Citation: Dzhambov AM, Tokmakova MP, Gatseva PD, Zdravkov NG, Gencheva DG, Ivanova NG, Karastanev KI, Vladeva SV, Donchev AT, Dermendzhiev SM. Community noise exposure and its eff ect on blood pressure and renal function in patients with hypertension and cardiovascular disease.Folia Medica 2017;59(3): 344-356. doi: 10.1515/folmed-2017-0045 Background: Road traffi c noise (RTN) is a risk factor for cardiovascular disease (CVD) and hypertension; however, few studies have looked into its association with blood pressure (BP) and renal function in patients with prior CVD. Aim: This study aimed to explore the eff ect of residential RTN exposure on BP and renal function in patients with CVD from Plovdiv Province. Materials and methods:We included 217 patients with ischemic heart disease and/or hypertension from three tertiary hospitals in the city of Plovdiv (March -May 2016). Patients' medical history, medical documentation, and medication regimen were reviewed, and blood pressure and anthropometric measurements were taken. Blood samples were analyzed for creatinine, total cholesterol, and blood glucose. Participants also fi lled a questionnaire. Glomerular fi ltration rate was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. All participants were asked about their annoyance by diff erent noise sources at home, and those living in the city of Plovdiv (n = 132) were assigned noise map L den and L night exposure. The eff ects of noise exposure on systolic blood pressure (SBP), diastolic blood pressure (DBP), and estimated glomerular fi ltration rate (eGFR) were explored using mixed linear models. Results: Traffi c noise annoyance was associated with higher SBP in the total sample. The other noise indicators were associated with non-signifi cant elevation in SBP and reduction in eGFR. The eff ect of L den was more pronounced in patients with prior ischemic heart disease/stroke, diabetes, obesity, not taking Ca-channel blockers, and using solid fuel/gas at home. L night had stronger eff ect among those not taking statins, sleeping in a bedroom with noisy façade, having a living room with quiet façade, and spending more time at home. The increase in L den was associated with a signifi cant decrease in eGFR among men, patients with ischemic heart disease/stroke, and those exposed to lower air pollution. Regarding L night , there was signifi cant eff ect modifi cation by gender, diabetes, obesity, and time spent at home. In some subgroups, the eff ect of RTN was statistically signifi cant. Conclusions: Given that generic risk factors for poor progression of cardiovascular diseases cannot be controlled suffi ciently at individual level, environmental interventions to reduce residential noise exposure might result in some improvement in the management of blood pressure and kidney function in patients with CVD.

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Introduction:This study aimed to explore the effect of community noise on body mass index (BMI) and waist circumference (WC) in patients with cardiovascular disease (CVD).Materials and Methods:A representative sample of 132 patients from three tertiary hospitals in the city of Plovdiv, Bulgaria was collected. Anthropometric measurements were linked to global noise annoyance (GNA) based on different residential noise annoyances, day–evening–night (L den), and nighttime (L night) road traffic noise exposure. Noise map L den and L night were determined at the living room and bedroom façades, respectively, and further corrected to indoor exposure based on the window-opening frequency and soundproofing insulation.Results and Discussion:Results showed that BMI and WC increased (non-significantly) per 5 dB. The effect of indoor noise was stronger in comparison with that of outdoor noise. For indoor L den, the effect was more pronounced in men, those with diabetes, family history of diabetes, high noise sensitivity, using solid fuel/gas for domestic heating/cooking, and living on the first floor. As regards indoor L night, its effect was more pronounced in those with low socioeconomic status, hearing loss, and using solid fuel/gas for domestic heating/cooking. GNA was associated with lower BMI and WC.Conclusion:Road traffic noise was associated with an increase in adiposity in some potentially vulnerable patients with CVD.

INTRODUCTION: Violent behaviour may be an appropriate response to a given set of environmental conditions in nature. Social organizations as power systems ensure stability through force or threat. However, there is a growing concern about the violence against health service staff in both hospitals and outpatient facilities. AIM: To study the frequency, types and determinants of patient violence towards health professionals in primary care in Bulgaria and to fi nd the specifi c characteristics of violent behaviour in patient subgroups as well as the attitudes of providers. MATERIAL AND METHODS: A sample of 165 doctors from primary care institutions in Bulgaria participated in a questionnaire study using a specially developed research tool. RESULTS: Prevalence of violent patient behaviour has not been studied extensively in Bulgaria leaving a gap in research data. The participating physicians, however, reported that there is a serious increase in the frequency and diversity of aggressive behaviour towards medical profession by patients and negative attitude of the general public indicating serious issues in public health care. CONCLUSION: Most often patients' aggression was provoked by factors associated with the health system organization and effectiveness and the socio-economic status of the population.

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