Women, conflict, and culture in former Yugoslavia.
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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.
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In a prospective study of more than 10000 Yugoslav men it was found that consumption of alcoholic beverages was inversely related to non-sudden death from coronary heart disease (CHD) and positively related to death from trauma. The consequence was an apparently U-shaped relation between alcohol consumption and death, the lowest mortality being among moderate drinkers. Excess mortality from trauma was evident only among men under 55 and only for those who reported at entry to the study that they had been drunk during the preceding week. Alcohol consumption as reported at entry was unrelated to subsequent mortality from liver cirrhosis or any form of cancer. An enlarged liver, however, was associated with higher death rates for liver cirrhosis. This raises the possibility that some of the men were heavy drinkers preceding their entry to the study but were no longer drinking heavily at the time of entry. Enlarged liver, however, was also related to hypertension and to chronic obstructive pulmonary disease and thus was not a specific indicator of alcohol abuse in this population. Recent drunkenness but not frequency of drinking was related to death from trauma and liver cirrhosis and to sudden CHD death. In short, both the pattern of drinking and the usual level of alcohol consumption appear to be related to mortality in this population.
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The relationship of level of baseline serum cholesterol to the seven-year incidence of death from all causes and from specific causes was examined in a cohort of 11,121 Yugoslav males aged 35--62 years at the time of their initial examination (1964--1965). Serum cholesterol was negatively related to mortality, i.e., those with a lower cholesterol experienced a higher mortality than those with a higher cholesterol. The negative relationship was significant (as assessed by logistic regression) and remained significant after adjusting for obesity, systolic blood pressure, cigarette smoking, age, history of intestinal parasitism, and socioeconomic status (as measured by years of education). The negative association of serum cholesterol and subsequent mortality appeared to be due to the relationship of cholesterol to deaths due to cancer and to deaths due to respiratory disease (tuberculosis and cor pulmonale). The cancer death-serum cholesterol relationship was not statistically significant but the respiratory disease death-serum cholesterol relationship was. Serum cholesterol, as expected, was positively related to the incidence of coronary heart disease death.
In two large general populations of Yugoslav men from Tuzia, Bosnia, and Remetinec, Croatia, examined in 1964-1965, it was found that a greater alcohol consumption was accompanied by higher blood pressures, higher pulse rates, and higher concentrations of serum cholesterol and hematocrit. A greater consumption was also associated with an enlarged liver, as well as a higher prevalence rate of chronic bronchitis and thrombophlebitis. All these were statistically significant even after allowing for differences in cigarette smoking and demographic characteristics. Pulse rate, liver size, and varices appear to be specifically associated with a history of episodes of drunkenness. There were significant differences in drinking habits by place of residence, religious background, years of schooling, and kind of work. These were allowed for in evaluating the relationship of drinking to other characteristics. Two anomalous findings were low prevalence rates for diabetes and gastritis among those drinking most frequently.
In a prospective study of more than 10,000 Yugoslav men residing in Bosnia and Croatia, who were first examined in 1964--1965, consumption of alcoholic beverages was related inversely to the subsequent appearance of coronary heart disease clinically manifest as myocardial infarction or nonsudden coronary heart disease death. Consumption of alcoholic beverages was not so related to sudden cardiac death. Men who drank most frequently had half the subsequent incidence of overall coronary heart disease as men who seldom or never drank. This finding was true for urban residents only. Serum cholesterol and Quetelet index were also related to coronary heart disease in urban areas but not in rural areas. The inverse relation of alcohol consumption to coronary heart disease incidence was statistically significant even after taking into account differences in blood pressure, serum cholesterol levels, cigarette smoking and other variables. The apparent absence of protection against sudden death may be due to chance or it may reflect the deleterious effects of high alcohol consumption on the myocardial cells and increased vulnerability to lethal arrhythmias in an especially lean population. There is, in fact, a specific association of recent drunkenness with sudden death in this population. Conceivably, the acute effect of heavy drinking may be a dominant factor in the incidence of sudden death for this population.
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