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Cilj ovog istraţivanja bio je istraţiti zdravstveno stanje i odrednice zdravlja populacije domaćica u Hrvatskoj. Korišteni su podaci iz istraţivanja „Hrvatska zdravstvena anketa 2003.“ u kojoj je bilo uključeno 9077 ispitanika. Taj populacijski uzorak bio je reprezentativan za populaciju odraslih osoba u Hrvatskoj. TakoĎer su korišteni i javnodostupni demografski i mortalitetni podaci. Prema Popisu stanovnika 2001. godine u Hrvatskoj, u populaciji od 4,437.460 stanovnika bile su 303.374 domaćice. U uzorku ovog istraţivanja od ukupno 6175 ispitanica, 1960 (31,7 posto) svoj je radni poloţaj karakteriziralo kao domaćica. S obzirom na mjesto stanovanja, najveći dio ispitanih domaćica ţivi na selu, njih 53,4 posto. Sveukupno bez ili samo sa završenom osnovnom školom bilo je 74,9 posto domaćica. Domaćice češće ţive u seoskim i prigradskim područjima, imaju niţi stupanj obrazovanja i manja primanja od zaposlenih ţena. Svoj ekonomski poloţaj ocjenjuju lošije nego zaposlene, ali bolje nego nezaposlene ţene. U ocjeni atraktivnosti ţivotnih uloga nisu prepoznate kao atraktivne. Domaćice imaju više stope smrtnosti od kardiovaskularnih bolesti, bolesti pluća te ozljeda nego ostale ţene u populaciji. Rezultati pokazuju veće i statistički značajne vjerojatnosti smrtnosti ţena domaćica od bolesti cirkulacijskoga sustava 1,48 puta, dišnoga sustava 1,50 puta, ozljeda i nesreća 1,29 puta te smrti povezanih s psihičkim bolestima 1,45 puta. MeĎu deset vodećih uzroka smrti prema dijagnozama, statistički značajne razlike izmeĎu domaćica i nedomaćica nisu utvrĎene za uzroke smrti vezane uz dijagnoze zloćudnih novotvorina dojke, zloćudne novotvorine debelog crijeva, zloćudne novotvorine dušnika i pluća te dijabetesa melitusa. Domaćice imaju veće šanse da budu ovisne o duhanu te više dosoljavaju hranu. Pozitivne oblike ponašanje u ovoj populaciji čine veća tjelesna aktivnost te više voća u prehrani. 98 Prehrambene navike pokazuju da domaćice u odnosu na zaposlene ţene koriste više masnoća ţivotinjskog porijekla, više dosoljavaju hranu, ali i jedu više voća. U odnosu na nezaposlene ţene domaćice koriste manje masti ţivotinjskog porijekla, više dosoljavaju hranu te jedu manje voća. Postupkom logističke regresije u populacijama domaćica i nedomaćica analiziran je omjer izgleda za subjektivnu ocjenu tjelesnog i mentalnog zdravlja. U odnosu na nedomaćice bez završene osnovne škole veće izglede za bolje mentalno zdravlje imaju: nedomaćice sa završenom osnovnom školom (1,42 puta), sa završenom srednjom školom (1,69 puta) te nedomaćice sa završenom višom školom (2,22) puta. Za skupinu domaćica ni u jednoj obrazovnoj kategoriji nisu jednoznačno utvrĎeni drukčiji izgledi za bolje mentalno zdravlje. U odnosu na domaćice bez završene osnovne škole veće izglede za bolje tjelesno zdravlje imaju: domaćice sa završenom osnovnom školom (1,63 puta), sa završenom srednjom školom (2,00) puta te domaćice sa završenim fakultetom (4,17 puta). Mjesto stanovanja, odnosno razina urbanizacije, ni kod domaćice niti kod nedomaćice ne mijenja jednoznačno izglede za bolje tjelesno zdravlje. Prikupljeni intervjui pokazuju kompleksnost uloge domaćice. Naime, osim uobičajenih odrednica socioekonomskog poloţaja i zdravlja u ţivotu ţena opće populacije, domaćice se izdvajaju i specifičnostima vezanim uza svoju ulogu. To su isključiva ekonomska ovisnost o suprugu, intenzivan i specifičan odnos s djecom, isticanje vlastite borbe za postignuća u ţivotu, kontradiktoran odnos prema zapošljavanju, specifična uloga domaćica u poslovima vezanim uz kuću (gradnja kuće, sudjelovanje u obiteljskom poslu) te intenzivan odnos s ostalim ukućanima. Ukupno rezultati ukazuju na lošije socioekonomsko i zdravstveno stanje domaćica u odnosu na ostatak ženske populacije., The aim of this study was to investigate health status and determinants of health in the housewife population in Croatia. The data were collected during the Croatian health survey in 2003, and compose representative sample of the Croatian population. Official demographic and mortality data for female population were used from the national census. Out of 4 437 460 citizens, 303 374 were housewives. Out of 6175 women in this study 1960 were housewives, 53,4% of them live in rural areas, whereas 74,9% don't have any or have only primary education. Housewives more often live in rural or suburban settings, have a lower education level and lower income than employed women. Their self assessment of the economic status is worse then of the employed, but better then the unemployed ones. Their position in the society is not recognized as attractive. Mortality rates for cardiovascular disease, pulmonary disease and injuries are higher in the housewife than in the non-housewife population. In comparison to non-housewives, housewives have higher chances for death caused by the following causes: 1,48 times for cardiovascular disease, 1,50 times for lung disease, 1,29 due to accidents and 1,45 due to psychiatric disorders. Among ten leading causes of death there are no significant differences between housewives and non-housewives for the cancers (breast, colon, lung), and diabetes. Smoking and higher salt consumption are important health risks for the housewives. Higher physical activity rates and fruit consumption are positive behavioural determinants. In comparison to employed women, housewives eat more animal fats, add more salt to food and eat more fruit. In comparison to unemployed women, housewives eat less animal fat, add more salt to food, and eat less fruit. 101 Logistic regression models were used to analyze socioeconomic determinants for mental and physical health. In comparison to non-housewives without formal education, non-housewives with some degree of education have higher chances for better mental health: with primary school 1,42 times, with secondary school 1,69 times, and with higher education level 2,22 times. Among housewives there is no recognized influence of the observed socioeconomic determinants to the mental wellbeing. In comparison to the housewives without formal education, the housewives with some degree of education have higher chances for better physical health: with primary school 1,63 times, secondary school 2,00 times and with university degree 4,17. There was no clear relation between place of living and better physical health among housewives and non-housewives. Information collected in the interviews show very complex structure of the housewife role. Apart from usually recognized health determinants among general female population, there are many specific factors relevant for housewives. These are: economic relation with employed husband, intensive relations with children, ambivalent attitude to the employment possibilities, specific workload related to the household (family business, house construction) and very intensive relation with other family members. Overall results suggest worse socioeconomic and health status of the housewife population than the general female population in Croatia.

This paper is part of a series of columns on complex patients. The paper talks about complex patients in context of European health and social policies.

Healthcare workforce shortage is a worldwide problem (1). Workforce shortage may be defined as not having the right number of people with the right skills in the right place at the right time, to provide the right services to the right people (2). In this regard, the trends are worrisome, and the situation is getting worse. The consequences are also very consistent – limited care health services and limited quality of health care (1). In short, there is an imbalance between need and supply. The solution: as health care needs increase worldwide, the “production” of personnel must be increased! But is it really that simple? Are the problem and the solution so reciprocal and directly linked?

Priručnik je nastao kao rezultat rada u provedbi OBZOR 2020 projekta pod nazivom NEFERTITI – Networking European Farms to Enhance Cross Fertilisation and Innovation Uptake through Demonstration, u kojem je Sukladno Ugovoru o financiranju bespovratnih sredstava (Grantm Agreement 772705), kao partner sudjelovalo Ministarstvo poljoprivrede, Uprava za stručnu podršku razvoju poljoprivrede. All informations about the project, goals and activities you can find in the first chapter. More details about all demo events you can find in the second chapter. The third chapter, The cow-calf system, describes breeds, many practical experiences in technology, feeding and accommodation, especially seen from the perspective of a practical breeder. As the NEFERTITI project is international, with the fourth chapter Beef cattle grazing in Europe – experiences and practice we wanted to focus on several topics and practical experiences of breeders from abroad. One of them is how farms that breed cows for calf production, besides fattening their own calves, can increase their income by selling beef directly. The last, fifth chapter Basic data on demo farms in the NEFERTITI project presents every farm we visited, and some production data that can be compared.

Volunteers have been present in palliative care since its inception. With the development of palliative care systems, their role and position are changing. Given growing long-term care needs and limited resources in health and social care, volunteers are becoming an important resource in meeting these needs. In Croatia, palliative care has been developing as an integrated care model since 2014. To assess the position and the role of volunteers, we analyzed legislative documents from healthcare and social care and conducted a focus group with volunteers in palliative care. We found that volunteers provide support from the social aspect of care, for the patient and the family. The formal palliative care system involves them as partners in the provision of care, even though this cooperation is informal. The main determinants of their activities are an individualized approach, flexibility, a community presence, and project funding. In conclusion, these determinants allow them to react quickly to identified needs, but with them come some uncertainties of their sustainability. Their activities could indicate what needs to be integrated between health and social care and in what areas. Volunteers both fill in gaps in the system and are ahead of the system, and by doing this they develop new processes around identified unmet needs.

This article compares the health system responses to COVID-19 in Bulgaria, Croatia and Romania from February 2020 until the end of 2020. It explores similarities and differences between the three countries, building primarily on the methodology and content compiled in the COVID-19 Health System Response Monitor (HSRM). We find that all three countries entered the COVID-19 crisis with common problems, including workforce shortages and underdeveloped and underutilized preventive and primary care. The countries reacted swiftly to the first wave of the COVID-19 pandemic, declaring a state of emergency in March 2020 and setting up new governance mechanisms. The initial response benefited from a centralized approach and high levels of public trust but proved to be only a short-term solution. Over time, governance became dominated by political and economic considerations, communication to the public became contradictory, and levels of public trust declined dramatically. The three countries created additional bed capacity for the treatment of COVID-19 patients in the first wave, but a greater challenge was to ensure a sufficient supply of qualified health workers. New digital and remote tools for the provision of non-COVID-19 health services were introduced or used more widely, with an increase in telephone or online consultations and a simplification of administrative procedures. However, the provision and uptake of non-COVID-19 health services was still affected negatively by the pandemic. Overall, the COVID-19 pandemic has exposed pre-existing health system and governance challenges in the three countries, leading to a large number of preventable deaths.

In recent years, the production and application of biochar as a soil amendment produced from pruning residues has gained attention worldwide. Since the effect of grapevine rootstock type on grapevine-pruning residues used as feedstock for biochar production had not yet been researched, the present research was performed. Two grapevine rootstocks, different in vigor, were selected, with the hypothesis that they would affect their chemical composition and, consequently, the composition of the produced biochar. In this work, grapevine-pruning residues of the indigenous variety “Istrian Malvasia” (Vitis vinifera L.) grafted on 420A and SO4 rootstocks were analyzed and used for biochar production under three peak temperature programs (400 °C, 500 °C, and 600 °C). Higher pyrolysis temperature decreased yield but increased EC, ash, and TC content, as well as the content of most of the studied elements. On the other hand, grapevine rootstock type affected biochar EC, ash content, and specific surface area. Results showed that a more vigorous rootstock affects the produced biochar qualities by enhancing the above-mentioned properties. The present research showed that biochar produced from grapevine-pruning residues, especially at 500 °C or 600 °C, could be a valuable tool for the valorization of this biomass as a soil amendment.

Kalcijev karbonat (CaCO3) je jedan od najrasprostranjenijih minerala u morskom okolišu. Nastaje procesima taloženja pod kojima podrazumjevamo procese formiranja nove čvrste faze iz homogenog sustava, preciznije iz vodenih, obično elektrolitnih otopina, kao što je slučaj i u biološkim sustavima. Procesi taloženja su fizikalno-kemijska osnova biomineralizacije (procesi formiranja biominerala u biološki sustavima). Biomineralizacijom u kalcificirajućim organizmima (mekušcima, koraljima, spužvama, krednjacima...) nastaje biogeni CaCO3. Glavna pokretačka sila koja kontrolira procese taloženja jest prezasićenost, no i drugi faktori kao što su koncentracija konstituirajućih iona i otopljenog ugljikovog dioksida (CO2), prisutnost aditiva, temperatura (t), pH, ionska jakost, hidrodinamika kontroliraju taloženje CaCO3 te posljedično i biomineralizaciju.

U ovom radu opisana su svojstva soje, njezina nutritivna svojstva, utjecaj na zdravlje i alergijske reakcije koje soja može izazvati. Također, u radu su istaknuta pozitivna svojstva soje kao zdrave namirnice, ali i negativan utjecaj na zdravlje ljudi, budući da predstavlja alergen u hrani. Soja je biljka koja je bogata proteinima i koja se koristi za prehranu ljudi. Također, koristi se u proizvodnji velikog broja namirnica. Simptomi i znakovi alergije na soju su blagi kao što su osip i svrbež u ustima. Kod većine osoba, alergija na soju je neugodna, ali nema ozbiljne posljedice. Ostali simptomi mogu biti otežano disanje, bolovi u trbuhu, mučnina i crvenilo na koži.

Aims and objectives: This paper investigates the feasibility and the perception of the nurse's role as the palliative care coordinator.Background:Integrated care is a global imperative in all healthcare improvement pro-cesses. Due to Andrija Štampar's success in the organisation of public health services, Croatia today has more than hundred years of experience in care integration. The pal-liative care system has been continuously developing since 2014 as an integrated care model, with nurses as care coordinators.Methods:The study used a mixed methodology based on pragmatic research prin-ciples, including an analysis of strategic and policy documents and reports, and the-matic analysis of focus group conducted with palliative care coordinators, following COREQ checklist.Results: Although a legal, professional and financial regulation of nurse coordinators has been achieved, a number of implementation challenges remain. These challenges arise as a result of long-term fragmentation of the health and social care, and can be found in both horizontal and vertical integration of care, that is in the dimensions of functional, clinical, cultural and social integration.Conclusions: Nurses play a central role in care coordination. Coordination and inte-gration promote professionalisation with clear roles and tasks. However, even with the legal, professional and financial implementation of the nurse coordinator model, it has to be further promoted as an equally important job in the healthcare system, with nurses as competent professionals in charge of care coordination.Relevance to clinical practice: Palliative care provides a range of individualised, coor-dinated services that meet the medical and non- medical needs of seriously ill patients. Described model of palliative care in Croatia is particularly important because it was developed as an integrated part of health care (and partly social welfare) system, indicating with the nurse's role as palliative care coordinator that coordination is a continuous process that requires a dedicated professional role.

Maria Montessori najpopularnije je ime u povijesti predškolskog odgoja i jedna je od najvažnijih osoba modernog odgoja. Bila je liječnica, učiteljica i filozofkinja, a najpoznatija je po svojoj Montessori metodi podučavanja djece od rođenja do adolescencije. Njezina se metoda i danas koristi u školama diljem svijeta, a nastala je promatranjem djece u igri. Radi u tišini, govori tiho ili šapatom. Temelj njezine metode i učenja su senzorna pomagala. Djeca svoje znanje grade na greškama i eksperimentima. Materijali koji djeca koriste izrađeni su tako da djetetu ne treba prisustvo učitelja radi kontrole. Djetetu treba dozvoliti da radi samo i tako mu omogućiti da upoznaje svijet i izgrađuje samostalnost. Kako bi se Montessori pedagogija što bolje implementirala, Maria Montessori u svojoj metodi njeguje sedam načela, a to su: poštivanje djeteta, osposobljavanje osjetila i kretanja, polarizacija pažnje, slobodan izbor, pripremljena okolina, uloga odgojitelja, „pomozi mi da učinim sam“. Suvremeni kurikulumski pristup odgoju i obrazovanju ima sličnosti s pedagoškom koncepcijom Marije Montessori. Iako je nastanak Montessori pedagogije od moderne obrazovne teorije odvojeno cijelo stoljeće, još uvijek postoji bezbroj sličnosti između Montessori nastavnih načela i moderne obrazovne teorije. Brojne su sličnosti i u teorijskim polazištima obrazovanja. U ustanovi Montessori prostor je posebno uređen posebnim Montessori priborom koje je izradila sama Maria Montessori. Odgojitelji i učitelji moraju steći Montessori obrazovanje kako bi dobili vještine i kompetencije potrebne za rad u Montessori ustanovama.

In children with complex needs, the primary circle of care includes parents/caregivers, health care, social care, and (pre)school system, local community, and non-governmental organizations. The necessity of integration and coordination of this wide range of stakeholders of different profiles was recognized not only by children, families, and stakeholders in care but also by the European Academy of Paediatrics. To achieve this, all elements, steps, and stakeholders in the care process must be clearly defined, and their relationship, temporal and spatial dynamics in the real context analysed. The methodology of analysis and mapping of care processes and stakeholders is very timely and based on Donabedian's model of quality, which defines inputs, processes, and outcomes of care. For example, under the guidance of the PUB HUB program of the School of Medicine in Zagreb, the methodology of mapping processes and needs was used throughout the European Commission's "Health infrastructure mapping - Slovenia, Croatia, Bulgaria" project, and served, per European request, as a guide for the new Croatian strategic framework for health. Care processes are shaped by the interrelationship, temporal, and spatial dynamics of inputs (people, equipment, space) in real, and - for each child and stakeholder - specific socioeconomic, infrastructural, and technicaladministrative contexts. Mapping analyses the process of care following the child’s needs and the care stakeholders’ availability, accessibility, and capacity to respond to the child's complex needs in a 24/7/365 timeframe. Thus, gaps in care which result in a child's unmet needs can be identified. This forms the basis for a deeper cause-and-effect analysis that enables the planning and implementation of quality and child- specific interventions, which are feasible for stakeholders. The stakeholders involved in care for a child with complex needs should cooperate in a timely, integrated and coordinated multidisciplinary manner, basing their decisions on the specific needs of the child. Achieving this goal must begin with creating a clear map of processes and interrelationships within the care system through the 24/7/365 timeframe.

Liposomes (lipid vesicles) are often considered to be a versatile tool for the synthesis of advanced materials, as they allow various control mechanisms to tune the materials’ properties. Among diverse materials, the synthesis of calcium phosphates (CaPs) and calcium carbonates (CaCO3) using liposomes has attracted particular attention in the development of novel (bio)materials and biomineralization research. However, the preparation of materials using liposomes has not yet been fully exploited. Most of the liposomes used have been anionic and/or zwitterionic, while data on the influence of cationic liposomes are limited. Therefore, the aim of this study was to investigate and compare the influence of differently charged liposomes on CaPs and CaCO3 formation. Zwitterionic 1,2-dimyristoyl-sn-glycero-3-phosphocholine (DMPC), negatively charged 1,2-dimyristoyl-sn-glycero-3-phospho-L-serine (DMPS), and positively charged 1,2-dioleoyl-sn-glycero-3-ethylphosphocholine (EPC) lipids were used to prepare the respective liposomes. The presence of liposomes during the spontaneous precipitation of CaPs and CaCO3 affected both the precipitation and transformation kinetics, as well as the morphology of the precipitates formed. The most prominent effect was noted for both materials in the presence of DMPS liposomes, as (nano) shell structures were formed in both cases. The obtained results indicate possible strategies to fine-tune the precipitation process of CaPs and CaCO3, which may be of interest for the production of novel materials.

Problem unapređenja poslovanja sa stanovišta optimizacije procesa i smanjenja troškova je standardni cilj svakog poslovnog sistema. Novija unapređenja su se zasnivala na primenama najnovijih tehnologija, ali su se one prvenstveno bavile parcijalnim segmentom poslovanja, kao na primer kod održavanja opreme radnim nalozima i analizama rezultata otklanjanja kvarova. Nisu uzimale u obzir kompletan proces, od prijave kvara do trenutka otklanjanja kvarova. Zbog toga su predložena rešenja bila parcijalna i u nekim slučajevima davala potpuno pogrešne rezultate analiza. Predloženo rešenje se bazira na definisanju načina obuhvata kompletnog procesa, izborom najoptimalnije standarda za snimanje, analizu i optimizaciju procesa i izborom odgovarajućeg formata podataka koji može da se usaglasi na analiziranim procesom i definisanim objektima snimljenim tokom procesa. Zbog toga se rešenje baziralo na primeni odgovarajućeg standarda za tu vrstu procesa do koje se došlo primenom višekriterijumske analize i analizom dostupne stručne literature, zatim na primeni skladišta podataka kao opšte strukture podataka, a dodatnim analizama je usvojen procesno skladište podataka (Process Data Warehouse, PDW), sa ciljnim parametrima analize i definisanim graničnim vrednostima. Ključni rezultati dobijeni analizom su pokazali da je primena izabranog standarda za snimanje procesa obezbeđena ključna baza elemenata koji su potrebni za optimizaciju, da je primenom objektnog PDW-a obezbeđena kvalitetna i realna baza podataka. Transformacijom podataka iz relacione u strukturu skladišta podataka, dobijena je jednostavna struktura koja je obezbedila dinamički pristup podacima i njihovo dinamičko grupisanje i specijalizaciju, a dodatna proširenja koja su se odnosila na granične i ciljane vrednosti su u potpunosti opravdale primenjen koncept. Ovim konceptom je prikazano da od prvobitnog polazišta da je sistem održavanja vrlo uspešan (uptime opreme na nivou >95%) kad se posmatra samo radni nalog, došlo se pokazatelja da u preko 30% intervencija, kad se pogleda kompletan proces, dolazi do kašnjenja u otklanjanju kvarova.

Uvod: Dostupne su brojne intervencije za neuropatsku bol (NeuP), ali njeno liječenje ostaje nezadovoljavajuće. Metode: Ovaj doktorski rad sastoji se od 4 studije koje su i) sustavno sažele dokaze iz sustavnih pregleda (SR) randomiziranih kontroliranih studija (RCT) o intervencijama za NeuP, ii) procijenile domene ishoda i mjere korištene za procjenu učinkovitosti i sigurnosti liječenja, iii) metodološku kvalitetu uključenih SR, i iv) svijest i prihvatljivost Inicijativa o metodama, mjerenju i procjeni boli u kliničkim ispitivanjima (IMMPACT) - preporučeni osnovni skup ishoda (COS) i temeljne mjere ishoda (COM) za kroničnu bol među autorima SRs. Rezultati: Najčešće intervencije u 97 uključenih SR bile su farmakološke (59%) i kirurške (15%). Većina analiziranih SR bila je srednje kvalitete. Više od 50% zaključaka iz sažetaka o učinkovitosti i oko 80% o sigurnosti bili su neuvjerljivi. Uključeni SR-ovi prijavili su medijan 4 od 6 ključnih domena IMMPACT-a. Intenzitet boli većinom je procijenjen VAS (n=59) i NRS (n=29) ljestvicama. Autori NeuP SR-ova nedovoljno koriste relevantni preporučeni COS jer nisu svjesni ili ga smatraju irelevantnim. Zaključci: Dokazi o intervencijama za NeuP često su neuvjerljivi ili ih uopće nema. Metodološka kvaliteta analiziranih SR u području NeuP nije bila optimalna. Potreban je daljnji rad na IMMPACT COS-u u smislu procjene njegove primjerenosti i prihvaćanja među autorima., Introduction: Numerous interventions for neuropathic pain (NeuP) are available, but its treatment remains unsatisfactory. Methods: This doctoral thesis consists of 4 studies that i) systematically summarized evidence from systematic reviews (SRs) of randomized controlled trials (RCTs) on interventions for NeuP, ii) assessed outcome domains and measures used for the assessment of treatment efficacy and safety, iii) the methodological quality of included SRs, and iv) awareness and acceptability of Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT)-recommended core outcome set (COS) and core outcome measures (COMs) for chronic pain among authors of SRs. Results: The most common interventions in 97 included SRs were pharmacological (59%) and surgical (15%). The majority of analyzed SRs were of medium quality. More than 50% of conclusions from abstracts on efficacy and around 80% on safety were inconclusive. The included SRs reported a median 4 out of 6 IMMPACT core domains. Pain intensity was mostly assessed with VAS (n=59) and NRS (n=29) scales. Authors of NeuP SRs insufficiently use relevant recommended COS because they are not aware of or they find it irrelevant. Conclusions: Evidence about interventions for NeuP is frequently inconclusive or completely lacking. The methodological quality of analyzed SRs in the field of NeuP was not optimal. Further work on the IMMPACT COS is needed, in terms of evaluating its adequacy and uptake among authors.

Ciljevi: Ciljevi istraživanja bili su: provesti pregled sustavnih pregleda o djelotvornosti i sigurnosti intervencija za liječenje postoperativne boli u djece te napraviti sintezu dokaza, analizirati domene ishoda u sustavnim pregledima i randomiziranim kontroliranim pokusima (engl. randomized controlled trial – RCT) koji su analizirali intervencije za liječenje postoperativne boli u djece te ih usporediti s preporučenim glavnim skupom ishoda inicijative PedIMMPACT (engl. Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials) te na koncu provesti anketu o svjesnosti i prihvaćenosti preporučenog glavnog skupa ishoda među autorima sustavnih pregleda i RCT-ova. Metodologija: U prvom dijelu istraživanja napravljen je pregled sustavnih pregleda o postoperativnoj boli u djece. Sveobuhvatnom strategijom pretraživanja pretraženo je 6 elektroničkih pismohrana. Dva autora su za svaku studiju neovisno vadili podatke iz članaka. Analizirana je efikasnost i sigurnost pojedinih intervencija, obilježja samih studija kao i njihova metodološka kvaliteta pomoću ljestvice AMSTAR. U drugom i trećem dijelu istraživanja su, nakon obnovljene strategije pretraživanja pomoću koje su pronađena 3 nova sustavna pregleda analizirani ishodi korišteni u sustavim pregledima i u RCT-ovima koji su u njih bili uključeni te uspoređeni s preporučenim ishodima inicijative PedIMMPACT. Za ovo istraživanje također su dva autora neovisno vadila podatke. U posljednjem dijelu istraživanja anketirani su autori analiziranih sustavnih preglednih članaka i RCT-ova kako bi se istražilo njihovo znanje i stavovi prema domenama ishoda koje preporučuje PedIMMPACT. Rezultati: Visokom metodološkom kvalitetom ocijenjeno je 38% sustavnih preglednih članaka o liječenju postoperativne boli u djece, 55% srednjom i 7% niskom kvalitetom. Pozitivno uvjerljiv dokaz o uspješnoj efekasnosti intervencije pronađen je u 18 sustavnih preglednih članaka dok je pozitivno uvjerljiv dokaz o sigurnosti intervencije pronađen u 14 sustavnih preglednih članaka. Medijan broja svih ishoda u uključenim sustavnim preglednim člancima bio je 4, dok je medijan ishoda preporučenih od strane PedIMMPACT inicijative bio 3. Najčešće opisani PedIMMPACT ishod bio je „nuspojave“, dok je drugi najčešći bio „intenzitet boli“. Nešto više od polovine preglednih članaka koji su analizirali intenzitet boli opisali su alat kojim su mjerili bol. Medijan svih ishoda u uključenim randomiziranim kontroliranim člancima je 5 dok je medijan PedIMMPACT ishoda 2. Najčešće korišten PedIMMPACT ishod bio je „intenzitet boli“ kojeg prate „nuspojave“. Ostala 4 PedIMMPACT ishoda opisana su u manje od 30% uključenih studija. Najčešći ishod koji nije dio preporučenih ishoda PedIMMPACT inicijative bio je „dodatna analgezija“ koja je analizirana u 71% studija. Nije bilo značajne statističke razlike u udjelu PedIMMPACT ishoda u studijama objavljenim prije i poslije objave preporuka. Najčešći alat za mjerenje intenziteta boli bila je vizualno-analogna ljestvica (24%). Samo trećina autora sustavnih preglednih članaka i randomiziranih kontroliranih pokusa o postoperativnoj boli u djece znaju za preporuke PedIMMPACT inicijative. Kao razloge ne korištenja preporučenih ishoda navode nedostatak informiranosti, poteškoće sa implementacijom te manjak resursa. Zaključak: Pozitivno uvjerljivo ocijenjene su sve intervencije koje su bile u skladu sa smjernicama za liječenje akutne bolni što upozorava na važnost pridržavanja smjernicama. Metodološka kvaliteta pronađenih sustavnih pregleda je varirala, a Cochraneovi pregledi imali su veću kvalitetu pa su samim time i korisniji kliničarima. Autori sustavnih pregleda i primarnih studija koje analiziraju intervencije za liječenje postoperativne boli u djece ne predržavaju se preporučenog glavnog skupa ishoda što otežava usporedbu, sintezu rezultata i izradu meta-analiza. Razlog nekorištenja preporučenog skupa ishoda za akutnu bol djece je u tome što većina autora nije nikad čula za inicijativu PedIMMPACT , a oni koji su čuli nedovoljno poznaju njene preporuke. Također su naveli razloge zbog kojih je implementacija smjernica otežana. Nužno je provesti daljnja istraživanja kako bi se vidjelo treba li revidirati preporučeni skup ishoda za akutnu bol djece i kako potaknuti autore da ga koriste., Aims: The aim of the first part of the study was to conduct an overview of systematic reviews that summarizes the results about efficacy and safety from randomized controlled trials involving the various strategies used for postoperative pain management in children. Second and third goal was to investigate the range of efficacy and safety outcomes used in systematic reviews (SRs) of randomized controlled trials (RCTs) of interventions for postoperative pain in children and compare them with outcome domains recommended in the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (PedIMMPACT). And the last aim was to analyze awareness about and acceptability of core outcome set (COS) for pediatric pain recommended by the PedIMMPACT. Methods: The first part of the study was an overview of systematic reviews. Six databases were searched from the earliest date to January 24, 2016. Two authors independently assessed the methodological quality of included reviews. A Measurement Tool to Assess Systematic Reviews (AMSTAR) quality assessment tool was used. In the second and third part of the study efficacy and safety outcomes were extracted from included systematic reviews and RCTs. The type and number of outcomes were analyzed and compared against the outcomes recommended by PedIMMPACT. In the last part of the study authors of systematic reviews and RCTs about interventions for postoperative pain in children were surveyed regarding their knowledge, attitudes and usage of the PedIMMPACT COS. Results: Out of 45 systematic reviews that investigated various interventions for postoperative pain in children, 19 systematic reviews (42%) presented conclusive evidence of efficacy. Positive conclusive evidence was reported in 18 systematic reviews (40%). More than half of systematic reviews included in this overview were rated as having medium methodological quality. Of 45 included systematic reviews, 10 were Cochrane reviews and they had higher methodological quality than non-Cochrane reviews. The median number of all outcomes in SRs was 4, while the median number of the PedIMMPACT core outcomes was three out of six. The most commonly reported outcome of the PedIMMPACT COS was “symptoms and adverse events,” followed by pain intensity, which was reported in 75% of the included SRs. Just over half of the SRs that included a pain intensity outcome also indicated the specific pain assessment tool used in the methods section. Median number of reported outcomes was five (range 1 to 11) for the included RCTs and two (range 0 to 6) for PedIMMPACT. The most commonly analyzed PedIMMPACT outcome domains were pain intensity (93%) and ‘symptoms and adverse events’ (83%). The remaining four PedIMMPACT outcomes were present in under 30% of included randomized controlled trials. There was no significant difference in the proportion of PedIMMPACT outcome domains’ use in RCTs published before or after the PedIMMPACT core outcome set. Only a third of surveyed authors of systematic reviews and randomized controlled trials about postoperative pain in children had heard about the PedIMMPACT COS for acute pediatric pain. Problems indicated as preventing them from using the COS were lack of awareness, difficulties with implementation, and lack of resources. Conclusion: All analysis of positive conclusive evidence of efficacy in included SRs, except one SR, are in line with guidelines for the management of acute postoperative pain. The superior quality of Cochrane reviews compared to non-Cochrane reviews has already been reported in multiple studies so Cochrane reviews remain the “gold standard” for clinical decision-making. Systematic reviews and RCTs in the field of pediatric pain do not use the recommended COS. This makes comparisons of efficacy and safety across interventions very difficult. Further discussions about the adequacy of COS for acute pediatric pain, as well as interventions to increase the uptake of COS may be warranted.

Sestrinstvo je relativno mlada disciplina unatoč činjenici da je njegovanje bolesnih, ranjenih, nemoćnih i siromašnih, kao jedan od oblika pomaganja, prisutno tijekom cijele povijesti čovječanstva. U povijesti sestrinstva najčešće se spominju imena žena koje su se posvetile njezi i pružanju pomoći drugima. To djelovanje najčešće je bilo vezano uz njihovo religijsko, karitativno, altruističko i filantropsko osobno određenje (1). Počeci razvoja zdravstva grada Koprivnice sežu u 14. i 15. stoljeću gdje nalazimo prve vrlo oskudne podatke o postojanju nekakve zdravstvene djelatnosti koja se u to vrijeme veže uz postojanje tzv. hospitala - ustanovu za zbrinjavanje nemoćnih, bolesnih i siromašnih građana. Zdravstvene prilike potkraj 19. i početkom 20. stoljeća bile su loše, bilo je to vrijeme ratova, epidemija i sl. nedaća. Povijest sestrinstva može se usporedno pratiti s razvojem medicine, od prvih početaka skrbi za bolesne i nemoćne pa sve do današnjeg modernog sestrinstva, kao nezaobilazne, samostalne medicinske struke. Prvobitna skrb bila je u rukama pojedinih žena, uglavnom iz kruga obitelji ili prijatelja oboljelog, temeljena na samaritanstvu i filantropiji. U malobrojnim bolnicama u 19. stoljeću brigu o bolesnicima vodile su nekvalificirane ili polukvalificirane bolničarke (15). Do dolaska dr. Nike Selaka na mjesto ravnatelja bolnice nigdje se ne spominje njegovateljski kadar. Tek 1938. dolaze prve medicinske sestre u Koprivnicu, no u prvo vrijeme rade u nekim izvanbolničkim djelatnostima. Od 1961. u ustanovu dolaze prve medicinske sestre s višom školom Zdenka Kovačić, Marija Stanišić, Krunoslava Ivančić i Ružica Lončarić koje su postale i prve glavne odjelne sestre. Od 1968. godine u sestrinstvu dolazi do užih specijalizacija, osobito za suvremeni medicinski tretman, prije svega u intenzivnoj njezi i anesteziji. Novi način rada zahtijevao je pojačane napore medicinskih sestara, traži se veći stupanj odgovornosti tako da se prelazi na rad u smjenama. Veliki iskorak u razvoju sestrinstva doprinijelo je preseljenje u novu bolnicu 1980. godine. Dolazi do otvaranja novih odjela, uvodi se sve više novih medicinsko-tehničkih i dijagnostičkih metoda, teži se standardizaciji provođenja sestrinskih postupaka te se prati kvaliteta provođenja što je zahtijevalo kontinuiranu edukaciju i školovanje medicinskih sestara., Nursing is a relatively young discipline despite the fact that nursing of the sick, the wounded, the helpless and the poor, as one of the forms of aid, has been present throughout the entire human history. The names of women who cared for others are often mentioned in the history of nursing. This activity was most often related to their religious, charitable, altruistic and philanthropic personal determination (1). The beginnings of Koprivnica's health care development date back to the 14th and 15th centuries, where we find the first very scarce data on the existence of some kind of healthcare that was at the time linked to the existence of a hospice - an institution for the helpless, sick and poor citizens. The health conditions at the end of the 19th and early 20th centuries were quite bad; it was the time of wars and epidemics. The history of nursing has been accompanied by the development of medicine, from the very beginnings of care for the sick and helpless until today's modern nursing, as an inevitable and independent medical profession. At its beginnings, nursing was in the hands of the women, who mostly came from the family or the circle of friends of the ill; based on samaritanism and philanthropy. In the small 19th century hospitals, patient care was conducted by unqualified or semi-qualified nurses (15) and until dr. Niko Selak's arrival as the head of the hospital, no nursing staff was mentioned. In 1938, the first nurses came to Koprivnica but at the beginning they did not even work with patients. In 1961, the hospital received the first nurses with higher education, Zdenka Kovačić, Marija Stanišić, Krunoslava Ivančić and Ružica Lončarić, who then became the first head nurses. Since 1968, nursing has greatly advanced, especially regarding modern medical treatment, such as intensive care and anesthesia. This requires increased efforts by nurses and a higher degree of responsibility, which is why nurses often work in shifts. A breakthrough in nursing development contributed to the relocation to a new hospital in 1980. New departments are opening, new medical-technical and diagnostic methods are introduced, the standardization of nursing practices is being pursued, and the quality of implementation has been followed, which requires continuous education and training of nurses.

Jedan od indikatora kvalitete je plan otpusta palijativnog pacijenta iz zdravstvene ustanove. Zbog učestalih promjena u društvu i zdravstvenom sustavu sve više se pažnje posvećuje kvalitetnom planu otpusta, naročito palijativnih pacijenata. Pravovremenim prepoznavanjem pacijenta koji ima potrebu za palijativnom skrbi i upisom u registar palijativne skrbi pridajemo važnost kvaliteti života pacijenta. Palijativni timovi u zdravstvenim ustanovama procjenjuju stanje pacijenta i sukladno tome uključuju obitelj u plan otpusta. Otpust se počinje planirati već pri samom prijemu pacijenta u zdravstvenu ustanovu. U kirurgiji palijativni zahvati imaju cilj smanjiti tegobe i patnje pacijenta te su u radu nabrojani palijativni zahvati. Na kirurškim odjelima kod otpusta palijativnog pacijenta veliku važnost pridajemo komunikaciji i edukaciji pacijenta i njegove obitelji / skrbnika. Procjenjuju se potrebe i želje pacijenta u planiranju otpusta. Kod otpusta pacijentu se daje otpusna dokumentacija, koja mora biti kvalitetno, detaljno i cjelovito sastavljena kako bi se nastavio kontinuitet skrbi kakvu je pacijent imao u bolnici. Kvalitetnim planom otpusta poboljšavamo kontinuitet i dostupnost skrbi za pacijenta., One of quality indicators is discharge planing for palliative patients. Significant and frequent changes in society and health systems require better quality of discharge summaries, especially for palliative patients. Recognizing the patient who needs palliative care, and adding them into register, we add value to quality of life for those patients. Palliative teams in health institutions asses condition of patient and include family into discharge plans. Discharge is planned from the moment patient is admitted to a hospital. In surgical specialties, palliative procedures aim to reduce discomfort and suffering of patient, and this paper is describing them. On surgical wards we emphasis importance of communication and education of patient and family involved in care when we plan discharge. We always consider and embrace needs and wishes of our patient. When discharged, patient has his discharge letters which need to be properly written in details and with all explanation needed so level of care remains the same, even not in hospital environment. Proper discharge planing improves continuity and availability of patient nursing care.

Kvalitetna zdravstvena zaštita, informiranost i edukacija o zdravlju i kvaliteti života, dio je ostvarenja osnovnih ljudskih potreba i prava, a temeljena je na adekvatnoj komunikaciji. Od najranije dobi, kad se oslanjamo na vlastiti govor te kad se očekuje samostalnost u obavljanju osnovnih aktivnosti, usvajamo obrazac pri rješavanju aktualnih zdravstvenih i drugih poteškoća. Postavljanje točne dijagnoze te put do rješavanja zdravstvenog problema otežan je ukoliko zdravstveni djelatnik od pacijenta ne dobiva potrebne informacije. Ovaj problem umanjuje i povjerenje u odnosu pacijent – zdravstveni djelatnik, a poznato je kako je upravo povjerenje važno u suradnji na projektu zvanom „očuvanje zdravlja“. S problematikom komunikacijske barijere pri ostvarivanju zdravstvene zaštite u Hrvatskoj susreću se i gluhe te gluhoslijepe osobe. Jezik je plod kulture te je tako i kultura gluhih i gluhoslijepih iznjedrila vlastiti – znakovni jezik. Kako ne postoji jedinstven govorni jezik, tako i svaka nacija gluhih ima vlastiti znakovni jezik. Neadekvatna edukacija zdravstvenog osoblja o hrvatskom znakovnom jeziku kao materinjem jeziku gluhih i gluhoslijepih u Republici Hrvatskoj, te o drugim primjerenim načinima komunikacije s osobama oštećenog audio – vizualnog sustava, doprinosi površnoj zdravstvenoj obradi i posljedično socijalnoj izolaciji ove skupine Hrvatskih državljana. Premda prema zakonskoj regulativi (Zakon o zdravstvenoj zaštiti, Zakon o zaštiti prava pacijenata, Konvencija Ujedinjenih naroda o pravima osoba s invaliditetom) gluhi i gluhoslijepi imaju pravo na jednaku kvalitetu zdravstvene skrbi kao i čujuće osobe, praksa pokazuje drugačiju stvarnost. Gluhe i gluhoslijepe osobe ostaju oni o kojima nitko ne brine jer ne zna kako. Ono što čujućoj osobi izgleda kao napredak i olakšanje u tehničkom dijelu bolničkog sustava – obavijesti, edukativni materijali, infrastruktura, osvjetljenje, komunikacijski kanali (Internet, telefon...), gluhoj i gluhoslijepoj osobi može biti problem i uteg. No uz malo dobre volje, truda i zalaganja i ova barijera može biti uklonjena, a kvaliteta života jedne, ne tako male, skupine uvelike unaprijeđena., Quality health care, information and education on health, and quality of life are part of the realization of basic human needs and rights and are altogether based on adequate communication. From an early age, when we rely on our own speech and when we are expected to be independent in performing our basic activities, we adopt a model to deal with various health and other difficulties. Making the right diagnosis and solving a health problem is difficult if the healthcare provider does not receive the necessary information from the patient. This problem also diminishes the trust in the patient - health care professional relationship, and it is well known that mutual trust is important while cooperating on a project called "health preservation". Deaf and deaf-blind people are also faced with the problem of communication barrier in achieving health care in Croatia. Language is the product of culture, and so the culture of the deaf and deaf-blind has introduced its own sign language. As there is no unique spoken language, deaf people of every nation have its own sign language. Inadequate education of health personnel on the subject of the Croatian sign language as the mother tongue of the deaf and deaf - blind in the Republic of Croatia, as well as on other appropriate ways of communication with persons with impaired audio - visual system, contributes to the superficial health treatment and consequently social isolation of this group of Croatian citizens. Although, by law (Health Care Act, Patient Rights Protection Act, United Nations Convention on the Rights of Persons with Disabilities), deaf and deaf-blind people are entitled to the same quality of care as hearing persons, the practice shows a different reality. Deaf and deaf-blind people remain those no one cares about because they do not know how. What appears to the hearing person to be progress and relief in the technical part of the hospital system - notifications, educational materials, infrastructure, lighting, communication channels (Internet, telephone ...), to the deaf and deafblind person can be a problem and a barrier. However, with some goodwill, effort and dedication, this barrier can be removed, and the quality of life of one, not so small group, greatly improved.

Brojni povijesni zapisi i dokazi ukazuju na to da korištenje droga nije fenomen novijeg razdoblja. Razvoj medicine utjecao je na shvaćanje učinaka droge na organizam, definirana je fizička i psihička ovisnost, tolerancija i apstinencijski sindrom. Sukladno sve većim zanimanjem stručnjaka za područje ovisnosti, nude se brojne definicije pojmova ovisnosti i psihoaktivne tvari. Iz ponuđenog je jasno vidljivo kako je u svim definicijama ovisnosti opisana žudnja za konzumacijom psihoaktivne tvari, dok je svim definicijama psihoaktivnih tvari zajednička činjenica kako se radi o tvarima prirodnog ili sintetiziranog porijekla, s moći izazivanja promjena psihičkog i/ili fizičkog stanja. Osim što se psihoaktivne tvari mogu podijeliti na prirodne i kemijski stvorene (podjela prema porijeklu), postoji podjela prema načinu djelovanja na središnji živčani sustav, pa se dijele na psihodepresorne, psihostimulativne i halucinogene droge. Konzumacijom psihoaktivnih sredstava, neovisno o tome kojoj skupini pripadaju, javljaju se mnogi štetni učinci i posljedice. Oni prvenstveno uzrokuju zdravstvene probleme, no uz njih se javljaju i društveni te socioekonomski problemi. Rastom incidencije o zlouporabi droga, raste i mogućnost sve većeg broja trudnoća koje su ugrožene zbog prenatalnog djelovanja teratogenog agensa na nerođeno dijete. Pri konzumaciji sredstvo prolazi kroz placentu, ulazi u djetetov krvotok i uzrokuje razne probleme. Neonatalni apstinencijski sindrom klinička je dijagnoza koja se javlja kod novorođenčadi majki ovisnica, a javljaju se simptomi gastrointestinalnog, respiratornog i središnjeg živčanog sustava, te poremećaji vazomotorike i promjene na koži, najčešće u prvih 48 sati života. Manifestacija simptoma ovisi o koncentraciji opijata u majčinu krvotoku. U skrbi za dijete sudjeluju specijalisti nekoliko područja, a sve u svrhu rješavanja kompleksnih specifičnih problema i osiguranja adekvatne skrbi za dijete. U tretmanu se roditelje nastoji uključiti u što više aktivnosti, s obzirom na to da se i samim kontaktom i prisutnošću mogu ublažiti simptomi neonatalnog apstinencijskog sindroma. Medicinske sestre moraju vladati širokim stručnim znanjem, vještinama, komunikacijom, a profesionalnim odnosom i iskazivanjem empatije, postiže se bolja suradnja roditelja, što uvelike pridonosi bržem oporavku., Numerous historical records and evidence suggest that drug use is not a phenomenon solely of recent times. The development of medicine influenced the understanding of the effects of drugs on the body, the physical and psychological dependence was defined, alongside the concepts of tolerance and the withdrawal syndrome. The growing interest of experts in the field of addiction is followed with an inflow of new proposals of numerous definitions for both addiction and psychoactive substances. From the current state, it is clear that in all definitions present, addiction is described as a craving for consumption of psychoactive substances, while all the definitions of psychoactive substances understand ingredients of natural or synthetic origin, with the ability to cause changes in mental and/or physical condition. In addition to the division of psychoactive substances to natural and chemically created (classification by origin), there is a classification according to the effect of the substances on the central nervous system, which goes as follows: psychodepressors, psychostimulants and hallucinogens. Consumption of psychoactive substances, regardless of which group they belong to, is a direct cause to various side effects. Primarily, they cause health problems, but these are often followed with social and socio-economic problems. Growing incidence of drug abuse increases the possibility of highly volatile pregnancies due to the prenatal effects of teratogenic agents on the unborn child. When using, the substance passes through the placenta, into the child’s blood stream causing various problems. A neonatal abstinence syndrome is a clinical diagnosis in infants of addicted mothers, and is manifested as the underdevelopment of gastrointestinal, respiratory and central nervous system, as well as the vasomotoric disorders and changes on the skin, usually in the first 48 hours of life. The manifestation of symptoms depends on the concentration of opiates in the mother's bloodstream. In child care, the specialists involved come from a wide range of areas, all with the combined aim to solve complex problems and ensure adequate care for the child. The treatment aims to involve parents in as many activities under the mentioned care due to the possible positive effects of contact and presence of a parent on the child suffering from the neonatal abstinence syndrome. Nurses must possess a wide set of skills, high expertise and professional attitude and through empathy they can achieve cooperation and a better understanding with parents, which can directly aid the process of recovery.