Učestalost ozljeda djece liječene u Zavodu za hitnu medicinu Splitsko-dalmatinske županije

Injuries in children are a major public health problem that has been recognized by the World Health Organisation, which adopted a 10-year action plan in 2006 for the prevention of children injuries. The aim of this study was to determine demographic data, preva- lence, severity and type of injuries in children admitted to the Emergency Department in the Split-Dalmatia County during a five- year period. This cross-sectional study included data on 25,037 subjects aged <18 who were treated in the period from January 2015 to January 2020. During the five-year study period, out of the total number of injured children, there were 16,158 (64.54%) boys and 8,879 (35.46%) girls. The highest number of injuries (n=8409; 33.59%) were recorded in the 6-12 age group, while the lowest number of injuries were recorded in the first year of life (n=1077; 4.30%). Injuries to the head were most common (n=9670; 38.62%), followed by injuries to the elbow, forearm, wrist and hand (n=5384; 21.50%) and injuries to the knee, lower leg, ankle and foot (n=5146; 20.55%). Out of the total number of injured children, the number of deaths at the scene of injury was 24 (0.09%), recorded in 16 boys and 8 girls. Further treatment at the Split University Hospital Centre was ordered in 7.88% of children.Ozljede djece veliki su javnozdravstveni problem koji je prepoznala i Svjetska zdravstvena organizacija te je 2006. godine donijela desetogodišnji plan aktivnosti djelovanja za prevenciju ozljeda djece. Cilj rada je utvrditi demografske podatke, učestalost, težinu i tip ozljeda u djece koja su u petogodišnjem razdoblju liječena u Zavodu za hitnu medicinu Splitsko-dalmatinske županije (ZHM SDŽ). Ova presječna studija obradila je uzorak od 25 037-ero ispitanika u dobi do 18 godina za razdoblje od siječnja 2015. do siječnja 2020. U promatranom petogodišnjem razdoblju od ukupnog broja ozlijeđene djece 16 158-ero (64,54% su dječaci i 8 879 (35,46%) djevoj- čice. Najveći broj ozljeda 8 409 (33,59%) zabilježen je u dobnoj kategoriji od šest do 12 godina, dok je najmanje ozljeđivanja u prvoj godini života 1 077 (4,30%). Najčešće su ozljede glave 9 670 (38,62%), zatim lakta, podlaktice, ručnog zgloba i šake 5 384 ( 21,50%) te ozljede koljena, potkoljenice, nožnog zgloba i stopala 5 146 (20,55%). Od ukupnog broja ozlijeđene djece broj umrlih na mjestu događaja ozljede iznosio je ukupno 24 (0,09%), i to 16 dječaka i osam djevojčica. Daljnja obrada i liječenje u Kliničkom bolničkom centru Split bilo je potrebno u 7,88% ozlijeđene djece

Union activity in subsidiaries of multinational corporations in Republic of Croatia

Multinational corporations as the primary holders of foreign direct investments have a significant impact on the national economy with a well-developed and prepared institutional infrastructure, but they have even stronger impact on the transition economies and developing countries. Expanding into new markets, multinational corporations create new jobs; therefore unions have an important role in protecting employees' rights and their representation towards employers. The role of unions in the lives of all employees is even more noticeable because the situation on the labor market is extremely unfavourable and in many countries employees' rights are threatened. But researches also show that the proportion of union membership in the developed countries is decreasing, and also in developing countries and this trend has not bypassed Croatia. The aim of this paper is to investigate the role of unions in the subsidiaries of multinational corporations in Croatia. In more than half of the analyzed subsidiaries of multinational corporations we identified one hundred percent coverage of employees by collective agreements. We analyzed the most common reasons for joining the union and evaluated the relationship between unions and human resource management departments.peer-reviewe

Composition and quantity of medical waste and its impact on the environment before and during the Covid-19 pandemic

Medical waste is generated in healthcare institutions and can be of different types. According to its properties, it can be classified as hazardous medical waste or non-hazardous medical waste. Due to its potentially dangerous properties, it is necessary to manage medical waste in accordance with the provisions of the Waste Management Act and the Ordinance on Medical Waste Management (1, 2). In the period from 2015 to 2019, the amount of medical waste grew annually by an average of 8%. In 2020, 7.014 tons of medical waste were generated, of which 74% was hazardous and 26% was non-hazardous medical waste. Compared to 2019, this was an increase of 28%, which can be attributed to the increased consumption of medical products due to the COVID-19 pandemic. The amount of hazardous medical waste increased by 18%, and the amount of non-hazardous medical waste by 67% (3). The aim of this work was to investigate the differences in the amount,ncomposition, and treatment of medical waste in the pre-pandemic and pandemic period during the COVID-19 pandemic in health care institutions of the Split-Dalmatia County. The increased use of additional protective equipment in the work of healthcare professionals during the COVID-19 pandemic caused the generation of three times more infectious waste. The paper highlights the importance of proper handling, collection, processing, and disposal of infectious medical wasteo to prevent direct or indirect transmission of infection and harmful effects on human and/or animal health

Quality of life of the elderly with chronic leukemia

Cilj: Ispitati i utvrditi prisutnost poteškoća i kvalitetu života bolesnika s kroničnom leukemijom s obzirom na spol, bračni status i starosnu dob bolesnika. Metode: Za potrebe istraživanja proveden je anketni upitnik među 44 bolesnika koji imaju dijagnosticiranu kroničnu leukemiju duže od godine dana. Istraživanje je provedeno u razdoblju od 15.6.2021. do 14.8.2021. godine. Ispitanici su anketirani preko anketnog upitnika koji je proveden pismeno, zaokruživanjem jednog od ponuđenih odgovora. Rezultati: U provedenom istraživanju sudjelovalo je 44 ispitanika, od kojih su 58,82 % muškarci i 41,18 % žene. Za većinu ispitanika postoji statistički značajna povezanost u prisutnosti poteškoća i kvaliteti života s obzirom na starosnu dob. Zaključci: Poteškoće uzrokovane leukemijom koje utječu na kvalitetu života s obzirom na spol bolesnika izraženije su kod žena. Poteškoće uzrokovane leukemijom koje utječu na kvalitetu života s obzirom na bračni status ispitanika nisu značajno izražene kod nijedne grupe ispitanika. Postoji povezanost između učestalosti općih poteškoća i starosne dobi, odnosno osobe starije životne dobi bilježe učestalije opće poteškoće.Objective: To examine and determine the presence of difficulties and quality of life of patients with chronic leukemia regarding gender, marital status and age of the patient. Methods: For the purposes of the research, a survey questionnaire was conducted among 44 patients who were diagnosed with chronic leukemia for more than a year. The research was conducted in the period from 06/15/2021. to 08/14/2021. Respondents were interviewed through a written questionnaire, rounding off one of the offered answers. Results: 44 respondents participated in the study, of which 58.82% were men and 41.18% women. For most respondents, there is a statistically significant association in the presence of difficulties and quality of life with respect to age. Conclusion: Difficulties caused by leukemia that affect the quality of life, depending on the gender of the patient, are more pronounced in women. Difficulties caused by leukemia that affect the quality of life with regard to the marital status of the respondents are not significantly expressed in any group of respondents. There is a connection between the frequency of general difficulties and age, that is, older people report more frequent general difficulties

Variability of arterial stiffness indicators

Cilj doktorske disertacije je bio istražiti čimbenike i korake u protokolu procjene PWV-a — zlatnog standarda za mjerenja arterijske krutosti, koji mogu utjecati na smanjenje neželjene varijabilnosti PWV-a unutar ispitanika i tako olakšati uvođenje PWV-a u kliničku praksu. Nadalje, istraženi su i identificirani i čimbenici koji mogu dovesti do tehničkih poteškoća u mjerenju PWV-a, a istraživala se i mogućnost utjecaja nedavne infekcije COVID-19 na stanje krvožilja nekoliko mjeseci nakon izlječenja i njezinog ometajućeg djelovanja u longitudinalnim studijama. Analize su provedene odvojeno za svaki od dva validirana uređaja - aplanacijski tonometar SphygłnoCor i oscilometar Arteriograph - koji koriste različite tehnike za neinvazivno mjerenje PWV-a, osim za studiju s ispitanicima koji su nedavno preboljeli COVID-19 u kojoj su mjerenja učinjena samo sa SphygmoCorom. Rezultati se temelje na dva jedinstvena ustroja studija u području. U studiji u kojoj se željelo identificirati eksperimentalne uvjete (različiti mjeritelji, doba dana i broj posjeta) i ostale zbunjujuće čimbenike (vanjski meteorološki uvjeti, fiziološki parametri — arterijski krvni tlakovi i brzina otkucaja srca, te obilježja ispitanika — dob, spol, status hipertenzije, ITM) koji utječu na izmjerene vrijednosti PWV-a i/ili uzrokuju tehničke poteškoće s mjerenjem PWV-a, a koji nisu kontrolirani u standardnom protokolu mjerenja, po prvi je puta sustavno ispitana kratkoročna varijabilnost PWV-a unutar ispitanika. Kako se unutar kratkog perioda promatranja od 2 tjedna ne očekuju klinički značajne promjene arterijske krutosti u pojedinca, intra-individualna varij abilnost PWV-a koja je opažena u studiji predstavlja grešku u longitudinalnim mjerenjima PWVa koja se može očekivati u klinici. Ustroj koji je korišten — jedno-zaslijepljena ukrižena studija s dva različita uređaja, randomizirana s obzirom na dva različita mjeritelja i dva različita doba dana (ujutro/poslijepodne) s 12 ponovljenih mjerenja po ispitaniku te ispitanicima koji su jednoliko i široko raspodijeljeni prema dobi, ITM-u, spolu i dijagnozi hipertenzije (nonnotenzivni/hipertenzivni) osigurava visoku razinu dokaza. Temeljem rezultata ove studije, predložen je niz preporuka koje bi mogle smanjiti neželjenu intraindividualnu varijabilnost prilikom procjene PWV-a te olakšati korištenje PWV-a u kliničkoj praksi. Druga studija je jedina studija do sada u kojoj su se promjene arterijske krutosti i centralne hemodinamike usporedile prije i poslije infekcije COVID-19. Rezultati pokazuju da se vrijednosti parametara nastavljaju pogoršavati u periodu između 2. i 3. mjeseca nakon završetka infekcije sugerirajući da je moguće da infekcija COVID-19 dolazi do trajnog pogoršanja arterijske krutosti. To posljedično znači i povećanje rizika za razvoj KVB, čak i u dominantno mladih, zdravih osoba s blagim oblikom bolesti, kao što su oni opisani u ovoj studiji. Rezultati ovog doktorskog rada, koji uključuju niz preporuka za smanjenje neželjene intra-individualne varijabilnosti PWV-a u pojedinca, kao i smanjenje pojavnosti tehničkih poteškoća prilikom mjerenja te identificiraju nove zbunjujuće čimbenike poput COVID-19, mogu olakšati uvođenje mjerenja PWV-a u kliničku praksu i interpretaciju longitudinalnih studija.The goal of the doctoral dissertation was to investigate the factors and steps in the PWV assessment protocol - the gold standard for arterial stiffness measurements, which can affect the reduction of unwanted PWV variability within subjects and thus facilitate the introduction of PWV into clinical practice. Furthermore, the factors that can lead to technical difficulties in measuring PWV were investigated and identified, and the possibility of the impact of a recent infection of COVID-19 on the state of blood vessels several months after recovery and its disruptive effect in longitudinal studies was also investigated. Analyses were performed separately for each of the two validated devices - the SphygmoCor applanation tonometer and the Arteriogaph oscillometer - which use different techniques for non-invasive PWV measurement, except for the study with subjects who had recently recovered from COVID-19 in which measurements were made only with the SphygmoCor. The results are based on two unique institutions of study in the area. In a study in which the aim was to identify the experimental conditions (different measuring devices, time of day and number of visits) and other confounding factors (external meteorological conditions, physiological parameters - arterial blood pressure and heart rate, and characteristics of the subjects - age, gender, hypertension status, BMI) that affect the measured PWV values and/or cause technical difficulties with PWV measurement, which are not controlled in the standard measurement protocol, for the first time the short-term variability of PWV within subjects was systematically examined. As clinically significant changes in arterial stiffness in an individual are not expected within a short observation period of 2 weeks, the intra-individual variability of PWV observed in the study represents an error in longitudinal measurements of PWV that can be expected in the clinic. The design used — a single-blind cross-over study with two different devices, randomized with regard to two different measuring devices and two different times of day (morning/aftemoon) with 12 repeated measurements per subject and subjects uniformly and widely distributed by age, BMI -in, gender and diagnosis of hypertension (normotensive/hypertensive) provides a high level of evidence. Based on the results of this study, a number of recommendations were proposed that could reduce unwanted intra-individual variability when assessing PMA" and facilitate the use of PWV in clinical practice. The second study is the only study to date that compared changes in arterial stiffness and central hemodynamics before and after infection with COVID-19. The results show that the values of the parameters continue to deteriorate in the period between 2 and 3 months after the end of the infection, suggesting that it is possible that the COVID-19 infection leads to a perrnanent deterioration of arterial stiffness. This consequently means an increase in the risk for the development of CVD, even in predominantly young, healthy individuals with a mild form of the disease, such as those described in this study. The results of this doctoral thesis, which include a number of recommendations for reducing unwanted intra-individual variability of PWV in an individual, as well as reducing the incidence of technical difficulties during measurement and identifying new confounding factors such as COVID-19, can facilitate the introduction of PWV measurement into clinical practice and interpreting longitudinal studies

EPIDEMIOLOGICAL CHARACTERISTICS OF HYPERTENSION PATIENTS WHO WERE TREATED AT THE DEPARTMENT OF EMERGENCY MEDICINE SPLITSKO-DALMATINSKE PART OF THE STATE IN OFFICES SPLIT AND KASTEL STARI IN THE PERIOD FROM 01.09.2013. TO 01.09.2014. YEAR

CILJ: Utvrditi epidemiološka obilježja bolesnika koji su se liječili na Zavodu za hitnu medicinu Splitsko-dalmatinske županije u ispostavama Split i Kaštel Stari, a to su spol, godište, u kojem kalendarskom mjesecu je ućestalije liječenje od arterijske hipertenzije, te gdje je bolesnik upućen poslije liječenja (doma ili na jedan od hitnih prijema u klinički bolnički cenatr). MATERIJALI I METODE: Podaci za pisanje ovog rada su prikupljeni na Zavodu za hitnu medicinu Splitsko-dalmatinske županije u ispostavama Split i Kaštel Stari. Uzorak istraživanja je bila ciljana skupina bolesnika koji su liječeni na Zavodu hitne medicine Splitsko-dalmatinske županije od arterijske hipertenzije. Istraživanje je provedeno retrospektivnom analizom podataka o bolesnicima koji su se liječili od arterijske hipertenzije u periodu od 01.09.2013. do 01.09.2014. godine, temeljem analiza protokola i evidencije (protokola) bolesnika liječenih na Zavodu za hitnu medicinu Splitsko-dalmatinske županije u ispostavama Split i Kaštel Stari. REZULTATI: Uspoređivanjem podataka o spolu i životnoj dobi (godištu) došlo se do podataka da liječenje od arterijske hipertenzije na Zavod za hitnu medicinu Splitsko-dalmatinske županije češće zatražuju osobe ženskog spola (58%), a muškarci (42%), te da se najčešće javljaju osobe u životnoj dobi u šestom i sedmom desetljeću života. Dobiven je podatak da se bolesnici s arterijskom hipertenziom češće zatražuju liječenje u mjesecima studenom, prosincu i siječnju, te da se poslije liječenja na Zavodu za hitnu medicinu Splitsko-dalmatinske županije češće upućeni doma nego li na daljnu obradu u klinički bolnički centar. ZAKLJUČAK: Arterijska hipertenzija se navodi kao prvi uzrok smrtnosti u svijetu, raste s dobi i sve je učestlija u ženske populacije. Bitno je dijagnosticirati na vrijeme i što prije početi s liječenjem. Učestalija je u osoba povećane tjelesne mase, fizički neaktivnih, te se češće javlja u zimskim mjesecima kada nema dovoljno fizičke aktivnosti,a konzumira se masnija i slanija hrana.OBJECTIVE: To determine the epidemiological characteristics of the patients who were treated at the Department of Emergency Medicine Splitsko-Dalmatianske part of the state offices in Split and Kastel Stari, such as gender, age, in which calendar month is more frequent treatment of arterial hypertension, and where the patient is addressed to later treatment (at home or at one of the emergency departments in the clinical hospital cenatr). MATERIALS AND METHODS: Data for writing this work were collected at the Department of Emergency Medicine Splitsko-Dalmatinske part of the state offices in Split and Kastel Stari. The research sample was targeted groups of patients who were treated at the Department of emergency medicine Splitsko-Dalmatinska part od the state of hypertension. The retrospective analysis of data on patients who have been treated for hypertension in the period from 01.09.2013. to 01.09.2014. year, based on the analysis of protocols and records (protocols) of patients treated at the Department of Emergency Medicine Splitsko-Dalmatinska part of the state in the offices of Split and Kastel Stari. RESULTS: Comparing the data on gender and age (age) provided information to the treatment of arterial hypertension in the Department of Emergency Medicine Splitsko-Dalmatinska part od the state often requests a females (58%) and men (42%), and that most often occur in people age in the sixth and seventh decade of life. This resulted in the fact that patients with arterial hipertenziom often requests a treatment in the months of November, December and January, and that after treatment at the Department of Emergency Medicine Splitsko-Dalmatinska part od the state home more often addressed than the further processing in the clinical hospital center. CONCLUSION: Arterial hypertension is listed as the first cause of mortality in the world, increases with age and is more common in women. It is important to diagnose at the time and as soon as possible to start treatment. It is more prevalent in persons of increased body weight, physically inactive, and occurs more frequently in the winter when there is not enough physical activity, and consumed oily and saltier food

Variability of arterial stiffness indicators

Cilj doktorske disertacije je bio istražiti čimbenike i korake u protokolu procjene PWV-a — zlatnog standarda za mjerenja arterijske krutosti, koji mogu utjecati na smanjenje neželjene varijabilnosti PWV-a unutar ispitanika i tako olakšati uvođenje PWV-a u kliničku praksu. Nadalje, istraženi su i identificirani i čimbenici koji mogu dovesti do tehničkih poteškoća u mjerenju PWV-a, a istraživala se i mogućnost utjecaja nedavne infekcije COVID-19 na stanje krvožilja nekoliko mjeseci nakon izlječenja i njezinog ometajućeg djelovanja u longitudinalnim studijama. Analize su provedene odvojeno za svaki od dva validirana uređaja - aplanacijski tonometar SphygłnoCor i oscilometar Arteriograph - koji koriste različite tehnike za neinvazivno mjerenje PWV-a, osim za studiju s ispitanicima koji su nedavno preboljeli COVID-19 u kojoj su mjerenja učinjena samo sa SphygmoCorom. Rezultati se temelje na dva jedinstvena ustroja studija u području. U studiji u kojoj se željelo identificirati eksperimentalne uvjete (različiti mjeritelji, doba dana i broj posjeta) i ostale zbunjujuće čimbenike (vanjski meteorološki uvjeti, fiziološki parametri — arterijski krvni tlakovi i brzina otkucaja srca, te obilježja ispitanika — dob, spol, status hipertenzije, ITM) koji utječu na izmjerene vrijednosti PWV-a i/ili uzrokuju tehničke poteškoće s mjerenjem PWV-a, a koji nisu kontrolirani u standardnom protokolu mjerenja, po prvi je puta sustavno ispitana kratkoročna varijabilnost PWV-a unutar ispitanika. Kako se unutar kratkog perioda promatranja od 2 tjedna ne očekuju klinički značajne promjene arterijske krutosti u pojedinca, intra-individualna varij abilnost PWV-a koja je opažena u studiji predstavlja grešku u longitudinalnim mjerenjima PWVa koja se može očekivati u klinici. Ustroj koji je korišten — jedno-zaslijepljena ukrižena studija s dva različita uređaja, randomizirana s obzirom na dva različita mjeritelja i dva različita doba dana (ujutro/poslijepodne) s 12 ponovljenih mjerenja po ispitaniku te ispitanicima koji su jednoliko i široko raspodijeljeni prema dobi, ITM-u, spolu i dijagnozi hipertenzije (nonnotenzivni/hipertenzivni) osigurava visoku razinu dokaza. Temeljem rezultata ove studije, predložen je niz preporuka koje bi mogle smanjiti neželjenu intraindividualnu varijabilnost prilikom procjene PWV-a te olakšati korištenje PWV-a u kliničkoj praksi. Druga studija je jedina studija do sada u kojoj su se promjene arterijske krutosti i centralne hemodinamike usporedile prije i poslije infekcije COVID-19. Rezultati pokazuju da se vrijednosti parametara nastavljaju pogoršavati u periodu između 2. i 3. mjeseca nakon završetka infekcije sugerirajući da je moguće da infekcija COVID-19 dolazi do trajnog pogoršanja arterijske krutosti. To posljedično znači i povećanje rizika za razvoj KVB, čak i u dominantno mladih, zdravih osoba s blagim oblikom bolesti, kao što su oni opisani u ovoj studiji. Rezultati ovog doktorskog rada, koji uključuju niz preporuka za smanjenje neželjene intra-individualne varijabilnosti PWV-a u pojedinca, kao i smanjenje pojavnosti tehničkih poteškoća prilikom mjerenja te identificiraju nove zbunjujuće čimbenike poput COVID-19, mogu olakšati uvođenje mjerenja PWV-a u kliničku praksu i interpretaciju longitudinalnih studija.The goal of the doctoral dissertation was to investigate the factors and steps in the PWV assessment protocol - the gold standard for arterial stiffness measurements, which can affect the reduction of unwanted PWV variability within subjects and thus facilitate the introduction of PWV into clinical practice. Furthermore, the factors that can lead to technical difficulties in measuring PWV were investigated and identified, and the possibility of the impact of a recent infection of COVID-19 on the state of blood vessels several months after recovery and its disruptive effect in longitudinal studies was also investigated. Analyses were performed separately for each of the two validated devices - the SphygmoCor applanation tonometer and the Arteriogaph oscillometer - which use different techniques for non-invasive PWV measurement, except for the study with subjects who had recently recovered from COVID-19 in which measurements were made only with the SphygmoCor. The results are based on two unique institutions of study in the area. In a study in which the aim was to identify the experimental conditions (different measuring devices, time of day and number of visits) and other confounding factors (external meteorological conditions, physiological parameters - arterial blood pressure and heart rate, and characteristics of the subjects - age, gender, hypertension status, BMI) that affect the measured PWV values and/or cause technical difficulties with PWV measurement, which are not controlled in the standard measurement protocol, for the first time the short-term variability of PWV within subjects was systematically examined. As clinically significant changes in arterial stiffness in an individual are not expected within a short observation period of 2 weeks, the intra-individual variability of PWV observed in the study represents an error in longitudinal measurements of PWV that can be expected in the clinic. The design used — a single-blind cross-over study with two different devices, randomized with regard to two different measuring devices and two different times of day (morning/aftemoon) with 12 repeated measurements per subject and subjects uniformly and widely distributed by age, BMI -in, gender and diagnosis of hypertension (normotensive/hypertensive) provides a high level of evidence. Based on the results of this study, a number of recommendations were proposed that could reduce unwanted intra-individual variability when assessing PMA" and facilitate the use of PWV in clinical practice. The second study is the only study to date that compared changes in arterial stiffness and central hemodynamics before and after infection with COVID-19. The results show that the values of the parameters continue to deteriorate in the period between 2 and 3 months after the end of the infection, suggesting that it is possible that the COVID-19 infection leads to a perrnanent deterioration of arterial stiffness. This consequently means an increase in the risk for the development of CVD, even in predominantly young, healthy individuals with a mild form of the disease, such as those described in this study. The results of this doctoral thesis, which include a number of recommendations for reducing unwanted intra-individual variability of PWV in an individual, as well as reducing the incidence of technical difficulties during measurement and identifying new confounding factors such as COVID-19, can facilitate the introduction of PWV measurement into clinical practice and interpreting longitudinal studies

Variability of arterial stiffness indicators

Cilj doktorske disertacije je bio istražiti čimbenike i korake u protokolu procjene PWV-a — zlatnog standarda za mjerenja arterijske krutosti, koji mogu utjecati na smanjenje neželjene varijabilnosti PWV-a unutar ispitanika i tako olakšati uvođenje PWV-a u kliničku praksu. Nadalje, istraženi su i identificirani i čimbenici koji mogu dovesti do tehničkih poteškoća u mjerenju PWV-a, a istraživala se i mogućnost utjecaja nedavne infekcije COVID-19 na stanje krvožilja nekoliko mjeseci nakon izlječenja i njezinog ometajućeg djelovanja u longitudinalnim studijama. Analize su provedene odvojeno za svaki od dva validirana uređaja - aplanacijski tonometar SphygłnoCor i oscilometar Arteriograph - koji koriste različite tehnike za neinvazivno mjerenje PWV-a, osim za studiju s ispitanicima koji su nedavno preboljeli COVID-19 u kojoj su mjerenja učinjena samo sa SphygmoCorom. Rezultati se temelje na dva jedinstvena ustroja studija u području. U studiji u kojoj se željelo identificirati eksperimentalne uvjete (različiti mjeritelji, doba dana i broj posjeta) i ostale zbunjujuće čimbenike (vanjski meteorološki uvjeti, fiziološki parametri — arterijski krvni tlakovi i brzina otkucaja srca, te obilježja ispitanika — dob, spol, status hipertenzije, ITM) koji utječu na izmjerene vrijednosti PWV-a i/ili uzrokuju tehničke poteškoće s mjerenjem PWV-a, a koji nisu kontrolirani u standardnom protokolu mjerenja, po prvi je puta sustavno ispitana kratkoročna varijabilnost PWV-a unutar ispitanika. Kako se unutar kratkog perioda promatranja od 2 tjedna ne očekuju klinički značajne promjene arterijske krutosti u pojedinca, intra-individualna varij abilnost PWV-a koja je opažena u studiji predstavlja grešku u longitudinalnim mjerenjima PWVa koja se može očekivati u klinici. Ustroj koji je korišten — jedno-zaslijepljena ukrižena studija s dva različita uređaja, randomizirana s obzirom na dva različita mjeritelja i dva različita doba dana (ujutro/poslijepodne) s 12 ponovljenih mjerenja po ispitaniku te ispitanicima koji su jednoliko i široko raspodijeljeni prema dobi, ITM-u, spolu i dijagnozi hipertenzije (nonnotenzivni/hipertenzivni) osigurava visoku razinu dokaza. Temeljem rezultata ove studije, predložen je niz preporuka koje bi mogle smanjiti neželjenu intraindividualnu varijabilnost prilikom procjene PWV-a te olakšati korištenje PWV-a u kliničkoj praksi. Druga studija je jedina studija do sada u kojoj su se promjene arterijske krutosti i centralne hemodinamike usporedile prije i poslije infekcije COVID-19. Rezultati pokazuju da se vrijednosti parametara nastavljaju pogoršavati u periodu između 2. i 3. mjeseca nakon završetka infekcije sugerirajući da je moguće da infekcija COVID-19 dolazi do trajnog pogoršanja arterijske krutosti. To posljedično znači i povećanje rizika za razvoj KVB, čak i u dominantno mladih, zdravih osoba s blagim oblikom bolesti, kao što su oni opisani u ovoj studiji. Rezultati ovog doktorskog rada, koji uključuju niz preporuka za smanjenje neželjene intra-individualne varijabilnosti PWV-a u pojedinca, kao i smanjenje pojavnosti tehničkih poteškoća prilikom mjerenja te identificiraju nove zbunjujuće čimbenike poput COVID-19, mogu olakšati uvođenje mjerenja PWV-a u kliničku praksu i interpretaciju longitudinalnih studija.The goal of the doctoral dissertation was to investigate the factors and steps in the PWV assessment protocol - the gold standard for arterial stiffness measurements, which can affect the reduction of unwanted PWV variability within subjects and thus facilitate the introduction of PWV into clinical practice. Furthermore, the factors that can lead to technical difficulties in measuring PWV were investigated and identified, and the possibility of the impact of a recent infection of COVID-19 on the state of blood vessels several months after recovery and its disruptive effect in longitudinal studies was also investigated. Analyses were performed separately for each of the two validated devices - the SphygmoCor applanation tonometer and the Arteriogaph oscillometer - which use different techniques for non-invasive PWV measurement, except for the study with subjects who had recently recovered from COVID-19 in which measurements were made only with the SphygmoCor. The results are based on two unique institutions of study in the area. In a study in which the aim was to identify the experimental conditions (different measuring devices, time of day and number of visits) and other confounding factors (external meteorological conditions, physiological parameters - arterial blood pressure and heart rate, and characteristics of the subjects - age, gender, hypertension status, BMI) that affect the measured PWV values and/or cause technical difficulties with PWV measurement, which are not controlled in the standard measurement protocol, for the first time the short-term variability of PWV within subjects was systematically examined. As clinically significant changes in arterial stiffness in an individual are not expected within a short observation period of 2 weeks, the intra-individual variability of PWV observed in the study represents an error in longitudinal measurements of PWV that can be expected in the clinic. The design used — a single-blind cross-over study with two different devices, randomized with regard to two different measuring devices and two different times of day (morning/aftemoon) with 12 repeated measurements per subject and subjects uniformly and widely distributed by age, BMI -in, gender and diagnosis of hypertension (normotensive/hypertensive) provides a high level of evidence. Based on the results of this study, a number of recommendations were proposed that could reduce unwanted intra-individual variability when assessing PMA" and facilitate the use of PWV in clinical practice. The second study is the only study to date that compared changes in arterial stiffness and central hemodynamics before and after infection with COVID-19. The results show that the values of the parameters continue to deteriorate in the period between 2 and 3 months after the end of the infection, suggesting that it is possible that the COVID-19 infection leads to a perrnanent deterioration of arterial stiffness. This consequently means an increase in the risk for the development of CVD, even in predominantly young, healthy individuals with a mild form of the disease, such as those described in this study. The results of this doctoral thesis, which include a number of recommendations for reducing unwanted intra-individual variability of PWV in an individual, as well as reducing the incidence of technical difficulties during measurement and identifying new confounding factors such as COVID-19, can facilitate the introduction of PWV measurement into clinical practice and interpreting longitudinal studies

Determinants of COVID Vaccination Willingness among Health and Non-Health Studies Students: A Cross-Sectional Study

Students, as a relatively health-informed population group, may still have limitations in health literacy, which is a concern as students take increasing responsibility for their health and make independent health decisions. The aim of this study was to evaluate the overall attitudes towards COVID vaccination among university students and to investigate various factors contributing to vaccination willingness among health and non-health studies students. A total of 752 students from the University of Split were included in this cross-sectional study and completed a questionnaire that consisted of three sections: socio-demographic data, health status information, and information on vaccination against COVID-19. Results show that the majority of students of health and natural sciences were willing to be vaccinated, but the majority of students of social sciences were not (p < 0.001). Students who used credible sources of information had a more significant proportion of those willing to be vaccinated and the majority of students who used less credible sources (79%) or did not think about it (68.8%) were unwilling to be vaccinated (p < 0.001). Multiple binary logistic regression modeling shows that female gender, younger age, studying social sciences, negative opinion about the need to reintroduce lockdown and the effectiveness of epidemiological measures, and usage of less credible sources of information were the most important factors contributing to increased vaccination hesitancy. Therefore, improving health literacy and restoring trust in relevant institutions can be critical in health promotion and COVID-19 prevention

Arterijska hipertenzija i bubrežna bolest - neočekivana komplikacija

Arterial hypertension and chronic kidney disease are mutually interconnected. Uncontrolled arterial hypertension along with diabetes is one of the two most common causes of end-stage chronic kidney disease. On the other hand, chronic kidney disease, as well as renal artery stenosis, results in the development of arterial hypertension. Hypertensive crisis with target-organ damage, also known as a hypertensive emergency, is a serious arterial hypertension complication which is however becoming less frequent. It requires urgent parenteral antihypertensive treatment adjusted to the values of arterial hypertension and accompanying clinical signs. Damage can manifest on numerous organ systems primarily eyes, brain, cardiovascular system, and the kidneys. This is a case report of a patient who presented with hypertensive crisis and kidney damage and was eventually diagnosed with abdominal aortic dissection expanding into the renal arteries, but without typical clinical presentation of stabbing pain. MSCT aortography, despite the risk of progression of renal damage due to the effect of contrast agent, allowed us to set definitive diagnosis and clarify the aetiology of kidney damage and resistant arterial hypertension.Arterijska hipertenzija i kronična bubrežna bolest uzročno-posljedično su povezane. Neregulirana arterijska hipertenzija uz šećernu bolest jedan je od dva najčešća uzroka završnog stadija kronične bubrežne bolesti, a s druge strane, kronična bubrežna bolest, jednako kao i bolest bubrežnih arterija, dovodi do razvoja arterijske hipertenzije. Hipertenzivna kriza s oštećenjem ciljnih organa, takozvana hipertenzivna emergencija, ozbiljna je komplikacija arterijske hipertenzije koja se ipak sve rjeđa viđa. Iziskuje hitno parenteralno antihipertenzivno liječenje prilagođeno prema vrijednostima arterijskog tlaka i pridruženim kliničkim znako-vima. Oštećenja se mogu manifestirati na brojnim organskim sustavima, prvenstveno očima, mozgu, kardiovaskularnom sustavu i bubrezima. Prikazan je slučaj bolesnika s hipertenzivnom krizom uz bubrežno oštećenje u kojeg se obradom izdiferencirala disek-cija abdominalne aorte sa širenjem u renalne arterije, no bez tipične kliničke slike s parajućim bolovima. Učinjenom kontrastnom pretragom, unatoč riziku, postavljena je definitivna dijagnoza i razjašnjena je etiologija bubrežnog oštećenja i uzrok pogoršanja arterijske hipertenzije