Coronavirus disease 2019 pandemic two years later… What’s next?

Looking back on the onset of the pandemic Exactly two years ago, we published an editorial in the Croatian Medical Journal discussing a global threat from a new coronavirus epidemic caused by the SARS-CoV-2 virus, which began in China at the end of 2019 and soon spread around the world (1). The first case of COVID-19 in Croatia was recorded on February 25, 2020, while the editorial was being written. On that occasion, we warned of the danger of the rapid spread and pathogenic potential of the novel coronavirus, the need for the constant monitoring of respiratory pathogens with high epidemic potential, as well as of the importance of developing vaccines and antiviral drugs rapidly to combat this and similar viruses

PARENTS’ ATTITUDES TOWARDS VACCINATION OF THEIR OWN CHILDREN: EXPERIENCE FROM TWO PEDIATRIC CLINICS OF THE ZAGREB-WEST HEALTH CENTER

Neki roditelji nisu skloni cijepljenju vlastite djece što je rezultiralo padom stope procijepljenosti djece čime je ozbiljno ugrožena razina kolektivnog imuniteta u Hrvatskoj. Stoga je cilj ovog rada bio ispitati stavove roditelja prema cijepljenju vlastite djece te čimbenike koji na njih utječu. Istraživanje je provedeno u dvije pedijatrijske ambulante Doma zdravlja Zagreb – Zapad u kojemu su sudjelovali roditelji koji su dovodili djecu na cijepljenje ili redovite preglede. Za ispitivanje je korišten anonimni upitnik koji je sadržavao 26 pitanja: prvi dio upitnika sadržavao je pitanja o demografskim i socioekonomskim obilježjima ispitanika, a drugi dio odnosio se na stavove roditelja prema cijepljenju vlastite djece koji su procijenjeni uz pomoć Likertove ljestvice. Dobiveni rezultati statistički su obrađeni korištenjem statističkog programa SPSS 21 (IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.) uz metode deskriptivne i inferencijske statistike. U istraživanju je sudjelovalo 120 roditelja od kojih je 80 (66,7 %) bilo ženskog spola. Većina (90 %) roditelja cijepi svoju djecu redovito, 6,7 % roditelja zabrinuto je zbog cijepljenja djece i nema jasan stav o zakonskoj obvezi cijepljenja djece, a samo se jedan (0,8 %) roditelj izričito protivi obveznom cijepljenju djece. Kada bi imali pravo izbora, 37 (30,8 %) roditelja bi i dalje cijepili svoju djecu, dok bi čak 76 (63,3 %) roditelja odbilo cijepiti svoje dijete. Kao najčešći razlog zbog kojeg bi roditelji odbili cijepiti svoje dijete navodi se strah od nuspojava (52,5 % roditelja). Postoji statistički značajna razlika u stavovima o cijepljenju između ispitanika s obzirom na spol ispitanika i broj djece u obitelji: pozitivniji stav o cijepljenju imaju očevi (p=0,036) te roditelji koji imaju više djece (p=0,000). Kao izvor informacija o cijepljenju 102 (85 %) ispitanika je navelo nadležnog liječnika, a 66 (55 %) medicinsku sestru. U procjeni zadovoljstva roditelja s dobivenim informacijama o cijepljenju pokazalo se da je 42 (35 %) roditelja nezadovoljno informacijama o cijepljenju koje su dobili od nadležnog liječnika i medicinske sestre. Nedostatno informiranje roditelja dovodi do njihove pretjerane zabrinutosti, osobito glede nuspojava cjepiva, što ponekad može rezultirati donošenjem neadekvatnih odluka o cijepljenju. Iako većina naših roditelja ima pozitivan stav prema cijepljenju i u vrlo visokom postotku ispunjavaju obvezu redovnog cijepljenja vlastite djece, potrebno je uložiti dodatne napore u educiranje javnosti o cijepljenju. Zdravstveni djelatnici, osobito prvostupnice i magistre sestrinstva, mogle bi imati veću ulogu u educiranju roditelja o važnosti cijepljenja, njegovoj učinkovitosti i sigurnosti, s ciljem podizanja i održavanja visokih stopa procijepljenosti djece u Hrvatskoj.Aim: Vaccination proved to be one of the most effective and safe healthcare interventions, which has significantly reduced the morbidity and mortality of many infectious diseases. However, some parents are not willing to have their children vaccinated, and the parents\u27 negative attitudes towards vaccination have resulted in a declined vaccination coverage rate. Therefore, the level of collective immunity has been severely compromised, primarily among pre-school children. The aim of this study was to examine parents\u27 attitudes towards vaccination of their own children and to determine factors that influence development of these attitudes. Methods: The study was conducted in two pediatric clinics of the Zagreb-West Health Center and included parents having brought their children for vaccination or regular examinations. Participants were asked to complete an anonymous questionnaire containing 26 questions used to evaluate the parents\u27 attitudes towards vaccination of their own children. The first part contained questions on demographic and socioeconomic characteristics. The second part contained Likert scale for assessment of the parents\u27 attitudes. The results obtained were statistically analyzed using the SPSS 21 statistical software (IBM SPSS Statistics for Windows, Version 21.0, Armonk, NY, IBM Corp.) and descriptive and inferential statistics methods. Results: The study included 120 parents, 80 (66.7%) of whom were women. The majority (90%) of parents vaccinated their children regularly, 6.7% were concerned about vaccination and had no clear view of the legal obligation to vaccinate children, and only one (0.8%) parent explicitly opposed mandatory vaccination. If they had the right to choose, 37 (30.8%) parents would still vaccinate their children, whereas 76 (63.3%) would refuse to do so. As many as 63 (52.5%) parents stated fear of side effects as the most common reason why they would refuse to vaccinate their child. There was a statistically significant difference in the parents\u27 attitudes towards vaccination according to participant gender and number of children: fathers (p=0.036) showed more positive attitude towards vaccination, as well as parents with more children (p=0.000). No statistically significant difference was found in the participants\u27 attitudes towards vaccination according to their age, marital status, level of education, employment, or family income. As their source of information about vaccination, 102 (85%) respondents listed their physician and 66 (55%) listed medical nurses. Internet as the source of information about vaccination was reported by 98 (81.7%) respondents, 75 (62.5%) respondents exchanged information about vaccination with their friends and other parents, and 33 (27.5%) respondents acquired needed information through leaflets, television and magazines. Regarding respondents\u27 satisfaction with the information about vaccination obtained, 77 (64.2%) parents were satisfied and 42 (35%) were dissatisfied with the information they received from their physician and medical nurse. Discussion: Most parents had a positive attitude towards child vaccination and a high percentage of them fulfilled their obligation and regularly vaccinated their children. Less than 1% of parents were explicit opponents of mandatory vaccination. The main reason why parents refused to vaccinate their children was fear from vaccine side effects, and not mistrust of their effectiveness. Inadequate information leads to parents\u27 over-concerns, especially regarding vaccine side effects, which may result in inappropriate decisions regarding vaccination. Conclusion: Although most of our parents had a positive attitude towards child vaccination and a high percentage of them regularly vaccinated their children, additional efforts should be made to educate the public about the importance of vaccination. Healthcare professionals, especially bachelors and masters of nursing, could play greater role in educating parents on the importance of vaccination, its effectiveness and safety, with the aim of raising and maintaining high childhood vaccination rates in Croatia

Health Care Workers and Influenza Vaccination

Cijepljenje je najbolji način sprječavanja zaraze virusom influence, kao i razvoja bolesti i njezinih komplikacija. Kada su cirkulirajući sezonski i cijepni soj antigeno slični, cijepljenje sprječava influencu u 70-90% cijepljenih prethodno zdravih odraslih osoba. Cijepljenje rezultira i smanjenjem stope bolovanja, manjim korištenjem zdravstvene službe, manjom potrošnjom antibiotika i manjom stopom komplikacija, hospitalizacija i smrti povezanih s influencom. Od 2010. godine u Sjedinjenim Američkim Državama (SAD) cijepljenje se preporučuje svim osobama ≥ 6 mjeseci života ako ne postoje kontraindikacije za cijepljenje. Kako tijekom epidemije influence zdravstveni radnici mogu prenositi virus na druge osobe, svoje ukućane i/ili bolesnike s kojima dolaze u kontakt, dio odgovornosti za širenje influence u zdravstvenim ustanovama leži i na zdravstvenim radnicima. Visoke stope procijepljenosti zdravstvenog osoblja protiv influence posredno pružaju zaštitu i onim bolesnicima koji iz bilo kojeg razloga nisu cijepljeni, a ujedno smanjuje stopu bolovanja i izostanak bolničkog osoblja s posla tijekom vrlo osjetljivog razdoblja epidemije sezonske influence. No kako bi se spriječilo širenje influence u zdravstvenim ustanovama, potrebno je postići procijepljenost zdravstvenih radnika veću od 80%. U jeku pandemije influence 2009. godine, unatoč velikoj kampanji kojom se promicalo cijepljenje, svega 20%odraslog pučanstva SAD-a cijepljeno je protiv virusa pandemijske influence. Još je porazniji podatak da se manje od polovice zdravstvenih radnika pristalo cijepiti. Doduše, pojava pandemije dovela je do porasta cijepljenja zdravstvenih radnika, ali samo protiv sezonske influence (s 43% na 61%), dok je u istoj godini u SAD-u svega njih 37% primilo cjepivo protiv pandemijskog soja virusa H1N1. U Hrvatskoj se 2007. godine procijepljenost pojedinih skupina bolničkog osoblja kretala od 10 do 90% s prosječnom procijepljenošću svih radnika od 26%. U 2009. je godini zbog pandemije influence i u hrvatskim bolnicama zabilježeno povećanje stope procijepljenosti bolničkog osoblja, ali samo protiv sezonske influence. Kako se dobrovoljnim cijepljenjem nisu postigle zadovoljavajuće stope procijepljenosti zdravstvenih radnika, u svijetu se uvodi obvezno cijepljenje protiv influence, poput onoga za druge zarazne bolesti. Za postizanje veće stope procijepljenosti potrebno je provoditi javne kampanje te donijeti jasne stručne preporuke nadležnih javnozdravstvenih institucija o potrebi cijepljenja. Odbijanje zdravstvenih radnika da se cijepe potiče u pučanstvu nelagodu i nepovjerenje u zdravstveni sustav te daje loš primjer javnosti. Budu li zdravstveni radnici i ubuduće odbijali i izbjegavali cijepljenje, ne moramo se čuditi ako javnost izgubi povjerenje u cijepljenje kao učinkovitu mjeru sprječavanja infektivnih bolesti.Vaccination is the best way to prevent the influenza virus infection, as well as development of the disease and its complications. As antigens of circulating seasonal and vaccination strains are similar, vaccination prevents influenza in 70-90% of vaccinated and previously healthy adults. Vaccination reduces sick leave rates, use of health care services, consumption of antibiotics and the rate of complications, hospitalization and influenza-related mortality. Since 2010 vaccination has been recommended in the USA to all persons ≥6 months of age and without any contraindications. As health care workers may spread the virus during the influenza epidemic to other persons, their family members and/or their patients, they also bear some responsibility for spreading influenza in health care institutions. High vaccination rates among health care workers indirectly protect those patients who have not been vaccinated for any reason whatsoever and they also reduce sick leave rates and staff absence during a sensitive period of seasonal influenza epidemic. However, to prevent the spread of influenza in health care institutions, vaccination rates among health care workers should exceed 80%. Despite a big campaign focused on the promotion of vaccination during the influenza pandemic in 2009, a mere 20% of adults in the USA got vaccinated against the pandemic influenza virus. The fact that less than a half of health care workers agreed to get vaccinated is even worse. The pandemic, however, resulted in higher vaccination rates among health care workers, but only as far as vaccination against seasonal influenza is concerned (from 43% to 61%). On the other hand, only 37% were vaccinated against pandemic H1N1 virus in the USA that same year. In Croatia, vaccination rates recorded in individual groups of health care workers in 2007 ranged from 10% to 90%, with the average vaccination rate among all workers of 26%. In 2009, i.e. during the influenza pandemic, vaccination rates also increased in Croatian hospitals, however only those for vaccination against seasonal influenza. As satisfactory vaccination rates among health care workers were not achieved through voluntary vaccination, mandatory vaccination against influenza, just as that against other infectious diseases, is being introduced on the global level. To increase vaccination rates, public campaigns should be carried out and competent health care institutions should define clear professional guidelines emphasizing the necessity of vaccination. The refusal of vaccination by health care workers creates unease and mistrust in the health care system among citizens and sets a bad example. If health care workers continue to refuse and avoid vaccination, it will not be surprising if citizens lose confidence in vaccination as an effective tool to prevent infectious diseases

Je li u Hrvatskoj sazrelo vrijeme za uvođenje tzv. koda lavande?

Zdravstveni djelatnici susreću se s nizom profesionalnih izazova u kojima su izloženi fizičkom i psihičkom preopterećenju. Tome doprinose opterećenost tijekom studiranja i kontinuirane izobrazbe, radno vrijeme koje često prelazi zakonski definirane norme, zbrinjavanje hitnih stanja uz suočavanje s neposrednom prijetnjom smrću svojih bolesnika i sl. Sve to doprinosi stresu kojim se mladi liječnici teško suočavaju na početku svoje profesionalne karijere dok se u starijih opterećenje i stres nagomilavaju, a socijalna podrška izostaje. Povećana izloženost stresu može dovesti i do sindroma izgaranja što u konačnici može rezultirati manjom radnom produktivnošću, a posljedično i smanjenjem kvalitete zdravstvene zaštite. Svi ovi profesionalni izazovi ponekad zahtijevaju hitnu intervenciju. Stoga je kao moguće rješenje za zdravstvene djelatnike u kriznim situacijama pokrenuta inicijativa koja se naziva kod lavande (engl. Code Lavender) zbog asocijacije na umirujući učinak boje i mirisa lavande. Radi se o liniji pomoći koja se može aktivirati u bilo koje vrijeme za zdravstvene djelatnike, ali i bolesnike te članove njihovih obitelji. Kod lavande podrazumijeva aktivaciju protokola podrške jednostavnim telefonskim pozivom. Podrška se ne postiže samom fizičkom prisutnošću, čime se izražava želja za pomoći i blizinom, već i samo nuđenjem toplih napitaka i grickalica, individualnog ili timskog razgovora, sve do dodatne psihološke i/ili farmakoterapije, pa i molitve i duhovne pomoći. Intervenciju provodi educirani pojedinac, a nerijetko i cijeli multidisciplinarni tim koji uključuje socijalnog radnika, psihologa, duhovnika (svećenika) i drugo educirano osoblje. Specifična provedba ove intervencije može se razlikovati od ustanove do ustanove, ali temeljno načelo je isto: pružanje trenutne i holističke skrbi u trenutku pojačanog stresa ili emocionalne potrebe uz promicanje kulture skrbi i podrške usmjerene na dobrobit zdravstvenih djelatnika. U nekim se ustanovama već formiraju trajni interdisciplinarni timovi, tzv. timovi lavande (engl. Team Lavender) koji su postali jedna od sastavnica koordiniranog oblika duhovne, emocionalne i psihološke podrške zdravstvenim djelatnicima. U ovakvim aktivnostima često sudjeluju svećenici i bolnički kapelani čime njihova nazočnost u zdravstvenim ustanovama dobiva novu dimenziju. Naime, dušobrižnike ne treba doživljavati kao izolirane pojedince već kao integralni dio medicinskog tima koji bolesnicima, ali i zdravstvenim djelatnicima, pruža holističku zdravstvenu skrb. Možda će se u budućnosti osvješćivanjem o psihološkim i duhovnim potrebama zdravstvenih djelatnika i u hrvatski zdravstveni sustav sustavnije i temeljitije pozicionirati uloga dušobrižnika, kao i interdisciplinarni i holistički pristup u zbrinjavanju zdravstvenih djelatnika uvođenjem tzv. koda (tima) lavande

Učinak propisanog snopa postupaka na smanjenje rizika profesionalne izloženosti bolničkog osoblja infekcijama koje se prenose krvlju [The impact of a care bundle on reducing the risk of occupational exposure to blood-borne infections among hospital personnel]

This dissertation demonstrates the positive impact of a care bundle on reducing the risk of occupational exposure to blood-borne pathogens among hospital personnel (HP). Employees from ten hospitals, representing 20% of the Croatian HP population, participated in a prospective study. Prior to the intervention, occupational risk and existing preventive measures were assessed. Based on the most significant shortcomings, a care bundle consisting of five interventions (improved vaccination rate against HBV, improved compliance with standard precautions, introduction of guidelines for reporting and management of exposures, improved serological diagnostics, and training of HP and infection control team members) was applied to the study population. During the follow-up, the following were achieved: a 4.4% (range 0–13.8%) increase in the vaccination rate; increased consumption of antiseptics (up to 43%) and personal protective equipment (range 6–101%) as indicators of compliance with standard precautions; reduced incidence (up to 3.8–8.3%) and increased reporting (up to 34.8%) of exposures; reduced time until the serological testing of the source patient (the number tested in <72 hours increased by 18.3%), serological testing (the number tested in <72 hours increased by 21.7%) and treatment of exposed HP (the number managed in <72 hours increased by 7.3%); and improved training of the HP. Since such intervention proved effective, it could also be applied in other healthcare settings

Znanstveno-stručni skupovi

Obljetnica hrvatskog društva za infektivne bolesti HLZ-a uz "Dan prof. dr. Frana Mihaljevića" 11. prosinca 2009. ESCMID Postgraduate Education Course Antibiotic Resistance and Healthcare-associated Infections: Prevention and Treatment Šibenik, 21. - 23. listopada 2009

Izvedivost multimodalne intervencije za prestanak pušenja tijekom hospitalizacije sa šetomjesečnim praćenjem nakon otpusta: pilot istraživanje

The main aim of this pilot project was to introduce multimodal smoking cessation intervention in the hospital setting and to analyze users’ satisfaction and efficacy of the intervention within six months post-discharge. Multimodal intervention for smoking cessation was used and it consisted of the “5 A’s” model (Ask, Advice, Assess, Assist, Arrange) for behavior change, printed self-help materials for smoking cessation, and telephone counseling (one, three and six months after discharge from the hospital). The main outcome of the study was smoking status at six months. A total of 103 participants were included in this pilot project. At six-month follow-up, 49% of participants self-reported continuous non-smoking. Among the remaining participants, 20 reported smoking reduction, 19 were still smoking, and 16 participants were unable to make contact with. In the logistic regression, among all analyzed variables, only two of them were positively associated with smoking cessation after six months: participants’ response that they would like to quit smoking within the next six months (B=4.688; p=0.018) and answering that they did not smoke when they were ill and bed-ridden due to illness (B=3.253; p=0.020). Satisfaction with the intervention was very high; 70% of participants rated the intervention as ‘excellent’. Therefore, multimodal smoking cessation intervention can be successfully introduced at hospital setting yielding high smoking abstinence rates at six months post-discharge and high level of user satisfaction. Healthcare workers who work in hospitals should be educated so they can provide such intervention on a regular basis.Glavni cilj ovoga probnog projekta bio je provesti multimodalnu intervenciju za prestanak pušenja kod hospitaliziranih bolesnika i analizirati učinkovitost intervencije šest mjeseci nakon otpusta iz bolnice, kao i zadovoljstvo korisnika intervencijom. Primijenjena je multimodalna intervencija za prestanak pušenja koja se sastojala od pristupa „5 P“ (Pitati, Poticati, Procijeniti, Pomoći i Pratiti) za promjenu ponašanja, tiskanih materijala za samopomoć kod prestanka pušenja i telefonskog savjetovanja (nakon jednog mjeseca, tri mjeseca i šest mjeseci od otpusta iz bolnice). Glavni ishod studije bio je pušački status nakon šest mjeseci. Uključeno je ukupno 103 sudionika. Nakon šest mjeseci praćenja 49% sudionika izjavilo je da su prestali pušiti. Među preostalim sudionicima 20 ih je smanjilo broj popušenih cigareta na dan, 19 ih je i dalje pušilo, a sa 16 sudionika se nije moglo stupiti u kontakt. U logističkoj regresiji su od svih analiziranih varijabla samo dvije bile pozitivno povezane s prestankom pušenja nakon šest mjeseci: odgovor sudionika da bi htjeli prestati pušiti u sljedećih šest mjeseci (B=4,688; p=0,018) i odgovor da ne puše kad su bolesni u toj mjeri da moraju ležati u krevetu (B=3,253; p=0,020). Zadovoljstvo intervencijom bilo je vrlo visoko; 70% sudionika ocijenilo je intervenciju kao “izvrsnu”. Stoga se multimodalna intervencija za prestanak pušenja može uspješno uvesti u bolničkim uvjetima, omogućuje visoku stopu apstinencije od pušenja šest mjeseci nakon otpusta i veliko zadovoljstvo korisnika. Zdravstveno osoblje koje radi u bolnicama trebalo bi se obrazovati kako bi mogli redovito pružati takvu intervenciju

Hepatitis G virus (HGV) infection in chronic haemodialysis patients in the County of Šibenik and Knin

Hepatitis G virus (HGV) i GB virus tipa C (GBV-C) danas se smatraju varijantama istog RNA virusa i svrstani su u porodicu Flaviviridae. Obzirom da se HGV prvenstveno prenosi parenteralnim putem, uočena je njegova učestalija pojava među dijaliziranim bolesnicima. Cilj ovog rada bio je istražiti pojavnost infekcije HGV-om u bolesnika s kroničnim zatajenjem bubrega liječenih kroničnom hemodijalizom u Jedinici za dijalizu Opće bolnice Šibenik te razmotriti značenje infekcije HGV-om u tih bolesnika. Od 79 bolesnika koji su u razdoblju od kolovoza 2004. do lipnja 2005. godine dijalizirani u ovoj bolnici, prospektivno je tijekom devet mjeseci praćeno 16 bolesnika koji su zadovoljavali uvjete za uključenje na listu čekanja za kadaveričnu transplantaciju bubrega. Infekcija HGV-om utvrđena je metodom lančane reakcija polimeraze u 6/16 ispitanika među kojima niti u jednog nije potvrđena koinfekcija HBV-om, dok je u jednog potvrđena koinfekcija HCV-om. Povišene vrijednosti aminotransferaza nađene su u 2/6 HGV-pozitivna bolesnika, od kojih je jedan bio koinficiran HCV-om. Vrijeme provedeno na hemodijalizi znatno pridonosi povećanju rizika akviriranja infekcije HGV-om. Međutim, višekratno liječenje krvnim pripravcima, koje se u literaturi spominje kao glavni čimbenik rizika za akviriranje infekcije HGV-om, nije utvrđeno kao značajan čimbenik rizika u naših ispitanika.Hepatitis G virus (HGV) and GB virus type C (GBV-C) are today considered variants of the same RNA virus that belong to the Flaviviridae family. Since HGV is primarily transmitted parenterally, its high prevalence has been recorded among dialyzed patients. The aim of this paper was to investigate the prevalence of HGV infection in patients with chronic renal failure undergoing chronic haemodialysis at the Dialysis Unit of the General Hospital Šibenik and to determine the significance of HGV infection in these patients. Out of 79 patients dialyzed in this Unit during the observed period (August, 2004 – June, 2005), we prospectively followed 16 patients that met inclusion criteria for cadaveric kidney transplant waiting list. HGV infection was detected by polymerase chain reaction (PCR) method in 6/16 examinees, non of whom had a HBV coinfection confirmed, only HCV coinfection in one patient. Elevated aminotransferases were found in two HGV-positive patients, of whom one was coinfected with HCV. The time spent on haemodialyis significantly increases the risk for activating HGV infection. However, multiple treatments with blood products, described in literature as the main risk factor for activating HGV infection, were not determined as a significant risk factor in our examinees