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The role of B chromosomes in the population dynamics of yellow-necked wood mice Apodemus flavicollis (Rodentia, Mammalia).

Seasonal changes in the frequency of animals with B chromosomes were studied during 1989 in the population of yellow-necked wood mice, Apodemus flavicollis, on the mountain Jastrebac in Yugoslavia. During the study the estimated density of animals reached a very large value (378.8 individuals/ha for the April sample), which produced stress conditions leading to population decline. Six samples with a total of 247 specimens were karyotypically analyzed. Animals with Bs were present in all samples in frequencies that differed significantly at the 5% level. This difference was produced by the reduction in frequencies of specimens with Bs between the April and May samples (0.53 versus 0.29; chi 2(1) = 9.44; p < 0.002) and appeared mostly as a result of increased elimination of B-carrying animals from the prereproductive group. Young animals with Bs were inferior in stress conditions produced by overabundance of animals. From the first to the last sample, the frequency of animals with one B among B-containing animals constantly decreased, while the frequency of animals with more than one B increased. The possible role of Bs in regulating population dynamics is discussed.

Age Factors↗

Isolation of a coronavirus from kidney biopsies of endemic Balkan nephropathy patients.

Endemic Balkan nephropathy (EBN) is a kidney disease of unknown etiology limited to Bulgaria, Rumania and former Yugoslavia. Primary kidney tissue cultures were established as explants from tissue obtained at operations from 5 EBN patients with urinary tract tumors. Four out of the five biopsy specimens on extended culture incubation at 33 degrees C yielded a coronavirus virus (EBNV) which was cytopathogenic for human fibroblast and Vero cells. In cells inoculated with EBNV, cytoplasmic immunofluorescence was found using antisera for human coronaviruses OC43 and 229E as well as the porcine transmissible gastroenteric virus and avian (chicken) bronchitis virus. In neutralization tests, EBNV failed to react with antisera to these viruses. Using hyperimmune serum raised with EBNV, positive cytoplasmic immunofluorescence was seen with cells infected with OC43, 229E, TGV and significantly with the kidney tissue of the biopsy specimens from the EBN patients. A screen for neutralizing antibody using the EBN virus revealed that 87.2% of EBN patients on dialysis were positive, also 74% of people from an endemic area were also positive, while only 13.5% from outside were positive. It is suggested that a coronavirus is involved in the etiology of the disease and that humans are an incidental host of a coronavirus zoonosis.

Animals↗

Survival of multiple sclerosis patients in the Belgrade population.

The aim of this study was to estimate survival rates of multiple sclerosis (MS) patients in the Belgrade population, Yugoslavia, and furthermore, to determine the prognostic value of some demographic and clinical variables for survival. The cumulative survival probability was calculated by the Kaplan-Meier method. The prognostic value of different variables was assessed by univariate and multivariate analyses using the Cox regression model. In the Belgrade population, the cumulative 25-year survival probability of MS patients and the mean survival time from MS onset were 73.2% and 38 years, respectively. The univariate analysis showed that survival was significantly related to sex, age at onset, course of disease and monoregional initial symptoms. A multivariate model demonstrated that a relapsing-remitting course of MS and monoregional onset were predictors of a better prognosis. The presence of motor symptoms at the onset was found to be an independent predictor of a poorer outcome of MS.

Adolescent↗

A multinational comparison of drug treatment in patients with cerebrovascular disease.

We have compared the frequency with which various drugs were used in patients with cerebrovascular disease in five countries (UK, Italy, Indonesia, Spain and Yugoslavia). There were very large variations in the use of anti-oedema agents, 'cerebral vasodilators', and vitamins, which were not explained by differences in the populations studied. This variation has probably less to do with any scientific validation for the various treatments, which in most cases does not exist, than with medical 'fashion' and commercial pressures. Large variations in prescribing habits for what is thought to be the same disease are undesirable, and reflect a dearth of facts and adequate clinical trials.

Aged↗

An etiological approach to Balkan endemic nephropathy based on the investigation of two genetically different populations.

The direct inheritance as a possible etiologic factor of Balkan endemic nephropathy (BEN) has been studied in an endemic area in the district of Slavonski Brod (Croatia-Yugoslavia). The basis for the investigation was given by a natural experiment induced by immigration of people from Ukraina to the endemic and nonendemic areas near Slavonski Brod. 1,536 persons in endemic villages and 733 inhabitants from the villages, where BEN has not been found, were studied with the aim of establishing diagnosis or excluding BEN. The generally adopted criteria enabling to classify the examined persons into the following 3 groups have been used: (a) diseased of BEN; (b) suspect to be diseased of BEN, and (c) individuals without signs of a renal disease. In the endemic villages among the population of Croatian aborigines, 12,1% diseased and suspects have been revealed. Among the Ukrainian immigrants and their offsprings, 10.5% diseased and suspects have been found. The difference is not significant (t = 0.7, p greater than 0.05). On the other hand, in nonendemic villages there were no diseased nor suspect BEN patients among the indigenous people as well as among the Ukrainians. The inference is suggested that the factors of the direct inheritance do not play a decisive role in the etiopathogenesis of BEN.

Balkan Nephropathy↗

Proteinuria in the elderly.

In a representative sample of 624 people, 65-84 years of age, from six regions of Croatia, Yugoslavia, proteinuria was investigated on the basis of certain medical characteristics. Established proteinuria was seen in 30.8% of females and 27.4% of males. Proteinuria was found to be significantly more common in people with urinary tract infections. Arterial hypertension with heart failure was more often seen in patients with than in patients without proteinuria, but the difference was not statistically significant.

Aged↗

Predeployment personality traits and exposure to trauma as predictors of posttraumatic stress symptoms: a prospective study of former peacekeepers.

OBJECTIVE: The authors' goal was to study the contribution of predeployment personality traits and exposure to traumatic events during deployment to the development of symptoms of posttraumatic stress disorder (PTSD) in individuals involved in military peacekeeping activities. METHOD: Five hundred seventy-two male veterans who participated in the United Nations Protection Force mission in the former Yugoslavia completed a short form of the Dutch MMPI before deployment. Following deployment, they participated in a survey of all Dutch military veterans who had been deployed in the years 1990-1995 and completed the Self-Rating Inventory for PTSD. RESULTS: Exposure to traumatic events during deployment had the highest unique contribution to the prediction of PTSD symptom severity, followed by the personality traits of negativism and psychopathology, followed by age. CONCLUSIONS: Both pretrauma vulnerabilities and exposure to traumatic events were found to be important factors in the etiology of posttraumatic stress symptoms. The current study replicates in a non-American sample of peacekeepers findings obtained among American Vietnam veterans. Particularly, there is accumulating evidence for an etiological role of the personality trait of psychoneuroticism in the development of posttraumatic stress symptoms.

Adolescent↗

Neurasthenia: a paradigm of social psychopathology in a transitional society.

A particular social aspect of an illness is reflected in an emphasis on those symptoms that the society considers socially detrimental and/or destabilizing. Thus, in the work- and production-oriented society, chronic fatigue, which affects one's productivity and ability to work, becomes a hallmark of neurasthenia or neurasthenia-like syndrome. In a society based on rigid social structures and severely limited possibilities for social change, excessive irritability and outbursts of anger are perceived as a greater threat to the stability of the existing social order, and therefore they come to dominate the concept of neurasthenia. In Yugoslavia, neurasthenia has been primarily conceived of as a manifestation of an accumulated social frustration and anger; neurasthenia has then been constructed as a mental disorder because anger was expressed in a way that the society considered inappropriate, maladaptive, and pathological. A far-reaching, underlying purpose of this conceptualization of neurasthenia has been a preservation of the social status quo. While neurasthenia as a distinct mental disorder remains controversial, its dependence on the social context cannot be denied. Although the designation of neurasthenia so often seems provisional, because it symbolizes limitations and failures of our diagnostic and nosological systems, it serves a definite social purpose, which varies from time to time, and from one culture to another.

Anger↗

Rehabilitation research under fire.

Catastrophes in the health area are frequent. A template for conduct and reporting of research in disaster responses has recently been published. The WHO Rehabilitation of War Victims Project basically followed these principles in former Yugoslavia to estimate defined needs, prioritise and evaluate methods used. Around 30% of war victims reported to be wounded were found to be in need of physical rehabilitation. Priority was given to the 5% with severe disabilities caused by amputations, spinal cord injuries and traumatic brain injuries. Most of the infrastructure was destroyed and WHO supported a community based rehabilitation approach (CBR). Evaluating this type of service delivery became extremely difficult under present circumstances. Waves of refugees rolled both within the republics and over the borders demonstrating both the needs and problems listed in the template referred to. The CBR service delivery worked out satisfactorily with high patient satisfaction. Limited medical training greatly improved the situation for the personnel. Even in a disaster situation research is needed for proper decision-making and to gain experiences for future aid.

Persons with Disabilities↗

Missing persons in post-conflict settings: best practices for integrating psychosocial and scientific approaches.

This paper argues the importance of establishing integrated systems to meet the needs of forensic investigations as well as the needs of families of the missing in post-conflict situations. Meeting the psychosocial needs of families to resolve uncertainty and to recover the remains of their loved ones must be part of a multidisciplinary team approach to a transparent and standardised scientific investigative protocol. The authors present several case studies from the former Yugoslavia illustrating community-based interventions combining education projects and participation in antemortem data collection as well as providing a support network for families of the missing. The participation of the scientific investigators (pathologists, anthropologists, crime scene investigators, etc), many of whom are unprepared for the presence of family members at the scene, is critical to the success of the integrated process. Providing for and sustaining a long term follow-up programme with families, who may require ongoing mental health and social support, is also essential.

Adaptation, Psychological↗

Carrier frequency of congenital adrenal hyperplasia (21-hydroxylase deficiency) in a middle European population.

Based on newborn screening data, the carrier frequency of congenital adrenal hyperplasia (CAH) in the general population has been estimated to be 1:55. The higher CAH frequency (particularly of milder forms of the disease) reported for certain populations including Yugoslavs (1.6%) relates to population genetic and hormonal data. However, so far, true carrier frequency for CAH due to 21-OH deficiency has not been determined by comprehensive mutation analysis of the 21-OH gene (CYP21A2) in an unselected European population. This study used CYP21A2 genotyping (sequence/Southern blot analysis) to determine CAH carrier frequency in a middle European (Austrian) population. The study included 100 migrants from the former Yugoslavia and 100 individuals of non-Yugoslavian origin. None of these individuals showed clinical hyperandrogenism or had a family history of CAH. Genotyping 400 unrelated alleles from 200 clinically unaffected individuals, this study revealed a carrier frequency of 9.5%, including so-called "classic" (5.5%) and "nonclassic" (4%) CYP21A2-gene aberrations. The observed heterozygosity for CAH in Yugoslavs was not different (P = 0.8095) from that in non-Yugoslavs. In conclusion, the observed CAH carrier frequency of 9.5% suggests a higher prevalence of CAH heterozygosity in a middle European population than hitherto estimated independently of the individuals' Yugoslav or non-Yugoslav origin.

Adrenal Hyperplasia, Congenital↗

A review of radiation accidents involving whole body exposure and the relevance to the LD50/60 for man.

The absorbed dose of low LET radiation that would be lethal (due to bone marrow failure) to 50% of an exposed human population is a matter for concern in planning for the consequences of an accident to a nuclear reactor and in the event of nuclear war. Since accidents with radiation-generating equipment or in the nuclear fuel processing industry might provide relevant human data, published accounts of these are reviewed. Two accidents, one in the USA, the other in Yugoslavia, both involving exposure to neutrons as well as gamma-rays, are identified as possibly satisfying the criteria of uniformity of dose, magnitude of dose and dose rate necessary to provide useful information on the value of LD50/60 for man. The symptomatology of the exposed individuals is discussed in terms of the published doses. Detailed examination of the dosimetry for these two accidents revealed possible ambiguities and a thorough re-examination has been carried out, the results of which are reported in detail in the Appendix. This indicates considerable and largely unresolvable uncertainty in the magnitude of the dose to exposed individuals when expressed as the low LET equivalent dose in bone marrow. It is also shown that the relationship between severity of effects and dose to exposed individuals is not the same for both accidents and it is argued that the experience from the Yugoslavian accident is more relevant to the determination of the sensitivity to radiation of an exposed human population. Given the uncertain nature of the accident data and the small amount of other relevant human data at present available, the uncertainty of current knowledge of man's sensitivity to the acute effects of exposure to ionising radiation is discussed.

Accidents, Occupational↗

Functional evaluation after partial resection in patients with carcinoma of the larynx.

This paper presents the results of conservative operations on patients with laryngeal carcinoma in the ENT Department of the University Hospital "Dr. Mladen Stoianović," Zagreb, Yugoslavia, during the last 20 years. The authors have evaluated the functional results after partial vertical and horizontal surgical interventions on the larynx and after the reconstruction of the larynx following these operations. Functional analysis of the voice was performed by stroboscopic, indirect microlaryngostroboscopic and sonagraphic examinations of the laryngeal function, as well as by the spirometric analysis of the respiratory potential of these patients, especially the degree of obstruction of the upper respiratory tract and changes on the cardiovascular system. Attention has been given likewise to the examination of the act of swallowing, especially after horizontal partial resections of the larynx. Radiography and radiocinematography was used for these examinations. Based on this research the authors have formulated new conceptions and opinions about the voice generator.

Airway Obstruction↗

Epidemiology of laryngeal cancer.

The patients with cancer of the larynx at the Ear, Nose and Throat Department in Zagreb during the period from 1945 to 1972, and the cases of laryngeal cancer at the Institute of Public Health of Croatia, were examined epidemiologically. The patients were from all parts of Croatia (West and south part of Yugoslavia) with the characteristics of Mediterranean and Continental climate. The following factors were discussed: age and sex distribution, localization of the tumor in three compartments of larynx, relationship between the villages and cities, occupation (peasants, workers and intellectual people), histologic types and the etiological factors (smoking and alcohol.

Adult↗

Increased risk of proteinuria among a cohort of lead-exposed pregnant women.

Long-term exposure to high concentrations of lead results in renal dysfunction. During a prospective study of environmental lead and pregnancy outcomes in 1502 women residing in two towns in Yugoslavia, we explored whether moderate exposure to lead results in increased rates of proteinuria. The geometric mean blood lead concentrations (BPb) were 17.1 and 5.1 micrograms/dl in the smelter and nonexposed towns, respectively. Increases in BPb were associated with increased odds ratios for both trace and > or = 1+ proteinuria, measured using a urinary dipstick. Comparing the women in the upper 10th percentile of exposure to those in the lowest 10th percentile, the adjusted odds ratio for > or = 1+ proteinuria was 4.5 (95% CI 1.5, 13.6). Similarly, the adjusted odds ratio for trace proteinuria was 2.3 (95% CI 1.3, 4.1). Similar to other studies showing associations between chronic exposure to lead and renal dysfunction, our data suggest that long-term exposure to environmental lead may be associated with proteinuria.

Adult↗

Personality factors and posttraumatic stress: associations in civilians one year after air attacks.

There is an ongoing debate on which risk factors for developing posttraumatic stress symptoms are more important--personality traits reflecting vulnerability, previous stressful experiences or characteristics of the traumatic event. In this study, posttraumatic stress symptoms and their relationship with personality traits, previous stressful experiences and exposure to stressful events during air attacks in Yugoslavia were investigated. The Millon Clinical Multiaxial Inventory (MCMI; Millon, 1983), Impact of Events Scale (IES; Horowitz, Wilner, & Alvarez, 1979), Life Stressor Checklist Revised (LSCL-R; Wolfe & Kimerling, 1997), and List of Stressors were administered to a homogeneous group of medical students 1 year after the attacks. In multiple regression analyses, compulsive and passive-aggressive personality traits and a higher level of exposure to stressors during air attacks independently predicted the degree of intrusion symptoms. Avoidance symptoms were predicted by avoidant personality traits and a higher exposure to stressors both previously in life and during the attacks. In the next step, we tested in analyses of variance whether personality traits, previous stressful experiences, and stressful events during attacks as independent variables interact in predicting intrusion and avoidance symptoms. For this, students were clustered into three groups depending on their predominant personality traits. In addition to direct predictive effects, there were significant interaction effects in predicting both intrusion and avoidance. The findings suggest that each of the tested factors, i.e., personality traits, previous stressful experiences, and exposure to traumatic events may have an independent and direct influence on developing posttraumatic stress. However, the effect of these factors cannot just be added up. Rather, the factors interact in their impact on posttraumatic stress symptoms. Bigger samples and longitudinal designs will be required to understand precisely how different personality traits influence response to stressful events.

Adaptation, Psychological↗

The effect of lead exposure on behavior problems in preschool children.

OBJECTIVES: Interpreting associations between lead exposure and child behavior problems is difficult because studies have not controlled for sociodemographic confounders or have used shed teeth to mark exposure. This study explored associations between blood lead and preschool behavior. METHODS: Children from a smelter town and a non-lead-exposed town in Yugoslavia were followed up prospectively from pregnancy through age 3. The Child Behavior Checklist was used to assess behavior problems in 379 3-year-olds, controlling for sociodemographic factors and difficult infant temperament. RESULTS: Multiple regression revealed the expected significant associations between checklist subscales and sociodemographic factors, which explained 7% to 18% of the variance on the subscales. Concurrent blood lead explained a significant 1% to 4% of the variance on the Destructive and Withdrawn subscales. Earlier difficult temperament explained an additional 2% to 5% of the checklist variance. Scores on the Destructive subscale were consistently associated with blood lead. As blood lead increased from 10 to 20 micrograms/dL, subscale scores increased by approximately 0.5 points. CONCLUSIONS: Lead/behavior associations are significant but small compared with the effects of social factors.

Air Pollutants, Occupational↗

Growth status and related medical conditions among refugee children in Massachusetts, 1995-1998.

OBJECTIVES: This study analyzed growth and identified related medical conditions among refugee children in Massachusetts. METHODS: Between July 1995 and June 1998, 1825 refugee children were screened. Variables included positive tuberculin (purified protein derivative; PPD) test; dental abnormalities; pathogenic parasites; weight-for-age, height-for-age, and weight-for-height z scores; and body mass index greater than the 84th percentile. RESULTS: Of all the children, 21% had parasites, 62% had caries, and 25% had a positive PPD reaction. Twelve percent overall and 28% younger than 2 years had anemia. Eight percent had height-for-age z scores less than -2, and 6% had weight-for-age z scores greater than +2. Of those aged 1 to 9 years, 7% had weight-for-height z scores greater than +2. Weight-for-height z scores less than -2 were concentrated among Africans and East Asians (both 8%). Height-for-age z scores less than -2 were seen among African (13%), Near Eastern (19%), and East Asian (30%) children. Weight-for-height z scores greater than +2 and body mass index greater than the 84th percentile were concentrated among children from the former Yugoslavia (8% and 15%) and the former Soviet Union (8% and 14%). CONCLUSIONS: Recently arrived refugee children have significant growth abnormalities. European refugees were overweight; those from developing countries had growth retardation.

Adolescent↗