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The incidence of environmental diseases, especially in highly developed industrial countries, has increased by more than 30% in the last few decades. These diseases represent a burden for both the individual and public health. Many of them (asthma, allergic rhinitis, chronic obstructive pulmonary disease, cardiovascular diseases) are a major public health problem, and it is necessary to identify harmful environmental factors, determine the mechanisms of their action, find adequate markers for early diagnosis and disease monitoring. By doing that better preventive and therapeutic effects can be achieved. In order to prevent the development of environmental diseases and to preserve environmental health in addition to knowing mechanisms by which harmful compounds enter the ecosystem (e.g. unintentional discharge, waste disposal, operation of industrial plants, transport) toxic kinetics is also important, i.e. absorption, biological conversion, distribution and excretion of harmful compounds and their metabolites from the organism. Intracellular matrix metalloproteinases (MMPs) are localized in various compartments within the cell including the cytosol, sarcomere, mitochondria, and nucleus. Intracellular MMPs contribute to the pathogenesis of various diseases. These include diseases with altered immune responses, cardiovascular diseases, respiratory diseases, inflammation, renal disorders, and malignant diseases. MMPs have antiviral and bactericidal effects and can act intracellularly through protease-dependent mechanisms. In addition to their immune status they are proven to be a good marker for monitoring environmental diseases. In addition to diagnosing and monitoring environmental diseases, MMPs and their tissue inhibitors (TIMPs) represent a potential treatment goal. [ABSTRACT FROM AUTHOR]

Described in the paper is the method for the assessment of manual work including repetitive tasks, occasional use of force, and improper body position. The method was developed based on an exhaustive and critical evaluation of literature on the subject, but also on the basis of our own studies conducted at a series of different work places. In addition to an objective description of tasks, repetitive movements, force and body positions, this method also provides the possibility of numerical computations of the listed activities, not ignoring their interactions. Work demands (task duration in the course of a work shift, repetition of movements, use of force, body position and work conditions) are presented using a point system, with each demand shown on a separate scale corresponding to the actual conditions. In order to calculate the overall risk it is necessary to multiply the value on the task duration scale by the sum of the values on the other scales. The final value indicates potential overload shown as a number that can then be entered in a table illustrating one of the four risk levels: green, yellow, orange, or red. Relevant literature states that the colour classification serves as an efficient help to the user in perceiving potential risk. This new method has been named SMART (Scoring Method for Assessment of Repetitive Tasks). So far it has been tested in 56 work places. The results show that 23% activities may be classified in the 'green' zone, 19% in 'yellow', 21% in 'orange' and 37% in 'red', thus leading to the conclusion that as much as 77% of assessed activities show increased load. The SMART method is still in the testing and validation stage as a tool for the assessment of statodynamic strains involved at different work places. [ABSTRACT FROM AUTHOR]

Exposure to allergens or irritants at the workplace is known to cause occupational contact dermatitis. Exposure assessment is primarily the scope of work of the specialist in occupational (and sports) medicine, especially when it comes to determining the health effects of exposure to the aforementioned noxae or process of establishing the diagnosis of occupational skin disease. It involves the identification of harm, characterization of the exposure, the assessment of the effects on the health of an individual or a group of workers. These steps are used when conducting a risk assessment or for the puropse of conducting exposure studies. It is often the case, even with a skilled expert, that exposure assessment is challenging so the purpose of this paper is to review the methods used for the workplace exposure assessment when diagnosi- ong occupational contact dermatitis. [ABSTRACT FROM AUTHOR]

Occupational and sports medicine (OSM) education is poorly represented in Croatian university undergraduate medical curricula. Zagreb University medical students are required to take OSM classes for a week on their final year of studies. The classes are organised around team-based learning (TBL). Given that students who attend TBL classes have significantly higher exam scores than students who take lectures ex cathedra, the aim of this study was to assess students’ knowledge and attitudes immediately after TBL OSM classes. This cross-sectional study included 162 final-year Zagreb University School of Medicine students taking TBL classes in OSM in the academic year of 2019/2020. They were recruited from 30 September 2019 to 4 March 2020. Participants filled in a 20-item questionnaire compiled by the authors and adapted to the Croatian legislation. Their answers demonstrated positive attitude toward OSM classes and negative attitude toward occupational medicine practice and OSM specialty. They showed moderate interest only for the job of sports physician. Even though they showed sufficient knowledge of OSM immediately after the course was completed, they were moderately satisfied with their knowledge. Our findings call for rethinking the practical aspects of teaching OSM classes in order to promote OSM practice among medical students or at least raise awareness about the importance of prevention of numerous work or sport-related disorders.

This paper describes development of a new tool, a Scoring Method for Assessment of Repetitive Tasks. This new numerical assessment makes possible to measure and evaluate both, tasks with high repetition and hard manual work. It is aimed at surveillance and detection of occupational health risks causing occupational musculoskeletal diseases.A comprehensive and critical review of the literature was conducted prior to designing the tool, together with follow-up evaluations of own studies. The new tool includes an objective description of tasks, repetition, force and body posture. Demands of work are presented with scores, each in individual scale which corresponds to the conditions encountered in practice. The classification of these scales and final numerical quantification gives an indication of overload and of load bottlenecks. Total numerical score is obtained by multiplying the scale value for the daily duration by the sum of other scale values. End result is a total score, with numerical value, describing the risk of physical overload. Numerical value is explained in explanatory table which contains four ranges of numerical values, also coloured in: green, yellow, orange and red accordingly with the level of risk. Until now, the draft method was tested and found easier to handle in the field, with fair correlation of results when assessing strains compared to results of other tested tools, providing easy numerical quantification of manual tasks with high repetition, occasional force exertion and awkward body postures together with their interaction. The draft is now in the further process of field testing and scientific evaluation. [ABSTRACT FROM AUTHOR]

Sore back is one of the most common causes of absence from work in Croatia and worldwide. Only in the past year 32,000 workers were temporarily disabled due to sore back. The cost of this to the workers, employers, the health care and retirement fund are enormous. Prevention is imperative to reduce the incidence and duration of this health problem. Prevention measures must be put in place at the work place itself, as the work place can be directly responsible for the sore back syndrome but it can also indirectly contribute to the existing condition caused by other factors. The prevention and treatment of sore back still predominantly relies on the biomedical model. In this model, the affliction is attributed exclusively to organic causes. Over the years, this model has proven effective in cases of acute disease but ineffective in chronic disorders such as sore back. Chronic diseases are multifactorial and thus for them the biopychosocial model seems to be a more adequate path for follow. According to this model, sore back is caused by an interaction of physiological, psychological and social factors where the severity of symptoms and the degree of disability are in direct correspondence with this interaction. In short, psychological and social factors affect a patient's reaction to the organic disorder. If complete cure of the organic disorder is not feasible, the return to the usual daily activities and work are considered a successful outcome. The biopsychosocial model includes proven measures such as education addressing all three aspects of the pain (biomedical, psychological and social), physical activity tailored to suit the individual, and adjustments made to the work place to help the health status of the worker. [ABSTRACT FROM AUTHOR]

A migrant worker is a worker who has worked, or works, and receives pay for his work in a state of which he is not a citizen. Migrant workers also include groups of workers working abroad or travelling as part of their work. Globalisation has increased the number of migrant workers. Commonly, migrant workers live in poor conditions, often work in workplaces with low levels of occupational safety and are forced to live away from family for longer periods of time. Frequently, the risk of injury at work is high. Migrant workers have a higher incidence of a variety of diseases, many of which directly affect their work ability. Significant numbers of migrant workers are exposed to infectious diseases such as tuberculosis and hepatitis, as well as to the ever growing incidence of HIV infection. [ABSTRACT FROM AUTHOR]

The labour force is aging throughout the industrialized world. This phenomenon is caused by an increase in the overall life expectancy of the people and a decline in their fertility rate. As a consequence, the workforce of these nations is getting older. This situation is exacerbated in communities where birth rates are low and many younger, skilled workers emigrate to take advantage of job opportunities in other countries. To offset this trend, policy makers must consider approaches that encourage older employees to remain productive and continue working. Therefore, this article presents selected statistical data concerning the aging population. These data stress the need of focusing on further research in working conditions and work capacity of older workers. On the basis of available research data, the article describes some job characteristics of older workers: job satisfaction, perceived job demands, job control, social support at work, job insecurity and work-family conflict. [ABSTRACT FROM AUTHOR]

In the Republic of Croatia, occupational infectious diseases are defined in the Act on the List of Occupational Diseases as "infectious or parasitic diseases transmitted to people from animals or animal remains" and as "infectious or parasitic diseases caused while working in circumstances with proven increased risk of infection." The paper discusses the data on the occupational infectious diseases recorded in the Register of Occupational Diseases maintained by the Croatian Institute for Health Protection and Safety at Work for the period from 1st January 2001 to 31st December 2010. The occupational infectious diseases in the Register are reviewed according to their overall incidence, their portion in the total number of occupational diseases in the Republic of Croatia, according to the type of disease, occupation of the infected workers and the employers' business. From 2001 to 2010 the Register records show a total of 1054 occupational diseases, of which 10% were infectious diseases. When compared to other occupational diseases, the incidence of infectious diseases occupies a high third place, and in some years within the studied period even the second or first place. The most common occupational infectious disease was tuberculosis, followed by different types of hepatitis and zoonoses, Q fever and hemorrhagic fever. Zoonoses occur most commonly in agriculture, forestry and veterinary practice. Tuberculosis and hepatitis occur among health care workers, nurses in particular. Given that the results indicate a steadily increasing incidence of tuberculosis in the overall number of occupational infectious diseases, additional cautionary measures should be taken, especially in health care, to prevent further increase in the number of infected individuals. [ABSTRACT FROM AUTHOR]

The aim of this study is to investigate the views of general practitioners regarding the reporting of occupational diseases and the possible link between work status, sickness and assessment of work ability with occupational diseases. The study also places focus on the need to improve collaboration with occupational medicine specialists, on general practitioners' need for education in certain areas of occupational health and occupational diseases, and on topics and ways of implementing education. The subjects were family physicians and general practitioners (50) employed in community health centers in Zagreb. The reported occupational diseases in family physician's surgeries were analyzed. It was found that 26% respondents reported occupational disease, 70% did not report it, and 4% did not know whether or not they had reported occupational disease in the last five years. The most commonly reported occupational diseases were diseases of the musculoskeletal system (38%) and skin diseases (38%). The reasons given for not reporting occupational diseases were that doctors were not aware that those were occupational diseases (91%), and because they feared that the patient may get fired (9%). The vast majority of respondents (94%) agreed that it is necessary to improve cooperation between family physicians and occupational medicine specialists. Seventy eight percent of family physicians were interested in education on how to recognize occupational diseases. Preventive team work on the part of occupational medicine specialists and family physicians using the 'check lists' in family physician's surgeries, and education courses on occupational health would improve primary prevention of occupational diseases, while early detection would halt the progress of occupational diseases and thus reduce ensuing disability caused by occupational disease. [ABSTRACT FROM AUTHOR]

The paper presents factor structure and reliability of the workplace stressor questionnaire for hospital healthcare workers and hopes to further validate and standardise the stress measuring instrument for healthcare workers and thus directly affect the safety of patients and healthcare workers in hospital environments. The study was based on a sample of 1,900 participants aged between 18 and 65, employed in healthcare (nurses, lab technicians and physicians) in the hospitals Dubrava, Zagreb, Sestre milosrdnice and Sveti Duh. All participants voluntarily joined the study. Rate of response was 78%, from the actual sample of 1,481 participants (1,086 nurses and technicians and 395 physicians). In addition to general socio-demographic questions, the questionnaire included 37 workplace stressors referring to work organisation, shift work, opportunities for promotion, education, professional demands, interpersonal communication, communication between the healthcare workers and patients, and fear of dangers and potential harms in healthcare. The participants assessed their experience on the Likert scale (1-5) from 1 = ''no stress'' to 5 = ''great stress''. Factor analysis yielded six factors of relatively high reliability of inner consistency (all values of Crombach a exceeded 0.7): Workplace Organisation and Financial Issues, Public Criticism, Dangers and Harms at Workplace, Conflicts and Communication at Work, Shift Work, Professional and Intellectual Demands. Individual particles logically explain the structure of the corresponding factors and provide good foundation for further development of the stress measuring instrument at the workplace for hospital healthcare workers. The study contributes to the improvement of a suitable measuring instrument and its implementation in practice, and assists in better recognition and better solutions in the prevention of stress and preservation of safety in hospitals which should help to protect the health of healthcare workers. [ABSTRACT FROM AUTHOR]

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide, including in Croatia. Since most patients have multiple disorders and diseases caused largely by the same risk factors, and as it is essential to approach each patient as a person with all disorders, today, we are talking about a new paradigm-cardio-renal-metabolic (CKM) syndrome and cardio-renal-metabolic health, which necessarily includes brain health. Elevated systolic blood pressure, LDL cholesterol, smoking, obesity, diabetes, impaired renal function or chronic kidney disease, which all stem from insufficient physical activity, an unhealthy diet with excessive intake of table salt, and air pollution, are the leading causes of overall morbidity and mortality from CKM diseases, especially mortality from CVD. Experts from various fields key to CKM health have written this document with the aim of integrating it as part of the national plan for the prevention of chronic non-communicable diseases with a focus on CVD, which should become mandatory and be based on the existing guidelines of professional societies.

Background . National surveys have reported variable prevalence of chronic kidney disease (CKD), due to differences in the characteristics of the population, study design, equations used for the estimated glomerular filtration rate (eGFR), and definitions. The EH-UH 2 survey is the first study evaluating CKD prevalence, characteristics, and awareness in Croatia. Methods . This was a cross-sectional nationwide observational study designed to assess the prevalence of CKD and cardio-kidney-metabolic risk factors in Croatia, which included 1765 randomly selected subjects. We estimated the prevalence of CKD by means of the albumin-to-creatinine ratio (ACR) and eGFR (CKD-EPI equation). Comorbidities and anthropometric and social factors related to the prevalence of CKD were analyzed, and the CV risk profile was evaluated. Results . The weighted prevalence of CKD (any stage), CKD stage ≥G3A A2, and CKD defined only as an eGFR <60 mL/min/1.73 m 2 were estimated at 17.1%, 9.8%, and 7.9%, respectively. The prevalence was higher in men than in women (11.8% vs. 7.9%; p < 0.001). The weighted prevalence of an ACR >30 mg/g was 15.1%. Older age, male gender, diabetes, ePWV, and uric acid were independently associated with CKD prevalence. The awareness of CKD was 9.5%. Persons unaware of CKD were older with lower income, less education, more frequent diabetes, hypertension (less frequently controlled), and milder renal impairment. Conclusions . In Croatia, the estimated prevalence of CKD is high, being presented more frequently in men than in women. CKD patients have an unfavorable CV risk profile. The awareness of CKD is very low, reflecting poor health literacy in the general population but also in health-care workers.

Cardiovascular diseases, which are the leading cause of death in Croatia, are linked to the high prevalence of hypertension. Both are associated with high salt intake, which was determined almost two decades ago when Croatian Action on Salt and Health (CRASH) was launched. The main objective of the present study was to evaluate salt, potassium, and iodine intake using a single 24 h urine sample in a random sample of the adult Croatian population and to analyse trends in salt consumption after the CRASH was intensively started., Methods: In this study, we analysed data on 1067 adult participants (mean age 57.12 (SD 13.9), men 35%)., Results: Mean salt and potassium intakes were 8.6 g/day (IQR 6.2-11.2) and 2.8 g/day (IQR 2.1-3.5), respectively, with a sodium-to-potassium ratio of 2.6 (IQR 1.8-3.3). We detected a decrease of 17.6% (2 g/day less) in salt consumption compared with our previous salt-mapping study. However, only 13.7% and 8.9% met the WHO salt and potassium recommended targets of 5 g/day and 3.5 g/day, respectively. Salt intake was higher, and potassium ingestion was lower, in rural vs. urban regions and in continental vs. Mediterranean parts of Croatia. Moderate to severe iodine insufficiency was determined in only 3% of the adult participants., Conclusion: In the last fifteen years, salt consumption has been significantly reduced in the Croatian adult population because of the intensive and broad CRASH program. However, salt intake is still too high, and potassium ingestion is too low. Salt reduction programs are the most cost-effective methods of cardiovascular disease prevention and merit greater consideration by the government and health policy makers.

Background: Carotid-femoral pulse wave velocity (cfPWV), acknowledged as a reliable proxy of arterial stiffness, is an independent predictor of cardiovascular (CV) events. Carotid-femoral PWV is considered the gold standard for the estimation of arterial stiffness. cfPWV is a demanding, time consuming and expensive method, and an estimated PWV (ePWV) has been suggested as an alternative method when cfPWV is not available. Our aim was to analyze the predictive role of ePWV for CV and all-cause mortality in the general population. Methods: In a stratified random sample of 1086 subjects from the general Croatian adult population (EH-UH study) (men 42.4%, average age 53 ± 16), subjects were followed for 17 years. ePWV was calculated using the following formula: ePWV = 9.587 - 0.402 × age + 4.560 × 10 -3 × age2 - 2.621 × 10 -5 × age2 × MBP + 3.176 × 10 -3 × age × MBP - 1.832 × 10 -2 × MBP. MBP= (DBP) + 0.4(SBP - DBP). Results: At the end of the follow-up period, there were 228 deaths (CV, stroke, cancer, dementia and degenerative diseases, COLD, and others 43.4%, 10.5%, 28.5%, 5.2%, 3.1%, 9.3%, respectively). In the third ePWV tercile, we observed more deaths due to CV disease than to cancer (20.5% vs. 51.04%). In a Cox regression analysis, for each increase in ePWV of 1 m/s, there was a 14% increase risk for CV death. In the subgroup of subjects with higher CV risk, we found ePWV to be a significant predictor of CV deaths (ePWV (m/s) CI 1.108; p < 0.029; HR 3.03, 95% CI 1.118-8.211). Conclusions: In subjects with high CV risk, ePWV was a significant and independent predictor of CV mortality.

The World Health Organization recommends adjusting salt intake as a part of the nine global targets to reduce premature mortality from non-communicable chronic diseases as a priority and the most cost-effective intervention. In 2006, the main aim of the Croatian Action on Salt and Health was to decrease salt intake by 16% because of its critical intake and consequences on human health. We have organized educative activities to increase awareness on salt harmfulness, define food categories of prime interest, collaborate with industries and determine salt intake (24 h urine sodium excretion). It was determined that the proportion of salt in ready-to-eat baked bread should not exceed 1.4%. In the period 2014-2022, salt in semi-white bread was reduced by 14%, 22% in bakery and 25% in the largest meat industry. Awareness of the harmfulness of salt on health increased from 65.3% in 2008 to 96.9% in 2023 and salt intake was reduced by 15.9-1.8 g/day (22.8% men, 11.7% women). In the last 18 years, a significant decrease in salt intake was achieved in Croatia, awareness of its harmfulness increased, collaboration with the food industry was established and regulatory documents were launched. However, salt intake is still very high, underlying the need for continuation of efforts and even stronger activities., Competing Interests: The authors declare no conflicts of interest.

Telework has become considerably more common during the ongoing pandemic. Although working remotely may have numerous advantages, negative impacts on workers' health and safety should also be considered. Telework is a major contributor to the development or aggravation of work-related musculoskeletal disorders where unsuited workstation ergonomics, sedentary behavior, as well as psychosocial and organizational factors play a role. This paper aims to identify telework-related risks and their impact on musculoskeletal health as well as provide recommendations that may be useful in constructing future preventive measures. A comprehensive literature search regarding the topic has been performed. Teleworkers experience musculoskeletal pain and discomfort mostly in low back area, neck, shoulders, arms, and hands. Poor ergonomic solutions when it comes to workstation design resulting in prolonged sitting in non-neutral positions contribute to the development and aggravation of musculoskeletal disorders in teleworkers. Working with inadequately placed screens and laptops and sitting in maladjusted seats without usual functionalities and ergonomic support is associated with musculoskeletal pain and discomfort. Extended working hours with fewer rest periods to meet increased work demands, social isolation, and lack of support from work colleagues and superiors as well as blurred work-home boundaries and omnipresence of work are commonly stated psychosocial and organizational factors associated with musculoskeletal disorders. Environmental factors such as poor lighting and glare, inadequate room temperature, and ventilation or noise, are frequently overlooked remote workstation risk factors. For a certain part of workers, telework will remain a common way of work in the post-pandemic period. Therefore, it is essential to identify telework-related risk factors for musculoskeletal disorders and address them with timely preventive measures tailored to each remote workstation's risks and individual workers' needs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Milaković, Koren, Bradvica-Kelava, Bubaš, Nakić, Jeličić, Bucić, Bekavac, Čvrljak and Capak.)

This paper examines the impact of work in a pandemic context on workers' mental health. Psychosocial risks have always been a challenging aspect of workplace health and safety practices. Moreover, the COVID-19 pandemic has affected workplaces in all sectors causing unexpected changes in work organization and working conditions, leading to the emergence of new psychosocial risks for health and wellbeing of workers. This mini-review aims to identify the main work stressors during pandemic period and related mental health problems to suggest recommendations and adjust health and safety practices regarding workplace mental health. A literature search has been performed using MEDLINE/PubMed, ResearchGate and Google Scholar databases, selecting articles focusing on work-related stressors and workers' mental health problems related to the pandemic. Specific psychosocial risks have been identified, including fear of contagion, telework-related risks, isolation and stigmatization, rapid digitalization demands, job insecurity, elevated risk of violence at work or home, and work-life imbalance, among others. All those risks can lead to elevated levels of stress among workers and affect their mental health and wellbeing, especially in terms of psychological distress, anxiety, and depression. As one of the social determinants of health, the workplace has an important and moderating role in workers' health. Therefore, in the pandemic context more than ever health protection practices at the workplace should be devoted to mental health problems. Recommendations provided in this study are expected to contribute to workplace practices to preserve and promote workers' mental health., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Koren, Milaković, Bubaš, Bekavac, Bekavac, Bucić, Čvrljak, Capak and Jeličić.)