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Було обстежено 196 працівників сфери охорони неврологічного й психічного здоров’я, які упродовж 30 днів вживали Мемопрув (EVER Pharma). Було визначено, що синдром емоційного вигорання спостерігався в 68,4 % лікарів. Встановлено, що в механізмах формування емоційного вигорання провідну роль відіграють переживання психотравмуючих чинників, редукція професійних обов’язків, неадекватне емоційне реагування, розширення сфери економії емоцій, емоційна й особистісна відстороненість. Доведена ефективність Мемопруву для подолання астенії (фізичної і психічної), підвищення активності й мотивації, а також покращення процесу уваги й працездатності в осіб із синдромом емоційного вигорання.

PurposeThe Responsible Care programme was first introduced in Canada in 1985 and now is implemented worldwide as one of the chemical industries' commitments to improve the industries' public image as well as their performance in health, safety and environmental aspects. In Malaysia, the Responsible Care programme has been implemented since 1994 with a current total of 148 companies pledged to implement it in their company; however, the effectiveness of the programme remains unknown. Hence, this paper aims to assess the effectiveness of the Responsible Care programme in improving performance in the environment, health and safety in terms of documentation, training, selection processes and stakeholders' engagement for the sustainability of chemical industries.Design/methodology/approachA survey was administered to the Responsible Care signatory companies in Malaysia. Of these, a total of 132 member companies either produced or provided services related to chemical products.FindingsThe majority of signatory companies agreed that the Responsible Care programme did improve their performance in the environment, health and safety. Besides that, the signatory companies were also keeping up their commitment to ensuring documentation, training, selection process and stakeholders' engagement run smoothly in line with Responsible Care's mission.Originality/valueAfter more than two decades of implementation in Malaysia, it is important to assess the Responsible Care programme's effectiveness. As an increasing number of chemical firms, without good management, it will possibly pose a danger to the environment and human health and safety. Through assessment, advances in Responsible Care management practices will considerably increase programme effectiveness in terms of environmental health and safety.

Background. GXN tablets are composed of Danshen and Chuanxiong, with the functions of activating blood circulation, removing blood stasis, invigorating the pulse, and nourishing the heart, which are used for CHD patients with stable exertional angina Grade I or II (according to traditional Chinese medicine, it is a syndrome of heart and blood stasis with chest pain and dark purple lips and tongue). Clinical trials have shown satisfactory effects on coronary heart disease (CHD). 90.6% of Chinese patients with CHD use both Western medicine and Chinese medicine with the latter being thought to promote blood circulation and remove blood stasis. Some researchers doubt that the combination of Chinese medicine increases the risk of bleeding. The main objective of this study is to observe the safety of long-term use of Guanxinning (hereafter referred to as GXN) tablets combined with aspirin. Methods. The study population is patients with CHD after percutaneous coronary intervention (PCI). Randomization was performed for patients with stable CHD who received dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel or ticagrelor for more than 12 months and then switched to the treatment with aspirin alone for 1 month. This study includes a total of 3,595 subjects in 63 hospitals. The experimental group took aspirin orally (100 mg, 1 time/day) + GXN tablets (0–6 months: 4 tablets/time, 3 times/day; 7–12 months, 4 tablets/time, 2 times/day), and the control group received oral aspirin (100 mg, 1 time/day). Major observation indicators are the incidence of bleeding events, adverse events (AEs), and adverse reactions. The primary endpoint indicators are the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) and the MACCE composite endpoint. Results. A total of 31 cases of symptomatic bleeding were found in the two groups, including 21 cases (0.98%) in the experimental group and 10 cases (0.86%) in the control group; the difference between the two groups was not statistically significant. There were 29 cases (1.35%) of bleeding not reaching BARC type 1 in the experimental group. No attention was paid to the laboratory indicators in the control group during the trial process, so the bleeding as a laboratory indicator between the two groups was not comparable. For BARC type 3–5 bleeding events, there were 3 cases in the experimental group (0.139%) and 2 cases in the control group (0.172%); the difference between the two groups was not statistically significant and not clinically significant. During the trial period, there were a total of 255 cases of adverse reactions in 208 subjects with an incidence of 6.57% (141/2146) in the experimental group and 5.77% (67/1161) in the control group, and the P value was 0.5021; the difference between the two groups was not statistically significant. According to the analysis, the adverse reactions with a statistically significant difference between the two groups were gastrointestinal diseases, with the incidence in the experimental group being higher than that in the control group, and the main manifestations were gastrointestinal symptoms. There was no statistical difference in other types of adverse reactions between the two groups. In the trial period, there were 10 cases of serious adverse reactions, including 5 cases in the experimental group (5/2146, 0.23%) and 5 cases in the control group (5/ 1161, 0.43%), the P value was 0.3351; the difference in the incidence between the two groups was not statistically significant. Conclusion. For CHD patients with heart-blood stasis syndrome, the combination of aspirin and GXN tablets in the experimental group did not increase the incidence of bleeding events, nor did it increase the risk of bleeding of types 3–5 defined by BARC. Except for the increase in gastrointestinal symptoms, there was no increase in other adverse reactions in the experimental group. This trial is registered with Registration no. ChiCTR-IIR-17010688.

This study concentrates on the effect of foreign ownership of companies on worker wage distribution. Using an innovative methodological approach that combines the Oaxaca–Blinder decomposition and the modified DiNardo et al. reweighting approach, we estimate the wage gap between domestic-owned and foreign-owned firms. The study confirms that firm ownership (domestic or foreign) influences the wage distribution of workers, as a worker employed in a foreign-owned firm earns, on average, 5 percent more than a matched worker in a domestic-owned firm with similar characteristics. We link that gap with an origin of foreign capital. This analysis demonstrates that the origin of capital has an impact on wage distribution in the firm and may affect wages in the whole section.

For over 100 years, the US Forest Service (USFS) has developed initiatives to improve safety outcomes. Herein we discuss the engineered solutions used from 1910 through 1994, when the agency relied on physical science to address the hazards of wildland fire suppression. We then interpret safety initiatives of the subsequent 25 years, as the USFS incorporated social science perspectives both into its understanding of emergency fire incidents and its mitigation of vulnerabilities across all fields of work. Tracing the safety programs using a historical sociology approach, we identify, within the agency’s narrative, three recent developments in its organizational safety culture: cultural awareness, cultural management, and cultural reorganization. This article describes how the development of top-down safety initiatives are questioned and shaped by employees who actively influence the trajectory of a safety culture in the USFS.

Infrared thermography is a technique that can detect anomalies in temperature patterns which can indicate some breast pathologies including breast cancer. One limitation of the method is the absenc...

Amid the coronavirus disease 2019 pandemic, demand for cloth face masks containing nanosilver has increased. Common product claims such as “antiviral” and “antimicrobial” can be attractive to buyers seeking to protect themselves from this respiratory disease, but it is important to note that filtration capabilities are the main factor to prevent virus transmission and that antimicrobial ability is a secondary protection factor. Silver has long been known to be antibacterial, and growing research supports additional antiviral properties. In this study, 40 masks claiming to contain silver were evaluated for substantiated antiviral and antimicrobial claims using methods available to the public. Criteria for determining the validity of substantiated claims included the use of patented technology, international certification for antimicrobial and/or antiviral textile by ISO or ASTM, EPA pesticide registration, and peer-reviewed literature. Our analysis showed that, of the 40 masks, 21 had substantiated claims. Using scanning electron microscopy (SEM), two of the substantiated face masks (A and B) were examined for silver identification for further confirmation. Mask A uses silver and copper ions attached to zeolite particles; the zeolite particles discovered through SEM were approximately 90–200 nm in diameter. In mask B, particles of silver and titanium at the 250 nm size were found. In conclusion, these certifications or patents are not enough to determine credibility, and stricter regulations by federal agencies on product testing for manufacturers that make claims are necessary to ensure the efficacy of the product advertised, as well as a cloth face mask inhalation standard.

Gingival smile is a term used to describe an aesthetic condition in which excessive gingival exposure at the jaw level occurs during smile. There are several factors related to its etiology, the most common is the altered passive eruption of anterior superior teeth. To correct this disharmony, a multidisciplinary approach is necessary, and the treatment plan depends on a correct diagnosis and assessment for a better prognosis. The present study aims to describe a clinical case where periodontal surgical techniques were used to correct this condition. Female patient, 25 years old, with aesthetic complaint of the amount of gum exposed when smiling and diagnosed with altered passive eruption. Clinical crown augmentation surgery was performed on the anterior superior teeth. After 1 and 2 years, periodontal clinical parameters (probing bleeding, probing depth, clinical attachment level, crown length, keratinized mucosa width and plaque index) were reassessed, through clinical examination, digital photographic monitoring and measurement tools. In two years, it was possible to note the stability of the results achieved, maintaining values similar to those of the immediate postoperative period. The case report confirmed the success of the clinical crown augmentation surgery and the periodontal parameters stability evaluated after 2 years. Keywords: Periodontics Surgery. Gingivectomy. Aesthetics. ResumoSorriso gengival é o termo utilizado para descrever uma condição estética em que ocorre uma exposição gengival excessiva ao nível da maxila, durante o sorriso. Há diversos fatores relacionados a sua etiologia, sendo a mais comum a erupção passiva alterada dos dentes ântero-superiores. Para correção dessa desarmonia é necessária uma abordagem multidisciplinar, sendo o plano de tratamento dependente de um correto diagnóstico e avaliação para um melhor prognóstico. O presente estudo tem objetivo de descrever um caso clínico onde técnicas cirúrgicas periodontais foram utilizadas para correção dessa condição. Paciente gênero feminino, 25 anos de idade, com queixa estética da quantidade de gengiva exposta ao sorrir e com diagnóstico de erupção passiva alterada. Foi submetida a cirurgia de aumento de coroa clínica nos dentes antero-superiores. Após 1 e 2 anos foram reavaliados os parâmetros clínicos periodontais (sangramento a sondagem, profundidade de sondagem, perda de inserção, comprimento da coroa, largura da mucosa queratinizada e índice de placa), através de exame clinico, acompanhamento digital fotográfico e ferramentas de medição de imagem. Em dois anos, foi possível constatar a estabilidade dos resultados alcançados, mantendo valores semelhantes aos do pós-operatório imediato. O relato de caso confirmou o sucesso da cirurgia de aumento de coroa clínica e a estabilidade dos parâmetros periodontais avaliados após 2 anos. Palavras-chave: Periodontia. Cirurgia. Gengivectomia. Estética.

There is increasing interest in understanding the role of air pollution as one of the greatest threats to human health worldwide. Nine of 10 individuals breathe air with polluted compounds that have a great impact on lung tissue. The nature of the relationship is complex, and new or updated data are constantly being reported in the literature. The goal of our review was to summarize the most important air pollutants and their impact on the main respiratory diseases (chronic obstructive pulmonary disease, asthma, lung cancer, idiopathic pulmonary fibrosis, respiratory infections, bronchiectasis, tuberculosis) to reduce both short- and the long-term exposure consequences. We considered the most important air pollutants, including sulfur dioxide, nitrogen dioxide, carbon monoxide, volatile organic compounds, ozone, particulate matter and biomass smoke, and observed their impact on pulmonary pathologies. We focused on respiratory pathologies, because air pollution potentiates the increase in respiratory diseases, and the evidence that air pollutants have a detrimental effect is growing. It is imperative to constantly improve policy initiatives on air quality in both high- and low-income countries.

Objectives: Nowadays, mobile phones have become a prime necessity. At present, various advance networking connections such as 3G and 4G are available in the market to get a faster service. However, these mobile phones emit harmful electromagnetic radiations which have various ill effects on different physiological systems. The present study has been done to find out the extent of damage caused by mobile phone radiation on liver cells, and, whether high-protein diet (HPD) has any ameliorative effect on such changes. Materials and Methods: Male Swiss Albino mice were divided into four groups. Two groups of animals were exposed to mobile phone radiation at global system for mobile communications like frequencies at 1.8 GHz for 3 h continuously per day for 90 days. One of these radiation exposed groups received a normal diet (containing 5% casein) and the other exposed group received a HPD (supplemented with 20% casein). The control group animals received only a normal diet, while the animals of the remaining group received only a HPD. The serum biochemical and histological parameters of liver tissues and ladder assay of hepatic DNA were studied. Results: A significantly elevated level (P < 0.05) of aspartate aminotransferase, alanine transaminase, bilirubin and serum caspase-3 levels was observed in the group of animals exposed to electromagnetic radiation emitted from mobile phone. Histological changes were also observed in the experimental groups. Moreover, in genomic DNA ladder assay, fragmented DNA was observed in exposed group, which is a probable sign of cell apoptosis. Recovery symptoms were observed in the animals supplemented with high casein diet. Conclusion: From the present study, it may be concluded that electromagnetic radiation emitted from mobile phones has damaging effects on hepatocytes which may be ameliorated by HPD.

The flood disaster in Kelantan in 2014 had resulted in substantial health implications including increased cases of communicable diseases. There was a lack of community preparedness including customized health educations in the prevention and control of flood-related communicable diseases in the affected areas. The research was aimed to evaluate the effectiveness of community-based health education modules on flood-related communicable diseases among communities in Kelantan. Health education modules focusing on major food-related diseases were developed. A non-randomized community-controlled trial using the modules were conducted. Outcomes were assessed on knowledge, attitude and preventive practice scores to flood-related communicable diseases using a pre-validated questionnaire. Independent t test was used to compare mean scores between the intervention community (Tumpat) and the control community (Bachok) at 1-month post intervention. One-way independent ANOVA test was done to compare score differences at baseline (pre), post 1-month and post 2-month from repeated surveys among random samples within the intervention community. There were significant improvements in all knowledge components from 9.4% to 52.6% with 10% increment in attitude scores toward preventing behaviours on flood-related communicable diseases. When compared against the control community at one-month post-intervention, there were significantly higher knowledge on types of diseases, symptoms and risk factors as well as practice scores of drinking safe water and protective habits. This research demonstrated that community-based health education is effective in improving relevant knowledge, attitude and preventive practices among affected communities as part of their preparedness toward communicable diseases related to flood.

Introduction. Chemical factors affect the emergence of carcinogenic and non-carcinogenic health risks when drinking water consumed in the arid regions of Russia and the world. Material and methods. The objects of the study are samples of water springs located in the city of Saratov. Methods of atomic-absorption spectrometry, spectrophotometry, and potentiometry were used to determine contaminants’ content in water of springs. The health and hygiene safety of spring water was assessed by calculating carcinogenic and non-carcinogenic risk, hazard level, and total hazard level. Results. The unacceptable level of non-carcinogenic risk (HI>1) was established to refer to the development of pathologies of the cardiovascular system and liver and the gastrointestinal tract, kidneys, skin, endocrine system. Nitrates are the greatest contributor to the formation of non-carcinogenic hazards of spring water from the sources studied. Discussion. The processes of rotting plant matter, agricultural activities, and exchange between water and underlying aquifer caused the exceeding of the admissible health risk of water springs located at higher elevations was mainly due to. The highest frequency and magnitude of excess non-carcinogenic sanitary and chemical indices are most often characteristic of springs at the highest elevations or located in the zone of active agricultural activity. The Ni 2+ ion, with the highest amount of the total carcinogenic risk caused the carcinogenic effect mainly. It corresponds to springs located on the slopes near the freeways. Conclusion. Nitrates, nickel, cadmium, and iron, made the most significant contribution to the risk of non-carcinogenic exposure in drinking water from the studied springs have. The presence of nickel had a more pronounced carcinogenic effect. Toxic non-carcinogenic water action is directed mainly at the cardiovascular system and liver. The use of water from the springs studied decreases with the increase in the height of the source above sea level caused the probability of non-carcinogenic and carcinogenic effects. The exchange processes with the underlying aquifer of carbonate rocks, as well as the life of iron-healing bacteria during floods and rains, can explain the effect of the arid climate on the distribution of carcinogenic and non-carcinogenic risks in the spring water of Saratov.

Introduction. In conditions of the high density of urban development, efficient use of municipal lands is of particular relevance. Food production facilities make up a significant sector of many cities’ economy, including centers of ferrous and non-ferrous metallurgy, chemistry, petrochemistry, mining, etc., i.e., settlements where significant areas are limited in use by sanitary protection zones. Resolution of the Government of the Russian Federation dated March 3, 2018, No. However, such a justification is a scientific and methodological problem since there is no regulatory consolidation of the procedure. The purpose of the study was to develop and practically test methodological approaches to justification the admissibility (inadmissibility) of placing a food production facility in the sanitary protection zone of enterprises in other line of the industry. Material and methods. Design and technical documentation were studied on sources of data on air quality at the industrial site and indoors, and the quality of food products. Authors performed hygienic assessment of the safety and quality of air, raw materials, water, and manufactured food products for compliance with sanitary requirements and standards. When analyzing potential threats to contamination of food products, a mechanism was used to isolate critical points of the technological process. Results. An algorithm for the formation of the evidence base of the absence (presence) of the negative impact on food quality, the fact of the location of the production facility in the sanitary protection zone of a large industrial enterprise on the quality of food products is proposed. On the example of the production of juices from natural concentrated products, each step of the algorithm has been worked out: analysis of the technological process of production; hazard identification, instrumental measurements of the quality of environmental objects and raw materials and products. Conclusion. The proposed algorithm allows creating a reliable evidence base for deciding on the admissibility (inadmissibility) of the location of the food production facility in the sanitary protection zone of the enterprise with a different type of activity, tested in real conditions of a large industrial unit. The algorithm can be used as a base for the widespread use and further improvement.

The aim of this study was to quantitatively assess the number of dentists who are specialists in Sports Dentistry and Specialist Physicians who are specialists in Sports Medicine, according to the Brazilian regions. The total number of dentists and doctors in Brazil and specialists in Sports Dentistry and Sports Medicine was collected on the websites of the Federal Council of Dentistry (CFO) and the Federal Council of Medicine (CFM), respectively. All data used in this research are publicly accessible. Rio de Janeiro and Minas Gerais are the Brazilian states with the largest number of specialist dentists in Sports Dentistry (n = 5) and São Paulo, the state with the highest number of sports medicine specialists (n = 236). By Brazilian regions, it was observed that most professionals specialized in Sports Dentistry (55.6%) and Sports Medicine (49.5%) are located in the Southeast region. In the Northeast region, for each specialist in Sports Dentistry, there are 109 physicians specialized in this therapy (1/109). There is a small number of dentists who are specialists in Sports Dentistry, when compared to the number of physicians specialized in Sports Medicine, mainly in the North and Northeast regions of the country. Keywords: Dentistry. Sports. Sports Medicine. Oral Health. ResumoO objetivo deste estudo foi avaliar quantitativamente o número de cirurgiões-dentistas especialistas em Odontologia do Esporte e médicos especialistas em Medicina Esportiva, de acordo com as regiões brasileiras. O número total de cirurgiões-dentistas e médicos no Brasil e de especialistas em Odontologia do Esporte e Medicina Esportiva, foi coletado nos sites do Conselho Federal de Odontologia (CFO) e Conselho Federal de Medicina (CFM), respectivamente. Todos os dados utilizados nesta pesquisa são de acesso público. O Rio de Janeiro e Minas Gerais são os estados brasileiros com o maior número de cirurgiões-dentistas especialistas em Odontologia do Esporte (n=5) e São Paulo, o estado com o maior número de médicos especialistas em Medicina Esportiva (n=236). Por regiões brasileiras, observou-se que a maioria dos profissionais especialistas em Odontologia do Esporte (55,6%) e em Medicina Esportiva (49,5%) estão localizados na região Sudeste. Na região Nordeste, para cada especialista em Odontologia do Esporte, existem 109 médicos com especialização nesta terapia (1/109). Há uma pequena quantidade de cirurgiões-dentistas especialistas em Odontologia do Esporte, quando comparados ao número de médicos especialistas em Medicina Esportiva, principalmente nas regiões Norte e Nordeste do país. Palavras-chave: Odontologia. Esportes. Medicina Esportiva. Saúde Bucal.

Studies with children and adult patients submitted to mandibular distraction osteogenesis surgery were analyzed, whose complication was ankylosis of the temporomandibular joint. In this study, the objective was to carry out a narrative review of the literature, seeking the prevalence of this complication after distraction osteogenesis. The literature review was carried out in the electronic databases, PubMed and Scopus, using mesh terms and their respective entry terms. The screening process consisted of two phases: Phase I - Select by titles and abstracts; Phase II - Complete reading article based on selected articles from phase I. It was observed after the data tabulation a lack of scientific evidence regarding this complication after distraction osteogenesis; as well as a very large variability in the case report studies or case series since there are no clinical trials on this subject. Thus, it can be concluded that there are few studies to state the relationship between ankylosis of the temporomandibular joint after distraction osteogenesis, requiring further clinical trial studies on the subject. Keywords: Temporomandibular Joint Dysfunction Syndrome. Temporomandibular Joint Disorders. Osteogenesis. Distraction. Callotasis; Bone Formation ResumoForam analisados estudos com pacientes crianças e adultos submetidos a cirurgia de distração osteogênica mandibular que tiveram como complicação a anquilose da articulação temporo-mandibular. Neste estudo o objetivo foi realizar uma revisão narrativa da literatura buscando a prevalência desta complicação após a distração osteogênica. A revisão de literatura foi realizada nas bases de dados eletrônicas, PubMed e Scopus, utilizando mesh terms e seus respectivos entry terms. O processo de triagem consistiu em duas fases: Fase I - Selecionar por títulos e resumos; Fase II- Artigo completo de leitura baseado em artigos selecionados da fase I. Observou-se após a tabulação dos dados a falta de evidência científica com relação a esta complicação após a distração osteogênica; bem como uma variabilidade muito grande nos trabalhos de relato de caso ou série de casos uma vez que não existem ensaios clínicos referente a este assunto. Desta forma pode-se concluir que há poucos estudos para afirmarmos a relação entre a anquilose da articulação temporo-mandibular após a distração osteogênica, sendo necessários mais estudos de ensaio clínico sobre o tema. Palavras-chave: Síndrome da Disfunção da Articulação Temporomandibular. Transtornos da Articulação Temporomandibular. Calotasia. Formação Óssea.

Objective: Seasonal influenza vaccination is the main method for influenza prevention. The main objective of this study is to estimate the frequency of vaccinations in patients with chronic illnesses presented to a primary health care (PHC) centre. Methods: This cross-sectional study was performed in patients admitted to the Kapandriti Health Centre. Their vaccination status with an influenza vaccine and their underlying diseases were recorded. Results: 34.8% of the subjects had been vaccinated against seasonal influenza. Vaccination coverage was found to be 53.9% in pulmonary, 55.6% in chronic kidney disease, 43.7% in cardiovascular disorders, 40.6% in diabetes, 40.6% in any kind of malignancy, and finally 33.3% in neurological patients. The most significant predictors for vaccination were the age group of 60 to 79 years (OR = 3.08, 95% CI: 1.79-5.29), age over 80 years (OR = 2.91, 95% CI: 1.58-5.36), respiratory disease (OR = 2.25, 95% CI: 1.33-3.76), cardiovascular disorder (OR = 1.46, 95% CI: 1.02-2.10), and 3 to 5 visits to the unit annually (OR = 1.57, 95% CI: 1.12-2.24). Finally, it was discovered that coexistence of one to three diseases reduced the likelihood ratio for vaccine uptake (OR = 0.15, 95% CI: 0.03-0.79, p < 0.05). Conclusions: The influenza vaccination rate for the population of the present study has been found higher than that reported previously in literature. We believe that there is a need to implement new and more effective strategies such as educating vulnerable groups on the benefits of vaccination and so reducing the incidence of influenza and its complications especially in vulnerable groups.

Currently, there is contradictory evidence for the risk of adverse pregnancy outcomes associated with maternal exposure to disinfection byproducts (DBPs). We examine the association between maternal exposure to trihalomethanes (THMs) in drinking water and adverse pregnancy outcomes, including premature birth, low birth weight (LBW) and small for gestational age (SGA). In total, 1,167 women older than 18 years were enrolled at public antenatal venues in two geographical districts. For each district, we measured the levels of residential drinking water DBPs (measured in THMs) through regulatory data and routine water sampling. We estimated the individual uptake of water of each woman by combining individual water use and uptake factors. Increased daily internal dose of total THMs during the third trimester of pregnancy significantly increased the risk of delivering premature infants (AOR 3.13, 95% CI 1.36–7.17). The risk of premature birth was also positiviely associated with exposure to total THMs during the whole pregnancy (AOR 2.89, 95% CI 1.25–6.68). The risk of delivering an SGA and LBW infant was not associated with maternal exposure to THMs. Our findings suggest that exposure to THMs is associated with certain negative pregnancy outcomes. The levels of THMs in water should be routinely monitored.

For industrialized areas, the problem of the anthropogenic pollution of the environment is not only relevant, but it also exacerbates at a qualitatively new level due to a significant deterioration of almost all the indicators of the population health, especially children's health. Among the wide variety of the factors that affect the people, the leading place belongs to the chemical one, in the spectrum of which the special place is occupied by the heavy metals and such a global and potentially dangerous toxicant as lead is on the first place. The purpose of research was to assess the low-dose effect of lead on the microelement state and prenosological indicators of the health of preschool children living under conditions of constant exposure to it. Material and methods. The obtained data testify to the constant presence of lead in environmental objects city Dnepr in concentrations for the most part do not exceed permissible ones, however, in 1.5-1.6 times higher than in unpolluted areas. Hygienic monitoring of the content of lead, copper and zinc in the air, water and food products of two industrial regions of the city of Dnipro and a "conditionally clean" region of a non-industrial city were carried out. The degree of influence of lead load was estimated with using a dose-dependent approach using biomonitoring and specific biochemical parameters. To assess the prenosological state of health of the child population, 46 and 57 children from preschool institutions in the observation areas aged 5 to 6 years old and 20 children from the control area were simultaneously examined according to a similar scheme. Results and discussion. The average content of lead in the blood of 70-100% of children from the industrial areas is 1.6-5 times higher than the standard and 9.5-30 times higher than the control one. In the urine of 33-66% of the surveyed children from the industrial areas and 12% of children from the control one the lead concentration is 6.4-12.8 times higher than the standard. Hair of preschoolers contains lead in concentrations that correspond to the permissible level, but 2-3.5 times higher than that of children in the control area, found in 73-78% of those surveyed. The concentration of lead in the teeth of children from industrial regions is 4.6 times higher than the normative level recommended by the World Health Organization, and in nails it is 3.2 times higher than the background values. The content of copper in all biosubstrates of children is determined at the physiological level, and zinc is lower by 49-80%. The increased content of lead in biosubstrates is accompanied by an increase of the activity of δ-ALA in the urine of children from the industrial areas by 1.2 and 1.9 times compared with the recommended norm, it was observed in 51-89% of the examined. Conclusion. The revealed biochemical disorders in the organism of children indicate the beginning of the development of microsaturnism, which, on the background of violations of the microelement status, is the ground for the search for effective measures of reducing the "lead pressure" on the health of the child population

Background. Workplace is associated with exposure to various products, which can be associated with adverse health outcomes. It is true with underground construction work. This study calculated the prevalence of common health problems among Nepalese underground construction workers in comparison to heavy construction workers. This type of study is rare in the context of Nepal and other developing countries, and we hope that the findings will help to take precautions for the prevention of these conditions. Method. It was a retrospective study based on the clinical record of outpatient cases and general health checkups of all Nepalese workers available at the Project clinic, Upper Tamakoshi Hydroelectric Project, Gongar, Bigu, Dolakha. We studied three hundred and ninety-eight workers. We used multipurpose analysis and conducted the Chi-square test and calculated correlations and odds ratios. Results. Two hundred and sixteen (54.3%) participants worked inside the tunnel, and 182 (43.2%) participants worked outside the tunnel. Respiratory disease, mainly upper respiratory tract infection (URTI) (23.4%), is the most common presentation among construction workers followed by injuries (16.7%). Injuries and hypertension were significantly higher in inside the tunnel workers, and acute gastroenteritis was significantly ( p value

Background. Dialysis water quality is one of the most important factors for ensuring the safe and effective delivery of hemodialysis. It has been known for over a decade that there might be hazardous contaminants in the water and concentrates used to prepare dialysis fluid. Rigorous international standards for the purification of dialysis fluids have been established, which were used in the present study to compare the quality of dialysis water as there is no national standard for dialysis water quality in Iraq. Objectives. There are more than 20 dialysis centers in Iraq, most of which contain similar units for the processing of dialysis water. The present study evaluated the quality of water used for dialysis in four dialysis centers located within Baghdad hospitals. Methods. Physical and chemical tests were carried out in the laboratory after sampling water from each dialysis center. Water samples were collected from three locations in each dialysis center. Hospital municipal water samples were collected from the tanks feeding dialysis units; samples of dialysis water were collected from the dialysis water treatment unit outlets; and samples of dialysis water were collected from the distribution network in dialysis rooms. Results. The results showed a fluctuation in the quality of the dialysis water (dialysis water and water from the dialysis distribution network), indicating that it is unacceptable compared to international standards. Chemical analysis showed that 75% of the dialysis water had elevated aluminum concentrations. Chemical analysis also found that dialysis water had elevated concentrations of free residual chlorine at some dialysis centers. Conclusions. All hemodialysis centers need careful monitoring and preventive maintenance to ensure good water quality. In addition, it is important to revise the design of the water treatment units according to water quality. Competing Interests. The authors declare no competing financial interests

COVID-19 pandemic has almost made hand sanitization a ritual resulting in a steep increase in the frequency of hand sanitization and an unprecedented surge in demand for hand sanitizers. In fact, several governments had to ration hand sanitizers in the retail outlets and over the counter chemist shops. Additionally, Indian government has put a cap on the prices of hand sanitizers. Currently, large sections of global and Indian population are grappling under financial crises. Therefore, mandatory hand sanitization has made an unwelcoming, yet unavoidable addition to the already-hard-to-maintain-grocery-list. Here, we have compared the anti-microbial efficacy of Patanjali Hand Sanitizer (PHS), developed and marketed by Patanjali Ayurved Ltd. (an India-based food and herbal medicine company) with one of the topmost hand sanitizers currently used under clinical set-ups. PHS has anti-microbial efficacy comparable to that of the standard hand sanitizer. Besides, disc diffusion and time-dependent thumb print assays showed that PHS has longer retentivity on the applied surfaces, suggesting lesser consumption of the sanitizer and concomitant relaxation on the monthly grocery budget. Observed anti-bacterial potency of PHS is attributed to the disruption of bacterial cell membrane, as employed by alcohol-based hand sanitizers. A rough estimation revealed that PHS is ~ 4.3 times cost effective than the standard hand sanitizer used as the positive control in this study. Taken together, PHS is a suitable alternative for existing hand sanitizers available in the market that can relax the demand–supply strain and soften significantly the burden of monthly expenditure on hand sanitizers.

Background The rapid cost escalation of the government employee scheme in Thailand was driven by the overprescription of non-essential drugs (NEDs), which were not listed in the National Lists of Essential Medicines. A restrictive reimbursement policy implemented in October 2012 required prescribers to base the prescription of NEDs on six criteria, including A and B for safety, C for effectiveness, D for availability, and E and F for costs, hence known as the A-F policy. Objective The A-F policy was examined in terms of its outcomes regarding the prescription volume and reimbursement expenditure for lipid-lowering drugs (LLDs). Methods Data on LLD prescription in 2012–2015 from outpatient settings in 29 public hospitals were standardized using quantities based on the World Health Organization's Anatomical, Therapeutic and Chemical (ATC) classification and the defined daily dose (DDD) system. The policy effects were estimated using an interrupted time-series analysis. Results The restrictive reimbursement policy decreased both the prescription volume and the reimbursement value of non-essential LLDs. Within the first month of policy implementation, the percentage of NEDs, as defined by DDDs and reimbursement expenditure, immediately decreased by 15.1 and 15.2% points in provincial hospitals and by 8.3 and 4.4% points in military hospitals, respectively. The prescription of NEDs continued to decrease thereafter, despite there being no statistically significant changes in the trend of decreased prescribing compared with the prepolicy period. The decrease in the prescription of NEDs resulted in the declining reimbursed amount per day and stable expenditure of LLDs as a whole. Conclusion The effectiveness on the A-F restrictive reimbursement on NED prescribing helped stabilize the expenditure on LLDs.

Objectives: The authors evaluate situation in the field of musculoskeletal disorders (MSDs) and working risk factors in the Czech Republic. Methods: Analysis of selected data from the Czech National Registry of Occupational Diseases during 2008-2018, description of criteria for recognition of occupational MSDs and risk factors associated with MSDs. Results: 6,152 cases of 6 selected recognized occupational musculoskeletal diseases represent 47% of all recognized occupational diseases. The main proportion formed diseases of peripheral nerves in the extremities in terms of compressive neuropathies due to long-term and stereotyped overload, diseases of tendons, tendon capsules or insertions of muscles or joints in the extremities due to long-term and stereotyped overload and diseases of peripheral nerves in the upper extremities in terms of ischaemic and compressive neuropathies due to work with vibrating tools and devices. The authors discussed decreasing trend of the exposure time in three main diagnoses and association of the incidence of MSDs with the risky work related to overload of the musculoskeletal system of the upper extremities. Conclusions: Important factors for the prevention of MSDs are directly related to the technical provision of production, the organization of work and the regime of work and rest, the length of working hours and the setting of production standards, and generally to the work related stress.

Objective: Recent experimental studies point to a high reactivity of nanoparticles and the potential of sunscreens to penetrate the skin. We measured 20 markers of oxidative stress and inflammation to find out whether skin exposure to nanoTiO2 sunscreen may elevate the level of the markers in exhaled breath condensate (EBC) and urine of exposed subjects, as was suggested by our earlier study. Methods: Six volunteers (3 males and 3 females), with a mean age of 48.0 ± 6.7 years, used commercial sunscreen for three days continuously. The first samples were collected before the test. The second samples were collected on day 4, before the sunscreen was washed off, and the third samples on day 11. The following biomarkers were measured: malondialdehyde, 4-hydroxy-trans-hexenal, 4-hydroxy-trans-nonenal, aldehydes C6-C12, 8-isoProstaglandin F2α, o-tyrosine, 3-chlorotyrosine, 3-nitrotyrosine, 8-hydroxy-2-deoxyguanosine, 8-hydroxyguanosine, 5-hydroxymethyl uracil, and leukotrienes B4, C4, D4, and E4, using liquid chromatography-electrospray ionisation-tandem mass spectrometry. Results: In the urine, 4-hydroxy-trans-hexenal was significantly higher in post-exposure sample 2, and the same trend was seen in all urinary markers. In EBC, no difference was seen between the mean values of 20 post-test markers as compared with pre-test samples. Conclusion: This study suggests potential side effects of the sunscreen - borderline elevation of markers of oxidative stress/inflammation - which may relate to the absorption of the nanoTiO2, and the non-significant difference may be explained by the small number of subjects. The effect was not seen in EBC, where nanoTiO2 was not found. A larger study is needed, as according to our previous study, the beneficial effect of the sunscreen to suppress oxidative stress caused by UV radiation may be questioned.

The aim of the present study was directed to investigate the effect of rosmarinic acid (RA) as a chemopreventive modality on experimentally induced hamster buccal pouch (HBP) carcinogenesis. Material and methods: Forty Syrian male hamsters five weeks old, weighing 80-120g, were divided into four groups of ten animals in each as follows, GI: Topical application of liquid paraffin alone (three times a week for 14 weeks), GII: Topical application of 7, 12 dimethyl benz[a]anthracene (DMBA) alone (0.5% in liquid paraffin, three times a week for 14 weeks), GIII: Topical application of DMBA (0.5% in liquid paraffin, three times a week for 14 weeks) + Oral administration of RA (100mg/kg b.w in 1ml distilled water by oral gavage, three times a week for 14 weeks on alternate days of DMBA application), GIV : Oral administration of RA alone (100mg/kg b.w in 1ml distilled water by oral gavage, three times a week for 14 weeks). Results: Gross observation and histopathological findings revealed a-GI: normal stratified squamous epithelium b- GII: well and moderately differentiated SCC c-: GIII: revealed considerably reversed tumor incidence d: GIV: normal similar to GI. Immunohistochemical results revealed, oral administration of RA to DMBA treated hamsters restored the normal expression of bcl-2 and Bax indicating that RA may have chemopreventive mechanism and/or pro-apoptotic effects. Conclusion: RA may act through various mechanisms, such as exerting anti-inflammatory, antioxidant effects as well as inhibiting cell proliferation, migration, and selectively inducing cancer cells apoptosis.

Objective: The study evaluates compliance with declared hygienic standards carried out by healthcare professionals in clinical practice within their scope of direct patient care and the maintenance of medical tools and devices in healthcare facilities in the Czech Republic. Methods: Cross-sectional questionnaire study focused on the standards of safe health care. All 80 addressed healthcare providers were also involved in the 2018 Adverse Event Reporting System (AERS) pilot project. Responses were scored on a 6-level scale, from "always" (100 points) to "never" (0 points). The evaluation was performed according to the frequency of responses and the average index (max. 100 points). Data analysis was performed using IBM SPSS Statistics version 22 (level of significance 1% and 5%). Results: There were statistically processed 2,016 questionnaires (100%). Most respondents stated their job classification as non-medical healthcare professionals (NHP) working at a patient's bedside (73%), physicians (16%), or other NHP (11%). As per their medical specialty, 43% of the respondents practice internal medicine, 28% surgery, 14% psychiatry, 9% long-term inpatient care, and 6% stated other fields of medicine. The lowest declared compliance was registered in the statement "I use a face mask when exposure to air-transmitted pathogens is anticipated" (rating index 80 points). The highest compliance (99.4 points) was registered in the statement: "I discard used sharp materials into sharps containers." Conclusion: In the surveyed healthcare facilities within the Czech Republic, overall compliance with hygiene standards is at a good level. Declared differences in compliance with hygiene standards in the selected items of the questionnaire are influenced by multiple factors. Generally, a higher level of compliance is linked to increasing age, years of practice, and a higher level of education. When comparing professional groups, a higher level of compliance with hygiene standards was registered in the NHP group.

Objective: The purpose of this article is to describe current research trends in medical tourism and implications for public health, especially in destination countries. Methods: The methods used for this article include a literature review of available sources on the research topic in the world's acknowledged databases Web of Science, Scopus, MEDLINE, and ScienceDirect. Results: The findings indicate that there is no consensus on the definition of medical tourism. However, there are a few conceptual models which can be used in further medical tourism research and practice. The findings also reveal that there are still certain issues, which hinder the fast growth of medical tourism, such as unclear impact on healthcare systems, ethical concerns or a lack of effective tools for the measurement of quality assurance of the medical tourism services and their products. Conclusions: There is a need for data collection on medical tourism, both at national and worldwide level to provide a realistic picture of this evolving field of tourism as well as implications for public health in destination countries.

The article is considers about the issues of physical education of students during their studies in universities. The purpose of the study is to experimentally identify the influence of calanetics as a means of physical education of students of major medical groups on the parameters of the functional state and the state of physical fitness. The basis of the research is the use of methods of obtaining empirical data: pedagogical experiment, pedagogical testing for the diagnosis of somatic health parameters, methods of mathematical statistics. The possibility of ensuring the effectiveness of this process by improving approaches to the organization, formation and implementation of the content of classroom lessons based on the introduction of new innovative tools in this process is substantiated. The development effectiveness is proved by the increase in the studied indicators and the magnitude of the manifestation of their values at the end of the year. Using the means of calanetics in the physical education of female students has been empirically tested. An expressive (p

Penelitian ini merupakan penelitian analisis. Tahapan penelitian di mulai dengan tim peneliti melakukan observasi menggunakan metode HIRA di laboratorium motor bakar Politeknik Negeri Subang. Data yang didapatkan kemudian di analisis dengan pengukuran yang digunakan dalam Australian Standard/New Zealand Standard (AS/NZS). Berdasarkan hasil temuan dan analisis, dapat disimpulkan bahwa (1) ditemukan 9 bahaya (hazard) di laboratorium motor bakar Politeknik Negeri Subang. Dari 9 bahaya tersebut terdiri dari 1 bahaya dalam kategori 3H (high) yaitu penempatan posisi motor terlalu berdekatan dan tidak menggunakan APD; 2 bahaya dalam kategori 2M (medium), dan 6 bahaya masuk kategori L (low). Tidak ada yang masuk dalam kategori bahaya ekstrem; (2) Rekomendasi tindakan yang bisa dilakukan untuk mengurangi bahaya di laboratorium motor bakar Politeknik Negeri Subang yaitu pembuatan SOP laboratorium, penataan kembali tata ruang dan peralatan, serta pemberian instruksi sebelum dan sesudah mahasiswa praktikum.

Currently, aesthetics, and especially the smile, adds considerable social value. In this way, patients suffering from dental loss wish that their rehabilitation be performed quickly and safely. The aim of oral rehabilitation is to restore masticatory, phonetic, aesthetic and quality of life to the patient. The diagnostic step is one of the most important and relevant steps in establishing a correct treatment plan and, in this way, it is possible to obtain excellent results. The present study aimed to demonstrate the importance of diagnostic waxing in oral rehabilitation. Patient sought treatment at the Dental Prosthesis Specialization Course at Odonto School, due to complaints associated with aesthetics and function. To improve their quality of life, planning of case was carried out through diagnostic waxing and a prosthetic solution was proposed. At the end of treatment and during the follow-up of the case, the patient reported satisfaction and significant improvement in quality of life. It can be concluded that the diagnostic waxing presents customized solutions offering, through a previous study, an effective clinical resolution to the patient. Keywords: Mouth Rehabilitation. Dental Restoration, Temporary. Dental Restoration, Temporary. Resumo Atualmente, a estética, e em especial o sorriso, agregam um valor social considerável. Dessa forma, ao sofrerem a perda dental, os pacientes desejam que sua reabilitação seja realizada de forma rápida e segura. A reabilitação oral tem como objetivo devolver ao paciente a eficiência mastigatória, fonética, estética e a qualidade de vida. A etapa diagnóstica constitui um dos passos mais importantes e relevantes no estabelecimento de um correto planejamento do tratamento e, desta forma, torna-se possível obter resultados de excelência. O presente estudo teve como objetivo demonstrar a importância do enceramento diagnóstico na reabilitação oral. Paciente procurou tratamento no Curso de Especialização em Prótese Dentária da Odonto School, devido a queixas associadas a estética e função. Para melhorar sua qualidade de vida, foi realizado o planejamento do caso por meio do enceramento diagnóstico e uma solução protética foi proposta. Ao final do tratamento e durante o acompanhamento do caso, a paciente relatou satisfação e melhora significativa na qualidade de vida. Pode-se concluir que o enceramento diagnóstico apresenta soluções personalizadas oferecendo, por meio de estudo prévio, uma resolução clínica efetiva ao paciente. Palavras-chave: Reabilitação Bucal. Restauração Dentária Temporária. Prótese Dentária Temporária.

The medical manufacturing industry is currently one of the sectors with great potential growth in Malaysia, which offers numerous job opportunities to local and foreign workers. The growing proportion of workers in this industry means that a large number of workers are potentially exposed to ergonomic risk factors at the workplace, which may consequently affect their health. Thus, this study was carried out is to investigate the ergonomic risk factors and the prevalence of musculoskeletal disorders among male workers in a medical manufacturing company in northern Malaysia. Eight industrial workers (n = 8) were recruited from two Plastic Technology (PT) departments to participate in this study. Observations were made by recording the participants performing two tasks (manual lifting of containers and bags of chemicals) using a video camera at the PT1 and PT3 departments. The participants’ personal information and their job-related characteristics were first collected using a demographic questionnaire. Next, the Cornell Musculoskeletal and Hand Discomfort Questionnaire (CMDQ) was used to evaluate the prevalence of musculoskeletal disorders among workers while Manual Handling Assessment Charts (MAC) were used to assess the most common risk factors during the lifting operations. The results showed that the highest prevalence of musculoskeletal disorders among the male workers at the medical manufacturing company was at the lower back (83.17%), upper back (4.38%), right shoulder (3.49%), and left shoulder (3.49%). Based on the results of the MAC, 100% of the participants were at high risk of injury from postures in the vertical lift zones, torso twisting, and sideways bending. In addition, 87.5 and 62.5% of the participants were at high risk of injury based on their hand distance from the lower back and grip on the load, respectively. The results of this study can serve as a guideline to implement interventional ergonomics programmes at the workplace and improve the musculoskeletal health of workers in the medical manufacturing industry in Malaysia.

Background Various risk factors influence obesity differently, and environmental endocrine disruption may increase the occurrence of obesity. However, most of the previous studies have considered only a unitary exposure or a set of similar exposures instead of mixed exposures, which entail complicated interactions. We utilized three statistical models to evaluate the correlations between mixed chemicals to analyze the association between 9 different chemical exposures and obesity in children and adolescents. Methods We fitted the generalized linear regression, weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR) to analyze the association between the mixed exposures and obesity in the participants aged 6–19 in the National Health and Nutrition Examination Survey (NHANES) 2005–2010. Results In the multivariable logistic regression model, 2,5-dichlorophenol (2,5-DCP) (OR (95% CI): 1.25 (1.11, 1.40)), monoethyl phthalate (MEP) (OR (95% CI): 1.28 (1.04, 1.58)), and mono-isobutyl phthalate (MiBP) (OR (95% CI): 1.42 (1.07, 1.89)) were found to be positively associated with obesity, while methylparaben (MeP) (OR (95% CI): 0.80 (0.68, 0.94)) was negatively associated with obesity. In the multivariable linear regression, MEP was found to be positively associated with the body mass index (BMI) z-score (β (95% CI): 0.12 (0.02, 0.21)). In the WQS regression model, the WQS index had a significant association (OR (95% CI): 1.48 (1.16, 1.89)) with the outcome in the obesity model, in which 2,5-DCP (weighted 0.41), bisphenol A (BPA) (weighted 0.17) and MEP (weighted 0.14) all had relatively high weights. In the BKMR model, despite no statistically significant difference in the overall association between the chemical mixtures and the outcome (obesity or BMI z-score), there was nonetheless an increasing trend. 2,5-DCP and MEP were found to be positively associated with the outcome (obesity or BMI z-score), while fixing other chemicals at their median concentrations. Conclusion Comparing the three statistical models, we found that 2,5-DCP and MEP may play an important role in obesity. Considering the advantages and disadvantages of the three statistical models, our study confirms the necessity to combine different statistical models on obesity when dealing with mixed exposures.

The paper is devoted to the development of students' physical activity by means of physical education during their studies in institutions of higher education is considered. The relevance of the study is due to the objective need to increase the effectiveness of physical education at all its levels in accordance with modern social development as a significant factor in optimizing students' motor activity and maintaining their health. The purpose of the work is to identify and determine the directions of increasing the level of physical activity of students in physical education lessons in extracurricular forms of physical education. Research methods: theoretical analysis, systematization, comparison of different views on the problem under study, generalization of scientific and methodological and specialized literature. Determination of the structure of movement activity of students in the mode of the school day, that in the structure of physical activity walking predominates, which accounts for 55-60% of the time in the weekly physical activity it is established. Second place is occupied by classes in sports sections, third place is occupied by physical education in the network of student educational schedule.Organizational support of extracurricular physical education classes aimed at the development of students' motor activity during training has been defined and scientifically substantiated. As a result, these include: the individualization of the means and methods of physical activity, the formation of knowledge in the development of motor activity, ensuring the widespread use of information means, the choice of adequate means and methodical methods of transferring educational information, the implementation of control over the results.

Objective: The main aim of this study is to discover and analyse the utilization of health impact assessment (HIA) among HIA certificate holders, and to ascertain their opinions on the current situation in the Czech Republic and on the possible future nationwide implementation of health impact assessment. Methods: The target group of the research was identified as holders of professional competence certificates in the field of public health impact assessment. A structured questionnaire was developed. The first part mapped the recent use of HIA in the Czech Republic, the second addressed the issue of linking HIA to regional policies and to the national strategy, the third aimed to gain information about the preparedness of the Czech Republic for the full implementation of HIA, and the last part focused on quality assessment and capacity building for HIA. Results: The results of the survey point to the inconsistencies in the perception of the whole concept of HIA in the Czech Republic by the professional public, and also to a shortage of experts in this area. There is only a narrow circle of experts, especially in the field of health care. It also lacks an informational base, which assist in the unification of processes in this area. As the results of the questionnaire showed, the problems are the lack of interest in the application of the HIA method and, subsequently, the lack of demand. Conclusion: The collected data showed obstacles and gaps in the implementation of the HIA methodology in the Czech Republic. At the same time it has revealed possible ways to change the current situation, based on the opinions of those who practice this methodology in the Czech Republic.

Objective: The aim of this analysis was to analyze the presence of the most important cardiovascular (CV) risk factors and to discuss patterns of LDL cholesterol management in the population studied. Methods: We enrolled 961 males, average age of 42.9 ± 4.7, and 851 females, average age of 51.2 ± 3.6. Data on personal, pharmacological and family history, and laboratory examinations were collected. Cardiovascular (CV) risk was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm with modifications according to the guidelines. Results: The distribution of CV risk in the observed cohort was as follows: 24% of the subjects had low, 51% moderate, 17% high and 8% very high risk. The percentage of patients who reached target values of LDL cholesterol was dramatically lower in the groups with very high (1%) and high (3%) risk than in the groups with moderate (14%) or low risk (59%). Dyslipidemia was newly identified in 20% of both sexes. Arterial hypertension was newly diagnosed in 8% of males and 5% of females, and type 2 diabetes mellitus was newly diagnosed in 3% of both the males and females. Dyslipidemia was present in 39% of males and 41% of females; arterial hypertension in 43% of males and 45% of females, and type 2 diabetes mellitus was diagnosed in 11% of the subjects of both sexes. 49% of males and 31% of females were overweight and 32% of both genders were obese. There were 36% of male smokers and 22% of female smokers. 48% of the participants were pharmacologically treated. Non-pharmacological treatment was recommended to 62% of male and to 65% of female participants. Pharmacological intervention was started in 53% of males and 51% of females. In both gender antihypertensive treatment with angiotensin-converting enzyme (ACE) inhibitors (29% of males and 27% of females) and lipid lowering therapy with a statin (28% of males, 27% of females) were the most commonly initiated treatments. In the subgroup of the 101 patients with LDL cholesterol levels > 5 mmol/L 56% were not treated with a statin. The analysis of relationship between the positive family history of any of the followed CV risks showed significant increases of the risk for arterial hypertension, type 2 diabetes mellitus and dyslipidemia. Conclusion: European guidelines suggest general screening for risk factors, including analysis of lipid profiles in the population of 40-year-old males and 50-year-old or postmenopausal women. Our study documents high prevalence and incidence of CV risk factors together with insufficient control of the risk factors in Czech patients of this age range. This finding suggests that preventive examinations should be undertaken earlier (e.g., in 30-year-old males and 40-year-old women). Exact timing of the preventive check-ups to yield the best cost-benefit ratio needs to be verified.

Objectives: Oral health can affect quality of life in all course of life, which is a key factor of general health. Dental caries, periodontitis and oral cancer are of the highest burden of oral diseases. Rising prevalence of soft drinks and alcoholic beverages consumption due to easy access and socio-demographic altering has increased the concerns on oral health. In this review our purpose was to show effects of the most consumed beverages on oral health in people older than 15 years. Methods: The review was based on papers published in last 10 years, searched with combined key words related to types of drinks and specific oral health problems. We included 4 older studies due to lack of newer studies on subjected topics. Results: Sugar-free soft drinks are found less cariogenic and erosive than regular versions in limited number of studies. Alcohol consumption is shown as one of the risk factors of prevalence and severity of periodontitis and is proven to have synergistic effects along with tobacco on oral cancer risk. Consumption of soft drinks and alcoholic beverages was related with tooth loss whether dental caries or periodontal diseases. Conclusion: There is good evidence for association between soft drinks and oral health problems, but still no clear answer exists about strength of association between sugar-free soft drinks and dental caries. Also the knowledge about influence of alcohol is inadequate. Since consuming style affects erosive potential of drinks manufacturers should be required to add some recommendations on labels about drinking style.

BACKGROUND: Urinary bladder cancer (UBC) is one of few cancers with an established gene-environment interaction (GxE) with smoking. However, it is unknown whether the interaction with tobacco use is present non-muscle invasive bladder cancer (NMIBC) and characteristics of prognostic relevance. We aimed to investigate if smoking status and/or smoking intensity interact with the effect of discovered variants on key NMIBC characteristics of tumor grade, stage, size, and patient age within the Bladder Cancer Prognosis Programme (BCPP) cohort. METHODS: Analyzed sample consisted of 546 NMIBC patients with valid smoking data from the BCPP. In a previous genome-wide association study (GWAS), we have identified 61 single nucleotide polymorphisms (SNPs) potentially associated with the NMIBC characteristics of tumor stage, grade, size, and patient age. In the current analysis, we have tested these SNPs for GxE with smoking. RESULTS: Out of 61 SNPs, 10 have showed suggestion (statistical significance level of P

Background Low-frequency (20–200 Hz) noise (LFN) from wind turbines has received much public attention due to potential health concerns. This work tries to estimate the sound power level of wind turbines (LW,A (dB)) at 20–200 Hz, which are not provided by manufacturers but essential for estimating LFN exposure (LAeq) of nearby residents. Methods LW,A at 20–200 Hz at three wind farms, each with a different brand of wind turbine (Brands A, B and C, respectively) were estimated using propagation model ISO 9613-2 under different weather conditions (rain, wind speed and wind direction) and validated with LFN monitoring data. The feasibility of using validated LW,A as inputs for ISO 9613-2 to simulate residents’ exposure (LAeq) to LFN were assessed considering interferences from rain, wind speed and wind directions. Results The average LW,A at 20–200 Hz ranged between 93.2 and 100.4 dB, 97.8 and 107.2 dB, and 96.5 and 110.4 dB for turbines of Brands A, B, and C, respectively, operating under wind speeds from 2 to 12 m/s. The LW,A at wind speed of 2–8 m/s increased on average by 1.4, 1.9 and 1.7 dB per 1 m/s increase for Brands A, B and C, respectively. The differences in modeled Leq obtained through the input of LW,A into the ISO 9613-2 model and the measured LAeq for the three studied wind farms all fall within 1.5 dB. Conclusion This study successfully determined and validated the LW,A of wind turbines of three brands, and subsequent residents’ LFN exposure (with 1.5 dB difference) at three wind farms. Accurately obtaining LFN exposure will serve as the basis for assessing LFN exposure-health relationship. As wind power widely use worldwide, health impact should be assessed based on validated LFN exposure assessment.

Background: Exposure to air pollution has been associated with a wide range of adverse health effects; however, few studies addressed the relationship between ambient particulate matter as well as the compositions in particulate matter such as lead and the risk of small for gestational age (SGA) in offspring. The aim of this study is to investigate the effect of maternal exposure to criteria air pollutants and the lead in total suspended particulate matter during pregnancy on SGA births in Taiwan. Methods: This population study consisted of 322,513 singleton live births in Taiwan between 1996 and 2002. Daytime (7 AM–7 PM) exposure to particulate matter ≤10 μm (PM10), carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3), and monthly exposure to lead in total suspended particles (TSP) during each trimester were estimated. Generalized additive model (GAM) was used to assess the association between maternal exposure to particulate air pollutants and SGA births, taking into account potential confounders and gaseous air pollutants. Results: We found significant association between the highest quartile (≥75th) of maternal PM10 exposure and SGA and demonstrated a significant exposure–response relationship. Furthermore, the highest quartile (≥75th) of maternal lead exposure was also associated with SGA during the second and third trimester of pregnancy, and there was a significant exposure–response relationship between maternal lead exposure and SGA during pregnancy. Conclusion: Maternal exposure to PM10 and lead in total suspended particulate matter during pregnancy was associated with an increased risk of SGA in offspring. Key Words: air pollution, lead, pregnancy, small for gestational age

Background Evidence-informed decision-making and better use of scientific information in societal decisions has been an area of development for decades but is still topical. Decision support work can be viewed from the perspective of information collection, synthesis and flow between decision-makers, experts and stakeholders. Open policy practice is a coherent set of methods for such work. It has been developed and utilised mostly in Finnish and European contexts. Methods An overview of open policy practice is given, and theoretical and practical properties are evaluated based on properties of good policy support. The evaluation is based on information from several assessments and research projects developing and applying open policy practice and the authors’ practical experiences. The methods are evaluated against their capability of producing quality of content, applicability and efficiency in policy support as well as how well they support close interaction among participants and understanding of each other’s views. Results The evaluation revealed that methods and online tools work as expected, as demonstrated by the assessments and policy support processes conducted. The approach improves the availability of information and especially of relevant details. Experts are ambivalent about the acceptability of openness – it is an important scientific principle, but it goes against many current research and decision-making practices. However, co-creation and openness are megatrends that are changing science, decision-making and the society at large. Against many experts’ fears, open participation has not caused problems in performing high-quality assessments. On the contrary, a key challenge is to motivate and help more experts, decision-makers and citizens to participate and share their views. Many methods within open policy practice have also been widely used in other contexts. Conclusions Open policy practice proved to be a useful and coherent set of methods. It guided policy processes toward a more collaborative approach, whose purpose was wider understanding rather than winning a debate. There is potential for merging open policy practice with other open science and open decision process tools. Active facilitation, community building and improving the user-friendliness of the tools were identified as key solutions for improving the usability of the method in the future.

Objective: Hepatitis E infection is one of the most frequent acute hepatitis in the world. Currently five human genotypes with different geographical distributions and distinct epidemiologic patterns are identified. In Slovakia, only rare cases of hepatitis E have been reported in recent years. Therefore, the aim of the study was to evaluate the prevalence of anti-HEV total antibodies and the main risk factors for HEV in the general population in Eastern Slovakia. Methods: Detection of anti-HEV total antibodies samples was done by a commercial enzyme-linked immunosorbent assay (ELISA) kit. Results: Of 175 hospitalized patients included in the study, 76 (43.5%) showed positivity for anti-HEV total antibodies. No statistically significant differences were found in anti-HEV positivity between men and women or in the groups of different living areas (town/village - urban/rural). Conclusion: Prevalence of anti-HEV total antibodies of hospitalised patients was high. The risk factor significantly associated with antibody positivity was eating raw meat. Other factors, such as sex, age, living area and contact with animals were not associated with antibody positivity.

Objective: The present research aimed to estimate macronutrients intake among adults in North Macedonia and to identify their predominant food sources. Methods: Within this cross-sectional study dietary data were collected using repeated 24h recall interviews. Nationwide, adults aged 18+ were recruited. Dietary data, anthropometric measures and socio-demographic characteristics were available for 496 participants. Nutrient intake was analyzed using the Balkan Food Composition Database and Diet Assess and Plan platform. Macedonian dietary guidelines were used for estimation of inadequacy. Results: Significant differences in macronutrients intake are noticed between age groups within certain socio-demographic factors. Total sugar intake was significantly higher among young adult females comparing with those older than 25 years (p = 0.049). Young urban females have significantly higher fats intake than older participants (p = 0.038). Higher total daily energy, proteins, fats and carbohydrates intake (p = 0.033, p = 0.043, p = 0.032, p = 0.042, respectively) was noticed among young urban males when compared to older ones. Only dietary fibre intake was higher among older urban males (p = 0.030). Univariate linear regression models showed that obese participants had significantly higher relative proteins intake comparing with those having BMI within recommended range (p = 0.024, beta = 1.21). Relative carbohydrates intake was significantly lower among males (p = 0.018, beta = -2.077) and among highly educated participants (p = 0.018, beta = -4.304). Participants with tertiary education had higher relative fats intake (p = 0.012, beta = 4.213). Conclusion: Macronutrients intake of adults should be improved. There is higher intake of dietary fats and need for an increase of complex carbohydrates intake, particularly dietary fibre. Findings of this survey should be used in shaping, fine-tuning and implementing food and nutrition policies that will stimulate healthier diets for prevention of diet related non-communicable diseases.

Objective: This article reviews the published studies dealing with the influence of cigarette smoking on metabolic changes and effectiveness of drugs used in the systemic chemotherapy of the lung cancer. Methods: The literature search of interactions between cigarette smoking and drugs used for lung cancer was carried out. The abstracted data mostly involved some induction of key drug-metabolizing enzymes of cytochrome CYP1A1/2, CYP2D6, CYP3A4 and isoforms of UDP-glucuronosyltransferase. Results: Metabolic changes are important both in the non-chemotherapy and for the drugs used in the chemotherapy. They can change pharmacokinetic and pharmacodynamic effects of drugs. Primarily, we addressed potential differences in drug effects on smokers and non-smokers. The increased clearance of erlotinib and irinotecan may have impact on effectiveness of the lung cancer therapy. The effects of taxanes and gemcitabine are more complex. Conclusion: The evaluated studies show that continued smoking after lung cancer diagnosis is related to poor prognosis, reduced survival, risk of second primary malignancies, and increased cancer recurrence. Of particular importance is the deterioration in the quality of life and an increased incidence of the adverse drug reactions in smokers. The patient's cigarette smoking history should be considered carefully and smoking cessation must be taken into account.

Objective: The aim of this study was to assess the incidence of thoracic tuberculosis (TB) in patients who underwent surgery for indeterminate lung nodules, mass and pleural effusions. Methods: A monocentric retrospective study was carried out from 2012 to 2018 in a high-volume thoracic surgery centre. All patients with finding of thoracic TB within surgery and/or confirmed post-surgery were studied. Demography, origin, TB related symptoms, immunosuppression, type of surgery, and complication of surgery were analyzed. Results: During the seven-year period TB was diagnosed in 71 cases, 58% were men. The mean age was 50 years. 21% of the cases had family history of TB or were successfully treated for TB in the past. 14% of patients had prior history of treatment for malignancy. Five patients (7%) received immunosuppressive therapy. The indication for surgery was indeterminate lung nodules and mass in 55 patients (77.5%) and indeterminate recurrent or persistent pleural effusions in 21 patients (22.5%). In five patients (7%) a lung carcinoma and a concomitant TB infection was detected. 63 of the cases (88.7%) had positive real-time PCR TBC test. Direct microscopic detection of Mycobacterium tuberculosis detected TB in five cases (7%). The microbiological diagnosis by culture was achieved in 19 patients (26.8%). Two patients (2.8%) were diagnosed with multidrug-resistant TB. Surgical procedure complications occurred in nine cases (12.7%). Conclusions: Although the overall incidence of TB in the Czech Republic is low and constantly continues to decrease, the number of TB detected by surgical procedures is increasing. Surgery still remains an important tool in diagnostics of nonobvious cases of TB, especially in patients with a potential risk of malignancy.

Background: Childhood developmental disorders and related problems such as learning disabilities and attention deficit hyperactivity disorder (ADHD) account for a growing burden on communities. Problems of child behavioral development could be caused by BisphenolA (BPA) in addition, westernization have the potential toinfluence its exposure.Exposure to BPA remains poorly characterizedin the developing countries so, in this pilot study, weevaluate BPA exposure and assess somesources of exposure among Egyptian children. Method: We measured total urinary BPA concentrations in spot samples in ADHD (N = 24) and healthy (N = 24) Egyptian children. We also collected questionnaire data regarding food storage behaviors to assess potential sources of exposure.Results: ADHD Egyptian children exhibited higher urinary BPA concentrations; with median value of 24.5 µg/L. Reported consumption of canned food wasa significant predictor of increasing concentrations of urinary BPA.Conclusions: The relatively high urinary BPA concentrations within Egyptian children with ADHD and the significantassociation between the canned foodconsumption and the increased urinary BPA concentration highlights the need to modify food and consumer product patterns to prevent potential adverse health outcomes in the future. Keywords: ADHD, Egyptian, children, Bisphenol A, canned food

International audience

Introduction. A Hormon-like agent such as phenol is able both to integrate into the work of hypothalamus-pituitary-ovary system and trigger a cascade of responses that leads to the development of the immune, hormonal and endocrine systems disorder. Material and methods. The study included 181 woman who permanently live in the area with contamination with phenol in air above standard level. All women are comparable in age, material status and ethnicity. Immunological and hormonal indices were determined by enzyme immunoassay, genetic markers were detected by polymerase chain reaction. Statistical data processing was carried out with the soffware Statistica 10.0, using parametric and non-parametric methods. Results. Between the study groups there were obtained significant differences in following markers: thyroid-stimulating hormone, serotonin, interleukin 6, interleukin 10, estradiol. The dependence of appearance of unfavorable reproductive effects on the presence of polymorphic allele’s was determined: A allele of a gene SULT1A1, G allele of a gene PER2, C allele of a gene SIRT1. Correlation models are defined: thyroid-stimulating hormone and phenol, serotonin and phenol, thyroid-stimulating hormone and cresol, serotonin and cresol, estradiol and cresol. Conclusion. All found markers (increased concentration of phenol in biological media, gene polymorphism, altered protein and receptor expression) create special conditions for the course of the miscarriage pathology.

Objective: Alcohol consumption is associated with substantial public health burden. This article summarises available information on the patterns and prevalence of alcohol use in the Czech Republic with a focus on the heavy alcohol use and its health and social consequences. Methods: A non-systematic literature review was conducted. The data sources included primarily 3 series of surveys in the adult population, 2 series of surveys in the school population, routine monitoring system of per capita alcohol consumption, routine statistics on alcohol-related morbidity and mortality, and alcohol-related crime. Results: In recent years the registered alcohol consumption in the Czech Republic has been very high; 9.8 litres of pure alcohol were consumed per capita in 2017. Recently, the prevalence of hazardous alcohol consumption in the adult population has reached 16.8-17.6% and harmful alcohol consumption 9.0-9.3%. From 12% to 17% of adult population and 12% of adolescent population were heavy episodic drinkers. Alcohol-related disorders are disproportionately higher (2-3 times) among men. Mortality for alcohol-related causes fully attributable to alcohol (AAF = 100%) and their proportion in overall mortality is on increase. Conclusions: Alcohol consumption as well as the prevalence of heavy episodic drinking in the Czech Republic belongs among the highest globally. On the other hand, declines in alcohol use have been recently observed among children and adolescents. Available data on alcohol-related morbidity indicate stable situation, though alcohol-related mortality is increasing. Alcohol-related burden is rather underestimated and evidence-based alcohol policy should be increasingly implemented.

This educational article/narrative review reflects the European Association for the Study of the Liver (EASL) clinical practice guidelines: management of alcohol-related liver disease. An important change contrasting with the 2012 guidelines is the new terminology of alcohol-related liver diseases. Another important outcome is the strong emphasis on prevention of alcohol use disorder which may be performed at all stages of public health care.

Objectives: The aim of the study was to determine the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae co-infections among patients with newly diagnosed syphilis. Methods: In patients with any stage of newly diagnosed syphilis swabs were performed from urethra, rectum, pharynx and cervix according to the gender and type of sexual intercourse. From these smears standard validated nucleic acid amplification tests (NAATs) for Chlamydia trachomatis and Neisseria gonorrhoeae infections were done. Results: From 548 (488 men, 60 women) screened patients co-infection was detected in 15.9% of the cases. The majority of the co-infections (86.2%) were asymptomatic. The overall prevalence of chlamydial infection was 11.1% and 8.8% for gonococcal infections. In men who have sex with men (MSM) the prevalence of co-infections was significantly higher (20.0%) than in heterosexual men and women (4.2%) (p < 0.001). In MSM patients the presence of co-infection was significantly associated with HIV infection (p < 0.001). Among MSM 9.6% of the tests detected infection in anorectal site, while prevalence in urethral (2.8%) and pharyngeal (2.4%) localization was significantly lower. In heterosexual patients prevalence was less than 2.0% in all anatomic sites. Conclusions: The implementation of screening tests in case of sexually transmitted infections in patients with newly diagnosed syphilis is an important part in the management of this disease. These results suggest that screening of asymptomatic heterosexual patients leads to detection of minimum co-infections, but in MSM (especially HIV positive) should always be performed at least in anorectal site, where asymptomatic co-infections are common.