Models to optimise medication safety in elderly and oncology inpatients

Medication therapy is recognised as a high-risk process. German Federal Ministry of Health has proposed certain measures to ensure an optimal medication process with the aim of reducing medication errors and thereby avoidable risks for the patient in drug therapy. The concept is called medication safety. Its centre of attention is fostering awareness of medication safety among patients, physicians, pharmacists and caregivers, to improve information on medicines and intersectional communication about drug therapy as well as facilitation of medication safety research. A central point represents the need for greater involvement and information of the patient with regard to his medication therapy. The focus of this thesis is to propose models to optimise medication safety in the hospital setting. The first part of the thesis presents a study protocol for multi-professional model to reduce drug-related readmissions in care-dependent elderly. The protocol is based on the foundation of Spirit 2013 statement, which defines standard protocol items for clinical trials. The model recognises the need for safer medication use through the concerted efforts of all caregivers. It has been developed and recently tested in a pilot study. First results showed the model’s tendency toward active collaboration among the ward-based caregivers and outlined a positive impact on medication safety. However, its effectiveness has still to be assessed in a full-scale evaluation with an adequate sample size. The planed evaluation study is an open randomised controlled trial supplemented by a qualitative evaluation of the intervention. During the hospital stay, patients are randomly allocated to either a control or an intervention group. Control group represent current medical standard of care where the intervention represents multi-professional care according to the defined Standard Operating Procedure for this purpose. After the hospital stay, both patient groups are followed up in the same manner for 12 months to assess the long-term efficacy of the model with a patient-relevant outcome – drug-related hospital readmissions. Qualitative assessment in this evaluation study consists of patient interviews at the end of the hospital stay and focus group for care providers after the study intervention time. Integrating qualitative methodologies implies studying individuals in their natural setting to characterise and provide potential explanations for particular events and behaviours. Evaluation of the model using mixed-methods approach should provide a useful example for further improvements of multi-professional complex intervention models and medication safety in Germany. The second part of this thesis presents the model of optimised pharmaceutical care service on the oncology ward and development of a prediction model. It is a pilot study outlined by STROBE and TRIPOD statement. Pharmaceutical care service was assessed in terms of management of drug-related problems (DRPs). The aim was to develop DRP prognostic model. The pharmaceutical care model was further assessed in terms of number, type and risk factors of DRPs leading to intervention, type of intervention provided, and PRO-CTCAE symptom burden and impact on pharmaceutical intervention. The most important measurements were: German PRO-CTCAE core item set (weekly assessment, recall period 7 days, 12 symptom item clusters, three dimensions: frequency, severity, interference), adverse drug reaction risk score on admission, APS-Doc® classification system for drug-related problems and Doku-PIK documentation system for pharmaceutical intervention, both developed for the hospital setting. In the study sample of 101 patients, 46 were women. Average age was 65 years and average stay on the ward was 10 days. The most frequent diagnoses were malignant neoplasm of bronchus or lung, diffuse large B-cell lymphoma and multiple myeloma. On average each patient had two DRPs leading to pharmaceutical intervention. The most common drug-related problems were drug-drug interactions, drug dosage, drug prescription/monitoring, indication and contraindication. The most frequent pharmaceutical interventions were symptom surveillance, information to physicians and nurses, initiated diagnostic tests, stop/pause the drug and change of the drug dose. The most frequently reported PRO-CTCAE symptoms were fatigue, anxiety and sadness, and pain. For 13 patients pharmaceutical recommendations were based on the PRO-CTCAE items. The implementation rate of pharmaceutical recommendations by the ward-based team was 93 %. Poisson regression model was performed to assess risk factors predicting pattern of DRPs leading to pharmaceutical intervention on the oncology ward. In the second step, the regression was used to combine multiple predictors by assigning relative weights to each predictor to obtain a probability of DRP during the stay on the oncology ward. There are two models to be distinguished: the initial or up to 5th day on the study ward, and follow-up model from the 5th day up to 10th day on the study ward. Significant risk factors in the initial model were ECOG performance score, adverse drug reaction risk score and presence of heart failure; in the follow-up model ECOG performance score and presence of renal failure. Prognostic ability of both regression models was assessed with ROC curve showing AUC of 0.777 (95 % CI 0.686 – 0.868, SE 0.046, p < 0.001) and AUC of 0.683 (95 % CI 0.532 – 0.835, SE 0.077, p = 0.033), respectively. Based on the initial regression model, DRP prognostic model has been proposed (AUC of 0.790 (95 % CI 0.697 – 0.883, SE 0.048, p < 0.001), with a scoring system from 0 to 10 and cut off at 5. That means patients with 5 or more points are according to the Initial DRP prognostic model highly probable to experience DRP leading to a pharmaceutical intervention during the five-day stay on oncology ward. The pilot study has showed that cancer patients exhibit many DRPs requiring a pharmaceutical intervention. PRO-CTCAE may support pharmaceutical care on the oncology ward. The high acceptance of the intervention indicates the need of a pharmacist as integrated part of the oncology ward-based team. The initial DRP prognostic model may assist pharmacist to prioritise their service and to optimise their workload. But small study sample and lack of internal validation limits score interpretation, considering current results provisional and calling for the score development and validation in a study with bigger sample size. The approach, however, provides the methodology for further research of the most optimised patient-oriented, quality-driven, outcome-based oncology ward teamwork

Models to optimise medication safety in elderly and oncology inpatients

Medication therapy is recognised as a high-risk process. German Federal Ministry of Health has proposed certain measures to ensure an optimal medication process with the aim of reducing medication errors and thereby avoidable risks for the patient in drug therapy. The concept is called medication safety. Its centre of attention is fostering awareness of medication safety among patients, physicians, pharmacists and caregivers, to improve information on medicines and intersectional communication about drug therapy as well as facilitation of medication safety research. A central point represents the need for greater involvement and information of the patient with regard to his medication therapy. The focus of this thesis is to propose models to optimise medication safety in the hospital setting. The first part of the thesis presents a study protocol for multi-professional model to reduce drug-related readmissions in care-dependent elderly. The protocol is based on the foundation of Spirit 2013 statement, which defines standard protocol items for clinical trials. The model recognises the need for safer medication use through the concerted efforts of all caregivers. It has been developed and recently tested in a pilot study. First results showed the model’s tendency toward active collaboration among the ward-based caregivers and outlined a positive impact on medication safety. However, its effectiveness has still to be assessed in a full-scale evaluation with an adequate sample size. The planed evaluation study is an open randomised controlled trial supplemented by a qualitative evaluation of the intervention. During the hospital stay, patients are randomly allocated to either a control or an intervention group. Control group represent current medical standard of care where the intervention represents multi-professional care according to the defined Standard Operating Procedure for this purpose. After the hospital stay, both patient groups are followed up in the same manner for 12 months to assess the long-term efficacy of the model with a patient-relevant outcome – drug-related hospital readmissions. Qualitative assessment in this evaluation study consists of patient interviews at the end of the hospital stay and focus group for care providers after the study intervention time. Integrating qualitative methodologies implies studying individuals in their natural setting to characterise and provide potential explanations for particular events and behaviours. Evaluation of the model using mixed-methods approach should provide a useful example for further improvements of multi-professional complex intervention models and medication safety in Germany. The second part of this thesis presents the model of optimised pharmaceutical care service on the oncology ward and development of a prediction model. It is a pilot study outlined by STROBE and TRIPOD statement. Pharmaceutical care service was assessed in terms of management of drug-related problems (DRPs). The aim was to develop DRP prognostic model. The pharmaceutical care model was further assessed in terms of number, type and risk factors of DRPs leading to intervention, type of intervention provided, and PRO-CTCAE symptom burden and impact on pharmaceutical intervention. The most important measurements were: German PRO-CTCAE core item set (weekly assessment, recall period 7 days, 12 symptom item clusters, three dimensions: frequency, severity, interference), adverse drug reaction risk score on admission, APS-Doc® classification system for drug-related problems and Doku-PIK documentation system for pharmaceutical intervention, both developed for the hospital setting. In the study sample of 101 patients, 46 were women. Average age was 65 years and average stay on the ward was 10 days. The most frequent diagnoses were malignant neoplasm of bronchus or lung, diffuse large B-cell lymphoma and multiple myeloma. On average each patient had two DRPs leading to pharmaceutical intervention. The most common drug-related problems were drug-drug interactions, drug dosage, drug prescription/monitoring, indication and contraindication. The most frequent pharmaceutical interventions were symptom surveillance, information to physicians and nurses, initiated diagnostic tests, stop/pause the drug and change of the drug dose. The most frequently reported PRO-CTCAE symptoms were fatigue, anxiety and sadness, and pain. For 13 patients pharmaceutical recommendations were based on the PRO-CTCAE items. The implementation rate of pharmaceutical recommendations by the ward-based team was 93 %. Poisson regression model was performed to assess risk factors predicting pattern of DRPs leading to pharmaceutical intervention on the oncology ward. In the second step, the regression was used to combine multiple predictors by assigning relative weights to each predictor to obtain a probability of DRP during the stay on the oncology ward. There are two models to be distinguished: the initial or up to 5th day on the study ward, and follow-up model from the 5th day up to 10th day on the study ward. Significant risk factors in the initial model were ECOG performance score, adverse drug reaction risk score and presence of heart failure; in the follow-up model ECOG performance score and presence of renal failure. Prognostic ability of both regression models was assessed with ROC curve showing AUC of 0.777 (95 % CI 0.686 – 0.868, SE 0.046, p < 0.001) and AUC of 0.683 (95 % CI 0.532 – 0.835, SE 0.077, p = 0.033), respectively. Based on the initial regression model, DRP prognostic model has been proposed (AUC of 0.790 (95 % CI 0.697 – 0.883, SE 0.048, p < 0.001), with a scoring system from 0 to 10 and cut off at 5. That means patients with 5 or more points are according to the Initial DRP prognostic model highly probable to experience DRP leading to a pharmaceutical intervention during the five-day stay on oncology ward. The pilot study has showed that cancer patients exhibit many DRPs requiring a pharmaceutical intervention. PRO-CTCAE may support pharmaceutical care on the oncology ward. The high acceptance of the intervention indicates the need of a pharmacist as integrated part of the oncology ward-based team. The initial DRP prognostic model may assist pharmacist to prioritise their service and to optimise their workload. But small study sample and lack of internal validation limits score interpretation, considering current results provisional and calling for the score development and validation in a study with bigger sample size. The approach, however, provides the methodology for further research of the most optimised patient-oriented, quality-driven, outcome-based oncology ward teamwork

Heritability of Indirect Bread-making Quality Traits in Segregating Generations of Two Winter Wheat Crosses

Modern wheat breeding programs aim to create cultivars with high genetic potential for yield and bread-making quality. The effectiveness of selection in segregating generations depends on the heritability of the traits under selection and on the correlations among traits. The aim of this study was to compare realized heritability of 1000 kernel weight and five indirect bread-making quality traits (grain protein content, wet gluten content, gluten index, the Zeleny sedimentation value and Pelshenke value) between segregating generations (F4 to F6) of two bi-parental wheat crosses, calculated using four different methods, and to estimate phenotypic correlations among these traits. Realized heritability of investigated traits, estimated as parent-off spring regression, ranged from 0.21 to 0.79. Realized heritability for wet gluten content, gluten index and Pelshenke value was much higher in comparison with other quality traits. Correlations between the four methods used to calculate realized heritability revealed the best agreement between heritability estimated as parent-off spring regression and that based on divergent screening, and the lowest agreement between realized heritabilities based on upward and downward screening. Strong positive correlations were observed among grain protein content, wet gluten content, and Zeleny sedimentation value; and strong negative correlations between gluten index on one side and grain protein content and wet gluten content on the other side

Androgenski receptori: nejasan sveprisutan mehanizam ili ključ koji nedostaje u trostruko negativnom raku dojke?

Androgen receptors (AR) are ligand-dependent nuclear transcription factors. These are steroid receptors, similar to estrogen receptors (ER). They are expressed in numerous cells in the body, with different constructive roles. AR signalling can be involved in the development of a variety of human malignant tumors, such as prostate cancer, bladder, liver, salivary glands, kidney, lung, melanoma, sarcoma, breast cancer, and many others. The role of AR is most clear and today best explained in prostate cancer. The mechanism of AR signalling in other human epithelial tumors is still quite unclear and the effects are different to entirely opposite in different tumors. In breast cancer, AR are the most commonly expressed receptors, but still with an incompletely clear role, prognostic and predictive significance. The expression of AR in triple-negative breast cancer (TNBC) is highly variable. Despite the marked differences in the results of the various analyzes, they appear to have a beneficial effect on the prognosis and are potentially the target of antihormone therapy for treatment of TNBC in the future.Androgenski receptori (AR) su jezgrini prepisivački čimbenici ovisni o ligandu. To su steroidni receptori, slični estrogenskim receptorima (ER). Izraženi su u brojnim stanicama s različitim gradivnim ulogama. AR signalizacija može biti uključena u razvoj različitih zloćudnih tumora, poput raka prostate, mokraćnog mjehura, jetre, žlijezda slinovnica, bubrega, pluća, melanoma, sarkoma, raka dojke i mnogih drugih. Uloga AR najjasnija je i najbolje objašnjena u raku prostate. Mehanizam AR signalizacije u drugim humanim epitelnim tumorima još je uvijek nejasan i učinci su kod različitih tumora različiti, sve do potpuno oprečnih. U raku dojke AR su najčešće izraženi receptori, ali još uvijek s nepotpuno jasnom ulogom, prognostičkim i prediktivnim značajem. Izraženost AR u trostruko negativnom raku dojke (TNBC) vrlo je varijabilna. Unatoč izraženim razlikama u rezultatima različitih analiza, čini se da blagotvorno utječu na prognozu i potencijalna su meta antihormonske terapije za liječenje TNRD u budućnosti

Effect of nitrogen fertilization rate and type of nitrogen fertilizer on agronomic and morphological traits of flue-cured tobacco

Cilj ovoga rada bio je utvrditi učinak gnojidbe dušikom (N) od 30 odnosno od 45 kg/ha, kao i trima komercijalnim dušičnim gnojivima, CaNO3 (15% N), KAN (27% N) i YaraMilaTM Cropcare (8:11:23), na agronomska svojstva: prinos, cijenu i vrijednost suhoga lista, kao i na šest morfoloških svojstava duhana tipa virdžinija. U poljski pokus, proveden u četiri okoline, bila su uključena tri hrvatska kultivara duhana. Gnojidba dušikom imala je signifikantan učinak samo na komponente prinosa: duljinu, širinu i površinu 9. lista, čije su vrijednosti kod gnojidbe s 45 kg N/ha bile za 2,2; 3,5 odnosno 5,8% veće u odnosu na gnojidbu s 30 kg N/ha. Tip korištenoga dušičnog gnojiva nije imao signifikantan učinak niti na jedno ispitivano svojstvo. Uzorak korelacija između morfoloških i gospodarskih svojstava bio je pod utjecajem okoline, kao i razine gnojidbe. Iako nije utvrđen učinak gnojidbe na gospodarska svojstva, signifikantno povećanje komponenata prinosa kod gnojidbe s 45 kg N/ha, u usporedbi s 30 kg N/ha, upućuje na višu razinu gnojidbe kao jamstvo osiguranja visokih i stabilnih prinosa te kvalitete osušenoga lista.The aim of this study was to determine the effect of nitrogen (N) fertilization rate of 30 and 45 N kg/ha, as well as three commercial N fertilizers, CaNO3 (15% N), KAN (27% N) and YaraMilaTM Cropcare (8:11:23) on the agronomic traits: yield, price, and value, as well as six morphological traits of flue-cured tobacco. The field experiments, which included three Croatian tobacco cultivars, were conducted in four environments. Nitrogen fertilization had a significant effect only on yield components: length, width and area of the 9th leaf, whose values for fertilization with 45 kg N/ha were 2.2%, 3.5%, and 5.8% higher, respectively, compared to fertilization with 30 kg N/ha. The type of N fertilizer did not have a significant effect on any of the traits. The pattern of correlations between morphological and economic traits was influenced by the environment, as well as by the level of fertilization. Although no effect of fertilization level on economic traits was found, the significant increase in yield components at 45 kg N/ha compared to 30 kg N/ha suggests a higher level of fertilization as a guarantee of ensuring high and stable yields and quality of the cured leaf

Karakteristike i prognoza bolesnica s trostruko negativnim rakom dojke: hrvatska monoinstitucijska retrospektivna kohortna studija

Triple-negative breast cancer (TNBC) occurs in around one-sixth of all breast cancer (BC) patients, with the most aggressive behavior and worst prognosis of all BC subtypes. It is a heterogeneous disease, with specific molecular characteristics and natural dynamics of early recurrence and fast progression. Due to the lack of biomarkers or any valid treatment targets, it can only be treated with classic cytotoxic chemotherapy. We analyzed a cohort of 152 patients, median age 58 years, diagnosed with and treated for early stage TNBC at the University Hospital for Tumors, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia, during the 2009-2012 period. Patients were treated with primary surgical approach, adjuvant chemotherapy and adjuvant irradiation. We observed a relatively large proportion of locally advanced TNBC at diagnosis, with large tumor size and nodal involvement, with high grade and high proliferation index Ki67. Patient age, tumor size and lymph node involvement, as expected, were significant and clinically most important prognostic factors for 5-year disease-free survival (67%; 95% CI 60%-75%) and overall absolute survival rate (74%; 95% CI 66%-81%).Trostruko negativni rak dojke (TNRD) javlja se u oko šestine svih bolesnica s rakom dojke, s najagresivnijim ponašanjem i najgorom prognozom od svih podtipova raka dojke. To je heterogena bolest sa specifičnim molekularnim karakteristikama i prirodnom dinamikom ranog povrata i brze progresije bolesti. Zbog nedostatka biobiljega ili bilo kakvog uporabljivog terapijskog cilja temelj liječenja i dalje je klasična citotoksična kemoterapija. Analizirali smo kohortu od 152 bolesnice, medijan dobi 58 godina, dijagnosticirane i liječene od ranog TNRD u Klinici za tumore Kliničkoga bolničkog centra Sestre milosrdnice u Zagrebu, Hrvatska u razdoblju od 2009. do 2012. godine. Bolesnice su liječene primarno kirurškim pristupom, adjuvantnom kemoterapijom i adjuvantnim zračenjem. Zamijetili smo relativno velik udio lokalno uznapredovalog stadija TNRD pri dijagnozi, s velikom veličinom tumora i zahvaćanjem limfnih čvorova, visokim gradusom i visokim proliferacijskim indeksom Ki 67. Dob bolesnica, veličina tumora i zahvaćenost limfnih čvorova, očekivano, pokazali su se statistički značajnim i klinički najvažnijim prognostičkim čimbenicima petogodišnjeg preživljenja bez bolesti (67%; 95% CI 60-75%) i stope sveukupnog preživljenja (74%; 95% CI 66-81%)

Possible predictive role of cancer/testis antigens in breast ductal carcinoma in situ

Cancer/testis antigens (CTAs) are a large family of tumor-associated antigens expressed in human tumors of different histological origin, but not in normal tissues, with the exception of the testes and placenta. Numerous immunohistochemical studies have reported associations between CTA expression and a negative estrogen receptor (ER) status in breast tumors, and demonstrated that CTAs are frequently expressed in tumors with higher nuclear grade. The expression of CTAs has not been studied as extensively in ductal carcinoma in situ (DCIS) as it has been in invasive breast cancer. The present retrospective study included archived paraffin-embedded specimens from 83 patients diagnosed with DCIS in the period between January 2007 and December 2014. The follow-up time for local recurrence ranged between 1 and 8 years (mean, 5.02 years). Antigens from the melanoma-associated antigen gene (MAGE) family, namely multi-MAGE-A, MAGE-A1, MAGE-A10 and New York esophageal squamous cell carcinoma 1 (NY-ESO-1) antigen, were evaluated by immunostaining and their subcellular location was investigated. Presence of tumor-infiltrating lymphocytes (TILs) was evaluated on all sections, together with the histopathological variables of DCIS. Specific tested antigens exhibited associations with histopathological parameters for DCIS and all demonstrated statistically significant associations with nuclear staining, simultaneous cytoplasmic and nuclear staining, and local recurrence. Antigen MAGE-A10 demonstrated a significant association with higher expression of ER (P=0.005) and higher tumor nuclear grade (P=0.001), cytoplasmic staining (P=0.029) and antigen NY-ESO-1 with higher tumor size (P=0.001), expression of TILs (P=0.001) and R1 resection (P=0.001). A χ2 test revealed significant associations between simultaneous cytoplasmic and nuclear staining and local recurrence (P=0.005), central necrosis (P=0.016), and the expression of ER (P=0.003) and progesterone receptor (PR) (P=0.010). Additional analysis revealed an association between antigen MAGE-A10 and TILs (P=0.05). Additional analysis of TILs indicated that they were significantly associated with tumor grade (P=0.023), central necrosis (P<0.001), ER (P=0.003) and PR (P=0.029). Overall, CTAs from the MAGE family (MAGE-A1, multi-MAGE-A and MAGE-A10) and NY-ESO-1 associate with histopathological predictive variables of DCIS. The expression of antigens NY-ESO-1 and MAGE-A10 could serve an important role in the treatment of patients with negative histopathological predictive variables, but further analysis is required. Simultaneous cytoplasmic and nuclear protein expression of MAGE-A family and NY-ESO-1 CTAs may represent an independent marker for local recurrence. Taken together, the present data suggest that CTAs are not perfect indicators of invasiveness for DCIS, but could inform treatment strategies for patients when taken in combination with other histopathological predictive variables. However, this was a small study and further larger studies will be necessary to confirm the current findings

EFFECT OF NITROGEN FERTILIZATION ON GRAIN YIELD AND QUALITY OF HULLED AND HULLESS SPRING OATS

Na pokusnome polju Bc Instituta d.d. u Botincu postavljen je 2014. pokus s ciljem da se ispita utjecaj četiri razine gnojidbe dušikom na prinos i kvalitetu zobi. U pokusu je bilo uključeno osam genotipova zobi pljevičastog i dva genotipa zobi gologa zrna. Između razina gnojidbe dušikom kod genotipova pljevičastog zrna uočene su signifikantne razlike u prinosu, hektolitarskoj masi, masi 1000 zrna i visini biljke. Genotipovi zobi pljevičastog zrna razlikovali su se u svim proučavanim svojstvima. Interakcija genotip × gnojidba nije pronađena. Kod genotipova zobi gologa zrna pronađene su razlike u visini prinosa, hektolitarskoj masi i masi 1000 zrna, dok su se gnojidbe razlikovale samo u prinosu. Reakcija genotipova na povišenu razinu dušika bila je pozitivna. Porast prinosa kod genotipova pljevičastog zrna ostvaren pri gnojidbama većim od 124 kg/ha N nije bio signifikantan, dok su kod genotipova zobi gologa zrna gnojidbe sa 133 i 151 kg/ha N rezultirale najvišim prinosima. Kod genotipova zobi pljevičastog zrna, razlike u hektolitarskoj masi zrna između gnojidbi s povećanim razinama gnojidbe dušikom nisu bile signifikantne, dok kodgenotipova zobi gologa razlika između svih gnojidbi u hektolitarskoj masi zrna nije uočena.A field trial was set up in 2014 the growing season at the Bc Institute’s experimental field in Botinec aiming to investigate the effect of four levels of nitrogen fertilization on grain yield, test weight, thousand kernel weight and plant height of eight hulled and two hulless oat genotypes. Significant differences were found out among nitrogen fertilization levels as well as among the eight hulled genotypes for all traits. The interaction genotype × N fertilization was not significant. Significant differences among the hulless oat genotypes were found out for yield, test weight and thousand kernel weight, while the nitrogen fertilization levels differed only for yield. All genotypes reacted positively to the increased levels of nitrogen fertilization. The yield increase of hulled oat genotypes was not significant at nitrogen fertilization being higher than 124 kg/ha N. However, fertilization levels of 133 and 151 kg/ha N resulted in significantly higher yields for the two hulless oat genotypes. At the fertilization levels higher than 124 kg/ha N, differences in grain test weight were nonsignificant for hulled oat genotypes, while for the two hulless genotypes they were nonsignificant among all four nitrogen fertilization treatments

PREGNANT WOMEN\u27S KNOWLEDGE AND HABITS REGARDING ALCOHOL CONSUMPTION DURING PREGNANCY

Uvod: Prenatalna izloženost alkoholu vodeći je preventabilni uzrok prirođenih mana i razvojnih poteškoća, od kojih je najteži oblik oštećenja Fetalni alkoholni sindrom. Unatoč preporuci stručnjaka o potpunoj apstinenciji, konzumacija alkohola u trudnoći i dalje je široko rasprostranjena te postaje jedan od značajnijih javnozdravstvenih problema. Prema istraživanjima, žene imaju nejasnu sliku o tome zašto se alkohol treba izbjegavati tijekom trudnoće te do kakvih poteškoća može dovesti. Cilj: Utvrditi znanja i navike trudnica vezano uz konzumaciju alkohola u trudnoći te ispitati postoji li razlika u znanju i navikama u odnosu na dob, razinu obrazovanja i socijalni status. Ispitati imaju li trudnice specifična znanja o učincima konzumacije alkohola tijekom trudnoće. Metode: Istraživanje je provedeno unutar Službe zdravstvene zaštite žena Dom zdravlja Požeško- Slavonske županije te u ginekološkoj ambulanti poliklinike Intermed kao presječna studija u koju je bilo uključeno 115 ispitanica. Istraživanje je provedeno anonimno, kroz samostalno izrađeni anketni upitnik s 25 pitanja. Kategorijski podatci su predstavljeni apsolutnim i relativnim frekvencijama. Rezultati: Alkohol tijekom trudnoće konzumira 18% trudnica, uglavnom 1-2 pića jednom mjesečno ili rjeđe, dok se 3 % trudnica opija. Nisu utvrđene značaje razlike u navikama konzumacije alkohola tijekom trudnoće u odnosu na dob, obrazovanje i socijalni status. Zbog trudnoće značajno više su promijenile navike ispitanice s 30 i više godina (Fisherov egzaktni test, P = 0,04). 39% ispitanica kao vodeći izvor informacija uz ovu temu navode suvremene medije, iako je u brojnim znanstvenim radovima naglašavana uloga zdravstvenih djelatnika. Za fetalni alkoholni sindrom čulo je 34 % ispitanica, značajno više ispitanice visoke stručne spreme te zaposlene (χ2 test, P = 0,001) dok je za fetalne alkoholne efekte čulo 26,9 % ispitanica. Samo 27 % ispitanica prepoznalo je deformaciju lica i mikrocefaliju kako moguću posljedicu fetalne izloženosti alkoholu. Prema procjeni trudnica potrebno je sve preventivne i edukativne mjere više provoditi. Zaključak: Žene konzumiraju alkohol za vrijeme trudnoće unatoč stavu da alkohol može izazvati zdravstvene poteškoće jer im nedostaje specifičnog znanja, stoga je nužno poboljšati metode edukacije i prevencije.Introduction: Prenatal alcohol exposure is a leading preventable causes of birth deffects and developmental problems, the most severe of which is Fetal Alcohol Syndrome. Despite the expert\u27s recommendation on full abstinence, alcohol consumption in pregnancy is still widespread and is becoming one of the major public health problems. According to research, women have an unclear picture of why alcohol should be avoided during pregnancy and what difficulties may arise. Aim: The aim of this paper is to determine knowledge and habits of pregnant women regarding alcohol consumption in pregnancy and to examine if there are differences between women’s habits and knowledge regarding alcohol use during pregnancy and their age, level of education and social status. Methods: The study was conducted within Women\u27s Health Protection Service of Požega-Slavonia County ( Health Center) and in Polyclinic Intermed gynecology clinic as a cross-sectional study involving 115 examinees. The research was conducted anonymously, through a self-made questionnaire which included 25 questions. Category data is represented by absolute and relative frequencies. Results: 18% of pregnant women consume alcohol during pregnancy, mostly 1-2 drinks once a month or less, while 3% of pregnant women reported binge drinking. There are no significant differences in age, education and social status. Due to pregnancy, examinees aged 30 and over significantly changed the habits of alcohol consumption (Fisher\u27s exact test, P = 0.04). 39% of examinees named contemporary media as the leading source of information on this topic although many papers highlighted the role of healthcare professionals. 34% of examinees have heard of fetal ačcohol syndrome, highly qualified and employed women significantly more (χ2 test, P = 0.001) while 26.9% of examinees have heard of fetal alcohol effects. Only 27% of examinees have identified face deformation and microcephaly as a possible consequence of fetal alcohol exposure. According to pregnant women\u27s estimate, all preventive and educational measures need to be implemented more. Conclusion: Women consume alcohol during pregnancy despite the fact that alcohol can cause health problems due to their lack of specific knowledge, therefore it is necessary to improve education and prevention strategies

Climatic change and agricultural production

Climatic extremes demonstrated that agriculture is sensitive to climate change. Climate changes shifting climate variables: temperature, precipitation, humidity, evaporation, sunlight, wind speed, etc. Climatic change has created challenges for the agricultural sector and added pressure on global agricultural and food systems. On many crops there are negative impacts from extreme weather as droughts, floods, higher temperatures and season shifts that climate change brings. Rising temperatures and water stress have already led to lower crop yields for maize, wheat, soybean, sunflower, buckwheat, millet, flax, potato, phacelia and other crops which typically relies on precipitation instead of irrigation. The rising temperature has adverse effect on flowering and leads to pests and disease buildup. Flood and excess rain over a short duration of time cause extensive damage to crops. For one country a decrease yields bring a high decline in production and therefore reducing the budget i.e. economic weakening. Climate change therefore threatens global food supply as certain crops become more expensive due to a decrease in production and supply. In such situations, should be introduced into production alternative crops like sorghum and millet, which can be grow at conditions where the dry season prevails during the crop vegetation. The agriculture also has to take place and in adverse climatic conditions and produce enough food by sowing tolerant varieties in changed environmental conditions