Jadranka Maksimovic

Environmental Factors and Parkinson's Disease: A Case-Control Study in Belgrade, Serbia

ABSTRACT A case-control study was performed in Belgrade in order to investigate the association between Parkinsons disease (PD) and some environmental factors. During the period 2001–2005, 110 new PD cases and 220 hospital controls were interviewed. Cases and controls were matched by sex, age (±2 years), and place of residence (urban/rural). According to multivariate conditional logistic regression analysis, PD was positively asssociated with exposure to insecticides (odds ratio (OR) 3.22, 95% confidence interval (95% CI) 1.32–7.87), dyes (OR 25.33; 95% CI, 2.89–222.0), and naphtha and its derivates (OR 9.53; 95% CI, 1.04–86.96), and with gardening (OR 5.51; 95% CI, 3.04–10.01), well water drinking (OR 2.62; 95% CI, 1.40–4.90), and spring water drinking (OR 2.19; 95% CI, 1.15–4.16). Negative association was found for service-sector working (OR 0.15; 95% CI, 0.04–0.59). The results obtained did not changed after adjustment for smoking. The findings of the present study support the role of environmental factors in the occurence of PD.

SOME LIFESTYLE HABITS OF FEMALE BELGRADE UNIVERSITY STUDENTS WITH MIGRAINE AND NON-MIGRAINE PRIMARY HEADACHE

AbstractWe performed a prevalence study to compare some lifestyle habits between subjects with migraine and those with nonmigraine primary headaches. We surveyed female students in randomly selected classes of the School of Medicine and the School of Pharmacy, Belgrade University. Among all observed students (1943 subjects), 245 had migraine and 1053 had non-migraine primary headache. According to multivariate logistic regression analysis, the following factors were associated with migraine: irregular eating (odds ratio (OR)=1.99; 95% confidence interval (95% CI), 1.69 to 2.34; p<0.01), sleep duration shorter than usual (OR=1.18; 95% CI 1.00 to 1.38; p=0.0449) and smoking >10 cigarettes per day (OR=1.18; 95% CI=1.00 to 1.39; p=0.0433). The results of the present study are in line with some other investigations suggesting that some lifestyle habits probably play a role as migraine precipitants.

Infections as a risk factor for Parkinson's disease: a case-control study.

Objectives: The etiology of Parkinsons disease (PD) is unknown. The aim of the study was to test the hypothesis that some infectious diseases are related to the occurrence of PD. Methods: The case–control study, conducted in Belgrade during the period 2001–2005, comprised 110 subjects diagnosed for the first time as PD cases, and 220 controls chosen among patients with degenerative joint disease and some diseases of the digestive tract. Results: According to logistic regression analysis, PD was significantly related to mumps [odds ratio adjusted on occupation and family history of PD (aOR) = 7.86, 95% confidence interval (CI) = 3.77–16.36], scarlet fever (aOR = 12.18, 95% CI = 1.97–75.19), influenza (aOR = 8.01, 95% CI = 4.61–13.92), whooping cough (aOR = 19.90, 95% CI = 2.07–190.66) and herpes simplex infections (aOR = 11.52, 95% CI = 2.25–58.89). Tuberculosis, measles and chicken pox were not associated with PD. Other infectious diseases we asked for were not reported (12 diseases), or were too rare (four diseases) to be analysed. Conclusion: The results obtained are in line with the suggestion that some infectious diseases may play a role in the development of PD.

Multivariate Analysis of Prognostic Factors in Male Breast Cancer in Serbia

BACKGROUND The aim of this study was to analyze the demographic and clinical characteristics of male breast cancer patients in Serbia, and furthermore to determine overall survival and predictive factors for prognosis. MATERIALS AND METHODS In the period of 1996-2006 histopathological diagnosis of breast cancer was made in 84 males at the Institute for Oncology and Radiology of Serbia. For statistical analyses the Kaplan-Meier method, long-rank test and Cox proportional hazards regression model were used. RESULTS The mean age at diagnosis with breast cancer was 64.3±10.5 years with a range from 35-84 years. Nearly 80% of the tumors showed ductal histology. About 44% had early tumor stages (I and II) whereas 46.4% and 9.5% of the male exhibited stages III and IV, respectively. Only 7.1% of male patients were grade one. One-fifth of all patients had tumors measuring ≤2 cm, and 14.3% larger than 5 cm. Lymph node metastasis was recorded in 40.4% patients and 47% relapse. Estrogen and progesterone receptor expression was positive in 66.7% and 58.3%, respectively. Among 14.3% of individuals tumor was HER2 positive. About two-thirds of all male patients had radical mastectomy (66.7%). Adjuvant hormonal (tamoxifene), systematic chemotherapy (CMF or FAC) and adjuvant radiotherapy were given to 59.5%, 35.7% and 29.8% patients respectively. Overall survival rates at five and ten years for male breast cancer were 55.0% and 43.9%, respectively. According to the multivariate Cox regression predictive model, a lower initial disease stage, a lower tumor grade, application of adjuvant hormone therapy and no relapse occurrence were significant independent predictors for good overall survival. CONCLUSIONS Results of the treatment would be better if disease is discovered earlier and therefore health education and screening are an imperative in solving this problem.

Rising incidence of Type 1 diabetes in Belgrade children aged 0–14 years in the period from 1982 to 2005

Background: Type 1 diabetes (T1DM) is an autoimmune disease in which both genetic and environmental factors play a role in the etiology. Aim: The aim of this study was to analyze the incidence of T1DM. Methods: A retrospective technique was used to register all newly diagnosed cases of T1 DM in Belgrade (Serbia) children at the age of 0–14 yr between 1982 and 2005. The incidence was adjusted directly by age using the Segi’s world population as the standard. A total of 702 cases was identified from the two sources: patients’ records from two pediatric hospitals in Belgrade referent for the disease, and from the population based register. Results: The average annual age adjusted incidence rate of T1DM for Belgrade was 10.4/100, 000 [95% confidence interval (95% CI)=3.8–15.4]. It was slightly higher in boys than in girls. The age-specific annual incidence rates (per 100, 000) for the age groups 0–4, 5–9, and 10–14 were 5.5 (95% CI=4.5–6.7), 11.9 (95% CI=10.5–13.5), and 15.4 (95% CI=13.8–17.1), respectively. Over the 24 yr incidence rates significantly increased by 8.5% for boys and 3.0% for girls. The highest increase of incidence rate was in the 5–9 age group. Discussion: The results obtained are in line with data from other studies showing that the incidence of T1DM has been increasing in almost all populations worldwide.

The Stressful Life Events and Parkinson's Disease: A Case–Control Study

A case-control study was conducted in order to investigate the possible link between stressful life events and Parkinsons disease (PD). A group of 110 consecutive newly diagnosed PD cases treated at the Institute of Neurology, Faculty of Medicine, Belgrade University, was compared with a control group comprising 220 subjects with degenerative joint disease and some diseases of the digestive tract. The case and control subjects were matched by sex, age (±2 years) and place of residence (urban/rural). According to conditional multivariate logistic regression analysis, PD was found to be significantly related to retirement (odds ratio--OR 18.73, 95% confidence interval--95%CI 1.9-175.4), birth of own child (OR 66.22, 95%CI 8.3-526.3) and air raids (OR 5.66, 95%CI 2.4-13.5). The risk of PD significantly increased with the number of stressful events. The results of the present study support the hypothesis that stress may play a role in the development of PD.

Cigarette smoking, coffee intake and alcohol consumption preceding Parkinson's disease: a case–control study

Objective: A case–control study was performed in Belgrade in order to investigate the association between Parkinsons disease (PD) and smoking, coffee and alcohol consumption. Methods: During the period 2001–2005, 110 new PD cases and 220 hospital controls were interviewed. Cases and controls were matched by sex, age and place of residence (urban/rural). For the analysis of data conditional univariate and multivariate logistic regression methods were used. Results: With PD were associated, independently from each other, current smoking [odds ratio (OR) = 0.44; 95% confidence interval (CI) = 0.23–0.82], alcohol consumption (OR = 4.78; 95% CI = 2.67–8.55) and coffee consumption (OR = 2.54; 95% CI = 1.36–4.75). In ever smokers the risk for PD significantly decreased with the increasing number of cigarettes smoked and with increasing duration of smoking. The risk for PD significantly increased with the increasing quantity of alcohol consumption. PD risk was significantly higher in subjects whose average daily consumption of coffee was 1 and 2–3 cups, and it was lower (but not significantly) in those whose daily coffee consumption was 4+ cups. Cases and controls did not differ in duration of alcohol and coffee consumption. The results of multivariate analyses did not substantially change after adjustment on family history positive on PD. Conclusion: The findings of this study support the hypotheses of inverse association of smoking with PD, but an inverse association with coffee was not confirmed. PD was found to be positively associated with coffee and alcohol consumption.

Frequency and characteristics of metabolic syndrome in patients with symptomatic carotid atherosclerosis

BACKGROUND Metabolic syndrome (MetS) is associated with increased risk of carotid atherosclerosis. AIM To estimate the frequency of MetS in patients with symptomatic carotid atherosclerotic disease, and to compare clinical, biochemical and ultrasonographic characteristics of patients with and without MetS. MATERIAL AND METHODS Cross-sectional study of 657 consecutive patients (412 males) with symptomatic carotid atherosclerotic disease. Carotid atherosclerosis was estimated by high resolution B-mode ultrasonography. National Cholesterol Education Program (NCEP) M criteria were used for estimation of MetS. RESULTS Metabolic syndrome was present in 55.6% of studied patients. Among patients with metabolic syndrome there was a significantly higher proportion of women, and mean values of body weight, body mass index, waist circumference, percentage of body fat, systolic and diastolic blood pressure, serum triglycerides, total cholesterol and glucose were significantly higher. Mean values of high density lipoprotein cholesterol and alcohol consumption were significantly lower in patients with MetS. No differences between patients with or without MetS, were observed for age, smoking, mean values of low density lipoprotein cholesterol, high sensitive C-reactive protein and fibrinogen, and for degree of carotidstenosis or severity of clinical manifestations. CONCLUSION Half of these patients with carotid stenosis have features of the metabolic syndrome.

Psychosocial Stress and Risk of Myocardial Infarction: A Case-Control Study in Belgrade (Serbia)

BACKGROUND The purpose of this study was to investigate which psychosocial risk factors show the strongest association with occurrence of myocardial infarction (MI) in the population of Belgrade in peacetime, after the big political changes in Serbia. METHODS A case-control study was conducted involving 154 consecutive newly diagnosed patients with MI, and 308 controls matched by gender, age, and place of residence. RESULTS According to conditional logistic regression analysis, after adjustment for conventional coronary risk factors, the odds ratios (95% confidence intervals) for work-related stressful events, financial stress, deaths and diseases, and general stress were 3.78 (1.83-7.81), 3.80 (1.96-7.38), 1.69 (1.03-2.78), and 3.54 (2.01-6.22), respectively. Among individual stressful life events, the following were independently related to MI: death of a close family member, 2.21 (1.01-4.84); death of a close friend, 42.20 (3.70-481.29); major financial problems, 8.94 (1.83-43.63); minor financial problems, 4.74 (2.02-11.14); changes in working hours, 4.99 (1.64-15.22); and changes in working conditions, 30.94 (5.43-176.31). CONCLUSIONS During this political transition period , stress at work, financial stress, and stress in general as they impacted the population of Belgrade, Serbia were strongly associated with occurence of MI.

[Oesophageal-cancer-derived death in the population of Belgrade in a period 1989-2006].

BACKGROUND/AIM Oesophageal cancer is the sixth most common cause of death from all malignant tumors in the world (fifth in men, eighth in women). This cancer was estimated to account for about 529 000 new cases and about 442 000 deaths in the year 2007. In the year 2002 the highest standardized mortality rates (per 100 000 habitants) of oesophageal carcinoma were noticed in the East Asia (men/women: 18.8/7.7) and East Africa (18.6/7.8), while the lowest were noticed in the Middle Africa (1.4/0.2) and West Africa (1.3/0.5). The aim of this descriptive epidemiologic study was to analyze epidemiologic situation of oesophageal cancer in Belgrade population during the period 1989-2006, using mortality data. METHODS Mortality data were collected from the City Organization for Statistics. In data analysis we used mortality rates which were standardized directly using those of the world population as the standard, and proportions. A denominator for mortality rates was calculated using the Belgrade population which was an average of the two latest register years (1991 and 2002). In order to analyze trend mortality from oesophageal cancer we used linear trend. RESULTS In Belgrade deaths from oesophageal cancer accounted for about 5.2% of all malignant tumors of intestinal system in male population, and 2.4% in female population. This cancer is, according to standardized mortality rates (per 100 000 habitants), on the fifth place in Belgrade population behind colorectal, stomach, pancreatic, liver and cholecystic cancer. During the period 1989-2006 in Belgrade 44 persons died from oesophageal carcinoma on the average each year, mainly men (75%), and the rest were women (25%). In male population during the same period we noticed a significant increase in trend mortality (y = 1.61 + 0.06x, p = 0.001), while in female population the increase of mortality was not significant. The male/female oesophageal cancer mortality ratio was 3:1. Mortality rates for oesophageal cancer rise with age in both sexes and they are highest in the age group of 70 and more years. Significant increase in mortality from oesophageal cancer was noticed in age groups 20-29 and over 70 in male population, and age group 40-49 in female population. CONCLUSION Increasing trend in oesophageal mortality suggests the necessity for improving measures of primary prevention including education about risk factors for this carcinoma (smoking, alcohol consumption, hot food and drinks), early diagnosis, and treatment.