Burnout syndrome among medical nurse-technicians in intensive care units in cardiovascular surgery.

Background: Healthcare workers in intensive care units work under specifically hard conditions compared to healthcare workers who work under regular clinical conditions. In this sense, the research aims at assessing the level of burnout symptomatology among nurse technicians working in intensive care units for cardiovascular surgery and to compare those burnout levels with those recorded for medical technicians working under regular clinical conditions. Method: The research was designed as a cross-sectional study. The sample consisted of nurse technicians working in intensive care units specializing in cardiovascular surgery (70 participants) and nurse technicians working under regular clinical conditions (70 participants) at the Institute for Cardiovascular Diseases "Dedinje," Belgrade, Serbia. To evaluate the manifestation of burnout syndrome at work, the analysis uses the Serbian version of the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Results: To examine the variances in the average sub-scores for burnout within two groups of medical technicians, the study used Two Independent Samples T-test. The statistically noteworthy differentiation was ascertained for emotional exhaustion and personal accomplishment, but this does not hold true for depersonalization. However, the mean score values across the different burnout levels (low, moderate, high) are similar in two cohorts of respondents (p > 0.05). Conclusion: This study will serve as an impetus for a policy reform focused on ameliorating working conditions and improving healthcare workers' satisfaction and overall healthcare quality.

Influence of Spatial and Temporal Distance of the Hospital on Survival of Patients with Dangerous Injuries Sustained in Traffic Accidents.

Background: Effective care of any trauma is a priority in all health care systems. If a patient gets adequate treatment within "golden hour" from the injury the prognosis is better, but not as the only factor. The objective was focused on the influence of time and spacial distance of the hospital from the accident as determinant factors of survival, all in the aim Public Health System of Montenegro reorganisation for better accessibility for traumatized persons from 2011-2020. Methods: Among 334 subjects, three groups were defined according to the type of injury: bleeding, ashpyxiations, and cranio-cerebral injuries. In every group lethal and non-lethal subjects were analyzed. Results: Cut-off values are given by ROC curves following proximity and transportation time to hospital specific for injury sustained, as well as for nearest hospital, showed significant differences for proximity of any hospital for bleeding and asphyxiation injuries, and for proximity of any hospital and transportation time to the hospital specific for the sustained cranio-cerebral injury. Conclusion: Most of the seriously injured patients with bleeding or asphyxiation could be taken care of in any hospital while for cranio-cerebral injuries the specific hospital is crucial. How it is very often about, different organ systems are usualy injured in single patient, so the forming of easily available trauma centers net is the best solution for Montenegro, which is necessary for better survival rates.

Lifestyle, Physical Activity, Eating and Hygiene Habits: A Comparative Analysis Before and During the COVID-19 Pandemic in Student Population.

Background: Changing daily habits such as diet, hygiene and physical activity may be some of the consequences of the COVID-19 pandemic. The aim of the study was to analyze the effect of this pandemic on lifestyle, physical activity, eating and hygiene habits among students. Methods: This cross-sectional study involved 171 students from the Faculty of Medical Sciences, University of Kragujevac, Serbia. Data were statistically analyzed using Wilcoxon Signed-Rank test, Marginal homogeneity test and Chi-square test. The differences were considered statistically significant when p ≤ 0.05. Results: In this study, it was observed that the most common physical activity before the pandemic was walking, while during the pandemic was home exercising. Compared to the period before the pandemic, there was no difference in the time spent engaging in daily physical activity (p = 0.334). However, there was a significant increase in sitting time during the pandemic (p = 0.005). Difference was noticed in the use of breakfast, the number of meals, and the type of fat in the diet before and during the pandemic (p = 0.000). During the pandemic, there was an increase in the use of fruits (p = 0.000), vegetables, and nuts (p = 0.001), while the use of fast food and alcohol have decreased. During the COVID-19 pandemic, a significant increase in the use of dietary supplements was observed (40.2%), (p = 0.008). Conclusions: Given that the COVID-19 pandemic is ongoing, certain changes in lifestyle observed in this study should be confirmed in more extensive population studies.

Analysis of Mortality from Carcinomas Primary Localized in Region of Lip, Oral Cavity and Pharynx in Central Serbia, 1999-2015.

BACKGROUND: Lip, oral cavity, and pharyngeal cancers have been globally estimated to account for about 3.8% of all cancer cases and 3.6% of cancer deaths. Mortality of these cancers is generally higher in developing than in developed countries. Overall cancer mortality rate in Serbia is one of the highest in the world. The aim of this study was to determine the mortality rate trends and the most common localization of lip, oral and pharyngeal cancers in Serbia. METHODS: The study was conducted in 2018 as descriptive epidemiological study and included years from 1999 to 2015. The differences in standardized mortality rates and number of deaths were analyzed with regard to age, gender, and tumor localization. Linear trend and regression were used to determine mortality rate trend. RESULTS: There was statistically significant difference in the number of deaths between men and women in the ages of 40 and over (P < 0.01); male/female cancer mortality ratio was 4.56:1. Generally, the most common localization of this carcinoma was hypopharynx. There was no statistically significant increase of mortality rates from these cancers for both genders (males: y = 4.77 + 0.42x, P = 0.069 % change = +20.35; females: y = 1.03 + 0.01x, P = 0.40 % change = +4) during 17-year period. CONCLUSION: Promotion of healthy habits, life-styles and regular inspection of mouth by patients and health professionals should be better prioritized especially in developing countries where implementing and improving national health prevention programs are essential.

Key Factors Determining Indoor Air PM10 Concentrations in Naturally Ventilated Primary Schools in Belgrade, Serbia.

INTRODUCTION: Indoor air quality (IAQ) is rated as a serious public health issue. Knowing children are accounted as more vulnerable to environmental health hazards, data are needed on air quality in schools. METHODS: A project was conducted from 2007 until 2009 (SEARCH, School Environment and Respiratory Health of Children), aiming to verify links between IAQ and children's respiratory health. Study was conducted in ten primary schools on 735 children, in 44 classrooms. Children were randomly selected. Research tools and indicators used for children's exposure to school environment were indoor and outdoor pollutants, two standardized questionnaires for school and classroom characteristics. In both classroom air and ambient air in front of them we measured, during a 5-day exposure period for continuous 24h measuring: carbon monoxide, carbon dioxide, indoor air temperature, relative humidity, and PM10 during classes. RESULTS: PM10 concentrations were significantly most frequent in an interval of ≥80.1µg/m3, that is, in the interval above 50µg/m3. Mean PM10 value was 82.24±42.43 µg/m3, ranging from 32.00µg/m3 to of 197.00µg/m3. CONCLUSION: The increase of outdoor PM10 concentration significantly affects the increase of indoor PM10. A statistically significant difference exists for average IAQ PM10 concentrations vs. indicators of indoor thermal comfort zone (p<0.0001); they are lower in the classrooms with indicators within the comfort zone. Moreover, dominant factors for the increase of PM10 are: high occupancy rate in the classroom (<2m2 of space per child), high relative humidity (>75%), and indoor temperature beyond 23°C, as well as bad ventilation habits (keeping windows shut most of the time).

The prevalence and socioeconomic correlates of depressive and anxiety symptoms in a group of 1,940 Serbian university students.

UNLABELLED: BACKGROUND/AIM. Mental health of university students is under increasing concern worldwide, because they face challenges which predisposes them to depression and anxiety. The aim of this study was to identify demographic and socioeconomic variables associated with depressive and anxiety symptoms among university students. METHODS: This cross-sectional study on 1,940 university students was performed using a questionnaire including demographic and socioeconomic variables, Beck Depression Inventory and Beck Anxiety Inventory. RESULTS: The prevalence of depressive symptoms in students was 23.6%, while the prevalence of anxiety symptoms was 33.5%. The depressive symptoms were significantly related to the study year (p = 0.002), type of faculty (p = 0.014), satisfaction with college major choice (p < 0.001), satisfaction with grade point average (p < 0.001). Female students (odds ratio--OR = 1.791, 95% confidence interval--CI = 1.351-2.374), older students (OR = 1.110, 95% CI = 1.051-1.172), students who reported low family economic situation (OR = 2.091, 95% CI = 1.383-3.162), not owning the room (OR = 1.512, 95%CI = 1.103-2.074), dissatisfaction with graduate education (OR = 1.537, 95% CI = 1.165-2.027) were more likely toshow depressive symptoms. The anxiety symptoms were significantly related to study year (p = 0.034), type of faculty(p < 0.001), family economic situation (p = 0.011), college residence (p = 0.001) satisfaction with the college major choice (p = 0.001), and satisfaction with graduate education(p < 0.001). Female students (OR = 1.901, 95% CI =1.490-2.425), and students who reported parents high expectations of academic success (OR = 1.290, 95% CI =1.022-1.630) were more likely to show anxiety symptoms. CONCLUSION: This is one of the largest study examining mental disorders in a sample of university students in Serbia. These findings underscore the importance of early detections of mental problems and prevention interventions in university students.

Association of Socioeconomic Factors and Sedentary Lifestyle in Belgrade's Suburb, Working Class Community.

BACKGROUND: Sedentary lifestyle represents a growing health problem and considering that there is already a range of unhealthy habits that are marked as health risk factors and the increasing prevalence of sedentary lifestyle worldwide, we aimed to investigate association of sedentary way of living in suburb, working class local community with socioeconomic determinants such as educational level, occupation and income status. METHODS: In this community-based cross-sectional study, 1126 independently functioning adults were enrolled into the study. The study protocol included a complete clinical and biochemical investigation revealing age, gender, lipid status, height, weight and blood pressure. Trained interviewers (nurses) collected information from patients about current state of chronic diseases (diabetes mellitus, arterial hypertension) smoking, medication and other socioeconomic data. Descriptive analysis, Chi-square and logistic regression were performed as statistical calculations. RESULTS: Patients with elementary school were seven times more likely to be classified in category with sedentary lifestyle compared to patients with college or faculty degree. Being retired and reporting low income were significantly associated with higher odds of sedentary behavior when compared with students and patients with high-income status, respectively. CONCLUSIONS: The significance of this study lies in the fact that our results may help to easier identification of patients who may have a tendency towards a sedentary lifestyle.

[Sudden hearing loss: our experiences in treatment with vasoactive and corticosteroid therapy].

INTRODUCTION: Sudden hearing loss is a clinical entity of ambiguously defined aetiology manifested by hearing loss of more than 30 dB on three contiguous frequencies occurring within 72 hours. The lack of standard therapy protocol led to the use of variety of different therapies, thus making difficult objective quantification of their effect. OBJECTIVE: The aim of the study was to present our experience in the treatment of sudden hearing loss with administration of vasoactive and corticosteroid therapy. METHODS: Our research included 59 hospitally treated patients with a sudden hearing loss. During the period 1995-2004, 37 patients were treated using vasoactive agents (xanthinol nicotinate and pentoxifylline), and from 2004-2009, 22 patients were treated using parenteral corticosteroids (dexamethasone). All patients had unilateral sensorineural hearing loss of different level at frequencies from 500-4000 Hz, while other diagnostic procedures (laboratory tests, internist and neurology examinations, X-ray) were within normal limits. Evaluation of therapy effect was done by follow-up of hearing threshold changes and subjective complaints. RESULTS: The results showed that full recovery was achieved in patients with a mild and not fully severe hearing loss, with the majority of those (73%) under corticosteroid treatment. In these patients recovery was also achieved more rapidly. A partial recovery of hearing was detected in patients with hearing loss of more than 80 dB, and mostly in patients treated with corticosteroids. CONCLUSION: Although statistical evaluation does not indicate significant differences between the application of vasoactive drugs or corticosteroids, clinical findings support advantages of corticosteroid therapy. Treatment of hearing loss, although controversial, requires change of some up-to-now used agents. Advantages should go in favour of contricosteroids.

[Influence of moderate physical activity on the levels of plasma lipoproteins in subjects with impaired glucose tolerance].

INTRODUCTION: Physical activity and healthy diet, as lifestyle factors, are essential components in the prevention of chronic non-communicable diseases. Impared glucose intolerance (IGT) is an independent cardiovascular risk factor. Dyslipidaemia is a cardiometabolic risk factor for the development of type 2 diabetes mellitus. OBJECTIVE: The aim of the study was to investigate the influence of moderate physical activity of plasma lipoprotein indicators in high-risk subjects for diabetes mellitus during one-year planned intervention. METHODS: We randomly assigned 60 overweight subjects with IGT aged 30-60 years. The subjects were divided into intervention group with 30 subjects, who were intensively and individually instructed on weight reduction, nutrition and increased physical activity, and control group with 30 subjects, who were counselled, as standard, on nutrition and increased exercise. Total cholesterol (TC), LDL cholesterol (LDL-C), HDL cholesterol (HDL-C) and triglycerides (Tg) were measured at the beginning of the study, and at 2 months, 6 months, and at the end of the study (12 months). RESULTS: Compared to the beginning of the study, after 2 and 6 months there was no statistically significant difference in serum lipid values. After 12 months, the average values of the measured lipid levels in the intervention group decreased by 18.36% for TC, 27.3% for LDL-C, and 34.2% for Tg (compared to 10.27%, 13.45%, and 10.4%, respectively in the control group). Value of HDL-C in the intervention group increased by 19.12%, and decreased in the control group by 1.48%. Total/HDL-C ratio was reduced by 30.6% and LDL-C/H by 38.1% in the intervention group (compared to 12.36%, and 15.9% in the control group). After 12 months, significantly greater decrease in TC (p < 0.01), LDL-C (p < 0.01) and Tg (p < 0.0001) and significantly greater increase in HDL-C (p < 0.05) was detected in the intervention group compared to the control group. CONCLUSION: Plasma lipoproteins can be significantly decreased by changes in the lifestyles of high-risk subjects during one-year planned intervention.

Hospital infections in a neurological intensive care unit: incidence, causative agents and risk factors.

INTRODUCTION: Hospital infections (HIs), which are frequently associated with hospital treatment, increase morbidity, mortality and treatment costs. The aim of this study was to establish the incidence of HIs in a neurological intensive care unit (nICU), and to determine the most prevalent causative agents and risk factors for HIs. METHODOLOGY: A cross-sectional study with nested case-control design was conducted between 1 July 2009 and 30 June 2010 at an 18-bed neurological intensive care unit at the Clinical Center Kragujevac, Serbia. RESULTS: In total, 537 patients were enrolled in the study, with 6,549 patient-days. There were 89 patients with 101 HIs. The incidence of patients with HIs was 16.57%, and incidence of HIs was 18.81%, while density of HIs was 15.42 per 1,000 patient-days. The most frequent anatomical sites of HIs were urinary tract (73.27%), blood (10.89%), and skin and soft tissues (10.89%). The following risk factors were identified: co-morbidity (OR=3.9; 95% CI=1.9-7.9), surgical intervention in the last 30 days (OR=5.6; 95% CI=1.5-20.4), urinary bladder catheterization longer than seven days (OR=3.8; 95% CI=1.8-8.2), value of Glasgow coma scale ≤ 9 (OR=3.7; 95% CI=1-6.9), and longer hospital stay (OR=1.1; 95% CI=1.1-1.2). CONCLUSIONS: Hospitalization in an nICU bears high risk of HIs, especially of urinary tract infections caused by Gram-negative bacteria, in patients with longer hospital stay or co-morbidities, and in those who have had surgical interventions or prolonged use of a urinary bladder catheter. Special attention should be paid to these patients to prevent HIs.

Biometeorological phases influence on stroke morbidity.

AIM: To determine influence of biometeorological phases on stroke incidence according to age and gender of patients, place of residence, days in a week, months in a year, type of stroke, additional diagnosis. METHODS: Comparative analysis of the data on stroke patients (according to age, months, days, place of residence, age, sex, stroke type, additional diagnosis and number of hospitalization days) obtained by examining the records of discharge and admission of patients in the Department of Neurology of Kragujevac and everyday biometeorological phases obtained from the Republic Hydrometeorological Service of Serbia (RHMS of Serbia), for the following years: 2003, 2004, 2007, 2008 and 2009 in Kragujevac. RESULTS: 4,700 patients diagnosed with stroke were hospitalized in the observed period. The highest number of strokes was noted in 2003 (1,030), the lowest in 2008 (851). The highest number of strokes was in March (444) and the lowest in February (351).The most frequent days were Mondays (805), and the least frequent Sundays (495). Three fifths of patients were from urban areas and the rest of them were from rural areas. Out of this number 2,382 (50.7%) were males and 2.318 (49.3%) were females, of which 1.847 (77.6%) males and 1,894 (81.7%) females were over 70 years old. The average number of hospitalization days was 12.29 days, and most patients were in hospital for less than 10 days (2101 patients). 4,130 (87.9%) patients were diagnosed with thromboembolism, 422 (9.0%) with intracerebral hemorrhage and 148 (3.2%) with subarachnoid hemorrhage. As an additional diagnosis 1,946 (41.4%) patients had hypertension, 867(18.6%) had heart insufficiency and 15.40% had diabetes. Most strokes with significant correlation were in biometheorological phases 9 and 4 (1,227 and 1,010 strokes) and the least were in phase 10 (29). As a daily average, the highest number of strokes was in phase 8 (2.76/ day), the lowest in phase 2 (2.33/day). CONCLUSIONS: Biometeorological phases have a great influence on stroke incidence, especially in phases with stable sunny weather and sudden impact of weather fronts, with sudden weather changes, with average incidence in the phase of foggy weather.

Significant influence of biometeorological conditions on the incidence of spontaneous pneumothorax in the Kragujevac city.

AIM: To explore and establish an influence of biometeorological conditions on the occurrence of spontaneous pneumothorax (SP) in the city of Kragujevac (Serbia) in a five-year period. METHODS: According to the type of series of cases, this was a retrospective, non-interventional study. The data collected from the medical records and operative protocols of the Thoracic Surgery Department in the period between 01.01.2005 and 31.12.2009, as well as the data on daily biometeorological phases for the Kragujevac city obtained from the Hydrometeorological Service of Serbia, and afterwards a comparative analysis of the data were performed. RESULTS: A total number of 159 patients with spontaneous pneumothorax were hospitalized. Most patients were treated in 2009 (55, 34.6%), least in 2005 (22, 13.8%). Most cases occurred in March (20, 12.6%), on Tuesdays (33, 20.7%), and in the biometeorological phase 2 (0.15 SP/day). The least number of cases occurred in September (9, 5.7%), on Saturdays (6, 3.8%) and in phase 8 (0.04/day) (p<0.01). CONCLUSIONS: There was an evident biometeorological influence on the occurrence of spontaneous pneumothorax in our area, so most cases were in the phase with sunny weather (atmospheric pressure falling, air temperature and moisture rising), while the lowest number was in the phase with a fall of atmospheric pressure, moisture and air temperature. The results of this research suggest a necessity of further investigations on this field.

[Biometeorological influence on motorcyclists and bicyclists trauma].

INTRODUCTION: Biometeorological circumstances have great influence on all traffic participants, especially on reflexes, movement coordination and perception ability, increasing the number of accidents. Motocyclists and bicyclists are specific participants in traffic, so their traumatism has its own special characteristics. OBJECTIVE: The aim of this study was to establish biometeorological influence on motorcyclists and bicyclists accidents. METHODS: Comparative analysis of everyday biometeorological phases for the city of Kragujevac determinated by the Republic Hydrometeorological Service of Serbia and motorcyclists and bicyclists accident evidence received from Kragujevac traffic police for the period 2004-2008. RESULTS: There were 5,180 traffic accidents in this period, with 180 accidents in which 77 motorcyclists and 116 bicyclists were knocked down. Most of the accidents were in 2008 (53) and the least in 2005 (28). Most accidents occurred during August (28) and between 19.00 and 20.00 hours (18). There were no accidents during January, between 04.00 and 06.00 hours. There were 85% accidents in the urban area. Most of 169 males were aged 16-20 and 21-25 years (20 and 21). Most of 24 females (6) were aged 11-15 years. Those who caused the accident mostly sustained injuries due to improper speed limit (31), while the victims due to the disrespect of street-crossing priorities (32). Forty-one motorcyclists and 85 bicyclists suffered mild body injuries. Thirty-one motorcyclists and 27 bicyclist suffered severe injuries. Five motorcyclists and four bicyclists ended lethally. Most accidents happened in biometeorological phases 9 (63), 4 (32) and 1 (31). CONCLUSION: Statistical analysis showed a significant correlation between accidents and biometeorological phases, with most accidents occurring during stabile warm weather and rapid penetrations of cold fronts, and with a sudden switch of weather conditions.

[Biometeorological phases influence pedestrian trauma].

INTRODUCTION: Biometeorological circumstances have a big influence on all traffic participants, especially reflexes, moving coordination and perception ability. With a lower attention and drivers' and pedestrians' concentration, there was a larger amount of pedestrian trauma in certain biometeorological phases. OBJECTIVE: The aim of this study was to establish the correlation between pedestrian trauma and biometeorological phases. METHODS: The comparative analysis of everyday biometeorological phases for the city of Kragujevac determined by RHMI and the evidence of knocked-down pedestrians from the Kragujevac traffic police for the period 2003-2008. RESULTS: There were 6,127 accidents, with 696 knocked pedestrians in 666 (10.87%) accidents. Most of them happened in 2003 (135), and the fewest in 2005 (90). Most accidents were during December (74), the fewest were in June (46). The fewest accidents were during 04-05-06 hour interval (by 2), most during 13-14 hours (61). There were 374 males and 349 females. Most of the males (by 60) were 0-10 and 11-20 years old, most of the females (74) were 11-20 years old. There were 443 pedestrians who suffered slight body injuries (112 were 11-20), 225 suffered heavy and 28 had lethal injuries (most over 70). As provokers, the pedestrians suffered because of improper crossing roads (185), while as a casualties, they suffered due to speeding of vehicles (285). Most accidents happened in biometeorological phases 4 (168) and 9 (151), the fewest in phase 10 (4). CONCLUSION: Statistical analysis shows a significant correlation between pedestrians' accidents and biometeorological phases, when the most accidents occurred during penetrations of cold fronts, while there was a sudden switch of weather conditions from warm-dry to cold-wet weather.

[Comparative analysis of audiometric and impedancemetric findings in workers exposed to the effects of various duration industrial noise].

BACKGROUND/AIM: Industrial noise is produced in workshops due to factory machinery and tools used in technological processes. It has detrimental effect to primarily the organ of the sense of hearing, thus damaging hearing in oversensitive subjects. The aim of the study was to perform a detailed analysis of audiometric and, especially, impedancemetric parameters in workers exposed to the effects of industrial noise of various duration, as well as to determine similarities and differences in workers with differences in sensitivity to damaging effects of noise. METHODS: The study included a homogenous group of 173 industrial workers involved in the same department of a huge workshop named "Kovacica" exposed to noise level above a threshold intensity, and divided into three groups: the group I of 116 workers (232 ears) exposed to noise for 8 h in the workshop "Kovacica", the group II of 41 workers (82 ears) exposed to noise only half of the working time, and the group III of 16 workers (32 ears) exposed to the same conditions and having the normal hearing sense. The group III served as a control group. Prior to the study any workers went through a thorough anamnesis and complete ORL examination, and then they were submitted to audiometric testing. The study included only the workers with no hearing damage due to diseases, injuries nor other detrimental factors in order to be sure that the hearing findings had been caused by industrial noise. RESULTS: The results obtained by audiometric testing showed that 90.75% of the workers had hearing damage of various degrees, while 9.25% of the workers had regular hearing although had been exposed to the same conditions. More severe hearing damage was revealed in the workers of the group I. Tympanometricly, in most ears of the group I workers (65.52%) a compliance value was found to be more than 0.9 cm3, while in the majority of those of the group II (59.75%) a compliance value was in the range from 0.5 to 0.9 cm3. In the workers of the group III with no hearing damage, a compliance value for any ears was in the range from 0.1 to 0.9 cm3. Mean value of threshold reflex (98.56 dB) at 500 Hz and 1 000 Hz in the group I was increased as compared with the group II (95.6 dB) and the group III (84.38 dB). At higher frequences, 2 000 and 4 000 Hz, threshold reflex was increased in the group I (99.05 dB), and in the group II (97.6 dB) as compared with the group III (86.4 dB). The amplitude of stapedic reflex was lowest in the group I, while mean values of amplitude at 500, 1 000, 2 000 and at 4 000 Hz were 2.31, 1.38, 1 and 0.3, respectively. In the group II mean values of amplitude at 500, 1 000, 2 000 and 4 000 Hz were 2.52, 1.80, 1.30 and 0.5, respectively. In the group III mean values of amplitude at 500, 1 000, 2 000 and at 4 000 Hz were 2.36, 2.45, 2.5 and 2.08, respectively. By measuring input (rising) and output angles it was revealed that most ears of the workers in the groups I and II had rising angle ranging from 41 to 50 degrees, and in the workers with no hearing loss from 31 to 50 degrees. In the majority of the ears of the groups I and II outlet angle was in the range from 16 to 35 degrees, and in the workers with no hearing damage from 26 to 35 degrees. CONCLUSION: By audiometric and impedancemetric examinations it was determined that for the sense of hearing it is significant not only a threshold hearing expressed in the audiometric curve at various frequences, but also a threshold of unpleasantness and pain under higher intensities shown by the occurrence of stapedic reflex. The less hearing field between threshold hearing and threshold acustic reflex is, the less capabilities of hearing perception due to the occurrence of recrutment.