[Earthquakes--a historical review, environmental and health effects, and health care measures]. / Potresi--povijesni pregled, okolisni i zdravstveni ucinci i mjere zdravstvene skrbi.

Earthquakes are natural disasters that can occur at any time, regardless of the location. Their frequency is higher in the Circum-Pacific and Mediterranean/Trans-Asian seismic belt. A number of sophisticated methods define their magnitude using the Richter scale and intensity using the Mercani-Cancani-Sieberg scale. Recorded data show a number of devastating earthquakes that have killed many people and changed the environment dramatically. Croatia is located in a seismically active area, which has endured a series of historical earthquakes, among which several occurred in the Zagreb area. The consequences of an earthquake depend mostly on the population density and seismic resistance of buildings in the affected area. Environmental consequences often include air, water, and soil pollution. The effects of this kind of pollution can have long-term health effects. The most dramatic health consequences result from the demolition of buildings. Therefore, quick and efficient aid depends on well-organized health professionals as well as on the readiness of the civil defence, fire department, and Mountain Rescue Service members. Good coordination among these services can save many lives Public health interventions must include effective control measures in the environment as secondary prevention methods for health problems caused by unfavourable environmental factors. The identification and control of long-term hazards can reduce chronic health effects. The reduction of earthquake-induced damages includes setting priorities in building seismically safe buildings.

Respiratory symptoms in fish processing workers on the Adriatic coast of Croatia.

This article describes respiratory symptoms and lung function in 98 fish processing female workers employed in a fish processing plant located on the Croatian Adriatic coast and 95 matching controls. The study included chronic and acute respiratory symptoms which developed during the shifts. Lung function measurements included forced vital capacity (FVC), one-second forced expiratory volume (FEV(1)) and maximal expiratory rates at 50 % and the last 25 % (FEF(50), FEF(25)). Chronic respiratory symptoms were significantly dominant in fish processing workers compared to controls. The most common chronic symptoms were hoarseness (57.1 %), nasal catarrh (51.0 %), chronic cough (42.9 %), chronic phlegm (34.7 %), and frequent chest cold (35.7 %). Exposed smokers and nonsmokers had a similar prevalence of chronic respiratory symptoms. Acute symptoms over the work shift were high, with headache in lead (smokers: 62.5 %; nonsmokers: 56.1 %). Most of the ventilatory capacity parameters were significantly lower than predicted, FEF(25) in particular, indicating obstructive changes predominantly in the smaller airways. These findings suggest that fish processing workers are prone to developing acute and chronic respiratory symptoms as well as to lung function changes. This calls for medical and technical preventive measures to be introduced in the work environment of the fish processing plant.

[Dance as a risk factor for injuries and development of occupational diseases]. / Ples kao cimbenik rizika za ozljede i razvoj profesionalnih bolesti.

Injuries and diseases can significantly affect the creativity and artistic performance. The link between working conditions and artistic performance had been recognised as early as the medieval age. Physically demanding performance arts such as dance can sometimes result in injuries, illnesses, inability to perform, and even end artist's career. Dancers are exposed to specific risks and in need of specific medical care. Many dancers often stretch their physical capabilities and endurance and neglect their physical limitations. Their health problems include a number of work-related illnesses that range from stress and stage fright to metabolic and nutritional disorders. They also include musculoskeletal injuries due to overload training that are often the beginning of chronic health problems.

Known symptoms and diseases of a number of classical European composers during 17th and 20th century in relation with their artistic musical expressions.

Medical history and relationship to the medical conditions as well as to the music creativity and productivity of some of the classical European composers have been described. In this review article we analyzed their illnesses as well as association between physical or mental diseases and their creativity and adaptability to disease. Some classical composers suffered from organic diseases, while others complained of mental disturbances. However, in spite of their disorders, the intensity of their creativity mostly remained unchanged.

Workplace noise exposure after modernisation of an aluminium processing complex.

The aim of this study was to assess to which extent modernisation of an aluminium production complex reduced occupational noise hazard for jobs with the highest potential of exposure. Periodical measurements of noise level were taken at the same workplaces using the same method, before and after modernisation of all plants. The results were compared with the recommended standard. After modernisation, the noise was significantly reduced in all sections of all plants. The greatest reduction was measured in the foundry. After modernisation, the portion of workplaces with excessive noise level dropped significantly (chisquare=21.315; p<0.0001) from 78.4% to 13%. Noise remained a problem in ingot casting and dross skimming section. In the anode plant, noise remained a problem in the green mill section where noise intensities generated by mills and vibrocompactors varied from 95 dB(A) to 102 dB(A). In the electrolysis plant, the portion of workplaces with extensive noise dropped from 77.8% to 39.3% after modernisation (p=0.0019). Noise remains to be a problem at the anode covering section where levels rise up to 100 dB(A). The modernisation of the factory has considerably reduced the noise level in the working environment of all plants, but it can not be reduced completely.

[Human lifespan: to live and outlive 100 years?]. / Ljudski vijek: dozivjeti i nadzivjeti 100 godina?

Aged population dominates in developed countries. Centenarians are a select group, and only one in 7,000 to 10,000 reach that age. Factors of longevity are numerous and include genetic predisposition (a locus on chromosome 4), environment, healthy lifestyle (hypocaloric diet, regular physical and mental exercise), accessible health services, and efficient health protection at old age. Centenarians are well adapted to the new life and compensate for the loss of functions with age. The limits of human life are extended, so that nowadays the oldest person has reached the age of 128. Some geographic areas are characterised by higher numbers of centenarians. This article mentions a few individuals who outlived 100 years in the world, Croatia, and neighbouring countries. Although some argue that the limits of human life cannot be extended over the age of 120 years, for now we cannot predict the actual limits of human life.

Respiratory function in wind instrument players.

BACKGROUND: The playing of wind instruments has been associated with changes in respiratory function. STUDY OBJECTIVES: To investigate the effect of playing wind instruments on lung function and respiratory symptoms. METHODS: The present study included 99 wind instrument players and a group of 41 string instrument players as a control from 3 major orchestras in Zagreb, Croatia. Data on chronic respiratory symptoms were recorded in all studied subjects. Lung function was measured in wind instrument players by recording maximum expiratory flow-volume curves. RESULTS: Wind instrument players demonstrated significantly higher prevalences of sinusitis, nasal catarrh and hoarseness compared to control musicians. One wind instrument player developed asthma associated with his work. Odds ratios for wind instrument players were significant for chronic cough, chronic phlegm and chronic bronchitis by smoking habit (p<0.05 or p<0.01) but not for length of employment. Ventilatory capacity data indicate that wind instrument players had significantly greater FEV1 (smokers and nonsmokers) as well as FEF50 (nonsmokers) (p<0.05) compared to predicted values. Regression analysis of pulmonary function tests in wind instrument players demonstrate a significant link between FEV1 and FEF50 and length of employment. Those wind instrument players with longer employment had the greatest increases in lung function. CONCLUSIONS: Our data suggest that musicians playing wind instruments may be susceptible to chronic upper airway symptoms. Interestingly wind instrument playing may be associated with higher than expected lung function parameters.

Gender and respiratory findings in workers occupationally exposed to organic aerosols: a meta analysis of 12 cross-sectional studies.

BACKGROUND: Gender related differences in respiratory disease have been documented. The aim of this study was to investigate gender related differences in respiratory findings by occupation. We analyzed data from 12 of our previously published studies. METHODS: Three thousand and eleven (3011) workers employed in "organic dust" industries (1379 female and 1632 male) were studied. A control group of 806 workers not exposed to any kind of dust were also investigated (male = 419, female = 387). Acute and chronic respiratory symptoms and lung function were measured. The weighted average method and the Mantel-Haentszel method were used to calculate the odds ratios of symptoms. Hedge's unbiased estimations were used to measure lung function differences between men and women. RESULTS: There were high prevalences of acute and chronic respiratory symptoms in all the "dusty" studied groups compared to controls. Significantly less chronic cough, chronic phlegm as well as chronic bronchitis were found among women than among men after the adjustments for smoking, age and duration of employment. Upper respiratory tract symptoms by contrast were more frequent in women than in men in these groups. Significant gender related lung function differences occurred in the textile industry but not in the food processing industry or among farmers. CONCLUSION: The results of this study suggest that in industries processing organic compounds there are gender differences in respiratory symptoms and lung function in exposed workers. Whether these findings represent true physiologic gender differences, gender specific workplace exposures or other undefined gender variables not defined in this study cannot be determined. These data do not suggest that special limitations for women are warranted for respiratory health reasons in these industries, but the issue of upper respiratory irritation and disease warrants further study.

New reference equations for forced spirometry in elderly persons.

This study identifies equations for predicting lung function values in a population of 'healthy', nonsmoking older adults, explores the applicability of prediction equations derived from younger adult populations to the elderly, and examines the justification of developing population-specific reference equations for older age. FVC, FEV(1), and PEF were measured according to the ATS criteria in 651 ambulatory volunteers aged 65-86 years, representative for the Croatian Mediterranean population. After exclusion of eversmokers and subjects with respiratory symptoms and/or diseases, 261 asymptomatic subjects were included in the analyses. Sex-specific reference equations and lower limits of normal were derived by using a linear model with height and age as predictors. The equations for lung volumes were more reliable than those for PEF. The new FVC and FEV(1) reference equations were found to be in agreement with those generated previously from primarily young and middle-aged adults. The latter perform reasonably well when extrapolated for ages beyond 65 years. Cross-validation of reference equations existing for the elderly showed that almost all European and U.S. equations systematically overpredicted lung function parameters in the Croatian sample. The overpredictions in means ranged between 14% and 34% for FVC and between 10% and 20% for FEV(1). Differences increased towards the extremes of distribution, which rendered these equations inappropriate for our elderly subjects. They identified FVC in 25-55% of the subjects as being below the lower limit of normal. The observed discrepancies strongly support the establishment of age- and population-specific reference equations for lung function assessment in older age.

Women in medicine through the ages.

BACKGROUND: Female practitioners of the medical arts have been active since the ancient world The role of women in science, and particularly in medicine, has changed significantly over time. METHODS: We provide a chronological review of the growing knowledge in medicine related to women's activities through the ages with particular attention to occupational medicine. Throughout history hazards have been shaped by the forces that shape work itself social evolution, shifting economic powers and demographic changes. RESULTS: Mythical Greece, Egypt and ancient Rome were the cradle of ancient medicine. In the past century, women were allowed to enter the medical profession with increasing acceptance. Some of the most important women in ancient and modern medicine are recalled, such as Mother Peseshet in ancient Egypt, Artemisia of Caria and Phanostrate and Philista in the Greek period, Hildegard of Bingen, Marie Marguerite Biheron in England, Elisabeth Blackwell, Emily Jennings, Maude E. Abbott and others. Women in occupational medicine are described separately, such as Alice Hamilton, Harriet L. Hardy, Molly Newhouse and Olga Macek. CONCLUSIONS: Certainly, the first few women who iluminated the way for the generations that followed them into medicine, the women who made outstanding contributions to medicine, and the women who are currently finding success in medicine deserve our respect and admiration.

Respiratory function in pesticide workers.

OBJECTIVE: Pesticide aerosols are frequently toxic irritants associated with respiratory symptoms and lung function impairment. METHODS: A cross-sectional study examined the prevalence of acute and chronic respiratory symptoms and lung function abnormalities in 82 workers employed in processing pesticides and in 60 control workers not exposed to irritants and employed in a soft drink bottling plant. RESULTS: The prevalence of almost all chronic respiratory symptoms was greater among pesticide workers than among controls. A logistic regression analysis shows differences between men and women. There was a high prevalence of acute symptoms during the work shift in pesticide workers. The data on ventilatory capacity indicates significant reductions in all tests compared to predicted. Multivariate analysis of lung function showed differences in smoking and work exposure effects in men and women. CONCLUSION: Our data indicate that duration of work exposure in the pesticide processing industry may be associated with the development of acute and chronic respiratory symptoms and lung function changes. These effects appear to be aggravated by smoking.

[Causes of climatic changes and their consequences on human health]. / Uzroci klimatskih promjena i njihove posljedice za zdravlje covjeka.

Environmental disasters are common phenomena caused by human factors. Disaster episodes may be the result of climatic changes such as global warming, which can lead to floods or drought. Greenhouse gases, and especially the ozone, represent a special problem. Atmospheric pollutions are the result of fire, storm dusts, winds, acid rain, etc. Underwater earthquakes very often end in tsunami with waves of up to 30 meters. Disasters described in the territory of Croatia include atmospheric pollutions, fires, floods, and droughts. All disasters affect the health of the population, particularly of the elderly. This most often includes the cardiovascular and respiratory systems, allergic reactions, and carcinogenic effects, resulting in increased mortality.

Ancient medicine--a review.

Different aspects of medicine and/or healing in several societies are presented. In the ancient times as well as today medicine has been closely related to magic, science and religion. Various ancient societies and cultures had developed different views of medicine. It was believed that a human being has two bodies: a visible body that belongs to the earth and an invisible body of heaven. In the earliest prehistoric days, a different kind of medicine was practiced in countries such as Egypt, Greece, Rome, Mesopotamia, India, Tibet, China, and others. In those countries, "medicine people" practiced medicine from the magic to modern physical practices. Medicine was magical and mythological, and diseases were attributed mostly to the supernatural forces. The foundation of modern medicine can be traced back to ancient Greeks. Tibetan culture, for instance, even today, combines spiritual and practical medicine. Chinese medicine developed as a concept of yin and yang, acupuncture and acupressure, and it has even been used in the modern medicine. During medieval Europe, major universities and medical schools were established. In the ancient time, before hospitals had developed, patients were treated mostly in temples.

Pharmacologic effects of grain weevil extract on isolated guinea pig tracheal smooth muscle.

The grain weevil, an insect (pest) that infects grain, is a frequent contaminant of processed wheat, and its presence may contribute to respiratory abnormalities in grain workers. We studied the in vitro effects of an extract of grain weevil (GWE) on airway smooth muscle. Pharmacologic studies included in vitro challenge of guinea pig trachea with GWE, in parallel organ baths, pretreated with mediator-modifying agents or a control solution. Dose-related contractions of nonsensitized guinea pig trachea (GPT) were demonstrated using this extract. Pharmacologic studies were performed by pretreating guinea pig tracheal tissue with drugs known to modulate smooth muscle contraction: atropine, indomethacin, pyrilamine, acivicin, NDGA, BPB, TMB8, captopril, and capsaicin. Atropine, pyrilamine, BPB, and capsaicin significantly reduced the contractile effects of the extract at most of the challenge doses (p < 0.01 or p < 0.05). Inhibition of GWE-induced contraction by blocking of other mediators was less complete. We suggest that GWE causes dose-related airway smooth muscle constriction of the GPT by nonimmunologic mechanisms involving a variety of airway mediators and possibly cholinergic receptors.

Hazardous agents in anode manufacture.

The aim of this study was to assess to which extent the modernisation of an anode plant had reduced occupational chemical health hazards for jobs with the highest potential of exposure. Periodical measurements of dust and gases were performed at the same workplaces using the same methods, before and after modernisation. These measurements were compared with the recommended standards. Before modernisation the concentrations of total dust, carbon monoxide, carbon dioxide, sulphur dioxide, hydrogen fluoride, benzene, and phenol were above the recommended standards in 56.9 % (74/130) of the samples. After modernisation, only 12.3 % (21/171) of the samples were non-conforming. Before modernisation, workers were exposed to higher concentrations of all agents in all production sections. After modernisation, dust remained the primary pollutant in harmful concentrations in the anode baking furnace (GM=22.1 mg m-3) and in the anode rodding room (GM=22.1 mg m-3), hydrogen fluoride in the anode rodding room (GM=4.2 mg m-3), and sulphur dioxide in all production sections. As plant modernisation has not completely resolved the exposure issue, stringent compliance to safety rules and regular medical checkups are necessary.

[Effects of volcanic eruptions on environment and health]. / Ucinci vulkanskih erupcija na okolis i zdravlje.

Volcanoes pose a threat to almost half a billion people; today there are approximately 500 active volcanoes on Earth, and every year there are 10 to 40 volcanic eruptions. Volcanic eruptions produce hazardous effects for the environment, climate, and the health of the exposed persons, and are associated with the deterioration of social and economic conditions. Along with magma and steam (H2O), the following gases surface in the environment: carbon dioxide (CO2) and sulphur dioxide (SO2), carbon monoxide (CO), hydrogen sulphide (H2S), carbon sulphide (CS), carbon disulfide (CS2), hydrogen chloride (HCl), hydrogen (H2), methane (CH4), hydrogen fluoride (HF), hydrogen bromide (HBr) and various organic compounds, as well as heavy metals (mercury, lead, gold).Their unfavourable effects depend on the distance from a volcano, on magma viscosity, and on gas concentrations. The hazards closer to the volcano include pyroclastic flows, flows of mud, gases and steam, earthquakes, blasts of air, and tsunamis. Among the hazards in distant areas are the effects of toxic volcanic ashes and problems of the respiratory system, eyes and skin, as well as psychological effects, injuries, transport and communication problems, waste disposal and water supplies issues, collapse of buildings and power outage. Further effects are the deterioration of water quality, fewer periods of rain, crop damages, and the destruction of vegetation. During volcanic eruptions and their immediate aftermath, increased respiratory system morbidity has been observed as well as mortality among those affected by volcanic eruptions. Unfavourable health effects could partly be prevented by timely application of safety measures.

Exposure to chemical agents in aluminium potrooms.

OBJECTIVES: To assess the effects of modernization of aluminium production on reducing the chemical health hazards in the working environment in aluminium potrooms (smelter). Modernization included the introduction ofa technique of point feeding of alumina and aluminium fluoride into the pots, semi-automatic equipment and computerized control. METHODS: Periodical environmental measurements of chemical substances, dusts containing alumina and fluorides, and gases, i.e., carbon monoxide, carbon dioxide, sulphur dioxide, hydrogen fluoride, nitrogen dioxide, and difluorosulphide, were performed at the same workplaces before (1986-1988) and sixteen years later, after modernization (2004). The measured values were compared with the recommended occupational safety and health standards. RESULTS: The concentrations of total dust (alumina and fluorides) and gases, i.e., carbon monoxide, carbon dioxide, sulphur dioxide, hydrogen fluoride and phenol, were above the recommended standards in 76.6% (95/124) of the samples before modernization and in only 23.8% (57/240) of the samples tested after modernization. Before modernization in almost all jobs the workers were simultaneously exposed to higher concentrations of all chemical agents present in the working environment. After modernization high concentrations of hydrogen fluoride were the primary pollutant in this plant (GM = 4.5451 ppm), while the presence of other gases was significantly reduced. Dusts containing alumina and fluorides and hydrogen fluoride gas were still present in considerable concentrations in the working environments of jobs such as changing and covering of anodes. CONCLUSION: The modernization of the aluminium smelter plant reduced the concentrations of the most harmful substances in the working environment and reduced the number of jobs where workers were simultaneously exposed to a variety of health hazards.

Occupational health hazards of artists.

Artists may be exposed to a variety of potentially noxious materials. The modern techniques they use imply exposure to environmental hazards. Occupational health was evaluated in individuals engaged in different arts such as sculpture, painting, printmaking, restoration photography, glass-work and ceramics, because of exposure to toxic chemicals in art materials, tools and methods used in their work. This evaluation demonstrated that artists sustain extensive exposure to toxic substances similar to occupational exposure of workers in different industrial settings. Hazards for artists are numerous and therefore it is important to identify the noxious materials and techniques used. Preventive measures should include basic safety, precautions, education and preventive medical surveillance.

Respiratory findings in a nursing home population.

The prevalence of respiratory abnormalities was studied in an elderly nursing home population. This study investigated 475 female and 147 male individuals living in five nursing homes in Zagreb, Croatia. Chronic respiratory symptoms were recorded using the British Medical Research Council questionnaire. Ventilatory capacity was measured with maximum expiratory flow-volume (MEFV) curves on which forced vital capacity (FVC), one-second forced expiratory volume (FEV1), maximum expiratory flow rate at 50% FVC (FEF50), and maximum expiratory flow rate at 25% FVC (FEF25) were measured. A high rate of chronic respiratory illness and symptoms was found in both female and male nursing home residents. The highest rates were for asthma, chronic cough, and for chest tightness. Odds ratios (OR) showed that smoking and the length of employment were significant risk factors among men. Pulmonary function testing demonstrated a decrease in measured values compared to predicted (p<0.01). This was particularly pronounced for FEF50 and FEF25, suggesting obstructive changes in smaller airways. Regression coefficients were significant for smoking and employment primarily for FEF50 and FEF25. Our data suggest that older individuals residing in nursing homes exhibit an excess of respiratory symptoms, and lung function abnormalities. Smoking and past employment are important risk factors for these respiratory findings. Medical surveillance and preventive strategies should be implemented for this high risk population.

Respiratory findings in art and medical students. Effects of the art environment.

BACKGROUND: Art students are exposed to many noxious agents during their training, in contrast to medical students, who are not exposed to known environmental pollutants. OBJECTIVES: In order to investigate the potential effects of toxic agents in the art students' environment, we studied respiratory findings in a cohort of 117 art students and 128 medical students, matched for age, sex and smoking. METHODS: Acute and chronic respiratory symptoms were evaluated by modifying the British Medical Research Council questionnaire. Lung function studies were performed with a spirometer (Jaeger, Germany) measuring maximum expiratory flow-volume (MEFV) curves. On these curves we calculated the forced vital capacity (FVC), one second forced expiratory volume (FEV1) and the maximal expiratory flow at 50% and the last 25% of the FVC (FEF50, FEF25). RESULTS: Significantly higher prevalences of most of the chronic respiratory symptoms were recorded in art students compared to medical students (p < 0.05). Art students who were smokers had significantly higher prevalences of many of the chronic respiratory symptoms than nonsmoking art students. Among medical students these differences were not statistically significant (NS). High prevalences of acute symptoms related to the study environment were recorded for art students. Odds ratios in male and female art students were significant for chronic cough, chronic phlegm and chronic bronchitis for the risk factor of smoking. Significantly decreased lung function values compared to predicted values were recorded mostly for FEF50 and FEF25 in male and female art students. Smoking and non-smoking art students had similar reductions of lung function. Lung function data in medical students were within predicted values. CONCLUSIONS: Our data indicate that art students may be at risk of developing chronic respiratory symptoms and lung function changes as a result of their environmental exposure and their smoking habits.