Standard human chorionic gonadotropin versus double trigger for final oocyte maturation in improving clinical outcome of IVF

CILJ ISTRAŽIVANJA: Cilj našeg istraživanja je usporediti stimulaciju završne maturacije jajnih stanica na krajnji ishod postupka medicinski potpomognute oplodnje (MPO) protokola u kojem se za stimulaciju ovulacije koristi kombinacija humanog korionskog gonadotropina i agonista gonadotropin-otpuštajućeg hormona (hCG+GnRH agonist) s protokolom u kojem se koristi samo humani korionski gonadotropin (hCG). ISPITANICI I METODE: Ovo retrospektivno istraživanje provedeno je na Zavodu za ginekološku endokrinologiju i humanu reprodukciju, Klinike za ženske bolesti i porode KBC Split u razdoblju od 1. siječnja 2017. do 1. siječnja 2019. godine. Podaci su prikupljeni iz medicinske dokumentacije žena koje se liječe od neplodnosti i koje su ispunjavale kriterije za ulazak u istraživanje. Obradom je obuhvaćeno 188 ispitanica: 94 ispitanice u kojih se za stimulaciju ovulacije koristila kombinacija hCG+GnRH agonista te 94 ispitanice kod kojih se za stimulaciju ovulacije koristio hCG. Također ispitanice su podijeljene po dobnim skupinama. Prva skupina su ispitanice do 35 godina, druga skupina obuhvaća ispitanice od 35 do 40 godina i treća skupina ispitanice iznad 40 godina. U studiji su ispitanicama obje skupine analizirane vrijednosti beta humanog korionskog gonadotropina (βhCG) kao pokazatelj uspješne implantacije, broj jajnih stanica u metafazi dva staničnog ciklusa (M2 faza) te broj zametaka u šestostaničnoj i osmostaničnoj fazi te blastociste. REZULTATI: Razdioba ispitanica prema implantaciji u odnosu na primjenjenu indukciju ovulacije (hCG+GnRH agonista u usporedbi s hCG) nije se statistički značajno razlikovala na razini značajnosti od 95% već na razini značajnosti od 93% (P=0,067). Medijan broja jajnih stanica u M2 fazi je za 2,5 veći kod ispitanica kod kojih se za indukciju ovulacije koristila kombinacija hormona nego u ispitanica kod kojih se za indukciju ovulacije koristio hCG (P=0,022), dok je medijan broja zametaka za 2 veći u ispitanica kod kojih se za indukciju ovulacije koristila kombinacija hormona (P40 godina u odnosu na skupinu ispitanica 40 godina u odnosu na skupinu ispitanica <35 godina (P=0,006). ZAKLJUČCI: Nema statistički značajne povezanosti između uspješnijeg ishoda implantacije gdje se za indukcije ovulacije koristila kombinacija hormona GnRH agonista i hCG-a u usporedbi s protokolima gdje se za indukciju ovulacije koristio hCG. Međutim, broj nastalih jajnih stanica u M2 fazi staničnog ciklusa i broj nastalih zametaka je veći kod ispitanica kod kojih se za indukciju ovulacije koristila kombinacija hormona.Također, uspješnost implantacije raste s većim brojem nastalih jajnih stanica u M2 fazi staničnog ciklusa i brojem zametaka. Konačno, postoji statistički značajna povezanost dobnih skupina ispitanica i uspješnog ishoda implantacije kao i nastanka većeg broja prikladnih gameta u korist mlađih ispitanica.OBJECTIVES: The aim of our study was to compare final maturation induction to the outcome of in vitro fertilization (IVF) process using different drugs. Ovulation was induced with combination of human chorionic gonadotropin and gonadotropin releasing agonist (hCG + GnRH agonist) in one group and human chorionic gonadotropin in another (hCG). MATERIALS AND METHODS: This retrospective study was conducted in Reproductive Health Centre, University Hospital of Split, from January 1st 2017 to January 1st 2019. The data were collected from the medical records of patients undergoing treatments for infertility and met the criteria for entering the research. The study included totally 188 patients: 94 to ovulation induction with combination of hCG+GnRH agonist and 94 to ovulation induction with hCG. Patients were divided in groups by age. First group were women aged 35 and younger, the second group included age 35 to 40 and the third group were patients over 40 years. In the study, both groups analyzed the values of beta human chorionic gonadotropin (βhCG) as an indicator of successful implantation, the number of metaphase II (MII) oocytes and the number of embryos. RESULTS: The distribution of implantation did not differ statistically significantly at 95% but at 93% significance level (P=0.067) between the two groups (hCG+GnRH agonist compared to hCG). The median of MII oocytes was for 2.5 higher in those using hormone combination for ovulation induction than in those using hCG (P=0.022) for ovulation induction, while median of embryos was for 2 higher in patients using hormone combinations (P<0.001). Median of MII oocytes in positive implantation was for 6 higher than in negative (P<0.001). The median of embryos in positive implantation was for 2 higher than in the negative (P<0.001). There was a statistically significance between females age and implantation (P=0.011). Also, there was a statistically significance between females age and MII oocytes number (P=0.016). The difference was made by a group of patients aged 40 years and older in correlation with participants aged 35 and younger (P=0.017). There was a statistically significance between the females age and number of embryos (P=0.004). The difference was the number of embryos among the respondents aged 40 years and older compared to the group of patients aged 35 years and younger (P=0.006). CONCLUSIONS: There was no statistically significance between two drugs used for ovulation induction (hCG+GnRH agonist and hCG) and better outcome of implantation. However, the number of MII oocytes and the number of embryos was greater where ovulation was induced by combination of hormones. Also, the success of implantation grew with a larger number of MII oocytes and embryos. Finally, there was a statistically significance between females age and positive outcome of implantation as well as the greater number of gametes in favour of younger patients

IMPACT OF LIVING AND WORKING CONDITIONS ON THE HEALTH OF MIGRANT WORKERS

Radnik migrant je svaki radnik koji je radio ili radi na poslu za koji dobiva naknadu u državi čiji nije državljanin. U radnike migrante ubrajaju se i skupine radnika koje u sklopu svojeg zanimanja rade u inozemstvu ili poslovno putuju. Globalizacija dovodi do stalnog porasta broja radnika migranata. Radnici migranti najčešće žive u lošim uvjetima, često rade na radnim mjestima gdje je niska razina zaštite na radu i na dulje vrijeme izbivaju iz obitelji. Često su izloženi visokom riziku od ozljeda na radu. Podložni su raznim bolestima, od kojih mnoge izravno smanjuju njihovu radnu sposobnost. Uz to, veliki dio radnika migranata izložen je zaraznim bolestima poput tuberkuloze i hepatitisa te sve raširenijoj zarazi virusom humane imunodeficijencije (HIV).A migrant worker is a worker who has worked, or works, and receives pay for his work in a state of which he is not a citizen. Migrant workers also include groups of workers working abroad or travelling as part of their work. Globalisation has increased the number of migrant workers. Commonly, migrant workers live in poor conditions, often work in workplaces with low levels of occupational safety and are forced to live away from family for longer periods of time. Frequently, the risk of injury at work is high. Migrant workers have a higher incidence of a variety of diseases, many of which directly affect their work ability. Significant numbers of migrant workers are exposed to infectious diseases such as tuberculosis and hepatitis, as well as to the ever growing incidence of HIV infection

New method for risk assessment of statodynamic strains - testing and validation

U ovom priopćenju opisana je metoda za bodovnu procjenu manualnog rada koji uključuje ponavljajuće zadatke, povremenu primjenu sile te nepravilan položaj tijela. Metoda je razvijena na temelju iscrpnog i kritičkog pregleda literature, ali i evaluacije u sklopu vlastitih istraživanja provedenih na različitim radnim mjestima. Osim što sadrži objektivni opis zadataka, ponavljajućih pokreta, sile i položaja tijela, ova metoda uključuje i mogućnost numeričkog izračuna spomenutih aktivnosti, ne zanemarujući njihovo međudjelovanje. Zahtjevi rada (trajanje zadatka tijekom radne smjene, ponavljajući pokreti, primjena sile, položaj tijela i radni uvjeti) prezentirani su bodovima, i to svaki na individualnoj ljestvici koja odgovara uvjetima u praksi. Kako bi se izračunala konačna vrijednost procjene rizika, potrebno je pomnožiti vrijednost dobivenu na ljestvici trajanja zadataka sa zbrojem vrijednosti koje su dobivene na ostalim ljestvicama. Konačna vrijednost ukazuje na potencijalnu preopterećenost, a iskazana je određenom brojkom koja se kasnije može uvrstiti u tablicu pojašnjenja pomoću koje se očitava jedna od moguće četiri razine rizika: zelena, žuta, narančasta ili crvena. U literaturi se upravo razvrstavanje kategorija prema bojama navodi kao učinkovita pomoć uz koju korisnik lakše percipira potencijalni rizik. Ova nova metoda zove se SMART (eng. Scoring Method for Assessment of Repetitive Tasks), a dosad je testirana na 56 radnih mjesta. Iz dobivenih rezultata vidljivo je kako se 23 % aktivnosti može smjestiti u “zeleno” područje, 19 % u “žuto”, 21 % u “narančasto” te 37 % u “crveno”, iz čega se može zaključiti kako je kod čak 77 % procjenjivanih aktivnosti bilo prisutno povećano opterećenje. SMART metoda u fazi je testiranja i validacije za procjenu statodinamičkih napora na raznim radnim mjestima.Described in the paper is the method for the assessment of manual work including repetitive tasks, occasional use of force, and improper body position. The method was developed based on an exhaustive and critical evaluation of literature on the subject, but also on the basis of our own studies conducted at a series of different work places. In addition to an objective description of tasks, repetitive movements, force and body positions, this method also provides the possibility of numerical computations of the listed activities, not ignoring their interactions. Work demands (task duration in the course of a work shift, repetition of movements, use of force, body position and work conditions) are presented using a point system, with each demand shown on a separate scale corresponding to the actual conditions. In order to calculate the overall risk it is necessary to multiply the value on the task duration scale by the sum of the values on the other scales. The final value indicates potential overload shown as a number that can then be entered in a table illustrating one of the four risk levels: green, yellow, orange, or red. Relevant literature states that the colour classification serves as an efficient help to the user in perceiving potential risk. This new method has been named SMART (Scoring Method for Assessment of Repetitive Tasks). So far it has been tested in 56 work places. The results show that 23% activities may be classified in the \u27green\u27 zone, 19% in \u27yellow\u27, 21% in \u27orange\u27 and 37% in \u27red\u27, thus leading to the conclusion that as much as 77% of assessed activities show increased load. The SMART method is still in the testing and validation stage as a tool for the assessment of statodynamic strains involved at different work places

Quality of reporting injuries with sharp objects to healthcare employees of the Republic of Croatia

Ozljede oštrim predmetima predstavljaju veliki rizik pri radu svih radnika u zdravstvenim ustanovama budući da do takvih incidenata često dolazi tijekom obrade pacijenta te kod manipulacije medicinskim otpadom. Glavnu opasnost pri tom predstavlja mogućnost zaraze ukoliko je igla ili oštri predmet bio prethodno u dodiru sa zaraženim bolesnikom. Iako se ozljeda oštrim predmetom priznaje kao ozljeda na radu, većina radnika ne pokreće postupak prijave ozljede na radu nakon ozljede oštrim predmetom zbog neinformiranosti ili zbog dugotrajnog i kompliciranog postupka prijave ozljede na radu. Stoga je bilo potrebno pojednostavniti sam postupak prijavljivanja ozljede oštrim predmetima nadležnim institucijama što je omogućeno stupanjem na snagu Pravilnika o načinu provođenja mjera zaštite radi sprječavanja nastanka ozljeda oštrim predmetima [1]. Primjenom tog pojednostavljenog postupka prijavljivanja bitno se povećao broj prijava, što će omogućiti bolje planiranje i provođenje dodatnih mjera zaštite zdravlja radnika izloženih riziku ozljeda oštrim predmetima. U daljnjoj suradnji s osiguravateljem, pokušat će se doći do ostvarenja prvotnog cilja – pojednostavljenog priznavanja prijavljenih ozljeda oštrim predmetima odnosno svih vrsta ekspozicijskih incidenata kao ozljede na radu.Sharps/needlestick incidents (percutaneous injuries) pose a considerable occupational risk for all healthcare workers because they frequently occur while providing patient care or handling medical waste. The major risk of percutaneous injuries is an infection following the contact between the needle or any sharp object and an infected patient. Although percutaneous injuries belong to a group of occupational injuries, most employees do not officially report on these incidents because they are either uninformed or think that the reporting process is time-consuming and complicated. It was therefore necessary to simplify the reporting procedure which was enabled by the entry into force of the Regulations on the implementation of protective measures to prevent the occurrence of injuries by sharp objects (Official gazette 84/13). By applying of the simplified reporting procedure, the number of applications has significantly increased, which will allow better planning and implementation of additional measures to protect the health of workers exposed to the risk of injury by sharp objects. In further co-operation with the competent insurer, efforts will be made to achieve the original goal - simplified recognition of reported injuries by sharp objects, ie all types of exposure incidents, as work-related injury

Quality of reporting injuries with sharp objects to healthcare employees of the Republic of Croatia

Ozljede oštrim predmetima predstavljaju veliki rizik pri radu svih radnika u zdravstvenim ustanovama budući da do takvih incidenata često dolazi tijekom obrade pacijenta te kod manipulacije medicinskim otpadom. Glavnu opasnost pri tom predstavlja mogućnost zaraze ukoliko je igla ili oštri predmet bio prethodno u dodiru sa zaraženim bolesnikom. Iako se ozljeda oštrim predmetom priznaje kao ozljeda na radu, većina radnika ne pokreće postupak prijave ozljede na radu nakon ozljede oštrim predmetom zbog neinformiranosti ili zbog dugotrajnog i kompliciranog postupka prijave ozljede na radu. Stoga je bilo potrebno pojednostavniti sam postupak prijavljivanja ozljede oštrim predmetima nadležnim institucijama što je omogućeno stupanjem na snagu Pravilnika o načinu provođenja mjera zaštite radi sprječavanja nastanka ozljeda oštrim predmetima [1]. Primjenom tog pojednostavljenog postupka prijavljivanja bitno se povećao broj prijava, što će omogućiti bolje planiranje i provođenje dodatnih mjera zaštite zdravlja radnika izloženih riziku ozljeda oštrim predmetima. U daljnjoj suradnji s osiguravateljem, pokušat će se doći do ostvarenja prvotnog cilja – pojednostavljenog priznavanja prijavljenih ozljeda oštrim predmetima odnosno svih vrsta ekspozicijskih incidenata kao ozljede na radu.Sharps/needlestick incidents (percutaneous injuries) pose a considerable occupational risk for all healthcare workers because they frequently occur while providing patient care or handling medical waste. The major risk of percutaneous injuries is an infection following the contact between the needle or any sharp object and an infected patient. Although percutaneous injuries belong to a group of occupational injuries, most employees do not officially report on these incidents because they are either uninformed or think that the reporting process is time-consuming and complicated. It was therefore necessary to simplify the reporting procedure which was enabled by the entry into force of the Regulations on the implementation of protective measures to prevent the occurrence of injuries by sharp objects (Official gazette 84/13). By applying of the simplified reporting procedure, the number of applications has significantly increased, which will allow better planning and implementation of additional measures to protect the health of workers exposed to the risk of injury by sharp objects. In further co-operation with the competent insurer, efforts will be made to achieve the original goal - simplified recognition of reported injuries by sharp objects, ie all types of exposure incidents, as work-related injury

Standard human chorionic gonadotropin versus double trigger for final oocyte maturation in improving clinical outcome of IVF

CILJ ISTRAŽIVANJA: Cilj našeg istraživanja je usporediti stimulaciju završne maturacije jajnih stanica na krajnji ishod postupka medicinski potpomognute oplodnje (MPO) protokola u kojem se za stimulaciju ovulacije koristi kombinacija humanog korionskog gonadotropina i agonista gonadotropin-otpuštajućeg hormona (hCG+GnRH agonist) s protokolom u kojem se koristi samo humani korionski gonadotropin (hCG). ISPITANICI I METODE: Ovo retrospektivno istraživanje provedeno je na Zavodu za ginekološku endokrinologiju i humanu reprodukciju, Klinike za ženske bolesti i porode KBC Split u razdoblju od 1. siječnja 2017. do 1. siječnja 2019. godine. Podaci su prikupljeni iz medicinske dokumentacije žena koje se liječe od neplodnosti i koje su ispunjavale kriterije za ulazak u istraživanje. Obradom je obuhvaćeno 188 ispitanica: 94 ispitanice u kojih se za stimulaciju ovulacije koristila kombinacija hCG+GnRH agonista te 94 ispitanice kod kojih se za stimulaciju ovulacije koristio hCG. Također ispitanice su podijeljene po dobnim skupinama. Prva skupina su ispitanice do 35 godina, druga skupina obuhvaća ispitanice od 35 do 40 godina i treća skupina ispitanice iznad 40 godina. U studiji su ispitanicama obje skupine analizirane vrijednosti beta humanog korionskog gonadotropina (βhCG) kao pokazatelj uspješne implantacije, broj jajnih stanica u metafazi dva staničnog ciklusa (M2 faza) te broj zametaka u šestostaničnoj i osmostaničnoj fazi te blastociste. REZULTATI: Razdioba ispitanica prema implantaciji u odnosu na primjenjenu indukciju ovulacije (hCG+GnRH agonista u usporedbi s hCG) nije se statistički značajno razlikovala na razini značajnosti od 95% već na razini značajnosti od 93% (P=0,067). Medijan broja jajnih stanica u M2 fazi je za 2,5 veći kod ispitanica kod kojih se za indukciju ovulacije koristila kombinacija hormona nego u ispitanica kod kojih se za indukciju ovulacije koristio hCG (P=0,022), dok je medijan broja zametaka za 2 veći u ispitanica kod kojih se za indukciju ovulacije koristila kombinacija hormona (P40 godina u odnosu na skupinu ispitanica 40 godina u odnosu na skupinu ispitanica <35 godina (P=0,006). ZAKLJUČCI: Nema statistički značajne povezanosti između uspješnijeg ishoda implantacije gdje se za indukcije ovulacije koristila kombinacija hormona GnRH agonista i hCG-a u usporedbi s protokolima gdje se za indukciju ovulacije koristio hCG. Međutim, broj nastalih jajnih stanica u M2 fazi staničnog ciklusa i broj nastalih zametaka je veći kod ispitanica kod kojih se za indukciju ovulacije koristila kombinacija hormona.Također, uspješnost implantacije raste s većim brojem nastalih jajnih stanica u M2 fazi staničnog ciklusa i brojem zametaka. Konačno, postoji statistički značajna povezanost dobnih skupina ispitanica i uspješnog ishoda implantacije kao i nastanka većeg broja prikladnih gameta u korist mlađih ispitanica.OBJECTIVES: The aim of our study was to compare final maturation induction to the outcome of in vitro fertilization (IVF) process using different drugs. Ovulation was induced with combination of human chorionic gonadotropin and gonadotropin releasing agonist (hCG + GnRH agonist) in one group and human chorionic gonadotropin in another (hCG). MATERIALS AND METHODS: This retrospective study was conducted in Reproductive Health Centre, University Hospital of Split, from January 1st 2017 to January 1st 2019. The data were collected from the medical records of patients undergoing treatments for infertility and met the criteria for entering the research. The study included totally 188 patients: 94 to ovulation induction with combination of hCG+GnRH agonist and 94 to ovulation induction with hCG. Patients were divided in groups by age. First group were women aged 35 and younger, the second group included age 35 to 40 and the third group were patients over 40 years. In the study, both groups analyzed the values of beta human chorionic gonadotropin (βhCG) as an indicator of successful implantation, the number of metaphase II (MII) oocytes and the number of embryos. RESULTS: The distribution of implantation did not differ statistically significantly at 95% but at 93% significance level (P=0.067) between the two groups (hCG+GnRH agonist compared to hCG). The median of MII oocytes was for 2.5 higher in those using hormone combination for ovulation induction than in those using hCG (P=0.022) for ovulation induction, while median of embryos was for 2 higher in patients using hormone combinations (P<0.001). Median of MII oocytes in positive implantation was for 6 higher than in negative (P<0.001). The median of embryos in positive implantation was for 2 higher than in the negative (P<0.001). There was a statistically significance between females age and implantation (P=0.011). Also, there was a statistically significance between females age and MII oocytes number (P=0.016). The difference was made by a group of patients aged 40 years and older in correlation with participants aged 35 and younger (P=0.017). There was a statistically significance between the females age and number of embryos (P=0.004). The difference was the number of embryos among the respondents aged 40 years and older compared to the group of patients aged 35 years and younger (P=0.006). CONCLUSIONS: There was no statistically significance between two drugs used for ovulation induction (hCG+GnRH agonist and hCG) and better outcome of implantation. However, the number of MII oocytes and the number of embryos was greater where ovulation was induced by combination of hormones. Also, the success of implantation grew with a larger number of MII oocytes and embryos. Finally, there was a statistically significance between females age and positive outcome of implantation as well as the greater number of gametes in favour of younger patients

Quality of reporting injuries with sharp objects to healthcare employees of the Republic of Croatia

Ozljede oštrim predmetima predstavljaju veliki rizik pri radu svih radnika u zdravstvenim ustanovama budući da do takvih incidenata često dolazi tijekom obrade pacijenta te kod manipulacije medicinskim otpadom. Glavnu opasnost pri tom predstavlja mogućnost zaraze ukoliko je igla ili oštri predmet bio prethodno u dodiru sa zaraženim bolesnikom. Iako se ozljeda oštrim predmetom priznaje kao ozljeda na radu, većina radnika ne pokreće postupak prijave ozljede na radu nakon ozljede oštrim predmetom zbog neinformiranosti ili zbog dugotrajnog i kompliciranog postupka prijave ozljede na radu. Stoga je bilo potrebno pojednostavniti sam postupak prijavljivanja ozljede oštrim predmetima nadležnim institucijama što je omogućeno stupanjem na snagu Pravilnika o načinu provođenja mjera zaštite radi sprječavanja nastanka ozljeda oštrim predmetima [1]. Primjenom tog pojednostavljenog postupka prijavljivanja bitno se povećao broj prijava, što će omogućiti bolje planiranje i provođenje dodatnih mjera zaštite zdravlja radnika izloženih riziku ozljeda oštrim predmetima. U daljnjoj suradnji s osiguravateljem, pokušat će se doći do ostvarenja prvotnog cilja – pojednostavljenog priznavanja prijavljenih ozljeda oštrim predmetima odnosno svih vrsta ekspozicijskih incidenata kao ozljede na radu.Sharps/needlestick incidents (percutaneous injuries) pose a considerable occupational risk for all healthcare workers because they frequently occur while providing patient care or handling medical waste. The major risk of percutaneous injuries is an infection following the contact between the needle or any sharp object and an infected patient. Although percutaneous injuries belong to a group of occupational injuries, most employees do not officially report on these incidents because they are either uninformed or think that the reporting process is time-consuming and complicated. It was therefore necessary to simplify the reporting procedure which was enabled by the entry into force of the Regulations on the implementation of protective measures to prevent the occurrence of injuries by sharp objects (Official gazette 84/13). By applying of the simplified reporting procedure, the number of applications has significantly increased, which will allow better planning and implementation of additional measures to protect the health of workers exposed to the risk of injury by sharp objects. In further co-operation with the competent insurer, efforts will be made to achieve the original goal - simplified recognition of reported injuries by sharp objects, ie all types of exposure incidents, as work-related injury

An alternative approach to the prevention and treatment of sore back at the work place

Bolna leđa su jedan od najčešćih uzroka izostanka s posla u Hrvatskoj i svijetu. Samo je prošle godine 32.000 radnika bilo onesposobljeno zbog boli u leđima. Posljedica toga su veliki troškovi koji se odnose na radnika, poslodavca, zdravstveni i mirovinski sustav. Stoga je potrebno preventivno djelovati kako bi se smanjila učestalost i trajanje ove bolesti, a preventivne aktivnosti treba provoditi na radnom mjestu, jer uvjeti radnog mjesta mogu izravno izazvati pojavu boli u leđima, i s druge strane, mogu neizravno pogoršati već postojeće stanje nastalo nevezano uz radno mjesto. U prevenciji i liječenju boli u leđima dominantnu ulogu ima biomedicinski model. Prema njemu nastanak bolesti je isključivo i samo posljedica organskog poremećaja. Tijekom niza godina takav se model nije pokazao učinkovitim kod kroničnih bolesti kao što su bolna leđa, već samo kod akutnih bolesti. Kronične bolesti su multifaktorijalne, te se kao primjereniji pristup pokazao biopsihosocijalni model. Prema tom modelu, bol u leđima nastaje kao posljedica fizioloških, psihičkih i socijalnih faktora koji su u međusobnoj interakciji, a jačina simptoma i razina onesposobljenosti ovise o toj interakciji. Drugim riječima, psihički i socijalni faktori posreduju u nečijoj reakciji na organski poremećaj tako, ako izlječenje organskog poremećaja nije moguće, uspješnim ishodom smatra se povratak normalnim aktivnostima na poslu i u svakodnevnom životu. U sklopu biopsihosocijalnog modela uspješnim preventivnim mjerama pokazale su se: edukacija koja obuhvaća sva tri aspekta boli (biomedicinski, psihološki i sociološki), fizička aktivnost prilagođena pojedincu i prilagodba radnog mjesta trenutnim zdravstvenim mogućnostima radnika.Sore back is one of the most common causes of absence from work in Croatia and worldwide. Only in the past year 32,000 workers were temporarily disabled due to sore back. The cost of this to the workers, employers, the health care and retirement fund are enormous. Prevention is imperative to reduce the incidence and duration of this health problem. Prevention measures must be put in place at the work place itself, as the work place can be directly responsible for the sore back syndrome but it can also indirectly contribute to the existing condition caused by other factors. The prevention and treatment of sore back still predominantly relies on the biomedical model. In this model, the affliction is attributed exclusively to organic causes. Over the years, this model has proven effective in cases of acute disease but ineffective in chronic disorders such as sore back. Chronic diseases are multifactorial and thus for them the biopychosocial model seems to be a more adequate path for follow. According to this model, sore back is caused by an interaction of physiological, psychological and social factors where the severity of symptoms and the degree of disability are in direct correspondence with this interaction. In short, psychological and social factors affect a patient\u27s reaction to the organic disorder. If complete cure of the organic disorder is not feasible, the return to the usual daily activities and work are considered a successful outcome. The biopsychosocial model includes proven measures such as education addressing all three aspects of the pain (biomedical, psychological and social), physical activity tailored to suit the individual, and adjustments made to the work place to help the health status of the worker

OUTDOOR WORKERS IN HIGH TEMPERATURE CONDITIONS - MEDICAL VIEW

U ovom je radu prikazan, s medicinskog gledišta, utjecaj povišene temperature prilikom fizičkog rada u otvorenom okolišu na ljudski organizam, te su preporučene smjernice koje bi trebale pomoći u zaštiti zdravlja ove skupine radnika. Prilikom samog fizičkog rada organizam proizvodi znatne količine topline. Zbog opterećenja vanjskom toplinom obrambeni mehanizmi organizma postaju dodatno opterećeni. Učinak aktivacije brojnih obrambenih mehanizama može se pojednostavljeno sažeti na čuvanje tekućine u organizmu te na hlađenje organizma. Štetni učinci vrućeg okoliša ovise o karakteristikama samog radnika, radnim uvjetima i čimbenicima okoliša. Temperaturna ugroženost radnika procjenjuje se pomoću toplinskih indeksa, no uvijek se prednost mora dati radnikovom subjektivnom doživljaju koliko mu je fizički teško. Rad na vrućini uzrokuje poremećaje na razini cijelog tijela, prvenstveno u smislu dehidracije i hiperpireksije, ali povećava i rizik od lokalnih poremećaja, na razini kože i mišića. Smanjen je i osjećaj komfora i radna sposobnost te je povećan rizik od nesreća na radu. Zdravstveni poremećaji uzrokovani toplinskim stresom mogu se prevenirati ispravnim ponašanjem i suradnjom radnika i poslodavca, a negativne posljedice na zdravlje mogu se umanjiti pravodobnim reakcijama pri pojavi početnih, blagih simptoma. Pravovremena, redovita i dostatna nadoknada vode, elektrolita i energije jedan je od najvažnijih postupaka. Prvi izbor za rehidraciju su izotonični napici obogaćeni ugljikohidratima. Uvijek je cilj prvenstveno zaštititi zdravlje ugroženih radnika, ali svakako je važno održati što bolju učinkovitost na radu.The paper provides the medical view of the influence of higher temperatures on the human organism during physical labour in the open. It also recommends guidelines which should help protect the health of these workers. During physical labour the organism generates high amounts of heat. The strain of outer heat causes significant additional strain to the body. In simple terms, the activation of the compensatory mechanisms can be summarized as the preservation of body liquids and the cooling of the organism. Harmful effects of a hot environment are specific to the particular worker and depend on the working conditions and the environmental factors. The temperature threat to a worker is estimated by the heat index. However, higher priority is always to be given to the worker’s subjective impression of physical strain. Working in heat causes disorders in the entire body, primarily through dehydration and hyperpyrexia, but it also increases the risk of local skin and muscle disorders. The feeling of comfort and the working capacity are decreased, whereas the risk of work accidents is increased. Medical disorders caused by heat stress can be prevented by proper behaviour of workers and their employers, whereas negative effects on health can be reduced by timely reactions to initial, mild symptoms. Timely, regular and sufficient replenishment of water, electrolytes and energy is one of the most important procedures. The best means of rehydration are isotonic drinks enriched with carbohydrates. The primary goal is to protect the health of the affected workers but also to maintain the best possible work efficiency

OCCUPATIONAL INFECTIOUS DISEASES IN THE REPUBLIC OF CROATIA

Profesionalne zarazne bolesti u Republici Hrvatskoj definirane su Zakonom o listi profesionalnih bolesti kao „zarazne ili parazitske bolesti prenesene na čovjeka sa životinja ili životinjskih ostataka“ i „zarazne ili parazitske bolesti uzrokovane radom u djelatnostima gdje je dokazan povećan rizik zaraze“. U ovome radu obrađeni su podatci o profesionalnim zaraznim bolestima koji su uneseni u registar profesionalnih bolesti Hrvatskog zavoda za zaštitu zdravlja i sigurnost na radu za desetogodišnje razdoblje od 1.1.2001. do 31.12.2010. godine. Prikazane su profesionalne zarazne bolesti u Republici Hrvatskoj u odnosu na njihov broj, udio u ukupnom broju profesionalnih bolesti, vrstu bolesti, zanimanje oboljelih radnika i gospodarstvenu djelatnost njihovih poslodavaca. U razdoblju od 2001. do 2010. godine u registar Hrvatskog zavoda za zaštitu zdravlja i sigurnost na radu unesene su sveukupno 1054 profesionalne bolesti, a od toga je 10 % zaraznih. U odnosu na druge profesionalne bolesti, prema učestalosti profesionalne zarazne bolesti zauzimaju visoko treće mjesto, a u pojedinim godinama razmatranog razdoblja drugo, pa čak i prvo mjesto. Od profesionalnih zaraznih bolesti najčešća je bila tuberkuloza, a slijedili su hepatitisi te zoonoze, Q groznica i hemoragijske groznice. Zoonoze se najčešće pojavljuju u djelatnosti poljoprivrede i šumarstva te kod veterinara. Tuberkuloza i hepatitisi pojavljuju se među djelatnicima u zdravstvenoj djelatnosti, a među njima najčešće kod medicinskih sestara. Budući da rezultati ukazuju na porast udjela tuberkuloze u ukupnom broju profesionalnih zaraznih bolesti, potrebno je ukazati na dodatan oprez i poduzeti potrebne mjere, osobito u zdravstvenoj djelatnosti, kako bi se spriječio daljnji porast broja oboljelih od tuberkuloze.In the Republic of Croatia, occupational infectious diseases are defined in the Act on the List of Occupational Diseases as \u27\u27infectious or parasitic diseases transmitted to people from animals or animal remains\u27\u27 and as \u27\u27infectious or parasitic diseases caused while working in circumstances with proven increased risk of infection.\u27\u27 The paper discusses the data on the occupational infectious diseases recorded in the Register of Occupational Diseases maintained by the Croatian Institute for Health Protection and Safety at Work for the period from 1st January 2001 to 31st December 2010. The occupational infectious diseases in the Register are reviewed according to their overall incidence, their portion in the total number of occupational diseases in the Republic of Croatia, according to the type of disease, occupation of the infected workers and the employers\u27 business. From 2001 to 2010 the Register records show a total of 1054 occupational diseases, of which 10% were infectious diseases. When compared to other occupational diseases, the incidence of infectious diseases occupies a high third place, and in some years within the studied period even the second or first place. The most common occupational infectious disease was tuberculosis, followed by different types of hepatitis and zoonoses, Q fever and hemorrhagic fever. Zoonoses occur most commonly in agriculture, forestry and veterinary practice. Tuberculosis and hepatitis occur among health care workers, nurses in particular. Given that the results indicate a steadily increasing incidence of tuberculosis in the overall number of occupational infectious diseases, additional cautionary measures should be taken, especially in health care, to prevent further increase in the number of infected individuals