Abstract Earthquakes are probably the scariest among the natural disasters that teach us about the forces of nature and their unpredictability. Knowing that there is nothing we can do to prevent the ...occurrence of an earthquake, we are forced to learn from our own experience. This paper systematizes the environmental, medical and public health impacts of earthquakes. Each is presented in a structured way, highlighting its most important aspects. The relationship between them and the affected environment and population; as well as the connection between these are emphasized during earthquakes. The environment at the place of occurrence of an earthquake is important for the survival of victims and also defines the particular medical and public health needs arising from its specificity. Every country needs good disaster management with specific protocols for the expected type of disaster. These protocols must incorporate environmental, medical and public health aspects and their implementation must be very efficient; they must include educating the inhabit- ants; training teams involved in rescue, (eventual) migration/ evacuation, medical treatments and public health actions, and training and educating leaders.
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.
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.
•Analysis of crisis management on the example of the COVID-19 pandemic co-occurring with two earthquakes in Zagreb, Croatia.•Vulnerability and resilience offer explanations for the stimulating effects of optimal stress during crisis events.•Arndt-Schulz Law and Hans Selye’s general adaptation syndrome may explain complex disasters dynamics.•Balance between vulnerability and resilience affected by complex crises may be influenced with comprehensive health policy.
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.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.
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.
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
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.
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.
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.
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.
Our aim was to examine the prevalence and the impact of culture of blame on health workers' health.
A cross-sectional study on healthcare workers at two Croatian hospitals was conducted using the Hospital Survey on Patient Safety Culture (PSC).
: 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.
: 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.
Zračenje je energija koja putuje kroz prostor i prisutna je svugdje oko nas. Život na zemlji razvijao se u okruženju ionizirajućeg zračenja. Otkrićem ionizirajućeg zračenja započinje značajno ...razdoblje u medicinskoj dijagnostici i liječenju. Otkrićem rendgenskog zračenja i njegovom upotrebom u medicini raste i svijest o njegovim štetnim učincima na ljudski organizam. Sve veća uporaba ionizirajućeg zračenja povećava mogućnost nastanka štetnosti opasnih za zdravlje ako se ono ne koristi pravilno. U zdravstvenim ustanovama ionizirajuće zračenje koristi se u dijagnostičkoj i intervencijskoj radiologiji, nuklearnoj medicini i onkologiji. Svakodnevnim razvojem medicinske radiologije dolazi se do novih spoznaja povezanih s dijagnosticiranjem i liječenjem, a samim time i do usavršavanja pojedinih postupaka. Medicinske sestre/tehničari koji su svakodnevno ili povremeno izloženi tijekom svojeg rada ionizirajućem zračenju mogu smanjiti opasnost nepoželjnih posljedica od zračenja odgovarajućom zaštitom na radu koja će spriječiti nepotrebnu izloženost velikim dozama. Ciljevi članka jesu osvrt i doprinos sustavu očuvanja i zaštiti zdravlja medicinskih sestra/tehničara koji su izloženi izvorima ionizirajućeg zračenja kao i njihovom sigurnom radu. Prikazani su prevencija, edukacija i mjere zaštite od ionizirajućeg zračenja koje je potrebno poduzeti kako bi se smanjila izloženost te štetan utjecaj za zdravlje čovjeka.
Dokazano je da izlaganje ionizirajućem zračenju štetno te su njegovi učinci mutageni, teratogeni i karcinogeni. Učinci se mogu javiti u različitim oblicima i različitim vremenskim rasponima. Izloženost medicinskih sestara/tehničara ionizirajućem zračenju povezana je s brojnim zdravstvenim rizicima. U cilju smanjenja negativnih posljedica potrebna je dobra stručna edukacija kao prvi preduvjet zaštite: dobro poznavanje posljedica zračenja te svih sredstava i metoda za smanjivanje izloženosti zračenju. Zaštita na radu medicinskih sestara/tehničara uključuje korištenje zaštitne odjeće, nošenje dozimetara i redovite sistematske preglede. Važna je stalna kontrola uređaja i njihovih dijelova prema zadanom Pravilniku, kontrola prostora gdje se izvode snimanja, provjera educiranosti osoblja, redovitost sistematskih pregleda te poštovanje nošenja zaštitne odjeće i njezine dostupnosti.
Radiation is the energy that travels through space and is present everywhere around us. Life on earth evolved in an environment of ionizing radiation. The discovery of ionizing radiation marks the beginning of a significant period in medical diagnosis and treatment. The discovery of X-rays and their use in medicine prompted a growing awareness of their adverse effects on the human body. Increased use of ionizing radiation increases the likelihood of harmful health hazards if
it is not used properly. In healthcare settings, ionizing radiation is used in diagnostic and interventional radiology, nuclear medicine and oncology. Ongoing development of medical radiology brings new insights related to diagnosis and treatment, and thus to the refinement of certain procedures. Nurses/technicians exposed to ionizing radiation on a
daily or occasional basis during their work may reduce the risk of undesired radiation exposure with adequate occupational safety measures that will prevent unnecessary exposure to high doses.
The paper aims to review and contribute to the preservation and protection of the health of nurses/ technicians exposed to ionizing radiation sources and their safe work. Prevention, education, and ionizing radiation protection measures to be taken to reduce exposure are presented, including adverse effects on human health.
Exposure to ionizing radiation has been shown to be harmful and its effects are mutagenic, teratogenic and carcinogenic. These effects can occur in different forms and in different time spans. Nurses/technicians' exposure to ionizing radiation is associated with a number of health risks. In order to reduce the negative effects, a good professional education is needed as a first prerequisite for protection.
It involves thorough knowledge of the consequences of radiation, and of
all means and methods for reducing radiation exposure. Occupational safety for nurses/technicians includes the use of protective clothing, wearing dosimeters and regular medical check-ups. It is important to maintain the equipment and its parts in compliance with the advised regulations, keep safe the environment where imaging is performed, supervise the education of the staff, ensure regular medical check-ups, make sure that the staff wear protective clothing and that adequate protective clothing is always available.
Posljednjih desetljeća puno se istražuje i govori o stresu na radnom mjestu koji je povezan s fizičkim, psihičkim ili socijalnim odgovorom, tj. disfunkcijom koja proizlazi iz osjećaja osobe da ne ...može ispuniti sve što se od nje očekuje, a može ga uzrokovati niz različitih čimbenika kao što su količina rada, organizacija posla, loša komunikacija, radno okruženje i slično. Sindrom izgaranja nastaje kao posljedica prisutnosti više stresora na radnom mjestu te dugotrajne izloženosti istima. Cilj ovog rada bio je istražiti prisutnost i intenzitet profesionalnog stresa i sindroma izgaranja kod djelatnika intenzivne psihijatrijske skrbi i hitne medicine. Također, istraživani su čimbenici psihofizioloških napora povezanih s većim intenzitetom stresa u ispitanika te čimbenici povezani sa sindromom izgaranja. U istraživanje bilo je uključeno 63 djelatnika intenzivne psihijatrijske skrbi Klinike za psihijatriju Vrapče i 63 djelatnika Nastavnog zavoda za hitnu medicinu Grada Zagreba. Korištena su tri standardizirana upitnika za samoprocjenu. Rezultati analize stresa na radnom mjestu kao značajnu izdvajaju kategoriju stresora „Organizacija radnog mjesta i financijska pitanja“. U toj kategoriji 70 % (N=88) od ukupnog broja ispitanika smatra da je stresor pod nazivom „Preopterećenost poslom“ dominantan izvor stresa (P=0,004). Procjena psihofizioloških napora pokazuje statistički značajnu razliku u kategorijama „Pritisak na poslu“ (P=0,001) i „Stres uzrokovan premalim radnim opterećenjem“ (P=0,004). Pri procjeni sindroma izgaranja 31,7 % (N=40) ispitanika ne pokazuje prisutnost sindroma izgaranja. Početno izgaranje uočeno je u 42,1 % (N=53) ispitanika, a visok stupanj izgaranja u 26,2 % (N=33) ispitanika. Rezultati dobiveni u ovom istraživanju ukazuju na potrebu provedbe programa sustavne prevencije i pomoći kod profesionalnog stresa i sindroma izgaranja te prepoznavanje specifičnih stresora za pojedinu ustanovu.
In the last decades professional stress taking the form of physical, psychological and social response has been investigated. The dysfunction caused by stress rests on a person's feeling that workplace demands cannot be fulfilled as expected. This is due to a series of factors: overwhelming workload, inadequate job organization, poor communication, and overall work environment. Burnout syndrome occurs as a result of multiple stressors in the workplace and long-term exposure to them. The aim of this study was to investigate the presence and intensity of professional stress and burnout syndrome in intensive psychiatric care and emergency medicine employees. The factors of psychophysiological work-related strains and their relation to higher intensity of stress and burnout syndrome in participants were explored. The survey included 63 intensive psychiatric care employees at the University Psychiatric Hospital Vrapče and 63 employees at the Institute of Emergency Medicine Zagreb. Three standardized self-assessment questionnaires were used. The results obtained by analyzing workplace stress highlight stressor category “Workplace organization and financial issues”. In this particular category 70% (N=88) of all participants believe that the stressor called “Excessive work” is a dominant source of stress (p=0.004). In assessing psychophysiological work-related strains, a statistically significant difference was found in the category “Pressure at work” (p=0.001) and “Stress caused by low workload” (p=0.004). In the evaluation of the burnout syndrome, 31.7% (N=40) of all participants was found without syndrome. Initial burnout was found in 42.1% (N= 53) of all participants, and 26.2% (N=33) of all participants showed a high degree of burnout. The results indicate the necessity of developing systematic programs for the prevention of professional stress with appropriate measures to improve working conditions in certain institutions.
Abstract
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.
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