Pregled bolesti u djece turista za vrijeme posjeta Splitsko-dalmatinskoj županiji

The aim was to determine morbidity of foreign children during their tourist visit to Split-Dalmatia County, Croatia. The study included medical documentation of 233 foreign children tourists aged under 18 years, hospitalized at Clinical Department of Pediatrics, Split University Hospital Center in the period from January 2007 to December 2013. Demographic data were statistically analyzed. Of 233 children tourists hospitalized at our department, 134 (57.5%) were boys. Most of the children tourists (51.1%) were aged 0-5 years. According to nationality, they were from 30 countries from all over the world, but mostly from Europe (97.9%). The highest number of children tourists were from Germany (14.2%). The highest percentage of children tourists (92.7%) were hospitalized during summer months. The mean length of hospital stay was 4.4±3.3 days. According to the reason for hospitalization, children tourists were mostly admitted to our hospital for nervous system symptoms (32.6%); 43.4% of these had febrile seizures and 39.5% epilepsy. The nervous system symptoms were followed by injury and poisoning (14.6%), respiratory symptoms (14.1%), submersion and heat injuries (9.9%), and digestive symptoms (9.4%). In conclusion, we describe foreign pediatric population hospitalized in the Split University Hospital Center during their vacation in the Split-Dalmatia County, Croatia. The largest number of children tourists were from Germany and the nervous system symptoms were the most common reason for hospitalization. Therefore, we suggest cooperation between the Croatian health care system and Croatian National Tourist Board for developing prevention strategies regarding morbidity in pediatric tourist population. In particular, prevention and fi rst line therapy for cerebral seizures should be broadly available, such as in hotels, apartments, and even on beaches.Cilj je odrediti morbiditet u strane djece za vrijeme turističkog posjeta Splitsko-dalmatinskoj županiji, Hrvatska. U istraživanje je uključena medicinska dokumentacija 233-je strane djece turista u dobi do 18 godina, hospitalizirane na Klinici za dječje bolesti KBC Split u razdoblju od siječnja 2007. do prosinca 2013. godine. Demografski podatci su statistički analizirani. Od ukupno 233-je djece turista hospitalizirane na našem odjelu njih 134 (57,5%) bili su dječaci. Većina djece turista (51,1%) bila je u dobnoj skupini od 0-5 godina. Prema nacionalnosti bila su iz ukupno 30 zemalja diljem svijeta, ali većinom iz Europe (97,9%). Najveći broj djece turista bio je iz Njemačke (14,2%). Najviši postotak djece turista (92,7%) bio je hospitaliziran ljeti. Hospitalizacija je prosječno trajala 4,4±3,3 dana. Najčešći razlozi hospitalizacije djece turista bili su neurološki simptomi (32,6%), od toga je 43,4% imalo febrilne konvulzije i 39,5% epilepsiju. Zatim su slijedile ozljede i trovanja (14,6%), od toga su ozljede bile prisutne u 61,8% slučajeva, a trovanja u 38,2%. Blesti dišnog sustava (14,2%) treće su po učestalosti, većina bolesnika imala je upalu donjih (42,4%) ili gornjih (36,4%) dišnih puteva. Potom slijede utapanja i ozljede toplinom (9,9%) te bolesti probavnog sustava (9,4%). Zaključno, opisali smo stranu pedijatrijsku populaciju hospitaliziranu u KBC-u Split za vrijeme turističkog posjeta Splitsko-dalmatinskoj županiji. Najveći broj djece turista bio je iz Njemačke i najčešći razlog hospitalizacije bili su neurološki simptomi. Stoga predlažemo suradnju između Ministarstva zdravlja i Hrvatske turističke zajednice radi razvoja strategije za prevenciju bolesti, uzimajući u obzir morbiditet u djece turista. Posebice treba naglasiti prevenciju cerebralnih napadaja te činjenicu da bi prvolinijska terapija trebala biti široko dostupna, primjerice u hotelima i apartmanima, pa i na plažama

Thyrotoxicosis in children and adolescents – diagnostic and therapeutic dilemmas

Tirotoksikoza je uzrokovana različitim čimbenicima, a manifestira se šarolikim kliničkim znakovima hipermetaboličkog stanja. Primjeren terapijski pristup ovisi o uzrocima bolesti i bolesnikovom stanju te zahtijeva brzu i pravilnu dijagnostičku obradu. Ovaj članak iznosi pregled liječenja tirotoksikoze zasnovano na klinički utemeljenim podatcima, a donosi i pregled vlastitih iskustava u četrnaestgodišnjem razdoblju. Pregledom literature, posebno različitih smjernica i drugih publiciranih materijala, služeći se PubMed-om, izdvojili smo podatke koje iznosimo u kritičkom tonu. Iskustva u četrnaestgodišnjem liječenju djece i adolescenata s tirotoksikozom u Klinici za dječje bolesti KBC-a Split usporedili smo s iskustvima drugih autora. Klinički opis uključuje početnu kli ničku evaluaciju i dijagnostički pristup tirotoksikozi, uključujući subkliničku hipertireozu, Hashimotovu i Gravesovu bolest. Pristup Gravesovoj bolesti uključuje tirostatske lijekove, terapiju radioaktivnim jodom i operativno liječenje. U našoj ustanovi u četrnaestgodišnjem razdoblju pregledali smo 59-ero bolesnika s tirotoksikozom, Hashimotovu bolest imalo je 17/59 (28,8%) bolesnika, a Gravesovu bolest 41/59 (69,5%), dok je 1/59 (1,7%) imao rijetki nedostatak TBG-a (engl. Thyroxine Binding Globulin). Remisiju bolesti doživjelo je 12/41 (29,2%) bolesnika s Gravesovom bolešću, a relaps 4/12 (33,3%). Terapija radioaktivnim jodom primijenjena je u 3/41 (7,3%), a operacija u 13/41 (31,7%) bolesnika s Gravesovom bolešću. Doneseno je više preporuka i zaključaka na utemeljenim kliničkim podatcima racionalnog, pouzdanog i optimalnog kliničkog pristupa oboljelima od tirotoksikoze. Odabir načina liječenja Gravesove bolesti složen je proces. Razgovor o prednostima i rizicima predloženih terapijskih mjera s bolesnikom i njegovim roditeljima je nužan. U našoj ustanovi preporuča se poticati roditelje bolesnika s Gravesovom bolešću koji imaju malu mogućnost za postizanje remisije na bržu odluku o defi nitivnom liječenju.Thyrotoxicosis is caused by diff erent etiologic factors and is manifested by various clinical signs of hypermetabolism. Appropriate therapeutic approach demands prompt and correct diagnosis and depends on the cause and condition of the patient. This article presents a clinical review of thyrotoxicosis treatment based on clinically acquired data and brings a review of personal experiences during a 14-year period. We searched the literature, on PubMed and other published materials. We compared our experience at Clinical Department of Pediatrics, Split University Hospital Center, with experiences of others. Clinical description includes initial evaluation and approach to thyrotoxicosis; subclinical hyperthyroidism/thyrotoxicosis; Hashimoto’s and Graves’ disease, and approach to Graves’ hyperthyroidism including antithyroid drugs, radioactive iodine and surgical treatment. During the 14-year period, we examined 59 patients with thyrotoxicosis, including 7/59 (28.8%) patients diagnosed with Hashimoto’s disease, 41/59 (69.5%) patients diagnosed with Graves’ disease, and 1/59 (1.7%) patient diagnosed with rare thyroxine binding globulin (TBG) insuffi ciency. Twelve of 41 (29.2%) patients with Graves’ disease had remission and relapse occurred in one-third (n=4) of these 12 (33.3%) patients. Radioiodine therapy was used in 3/41 (7.3%) patients with Graves’ disease, whereas 13/41 (31.7%) patients underwent surgical operation. Many recommendations and conclusions have been drawn on the basis of clinical data on the rational, safe and optimal medical approach to patients with thyrotoxicosis. Choosing treatment for Graves’ disease is a complex process. Discussing advantages and risks of recommended therapies with patients and parents is desirable and necessary. In our institution, it is necessary to encourage parents of Graves’ disease patients with minor chance of remission to make quick decision on defi nitive care

The Prevalence of Metabolic Syndrome and Cardiovascular Risk Factors in Obese Children and Adolescents in Dalmatia: A Hospital Based Study

Obesity and metabolic syndrome (MS) are one of the biggest public health issues in child and adolescent population. To the best of the authors’ knowledge, this hospital based study is the first report on the prevalence of MS in obese children and adolescents in Dalmatia, the Mediterranean part of Croatia. The objectives of this study were to determine the prevalence of individual cardiovascular risk factors and MS. Between January 2009 and June 2014, 201 obese subjects aged 6 to 18 were analyzed retrospectively from our Pediatric Endocrine Unit database. The subjects were then classified in two groups of obesity; subjects with BMI z score 2.0–3.0 were classified as moderately obese and subjects with BMI z score > 3.0 were classified as severely obese. The overall prevalence of MS using the modified IDF criteria was 30.3%. The most common component of MS in both groups was arterial hypertension, while impaired fasting glucose was the least common component of MS. Our finding of high prevalence of MS underlines the importance of early childhood obesity treatment

TRUDNOĆA – NEISKORIŠTENE PRILIKE ZA PREVENCIJU I INTERVENCIJU U PATRONAŽNOJ SLUŽBI

Attachment is a term used to describe a deep and lasting emotional relationship with another individual. It primarily designates emotion between a mother and her baby, but it is also inherent to life-long human behavior. It is characterized by a tendency to seek and maintain closeness with caring people in stressful situations. The feeling of safety that is generated through the mother-child relationship is the foundation for basic trust or distrust in relationships, and also affects children’s expectations concerning how the environment will respond to their needs. Development of attachment is to a large extent determined by the mother’s responsiveness to the child’s needs, compatibility of the mother and her child, the child’s temperament, the mother’s recollections of her childhood, and the supporting community. Good functioning of families is of great importance to all family members, especially pregnant women. The health care system supports pregnant women through the visiting nurse service that is in charge of preventive measures. Of all health professionals, the community health nurse is the only one who, visiting the home and family environment of a pregnant woman, has complete insight into the possible occurrence of risk factors for the development of maternal and child disorders. With this intervention, we can act preventively in order to preserve physical, mental and social well-being. The aim of this study was to determine discrepancy in the number of anticipated and performed preventive nursing visits to pregnant women in Croatia. The situation was analyzed at county (regional) and national level. The authors used the information on the health care of pregnant women, puerperal women and infants up to 12 months of age published in the Croatian Health Statistics Yearbooks and in reports on the natural change in the population by the Croatian Bureau of Statistics between 1995 and 2018. Study results showed the rate of nursing visits to pregnant women and to infants up to 12 months of age, as well as the difference in the number of nursing visits in the Republic of Croatia over a period of 23 years. During the observed period, there was a signifi cant drop in the total number of childbirths, as well as in the number of nursing visits to pregnant women, and the trend has continued. During the observed period, a mean of 42.1% of women went through their pregnancy without a single nursing visit, which means that an opportunity to provide such a vulnerable group with an important segment of social and professional support was lost. The potential opened by drop in the number of pregnant women to increase the scope of nursing visits to at least once per pregnancy, after the 16th week of pregnancy, remained unused. The number of visits to newborns and women in the puerperal period was on the rise, while visits to infants were oscillating with a slight downward trend. In conclusion, the opportunity created by drop in the number of pregnancies was not utilized to improve the scope of community nurse visits to at least once in pregnancy after week 16. Community health nursing for pregnant women failed to reach the desired health care standard.Privrženošću opisujemo duboku i trajnu emocionalnu vezu s drugom osobom. Privrženošću se primarno opisuje emocionalna veza između dojenčeta i majke, iako je privrženost svojstvena cjeloživotnom ljudskom ponašanju. Obilježava ju tendencija traženja i održavanja bliskosti privrženim ljudima za vrijeme stresnih situacija. Osjećaj sigurnosti nastao iz odnosa majke i djeteta stvara osnovno povjerenje ili nepovjerenje u odnosima te određuje vjerovanje djeteta o tome kako će okolina reagirati na njegove potrebe. U razvoju privrženosti važnu ulogu ima osjetljivost majke za potrebe djeteta, usklađenost majke i djeteta, temperament djeteta, majčina sjećanja iz njezina djetinjstva kao i podržavajuća okolina. Zdravo obiteljsko funkcioniranje vrlo je važno svim članovima obitelji, osobito trudnicama. Zdravstveni sustav trudnicama pruža potporu kroz sustav preventivnih posjeta patronažne službe. Od svih zdravstvenih djelatnika patronažna sestra je jedina koja ulaskom u dom i obiteljsku sredinu trudnice ima cjelokupan uvid u moguću pojavu rizičnih čimbenika za razvoj poremećaja povezanosti majke i djeteta. Ovom intervencijom možemo preventivno djelovati u cilju očuvanja fi zičkog, psihičkog i socijalnog blagostanja. Cilj je bio utvrditi razlike u broju predviđenih i ostvarenih preventivnih posjeta patronažne sestre trudnicama u Hrvatskoj. Analiza je napravljena po županijama Republike Hrvatske i na razini cijele Hrvatske. Korišteni su podatci o zdravstvenoj zaštiti trudnica, babinjača i djece do godinu dana života objavljeni u hrvatskim zdravstveno-statističkim ljetopisima i izvješću o prirodnom kretanju stanovništva Državnog zavoda za statistiku u razdoblju od 1995. do 2018. godine. Prikazan je broj posjeta patronažne sestre trudnicama i djeci do godine dana života te razlika broja posjeta u Republici Hrvatskoj u razdoblju od 23 godine. Očevidan je značajan pad broja živorođenih, ali isto tako i pad broja posjeta trudnicama, a tendencija pada se nastavlja. U promatranom razdoblju prosječan broj trudnica (nakon 16. tjedna trudnoće) bez ijednog patronažnog posjeta je 42,5 %, a posljednjih godina taj postotak raste. Tako se propušta prilika da se toj osjetljivoj skupini pruži makar taj segment socijalne i stručne potpore i pomoći. Nije iskorišten prostor nastao smanjenjem broja trudnica za povećanje obuhvata posjetom patronažne sestre makar jednom u trudnoći. Broj posjeta babinjačama i novorođenčadi raste, dok broj posjeta trudnicama pada, pa je 2018. godine bez ijednog patronažnog posjeta bilo 62,1 % trudnica u Hrvatskoj. Zaključuje se kako nije iskorišten prostor nastao smanjenjem broja trudnica za povećanje obuhvata posjetom patronažne sestre makar jednom u trudnoći, a nakon 16. tjedna trudnoće. Patronažna zaštita trudnica nije dostigla predviđeni standard zdravstvene zaštite

TRUDNOĆA – NEISKORIŠTENE PRILIKE ZA PREVENCIJU I INTERVENCIJU U PATRONAŽNOJ SLUŽBI

Attachment is a term used to describe a deep and lasting emotional relationship with another individual. It primarily designates emotion between a mother and her baby, but it is also inherent to life-long human behavior. It is characterized by a tendency to seek and maintain closeness with caring people in stressful situations. The feeling of safety that is generated through the mother-child relationship is the foundation for basic trust or distrust in relationships, and also affects children’s expectations concerning how the environment will respond to their needs. Development of attachment is to a large extent determined by the mother’s responsiveness to the child’s needs, compatibility of the mother and her child, the child’s temperament, the mother’s recollections of her childhood, and the supporting community. Good functioning of families is of great importance to all family members, especially pregnant women. The health care system supports pregnant women through the visiting nurse service that is in charge of preventive measures. Of all health professionals, the community health nurse is the only one who, visiting the home and family environment of a pregnant woman, has complete insight into the possible occurrence of risk factors for the development of maternal and child disorders. With this intervention, we can act preventively in order to preserve physical, mental and social well-being. The aim of this study was to determine discrepancy in the number of anticipated and performed preventive nursing visits to pregnant women in Croatia. The situation was analyzed at county (regional) and national level. The authors used the information on the health care of pregnant women, puerperal women and infants up to 12 months of age published in the Croatian Health Statistics Yearbooks and in reports on the natural change in the population by the Croatian Bureau of Statistics between 1995 and 2018. Study results showed the rate of nursing visits to pregnant women and to infants up to 12 months of age, as well as the difference in the number of nursing visits in the Republic of Croatia over a period of 23 years. During the observed period, there was a signifi cant drop in the total number of childbirths, as well as in the number of nursing visits to pregnant women, and the trend has continued. During the observed period, a mean of 42.1% of women went through their pregnancy without a single nursing visit, which means that an opportunity to provide such a vulnerable group with an important segment of social and professional support was lost. The potential opened by drop in the number of pregnant women to increase the scope of nursing visits to at least once per pregnancy, after the 16th week of pregnancy, remained unused. The number of visits to newborns and women in the puerperal period was on the rise, while visits to infants were oscillating with a slight downward trend. In conclusion, the opportunity created by drop in the number of pregnancies was not utilized to improve the scope of community nurse visits to at least once in pregnancy after week 16. Community health nursing for pregnant women failed to reach the desired health care standard.Privrženošću opisujemo duboku i trajnu emocionalnu vezu s drugom osobom. Privrženošću se primarno opisuje emocionalna veza između dojenčeta i majke, iako je privrženost svojstvena cjeloživotnom ljudskom ponašanju. Obilježava ju tendencija traženja i održavanja bliskosti privrženim ljudima za vrijeme stresnih situacija. Osjećaj sigurnosti nastao iz odnosa majke i djeteta stvara osnovno povjerenje ili nepovjerenje u odnosima te određuje vjerovanje djeteta o tome kako će okolina reagirati na njegove potrebe. U razvoju privrženosti važnu ulogu ima osjetljivost majke za potrebe djeteta, usklađenost majke i djeteta, temperament djeteta, majčina sjećanja iz njezina djetinjstva kao i podržavajuća okolina. Zdravo obiteljsko funkcioniranje vrlo je važno svim članovima obitelji, osobito trudnicama. Zdravstveni sustav trudnicama pruža potporu kroz sustav preventivnih posjeta patronažne službe. Od svih zdravstvenih djelatnika patronažna sestra je jedina koja ulaskom u dom i obiteljsku sredinu trudnice ima cjelokupan uvid u moguću pojavu rizičnih čimbenika za razvoj poremećaja povezanosti majke i djeteta. Ovom intervencijom možemo preventivno djelovati u cilju očuvanja fi zičkog, psihičkog i socijalnog blagostanja. Cilj je bio utvrditi razlike u broju predviđenih i ostvarenih preventivnih posjeta patronažne sestre trudnicama u Hrvatskoj. Analiza je napravljena po županijama Republike Hrvatske i na razini cijele Hrvatske. Korišteni su podatci o zdravstvenoj zaštiti trudnica, babinjača i djece do godinu dana života objavljeni u hrvatskim zdravstveno-statističkim ljetopisima i izvješću o prirodnom kretanju stanovništva Državnog zavoda za statistiku u razdoblju od 1995. do 2018. godine. Prikazan je broj posjeta patronažne sestre trudnicama i djeci do godine dana života te razlika broja posjeta u Republici Hrvatskoj u razdoblju od 23 godine. Očevidan je značajan pad broja živorođenih, ali isto tako i pad broja posjeta trudnicama, a tendencija pada se nastavlja. U promatranom razdoblju prosječan broj trudnica (nakon 16. tjedna trudnoće) bez ijednog patronažnog posjeta je 42,5 %, a posljednjih godina taj postotak raste. Tako se propušta prilika da se toj osjetljivoj skupini pruži makar taj segment socijalne i stručne potpore i pomoći. Nije iskorišten prostor nastao smanjenjem broja trudnica za povećanje obuhvata posjetom patronažne sestre makar jednom u trudnoći. Broj posjeta babinjačama i novorođenčadi raste, dok broj posjeta trudnicama pada, pa je 2018. godine bez ijednog patronažnog posjeta bilo 62,1 % trudnica u Hrvatskoj. Zaključuje se kako nije iskorišten prostor nastao smanjenjem broja trudnica za povećanje obuhvata posjetom patronažne sestre makar jednom u trudnoći, a nakon 16. tjedna trudnoće. Patronažna zaštita trudnica nije dostigla predviđeni standard zdravstvene zaštite

The efficiency of disinfection and the microbiological quality of drinking water in the town of Šibenik

Kakvoća vode za ljudsku potrošnju u vodoopskrbnom sustavu uvjetovana je nizom čimbenika, a prije svega kakvoćom vode na mjestu zahvaćanja u prirodi (arteški bunar, jezero, vodotok), procesu prerade te sanitarno-tehničkim i higijenskim uvjetima u vodoopskrbnim objektima i pratećoj infrastrukturi. Zdravstveno ispravnom vodom za ljudsku potrošnju smatra se voda koja: (i) ne sadrži mikroorganizme, parazite i njihove razvojne oblike u broju koji predstavlja opasnost za zdravlje ljudi, (ii) ne sadrži štetne tvari u koncentracijama koje same ili zajedno s drugim tvarima predstavljaju opasnost za zdravlje ljudi, (iii) ima vrijednosti parametara zdravstvene ispravnosti vode za ljudsku potrošnju u skladu s odredbama Zakona o vodi za ljudsku potrošnju (MZ HR, NN 56/13, 65/15, 104/17) i Pravilnika o parametrima sukladnosti i metodama analize vode za ljudsku potrošnju (MZ HR, NN 125/13, 141/13, 128/15). Cilj ovog rada bio je utvrditi učinkovitost dezinfekcije i mikrobiološku kakvoću vode za ljudsku potrošnju koja se putem vodoopskrbnog sustava Jaruga isporučuje stanovnicima grada Šibenika. Analizirani su podaci o koncentraciji slobodnog rezidualnog klora te pojavnosti mikrobioloških parametara (broj kolonija na 22 °C i 37 °C, ukupni koliformi, Escherichia Coli, Closridium Perfringens, Pseudomonas aeruginosa i enterokoki) tijekom petogodišnjeg razdoblja (2011. - 2015.). Grupiranjem pojedinih podataka, ovisno o dijelu godine, utvrdila se i učinkovitost dezinfekcije vode o godišnjem dobu s obzirom da se voda koja se isporučuje stanovnicima grada Šibenika zahvaća iz podzemnih izvora, a koji su, uslijed geološkog sastava tla, podložni utjecaju padalina.Quality of drinking water is influenced by many factors, primarily by the source (well, lake, river), processing and sanitary conditions in water-supply system and infrastructure. Safe drinking water (a) is free of presence of mycroorganisms, parasites and their developmental forms in numbers that pose a risk for human health, (b) is free of harmful compounds in concentrations that individually or in combination pose a risk for human health, (c) i sin accordance with parameters of quality defined by Croatian laws (MZ HR, NN 56/13, 65/15, 104/17) and bylaws (MZ HR, NN 125/13, 141/13, 128/15). The aim of this research was to evaluate efficiency of disinfection and microbial quality of drinking water supplied by water-supply system Jaruga to Šibenik residents. The data on free and bound chlorine and microbial parameters (colony count at 22 °C and 37 °C, total coliforms, Escherichia coli, Closridium perfringens, Pseudomonas aeruginosa, enterococci) collected during 5-year period (2011-2015) were analysed. Disinfection efficiency was established by grouping of values, depending on season, since water is collected from the wells that are influenced by rainfall due to geological properties