Support to responsive parenting through communication tools

Issue

Counselling unit for positive parenting “Halobeba” has been established at Institute of Public Health of Belgrade with support of UNICEF in order to enable continuum of mother and child health care. Availability of information on child care and development was noticed as significant factor for parental confidence and practice.

Description of the problem

Trained nurses provide responses to parental questions through 24/7 phone and e mail communication to assist in problem solving and offer emotional support. Nurses are skilled in active listening, proper questioning, counselling and effective encouragement. Free mob app on breastfeeding was developed as knowledge base for parents. New interactive mob app was recently launched as parenting tool for child health and development monitoring.

Results

Since 2002, more than 1,700,000 responses were provided through phone communication and over 20,000 via email and number of beneficiaries has increased over the years. Most common topics were about breastfeeding, introducing solid food, treatment of fever and respiratory infections, gastrointestinal problems, injuries, immunization, and developmental milestones. Less than 15% of cases were referred to pediatric clinic. Level of parental overall satisfaction was very high and availability and effectiveness of service were especially valued as well as nurses communication skills.

Lessons

Family centered service that corresponds to caregivers needs is effective approach to support nurturing care for young children. Personalized M-health tools make child care more accessible and build capacities of caregivers.

Key messages

Sending consistent and trusted messages through different communication channels contribute to enhancing users' knowledge and skills. Knowledgeable and responsive caregivers properly interpret child’s needs, respond appropriately, facilitate the child’s social and emotional development, and provide proper care.

The influence of CYP2C8*3 on carbamazepine serum concentration in epileptic pediatric patients

The aim of the present study was to investigate the distribution of CYP2C8 variants *3 and *5, as well as their effect on carbamazepine pharmacokinetic properties, in 40 epileptic pediatric patients on carbamazepine treatment. Genotyping was conducted using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), and allele-specific (AS)-PCR methods, and steady-state carbamazepine plasma concentrations were determined by high performance liquid chromatography (HPLC). The CYP2C8 *3 and *5 polymorphisms were found at frequencies of 17.5 and 0.0%, respectively. After dose adjustment, there was a difference in daily dose in CYP2C8*3 carriers compared to non carriers [mean ± standard deviation (SD): 14.19 ± 5.39 vs. 15.46 ± 4.35 mg/kg; p = 0.5]. Dose-normalized serum concentration of carbamazepine was higher in CYP2C8*3 (mean ± SD: 0.54 ± 0.18 vs. 0.43 ± 0.11 mg/mL, p = 0.04), and the observed correlation between weight-adjusted carbamazepine dose and carbamazepine concentration after dose adjustment was significant only in CYP2C8*3 non carriers (r = 0.52, p = 0.002). However, the population pharmacokinetic analysis failed to demonstrate any significant effect of CYP2C8 *3 polymorphism on carbamazepine clearance [CL L/h = 0.215 + 0.0696*SEX+ 0.000183*DD]. The results indicated that the CYP2C8*3 polymorphism might not be of clinical importance for epilepsy treatment in pediatric populations.

The validation and inter-rater reliability of the Serbian translation of the Richmond agitation and sedation scale in post anesthesia care unit patients

BACKGROUND

Targeted light sedation is recommended because it shortens the time of mechanical ventilation and the length of stay in an intensive care unit (ICU). However, there is no validated scale for sedation and agitation in ICU in the Serbian speaking area. The aim of the current study was to validate, verify the reliability and enable the application of the Richmond Agitation and Sedation Scale (RASS) in the Serbian speaking area.

METHODS

In this prospective cohort study, RASS was applied to 301 adult patients hospitalized in surgical ICUs by two different research team members. We tested RASS for inter-rater reliability by the correlation between them. The scale was validated by comparison to Glasgow Coma Scale (GCS) scores which was applied by the third investigator. Interrater agreement was measured using weighted kappa (k) and for correlation Spearman's test was used.

RESULTS

The inter-rater reliability of the scale was high (k ˃0.7). The degree of correlation between the RASS and the GCS during all five days of observation was high (˃0.7 for both investigators, the fifth day). In all the cases, Spearman's correlation coefficient was highly significant (p ˂0.01).

CONCLUSIONS

The Serbian translation of the RASS is a reliable and valid instrument for the assessment of the levels of sedation and agitation with patients in ICU. Hippokratia 2016, 20(1): 50-54.

Salivary antioxidants as periodontal biomarkers in evaluation of tissue status and treatment outcome

BACKGROUND AND OBJECTIVE

One of the major pathologic patterns in periodontitis represents an imbalance among the production of free radicals and local antioxidants resulting in periodontal tissue destruction. The objective of the study was to investigate the influence of non-surgical periodontal treatment on salivary antioxidants and to evaluate their capacity as biomarkers reflecting periodontal tissue condition and therapy outcome.

MATERIAL AND METHODS

Sixty-three systemically healthy non-smokers, including 21 periodontally healthy subjects (HC) and 42 patients with current chronic periodontitis fulfilled the inclusion criteria. Half of the patients received scaling and root planing (SRP) and the other half received only oral hygiene instructions. Full mouth clinical measurements, including gingival index (GI), plaque index (PI), periodontal pocket depth, clinical attachment level and saliva sampling were performed at baseline visit and 2 mo after treatment/baseline visit. Total antioxidant capacity (TAOC), albumins (ALB), uric acid (UA), superoxide dismutase (SOD) and glutathione peroxidase (GPX) were evaluated in saliva samples using commercial kits.

RESULTS

All measured antioxidants were affected by treatment resulting in significant increase in TAOC (p < 0.005), ALB (p < 0.001), UA (p < 0.001) and GPX (p < 0.001) and decrease of SOD (p < 0.005) in response to SRP, where no differences were observed for any of parameters in the oral hygiene instructions group. Comparison of antioxidant levels between the HC and SRP group showed that before treatment ALB were significantly higher in HC when compared to the SRP group (p = 0.039), and GXP (p = 0.000) and SOD (p = 0.021) levels were significantly higher in the SRP group. Comparison of values after treatment showed that TAOC was significantly higher in the HC than in the SRP group (p = 0.001), but UA was, inversely, significantly higher in the SRP group (p = 0.034). All clinical parameters except clinical attachment level were significantly decreased after SRP and significant correlations were observed between SOD and GI (p = 0.017), SOD and PI (p = 0.011), GPX and GI (p = 0.003) and GPX and PI (p = 0.008).

CONCLUSION

Non-surgical periodontal treatment affected salivary TAOC, ALB, UA, SOD and GPX; moreover, these biochemical parameters convincingly reflected periodontal status and tissue response on treatment.

Ki-67 expression in oral lichen planus

PURPOSE

The monoclonal antibody Ki-67 detects a nuclear antigen that is present only in proliferating cells. This is of particular interest for the analysis of the proliferation rates of malignant tumors. The aim of this study was to investigate the malignant potential of oral lichen planus (OLP) on the basis of expression of Ki-67 in healthy individuals (HI), patients with OLP and patients with squamous cell carcinoma (SCC), and to see for any potential interdependence between Ki-67 expression and different clinical and histopathological parameters in OLP.

METHODS

Immunohistochemistry for Ki-67 was carried out using an avidin-biotin peroxidase complex method.

RESULTS

Ki-67 was more expressed in keratinocytes and lymphocytes of OLP patients compared with HI, but less compared with patients with SCC. Keratinocytes and lymphocytes stained with Ki-67 in OLP patients were significantly higher in males, and in OLP specimens showed less developed civatte bodies (CB) and thickening of the basal membrane (TBM).

CONCLUSION

Ki-67 may not serve as prognostic biomarker in oral cancer development from the initially diagnosed OLP, but it could help selecting patients with higher need of follow up for prevention of malignancy.

Platelet-rich fibrin and bovine porous bone mineral vs. platelet-rich fibrin in the treatment of intrabony periodontal defects

BACKGROUND AND OBJECTIVE

Bovine porous bone mineral (BPBM) is a xenograft that has been successfully utilized in periodontal regeneration. Platelet-rich fibrin (PRF) is a leukocyte and platelet preparation that concentrates various polypeptide growth factors and therefore has the potential to be used as regenerative treatment for periodontal defects. The purpose of this study was to examine the suitability of autologous PRF as regenerative treatment for periodontal intrabony defects in humans and to examine the ability of BPBM to augment the regenerative effects exerted by PRF.

MATERIAL AND METHODS

Using a split-mouth design, 17 paired intrabony defects were randomly treated either with PRF or with PRF-BPBM combination. Re-entry surgeries were performed at 6 mo. Primary study outcomes were changes in pocket depth, attachment level and defect fill.

RESULTS

Preoperative pocket depths, attachment levels and transoperative bone measurements were similar for the PRF and PRF-BPBM groups. Postsurgical measurements revealed a significantly greater reduction in pocket depth in the PRF-BPBM group (4.47±0.78 mm on buccal and 4.29±0.82 mm on lingual sites) when compared with the PRF group (3.35±0.68 mm on buccal and 3.24±0.73 mm on lingual sites). The PRF-BPBM group presented with significantly greater attachment gain (3.82±0.78 mm on buccal and 3.71±0.75 mm on lingual sites) than the PRF group (2.24±0.73 mm on buccal and 2.12±0.68 mm on lingual sites). Defect fill was also greater in the PRF-BPBM group (4.06±0.87 mm on buccal and 3.94±0.73 mm on lingual sites) than in the PRF group (2.21±0.68 mm on buccal and 2.06±0.64 mm on lingual sites).

CONCLUSION

The results of this study indicate that PRF can improve clinical parameters associated with human intrabony periodontal defects, and BPBM has the ability to augment the effects of PRF in reducing pocket depth, improving clinical attachment levels and promoting defect fill.

Correlation between different genotypes of human cytomegalovirus and Epstein-Barr virus and peri-implant tissue status

BACKGROUND

The purpose of this study was to estimate the prevalence of different genotypes of human cytomegalovirus (HCMV) and Epstein-Barr virus (EBV) in peri-implantitis and mucositis sites, and to evaluate the correlation between herpesvirus presence and clinical parameters.

METHODS

A total of 80 dental implants (mean time of loading, 4.16 ± 1.8 years) were evaluated during the course of the study (30 peri-implantitis, 25 mucositis and 25 healthy peri-implant sites). The following clinical parameters were assessed: visible plaque index, bleeding on probing, suppuration and probing depth. A polymerase chain reaction (PCR) assay was used to identify the presence of different HCMV and EBV genotypes in peri-implant tissue plaque samples.

RESULTS

HCMV-2 was detected in 53.3% and EBV-1 in 46.6% of the 30 peri-implantitis sites evaluated. By contrast, HCMV-2 was not detected in healthy periodontal sites and EBV-1 was detected in one healthy site. A statistically significant correlation was found between the presence of HCMV-2 and EBV-1 genotypes and clinical parameters of peri-implantitis.

CONCLUSIONS

The results from the present study confirmed the high prevalence of HCMV-2 and EBV-1 in the peri-implant tissue plaque of peri-implantitis sites and suggests a possible active pathogenic role of the viruses in peri-implantitis.

Hypothalamic dysfunction in a patient with primary lymphoma of the central nervous system

A 60-year-old woman with no previous history of chronic disease or malignancy presented with intense back and left leg pain and sleep disturbances. The patient had been treated unsuccessfully for the past 6 months with analgetics. Magnetic resonance imaging showed a soft tissue tumor in the L5-S1 region that involved the spinal canal, and a pathohistological analysis of the tumor specimen confirmed the presence of non-Hodgkin, diffuse large B cell lymphoma. After the diagnosis was confirmed, malaise, nausea, and vomiting developed. Multislice computed tomography of the endocranium showed focal infiltration of the hypothalamus and lateral ventricle; dissemination of a systemic lymphoma was excluded. Therapy was initiated as per the De Angelis protocol. After intravenous and intrathecal administration of metotrexate, the patient developed signs of central diabetes insipidus, which responded to therapy with an antidiuretic hormone analog. Despite the obvious infiltration of the hypothalamus, we cannot exclude an idiosyncratic effect of methotrexate on the central diabetes insipidus.

Risk characterization for mercury, dichlorodiphenyltrichloroethane and polychlorinated biphenyls associated with fish consumption in Serbia

The aim of this work was to assess the risk due to mercury (Hg), dichlorodiphenyltrichloroethane (DDT) and non-dioxin-like polychlorinated biphenyls (ndl PCBs) intake via fish consumption in Serbia. We have developed 24 scenarios using four concentration levels (mean, maximum, 50th and 95th percentile) of contaminants, determined in 521 samples of fish products available on Serbian market; two consumption levels (Food and Agriculture Organization/World Health Organization data and recommendation of American Heart Association); and three body weights (5th, 50th and 95th percentile). All the values concerning the intake of DDT are below the corresponding health based guidance value. Calculated weekly intake of Hg using maximal concentration, intake of 340g/week and 5th percentile of body weight exceeded the provisional tolerable weekly intake (PTWI). When maximal and 95th percentile concentration of ndl PCBs was used, weekly intakes exceeded a "guidance value" with one exception i.e., when 95th percentile of concentration along with 95th percentile of body weight were used. Concerning Hg and ndl PCBs, when extreme concentrations were used, HIs exceeded the value of 1, indicating that fish and fishery products may pose a threat to consumer's health.

Percutaneous imaging-guided radiofrequency ablation of small renal cell carcinoma: techniques and outcomes of 24 treatment sessions in 18 consecutive patients

PURPOSE

To evaluate the early clinical experience associated with percutaneous imaging-guided radiofrequency ablation (RFA) in patients with renal cell carcinoma (RCC).

METHODS

Eighteen consecutive patients with RCC were treated with percutaneous RFA sessions (24 sessions for 19 solitary RCC in 18 patients: 15 patients underwent a single RFA session, 3 had 2 sessions and one 3 sessions). Treatment indications were localized, solid renal mass <4.5 cm, comorbidities precluding surgery, high operation risk, and refusal to perform surgery. During 23 sessions, RFA was performed using computed tomography (CT) guidance and in one session it was guided by ultrasonography. The average patient age was 76.8±7.6 years (range 64-89), and the average renal mass size 3.3 ±0.7 cm (range 2.0-4.5). Follow-up imaging was performed at 3- and 6-month intervals and yearly thereafter. Successful treatment was defined as lack of enhancement of the treated region on follow-up CT studies.

RESULTS

RFA was technically successful in all patients. After the last imaging control, 17 of the 19 tumors were completely necrotic according to the imaging criteria (the secondary clinical success rate was 89.5%). Thirteen tumors were not visible on the first follow-up imaging control (the primary clinical success rate was 68.4% - 13 of 19). In 4 of the 6 patients residual tumors were successfully re-ablated, while in 2 patients repeated RFAs were not performed at the time of writing this report. Five patients (20.8%) developed treatmentrelated complications, including mild pain, large perirenal abscess, mild perirenal hematoma and transient elevation of the white blood cell count. The mean follow-up period was 25.3±16.8 months (range 1-51).

CONCLUSION

RFA is effective and safe treatment option of exophytic RCC <5 cm in diameter in patients not suitable for surgery due to serious concomitant diseases or advanced age.

Efficacy and safety of two generic copies of nimesulide in patients with low back pain or knee osteoarthritis

BACKGROUND

Two generic bioequivalent copies of the same drug sometimes do not achieve therapeutic equivalence. This may produce adverse events in clinical practice if the therapeutic index of that drug is narrow.

OBJECTIVE

To compare the efficacy and safety of two generic copies of nimesulide Nimulid (N) and Tenaprost (T).

METHODS

60 out-patients with symptomatic low back pain or knee osteoarthritis were randomized to take T or N (100 mg 2 x/day for 20 days) in a prospective double-blinded randomized phase four clinical trial conducted at the Institute of Rheumatology, Belgrade, Serbia. Pain was evaluated by VAS. Paravertebral muscle spasm (PVM), sagittal mobility, and the Lasegue's test (LT) were estimated in low back pain. In knee osteoarthritis, knee circumference, motion, and knee tendons sensitivity (KTS) to palpation were assessed. Adverse events reported by the patients, or observed by the investigators were recorded.

RESULTS

T and N significantly reduced pain levels in patients with low back pain and knee osteoarthritis (p<0.001) as well as knee circumference and KTS to palpation (p<0.05). Compared to N, T showed slightly better effects on the Lequesne functional index (p<0.05) and PVM spasm in patients with lower back pain, but that was not of clinical relevance. Tolerability of T and N was good.

CONCLUSION

T and N are equally effective and safe forms of nimesulide for pain management in low back pain and knee osteoarthritis. Price per daily dose is a relevant parameter for making a choice. However, regulations regarding drug bioequivalence criteria should be met for drug marketing authorization submission.

T-cell large granular lymphocytic (T-LGL) leukemia: a single institution experience

BACKGROUND

T-cell large granular lymphocytic (T-LGL) leukemia is a rare lymphoproliferative disease which usually affects elderly people. The clinical course of T-LGL leukemia is generally indolent, with lymphocytosis and splenomegaly in 20-50% patients, hepatomegaly in 5-20% of patients, and less commonly, lymphadenopathy. T-LGL leukemia is associated with immunological abnormalities: rheumatoid factor with or without rheumatoid arthritis (RA), Coombs positive hemolytic anemia, idiopathic thrombocytopenic purpura (ITP), pure red cell aplasia (PRCA), positive anti-nuclear antibodies (ANA), anti-neutrophil cytoplasmic antibodies (ANCA), hypogammaglobulinemia, and polyclonal hypergammaglobulinemia. Aim To compare clinical and laboratory features of T-LGL leukemia patients and their responses to different chemotherapy regimens.

METHODS

Six patients (3 males and 3 females) with T-LGL leukemia were analyzed. The diagnosis was based on accepted morphologic criteria, immunophenotype, and polymerase chain reaction (PCR) detection of T-cell receptor (TCR) gene rearrangements.

RESULTS

All patients exhibited lymphocytosis, mainly with unusual morphologies, splenomegaly, and elevated serum lactate dehydrogenase (LDH). Three patients were treated with a Fludarabine-Cyclophosphamide (FC) combination as initial therapy while three patients received CHOP. Two patients received more than one treatment regimen. One patient died due to T-LGL leukemia in first year after diagnosis, one patient died 4 years after diagnosis, two patients interrupted their treatment, and two patients are still alive.

CONCLUSIONS

Further prospective studies are needed for establishing a gold standard therapy for T-LGL leukemia.

Diffuse malignant peritoneal mesothelioma in a 31-year-old patient--case report

This is a case report of a diffuse malignant peritoneal mesothelioma in a 31-year-old woman. The patient presented with pains in the small pelvis followed by abdominal distension. By pelvic ultrasonography a tumorous mass of cystic architecture was verified in the small pelvis. She was submitted to laparoscopy. The diagnosis of the disease was established by histopathological examination of the material sample taken during laparoscopy. The patient was subsequently submitted to laparotomy upon which peritonectomy, omentectomy and appendectomy were performed. Postoperative combined chemotherapy was given. The patient has been well since completion of the treatment.

[Risk factors for urinary bladder cancer]

A matched case control study was conducted in order to assess possible relationships between some habits and risk of bladder cancer. The study included 130 newly diagnosed bladder cancer patients and the same number of controls matched with respect to sex, age (+/- 2 years) and type of residence (rural-urban). According to multivariate logistic regression analysis, risk factors of bladder cancer were smoking habits (OR = 3.15), consumption of animal fats (RR = 2.10) and pickled food (RR = 21.28). Higher level of educational (RR = 0.51), frequent urination (RR = 0.21), consumption of greens (RR = 0.10), cherry (RR = 0.03) and tangerines (RR = 0.02) had a protective effect.

Endoluminal stenting for subclavian artery stenosis in Takayasu's arteritis

We describe a patient with Takayasu's arteritis (type I): occlusion of all large vessels of the aortic arch except the left subclavian artery which was, however, almost completely occluded, resulting in a characteristic subclavian steal syndrome. Elective left main subclavian artery balloon angioplasty followed by endoluminal stenting was performed with excellent results. After prolonged immunosuppressive treatment, at the 12-month follow-up there was no evidence of restenosis. In selected patients with Takayasu's arteritis and subclavian stenosis, elective endoluminal stenting can be used as a definitive procedure or as a bridge to surgical revascularization.

[Incidence of stroke in central Dalmatia during the war in the Republic of Croatia (1991-1995)]

INTRODUCTION AND METHOD

A retrospective study was made of the incidence of stroke in the Dalmatian region (Split) during the war in the Republic of Croatia (1991-1995), to determine whether the war had affected the incidence of stroke in the population at risk. The data obtained was compared with data regarding the incidence of strokes in the pre-war period (1986-1990).

RESULTS AND CONCLUSIONS

There was a small but significant increase in the incidence of strokes during the war period. There was also a considerable increase in patients with primary intracerebral hemorrhage during this period. The possible causes of this increase in patients with primary intracerebral hemorrhage are discussed.

Peripheral nerve war injuries

OBJECTIVE

The purpose of this study is to evaluate peripheral nerve war injuries sustained during the war in southern Croatia and Bosnia and Herzegovina.

PATIENTS AND METHODS

During the war in Croatia, 713 patients (99% male and 1% female) with wounds inflicted by firearms were examined at the Laboratory of Neurophysiology, University Hospital, Split. The patients, soldiers and civilians alike, ranged in age from 6 to 73 years (average, 28 years). All patients with firearm nerve war injuries underwent detection by electromyography and plurisegmental examination of the damaged peripheral nerve (neurography). The patients were examined and controlled on three occasions: within 2 months after wounding; up to 6 months after wounding; and more than 6 months after wounding.

RESULTS

Single peripheral nerve lesions were present in 80% of the patients, and multiple peripheral nerve or plexus lesions were present in 20% of the patients. Peroneal and ulnar nerves were most often involved (20.9% and 19.8%, respectively). Associated massive injuries to the muscles, large blood vessels, or vital organs were present in 45% of the patients. Wounds were inflicted by shell fragments in 80% of the patients and by projectiles in 20% of the patients.

CONCLUSION

According to our results, better recovery was achieved with conservative treatment and when physical therapy was initiated early with maximal patient cooperation. Electromyoneurographic findings were the most valid in the prognostic classification of war-inflicted peripheral nerve injuries.

Differences in the effects of vasopressin and oxytocin on feline gastric corpus motility: selective action of vasopressin on longitudinal muscle

The effect of vasopressin and oxytocin on the contractile activity of preparations isolated from the feline gastric corpus wall was investigated. Vasopressin (1.5 x 10(-9)-2.1 x 10(-7) M), but not oxytocin, evoked concentration-dependent tonic contractions only of longitudinal muscle strips. At the same time, vasopressin (1.5 x 10(-9)-2.1 x 10(-7) M) potentiated the magnitude of amplitudes, but not the frequency, of spontaneous contractions. Both the vasopressin V1 receptor antagonist d(CH2)5-(Me)2-Tyr-AVP and the predominantly vasopressin V2 receptor antagonist d(CH2)5, D-Ile2, Ile4-AVP, the non-selective muscarinic receptor antagonist, atropine, the predominantly selective muscarinic M1 receptor antagonist, pirenzepine, the predominantly selective muscarinic M2 antagonist, methoctramine, the predominantly selective muscarinic M3 receptor antagonist, para-fluoro-hexahydro-siladifenidol, and the calcium channel blocker, nifedipine, but not the ganglion blocking agent, mecamylamine, depressed or blocked the tonic contractions induced by vasopressin. Among the antagonists, only atropine and nifedipine inhibited the spontaneous contractions. On the other hand, the anticholinesterase, physostigmine, potentiated both the vasopressin-induced tonic and spontaneous contractions. With regard to the receptors, the vasopressin-induced tonic contractions are mediated at least in part through vasopressin V1 and V2 receptors, non-selective muscarinic and selective muscarinic M1, M2 and M3 receptors. The increase in amplitudes of spontaneous contractions is mediated only via-nonselective muscarinic receptors. Vasopressin receptors appear to be located mostly pre-synaptically, although the direct effect of vasopressin on post-synaptic receptors cannot be excluded. The pA2 values suggests rather V1a than V1b vasopressin receptor subtype involvement in tonic contractions vasopressin had produced. The tonic as well as spontaneous contractions are calcium-dependent. In addition, these results point to the existence of non-selective muscarinic receptors, which participate in the regulation of both tonic and spontaneous contractions, while muscarinic M1, M2 and M3 receptors subserve only the tonic contractions.

Attitude of involved epidemiologists toward the first European outbreak of rhinosporidiosis

Rhinosporidiosis occurs extremely seldom in Europe. Until recently, the disease was unknown in Serbia (Yugoslavia). An outbreak that began in January 1992, affected 21 individuals. All of them had been exposed to the same source of stagnant water. The purpose of this study was to assess which control measures would be selected by epidemiologists potentially involved in the control of the disease. Most respondents (20 of 32 or 62.5%) opted only for an information release as the most appropriate control measure. The reasons listed by the epidemiologists to justify their choice of optimal control measures showed that the political and economic hardships, including an embargo imposed upon rump Yugoslavia, did not hamper their judgment. The turmoil associated with the disintegration of Yugoslavia, however, appears to have significantly affected the information level of the participants.

Cancer mortality of family members of patients with chronic lymphocytic leukemia

A case-control study comprised 130 cases affected by chronic lymphocytic leukemia and the same number of individually matched controls, with accidental injuries as a cause of hospitalization. Matching criteria were: sex, age, type of settlement, and area of residence. Both leukemias and all cancers were more frequent among family members of cases, as compared to controls.

Well water characteristics and the Balkan nephropathy

A total of 366 inhabitants of a village affected by Balkan nephropathy (BN) have been followed over 12 years. It was shown that depth of the well to the water level, height of the water column, electroconductivity, and NO3 content of the water were not associated with BN. The risk of developing the disease was significantly higher if a well was at a lower altitude and contained a higher concentration of SiO2. Low altitude might have been expected to correlate with the BN frequency; as for silica, however, there are sound indications that it could just be a correlate of a cause rather than a direct determinant of BN.