Search

Uvod: Smrtnost sepse je visoka usprkos antimikrobnim lijekovima, stoga se ispituju imunomodulatorni lijekovi, između ostalih i statini. Cilj: Pokazati imaju li bolesnici prethodno liječeni statinima lakši klinički oblik i manju smrtnost sepse. Ustroj: Retrospektivno kohortno, opservacijsko istraživanje, usporedba prethodno liječenih i prethodno neliječenih statinima. Ispitanici: Sepsa iz opće populacije, bakterijski izolat iz hemokultura, dob ≥ 50 god. Rezultati: Uključeno 899 bolesnika, 116 (12.9%) prethodno liječenih statinima. Bez statistički značajnih razlika u izraženosti parametara sustavnog upalnog odgovora. Medijan SOFA zbroja u prethodno liječenih statinima iznosio je 2.0 kao i u skupini prethodno neliječenih (p=0.117). Ukupna smrtnost 9.2%, prethodno liječeni 6.0%, prethodno neliječeni 9.7%, (p=0.231). Nema razlike u 28-dnevnoj smrtnosti (log-rank test, p=0.693). Zaključak: Nema statistički značajne razlike u težini kliničke slike kao ni u smrtnosti sepse između bolesnika prethodno liječenih i prethodno neliječenih statinima., Introduction: Sepsis mortality is high despite antimicrobial drugs, therefore immunomodulatory drugs (including statins) are being investigated. Objective: To show whether patients with prior statin therapy had less severe clinical presentation and lower mortality of sepsis. Design: Retrospective, cohort, observational study, comparison of patients with and without prior statin therapy. Patients: Community-acquired sepsis, age ≥ 50 years, bacterial isolate from blood cultures. Results: 899 patients included, 116 (12.9%) with prior statin therapy. No significant difference in SIRS parameters. Median SOFA score 2.0 in both groups (p= 0.1179). Total mortality 9.2%, in prior statin group 6.0%, in nonprior statin group 9.7% (p=0.231). No difference in 28-day mortality, log-rank test, p=0.693). Conclusion: There are no statistically significant differences in the severity and mortality of community acquired sepsis in patients with and without prior statin therapy.

The aim of the following study is to depict the causes of death that were most common during a time period between 1880–1949 in the small villages Ivetofta, Ivö, Rinkaby and Vinslöv. The results will be presented in different time intervals of 10 years. Furthermore, the surge will analyse the variations over time and explain why causes of death may altern. In addition, it will also highlight specific aspects of the subject such as age, gender, birth, violent death, suicide and the Spanish flue. The results in the different areas will be compared to each other to illuminate similarities and differences. Moreover it will also be compared to national statistics to see if the different villages comply or oppose with the results. In order to improve the study, the conclusion will also be compared and connected to the two theories the demographic transition and The Epidemiologic Transition. They offer an explaination to the outcome and allow us to integrate this study in a greater context. The results of this survey, show that the most common cause of death was that of age. Furthermore, there was a huge up-swing in heart diseases, brain diseases and cancer in the later time periods. At the beginning, most people that died were very young. This changed however and as time passed, more and more people began to decease at an older age and this complied with national statistics. There was a slight majority of women that passed away although almost all persons that occured in cases of violent death, were men and this category increased with time. Even though a lot of people died, a lot more were born and therefore the small societies had a positive birth ratio. There occured cases of the Spanish flue although it did not influence the vast statistics.

Background: Congenital heart disease (CHD) includes a wide range of malformations, from simple lesions, e.g. ventricular septal defect, that resolve spontaneously, to severe lesions, e.g. univentricular heart, not compatible with life without intervention. Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease. In Sweden, approximately 1% of the children are born with CHD each year of which about 30 have ToF. The prognosis has improved remarkably due to advances in surgical techniques as well as peri- and postoperative care. Nowadays, 97% of babies with CHD born in Sweden can be expected to survive into adulthood. Despite huge improvements in prognosis, the relative mortality is still 7 to 97 times higher in patients with CHD, depending on lesion severity, compared with matched controls. Therefore, it is important to improve long-term follow-up and to identify robust and easily available tools to predict poor outcome and optimize timing of possible reinterventions. Addressing quality of life (QoL) has also become more important when survival increases. The main focus of this thesis was on QoL and long-term outcome in patients with repaired tetralogy of Fallot (rToF). In studies I, II and III, we analysed health related quality of life (HRQoL), prevalence of cardiac devices (i.e. pacemakers and implantable cardioverter defibrillators), and exercise capacity, respectively, in patients with rToF. In study IV, the aim was to broaden the perspective and include patients with a wide range of CHD, and to investigate whether exercise capacity, measured as workload could be of help in predicting mortality. Methods: The studies were performed as nationwide register studies. Data from the Swedish registry of congenital heart disease (SWEDCON) were used in studies I-IV. Study II also included data from the Swedish ICD and Pacemaker registry. In studies I-III, only patients with rToF were included, whilst study IV included patient with a broad spectrum of CHD diagnoses. Results: More than half (57%) of the patients with rToF reported best possible HRQoL. New York Heart Association (NYHA) class I and being physically active were associated with best possible HRQoL. Fourteen percent of patients with rToF had a cardiac device, either a pacemaker or an implantable cardioverter defibrillator (ICD). The prevalence of having a cardiac device was lower compared with reports from previous studies, especially for ICDs. Exercise capacity was 75% of predicted in patients with rToF and there was no decline in percent of predicted exercise capacity with age. Low heart rate reserve and low percent of predicted exercise capacity were associated with higher mortality. In study IV, including a wide range of lesions, percent of predicted exercise capacity was associated with mortality. Patients with percent of predicted exercise capacity between 50 and 69.9% had 1.7 times, and patients with exercise capacity Zoom för disputation: https://umu.zoom.us/j/68136604319Kod: 112233

Kronična bubrežna bolest (KBB) obilježena je postupnim i progresivnim gubitkom svih bubrežnih funkcija. Petina muškaraca i četvrtina žena u dobi nakon 65 godina boluje od KBBa. Uzimajući u obzir rastuću incidenciju dijabetesa i arterijske hipertenzije koji su glavni uzroci kroničnog gubitka bubrežne funkcije, može se zaključiti da KBB postaje globalni javnozdravsteni problem. Vodeći uzrok smrti u oboljelih od KBB-a jesu kardiovaskularne bolesti (KVB), i to ponajviše bolesti vezane uz srce poput ishemijske bolesti srca i srčanog zatajivanja. Visokoosjetljivi troponini (hs-cTnT, hs-cTnI) zlatni su standard u dijagnostici kardijalne patologije. Najčešće se rabe u detekciji akutnoga koronarnog sindroma, ali se povišene vrijednosti mogu zabilježiti u nizu drugih stanja. Poznato je da se povišene serumske vrijednosti troponina mogu zabilježiti u više od dvije trećine bolesnika s KBBom na dijalizi, čak i u odsutnosti KVB-a. Svrha je ovoga prikaza bila ustanoviti potencijalne uzroke porasta troponina u kroničnih bubrežnih bolesnika te zaključiti postoji li veza između njihova porasta i mortalitetnih i morbiditetnih pokazatelja. Pretraživanjem literature ustanovljeno je da su bolesnici u terminalnim stadijima bubrežnog zatajenja u znatno povišenom riziku za razvoj KVB-a i smrtnoga ishoda. Istraživanja su također upozorila na snažnu povezanost između koncentracije visokoosjetljivih troponina i kardiovaskularnog, odnosno ukupnog mortaliteta u oboljelih. S druge strane, malo se zna o načinu metaboliziranja i ekskrecije troponina. Teorija prema kojoj se troponini izlučuju bubrezima postaje sve prihvaćenija unutar znanstvenih krugova. Pojedina su istraživanja, od kojih i neka hrvatska, dokazala prisutnost troponina u urinu, no potrebna su i daljnja istraživanja kako bi se ustanovilo je li moguće iskoristiti troponine u urinu kao potencijalne nove biomarkere u pravodobnom prepoznavanju KBB-a i KVB-a., Chronic kidney disease (CKD) is characterized by gradual progressive loss of all kidney functions over a period of time. One-fifth of men and one-quarter of women over the age of 65 suffer from CKD. Given the growing incidence of diabetes and hypertension, which are the main causes of this disease, CKD is becoming one of the major global public health issues. Cardiovascular diseases are the leading cause of death in people with CKD, primarily heart-related conditions such as ischemic heart disease and heart failure. High-sensitivity troponins (hs-cTnT, hs-cTnI) are crucial biomarkers used in the detection of cardiac pathology. They are mostly used in the detection of acute coronary syndrome, but elevated values can be also observed in several other conditions. Studies have shown that serum troponin levels are elevated in more than two-thirds of patients with CKD on dialysis, even in those without any cardiovascular pathology. The aim of this review was to examine the literature and to determine the reason for troponin increase in patients with CKD, and to establish whether there is a connection between their increase and the mortality rate. A literature search revealed that patients with end-stage renal disease (ESRD) are at especially high risk of cardiovascular morbidity and mortality. Studies have also found a strong association of high-sensitivity troponins with cardiovascular and all-cause mortality in those patients. On the other hand, even though the function of troponins is very well-known, little is known about their production and excretion from the body. The theory that troponins are excreted by the kidneys is becoming widely accepted in scientific circles. New studies, some of which are Croatian, have demonstrated the presence of troponins in urine, but further research is needed to determine whether it is possible to use troponins in urine as potential biomarkers for cardiovascular and kidney disease.

Cilj je rada istražiti pojavu i utjecaj španjolske gripe u gradu Splitu tijekom 1918. i 1919. godine. Za utvrđivanje i opisivanje pojavnosti španjolske gripe na prostoru grada korištene su matične knjige umrlih župa sveti Križ, sveti Petar i Katedrala te registar umrlih splitske Državne bolnice. Pomoću spomenutih dokumenata prikupljeni su podatci o broju umrlih, te o njihovom spolu i dobi. Na temelju prikupljenih podataka provedena je deskriptivna statistička analiza. Prvi smrtni slučajevi pojavili su se početkom rujna 1918. godine, no vrhunac epidemije je bio u listopadu i studenom. Najveći broj umrlih zabilježen je u župi sveti Križ, a najmanji u župi Katedrala. Većina umrlih bila je u dobi od 20-40 godina života, te je smrtno stradao veći broj žena. Analizom novina Novo doba utvrđeno je da je španjolskoj gripi posvećeno malo medijskog prostora s obzirom na mortalitet koji je uzrokovala. The aim of the paper was to investigate the occurrence and impact of the Spanish flu in the city of Split during 1918 and 1919. The registers of the deceased of parishes St. Cross, St. Peter and the Cathedral and the register of the dead of the Split State Hospital were used to determine and describe the occurrence of the Spanish flu in the city. With the help of the mentioned documents, data on the number of deaths and their gender and age were collected. Based on the collected data, a descriptive statistical analysis was performed. The first deaths from this disease appeared in early September 1918, but the peak of the epidemic was in October and November same year. The highest number of deaths was recorded in the parish of the St. Cross, and the lowest in the parish of Cathedral. Most of the dead were between the ages of 20 and 40. In addition, a more women died from the consequences of illness. The analysis of Novo doba newspaper confirmed that very little media space was devoted to the Spanish flu even though it caused a high mortality.

A survey of the birth and mortality of European Bison (Bison bonasus bonasus L1758) conducted from 2000 to 2018 in two nurseries showed that the females in the first study group had the first mating at an average age of 42.54 months, with an interval from 23 to 84.5 months. The average age of the first mated females in the second study group was 31.67 months, with an interval from 39.5 to 66.93 months. The average time between calving for the first group females was 9.95 months, with an interval from 0.5 to 28.5 months. The calving interval for the second group was 8.53 months with variation from 1 to 32 months. The first group had a maximum of seven calves, while the maximum in the second group was 13.A total of 33 calves were born in the first group during the study period, 16 males (48.48%) and 17 females (51.51%), while 40 calves were born in the second group,16 males (40.0%) and 24 females (60.0%).The mortality rate in the first group ranged between 14.3 and 30.0%, with a mortality rate of males of 20 to 60% and for females of 16.66 to 50%. In the second group, the mortality rate was from 9.09 to 23.08%, for males 33.33% and from 11.11 to 25.0% for females. The results indicate that future studies should address greater attention to birth and mortality rates., Prateći natalitet i mortalitet, u dva stada, u razdoblju 2000.-2018., europskog bizona (Bison bonasus bonasus L. 1758) ustvrđeno je da se prvoj oglednoj skupini prvo parenje krava događa, u prosjeku, s uzrastom od 42,54 mjeseca, uz interval variranja od 23 do 84,5 mjeseci. U drugoj oglednoj skupini uzrast ženskih grla pri prvom parenju bila je prosječno, 31,67 mjeseci s intervalom variranja od 39,5 do 66,93 mjeseci. Međutelidbeni interval u ženskih grla u prvoj skupini bio je, prosječno, 9,95 mjeseci s intervalom 0,5-28,5 mjeseci. U drugoj skupini ovaj je interval prosječno iznosio 8,53 mjeseca uz variranje od 1-32 mjeseca. Kada je riječ o broju teljenja ustvrđeno je da je u prvoj skupini, maksimalan broj teljenja bio 7, a u drugoj skupini 13. Kada je riječ o odnosu spolova oteljene teladi u prvoj je skupini za promatrano razdoblje, oteljeno 33 teleta, 16 muških (48,48 %) i 17 ženskih (51,51%). U drugoj skupini oteljeno je 40 - 16 muških (40,0 %) i 24 ženska (60,0 %) teleta. Mortalitet grla, u promatranom razdoblju, u prvoj skupini kretao se od 14,29 % do 30,0 %. Promatrano po spolovima muških grla se kretalo u granicama od 20,0 % do 60,0 %, a u ženskih grla od 16,66 % do 50,0 %. U drugoj promatranoj skupini mortalitet se kretao u granicama od 9,09 % do 23,08 %. Smrtnost muških grla je bila 33,33 %, a ženskih od 11,11 % do 25,0%.Na osnovu analize dobivenih rezultata jasno je da se proučavanju nataliteta i mortaliteta u populaciji europskih bizona mora pristupiti organiziranije i temeljitije.

Background: Acute respiratory distress syndrome (ARDS) is a condition characterized by an acute, diffuse, inflammatory lung injury with high morbidity and mortality. Since it was first reported in 1976, prone position has been increasingly used to treat patients with ARDS as it improves oxygenation. However, the evidence on mortality is conflicting. Objective: The purpose of this project thesis is to assess the effect on mortality of prone positioning in patients with moderate and severe ARDS. Material and methods: A literary review was conducted January 2021 through a search in PubMed database. Only randomized controlled studies were included. To be included, studies had to meet the selected PICO-criteria: P; adults with moderate or severe ARDS, I; prone position, C: supine position or conventional treatment, O; mortality/survival. The search included several MeSH-terms and was limited to English articles. Results: Based on the PICO-criteria, five articles were included, addressing mortality as their primary endpoint. All of the five articles found an improvement in mortality in patients turned prone in contrast to supine. However, only one of the studies managed to achieve a statistically significant improvement. The remaining four articles failed to show a significant reduction in mortality in patients randomized to the prone position and were prematurely stopped mostly due to a low patient recruitment rate. Conclusion: Prone position may have a beneficial effect on mortality, even though underpowered RCT studies have failed to confirm a direct positive effect on mortality in adult patients with ARDS. Factors such as duration and application of prone positioning, as well as the interval between onset of ARDS should be taken in consideration when considering the effect of prone position.

Tall och gran är de vanligaste trädarterna i svenska skogar. Förutom deras ekonomiska värde är de viktiga värdar för andra organismer och nyttjas oftast när de är döda. Säby Västerskog har skyddats i hundra år och är ett urskogsartat naturreservat där inga fördjupade analyser av dynamiken i trädskiktet har gjorts sedan 1930-talet. Denna studie gjordes med syfte av att uppdatera informationen om reservatets trädstatus samt att undersöka mortaliteten hos skogens barrträd. Det som undersöktes var om mortaliteten skiljde sig mellan trädslag, storleksklass och markslag. Förändringar i grundytan och balansen mellan arten undersöktes också. Träd identifierades med hjälp av data från en detaljerad karta från 1937, det togs mått på deras diameter och noterades vilken mark de stod på. Fler granar än tallar har dött i reservatet sedan 1937. Trädens storlek spelade ingen roll för tallars mortalitet, men väl för granar. Granens mortalitet skiljde sig inte mycket mellan olika markslag, men verkade spela roll för tall som hade högst mortalitet på våtmark och lägst på blockmark. Trots mortaliteten ökade trädens grundyta. Balansen mellan arterna förblev samma. Scots pine and Norway spruce are the most common tree species in Swedish forests. They are important hosts to other organisms – mostly as dead wood. Säby Västerskog has been protected in hundred years but no in-depth analyses of dynamics in the tree layer have beendone since the 1930s. This study was done to update the information about the reserve’s tree status and examined mortality of conifers. I evaluated if mortality depended on tree species, size of the trees, or the type of ground they stood on. I also examined changes in trees’ basal area. The trees were identified with help of an old, detailed map from 1937. Their diameters were measured and the ground type they were standing on was noted. More spruces than pines had died in the reserve since 1937. Mortality varied with the tree size for spruce but not for pines. The mortality of pines varied among ground types (with the highest on wetlands and lowest on boulder deposits), but not for spruce. Despite high mortality basal area had increased. The balance between the species remained the same.

Sepsa je klinički sindrom karakterisan prisustvom infekcije i neadekvatnog sistemskog inflamatornog odgovora organizma i može se komplikovati razvojem septičnog šoka i multiorganske disfunkcije. Sepsa predstavlja jedan od najvećih zdravstveniih problema današnjice širom sveta sa visokim mortalitetom. Takođe, ona je glavni preventabilni uzrok smrti unutar bolnica. Poznavanje i jasno definisanje prediktivnih faktora mortaliteta kod pacijenata u sepsi pomaže u bržoj identifikaciji kritično obolelih pacijenata i pravovremenom ordiniranju adekvatne terapije, te doprinosi razvoju novih strategija primarne i sekundarne prevencije. Kreiranje modela za predikciju mortaliteta pruža mogućnost kvantifikacije težine stanja pacijenata, što ih čini neizostavnim u naučno-istraživačkom radu, pogotovo u oblastima poboljšanja kvaliteta i personalizovane medicine. Opšti cilj ovog istraživanja je bio da se utvrde nezavisni prediktori mortaliteta u sepsi, kao i da se formira prediktivni model smrtnog ishoda. Specifični ciljevi su bili da se utvrdi korelacija koncetracije laktata, vrste prijema i komorbiditeta sa mortalitetom u sepsi. Ispitivanje je sprovedeno kao opservaciono, neinterventno, delom retrospektivno, delom prospektivno. Obuhvaćena je konsekutivna serija pacijenata sa sepsom primljenih u Jedinicu intenzivnog lečenja Instituta za plućne bolesti Vojvodine u Sremskoj Kamenici od 01.01.2017. do 31.07.2019. godine. Metodama logističke regresivne analize su procenjeni faktori rizika za 28-dnevni mortalitet. Nakon identifikacije nezavisnih prediktora konstruisan je i validiran prediktivni model. Studijom je ukupno obuhvaćeno 307 pacijenata sa sepsom od kojih je 52,4% preminulo unutar 28 dana od prijema. Nije postojala statistički značajna razlika (p>0,05) u mortalitetu od sepse u odnosu na vrstu prijema pacijenata u jedinicu intenzivne nege. Vrednost laktata pri prijemu i vrednost Čarlson skora je bila u pozitivnoj korelaciji sa mortalitetom. Konačni model predikcije mortaliteta sadrži sledeće varijable: vrednost APAČE 2 skora preko 20, SOFA skora iznad 7, Čarlsonovog indeksa komorbiditeta preko 3 i koncentracija laktata u serumu iznad 2,32 mmol/l. Formiran model predikcije je pokazao dobru diskriminaciju (AUC 0,754: 95% IP=0,700-0,808), a ispravno je klasifikovao 67,4% pacijenata, sa 70,8% osetljivosti i 63,7% specifičnost. Zaključujemo da su nezavisni prediktori mortaliteta kod pacijenata u sepsi: viša koncentracija laktata merena u prva 24 časa od prijema u jedinicu intenzivnog lečenja, više vrednosti APAČE 2 skora, više vrednosti SOFA skora i više vrednosti Čarlsonovog indeksa komorbiditeta. Za razliku od laktata i komorbiditeta, ne postoji statistički značajna razlika u mortalitetu od sepse u odnosu na vrstu prijema. Konstruisan model predikcije je pokazao dobru prediktivnu validnost, uporedivu sa ostalim najčešće korišćenim modelima., Sepsis is a clinical syndrome characterized by both the presence of the infection and inadequate systemic inflammatory organism response that can be additionally complicated by the development of septic shock and multiorgan dysfunction. Recently sepsis is defined as one of the biggest health problems in the world with high mortality and a major preventable cause of death within hospitals. Knowledge and clear definition of predictive mortality factors for patients with sepsis contribute to faster identification of critically ill patients and timely administration of adequate therapy, as well as to the development of new strategies for primary and secondary prevention. Creating a model for predicting mortality provides the possibility of quantifying the severity of the patients' condition that can be indispensable in scientific research, especially in the areas of quality improvement and personalized medicine. The overall aim of this thesis was to determine independent predictors of mortality in sepsis, as well as to form a predictive model of mortality. Whereas specific objectives of the thesis were to determine the correlation of lactate concentration, type of admission and comorbidity with mortality for sepsis. The investigation was conducted as observational, noninterventional, partly retrospectively, partly prospectively. The research included consecutive series of patients with sepsis admitted to the Intensive Care Unit of the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica from 01.01.2017 to 31.07.2019. Risk factors for 28-day mortality were estimated by logistic regression analysis methods. After the estimation of independent predictors, a predictive model was constructed and validated. The study involved a total of 307 patients with sepsis, of whom 52.4% died within 28 days of admission. There was no statistically significant difference (p>0.05) in mortality from sepsis in relation with the admission type of patients to the intensive care unit. The value of lactate at the time of admission and the value of the Charlson score were positively correlated with mortality. The final mortality prediction model contained the following variables: APACHE II score above 20, SOFA score above 7, Charlson comorbidity index over 3, and serum lactate concentrations above 2.32mmol/l. The prediction model formed showed good discrimination (AUC 0.754: 95% CI = 0.700-0.808), and were correctly classified 67.4% of patients, with 70.8% sensitivity and 63.7% specificity. It can be concluded that independent predictors of mortality in patients with sepsis are: higher lactate concentration measured in the first 24h of admission to the Intensive Care Unit, higher APACHE II scores, higher SOFA scores, and higher Charlson comorbidity index values. Unlike lactate and comorbidity, there is no statistically significant difference in mortality from sepsis in relation with the admission type. The constructed prediction model exhibited good predictive validity, comparable to other commonly used models.

Sepsa je klinički sindrom karakterisan prisustvom infekcije i neadekvatnog sistemskog inflamatornog odgovora organizma i može se komplikovati razvojem septičnog šoka i multiorganske disfunkcije. Sepsa predstavlja jedan od najvećih zdravstveniih problema današnjice širom sveta sa visokim mortalitetom. Takođe, ona je glavni preventabilni uzrok smrti unutar bolnica. Poznavanje i jasno definisanje prediktivnih faktora mortaliteta kod pacijenata u sepsi pomaže u bržoj identifikaciji kritično obolelih pacijenata i pravovremenom ordiniranju adekvatne terapije, te doprinosi razvoju novih strategija primarne i sekundarne prevencije. Kreiranje modela za predikciju mortaliteta pruža mogućnost kvantifikacije težine stanja pacijenata, što ih čini neizostavnim u naučno-istraživačkom radu, pogotovo u oblastima poboljšanja kvaliteta i personalizovane medicine. Opšti cilj ovog istraživanja je bio da se utvrde nezavisni prediktori mortaliteta u sepsi, kao i da se formira prediktivni model smrtnog ishoda. Specifični ciljevi su bili da se utvrdi korelacija koncetracije laktata, vrste prijema i komorbiditeta sa mortalitetom u sepsi. Ispitivanje je sprovedeno kao opservaciono, neinterventno, delom retrospektivno, delom prospektivno. Obuhvaćena je konsekutivna serija pacijenata sa sepsom primljenih u Jedinicu intenzivnog lečenja Instituta za plućne bolesti Vojvodine u Sremskoj Kamenici od 01.01.2017. do 31.07.2019. godine. Metodama logističke regresivne analize su procenjeni faktori rizika za 28-dnevni mortalitet. Nakon identifikacije nezavisnih prediktora konstruisan je i validiran prediktivni model. Studijom je ukupno obuhvaćeno 307 pacijenata sa sepsom od kojih je 52,4% preminulo unutar 28 dana od prijema. Nije postojala statistički značajna razlika (p>0,05) u mortalitetu od sepse u odnosu na vrstu prijema pacijenata u jedinicu intenzivne nege. Vrednost laktata pri prijemu i vrednost Čarlson skora je bila u pozitivnoj korelaciji sa mortalitetom. Konačni model predikcije mortaliteta sadrži sledeće varijable: vrednost APAČE 2 skora preko 20, SOFA skora iznad 7, Čarlsonovog indeksa komorbiditeta preko 3 i koncentracija laktata u serumu iznad 2,32 mmol/l. Formiran model predikcije je pokazao dobru diskriminaciju (AUC 0,754: 95% IP=0,700-0,808), a ispravno je klasifikovao 67,4% pacijenata, sa 70,8% osetljivosti i 63,7% specifičnost. Zaključujemo da su nezavisni prediktori mortaliteta kod pacijenata u sepsi: viša koncentracija laktata merena u prva 24 časa od prijema u jedinicu intenzivnog lečenja, više vrednosti APAČE 2 skora, više vrednosti SOFA skora i više vrednosti Čarlsonovog indeksa komorbiditeta. Za razliku od laktata i komorbiditeta, ne postoji statistički značajna razlika u mortalitetu od sepse u odnosu na vrstu prijema. Konstruisan model predikcije je pokazao dobru prediktivnu validnost, uporedivu sa ostalim najčešće korišćenim modelima. Sepsis is a clinical syndrome characterized by both the presence of the infection and inadequate systemic inflammatory organism response that can be additionally complicated by the development of septic shock and multiorgan dysfunction. Recently sepsis is defined as one of the biggest health problems in the world with high mortality and a major preventable cause of death within hospitals. Knowledge and clear definition of predictive mortality factors for patients with sepsis contribute to faster identification of critically ill patients and timely administration of adequate therapy, as well as to the development of new strategies for primary and secondary prevention. Creating a model for predicting mortality provides the possibility of quantifying the severity of the patients' condition that can be indispensable in scientific research, especially in the areas of quality improvement and personalized medicine. The overall aim of this thesis was to determine independent predictors of mortality in sepsis, as well as to form a predictive model of mortality. Whereas specific objectives of the thesis were to determine the correlation of lactate concentration, type of admission and comorbidity with mortality for sepsis. The investigation was conducted as observational, noninterventional, partly retrospectively, partly prospectively. The research included consecutive series of patients with sepsis admitted to the Intensive Care Unit of the Institute for Pulmonary Diseases of Vojvodina in Sremska Kamenica from 01.01.2017 to 31.07.2019. Risk factors for 28-day mortality were estimated by logistic regression analysis methods. After the estimation of independent predictors, a predictive model was constructed and validated. The study involved a total of 307 patients with sepsis, of whom 52.4% died within 28 days of admission. There was no statistically significant difference (p>0.05) in mortality from sepsis in relation with the admission type of patients to the intensive care unit. The value of lactate at the time of admission and the value of the Charlson score were positively correlated with mortality. The final mortality prediction model contained the following variables: APACHE II score above 20, SOFA score above 7, Charlson comorbidity index over 3, and serum lactate concentrations above 2.32mmol/l. The prediction model formed showed good discrimination (AUC 0.754: 95% CI = 0.700-0.808), and were correctly classified 67.4% of patients, with 70.8% sensitivity and 63.7% specificity. It can be concluded that independent predictors of mortality in patients with sepsis are: higher lactate concentration measured in the first 24h of admission to the Intensive Care Unit, higher APACHE II scores, higher SOFA scores, and higher Charlson comorbidity index values. Unlike lactate and comorbidity, there is no statistically significant difference in mortality from sepsis in relation with the admission type. The constructed prediction model exhibited good predictive validity, comparable to other commonly used models.

U članku se analiziraju kvantitativna i kvalitativna obilježja stanovništva u pet gradova Bjelovarsko-bilogorske županije, s projekcijom broja stanovnika do 2051. godine. Prikazano je kretanje broja stanovnika u razdoblju 1857.–2016. godine, s naglaskom na procese depopulacije u zadnjih pola stoljeća. Zahvaljujući procesima industrijalizacije i deruralizacije, broj stanovnika Bjelovara i Daruvara bilježi sve do 1991. godine intenzivan rast, dok stanovništvo Čazme, Garešnice i Grubišnoga Polja počinje opadati već od prvih popisa nakon Drugoga svjetskoga rata. U posljednjih pola stoljeća bitno se promijenila prostorna slika naseljenosti Županije, uz intenzivnije procese depopulacije ruralnih područja od prosjeka Hrvatske. To potvrđuje i analiza prirodnog kretanja stanovništva. Sve općine, ali i gradska naselja Županije već od 1970-ih godina ulaze u posttranzicijsku demografsku fazu, koju karakteriziraju oznake negativnih razlika između nataliteta i mortaliteta te negativna migracijska bilanca. To su i osnovni uzroci gotovo dramatične depopulacije praktički svih naselja u Županiji. U izravnoj je vezi s navedenim kretanjima i pogoršanje starosne strukture stanovništva. Sve je veći nedostatak mladog stanovništva, dok je kontingent staroga stanovništva u stalnom porastu. Stanovništvo ima sve povoljniju školsku (obrazovnu) strukturu, što u određenom smislu povećava pokretljivost, odnosno hrani negativnu migracijsku bilancu. Ako se sadašnji trendovi kretanja stanovništva (u zadnjih 20-ak godina) projiciraju do 2051. godine, onda će sredinom 21. stoljeća broj stanovnika Bjelovara biti manji za oko 25%, Čazme za 47%, Daruvara za 54%, Garešnice za oko 63% te Grubišnoga Polja za čak gotovo 80%. To će izazvati i vrlo negativna kretanja u procesima starenja stanovništva i u drugim kvalitativnim obilježjima, a uz dramatično demografsko pražnjenje ruralnih područja. Takva demografska kretanja trebaju biti zadnji alarm cijelom društvu u stvaranju i provođenju nove, dugoročne demografske i razvojne politike., The paper analyses quantitative and qualitative features of the population of five towns in the Bjelovar-Bilogora County, with the predicted number of inhabitants by 2051. It presents the movement in the number of inhabitants in the period 1857–2016, stressing the depopulation processes in the last five decades. Thanks to the industrialisation and deruralisation processes, up to the year 1991, there had been an intensive increase in the number of inhabitants of Bjelovar and Daruvar, while the number of inhabitants in Čazma, Garešnica and Grubišno Polje began decreasing as soon as at the time of the first census following World War Two. Over the last fifty years, the spatial image of the presence of population in the County changed significantly. In comparison with the Croatian average, depopulation processes in rural areas in this area were more intensive. This was confirmed by the analysis of the natural movement of population. As early as in the 1970s, not only all the municipalities, but also urban settlements of the Country entered the post-transitional demographic phase, which was characterised by negative differences between the birth and the death rates, as well as by a negative migration balance. These were the main causes of a nearly dramatic depopulation having taken place in the vast majority of settlements in the County. Furthermore, the aggravation of the age structure of population is directly connected with the aforementioned movements. There is a decrease in the percentage of the young population, whilst the contingent of the old population is in constant increase. The schooling (educational) structure of the population is becoming increasingly favourable, which – in a certain sense – increases the mobility, i.e. stimulates the negative migration balance. If the current trends of population movement (present for the last two decades) are projected into 2051, the number of inhabitants of Bjelovar will – around the mid-21st century – decrease by approximately 25 %, of Čazma by 47 %, of Daruvar by 54 %, of Garešnica by around 63 %, and of Grubišno Polje by nearly 80 %. This is more than likely to initiate extremely negative movements within population aging processes and other qualitative features, accompanied by dramatic demographic vacation of rural areas. Demographic movements of this kind oughtto present the final alarm for the entire society to create and implement a new, long-term demographic and developmental policy.

Izuzetno razorni, osmansko-mletački, imperijalni ratovi 17. stoljeća imali su za posljedicu novo geopolitičko preslagivanje i povlačenje nove granične crte, kao stvarne rezultante i ravnoteže njihovih imperijalnih snaga, čega je daljnja posljedica bila ostanak prostora Ljubuškog na periferiji Osmanskoga Carstva, ali i njegov preustroj i u državno upravnom i u crkveno-upravnom smislu. Nakon strahovitog demografskoga rasapa i snažnih ambijentalnih preobrazbi izazvanih spomenutim ratnim destrukcijama, nastupilo je dugotrajno razdoblje političke stabilnosti, kao preduvjet ponovne repopulacije i bonifikacije prostora. Taj je proces bio spor i dugotrajan i svoj istinski zamah dobiva u prvoj polovici 19. st., na kojem je i fokus naših istraživanja. Sinergijom više silnica, od snažnoga demografskoga pritiska sa svih okolnih prostora i unutarnjega prirodnoga prirasta, gospodarskih interesa osmanske (navlastito muslimanskih zemljoposjednika) i austrijske države, te nezaustavljivog procesa modernizacije, dolazi do repopulacije prostora i intenzivnih hidromelioracijskih zahvata. Ekohistorijsku sliku istraživanoga prostora, koju su dominantno obilježavali rijeka Trebižat (Mlade) i pripadnost sredozemnom klimatskom pojasu, s razdobljem utjecaja maloga ledenoga doba i njegove etape izrazitih hladnoća, pokušali smo rasvijetliti razumijevanjem prirodnih datosti, socioekonomskih čimbenika, te intelektualnih doživljaja okoliša u jednom interdisciplinarnom obuhvatu, tako primjerenom ekohistoriji. Geološke, geomorfološke, pedološke, hidrološke itd. pojave „dugoga trajanja“, klima i vrijeme, biljni i životinjski svijet, toponimija, kolektivni imaginariji, samo se neki aspekti ljubuškog okoliša rasvijetljeni korištenjem pisanih povijesnih izvora, ponajprije matičnih knjiga i ljetopisa, kartografskih prikaza, proučavanjem materijalnih ostataka putem terenskih istraživanja, te ispitivanjem raznoraznih usmenih predaja u vidu jedne vrlo osebujne oral history. Nakon rekonstrukcije demografske slike i analize naseljenosti pojedinih ljubuških seoskih mikrocjelina, posebna pozornost posvećena je rekonstrukciji pripadnosti rodovskim zajednicama osoba sporadično spominjanih prije biskupskih popisa iz sredine 18. st. od kada se iste mogu sustavnije pratiti. Na temelju spomenutih popisa napravljena je svojevrsna inventura rodova i naselja, što je nastavljeno analizom prvoga sveska matične knjige krštenih na prijelazu 18./19. stoljeća, kao i analizom natalitetnih pojavnosti, također na temelju spomenute matične knjige. Još minucioznija analiza nastavljena je proučavanjem demografskih pojavnosti na razini pojedinoga naselja, pače svakoga roda, što su omogućile matične knjige župe Ljubuški iz prve polovice 19. stoljeća. Pri tome je posebna pozornost posvećena migracijskim kretanjima i podrijetlu stanovništva, zbog toga što je to u prošlosti bilo predmet mitomanskih, velikosrpskih i velikobošnjačkih, pseudohistorijskih prisezanja. Ipak, okosnicu rada predstavljale su sintetičke analize na razini cijele župe triju demografskih značajki, nataliteta, nupcijaliteta i mortaliteta. Raščlambom nataliteta razglabano je o fenomenu znamenovanja, rađanju nezakonite djece i blizanaca, imenskom fondu rođenih, rodovima s najviše rođenih, a posebna pozornost je posvećena sezonalitetu začeća (rođenja). Sezonalitet je bio predmet raščlambe i ostalih dviju demografskih značajki, nupcijaliteta i mortaliteta, a usto je kod nupcijaliteta razmatrana ženidbena dob mladenaca, ponovni brakovi udovaca i udovica, te rodovi s najviše mladoženja i mladenki. Uz spomenutu sezonalnost, kod mortaliteta je analiziran raspored umrlih po naseljima, dobnim skupinama, spolu, kao i uzroci smrti, a posebno je razmotrena epidemija kuge iz drugog desetljeća 19. st. koja je snažno obilježila kolektivni imaginarij ljubuškog stanovništva. Dakako, svi analizirani pokazatelji razmotreni su u komparativnom kontekstu, što je pokazalo velik stupanj podudarnosti s već obavljenim sličnim istraživanjima predmodernih društava na širem euromediteranskom prostoru, napose u dinarskim predjelima kojih je dio i istraživana mikrocjelina. Extremely devastating, Ottoman-Venetian, imperial wars of the 17th century resulted in a new geopolitical rearrangement and demarcation, as real results and balance of their imperial powers, which left the area of Ljubuški on the periphery of the Ottoman Empire, but also caused its reorganization in both state-administrative and church-administrative sense. After a terrible demographic disintegration and strong ambient transformations caused by the aforementioned war destructions, occurred a long period of political stability as a precondition for the area’s repopulation and bonification. This process was slow and long lasting and gained its true momentum in the first half of the 19th century, which is the focus of our research. The synergy of several forces, from strong demographic pressure from all surrounding areas and internal natural growth, economic interests of the Ottoman (especially Muslim landowners) and the Austrian state, and the unstoppable process of modernization, led to the repopulation of the area and intensive hydro-melioration interventions, which were causally related. We tried to shed light on the ecohistorical picture of the researched area, which was predominantly marked by the river Trebižat (Mlade) and belonging to the Mediterranean climate zone, with the period of the Little Ice Age and its stage of extreme cold, by understanding and connecting natural conditions, socioeconomic factors and intellectual experiences of the environment in an interdisciplinary coverage, so appropriate to the ecohistory. Geological, geomorphological, pedological, hydrological, etc. phenomena of “long duration”, climate and time, flora and fauna, toponymy, are only some aspects of the environment of Ljubuški and its experience in the imaginary of the locals, illuminated using written historical sources, primarily parish registers and chronicles, cartographic representations, study of material remains through field research, and the examination of various oral traditions in the form of a very peculiar oral history. After an extensive reconstruction of the demographic picture, especially in the second half of the 17th and the first decades of the 18th century, and an analysis of population of the individual rural micro-units of Ljubuški, special attention was paid to the reconstruction of the belonging to clan communities which were sporadically mentioned before the mid-18th century episcopal censuses. On the basis of the mentioned episcopal censuses, a kind of inventory of clans and settlements was made, which continued with the analysis of the first volume of the parish register of baptisms at the turn of the 18th/19th century, as well as with the analysis of birth rates based on the aforementioned parish register. An even more meticulous analysis continued with the study of demographic indicators at the level of the individual settlements, an even of the each clan, which was made possible by the parish register of the Ljubuški parish from the first half of the 19th century. In doing so, special attention is paid to migrations and the origin of the population, all the more so because in the past it was the subject of mythomaniac, Greater Serbian and Greater Bosniak, (pseudo)historical pretensions. Nevertheless, the backbone of the scientific work were parish-wide synthetic analyzes of three demographic characteristics, natality, nuptiality, and mortality. The analysis of birth rates discussed the phenomenon of naming, the birth of illegitimate children and twins, the name fund of the newborns, the families with the most births, and special attention was paid to the seasonality of conceptions (births). Seasonality was the subject of analysis of the other two demographic characteristics, nuptiality and mortality, and in addition to nuptiality, the marriage age of the newlyweds, the remarriage of widows and widowers, and the clans with the most grooms and brides were considered. In addition to the mentioned seasonality, the distribution of deaths by settlements, age groups, sex, as well as causes of death were analyzed in connection with the mortality, and the plague epidemic from the second decade of the 19th century, which strongly marked the collective imaginary of the Ljubuški population, was especially considered. Of course, all analyzed indicators were considered in a comparative context, which showed a high degree of congruence with similar studies of premodern societies in the wider Euro-Mediterranean area, especially in the Dinaric regions of which the researched micro-unit is part.

Uporaba agrokemikalija u poljoprivredi ima znatne posljedice na onečišćenje okoliša. Sve je manje aktivnih tvari na tržištu zbog nepovoljnih toksikoloških svojstava, što dodatno otežava uobičajenu zaštitu bilja. Osim toga uslijed dugogodišnje i nepravilne uporabe sredstva za zaštitu bilja često dolazi do razvoja rezistentnosti brojnih vrsta kukaca. Nužno je istražiti nove formulacije i nove ekološki prihvatljive aktivne tvari. Jedna od mogućih novih ekološki prihvatljivijih formulacija su mikrosfere. Alternativa i zamjena sintetičkim kemikalijama mogu biti prirodni toksini koje proizvode brojni člankonošci kao što je apitoksin. Cilj ovoga istraživanja bio je utvrditi učinkovitost apitoksina u suzbijanju štetnih kukaca. Istraživanje je provedeno na tri različite vrste kukaca u odraslom i ličinačkom razvojnom stadiju (Leptinotarsa decemlineata, Tenebrio molitor, Sitophilus granarius). Procedure su optimizirane te je utvrđeno želučano i kontaktno djelovanje apitoksina. Mikrosfere s apitoksinom imaju dugo početno i rezidualno djelovanje, zbog sporog otpuštanja apitoksina iz mikrosfere. U istraživanju je utvrđeno značajno bolje želučano u usporedbi s kontaktnim djelovanjem na kukce. Podaci istraživanja pridonijeti će ukupnom znanju o primjeni i razvoju inkapsuliranih formulacija, a mikrosfere apitoksina imaju potencijal da postanu alternativa u ekološkoj i visoko dohodovnoj proizvodnji.

Spanskesyken er estimert til å ha tatt livet av mellom 50 og 100 millioner mennesker. Tidligere forskning har vist at hvor dødelig denne pandemien var, varierte mye mellom folkegrupper og geografiske områder. I denne oppgaven er det sett nærmere på individdata for mortaliteten i Kautokeino og Karasjok under spanskesyken årene 1918-20. Aldersfordelingen av dødeligheten er undersøkt med utgangspunkt i en hypotese om at relativ isolasjon og manglende tidligere eksponering for sesonginfluensa har gitt høyere dødelighet og en annen aldersfordeling av mortaliteten enn den som er typisk for spanskesyken i majoritetsbefolkninger. Undersøkelsene har vist at dette var områder med en høyere dødelighet. I tillegg er det observert et mortalitetsmønster som avviker fra det som er vanlig i befolkninger med mer mobilitet. I Kautokeino og Karasjok var det ikke de unge voksne alene som dro opp dødeligheten. Nøkkelord: Spanskesyken, demografi, mortalitet, Kautokeino, Karasjok, pandemi

The most common cause of rapidly progressive glomerulonephritis in elderly, antineutrophil cytoplasmic antibody-associated glomerulonephritis (ANCA-GN), demands immunosuppressive therapy (IS) regimen in a multi-morbid disease burdened population. Our aim was to assess outcome differences in two age groups. The study included a total of 38 ANCA-GN renal limited patients (18 men) treated from 1990 to 2018, of which 11 were 65 years of age and older (median 70, min. - max. 66 - 79 years), and 27 younger than 65 (median 55, min. - max. 23 - 64 years). All patients were treated with mono/combination of IS. Most commonly applied IS in elderly was combination of IV cyclophosphamide and corticosteroids (CS) (in 9 [81.8%]), while in younger it was a combination of CS and cyclophosphamide or rituximab (59.2%). Older patients had comparable mortality (3, [14.8%] vs. 4, [27.3%]; P = 0.369), malignancies (1, [3.7%] vs. 1, [9.1%]; P = 0.5) and infectious complications (10, [46.7%] vs. 7, [63.6%]; P = 0.388). Ten patients at the end of the follow up were at renal replacement therapy (RRT ), with no difference between age groups (6, [22.2%] vs. 4, [36.4%]; P = 0.369). Interestingly, from initial need for RRT , half of the younger and older patients recovered with IS. Our findings give more credit to the current paradigm to treat elderly ANCA-GN patients with IS therapy due to the similar outcome of elderly as younger ones., Najčešći uzrok brzoprogresivnog glomerulonefritisa u starijih je glomerulonefritis s antineutrofilnim citoplazmatskim protutijelima (ANCA-GN, od eng. antineutrophil cytoplasmic antibody related glomerulonephritis), a s obzirom na komorbiditete predstavlja izazov u odluci oko primjene imunosupresivne terapije (IS). Cilj ovog istraživanja je usporediti razlike u ishodu dvije dobne skupine bolesnika. Istraživanje je obuhvatilo slučajeve ANCA-GN ograničenih na bubrege, liječene od 1990. do 2018. godine, njih 38 (18 muških), od kojih 11 ima 65 ili više godina (medijan 70, min.-max. 66 - 79 godina) a 27 mlađih (medijan 55, min. - max. 23 - 64 godina). Svi bolesnici su liječeni monoterapijom ili kombinacijom IS-a. Najčešće primjenjena IS u starijoj populaciji bila je kombinacija intravenskog ciklofosfamida i kortikosteroida (KS) (u 9 (81,8%)), u mlađoj kombinacija KS s ciklofosfamidom ili rituksimabom (59,2%). Stariji pacijenti imali su sličnu učestalost smrtnosti (3, 14,8% vs 4, 27,3%; P = 0.369), zloćudnih bolesti (1, 3,7% vs 1, 9,1%; P = 0.5) i infektivnih komplikacija (10, 46,7% vs 7, 63,6%); P = 0.388). Deset bolesnika je na kraju praćenja bila ovisno o nadomještanju bubrežne funkcije (NBF) bez razlike u dobnoj skupini (6, 22,2% vs 4, 36,4%; P = 0.369). Međutim, od inicijalne potrebe NBF-om se uz IS oporavila polovica starijih i mlađih bolesnika. Naši rezultati su u skladu trenutačnim stajalištima koja podupiru primjenu IS terapije kod starijih bolesnika sa ANCA-GN zbog usporedivih ishoda i rizika komplikacija kao u mlađih bolesnika.

Cilj: Prikazati trendove incidencije, mortaliteta te hospitalizacija za novotvorine u Zadarskoj županiji (Zž) od 1998. do 2018. godine, te dobivene rezultate usporediti s podacima za Republiku Hrvatsku (RH). Materijali i metode: U radu su korišteni podaci incidencije zloćudnih novotvorina Registra za rak Hrvatskog zavoda za javno zdravstvo (HZJZ) od 1998. do 2017. godine. Mortalitetni podaci za RH preuzeti su iz Zdravstveno-statističkog ljetopisa HZJZ-a, a za Zž iz Zdravstveno-statističkog ljetopisa Zadarske županije, Zavoda za javno zdravstvo (ZZJZ) Zadar od 1998. do 2018. godine. Podaci o hospitalizacijama preuzeti su iz Baze hospitalizacija, HZJZ-a. Rezultati: U Zž incidencija novotvorina ima trend kontinuiranog povećavanja. Ukupan broj novooboljelih u Zž povećao se za 81%, (594 novooboljeli, stopa 279/100.000 u 1998. godini, u 2017. godini 1076 novooboljelih, stopa 638/100.000). U RH se također uočava porast broja novooboljelih, ali za 48%, a stope su se kretale od 344/100.000 u 1998. godini do 591/100.000 u 2017. Na početku promatranog razdoblja stope incidencije u Zž bile su manje od stopa u RH, a na kraju nešto veće nego u RH. Isti trend povišenja stopa uočava se u muškaraca, ali ne i u žena. Ukupni broj umrlih od svih novotvorina u Zž povećao se za 62% (350 umrlih osoba, stopa 216/100.000 u 1998. godini, a u 2018. godini 562 umrle osobe, sa stopom od 331/100.000). U RH također se prati porast broja novooboljelih, ali za 23%, a stope su se kretale od 239/100.000 u 1998. godini do 348/100.000 u 2018. U najvećem djelu promatranog razdoblja stope smrtnosti u Zž manje su nego u RH. U ukupnom zbroju i u muškaraca su stope bile veće u Zž samo u 2011. i u 2015. U žena je u svim godinama stopa smrtnosti manja nego u RH. Stope hospitalizacije u stacionarnom dijelu vrlo su slične u muškaraca i u žena, za oba promatrana područja. U 1998. godini zabilježeno je 2386 stacionarnih hospitalizacija za stanovnike s prebivalištem u Zž, bez obzira na mjesto i ustanovu liječenja, a u 2018. godini 3.388 hospitalizacija (povećanje za 45%). Stope hospitalizacija za liječenje u dnevnim bolnicama u Zž veće su od stopa u RH u cijelom promatranom razdoblju i kretale su se u Zž od 1582 u 2008. godini do 5139/100.000 u 2018. godini, dok su se u RH kretale od 342 do 4346/100.000 stanovnika. Zaključak: Novotvorine u Zž, kao i u RH predstavljaju značajan javnozdravstveni problem. U cijelom promatranom razdoblju prati se povećanje mortaliteta, incidencije i hospitalizacija. Potrebno je uložiti dodatne napore na povećanju svijesti stanovništva i upućivati ih na važnosti ranog otkrivanja raka i redovitog sudjelovanja u nacionalnim programima probira.

U ovom izlaganju analizirat će se osnovni demografski procesi u Splitsko-dalmatinskoj županiji, s posebnim osvrtom na učinke pandemije bolesti COVID-19. Demografski trendovi u Splitsko- dalmatinskoj županiji su relativno stabilniji i povoljniji nego u većini drugih županija u Hrvatskoj. No pandemija bolesti COVID-19 i u toj županiji imala je kratkoročne učinke na tri temeljna demografska procesa: mortalitet, fertilitet i migraciju. Dugoročni učinci pandemije na osnovne demografske procese u županiji još su nam nepoznati, ali se kratkoročni već sada mogu kvantificirati. Učinak pandemije na mortalitet je najvidljiviji iz pokazatelja prekomjerne smrtnosti. Višak mortaliteta, koji je zabilježen i u Splitsko- dalmatinskoj županiji u 2020., pokazuje dodatan broj umrlih u odnosu na očekivani broj umrlih koji bismo zabilježili u „normalnim“, pretpandemijskim vremenima, a pri tom su prisutne razlike između općina i gradova županije. Istovremeno, ostvareni višak mortaliteta visoko korelira sa službeno evidentiranim brojem umrlih od bolesti COVID-19. Utjecaj pandemije na fertilitet manje je očit, no trenutačno ga je moguće pratiti samo na razini čitave države preko preliminarnih mjesečnih objava Državnog zavoda za statistiku. S druge strane, restriktivne mjere uvedene radi suzbijanja širenja epidemije djelovale su i na smanjivanje unutarnje mobilnosti u Splitsko-dalmatinskoj županiji u odnosu na prethodnu godinu. Dok je pad broja iseljenih u inozemstvo u 2020. prisutan u većini hrvatskih županija, u Splitsko-dalmatinskoj županiji je povećan, što je ponajviše rezultat povratka stranih državljana zaposlenih u turističkom sektoru.