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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↗

Oral health in SFR Yugoslavia in 1986.

A pilot oral health epidemiological survey using WHO assessment forms was conducted in Yugoslavia in the year 1986. The study population consisted of 2600 persons aged 6, 12, 15, 18, 35-44, and over 65 yr. The survey included 22 towns (11 developed and 11 underdeveloped) in the six Republics and two Provinces of Yugoslavia. The results showed the prevalence of dental caries in the Yugoslav population to be very high (98.7% in 12-yr-olds). The mean decayed, missing, and filled teeth (DMF) scores were as follows: 6.1 at age 12 yr, 9.6 at age 15, 10.9 at age 18, 18.0 at age 35-44, and 28.0 in persons aged over 65 yr. Assessment of the periodontal status showed calculus to be the predominant disorder in the age groups 18 and 35-44 yr, while loss of sextants prevailed in persons aged over 65 yr.

Adolescent↗

Diabetes services in Yugoslavia.

The Socialist Federal Republic of Yugoslavia lies in south east Europe between the Soviet block and the free enterprise countries of Western Europe. It was originally established as a confederation of independent Balkan states after the first world war; after the second world war it became an independent federation of the socialist republics of Bosnia, Herzegovnia, Montenegro, Croatia (including Dalmatia), Slovenia, and Serbia, together with the two small autonomous provinces of Kosovo and Vojvodina. In the subsequent 30 years the trend towards decentralised decision making and institutional self management has continued. Nevertheless, the federal authorities retain major control over economic decision making and policies. For example, they forbid anyone from owning more than two houses or 10 hectares of land, and no factory owner may employ more than 10 people. Capitalism in any other than this minor form is not allowed, and any businessman whose business expands must become involved in frustrating negotiations with the local government to set up a state industry. I recently visited Yugoslavia as a guest of the Institute for Diabetes, Endocrinology, and Metabolic Diseases and of the medical faculty of the University of Zagreb and visited various health care units which provide services for diabetics in Croatia. As well as Zagreb itself I visited units in Split on the Adriatic coast and at Varazdin, near the Hungarian border. Necessarily my observations are based on the diabetes services in Croatia, but although the other republics may have less developed services they follow similar principles.

Diabetes Mellitus↗

Somatisation: illness perspectives of asylum seeker and refugee patients from the former country of Yugoslavia.

BACKGROUND: Somatisation is particularly challenging in multicultural contexts where patients and physicians often differ in terms of their illness-related beliefs and practices and health care expectations. This paper reports on a exploratory study aimed at better understanding how asylum seeker and refugee patients from the former country of Yugoslavia who were identified by their physicians as somatising make sense of their suffering. METHODS: We conducted semi-structured interviews with 26 asylum seeker and refugee patients from the former country of Yugoslavia who attended the general medicine outpatient clinic of a Swiss teaching Hospital and were identified as presenting with somatisation. Interviews explored patients' illness perspectives and health care expectations. Interviews were audio taped, transcribed verbatim and analyzed to identify key themes in patients' narratives. RESULTS: Patients attributed the onset of symptoms to past traumatic experiences and tended to attribute their persistence to current living conditions and uncertain legal status. Patients formulated their suffering in both medical and social/legal terms, and sought help from physicians for both types of problems. CONCLUSION: Awareness of how asylum seeker and refugee patients make sense of their suffering can help physicians to better understand patients' expectations of the clinical encounter, and the particular nature and constraints of the patient-provider relationship in the context of asylum.

Adult↗

The international criminal tribunal for the former Yugoslavia (ICTY) and the forensic pathologist: ethical considerations.

Since 1991, war crimes in the former Yugoslavia have been the subject of several international medico-legal investigations of mass graves within the framework of inquiries led by the International Criminal Tribunal for the former Yugoslavia (ICTY). Forensic pathologists involved in the ICTY missions could be subjected to ethical tensions due to the difficulties of the missions, the emergent conflicts between forensic scientists of the investigating teams and the original nature of the ICTY proceedings. In order to study the nature of such ethical tensions, we sent a questionnaire to 65 forensic pathologists who have been involved in the ICTY missions. The rate of response was 38%. The majority of forensic pathologists questioned (n=18) did not know how the medico-legal data was exploited by the ICTY. Three of them have been subjected to pressures. Three of them were aware of mass grave sites knowingly not investigated by the ICTY. Fifteen considered that the ICTY respected the elementary rules of the law and four of them questioned the impartiality of the justice led by the ICTY. Two conflicting types of ethics can be drawn from these results: conviction ethics, which are shared by most of the forensic pathologists questioned, and responsibility ethics. In the former, the forensic pathologist completely agrees with the need for an international war crimes tribunal, even if such justice can be challenged regarding the respect of human rights and impartiality. In the latter, he or she needs to conduct him or herself in ways that do not infringe impartiality. As medical deontology duty requires impartiality ethics, discursive ethics are needed to ease ethical tensions and to suggest ethical guidelines. Alternatives to international justice, through a truth and reconciliation commission and by way of humanitarian missions combining victims' identification with forensic investigations for historical purposes, could be considered.

Forensic Pathology↗

The Yugoslavia Prospective Study of environmental lead exposure.

The Yugoslavia Prospective Study of environmental lead exposure has studied the associations between exposure to lead and pregnancy outcomes; childhood neuropsychological, behavioral, and physical development; and hematologic, renal, and cardiovascular function. The cohort comprises 577 children born to women recruited at midpregnancy in two towns in Kosovo, Yugoslavia; one town is the site of a lead smelter, refinery, and battery plant and the other is 25 miles away and relatively unexposed. A sample of these children has been followed at 6-month intervals through 7.5 years of age. Blood lead concentrations ranged from 1 to 70 microg/dl. Exposure to lead was not associated with adverse pregnancy outcomes. Exposure was associated with modest decrements in intelligence, small increases in blood pressure, higher risks of proteinuria, small increases in behavior problems, and perturbed hematopoiesis. Only at low level exposures (i.e., <16 microg/dl) were small associations with decreased height found. We discuss methodological problems that may hinder causal interpretation of these data, namely, use of blood lead concentration as an exposure measure, confounding, and town-specific associations. We conclude that while reported associations are small, collectively they lend support to the notion that lead is a toxicant with numerous adverse health effects.

Age Factors↗

The making and breaking of Yugoslavia and its impact on health.

The creation of nation-states in Europe has generally been assumed to be intrinsic to modernization and to be irreversible. The disintegration of Czechoslovakia, the Soviet Union, and Yugoslavia demonstrates that the process is not irreversible. I argue that in the case of Yugoslavia, (1) disintegration was caused by the interaction between domestic policies with regard to nationalities and integration into the global economy and (2) the impact of the disintegration of the federation on health care and public health systems has been profound. Improving and converging measures of mortality before the collapse gave way to increasing disparities afterward. The lesson is that processes of individual and social modernization do not result in improvements in health and well-being that are necessarily irreversible or shared equally.

History, 19th Century↗

The recruitment, training, and distribution of physicians in Yugoslavia.

Yugoslavia has developed a form of communism very different from that found in other communist nations, yet it has faced problems of health manpower distribution not unlike those existing in other countries, both communist and non-communist. Recruitment and training patterns are in some respects similar to those found in the United States: medical students tend to come from high-status, urban families and specialization has increased very dramatically over the past thirty years, in marked contrast to the pattern in the United States. Moreover, though there are continuing discrepancies in physician distribution among urban and rural communes and developed and underdeveloped republics and provinces, these differences are not widening as they have in the United States when similar regional units are observed. It is suggested that physician distribution has been controlled more effectively in Yugoslavia than in the United States, in large part because of the control over available positions exercised by health workers and representatives of social insurance and other institutions.

Communism↗

Typing of field rabies virus strains in FR Yugoslavia by limited sequence analysis and monoclonal antibodies.

A total of 32 rabies virus isolates (15 of fox, 14 of cat and 3 of dog origin) from the territory of FR Yugoslavia were collected from December 1996 till February 1998 and analyzed by limited sequencing of N gene and by indirect immunofluorescence and a panel of 20 antinucleocapsid monoclonal antibodies (MAbs). All examined strains were characterized as sylvatic fox strains. Two main genetic variants were detected, 15 isolates belonging to Group I, 14 belonging to Group II, while the remaining 3 could not be classified into any group. This classification was confirmed by MAbs. The obtained results indicate at least two independent cycles of rabies transmission, probably resulting from multiple modes of transmission to the territories now belonging to FR Yugoslavia.

Animals↗

The problem of goitre prevention in Yugoslavia.

The study of goitre in Yugoslavia has been actively prosecuted since 1923, with some interruptions, and it is estimated that some 1,400,000 persons suffer from the disease. The use of iodized salt (5 mg of potassium iodide per kg of salt) as a prophylactic measure was begun in 1937 but was interrupted from 1941 to 1948. In 1946 it became evident that goitre and hyperthyroidism were on the increase, and the medical authorities agreed to devote particular attention to the problem. It was also agreed that a goitre centre should be set up in each of the Yugoslav Republics. These centres should carry out surveys among newborn children, schoolchildren, and army recruits. Hospitals and pathological institutes should compile statistics on diseases of the thyroid. However, the most urgent need in goitre prevention is for adequate supplies of iodized salt, containing 10 mg of potassium iodide per kg-the level recommended by the Swiss Goitre Commission. This presents a considerable technical and economic problem since, while it is estimated that Yugoslavia requires some 197,500 tons of salt per year, only 18,000 tons of iodized salt and 62,500 tons of non-iodized marine salt can be produced within the country. The author concludes by emphasizing the need for further research, particularly with the use of radioactive iodine.

Biomedical Research↗

A CONTROLED FIELD TRIAL OF THE EFFECTIVENESS OF ACETONE-DRIED AND INACTIVATED AND HEAT-PHENOL-INACTIVATED TYPHOID VACCINES IN YUGOSLAVIA.

In 1954-60 a Yugoslav Typhoid Commission showed in the first controlled field trial of typhoid vaccines, carried out in Osijek, Yugoslavia, that heat-phenol-inactivated typhoid vaccine gave a relatively high and long-lasting immunity. However, this liquid vaccine preparation was unstable and laboratory potency tests were inconclusive, and it was therefore decided that stable, dried, heat-killed, phenol-preserved vaccine be tested together with an acetone-inactivated and -dried vaccine in controlled field trials, supported in part by the World Health Organization, in Yugoslavia and British Guiana.This is report on the controlled trials organized in two Yugoslav towns, Bitola and Pristina. Three comparable groups were formed by random allocation of vaccines among 45 497 volunteers in the two towns. In each town one group received heat-phenol vaccine, the second group acetone-dried vaccine and the third (control) group tetanus toxoid. Two doses were given four weeks apart in the spring of 1960 and the vaccinated persons were followed up for 2 1/2 years. The effectiveness of the vaccines was measured by comparing typhoid morbidity rates in the three groups. It was found during an outbreak of typhoid fever in Pristina two years after primary vaccination that both the acetone-dried and the heat-phenol vaccines were effective, the former being superior.

Accident Prevention↗

[Thyroid gland disease mortality in Yugoslavia from 1987 to 1992].

The aim of this paper was to obtain the data on mortality rate due to thyroid glang diseases in FR Yugoslavia from Mortality Banc Data, and to compare them with data about the total mortality in Yugoslavia, and to mortality rate due to other endocrine gland diseases over the period from 1987 to 1992. The obtained data indicate that the average mortality rate (number of cases per 100,000 inhabitants) due to thyroid gland diseases was 0.72 and 2.45% of deaths related to other endocrine glands. The main causes of death were adenocarcinoma thyreoideae (72.3%) and hyperthyreosis (19.0%). In total number of deaths due to adenocarcinoma 65.75% were women and 34.25% men; and in total number of deaths related to hyperthyreosis 88.24% were women and 11.76% men.

Female↗

[The occurrence of diabetes and organization of diabetes health services in Yugoslavia].

According of data of the antidiabetic medical service, in Yugoslavia there are registered 380,000 patients with diabetes. This makes 1.70% of total population. In northern parts of the country, with a higher development of agriculture, industrialization and urbanisation, the prevalence of diabetes is over 2%. In southern parts, mostly highlands, the prevalence of diabetes is less than 1%. According to needs, the antidiabetic medical service is better in developed parts of the country with higher prevalence of diabetes. Altogether in Yugoslavia, there are 8 central institutions for diabetes and endocrinology, 81 dispensaries, and 130 out-patients units for diabetics. The antidiabetic medical service is in progress, qualitatively and quantitatively, along with the progress of the prevalence and incidence of diabetes.

Diabetes Mellitus↗

[Epidemiology of suicide in Yugoslavia--methodological questions].

This study deals with, what could be called the "Yugoslav suicide paradox", namely the fact that such a regional variety of suicide incidence can be observed on the comparatively small territory of Yugoslavia. The northern areas--Slovenia, Croatia and Vojvodina--show very high suicide rates, which surpass even the average of Northern and Central Europe--the cauldron of the highest suicide rates in the world (e.g. Slovenia = 32.7 in 1982). Towards the south and the east, the incidence of suicide is rapidly declining, so that the rates in Kosovo and Macedonia even amount to below the smallest European numbers concerned (e.g. Kosovo = 2.4 in 1982). Obviously, the "Yugoslav suicide paradox" can be suitably investigated only with a transcultural approach. The second postulaten in the designing of suicidal research in Yugoslavia as a whole, and it probably applies to suicidology in general, is the need for interdisciplinarity, since the most convincing answers to the questions which the epidemiology of suicide is raising, do not come from the side of medicine and biology, but still out of the facts disclosed by the socio-cultural and psycho-social circumstances in which the people are living. The study tries to illustrate this thesis with some demographical facts concerning four Yugoslav republics, resp. the autonomous provinces. The necessity for the replenishment of statistical and sociological statements with psycho-dynamically accentuated "psychological autopsies" (Sheidman), is also emphasized.

Humans↗

A study of several red cell enzyme markers in the Rumanian ethnic group in Yugoslavia.

The present investigation reports the polymorphism of eight red cell enzymes, studied in 308 unrelated voluntary blood donors from the Rumanian ethnic group of Yugoslavia. Only common phenotypes were detected, which are distributed as in European populations. The estimated gene frequencies were: GLO1*1 = 0.401, GPT*1 = 0.533, PGM1*1 = 0.707, ESD*1 = 0.878, AK1*1 = 0.982, PGD*A = 0.974, ADA*1 = 0.939, ACP1*A = 0.384, ACP1*B = 0.550 and ACP1*C = 0.065. The observed gene frequencies are discussed in the context of other European populations and other populations from Yugoslavia.

Adolescent↗

Red cell enzyme polymorphisms of the Hungarian ethnic group in Yugoslavia.

A genetic study was carried out on phenotype and gene frequencies of the genetic markers in eight red cell enzymes: glyoxalase I (GLO1), glutamic pyruvate transaminase (GPT), phosphoglucomutase (PGM1), esterase D (ESD), adenylate kinase (AK1), 6-phosphogluconate dehydrogenase (6-PGD), adenosine deaminase (ADA), acid phosphatase (ACP1), in the Hungarian ethnic group living in Yugoslavia. The gene frequencies obtained were: GPT*1 = 0.542, PGM1*1 = 0.760, ESD*1 = 0.909, AK*1 = 0.971, PGD*A = 0.971, ADA*1 = 0.939, GLO1*1 = 0.417, ACP1*A = 0.329, ACP1*B = 0.591 and ACP1*C = 0.080. The distribution of these phenotype and gene frequencies was examined and compared with the phenotype and gene frequencies found for the Hungarian population living in Hungary and for other populations living in the northeast of Yugoslavia.

Adolescent↗

[Evaluation of the reliability of statistics on suicide in Yugoslavia and throughout the world].

On the basis of WHO reports on suicides the authors studied the problem of suicides in the world. They present the most jeopardized regions. On the basis of data on suicides in Yugoslavia, the authors evaluate this problem within Yugoslavia. They payed special attention to the quality of statistical data on suicides and validity of comparative statistical information on international level.

Female↗

Hemorrhagic fever with renal syndrome in Yugoslavia: antigenic characterization of hantaviruses isolated from Apodemus flavicollis and Clethrionomys glareolus.

Hantavirus antigens were detected in lung tissues of 8/113 Apodemus flavicollis and 2/17 Clethrionomys glareolus captured in 1984 in Fojnica, a region of Yugoslavia endemic for hemorrhagic fever with renal syndrome; hantavirus antigens were not detected in lung tissues from 126 other mammals collected in Fojnica. Three hantaviruses, 2 from A. flavicollis and 1 from C. glareolus, were isolated directly in Vero E6 cells and were partially characterized. The isolates from A. flavicollis, designated Fojnica virus, were antigenically similar but not identical to Hantaan virus strain 76-118, whereas the isolate from C. glareolus was antigenically indistinguishable from Puumala virus, strain Hällnäs B1. These data are consistent with previous studies that indicate the existence of at least 2 hantavirus serotypes in Yugoslavia.

Animals↗