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Staphylococci are ubiquitous microorganisms that predominate in normal skin and mucosal flora. Staphylococcus aureus and Staphylococcus epidermidis have been identified as a major cause of nosocomial infections, especially in patients with predisposing factors such as indwelling or implanted foreign bodies. The ability of both S. epidermidis and S. aureus to produce biofilm was compared between 116 clinically significant strains (46 from blood cultures of patients with bloodstream infection and 70 isolated from catheters) and 60 strains isolated from nasal swabs of healthy carriers from hospital staff. The presence of the intercellular adhesion genes (icaA and icaD) was determined by the Polymerase Chain Reaction method, and slime production was examined using qualitative Congo red agar technique. Among clinical strains, 35.2% (19/54) of S. aureus and 48.4% (30/62) of S.epidermidis were both positive icaA and icaD and they produced slime. Among carrier strains, 22.2% (8/36) of S. aureus and 33.3% (8/24) of S. epidermidis were positive for slime synthesis and exhibited ica genes. Our results suggest that the virulence factors contributing to the development of infections can be present in patient and hospital staff isolates. Thus, we consider it is important to detect healthy carriers of slime-producing staphylococci and to control the dissemination of these microorganisms especially in a hospital.

In the study the results of the relation between infant (neonatal + post-neonatal) mortality and the gynaecological and unemployment factors are presented. The findings are based on Bayesian modelling and indicate the possible influence of the unemployment situation on mortality, whereas no correlation was found as regards access to the availability of gynaecological health care. The main conclusion is that elevated unemployment which could be referred to a poor socioeconomic situation (amongst other factors) may force pregnant women to pay more attention to improving their life conditions, than to sufficient medical controlling.

CYP21 gene molecular analysis was performed to determine the mutational analysis of 87 unrelated Czech patients with different forms of steroid 21-hydroxylase deficiency. Eight of the most common point mutations (intron 2 splice, P30L, 8 bp deletion in exon 3, I172N, V281L, Q318X, R356W, P453S) were analyzed using Amplification-created restriction site method. Cluster in exon 6 mutation was analyzed using allele-specific oligonucleotide hybridisation. Deletions and conversions were screened by modification of an sequence specific oligonucleotides hybridisation. The most frequent mutation in Czech patients was intron 2 splice mutation (45.4%). The comparison of mutation frequencies was made among Czech and European population (high frequency of intron 2 splice, 8bp deletion, P30L, P453S and low frequency of deletions/conversions in Czech population) and among Czech and different regions worldwide (low frequency of deletions/large gene conversions, V281L, R356W, high frequency of intron2, 8bp deletion, P30L and P453S in Czech population). We compared common mutation frequencies of different regions worldwide (North and South America, Asia, North Africa, Europe). Significant differencies in selected regions were determined by ANOVA statistical analysis (One-sample t-test, confidence interval) at value of p<0.05.

The rapid growth of medical knowledge creates a demand for new ways of providing information. Health professionals are dealing with a variety of cases, and as they have no time to visit the library, they need filtered information instantly. Medical knowledge databases and data sets are increasingly available in electronic form, particularly on the World Wide Web. The premise of this medium is that it offers a "world of` knowledge at your fingertips". The reality, however, is somewhat different, as information systems are not well integrated into clinical practice, they prove difficult to find specific information in, and contain content of varying quality. The continued evaluation of the medium in the future, should be beneficial as evidence-based resources available, and these resources are integrated into electronic medical record systems. The DIMDI and OVID CD-ROM databases are presented as vehicles of research in Bio-Medical Sciences.

The study of reliability was part of a project funded by the Grant Agency of the Czech Ministry of Health. The repeatability of answers, 180 questionnaires being sent again after a six week interval, was assessed by two methods: by the percentages of agreement and using the Kappa index. We evaluated 61 questions, which were divided into five sections (general questions, questions on employment, lifestyle, health, and personality). The agreement rate varied from 46 % to 100 % and the value of the Kappa index from -0.01 to 1. The agreement performed by the Kappa index was divided into 4 groups (0.4 - poor; 0.41-0.6 average; 0.61-0.80- good; 0.81-1 almost perfect). The agreement across our questionnaire was poor in 6.6 % of the questions, average - in 31.1 %, good - in 45.9 % and almost perfect - in 16.4 % of the questions. Next we divided the questions by their content into two groups - the factual questions (group 1) and questions where answers contain an evaluative or motivational element (group 2). Significant differences (p<0.001) were found between groups 1 and 2 in the agreement (86.8 %; 72.1 %) and the Kappa index (0.73; 0.48). In questions where agreement of answers is evaluated as average or even weak we used three types of solution: a) substitution by the analogous questions with a higher agreement, b) aggregation of the answers if possible, or c) the questions were not used for the analyses. These important results will be considered in further analyses of the data and in the interpretation of the study results. The detailed information about the whole project and the results has already been published or presented are available on the following web site: www.zuova.cz/projekty/ses.php

This study is a part of a larger project Nr. NJ 6139-3 funded by the Grant Agency of the Czech Ministry of Health. The aim of the paper was to analyse the response rate using standard statistical methods and the Geographical Information System (GIS); to indicate differences in the response by sex, age, education, and employment; to determine the breakpoint for the collection of questionnaires according to which we can estimate the total response rate; to indicate whether the study sample was representative enough to generalize the project results. The additional aim of the paper was to collect those background literary sources dealing with the response rate as a methodological paradigm.
The statistical and GIS analysis were based on comparison of the total population data (Census 2001), the study sample and the sample of the completed questionnaires data in the 23 districts of the city of Ostrava. The information from the data collection was derived from the date of receipt for each questionnaire. The literature sources were obtained from the Internet - in total 228 papers from the period since 1986 to the present have been checked.
The main results of this study are: the GIS analysis was confirmed in all stages by standard statistical methods - it can therefore be used as a valid tool for quick orientation in data and for the comparison of a study sample with the general population; we did not find significant differences in the course of the collection of the questionnaires between sex, age, education, and the employment of respondents; it can be seen that the breakpoint according to which we can estimate the total response rate, is the 10th day after the questionnaires are distributed by post (75% of the questionnaires collected); our sample is representative enough from the geographical point of view. More detailed information about the whole project and results already published or presented are available on the following web site: www.zuova.cz/projekty/ses/php

The internal tobacco industry documents have also been used to study tobacco industry operations outside the United States. The scope of the documents on a country outside the US is decided mainly by the extent to which documents and reports were transmitted from the abroad offices of the US tobacco companies to headquarters. We explored whether the material from a private archive of a Finnish public relation consultant to Philip Morris will augment or revise the earlier reports on tobacco industry manipulation in Finland. The private records add more details to previously published reports. The new information mainly concerned implementation of the tobacco industry strategies. A general conclusion is that tobacco industry documents may not give a detailed picture of tobacco industry activities in distant markets, which would be of interest locally, even if they provide sufficient information to convey a general view of tobacco industry strategies.

Introduction: Adolescents often look to mass media for information regarding issues of sexuality. As one form of media, teenage magazines have long constituted a pervasive and effective element of adolescent media exposure. Teenage magazines discuss a number of aspects concerning adolescent sexuality. Considering their potential impact on health related behaviors, the information they provide and the message(s) they send warrant attention.
Aim/Purpose: The aim of this study is to perform a content analysis of sexual development and behavior information presented in Polish teenage magazines. Social Cognitive Theory was used as a theoretical basis for this analysis.
Methods and Materials: The media chosen for this study were general-themed publications targeting an adolescent female audience: Bravo Girl!, Filipinka and Dziewczyna. Each entry was analyzed using a structured key. The specific categories of behavior and development used for this study are: biological information, pedagogic instruction, topics of moral-ethical concern, results of sexual activity, and interpersonal relationships. Each category was then subdivided into separate units.
Results: The findings indicate that Polish teenage magazines predominantly focus on relationships, contraception and sex education. Relationships were most often of a romantic nature and discussed sexual activity or the potential of sexual activity. Non-prescription contraceptive methods were most often discussed, with attention given to pregnancy prevention. Sex education offered detailed information on sexual practices and behaviors with much discussion on losing one's virginity.
Conclusions: The general approach of the analyzed magazines is that adolescents currently are, or soon will be, sexually active. As a result, certain sexual behavior and development issues are discussed in great detail, while other topics are somewhat neglected. Accepting informationseeking during adolescence as commonplace, these findings suggest that teenage magazines hold the potential for influencing adolescent sexual behavior and development.

With respect to the fact that acute respiratory infections (hereafter ARI) are a world-wide serious social and economic problem, more and more attention is being paid to the development and application of oral bacterial immunomodulators.
The preventive effect of GS Imunostim has been evaluated during the respiratory season 2005. The study took place at 10 outpatient sites of general practitioners and lung specialists in Prague, Pilsen and Brno in the respiratory season from January to April 2005. The comparison with the ARI morbidity reports in the studied period revealed statistically significant morbidity reduction in the study participants compared to the ARI morbidity in the Czech population in the studied period from January to April 2005. The morbidity rate in the studied group was 7%, whereas ARI morbidity 15.1% was reported in the general population. The morbidity in the study group was significantly lower that in the general population.

Objective: To study the association between common cold during pregnancy and pregnancy complications and delivery outcomes: gestational age/birth weight, in addition preterm birth and low birthweight.
Method: In the population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities (HCCSCA), 19801996, controls without congenital abnormalities were analysed.
Results: Of 38,151 newborn infants, 5,475 (14.4%) had mothers with common cold. The prevalence of threatened preterm delivery, placental disorders and severe nausea and vomiting was lower while the occurrence of anemia was higher in pregnant mothers with common cold than in mothers without common cold. Mothers with common cold in pregnancy had 0.1 week shorter gestational age, thus the proportion of preterm births (9.8% vs 9.1%) was somewhat larger. However, mean birth weight was somewhat larger (3,305 vs 3,271 g) and the proportion of low birthweight newborns (4.2% vs 5.9%) was smaller.
Conclusion: Common cold during pregnancy does not increase the occurrence of pregnancy complications except anemia, while delivery outcomes showed minor but opposite (higher rate of preterm birth and lower rate of low birthweight) changes.

The study is aimed at the detection and intervention of risk factors for cardiovascular diseases (CVD) and at the part played by stress in their development. The methods applied are designed to eliminate the risks and, simultaneously, to identify the function of the two main parts of stress reaction, i.e., in terms of the extent, level and type of the stressors experienced, and in terms of the level of mental resilience and related psychosocial factors which affect the experiencing of and coping with stress. The purpose of medical examination based on the patient's history, subjective complaints and objective tests, including a study of dietary habits and psychological methods was to establish the status praesens and identify the main risk factors and symptoms leading to ischemic heart disease (IHD). Intervention was performed in subjects with increased cardiovalscular risk factors.

Although large-scale epidemiologic studies, as well as interventional trials have provided strong evidence of a consistent and robust association between physical activity and cardiovascular disease, the effect of exercise on the burden of stroke is not well understood and appreciated. This review has a purpose to summarize the literature on the effect of physical activity on stroke morbidity and mortality, and to provide current scientific evidences.

Waste landfills are a potential hazard to health. Public concern exists about this potential hazard and researchers agree that further research is required on this field. The objective of the study was to investigate the association between waste landfill location and congenital anomalies risk in Denmark. The study was a multisided epidemiological geographical comparison study of risk of congenital anomalies combined and congenital anomalies of the cardiovascular and nervous systems with maternal residence in the vicinity of 48 Danish waste landfills compared with those living further away in the years 1997 to 2001. We used routine health and population data in Geographical Information System (GIS) to investigate the risk. The subjects were 2,477 live birth with congenital anomalies.
All relative risks in the proximal zones of 0-2 km were set to 1 for comparison. For all anomalies combined relative risk in the middle zones of 2-4 km joint was 0.991 and in the distal zones of 4-6 km joint the relative risk was 1.013. For congenital anomalies of the nervous system, the relative risk in the middle zones was 1.226 and in the distal zones 1.113. For congenital anomalies of the cardiovascular system, the relative risk in the middle zones was 0.926 and in the distal zones 0.854. This result was not supported by the aggregated risk ratio mean.
We found no association between waste landfill location and congenital anomalies combined or of the nervous system. However, we found small excess risk for congenital anomalies of the cardiovascular system. No causal mechanisms are available to explain these findings, but alternative explanations include approximated birth rates and residual confounding. It is our recommendation that more comprehensive multisided studies will be executed to examine the safety of waste landfills.

Aims: To study the role of maternal employment status as indicator of socioeconomic status in the origin of isolated orofacial clefts (OFC) and in the use of periconceptional folic acid/multivitamin supplementation.
Methods: 1,975 cases with OFC (1,374 cases with cleft lip ± palate and 601 cases with posterior cleft palate), 38,151 population controls without any defects and 20,868 patient controls with other isolated defects were compared in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA), 1980-1996.
Results: The proportion of professionals and managerials was lower, while the proportion of unskilled workers, housewives and others was higher in the mothers of cases with OFC compared with the population control group. However, the comparison of OFC and patient control groups did not show any difference in the employment status of mothers. A lower level of folic acid supplementation occurred in the professional and skilled worker mothers of cases with OFC compared with the population control group. This difference was confirmed by the comparison of folic acid used by mothers of cases with OFC compared with patient controls. An infrequent multivitamin use was displayed in the studied groups. Conclusions: The prevalence of OFC at birth shows a slightly lower maternal employment status as indicator of socioeconomic status than in the population control group. The higher level of maternal education does not imply a higher rate of folic acid supplementation in the group of OFC.

The aim of the study was to assess the reliability of questionnaire information on visits to a physician and the use of antibiotics taken for respiratory infections among schoolchildren attending a water-damaged school and a reference group of schoolchildren attending an undamaged school. Two similar questionnaires on respiratory morbidity in two consecutive years were sent to the parents. The information given on the questionnaires was compared with the patient's records of the local health centre. Although the overall total numbers of ambulatory visits in the patients' records and questionnaires seemed to indicate good reliability, a more detailed individual investigation showed poor recall validity from the questionnaires, including a high percentage of unreported visits to the local health centre from both schools. Underreporting was commoner in the control school than in index school. Recall was best for the children who had no visits to a doctor. Use of antibiotics had a better recall than ambulatory visits in both schools. The study indicates that information on health services in questionnaires is not reliable, at least when occurrences in a period of one year or more are evaluated. The use of patient records as a reference of accuracy is also unreliable, unless all the health care services available to the people in the community are covered.

Patients with autoimmune hepatitis (AIH) are a group at risk of disease exacerbation or relapse of the underlying disease should they fall ill with infectious hepatitis A (HAV) or B (HBV). Therefore, it seems appropriate to protect this group of persons against HAV and HBV disease by vaccination. An open study evaluated the safety, reactogenicity and immunogenicity of a combined HAV and HBV vaccine in 10 patients with AIH (6 patients aged 1-15 years and four patients aged 16+ years). The vaccine was administered using a three-dose vaccination schedule (0, 1 and 6 months). The vaccine course was well tolerated, safe and did not aggravate the clinical course of the underlying disease. Patients responded with 100% seroconversion for antibody to the HAV vaccine component and geometric mean antibody concentration (GIVIC) comparable to healthy cohorts. Response to the HBV component antigen was comparable to previous reports of HBV vaccination in immune compromised individuals with lower GMC than observed in healthy populations. One month after the third vaccine dose (month 7), all six vaccinees in the 1-15 years age group developed protective levels of anti-HBs as compared to two of the four vaccinees in the 16+ years age group.

The authors analyzed two hospital outbreaks of epidemic keratoconjunctivitis (EKC), one at the Department of Ophthalmology (30 cases) and another one at the Department of Premature Newborns (22 cases). In both outbreaks, EKC was diagnosed in inpatients (16 and 6 respectively), outpatients (5 and 3 respectively), healthcare workers (HCWs) (3 and 5 respectively), and relatives of EKC patients (6 and 8 respectively). Implemented infection control measures included isolation precautions, improved disinfection and hand-washing of both hospital and outpatient department personnel. Shortly after implementation of control measures the rate of infection transmission started to decrease significantly.

Four new AChE oximes for reactivation of acetylcholinesterase inhibited with tabun - K027 [1-(4-hydroxyiminomethylpyridinium)-3-(4-carbamoylpyridinium) propane dibromide], K005 [1,3-bis(2-hydroxyiminomethylpyridinium) propane dibromide], K033 [1,4-bis(2-hydroxyiminomethylpyridinium) butane dibromide] and K048 [1-(4-hydroxyiminomethylpyridinium)-4-(4-carbamoylpyridinium) butane dibromide] were prepared. Their efficacies to reactivate tabun-inhibited acetylcholinesterase were studied and compared with the currently used acetylcholinesterase reactivators (pralidoxime, obidoxime and HI-6). Reactivator K048 seems to be promising reactivator of tabun-inhibited AChE. Its reactivation potency is significantly higher than the efficacy of HI-6 and pralidoxime, and comparable with the potency of the obidoxime at human relevant doses.

Studies aimed at the influence of smoking on reproductive functions have found out fertility disorders in smokers occurring at any stage of reproductive processes. In our experiments the role of cadmium, nicotine and anabasine was investigated in the expansion of oocyte-cumulus complexes (OCC) isolated from large antral porcine follicles. Suppression of FSH-induced cumulus expansion and significant inhibition of synthesis and accumulation of hyaluronic acid in the cell/matrix compartment of the OCC was observed in the presence of different concentrations of tested compounds. The suppressive effect of cadmium and tobacco alkaloids on the cumulus expansion was accompanied by decreased progesterone production by cumulus cells during 42 h incubation of the OCC with FSH.

Objective: To review strategies of transnational tobacco companies (TTCs) at creating a favourable advertising environment for their products in Hungary, with special regard to efforts resulting in the liberalisation of tobacco advertising in 1997.
Method: Analysis of internal tobacco industry documents relevant to Hungary available on the World Wide Web. Transcripts of speeches of members of the Parliament during the debate of the 1997 advertising act were also reviewed.
Conclusions: The tobacco companies not only entered the Hungarian market by early participation in the privatisation of the former state tobacco monopoly, but also imported their sophisticated marketing experiences. Evasion and violation of rules in force, creation of new partnerships, establishment and use of front groups, finding effective ways for influencing decision makers were all parts of a well orchestrated industry effort to avoid a strict marketing regulation for tobacco products.

On the Czech set of European Longitudinal Study of Pregnancy and Childhood (ELSPAC), we tried to verify whether it is possible to confirm the results of foreign studies which found out that the both prenatal and postnatal exposure of newborns to chemicals on cigarette smoke could influence the newborns'morbidity in the first six months of their life.
Mothers, who served as sources of data about their smoking behaviour during the pregnancy and after the birth as well as information about the health status of the children after the birth (N=3,871) were divided into four groups: 1. women who never smoked (74.3%), 2. women who stopped smoking in pregnancy and started to smoke after delivery (18.3%), 3. women who smoked both during pregnancy and after delivery (7.2%), 4. women who smoked during pregnancy and stopped after delivery. Unfortunatelly, the last group was very small (only seven mothers) and did not allow assessment of exclusively prenatal exposition.
Sucklings from Czech ELSPAC set exposed to chemicals in cigarette smoke either only after the birth or also during the prenatal period, showed significantly higher occurence of different symptoms of respiratory tract damages and their complications (like otitis media) when compared to children of non smoking mothers. Due to illnesses during the first six months after the birth, their parents had to look more often for the consultations of physician, including hospitalization. Our results, as well as results of foreign studies, confirm, that smoking of mothers during the pregnancy and after the birth represents significant risk for the first months of life. Illnesses of children in this early period can cause longitudinal consequences which emerge during the childhood as well as in adulthood. They also represent a strong stressogenic factor. Children's health consequences of exposure to cigarette smoke request very often intensive and expensive care within health system.
Our results are the same as those of foreign studies and confirm that both prenatal and postnatal exposure to chemicals of cigarette smoke is significant risk factor which negatively influences the health status on the early periods life.

The purpose of the article is to present the National Breastfeeding Promotion Programme in the Czech Republic in the course of the last decade. It summarizes the main strategies, education and training activities of the National Breastfeeding Committee, its collaboration with the Government, Parliament, IBFAN and UNICEF. The article reviews the relevant studies on infant feeding which illustrate the increase of the prevalence of breastfeeding in the course of the 1990's and reflect the effect of the programme. Recent negotiations with the Ministry of Health have outlined the implementation of the WHO global strategy for infant and young child feeding in the Czech Republic.

HESP 2.b risk assessment program was studied in detail concerning the effect of changing different input parameters for the output ADI values calculated by the program. We used the standard Netherlands 1.0 scenario offered by the program. With this we fixed a lot of input parameters which define the area, human and animal recipient parameters etc. The remaining 31 unfixed parameters were fixed at first to "BASE" input values and the BASE output values were calculated by HESP. Later we chose only one parameter at a time and changed it to an another value. The calculated ADI values were then compared to BASE output values. Seven parameters (soil type, soil usage, site length, soil pH, groundwater fraction in drinking water, basement floor type and Qev) were studied. We found, that changing soil pH or Qev have not any influence on the output ADI values in case of any contaminant. Soil type change has not any effect on the output ADI value in case of Pb or Cd but it seems to play important role in all cases of the four organic material we investigated. Changing soil usage have influence on the output ADI value almost in every case. It seems to be linear relation between the maximal concentration of contaminant and calculated ADI. Changing the site length and basement floor type gave in some cases different ADI values compared to BASE values. If we alter the groundwater fraction in drinking water we got usually different ADI values. With Risc Human risk assessment program we got similar results: nor the changes in soil type, site diameter or soil pH gave any changes in output ADI values. Our results hint that using HESP and Risc Human requires enhanced caution.

One of the tools for preventing soil pollution and thus protection of public health is the application of appropriate limit values. Policies on soil protection in relation to soil pollution include two basic strategies: a preventive approach and a remediation or cleanup approach. Preventive, multifunctional limit values are independent from present or future land use. Remediation limit values are connected with land use - these are functional limit values. Both types of limit values are applied in Hungary. Determination of soil limit values demands long-term field investigations, but to estimate allowable concentration for a given site reverse risk assessment methods are well applicable. A comparison and evaluation of the calculated data and the measurement results obtained at the use of the area is indispensable. Further investigations are needed for establishment of combined limit values when more polluting components are present simultaneously in the soil.

The US EPA integrated Exposure Uptake Biokinetic (IEUBK 0.99d) lead exposure for children was validated, updated, and applied to predict mean blood lead levels based on lead uptake from multiple sources and provide assessment of risk. Surveys were carried out around houses in a polluted area (Heves, Hungary) in 1995. The collected data from that area have shown very high levels of lead in soil. In some cases the level of lead in soil has reached more than 1000 times the allowable limit value used (100 mg/kg) in Hungary. Moreover, the concentration of lead in air was measured and the concentration of lead in air varied from 0.05-1.83 micrograms/m3. The environmental data within the community were used to predict the children blood lead levels and to compare the observed estimates with the other predicted ones. The age of the investigated group of children varied from 0-60 months. The estimated blood lead levels have illustrated variation according to age, sex, and the specific site. It can be concluded from this study that the model can be used on a wide range to give us an excellent picture for site cleanup, to decision makers, and finally to use the environmental data to predict blood lead level for the community or population. Results of several validation exercises utilizing the IEUBK model comparing predicted and measured blood lead levels with international guidelines and the percent of risk of exceeding a specific blood lead level (i.e., 10 micrograms/dl) are presented in this paper.

A panel of immunological parameters has been examined in a group of dry-cleaning workers (n = 21) and in a control group of administrators (n = 16) from the same plant. The results were also compared to long-term laboratory reference values (LRV) (n = 14-311). External exposure to tetrachloroethylene (PER) was represented by TWA (8 h) values in the range 11-752 mg PER/m³. Biological monitoring showed an amount from 9 to 344 mg PER/m³ in exhaled air by the end of workshift. 1. The exposed dry-cleaning workers compared to the controls from the plant had statistically significant changes in metabolic activity of phagocytes, α₂-macroglobulin, C3 and C4 complement component, salivary secretory IgA, and blastic transformation test. Most of the values were within the range of normal values. 2. The exposed dry-cleaning workers had several abnormal immune parameters compared to the long-term laboratory values (LRV) especially in the α₂-macroglobulin, C3 and percentage of T-lymphocytes. Most of the changes, even those that were statistically significant, were still within the range of normal values, but they might be classified as trends or shifts away from normal (spontaneous blastic transformation, absolute number of phagocyting cells, coeruloplasmin, circulating immunocomplexes, serum lysozyme). 3. The non-exposed controls from the same plant showed both quantitative and qualitative differences when compared to the LRV. Changes were seen in IgG, C4, CSI and in increased spontaneous metabolic activity of leucocytes, total leucocyte count, absolute number of phagocyting cells, α₂-macroglobulin, prealbumin, C4, circulating immunocomplexes and serum lysozyme. 4. The distribution analysis of all results detected a large number of abnormal values in both groups, more in the at-risk group. 5. As inhalation was the main route of PER exposure it was concluded that the changes might represent aspects of the response of the respiratory immune system, mainly of the alveolar macrophages. Additional postinfection effects could not be excluded in both studied groups. Individual differences in immune reactivity as well as individual range of exposure should be taken into consideration.