Srce obrani – pravilno se hrani!Unapređenje prehrambenih navika u svrhu prevencije infarkta miokarda

Na osnovi kvantitativnih i kvalitativnih pokazatelja zamijećen je porast broja kardiovaskularnih bolesti u populaciji, te je stoga povećan i broj istraživanja koja se bave ovom problematikom. Potreba definiranja najvažnijih čimbenika koji pojačano utječu na razvoj bolesti povezanih s kardiovaskularnim sustavom, sve je veća. Svakako, jedan od čimbenika je i prehrana, ali nije definirano i u kojoj mjeri utječe. Također, smatra se da je poznavanje prehrambenh navika populacije određene zemlje važno, jer se incidencija infarkta miokarda ne može generalizirati u svjetskim okvirima već ovisi i o tome “što nacija jede” (jednako kao i o sprezi sa drugim čimbenicima). Projekt bi se sprovodio u Specijalnoj bolnici za medicinsku rehabilitaciju bolesti srca, pluća i reumatizma Thalassotherapia Opatija. U okviru projekta istraživanje je osmišljeno u želji otkrivanja povezanosti prehrambenih navika i nastanka kardiovaskularnih bolesti, odnosno povezanosti sa neposrednim čimbenicima rizika za nastanak kardiovaskularnih bolesti (osobito pretilost), a u svrhu osiguravanja znanstvene osnove za uspješno vođenje politike budućeg razvoja prevencije kardiovaskularnih bolesti

Earthquakes and their environmental, medical and public health impacts

Earthquakes are probably the scariest among the natural disasters that teach us about the forces of nature and their unpredictability. Knowing that there is nothing we can do to prevent the occurrence of an earthquake, we are forced to learn from our own experience. This paper systematizes the environmental, medical and public health impacts of earthquakes. Each is presented in a structured way, highlighting its most important aspects. The relationship between them and the affected environment and population; as well as the connection between these are emphasized during earthquakes. The environment at the place of occurrence of an earthquake is important for the survival of victims and also defines the particular medical and public health needs arising from its specificity. Every country needs good disaster management with specific protocols for the expected type of disaster. These protocols must incorporate environmental, medical and public health aspects and their implementation must be very efficient; they must include educating the inhabitants; training teams involved in rescue, (eventual) migration/evacuation, medical treatments and public health actions, and training and educating leaders

EPIGENETIC IMPRINT OF "COMPASSIONATE SOCIETY" TRIGGERED BY VULNERABILITY AND MENTAL ILLNESSES

Epigenetics investigates connection between our genes and our environment. It has been hypothesized that certain conditions we experience can influence our gene expression and can probably be passed onto our children, transgenerational transfer of trauma being one of them. We postulate that the notion of compassion has also been passed on from one generation to another. Our ancestors discovered that groups have a higher chance of survival than individuals. Thus, psychological traits that help form social cohesion, like compassion, are proven beneficial and passed onto the next generation. However, our perception of compassion has changed through time. In the beginning, it was expressed as a feeling of sympathy for the vulnerable, for example the elderly, the sick, pregnant women and children. These groups were innately perceived as deserving compassion. As our social awareness grew, so did the list of vulnerable groups, including members of different races, sexual or gender orientations, etc. Over time, a shift in the way we feel compassion has occurred. Nowadays, it almost seems like only those belonging to a vulnerable group are justified to feel suffering or oppression. At the same time, the suffering of those who do not belong to these exclusive vulnerable groups is marginalized. Mental illnesses like anxiety or depression are trivialized if the person in question is perceived as being privileged (in any sense), while at the same time, they are seen as warning signs if the person suffering is vulnerable. If one truly needs attention, help, or both, the easiest way is to declare oneself vulnerable. If this trend continues, we postulate that a lack of compassion in our modern society will have an impact on future societies as well. Through transgenerational epigenetic inheritance, this can create future societies whose sense of compassion will be shaped only by the definition/perception of those who are currently perceived as vulnerabl

Impacts of Medical Tourism on Healthcare Access

Today, medical tourism is underrated and mostly perceived as a beauty tourism. However, except dermatological and dental services also organ transplantation, IVF and many other therapies are well present in medical tourism travel arrangements. Medical tourism without any doubt impacts access to healthcare. Healthcare system in many countries allows access to some of these services but all-around world approaches differ. We believe that healthcare access could greatly benefit by opening this kind of services to wider population while at the same time not endangering patient’ safety. Harmonized propositions, accreditations and certificates for medical tourism industry access covered by both, private and public health insurances, would contribute to service transparency and patient’ safety while taking care of moral aspects of such services. Therefore, if consciously incorporated, medical tourism, as a part of global healthcare could easily become an efficient and effective additional access to healthcare

Safety at work of nurses/technicians employed in ionizing radiation zone

Zračenje je energija koja putuje kroz prostor i prisutna je svugdje oko nas. Život na zemlji razvijao se u okruženju ionizirajućeg zračenja. Otkrićem ionizirajućeg zračenja započinje značajno razdoblje u medicinskoj dijagnostici i liječenju. Otkrićem rendgenskog zračenja i njegovom upotrebom u medicini raste i svijest o njegovim štetnim učincima na ljudski organizam. Sve veća uporaba ionizirajućeg zračenja povećava mogućnost nastanka štetnosti opasnih za zdravlje ako se ono ne koristi pravilno. U zdravstvenim ustanovama ionizirajuće zračenje koristi se u dijagnostičkoj i intervencijskoj radiologiji, nuklearnoj medicini i onkologiji. Svakodnevnim razvojem medicinske radiologije dolazi se do novih spoznaja povezanih s dijagnosticiranjem i liječenjem, a samim time i do usavršavanja pojedinih postupaka. Medicinske sestre/tehničari koji su svakodnevno ili povremeno izloženi tijekom svojeg rada ionizirajućem zračenju mogu smanjiti opasnost nepoželjnih posljedica od zračenja odgovarajućom zaštitom na radu koja će spriječiti nepotrebnu izloženost velikim dozama. Ciljevi članka jesu osvrt i doprinos sustavu očuvanja i zaštiti zdravlja medicinskih sestra/tehničara koji su izloženi izvorima ionizirajućeg zračenja kao i njihovom sigurnom radu. Prikazani su prevencija, edukacija i mjere zaštite od ionizirajućeg zračenja koje je potrebno poduzeti kako bi se smanjila izloženost te štetan utjecaj za zdravlje čovjeka. Dokazano je da izlaganje ionizirajućem zračenju štetno te su njegovi učinci mutageni, teratogeni i karcinogeni. Učinci se mogu javiti u različitim oblicima i različitim vremenskim rasponima. Izloženost medicinskih sestara/tehničara ionizirajućem zračenju povezana je s brojnim zdravstvenim rizicima. U cilju smanjenja negativnih posljedica potrebna je dobra stručna edukacija kao prvi preduvjet zaštite: dobro poznavanje posljedica zračenja te svih sredstava i metoda za smanjivanje izloženosti zračenju. Zaštita na radu medicinskih sestara/tehničara uključuje korištenje zaštitne odjeće, nošenje dozimetara i redovite sistematske preglede. Važna je stalna kontrola uređaja i njihovih dijelova prema zadanom Pravilniku, kontrola prostora gdje se izvode snimanja, provjera educiranosti osoblja, redovitost sistematskih pregleda te poštovanje nošenja zaštitne odjeće i njezine dostupnosti.Radiation is the energy that travels through space and is present everywhere around us. Life on earth evolved in an environment of ionizing radiation. The discovery of ionizing radiation marks the beginning of a significant period in medical diagnosis and treatment. The discovery of X-rays and their use in medicine prompted a growing awareness of their adverse effects on the human body. Increased use of ionizing radiation increases the likelihood of harmful health hazards if it is not used properly. In healthcare settings, ionizing radiation is used in diagnostic and interventional radiology, nuclear medicine and oncology. Ongoing development of medical radiology brings new insights related to diagnosis and treatment, and thus to the refinement of certain procedures. Nurses/technicians exposed to ionizing radiation on a daily or occasional basis during their work may reduce the risk of undesired radiation exposure with adequate occupational safety measures that will prevent unnecessary exposure to high doses. The paper aims to review and contribute to the preservation and protection of the health of nurses/ technicians exposed to ionizing radiation sources and their safe work. Prevention, education, and ionizing radiation protection measures to be taken to reduce exposure are presented, including adverse effects on human health. Exposure to ionizing radiation has been shown to be harmful and its effects are mutagenic, teratogenic and carcinogenic. These effects can occur in different forms and in different time spans. Nurses/technicians\u27 exposure to ionizing radiation is associated with a number of health risks. In order to reduce the negative effects, a good professional education is needed as a first prerequisite for protection. It involves thorough knowledge of the consequences of radiation, and of all means and methods for reducing radiation exposure. Occupational safety for nurses/technicians includes the use of protective clothing, wearing dosimeters and regular medical check-ups. It is important to maintain the equipment and its parts in compliance with the advised regulations, keep safe the environment where imaging is performed, supervise the education of the staff, ensure regular medical check-ups, make sure that the staff wear protective clothing and that adequate protective clothing is always available

INTEGRATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE WITH PRIMARY HEALTH CARE IN CROATIA OPINIONS OF PRIMARY HEALTH CARE PHYSICIANS

Od prijelaza stoljeća u Hrvatskoj se intenzivno razvijaju i postaju sve popularnije metode komplementarne i alternativne medicine (KAM). Promatrajući razvoj KAM-a u razvijenim zdravstvenim sustavima za očekivati je da će se prije ili kasnije metode KAM-a integrirati u sustav primarne zdravstvene zaštite u Hrvatskoj. Radi toga proveli smo ovo istraživanje među liječnicima u primarnoj zdravstvenoj zaštiti o njihovom stavu i mišljenju o komplementarnoj i alternativnoj medicini. Od ukupnog broja ispitanika (N=84) 88,1 % ih smatra da bi metode KAM-a trebalo kombinirati s postupcima konvencionalne medicine, a da bi trebalo voditi evidenciju u zdravstvenim kartonima pacijenata o pacijentovoj primjeni KAM-a smatra čak 97,6 % ispitanika. Paralelno 76,2 % tih istih, slučajno odabranih liječnika u primarnoj zdravstvenoj zaštiti, smatra da postoji jak otpor prema KAM- u među liječnicima u Hrvatskoj.Since the turn of the century, Complementary and Alternative Medicine (CAM) has been on the fast track in Croatia, particularly in big cities. Following the examples of developed health systems in the world, it was to be expected that sooner or later CAM would be integrated within primary health care system in Croatia as well. The main aim of this survey was to reveal the actual attitude and opinion of the Croatian primary health care physicians toward CAM. Specific aims were to reveal the physicians’ need for additional education and to reveal the need for keeping CAM therapy records in patient history of illness. On-line questionnaire consisted of 10 questions with two possible answers, Yes or No. The questionnaire was sent to 388 e-addresses and 84 (21.6%) of them responded. This response rate we considered sufficient for further statistical analyses. Although most of the respondents could differentiate alternative and complementary medicine, 21.4% of them still did not know the difference between these two types of medical approach. Furthermore, 79.8% of the respondents confirmed patient interest in CAM. Almost 72% of the respondents considered they did not have sufficient knowledge for informative conversation about CAM with their patients. Only 27.4% of the respondents had enrolled some kind of formal education related to CAM, and almost 73% confi rmed their need for formal education on the topic; 88.1% of the respondents considered that CAM methods should be combined with conventional medicine and 97.6% believed that primary health care physicians should keep records on patient use of CAM methods. Interestingly, 76.2% of the same randomly chosen primary health care physicians considered that there is strong resistance among medical doctors towards CAM methods, but our results did not show it. According to the results of our survey, although the majority of respondents (primary care physicians) distinguished alternative and complementary medicine, 21.4% of respondents still did not differentiate these two concepts. Accordingly, it is concluded that as many as 21.4% of general practitioners and family physicians lack even basic knowledge about CAM and thus are not qualified for even initial communication with their patients on the subject of CAM. These physicians show no interest in CAM since they could have learned about this difference independently of their formal education through numerous articles published daily in popular media. Furthermore, the results showed that 79.8% of respondents received queries from their patients with regards to CAM, and this indicator clearly shows that there is strong market demand for this service. In order to meet this demand, it is necessary to urgently organize or expand the existing formal education with regards to CAM with the aim of encompassing as many primary health care physicians as possible, which is also considered necessary by physicians themselves (76.2%). These data indicate the need for urgent organization of teaching and training programs on the subject of CAM, as well as expansion and increased scope of the existing programs. Unresolved legislation and lack of appropriate registered academic state and private institutions and programs for education in CAM certainly contribute to the current situation in which the position of CAM in Croatia is not regulated. Acts and declarations do not automatically make CAM services safer, but will start the new age of CAM integration in the health care system, thus empowering patient rights

Profesionalni stres i sindrom izgaranja u djelatnika intenzivne psihijatrijske skrbi i hitne medicine

In the last decades professional stress taking the form of physical, psychological and social response has been investigated. The dysfunction caused by stress rests on a person\u27s feeling that workplace demands cannot be fulfilled as expected. This is due to a series of factors: overwhelming workload, inadequate job organization, poor communication, and overall work environment. Burnout syndrome occurs as a result of multiple stressors in the workplace and long-term exposure to them. The aim of this study was to investigate the presence and intensity of professional stress and burnout syndrome in intensive psychiatric care and emergency medicine employees. The factors of psychophysiological work-related strains and their relation to higher intensity of stress and burnout syndrome in participants were explored. The survey included 63 intensive psychiatric care employees at the University Psychiatric Hospital Vrapče and 63 employees at the Institute of Emergency Medicine Zagreb. Three standardized self-assessment questionnaires were used. The results obtained by analyzing workplace stress highlight stressor category “Workplace organization and financial issues”. In this particular category 70% (N=88) of all participants believe that the stressor called “Excessive work” is a dominant source of stress (p=0.004). In assessing psychophysiological work-related strains, a statistically significant difference was found in the category “Pressure at work” (p=0.001) and “Stress caused by low workload” (p=0.004). In the evaluation of the burnout syndrome, 31.7% (N=40) of all participants was found without syndrome. Initial burnout was found in 42.1% (N= 53) of all participants, and 26.2% (N=33) of all participants showed a high degree of burnout. The results indicate the necessity of developing systematic programs for the prevention of professional stress with appropriate measures to improve working conditions in certain institutions.Posljednjih desetljeća puno se istražuje i govori o stresu na radnom mjestu koji je povezan s fizičkim, psihičkim ili socijalnim odgovorom, tj. disfunkcijom koja proizlazi iz osjećaja osobe da ne može ispuniti sve što se od nje očekuje, a može ga uzrokovati niz različitih čimbenika kao što su količina rada, organizacija posla, loša komunikacija, radno okruženje i slično. Sindrom izgaranja nastaje kao posljedica prisutnosti više stresora na radnom mjestu te dugotrajne izloženosti istima. Cilj ovog rada bio je istražiti prisutnost i intenzitet profesionalnog stresa i sindroma izgaranja kod djelatnika intenzivne psihijatrijske skrbi i hitne medicine. Također, istraživani su čimbenici psihofizioloških napora povezanih s većim intenzitetom stresa u ispitanika te čimbenici povezani sa sindromom izgaranja. U istraživanje bilo je uključeno 63 djelatnika intenzivne psihijatrijske skrbi Klinike za psihijatriju Vrapče i 63 djelatnika Nastavnog zavoda za hitnu medicinu Grada Zagreba. Korištena su tri standardizirana upitnika za samoprocjenu. Rezultati analize stresa na radnom mjestu kao značajnu izdvajaju kategoriju stresora „Organizacija radnog mjesta i financijska pitanja“. U toj kategoriji 70 % (N=88) od ukupnog broja ispitanika smatra da je stresor pod nazivom „Preopterećenost poslom“ dominantan izvor stresa (P=0,004). Procjena psihofizioloških napora pokazuje statistički značajnu razliku u kategorijama „Pritisak na poslu“ (P=0,001) i „Stres uzrokovan premalim radnim opterećenjem“ (P=0,004). Pri procjeni sindroma izgaranja 31,7 % (N=40) ispitanika ne pokazuje prisutnost sindroma izgaranja. Početno izgaranje uočeno je u 42,1 % (N=53) ispitanika, a visok stupanj izgaranja u 26,2 % (N=33) ispitanika. Rezultati dobiveni u ovom istraživanju ukazuju na potrebu provedbe programa sustavne prevencije i pomoći kod profesionalnog stresa i sindroma izgaranja te prepoznavanje specifičnih stresora za pojedinu ustanovu

INTEGRATION OF COMPLEMENTARY AND ALTERNATIVE MEDICINE WITH PRIMARY HEALTH CARE IN CROATIA OPINIONS OF PRIMARY HEALTH CARE PHYSICIANS

Od prijelaza stoljeća u Hrvatskoj se intenzivno razvijaju i postaju sve popularnije metode komplementarne i alternativne medicine (KAM). Promatrajući razvoj KAM-a u razvijenim zdravstvenim sustavima za očekivati je da će se prije ili kasnije metode KAM-a integrirati u sustav primarne zdravstvene zaštite u Hrvatskoj. Radi toga proveli smo ovo istraživanje među liječnicima u primarnoj zdravstvenoj zaštiti o njihovom stavu i mišljenju o komplementarnoj i alternativnoj medicini. Od ukupnog broja ispitanika (N=84) 88,1 % ih smatra da bi metode KAM-a trebalo kombinirati s postupcima konvencionalne medicine, a da bi trebalo voditi evidenciju u zdravstvenim kartonima pacijenata o pacijentovoj primjeni KAM-a smatra čak 97,6 % ispitanika. Paralelno 76,2 % tih istih, slučajno odabranih liječnika u primarnoj zdravstvenoj zaštiti, smatra da postoji jak otpor prema KAM- u među liječnicima u Hrvatskoj.Since the turn of the century, Complementary and Alternative Medicine (CAM) has been on the fast track in Croatia, particularly in big cities. Following the examples of developed health systems in the world, it was to be expected that sooner or later CAM would be integrated within primary health care system in Croatia as well. The main aim of this survey was to reveal the actual attitude and opinion of the Croatian primary health care physicians toward CAM. Specific aims were to reveal the physicians’ need for additional education and to reveal the need for keeping CAM therapy records in patient history of illness. On-line questionnaire consisted of 10 questions with two possible answers, Yes or No. The questionnaire was sent to 388 e-addresses and 84 (21.6%) of them responded. This response rate we considered sufficient for further statistical analyses. Although most of the respondents could differentiate alternative and complementary medicine, 21.4% of them still did not know the difference between these two types of medical approach. Furthermore, 79.8% of the respondents confirmed patient interest in CAM. Almost 72% of the respondents considered they did not have sufficient knowledge for informative conversation about CAM with their patients. Only 27.4% of the respondents had enrolled some kind of formal education related to CAM, and almost 73% confi rmed their need for formal education on the topic; 88.1% of the respondents considered that CAM methods should be combined with conventional medicine and 97.6% believed that primary health care physicians should keep records on patient use of CAM methods. Interestingly, 76.2% of the same randomly chosen primary health care physicians considered that there is strong resistance among medical doctors towards CAM methods, but our results did not show it. According to the results of our survey, although the majority of respondents (primary care physicians) distinguished alternative and complementary medicine, 21.4% of respondents still did not differentiate these two concepts. Accordingly, it is concluded that as many as 21.4% of general practitioners and family physicians lack even basic knowledge about CAM and thus are not qualified for even initial communication with their patients on the subject of CAM. These physicians show no interest in CAM since they could have learned about this difference independently of their formal education through numerous articles published daily in popular media. Furthermore, the results showed that 79.8% of respondents received queries from their patients with regards to CAM, and this indicator clearly shows that there is strong market demand for this service. In order to meet this demand, it is necessary to urgently organize or expand the existing formal education with regards to CAM with the aim of encompassing as many primary health care physicians as possible, which is also considered necessary by physicians themselves (76.2%). These data indicate the need for urgent organization of teaching and training programs on the subject of CAM, as well as expansion and increased scope of the existing programs. Unresolved legislation and lack of appropriate registered academic state and private institutions and programs for education in CAM certainly contribute to the current situation in which the position of CAM in Croatia is not regulated. Acts and declarations do not automatically make CAM services safer, but will start the new age of CAM integration in the health care system, thus empowering patient rights

NOISE AND MODERNISATION OF THE ALUMINIUM INDUSTRY

Cilj rada je procijeniti utjecaj novih tehnologija i modernizacije tehnološkog procesa u proizvodnji primarnog aluminija na razinu ukupne buke kojoj su radnici izloženi tijekom rada u radnom okolišu. U tu svrhu uspoređivani su rezultati obveznih periodičkih mjerenja fizikalnih čimbenika na radnim mjestima u radnim prostorima tvornice Aluminij d.d., Mostar provedenih prije modernizacije tvornice (1988.) i nakon modernizacije tvornice (2004.). Mjerenja ukupne razine buke provedena su na istim radnim mjestima. Izmjerene razine ukupne buke nakon modernizacije uspoređene su s razinama buke prije modernizacije u pogonima Anoda, Elektroliza, Ljevaonica i Pogonu obrade plinova. Rezultati mjerenja ukupne razine buke prije modernizacije pokazuju prisutnost prekomjerne buke na 68,9% radnih mjesta. Nakon modernizacije značajno se smanjio broj radnih mjesta, 28,6% (48/168), na kojima su radnici izloženi prekomjernoj buci, a same razine buke su niže. Najbolji rezultati postignuti su u pogonima Anoda i Ljevaonica, gdje se broj radnih mjesta s prekomjernom bukom smanjio za više od polovine. Buka i dalje ostaje najveći problem u Pogonu obrada plinova gdje razina buke prelazi preporučene vrijednosti i nakon modernizacije na više od polovine radnih mjesta. Iako su vidljiva poboljšanja u smanjenju buke na radnim mjestima nakon modernizacije tvornice i unapređenja tehnoloških procesa, ipak ju u cijelosti nije moguće ukloniti.SUMMARY: The objective is to assess the effects of the new technologies and the modernisation of the technological processes employed in the production of primary aluminium on the level of total noise workers are exposed to in the work environment. For this purpose the results of mandatory periodic measurements of physical factors at the work places in the factory Aluminij d.d. Mostar were compared, before the modernisation (1988) and after the modernisation (2004). The measurements of the total noise levels were made at the same work places. In the paper the measured total noise levels after the modernisation are compared with those before the modernisation in the factory plants Anode, Electrolysis, Foundry and Gas Processing. The results measured before the modernisation show excess noise at 68.9% work places. After the modernisation the number of the work places with excess noise was significantly reduced, by 28.6% (48/168), and the levels of noise were also lower. Best results were achieved in the plants Anode and Foundry, where the number of the work places with excess noise was reduced by more than a half. Noise remains the greatest problem in the Gas Processing plant where the noise level exceeds the recommended values, even after the modernisation, at more than half of the work places. Despite evident improvements in noise reduction after the factory modernisation and more sophisticated technological processes introduced, excess noise has not been removed