Blunt trauma of thorax with subclavian and axillary artery lesion--case report.

We report a rare case of blunt trauma of the axillary artery in a 20-year-old man who was injured as a motorcycle rider and received severe body injuries. Injuries included severe trauma of the left lower leg with contusion and extensive soft tissue and bone trauma of these regions with poor general condition and with the presence of clinical signs of traumatic shock. Upon arrival, we found that in addition to earlier clearly visible trauma to the leg, there was a hematoma of the medial side of the left supraclavicular region and the absence of the radial artery pulse with paralysis of the left arm. Given the clinical findings, emergency radiological examination was made to the patient (X-ray, US, CDFI, MSCT-angiography) and we found out that there was trauma of axillary artery with clear signs of thrombosis of extra thoracic part of subclavian artery due to its transition into the axillary artery. After hemodynamic stabilization, above knee amputation of the left leg was performed and emergency exploration of earlier mentioned arteries. Bypass of the damaged arteries with synthetic graft 6 mm in diameter was made. Control MSCT angiography showed normal flow in the arterial tree of the whole left hand and the MRI of the cervical spine and shoulder girdle did not found lesions of the brachial plexus. SSEP demonstrated the absence of pulses on the left hand. Patient on regular check-ups showed normal general condition, with adequate passable graft and pronounced paralysis on the left hand. In the process of rehabilitation physiotherapy was also included. Blunt trauma to the axillary artery is an extremely rare example of trauma of blood vessels which makes only 0.03% of all vascular injuries.

Alcohol-related road traffic accidents before and after the passing of the Road Traffic Safety Act in Croatia.

The aim of this study was to gather enough data in order to formulate theory- and research-based recommendations to policy makers with the intention of decreasing the number of alcohol-related accidents and victims on Croatian roads. The data on the injured traffic participants and the share of participants under the influence of alcohol were collected from the police reports of the Traffic Police Department, Ministry of the Interior, written at the scene of the respective accidents. This documentation was then processed by descriptive epidemiology and analysed through a four-year period, before and after the passing of the New Road Traffic Safety Act in the Republic of Croatia, on 20 August 2004. In the first six months of 2005, after the passing of the Act, there were 3,275 accidents caused by the motorists under the influence of alcohol (12.5% of all the accidents), with 64 persons killed. Only 5 fatalities (8%) were caused by the drivers with measured blood alcohol concentration of up to 0.5 per thousand. As much as 27 fatalities (42%) were caused by the drivers with measured more than 1.5 per thousand, while half of the fatalities, 32 (50%), were caused by drivers with 0.5-1.5 per thousand. In this period, more than 451,000 violations were recorded, whereas in the same period of the previous year, the number of violations was about 519,000. A reduction of the total number of accidents is the result of the new regulation provision, according to which the incidents without human victims do not have to be reported to the police. The number of traffic accidents caused by drivers under the influence of alcohol had increased by some dozen per cents, namely: 2005 - 6,219 persons, 2006- 6,590 persons, noting that in 2006 one less person was killed (123) compared to 2005. In 2005, drivers with alcohol concentration of 0-0.5 per thousand caused 1,096 accidents, with 14 fatalities, whereas in 2006 there were 1,164 accidents with 9 fatalities. A total of 2,314 accidents were caused by drivers with more than 0.5 per thousand and up to 1.5 per thousand in 2005 (in 2006 - 2,582), along with 53 fatalities (1 fewer than in 2006). Drivers with more than 1.5 per thousand participated in 2,809 accidents (2006 - 2,844), with the number of killed drivers amounting to 57, three fewer than in 2006. In light of these facts, alcohol use still remains a significant factor in road traffic accidents and is an important area for injury prevention efforts.

Physical inactivity changes in Croatia: the CroHort study.

The aim of this paper was to compare the surveys conducted respectively in 2003 and 2008 within the Croatian Adult Health Cohort Study (CroHort) regarding the physical activity/inactivity of the inhabitants of the Republic of Croatia. The collected data show a significant decline in the intensity of physical activity in 2008 with regards to 2003, regarding the way of getting to work (60.7%), the level of physical strain at work (72.2%), and the frequency of physical activity taken in the subjects' spare time (55.8%). In order to prevent the risk of cardiovascular diseases and to raise the public awareness of the potential health threat physical inactivity poses, a number of thoroughly conceived health promotion strategies should be implemented, which would equally encompass all the segments of Croatian society.

Civil aviation rules on crew flight time, flight duty, and rest: comparison of 10 ICAO member states.

INTRODUCTION: Members of the International Civil Aviation Organization (ICAO) use various criteria to control flight crew scheduling and rest periods with the intention of reducing fatigue and thus improving airline safety. Comparison of these rules across nations may allow future harmonization of the criteria. METHODS: The regulations of 10 ICAO member states were compiled to determine the factors used by each to control scheduling. RESULTS: We identified 12 factors that are used by member states in their regulations; specific nations use 4-7 of these factors. The most frequently used criteria and the number of states using them include Duty Time (N = 8), Crew Augmentation (N = 8), Night Flight (N = 7), Number of Flight Segments (pairs of takeoffs and landings--T/L) (N = 6), Flight Range (N = 6), Flight Time (N = 5), and Number of Crew (N = 5). All 10 states have established limits on Flight Time and/or Duty Time, and 6 have requirements related to Previous Rest and/or Night Sleep. Seven member states undertake regulation of Night Flying, but they vary in defining "night" and the maximum permissible duration of night duty. All states limit flying hours on a monthly and yearly basis, but the specified limits vary. DISCUSSION: Although the 10 states in this study have common aims and premises for regulating crew duty, their regulations diverge with respect to details, using different tools in an effort to prevent the occurrence of excessive fatigue in aircrew members.

Piracy on the high seas-threats to travelers' health.

BACKGROUND: Piracy has been threatening international sea trade and creating risk for crews and passengers worldwide. The problem is largely confined to the Somalia coast, West Africa, South America, and Southeast Asia. The targets are merchant ships, cruising yachts, and passenger ships with several thousand people on board. Such attacks can result in loss of lives, short- and long-term health problems, and can further be complicated by the consequences of hostage situations on shore. The purpose of this article is to present the problem of piracy, its relevance to the field of travel medicine, and help travel medicine practitioners to deal with its specifics before, during, and after attack. METHODS: Comprehensive literature research was done and published data from 2002 until 2012 from the International Chamber of Commerce specialized division-International Maritime Bureau (IMB)-on 3,806 attacks and 7,635 incidents involving human victims are analyzed. Available occupational health data in merchant marine and epidemiological data acquired on board cruise ships were used to estimate the health risks. RESULTS: From 2002 until 2012, 3,806 ships were attacked including 82 yachts and 13 passenger ships. A number of reported piracy attacks worldwide continued to threaten security and lives on sea. In 2012, 297 incidents of piracy and armed robbery were reported, a total of 585 crew members were taken hostage, 26 kidnapped, and 6 killed as a direct result of the incident.(1) CONCLUSION: The risk of being injured or killed by pirates on board cruise ships is actually very low. Piracy on the world's seas is in decline and remains a reasonably localized issue. While this improvement is a result of continued efforts of international naval forces, that protection is only partial and fails to suppress piracy completely. Piracy still presents significant threat to international travel, and future involvement of travel medicine practitioners in providing advice to travelers to piracy regions or victims of piracy is expected.

Fatality risk factors for bicyclists in Croatia.

AIM: To present the epidemiology of fatal bicyclist injuries in traffic accidents in Croatia. METHODS: Between January 1, 1997 and December 31, 2000, there were 253 bicyclist fatalities in Croatia. The data were collected from the police reports of the Department of Traffic Police, Ministry of the Interior, written at the place of the accident. The data were processed by descriptive epidemiology and compared by tests of significance. RESULTS: The percentage of bicyclist fatalities among total road fatalities showed a decreasing trend over the years, from 11.6% in 1998 to 8.2% in 2000. The most frequent type of accident involving bicyclist fatalities were accidents in car-bicycle collisions (lowest: 74.7% in 1998; and highest: 81.3% in 1997). Most accidents occurred at the beginning and at the end of the bicycle season--months of April and October. Elderly people were involved in accidents occurring mainly in the morning hours--from 6 to 12 a.m., whereas the youngest and the middle-aged got injured or killed mainly in the evening - 6 to 9 p.m. This association between the age and the part of day when the accident happened was statistically significant (chi square=36.51, p<0.0001). CONCLUSION: Bicycle-related fatal injuries as a part of total road fatalities showed a gradual decrease. Regulation of bicycle traffic, more stringent protection measures and their implementation, as well as preventive measures regarding the time of day are needed to further decrease bicyclist fatalities in traffic.