Pozasłuchowe skutki działania hałasu ze szczególnym uwzględnieniem chorób układu krążenia

present conditions of technological development and intensity of urban life, noise is a highly prevalent hazard in occupational and communal environment as it accompanies everyday activities at work, home and even during sleep. The negative impact that noise has on human health depends on the level of acoustic pressure and the duration of exposure, or the „dose of noise” received. The major adverse health effect of noise exposure is thought to be its influence on the function of the hearing organ. A defense mechanism in response to excessive noise is temporary (hearing) threshold shift, which is a transient effect. However, permanent threshold shift, resulting from noise-induced effects within the critical organs of inner and middle ear, is irreversible and corresponds to the hearing loss. The health effects of noise exposure are not limited only to the hearing organ but they may also concern the functions of the cardiovascular, digestive, hormonal and nervous systems as well as the impact on mental health and ageing. Both the large-scale epidemiological studies and case-control studies provide evidence for a significant correlation between noise intensity and the risk of myocardial infarction and arterial hypertension. The findings refer both to communal and occupational noise. According to the state-of-the-art knowledge, such risk of cardiac effects should be considered particularly in individuals exposed to high levels of noise. Recently, some reports have also been published on a possible relationship between noise exposure and type 2 diabetes. It was found that household noise levels > 60 dB were associated with a 22% increase in the risk of diabetes among fa milies dwelling there, compared to lower levels of household noise. The health effects of noise exposure that are not related to hearing tend to be more pronounced in individual s already suffering from hearing impairments and in elderly persons. Exposure to noise was also found to be a risk factor of premature retirement due to the worker’s general health condition.Obecnie hałas towarzyszy człowiekowi nieprzerwanie, w domu, w pracy, podczas wypoczynku, a często także podczas snu. Szkodliwość oddziaływania hałasu zależy od poziomu ciśnienia akustycznego i czasu trwania narażenia, czyli tak zwanej dawki hałasu. Negatywny wpływ hałasu na organizm człowieka jest utożsamiany przede wszystkim z jego bezpośrednim oddziaływaniem na narząd słuchu. Reakcją obronną organizmu na nadmierny hałas jest czasowe przesunięcie progu słyszenia, które ustępuje po upływie określonego czasu. Trwałe przesunięcie progu słyszenia jest nieodwracalne i wynika z wywołanych hałasem zmian w uchu środkowym i wewnętrznym, które są narządami krytycznymi. Działanie hałasu nie ogranicza się tylko do narządu słuchu, obejmuje także inne skutki zdrowotne. Hałas wpływa na układ krążenia, układ pokarmowy, układ wewnątrzwydzielniczy, układ nerwowy, psychikę, powoduje wcześniejsze starzenie się organizmu. Zarówno badania epidemiologiczne obejmujące bardzo duże grupy eksponowane, jak i badania kliniczne potwierdzają występowanie istotnego związku między natężeniem hałasu, a ryzykiem zawału serca i nadciśnienia tętniczego. Dotyczy to zarówno hałasu komunalnego, jak i hałasu występującego w pracy. Zgodnie z obecną wiedzą ryzyko takie należy uwzględniać szczególnie w grupach narażonych na wysokie poziomy hałasu. W ostatnim czasie pojawiły się także badania na temat związku cukrzycy typu 2 z narażeniem na hałas. Stwierdzono, że u osób, dla których hałas w domu wynosił > 60 dB, ryzyko cukrzycy było o 22% wyższe niż u osób, dla których hałas był niższy. Pozasłuchowe skutki hałasu są bardziej nasilone u osób z ubytkiem słuchu, a także u osób starszych. W badaniach wykazano także, że ekspozycja na hałas jest czynnikiem ryzyka przedwczesnego zakończenia aktywności zawodowej z powodu ogólnego stanu zdrowia

Genetyczne uwarunkowania chorób układu krążenia

Rozwój metod biologii molekularnej pozwala na ocenę udziału czynników genetycznych w patogenezie chorób układu sercowo-naczyniowego poprzez precyzyjne badania struktury i funkcji genów. W pracy dokonano przeglądu aktualnego stanu wiedzy na temat genetycznych uwarunkowań chorób układu krążenia, ze szczególnym uwzględnieniem choroby niedokrwiennej serca i nadciśnienia tętniczego. Polimorfizmy genów odpowiadających za funkcjonowanie układu krążenia mogą mieć istotny wpływ na powstanie choroby niedokrwiennej serca (ChNS). Jest ona związana z wieloma czynnikami genetycznymi (poligenowość). Geny regulujące metabolizm lipidów mogą mieć bezpośredni wpływ na powstanie choroby wieńcowej. Polimorfizm insercyjno/delecyjny (I/D) genu kodującego konwertazę angiotensyny (ACE) może w istotny sposób wpływać na rozwój choroby niedokrwiennej serca. Natomiast agregacja płytek, powstawanie zmian miażdżycowych oraz proces krzepnięcia wiążą się z polimorfizmem glikoproteiny GPIIIa. Patogeneza nadciśnienia tętniczego ma charakter poligenowy. Mutacje zachodzące w genie 11β-HSD2 mogą prowadzić do utraty aktywności enzymu dehydrogenazy 11β-hydroksysteroidowej typu 2 (11β-HSD2). Rozwój nadciśnienia tętniczego może także być spowodowany mutacjami receptora mineralokortykosteroidów (MR). Natomiast zaburzenia genu czynnika wzrostu fibroblastów typu 1 (FGF1) mogą prowadzić do nadciśnienia o charakterze rodzinnym. Mutacje genu angiotestynogenu (ATG) skutkują zmianami w łańcuchu polipetydowym angiotensynogenu. Pojawienie się genu chimerycznego(CYP11B1/B2) prowadzi do rozwoju rodzinnego hiperaldosteronizmu typu I(zespół GRA). Rodzinny hiperaldosteronizm typu I może wywoływać podatność na krwotoczne udary mózgu i zaostrzenie przebiegu nadciśnienia w czasie ciąży. W obrębie genu ACE może dojść do polimorfizmu insercyjno/delecyjnego, co w konsekwencji może prowadzić do nadciśnienia. Autosomalnie dominująco dziedziczy się zespół Gordona, który objawia się występowaniem nadciśnienia z hiperkaliemią. Kardiomiopatie to heterogenna grupa chorób serca, które mogą mieć podłoże genetyczne. Wyróżnia się kardiomiopatię przerostową (HCM) dziedziczącą się autosomalnie dominująco. Kardiomiopatia rozstrzeniowa (DCM) jest powodowana przez pojedyncze mutacje punktowe w obrębie genów dla białek aparatu kurczliwego kardiomiocytu

THE IMPORTANCE OF SIGHT FOR DRIVERS

Sight is the basic sense for drivers. Condition of the eye determines correct, comfortable and safe performance of the work as drivers. This article presents various factors influencing the sight condition. There are two groups of factors, external (environment, the kind and time of work, stress caused by work) and internal (systemic and local disorders). All these factors can reduce significantly visual functions, such as visual acuity, field of vision, color vision, strereoscopic vision, twilight vision and glare sensitivity. There are also presented actual requirements for drivers and causes of the car accidents in various age groups. Impairments in vision functions can be dangerous for both the driver and other road users. Med Pr 2013;64(3):419–42

Can alveolar hypoventilation due to kyphoscoliosis be a contraindication to driving?

Road accidents are among the main fatalities worldwide and drowsy driving is a significant cause of road deaths where drivers are at fault. There are well known diseases which impair sensory and cognitive functions and can cause sleepiness during driving. Such diseases can be an important contraindication to driving because they may have an adverse effect on its safety. Thus, medical examinations for drivers should also be directed at identifying any possible conditions posing risks for driving safety. Occupational medicine specialists should look for symptoms of locomotor and sleep-related breathing disorders as these are medical conditions which could preclude a person from driving. In this case report, the authors describe a professional driver with chest deformity and present a pioneering attempt at assessing his medical fitness to drive. It is also explained why scoliosis can impair driving ability and how it should be diagnosed and treated. Finally, the authors describe how they used driving simulator tests as part of their diagnosis and suggest a relevant treatment regimen

PHYSIOLOGICAL REACTION TO WORK IN COLD MICROCLIMATE

Abstract Objectives: In Poland, occupational exposure to cold microclimate is quite common (5.1 workers/1000 occupationally active people). Reports on health effects of this exposure are rather scarce. The aim of the study was to evaluate the physiological reaction in workers occupationally exposed to cold microclimate. Materials and Methods: Examinations were performed in a group of 102 workers (41 women and 61 men) employed at cold storage units. The mean age in the group was 39.1 ± 9.9 years and the duration of employment under conditions of cold environment was over 12 years. The study population was divided into four groups, according to microclimate conditions (group I, ambient temperature -26°C; group II, 10-14°C; group III, 18-20°C, control group; and group IV, 0-10°C). The workers underwent the following procedures: general medical examinations, cold pressor test, ambulatory blood pressure monitoring, and heart rate variability (HRV) analysis (time-and frequency-domain parameters). Results: The results were adjusted for confounding factors (age, smoking and drinking habits). The analysis of HRV parameters did not reveal any significant differences between the study groups. However, systolic and diastolic blood pressure (BP) in the daytime and at night was significantly higher in group IV compared to group II. Mean heart rate (HR) in the daytime and at night and the BP and HR day/night ratio did not differ between the groups. The analysis of BP by gender revealed that in women, systolic BP during the day and at night was significantly higher in group IV than in group II. In the group of workers with hypertension (18 men and 5 women), men reacted to the cold pressor test either by increased or decreased BP while all the women reacted by the increased BP. Conclusions: Our findings indicated that in workers exposed to cold microclimate, the physiological reaction was dependent on gender and ambient temperature. Women seemed to be more sensitive to cold stress than men. However, this finding must be further investigated

Prevention of cardiovascular diseases – Prophylactic program in a selected enterprise

Background: In Poland cardiovascular diseases (CVD), classified as work-related diseases, are responsible for 25% of disability and cause 50% of all deaths, including 26.9% of deaths in people aged under 65 years. The aim of the study was to analyze employee expectations regarding CVD- oriented prophylactic activities in the selected enterprise. Material and Methods: A questionnaire, developed for this study, consists of: socio-demographic data, job characteristics, occupational factors, and questions about the respondents’ expectations concerning the prevention program. The study group comprised 407 multi-profile company employees aged (mean) 46.7 years (standard deviation (SD) = 9.1), including 330 men (81.1%), mean age = 46.9 (SD = 9.2) and 77 women (18.9%), mean age = 45.9 (SD = 8.2) The study was performed using the method of auditorium survey. Results: Employees declared the need for actions related to physical activity: use of gym, swimming pool, tennis (56.5%), smoking habits – education sessions on quitting smoking (24.6%). A few people were interested in activities related to healthy diet. According to the majority of the study group, the scope of preventive examinations should be expanded. Based on our own findings and literature data CVD- oriented preventive program, addressed to the analyzed enterprise was prepared. The program will be presented in another paper. Conclusions: The results showed significant quantitative and qualitative differences in the classic and occupational CVD risk factors between men and women, as well as in preferences for participation in prevention programs. Therefore, gender differences should be taken into account when planning prevention programs. Med Pr 2017;68(6):757–76

The risk of subjective symptoms in mobile phone users in Poland – An epidemiological study

Objectives: To assess the type and incidence of subjective symptoms related to the use of mobile phones in Polish users. Material and Methods: The study was conducted in 2005 using a questionnaire survey. Although it has been quite a long time, up to now, no such data have been published for Poland. The questionnaire consisted of 53 questions concerning sex, age, education, general health, characteristics of a mobile phone (hand-held, loud-speaking unit) as well as the habits associated with its use (frequency and duration of calls, text messages, etc.) and complaints associated with using a mobile phone. Results: As many as 1800 questionnaires were sent. The response was obtained from 587 subjects aged 32.6±11.3 (48.9% women, 51.1% men); the age did not differ significantly between men and women. The subjects owned a cell phone for an average of 3 years. Majority of the respondents used the phone intensively, i.e. daily (74%) or almost daily (20%). Headaches were reported significantly more often by the people who talked frequently and long in comparison with other users (63.2% of the subjects, p = 0.0029), just like the symptoms of fatigue (45%, p = 0.013). Also, the feeling of warmth around the ear and directly to the auricle was reported significantly more frequently by the intensive mobile phone users, compared with other mobile phone users (47.3%, p = 0.00004 vs. 44.6%, p = 0.00063, respectively). Most symptoms appeared during or immediately after a call and disappeared within 2 h after the call. Continuous headache, persisting for longer than 6 h since the end of a call, was reported by 26% of the subjects. Conclusions: Our results show that the mobile phone users may experience subjective symptoms, the intensity of which depends on the intensity of use of mobile phones