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Attitudes of medical students in Belgrade, Yugoslavia, toward preventive medicine and epidemiology.

Medical students in Belgrade were interviewed regarding their opinions about the teaching of preventive medicine, with particular emphasis on epidemiology, at the beginning and at the end of the course. Results indicated that the course provoked no interest whatsoever in the disciplines of preventive medicine. A part of social factors influencing the motivation of students, the didactic approach to teaching and the strict division between preventive and clinical medicine were implicated as the main reasons for this lack of enthusiasm. The absence in this country of clear and generally accepted ideas regarding what a graduate student should know in order to meet optimally the health needs of the community has been assessed as the factor which obscures definition of the aims of teaching and, accordingly, the creation of purposeful syllabuses.

Attitude of Health Personnel↗

Psychiatric disorders and selected variables among medical students in Belgrade (Yugoslavia).

The mental health of a group of 523 medical freshmen (97% of the respective population) was assessed 1 month after enrollment. Students with psychiatric impairment (84 or 16.1%) were compared with those assessed to be mentally healthy in respect of a number of variables. Cluster, correlation, and principal component analyses revealed that psychiatric disorders were related to the result of the screening test, in a lesser degree to the test anxiety, and not at all to any of the other tested variables (separation from parents, family completeness, education of parents, number of siblings, number of employees in the family, grade point average in high school, and smoking).

Humans↗

Frequency of alcohol consumption and morbidity and mortality: The Yugoslavia Cardiovascular Disease Study.

The association of frequency of alcohol consumption with the seven-year incidence of coronary heart-disease and with mortality both from all causes and from specific causes was examined in a cohort of 11 121 Yugoslav males aged 35-62 at the time of their initial examination. Consumption of alcohol seemed to be inversely related to incidence of coronary heart-disease morbidity and mortality, but not to risk of dying. Those consuming alcoholic beverages most frequently were at increased risk of death from stroke and accidents or violence. The frequency of alcohol consumption was associated with high blood-pressure and serum cholesterol levels. The associations with coronary heart disease and death from all causes could not be fully explained by these covariates.

Accidents↗

Prevalence of antibodies to hepatitis A virus among urban children aged 0-7 years in Yugoslavia.

In a study of the prevalence of hepatitis A virus antibody in urban Yugoslav children aged 0-7 years, 18.2% were positive; most of them were only a few months old. The maternal origin of antibody in these very young children could be inferred from the rapid decrease of antibody during the first 5-7 months of life, following which period until the age of 7 years, there was no significant increase in the proportion with antibody. It was concluded that the age range included in this study (0-7 years) does not represent a time of life when most urban Yugoslav children come into contact with hepatitis A virus.

Child↗

Hepatitis C virus RNA testing by nested PCR in blood preparations in Yugoslavia.

Patients receiving any kind of human blood preparations are in permanent danger of any infection including hepatitis C (HCV) infection. Testing for the presence of HCV in blood preparations is one of the steps towards safe medical treatment. One of the approaches for this testing is a detection of HCV nucleic acid. In this paper we describe a simple method for isolation of HCV RNA from blood preparations and control of HCV RNA presence in 19 intravenous and intramuscular products, manufactured in the National Blood Transfusion Institute in Belgrade. RT-PCR was performed according the rules saving RNA. Primers were located in 5' conserved region. Seven out of 19 batches of gamma-globulin, albumin, anti-tetanus and anti-rabies immunoglobulin preparations were found to be HCV RNA positive. For the time being, the PCR method is too expensive for routine HCV RNA testing of hundreds of blood donors per day. Serological screening test of blood donors and nested PCR testing for HCV RNA in blood preparations could be an efficient combination of tests in prevention of posttransfusion hepatitis C.

Blood Donors↗

Campylobacter jejuni and Campylobacter coli diarrhoea in rural and urban populations in Yugoslavia.

During a 4-month period during the summer of 1985, campylobacters were isolated from 338 (16.3%) of 2080 patients with acute diarrhoea attending the University Hospital of Infectious Diseases in Zagreb. Of these isolates 220 (64.1%) were Campylobacter jejuni and 118 (34.9%) were C. coli. The patients were drawn from three residential zones in and around Zagreb: inner city, peripheral city and rural. Incidences of campylobacter diarrhoea ranged from 71 per 100,000 per year in inner city residents to 99 per 100,000 per year in the rural residents. Most infections were in young children; the incidence in infants ranged from 800 to 2500 per 100,000 per year in the inner city and rural zones respectively. The isolation rate from faecal specimens of infants from the rural zone was 61%. The ratio of isolation rates in males and females (all ages) was 1.1:1, but in infants it was 0.7:1 and in patients over the age of 65 years it was 0.4:1. The incidence of C. coli in the rural zone was four times that in the inner city and twice that in the peripheral zone. This survey shows that campylobacter infection in Zagreb has distinctive epidemiological features. The transmission of infection appears to be midway between that found in industrialized and developing countries, and there is an unexplained excess of C. coli infection.

Adolescent↗

Long-term follow-up and prognosis of chronic granulomatous disease in Yugoslavia: is there a role for early bone marrow transplantation?

We report the long-term follow-up of 12 pediatric-aged patients with chronic granulomatous disease (CGD). The mean age at the onset of infections was 5 months with a median delay in diagnosis of 2.5 years. Bacille Calmette-Guérin lymphadenitis was the most common presenting infection (6) followed by suppurative lymphadenitis (4), liver abscess (1), or Salmonella sepsis (1). Prophylaxis with cotrimoxazole was recommended to all patients. During the mean follow-up of 10 years (range, 4-23 years) pneumonitis was the most prevalent infection (91%) followed by lymphadenitis (83%), aphtous stomatitis (58%), and liver abscesses (25%). Seven (58%) patients developed chronic lung disease due to grossly delayed diagnosis (3) or poor compliance with antimicrobial prophylaxis (4). Five (41%) patients died during the second decade of life of aspergillosis (3) or chronic lung disease (2). Probability of survival into the third decade of life was estimated to be only 19%. We argue that HLA-identical bone marrow transplantation (BMT), if possible, should be attempted at early age because of significant morbidity and mortality in adolescence. BMT also should be considered in patients who suffer severe infections despite antimicrobial prophylaxis or patients with evidence of chronic lung disease. Possibility of elective BMT from unrelated donors remains to be carefully evaluated.

Adolescent↗

Genetic and clinical analysis of spinocerebellar ataxia type 8 repeat expansion in Yugoslavia.

Spinocerebellar ataxia type 8 (SCA8) is a slowly progressive ataxia causally associated with untranslated CTG repeat expansion on chromosome 13q21. However, the role of the CTG repeat in SCA8 pathology is not yet well understood. Therefore, we studied the length of the SCA8 CTA/CTG expansions (combined repeats, CRs) in 115 patients with ataxia, 64 unrelated individuals with non-triplet neuromuscular diseases, 70 unrelated patients with schizophrenia, and 125 healthy controls. Only one patient with apparently sporadic ataxia was identified with an expansion of 100 CRs. He had inherited the expansion from his asymptomatic father (140 CRs) and transmitted the mutation to his son (92 CRs). Paternal transmission in this family produced contractions of 40 and 8 CRs, respectively. None of the subjects from other studied groups had an expansion at the SCA8 locus. In the control group the number of CRs at the SCA8 locus ranged from 14 to 34. Our findings support the notion that allelic variants of the expansion mutation at the SCA8 locus can predispose to ataxia.

Genes, Dominant↗

Prevalence of multiple sclerosis in Belgrade, Yugoslavia.

OBJECTIVES: To estimate the distribution of multiple sclerosis in the Belgrade population. METHODS: All persons who were affected and/or died from multiple sclerosis (Poser's criteria), with residence in the Belgrade region had been collected from January 1, 1985 to December 31, 1996. Prevalence was adjusted by direct method, using world population. RESULTS: From 1985 to 1996, 823 patients were suffering from multiple sclerosis. Sex ratio was 1:1.9. The mean age at onset was 32.2 +/- 9.8 years. A relapsing-remitting course of multiple sclerosis was reported in 50.7% patients, secondary progressive in 36.4%, patients, and primary progressive in 12.9% patients. On December 31, 1996, age-adjusted prevalence of multiple sclerosis in Belgrade was 41.5/100,000, 28.2/100,000 for males, and 54.1/100,000 for females. During the period studied, statistically highly significant increasing trend of multiple sclerosis prevalence was observed (P = 0.0001). CONCLUSIONS: According to findings presented in this study, Belgrade is an area with high prevalence of multiple sclerosis.

Adult↗