services for a rural area. Impacts on health care provider and study population behavior have been hypothesized. The evaluation design includes one study and one control health care district with pre- and post-program surveys conducted in each area. The study will be completed in 1978. Baseline and longitudinal results are reported. Specific change objectives have been achieved in early cancer detection and in maternal and child health.

Adolescent

The Yugoslavia cardiovascular disease study. II. Factors in the incidence of coronary heart disease.

In a 7-year follow-up of 11,121 Yugoslav men first examined in 1964-1965 when they were 35-62 years old, it was found that the incidence of coronary heart disease (CHD) was one-fourth that of a comparable Framingham (USA) group. Incidence in rural men was only 59% of urban men. In both urban and rural groups, men with higher blood pressures had greater CHD incidence, and cigarette smoking was also associated with greater incidence. In the urban but not the rural groups serum cholesterol and weight/height were also CHD risk factors. Levels of serum cholesterol and weight were lower in urban Yugoslavia than Framingham and lowest in rural Yugoslavia. At the same levels of these characteristics Framingham incidence was 3 times that in Yugoslavia. At the very low rural levels of weight and blood pressure CHD incidence was the same in urban as rural Yugoslav groups.

Adult

Health care and workers' self-management in Yugoslavia.

The form of communism developed in Yugoslavia since the early 1950s--called workers' self-management--has been of interest to many westerners concerned with the ideas of participatory democracy and workers' self-management. Yugoslavia's economic growth and general openness toward the West have encouraged many people to visit and to investigate the health care system as well as other aspects of the society. It is generally said that self-management is responsible for the remarkable successes that Yugoslavia has achieved. This paper suggests, on the other hand, that many of the successes achieved in the health care system are attributable largely to the fact that self-management is not allowed to work as freely as it does in other sectors of the economy.

Communism

A fossil hominid frontal from Velika Pećina (Croatia) and a consideration of Upper Pleistocene hominids from Yugoslavia.

Fossil hominid remains dating to the Upper Pleistocene in Yugoslavia are reviewed. Particular emphasis is placed on the assessment of a hominid frontal from the site of Velika Pećina in northwestern Croatia. This specimen represents the earliest absolutely-dated hominid associated with the Upper Paleolithic in Europe. Also the hominid material from the site of Veternica is discussed, and data are presented on the new remains from Sandalja. It is concluded that no Neandertal remains, except for Krapina, have been found in Yugoslavia.

Cephalometry

The Yugoslavia Cardiovascular Disease Study. 3. Death by cause and area.

In the seven years following initial examination (1964--65) 758 deaths were observed in 11,121 Yugoslav men aged 35--62. The mortality rate was similar to that found for men in the Framingham (Massachusetts) study. However, coronary heart disease (CHD) mortality was much lower in Yugoslavia but mortality from cancer, accidents and violence and respiratory disease was much higher. The excess cancer mortality was chiefly from stomach cancer. The excess respiratory mortality was from both tuberculosis and chronic obstructive respiratory disease. Within Yugoslavia there were area differences in mortality by cause but little difference in total mortality: in Tuzla (Bosnia) there was a higher respiratory disease mortality but a lower mortality from accidents and violence than in Remetinec (Croatia). In the rural areas of the study there was a higher mortality from respiratory diseases and accidents and violence than in urban areas but a counterbalancing lower mortality from cardiovascular diseases. The low coronary death rates and high cancer of the stomach death rates in this population present an important epidemiological challenge.

Accidents

Some experiences with the F scale in Yugoslavia.

Two studies in which the original F scale (Adorno, Frenkel-Brunswik, Levinson & Sanford, 1950) has been used in Yugoslavia are reported. The first one considers inter-item correlations whereas the second rates total score to several personality variables. It has been found that these studies provide evidence for the existence of several hard-to-interpret first-order factors which do lead to one higher-order factor. The F scale measures anxiety, independence (dominance) and also unexpected social adjustment second-order personality factors. Both political and cultural influences could be considered as explanations for these results but the latter seem to be more pronounced. That being the case, revisions of the scale have been suggested.

Adolescent

An outbreak of acute hemorrhagic conjunctivitis in Yugoslavia in 1973.

An outbreak of approximately 200 cases of acute hemorrhagic conjunctivitis is described in Prekmurje, a northern province in Yugoslavia. The epidemic was caused by enterovirus type 70, serologically identical with the causative agents of similar outbreaks in London and Japan. The origin of the outbreak could not be elucidated but a link was seen between this case and a small outbreak in Veenendaal in the Netherlands.

Acetates

Topographical distribution of Balkan endemic nephropathy in Serbia (Yugoslavia).

Topographical characteristics of 91 settlements affected by endemic nephropathy in Serbia--the region most frequently attacked by the disease--were analyzed and compared with the other known endemic areas in Yugoslavia. Numerical data were provided on the common characteristics of the affected villages--vicinity of a Danube tributary and low altitude. It was pointed out that only two endemic settlements lie above the altitude of 300 m. It is therefore suggested that investigation of the hydrogeological structure of these villages may provide valuable data, if an agent in water or soil is searched for.

Humans

[Epidemiology of chronic non-specific pulmonary diseases in Yugoslavia (author's transl)].

In Yugoslavia the diseases of the respiratory system (without tuberculosis) ranges with 23% in front of all other organ-localised diseases. 53--95% of all chronic non-specific lung diseases are registrated in the chest clinics of the different republics. 67% of all lung diseases registrated belong to the obstructive syndrom, 6% are bronchial carcinomas and 27% represent the group of other chronic pulmonary diseases. 31,5% of all patients with chronic obstructive bronchitis are younger than 50 years old, 34,7% are in the age-group between 50-65 years. Assuming the best registered incidence and prevalence rates of bronchial carcinoma, chronic bronchitis, asthma and emphysema in Slowenia as a basis, the expected morbidity of these diseases in each autonomic republic are compared.

Adolescent

Blood levels of chlorinated hydrocarbon residues in the population of a continental town in Croatia (Yugoslavia).

Plasma or serum samples of 147 individuals from the general population of a continental town in Croatia (Yugoslavia) were analyzed for chlorinated hydrocarbons in 1975. The compounds were determined by gas chromatography and identified by comparing their retention times with those of known standards. All samples contained p,p'-DDE; mean concentration was 35.3 ppb. Only 20 samples contained p,p'-DDT; mean concentration was 22.7 ppb. Concentrations of alpha-BHC, lindane, and p,p'-TDE were 3.25, 4.09, and 11.6 ppb, respectively.

Adolescent

Low birth weight subsequent to induced abortion. A historical prospective study of 948 women in Skopje, Yugoslavia.

In the fall of 1972, interviews were conducted with 948 Yugoslavian women whose first pregnancies had been terminated by induced abortion (222) or delivery (726) during 1968-1969. Subjects were indentified from records of the Obstetrics and Gynecology Clinic of Skopje University, Macedonia. Subsequent pregnancies were studied to determine the relative effects of first-pregnancy abortion or delivery on incidences of adverse outcomes. No significant difference were found between first-pregnancy aborters and deliverers for subsequent conception rates, spontaneous abortions, or low-birth-weight rates. The data suggest that while induced abortion of the first pregnancy did not protect against the greater risk of low birth weight for a primiparous birth, neither did it increase that risk. The high proportion of women who denied their abortion raises questions about results of retrospective abortion studies which depend on patient recall.

Abortion, Induced

Bone status and fracture rates in two regions of Yugoslavia.

Bone status and fracture rates were evaluated in two Yugoslav populations with very different dietary habits. In district A (Podravina) the daily calcium intake was about twice that in district B (Istra). There were similar but smaller differences in the intakes of other nutrients. In district B metacarpal cortical width was reduced in all age groups of both sexes but the difference tended to decrease with age. The proximal femur fracture rate was higher in district B than district A but there was no difference between the forearm fracture rates in the two districts. Our results confirm that bone mass at any age is clearly the result of age and sex and most probably other genetically determined factors but also show that this expression is nutrition related. The data suggest that nutrition (in particular the calcium intake) is an important determinant of bone mass in young adults but seems to have little effect on age-related bone loss in either males or females. The main determinant of cortical bone mass in the elderly seems to be the cortical bone mass in middle life. The proximal femur fractures of old people reflect declining cortical bone mass but the distal forearm fractures of middle-aged women are unrelated to cortical bone mass or nutritional status.

Adult