Browsing by Author "Sipetic-Grujicic, Sandra (6701802171)"

Aims and background. The aim of the present study was to examine if certain aspects of a woman's experience of abortion might be associated with the risk of breast cancer. Methods and study design. The case-control study was conducted in Kragujevac (Serbia) during the period 2004-2005. The case group (191 women) consisted of patients with newly diagnosed first primary breast cancer, which was histologically confirmed. The control group (191 women), individually matched by age (± 2 years), hospital admittance and place of residence (rural/urban) to the respective cases, was selected from female patients admitted for other diseases. The analysis was restricted to parous women (168 cases and 171 controls). Results. Breast cancer risk was reduced among women who had a history of any abortion (adjusted OR, 0.46; 95% CI, 0.24-0.88). The protective effect was found for both induced abortion (adjusted OR, 0.47; 95% CI, 0.25-0.90) and spontaneous abortion (adjusted OR, 0.31; 95% CI, 0.10-0.98). It seems that these associations did not depend on the number of abortions, age at first abortion, or gestational age at first aborted pregnancy. Conclusions. Our study suggests that even short pregnancies ending in abortion add to the protection against breast cancer.

Aims and background. The aim of the present study was to examine if certain aspects of a woman's experience of abortion might be associated with the risk of breast cancer. Methods and study design. The case-control study was conducted in Kragujevac (Serbia) during the period 2004-2005. The case group (191 women) consisted of patients with newly diagnosed first primary breast cancer, which was histologically confirmed. The control group (191 women), individually matched by age (± 2 years), hospital admittance and place of residence (rural/urban) to the respective cases, was selected from female patients admitted for other diseases. The analysis was restricted to parous women (168 cases and 171 controls). Results. Breast cancer risk was reduced among women who had a history of any abortion (adjusted OR, 0.46; 95% CI, 0.24-0.88). The protective effect was found for both induced abortion (adjusted OR, 0.47; 95% CI, 0.25-0.90) and spontaneous abortion (adjusted OR, 0.31; 95% CI, 0.10-0.98). It seems that these associations did not depend on the number of abortions, age at first abortion, or gestational age at first aborted pregnancy. Conclusions. Our study suggests that even short pregnancies ending in abortion add to the protection against breast cancer.

Background: Acne vulgaris is recognized as the third most prevalent skin disease worldwide, with highest prevalence among adolescents. Beliefs and perceptions of adolescents about acne are incoherent in the literature. Objectives: To assess the most frequently reported acne-related beliefs in adolescents in order to focus on misconceptions and develop proper recommendations. Methods: A cross-sectional community-based study on representative sample of 2516 schoolchildren was conducted in six randomly selected secondary schools in Belgrade, Serbia. Only schoolchildren with present or past acne history participated. Factors believed to aggravate or ameliorate acne were recorded and analyzed, and the comparisons between girls and boys were evaluated using Pearson's chi-squared test. Results: A total of 1452 schoolchildren with acne participated, aged 14–18 years, among them 801 (55.2%) girls and 651 (44.8%) boys. Boys significantly more frequently believed that sweating, exercise, and dairy foods aggravate acne, whereas girls significantly more frequently blamed emotional stress, sweets, fatty foods, sun, and lack of sleep. The top four amelioration factors were as follows: comedone extraction, healthy diet, sun exposure, and increased water consumption. Acne regression was more frequently perceived to be linked with cigarettes in boys, but with sun exposure and weight loss in girls. Study limitations: The narrow age span of adolescents (14–18 years) and exclusion of acne-free adolescents are limitations due to study design. Conclusion: This survey is part of the first epidemiological study on a representative sample in the Western Balkan region. The significance of the most frequent acne-related beliefs is discussed and myths about acne are highlighted. © 2019 Sociedade Brasileira de Dermatologia

Objective To identify independent risk factors for the development of bladder cancer after surgical management of upper urinary tract transitional cell carcinoma (UUT-TCC). Patients and methods Between January 1999 and December 2008, 154 patients were treated surgically for UUT-TCC at the Clinic of Urology, Clinical Center of Serbia. Patients with a previous history of bladder cancer and patients with concomitant bladder cancer were excluded from the study. In all, 92 patients were then available for evaluation. The median follow-up after surgery was 39.5 months. Univariate and multivariate analyses using the logistic regression model were performed. The intravesical disease-free rate and survival were calculated using the Kaplan-Meier method, and the log-rank test was used to determine statistical differences. Results and limitations In this study, 21.7% patients treated for UUT-TCC developed subsequent bladder tumors. Tumor multifocality was the only independent predictor associated with the development of subsequent bladder cancer (P = 0.028, RR = 3.52). Intravesical recurrence-free survival rates for these 92 patients at 1, 3, 5, and 7 years were 85.8, 80, 79.3, and 78.3%, respectively. Patients with tumors extending to multiple sites were significantly more likely to present subsequent intravesical recurrence (P = 0.006). The development of bladder cancer had no significant effect on the survival of patients who underwent surgical treatment of UUT-TCC, compared to patients without bladder cancer development (P = 0.660). Neither did the type of surgery mode affect patient survival (P = 0.245). This study is limited by biases associated with its retrospective design. Conclusion The multiplicity of the UUT-TCC is an independent risk factor for the occurrence of bladder cancer. © Springer Science+Business Media, B.V. 2011.

Background: To compare breast cancer incidence and mortality trends in Central Serbia between males and females in the period 1999-2009. Materials and Methods: In this descriptive study, mortality data were obtained from the National Statistics Institute and morbidity data were derived from Institute of Public Health of Serbia for the period of interest. Results: Breast cancer is a leading cancer in the female population of Central Serbia, whereas in male population it is not on the list of 10 leading localizations, concerning both incidence as well as mortality. In the period 1999-2009 the average standardized incidence rates of breast cancer were 60.5/100,000 in women and 1.4/100,000 in men, while average standardized mortality rates were 20.4/100,000 and 0.4/100,000. The average standardized incidence and mortality rates were about 45 times higher in females than males. Male breast cancer comprises approximately 2.1% of all breast cancer cases. The average age-specific mortality and incidence rates increased with age in both sexes. In the observed period standardized mortality rates of breast cancer increased significantly only in men (y=0.320+0.0215×, p=0.044). Conclusions: The increase of breast cancer incidence in both sexes and mortality in men, indicate an urgent need for Serbian health professionals to apply existing cancer control and preventive measures. Male breast cancer is more present than in other world regions, with an outstanding increase of mortality, which demands a timely identification (screening) and adequate treatment. A national policy including mammography should be considered in the light of the newest findings.

Background: To compare breast cancer incidence and mortality trends in Central Serbia between males and females in the period 1999-2009. Materials and Methods: In this descriptive study, mortality data were obtained from the National Statistics Institute and morbidity data were derived from Institute of Public Health of Serbia for the period of interest. Results: Breast cancer is a leading cancer in the female population of Central Serbia, whereas in male population it is not on the list of 10 leading localizations, concerning both incidence as well as mortality. In the period 1999-2009 the average standardized incidence rates of breast cancer were 60.5/100,000 in women and 1.4/100,000 in men, while average standardized mortality rates were 20.4/100,000 and 0.4/100,000. The average standardized incidence and mortality rates were about 45 times higher in females than males. Male breast cancer comprises approximately 2.1% of all breast cancer cases. The average age-specific mortality and incidence rates increased with age in both sexes. In the observed period standardized mortality rates of breast cancer increased significantly only in men (y=0.320+0.0215×, p=0.044). Conclusions: The increase of breast cancer incidence in both sexes and mortality in men, indicate an urgent need for Serbian health professionals to apply existing cancer control and preventive measures. Male breast cancer is more present than in other world regions, with an outstanding increase of mortality, which demands a timely identification (screening) and adequate treatment. A national policy including mammography should be considered in the light of the newest findings.

Background: To evaluate the level of knowledge among men who have sex with men regarding human papillomavirus (HPV), anal cancer screening, and HPV vaccine. Methods: A cross-sectional study was conducted in 2013 in Belgrade, Serbia, comprising 142 HIV-positive and 128 HIV-negative persons. Results: Of all participants, 34.8% had never heard of HPV infection; 43.3% of participants were informed that HPV infection might be asymptomatic, while 30.4% knew that HPV is not transmitted by towels/cloth. Furthermore, 45.9% answered that HPV is a cause of genital warts, while 28.9%, 14.4%, and 17.4%, respectively, answered that it can cause anal, penile, and oral cancers. Only one-fourth of participants knew that anal cancer is more frequent in homosexual men. More than 50% had not heard of anal Papanicolaou (Pap) smears, and less than 3% had ever had it. Almost 90% of participants did not know which physicians provide anal Pap smears. Less than one-third knew that regular anal Pap smears might prevent consequences of anal HPV infection. The majority of participants did not know that there is a vaccine against HPV and anal cancer. Less than 50% reported willingness to receive HPV vaccine. Knowledge was slightly better in HIV-positive men in comparison with HIV-negative ones. Conclusions: Results point out the need for community efforts to promote knowledge about HPV, anal carcinoma, and anal Pap screening among men who have sex with men and their healthcare providers, and to increase the acceptance of HPV vaccine by the population. © 2016 The International Society of Dermatology

Most of what is known about the metabolically healthy obese phenomenon is derived from studies in the adult population and no standardized criteria to identify these individuals exist to date. The aim of this study was to determine if the preserved insulin sensitivity evaluated by homeostatic model assessment of insulin resistance (HOMA-IR) index is associated with favorable metabolic profile in the obese children. We studied a group of 248 children and adolescents (150 female, 98 male), aged 5.9-18.9 years with diet-induced obesity (BMI >95th percentile). The entire cohort was divided into quartiles based on levels of insulin resistance determined by HOMA-IR index. Subjects in the lower quartile of HOMA-IR were classified as insulin-sensitive group (ISG), whereas children in the upper quartile were categorized as insulin-resistant group (IRG). The ISG subjects had values of HOMA-IR ≤2.75 while the children from the IRG group had HOMA-IR ≥6.16. Subjects from ISG group had lower basal β-cell activity and were less likely to have impaired fasting glucose or impaired glucose tolerance. Concentrations of LDL and total cholesterol, triglycerides, and transaminases were lower and HDL cholesterol levels were higher in ISG subjects. Findings obtained by the use of Matsuda index correlated well with the findings obtained by the use of HOMA-IR. Conclusion: Lower HOMA-IR values were significantly associated with favorable metabolic profile in studied children, which correlates with findings in the adult population and emphasizes the need for further, longitudinal studies of insulin resistance development in childhood obesity. © 2012 Springer-Verlag Berlin Heidelberg.

Aim. To examine the prevalence of low back pain, to identify self-perceived triggers of low back pain, and to investigate the impact of perceived pain on the daily activities and mood among medical students. Methods. This cross-sectional study enrolled 459 fourth year students at the Faculty of Medicine in Belgrade during December 2014. The anonymous questionnaire was used for data collection. In data analysis, the chi-square test and t-test were used. Results. The lifetime prevalence of low back pain was 75.8%, 12-month prevalence 59.5%, and point prevalence 17.2%. Chronic low back pain was experienced by 12.4% of the students. Both the lifetime (p=0.001) and the 12-month (p=0.001) low back pain prevalence rates were significantly higher among female medical students. Mental stress during an exam period (p=0.001), sitting at the university (p=0.002), fatigue (p=0.043), improper body posture (p=0.005), and lack of exercise (p=0.001) as self-perceived triggers of low back pain were significantly more often reported by female students, compared to males. Regarding daily functioning, the experience of low back pain mostly affects students sleeping (14.6%) and walking (12.0%). Conclusions. The prevalence of LBP is high among Belgrade medical students and significantly affects their everyday functioning. © 2018 Isidora Vujcic et al.

Aim. To examine the prevalence of low back pain, to identify self-perceived triggers of low back pain, and to investigate the impact of perceived pain on the daily activities and mood among medical students. Methods. This cross-sectional study enrolled 459 fourth year students at the Faculty of Medicine in Belgrade during December 2014. The anonymous questionnaire was used for data collection. In data analysis, the chi-square test and t-test were used. Results. The lifetime prevalence of low back pain was 75.8%, 12-month prevalence 59.5%, and point prevalence 17.2%. Chronic low back pain was experienced by 12.4% of the students. Both the lifetime (p=0.001) and the 12-month (p=0.001) low back pain prevalence rates were significantly higher among female medical students. Mental stress during an exam period (p=0.001), sitting at the university (p=0.002), fatigue (p=0.043), improper body posture (p=0.005), and lack of exercise (p=0.001) as self-perceived triggers of low back pain were significantly more often reported by female students, compared to males. Regarding daily functioning, the experience of low back pain mostly affects students sleeping (14.6%) and walking (12.0%). Conclusions. The prevalence of LBP is high among Belgrade medical students and significantly affects their everyday functioning. © 2018 Isidora Vujcic et al.

The study identifies the prevalence of violence victimization and the perpetration among youths, and explores the determinants and predictors using a socio-ecological model. The data of 36 variables from a representative sample of 1722 persons, ages 15–24 years, from the National Health Survey of Serbia in 2013, were analyzed by a multivariate logistic regression modeling. The study shows that 13.4% of youths experienced multi-victimization, while 10.4% were perpetrators of violence. Up to one-third of the victims were violence perpetrators. A small percentage of victims seek family and community support. Predictors of violence among youths were: male sex, households with fewer members, urban settlements, violence perpetration, self-assessed health as poor, lack of close friends and perception that it was difficult to obtain the assistance needed. Predictors of youth violence highlighted the need to improve health education, social support and community regulations, as well as strengthen the promotion of gender equality and a healthy environment. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

The study identifies the prevalence of violence victimization and the perpetration among youths, and explores the determinants and predictors using a socio-ecological model. The data of 36 variables from a representative sample of 1722 persons, ages 15–24 years, from the National Health Survey of Serbia in 2013, were analyzed by a multivariate logistic regression modeling. The study shows that 13.4% of youths experienced multi-victimization, while 10.4% were perpetrators of violence. Up to one-third of the victims were violence perpetrators. A small percentage of victims seek family and community support. Predictors of violence among youths were: male sex, households with fewer members, urban settlements, violence perpetration, self-assessed health as poor, lack of close friends and perception that it was difficult to obtain the assistance needed. Predictors of youth violence highlighted the need to improve health education, social support and community regulations, as well as strengthen the promotion of gender equality and a healthy environment. © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

The purpose of our study was to determine the prevalence of macrolide resistance in 3,188 pharyngeal Streptococcus pyogenes isolates collected at the Institute of Public Health of Serbia during the period 2006-2008. The disk diffusion tests were used to determine the susceptibility of the isolates. Two hundred and sixteen S. pyogenes isolates (6.8z) were resistant to erythromycin, with 9 isolates coresistant to tetracycline: 181 isolates harbored mefA gene, 19 ermB gene, 11 ermA(TR) gene, 5 ermB and mefA genes, and 7 tetM gene. Although the prevalence of macrolide resistance in pharyngeal S. pyogenes isolates is low in Serbia, monitoring of the emergence of resistance is advisable.

Objective: To evaluate the prognostic factors for survival and disease recurrence in patients treated surgically for upper tract urothelial carcinoma (UTUC), focusing especially on the impact of history of non-muscle-invasive bladder cancer. Patients and methods: A single-center series of 221 consecutive patients who were treated surgically for UTUC between January 1999 and December 2010 was evaluated. Patients who had a history of bladder tumor at a higher stage than the upper tract disease, preoperative chemotherapy, or previous contralateral UTUC were excluded. None of the patients included in this study had distant metastasis at diagnosis of UTUC. In total, 183 patients (mean age 66 years, range 36-88) were then available for evaluation. Tumor multifocality was defined as the synchronous presence of 2 or more pathologically confirmed tumors in any upper urinary tract location (renal pelvis or ureter). All patients were treated with either open radical nephroureterectomy (RNU) or open conservative surgery. Recurrence-free probabilities and cancer-specific survival were estimated using the Kaplan-Meier method and Cox regression analyses. Results: Fifty-one patients (28%) had previous carcinoma not invading bladder muscle. Previous history of non-muscle-invasive bladder cancer was significantly associated with tumor multifocality (P < 0.001), concomitant bladder cancer (P < 0.001), higher tumor stage (P = 0.020), and lymphovascular invasion (P = 0.026). Using univariate analyses, history of non-muscle-invasive bladder cancer was significantly associated with an increased risk of both any recurrence (HR = 2.17; P = 0.003) and bladder-only recurrence (HR = 3.17; P = 0.001). Previous carcinoma not invading bladder muscle (HR = 2.58; P = 0.042) was an independent predictor of bladder-only recurrence. Overall 5-year disease recurrence-free (any recurrence and bladder-only recurrence) survival rates were 66.7% and 77%, respectively. Previous history of non-muscle-invasive bladder cancer was not associated with cancer-specific survival. Our results are subject to the inherent biases associated with high-volume tertiary care centers. Conclusions: Patients with previous history of non-muscle-invasive bladder cancer had a higher risk of having multifocal and UTUC with higher tumor stages (pT3 or greater). History of bladder tumor was an independent predictor of bladder cancer recurrence but had no effect on non-bladder recurrence, and cancer-specific survival in patients who underwent surgical treatment of UTUC. © 2013 Elsevier Inc.

Strategic Management, Public Health Information, Public Health Legislation, as well as Public Health Training and Research are considered essential elements of a coherent public health strategy for Serbia, a republic of the former Yugoslavia. Whereas the strategic framework in Serbia is outlined in detail, which includes an action plan that is linked with local pilot initiatives, the information base is well developed but not yet sufficiently related to the strategic objectives. The transformation of strategic considerations and information into meaningful legislative acts stands at halfway and has to cope with a heritage of unrelated and dysfunctional laws. A big step forward was made with the establishment of a modern School of Public Health in Belgrade in 2004, which acts as a brain-trust for the New Public Health in Serbia. The multi-professionalism at the Institutes of Public Health and the corresponding inter-disciplinarity at the academic Schools of Public Health provide an adequate institutional environment if the resources of skills, knowledge and experience are adequately managed - in a participatory and supportive system representing a flat hierarchy.

Strategic Management, Public Health Information, Public Health Legislation, as well as Public Health Training and Research are considered essential elements of a coherent public health strategy for Serbia, a republic of the former Yugoslavia. Whereas the strategic framework in Serbia is outlined in detail, which includes an action plan that is linked with local pilot initiatives, the information base is well developed but not yet sufficiently related to the strategic objectives. The transformation of strategic considerations and information into meaningful legislative acts stands at halfway and has to cope with a heritage of unrelated and dysfunctional laws. A big step forward was made with the establishment of a modern School of Public Health in Belgrade in 2004, which acts as a brain-trust for the New Public Health in Serbia. The multi-professionalism at the Institutes of Public Health and the corresponding inter-disciplinarity at the academic Schools of Public Health provide an adequate institutional environment if the resources of skills, knowledge and experience are adequately managed - in a participatory and supportive system representing a flat hierarchy.

Purpose: To investigate the association between tumor size and clinicopathologic factors and outcomes of upper urinary tract urothelial carcinoma (UTUC) in patients treated surgically for UTUC. Methods: A single-center series of 235 consecutive patients who were treated surgically for UTUC between January 1999 and December 2011 was evaluated. Patients with a history of muscle-invasive urothelial carcinoma of the urinary bladder, those who received neoadjuvant therapies, and those with previous contralateral UTUC were excluded. Bladder-only recurrence, any recurrence, and cancer-specific mortality after surgery were analyzed. Recurrence-free probabilities and cancer-specific survival (CSS) were estimated using the Kaplan-Meier method and Cox regression analyses. Results: Tumor size was significantly associated with age of the patient (P = 0.001), tumor location (P < 0.0001), tumor multifocality (P = 0.005), higher tumor stage (P < 0.0001), higher tumor grade (P = 0.038), lymphovascular invasion (P = 0.002), and mode of operation (P = 0.001). Tumor size was not associated with bladder-only recurrence (HR 0.91; 95 % CI 0.46-1.80; P = 0.79). The Kaplan-Meier method showed that tumor size >3 cm was significantly associated with worse CSS (P = 0.006, log rank). The 5-year CSS for patients with tumor size ≤3 cm was 70.1 % and for patients with tumor size >3 cm was 56.1 %. Tumor size was not associated with cancer-specific survival in multivariable analysis (HR 1.53; 95 % CI 0.89-2.61; P = 0.12). Conclusions: Tumor size >3 cm was associated with a lower 5-year CSS at Kaplan-Meier analysis, but was not an independent predictor of CSS, bladder-only recurrence, and any recurrence-free survival at multivariable analysis. © 2013 Springer Science+Business Media.

Objective To identify the impact of tumour location on the disease recurrence and survival of patients who were treated surgically for upper urinary tract transitional cell carcinoma (UUT-TCC). Patients and Methods A single-centre series of 189 consecutive patients who were treated surgically for UUT-TCC between January 1999 and December 2009 was evaluated. Patients who had previously undergone radical cystectomy, preoperative chemotherapy or contralateral UUT-TCC were excluded. In all, 133 patients were available for evaluation. Tumour location was categorized as renal pelvis or ureter based on the location of the dominant tumour. Recurrence-free probabilities and cancer-specific survival were estimated using the Kaplan-Meier method and Cox regression analyses. Results The 5-year recurrence-free and cancer-specific survival estimates for the cohort in the present study were 66% and 62%, respectively. The 5-year bladder-only recurrence-free probability was 76%. Using multivariate analysis, only pT classification (hazard ratio, HR, 2.46; P= 0.04) and demographic characteristics (HR, 2.86 for areas of Balkan endemic nephropathy, vs non-Balkan endemic nephropathy areas; 95% confidence interval, 1.37-5.98; P= 0.005) were associated with disease recurrence Tumour location was not associated with disease recurrence in any of the analyses. There was no difference in cancer-specific survival between renal pelvis and ureteral tumours (P= 0.476). Using multivariate analysis, pT classification (HR, 8.04; P= 0.001) and lymph node status (HR, 4.73; P= 0.01) were the only independent predictors associated with a worse cancer-specific survival. Conclusions Tumour location is unable to predict outcomes in a single-centre series of consecutive patients who were treated with radical nephroureterectomy for UUT-TCC. © 2011 The Authors. BJU International.