Rewarming curves and derived parameters in the diagnosis of hand-arm vibration syndrome.

BACKGROUND: Exposure to hand-arm vibrations is a known cause of the Hand-arm vibration syndrome (HAVS), a progressive syndrome beginning with sensory loss and leading to gangrene, making timely diagnosis essential. OBJECTIVES: Assessment of the usefulness of 9 diagnostic parameters claimed as being of greatest value in the diagnosis of HAVS, and examination of the complementary diagnostic value of the curve shapes. METHODS: Three groups of subjects (HAVS cases, exposed workers without irreversible changes, and controls) were examined by cold provocation followed by thermographic imaging, obtainment of rewarming curves for four preselected regions and calculation of parameters. The discriminative value of individual parameters and the discriminative power of a combination of all the parameters were assessed. Qualitative curve shape analysis was included. RESULTS: The greatest individual discriminative ability is associated with RT (rewarming time to pre-cooling value, p < 0.001), Tmax (maximum temperature during the 10-minute recovery, p < 0.001), k (rewarming rate, p < 0.012) and RD (rewarming delay, p < 0.031). The discriminant analysis yielded one significant discriminant function (Wilks' lambda = 0.278, chi2 (18) = 48.67, p < 0.001, canonical R2 = 0.63). Four types of rewarming curves were identified. CONCLUSIONS: RT, Tmax, k and RD appear to be the most suitable individual parameters for group discrimination. When linearly combined, the parameters can be useful for discriminating HAVS cases from both Controls and Claimants, which constitutes the main task of an occupational health physician. Additional information is available from the qualitative assessment of the rewarming curve shape.

Cigarette smoking in Serbia. Impact of the 78-day NATO bombing campaign.

PURPOSE: To estimate short-term and long-term influence of protracted stress caused by the NATO bombing of Serbia on self-reported cigarette smoking, we performed and analyzed smoking survey data. MATERIALS AND METHODS: The survey included 320 adult citizens from Sombor, Novi Sad, and Belgrade, three cities that were bombed during the NATO campaign along with other Serbian target cities. We queried participants about their smoking habits before, during, and 8 years after the military intervention. We recorded smoking prevalence rates, intentions to stop smoking, and the age at which smoking began. We also recorded smoking history and cessation attempts. RESULTS: Prior to bombing, 48% of the women and 63% of the men were smokers. During the bombing period, smoking prevalence in male smokers increased significantly. During this period, 32% of the women and 36% of the men increased their smoking by as much as two packs of cigarettes per week. A month after the bombing, the rate of consumption returned to the prewar levels. At present, 44% of the women, and 59% of the men smoke. The average age of current smokers is 43 years (standard deviation /SD/, 14.4) for women and 45 (SD, 16.3) years for men. Female smokers expressed greater interest in quitting smoking than their male counterparts, and they were slightly more successful than men at maintaining abstinence (20 vs. 18%). The participants in our study acknowledged that a compounding factor for successful abstinence was information on depleted uranium (DU) and other pollutants introduced into the environment by the war. CONCLUSION: Prolonged stress imposed by war causes a short-term increase in smoking prevalence in male smokers and higher cigarette consumption both in male and female smokers. Even though these increases dissipated after the war was over, the prevalence of smoking within the population of urban Serbia remains very high. Counseling and pharmacological support for abstinence relapse in Serbia ere insufficient to sustain smoking cessation during the 8-year period after the NATO bombing. Motivation for smoking cessation stems primarily from governmental regulatory measures and awareness of the dangers to health posed by tobacco smoking.

Twenty five years of antismoking movement started by medical students: some further goals.

Twenty five years ago, medical students of the former Yugoslavia accepted an idea that emerged from the Medical School in Tuzla to carry out a national preventive campaign "January 31st, a Day without Cigarette". This campaign was soon recognized by the World Health Organization (WHO) as one of "the most successful preventive achievement of medical students in Europe". The only contribution that the government made was printing and releasing a postal stamp on January 31st, 1990. During the war in Bosnia, the UN sanctions imposed to Serbia, and the NATO bombing campaign of the F.R. Yugoslavia (Serbia & Montenegro) weakened this antismoking campaign. At the time of the civil war in several Yugoslav republics, more citizens, including children and youth, started to smoke than in previous years. In 2002, January 31st was proclaimed as the National Antismoking Day in Serbia and the "Republic of Srpska" in Bosnia & Herzegovina; the Republic of Slovenia, and to a smaller extent the rest of the "Bosnian Federation", continued to observe this antismoking campaign. In the future, the medical professionals have to look for new ways to help smokers quit smoking and to maintain abstinence. In addition to education and professional advice, they may use smoking cessation interventions, especially to smokers that require elective surgery. Medical students should continue to participate in the national antismoking campaigns, and they could be included in the comprehensive smoking intervention programs to improve their smoking cessation counseling skills. However, the governments should plan and rigorously realize needed measures to control smoking at public places, offices, and other closed working places. Such measures are especially needed in poor and developing countries where many people die unnecessarily.

Strenuous exercise and action of antioxidant enzymes.

BACKGROUND: During the course of evolution, the antioxidant system has developed in order to prevent cell damage and to maintain equilibrium between production of free radicals and their neutralization. Because of increased oxygen consumption and energy utilization during physical work, oxidative stress may be expected. A review of current literature revealed no consistent data regarding activity of antioxidant enzymes during strenuous exercise. OBJECTIVES: The aim of this paper was to identify the activity of antioxidant enzymes in erythrocytes during strenuous short-term exercise. METHODS: The activity of superoxide dismutase (SOD), glutathione peroxidase (GPX), and glutathione reductase (GR) were investigated. Also, glucose-6-phosphate dehydrogenase (G-6-PDH) activity was studied in order to assess the level of recovery of reduced glutathione (GSH) by maintaining NADPH. Peripheral blood was drawn before (1) and immediately after (2) the test completed. Modified Astrand's protocol on a bicycle ergometer was used to achieve strenuous exercise in volunteers. RESULTS: The results obtained were: SOD1--897.95 +/- 99.85 U/g Hb and SOD2--828.38 +/- 75.12 U/g Hb; GPX1--30.19 +/- 4.03 U/g Hb and GPX2--26.00 +/- 4.85 U/g Hb; GR1--58.29 +/- 8.23 U/L and GR2--62.67 +/- 7.29 U/L; G-6-PDH1--14.97 +/- 3.79 IU/g Hb and G-6-PDH2--16.5 +/- 2.74 IU/g Hb. The difference was statistically highly significant: p < 0.001 for SOD, GPX, and GR activities, and p = 0.018 for G-6-PDH activity. CONCLUSION: The results reflect the presence of oxidative stress in erythrocytes after strenuous exercise. Further investigations should clarify the role of other antioxidant-relevant compounds during exercise such vitamins, trace elements, and metals and enable estimation of the level of damage caused by generation of free radicals (e.g., malonyl dialdehyde, 8-hydroxydeoxyguanosine etc.). All this information together will undoubtedly give us clear insight into free radical generation during strenuous workloads.

Comparison of certain biochemical changes during exercise tests on treadmill and bicycle-ergometer with equal workload intensity.

Ergometrics, using both treadmill (T) and bicycle-ergometer (B), plays an important role in assessing physical work capacity. In addition to the other important parameters (blood pressure, heart rate, oxygen consumption, oxygen and carbon dioxyde-partial pressure in blood, etc.), it is of interest to follow, measure and compare values of certain metabolic products immediately after completion of exercise on T and B. The aim of this study was to define which test develops the most significant changes in metabolic parameters when the same workload intensity is maintained. The metabolic parameters measured were: lactate, pyruvate, 2.3-diphosphoglycerate (2.3-DPG), lactate dehydrogenase (LDH) and aldolase activity. The mean values obtained at the end of both tests were: lactate 3.17 mmol/l +/- 1.017 mmol/l (T) and 4.28 mmol/l +/- 1.2 mmol/l (B); pyruvate 78.17 mumol/l +/- 30.32 mumol/l (T) and 92.16 mumol/l +/- 32.73 mumol/l (B); 2.3-DPG 3.58 mmol/l +/- 1.31 mmol/l (T) and 3.93 mmol/l +/- 1.44 mmol/l (B); LDH activity 239.22 U/I +/- 38.24 U/I (T) and 260.5 U/I +/- 61.27 U/I (B); aldolase activity 4.93 U/I +/- 1.45 U/I (T) and 5.88 U/I +/- 2.31 U/I (B). The results obtained indicate that a much higher production and/or lower elimination of acid metabolic products occurs during the test on B. This is most likely due to increased muscle pressure in big muscle groups in the legs which, by compressing the local blood vessels, diminish oxygen supply and the elimination of acid metabolic products. According to the results of the study, the use of T can be recommended as a more appropriate method for physical work capacity assessment of untrained individuals in occupational medicine.

[Psychophysiological fatigue in persons with normal and increased blood pressure during work with video display terminals]. / Psihofizioloski zamor kod osoba s normalnim i povisenim krvnim pritiskom pri radu s videoterminalom

In a field study, on the sample of 73 phototype-setters employed in newspaper press, various data of objective and subjective changes in psychophysiological functions were collected during work with Video Display Terminals. Using the "matched pairs" method, two groups were definitely formed; the first with normal blood pressure and the second with increased blood pressure. The subjects of 11 matched pairs within these two groups differed in value of blood pressure measured at the beginning of work, while they were matched with respect to sex, age, shift of work and the level of psychophysiological abilities that were examined at the beginning of work by fatigue tests. In addition to questionaries, the following methods were applied: flicker fusion frequency, dynamometry, reaction time measurement and measurements of retinal adaptation to darkness, convergence, stereoscopic vision and lateral phorias. The higher degree of general psychophysiological fatigue was discovered in group with increased blood pressure, but the same was not true for more specific visual fatigue that was more apparent in group of phototype-setters with normal blood pressure. According to one division of the degree of fatigue based on investigation of 50 different occupations with combined mental and physical work, it can be concluded that the degree of fatigue that was found in the group of phototype-setters with increased blood pressure during work with Video Display Terminals, is relatively the highest, so that it is very difficult for workers to adjust to it in biological sense.

[Effect of heterologous seminal plasma on the improvement of the quality of the ejaculate]. / Untersuchungen über die Wirkung von fremdem Seminalplasma auf die Verbesserung der Qualität des Ejakulates.

Seminal plasma from oligozoospermic ejaculates and ejaculates with high rate of pathological spermatozoa was substituted for seminal plasma from normal ejaculates in experiments carried out in order to improve the ejaculate quality. In these experiments the improvement of ejaculate quality could not be established. The progressive increase of 20% in the motility of spermatozoa was recorded, in 4 out of 7 ejaculates with hypokinetic motility of spermatozoa where plasma was substituted, while in one case the motility remained unchanged. When plasma from normal ejaculates was substituted for plasma from ejaculates of poorer quality, the intensity of the motility of spermatozoa decreased for 10-20% in 3 of cases while in 1 it remained unchanged. Deep freezing of ejaculates after seminal plasma was substituted did not gain satisfactory results except when cases of substitution for plasma from normal ejaculates were concerned.

[Cervical mucus as a barrier to conception and spermatozoa migration]. / O cervikalnoj sluzi kao barijeri koncepcije i migraciji spermatozoida.

Cervical mucus plays an important role in the migration of spermatozoids only in certain species. The transport of spermatozoids through the cervix is greatly influenced by seminal protease, the pH of the cervical mucus, proteins, immune antibodies of the seminal plasma, and ovarian hormones. A considerable part in the mechanism of spermatozoid migration through the uterus and tubes, along with their own motility, the chemotaxis of the ovarian cell, and prostaglandin, is played also by oxytocin. Apart from the well-known effect of this hormone on the transport of spermatozoids, its small doses stimulate the elimination of luteinizing hormones, in which way they enhance success in fertilization, and this has been substantiated by an experiment in 413 animals. A successful fertilization is greatly ensured also by the capacitation of spermatozoids.

[Current results and methods in eradication of typhus fever on the Serbian territory excluding autonomic provinces]. / Dosadasnji rezultati i metode u eradikaciji pegavog tifusa na teritoriji Srbije van autonomnih pokrajina

Since 1969 Serbia has been conducting the programme of eradication louse-borne typhus. To this effect of Law on the eradication of communicable diseases has been passed. In addition to Republic Commission, as well as 6 regional commissions, and 18 communal commissions in whose territory the disease is being eradicated, have been formed. The operations consist of four phases: preparatory attack, consolidation and final phase. The methods and measures applied under the programme include the measures concerned with the control of vectors, i.e. lousiness, measures to detect the source of infection, respectively patients with louse-borne typhus and Brill-Zinsser disease. The control of louseiness effected through the impregnation of underwears and bed linens by means of syntheic insecticides (DDT, Maltox), as well as through health education activities, has yielded good results, so that the highest rate of lousiness: 9.08% (Sjenica, Tutin 4.37%), was reduced to less than 1% in 1972. To detect the source of infection, both active and pasiive investigation has been carried out. Active investigation included regular control of the health state through thermometry applied to registered households with lice. Passive investigation is carried out trough out -patient units and residential services which take care of all febrile patients coming from endemic areas. The results obtained from the three-year operations indicate that the percentage of dected patients with Brill-Zinsser amounts to 0--4--3.9%, as well as that it is still lagging behind with respect to the immunity acquired through previous affections in the endemic areas. The distribution of detected patients with Brill-Zinsser especially indicates that a small number of patients from endemic ares has been detected. The paper presents the criteria for the evaluation of results, making a proposal that a professional body should be formed at the federal level to coordinate the methods and programmes of operations. In addition that body's task would be to expand the operations to all endemic areas in the country.