Impact of antibiotic consumption on the carriage of antibiotic-resistant bacteria by school children.

BACKGROUND: Antibiotic consumption in the paediatric population is one of the key drivers of the emergence and spread of antimicrobial resistance, which is a serious global threat to public health and clinical medicine. The aims of this study were to investigate systemic antibiotic consumption in school children and to assess the associations among antibiotic consumption, carriage rate and resistance of respiratory pathogens residing in the upper respiratory tract mucosa. METHODS: In this prospective study, throat and nasopharyngeal swabs from 450 school children, 6-15 years of age (225 healthy children and 225 patients who were ambulatory treated for upper respiratory tract infection), were processed in 2014 in Rijeka, Croatia, and clinical data were obtained via a questionnaire. RESULTS: In total, 17% of the children had consumed an antibiotic in the previous 6 months, including 7% of the healthy children and 27% of the acutely ill patients. The most commonly prescribed antibiotics were amoxicillin (26%), amoxicillin with clavulanic acid (26%) and macrolides (18%). Respiratory pathogens were more frequently isolated from children who had consumed an antibiotic in the previous 6 months [odds ratio (OR) 3.67, P < 0.001]. Antibiotic-resistant bacteria were also more frequent in children who had been exposed to antibiotics (OR 5.44, P < 0.001). CONCLUSIONS: Penicillins are the most frequently used antibiotics among school children. The results of this study demonstrate that antibiotic consumption is linked with higher carriage rates and resistance rates of respiratory tract pathogens. Therefore, rational use of antibiotics could prevent the emergence and spread of resistant bacteria.

Development of the Croatian model of organ donation and transplantation.

During the past ten years, the efforts to improve and organize the national transplantation system in Croatia have resulted in a steadily growing donor rate, which reached its highest level in 2011, with 33.6 utilized donors per million population (p.m.p.). Nowadays, Croatia is one of the leading countries in the world according to deceased donation and transplantation rates. Between 2008 and 2011, the waiting list for kidney transplantation decreased by 37.2% (from 430 to 270 persons waiting for a transplant) and the median waiting time decreased from 46 to 24 months. The Croatian model has been internationally recognized as successful and there are plans for its implementation in other countries. We analyzed the key factors that contributed to the development of this successful model for organ donation and transplantation. These are primarily the appointment of hospital and national transplant coordinators, implementation of a new financial model with donor hospital reimbursement, public awareness campaign, international cooperation, adoption of new legislation, and implementation of a donor quality assurance program. The selection of key factors is based on the authors' opinions; we are open for further discussion and propose systematic research into the issue.

Croatian children's views towards importance of health care information.

The aim of research was to investigate: the need for health care information of Croatian adolescents aged from 13 to 18 years; the difference in evaluation of the frequency of receiving information between hospitalized and healthy children; if the hospitalized children expectations about the frequency of receiving health care information differed significantly from information they have actually received; whose information was most comprehensible to the hospitalized children (doctors, parents, other health care givers). The children were either hospitalized in the pediatrics departments or were high schools pupils (healthy children). The hospitalized children "Completely agreed" (92.7%) with the statement "When I am sick, I should receive information about my health" in comparison to the healthy children (85.1%). In comparison to healthy children, the hospitalized children assessed that doctors, other health care givers and parents should give them information more frequently. The experience of hospitalized children indicate that they received less information then they have actually excepted. The information received from doctors was mostly in correlation with the understanding of this information. We concluded that the children want to be informed about their health, especially hospitalized children. Health care professionals should offer understandable health care information according to the children's expectation.

The influence of medical and nonmedical factors to the progression of renal osteodystrophy.

We report a 13-year-old boy hospitalized for the first time at the age of 17 months with clinical and laboratory signs of chronic kidney disease (CKD) and renal osteodystrophy caused by severe obstructive uropathy of the single kidney. Prevention and treatment of renal osteodystrophy has been target for aggressive therapy and the great challenge for pediatric nephrologists. The outcome of the therapy of renal osteodystrophy is influenced by medical and non-medical factors. It was concluded that the place of living (in our example a small village distant from primary care physicians, far from the social care professionals and far from the hospital), inferior social and economical status with inadequate nutrition present negative factors that contributed to the outcome and development of CKD and its complications as is renal osteodystrohy. The coordination of medical and non-medical professionals is necessary on the primary and secondary level to achieve positive results of therapy in patients with CKD.

Influence of the "Rijeka model" of bioethics education on attitudes of medical students towards death and dying--a cross sectional study.

The aim of this study was to assess attitude towards euthanasia, and the influence of socio-demographic data and death education carried out through the "Rijeka model" of bioethics education for the first-year medical students of the School of Medicine, University of Rijeka, Croatia. The cross-sectional study was conducted in the academic year 20031 2004. 124 (61% female) participants were surveyed by using an anonymous questionnaire before and after training. Catholics (p = 0.003) and students from areas with populations of less than 50,000 inhabitants (p = 0.001) had significantly negative attitude towards euthanasia than others before the course, yet no differences were found following this training. Attitude towards euthanasia was significantly positive after the course (p = 0.005). All items in the questionnaire, except "Croatia should legalise euthanasia", received more positive scores after the course. Death education carried through the "Rijeka model" of bioethics education has changed attitudes of medical students towards a more positive perception of euthanasia.