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The World Health Organisation (WHO) has been at work in the former Yugoslavia since the summer of 1992. The Scandinavian countries have been very active in the project, and many Scandinavian citizens have been involved. Considerable contributions will be required for a long time to come. The article provides an account of the background to the WHO project and of its organisation, working methods and results.
In this paper the authors present distribution of tick Ixodes ricinus in both republics of Yugoslavia--Serbia and Montenegro. The ticks were collected from domestic animals and humans sporadically. The determination showed following species: Ixodes ricinus, I. persulcatus, I. hexagonus, Dermacentor marginatus, D. pictus, Rhipicephalus bursa, R. sanguineus, Haemaphysalis punctata, H. inermis, H. sulcata, H. leporis-palustriis, H. concinna, Boophilus (margaporus) calcaratus, Hyalomma savignyi, H. excavatum, H. detritum and H. rufipes. The species I. ricinus has been detacted in all parts of the country.
This paper debunks three widely believed myths about the former Yugoslavia's health care system: that it was characterized by: (1) social ownership of "self-managing" provider organizations; (2) a commitment to primary health care; and (3) a faith in what might be called the "march of progress"--the health system's continuous expansion and improvement. In contrast to this picture, we present an alternative view and conclude with a word of caution for American consultants and health care reformers in Eastern European countries and newly independent states: If universal health coverage is to be maintained, beware of reforms that do no more than substitute private for public organizational forms.
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.
War wounds of the maxillofacial region occur in 5-17% of casualties. In the Clinic for Maxillofacial Surgery of the Military Medical Academy, during the war in former Yugoslavia, 482 casualties with dominant wounds in the maxillofacial region were treated. The outcome of the treatment depended on the quality and speed of the first aid and general medical aid, as well as on qualified specialist treatment. Specificity of the management of the war wounds of maxillofacial region includes: minimal debridement of soft tissues, removal of only deperiosted fragments of bony tissues, valid reconstruction of bony and soft tissues defects, correct immobilization, antitetanus prophylaxis, adequate antibiotic therapy, as well as permanent and very meticulous postoperative care.
According to the established monitoring program in Yugoslavia, 941 swine, 561 cattle, and 358 lamb samples collected during a 5-year period were analyzed for chlorinated pesticide residues. Less than 10% of the examined samples contained residues of HCB (hexachlorobenzene), HCH (hexachlorocyclohexane), lindane (gamma-hexachlorocyclohexane), and total DDT (p,p'-DDT and metabolites) at concentrations greater than the lowest detectable limit. None of the swine and cattle samples exceeded the residue limit (RL). Among lamb samples, 2.5% contained lindane residues exceeding the RL, with a mean of 4.75 mg/kg. This finding suggests lindane's improper use as a veterinary pesticide, probably as a sheep-dip for destroying ectoparasites. During the same period, 849 swine, 584 cattle, and 350 lamb samples also were analyzed for toxic elements (Pb, Cd, Hg, and As). In the majority of samples, toxic elements were present at levels less than 50% of RLs. Only Cd and Pb RLs were exceeded in several cases. Differences in trace element contents of samples from different animals were not significant. The data indicate that residues in tissues of food-producing animals do not have a great potential impact on public health.
Small mammals were collected in natural foci of hemorrhagic fever with renal syndrome (HFRS) in Slovenia, Yugoslavia, and a hantavirus was isolated from the lungs of an Apodemus flavicol lis captured in Dobrava village. This new isolate, Dobrava virus, was compared with representative strains of the Hantavirus genus by serological and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods. It was found by cross immunofluorescent and enzyme-linked immunosorbent assays that antigenic properties of Dobrava virus were different from those of other hantaviruses. The RNA of this virus was successfully amplified with hantavirus genus reactive primer sets by reverse transcriptase polymerase chain reaction (RT-PCR); however, PCR-RFLP analysis of the amplified product was shown to be unique among those of the known hantaviruses, further indicating that Dobrava virus represents a new hantavirus serotype.
Concentrations of p,p'-DDE, p,p'-DDD, and p,p'-DDT were determined in 34 samples of human milk obtained 3-5 days after delivery and in 37 samples obtained at later times of lactation (up to 55 weeks). All samples contained p,p'-DDE, but only several contained p,p'-DDD and p,p'-DDT. The concentrations of p,p'-DDE were 31 microgram/l in the beginning of lactation and 53 microgram/l at later time intervals. The concentration ranges in both groups overlap almost completely and the difference in the mean values is not significant. Serum samples from 35 mothers and cord blood were also analyzed. All samples contained p,p'-DDE, the concentrations being 18 microgram/l and 6.8 microgram/l in the mothers' and cord blood serum, respectively. Serum samples of 24 non-pregnant women contained the same amount of p,p'-DDE (20 microgram/l) as mothers' sera. All samples were collected in a continental town of Croatia (Yugoslavia) between 1977 and 1979. The concentrations of DDT residues were determined by gas chromatography, and two methods for extraction from milk were used and compared.
For an evaluation of the extent of pollution in Rijeka Bay, Yugoslavia by chlorinated hydrocarbons an investigation of levels in sediments and the most abundant benthic organisms (Asteroidea and Holothuroidea species) has been carried out. Samples were collected at several stations in October 1981. The concentrations of chlorinated insecticides and polychlorinated biphenyls (PCBs) in Asteroidea species were from 0.5 to 46.0 micrograms kg-1 for DDTtotal, and from 2.5 to 435 micrograms kg-1 (wet weight) for PCBs. For the PCBs in Holothuroidea species the values ranged from 4.4 to 37.2 micrograms kg-1 and for DDTtotal from 0.9 to 48.5 micrograms kg-1. The contamination of Asteroidea and Holothuroidea samples from Rijeka Bay with persistent chlorinated hydrocarbons was compared with other data for the same species from other parts of the world. Accumulation of chlorinated hydrocarbons by Asteroidea and Holothuroidea species from sediments of Rijeka Bay is discussed with respect to concentration factors (CF). The highest CF (70.0) (dry biota/dry sediment) was obtained for the intestines of Asteroidea species for PCBs and a value of only 2.6 was obtained for DDTtotal for the skin and muscle of Holothuroidea species. The relatively low bioaccumulation of PCBs and DDTs from sediments in the Rijeka Bay by the Asteroidea and Holothuroidea species is reassuring, because of the problem of dredging and ocean dumping of sediments polluted with persistent chlorinated hydrocarbons.
About 120 homes in Slovenia, Yugoslavia, were selected in urban areas, in a uranium rain and mill region, around coal-fired plants and around a phosphate mill. Radon-222 in air was determined using alpha scintillation cells and the gamma dose rate measured with thermoluminescent dosimeters. The levels obtained were explained by differences in building materials and ventilation rates of homes, as well as by the influence of man-made radioactivity sources. The results show that in the same region radon concentration, expressed as geometric mean, can be up to eight times higher in winter than in the autumn (Pohorje) or nine times higher in one region relative to another (Zirovski vrh-Zasavje).
An overview of environmental distribution of tritium in the Danube basin in Yugoslavia during the period 1976-1990 is presented. Temporal and regional variations of environmental tritium in the Danube along its flow (1425-847 km from the confluence) and its tributaries (the Sava, the Tisa, the Velika Morava and the Timok) at various locations, as well as in alluvial groundwaters, are given. In Belgrade, monthly values of tritium in rainfall ranged from 1.1 to 18.3 Bq litre(-1), with a maximum in the late spring and early summer months. The half-life for decline in concentration was estimated as 8.3+/-1.0 years. The total amount of tritium deposited in the first 6 months during 1976-90 was 35% larger than in the second 6 months for the same period. Seasonal variations were noticeable in rivers and groundwaters, but these were greatly attenuated and smoothed for the latter. Tritium content in the monthly composite samples from the river in the Belgrade region varied between 2.5 and 18.2 Bq litre(-1) for the Danube and from 1.5 to 16.8 Bq litre(-1) for the Sava. The yearly mean values along the Danube and its tributaries ranged from 2.4 to 15.9 Bq litre(-1) with individual measurements 1.0-30.2 Bq litre(-1). The half-lives were between 6.9+/-1.7 for the Velika Morava and 9.4+/-0.9 for the Danube. Groundwaters, particularly ones in the Ranney wells, followed changes of tritium content in the rivers with a time lag from a few days to a month. During the period of observation, tritium content decreased in alluvial waters with half-lives from 9.9+/-1.6 (Belgrade area) to 7.3+/-1.8 (the Velika Morava).
A study of the social and health status of women from the former Yugoslavia was conducted in Queensland, Australia. Study participants were predominantly refugee women who had migrated to Australia between 1991 and 1996. A significant number of the women rated their health status as poor or fair. Most women did not perceive any change in health following migration, but more felt that their health had deteriorated than improved. Applying a social model of health, we explored the social contexts of countries of origin and destination that impact on women's health. We analyze how pre-immigration trauma, settlement problems, health risk behaviors, and participation in screening programs affect women's health status and health needs. Data analysis indicated that government and non-government services can reduce the impact of pre-immigration experience on health risk behaviors and poor health outcomes only to a limited degree. Since the low socioeconomic status of immigrants following immigration was identified by women as a main contributing factor to their poor health status, government support in tackling structural barriers in accessing the Australian labor market is essential to achieve positive health outcomes.
Since the World Health Organisation's effort in former Yugoslavia started in July 1992 it has been concerned with the public health policies of survival. It has provided advice to the United Nations High Commission for refugees, helped the voluntary agencies coordinate their work, assessed health needs, and provided practical help in the field to all parties to the conflict. Three features of the Bosnia war have particularly deplorable effects on health: ethnic cleansing, deliberate attacks on hospitals, and systematic rape. The WHO's response has included initiatives in nutrition, winter survival, and medical supplies. This experience shows that the WHO can have a useful role complementary to that of other agencies in situations where the basic elements for survival of the population are seriously compromised by war.
The establishment of the International Criminal Tribunal for the former Yugoslavia reflects the human rights idea that there can be no justice without truth and that notions of justice must inform the process of extracting some truth from the many stories, myths and lies that have been told about "ethnic cleansing." This article uses a three-pronged approach to combine the normative framework of human rights with the practical, quantitative methods of public health. This approach provides powerful mechanisms for extablishing truth and accountability for ethnic cleansing. First, clinical and forensic evidence is critical in documenting when and whether ethnic cleansing actually occurred. Second, public health methodology can be brought to bear to define both the nature of the legally cognizable crimes committed and the nature of the harms ensuing from those crimes. Third, public health tools can help reinforce conceptions of individual responsibility and identity formation that refute the premises of ethnic cleansing and which are essential to the future of the Tribunal and to international human rights law in general.
AIM: To compare the service quality in public and private pharmacies in the city of Kragujevac by measuring patient care and health facility indicators. METHODS: The patient care indicators and health facility indicators, established by the World Health Organization in 1995, were measured prospectively in 7 public and 7 private pharmacies in Kragujevac, Yugoslavia, during November and December 1999. A sample of 100 patient-visits was analyzed in each pharmacy. RESULTS: Our study showed that the average drug dispensing time ranged from 20.5 to 48.2 seconds, being significantly longer in private (21.1-48.2 s) than in public pharmacies (20.5-33.7 s) (F=13.12, p<0.001). The percentage of actually dispensed drugs ranged from 29% to 63%, and no significant difference was found between public and private pharmacies. Patients' knowledge of a correct dosage ranged from 30% to 74% and the availability of key drugs ranged from 67% to 93% with no significant difference between public and private pharmacies. There was serious negligence in labeling the dispensed drugs in both public and private pharmacies: not a single drug package was labeled according to the World Health Organization recommendations. Key drugs were highly available in both public and private pharmacies. CONCLUSION: The average drug dispensing time was too short for a proper interaction between a pharmacist and a patient in both public and private pharmacies. The results of our study suggest that there was no real difference in the service quality between the public and the private pharmacies.
Providing of children aged 3-5 years with vitamins C, B1, B2, B6 and PP was studied before and after intake (during 3 months) of multivitamin "Pikovit" (KRKA, Yugoslavia) by the excretion with urine of ascorbic acid, thiamine, riboflavin, 4-pyridoxic acid and N-methylnicotinamide. Before "Pikovit" intake the mean level of thiamine excretion was close to the lower border of the normal level, while ascorbic acid and N-methylnicotinamide levels were lower than the normal in 73 and 69% of the children studied, respectively. "Pikovit" induced an increase in the mean values of excretion of all vitamins studied except for ascorbic acid. The multivitamin prevented the impairment of children providing with vitamins C and B6, and improved their provision with vitamins B1, B2 and PP. However, the doses of vitamins used proved to be insufficient for complete normalization of the vitamin status in children, therefore it is necessary to use "Pikovit" in higher doses as it is recommended by the firm-manufacturer.
263 fasting female Ixodes ricinus were examined for Borrelia burgorferi, the vector of Lyme borreliosis. Female ticks were collected by flagella in the biotopes (Belgrade and Osijek) in which ticks bite patients with Lyme borreliosis. Borrelia burgorferi was proved in 58 (22%) of 263 female ticks in the native preparations of the intestinal contents by darkfield microscopy. In macerates of two groups of 5 female ticks each, Borrelia burgorferi was isolated by cultivation in the modified Kelly nutrient media for borrelia. The supposition that Ixodes ricinus is the vector of Lyme borreliosis in Yugoslavia is confirmed.
From November 1992 to April 1993, the 212th Mobile Army Surgical Hospital (MASH) was deployed from Germany to Zagreb, Croatia, to provide medical support for the United Nations Protection Force serving in the former Yugoslavia. A 60-bed deployable medical systems hospital was established. The usual MASH 72-hour evacuation policy was extended to 30 days; the orthopedic equipment inventory and surgical capability were increased significantly. Eighty-three orthopedic surgical procedures were performed during a 5-month period on soldiers from 14 nations. Sixty-two (75%) of these procedures were non-emergent, including internal fixation of fractures, bone and skin grafting, and arthroscopy. There were no documented early infections; the complication rate was acceptable. Orthopedic aftercare was supplemented by physical therapy and the capability of prosthetic fitting for amputees. The majority of soldiers (60%) received definitive orthopedic surgical care in theater. The feasibility of performing non-emergent orthopedic procedures in a field environment was demonstrated. Expanded medical support for other similar missions may be required in the future.