Therapeutic efficacy of "Milgamma" in patients with painful diabetic neuropathy.

Forty-five diabetes patients with painful peripheral polyneuropathy were enrolled in a 3-month observational study comparing the therapeutic efficacy of Milgamma tablets (50 mg benfothiamine and 0.25 mg cyancobalamine) with parallel randomized treatment assignment with the conventional vitamin B complex treatment regimen Neurobex. Thirty patients in group one were randomized to receive two Milgamma tablets qid for three weeks followed by 1 Milgamma tablet tid for 9 weeks. In group two 15 patients received two Neurobex tablets tid for the entire 3-month study period. Therapeutic efficacy was assessed on the basis of within-patient differences in pain severity between Milgamma and Neurobex-treated patients and in vibration perception thresholds using the Rydel-Seiffer biothesiometer at baseline and at the end of the study. Statistically significant relief of both background and peak neuropathic pain was achieved in all of the Milgamma-treated patients and vibration perception thresholds dramatically improved with a median of 1.56 measured on the biothesiometer scale (t = 3.24, P < 0.01). The sensory symptoms improvement was insignificant in the Neurobex-treated patient group and the changes in the vibration perception thresholds failed to reach statistical significance. The therapeutic efficacy of Milgamma was greater in patients with early-stage diabetes as compared with those with advanced diabetic neuropathy. No adverse reactions were observed following the administration of the medication. Our results underscore the importance of Milgamma tablets as an indispensable element in the therapeutic regimen of patients with painful diabetic polyneuropathy.

Percutaneous ethanol sclerotherapy of autonomous thyroid nodules: preliminary results.

Percutaneous ethanol sclerotherapy was applied to 20 patients (17 women and 3 men, aged 30 to 77 yrs) with autonomous thyroid nodules. The patients either were contraindicated because of hazardous concomitant diseases or refused surgical or 131I treatment. Ethanol (95 alc%) was injected in 4 to 6 sessions at a mean dose of 0.63 ml/cc nodular tissue. Physical examination, T3, T4 and TSH assays, thyroid scintigraphy, sonography, and fine needle aspiration biopsy were used to evaluate the treatment results within a 12-month follow-up. Two months after ethanol injection all patients showed an improvement; in six patients the symptoms recurred in the 6th month. Two of them underwent a second cycle of ethanol injection. 12 months later an euthyroid state was maintained in 16 (80%) patients, while 4 (20%) did not respond to the treatment. The treatment results were markedly determined by the nodule size as no effect was achieved in nodules larger than 15-20 ml in volume. This method appears to be an appropriate and harmless alternative to the surgical and 131I treatment of autonomous thyroid nodules less than 15-20 ml in volume, especially in patients with grave concomitant diseases.

[An occupational physiology study at the Asarel Mining and Milling Works. The evaluation of the work load in the basic jobs in an open-pit mine]. / Trudovo-fiziologichno prouchvane v MOK "Asarel". Otsenka na tezhestta na truda pri osnovni profesii v otkritiia rudnik.

This occupational physiology study was undertaken within a wider applied-research framework designed to evaluate the occupational environment and its impact on workers at "Asarel" Mining and Milling Works. Analysis of activities showed physical effort (dynamic and static) to be the major problem at the open pit, though varying in extent between jobs (most prominent for blasters and bulldozerists). Nervous/emotional strain, while not leading, was sustained mostly by diggers and blasters, followed by drivers. Organization of work (shift regimen, no regulated breaks, stepwise schedule of days off work) was hardly appropriate and did not allow for recovery. Interviewed workers qualified working conditions as extremely unfavorable; they disapproved with the physical factors of the occupational environment, the workplace, the state of machines and devices, and remuneration for work performed. Exertion from work, assessed by pulse rate and energy expended, was moderate for most activities of diggers, drivers, and drillers. The burden of physical effort was great for blasters at the open pit and for diggers and drillers performing extra repair operations (pulse rate, 100-110 strokes/min; energy expended, 5.2-5.5 Kcal/min). Hardest and least attractive was the work of blasters at stores for explosive materials (pulse rate, 120-141 strokes/min; energy expended, 5.5-6.5 Kcal/min). These adverse factors of labor activities might produce a negative impact on worker health and performance, leading to occupational impairment of their musculoskeletal system, to labor-related disorders of their cardiovascular and nervous systems, etc. Preventive measures are thus necessary to limit physical exertion, optimize the work-and-rest regimen; also, there is a need for conducting pertinent preventive medical examinations, providing social measures (conditions for transportation, rest, nutrition, sports), etc.

[An occupational physiology study at the Asarel Mining and Milling Works--screening for risk factors of the cardiovascular system in workers in an open-pit mine]. / Trudovo-fiziologichno prouchvane v MOK "Asarel"--skrining na niakoi riskovi faktori za surdechno-sudovata sistema na rabotnitsi v otkritiia rudnik.

It was the purpose of this study to define the frequency of occurrence of a number of individual and occupational factors contributing to development of arterial hypertension in "Asarel" MMW open-pit workers. The investigated subjects numbered 36 and ranged in age from 22 to 55 years (average, 36 +/- 1.9 years). The jobs represented included mainly: diggers, bulldozers, driver, drillers, blasters, road-service workers, electric and mechanic fitters. Endpoints measured and evaluated included: arterial blood pressure, pulse rate, biometric characteristics (age, occupational experience, body height and weight), common risk factors, such as family antecedents, cigarette smoking, alcohol consumption, level of physical activity at and off work, etc. For this sample of open-pit workers, findings indicated a relatively high incidence of hypertension (28% of subjects). The level of arterial hypertension consistently correlated with worker age, length of occupational experience, and body weight. There was high prevalence of cardiovascular risk factors: alcohol consumption, family history, cigarette smoking, use of salty foods, overweight. The observed changes in the cardiovascular system and high prevalence of risk factors point to the necessity of taking specific medical prevention measures. These have been taken into consideration in designing the overall program of upgrading work conditions and organization, as well as improving the style of life of "Asarel" MMW workers.

[Chronic occupational stress and the cardiovascular risk in teachers]. / Khronichen profesionalen stres i surdechno-sudov risk pri uchiteli.

Age changes in arterial pressure (AP) and incidence of arterial hypertension (AH), as well as probability of developing IHD, were compared between school teachers and a control group sustaining no excessive occupational stress. The investigated teachers, numbering 168, were from Sofia public schools and technical schools. The control group consisted of 103 women: office employees, designers, research workers, etc. Findings indicated teachers to have a closer age relationship to AP level, compared to controls. Considerable increase in systolic AP was observed after 45 years of age, and there was a significant difference between the first and the second halves of the 4th decade. Diastolic AP was also higher in teachers than in controls. Duration of teaching experience proved to be strongly correlated with systolic and diastolic AP levels (r = 0.56, p < 0.001; and r = 0.50, p < 0.001). Beyond 40 years of age, teachers showed a high incidence of AH, 31%. The group as a whole was at high cardiovascular risk.

[An evaluation of the strain in the work of teachers]. / Otsenka na naprezhenieto pri rabota na uchiteli.

Psychophysiological studies on teachers' work include generally the evaluation of occupational stressors influencing the work load and strain and the assessment of transient and long-term changes in teachers' functional state and health due to these stressors. Results from investigations of some changes in the functional state of the organism of female teachers working in secondary and technical schools of different profiles were presented in this study. The following parameters were applied: subjective feeling of fatigue, heart rate [HR], excretion rates of 11-oxycorticosteroids (11-OCS), adrenaline (A) and noradrenaline (NA) during work. According to the mean HR values during work a moderate cardio-vascular strain was obtained (HR between 80-90 beats) min. Transient HR values over 100 beats/min were registered during periods connected with specific stressful working conditions. The levels of 11-OCS and the catecholamines excretion rates also indicated a moderate job strain. More pronounced changes in 11-OCS, NA and A were found when teaching in the upper classes of the secondary and technical schools. Significant correlations were established between the changes of HR, 11-OCS, NA and A and some individual characteristics of the examined persons, such as: age, length of service, HR at rest and level of neuroticism. Our data reveal the usefulness of the indices and procedures applied for the evaluation of teachers' strain at work.

Prevalence of arterial hypertension among school teachers in Sofia.

The aim of the present study was to investigate the age-related changes of blood pressure (BP) and prevalence of arterial hypertension (AH) among school teachers. 168 female teachers between 25 and 55 years of age from comprehensive and technical schools in Sofia were studied. A group of 103 female employees (designers, researchers) served as controls. The age-related changes of systolic and diastolic BP were more pronounced in the teachers' group. An abrupt elevation of mean SBP was disclosed in teachers more than 45 years old and a significant difference of SBP between teachers during the first and second half of the fourth decade was found. The elevation of the DBP with age was more expressed among the teachers than the controls. A strong positive correlation between teachers' length of service and the levels of SBP and DBP was revealed (r = 0.56; p < 0.001 and r = 0.50; p < 0.001, respectively). The similarity in age distribution, body weight and tobacco consumption of the subjects of both examined groups, disqualify these variables as risk factors for the obtained age-related differences. The estimated relative risk for AH among teachers in total was 1.5 and the AH prevalence among teachers over 40 years old was 31%, which can classify this occupation as high risk for AH.

Cardiovascular changes in operators on 12-hour shifts.

Many alternative shift schedules "compress" the working week into a smaller number of days by adding more work hours per day. The assessment of such work schedules needs to take into consideration the advantages and disadvantages of this style of work on workers' health and well-being. The aim of the present study was to evaluate the cardiovascular strain in control room operators in a chemical plant working on an extended workday schedule and to assess their tolerance to the longer shifts. The cardiovascular strain of the operators (11 males and 10 females) was evaluated by ECG Holter monitoring during both the 12-hour day and night shifts. The results obtained indicate a light to moderate cardiovascular strain in the male operators. The higher work heart rate (HR) and more pronounced ECG changes (frequent HR peak values, transient ST-depressions, etc.) indicate a higher level of cardiovascular strain in the female group during the day shift. During the night shift the mean HR values were significantly lower in both groups. At night the HR of the male operators displayed a well expressed circadian rhythm while we observed a flattening of the HR variations in the female group. The results of the job analysis, the time-budget survey and the data obtained by the ECG Holter monitoring indicate in general that the cardiovascular strain in this occupation is acceptable and the chemical operators' job is suitable for a longer shift duration. Nevertheless a need for the improvement of the working conditions and organization, especially for the female operators, is apparent.

Cardiovascular changes at work: relation with some individual risk factors.

Heart rate (HR) acceleration during work which is accepted as a main cardiovascular response to stress could be influenced not only by the work itself but also by some behavioural variables. The purpose of this study was to investigate the effect of several individual characteristics (age, body mass index, arterial blood pressure, VO2max, leisure time physical activity, Type A behavior and neuroticism) on HR reactivity during work and rest. Sixty-nine male subjects practising several occupations (air traffic controllers, railway station controllers, managers, chemical operators, etc.) participated in the study. The common characteristic of all jobs was the presence of neuro-emotional strain of various degrees. The ECG Holter Medilog 4500 system was used for monitoring the HR during the working day. The HR at work was applied as a single dependent variable in the multiple regression analysis and the independent contribution of the following variables was evaluated: HR at rest, neuroticism and Type A behaviour pattern. They appeared to be the most significant determinants in this model and explained about 23% of the variation in HR during work. As second-rank predictors, age and leisure time physical activity led to a non-essential increase (up to 25%) of the multiple regression coefficient. In order to reduce the risk effects of health-related behaviours and individual patterns on the cardiovascular system it is recommended that a preventive approach based on behavioural modification should be adopted.

[The assessment of physical work capacity and its dependence on the occupational and individual risk factors of jobs with hypodynamia and neuropsychic stress]. / Otsenka na fizicheskiia raboten kapatsitet i zavisimostta mu ot profesionalni i individualni riskovi faktori pri profesii s khipodinamiia i nervno-psikhichno naprezhenie.

The physical work capacity is studied in representatives of 3 professions with decreased motor activity and neuropsychic stress: managers in industry (20), railway controllers (41) and machine-builders (107). The dependence of the physical work capacity on the age, type of work, physical activity during free time, and other biometric and individual characteristics on the examined persons were studied. The physical working capacity was measured in standard laboratory conditions by bicycle ergometer [correction of veloergometer] Lano at submaximal rates of loading 50, 100 and 150 watt with duration 2 min each and velocity of pedalling 60 r/min. The maximal working capacity (MWC) was measured directly by continuous loading increase to refusal. The results pointed out ineffective reaction of the cardiovascular system at dosage of physical effort (increase of the "normative" values of the pulse rate for respective loading with 5 to 15 beats/min with all examined groups). The aerobic capacity level is under the average, as most unfavourable are its values in the managers from the industry, followed by the railway controllers and machine-builders. Hypodynamic during work, combined with low physical activity during free time, are basic risk factors for the maximal working capacity and the cardio-vascular system. There is a dependence of the aerobic capacity on some individual characteristics (age, body weight, pulse frequency and blood pressure at rest, etc.).

[ECG changes in persons representing present-day professions]. / EKG promeni pri rabotna proba na predstaviteli na s'vremenni profesii.

Subject of the study are the two up-to-date professions with well expressed neuropsychic stress and hypodynamia: 19 managers from industry and 41 controllers from the railway transport. Both professional groups were subject to a definite dose of physical loading and estimation of the ECG changes by the aid of Minnesota's code (WHO 1968) and its modification by the Swedish Cardiological Association. Relatively high percents of positive working samples for healthy middle-aged men were found, which could be related with considerable occupational risk in both professions.

[Physical work capacity of Bulgarian workers in the Komi ASSR]. / Fizicheski raboten kapatsitet na bulgarski rabonitsi v Komi-ASSR.

In view of assessing the physical fitness of Bulgarian men going to work in lumber production in the Komi ASSR (180 men of different professions) the physical working capacity was measured by bicycle ergometer with submaximum loading (50, 100 and 150 W). The maximum aerobic capacity is extrapolated after the nomogram of Astrand and the individual regressive lines. The results point out the mean values of physical working capacity assessed after oxygen consumption and pulse. Frequency at submaximum loading (at 150 W average for the group they are respectively 2, 12 dm3/min and 166 beating/min). The assessment of the physical working capacity after the maximum oxygen consumption is also about the mean (2.7 dm3/min). The representatives of the so called sitting professions (employees, drivers) have lower aerobic capacity then those engaged mainly in physical work (machine building, construction workers). In comparison with literature data the examined persons have lower working capacity for the corresponding age. Juxtaposing the results of the mean data for physical working capacity with the high energy losses in the lumber industry imposes measures for raising the physical working capacity of the Bulgarian workers departing for the Komi ASSr, by effective training system, improving the work and rest regimen, professional selection by examining the physical working capacity etc.

[Work difficulty and the physical work capacity of female afforestation workers in forestry]. / Tezhest na truda i fizicheski raboten kapatsitet na zalesitelki v gorskoto stopanstvo.

The severity of labour in manual soil-preparation and planting has been studied and the physical capacity for work of the female workers--determined, who performed those basic afforestation activities in the national forestry. The severity of labour has been characterized by the values of oxygen consumption, energy-expenditure and pulse rate during work. The physical capacity for work has been determined by physical loading on the Lanoy bicycle ergometer , with submaximum degrees of loading. The maximum working capacity was calculated by the values of the pulse rate with submaximum degrees of loading according to Astrand method. The physical loading during manual soil-preparation is high (6.6 kcal/min, 27.6 kJ resp.), and that of planting--moderate. The maximum aerobic capacity of the afforestation female workers examined, was characterized by maximum oxygen consumption 2.04 dm3/min, 29.6 cm3/kg/min resp., and maximum pulse rate--177 beats/min. Energy losses during work surpassed, to a considerable degree, 30 per cent of the maximum aerobic capacity of the female afforestation workers. On the base of the results obtained, measures are proposed for the reduction of the severity of labour and for improvement of the organization of the work during the afforestation activities in national forestry.

[Physical work capacity of miners]. / Fizicheski raboten kapatsitet na min'ori.

The effect of the occupational activity on the physical capacity of work is of great interest for labour physiology. In connection with that, the physical capacity for work of the miners from coal industry, at different age and with different length of service was studied. Submaximum loading of bicycle ergometer was applied--50, 100 and 150 wt. The maximum working capacity was determined by the nomogram of Astrand. The miners, aged from 21-30 (3.4 l/min maximum oxygen consumption) have the highest capacity. At the age of 31-40, it is abruptly dropped (2.54 l/min maximum oxygen consumption) anf is maintained at the same level after that age (2.49 l/min maximum oxygen consumption). The decrease of the physical capacity for work of the miners, over the age of 30, ie greater than the "normal" age decrease as well as than that of the workers from other occupations. The high physical capacity for work of the young miners (to the age of 30) allows the performance of heavy physical work (allowable energy expenditure 5.1 kcal/min, and in peak loading--8.5 Ical/min). The established decrease of the physical capacity for work after that age determines the lower allowable energy loss at work (3.8 kcal/min). The discrepancy between the real physical capacity for work of the workers between 31 and 50 years of age and corresponding allowable energy expenditure as well as the higher energy expenditure determined during work is a circumstance that requires particular attention. In fact, measures intended not to allow the exceeding of the maximum allowable loading are necessary for the older workers.

[Physical work capacity under different levels of measured stress in relation to type-A personality in intellectual workers]. / Izsledvaniia na fizicheskiia raboten kapatsitet pri razlichni niva na dozirano natovarvane v zavisimost ot tip A pri umstveni rabotnitsi.

The physical work capacity of 122 designers is defined in order to characterize the effect of work activity in the individual standard types /types A and B/ at physical dosage loading. The following methods are used: bicycle ergometry with determination of lung ventilation, oxygen consumption, pulse frequency, etc. by means of the Jaeger ergooxyscreen. Defining the type of behavior of the individual by Rosenman's questionnaire. Determination of catecholamine excretion after the method of Euler and Lishajko. The results pointed out that the physical work capacity of designers is satisfactory and mean in rate, evaluated according to the internationally confirmed classifications. The effect of hypokinesia, age and sex differences and the importance of type A are discussed in relation to the reaction of the organism to the dosage loading, as well as some methodological problems concerning the determination of type A way of behavior.

[Physical work capacity of electronics workers (the assembling and checking of printed circuit boards)]. / Fizicheski raboten kapatsitet na rabotnitsi ot elektronikata (montazh i kontrol na pechatni platki).

The physical capacity for work of electronic workers that assembly and check up the printed was determined. The physical capacity for work of the female assembly-workers is assessed to be moderate and that of the operators-very good. A reduction of the maximum oxygen consumption with 0.375 ml/kg per year was established in the female assembly-workers, in the age group 21-40. The results obtained are discussed in connection with the unfavourable effect of the reduced motor activity during work, taken as base for the elaboration of measures for the improvement of the physical capacity for work.

Changes in the excretion of corticosteroids and catecholamines in tractor-drivers.

An investigation was carried out to study the effect of mechanized agricultural work on the excretion of some corticosteroids and catecholamines in tractor-drivers during a seasonal field work. Group 1 (15 subjects) was examined three times: in the morning hours before starting work and at two intervals during the first and second half of the working day. In group two (11 subjects) the characteristics of the circadian rhythm for 24h were investigated in urine collected at six intervals. The results from both studies disclose a considerable increase of the total 17-ketosteroids, total 17-oxycorticosteroids, free 11-oxycorticosteroids, nor-adrenaline and adrenaline excretion levels which indicates overactivity of the hypothalamic-pituitary-adrenal and sympathetic nervous systems. The circadian rhythms of the examined parameters are characterized by an increasing of the mesors and a lowering of the amplitudes of the rhythmic variations. No significant changes of corticosteroids and catecholamines are established. Considerable interindividual differences in the course of excretion of the studies indices as well as the lack of marked circadian rhythm in about 50% of the subjects are found.

[Age-related changes in work capacity]. / Prouchvane na niakoi promeni v rabotosposobnostta na vuzrastov aspekt.

Bank female employees, aged from 18 to 55, were examined in order to characterize some changes in the nervous-psychic capacity for work in age aspect. The following methods were used: inquiry for the subjective assessment of the strain and fatigue during work, DAM--a test characterizing the activity, disposition and mood, level of neurotism according to Ajsenk, time of single visual-motor reaction and reaction of choice. Some age changes in the subjective assessment of fatigue, disposition, and activity were established. The age changes in psychomotor sphere were enhanced under the effect of work loading. Among the age group 51-55, the subjective assessment of fatigue, disposition and activity were more favourable, not corresponding to the clearly manifested age changes in psychomotor sphere. Prophylactic measures, aiming at the optimization of the work of bank female workers, are elaborated on the base of the examinations carried out.

[Physical state and the capacity of agricultural machinery operators]. / Fizichesko sustoianie i deesposobnost na mekhanizatori ot selskoto stopanstvo.

Based on anthropometric investigations, and on some biometrical indices and physiological parameters, the authors study the physical fitness and ability for work in a group of 1216 machine operators, engaged in farming activities. Upon comparison of the data obtained, practically insignificant differences are established for the respective age groups relative to the general population. Virtually equal indices are recorded in most of the cases. Emphasis is laid on the necessity to estimate the working load among technicians older than 45 years.