CRUSH SYNDROME IN EARTHQUAKES - STAY AND PLAY OR LOAD AND GO?

Earthquakes are unpredictable natural disasters accompanied by material damage and many victims. In the case of a person remaining trapped under the collapsed material, the development of crush syndrome can occur. Crush syndrome is the result of traumatic rhabdomyolysis and is present in 2%-15% of all injured persons in an earthquake. It is not easy to recognize, and proper treatment is challenging. Persons who have a clear crush injury and/or have been immobilized for more than four hours should be considered potential victims of crush syndrome. Therefore, knowledge about crush syndrome must be comprehensive and accessible to all parties involved. In this paper, the management of crush syndrome victims, which includes the principles of triage, and medical and logistic principles as well, is presented. Triage principles are presented at the level of triage priorities, places, and diagnoses. Medical principles, crucial for crush syndrome, are presented regarding the duration of compression and time before or after extraction of the patient. Logistic principles provide an overview of the priorities and modes of transport in relation to distance of health institutions, and the importance of management and education associated with crush syndrome. Each country with recognized disasters (natural or man-made) in which crush-related victims are expected, will benefit if the knowledge about triage, medical and logistic principles for crush syndrome is incorporated in their educational programs and regularly updated.

A case study of complex disasters within the resilience framework in Zagreb, Croatia: Two earthquakes in one pandemic.

This paper is an analysis of complex crisis management and the importance of resilience on the example of co-occurring disasters. A resilience framework model was analyzed based on epidemiologic data and the interplay of several disasters; the COVID-19 pandemic and two 2020 Zagreb, Croatia earthquakes. A dose-response principle may be applied to a complex crisis scenario, within a resilience-vulnerability framework. The available data present the concept of balance between vulnerability and resilience of the population affected by complex crises as well as possible adaptation mechanisms. Multiple disasters that last for a prolonged period reduce the populations' resilience and increase the risk of the next crisis becoming a disaster as well. Such complex disasters should not be approached by multiple risk management protocols, but rather by a single, multilayered protocol. Health policies that predict the possible effects of complex disasters on health risk management need to provide measures to maintain and promote resilience instead of collapse. These is a clear need to adopt green environmental policies, reduce socioeconomic inequality, train volunteer managers during crises, introduce timely evidence-informed policies and transfer new research and innovations in society rapidly.

Methodological considerations in injury burden of disease studies across Europe: a systematic literature review.

BACKGROUND: Calculating the disease burden due to injury is complex, as it requires many methodological choices. Until now, an overview of the methodological design choices that have been made in burden of disease (BoD) studies in injury populations is not available. The aim of this systematic literature review was to identify existing injury BoD studies undertaken across Europe and to comprehensively review the methodological design choices and assumption parameters that have been made to calculate years of life lost (YLL) and years lived with disability (YLD) in these studies. METHODS: We searched EMBASE, MEDLINE, Cochrane Central, Google Scholar, and Web of Science, and the grey literature supplemented by handsearching, for BoD studies. We included injury BoD studies that quantified the BoD expressed in YLL, YLD, and disability-adjusted life years (DALY) in countries within the European Region between early-1990 and mid-2021. RESULTS: We retrieved 2,914 results of which 48 performed an injury-specific BoD assessment. Single-country independent and Global Burden of Disease (GBD)-linked injury BoD studies were performed in 11 European countries. Approximately 79% of injury BoD studies reported the BoD by external cause-of-injury. Most independent studies used the incidence-based approach to calculate YLDs. About half of the injury disease burden studies applied disability weights (DWs) developed by the GBD study. Almost all independent injury studies have determined YLL using national life tables. CONCLUSIONS: Considerable methodological variation across independent injury BoD assessments was observed; differences were mainly apparent in the design choices and assumption parameters towards injury YLD calculations, implementation of DWs, and the choice of life table for YLL calculations. Development and use of guidelines for performing and reporting of injury BoD studies is crucial to enhance transparency and comparability of injury BoD estimates across Europe and beyond.

Digital technology and HIV, HCV and STI voluntary counselling and testing: good practice example from Croatia.

The aim of this paper is to introduce the digitalization process and its effects on better reach of the target population. Progress in the digitalization and e-health tools worldwide enables new opportunities in prevention, diagnostics and treatment for people living with HIV (PLHIV) and people in the risk of HIV infection, hepatitis C (HCV) and other sexually transmitted infections (STIs), especially in the context of the COVID-19 pandemic. The system already used for voluntary counselling and testing (VCT) at the CheckPoint Centre Zagreb run by the non-governmental organization (NGO) Croatian Association for HIV and Viral Hepatitis (CAHIV) was upgraded and adapted (due to the COVID-19 prevention epidemiological measures) and developed for implementation of the pilot project of feasibility and acceptability of home HIV self-testing (HIVST) among men who have sex with men (MSM) in Zagreb. A special feature of the HIVST mobile application enables an innovative approach in collecting clients' test result feedback. This paper presents the method of use digitalization of the VCT and HIVST activities to support and increase availability of screening testing. Described procedures of new technologies application in VCT services and preliminary results of the HIVST pilot project indicate that technology-delivered interventions can contribute and improve access and utilisation of HIV/STI prevention and care services.

Epigenetic Imprint of "Compassionate Society" Triggered by Vulnerability and Mental Illnesses.

Epigenetics investigates connection between our genes and our environment. It has been hypothesized that certain conditions we experience can influence our gene expression and can probably be passed onto our children, transgenerational transfer of trauma being one of them. We postulate that the notion of compassion has also been passed on from one generation to another. Our ancestors discovered that groups have a higher chance of survival than individuals. Thus, psychological traits that help form social cohesion, like compassion, are proven beneficial and passed onto the next generation. However, our perception of compassion has changed through time. In the beginning, it was expressed as a feeling of sympathy for the vulnerable, for example the elderly, the sick, pregnant women and children. These groups were innately perceived as deserving compassion. As our social awareness grew, so did the list of vulnerable groups, including members of different races, sexual or gender orientations, etc. Over time, a shift in the way we feel compassion has occurred. Nowadays, it almost seems like only those belonging to a vulnerable group are justified to feel suffering or oppression. At the same time, the suffering of those who do not belong to these exclusive vulnerable groups is marginalized. Mental illnesses like anxiety or depression are trivialized if the person in question is perceived as being privileged (in any sense), while at the same time, they are seen as warning signs if the person suffering is vulnerable. If one truly needs attention, help, or both, the easiest way is to declare oneself vulnerable. If this trend continues, we postulate that a lack of compassion in our modern society will have an impact on future societies as well. Through transgenerational epigenetic inheritance, this can create future societies whose sense of compassion will be shaped only by the definition/perception of those who are currently perceived as vulnerable.

Victims of disaster: can ethical debriefings be of help to care for their suffering?

Victims of disaster suffer, not only at the very moment of the disaster, but also years after the disaster has taken place, they are still in an emotional journey. While many moral perspectives focus on the moment of the disaster itself, a lot of work is to be done years after the disaster. How do people go through their suffering and how can we take care of them? Research on human suffering after a major catastrophe, using an ethics of care perspective, is scarce. People suffering from disasters are often called to be in distress and their emotional difficulties 'medicalised'. This brings them often into a situation of long term use of medication, and one can wonder if medication is of help to them in the long run. In our paper, we will explore another moral perspective, focusing on the importance of the victims' narrative and their lived experiences. We will use Paul Ricoeur's phenomenological reflections from 'Suffering is not the same as pain' for conceptualizing human suffering and how to apply it to victims of disaster. Ricoeur suggests that suffering is not a quantity that can be measured, but a characteristic that should be studied qualitatively in interpersonal and narrative contexts. Above all, the perspective of care and listening could offer an opportunity to reconcile people from their loss and suffering.

Thermography--a feasible method for screening breast cancer?

Potential use of thermography for more effective detection of breast carcinoma was evaluated on 26 patients scheduled for breast carcinoma surgery. Ultrasonographic scan, mammography and thermography were performed at the University Hospital for Tumors. Thermographic imaging was performed using a new generation of digital thermal cameras with high sensitivity and resolution (ThermoTracer TH7102WL, NEC). Five images for each patient were recorded: front, right semi-oblique, right oblique, left- semi oblique and left oblique. While mammography detected 31 changes in 26 patients, thermography was more sensitive and detected 6 more changes in the same patients. All 37 changes were subjected to the cytological analysis and it was found that 16 of samples were malignant, 8 were suspected malignant and 11 were benign with atypia or proliferation while only 2 samples had benign findings. The pathohistological method (PHD) recorded 75.75% malignant changes within the total number of samples. Statistical analysis of the data has shown a probability of a correct mammographic finding in 85% of the cases (sensitivity of 85%, specificity of 84%) and a probability of a correct thermographic finding in 92% of the cases (sensitivity of 100%, specificity of 79%). As breast cancer remains the most prevalent cancer in women and thermography exhibited superior sensitivity, we believe that thermography should immediately find its place in the screening programs for early detection of breast carcinoma, in order to reduce the sufferings from this devastating disease.

Self-reported HPV vaccination status and HPV vaccine hesitancy in a nationally representative sample of emerging adults in Croatia.

Introduction: The aim of this study was to determine self-reported human papillomavirus (HPV) vaccination status among emerging adults in Croatia, intention to get the HPV vaccine among unvaccinated individuals and correlates of HPV vaccine hesitancy. Methods: Data were collected via a cross-sectional survey based on a probabilistic national sample. The sample included 1,197 individuals aged 18-25 years (50.6% were women) who were recruited from November 2021 to February 2022 as part of the commercial online panel. Analyses included 981 participants who correctly answered two "attention trap" questions using descriptive statistics and multivariate analyses. The data were post-hoc weighted for gender and age and adjusted for clustering effect. To adjust standard errors for the sampling design, multivariate analyses were carried out using the complex samples module in the IBM SPSS 27 statistical software package. Results: Overall, 18.3% of participants (25.0% of women and 11.7% of men) reported that they were HPV vaccinated, while 21.9% did not know their HPV vaccination status. Of those vaccinated, 65.6% were women. The odds of being HPV-vaccinated were significantly higher among female participants. Among the unvaccinated, 35.4% expressed a willingness to get the vaccine. The odds of vaccination hesitancy were significantly lower among women, participants who reported a higher perceived risk of STIs, those who recognized that HPV could result in cervical cancer, and significantly higher among those who were more religious. Conclusion: Our findings suggest a need to increase HPV vaccination uptake in Croatia through raising awareness about HPV vaccine effectiveness and also through the implementation of strategies to make vaccination more available.

[Preemptive kidney transplantation in children--experience in UHC Zagreb]. / Preemptivna transplantacija bubrega u djece--iskustvo KBC-a Zagreb.

AIM: To discuss preemptive kidney transplantation outcomes in children with end stage kidney disease. METHODS: We present the data of patients younger than 18 years who were transplanted without previous dialysis in our Clinic. We retrospectively analyzed data available in medical health records. RESULTS: Preemptive living donor kidney transplantation was performed in 6 patients younger than 18 years. Creatinine clearance before transplantation was 9 +/- 4.15 ml/min (range = 2.7-12.3 ml/min, median = 8.5 ml/min). Currently, serum creatinine in patients with functioning graft is 139.4 +/- 60.9 micromol/l (range = 72-237 micromol/l, median = 130 micromol/l). One, three and five year graft survival was 100%. Overall graft and patient survival in the follow-up period was 83.3% and 100%, respectively. After 10 years one patient started with dialysis due to chronic graft rejection. CONCLUSION: From medical and socioeconomic point of view preemptive transplantation is optimal method for treatment of children with end-stage kidney disease. Membership in Eurotransplant should increase the number of preemptive transplantations in Croatia.

Management of Cardiac Patients in Epidemic Outbreak.

In times of COVID-19 epidemic/pandemic, cardiac patients are vulnerable group with many specific conditions that could aggravate their condition. In this narrative review, we present possible measures adequate in managing cardiac patients in epidemic outbreak. An overview of the role of cardiologists and Crisis Management Team in management of cardiac patients is given. Protocols and measures implemented in COVID-19 crises are presented in light of risk assessment and disease prevention of cardiac patients and measures that should be taken for each cardiac condition. Specificity of epidemics calls for specific measures in addressing cardiac patients as part of the affected population. Many possible outcomes could be expected in an epidemic outbreak in relation to cardiovascular diseases, but tailored measures will keep cardiac patients safe. Proposed preventive measures for cardiac patients could be implemented in existing protocols for epidemic outbreak.

Differences in eating and lifestyle habits between first- and sixth-year medical students from Zagreb.

Eating and lifestyle habits of first (n=169) and sixth (n=272) year students, aged 18 to 26 years, attending a Medical School in Zagreb, were compared related to the years of study. A self-administered questionnaire created for this study incorporated a food frequency questionnaire. Both year students reported similar number of meals per day, irregular consumption of meals, skipping breakfast, frequency of vegetables, fruits, cereals, sweets, milk and dairy products consumption, body mass index (BMI) calculated from self-reported weight and height and alcohol consumption. Significant differences between groups were observed in consuming supper (p = 0.001), being on diet (p = 0.032), intake of supplements (p = 0.041), meat (p < 0.001), dried meat (p = 0.027), coffee and tea consumption (p = 0.016), physical activity (p = 0.041; p = 0.016), and smoking (p = 0.029). This study showed non-healthy eating arid lifestyle behavior among Medical School students. We observed association between the year of study, and some of the eating habits and lifestyle factors.

[Food processing industry--the salt shock to the consumers]. / Prehrambena industrija--udar soli na potrosace.

Industrial food production and processing is necessarily connected with the use of salt. Salt or sodium chloride is used as a preservative, spice, agent for color maintenance, texture, and to regulate fermentation by stopping the growth of bacteria, yeast and mold. Besides kitchen salt, other types of salt that also contain sodium are used in various technological processes in food preparing industry. Most of the "hidden" salt, 70%-75%, can be brought to the body by using industrial food, which, unfortunately, has been increasingly used due to the modern way of life. Bread and bakery products, meat products, various sauces, dried fish, various types of cheese, fast food, conserved vegetables, ready-made soups and food additives are the most common industrial foods rich in sodium. Many actions have been taken all over the world to restrict salt consumption. The World Health Organization recommends the upper limit of salt input of 5 g per day. These actions appeal to food industry to reduce the proportion of salt in their products. Besides lower salt addition during manufacture, food industry can use salt substitutes, in particular potassium chloride (KCl), in combination with additives that can mask the absence of salt, and flavor intensifiers that also enhance the product salinity. However, food industry is still quite resistant to reducing salt in their products for fear from losing profits.

[Dietary habits and cardiovascular diseases]. / Prehrambene navike i kardiovaskularne bolesti.

Cardiovascular diseases are a major public health problem worldwide. They are the main cause of death in industrialized countries, while the mortality associated with cardiovascular disease is increasing in less developed countries. The modifiable risk factors for cardiovascular disease are cigarette smoking, hypertension, hyperlipidemia, diabetes mellitus and obesity. Obesity has been recorded in 10%-25% of the population, indicating that poor or inappropriate diet is one of the most common causes of cardiovascular disease. Unhealthy dietary habits including place and way of taking meals, number of daily meals and excessive salt intake from processed foods also contribute to body mass gain. In the present study, dietary habits were assessed in cardiovascular patients versus control group by use of Dietary Habits Questionnaire. Study results showed a statistically significantly higher (P < 0.05) prevalence of inappropriate eating habits in cardiovascular patients (lower number of daily meals, more often skipping breakfast and having dinner) than in control group. In conclusion, many lifestyle and individual behavior modifications are needed in most patients with or at a high risk of cardiovascular disease.

Treatment of pineal region lesions: our experience in 39 patients.

The pineal region is the origin of lesions with a highly diverse histopathology. The aim of this study was to present our experience in treating patients with the pineal region lesions. In period between 1990 and 2007, 39 patients with pineal region lesions were operated on at the Department of Neurosurgery, University Hospital "Sestre milosrdnice", Zagreb, Croatia. The study group consisted of 21 female and 18 male patients with the median age of 24.4 years (4-66 years). Surgery was performed using the infratentorial supracerebellar approach in all patients. The pineal region lesions were removed totally in 23 (58.97%), subtotal in 14 (35.9%) and partially in 2 (5.13%) patients. Pathohistological examination revealed 13 pineocytomas (33.33%), 10 germinomas (25.64%), 7 glial cysts (17.94%), 3 pineoblastomas (7.69%), two pilocytic astrocytomas (7.69%) and one case (2.56%) of papilloma plexus chorioideus, epidermal cyst, yolk sack tumor and ganglioglioma. There was no surgical mortality. Thirteen patients (33.3%) experienced complications in the postoperative period. During the follow-up period that ranged from 3 to 48 months six patients died (15.4%). The infratentorial supracerebellar approach is a safe and effective surgical approach. Benign pineal lesions could be cured with surgery alone. In the case of malignant pineal lesions radical surgical resection allowed determining the exact pathohistological diagnosis and facilitated adjuvant therapy (irradiation and chemotherapy).

Regional differences in dietary habits of adult Croatian population.

The aim of this study was to investigate the dietary habits of the adult Croatian population according to geographical regions and gender. Date was obtained from the Croatian Adult Health Survey questionnaire, carried out in six regions of Republic of Croatia (Eastern, Northern, Central, City of Zagreb, Mountainous and Coastal), with a total of 9,070 responses. Results have shown that the highest prevalence of unhealthy dietary habits was recorded in Eastern and Central regions, while Coastal region and city of Zagreb had significantly lower prevalence of unhealthy dietary habits (P < 0.05). Prevalence of unhealthy dietary habits was higher in men in all regions. Women had healthier dietary habits, what was strongly expressed in Coastal and Mountainous region. This study has shown that the unhealthy dietary habits were practiced by approximately one quarter of the adult population, regardless on the region in which they resided. Regional differences in dietary habits should be taken into account in any new public health studies and interventions.

[Mortality caused by injury, poisoning and other consequences of external causes in the Split-Dalmatia county population 2001-2005]. / Smrtnost stanovnistva splitsko-dalmatinske zupanije zbog ozljeda, otrovanja i ostalih posljedica vanjskih uzroka u razdoblju 2001-2005.

AIM: To present mortality caused by injury, poisoning and other consequences of external causes (S00-T98, ICD-10) in the Split-Dalmatia County population during the 2001-2005 period. METHODS: The methods of descriptive epidemiology were used. We included all County population with the diagnosis of fatal injuries (S00-T98, ICD-10) recorded during the study period. Mortality data were collected from the Central Bureau of Statistics. The distribution of mortality indicators according to the cause of death, age and sex is presented as absolute numbers, percentage and specific rates per 100,000 population. RESULTS: The group of injury, poisoning and other consequences of external causes (S00-T98, ICD-10) was the third or fourth leading cause of death in the County population, both males and females. During the study period, the specific injury mortality rates showed no significant oscillations. In this group, male subjects and those aged 75 or older were found to predominate. Concerning external causes of mortality, we determined the circumstances in which fatal injuries were inflicted. Falls were the leading cause of injury and death in females aged 75 or older. Traffic accidents predominantly involved younger and older males, while deliberate self-harm was most common in middle-aged and old aged subjects, male in particular. CONCLUSION: The role of public health is to point to the prevention of injuries because of their growing tendency in the population.

Culture of Blame-An Ongoing Burden for Doctors and Patient Safety.

Introduction: Every procedure in healthcare carries a certain degree of inherent unsafety resulting from problems in practice, which might lead to a healthcare adverse event (HAE). It is very important, and even mandatory, to report HAE. The point of HAE reporting is not to blame the person, but to learn from the HAE in order to prevent future HAEs. Study question: Our aim was to examine the prevalence and the impact of culture of blame on health workers' health. Methods: A cross-sectional study on healthcare workers at two Croatian hospitals was conducted using the Hospital Survey on Patient Safety Culture (PSC). Results: The majority of PSC dimensions in both hospitals were high. Among the dimensions, Hospital Handoffs and Transitions and Overall Perceptions of Safety had the highest values. The Nonpunitive Response to Error dimension had low values, indicating the ongoing culture of blame. The Staffing dimension had low values, indicating the ongoing shortage of doctors and nurses. Discussion: We found inconsistencies between a single-item measure and PSC dimensions. It was expected that Frequency of Events Reported (PSC dimension) relates to Number of Events Reported (single-item measure). However, in our study, the relations between these pairs of measures were different between hospitals. Our results indicate the ongoing culture of blame. Healthcare workers do not report HAE because they fear they will be punished by management or by law.

Ethics and Floods: A Systematic Review.

Disaster ethics is a developing field of inquiry recognizing the wide variety of ethical issues confronting various professionals involved in planning for and responding to different types of disasters. This article explores how ethical issues related to floods are addressed in academic literature. The review involved analysis of publications on ethics and floods identified in a systematic literature search of electronic databases that included sociological, biomedical, and geophysical sources. The review methods were guided by the PRISMA Statement on systematic reviews, adapted to this topic area, and followed by a qualitative analysis of the included publications. All articles were analyzed using NVivo software version 11. The qualitative analysis showed that further research is needed on the ethical issues involved in flood disasters. Ethical guidelines are needed for flood planners and responders that are based on the consistent application of well-established ethical principles, values, and virtues to the specific circumstances arising with each flood. Flexibility is required in applying such approaches. The results suggest that interdisciplinary collaboration (sociological, biomedical, geophysical, engineering, and ethical) could contribute significantly to the development of ethics in floods. (Disaster Med Public Health Preparedness. 2019;13:817-828).

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.