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PubMed1976

[Neurosurgical wounds in the defensive war].

In Yugoslavia there is a defence war act by which every hospital has to have prospect about defence of whole population in case of attack from abroad. First step of every prospect is the evaluation of casualties. Evaluation of casualties in possible war and neurosurgical discipline should be made from following aspects: estimation of amount of neurosurgical injuries, number of neurosurgical patients before the war, disposal of hospitals and beds for neurosurgery, equipment, and number of neurosurgeons. Management of neurosurgical injuries in the war begins with the first aid. After that casualties should be divided into several groups. Certain amount of patients with minor injuries of the head could be managed by general practitioner or general surgeon. The first group of really neurosurgical cases is consisted of injuries which must be operated upon by neurosurgeon immediately, without any delay. The second group are made of patients who need neurosurgical help, but it can be delayed several hours or so. The third group is consisted from injuries which should not be treated operatively. And the last one is a group of cases who will die with or without neurosurgical help. The treatment in these cases should be paliative without neurosurgical staff and equipment involved.

Brain Injuries↗
PubMedDate not supplied

[The psychological profile using the Minnesota Multiphasic Personality Inventory and the value of this test in the evaluation of post-traumatic stress disorder in combat participants].

Different stress disorders, including the posttraumatic stress disorder (PTSD), developed as the consequence of traumatic stress experience, represent the most frequent patterns of reactive mental disorders of the soldiers in war. Clinical picture of those events has mostly been described in details in the literature, but the search for simple and reliable methods of detection still lasts. The aim of this study was to determine psychological profile and value of Minnesota Multiphasic Personality Inventory (MMPI) for the detection and description of PTSD in psychotraumatized examinees. It was investigated totally 119 soldiers--the participants of combat actions in the area of former Yugoslavia, among whom 71 examines formed part of clinical group that manifested symptoms of posttraumatic stress disorder, and control group consisted of 48 war participants, but without psychopatologic consequences. The investigation was performed by application of MMPI-personality test (form MMPI-201). Significant differences between clinical and control groups of examinees were determined, which confirmed the value of that inventory in the detection of PTSD symptoms. The most discriminative value was noticed in the next test scales: atypical behavior (F), depression (D), and paranola (Pa), that was also observed in relevant foreign studies carried in war veterans.

Adult↗
PubMed1998

[Psychiatric disorders in refugees and asylum seekers: psychological trauma as a cause?].

Posttraumatic stress disorder was diagnosed in two patients, men aged 26 and 29, an asylum seeker from the Middle East and a refugee from former Yugoslavia respectively. They had experienced severe psychotraumatic events. They were referred to a clinic for traumatised refugees and asylum seekers. Their psychiatric disturbances did not fit posttraumatic stress disorder, however. The former suffered from a schizophrenic disorder, the latter from psychosis and depression based on alcohol dependence. Growing awareness of the high prevalence of traumatic experiences in the population leads to a contextual shift in therapists regarding their understanding of the short and long term effects of traumatization in their patients. Exclusive focus on the traumatic history, however, biases the diagnostic process and could lead to wrong conclusions about a causal relationship between traumatic experiences and the psychopathology observed in the patient. When treating asylum seekers or refugees the risk of jumping to this false conclusion is even higher, partially due to cultural and language barriers.

Adult↗
PubMed1998

Dimensions of psychological stress in peacekeeping operations.

U.S. military forces are increasingly involved in a variety of multinational peacekeeping and humanitarian assistance missions. How well combat-trained units and soldiers adapt to these new roles will determine U.S. success in such operations, as well as the future health and readiness of the force. In preparing soldiers for such missions, it is critical that leaders and health care providers have a clear understanding of the nature of the stressors they are likely to encounter. This report summarizes findings from a longitudinal, descriptive case study of a U.S. Army medical unit performing a peacekeeping mission in the former Yugoslavia. The goal of the investigation was to identify key sources of stress and to delineate the effect of these stressors on the health, morale, and mental readiness of soldiers. Findings suggest a range of psychological stressors that varies somewhat across operational phases of a peacekeeping mission. Furthermore, the degree of stress experienced in various areas correlates significantly with depression, psychiatric symptoms, and low reported morale. The range of stressors is reduced and summarized in a conceptually derived model of five underlying dimensions of psychological stress salient to soldier adaptation in peacekeeping operations: isolation, ambiguity, powerlessness, boredom, and danger/threat. This model provides a useful heuristic for organizing thinking about stress in peacekeeping operations and leads to several recommendations for "countermeasures" that organizational leaders can take to maintain soldier psychological readiness during peacekeeping operations.

Adaptation, Psychological↗
PubMedDate not supplied

[Remembering the first successful bone marrow transplantation performed in 1977 in Novi Sad].

The author describes circumstances under which a young man with a severe idiopathic aplastic anemia, pancytopenia and hemorrhagic syndrome had undergone the first successful bone marrow transplantation performed at the Department of Haematology of the Internal Clinic in Novi Sad in 1977. As the patient did not react to the androgenic therapy and he had a healthy twin-brother with the same blood group and HLA system and MCL, differing only in Rh genotype, bone marrow transplantation was suggested. Attempted transplantation without immunosuppression and with a small number of bone marrow cells was performed in 1976 at the Military Medical Academy (MMA) in Belgrade, but it was unsuccessful. The patient suffered from a serious pancytopenia and hemorrhagic syndrome, and survived due to blood transfusions. There were 56 blood transfusions with more than 20 liters of blood. At that time bone marrow transplantations were not performed in Yugoslavia, only MMA started this method. The patient could not be transported, so the author with his associates decided to perform a new transplantation with immunosuppressive therapy with cyclophosphamide and with sufficient number of bone marrow cells, believing that it was the only chance their patient had to get better. Without special equipment, improvising a sterile room, the author performed a new transplantation. Two weeks later first signs of improvement of pancytopenia occurred, whereas after reticulocytic crisis, 45 days later, the number of blood cells reached normal values. On the occasion of examining Rh genotype of our patient it was established that, instead of previous Rh genotype inherited from his father, after retransplantation he had a new Rh phenotype acquired from his brother who inherited it from their mother. It was a proof that the transplantation was a complete success. On the occasion of 20th anniversary of that event in 1977, the whole team, which had performed the retransplantation, met their ex-patient. Today he is healthy, employed and a successful sportsman.

Bone Marrow Transplantation↗
PubMed1998

Quarantine strawberry vein banding virus firstly detected in Slovakia and Serbia.

Strawberry vein banding virus (SVBV) was detected by polymerase chain reaction (PCR) and dot-blot hybridisation in samples of cultivated strawberry plants originating from central Slovakia and in samples of wild strawberry plants from south-eastern Serbia in Federal Republic of Yugoslavia (FRY). This is the first finding of SVBV in these countries as well as of SVBV in wild strawberry plants in Europe.

Caulimovirus↗
PubMedDate not supplied

[Evaluation of the effect of the health education intervention project "Healthy School"].

UNLABELLED: Contemporary health-education intervention programs are increasingly used as a tool for improving health of school children [1-4]. Since 1992 a Network of 13 elementary Health Promoting Schools established in Yugoslavia (though not yet admitted to the European Network) has been operational. The Project was approved by the Ministries of Health, Education and Ecology from the very beginning, and financially supported by the Government of Serbia since 1995. The team of up to 40 health professionals, school principals and school project managers worked together for four years to change the working conditions in schools knowledge, attitudes and behaviour of school children and staff in order to improve their health [5]. The goal of this paper is to present results of health education intervention in changing of hygienic conditions in schools, as well as some of the attitudes, behaviour and knowledge of pupils and their parents. METHOD: The study took place before and after the intervention--at two points in time--during 1993 and 1996. The tri-angular approach including (1) pupils, (2) schools (teachers, school environment), and (3) parents, was used. A random pretest and post-test study design with control group (12 experimental and two control schools) has been implemented. The multiphase cluster sample was employed in order to represent all of the country typical regions. Six types of especially designed questionnaires were used to provide comparable variables in the sample of pupils, their parents and teachers. Exception were 1st-graders and 4th-graders for whom information were gathered by means of a "draw-and-write" investigation technique [6]. The response rate was 88.70% before and 98.28% after intervention. Data were analyzed by descriptive and inferential statistics using SPSS/PC software. RESULTS: Schools are somewhat less overcrowded, much cleaner and better maintained after the four-year intervention. Toilets are in a better condition, but there is still much more to be done. The 1st- and 4th-graders, surveyed by the draw-and-write method, mentioned numerous ways of keeping and improving health, which were summarized as fifteen health-improvement measures (Graph 1). The most frequently mentioned measures were nutrition, physical activity, general hygiene, oral and dental hygiene, sleeping and fresh air. Each of these measures was mentioned by over 20% of the surveyed pupils. Eleven of 15 variables showed significant increase in frequencies (at the level of at least p < 0.01) after the intervention. As an indicator of a nutrition behaviour, the regularity of main meals is analyzed (Graph 2). The majority of children eat regularly and the difference before and after intervention is significant only for the school meal (c2 = 30.715, p < 0.001). Although over 70% of children learn that general hygiene is good for health in junior graders, only about little more than 30% of senior graders have a bath or shower every day, while others only once or twice a week. The differences are significant before and after the intervention (c2 = 10.648, p < 0.05) only for everyday practice. More than 90% of senior-grade pupils brush their teeth at least once or several times a day. Over 60% of children in our survey go in for sport, whereas about 20% never do so. It seems that the intervention contributed symbolically to this practice important for health, though before-after difference is significant (c2 = 6.673, p < 0.05). However, in the control group schools children have much less physical activity in 1996, and this difference is significant (c2 = 14.070, p < 0.010). The psycho-emotional status of Yugoslav young people is strongly influenced by the situation in the country the war, the economic disaster and the impact of international sanctions. Consequently, more than one-fourth of the children complained of frequent exhaustion and concentration problems, which their parents also noticed. (ABSTRACT TRUNCATED)

Child↗
PubMed2005

Failure to find alpha-synuclein gene dosage changes in 190 patients with familial Parkinson disease.

BACKGROUND: Recently, a triplication of the alpha-synuclein locus was found associated with autosomal dominant Parkinson disease in a large family. OBJECTIVE: To determine whether a triplication or some other dosage alteration in the alpha-synuclein gene is present in one or more patients with familial PD in a large multinational collective. DESIGN: Retrospective recruitment of the largest families who were willing to cooperate with the study. SETTING: Centers with specialization in movement disorders genetics. PATIENTS: One hundred ninety unrelated patients with familial PD from Germany, Portugal, and Yugoslavia. MAIN OUTCOME MEASURES: Alpha-synuclein gene dosage values measured with real-time polymerase chain reaction. RESULTS: None of the samples showed alpha-synuclein triplication, duplication, or deletion. CONCLUSION: Alterations in alpha-synuclein gene dosage are rare in familial PD.

Adult↗
PubMed1998

Health status of pediatric refugees in Portland, ME.

BACKGROUND: An understanding of the health conditions affecting pediatric refugees is essential to providing responsible health care for them when they arrive in the United States. OBJECTIVE: To assess the health status of pediatric refugees in an area of increased refugee resettlement. DESIGN: Retrospective medical records review. SETTING: Ambulatory clinic at Maine Medical Center in Portland, a community and referral hospital. PATIENTS: One hundred thirty-two refugees and immigrants aged 2 months through 18 years who had initial health care evaluations during 1994 and 1995. RESULTS: Sixty-six patients arrived from Africa, 22 from the former Yugoslavia, and the remainder from the former Soviet Union, Middle Asia, Southeast Asia, and Latin America. The mean age of the patients was 10 years; 56 (42.4%) were female. The overall health status of most of the children was good, with most having appropriate weight and height for age. Dental caries and dermatologic conditions were the most prevalent findings on physical examination. Two patients had evidence of traumatic injuries. The results of tuberculin (Mantoux) tests were positive (> or =10 mm) in 45 (35.2%) of 128 children for whom results were noted, hepatitis B surface antigen was detected in 5 (4.0%) of 124 children, and hepatitis B surface antibody was detected in 26 (21.1%) of 123 children. Five (16.7%) of 30 children younger than 6 years had elevated blood lead levels; anemia was detected in 25 (19.7%) of 127 children with hematocrit results available. Stool specimens were obtained from 87 patients, of whom 38 (43.7%) had pathogenic parasites in at least 1 specimen. CONCLUSIONS: Pediatric refugees arrive in the United States with a variety of conditions that may be unfamiliar to practitioners trained in this country. The results of this study support the screening of refugees from Africa and other regions for tuberculosis, stool parasites, and hepatitis B.

Adolescent↗
PubMed1991

Zinc deficiency. A public health problem?

Zinc deficiency occurs in individuals and populations whose diets are low in sources of readily bioavailable zinc such as red meat, and high in unrefined cereals that are rich in phytate and dietary fibers. Dietary zinc deficiency was described nearly three decades ago among the poor of the Middle East. It is now known to occur in children and adolescents from widely diverse areas including Egypt, Iran, Turkey, China, Yugoslavia, Canada, and the United States; and among pregnant women from Iran, Turkey, the United Kingdom, Australia, and the United States. Major manifestations include retarded growth and development and an increased incidence of pregnancy complications. Other manifestations may include suppressed immunity, poor healing, dermatitis, and impairments in neuropsychological functions. Precise information as to the numbers of people affected by dietary zinc deficiency is not available. Even so the nature of diets associated with zinc deficiency suggests that mild deficiency is common in some populations.

Animals↗
PubMed1997

The association between lactation and breast cancer in an international case-control study: a re-analysis by menopausal status.

In the large, hospital-based, international case-control study of breast cancer conducted by MacMahon and colleagues in the 1960s, no protective effect of lactation was observed. However, more recent reports have suggested that such an association may be limited to pre-menopausal women. Therefore, a re-analysis of the data from that original study was performed by menopausal status and with control for additional breast-cancer risk factors since identified. Overall, data from 4,671 parous pre-menopausal and 7,200 parous post-menopausal women were analyzed, from 7 different sites representing areas of high risk (Glamorgan, Wales; Boston, USA), moderate risk (Athens, Greece; Slovenia, ex-Yugoslavia; São Paolo, Brazil), and low risk (Tokyo, Japan; Taipei, Taiwan) of breast cancer. No significant effect of lactation was found for pre-menopausal or post-menopausal women from the high-, moderate-, or low-risk areas; the center-adjusted, combined odds ratio (OR) for having breast-fed was 1.05 (95% confidence interval, 0.86-1.29) among pre-menopausal and 1.04 (0.88-1.24) among post-menopausal women. Moreover, examination of cumulative duration of lactation did not support an inverse association between breast cancer and increased length of total breast-feeding. In conclusion, re-analysis of these data, by menopausal status and adjusting for age at first parity, age at menarche, age at menopause, body-mass index and years of schooling, did not reveal a protective effect of lactation or duration of lactation against breast-cancer occurrence among the pre-menopausal, parous women.

Adult↗
PubMed1999

Survey of drugs sold in pharmacies in Afghanistan.

OBJECTIVE: To compare retail prices and manufacturers of drugs sold in pharmacies in the developing country Afghanistan. SETTING: Jalalabad, Afghanistan, and pharmacies located around the secondary referral centre and teaching hospital Public Health hospital. DESIGN AND METHODS: Descriptive survey of 10 pharmacies, where hospital patients purchase medication. The pharmacies were interviewed about retail prices and manufacturers of paracetamol, chloroquine, metronidazole, ampicillin, and levamizole. RESULTS: Paracetamol tablets were offered by eight different producers (seven in Pakistan, one in the United Kingdom). The price range per tablet was Afghani 15-120 (mean Afghani 59). The different manufacturers (six in Pakistan, two in the United Kingdom, one in Germany, one in India) offered paracetamol syrup with a price range per bottle between Afghani 800-3000 (mean Afghani 1544). Chloroquine tablets were offered by six different producers (one in Pakistan, one in China, one in France, one in Iran, one in India, one in Germany). The price range per tablet was Afghani 45-100 (mean Afghani 76). Three producers from Pakistan offered chloroquine ampoules and the price range was Afghani 250-1020 (mean Afghani 412). Chloroquine syrup was offered by 11 different producers (eight in Pakistan, one in Afghanistan, one in India, one in France). The price range was Afghani 500-2000 (mean Afghani 1226). Metronidazole tablets were offered by five different producers (two in Pakistan, one in France, two in India). The price range was Afghani 60-300 (mean Afghani 175). Metronidazole syrup was offered by four different producers (three in Pakistan, one in France). The price range was Afghani 1000-4500 (mean Afghani 2800). Ampicillin capsules were offered by five different producers (one in Pakistan, one in the United Kingdom, one in India, two in Iran). The price range was Afghani 140-650 (mean Afghani 238). Ampicillin ampoules were offered by five different producers (one in China, one in Germany, one in India, one in France, one in Yugoslavia). The price range was Afghani 600-1700 (mean Afghani 1207). Ampicillin syrup was offered by eight different producers (six in Pakistan, one in China, one in the United Kingdom). The price range was Afghani 900-3500 (mean Afghani 2450). Levamizole tablets were offered by two producers from Pakistan, and three from India. The price range was Afghani 30-500 (mean Afghani 110). CONCLUSION: Up to 11 producers (chloroquine syrup) offered the same drug with price differences up to 1600% (levamizole).In developing countries with scarce resources for health care and no free health care, regulation and control of drugs could improve efficient use of resources and in hospital medicine patients should obtain all mediation from one supervised hospital pharmacy.

Journal Article↗
PubMed1999

Human biology: From a love to profession and back again.

In 1937-1939, while working with my right hand as psychologist in the Bata Shoe Co. in Zlín, Moravia, with my left hand I was involved in research on age changes in body dimensions and profited from the interdisciplinary orientation of the (Czech) Biotypological Society, of which I was an active member. In 1941 I joined the Laboratory of Physiological Hygiene, a research and teaching unit in the School of Public Health of the University of Minnesota. My contributions ranged from philosophy of science through a broadly conceived physical anthropology, including nutritional anthropometry, to the study of behavior. I did field work both in Yugoslavia and in the United States. The research topics included aging, the effects of smoking, and etiology of coronary heart disease. In the collaborative monograph on The Biology of Human Starvation, I co-authored chapters on body weight, physical appearance and external dimension, body fat, a synthesizing chapter on compartments of the body, special senses, neuromuscular functions and motor performance, and seven chapters devoted to psychology. Am. J. Hum. Biol. 11:143-155, 1999. Copyright 1999 Wiley-Liss, Inc.

Journal Article↗
PubMed1987

Primary malignant lymphoma of the breast. Lymphoma of the mucosa-associated lymphoid tissue.

Eight cases of primary non-Hodgkin's lymphoma of the breast found in the pathology files of the Institute of Oncology, Ljubljana, Yugoslavia, for a period of 25 years (from 1961 to 1985) were analyzed. During the same period 5711 cases of breast carcinoma were seen. Seven cases were diffuse lymphomas, and one case was nodular. Five cases were high-grade large cell lymphomas and three cases were of low-grade type. One case of the latter group was associated with elevated IgA in the serum and showed monoclonal reaction of plasmacytic lymphoma cells for kappa light chain and IgA. In this case amyloid deposits were seen in the breast tumor. In six cases, focal infiltration of ductal/lobular epithelium by lymphoma cells was found. This so-called lymphoepithelial lesion appears to be an important characteristic of various mucosa-associated lymphoid tissue lymphomas which have been described in different extranodal sites (e.g. gastrointestinal tract, and respiratory tract). They may show different behavior from nodal counterparts, especially in terms of their spread to other mucosal sites which may appear before or without nodal dissemination. The breast appears to be yet another location for these lymphomas.

Adult↗
PubMed2002

Perazine for schizophrenia.

BACKGROUND: Perazine is an old phenothiazine derivative used for the treatment of people with schizophrenia which has a reputed low level of extrapyramidal side-effects. However, its use is restricted in the sense that - to the best knowledge of the reviewers - it is only marketed in Germany, Poland, Yugoslavia and the Netherlands. OBJECTIVES: To examine the effects of perazine for those with schizophrenia, and schizophrenia-like psychoses. SEARCH STRATEGY: Electronic searches of the Cochrane Schizophrenia Group's register which includes relevant randomised controlled trials from the bibliographic databases Biological Abstracts, CINAHL, The Cochrane Library, EMBASE, MEDLINE, PsycLIT, LILACS, PSYNDEX, Sociological Abstracts and Sociofile were undertaken. References of all included studies were searched for further trials. Pharmaceutical companies and authors of trials were contacted. SELECTION CRITERIA: All randomised controlled trials that compared perazine with other treatments for people with schizophrenia and/or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS: Citations and, where possible, abstracts were independently inspected by two reviewers, papers ordered, re-inspected and quality assessed. Data were independently extracted. Data were excluded if loss to follow up was greater than 50%. For homogeneous dichotomous data the Relative Risk (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) were calculated on an intention-to-treat basis. For continuous data, weighted mean differences were calculated (WMD). All data were inspected for heterogeneity. MAIN RESULTS: Six trials with a total of 288 participants are included. According to only one trial with 95 participants perazine appeared superior to active placebo (trimipramine) at five weeks for the outcome of 'no important global improvement' (n=95, RR 0.6, CI 0.3-0.9, NNT 4, CI 2-17), but there was no difference in various measures of mental state. The side-effect risk of perazine compared to placebo could not be estimated because they were not reported. Five small trials including only 193 participants which compared perazine with other antipsychotics were incompletely reported and the outcomes were presented in various ways so that meta-analysis was not possible in most occasions. A similar number of participants receiving perazine or comparator antipsychotics left the studies early (n=193, RR 0.9, CI 0.5-1.4). The results on efficacy were controversial and need further assessment by randomised controlled trials. No obvious differences in adverse events between perazine and other antipsychotics could be derived from these limited data. Two haloperidol comparisons did not present extrapyramidal side-effects in a way usable for meta-analysis, but three small comparisons with the atypical antipsychotics zotepine and amisulpride showed no higher risk of akathisia (n=111, RR 0.3, CI 0.1-1.1), dyskinesia (n=111, RR 0.5, CI 0.1-3.5), parkinsonism (n=81, RR 1.2, CI 0.5-2.8) or tremor (n=40, RR 0.8, CI 0.3-2.3) with perazine. REVIEWER'S CONCLUSIONS: The number, size and reporting of randomised controlled perazine trials is insufficient to present firm conclusions about the properties of this antipsychotic. It is possible that perazine is associated with a similar risk of extrapyramidal side-effects as some atypical antipsychotics, and this should be clarified in larger, well-designed trials.

Antipsychotic Agents↗
PubMed2006

Perazine for schizophrenia.

BACKGROUND: Perazine is an old phenothiazine derivative used for the treatment of people with schizophrenia and is reputed to have a low level of extrapyramidal adverse effects. As far as we are aware, its use is limited to Germany, Poland, the former Yugoslavia and the Netherlands. OBJECTIVES: To examine the effects of perazine for those with schizophrenia, and schizophrenia-like psychoses. SEARCH STRATEGY: We searched the Cochrane Schizophrenia Group's register which includes relevant randomised controlled trials from the bibliographic databases Biological Abstracts, CINAHL, The Cochrane Library, EMBASE, MEDLINE, PsycLIT, LILACS, PSYNDEX, Sociological Abstracts and Sociofile (last update of the review March 2005). We searched references of all included studies for further trials. We contacted pharmaceutical companies and authors of trials. SELECTION CRITERIA: We selected all randomised controlled trials that compared perazine with other treatments for people with schizophrenia and/or schizophrenia-like psychoses. DATA COLLECTION AND ANALYSIS: We independently (SL, BH) inspected citations and where possible abstracts and ordered papers for re-inspection and quality assessment. We independently extracted data. We excluded data if loss to follow up was greater than 50%. For homogeneous dichotomous data we calculated the Relative Risk (RR), 95% confidence interval (CI) and, where appropriate, the number needed to treat (NNT) on an intention-to-treat basis. For continuous data, we calculated weighted mean differences (WMD). We inspected all data for heterogeneity. MAIN RESULTS: We included six trials with a total of 288 participants. In only one trial with 95 participants, perazine appeared superior to 'active placebo' (trimipramine) at five weeks for the outcome of 'no important global improvement' (n=95, RR 0.43 CI 0.2 to 0.8, NNT 4 CI 2 to 13), but there was no statistically significant difference in most measures of mental state. Perazine did not induce more general adverse events than placebo, but more participants received at least one dose of antiparkinson medication (n=95, RR 4.50 CI 1.0 to 19.5, NNH 6 CI 4 to 33). Five small trials comparing perazine with other antipsychotics, including in total only 193 participants, were incompletely reported and the outcomes were presented in various ways so that meta-analysis was not possible in most occasions. A similar number of participants receiving perazine or comparator antipsychotics left the studies early (n=193, RR 0.85, CI 0.5 to 1.4). The results on efficacy were controversial and need further assessment by randomised controlled trials. No obvious differences in adverse events between perazine and other antipsychotics could be derived from the limited data. Two haloperidol comparisons did not present extrapyramidal side-effects in a suitable way for use in meta-analysis, but three small comparisons with the atypical antipsychotics zotepine and amisulpride showed no higher risk of akathisia (n=111, RR 0.31 CI 0.1 to 1.1), dyskinesia (n=111, RR 0.47 CI 0.1 to 3.5), parkinsonism (n=81, RR 1.21 CI 0.5 2.8) or tremor (n=40, RR 0.80 CI 0.3 to 2.6) with perazine. AUTHORS' CONCLUSIONS: The number, size and reporting of randomised controlled perazine trials is insufficient to present firm conclusions about the properties of this antipsychotic. It is possible that perazine is associated with a similar risk of extrapyramidal side-effects as some atypical antipsychotics, and this should be clarified in larger, well-designed trials.

Antipsychotic Agents↗
PubMedDate not supplied

Decentralization and health care in the former Yugoslav Republic of Macedonia.

Since its independence in 1991, the Republic of Macedonia became a highly centralized state, with most relevant decisions taken at the central level in Skopje, resembling the highly centralized system, which once characterized Former Yugoslavia. As agreed in the Framework Agreement, which ended six months of internal conflict, the Macedonian Government will decentralize public services delivery, including social protection, health, education, and infrastructure over the course of the next few years. Within health care, it is argued that by placing policy-making authority and operating control closer to the client, decentralization will reduce some of the inequities in service provision and inefficiencies present within the current centrally controlled system. In principle, local voters will have more information on the price and quality of services, thereby increasing competition in the sector and strengthening the private sector. The emphasis on market incentives resulting in greater efficiency and better management of health care institutions is viewed as one of the benefits of privatization. Critics of decentralization and the subsequent privatization of public services fear it may result in an erosion of quality and consistency across regions, leaving some regions, cities, villages and potentially vulnerable groups worse off than others. The paper argues that if the institutional weaknesses in Macedonia have not been addressed, decentralisation could result in further excluding the rural population from health care provision. Similarly, the need for a clear delineation of responsibilities and functions among different levels and institutions is outlined.

Delivery of Health Care↗
PubMed1980

Patterns of gastro-intestinal cancer in European migrants to Australia: the role of dietary change.

Cancers of the stomach, pancreas, colon and rectum are increasingly regarded as being diet-influenced. Migrants to Australia from England, Scotland, Ireland, Poland, Yugoslavia, Greece, and Italy have come from countries with varied dietary backgrounds and gastrointestinal cancer risks. Age-standardized cancer death rates in migrrants, by country of origin, sex, age, and duration of residence in Australia (less than or equal to 16 years and greater than 16 years), have been calculated for 1962-76, and compared with those of the Australian-born population. All seven migrant source countries, in 1970, had higher rates of stomach cancer than Australia, and the corresponding migrants groups, which initially reflected those higher rates, experienced an approximately 25% risk reduction with increased duration of residence. For cancer of the pancreas, migrants initially had rates well above their "native" rates; with longer stay, the risks generally converged upon that of the Australian-born population. The four "continental" (European) migrant groups, whose native risk of colon cancer is about half that of the Australian population, showed an increased risk with increasing duration of stay. The increase was greater in men than in women, perhaps reflecting their greater dietary acculturation. By contrast, Scottish migrants, with an initially high risk of cigrants showed even larger increases than colon cancer, while in British migrants there was a marked decline towards the "Australian-borne" risk. These various changes in cancer risk are discussed with reference to inter-country dietary differences.

Adolescent↗