Healthcare professionals working in intensive care units are often involved in end-of-life decision-making. No research has been done so far about these processes taking place in Croatian ICUs. The aim of this study was to investigate the perceptions, experiences, and challenges healthcare professionals face when dealing with end-of-life decisions in ICUs in Croatia. A qualitative study was performed using professionally homogenous focus groups of ICU nurses and physicians of diverse professional and clinical backgrounds at three research sites. In total, six (...) institutions at the tertiary level of healthcare were included. The constant comparative analysis method was used in the analysis of the data. Differences were found between the perceptions and experiences of nurses and physicians in relation to end-of-life decisions. Nurses’ perceptions were more focused on the context and features of immediate care, while physicians’ perceptions also included the wider sociocultural context. However, the critical issues these specific professional groups face when dealing with end-of-life decisions seem to overlap. A high variability of practices, both between individual practitioners and between different organizational units, was omnipresent. The lack of adequate legal, professional, and clinical guidelines was commonly expressed as one of the most critical source of difficulties. (shrink)

BackgroundPatient autonomy is a fundamental, yet challenging, principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, has become increasingly prominent in current literature. However, this has not always been the case, especially in communist countries where paternalistic attitudes have been interwoven into all relationships including medical ones. Patients’ expectations and the role of the doctor in the patient-physician relationship are changing. Croatia, as a transitional country, is (...) currently undergoing this particular process.MethodsQualitative research was conducted by means of six focus group discussions held in the years 2012 and 2013 in Croatia. Focus groups were held separately with each of the following: first year and final year medical students, physicians engaged in medical ethics education, physicians practicing in a clinical hospital, family medicine residents and individuals representing patients with chronic disease. This research specifically addresses issues related to patient autonomy, in particular, the principles of truth telling, confidentiality, and informed consent. All focus group discussions were audio taped and then transcribed verbatim and systematized according to acknowledged qualitative analysis methods.Results and discussionPatient autonomy is much more than a simple notion defined as the patient’s right to make treatment decisions independently. It has to be understood in context of the broader socio-cultural setting. At present, both patients and medical doctors in Croatia are increasingly appreciating the importance of promoting the principle of autonomy in medical decision-making. However, the current views of medical students, physicians and patients reveal inconsistencies.Conclusions Knowing how to respect the various facets of patients’ autonomy should be part of physician’s professional duties, and also be reflected in his or her core clinical competencies. For this reason greater importance should be dedicated to patient autonomy issues in medical education in Croatia. (shrink)

There are not many public health issues where views are as extremely polarized as those concerning vaccination policies. Ever since its Fast Track approval by the U.S. Food and Drug Administration in 2006, Merck's human papilloma virus vaccine Gardasil has been sparking controversy. Initially, the criticism has been focused at Merck, due to their overly aggressive marketing strategies and lobbying campaigns. According to a 2007 editorial in Nature Biotechnology, Surrounded by a chorus of disapproval, Merck cracked. As Nature Biotechnology went (...) to press, the company announced a cessation of all efforts to lobby for US state laws requiring compulsory vaccination. Subsequently, questions have been raised whether it was appropriate for vaccine manufacturers to partake in public health policies when their conflicts of interests were so obvious. Some of their advertising campaign slogans, such as cervical cancer kills x women per year and your daughter could become one less life affected by cervical cancer, seemed more designed to promote fear rather than evidence-based decision making about the potential benefits of the vaccine versus any risks. (shrink)

Biomedical ethics requires that clinical trial participants be accurately informed of the potential risks associated with investigational medical products. We found that the vaccine manufacturer Merck made false statements to the trial participants about the safety of Gardasil in its Future II HPV vaccine trial in Denmark. The clinical study protocol specified that safety testing was one of the trial’s primary objectives, but the recruitment brochure given to trial participants stated this was not the case, as allegedly the vaccine had (...) already been proven safe in previous trials. The advertising material for the trial and the informed consent forms stated that the comparator was saline or an inactive substance, when, in fact, it contained Merck’s proprietary aluminum adjuvant which is highly immunogenic. Several trial participants experienced long-term disabling symptoms during the trial, also some randomized to the adjuvant “placebo” control group. In all cases, their serious adverse events were dismissed as unrelated to the study treatment by Merck’s clinical investigators. We demonstrate that Merck’s published statements about the safety of their proprietary aluminum adjuvant is contradicted by the research evidence. The use of adjuvants as “placebos” in vaccine clinical trials is unethical as it makes it difficult to discover serious vaccine harms. (shrink)

Dvorec Jelšingrad (Erlachstein), ki se nahaja na severozahodnem obrobju Šmarja pri Jelšah, je bil v sredini 19. stoletja deležen prenove vzhodnega dela stavbe, interierjev in parka po vzorih mavrske in orientalske arhitekture. Za novo eksotično podobo je bil zaslužen tedanji lastnik Rudolf Oskar Gödel-Lannoy (1814–1883), ki je med svojo dolgoletno diplomatsko kariero v Egiptu, na Bližnjem vzhodu in Balkanu načrtno zbiral antikvitete. Ob vrnitvi v domovino jih je v svojem dvorcu razstavil v treh novo nastalih orientalskih dvoranah, kar se v (...) sočasnih virih omenja kot “orientalni muzej”. Iz popisa predmetov, ki so jih leta 1943 v dvorcu zasegli Nemci in prenesli v Pokrajinski muzej Maribor, je razvidno, da je Lannoyjeva zbirka starin vključevala številne predmete iz starega Egipta, Mezopotamije, Grčije in Rima. Z izjemo staroegipčanskega fragmenta Merimosejevega sarkofaga iz 18. dinastije, ki ga danes hranijo v Narodnem muzeju v Pragi, v dosedanjih raziskavah vsebina Lannoyjevih starinoslovnih zbirk še ni bila deležna strokovne pozornosti. Pričujoči prispevek se osredotoča na jelšingrajsko zbirko mezopotamskih predmetov, tj. cilindričnih pečatov, pečatnih kamnov, živalskih amuletov in glinenega stožca kralja Gudea iz Lagaša, ki jih danes hranijo v depoju arheološke zbirke Univerzalnega muzeja Joanneum v Gradcu. (shrink)

Hyperbaric oxygen (HBO) therapy still lacks proper interpretations of its many actions. This hypothesis is based on reports of temporarily elevated peripheral vascular resistance (PVR) during HBO sessions. Besides that, during HBO sessions, hyperoxygenated tissues can reduce their perfusion so much that CO2 can accumulate in them. Tissue perfusion depends on vascular innervation and on the balance between systemic constrictors and local dilators. During an HBO session, increased tissue oxygen levels suppress dilatory mechanisms. Tissue hyperoxygenation increases PVR, suggesting that the (...) HBO action on an edematous tissue may be caused by an oxygen‐induced disbalance among Starling capillary forces. The presented hypothesis is that oxygen‐caused arteriolar constriction reduces the hydrostatic pressure in downstream capillaries. Thus, more tissue fluid is absorbed in vascular capillaries, under the condition that the plasma colloid osmotic pressure remains unaltered during the HBO session. Among several known mechanisms behind the HBO actions, the vasoconstriction has been listed as a therapeutic modality for the reduction of the tissue edema, for a crush injury, for burns (in an acute phase), and for the compartment syndrome. The Bell's palsy is among often listed indications for the HBO treatment, although evidence is poor and reports of randomized trials are scarce. (shrink)

BackgroundThere has been no in-depth research of public attitudes on withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. The aim of this study was to examine these attitudes and their correlation with sociodemographic characteristics, religion, political orientation, tolerance of personal choice, trust in physicians, health status, experiences with death and caring for the seriously ill, and attitudes towards death and dying. MethodsA cross-sectional study was conducted on a three-stage random sample of adult citizens of (...) the Republic of Croatia, stratified by regions, counties, and locations within those counties. In addition to descriptive statistics, ANOVA and Chi-square tests were used to determine differences, and factor analysis, correlation analysis and multiple regression analysis for data analysis.Results38.1% of the respondents agree with granting the wishes of dying people experiencing extreme and unbearable suffering, and withholding life-prolonging treatment, and 37.8% agree with respecting the wishes of such people, and withdrawing life-prolonging treatment. 77% of respondents think that withholding and withdrawing procedures should be regulated by law because of the fear of abuse. Opinions about the practice and regulation of euthanasia are divided. Those who are younger and middle-aged, with higher levels of education, living in big cities, and who have a more liberal worldview are more open to euthanasia. Assisted suicide is not considered to be an acceptable practice, with only 18.6% of respondents agreeing with it. However, 40.1% think that physician assisted suicide should be legalised. 51.6% would support the dying person’s autonomous decisions regarding end-of-life procedures.ConclusionsThe study found low levels of acceptance of withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. In addition, it found evidence that age, level of education, political orientation, and place of residence have an impact on people’s views on euthanasia. There is a need for further research into attitudes on different end-of-life practices in Croatia. (shrink)

The precarious rights of senior citizens, especially those who are highly educated and who are expected to counsel and guide the younger generations, has stimulated the creation internationally of advocacy associations and opinion leader groups. The strength of these groups, however, varies from country to country. In some countries, they are supported and are the focus of intense interest; in others, they are practically ignored. For this is reason we believe that the creation of a network of all these associations (...) is essential. The proposed network would act as a support for the already-existing policies of the United Nations’ High Commission for Human Rights, of independent experts, and of the Global Alliance for the Rights of Older People. All three have long ago recommended the creation of a recognized instrument for uniting presently scattered efforts. The proposed network, therefore, will seek to promote the international exchange of relevant expertise, and it will reinforce the commitments and actions that single countries are currently taking to meet these objectives. For example, informative public events can be organised to promote particular support initiatives and to provide an opportunity for new members of the network to be presented. The network will promote health for senior citizens, disease prevention, senior mobility, safe free time for seniors, alimentary education, protection against new risks and dangers, as well as equity in the services necessary for seniors to adopt new information and communication technologies. In the case of retired academic members, the network will promote equality with respect to continuing use of digital technologies (particularly email), continuing access to research libraries, and the guaranteed ability for seniors to fund their own research programs and to deliver free seminars. (shrink)

We examine conditions under which, in a computable topological space, a semicomputable set is computable. It is known that in a computable metric space a semicomputable set S is computable if S is a continuum chainable from a to b, where a and b are computable points, or S is a circularly chainable continuum which is not chainable. We prove that this result holds in any computable topological space.

Engagement in marine science has historically been the privilege of a small number of people with access to higher education, specialised equipment and research funding. Such constraints have often limited public engagement and may have slowed the uptake of ocean science into environmental policy. Recognition of this disconnect has spurred a growing movement to promote ocean literacy, defined as one’s individual understanding of how the ocean affects people and how people affect the ocean. Over the last 2 decades, this concept (...) has gained significant traction in marine biology and environmental education circles and now plays a prominent role in the UN’s Decade of Ocean Science for Sustainable Development. Here, we argue that the ocean literacy agenda has largely been shaped and discussed by marine scientists and educators but needs to be expanded to a much larger constituency to be more effective, accessible and inclusive. We discuss diverse cultural settings from around the world and provide examples of indigenous, spiritual, art, ocean user and other groups that are already deeply engaged with the ocean and could provide a variety of perspectives to enrich the ocean literacy concept beyond an understanding of marine science. We suggest that such inclusiveness could remove the historic barriers that have surrounded the field, transform our collective awareness of and relationship with the ocean and help support ongoing efforts to restore marine biodiversity. (shrink)

Spis z naslovom Knjiga Lucija Cecilija izpovedovalcu Donatu o smrtih preganjalcev (De mortibus persecutorum) je ohranjen v enem samem rokopisu iz 11. stoletja, odkritem leta 1778 v samostanski knjižnici v Moisacu. Ob prvi objavi (1779) ga je Etienne Baluze pripisal krščanskemu piscu in učitelju retorike Laktanciju (ok. 250–ok. 325), najbolj znanemu po prvi celoviti obravnavi krščanske vere, spisu Božji nauk (Divinae institutiones), a kmalu so se pojavili dvomi o njegovem avtorstvu. Tako po formi kot po obravnavani temi, strahotnih koncih (...) cesarjev preganjalcev, ki jih je Bog strogo kaznoval za njihove zločine, spis v antični književnosti nima prave primere. Zato je bil deležen različnih opredelitev kot krščanski pamflet, Konstantinov panegirik, konstantinska propaganda ipd. Forma je izrazito retorična, vsebuje tudi elemente krščanskega in poganskega zgodovinopisja in hagiografije, zgleduje se po judovski in antični tradiciji, v njem so opazne sorodnosti z Drugo knjigo Makabejcev in Konstantinovim govorom Oratio ad sanctorum coetum. Po vrsti razprav in člankov za in proti Laktancijevemu avtorstvu, ko se je zdelo že, da dvomov ni več, je leta 2013 izšla knjiga Jeana Rougeja in Daniela de Deckerja z obnovljeno tezo, da je spis služil konstantinski propagandi in je nastal na pobudo cesarja, podkrepljeno s temeljito študijo drugih Laktancijevih del, in argumenti, oprtimi tudi na izsledke računalniško pripravljenih analiz. Zdi se, da vprašanje ostaja odprto. (shrink)