Pregnancy related anxiety and general anxious or depressed mood and the choice for birth setting:A secondary data-analysis of the DELIVER study

BACKGROUND: In several developed countries women with a low risk of complications during pregnancy and childbirth can make choices regarding place of birth. In the Netherlands, these women receive midwife-led care and can choose between a home or hospital birth. The declining rate of midwife-led home births alongside the recent debate on safety of home births in the Netherlands, however, suggest an association of choice of birth place with psychological factors related to safety and risk perception. In this study associations of pregnancy related anxiety and general anxious or depressed mood with (changes in) planned place of birth were explored in low risk women in midwife-led care until the start of labour. METHODS: Data (n = 2854 low risk women in midwife-led care at the onset of labour) were selected from the prospective multicenter DELIVER study. Women completed the Pregnancy Related Anxiety Questionnaire-Revised (PRAQ-R) to assess pregnancy related anxiety and the EuroQol-6D (EQ-6D) for an anxious and/or depressed mood. RESULTS: A high PRAQ-R score was associated with planned hospital birth in nulliparous (aOR 1.92; 95% CI 1.32–2.81) and parous women (aOR 2.08; 95% CI 1.55–2.80). An anxious or depressed mood was associated with planned hospital birth (aOR 1.58; 95% CI 1.20–2.08) and with being undecided (aOR 1.99; 95% CI 1.23–2.99) in parous women only. The majority of women did not change their planned place of birth. Changing from an initially planned home birth to a hospital birth later in pregnancy was, however, associated with becoming anxious or depressed after 35 weeks gestation in nulliparous women (aOR 4.17; 95% CI 1.35–12.89) and with pregnancy related anxiety at 20 weeks gestation in parous women (aOR 3.91; 95% CI 1.32–11.61). CONCLUSION: Low risk women who planned hospital birth (or who were undecided) more often reported pregnancy related anxiety or an anxious or depressed mood. Women who changed from home to hospital birth during pregnancy more often reported pregnancy related anxiety or an anxious or depressed mood in late pregnancy. Anxiety should be adequately addressed in the process of informed decision-making regarding planned place of birth in low risk women

Workplace Mobbing

Mobbing odnosno zlostavljanje na radnome mjestu predstavlja neprijateljsku i neetičnu komunikaciju, koja je sustavno usmjerena od jednoga ili više pojedinaca prema, uglavnom, jednom pojedincu, koji je zbog mobbinga gurnut u poziciju u kojoj je bespomoćan ili se ne može obraniti te držan u njoj s pomoću stalnih zlostavljačkih (mobinških) aktivnosti. U članku je obrađeno nekoliko bitnih značajki zlostavljanja: ponašanja karakteristična za zlostavljača, organizacijski uzroci pojave, konflikt u poduzeću kao njegov povod, žrtva, izvanorganizacijski čimbenici njegova razvoja te posljedice zlostavljanja. Suvremeni poslovni svijet je kompleksan, dinamičan i promjenljiv te zahtijeva sve veću umješnost i sposobnost prilagodbe. Sukobi su dakako neizbježan dio svake organizacije, ali ih je menadžment dužan pravodobno prepoznati i njima upravljati radi sprječavanja štetnih posljedica za produktivnost i troškove poduzeća, radi zaštite zaposlenika te suzbijanja psihičkih i tjelesnih poremećaja koji nastaju psihičkim nasiljem i iskrivljenim oblikom ponašanja kakav je mobbing. On je problem suvremenog društva, nov i u nas nedostatno istražen oblik kršenja ljudskih prava. Zbiva se uglavnom na psihološkoj razini, negativno utječe na zdravlje i život, kvalitetu rada, proizvodnju i pružanje usluga, produktivnost i profitabilnost te značajno utječe na ekonomske gubitke u zajednici. Zlostavljanje na radnome mjestu treba rješavati multidisciplinarno: inicirajući zajedničke aktivnosti zaposlenika i uprave, uključujući medicinske stručnjake, pravnike, pa i društvenu zajednicu u cjelini. Što se u organizaciji više teži izvrsnosti koja se temelji na povjerenju i radnoj etici, to je veća vjerojatnost njegovog sprječavanja i rješavanja.Workplace mobbing is a hostile and unethical communication, systematically aimed from one or more individuals towards mostly one individual, who are forced into a helpless position and are held in it by constant bullying. This article describes some of the most important characteristics of mobbing: offensive behaviour, organizational and non-organizational causes of this behaviour, the victim, and the consequences. Modern business environment is complex, dynamic, volatile, and requires better ability to adjust. Constant changes are a part of organizational reality, but they also produce an ideal environment for all kinds of conflicts. Conflicts are inevitable in every organization, but the task of its management is to identify them and resolve before they affect the workforce, productivity, and costs. The idea is to avert psychological abuse and aberrant behaviour such as mobbing that may cause physical and mental disorders. Mobbing is a problem of the modern society; as a violation of human rights it is relatively new and unrecognised in Croatia. Abuse is mostly psychological; it affects the victim’s health and life, quality of work, productivity, profitability, and may lead to significant economic losses in the community. Mobbing can be averted by joint forces that would involve employees and management, medical and legal professionals, and even community as a whole. The more an organization pursues excellence based on trust and business ethics, the higher the probability that mobbing will be averted or stopped

Hemorrhagic Shock Caused by Mesenteric Injury - Ski Pediatric Blunt Abdominal Trauma case report

Trauma is the leading cause of pediatric mortality and abdominal injury is a significant contributor to morbidity. Abdominal trauma in the population of injured children, is the third leading cause of death in this population, after head and thoracic injuries. It is the most common cause of death owing to unrecognized injury. They most often occur in traffic accidents, games and sports. The clinical presentation depends on the severity of the injury, the injured organ and the associated injuries. Mesenteric injury from blunt abdominal trauma is uncommon and can be difficult to diagnose. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. We present an unusual case, a seven-year-old boy who was injured while skiing. The patient was in a state of hemorrhagic shock and underwent emergency surgery after an urgent diagnosis. During the operation, the leading trauma and the reason for the hemorrhagic shock were found to be a mesenteric injury, and bleeding from the branches of the superior mesenteric artery. Early transport, monitoring and diagnostics significantly contribute to reducing morbidity and mortality. The standard in surgery is non-operative treatment of injured parenchymal organs. A multidisciplinary approach that includes doctors of various specialties (pediatric surgeons, pediatricians, neurosurgeons, anesthesiologists and radiologists) who contribute to the diagnosis and treatment of injured children through diagnostic and therapeutic procedures has a key role. At the end, the decision regarding surgical treatment is responsibility of pediatric surgeon.</jats:p

A novel LUMNAqSoP approach for prioritising groundwater monitoring stations for implementation of the Nitrates Directive

Abstract Background The Nitrates Directive (ND) is an EU anti-pollution legislative that, for almost 30 years, has controlled and protected hydro-resources against excessive levels of nitrates originating from agroecosystems, striving to prevent the further exacerbation of the nitrates in aquatic environments. ND sets several principal goals that member states must accomplish, such as performing spatiotemporal nitrate analyses in ground/surface water networks to achieve national water quality monitoring programme. Results In this study, using the novel LUMNAqSoP approach, the prioritisation of 151 candidate groundwater stations for ND monitoring in Croatia was performed. The LUMNAqSoP integratively evaluates: (i) the most dominant loads from the agroecosystem (land use and management, net nitrogen application) and (ii) environmental (aquifer and soil) vulnerabilities and sensitivities of groundwater resources to nitrate pollution. By comparing stations which scored the most agro-environmental loads vs. the data from water stations containing elevated mean nitrate concentrations (from existing monitoring programmes) a very good agreement was confirmed. Moreover, deviations close to large urban zones were detected, suggesting that elevated nitrates in groundwaters in those areas likely originated from municipal/industrial rather than agricultural sources; however, further studies are needed for elucidation. Conclusions The presented approach can serve as a useful tool to policy makers and regulators for: (i) more efficient and reliable establishment of water monitoring programme pursuant to ND, as well as (ii) better management and shaping (designating/derogating) of nitrate-vulnerable zones, especially in diverse environmental conditions and dynamic agroecosystems as have been confirmed in recent decades across the EU member states. </jats:sec