The Influence of Hyperthyroidism on the Coagulation and on the Risk of Thrombosis.

Introduction: Apart from the well-known fact that hyperthyroidism induces multiple prothrombotic disorders, there is no consensus in clinical practice as to the impact of hyperthyroidism on the risk of thrombosis. The aim of this study was to examine the various hemostatic and immunologic parameters in patients with hyperthyroidism. Methods: Our study consists of a total of 200 patients comprised of 64 hyperthyroid patients, 68 hypothyroid patients, and 68 euthyroid controls. Patient thyroid status was determined with standard tests. Detailed hemostatic parameters and cardiolipin antibodies of each patient were determined. Results: The values of factor VIII (FVIII), the Von Willebrand factor (vWF), fibrinogen, plasminogen activator inhibitor-1 (PAI-1), and anticardiolipin antibodies of the IgM class were significantly higher in the hyperthyroid patients than in the hypothyroid patients and euthyroid controls. The rate of thromboembolic manifestations was much higher in hyperthyroid patients (6.25%) than in hypo-thyroid patients (2.9%) and euthyroid controls (1.4%). Among hyperthyroid patients with an FVIII value of ≥1.50 U/mL, thrombosis was recorded in 8.3%, while in hyperthyroid patients with FVIII value ≤ 1.50 U/mL the occurrence of thrombosis was not recorded. The incidence of atrial fibrillation (AF) was significantly higher (8.3%) in the hyperthyroid patients compared to the hypothyroid patients (1.5%) and euthyroid controls (0%). Conclusions: High levels of FVIII, vWF, fibrinogen, PAI-1, and anticardiolipin antibodies along with other hemostatic factors contribute to the presence of a hypercoaguable state in patients with hyperthyroidism. The risk of occurrence of thrombotic complications is especially pronounced in patients with a level of FVIII exceeding 150% and positive anticardiolipin antibodies of the IgM class. Patients with AF are at particularly high risk of thrombotic complications due to a hyperthyroid prothrombotic milieu.

The timeline of blood pressure changes and hemodynamic responses during an experimental noise exposure.

BACKGROUND: Noise exposure increases blood pressure and peripheral vascular resistance in both genders in an experimental setting, as previously reported by the authors. OBJECTIVES: The aim of this re-analysis was to present the minute-by-minute timeline of blood pressure changes and hemodynamic events provoked by traffic noise in the young and healthy adults. METHODS: The experiment consisted of three 10-min phases: rest in quiet conditions before noise (Leq = 40 dBA), exposure to recorded road-traffic noise (Leq = 89 dBA), and rest in quiet conditions after noise (Leq = 40 dBA). Participants' blood pressure, heart rate, and hemodynamic parameters (cardiac index and total peripheral resistance index) were concurrently measured with a thoracic bioimpedance device. The raw beat-to-beat data were collected from 112 participants, i.e., 82 women and 30 men, aged 19-32 years. The timeline of events was created by splitting each experimental phase into ten one-minute intervals (30 intervals in total). Four statistical models were fitted to answer the six study questions what is happening from one minute to another during the experiment. RESULTS: Blood pressure decreased during quiet phase before noise, increased in the first minute of noise exposure and then decreased gradually toward the end of noise exposure, and continued to decline to baseline values after noise exposure. The cardiac index showed a gradual decrease throughout the experiment, whereas total vascular resistance increased steadily during and after noise exposure. CONCLUSIONS: The timeline of events in this 30-min experiment provides insight into the hemodynamic processes underlying the changes of blood pressure before, during and after noise exposure.

Predisposing Factors Responsible for the Occurrence of Bacterial Purulent Meningoencephalitis

Bacterial purulent meningoencephalitis (BPME) is a life-threatening infectious disease caused by various pyogenic bacteria. The disease is defined as the inflammatory process of leptomeninges (visceral layer, pia mater and arachnoid membrane) and brain parenchyma with exudates in the subarachnoid space and surrounding brain structures. The aim of the study was to define the predisposing factors responsible for the occurrence of BPME, as well as the possible correlation between the presence of predisposing factors and patient demographic characteristics, etiology and outcome of the disease. This retrospective-prospective study included 90 patients with BPME confirmed by clinical, neuroradiological and laboratory findings. Multivariate logistic regression models were fitted to analyze the impact of the predisposing factors on the disease outcomes. Predisposing factors that were related to BPME were found in 61% of patients. Cranial trauma as the leading factor was recorded in 23.3% of patients, followed by previous neurological disease in 14.4% of patients, while 13 patients were exposed to previous chemotherapy or long-term corticosteroid therapy. Cardiovascular diseases were reported in 12.2% and diabetes in 7.8% of patients. The existence of cardiovascular diseases significantly influenced unfavorable outcome of the disease, i.e. "deceased" in comparison to "cured" (OR=8.418; 95% CI=1.007-76.270), independently of age and gender. None of the examined predisposing factors was significantly related to the "recovered with sequels" outcome as compared with "cured" outcome. Older age and presence of cardiovascular disease as a predisposing factor significantly increased the odds of the BPME unfavorable outcome "deceased" as compared to "cured" outcome.

Suitability of blood-pressure-to-height ratio as the criterion for high blood pressure in children in an environmental study.

BACKGROUND: Blood-pressure-to-height ratio is considered a simple, accurate, inexpensive and non-age-dependent index for screening high blood pressure in a clinical setting, but its suitability in epidemiological surveys was not taken into consideration. The aim of this study was to test the suitability of blood-pressure-to-height ratio against blood pressure for age percentiles for the identification of high blood pressure in an environmental study. METHODS: The sample consisted of 2195 children, aged 3 to 15 years, whose blood pressure was measured as part of an environmental study in Belgrade, Serbia. High blood pressure was estimated using percentiles (gold standard) and blood-pressure-to-height ratios for systolic and diastolic pressures separately (proposed criterion). The optimal cut-offs of the blood-pressure-to-height ratio (BPHR) were selected based on Youden's index (sensitivity + specificity - 1) calculated from the receiver operator characteristic curve analysis. RESULTS: The proposed criterion identified five times more cases of high blood pressure in the investigated children of all age groups in comparison to the gold standard. The optimal cut-off values were selected based on the sensitivity and specificity values by age groups and gender. CONCLUSION: Blood-pressure-to-height ratio can be a reliable criterion for the estimation of high blood pressure in epidemiological studies. This is the first study on the applicability of blood-pressure-to-height ratio in Serbian children, but it may not be easily generalized to other populations due to small sample size across the examined age groups and potential diversities in risk factors for high blood pressure. Applied in epidemiological studies, BPHR would help researchers estimate the role of certain environmental factors on blood pressure in children.

Noise annoyance is related to the presence of urban public transport.

BACKGROUND: The association between noise annoyance and public transport as a source of noise has not been studied previously. The aim was to study noise annoyance in an urban population due to the presence, the type and the number of public transport vehicles, in relation to other acoustical and non-acoustical parameters. METHOD: The study sample comprised 5861 adults residing in 118 streets in the city center of Belgrade. The presence, the type and the number of public transport vehicles were assessed using official transport maps and matched with residential addresses. Noise annoyance was assessed by a questionnaire including a self-report five-graded scale. 'High noise annoyance' was defined by merging 'very' and 'extremely' annoyed answers. RESULTS: Significant predictors of high noise annoyance were the presence of public transport at daytime (yes vs. no) (odds ratio=1.47, 95% confidence interval=1.28-1.70), and at night (yes vs. no) (OR=1.39, 95% CI=1.20-1.61). Residing in the streets with more than 79 public transport vehicles per hour (3rd tercile vs. 1st tercile) predicted high noise annoyance at daytime (OR=1.64, 95% CI=1.18-2.27). Residing in the streets with buses and trams at night ('bus and tram' vs. no public transport) increased the risk of high noise annoyance (OR=2.67, 95% CI=1.78-4.09). These associations were independent from noise sensitivity, orientation of bedroom windows, floor level, and equivalent noise levels. Living in the apartment with bedroom windows facing the street was the strongest confounder for the association between noise annoyance, noise levels and public transport. CONCLUSION: The study has identified the presence of public transport at daytime and at night as a significant and independent predictor of high noise annoyance. Future intervention measures should concern the presence, the type and the number of public transport vehicles in order to reduce noise annoyance reactions in urban areas.

Thoracic bioelectrical impedance assessment of the hemodynamic reactions to recorded road-traffic noise in young adults.

Noise exposure increases blood pressure in both experimental and field studies. The underlying mechanisms may be evaluated by thoracic bioelectrical impedance. The aim of this experimental study was to assess changes in blood pressure, cardiac and hemodynamic parameters provoked by recorded traffic noise in young adults. The study included 130 participants (42 men and 88 women), aged 24.88±2.67 years. Thoracic electrical bioimpedance device was applied to monitor cardiac parameters, hemodynamic parameters, heart rate variability, blood pressure and heart rate. The testing procedure consisted of three phases. Participants were exposed to recorded road-traffic noise (Leq=89dBA) for 10min and relaxed in quiet conditions (Leq=40dBA) before and after noise exposure. Listening to recorded noise resulted in significant decrease of stroke volume and cardiac output, and an increase of vascular resistance. Heart rate variability and the overall sympathovagal balance remained similar through all experimental conditions. During noise exposure, systolic pressure increased by 2mmHg among women (95% confidence interval=0.97-2.73mmHg), and by 4mmHg among men (95% confidence interval=2.16-5.00mmHg). Similarly, diastolic pressure increased by 2mmHg among women (95% confidence interval=0.95-2.47mmHg), and by 4mmHg among men (95% confidence interval=2.46-5.28mmHg). Once noise ceased, both pressures returned to pre-exposure levels. Experimental exposure to recorded road-traffic noise of 89dBA for 10min provoked significant hemodynamic changes in young adults, including vasoconstriction (increase of vascular resistance), and hypodynamics (decrease of global heart flow). The interaction of these effects resulted in the elevation of blood pressure during noise exposure.

The pathophysiological basis of carotid baroreceptor stimulation for the treatment of resistant hypertension.

The prevalence of resistant hypertension and existing limitations in antihypertensive drug therapy renders the interventional management of hypertension an attractive alternative. Carotid baroreceptors have been traditionally thought to be implicated only in short-term blood pressure regulation; however recent evidence suggests that the baroreceptors might play an important role even in the long-term blood pressure regulation. Electrical baroreflex stimulation appears safe and effective and might represent a useful adjunct to medical therapy in patients with resistant hypertension. This review endeavors to summarize the complex pathophysiology of blood pressure regulation, to describe the baroreflex circuit, its anatomy and physiology, to present previous data refuting a role for the baroreceptors in the long-term control of blood pressure and recent animal and human data suggesting an effective role of carotid baroreceptor activation in long-lasting blood pressure reduction. In this paper we attempt to critically evaluate existing information in this area and provide the scientific basis for carotid baroreceptor stimulation in the management of resistant hypertension.

Prevalence of arterial hypertension in Serbia: PAHIS study.

BACKGROUND: Arterial hypertension (AH) is the most common cardiovascular disease risk factor, affecting between 30 and 50% of the adult population in developed countries. A steady increase of the prevalence of AH by about 60% is expected by year 2025. METHODS: Serbian Society of Hypertension conducted a prevalence study from February to May 2012 on a sample of 3878 adult respondents. The study included 2066 women (53.3%) and 1812 men (46.7%). Average age was 48.89 ±â€Š17.48 years. Most participants resided in urban areas (2956 people, 76.2%), whereas 922 resided in rural areas (23.8%). RESULTS: The prevalence of AH in Serbia is 42.7%. Hypertension is more frequently diagnosed among women (53.3%), than among men (46.7%). One thousand, four hundred and twelve respondents were previously diagnosed and treated for hypertension. The estimated awareness of the presence of AH was 42.99% (i.e. 40.00% among male and 45.41% among female participants). Out of all diagnosed cases of hypertension, 390 persons (27.7%) have well regulated blood pressure values, whereas 1022 persons (72.3%) do not have their blood pressure under control. CONCLUSION: Serbia belongs to countries with a high prevalence of AH. A poor control of AH may be explained in view of socioeconomic problems. High prevalence of AH may indicate a remarkably high cardiovascular disease mortality in Serbia.

Blood pressure of urban school children in relation to road-traffic noise, traffic density and presence of public transport.

The aim of the study was to investigate the relationship between noise levels, traffic density and the presence of public transport and children's blood pressure. Another aim was to assess the applicability of public transport as a proxy indicator of noise exposure. A cross-sectional study involved 1113 children aged 7-11 years from a central municipality in Belgrade. Equivalent noise levels were measured in front of all schools and in the middle of all streets. Traffic density was defined as number of light and heavy vehicles per hour. The number of public transport vehicles was calculated from official timetables. Children's addresses were matched with noise levels and transport maps. A physician measured blood pressure with the sphygmomanometer. Children attending schools with public transport running nearby had by 1.3 mmHg higher systolic pressure than did children from schools without public transport. This relationship was independent from children's age, gender, and body mass index, family history of hypertension, some dwelling characteristics, and lifestyle habits. The association between diastolic pressure and public transport was statistically insignificant. The study indicated a possible positive association between the presence of public transport in the vicinity of schools with systolic blood pressure in 7-11 year-old schoolchildren. The presence of public transport may serve as an auxiliary indicator of noise exposure in undeveloped countries with limited capacities for noise measurement or modeling.

Low levels of arsenic in drinking water and type 2 diabetes in Middle Banat region, Serbia.

Arsenic in drinking water presents a serious public health problem in Serbia, but its relationship with diabetes has not been studied previously. The aim of this study was to explore the association between exposure to arsenic in drinking water and the occurrence of type 2 diabetes in Middle Banat region, Serbia. This cross-sectional study comprised two populations. Exposed population in Middle Banat region consumes drinking water with arsenic (mean = 56 µg/L); unexposed population from six regions in Central Serbia consumes arsenic below detection limit (2 µg/L). Newly diagnosed cases of type 2 diabetes were obtained from the National Registry of Diabetes in 2008. The Registry included age, gender, family history of diabetes, presence of overweight, central obesity, cholesterol and triglyceride levels. In addition, the number of cases of diabetes reported in years 2006, 2007 and 2009 was used to calculate standardized incidence rates for both populations. Two populations were comparable by age, family history of diabetes and prevalence of overweight persons. Unexposed population was more likely to have central obesity, and high total cholesterol and triglycerides. Standardized incidence rates of type 2 diabetes were higher in exposed population. Odds ratios for type 2 diabetes were significantly higher for the exposed population, both men and women, in the period from 2006 to 2009, when compared with the unexposed population. The population from Middle Banat region, consuming drinking water with low levels of arsenic, was at higher risk for the occurrence of type 2 diabetes in comparison to the unexposed population in Central Serbia.

Arsenic in drinking water and acute coronary syndrome in Zrenjanin municipality, Serbia.

BACKGROUND: Arsenic is constantly present in drinking water supply systems of Zrenjanin municipality across decades. It presents a great public health problem in Serbia, but its relationship with acute coronary syndrome (ACS) has not been studied previously. OBJECTIVES: The aims of this study were to assess the incidence of ACS in two areas from Zrenjanin municipality consuming different levels of arsenic in drinking water, and to explore the association between arsenic exposure and the probability of fatal outcome of ACS. METHODS: The research was a registry-based ecological study of two populations consuming water with different arsenic levels, based on current guidelines (10 µg/L). Median arsenic in the area above national standard was 80 µg/L; median arsenic in the other area was 1 µg/L. Newly diagnosed cases of ACS were obtained from the National Registry for Acute Coronary Syndrome from 2006 to 2010. RESULTS: The two populations were comparable by age, gender, and prevalence of risk factors for ACS. Standardized incidence rates (SIR) of ACS were higher for people consuming arsenic above standard (average five-year SIR was 237.00 per 100.000; 95% CI=214.93-260.74), in comparison to people consuming arsenic within limits (average SIR=124.40 per 100.000; 95% CI=96.00-158.56). Exposure to arsenic above limits was insignificantly associated with fatal outcome of ACS for the whole population, men and women. CONCLUSIONS: Consumption of arsenic above national standards was associated with higher risk for the occurrence of acute coronary syndrome and with insignificantly higher probability of fatal outcome of ACS in Zrenjanin municipality.

Favourable prognostic factors in therapy related acute myeloid leukaemia.

INTRODUCTION: Therapy related acute myeloid leukaemia (t-AML) is a distinct clinical entity recognized by the World Health Organization classification occurring after chemotherapy and/or radiation treatment administered for a previous disease. T-AML is characterised by pancytopenia, three-lineage myelodysplasia, high frequency of unfavourable cytogenetics and short survival. OBJECTIVE: The aim of this study was to analyse clinical, cytogenetic, and cytological characteristics of t-AML and their impact on survival. METHODS: Seventeen patients with t-AML (8 male and 9 female; median age 59 years) were identified among 730 consecutive patients with acute myeloid leukaemia. The degree of three-lineage dysplasia as well as haematological, cytological and cytogenetic analyses, were assessed by standard methods. RESULTS: The patients survived a median of 62.5 days with the 10% probability of survival during two years. Prognostically favourable factors were a higher percentage of dysplastic granulocytic cells, age less than 60 years, and presence of prognostically favourable karyotype inv(16), t(15;17), t(8;21). CONCLUSION: The stated prognostic factors that include age, cytogenetics findings and granulocytic dysplasia analysis could contribute to adequate risk stratification of t-AML, though fuller results would require additional analyses.

Cardiovascular effects of environmental noise: research in Serbia.

Research on the cardiovascular effects of noise in Serbia started in the year 2002, including experimental studies on humans and epidemiological studies on the adult and children population of Belgrade and Pancevo. Experimental exposure to noise [L eq = 89 dB (A)] had a hypodynamic effect, significantly lowering the cardiac index, cardiac work, and pump performance (P < 0.01). The vasoconstrictive effect of noise was shown through the significant elevation of after-load (P < 0.01). In a cross-sectional population study that was carried out on 2874 residents [1243 males and 1631 females] in Pancevo City, a significant odds ratio (adjusted for age, body mass index (BMI), and smoking habits) was found for self-reported hypertension (OR = 1.8, 95% CI = 1.0 - 2.4, P < 0.01) in men with a high level of noise annoyance compared to those with a low level of noise annoyance. In another study on 2503 residents (995 men and 1508 women) residents of Belgrade, the proportions of men with hypertension in the noisy [(L night , 8h > 45 dB (A)] and quiet areas [(L night , 8h ≤ 45 dB (A)] were 23.6% and 17.5%, respectively. The adjusted odds ratio (OR) for hypertension of the exposed group was 1.58 (95% CI = 1.03 - 2.42, P = 0.038), where men living in quiet streets were taken as a reference category. Associations between road traffic noise and blood pressure were also investigated in 328 preschool children in Belgrade. The systolic blood pressure was significantly higher among children from noisy residences and kindergartens, compared to children from both quiet environments (97.30 ± 8.15 and 92.33 ± 8.64 mmHg, respectively, P < 0.01). As a continuation of the study on preschool children, investigations were also carried out on 856 school children, aged between seven and eleven years, in Belgrade. It was found that systolic pressure was significantly higher among children from noisy schools and quiet residences, compared to children from both quiet environments (102.1 ± 9,3 and 100.4 ± 10.4 mmHg, respectively, P < 0.01).

Obesity and fat distribution as predictors of aortoiliac peripheral arterial disease in middle-aged men.

BACKGROUND: Peripheral arterial disease (PAD) in the aortoiliac segment is found in nearly a half of patients with PAD. The aim of this study was to estimate the influence of obesity and fat distribution on the occurrence of aortoiliac PAD in middle-aged men. METHODS: This case-control study included 204 middle-aged men (mean 58±7 years; range 45-70 years): 102 patients with aortoiliac PAD and 102 healthy controls without PAD. Aortoiliac PAD was diagnosed by ankle-brachial index (ABI) and angiography. Body mass index (BMI) was categorized as: normal weight, overweight, and obese. Percents of body fat were grouped according to quartile distribution. The relationship between anthropometrics and aortoiliac PAD was estimated by multivariate logistic regression. RESULTS: Patients with aortoiliac PAD had higher body mass index, waist circumference, waist-hip ratio and percent of body fat. A strong correlation between all anthropometric parameters and ABI index and mean angiographic score was shown among patients with PAD. Multivariate regression, adjusted for blood pressure and cholesterol level, identified being overweight, body fat over 26.5% and WHR over 1.02 as predictors for aortoiliac PAD. Body fat over 26.5% and WHR over 1.02 remained significant after further adjustment for blood pressure, cholesterol and body mass index. CONCLUSION: This study has identified the quantity of fat tissue (body fat over 26.5%) and its visceral distribution (waist-hip ratio over 1.02) as predictors of aortoiliac PAD in middle-aged men. Body mass index, a crude indicator of obesity, should be combined with these parameters when assessing the risk for aortoiliac PAD.

Assessment of the left ventricular chamber stiffness in athletes.

Since diastolic dysfunction is an early sign of the heart disease, detecting diastolic disturbances is predicted to be the way for early recognizing underlying heart disease in athletes. So-called chamber stiffness index (E/e')/LVDd was predicted to be useful in distinguishing physiological from pathological left ventricular hypertrophy, because it was shown to be reduced in athletes. It remains unknown whether it is reduced in all athletic population. Standard and tissue Doppler were used to assess cardiac parameters at rest in 16 elite male wrestlers, 21 water polo player, and 20 sedentary subjects of similar age. In addition to (E/e')/LVDd index, a novel (E/e')/LVV, (E/e')/RVe'lat indices were determined. Progressive continuous maximal test on treadmill was used to assess the functional capacity. VO(2) max was the highest in water polo players, and higher in wrestlers than in controls. LVDd, LVV, LVM/BH(2.7) were higher in athletes. Left ventricular early diastolic filling velocity, deceleration and isovolumetric relaxation time did not differ. End-systolic wall stress was significantly higher in water polo players. RV e' was lower in water polo athletes. Right atrial pressure (RVE/e') was the highest in water polo athletes. (E/e'lat)/LVDd was not reduced in athletes comparing to controls (water polo players 0.83 ± 0.39, wrestlers 0.73 ± 0.29, controls 0.70 ± 0.28; P = 0.52), but (E/e's)/RVe'lat better distinguished examined groups (water polo players 0.48 ± 0.37, wrestlers 0.28 ± 0.15, controls 0.25 ± 0.16, P = 0.015) and it was the only index which predicted VO(2) max. In conclusion, intensive training does not necessarily reduce (E/e'lat)/LVDd index. A novel index (E/e's)/RVe'lat should be investigated furthermore in detecting diastolic adaptive changes.

Arsenic occurrence in drinking water supply systems in ten municipalities in Vojvodina Region, Serbia.

Vojvodina, a northern region of Serbia, belongs to the Pannonian Basin, whose aquifers contain high concentrations of arsenic. This study represents arsenic levels in drinking water in ten municipalities in Serbia. Around 63% of all water samples exceeded Serbian and European standards for arsenic in drinking water. Large variations in arsenic were observed among supply systems. Arsenic concentrations in public water supply systems in Vojvodina were much higher than in other countries in the Pannonian Basin.

Predictors of noise annoyance in noisy and quiet urban streets.

OBJECTIVES: Although noise annoyance is a major public health problem in urban areas, there is a lack of published data on predictors for noise annoyance in acoustically different urban environments. The aim of the study was to assess the predictive value of various factors on noise annoyance in noisy and quiet urban streets. METHODS: Equivalent noise levels [Leq (dBA)] were measured during day, evening and night times in all of the streets of a central Belgrade municipality. Based on 24-hour noise levels, the streets were denoted as noisy (24-hour Leq over 65 dBA), or quiet (24-hour Leq under 55 dBA). A cross-sectional study was performed on 1954 adult residents (768 men and 1186 women), aged 18-80 years. Noise annoyance was estimated using a self-report five-graded scale. In both areas, two multivariate logistic regression models were fitted: the first one with nighttime noise indicators and the other one with parameters for 24-hour noise exposure. RESULTS: In noisy streets, the relevant predictors of high annoyance were: the orientation of living room/bedroom toward the street, noise annoyance at workplace, and noise sensitivity. Significant acoustical factors for high noise annoyance were: nighttime noise level [OR=1.02, 95%CI=1.00-1.04 (per decibel)], nighttime heavy traffic [OR=1.01, 95%CI=1.00-1.02 (per vehicle)]; or day-evening-night noise level (Lden) [OR=1.03, 95%CI=1.00-1.07 (per decibel)]. In quiet streets, the significant predictors were: noise sensitivity, the time spent at home daily, light vehicles at nighttime or heavy vehicles at daytime. CONCLUSIONS: Our study identified subjective noise sensitivity as a common annoyance predictor, regardless of noise exposure. Noise levels were important indicators of annoyance only in noisy streets, both for nighttime and 24-hour exposure. We propose that noise sensitivity is the most relevant personal trait for future studies and that nighttime noise levels might be as good as Lden in predicting annoyance in noisy urban areas.

Road-traffic noise and factors influencing noise annoyance in an urban population.

Noise annoyance is influenced by sound-related factors: type of noise, noise level and frequency, and person-related factors-physiological, psychological, and social factors. Prior to implementation of the Directive 2002/49/EC of the European Parliament and of the Council in Serbia, there was a need for the first comprehensive study on noise annoyance in Serbian urban population. The aim of this study was to determine principal factors for high noise annoyance in an adult urban population and to assess their predictive value. A cross-sectional study was performed on 3097 adult residents of a downtown municipality in Belgrade (1217 men and 1880 women), aged 18-96 years. Equivalent noise levels [Leq (dBA)] were measured during day, evening and night in all streets of the municipality. Noise annoyance was estimated using self-reported annoyance scale. Noise annoyance showed strong correlation with noise levels, personal characteristics and some housing conditions. Dose-response relationship was found between the percentage of highly annoyed residents and Lden. Logistic regression model identified increased risk for a high level of noise annoyance with regard to: orientation of living room/bedroom toward the street (Odds Ratio=2.60; 95% Confidence Interval=2.04-3.31), duration of stay at apartment during the day [OR=1.04, 95%CI=1.02-1.06 (per hour)], noise sensitivity [OR=1.04, 95%CI=1.03-1.04 (per scale unit)], and nighttime road-traffic noise level [OR=1.03, 95%CI=1.02-1.04 (per decibel)].

[Changes and variations of body weight as risk factors for coronary heart disease].

INTRODUCTION: Weight variations are a common phenomenon. Therefore, concern has been raised about the association between weight changes and weight variations and coronary heart disease (CHD). The aim of this study was to estimate the influence of weight change and weight variations as risk factors for coronary heart disease. MATERIALS AND METHODS: The investigation was conducted as an observational cross-sectional study, including 102 participants of both genders: 61 patients with CHD and 41 healthy controls. All participants underwent anthropometric measurements and completed a questionnaire that included 1) weight changes in adulthood (maximum and minimum weight), 2) presence and number of weight variations in the 10 years prior to the onset of disease and 3) the size of weight change (weight gain or weight loss in kg). One weight variation was defined as weight loss followed by weight gain for more than 10% of body weight, or about 7 kg. Multivariant logistic regression was used for the estimation of significant predictors for the occurrence of coronary heart disease. RESULTS: Participants with CHD had higher values of body weight in adulthood compared to healthy controls, larger number of weight variations in the last 10 years, and more frequently reported weight gain and weight loss for more than 10 kg. The highest risk for the occurrence of coronary heart disease was observed for participants who had more than 3 weight variations for 10% (OR = 2.13; 95% CI = 0.98-5.48), those with weight loss over 10 kg (OR = 2.16; 95% CI = 1.71-2.72) and those with weight gain over 10 kg (OR = 2.71: 95% CI = 1.08-6.83), regardless of gender, age, smoking, body mass index and blood pressure. DISCUSSION: Several mechanisms are suggested to explain the relationship between weight changes and variations and coronary heart disease, including changes in plasma lipid levels, insulin levels. decrease of HDL cholesterol, increase of C-reactive protein and increase of blood pressure. CONCLUSION: This study suggests that frequent and very intense weight changes can be considered important predictors for the occurrence of coronary heart disease.

Arsenic and bladder cancer: observations and suggestions.

Arsenic from drinking water is a well-known risk factor for bladder cancer. The purpose of this paper is to systematize some important yet often overlooked facts considering the relationship between arsenic exposure and the occurrence of bladder cancer. Since the exposure to inorganic arsenic from food, inhaled air, and skin absorption as well as arsenic methylation ability are not fully investigated, our assumption is that the exposure of arsenic only from drinking water is underestimated and its role as a risk factor is highly overestimated. This paper proposes some qualitative and quantitative parameters of arsenic as a risk factor for bladder cancer. The recommended qualitative parameters of arsenic intake are first, pathways of exposure, and second, toxicity and metabolism. The suggested quantitative parameters of arsenic intake include amounts of arsenic absorbed in the body, duration of arsenic exposure, and duration of arsenic presence in the urinary bladder. This approach can be implemented in a systematic classification and explanation of various risk factors and their mutual interactions for other types of cancer or diseases in general.