The readiness of the spontaneous reporting system for COVID-19 vaccines safety monitoring in Croatia.

We aimed to identify whether a spontaneous reporting system (SRS) in Croatia could timely identify and confirm signals for COVID-19 vaccines. Post-marketing spontaneous reports of adverse drug reactions (ADRs) following COVID-19 immunisation reported to the Agency for Medicinal Products and Medical Devices of Croatia (HALMED) were extracted and analysed. 6624 cases reporting 30 655 ADRs following COVID-19 immunisation were received from 27th December 2020 to 31st December 2021. Available data in those cases were compared with data available to the EU network at the time when signals were confirmed and minimisation measures were implemented. 5032 cases, reporting 22 524 ADRs, were assessed as non-serious, and 1,592 cases, reporting 8,131 ADRs as serious. The most reported serious ADRs, which were listed in the MedDRA Important medical events terms list, were syncope (n = 58), arrhythmia (n = 48), pulmonary embolism (n = 45), loss of consciousness (n = 43), and deep vein thrombosis (n = 36). The highest reporting rate had Vaxzevria (0.003), followed by Spikevax and Jcovden (0.002), and Comirnaty (0.001). Potential signals were identified, however, they couldn't be timely confirmed solely on cases retrieved by SRS. In order to overcome the limitations of SRS, active surveillance and post-authorisation safety studies of vaccines should be implemented in Croatia.

Incidence and Clinical Phenotype of Multisystem Inflammatory Syndrome in Children After Two SARS-CoV-2 Pandemic Waves: A Croatian Prospective Nationwide Study.

This prospective nationwide study in Croatia (March 1, 2020-December 31, 2021) embraced 121 children with multisystem inflammatory syndrome. Incidence rates, disease course and outcomes were similar to those reported from other European countries. The severe acute respiratory syndrome coronavirus 2 virus Alpha strain appeared associated with a higher propensity to result in multisystem inflammatory syndrome in children than the Delta strain but did not appear related to disease severity.

COVID-19 pandemic: Impact on the cardiac implantable electronic devices' implantation rates in Croatia.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has influenced health-care organization worldwide, including management of non-communicable diseases. The aim of this study was to determine the impact of COVID-19 pandemic on cardiac implantable electronic devices' (CIEDs) implantation rates in Croatia. METHODS: A retrospective, observational, national study was conducted. The data on CIEDs' implantation rates from 20 Croatian implantation centres, between January 2018 and June 2021, were extracted from the national Health Insurance Fund registry. Implantation rates before and after COVID-19 pandemic started, were compared. RESULTS: The overall numbers of CIED implantations in Croatia during COVID-19 pandemic were not different in comparison to 2 years pre-COVID-19 time (2618 vs. 2807, p = .081). The pacemaker implantation rates decreased significantly (by 45%) during April (122 vs. 223, p < .001) and May 2020 (135 vs. 244, p = .001), as well as during November 2020 (177 vs. 264, p = .003), but significantly increased during summer months 2020 comparing to 2018 and 2019 (737 vs. 497, p<0.001). The ICD implantation rates decreased significantly by 59% in April 2020 (26 vs. 64, p = .048). CONCLUSION: To the authors best knowledge this is a first study including complete national data on CIED implantation rates and COVID-19 pandemic impact. A significant reduction in number of both pacemaker and ICD implants during specific months of the COVID-19 pandemic was determined. However, afterwards compensation in implants resulted in similar total number when the complete year was evaluated.

Emergency Air Transport of Patients with Acute Chest Pain in the Adriatic Islands of Croatia: A Four-Year Analysis.

BACKGROUND: An efficient first-aid system usually supports ground services with a helicopter emergency medical service (HEMS). An HEMS is important for patients with acute chest pain on remote islands. The current study sought to identify the characteristics of HEMS in acute chest pain cases on the Croatian Adriatic islands over a four-year period. METHODS: We conducted a four-year observational study to investigate HEMS from Adriatic islands. The study population consisted of all patients with acute coronary syndrome or pulmonary embolisms who were urgently transferred by HEMS to the University Hospital in Split 1 June 2018-1 June 2022. RESULTS: During the observation period, 222 adult patients (67 females, or 30.2%) were urgently transferred. The mean age was 71.81 ± 13.42 years. The most common diagnosis was ST-elevated myocardial infarction (113, 50.9%). Most of the HEMS cases were from Hvar (91, 41.0%). The mean call-to-flight time was 19.10 ± 10.94 min, and the total time from call to hospital was 68.50 ± 22.29 min. The total time from call to hospital was significantly correlated with call-to-flight time (r = 0.761, P < 0.001). Of the 222 participants, 5 (2.25%) were transported for more than 120 min, and 35 (15.8%) were transported for more than 90 min. CONCLUSION: This study provided a detailed insight into HEMS in the area of the Croatian Adriatic islands. The average time from the call to the helicopter taking off was 19.10 min. An increase in dispatching time has a significant impact on the prolongation of the total time for the hospital admission. Shortening the response time is critical to reducing hospital arrival time.

Cyberchondria in the age of COVID-19.

The global epidemic of (mis)information, spreading rapidly via social media platforms and other outlets, can be a risk factor for the development of anxiety disorders among vulnerable individuals. Cyberchondria can be a vulnerability factor for developing anxiety in a pandemic situation, particularly when the Internet is flooded with (mis)information. The aim of our study was to examine how cyberchondria is related to changes in levels of COVID-19 concern and safety behaviours among persons living in Croatia during the period in which the first COVID-19 case was identified and when the country recorded its first fatality. Repeated cross-sectional data collection was conducted during two waves over a period of three weeks (N1 = 888; N2 = 966). The first began on the day of the first confirmed case of COVID-19 in Croatia (February 24th, 2020) and the second wave began three weeks later, on the day the first COVID-19 fatality was recorded in Croatia (March 19th, 2020). Participants completed an online questionnaire regarding various COVID-19 concerns and safety behaviours aimed at disease prevention (information seeking, avoidance and hygiene) and a measure of cyberchondria (Short Cyberchondria Scale, SCS). We analysed whether changes to the epidemiological situation during the period between the two waves of data collection led to an increase in COVID-19 related behaviour directly and indirectly via an increase in COVID-19 concerns. The results indicated that, between the two waves of research, there was a pronounced increase in concerns regarding COVID-19 (b = 1.11, p < .001) as well as significant behavioural changes (b = 1.18-2.34, p < .001). Also, results demonstrated that cyberchondria plays a moderating role in these changes. In the first wave, persons with severe cyberchondria were already intensely concerned with safety behaviours. High cyberchondria and high levels of concern about the COVID-19 are associated with intense avoidance behaviours, R2 = .63, p < .001. A moderated partial mediation model was confirmed, in which the effect of the epidemiological situation was weaker for those with higher results on the SCS (as indicated by index of moderated mediation between -.10 and -.15, p < .05). As such, cyberchondria is a contributing factor to long-term anxiety and its impact during pandemic on the general mental health burden should therefore be further investigated.

Extracorporeal membrane oxygenation in COVID-19: Results of the Croatian Extracorporeal Membrane Oxygenation Referral Center.

At the beginning of the COVID-19 pandemic, the role of extracorporeal membrane oxygenation (ECMO) was uncertain and the outcomes of ECMO-treated patients were unfavorable. During the pandemic, medical community realized that carefully selected patients may benefit from ECMO support. The goal of the study was to present the outcomes of ECMO-treated patients with severe COVID-19 ARDS referred to the respiratory ECMO hub in Croatia and to determine variables that influenced the outcome. Our study included all adult patients with confirmed COVID-19 ARDS that required ECMO treatment, in the period between February 2020 and April 2022. All ECMO circuits were veno-venous with femoro-jugular configuration, with drainage at the femoral site. A total of 112 adult patients with COVID-19 induced ARDS were included in the study. All patients had veno-venous ECMO treatment and 34 survived. Surviving patients were discharged home either from the hospital or from a designated rehabilitation facility. The mortality was associated with the incidence of nosocomial bacteremia, occurrence of heparin induced thrombocytopenia and acute renal failure. In order to reduce the mortality in COVID-19 ECMO patients, the treatment should be started as soon as criteria for ECMO are met. Furthermore, complications of the procedure should be detected as soon as possible. However, despite even the optimal approach, the mortality in COVID-19 ECMO patients will surpass that of non-COVID-19 ARDS ECMO patients, mostly due to poor resolving and long lasting ARDS with longer ECMO runs and ensuing infectious complications.

THE IMPACT OF COVID-19 PANDEMIC ON DIAGNOSIS AND TREATMENT IN OTORHINOLARYNGOLOGY PATIENTS IN CROATIA.

COVID-19 pandemic resulted in a decrease in the number of diagnostic and therapeutic procedures in most ENT departments. We performed a survey among ENT specialists in Croatia aiming to assess how the pandemic influenced their practice, and consequently the patient diagnosis and treatment. The majority of the 123 participants who completed the survey stated that there was a delay in diagnosis and treatment of ENT diseases, which they expected to have negative effects on patient outcomes. Since the pandemic is still ongoing, there is the need for improvement at different levels of the healthcare system to minimize the consequences of the pandemic in non-COVID patients.

How Different Predominant SARS-CoV-2 Variants of Concern Affected Clinical Patterns and Performances of Infected Professional Players during Two Soccer Seasons: An Observational Study from Split, Croatia.

There are limited data describing clinical patterns and match running performance (MRP) among players with COVID-19 infection before and after infection, particularly related to different predominant SARS-CoV-2 variants, as well as in comparison to uninfected players. This observational study was conducted during two consecutive soccer seasons in one professional club in Split, Croatia. There were four clusters of mild, self-limited, or asymptomatic infection characterised by low adherence to preventive measures. Infected players had significantly more symptoms (t-test = 3.24; p = 0.002), a longer period of physical inactivity (χ2 = 10.000; p = 0.006) and a longer period of self-assessment for achieving full fitness (χ2 = 6.744; p = 0.034) in the 2020-2021 season (Wuhan wild strain and Alpha variant) than in the 2021-2022 season (Omicron variant). It was also found that, despite the milder clinical presentation of the infection in the 2021-2022 season, the players had significantly more abnormal laboratory findings (χ2 = 9.069240; p = 0.002), although without clinical significance at the time of the study. As for the MRP, player performance in the 2021-2022 season was not negatively affected by the Omicron variant, while there was an improvement in MRP in scores for a sample of all players. The RTP protocol was correctly applied because it helped the athletes to recover their pre-infection physical capacities relatively quickly. This study advances the understanding that an optimally and individually planned RTP protocol is crucial for the MRP of infected players. Future research needs to replicate the findings of abnormal laboratory results and extend the study focusing on their potential long-term clinical significance.

Changes in consultation mode during different phases of the COVID-19 pandemic in Croatian family medicine: a cross-sectional study.

OBJECTIVES: To describe the changes in the type, length and reasons for consultations in primary healthcare during the COVID-19 pandemic in Croatia. This study aimed to test a hypothesis regarding the increased workload of general practitioners (GPs) by introducing more virtual consultations (VCs). DESIGN: The study design was cross-sectional and comprised two phases: retrospective and prospective. The retrospective phase included data from April, May and June of 2019, 2020 and 2021, and the prospective phase included data from 2 weeks in June 2021. Additionally, the number, length and reasons for face-to-face consultations (FTFC), VCs and telephone consultations (TCs) with nurses were collected. SETTING AND PARTICIPANTS: Overall, 6 GPs from different regions in Croatia with 10 125 enlisted patients. MAIN OUTCOMES MEASURES: The retrospective phase compared data for consultation types obtained from electronic medical records. The prospective phase collected the number, length and reasons for FTFCs, VCs and TCs with nurses. RESULTS: FTFCs decreased from 58.1% of the total number of visits in 2019 to 41.2% in 2020, while VC increased from 41.9% in 2019 to 58.8% in 2020. Furthermore, an eightfold increase in email consultations was recorded. The average lengths of an FTFC and TC were 7.13±3.38 and 4.01±2.09 min, respectively; FTFCs were significantly longer than TCs (t=7.038, p<0.0001). There was an increase in the total workload (9.4%) in 2021 compared with 2019. CONCLUSION: Croatian GPs faced changes in work organisation along with increased workload during the pandemic. Despite the shortening of time in FTFCs, the workload has increased due to the increase in VCs. An appropriate legal framework should be implemented for this new form of consultation. Future research is needed to address the impact of these changes on healthcare quality.

Women's perspectives on the quality of hospital maternal and newborn care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina.

OBJECTIVE: To assess the quality of maternal and newborn care (QMNC) in countries of the former Yugoslavia. METHOD: Women giving birth in a facility in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina between March 1, 2020 and July 1, 2021 answered an online questionnaire including 40 WHO standards-based quality measures. RESULTS: A total of 4817 women were included in the analysis. Significant differences were observed across countries. Among those experiencing labor, 47.4%-62.3% of women perceived a reduction in QMNC due to the COVID-19 pandemic, 40.1%-69.7% experienced difficulties in accessing routine antenatal care, 60.3%-98.1% were not allowed a companion of choice, 17.4%-39.2% reported that health workers were not always using personal protective equipment, and 21.2%-53.8% rated the number of health workers as insufficient. Episiotomy was performed in 30.9%-62.8% of spontaneous vaginal births. Additionally, 22.6%-55.9% of women received inadequate breastfeeding support, 21.5%-62.8% reported not being treated with dignity, 11.0%-30.5% suffered abuse, and 0.7%-26.5% made informal payments. Multivariate analyses confirmed significant differences among countries, with Slovenia showing the highest QMNC index, followed by Croatia, Bosnia-Herzegovina, and Serbia. CONCLUSION: Differences in QMNC among the countries of the former Yugoslavia during the COVID-19 pandemic were significant. Activities to promote high-quality, evidence-based, respectful care for all mothers and newborns are urgently needed. CLINICALTRIALS: gov Identifier: NCT04847336.

Differences between COVID-19-vaccinated and unvaccinated participants from Croatia.

AIM: To compare Croatian participants vaccinated against coronavirus disease 2019 (COVID-19) and unvaccinated participants in terms of socio-demographic, personal, social, and COVID-19-related variables. METHODS: From August till December 2021, 721 (465 vaccinated and 256 unvaccinated) participants completed an online survey about socio-demographic (age, sex income, education, marital status), personal (well-being indicators, personality measures and health), social (trust in experts, trust in government), and COVID-19-related characteristics (fear of COVID-19, history of COVID-19 infection). Differences between the groups were assessed with discriminant analysis. RESULTS: The variables that best discriminated between vaccinated and unvaccinated participants were higher trust in experts, no history of COVID-19 infection, older age, higher fear of COVID-19, and intellect. Conclusion The study points to the importance of trust in experts in the promotion of COVID-19 vaccine.

Croatian national audit on videolaryngoscopes and alternative intubation devices in the era of COVID-19 pandemic.

INTRODUCTION: Videolaryngoscopy (VL) is the recommended strategy for airway management in COVID-19 patients and guidelines recommends that all anesthesiologists should be trained to use and have immediate access to the device. However, the availability of VL in hospitals and its use may vary, as well as the choice of the device and necessary training. Our primary aim was to investigate data on availability of VL in Croatia, its use, the choice of the device and its implementation, with special consideration of COVID-19 management. MATERIALS AND METHODS: An electronic survey was sent to all Croatian hospitals that have anesthesiology service available. The survey was designed to examine data on availability and use of VL with special consideration of COVID-19 wards. The survey was conducted between 1.03.2021 and 30.08.2021. RESULTS: Response rate was 83%. VL was available in 86% of hospitals and the best supplied areas were intensive care units, general surgery and gynecology/obstetrics. The most common VL devices were Bonfils, C-MAC and C-MAC D-blade. The choice of VL was mainly based on centralized hospital procurement and informal introduction was found to be the most frequent training method. The VL was mainly used in Croatian hospitals in cases of difficult airway or as a backup method after failed intubation. Only 16% of hospitals reported regular use in everyday practice. Even though, VL was available in 64% of COVID-19 wards, only 21% of hospitals reported routine use. CONCLUSION: Although VL is available in the majority of Croatian hospitals, its use is still mainly restricted to difficult airway scenarios. Use of VL in COVID-19 management is also low and education on the method is still mainly informal. Based upon our results better implementation in practice should be targeted, as well as formal skill trainings especially regarding COVID-19 care.

Changes following the Onset of the COVID-19 Pandemic in the Burden of Hospitalization for Respiratory Syncytial Virus Acute Lower Respiratory Infection in Children under Two Years: A Retrospective Study from Croatia.

To understand the changes in RSV hospitalization burden in children younger than two years following the onset of the COVID-19 pandemic, we reviewed hospital records of children with acute lower respiratory infection (ALRI) between January 2018 and June 2022 in Split-Dalmatia County, Croatia. We compared RSV activity, age-specific annualized hospitalization rate, and disease severity between pre-COVID-19 and COVID-19 periods. A total of 942 ALRI hospital admissions were included. RSV activity remained low for the typical RSV epidemic during 2020-2021 winter. An out-of-season RSV resurgence was observed in late spring and summer of 2021. Before the COVID-19 pandemic, the annualized hospitalization rate for RSV-associated ALRI was 13.84/1000 (95% CI: 12.11-15.76) and highest among infants under six months. After the resurgence of RSV in the second half of 2021, the annualized hospitalization rate for RSV-associated ALRI in children younger than two years returned to the pre-pandemic levels with similar age distribution but a statistically higher proportion of severe cases. RSV immunization programs targeting protection of infants under six months of age are expected to remain impactful, although the optimal timing of administration would depend on RSV seasonality that has not yet been established in the study setting since the onset of the COVID-19 pandemic.

Loneliness and psychosocial predictors of psychosis-proneness during COVID-19: Preliminary findings from Croatia.

The present study investigated psychosocial predictors of psychosis-risk, depression, anxiety, and stress in Croatia during the COVID-19 pandemic. Given Croatia's recent transgenerational war trauma and the relative lack of available prodromal data, this study presents a unique opportunity to examine the impact of loneliness and other psychosocial factors on psychosis-risk and mental health in this population. 404 Croatian participants completed an anonymous online survey of physical and mental health questions. 48 participants met the criteria for elevated psychosis-risk on prodromal questionnaire (PQ-16). Loneliness had a significant impact on psychosis-risk. Exposure to trauma was associated with psychosis-risk and loneliness, while domestic abuse/violence was associated only with the distress surrounding psychotic-like symptoms. COVID concern was also associated with psychosis-risk. Lastly, the associations between psychosis-risk and depression, anxiety, and stress were robust. These findings highlight the important role of loneliness in psychosis-proneness in Croatia. Depression, anxiety, and stress were also closely related to elevated psychosis-risk. Loneliness is a highly salient issue for individuals with psychosis and it is important to target loneliness within a multi-faceted psychosocial intervention for those at risk for schizophrenia.

Continuity of care in patients with type 2 diabetes in Croatian primary care setting during COVID-19 pandemic: A retrospective observational study.

AIM: To examine the differences in the continuity of health care for type 2 diabetic patients before and during COVID pandemic in family medicine depending on whether the physician who provided care finished vocational training in family medicine or not. METHODS: This retrospective longitudinal research lasted from 2018 to 2020 in eight family medicine practices on 648 patients with type 2 diabetes diagnosed before 2018, and without Sars-Cov2 infection in previous medical history in Zagreb, Croatia. Follow-up parameters (HbA1c, LDL, eGFR, blood pressure, BMI, eye fundus and neurological findings, number of check-ups and vaccination against the flu) were noted before (2018, 2019), and in the COVID period (2020) in the care of family medicine specialists (FMPs) and without it (FMPws). RESULTS: No differences were found between the gender and age of patients. A decrease was seen in existing laboratory findings (64-47%, P < 0.001), eye fundus check-ups (39-37%, P = NS), neurologist check-ups (28-25%, P = NS) and FMP check-ups (382-321, P < 0.001) during the COVID period with significant differences between FMPs and FMPws. Significant changes were seen in LDL cholesterol (2.7-2.4 mmol/L, P < 0.001) and eGFR (83-80 ml/min/1.73 m2, P = 0.002), but BMI, blood pressure and HbA1c (>7% had 42% of patients) values did not differ during the COVID period. CONCLUSION: According to the observed parameters, the continuity of care for diabetic patients in Zagreb has worsened during the COVID pandemic but remained significantly better in care of FMPs than in FMPws, without differences in achieving target values of follow-up parameters.

"Because This Is an Evidence-Based Program": The Learning Experience of Croatia with the Lions Quest Skills for Adolescence, Implemented In-Person and Online.

Background: The Lions Quest Skills for Adolescence (LQSFA) is an evidence-based social and emotional learning program for school students. It is implemented as a teacher-led extracurricular activity for children aged 10-15 years. From 2019 to 2022, the United Nations Office on Drugs and Crime, in collaboration with Lions Clubs International Foundation, implemented the LQSFA in 41 schools in Croatia. Due to the COVID-19 lockdown measures, the intervention was adjusted into a hybrid modality (in-class and online). We evaluated the experience that the teachers had with the LQSFA in a hybrid modality. Methods: We used a focus-group discussion approach to evaluate the experience of five LQSFA teachers. Results: Three themes emerged: (1) the appreciation of evidence-based programs by the teachers, (2) the benefit of the LQSFA on the parents, and (3) the length of the online version of the questionnaire tool that was used to assess pre- and post-LQSFA experiences among students was too long. These results indicate that the LQSFA is undergoing a scaling on a national level in Croatia, even when implemented in a hybrid setting. Conclusions: Using an evidence-based program such as the LQSFA was rewarding for teachers, despite the challenges in the administrative adjustments regarding the online and in-person class teaching. LQSFA filled an important gap during COVID19-related stress.

Mental Health of Psychiatrists and Physicians of Other Specialties in Early COVID-19 Pandemic: Risk ind Protective Factors.

BACKGROUND: Many research has indicated that, during the COVID-19 pandemic, health care workers are under greatly increased pressure and at increased risk for the development of mental health problems. Furthermore, previous research has indicated that psychiatrists are exposed to a number of unique stressors that may increase their risk for poor mental health. The aims of the present study were to assess the level of COVID-19 related concerns, psychological distress and life satisfaction among psychiatrists and other physicians during the first period of the pandemic and to examine whether individual differences in COVID-19 concerns, psychological flexibility, psychological resilience and coping behaviors account for differences in mental health indicators. SUBJECTS AND METHODS: The sample consisted of N=725 physicians, among whom 22.8% were psychiatrists. This study was conducted online during the first lockdown in Croatia and collected data regarding COVID-19 related concerns, coping behaviors and mental health indicators (Psychological Distress and Life Satisfaction). RESULTS: Physicians of other specialties had higher scores on a measure of COVID-19 anxiety than psychiatrists (p=0.012). In addition, a number of differences in coping behaviors are evident. Specifically, psychiatrists were less likely than physicians of other specializations to believe that being informed about COVID-19 is an effective coping strategy (p=0.013), but more prone to using sedatives and drugs as a coping strategy (p=0.002; p=0.037). CONCLUSIONS: Psychiatrists are at special risk for substance abuse. Younger age, psychological inflexibility, low resilience and greater COVID-19 concerns might act as specific risk factors for distress. Our findings highlight the need for promoting a healthy lifestyle and psychological flexibility as universal protective factors.

Differences in Distress and Coping with the COVID-19 Stressor in Nurses and Physicians.

BACKGROUND: Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, health workers have shown an incredible commitment to their patients, sometimes in apocalyptic conditions. We explored ways to deal with the coronavirus stressor and psychological outcomes among physicians and nurses. SUBJECTS AND METHODS: 124 healthcare workers in General Hospital Nasice (Croatia) were invited to participate in a study by performing within the period of March 26 to April 6 2020 questionnaire collected information on socio-demographic characteristics and living conditions that may be risk factors for covid-19 concern, Short form health survey-36, Depression Anxiety Stress Scales (DASS-21) and Ways of Coping Questionnaire (WOC; consisting of 8 subscales: Confrontive Coping, Distancing, Self-Controlling, Seeking Social Support, Accepting Responsibility, Escape-Avoidance, Planful Problem Solving, Positive Reappraisal). RESULTS: 11% healthworkers reports moderate to very-severe depression, 17% moderate to extremely-severe anxiety and 10% for moderate to extremely-severe stress. 67% of medical staff are worried. No statistically significant differences in the scales of depression, anxiety, and stress were found between nurses and physicians, but differences were found on Escape-Avoidance and Positive Reappraisal subscales. Nurses use significantly more avoiding coping style and positive reappraisal than doctors. Seeking social support is more pronounced in those over 40 years old, while those under 40 use more avoidable stress management techniques. CONCLUSIONS: Monitoring and ensuring the mental health of coronavirus care staff is crucial for global health. The education of medical staff in the field of stress management is a conditio sine qua non of the issue of an adequate relationship with the COVID-19 pandemic.

Impact of Human Disasters and COVID-19 Pandemic on Mental Health: Potential of Digital Psychiatry.

Deep emotional traumas in societies overwhelmed by large-scale human disasters, like, global pandemic diseases, natural disasters, man-made tragedies, war conflicts, social crises, etc., can cause massive stress-related disorders. Motivated by the ongoing global coronavirus pandemic, the article provides an overview of scientific evidence regarding adverse impact of diverse human disasters on mental health in afflicted groups and societies. Following this broader context, psychosocial impact of COVID-19 as a specific global human disaster is presented, with an emphasis on disturbing mental health aspects of the ongoing pandemic. Limited resources of mental health services in a number of countries around the world are illustrated, which will be further stretched by the forthcoming increase in demand for mental health services due to the global COVID-19 pandemic. Mental health challenges are particularly important for the Republic of Croatia in the current situation, due to disturbing stress of the 2020 Zagreb earthquake and the high pre-pandemic prevalence of chronic Homeland-War-related posttraumatic stress disorders. Comprehensive approach based on digital psychiatry is proposed to address the lack of access to psychiatric services, which includes artificial intelligence, telepsychiatry and an array of new technologies, like internet-based computer-aided mental health tools and services. These tools and means should be utilized as an important part of the whole package of measures to mitigate negative mental health effects of the global coronavirus pandemic. Our scientific and engineering experiences in the design and development of digital tools and means in mitigation of stress-related disorders and assessment of stress resilience are presented. Croatian initiative on enhancement of interdisciplinary research of psychiatrists, psychologists and computer scientists on the national and EU level is important in addressing pressing mental health concerns related to the ongoing pandemic and similar human disasters.

The Importance of Psychodynamic Approach during COVID-19 Pandemic.

The coronavirus (COVID-19) outbreak was labeled a global pandemic by the WHO in March of 2020. Understanding how crisis influence an individual's reactions to stressful events (and vice versa) is important in order to create meaningful and effective interventions. Our literature search have revealed lack of the papers related to psychodynamic approach to recent crisis. Psychodynamic places a large emphasis on defense mechanisms and unconscious mind, where upsetting feelings, urges, and thoughts that are too painful for us to directly look at are housed. Even though these painful feelings and thoughts are outside of our awareness, they still influence our behavior in many ways. Optimal application of psychodynamic approach offers the frame for acceptance of psychological stress in a more positive way and benefits psychological growth. We believe that including psychodynamic approach in the national public and mental health emergency system will empower Croatia and the world during (and after) COVID-19 pandemic crisis.