Early adolescence and suicidal ideations in Croatia: sociodemographic, behavioral, and psychometric correlates.

BACKGROUND/AIMS: Suicidal ideations (SI) indicate and predict psychological distress. We examined the prevalence of SI among early adolescents and its association with parental war participation, personal, behavioral, and sociodemographic characteristics. METHODS: We performed a cross-sectional questionnaire study on 803 12-year-old adolescents. Data were collected using a sociodemographic questionnaire, the Junior Eysenck Personality Questionnaire and Children Depression Inventory. Unintentional injuries, physical fighting, and involvement in bullying behavior were assessed using questions from the World Health Organization (WHO) survey Health Behavior in School-aged Children. Suicidal ideations were assessed with three dichotomous items. RESULTS: There were no gender differences in SI prevalence. SI in males were associated with lower maternal education, crowded families, birth order, parental war participation, physical fighting, being bullied, and substance use. In females, we found associations with lower parental educational level, number of brothers, lower perception of the relationship with parents, parental relationship, family cohesion and parental control, negative attitude toward school, rare church attendance, fighting, and being bully or bullied. Depressive symptoms and SI were associated in both genders. CONCLUSIONS: SI showed gender-specific associations that may partially be explained with parental war involvement. These findings may have potentially important clinical and preventive implications.

[Succinylcholine use by anesthesiologists in Croatia--is it really abandoned?]. / Uporaba sukcinil-kolina medu hrvatskim anesteziolozima--je li taj lijek zaista odbacen?

The aim was to establish the prevalence of succinylcholine use among Croatian anesthesiologists in adult elective and emergency surgery, as well as in pediatric surgery, regarding gender, position, working place, and working experience of physicians. The anesthesiologists were expected to express their personal opinions regarding the drug, as well as experienced side effects in their own clinical practice. A total of 125 anesthesiologists (out of 590 in Croatia) from both university and county hospitals in Croatia anonymously filled out the questionnaire regarding the use of succinylcholine (Appendix 1). The questionnaire was structured to assess the use of succinylcholine in adult elective and emergency surgery, and in pediatric anesthesia, to obtain the reasons for the preference or rejection of succinylcholine, and information about observed side effects. The differences in use regarding gender, position, working place, and working experience were tested using chi-squared test and Fisher's exact test. p < 0.05 was considered significant. Vast majority (approximately 70%) of anesthesiologists in Croatia still use succinylcholine. The percentages of anesthesiologists that never use succinylcholine in adult elective, adult emergency and pediatric surgery were 20%, 6%, and 31%, respectively. There were no significant differences in the use of succinylcholine regarding position, working place, and working experience, but male anesthesiologists used it less frequently in pediatric anesthesia compared with their female colleagues (chi2 = 5.08; p = 0.02). Forty-two per cent never experienced a complication from the drug use. The most frequently reported side effects were bradycardias (67%) and myalgias (54%), followed by prolonged blockade (33%), and allergy (33%). Asystole was reported by 10% of the respondents. In conclusion, succinylcholine is still widely used by anesthesiologists in Croatia. The majority of surveyed physicians were aware of its possible dangerous adverse effects, but still use it in certain situations. Therefore, indications and contraindications for its use deserve expert consensus guidelines based on the available scientific evidence.

The impact of a single 24 h working day on cognitive and psychomotor performance in staff anaesthesiologists.

BACKGROUND AND OBJECTIVE: The profession of anaesthesiologist is demanding and potentially hazardous. Extended work shifts combined with intensive work load may adversely affect physicians' performance. The aim of this study was to explore the impact of a single in-hospital 24 h shift on the cognitive and psychomotor performance of anaesthesiologists in a surgical emergency department. METHODS: Following ethical and institutional approval, 11 staff anaesthesiologists [six men, five women, age 48 (35-50), years of experience 17 (7-20), median (range)] successfully completed the study protocol. Four computer-generated psychological tests (CRD, Complex Reactionmeter Drenovac, Croatia) consisting of light signal position discrimination (CRD 311), simple visual orientation (CRD 21), simple arithmetic operations (CRD 11), and complex psychomotor coordination (CRD 411) were used to measure objective parameters of cognitive and psychomotor performance at four time points (D1 = 8:00 a.m., D2 = 3:00 p.m., D3 = 11:00 p.m.; and D4 = 7:00-8:00 a.m. next day) during the 24 h working day. The control testing on an ordinary working day was performed at two time points (C1 = 8:00 a.m., C2 = 3:00 p.m.). Three parameters were recorded: total test solving time (TTST), total variability, and total number of errors for all four tests. RESULTS: TTST was significantly impaired during the 24 h shift in all tests, and TTST was prolonged in CRD 21 test at different time points from 1.6 +/- 1.4 to 5.5 +/- 1.6 s compared with the control (F = 6.39, P = 0.001). The reaction times were prolonged from 1.3 +/- 1.8 to 5.4 +/- 1.2 s (F = 3.49, P = 0.009) in CRD 311, from 3.8 +/- 9.0 to 34.3 +/- 5.8 s (F = 5.05, P = 0.002) in CRD 11 TTST, and from 0.8 +/- 3.0 to 16.3 +/- 8.6 s (F = 2.67, P = 0.034) in CRD 411. Total variability was significantly altered during the 24 h shift only in CRD 411 (F = 2.63, P = 0.036). There was no difference in the total number of errors between the 24 h shift and the ordinary working day. CONCLUSION: Anaesthesiologists' 24 h working day in the emergency department altered cognitive and psychomotor function in comparison with ordinary working days. Speed, reliability and mental endurance (measured by TTST) were significantly impaired in all four tests. Stability and reaction time (measured by total variability) were only slightly impaired. Paradoxically, attention and alertness (measured by total number of errors) were not adversely affected. In conclusion, anaesthesiologists' psychomotor performance was impaired during the single 24 h shift.

Pulmonary function in persons who are professionally exposed to formaldehyde fumes.

The present study examines long-term effects of occupational exposure to formaldehyde fumes on lung function. Forced spirometry and diffusing lung capacity were measured in 16 health-service professionals (8 medical doctors and 8 laboratory technicians) working at the pathoanatomic laboratory for at least 4 years with daily exposure 8 +/- 1 hours. Control group employed 16 males, which were matched by age and stature to members of the exposed group. Only non-smokers were included in the study. Spirometric parameters in study participants exposed to formaldehyde fumes compared to control group were not significantly different indicating absence of restrictive and/or obstructive deterioration of lung function in exposed group. The only parameter differing in two groups was blood volume of pulmonary capillaries (Vc') which was significantly larger in a group exposed to formaldehyde fumes. The possibility that the hyperemic lung reaction is the consequence of the exposure to formaldehyde fumes should be further explored.

Association of oculocardiac reflex and postoperative nausea and vomiting in strabismus surgery in children anesthetized with halothane and nitrous oxide.

BACKGROUND: Postoperative nausea and vomiting (PONV) occurs frequently after strabismus surgery. The controversy still exists regarding the association of PONV and the oculocardiac reflex (OCR). A recent study has proven that rocuronium attenuates OCR. If these two occurrences are dependent, it is expected that with the diminution of OCR, occurrence of PONV will also be reduced. The goal of this randomized, controlled study was to prove an association between OCR and PONV by attenuating OCR with 0.4 mg x kg(-1) of rocuronium and subsequently diminishing PONV if these occurrences are associated. METHODS: A total of 119 ASA 1 children, aged between 3 and 10, undergoing surgery of the medial rectus muscle, were randomly assigned to two groups. In group R (n = 59), 0.4 mg x kg(-1) of rocuronium was administered i.v. before intubation. Group C (controls, n = 60) received no muscle relaxant. The anesthesia was induced and maintained with halothane and N(2)O/O(2) (50/50%). Chi-squared test, Fisher's exact test, t-test, and anova were used for statistical analysis; P-value <0.05 was considered statistically significant. RESULTS: There were no differences between groups regarding patients' characteristics as well as endtidal halothane and duration of surgery and anesthesia. The occurrence of OCR was different between groups (R: 16/59, 27.1%, C: 28/60, 46.7%; P = 0.027), but not the occurrence of PONV (R: 27/59, 45.8%, C: 28/60, 46.7%; P = 0.921). There was an equal number of patients with PONV and bradycardias in both groups (R: 4/27 vs C: 4/28; P = 0.858), whereas there was different, but statistically insignificant distribution of patients (R: 3/27 vs C: 10/28; P = 0.086) with PONV and arrhythmias other than bradycardia. However, simultaneous occurrence of total OCR and PONV in the 24-h period was not different between the two groups (P = 0.964). CONCLUSIONS: Rocuronium (0.4 mg x kg(-1)) attenuates the occurrence of OCR, but with the reduced occurrence of OCR we were not able to attenuate the occurrence of PONV, therefore the association of OCR and PONV in strabismus surgery in children anesthetized with halothane and nitrous oxide remains unclear, and if there is a link between the two, it could be related to arrhythmias and not bradycardia.