Nataša Janev Holcer

Health protection and risks for rescuers in cases of floods.

Abstract Floods can pose a number of safety and health hazards for flood-affected populations and rescuers and bring risk of injuries, infections, and diseases due to exposure to pathogenic microorganisms and different biological and chemical contaminants. The risk factors and possible health consequences for the rescuers involved in evacuation and rescuing operations during the May 2014 flood crisis in Croatia are shown, as well as measures for the prevention of injuries and illnesses. In cases of extreme floods, divers play a particularly important role in rescuing and first-response activities. Rescuing in contaminated floodwaters means that the used equipment such as diving suits should be disinfected afterwards. The need for securing the implementation of minimal health and safety measures for involved rescuers is paramount. Data regarding injuries and disease occurrences among rescuers are relatively scarce, indicating the need for medical surveillance systems that would monitor and record all injuries and disease occurrences among rescuers in order to ensure sound epidemiological data. The harmful effects of flooding can be reduced by legislation, improvement of flood forecasting, establishing early warning systems, and appropriate planning and education. Na poplavama pogođenom području mogu se kriti brojne opasnosti za sigurnost i zdravlje stanovništva i spasilaca, među kojima ozljede, infekcije i bolesti zbog izloženosti patogenim mikroorganizmima i raznim biološkim i kemijskim onečišćivačima. U radu su prikazani čimbenici rizika i moguće zdravstvene posljedice za spasioce koji su bili uključeni u evakuaciju i spašavanje tijekom poplava u Hrvatskoj u 2014. te mjere sprečavanja ozljeda i bolesti. U slučaju ekstremnih poplava ronioci imaju važnu ulogu u spašavanju. Akcije spašavanja iz potencijalno onečišćenih poplavnih voda dovode do potrebe dezinfekcije rabljene opreme, pri čemu je najvažnije da se spasiocima osigura provedba minimalnih zdravstvenih i sigurnosnih mjera. Vrlo je malo podataka o njihovim ozljedama i bolestima, što upućuje na potrebu da se uspostavi zdravstveno praćenje svih ozljeda i bolesti spasilaca kako bi se dobili odgovarajući epidemiološki podaci. Štetne posljedice poplava mogu biti umanjene zakonodavnim odredbama, unapređenjem sustava za predviđanje poplava, uspostavom sustava za pravodobno upozoravanje te odgovarajućim planiranjem i edukacijom.

The use of mercury-based medical devices across Croatian healthcare facilities.

The Use of Mercury-Based Medical Devices Across Croatian Healthcare Facilities In 2009, we conducted a survey to assess the use of mercury-based thermometers and sphygmomanometers and their disposal in Croatian healthcare facilities. The questionnaire addressing the use of mercury-based medical devices, waste management, preferences between mercury-based and electronic devices, and the knowledge on mercury toxicity was filled by ward nurses affiliated with 40 (71.4 %) out of 56 contacted healthcare facilities. Only one of these facilities had given up the use of mercury-containing medical devices at the time. As many as 84.6 % of the nurses believed that broken devices did not increase the risk of mercury exposure, even though 90 % claimed they were aware of mercury toxicity. In fact, 69.4 % of the nurses preferred mercury-containing devices on account of their precision and reliability and because they received little training in the use of electronic devices. Breaking of thermometers and sphygmomanometers is common in healthcare facilities. The number of broken thermometers and sphygmomanometers was estimated to 278 and five per month, respectively. Only 18 (46.2 %) of the surveyed healthcare facilities claimed to have had a proper disposal procedure for mercury from broken devices. Nurses, who most often handle these devices and collect mercury spills, are primarily exposed to mercury vapours via inhalation. Croatia has adopted the EU Directive 76/769/EEC intended to reduce mercury exposure in the living and working environment. Our survey suggests that all healthcare professionals need training in proper management of broken mercury-based medical devices, nurses in particular. To reduce the risk of exposure, all Croatian healthcare facilities should implement guidelines for staff protection and programmes to gradually replace mercury-based with electronic devices. Upotreba živinih mjernih uređaja u zdravstvenim ustanovama u Hrvatskoj Živa je štetni čimbenik izravno povezan s provođenjem zdravstvene zaštite. Tijekom 2009. provedeno je istraživanje u zdravstvenim ustanovama RH, s ciljem procjene uporabe živinih mjernih instrumenata, toplomjera i tlakomjera te načina odlaganja razbijenih uređaja. Upitnik o uporabi živinih uređaja, zbrinjavanju otpada, sklonostima uporabi živinih, odnosno elektroničkih mjernih uređaja te pitanja o poznavanju toksičnosti žive, ispunile su odjelne medicinske sestre iz 40 (71,4 %) od 56 zdravstvenih ustanova. Samo u jednoj ustanovi živini se mjerni uređaji uopće ne rabe. Čak 84,6 % ispitanica smatra da nisu dodatno izložene živi iz razbijenih uređaja, iako je 90 % svjesno toksičnosti Hg. Zbog njihove preciznosti, pouzdanosti i nedostatka edukacije o uporabi i održavanju elektroničkih uređaja prednost uporabi živinih uređaja daje 69,4 % medicinskih sestara. Razbijanje toplomjera i tlakomjera čest je incident u zdravstvenim ustanovama. Procijenjeni broj mjesečno razbijenih toplomjera bio je do 278, a razbijenih tlakomjera do 5. U samo 18 (46,2 %) ustanova pravilno se odlagala živa iz razbijenih uređaja. Medicinske sestre koje najčešće rukuju uređajima i prikupljaju živu najizloženije su živinim parama putem inhalacije. U Hrvatskoj su doneseni pravni akti s namjerom smanjenja prisutnosti žive u životnom i radnom okolišu. Time je stupila na snagu EU direktiva 76/769/EEZ-a o smanjenju proizvodnje i prometa uređaja koji ju sadržavaju. Rezultati upućuju na potrebu edukacije svih zdravstvenih radnika, posebno medicinskih sestara, o zbrinjavanju razbijenih živinih mjernih uređaja. Radi smanjenja potencijalne izloženosti i osiguranja boljih zdravstvenih uvjeta na radnome mjestu sve hrvatske zdravstvene ustanove trebaju provoditi smjernice za zaštitu radnika i programe za smanjenje uporabe žive uporabom zamjenskih toplomjera i tlakomjera dostupnih na tržištu.

Zdravstvena zaštita i rizici za spasioce u poplavljenim područjima

Abstract Floods can pose a number of safety and health hazards for flood-affected populations and rescuers and bring risk of injuries, infections, and diseases due to exposure to pathogenic microorganisms and different biological and chemical contaminants. The risk factors and possible health consequences for the rescuers involved in evacuation and rescuing operations during the May 2014 flood crisis in Croatia are shown, as well as measures for the prevention of injuries and illnesses. In cases of extreme floods, divers play a particularly important role in rescuing and first-response activities. Rescuing in contaminated floodwaters means that the used equipment such as diving suits should be disinfected afterwards. The need for securing the implementation of minimal health and safety measures for involved rescuers is paramount. Data regarding injuries and disease occurrences among rescuers are relatively scarce, indicating the need for medical surveillance systems that would monitor and record all injuries and disease occurrences among rescuers in order to ensure sound epidemiological data. The harmful effects of flooding can be reduced by legislation, improvement of flood forecasting, establishing early warning systems, and appropriate planning and education. Na poplavama pogođenom području mogu se kriti brojne opasnosti za sigurnost i zdravlje stanovništva i spasilaca, među kojima ozljede, infekcije i bolesti zbog izloženosti patogenim mikroorganizmima i raznim biološkim i kemijskim onečišćivačima. U radu su prikazani čimbenici rizika i moguće zdravstvene posljedice za spasioce koji su bili uključeni u evakuaciju i spašavanje tijekom poplava u Hrvatskoj u 2014. te mjere sprečavanja ozljeda i bolesti. U slučaju ekstremnih poplava ronioci imaju važnu ulogu u spašavanju. Akcije spašavanja iz potencijalno onečišćenih poplavnih voda dovode do potrebe dezinfekcije rabljene opreme, pri čemu je najvažnije da se spasiocima osigura provedba minimalnih zdravstvenih i sigurnosnih mjera. Vrlo je malo podataka o njihovim ozljedama i bolestima, što upućuje na potrebu da se uspostavi zdravstveno praćenje svih ozljeda i bolesti spasilaca kako bi se dobili odgovarajući epidemiološki podaci. Štetne posljedice poplava mogu biti umanjene zakonodavnim odredbama, unapređenjem sustava za predviđanje poplava, uspostavom sustava za pravodobno upozoravanje te odgovarajućim planiranjem i edukacijom.

Risk factors and children injuries while performing agricultural work in the Požega-Slavonia County

Uz obavljanje poljoprivrednih poslova vezani su brojni zdravstveni problemi i ozljede. Djeca na obiteljskim posjedima obavljaju razlicite poljoprivredne poslove, koji ih izlažu brojnim opasnostima i zdravstvenim rizicima sto mogu uzrokovati ozljede. Cilj je utvrditi postojece stanje zastite zdravlja i sigurnosti djece u poljoprivrednim kucanstvima u Požesko-slavonskoj županiji, opasnosti i stetnosti sto se javljaju prilikom obavljanja poljoprivrednih poslova radi uređivanja i donosenja specifi cnih mjera za zastitu zdravlja kojima se mogu otkloniti i smanjiti ozljede. Upitnikom su prikupljeni podatci o poljoprivrednim poslovima sto su ih su djeca obavljala, najcescim ozljedama i primjeni zastitne opreme. Istraživanje provedeno od rujna 2011. do svibnja 2012. godine pokazalo je da od 188-ero pracene djece njih 52, 1% svakodnevno obavlja razlicite poljoprivredne poslove. Ozljede nastale prilikom obavljanja poljoprivrednih poslova, okarakterizirane kao lakse i teže, zadobilo je 30, 6% ispitanika. Najveci broj nastalih ozljeda uzrokovale su mehanicke sile pri radu s poljoprivrednim strojevima, raznim rucnim alatima i pri radu sa životinjama. Na djecu kao clanove poljoprivrednih kucanstava ne primjenjuju se mjere i pravila sigurnosti za osiguranje njihove zastite zdravlja, ni nadzor nad njihovom primjenom temeljem postojecih zakona, jer nije zasnovan radni odnos. Prikazani podatci o stanju zastite zdravlja djece upucuju na potrebu prosirivanja istraživanja zdravstvenog statusa djece u ruralnim podrucjima Republike Hrvatske i utjecaja obavljanja poljoprivrednih poslova na pojavu ozljeda i bolesti, kao i pristupanju uređivanja i donosenja mjera kojima bi se djeci, kao clanovima poljoprivrednih kucanstava, osigurali sigurniji uvjeti rada i zastite zdravlja.

Dance as a Risk Factor for Injuries and Development of Occupational Diseases

Ples kao čimbenik rizika za ozljede i razvoj profesionalnih bolesti Ozljede i bolesti mogu znatno utjecati na stvaralačku sposobnost, kreativnost i dostignuća umjetnika. Povezanost uvjeta i načina rada s pojavom bolesti u umjetnika prepoznata je već u srednjem vijeku. Tjelesna zahtjevnost izvedbe, gdje se tijelo koristi kao instrument izražavanja, može uzrokovati ozljede i razvoj profesionalnih bolesti koje mogu dovesti do nemogućnosti umjetničke interpretacije na očekivanoj razini, prekinuti aktivnosti i onemogućiti nastavak profesionalne karijere. Plesači su jedna od skupina umjetnika-izvođača koji su izloženi specifičnim rizicima i kojima treba specifična zdravstvena zaštita, što nije moguće ostvariti bez poznavanja mehanizama nastajanja ozljeda i uvažavanja posebnosti potreba plesača. Mnogi plesači teže visokim umjetničkim i estetskim kriterijima izvedbe, pri čemu često protežu svoje tjelesne mogućnosti i izdržljivost i zanemaruju vlastita tjelesna ograničenja. Zdravstveni problemi plesača obuhvaćaju čitav niz ozljeda, profesionalnih bolesti i bolesti vezanih uz rad koji se kreću od stresa i straha od nastupa sve do poremećaja u prehrambenim navikama. Također obuhvaćaju ozljede mišićno-koštanoga sustava, sindrome prenaprezanja i trenažnoga preopterećenja koje može uzrokovati karakterističnu topološku pojavu boli, koja je često početak kroničnih zdravstvenih problema kod plesača. Navedeni zdravstveni problemi plesača sve su češće područje zanimanja liječnika različitih specijalizacija, unaprjeđenja i provođenja preventivnih programa, dijagnostičkih metoda i liječenja u tom djelu populacije. Dance as a Risk Factor for Injuries and Development of Occupational Diseases 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 artists 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.

Rainwater Collecting as a Part of Implementation of the Sustainable Development Principles on Croatian Islands — Old Habits for New Era

The article investigates availability and quality of drinking water along with possibilities of rainwater harvesting, as an element of sustainable development on four Croatian islands. Investigated islands, represent two main regions: northern and southern Adriatic coast. This division corresponds with gravity to two main macro regional centers on the coast and it is common in demographic, economic and sociological research. Data on local water resources, conditions and type of water supply, quality of water, prices, consumption of water, number and condition of cisterns and demographic records are collected and analyzed. Also, meteorological data on annual rainfall in past 26 years are collected and analyzed. Drinking water quality corresponds with Croatian law regarding physical and chemical parameters, while most of microbiological parameters are unacceptable. The results point out modest possibility of developing public water supply on islands. Average annual rainfall indicates that harvesting of rainwater should be integrated as additional water source on investigated islands which would save great quantities of the drinking water that are used as technical water and for the other purposes such as agriculture or forest fires. Also that would lower the household expenses for the water and diminish water crisis during the tourist season months. Natural water resources on Croatian islands are scarce and it is our ethical obligation to preserve them in favor of existing eco systems and long term exploitation.

Fish consumption and mercury body burden in women of reproductive age from urban area in Croatia

Mercury entering aquatic environment can be transformed by microorganisms into toxic methyl-mercury that biomagnifies in aquatic organisms. Seafood consumption is primary exposure route to mercury for humans. The most vulnerable groups are unborn and young children. The aim of this article is to investigate is there possible connection of fish consumption and mercury body burden in women of reproductive age in Croatia. Sample consisted of 75 women age 22 to 40, living in urban area for at least five years, and not occupationally exposed to mercury. They answered questionnaire about fish consumption and living environment as source of possible additional exposure to mercury. Hair samples were used as biomarker of exposure. Total mercury (tHg), that reflects methyl-mercury exposure, were measured using atomic absorption spectrometry method, using a single purpose instrument AMA 254 (Advanced Mercury Analyser), ALTEC Ltd, Praha, Czech Republic, which advantage is no sample pre-treatment. Women were divided in vegetarian 17 (23%) and non vegetarian 58 (77%). Results show that all 74 women had detectable levels of mercury in hair. The range of total mercury values in hair was from highest level of 3.90  g/g to lowest level of 0.08  g/g. Out of 75 women, 11 (14.8%) women were above the most protective reference dose of 1  g Hg/g in hair, calculated by US EPA. The lower values of tHg in hair from 0, 19 to 0, 08  g/g Hg were detected in 17 (22.9%) women who did not consume fish at all. All 75 women had values below the benchmark dose of 10  g/g Hg in the hair, set by WHO. The average fish consumption in sample was 1 meal per week. Mostly consumed fish is predominantly of local origin, canned tuna from unknown origin and rarely frozen imported fish. Although measured values of tHg in hair in some examinees is above most protective values, collected data on fish consumption which correspond with average fish consumption in Croatia show that overall consumption is very low and there is no danger of Hg exposure of vulnerable population. However, further and more detailed investigation is needed, with specific focus on Croatian coastal areas and islands where people consume considerably larger amounts of fish mainly from local sources. The common opinion that locally caught fish is not mercury contaminated become questionable, because latest studies show that 41% of the captive Atlantic bluefin tuna farmed in Adriatic Sea contain mercury above the maximum level of 1µ ; ; ; g/g wet weight defined by the European Commission Decision and Croatian legislation.