Cardiovascular risk factors and visiting nurse intervention - evaluation of a Croatian survey and intervention model: the CroHort study [Kardiovaskularni rizični čimbenici i intervencija patronažnih sestara - evaluacija istraživanja u Hrvatskoj i intervencijski model: CroHort studija]

The aim of this study is to identify factors that influence the success of the implementation of the primary and secondary prevention programs in Croatia by the visiting/community services. Two main sources of information were used: reports about regular visiting nurse services in Croatia and research about visiting nurse participation in the Croatian Adult Health Cohort Study (CroHort) 2008. Out of the total number 9,070 respondents who participated in CAHS 2003 survey, during CroHort 2008 program 3,229 (35.6%) participants were re-interviewed. The qualitative analysis was done with a sample of 34 visiting nurses, which participated in the CroHort 2008. Results show that there are three key problems which limit preventive programs: inability of the health care system to recognize the importance of the primary prevention; visiting nurses' lack capacity to implement prevention and populations' lack of motivation and education

Medical Waste Management: the Law and Its Application

Gospodarenje medicinskim otpadom, koji po svojim svojstvima može biti opasan i/ili inertan, u Hrvatskoj je regulirano trima temeljnim pravnim aktima: Zakonom o otpadu, Pravilnikom o vrstama otpada te Naputkom o postupanju s otpadom koji nastaje pri pružanju zdravstvene zaštite. Uz njih još su i Zakon o prijevozu opasnih tvari i Zakon o otrovima akti koji podupiru provedbu ovih propisa. Slijedom razvoja suvremenih cjelovitih sustava za gospodarenje otpadom razvijen je i cjeloviti sustav za gospodarenje medicinskim otpadom koji se zasniva na hijerarhijskome načinu postupanja s otpadom, i to od kontrole mjesta nastanka do mjesta konačne dispozicije. Prioritet je svakako izbjegavanje nastanka otpada, tj. smanjenje potencijala otpada, međutim to nije uvijek moguće, stoga je otpad potrebno sortirati, primjereno predobraditi, na poseban način transportirati, konačno obraditi te ostatke prikladno deponirati. Konačna metoda obrade mora biti ona koja će proizvesti najmanji rizik za ljudsko zdravlje i okoliš. Provođenjem cjelovitog sustava gospodarenja otpadom velike količine otpada mogle bi se zbrinuti u okviru tehnološkog i komunalnog otpada, čime bi zbrinjavanje opasnoga medicinskog otpada zahtijevalo manja financijska sredstva. Svaki od ovih koraka zakonski je definiran i opisan, međutim njegovo je provođenje najveći problem. U lancu od mjesta nastanka u zdravstvenim ustanovama pa sve do konačne dispozicije nailazimo na neprimjereno rukovanje, nepoštivanje propisa o ambalaži, pa sve do obrade u postrojenjima bez uporabne dozvole. Nema potpunih podataka o količinama i tokovima medicinskog otpada, ali ni sustava državne kontrole putem sanitarne inspekcije. Poseban su problem lokacije za konačno odlaganje, tj. nedostatak sanitarnih odlagališta. Hrvatska je potpisnica međunarodnih konvencija o nadzoru prekograničnog prometa opasnog otpada i njegovu odlaganju (Baselska konvencija). U okviru projekta CARDS započeta je izrada analize stupnja usklađenosti zakonodavstva RH s pravnom stečevinom EU-a za područje gospodarenja otpadom.Medical waste management in Croatia is regulated by three fundamental legal acts: Waste Act, Ordinance on Waste Types and Directive on Manipulation of Waste Generated in Health Care. The implementation of these acts and waste management in general are also supported by Transport of Hazardous Materials Act and Toxic Substances Act. Modern trends in waste management promote an integral approach also called “waste chain”. This integral approach to medical waste management is based on hierarchical structuring of waste management structure from the point at which the waste is produced to its final disposal. Priority is always given to reducing the amount and the harmfulness of waste by replacing harmful materials with those that are not, but where this is not possible, waste management includes reduction by sorting and separating, pretreatment on site, safe transportation, final treatment and sanitary disposal. Methods of choice for the final treatment should be the least harmful for human health and environment. Integral medical waste management could greatly reduce quantities of medical waste and consequently financial strains. Even though Croatian regulations define and cover all steps in the waste management chain their implementation is one of the country’s greatest issues. Improper practice is seen from waste production in healthcare institutions to the final disposal, and includes handling, sorting, use of containers, or treatment in incinerators. Information on quantities, type and flow of medical waste are inadequate, just as sanitary control. In addition, Croatia lacks locations for sanitary landfills. Croatia has signed international conventions on the supervision and control of transfrontier waste shipments. Within the CARDS project, Croatia has started to harmonise its laws with acquis communitaire related to waste management. Although waste management is one of the priorities defined within the National Environment Action Plan, Croatia still has not made a strategy for waste management

HEALTH PROTECTION OF THE FARMING POPULATION IN POŽEŠKO-SLAVONSKA COUNTY

U ruralnim područjima živi 47,6 % ukupnog stanovništva Hrvatske. Procjenjuje se da ima 1.485.647 članova poljoprivrednih kućanstava u koje ubrajamo pored radno aktivnih muškaraca i žena, djecu te starije i invalidne osobe. Na članove poljoprivrednih kućanstava ne primjenjuju se mjere i pravila sigurnosti za osiguranje njihove zaštite zdravlja, ni nadzor nad njihovom primjenom temeljem postojećih zakona jer nije zasnovan radni odnos. Broj ozljeda i profesionalnih bolesti se ne može utvrditi jer ne postoji obveza prijavljivanja. Cilj rada je utvrditi postojeće stanje zaštite zdravlja i sigurnosti članova poljoprivrednih kućanstava na području Požeško-slavonske županije, opasnosti i štetnosti koje se javljaju prilikom obavljanja poljoprivrednih poslova zbog uređivanja i donošenja specifičnih mjera i minimalnih uvjeta za zaštitu zdravlja i sigurnost kojima se mogu otkloniti i smanjiti ozljede te profesionalne bolesti. Upitnikom su prikupljeni podaci o članovima poljoprivrednih kućanstava, najčešćim ozljedama, profesionalnim bolestima, nošenju zaštitne opreme te uporabi pesticida. Istraživanje je provedeno na području Požeško-slavonske županije u razdoblju od veljače do travnja 2011. godine, a obuhvatilo je 164 ispitanika, od toga 104 žene (dobi od 18 do 83) i 60 muškaraca (od 18 do 93 godina). Ozljede prilikom obavljanja poljoprivrednih poslova zadobilo je 32 (19,5 %) ispitanika. Utvrđene ozljede klasificirane su kao lakše i teže, a otrovanje pesticidima zabilježeno je u 6 ispitanika (3,6 %). Zaštitnu opremu, uglavnom rukavice, nose njih 84 (51,2 %). Od ukupno 91 djeteta, njih 58 (63,7 %) obavlja poljoprivredne poslove u kućanstvima. Prikazani podaci o stanju zaštite zdravlja i sigurnosti upućuju na potrebu proširivanja istraživanja ruralnih područja RH te pristupanja uređivanju i donošenju mjera i pravila kojima bi se svim članovima poljoprivrednih kućanstava osigurali bolji uvjeti rada i zaštite zdravlja.In Croatia, 47.6% of the population lives in rural areas. It is estimated that the number of persons working in farm households is around 1,485,647 which includes labour-active male and female population, children, the elderly and disabled persons. Occupational safety measures and regulations are not enforced in the case of the farm households and their implementation cannot be controlled as the people are not officially employed. The exact number of injuries and professional diseases cannot be determined since there is no obligation of reporting. This research aims to describe the current status of health protection and safety in farm households as found in Požeško-slavonska County. The gathered information can be used to introduce specific minimum health protection and safety measures in agriculture intended to remove causes of injuries and occupational diseases. Using the HELS questionnaire data was collected regarding participants\u27 health status, behaviour and perception of typical factors related to agriculture and rural life, most frequent injuries and occupational diseases, usage of protective equipment and methods of pesticides application. The research was conducted from February to April 2011 in Požeško-slavonska County. The research sample consisted of 164 participants, 104 women (aged 18 to 83) and 60 men (aged 18 to 93). Injuries were reported in 32 (19,5%) participants and categorised from minor to severe. Pesticide intoxication was reported in 6 (3,6%) participants. The questionnaire shows that protective equipment, mostly work gloves, is used by 84 (51,2%). Out of 91 children in families that participated in this research, 58 (63,7%) worked in agriculture. Presented results suggest the need for further research in rural areas of Croatia regarding health protection and safety of farm households and a need for securing the implementation of equal or at least minimum health and safety measures for all members of farm households

EXCAVATOR’S AND BULLDOZER’S DOWNTIME COMPARISON AND RISK MANAGEMENT: PRELIMINARY STUDY

Risk management of engineering systems is of vital importance, but very often there is no enough data to quantitatively evaluate risk and accordingly create risk management strategy. Proper maintenance of excavators and bulldozers maximizes fuel efficiency and reduces operating costs, as well as reduces equipment failure and enhances safety. Accordingly, previous research opens avenue to analyze these two machinery types when working in mining industry. This paper aims to create statistical comparisons on data collected about excavators’ and bulldozers’ as technological failure/stoppage, electrical failure/stoppage, mechanical failure/stoppage, misuse, organizational failure/stoppage and external cause of failure/stoppage. After performing descriptive statistics, hypothesis testing has not found significant differences between technological failures/stoppages of excavators vs. bulldozers, mechanical failures/stoppages between already mentioned machines or theirs hazard degrees or total downtimes. Further research focus should be directed to the sample enlargement and further analysis, which is expected to prove preliminary results

Cardiovascular Risk Factors and Visiting Nurse Intervention – Evaluation of a Croatian Survey and Intervention Model: the CroHort Study

The aim of this study is to identify factors that influence the success of the implementation of the primary and secondary prevention programs in Croatia by the visiting/community services. Two main sources of information were used: reports about regular visiting nurse services in Croatia and research about visiting nurse participation in the Croatian Adult Health Cohort Study (CroHort) 2008. Out of the total number 9,070 respondents who participated in CAHS 2003 survey, during CroHort 2008 program 3,229 (35.6%) participants were re-interviewed. The qualitative analysis was done with a sample of 34 visiting nurses, which participated in the CroHort 2008. Results show that there are three key problems which limit preventive programs: inability of the health care system to recognize the importance of the primary prevention; visiting nurses’ lack capacity to implement prevention and populations’ lack of motivation and education

Detrimental Effect of Various Preparations of the Human Amniotic Membrane Homogenate on the 2D and 3D Bladder Cancer In vitro Models

Despite being among the ten most common cancers with high recurrence rates worldwide, there have been no major breakthroughs in the standard treatment options for bladder cancer in recent years. The use of a human amniotic membrane (hAM) to treat cancer is one of the promising ideas that have emerged in recent years. This study aimed to investigate the anticancer activity of hAM homogenate on 2D and 3D cancer models. We evaluated the effects of hAM homogenates on the human muscle invasive bladder cancer urothelial (T24) cells, papillary cancer urothelial (RT4) cells and normal porcine urothelial (NPU) cells as well as on human mammary gland non-tumorigenic (MCF10a) cells and low-metastatic breast cancer (MCF7) cells. After 24 h, we observed a gradual detachment of cancerous cells from the culture surface, while the hAM homogenate did not affect the normal cells. The most pronounced effect hAM homogenate had on bladder cancer cells; however, the potency of their detachment was dependent on the treatment protocol and the preparation of hAM homogenate. We demonstrated that hAM homogenate significantly decreased the adhesion, growth, and proliferation of human bladder invasive and papillary cancer urothelial cells and did not affect normal urothelial cells even in 7-day treatment. By using light and electron microscopy we showed that hAM homogenate disrupted the architecture of 2D and 3D bladder cancer models. The information provided by our study highlights the detrimental effect of hAM homogenate on bladder cancer cells and strengthens the idea of the potential clinical application of hAM for bladder cancer treatment

Human amniotic membrane inhibits migration and invasion of muscle-invasive bladder cancer urothelial cells by downregulating the FAK/PI3K/Akt/mTOR signalling pathway

Bladder cancer is the 10th most commonly diagnosed cancer with the highest lifetime treatment costs. The human amniotic membrane (hAM) is the innermost foetal membrane that possesses a wide range of biological properties, including anti-inflammatory, antimicrobial and anticancer properties. Despite the growing number of studies, the mechanisms associated with the anticancer effects of human amniotic membrane (hAM) are poorly understood. Here, we reported that hAM preparations (homogenate and extract) inhibited the expression of the epithelial–mesenchymal transition markers N-cadherin and MMP-2 in bladder cancer urothelial cells in a dose-dependent manner, while increasing the secretion of TIMP-2. Moreover, hAM homogenate exerted its antimigratory effect by downregulating the expression of FAK and proteins involved in actin cytoskeleton reorganisation, such as cortactin and small RhoGTPases. In muscle-invasive cancer urothelial cells, hAM homogenate downregulated the PI3K/Akt/mTOR signalling pathway, the key cascade involved in promoting bladder cancer. By using normal, non-invasive papilloma and muscle-invasive cancer urothelial models, new perspectives on the anticancer effects of hAM have emerged. The results identify new sites for therapeutic intervention and are prompt encouragement for ongoing anticancer drug development studies

The Cells and Extracellular Matrix of Human Amniotic Membrane Hinder the Growth and Invasive Potential of Bladder Urothelial Cancer Cells

Bladder cancer is one of the most common cancers among men in industrialized countries and on the global level incidence and mortality rates are increasing. In spite of progress in surgical treatment and chemotherapy, the prognosis remains poor for patients with muscle-invasive bladder cancer. Therefore, there is a great need for the development of novel therapeutic approaches. The human amniotic membrane (hAM) is a multi-layered membrane that comprises the innermost part of the placenta. It has unique properties that make it suitable for clinical use, such as the ability to promote wound healing and decrease scarring, low immunogenicity, and immunomodulatory, antimicrobial and anticancer properties. This study aimed to investigate the effect of (i) hAM-derived cells and (ii) hAM scaffolds on the growth dynamics, proliferation rate, and invasive potential of muscle-invasive bladder cancer T24 cells. Our results show that 24 and 48 h of co-culturing T24 cells with hAM-derived cells (at 1:1 and 1:4 ratios) diminished the proliferation rate of T24 cells. Furthermore, when seeded on hAM scaffolds, namely (1) epithelium of hAM (e-hAM), (2) basal lamina of hAM (denuded; d-hAM), and (3) stroma of hAM (s-hAM), the growth dynamic of T24 cells was altered and proliferation was reduced, even more so by the e-hAM scaffolds. Importantly, despite their muscle-invasive potential, the T24 cells did not disrupt the basal lamina of hAM scaffolds. Furthermore, we observed a decrease in the expression of epithelialmesenchymal transition (EMT) markers N-cadherin, Snail and Slug in T24 cells grown on hAM scaffolds and individual T24 cells even expressed epithelial markers E-cadherin and occludin. Our study brings new knowledge on basic mechanisms of hAM affecting bladder carcinogenesis and the results serve as a good foundation for further research into the potential of hAM-derived cells and the hAM extracellular matrix to serve as a novel bladder cancer treatment

Risk Factors for Cardiovascular Disease in Rural Area of Croatia

Rural areas, where 47.6% of the Croatian population lives are not generally the focus of research; yet there are challenges which affect the rural population that often go unreported. These communities often exhibit disadvantages in many areas of health. The aim of this study is to examine the specific health needs and related determinants of rural populations influenced by transition that were affected by the consequences of war. The focus of the research is rural lifestyle, behaviour and cardiovascular risk factors in three villages of Sisa~ko-moslava~ka County. Results show that participants generally understand that their own lifestyles influence their health, but they often neglect to change their behaviour to improve their health. This can be explained through complex socio-economic conditions and traditional values of their heritage. These results suggest a need for further research on health status, attitude, and behaviour of Croatia’s rural population. Specific public health intervention and services for rural populations must be promoted

Risk Factors for Cardiovascular Disease in Rural Area of Croatia

Rural areas, where 47.6% of the Croatian population lives are not generally the focus of research; yet there are challenges which affect the rural population that often go unreported. These communities often exhibit disadvantages in many areas of health. The aim of this study is to examine the specific health needs and related determinants of rural populations influenced by transition that were affected by the consequences of war. The focus of the research is rural lifestyle, behaviour and cardiovascular risk factors in three villages of Sisa~ko-moslava~ka County. Results show that participants generally understand that their own lifestyles influence their health, but they often neglect to change their behaviour to improve their health. This can be explained through complex socio-economic conditions and traditional values of their heritage. These results suggest a need for further research on health status, attitude, and behaviour of Croatia’s rural population. Specific public health intervention and services for rural populations must be promoted