Natasa Rancic

Dietary micronutrients and gastric cancer: hospital based study

The association between micronutrients and gastric cancer is still unclear. The aim of this study is to determine the relationship between dietary intake of micronutrients and risk for gastric cancer. We used data from hospital-based case control study conducted at Clinical Centre Nis (Serbia) from 2005 and 2006. Patients (n=102) with first histologically confirmed gastric cancer and matched non-cancer patients (controls, n=204) were interviewed using structured questionnaire and FFQ (Food frequency questionnaire). Multivariate logistic regression analysis showed a significant positive association between gastric cancer and dietary intake of sodium (OR=6.22; 95%CI 1.99–7.86), but a significant negative association between potassium (OR 0.01; 95%CI 0.00–0.08), iron (OR 0.05; 95%CI 0.01–0.56), vitamin C (OR 0.05; 95%CI 0.01–0.38), vitamin E (OR 0.04; 95%CI 0.01–0.29) and niacin (OR 0.07; 95%CI 0.00–0.38) dietary intake. Intake of phosphorus, calcium, magnesium, zinc, retinol, β carotene, tiamin, vitamin B6, and folic acid was not significantly related to gastric cancer risk.In conclusion, we found that a dietary pattern of high consumption of antioxidants (vitamin C, vitamin E, niacin), iron and potassium and low consumption of foods that are sources of sodium, decreased risk for gastric cancer. Our results require confirmation in future studies.

Health-related quality of life in patients after the acute myocardial infarction

IntroductionAcute myocardial infarction has a negative impact on patient’s quality of life. The aim of this paper was to evaluate the health-related quality of life in patients one month after the acute myocardial infarction.Material and methodThe study involved 160 patients of both sexes, 30 to 79 years of age. The health-related quality of life in patients was assessed at the admission at the coronary care unit, and one month after. The following questionnaires were used: EuroQuolVAS and EuroQuol 5 Dimension. Angina pectoris was ranked according to the Canadian Cardiovascular Society Classification. Results: Men and women evaluated their health condition in a similar way (60.48±11.98 vs 60.55±12.24). Patients who (have) undergone primary coronary intervention had significantly higher average scores on EuroQuolVAS than the patients who were treated with thrombolytic therapy (68.69±9.67 vs 52.31±7.87, p<0.001). Modest and severe problems were the most presented in answers to those questions: pain/discomfort, anxiety/depression and self-care. Both men (0.92±0.43 vs 3.27±0.59, p<0.001) and women (0.89±0.46 vs 3.19±0.55, p<0.001) had significiantly lower average marks of angina pectoris one month after the acute myocardial infarction than at the admission to the hospital.ConclusionOne month after the acute myocardial infarction the quality of life in patients was very impared. Patients who undergone to the primary coronary intervention evaluated their health condition as better than the patients who were treated with thrombolytic therapy. Those patients also had the lower average marks of angina pectoris and the higher health-related quality of life.

[Association of stressful life events with acute myocardial infarction in population in the city of Nis within the period from 1998-2000].

BACKGROUND/AIM Stressful life events present a very important category of psychosocial stress. A few studies have showed that a psychosocial stress represents a very important risk factor for acute myocardial infarction (AMI), but measures of stress may not be suitable for different countries, cultures and ethnic groups. The aim of this study was to investigate the relation of stressful life events with AMI in the period of 1998-2000 in the population of the city of Nis. METHODS A case-control study included 100 patients with the first MI (in the period 1998-2000) and 100 healthy subjects, matched with respect to sex and age (+/- 2 years) from the city of Nis. The data of stressful life events were obtained by the Scaling of life events by Paykel ES, modified by the authors consistent with the examined population and the period of investigation. The Yates chi2 test, odds ratio - OR and their 99% interval of confidence were used as statistical procedures. RESULTS The results showed that stressful life events in the period of investigation were very important risk factors for AMI with a statistically significant level (p = 0.000). Huge financial problems (OR = 202.36, Ci = 24.82-4387.58), violation of law (OR = 168.00, Ci = 10.66-6658.96) and serious illness of family members (OR = 159.60, Ci = 19.05- 3514.81) were the highest risk for AMI. The patients who reported that his/her son or other member of family had been gone to the army (or mobilization) before the illness onset, had 138 times higher risk of AMI (Ci = 14.98-3222.47, chi2 = 40.95, p = 0.000), while the patients who had mobilized themselves had 84 times higher risk (Ci = 7.00-2363.06, chi2= 23.87, p = 0.000). Effect of several stressful life events lead to significantly increased risk of AMI andthat significance is larger as the number of life events is more frequent (one life event: OR = 28.41, Ci = 3.73-593.52; chi2 = 17.40, p = 0.000; ? 4: OR = 336.00, Ci = 28.31-9760.28, chi2 = 50,43, p = 0,000). CONCLUSION These findings indicate that stressful life events are associated with AMI and that they are very important for further epidemiological investigation of the triggering mechanisms and should improve preventive strategies of this serious disorder.

Trends in incidence of non-melanoma and melanoma skin cancers in central Serbia

Online first: January 30, 2018 SUMMARY Introduction/Objective The incidence of both melanoma and non-melanoma skin cancers (NMSC) has been increasing over the past decades worldwide. NMSC is the most common cancer in white population and melanoma is one of the deadliest cancers today. The objective of the paper was to determine trends in age-standardized incidence rates of NMSC and melanoma in central Serbia from 1999 to 2013. Method A descriptive epidemiological study was done. Data about incidence for NMSC and melanoma were obtained from the Serbian Cancer Registry and data about population originating from 1991, 2001, and 2011 censuses. Crude incidence rates were calculated per 100,000 inhabitants. Direct method of standardization was performed with the world population as the standard. Trend lines were estimated using linear regression. Results During a 15-year period, the total number of new NMSC cases was 41,719 [21,690 (52%) in men and 20,029 (48%) in women]. There were 5,781 new cases of melanoma [2,969 (51.4%) in men and 2,812 (48.6%) in women]. A significantly increasing incidence trend for NMSC both in men (y = 0.617x + 24.29, R2 = 0.500) and women (y = 0.672x + 0.670, R2 = 0.670) was determined. In the same period, a statistically significant increase of incidence trend for melanoma was determined in men (y = 0.111x + 3.708, R2 = 0.384) and in women (y = 0.098x + 3.375, R2 = 0.409). NMSC was registered in persons of all ages. NMSC incidence increased rapidly in persons older than 50 years. Melanoma predominates in children and adolescents and is registered more frequently than NMSC in persons bellow 60 years of age. Conclusion Our findings showed significantly increasing trend of age-standardized incidence rates for both NMCC and melanoma. In the observed period, there were 7.2 times more new cases of NMSC than melanoma in the population of central Serbia. There were more registered new cases of NMSC and melanoma in men than in women. Screening of skin cancers and earlier diagnosis may improve treatment and prognosis.

Impact of socio-demographic characteristics and long-term complications on quality of life in patients with diabetes mellitus

OBJECTIVE Diabetes mellitus (DM) has been one of the leading chronic diseases worldwide over past decades. The objective of the study was to identify predictors associated with health-related quality of life (HRQOL) in diabetic patients. METHODS A cross-sectional questionnaire-based study was conducted at the General Hospital of the city of Leskovac, between June and November 2015. The Short Form-36 (SF-36) questionnaire, EuroQol-5D (EQ-5D) and EuroQol-VAS (EQ-VAS) questionnaires were used. Univariate and multivariate linear regression analyses were performed. RESULTS The total number of patients was 285, 112 men (39.3%) and 173 women (60.7%), average age 63.92 ± 1.07 years. The results of multiple linear regression of socio-demographic characteristics in relation to dimensions of the quality of life measured by SF-36 and EQ-VAS showed that age, country (rural) life, low level of education, retirement, and poor economic status are predictors of lower quality of life. Our results showed that employment has a significant association with higher Physical Component Score (PCS), Mental Component Score (MCS) and EQ-VAS score, which can be explained with higher incomes, improved economic status and less possibility for the occurrence of depressive mood. Patients without formal education have lower QOL. Univariate multiple regression analysis of the presence of micro- and macrovascular complications of DM showed that angina pectoris, heart failure, diabetic retinopathy, and diabetic nephropathy are the most important factors affecting the quality of life in our population. After including the multivariate model, all tested complications remained statistically significant. CONCLUSION Our results showed that both socioeconomic and chronic complications are relevant factors of HRQOL in type 1 and 2 diabetes mellitus patients. Age, rural lifestyle, retirement, lower level of education and low socioeconomic status, as well as DM complications (angina pectoris, hearth failure, diabetes nephropathy, and diabetes retinopathy) were found to be independent risk factors for the component scores of SF-36 and EQ-VAS score. Taking into consideration the results obtained, health practitioners should be aware not only of the clinical parameters of patients with DM, but also of their educational level and working status.

Correlation between risk factors, functional recovery, and the health-related quality of life of stroke survivors

Introduction/objective: It has been estimated that 50% of strokes are preventable through the control of modifiable risk factors. The objective of the paper was to determine the correlation between the risk factors, functional status, and the health-related quality of life (HRQOL) of stroke survivors. Method: The prospective cohort study was used. The study included 136 patients 30–79 years old. Functional recovery was assessed using the Barthel index (BI) and the Modified Rankin Scale (mRS). The HRQOL was evaluated by the generic Short Form 36 (SF-36) questionnaire. BI and mRS were determined at admission at the rehabilitation, one, three and six months after the stroke. The SF-36 was filled out at the same time. The analysis of the repeated measure variance (Repeated Measures ANOVA) was applied, as well as the correlation analysis and Spearman’s coefficient of rank correlation. Results: A total number of 136 patients [66 (48.5%) male and 70 (51.5%) female] completed the questionnaire. The average age of stroke survivors was 63.72 ± 8.73. At admission, mRS was 4.75 ± 0.55, and six months after the stroke onset it decreased to 2.60 ± 1.08. The average value of BI at admission was 25 ± 24.66, and within six months it increased to 83.75 ± 18.59 (p = 0.001). The ANOVA showed that the values of mRS significantly decreased (p < 0.001) and the values of BI significantly increased (ANOVA: p < 0.001). All domains of the SF-36 questionnaire, except for the pain domain, significantly increased (p < 0.001). The physical function (r = 0.238; p < 0. 01), physical role (r = 0.199; p < 0.05), and emotional role (r = 0.237; p < 0.01) were significantly lower among alcohol addicts (r = 0.199; p < 0.05). Mental health (r = 0.244; p < 0.01) and social relationships domains were significantly lower among smokers (r = 0.272; p < 0.01). The general health (r = -0.290; p < 001) and health condition change domains were significantly lower among smokers (r = 0.225; p < 0.01). Conclusion: The most important risk factor which was negatively correlated with the HRQOL was smoking. The patients who were smokers and alcohol addicts had a significantly smaller increase of the HRQOL domains compared to other patent groups. Six months after the stroke, all domains of the HRQOL significantly increased. The significant improvement of patients’ functional status was positively correlated to the increase of their HRQOL.

Epidemiological Characteristics of Carrying Viral Hepatitis B Antigen in the Population of the Nišava District

Summary The aim of this paper was to determine the trend of diseases and epidemiological characteristics of viral antigen carrying of hepatitis B for better implementation of prevention and control of the disease activity. The annual reports, reports of diseases - deaths from infectious diseases, epidemiological survey of the Public Health Institute (IPH) Niš were used as the material. The period from 2002 to 2011 in the Nišava District was considered. A descriptive method was used. HBsAg carrying shows an upward trend (y=15+3.27 x). Most carriers are males (57.27%), live in urban areas (98.16/ 100.000 population), average age 41.92 years old ±SD 18.59, pensioners (22.42%). 54.05% are nephrology patients (almost all retirees under the age of 60 years old). Only 15.76% were hospitalized. The data on the vaccination status are insufficient. In 5.45%, co-infection with hepatitis C virus was found. 63.33% belong to the group of patients for whom there were no data on the mode of transmission. Hemodialysis patients make 16.67%, blood donors 9.39%, 6.36% pregnant women and injecting drug users 1.21%. The upward trend of carrying, the presence of all known risk groups in the population of carrying in the Nišava District points to the need for improved epidemiological surveillance, strict application of protective measures, conducting of statutory vaccination of all categories of people exposed to particular risk of infection as well as continuing education on preventive measures of both population and health care providers.

Cervical Cancer Trends in the Toplica District

SUMMARY Cervical cancer is the third most common malignant neoplasm in women. It is also the fourth cause of death in women amongst malignant neoplasms in the Toplica District. The aim of the paper was to show the most important epidemiological characteristics of cervical cancer and to analyze its incidence and mortality trends during the period 1999-2012. Data on cancer for Toplica District were obtained in the Public Health Institute Niš. Descriptive epidemiological method was used. Crude rates were calculated per 100.000 inhabitants (Census 2002). During the study period, there were 230 newly diagnosed women, out of which 84 died due to cervical cancer. The average age of women who were diagnosed with cancer was 58.9 years. The average age of deceased women was 60.6 years. The average annual crude incidence rate was 32.12 and mortality rate was 11.74. Cervical cancer incidence rates decreased while mortality rates showed a slight increase. The highest incidence rate was in the municipality of Prokuplje (25.45) and the highest mortality rate was in the municipality of Kuršumlija ( 8.11). The lowest incidence rate was in the municipality of Blace (16.15) and the lowest mortality rate in the municipality of Žitorađa (6.01). Cervical cancer is an important sociomedical problem amongst women during their reproductive period. Efficient implementation of primary and secondary preventive measures may lead to a reduction in the incidence and mortality rates due to this cancer.