Hygiene of schools and preschool institutions

Čovjekovo je zdravlje najveće i najvrjednije bogatstvo. Kako bi se spriječile razne bolesti, važno je sprječavati njezine uzročnike i širenje. Osobna je higijena najvažniji način sprječavanja bolesti, a predškolsko i školsko doba najpogodnije je za razvijanje higijenskih navika. Usvoje li ih djeca u djetinjstvu, primjenjivat će ih i kasnije, u životu. Djeca najbolje uče gledajući na svijet oko sebe, stoga im roditelji, odgojitelji i učitelji trebaju biti primjer i pomoći im da razviju svoje sposobnosti i navike. Izreka kaže: „Uči dijete prema putu kojim će ići pa neće odstupiti od njega ni kad ostari“ (Mudre izreke 22,6). Bez suradnje vrtića, škole, odgojitelja, učitelja i roditelja i njihovih primjera teško se mogu ostvariti brojene zadaće. Svrha je ovoga rada proučiti literaturu i istražiti kako predškolske i školske ustanove brinu o higijeni djece i potiču li ih na usvajanje i primjenu higijenskih navika i mjera.Human health is the greatest and the most valuable asset. In order to prevent different disaeses it is important to prevent agents and spreading. Personal hygiene is the most important way of preventing various diseases and pre-school and school age are tbe best for adopting hygienic habits. Habits that children adopt in a childhood will be applied later in life. Children learn best through an example, therefore parents, educators and teachers should be an example and help children to develop their abilities and habits. The phrase says „Train up a child in the way he should go, and when he is old he will not depart from it.“ (Proverbs 22:6). Without the collaboration of kindergartens, schools, educators, teachers and parents and their example we can hardly accomplish numerous tasks. The purpose of this work is to study literature and explore how pre-school and school institutions take care of hygiene and if they encourage children to adopt and apply numerous hygienic habits and measures

Hygiene of schools and preschool institutions

Čovjekovo je zdravlje najveće i najvrjednije bogatstvo. Kako bi se spriječile razne bolesti, važno je sprječavati njezine uzročnike i širenje. Osobna je higijena najvažniji način sprječavanja bolesti, a predškolsko i školsko doba najpogodnije je za razvijanje higijenskih navika. Usvoje li ih djeca u djetinjstvu, primjenjivat će ih i kasnije, u životu. Djeca najbolje uče gledajući na svijet oko sebe, stoga im roditelji, odgojitelji i učitelji trebaju biti primjer i pomoći im da razviju svoje sposobnosti i navike. Izreka kaže: „Uči dijete prema putu kojim će ići pa neće odstupiti od njega ni kad ostari“ (Mudre izreke 22,6). Bez suradnje vrtića, škole, odgojitelja, učitelja i roditelja i njihovih primjera teško se mogu ostvariti brojene zadaće. Svrha je ovoga rada proučiti literaturu i istražiti kako predškolske i školske ustanove brinu o higijeni djece i potiču li ih na usvajanje i primjenu higijenskih navika i mjera.Human health is the greatest and the most valuable asset. In order to prevent different disaeses it is important to prevent agents and spreading. Personal hygiene is the most important way of preventing various diseases and pre-school and school age are tbe best for adopting hygienic habits. Habits that children adopt in a childhood will be applied later in life. Children learn best through an example, therefore parents, educators and teachers should be an example and help children to develop their abilities and habits. The phrase says „Train up a child in the way he should go, and when he is old he will not depart from it.“ (Proverbs 22:6). Without the collaboration of kindergartens, schools, educators, teachers and parents and their example we can hardly accomplish numerous tasks. The purpose of this work is to study literature and explore how pre-school and school institutions take care of hygiene and if they encourage children to adopt and apply numerous hygienic habits and measures

Exercise heart rate recovery in obesity

Introduction: Obesity is an epidemic that carries significant cardiovascular (CV) burden. Autonomic dysfunction, characterized by reduced vagal tone and sympathetic overactivity, has been found in diabetes, hypertension, heart failure, metabolic syndrome, and other conditions. Heart rate decrease after exercise, or heart rate recovery (HRR) reflects cardiac autonomic activity. Decreased HRR is a powerful predictor of CV disease, CV and all-cause mortality.1-3 Patients and Methods: A total of 54 obese patients (24% male, 76% female), age 22-66 (mean 47 year), BMI 29.4-53.3 (mean 40.3 kg/m2), were enrolled in a multidisciplinary weight management program. Treadmill testing was done initially and after 6-month follow-up. Standard Bruce protocol was used to assess exercise capacity and passive HRR (15 sec, 3 and 6 min into the recovery period, as per institutional protocol). Control group was composed of age- and sex-matched non-obese subjects. Results: Obese subjects had significantly slower HRR (HRR0:15 6.1 vs. 9.1 BPM, HRR3:00 57.8 vs. 66.6 BPM, HRR6:00 63.3 vs. 72.7 BPM; p=0.0216, 0.0006, 0.0004, respectively). Exercise capacity was also significantly lower in comparison to control (6.7 vs. 8.6 METs; p=0.000001), with reduced exercise time (6.0 vs. 8.2 min; p=0.000001). Sixteen subjects that reached 6-month follow-up lost 5.4 kg on average. Exercise capacity increased mildly (6.4 to 7.1 METs; NS), as well as total exercise time (5.6 to 6.6 min; NS). Discussion and Conclusion: Physiological HRR kinetics follows exponential decay function. Rapid first phase, mediated by vagal reactivation is followed by a gradual HRR decline, dominated by sympathetic withdrawal. We found significantly slower HRR over different time-points in the obese, which reflects autonomic imbalance. Functional aerobic capacity was also significantly reduced. Somewhat improved functional capacity and dynamics of HRR after weight loss did not reach statistical power. To conclude, we found evidence of significantly impaired cardiac autonomic function in obese subjects, together with reduced functional capacity. As the study is ongoing, we hope to demonstrate sustained effect of exercise and diet on autonomic function. Potential benefit on mortality and CV risk reduction should encourage patients and health care providers to manage obesity more vigorously

Mini Mental State Examination did not reveal cognitive impairment in our patients with atrial fibrillation

Background: Atrial fibrillation (AF), the most common arrhythmia in the general population, is associated with accelerated cognitive decline in comparison with healthy individuals1. Some studies reported that the duration of exposure to AF increases the risk of dementia2. Objective: The aim of this study was to evaluate the reported link between AF and its characteristics, such as type and duration, and cognitive abilities in affected individuals. Patients and Methods: 105 patients (63 males, 42 females, aged 67.29±24.54 years) from the University Hospital Centre Zagreb outpatient department were enrolled in the study. The average duration of paroxysmal AF was 46.52, and of persistent AF 87.94 Mo. The patients’ cognitive abilities were evaluated using Mini Mental State Examination (MMSE). Other confounding factors were analyzed: body mass index, comorbidities (hypertension, diabetes, hyperlipidemia, ischemic heart disease, etc.), level of education, prescribed medications, blood biochemistry, and echocardiographic parameters. Results: No significant differences between MMSE scores of patients with paroxysmal and persistent AF were found (27.43 in those with paroxysmal and 27.09 in those with persistent AF, p=0.5698). Statistical analysis also showed no correlation between the duration of AF and MMSE results (r=-0.0805, p=0.451), which was in contrast with predicted findings. However, we found a statistically significant difference between MMSE scores of patients grouped by their achieved level of education (24.60, 27.70, 28.25 and 28.22 in patients with primary, secondary, post-secondary and tertiary level of education, respectively, p=0.00002), and a correlation with estimated glomerular filtration rate (r=0.199, p<0.05) and heart rate (r=-0.2291, p=0.026). Female participants had lower MMSE scores than males (26.31 in females and 27.89 in males, p=0.038) and participants’ age also affected their MMSE results (r=-0.2866, p=0.003). Conclusion: The results of this pilot study do not support previously described correlations between the duration and type of AF and cognitive deterioration, at least not measurable by MMSE. Our results indicated that the strongest predictor of one’s MMSE score is the achieved level of education. This research will be continued, and we expect more reliable results on a larger cohort of patients

Severe Acute Pancreatitis as a Part of Multiple Dysfunction Syndrome

Acute pancreatitis is a disease with various degrees of clinical manifestations. Mild and moderate severe acute pancreatitis is an illness characterized with chemical inflammation which, in general, passes without major complications. Clinical picture of severe acute pancreatitis other side is commonly complicated with functional deterioration of other organs, and frequently has characteristics of multiple organ dysfunction or failure syndrome with or without bacterial super infection. We studied 82 patients admitted to the intensive care unit with severe acute pancreatitis, 14 died. The mortality was in statistically significant correlation with the severity of clinical condition at admission assessed by APACHE II score, and higher Ranson’s and Glasgow criteria by admission. Adequate volume supplementation, on time, as well as percutaneous drainage of infected pancreas collection reduces a risk of pure outcome

Neinvazivna mehanička ventilacija u akutnoj respiracijskoj insuficijenciji zbog COVID-19

Coronavirus disease 2019 (COVID-19) is presented with a wide range of symptoms, from asymptomatic disease to severe and progressive interstitial pneumonia. As part of interstitial pneumonia, respiratory failure is typically presented as hypoxia and is the most common cause of hospitalization. When oxygen therapy fails, continuous positive airway pressure (CPAP) or noninvasive mechanical ventilation (NIV) are used as respiratory support measures of first choice. Noninvasive respiratory support (NIRS) is applied in order to save intensive care unit resources and to avoid complications related to invasive mechanical ventilation. Emerging evidence has shown that the use of CPAP or NIV in the management of acute hypoxemic respiratory failure in COVID-19 reduces the need for intubation and mortality. The advantage of NIRS is the feasibility of its application on wards. NIV could be administered via a face mask or helmet interface. Helmet adheres better than mask and therefore leakage is reduced, a delivery of positive end-expiratory pressure is more accurate, and the risk of nosocomial transmission of infections is lowered. Patients on NIRS must be carefully monitored so that further respiratory deterioration is not overlooked and additional measures of care including timely intubation and invasive mechanical ventilation could be performed if needed.Bolest uzrokovana novim koronavirusom 2019 (COVID-19) prezentira se širokim rasponom simptoma, od asimptomatske bolesti do teške i progresivne intersticijske upale pluća. Kao dio intersticijske pneumonije respiracijska insuficijencija tipično je obilježena hipoksijom i najčešći je uzrok hospitalizacije. Kada terapija kisikom ne uspije, kontinuirani pozitivni tlak u dišnim putovima (CPAP) ili neinvazivna mehanička ventilacija (NIV) mjere su respiracijske potpore prvog izbora. Neinvazivna respiracijska potpora (NIRS) primjenjuje se kako bi se uštedjeli resursi jedinica intenzivnog liječenja i izbjegle komplikacije povezane s invazivnom mehaničkom ventilacijom. Uporaba CPAP-a ili NIV-a u liječenju akutne hipoksemične respiracijske insuficijencije kod COVID-19 smanjuje potrebu za intubacijom i smrtnost. Prednost NIRS-a je da se može provoditi na odjelima. NIV se može primijeniti preko maske ili kacige. Kaciga bolje prianja u odnosu na masku i stoga je smanjen gubitak zraka, isporuka pozitivnog tlaka na kraju izdisaja je točnija, a rizik od nozokomijalnog prijenosa infekcija je manji. Bolesnici na NIRS-u moraju se pažljivo nadzirati kako se ne bi previdjelo daljnje respiracijsko pogoršanje i kako bi se mogle provesti dodatne mjere skrbi uključujući pravodobnu intubaciju i invazivnu mehaničku ventilaciju