WAGES IN CROATIA - CONDITION AND IMPLICATIONS OF DIFFERENT SCENARIOS OF FUTURE TRENDS

Autori analiziraju kretanja plaća u tranzicijskom razdoblju u Hrvatskoj, kako ukupnog gospodarskog stanja, tako i samih plaća, daju usporedbe kretanja plaća i drugih makroekonomskih pokazatelja tijekom vremena, međunarodne usporedbe razine plaća i njihove kupovne moći, analizu plaća po sektorima ianalizu poreznog opterećenja plaća. Razmatraju makroekonomske implikacije budućeg kretanja plaća dajući četiri moguća scenarija kretanja plaća u idućim godinama, ovisno o varijanti koju izaberu nositelji ekonomske politike, odnosno koju dogovore socijalni partneri. Takva analiza trebala bi pomoći nositelji maekonomske politike u definiranju osnovnih načela politike plaća u idućim godinama.The subject of the paper is the analysis of wages trends in transitional period in Croatia and consideration of macroeconomic implications of several possible scenarios of future wages development. Such analysis should help the bearers of economic policy in defining main principles of wage policy in the forthcoming years. The increase of wages supply after 1994 was the main originator of personal consumption growth and one of the main factors of entire economic growth in the following years. Expenditures for public sector wages were increasing their share in any how strongly growing entire government expenditure. Growing domestic consumption also caused remarkable deficits of current account and growing foreign borrowing. Sustainable economic growth on these bases is not possible in Croatia any more. Therefore it has been considered what can be done in wage policy in order to change that. In the first part the paper gives the analysis of condition, both of entire economic and of wages themselves. It shows comparisons of wages trends and other macroeconomic indicators during the period of time, international comparisons of levels of wages and their purchasing power, as well asanalysis of wages by sectors, and tax burden of wages. The second part shows implications of four possible scenarios of wages trends in following years. Depending on variant chosen by economic policy bearers or agreed upon by social partners, the results are different in view of economic growth, deficit, balance of payments, rates of investment, national savings and employment. Projections show that growth of wages which lags behind the GDP growth improves entire economic efficiency of economy. Stronger restriction of wages and employment in public sector accelerates economic growth but has short-term cost in the form of strongly growing unemployment. If private sector integrates with public in wage policy according to which average wages would grow more slowly than the growth of productivity, entire economic efficiency would be higher than if such policy is conducted only by public sector

Spinal shock after a ground-level fall

Falls are the most common cause of spinal cord injuries (SCIs) in patients older than 65. The worldwide annual incidence of SCIs is reported to be around 15 – 40/ 1000000

GUIDELINES FOR THE CLASSIFICATION, DIAGNOSIS, TREATMENT AND REHABILITATION OF NEWBORNS AND CHILDREN WITH BRACHIAL PLEXUS BIRTH INJURY

Porođajno oštećenje pleksusa brahijalisa (POPB) je neuromotorna fl akcidna paraliza ruke uzrokovana ozljedom jednog ili više korijenova pleksusa brahijalisa (PB) tijekom poroda. Uočava se obično ubrzo nakon poroda. Incidencija POBP je između 0,5 i 4,4 na 1000 poroda. U većini slučajeva, oštećenja brahijalnog pleksusa (OPB) su prolazna i dolazi do spontanog, potpunog oporavka funkcije u prvim tjednima života. Kod neke djece (20 do 30 %) slabost ruke zaostaje i dovodi do živčano-mišićne disfunkcije i trajnog invaliditeta. U literaturi postoje razlike u klasifi kaciji, dijagnozi i liječenju ovog poremećaja. Variraju od autora do autora i zasnivaju se na različitim studijama. Zajednički cilj habilitacije je vratiti senzornu i motoričku kontrolu, održati i povećati opseg pokreta, povećati mišićnu snagu, potaknuti bilateralnu funkcionalnu aktivnost i spriječiti sekundarne komplikacije. Razlike nastaju u načinu ostvarivanja tih zadataka. Dva su osnovna oblika liječenja OBP: konzervativno i kirurško. Konzervativno liječenje uključuje: intenzivnu kineziterapiju, korištenje komplementarnih tehnika poput elektrostimulacije, termoterapije, hidrogimnastike, udlaga, injekcija botulin toksina, radne terapije. Rano konzervativno liječenje je glavna opcija u liječenju OBP. Pregledom literature smo primijetili da nema znanstvenih dokaza o nekim habilitacijskom tehnikama koje se koriste u konzervativnom liječenju. Koriste se u brojnim centrima, iako njihova djelotvornost nije dokazana. Kirurško liječenje OBP-a može biti primarno (neurokirurško) i sekundarno (ortopedsko). Postoje razmimoilaženja u literaturi u pogledu potrebe neurokirurškog liječenju OBP-a kao i o dobi kada ga provesti. Svrha ovog istraživanja bila je učiniti pregled literature o klasifi kaciji, dijagnostičkoj obradi i habilitaciji POPB-a te odgovoriti na pitanja s kojima se susrećemo u svakodnevnom radu. Zbog neujednačenih stavova u literaturi, na osnovi dostupnih znanstvenih dokaza te osobnih kliničkih iskustava, izradili smo vlastite smjernice za klasifi kaciju, dijagnostiku, obradu i habilitaciju novorođenčadi i djece s OPB-om. Članovi Sekcije dječjih fi zijatara pri Hrvatskom društvu za fi zikalnu i rehabilitacijsku medicinu na Kongresu fi zikalne i rehabilitacijske medicine u travnju 2022. u Šibeniku usvojilii su ove smjernice (postupnik) za habilitaciju djece s porođajnim oštećenjem pleksusa brahijalisa.Brachial plexus birth palsy (BPBP) is a neuromotor fl accid paralysis caused by injury to one or more roots of the brachial plexus (BP) during childbirth. It is usually observed shortly after birth. The incidence of BPBP is between 0.5 to 4.4 per 1000 childbirths. Most cases of BPBP are transient and there is a spontaneous, complete recovery of function in the fi rst weeks of life. In some children (20% to 30%), arm weakness persists and leads to neuromuscular dysfunction and permanent disability. In the literature, there are still variations in the classifi cation, diagnosis and treatment of this disorder. They vary from author to author and are based on different studies. The common guideline for habilitation is to restore sensory and motor control, maintain and increase the range of motion, increase muscle strength, encourage bilateral functional activity, and prevent secondary complications. Differences can be seen in the way these tasks are accomplished. There are two basic forms of BPBP treatment, conservative and surgical. Conservative treatment includes intensive kinesitherapy, use of complementary techniques such as electrostimulation, thermotherapy, hydrogymnastics, use of splints, botulinum toxin injections, occupational therapy, etc. Early conservative treatment is the main option in the treatment of BPBP. By reviewing the literature, we noticed that there is no scientifi c evidence for some habilitation techniques used in conservative treatment. They are used in many centers, although their effectiveness has not been proven. Surgical treatment can be primary (neurosurgical) and secondary (orthopedic). There are disagreements in the literature regarding the need for neurosurgical treatment of PBPB and, if decided upon, the age at which it should be performed. The purpose of this research was to review the literature with the aim of assessing the available information on the classifi cation, diagnosis and habilitation prognosis. Due to uneven attitudes in the literature, based on the available scientifi c evidence and personal clinical experiences, we have created our own guidelines for the classifi cation, diagnosis, treatment and habilitation of newborns and children with BPBP. Members of the Section of Pediatric Physiatrists at the Croatian Society for Physical and Rehabilitation Medicine adopted these guidelines (procedure) for the habilitation of children with brachial plexus birth injury at the Congress of Physical and Rehabilitation Medicine in April 2022 in Šibenik

GUIDELINES FOR THE CLASSIFICATION, DIAGNOSIS, TREATMENT AND REHABILITATION OF NEWBORNS AND CHILDREN WITH BRACHIAL PLEXUS BIRTH INJURY

Porođajno oštećenje pleksusa brahijalisa (POPB) je neuromotorna fl akcidna paraliza ruke uzrokovana ozljedom jednog ili više korijenova pleksusa brahijalisa (PB) tijekom poroda. Uočava se obično ubrzo nakon poroda. Incidencija POBP je između 0,5 i 4,4 na 1000 poroda. U većini slučajeva, oštećenja brahijalnog pleksusa (OPB) su prolazna i dolazi do spontanog, potpunog oporavka funkcije u prvim tjednima života. Kod neke djece (20 do 30 %) slabost ruke zaostaje i dovodi do živčano-mišićne disfunkcije i trajnog invaliditeta. U literaturi postoje razlike u klasifi kaciji, dijagnozi i liječenju ovog poremećaja. Variraju od autora do autora i zasnivaju se na različitim studijama. Zajednički cilj habilitacije je vratiti senzornu i motoričku kontrolu, održati i povećati opseg pokreta, povećati mišićnu snagu, potaknuti bilateralnu funkcionalnu aktivnost i spriječiti sekundarne komplikacije. Razlike nastaju u načinu ostvarivanja tih zadataka. Dva su osnovna oblika liječenja OBP: konzervativno i kirurško. Konzervativno liječenje uključuje: intenzivnu kineziterapiju, korištenje komplementarnih tehnika poput elektrostimulacije, termoterapije, hidrogimnastike, udlaga, injekcija botulin toksina, radne terapije. Rano konzervativno liječenje je glavna opcija u liječenju OBP. Pregledom literature smo primijetili da nema znanstvenih dokaza o nekim habilitacijskom tehnikama koje se koriste u konzervativnom liječenju. Koriste se u brojnim centrima, iako njihova djelotvornost nije dokazana. Kirurško liječenje OBP-a može biti primarno (neurokirurško) i sekundarno (ortopedsko). Postoje razmimoilaženja u literaturi u pogledu potrebe neurokirurškog liječenju OBP-a kao i o dobi kada ga provesti. Svrha ovog istraživanja bila je učiniti pregled literature o klasifi kaciji, dijagnostičkoj obradi i habilitaciji POPB-a te odgovoriti na pitanja s kojima se susrećemo u svakodnevnom radu. Zbog neujednačenih stavova u literaturi, na osnovi dostupnih znanstvenih dokaza te osobnih kliničkih iskustava, izradili smo vlastite smjernice za klasifi kaciju, dijagnostiku, obradu i habilitaciju novorođenčadi i djece s OPB-om. Članovi Sekcije dječjih fi zijatara pri Hrvatskom društvu za fi zikalnu i rehabilitacijsku medicinu na Kongresu fi zikalne i rehabilitacijske medicine u travnju 2022. u Šibeniku usvojilii su ove smjernice (postupnik) za habilitaciju djece s porođajnim oštećenjem pleksusa brahijalisa.Brachial plexus birth palsy (BPBP) is a neuromotor fl accid paralysis caused by injury to one or more roots of the brachial plexus (BP) during childbirth. It is usually observed shortly after birth. The incidence of BPBP is between 0.5 to 4.4 per 1000 childbirths. Most cases of BPBP are transient and there is a spontaneous, complete recovery of function in the fi rst weeks of life. In some children (20% to 30%), arm weakness persists and leads to neuromuscular dysfunction and permanent disability. In the literature, there are still variations in the classifi cation, diagnosis and treatment of this disorder. They vary from author to author and are based on different studies. The common guideline for habilitation is to restore sensory and motor control, maintain and increase the range of motion, increase muscle strength, encourage bilateral functional activity, and prevent secondary complications. Differences can be seen in the way these tasks are accomplished. There are two basic forms of BPBP treatment, conservative and surgical. Conservative treatment includes intensive kinesitherapy, use of complementary techniques such as electrostimulation, thermotherapy, hydrogymnastics, use of splints, botulinum toxin injections, occupational therapy, etc. Early conservative treatment is the main option in the treatment of BPBP. By reviewing the literature, we noticed that there is no scientifi c evidence for some habilitation techniques used in conservative treatment. They are used in many centers, although their effectiveness has not been proven. Surgical treatment can be primary (neurosurgical) and secondary (orthopedic). There are disagreements in the literature regarding the need for neurosurgical treatment of PBPB and, if decided upon, the age at which it should be performed. The purpose of this research was to review the literature with the aim of assessing the available information on the classifi cation, diagnosis and habilitation prognosis. Due to uneven attitudes in the literature, based on the available scientifi c evidence and personal clinical experiences, we have created our own guidelines for the classifi cation, diagnosis, treatment and habilitation of newborns and children with BPBP. Members of the Section of Pediatric Physiatrists at the Croatian Society for Physical and Rehabilitation Medicine adopted these guidelines (procedure) for the habilitation of children with brachial plexus birth injury at the Congress of Physical and Rehabilitation Medicine in April 2022 in Šibenik

Urological emergencies

Hitna urološka stanja rijetka su u usporedbi s hitnim stanjima drugih kirurških područja, a rijetko su i životno ugrožavajuća. Kako su brojne strukture urogenitalnog sustava smještene retroperitonealno i samim time nedostupne palpaciji, uz kvalitetan fizikalni pregled i iscrpnu anamnezu, od velike koristi su i slikovne dijagnostičke metode poput ultrazvuka, kompjuterizirane tomografije (CT), magnetske rezonancije te kontrastnih slikovnih metoda. U ovome radu redom su opisana stanja: torzija testisa, prijapizam, parafimoza, Fournierova gangrena, akutna retencija urina te urotrauma. Torzija testisa stanje je nastalo rotiranjem testisa oko uzdužne osi što dovodi do kompresije vaskularnog protoka. Brzo prepoznavanje i liječenje nužni su za spašavanje testisa, a torzija se mora isključiti u svih pacijenata s akutnim skrotumom. Prijapizam je prolongirana erekcija penisa koja traje >4 h, a nije povezana sa seksualnom interakcijom. Dijagnoza je klinička, a hitno liječenje je potrebno kako bi se izbjegla trajna erektilna disfunkcija. Parafimoza je hitno stanje u kojem prepucij ostane zarobljen proksimalno od korone glandis što dovodi do strangulacije distalnog penisa. Promptna reakcija smanjivanja edema ključna je kako bi se spriječila nepovratna nekroza penisa. Fournierova gangrena stanje je brzoprogresivne nekrotizirajuće infekcije kože i mekih tkiva perinealne regije. Multidisciplinaran pristup liječenju, korištenje širokospektralnih antibiotika te kirurške intervencije ključni su kako bi se spriječile akutne i kronične posljedice za pacijenta. Akutna retencija urina stanje je obilježeno iznenadnom nemogućnošću voljnog pražnjenja mokraćnog mjehura. Uzroci su brojni, a u liječenju je bitno izvesti dekompresiju mokraćnog mjehura kateterizacijom te naknadno dijagnosticirati i liječiti direktan uzrok. Trauma urogenitalnog trakta rijetka je jer su bubreg, ureteri i mokraćni mjehur zaštićeni unutar zdjelice i abdomena, a testisi i penis su mobilni. Uz to, urološka trauma uglavnom nastaje u politraumatiziranih bolesnika.In comparison to other surgical emergencies, urological emergencies are not so frequent conditions, and are rarely life-threatening. As many urogenital structures are located retroperitoneally, and are therefore inaccessible to palpation, with quality physical examination and comprehensive history, diagnostic imaging methods such as ultrasound, computed tomography (CT), magnetic resonance imaging and various contrast enhanced methods are very useful. This review describes the following conditions: testicular torsion, priapism, paraphimosis, Fournier's gangrene, acute urinary retention and urotrauma. Testicular torsion is a condition caused by the rotation of the testicles around the longitudinal axis, which leads to the compression of vascular flow. Rapid recognition and treatment are necessary to save the testis, and torsion must be ruled out in all patients with acute scrotum. Priapism is a prolonged erection of the penis that lasts >4 hours and is not associated with sexual interaction. The diagnosis is clinical and urgent treatment is needed to avoid permanent erectile dysfunction. Paraphimosis is an emergency in which the foreskin remains trapped proximal to the corona glandis, leading to the strangulation of the distal penis. Prompt response including oedema reduction is crucial to prevent irreversible penile necrosis. Fournier's gangrene is a condition of rapidly progressive necrotizing infection of the skin and soft tissues of the perineal region. A multidisciplinary approach to treatment, the use of broad-spectrum antibiotics and surgical interventions are key to preventing acute and chronic consequences for the patient. Acute urinary retention is a condition characterized by a sudden inability to voluntarily empty the bladder. The causes are numerous, and in the treatment it is important to perform a decompression of the bladder by catheterization and subsequently diagnose and treat the direct cause. Urogenital trauma is rare because the kidneys, ureters, and bladder are protected within the pelvis and abdomen, and the testicles and penis are mobile. In addition, urological trauma mainly occurs in polytraumatized patients

Urological emergencies

Hitna urološka stanja rijetka su u usporedbi s hitnim stanjima drugih kirurških područja, a rijetko su i životno ugrožavajuća. Kako su brojne strukture urogenitalnog sustava smještene retroperitonealno i samim time nedostupne palpaciji, uz kvalitetan fizikalni pregled i iscrpnu anamnezu, od velike koristi su i slikovne dijagnostičke metode poput ultrazvuka, kompjuterizirane tomografije (CT), magnetske rezonancije te kontrastnih slikovnih metoda. U ovome radu redom su opisana stanja: torzija testisa, prijapizam, parafimoza, Fournierova gangrena, akutna retencija urina te urotrauma. Torzija testisa stanje je nastalo rotiranjem testisa oko uzdužne osi što dovodi do kompresije vaskularnog protoka. Brzo prepoznavanje i liječenje nužni su za spašavanje testisa, a torzija se mora isključiti u svih pacijenata s akutnim skrotumom. Prijapizam je prolongirana erekcija penisa koja traje >4 h, a nije povezana sa seksualnom interakcijom. Dijagnoza je klinička, a hitno liječenje je potrebno kako bi se izbjegla trajna erektilna disfunkcija. Parafimoza je hitno stanje u kojem prepucij ostane zarobljen proksimalno od korone glandis što dovodi do strangulacije distalnog penisa. Promptna reakcija smanjivanja edema ključna je kako bi se spriječila nepovratna nekroza penisa. Fournierova gangrena stanje je brzoprogresivne nekrotizirajuće infekcije kože i mekih tkiva perinealne regije. Multidisciplinaran pristup liječenju, korištenje širokospektralnih antibiotika te kirurške intervencije ključni su kako bi se spriječile akutne i kronične posljedice za pacijenta. Akutna retencija urina stanje je obilježeno iznenadnom nemogućnošću voljnog pražnjenja mokraćnog mjehura. Uzroci su brojni, a u liječenju je bitno izvesti dekompresiju mokraćnog mjehura kateterizacijom te naknadno dijagnosticirati i liječiti direktan uzrok. Trauma urogenitalnog trakta rijetka je jer su bubreg, ureteri i mokraćni mjehur zaštićeni unutar zdjelice i abdomena, a testisi i penis su mobilni. Uz to, urološka trauma uglavnom nastaje u politraumatiziranih bolesnika.In comparison to other surgical emergencies, urological emergencies are not so frequent conditions, and are rarely life-threatening. As many urogenital structures are located retroperitoneally, and are therefore inaccessible to palpation, with quality physical examination and comprehensive history, diagnostic imaging methods such as ultrasound, computed tomography (CT), magnetic resonance imaging and various contrast enhanced methods are very useful. This review describes the following conditions: testicular torsion, priapism, paraphimosis, Fournier's gangrene, acute urinary retention and urotrauma. Testicular torsion is a condition caused by the rotation of the testicles around the longitudinal axis, which leads to the compression of vascular flow. Rapid recognition and treatment are necessary to save the testis, and torsion must be ruled out in all patients with acute scrotum. Priapism is a prolonged erection of the penis that lasts >4 hours and is not associated with sexual interaction. The diagnosis is clinical and urgent treatment is needed to avoid permanent erectile dysfunction. Paraphimosis is an emergency in which the foreskin remains trapped proximal to the corona glandis, leading to the strangulation of the distal penis. Prompt response including oedema reduction is crucial to prevent irreversible penile necrosis. Fournier's gangrene is a condition of rapidly progressive necrotizing infection of the skin and soft tissues of the perineal region. A multidisciplinary approach to treatment, the use of broad-spectrum antibiotics and surgical interventions are key to preventing acute and chronic consequences for the patient. Acute urinary retention is a condition characterized by a sudden inability to voluntarily empty the bladder. The causes are numerous, and in the treatment it is important to perform a decompression of the bladder by catheterization and subsequently diagnose and treat the direct cause. Urogenital trauma is rare because the kidneys, ureters, and bladder are protected within the pelvis and abdomen, and the testicles and penis are mobile. In addition, urological trauma mainly occurs in polytraumatized patients