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Background/Aim. Prehypertension and hypertension are an important public health problem worldwide and although they can be modified, they are often a risk for cardiovascular diseases. The aim of this study was to determine the prevalence of prehypertension and hypertension and associated risk factors in the adult population (15+ years) of Serbia. Methods. The cross-sectional study covered 14,623 adult respondents, but 14,422 volunteered to measure their blood pressure according to a pre-defined protocol. A stratified two-stage national representative random sampling approach was used for the selection of the survey sample. Results. In 2013, 17.7% of Serbian population, aged 15 and over, was normotensive, every third (33.1%) person had prehypertension, and every second (49.3%) had hypertension. The standardized prevalence of prehypertension and hypertension was 40.6% and 34.5%, respectively; 57.8% of the hypertensive population were receiving medical treatment. Among those receiving medical treatment, 35.2% (36.4% males and 33.2% females) had a blood pressure within the normal range. According to the results of multivariate logistic regression analysis, independently significant risk factors for hypertension compared to persons with normotension were older age (50 and more) (p < 0.001), overweight (p < 0.001) and obesity (p < 0.001), moderate (p < 0.001) and large (p < 0.001) waist circumference in both sexes, and nonurban place of residence in females (p = 0.006). In females, independently significant risk factors for prehypertension compared to persons with normotension were older age (50 and more) (p < 0.001), overweight (p < 0.001) and obesity (p < 0.001), moderate (p < 0.001) and large (p < 0.001) waist circumference, but high level of physical activity was significantly protective (p = 0.014). In males, overweight (p < 0.001) and obesity (p < 0.001) were independently significant risk factors for prehypertension. Conclusion. Serbia belongs to countries with a high prevalence of prehypertension and hypertension. Our results emphasize the need for a new public health strategy for the prevention, detection and treatment of prehypertension and hypertension. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. 175042]

The aim of this paper is to define the population indicators of the nutritional status among the working population of the Republic of Serbia based on the value of Body Mass Index (BMI). The sample consisted of a total of 7.125 working subjects, among which 4.525 males (63.51%) and 2.600 females (36.49%). The subjects were from the following regions: Northern Serbia-Vojvodina, Capital city - Belgrade, Central Serbia, Western Serbia, Southern Serbia and Eastern Serbia. The average BMI values based on test groups of men and women were 26.53±4.07 and 24.07±5.09 kg, respectively. On the basis of the obtained results, it was determined that statistically significant BMI differences exist among subjects in general, i.e. in relation to gender (F=58.412, p

Background/Aim. Cancers of the lip, oral cavity and pharynx (LOCP) are frequently grouped together mainly because they have similar risk factors. The incidence rate of these cancers varies worldwide depending on the geographic location. The aim of this study was to determine trends in age-standardized incidence rates of LOCP cancers in the Belgrade population during a 12-year period, from 1999 to 2010. Methods. From The Serbian Cancer Registry (The Registry), we extracted all cases of LOCP cancers registered in Belgrade from January 1, 1999 to December 31, 2010. Joinpoint regression analysis was used to define trends and annual percentage change (APC). Results. A total number of 2,025 (1,509 in men and 516 in women) LOCP cancers were reported to the Registry during the study period. The age standardized rate (ASR) for the entire period and for all LOCP cancers, was 6.24 per 100,000 persons (10.35 for men and 2.86 for women). ASR for lip cancers decreased (p < 0.001) during the study period with APC of -8.4%. The ASR for oral cavity and pharyngeal cancers increased (p < 0.05). Conclusion. Our results show a significantly decreasing trend of the incidence rate for lip cancers in the population of the city of Belgrade between 1999 and 2010. On the contrary, the incidence of oral cavity and pharyngeal cancers increased for both men and women.

Introduction. Nonmelanoma skin cancers in the literature are mainly related to basal cell and squamous cell skin carcinoma. Objective. The aim of the study was to determine the trend in the incidence of histological types of nonmelanoma skin cancers in the population of the city of Belgrade from 1999 to 2011. Methods. From the Serbian National Cancer Registry we extracted all recorded cases of skin cancer in Belgrade from January 1st 1999 to December 31st 2011. Incidence rates were standardized by the method of direct standardization with the world population as the standard population. Trends and annual percentage change (APC) of incidence rate were calculated by performing joinpoint regression analyses. Results. Incidence rate of nonmelanoma skin cancer showed significantly increasing trend between 1999 and 2006 with APC of 8.6% (95% CI: 5.6-11.7), basal cell carcinoma increased with APC of 8.4% (95% CI: 5.2-11.6) and squamous cell skin carcinoma with APC of 9.33% (95% CI: 5.7-13.1). The incidence increased with age for both men and women, especially after the age of 60. Conclusion. Our results showed a continuously increasing incidence trend of both basal cell and squamous cell skin carcinomas in the population of the city of Belgrade between 1999 and 2011. Adequate primary and secondary prevention would certainly be successful in reducing this type of cancer in the future.

Background/Aim. Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders. It is recognized as a serious risk factor for car and workplace accidents due to daytime sleepiness, and factor for coronary heart diseases and stroke. The aim of this study was to examine the effectiveness of oral appliances for mandibular advance in treating mild to moderate OSA. Methods. A total of 15 patients were included in this study, all diagnosed with mild or moderate OSA. Oral appliances were custom made for each patient in protrusive position at 50% of maximum mandibular advancement. The patients were given instructions not to sleep on their backs and avoid alcohol consumption during the study as these are the factors that can contribute to symptoms progression. Results. Complete and partial treatment success was achieve in 14 of the patients. Apnea-hypopnea index values were significantly lower (p < 0.05) at the end of a 6-month observation period compared to those at the treatment beginning. A great improvement in symptoms was observed, with daytime sleepiness index values significantly reduced already within the first month of the treatment. Conclusion. Treatment of obstructive sleep apnea with oral appliances has proven successful. Patients were comfortable using oral appliances and were ready to wear them for prolonged period of time. Use of oral appliances is very common in the world and should not be discarded. They are also very comfortable, practical and affordable comparing to continuous positive airway pressure (CPAP) apparatus, not to mention surgery. Use of oral appliances is safe and very well tolerated, and ought to be offered to patients with OSA.

Background/Aim. Nasopharyngeal carcinoma (NPC) is a relatively rare malignant disease, of which 80 000 individuals become ill around the world annually, which amounts to 0.7% of all carcinomas. The aim of this descriptive study was to analyze NPC incidence in Belgrade (the capital city of Serbia, with about 1.6 million inhabitants) during the period 1991-2005. Methods. In data analysis, crude rates age and sex specific rates, and standardized incidence rates were used. Standardization was performed by a direct method, using world population as the standard. Results. In Belgrade, during the observed 15-year-period, the number of new NPC patients totaled 118, of which 86 (72.9%) were male and 32 (27.1%) were female. The average standardized incidence rate for men was 0.52 per 100 000 and for women 0.16 per 100 000. In both sexes the incidence was very low before 40 years of age. In men, the greatest incidence rate of NPC was in the 50-59 years age group, and in women in those 60 and more years old. Furthermore, undifferentiated carcinoma of nasopharyngeal type was 3.6 times more often in comparison to squamous cell carcinoma. Conclusion. Belgrade belongs to a region with a low incidence rate of NPC. Further investigations are needed to explain higher frequency of undifferentiated carcinoma of nasopharyngeal type than squamous cell carcinoma.

The goal of this research was to define the initial body structure model of female students of Faculty of Special Education and Rehabilitation (FASPER), University of Belgrade, as a person whose professional and work commitment is working with disabled people and it's perceived as a very responsible, stressful and atypical work profile. The sample was made of 125 participants (female students) of III and IV year of Bachelor studies of FASPER. Research was conducted in a Methodical-research laboratory (MRL) in Faculty of sport and physical education, University of Belgrade in a time period 2012-2017, in accordance with standardized procedure of applying electrical multichannel bioimpedance method with body structure analyzer - InBody 720. It contained twenty (20) variables, eight (8) were basic and twelve (12) were derived. Based on BMI it's claimed that 77.60% participants has a normal body status, but the prevalence of overweight students (BMI18.50) is 11.20%, with 4.00% participants who were significantly thinness underweight i.e. poorly nourished (BMI>17.50). According to the results it was concluded that even 96.8% of sample was not in line with ideal or optimal body structure profile. For example, 63.2% participants has some form of body mass deficits (average of 5.25 kg) with mostly muscle component deficit 78.4% (average muscle mass deficit is 4.28 kg) and with body fat component deficit 43.2% (average deficit of body fat is 2.01 kg). On the other hand, 33.6% participants has a form of surplus (average surplus in body structure is 9.44 kg) where even 54.4% has a surplus of body fat component (average level of surplus of body fat 7.48 kg). The results of 4D body structure model of female students from FASPER can be defined like this: 31.77 L of Total Body Water (53.37%), 8.50 kg of proteins (14.26%), 16.98 kg of body fat (27.10%) and 3.10 kg of minerals (5.18%). Beside the probability that the reason of bad nutrition behaviour of these students is the cause of their increasing fat depots it's also a fact that 69.6% of these students are physically inactive and 21.6% just occasionally active, which mean that 91.2% of students was physically non active person, could indicate a most possible reason of body fat component suficit and body muscle component deficit as a main body structure characteristics.

Introduction Data regarding patients with acute coronary syndrome (ACS) did not exist in Serbia until 2002. By establishing the National Registry for Acute Coronary Syndrome (NRACS), the data collection based on the filled-in "coronary questionnaire" for each patient hospitalized and diagnosed with acute infarction of the myocardium (AIM) and unstable angina pectoris (UAP) was initiated in Serbia. Objective The aim of the study was to analyze clinical characteristics, complications, applied reperfusion-thrombolytic treatment and standard therapy, and mortality rate of patients treated in coronary or intensive care units during the 2002, 2003, 2004 and 2005. Method We chose a "coronary protocol" with minimal set of the patient’s data that was filled-in by the attending physician. The collection of the data was initiated in July 2002. Results During four months of 2002, 4202 patients were treated for ACS; in 2003 12739 patents, in 2004 12351 patients and 12598 patients in 2005. AIM with ST elevation (STAIM), as related to AIM without ST elevation (NSTAIM), was more often encountered in Serbian population in comparison to other European countries: in 2002, it was registered among 52.3% of patients, in 2003 among 52.7%, in 2004 among 51.8%, and in 2005 among 50.7% of patients. The patients suffering from the ACS in Serbia were of younger age, with a significant prevalence of females, as compared to the data from the European countries. Thrombolytic therapy in STAIM was applied in only 24.5% of patients in 2002, which then rose by each year, to reach 36.4% of patients in 2005. At the same time, as expected, hospital mortality rate decreased: from 14.8% in 2002 to 8.2% in 2005. STAIM patients untreated by thrombolytic therapy had a considerably higher mortality rate: in 2002 it was 20.3%, in 2003 15.3%, in 2004 14.3%, and in 2005 13.8%. Total mortality rate in patients with STAIM gradually decreased from 19% in 2002 to 11.7% in 2005. Conclusion From 2002-2005, the patients treated for ACS in Serbia were younger, with higher prevalence of females, and with a higher incidence of STAIM in relation to NSTAIM. The administration of reperfusion therapy in STAIM patients has been increasing significantly, from 24.5% in 2002 to 36.4% in 2005, and was followed by a decrease in hospital mortality rate of 14.8% in 2002 to 8.2% in 2005. Overall mortality of STAIM patients treated with or without thrombolytic therapy gradually decreased from19% in 2002 to 11.7% in 2005.

Background: Substantial inequalities in the overall prevalence and patterns of multimorbidity have been widely reported, but the causal mechanisms are complex and not well understood. This study aimed to identify common patterns of multimorbidity in Serbia and assess their relationship with air pollutant concentrations and water quality indicators., Methods: This ecological study was conducted on a nationally representative sample of the Serbian population. Data were obtained from the European Health Interview (EHIS) Survey, a periodic study designed to assess population health using widely recognized standardized instruments. The study included 13,069 participants aged 15 and older, randomly selected through a multistage stratified sampling design. Multimorbidity was defined as having two or more self-reported diagnoses of chronic non-communicable diseases. Latent class analysis (LCA) was performed to identify clusters of multimorbidity. Concentrations of particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3), as well as water quality indicators, were obtained from the Serbian Environmental Protection Agency., Results: The overall prevalence of multimorbidity was 33.4% [32.6%-34.2%]. Six latent classes of multimorbidity were identified: Healthy, Multicondition, Cardiovascular, Metabolic syndrome, Respiratory, and Musculoskeletal. Annual increases in PM10 and SO2 concentrations, as well as daily increases in O3 concentrations, significantly raised the odds of having multimorbidity (OR = 1.02, 95% CI 1.02-1.03; OR = 1.01, 95% CI 1.00-1.02 and OR = 1.03, 95% CI 1.02-1.03, respectively). A pattern of increased risk was observed with rising levels of water contamination. Exposure to physico-chemical, microbiological and combined contamination was associated with a 3.92%, 5.17% and 5.54% higher probability, respectively, of having multiple chronic conditions. There was strong evidence that air pollutants, as well as chemical and microbial water contamination, were significantly associated with higher odds of the most common clusters of multimorbidity identified by LCA., Conclusion: There is compelling evidence of an association between multimorbidity and environmental pollution, suggesting that exposure to air pollutants and water contaminants may contribute to disease accumulation and help explain geographically and socioeconomically patterned inequalities. These findings underscore the need for extensive studies that simultaneously measure both multimorbidity and pollution to explore their complex interrelationships., Competing Interests: Declarations Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the Institute of Public Health of Serbia (date: 10.06.2021; n˚ 3607/1). Informed consent was obtained from all individual participants included in the study. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Introduction : To assess incidence and mortality trends of acute myeloid leukemia (AML) in Belgrade (Serbia) in a 15-year period (from 1999 to 2013). Material and Methods: Data were obtained from the Cancer Registry of Serbia, Institute of Public Health of Serbia. Standardized incidence and mortality rates per 100,000 inhabitants were calculated by direct standardization method using World Standard Population. Analysis of raw data indicated single-digit numbers per year and per 5-year age cohorts. Therefore, we merged years of diagnosis to three-year intervals, creating so-called "moving averages". We also merged study population to 10-year age cohorts. Results: Both incidence and mortality rates increased with age, i.e., the lowest rates were observed in the youngest age groups and the highest rates were observed in oldest age groups. In all age groups, except the youngest (15⁻24 years), AML incidence was statistically significantly higher in men compared with women. Average age-adjusted incidence was 2.73/100,000 (95% confidence interval (CI) 2.28⁻3.71). Average age-adjusted mortality was 1.81/100,000 (95% CI 1.30⁻2.26). Overall, there were no significant changes in incidence trend. Age-adjusted incidence rates had increasing tendency among men aged 65⁻74 years (B = 0.80, standard error (SE) = 0.11; p = 0.005) and in total population aged 65⁻74 years (B = 0.41, SE = 0.09; p = 0.023). Increasing tendency in incidence of AML among women was observed in age group >75 years (B = 0.63, SE = 0.14; p = 0.019). No changes of mortality trend were observed. Conclusion: There was no significant change in trends of AML from 1999 to 2013 in the population of Belgrade., Competing Interests: The authors declare no conflict of interest.

Colorectal cancer (CRC) is becoming a major public health problem in the Republic of Serbia. Organized mass screening has been shown to decrease CRC mortality and even its incidence. The aim of this study was to assess the acceptability of a faecal immunochemical test for haemoglobin proposed by primary care physicians. From August to November 2013, a pilot study for CRC screening was organized in individuals aged 50 to 74 years. The study included 50 primary healthcare centres from all 25 administrative regions of Serbia. A qualitative immunochromatographic faecal immunochemical test for human haemoglobin detection was used. Overall, 50 894 individuals were invited. The participation rate was 67.8 and 3.4% of the tests were positive. Among individuals with a positive test, 69.7% agreed to undergo colonoscopy. The positive predictive value was 27.1% for adenoma and 14.6% for carcinoma. This was the first CRC screening project encompassing approximately one-third of primary healthcare facilities in all regions across the country. It showed a good response of the target population and satisfactory cooperation of the healthcare professionals involved.

Background: In the past decade, the incidence of thyroid cancer (TC) has shown a stable increase, for both sexes, in many parts of the world at a rate faster than for any other type of malignancy. The aim of our study was to analyze and report changes in TC incidence in Serbia, as well as to evaluate potential reasons for these changes. So far, the incidence of TC in Serbia has not been reported., Material and Methods: This is a retrospective descriptive epidemiological study of TC data from the Cancer Register for Serbia for a ten year period, from 1999 to 2008. Crude rates (CR), age-specific rates (ASR), age-adjusted rates (AAR), linear trends and average annual percentage changes (AAPC) were calculated and analyzed., Results: TC incidence increased substantially for both genders with the highest increase in 2007 for the age group 50-59 (females 14.2, males 10.3). TC was three times more common in females (CR 4.7:1.5). The AAR for females ranged 1.9-4.8 (3.3, 95% CI 2.6-4.0), for males 1.0-2.6 (1.0, 95% CI 0.8-1.2) and for both sexes combined 1.4-3.2 (2.2, 95% CI 1.7-2.6). The incidence trend for males showed an increase (y =0.05x + 0.70, p =0.058). It was highly statistically significant for females (y =0.31x + 1.61, p <0.001) and both genders combined (y =0.18x + 1.18, p <0.001). AAPC was highest for ages 20-29 and 30-39, for females (+25.2%) and males (+17.3%), respectively., Conclusions: We found a substantial increase in TC incidence in Serbia for both genders. The highest increase in TC incidence was found in females aged 20 to 29 years while the highest incidence was found in the age group 50 to 59.

Purpose: The aim of this study was to analyze trends of death rates for cervical cancer (CC) on territory of The Republic of Serbia in the period 1991-2011., Methods: In this descriptive epidemiological study, unpublished data of the Statistical Office of the Republic of Serbia were used for the analysis of mortality due to CC among women in Serbia, from 1991 to 2011. Three different types of rates were calculated: crude, age-specific and age-adjusted rates. The age-standardized rates were calculated by the direct method of standardization using the World Standard Population as standard. The trends were assessed by joinpoint linear regression analysis. An average annual percentage change (AAPC) and the corresponding 95% confidence intervals (CI) were computed for trends., Results: The average age-standardized CC mortality rate (ASCCMR) was 7.03 per 100,000. The lowest value of the ASCCMR was at the beginning of the observed period (6.05 per 100,000) and the highest was 8.17 per 100,000 in 2008. The age-adjusted CC mortality rates have been continuously and significantly increasing (AAPC=+0.7, 95% CI=0.3- 1.1, p<0.05). In all age groups we found increasing trends, except in the age group of 65-74 years., Conclusion: Since ASCCMR has been steadily increasing during the period observed, reducing these rates is highly warranted. To achieve this target, an organized CC screening program is essential.

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+0.021?, 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.

There is growing concern that pollution from petrochemical and oil refinery installations in Pancevo (Serbia) has increased the incidence of various diseases including cancer. The aim of our study was to investigate cancer incidence in Pancevo and to compare it with the region of central Serbia. Cancer incidence data were obtained from the corresponding Serbian Cancer Registries. Systematic local monitoring of benzene, toluene and methyl mercaptane in the atmosphere within Pancevo's industrial area indicated that the average monthly and yearly concentrations often exceeded permitted levels proposed by EU standards (5 microgm(-3)). Cancer incidence was lower in Pancevo than in central Serbia (the standardised incidence for all types of cancers in Pancevo was 218.3 and in central Serbia it was 241.7 per 100,000 inhabitants). The available data do not allow us to correlate air pollution in Pancevo with increased cancer incidence.

Aim: To analyze cancer mortality trends in men in Central Serbia during 1985-2006 period., Methods: Mortality rates and trends for the most frequent cancers in men (lung, stomach, colorectal, pancreatic, and prostate cancer) were calculated. Mortality rates for all cancers were adjusted by direct standardization. Percentage changes of the rates were calculated as the percentage difference between the rates of two successive years and then as a mean of these changes for the entire observed period. Trend lines were estimated using linear regression., Results: Total cancer mortality in men increased, with mean percentage of annual changes being 1.53% (95% confidence interval [CI], -0.09-3.16). Lung, stomach, colorectal, pancreatic, and prostate cancers represented 58.1% and 61.6% of total cancer deaths in 1985 and 2006, respectively. Increasing trends were observed for all investigated cancers: mean annual percentage change for lung cancer was 2.31%(95% CI, 1.03-3.59), for colorectal cancer 2.23% (95% CI, -0.18-4.65), for prostate cancer 3.06% (95% CI, -2.07-8.18), and for pancreatic cancer 1.58% (95% CI, -2.17-5.32). Stomach cancer mortality significantly decreased in age groups 40-49 and 50-59 years., Conclusion: The most frequent cancers in men in Central Serbia, i.e., lung, colorectal, prostate, and pancreatic cancer, showed an increasing trend. Only stomach cancer mortality decreased over time.

Background: Health care workers (HCWs) are at risk of occupational exposure to human immunodeficiency virus (HIV)., Aim: To investigate the perception of professional risk from, and the knowledge, attitudes and practice of HCWs to HIV and AIDS in Serbia., Methods: Cross-sectional study of 1,559 Serbian HCWs using self-administered anonymous questionnaires. Chi-square testing and multiple logistic regression analysis were applied., Results: Eighty-nine per cent of HCWs believed that they were at risk of acquiring HIV through occupational exposure. The perception of professional risk was higher among HCWs frequently exposed to patients' blood and body fluids (OR 7.9, 95% CI 4.4-14.5), who used additional personal protection if the HIV status of patient was known (OR 2.6, 95% CI 1.5-4.6), who had experienced sharp injuries within the last year (OR 1.9, 95% CI 1.0-3.8) or who had been tested for HIV (OR 2.1, 95% CI 1.2-3.5), and among HCWs who had treated HIV-positive patients (OR 1.7, 95% CI 1.1-2.8). The majority of respondents had deficient knowledge about modes of HIV transmission. Attitudes towards HIV-positive patients were significantly different by occupation. Seventy per cent of HCWs used appropriate protection during their daily work with patients., Conclusions: HCWs require specific educational programmes and training protocols to ensure that they are adequately protected when carrying out high quality care.

The objective of the work was to study blood pressure and some anthropometric characteristics in children. The study design included the prevalence study at Belgrade, Serbia and Montenegro. The study comprised 1651 subjects (809 boys and 842 girls) aged 7-14 years, that is, 2.6% of all relevant population. The average levels of systolic and diastolic blood pressures (SBP and DBP) were 113.4/70.3 mmHg in boys and 114.6/71.1 mmHg in girls. High SBP was present in 4.7% of boys and in 5.3% of girls. High DBP was found in 5.6% of boys and in 4.8% of girls. According to multivariate regression analysis, in boys SBP and DBP were significantly associated with age, body mass index (BMI) and subscapular skinfold, SBP was also associated with body weight, and DBP with triceps skinfold. In girls, SBP was significantly related to BMI, suprailiac skinfold and body height, and DBP was significantly associated with BMI, suprailiac and subscapular skinfolds. The results of the present study support the opinion that BMI is a significant predictor of blood pressure in children and point out to suprailiac skinfold in girls as a possible predictor of blood pressure.