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Uvod: Jedna od potencijalnih prijetnji sigurnosti pacijenata je dijeljenje lijekova, što je oblik samo-liječenja. Ovaj je projekt analizirao učestalost, percepciju rizika i čimbenike povezane s dijeljenjem analgetika na recept. Metode: Proveli smo dva kvalitativna i jedno presječno kvantitativno istraživanje. Prvo kvalitativno istraživanje provedeno je polu-strukturiranim intervjuima među 15 liječnika zaposlenih u hrvatskim Ambulantama za liječenje boli. Drugo kvalitativno istraživanje je bilo provedeno u fokus skupnim raspravama s 40 ispitanika. Bili su uključeni odrasli u dobi od ≥18 godina koji su dobili recept za analgetik najmanje jednom u životu. Provedeno je šest zasebnih fokus skupina s kojima se raspravljalo o percepciji rizika povezanih s dijeljenjem receptnih analgetika među pacijentima. Osim toga, ispitanici su bili ispunili dva upitnika o demografskim podacima, osobnom ponašanju povezanim sa dijeljenjem analgetika i njihovim stavovima o rizicima povezanim s dijeljenjem analgetika na recept. Presječno kvantitativno istraživanje je bilo provedeno u 10 ordinacija obiteljske medicine u Hrvatskoj među 1000 pacijenata kojima su liječnici najmanje jednom u životu propisali analgetike. Upotrijebljen je upitnik za prikupljanje podataka o intenzitetu boli pacijenata, navikama dijeljenja analgetika na recept, čimbenicima koji su povezani s takvim ponašanjem, percepcijom rizika povezanih s tim ponašanjem i demografskim podacima. Logistička regresija provedena je kako bi se analizirali neovisni čimbenici povezani sa davanjem drugim osobama i uzimanjem od drugih osoba analgetika na recept. Rezultati: Među liječnicima, dvanaestero ih se bilo susrelo s pacijentom koji dijele analgetike na recept s drugim pacijentima kojima nije namijenjen recepta. Većina liječnika smatra da je dijeljenje receptnih analgetika rizično i negativno ponašanje. U drugom kvalitativnom istraživanju u upitniku 55% ispitanika je bilo navelo da dijele receptne analgetike, a naknadno u raspravama fokusnih skupina 76% ih je bilo priznalo takvo ponašanje. Ispitanici su prepoznali određene rizike povezane s dijeljenjem analgetika na recept, spomenuli brojne razloge za uključivanje u takvo ponašanje i ukazali na određene pozitivne aspekte takvog ponašanja. U presječnom kvantitativnom istraživanju ustanovljeno je da 61% pacijenata iz ordinacije obiteljske medicine dijeli analgetike na recept, bilo da se radi o davanju drugoj osobi (42%) i/ili o uzimanju od druge osobe (54%). Neovisni pozitivni prediktori za davanje analgetika na recept drugim osobama su bili: anamneza dijeljenja lijekova na recept koji nisu analgetici, pružanje informacija o lijekovima na recept koji idu uz taj lijek, ne čitanje uputa za lijek, subjektivna percepcija zdravlja i smanjena svjesnost o štetnosti povezane sa davanjem analgetika na recept drugoj osobi. Neovisni pozitivni prediktori za uzimanjem analgetika na recept od druge osobe su bili: mlađa životna dob, priopćavanje pojedinosti o lijeku koji se daje, sklonost čitanju uputa o lijeku, pristrana procjena osobnog zdravlja i percepcija da je alternativna medicina sigurnija opcija od konvencionalne medicine. Zaključak: Dijeljenje receptnih analgetika vrlo je zastupljeno među pacijentima u obiteljskoj medicini. Edukacija pacijenta i veća uključenost liječnika u prepoznavanju tog ponašanja navedeni su kao potencijalne mjere za sprečavanje dijeljenja analgetika na recept. Potrebno je osmisliti i afirmirati preventivne intervencije. Background: One of the potential threats to patient safety is the sharing of medication among patients, which is form of self-medication. This project analyzed frequency, perception of risks and factors associated with sharing prescription analgesics. Methods: For this project we were conducted two qualitative and a cross-sectional research. The first qualitative study was conducted by semi-structured interviews among 15 PMPs employed in Croatian pain clinics. Second qualitative study was conducted by focus group discussions with 40 participants. Adults aged ≥18 years who had received a prescription for an analgesic at least once in a lifetime were included. Six separate focus groups were conducted to discuss participants’ perception of risks associated with sharing of prescription analgesics among patients. Additionally, participants filled out two questionnaires on demographic data, their own behavior regarding sharing analgesics, and their attitudes about risks associated with sharing prescription analgesics. A cross-sectional study was conducted in 10 outpatient family medicine practices in Croatia amongst 1000 patients to whom their physicians have prescribed analgesics at least once in their lives. A questionnaire was used to collect data about patients’ pain intensity, prescription analgesic sharing habits, factors associated with this behavior, perception of risks associated with the conduct and demographic data. Logistic regression was conducted to analyze independent factors associated with lending and borrowing prescription analgesics. Results: Among PMPs, twelve have seen patients who share their prescription analgesics with other patients for whom prescription is not intended. Most PMPs consider prescription analgesics sharing a risky and negative behavior. In second qualitative study in a questionnaire, 55% of the participants indicated that they personally shared prescription analgesics, while subsequently in the focus group discussions, 76% confessed to such behavior. Participants recognized certain risks related to sharing of prescription analgesics, mentioned a number of reasons for engaging in such behavior, and indicated certain positive aspects of such behavior. In the cross-sectional research we found that 61% of patients in family medicine practices engage in sharing prescription analgesics, whether it was lending (42%) and/or borrowing (54%). Independent predictors of lending prescription analgesics were as follows: history of sharing prescription medication other than analgesics, providing information regarding the medication alongside the prescription medication itself, not reading package insert that accompanies medication, subjective perception of personal health and decreased awareness of personal harm associated with prescription analgesic sharing. Independent predictors of prescription analgesic borrowing were as follows: younger age, communicating details regarding the medication that was given, scanning of package insert accompanying the medication, biased subjective perception of personal health and perceiving alternative medicine as a safer option over conventional medicine. Conclusion: Sharing prescription analgesics is highly prevalent amongst patients in family medicine. Patient education and more involvement of physicians in identifying this behavior were cited as potential remedies for preventing sharing of prescription analgesics. Preventive interventions should be conceived and established.

Rizici kojima su izloženi zaposlenici jedni su od najvažnijih kojima poduzeća trebaju upravljati bilo da ih izbjegavaju, smanjuju, prenose ili prihvaćaju (i financiraju). Za procjenu rizika u vezi s ozljedama na radu, profesionalnim bolestima, bolestima u svezi s radom te poremećajimaa u procesu rada, prema Zakonu o zaštiti na radu, određene organizacije obvezne su izraditi procjenu rizika. Uvelike je važna kvalitetna izrada procjene rizika radnih mjesta u metaloprerađivačkim poduzećima. Prema statistici u posljednjih pet godina, upravo ova djelatnost u najvećoj mjeri pridonosi ukupnom broju ozljeda na radu na razini Republike Hrvatske. U radu su dane teorijske podloge u vezi s upravljanjem rizicima i pregled regulative iz područja zaštite na radu. Na primjeru radnog mjesta radnika na strojnoj obradi u metaloprerađivačkoj industriji prikazani su sadržaj i postupci procjene rizika, kao obveznog dokumenta za navedenu vrstu industrijskog pogona., Risks to which employees are exposed are some of the most important risks that companies need to manage. Risks are to be avoided, reduced, transferred, and if need be accepted (and financed). According to the Occupational Health and Safety Act, certain types of companies are under obligation to draft a risk assessment document including possible injuries at work, occupational diseases, disturbances and disruptions of the work process, etc. Quality risk assessment of workplaces in metalworking companies is essential since statistical data show that in the last five years the metalwork industry in the Republic of Croatia has had the highest incidence of work injuries. The paper provides a theoretical background on risk management and a survey of regulations governing occupational safety. An example of the content and methods for drafting a compulsory risk assessment document for a machine processing workplace in a metalwork plant is given.

Sve veća važnost informacijskih sustava u poslovnim subjektima (tvrtkama) zahtjeva pažljivo procjenjivanje ranjivosti sustava i utjecaja mogućih neželjenih događaja na poslovanje tvrtke (prije svega financijski gubitak). Vezano uz ovaj problem tvrtke implementiraju sustave upravljanja sigurnošću informacija (ISMS – Information Security Management System) kako bi rizik neželjenih događaja svele na prihvatljivu mjeru. Upravljanje rizikom (RM - Risk Management) je ključni dio sustava, a predstavlja proces u kojem se definiraju čimbenici koji mogu neželjeno utjecati na očuvanje povjerljivosti, cjelovitosti i raspoloživosti informacija. Upravljanje rizikom je složen proces koji se sastoji od više faza, a čiji je cilj svođenje rizika na prihvatljivu mjeru. Radom su prikazani osnovni elementi sustava upravljanja sigurnošću informacija te sam proces uspostave sustava. U radu je obrađeno nekoliko metoda procjene rizika uz prikaz njihovih prednosti i mana. Primjerom (dokumentacijom) iz prakse prezentiran je model uspostave sustava upravljanja sigurnošću informacija. Because information systems are more important for companies every day, companies must assess vulnerabilities of system and impact of unwanted events on companies (especially financial impact). Regarding that issue companies implement ISMS (Information Security Management System) to reduce risk to acceptable level. Very important prerequisite, which precede implementation of ISMS is recognition of data (information) as asset (value) owned by company. RM (Risk Management) is key element of system, representing process in which key factors which can affect conservation of confidentiality, integrity and availability of information are defined. Risk management is complex process consisting of many fazes, with goal to reduce risk to acceptable level. Work presents basic elements of ISMS and process of implementation of ISMS. In this work, several methods of risk assessment are elaborated and their advantages and disadvantages are presented. Example (documentation) from practice presents model of implementation of Information Security Management System.

Prema sadašnjim spoznajama nije moguće konstruirati potpuno sigurno tehnološko postrojenje. Stoga se nesreća može dogoditi u svakom postrojenju, pa tako i u nuklearnoj elektrani. Zbog prisutne velike količine radioaktivnih tvari, nesreće u nuklearnim elektranama mogu prouzročiti znatne posljedice, i to ne samo unutar postrojenja nego i u užem i širem okolišu. U okviru magistarskog rada razvijena je metoda za kvantitativnu procjenu rizika za zdravlje ljudi od nesreća u nuklearnim elektranama. Nova je metoda nazvana PRONEL. Metoda je namijenjena procjeni rizika od elektrana koje se nalaze na udaljenosti 40 do 1.300 km od odabranog mjesta izlaganja. Zbog toga što se radi o relativno velikim udaljenostima, u obzir se uzimaju samo nuklearne nesreće prilikom kojih bi došlo do ispuštanja najvećih količina radioaktivnog materijala. Tu se ubrajaju nesreće koje uključuju oštećenje jezgre i odmah potom brzo ispuštanje zaštitne zgrade ili njen zaobilazak. Metoda PRONEL primijenjena je u procjeni individualnih rizika od nuklearnih nesreća za građane Zagreba, Osijeka, Rijeke i Splita, kao i kolektivnog rizika za sveukupno stanovništvo Republike Hrvatske. Procjenom je obuhvaćeno 90 energetskih reaktora koji se nalaze na udaljenosti do 1.000 km, a zadatak je bio procijeniti rizike od pojedinih elektrana, tipova elektrana te skupina elektrana formiranih s obzirom na njihovu udaljenost. Rezultati su pokazali da je od četiri analizirana populacijska centra najrizičniji Osijek. Rizici za Zagrepčane su upola manji, a rizici za Riječane i Splićane približno četiri puta manji od onih za Osječane. Najveći doprinos individualnim i kolektivnom riziku daju energetski reaktori “istočne” proizvodnje, i to oni tipa VVER-440 V230 i VVER-440 V213. Identificirane su i tri elektrane koje generiraju rizik bitno veći od ostalih. To su NE Paks u Mađarskoj, NE Bohunice u Slovačkoj i NE Kozloduy u Bugarskoj. Ako bi se nuklearne elektrane prema udaljenosti od mjesta izlaganja podijelile u pet skupina (750 km), za Zagrepčane i Riječane bi najveći rizik predstavljale elektrane na udaljenosti 250-500 km. Za Osječane bi najveći rizik generirale elektrane na udaljenosti 50-250 km, a za Splićane one udaljene 500-750 km. Present knowledge does not allow for constructing a completely safe industrial facility. Therefore an accident can occur in any facility, including a nuclear power plant. Due to a large quantity of radioactive material present, accidents in nuclear power plants can have significant effects, not only within the facility itself but also in its immediate and distant environment. The master’s thesis develops a method for quantitative human health risk assessment related to nuclear accidents. The new method is called PRONEL. The method is intended for risk assessment of power plants that are located between 40 and 1.300 km away from the selected exposure site. Since these distances are relatively long, only nuclear accidents which included release of the largest quantities of radioactive material have been taken into account. This includes core melt accidents followed by early major containment failure or containment bypass. PRONEL method was applied in assessment of individual risks of nuclear accidents for citizens of Zagreb, Osijek, Rijeka and Split, as well as assessment of collective risk for entire population of the Republic of Croatia. The assessment included 90 power reactors located up to 1.000 km away, and the task was to assess the risks represented by individual power plants, types of power plants and groups of power plants formed on the basis of their distance from selected location. The results have shown that out of four analyzed population centers Osijek is the one with the highest risk. Risks for citizens of Zagreb amount to half of that, while citizens of Rijeka and Split are exposed to four times lower risk than the citizens of Osijek. The greatest contributors to individual and collective risk are power reactors of “eastern” origin, of types VVER-440 V230 and VVER-440 V213. Three nuclear power plants have been identified as generating a risk much higher than the rest. These are Paks NPP in Hungary, Bohunice NPP in Slovak Republic and Kozloduy NPP in Bulgaria. If one would divide the NPPs according to their distance from the exposure site into five groups (750 km), the highest risk for citizens of Zagreb and Rijeka would come from power plants located at distance of 250500 km. For citizens of Osijek, the highest risk would be generated by power plants 50250 km away, and for citizens of Split those power plants that are located at distance of 500-750 km.

U radu se raspravlja o dva osnovna pristupa opasnim, tj. rizičnim pojavama. Prvi način, nazvan laičkim i najrašireniji u javnosti, osniva svoje percipiranje i prosudbe na nizu elemenata koji se ne zasnivaju na mjerenjima, klasifikaciji i poznavanju stvarnih dimenzija opasnih i rizičnih pojava. On se osniva na specifičnim vrijednosnim karakteristikama koje se pridaju rizicima kao kompleksnim pojavama. Nasuprot tome, ekspertna prosudba rizika osniva se na mjerljivim elementima, dozama tolerancije i povjerenju u kontrolu opasnosti mjerama tehnoloških sustava. Ekspertno shvaćanje rizik kategorizira, klasificira i određuje granice prihvatljivosti koristeći se različitim metodama. U radu se pokazuje kako navedeni oblici prosuđivanja polaze od različitih pretpostavki, od različitih vrijednosnih sklopova, a ukazuje se i na razloge međusobne netolerancije. Navode se i neke metode ekspertnog uočavanja opasnih pojava i najvažniji procesi o kojima valja voditi računa kada se razmatra tzv. laičko reagiranje na opasne pojave i stanja. U zaključnom dijelu rada ukazuje se na osnovne razloge razlikovanja laičkih i ekspertnih prosudbi rizika te na najvažnije aspekte njihova približavanja., The paper dissertates two basic approaches to hazards and risks. The first, lay approach, which is the most widespread in general public, founds its risk perception and assessment of on a range of elements not based on measurement, classification and knowledge of real dimensions of hazards and risks. It is based on specific value characteristics that are attributed to risks as complex phenomena. Expert risk assessment, on the other hand, is based on measurement, tolerance doses and trust in risk control by various technological measures. Expert approach categorizes risks, classifies them and defines the risk acceptances limits using various methods. The paper shows that the two approaches start form different assumptions and value frameworks, pointing to the most important reasons of their mutual intolerance. Authors describe the main methods of expert risk assessment, and main characteristics of lay risk perception which should be taken into account when so called "lay reactions" to risks are being considered. The conclusive part of the paper points out the basic reasons for differences between lay and expert approach to risks, as well as the most important presumptions for overcoming of the differences., In der Arbeit werden zwei grundlegende Ansätze bei der Beurteilung (Feststellung, Wahrnehmung) der gefährlichen bzw. mit einem Risiko verbundenen Erscheinungen erörtert. Der erste, sog. laienhafte Ansatz ist am meisten verbreitet in der Öffentlichkeit und gründet sich auf einer Reihe von Elementen, die sich weder bemessen noch einordnen lassen. Es handelt sich dabei nicht um Kenntnis wirklicher Dimensionen von gefährlichen und riskanten Erscheinungen, sondern um spezifische Wertmastäbe, nach denen Risiken als komplexe Erscheinunngen beurteilt werden. Im Gegensatz dazu, beruht die fachmännische Beurteilung von Risiken auf mebaren Elementen, Toleranzdosen und dem Vertrauen in die Risikokontrole durch technologische Manahmen. Bei der fachmännischen Beurteilung werden die Risiken kategorisiert und eingestuft, indem mit Hilfe verschiedener Methoden die Zulässigkeitsgrenze festgelegt wird. In dieser Arbeit wird aufgedeckt, da die genannten Beurteilungsformen von verschiedenen Grundsätzen und Bewertungsmastäben ausgehen, zugleich wird auf die Ursachen für die gegenseitige Intoleranz hingewiesen. Angefürhrt werden auch einige Methoden der fachmännischen Feststellung von Risiken und die wichtigsten Prozesse, die bei der Beurteilung von öffentlichen Reaktionen auf gefährliche Erscheinungen und Zustände berücksichtigt werden müssen. Im Schluteil der Arbeit wird auf grundlegende Unterschiede zwischen der laienhaften und fachmännischen Beurteilung von Risiken, sowie auf deren mögliche Berührungspunkte hingewiesen.