ix Flexibility has traditionally been considered an important component of human physical fitness but this conjecture lacks supporting empirical evidence. While there is extensive published research examining the relative importance of flexibility and the impact of various methods of stretching on levels of flexibility, performance and injury risk, the quality of studies has varied considerably, reliability and validity of methodology has not always been proven, and rationale has at times been questionable. Additionally, much literature has focused on static flexibility which is not necessarily related to properties of the musculotendinous unit and thus dynamic flexibility. This thesis was designed to fill gaps in the existing literature by using accepted methods to establish relative and absolute reliability of hamstring flexibility tests, consider the comparability of static and dynamic components of the global concept of flexibility and explore how dynamic flexibility and performance are influenced by fatiguing exercise and subsequent static stretching. The first aim was realised by a repeated measures study designed to establish the intraday and interday, intrarater reliability and measurement error of static and dynamic measures of hamstring flexibility. Significant relative reliability for measures of static and dynamic hamstring flexibility was demonstrated via intraclass correlation coefficient (3,1) but limits of agreement analysis indicated there was a degree of absolute measurement error that must be interpreted in relation to analytical goals. The second aim required evaluation of relationships shared by static and dynamic measures of hamstring flexibility. Significant relationships between the different static flexibility tests were established but the extent of unexplained variance indicated that only measurements from the same tests should be directly compared to each other. Relationships between different measures of dynamic flexibility and static flexibility varied from non-significant to moderately strong, suggesting that measures of static and dynamic flexibility are not identical and results should not be interchanged between the two types of tests. Due to a lack of explanatory empirical evidence, the final chapter aimed via a prospective randomised repeated measures study to investigate the impact of fatigue and post-exercise static stretching on measures of dynamic flexibility and performance. Fatigue resulted in no significant changes to passive or active dynamic flexibility measures but a significant worsening of static flexibility levels and perceived stiffness. Post-exercise stretch resulted in significantly increased passive and active energy absorption immediately and 18 hours post-exercise and in significantly reduced joint position sense immediately post-exercise. Effect sizes were small so the clinical meaningfulness of performing post-exercise static stretching is questionable, particularly if performed in place of other, potentially more beneficial practices. / Thesis (DPhil)--University of Pretoria, 2013. / gm2014 / Biokinetics, Sport and Leisure Sciences / unrestricted

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Child safety is a well investigated field of research, as is the field of children’s citizenship. This study explores the intersection between these two areas. The aim of the study is to explore children’s lived citizenship from their everyday knowledge about injury risks and safety. The idea of "lived citizenship" refers to how children understand and negotiate rights and responsibilities, and to how they actually practice their citizenship in their daily lives. In the study, a concept of citizenship is used, defining it as composed of the following dimensions: rights, responsibilities, participation, identity, membership, equal status, respect, and recognition. In the study children in grades 2, 5 and 8 participated in focus group interviews. The results of the study suggest that, although the children had good awareness of risk and safety, they regarded risk as something largely positive, connecting it with opportunities for challenges and exciting adventures. School rules and also traffic rules were frequently called into question by the children, even though they were very well aware of the potential physical or legal consequences. The rules at the children’s sports clubs, in contrast, were not challenged. Talk of injury risks and safety may be understood as individual and collective identity work. When children told stories about injuries and accidents, they were also telling stories about themselves, who they were, and where they belonged. Being adventurous and daring gave status in the groups for both girls and boys.  Drawing on the results an “action zone,” as an analytical concept is suggested. The action zone is about the physical and symbolic dynamic space where children can move and act independently. Some features of the action zone are proposed in terms of boundaries, boundary guards, (rules, norms and authorities), negotiation, boundary crossing, identity, self-management and situated agency. I argue that the concept puts focus on children’s lived citizenship as a whole and that the physical aspect of citizenship is emphasized. / Barnsäkerhet och barns medborgarskap är två områden som var för sig är väl undersökta. Den här avhandlingen tar sitt avstamp i gränssnittet mellan dem, ett inte lika utforskat område. I studien samtalar barn mellan åtta och femton år i fokusgrupper om olycksrisker och säkerhet. Utifrån deras vardagskunskaper om dessa ämnen dras slutsatser om gemensamma föreställningar om levt medborgarskap. Studien visar att risker och olyckor enligt barnen är en del av livet, något som gör det roligare. Tal om säkerhet har således liten relevans i barnens tillvaro. Säkerhetsregler i skolan men också i trafiken ifrågasätts av barnen, trots att de är väl medvetna om såväl risker som tänkbara påföljder. I de idrottsföre­ningar som barnen tillhör, ifrågasätts regler däremot över huvud taget inte. Resultaten visar vidare att barn och föräldrar ofta har nått ett samförstånd runt regler och att barnen i stor utsträckning tar ett eget ansvar. När det gäller delaktighet i skolan, så finns möjligheter för barnen att göra sig hörda i råd av olika slag, även om inflytandet i realiteten tycks vara begränsat. Barnens tal om olycksrisker och säkerhet kan förstås som ett uttryck för identitetsskapande, visar studien. Att vara någon som tar risker ger status i kamratgruppen, för såväl flickor som pojkar. Utifrån resultaten föreslås aktionszon som ett begrepp för att studera barns levda medborgarskap. Aktionszonen avser det dynamiska, fysiska och symboliska utrymme barn har, i tid och rum, att fritt röra sig i och agera självständigt.

Les piétons comptent parmi les usagers de la route les plus vulnérables dans la mesure où ils ne bénéficient d'aucune protection en cas d'impact avec un véhicule automobile. Plus de 1,17 millions de personnes sont tués sur la route de part le monde dont environ 65% ce piétons. Les blessures de la tête, souvent fatales, concernent environ 30 % des blessures enregistrées. Ces blessures conduisent à des incapacités de longue durée avec un coût sociétal et économique immense. Il est par conséquent essentiel de comprendre aussi bien les mécanismes d'accidents que les mécanismes de blessure de la tête afin d'intervenir sur la conception de la face avant des véhicules automobile. Dans ce contexte l'objet de la présente thèse est d'analyser la répons dynamique du piton en cas d'accident et ce contribuer au développement de critères de blessure de la tête. Dans le but d'étudier l'influence de la position du piéton, de la géométrie de la face avant du véhicule et de sa vitesse initiale sur la cinématique du piéton et les conditions d'impact de la tête, une simulation multi-corps a été mise en place. Les résultats de ces simulations donnent la vitesse et l'angle d'impact de la tête et la position de l'impact sur le véhicule. Cette analyse paramètrique a été conduite sur cinq types de véhicules et pour un modèle humain adulte et enfant de 6 ans et a permis de consolider les connaissances sur la conditions d'impact de la tête en comparaison avec les tests normatifs en vigueur.[...] / Pedestrians are regarded as an extremely vulnerable and high-risk group of road users since they are unprotected in vehicle impacts. More than 1.17 million people throughout the world are killed in road traffic accidents each year. Where, about 65% of deaths involve pedestrians. The head injuries in vehicle-pedestrian collisions accounted for about 30% of all reported injuries on different body regions, which often resulted in a fatal consequence. Such injuries can result in disabilities and long-term sequence, which lead to significant social costs. It is therefore important to study the characteristics of pedestrian accidents and understand the head injury mechanism of the pedestrian so as to improve vehicle design for pedestrian protection. The aim of this study is to investigate pedestrian dynamic response and develop head injury risk functions.In order to investigate the effect of pedestrian gait, vehicle front geometry and impact velocity on the dynamic responses of the head, the multi-body dynamic (MBD) models were used to simulate the head responses in vehicle to pedestrian collisions with different vehicle types in terms of head impact point measured with Wrap Around Distance (WAD), head relative velocity and impact angle. A simulation matrix is established using five vehicle types, and two mathematical models of the pedestrians represented a 50th male adult and a 6 year old child as well as seven pedestrian gaits based on typical postures in pedestrian accidents. In order to simulate a large range of impact conditions, four vehicle velocities (30 km/h, 40 km/h, 50 km/h and 60 km/h) are considered for each pedestrian position and vehicle type.A total of 43 passenger car versus pedestrian accidents were selected from In-depth Investigation of Vehicle Accidents in Changsha, China (IVAC) and German In-Depth Accident Study (GIDAS) database for simulation study. According to real-world accident investigation, accident reconstructions were conducted using multi-body system (MBS) pedestrian and car models under MADYMO simulation environment to calculate head impact conditions, in terms of head impact velocity, head position and head orientation. In order to study kinematics of adult pedestrian, relationship curves: head impact time, throw distance, head impact velocity and vehicle impact velocity, were computed and logistic regression models: head impact velocity, resultant angular velocity, HIC value, head contact force and head injuries, were developed based on the results from accident reconstructions.The automobile windshield, with which pedestrians come into frequent contact, has been identified as one of the main contact sources for pedestrian head injuries. In order to investigate the mechanical behavior of windshield laminated glass in the caseof pedestrian head impact, windshield FE models were set up using different combination for the modeling of glass and PVB, with various connection types and two mesh sizes (5 mm and 10 mm). Each windshield model was impacted with a standard adult headform impactor in an LS-DYNA simulation environment, and the results were compared with the experimental data reported in the literatures.In order to assess head injury risks of adult pedestrians, accident reconstructions were carried out by using Hybrid III head model based on the real-world pedestrian accidents. The impact conditions were obtained from the MBS simulation, including head impact velocity, head position and head orientation. They were used to set the initial conditions in a simulation of a Hybrid III FE head model striking a windshield FE model. Logistic regression models, Skull Fracture Correlate (SFC), head linear acceleration, Head Impact Power (HIP), HIC value, resultant angular acceleration and head injuries, were developed to study brain injury risk.{...]

In Europe, the deployment characteristics of frontal crash restraints are generally optimised to best protect an average young male, since a 50th percentile male dummy is used in a stylised frontal impact scenario. These single point restraint systems may not provide similar levels of effectiveness when the crash scenarios vary with respect to the regulatory and consumer crash test procedures. Previous research has demonstrated that varying restraint deployment characteristics according to occupant and crash variation can provide further injury reduction in frontal impacts. This thesis reports the investigation conducted to assess the potential real world injury reduction benefit of smart restraint systems in frontal impacts. The intelligent capability of the restraint was achieved by varying the seat belt load limiter (SBL) threshold, according to the frontal crash scenario. Real world accident data (CCIS) were analysed to identify the target population of vehicle occupants and frontal impact scenarios where employing smart load limiters could be most beneficial, particularly in reducing chest injury risk. From the accident sample, the chest was the most frequently injured body region at an AIS 2+ level in frontal impacts (7% of front seat occupants). The proportion of older vehicle front seat occupants (>64 years old) with AIS 2+ injury was also greater than the proportion of younger occupants. Additionally, older occupants were more likely to sustain seat belt induced serious chest injury in low and moderate speed frontal crashes. Numerical simulations using MADYMO software were conducted to examine the effect of varying the load limiter thresholds on occupant kinematics and injury outcome in frontal impacts. Generic baseline driver and front passenger numerical models were developed using a 50th percentile dummy and were adapted to accommodate a 5th and 95th percentile dummy. Simulations were performed where the load limiter threshold was varied in five frontal impact scenarios which were selected to cover as wide a range of real frontal crash conditions as possible. From the simulation results, it was found that for both the 50th and 95th percentile dummy in front seating positions (driver and passenger), the low SBL provided the best chest injury protection, without increasing the risk to other body regions. In severe impacts, the low SBL allowed the dummy to move further towards the front facia, thus increasing the chance of occupant hard contact with the vehicle interiors. The Smart load limiters predicted no injury risk reduction for the 5th percentile drivers, who are shorter and tend to sit closer to the steering wheel. The potential injury reduction of the smart load limiters was quantified by applying the estimated injury risk reduction from the simulation to the real world accident data sample. Thoracic injury predictions from the simulations were converted into injury probability values using AIS 2+ age dependent thoracic risk curves which were developed and validated based on a methodology proposed by Laituri et al. (2005). Real world benefit was quantified using the predicted relative AIS 2+ risk reduction and assuming an appropriate adaptive system was fitted to all the cars in the real world sample. When applying the AIS 2+ risk reduction findings to the weighted accident data sample, the risk of sustaining an AIS 2+ seat belt injury reduced from 1.3% to 0.9% for younger front seat occupants, 7.6% to 5.0% for middle aged front seat occupants and 13.1% to 8.6% for the older front seat occupants. The research findings clearly demonstrate a chest injury reduction benefit across all age groups when the load limiter characteristics are varied. It suggests that employing a smart load limiter in a vehicle would not only benefit older occupants but also middle aged and young occupants. The benefit does appear to be most pronounced for older occupants, since the older population is more vulnerable to chest injury. As the older population of car users is rapidly rising, the benefits of smarter systems can only increase in the future.

Fler vegetationsbränder förväntas framöver i Sverige som följd av temperaturökning och förändrat nederbördsmönster. För att distribuera resurser effektivt vid ett släckningsarbete i vegetation kan information som tillgänglighet och brandbenägenhet vara önskvärt. Riskområden för personsäkerhet i samband med släckningsarbete bör granskas för att undvika onödiga risker. Syftet med studien var att undersöka hur brandbenägenhet, tillgänglighet och personskaderisk varierade geografiskt inom Arvika kommun. Med rasteranalys och weighted overlay beräknades brandbenägenhet med faktorerna: krontäthet, lutning, lutningsriktning, skogens utvecklingsfas och vegetation. Tillgängligheten beräknades med följande faktorer: avstånd till väg, avstånd till vatten, körtid, lutning, skogens utvecklingsfas och vegetation. Personskaderisken beräknades enligt följande faktorer: elektrifierad järnväg, förorenade områden, kraftledning, lutning och militära områden. Analysen visar att brandbenägenheten är mycket hög i ett fåtal områden, den största delen av studieområdet har brandbenägenhet mellan värde 4,1–6 av 10. Tillgängligheten är hög eller mycket hög i 98 % av studieområdet. Den lägsta tillgängligheten finns i studieområdets norra och södra delar. 92 % av studieområdet har en låg eller mycket låg personskaderisk med värde mellan 1–4 av 10. Brandbenägenhet, tillgänglighet och personskaderisk studerades på platser där bränder rapporterats åren 2008–2019. Bränder mellan år 2008–2017 med avbränd areal större än 1 hektar studerades igen. Den största faktorn för brandbenägenheten är lutningsriktning för dessa platser. Tillgänglighetens viktigaste faktorer är avstånd till väg och vegetation. Personskaderiskens största faktor är förorenade områden där bränderna var rapporterade. Brandbenägenheten inom studieområdet var störst vid lutning mot syd eller sydväst. Plana områden har generellt låg brandbenägenhet. Enligt analysen är tillgängligheten lägst i studieområdets yttre delar, speciellt dem sydligaste och nordligaste delarna. Områden i närhet av brandstationer har generellt en bättre tillgänglighet. Personskaderisken är koncentrerad till elektrifierad järnväg och kraftledning som medför direkt fara. Potentiellt förorenade områden finns spridda i hela studieområdet. Hur dessa påverkar människor är ovisst och varierar beroende på förorening. / In the future, more wildfires are expected in Sweden because of increasing temperature and changing precipitation. To being able to effectively distribute the resources of the firefighters, information about accessibility and fire tendency can come in handy. In order to avoid unnecessary risks, areas with potential hazard for the firefighters should be examined. The purpose of this study is to analyse how fire tendency, accessibility and personal injury risk varies in Arvika municipality, Sweden. Raster analysis and weighted overlay were applied in this study to examine fire tendency using the factors: crown closure, slope, aspect, the stage of stand development and vegetation. Accessibility was calculated including the following factors: distance to roads, distance to water, driving time, slope, the stage of stand development and vegetation. The personal injury risk was calculated by the following factors: electrified railways, polluted areas, power lines, slopes and military areas. The results show a high fire tendency in a few areas. Most of the areas have a fire tendency value between 4. 1–6 out of 10. Areas with a good or very good accessibility covers 98 % of the study area. Only a few spots have a very low accessibility. Areas with a low or very low personal injury risk covers 92 % of the study area. In the next part sites, with wildfires reported too MSB between 2008–2019 were studied. Wildfires larger than 10 000 square meters were studied again. Aspect was considered as a factor with a high impact on fire tendency. The major factor of the accessibility is distance to the road and the vegetation of those places. Polluted areas have the largest risk for extinguishing the fire in those places. Fire tendency shows its peaks in areas with slopes and aspect to the south or southwest thanks to the results. Flat areas receive a low risk of fire tendency. Accessibility is lowest in the outer parts of the study area, especially the southern and northern parts. Areas with risks for firefighter injury are concentrated to electrified railways and power lines, especially those that cross polluted areas. However, not all the polluted areas have been investigated in this study, therefore the effect of the pollution on the people’s health is uncertain.

Bakgrund  Bedömning av skaderisk bland lagidrottare görs ofta med analys av nedre extremiteternas mekanik under hopptester. Dessa hopptester saknar dock oftast samtidiga kognitiva krav och speglar inte den kaotiska idrottsmiljön. För att öka den validiteten av hopptesterna har ett antal studier de senaste åren undersökt inverkan av sekundära kognitiva uppgifter på prestation och rörelsemönster.  Syfte  Syftet var att sammanställa och utvärdera evidensen för inverkan av sekundära kognitiva uppgifter för prestation och nedre extremiteternas mekanik vid hopptester bland atleter.  Metod  En systematisk litteraturöversikt utfördes enligt PRISMA:s riktlinjer. Tre databaser (PubMed, Cinahl och SportDiscus) söktes för studier som jämförde prestation och/eller nedre extremiteternas mekanik mellan ett hopptest med och utan en kognitiv uppgift bland idrottsaktiva personer mellan 15 – 40 år. Studierna granskades för Risk of Bias med en modifierad version av Downs and Black checklista och för kvalitén av evidensen med GRADE.   Resultat  Av 241 hittade artiklar ansågs 10 uppfylla kriterierna för översikten. De hopptest som analyserats var till exempel drop vertical jump, enbenslandningar och riktningsförändringar. Kognitiva uppgifterna bestod bland annat av räkningsuppgifter, beslutsfattande och arbetsminne. Baserat på väldigt låg till moderat evidens, tyder resultaten på att en sekundär kognitiv uppgift vid hopptester leder till signifikant mindre knäflexion, större knäabduktion, samt större inåtrotation i knä och anklar bland idrottare. Baserade på samma evidensnivå visade resultaten på längre markkontakttid samt lägre reaktiv styrka och lägre hopphöjd.  Slutsats  Sekundär kognitiva uppgifter påverkar prestation och mekaniken i nedre extremitet under ett hopp. Resultaten tyder på att bedömning av skaderisk vid hopptester bör ske med en sekundär kognitiv uppgift för ökad känslighet.

No description available.

Um die Fahrzeugsicherheit auch weiterhin zu verbessern, können Systeme der Aktiven Sicherheit ihren Beitrag leisten. Zu diesem Zweck werden u. a. Unfalldatenbanken mit precrash relevanten Parametern herangezogen, mit welchen der Systemnutzen frühzeitig auf das Unfallgeschehen analysiert wird. Aufgrund von Informationsdefiziten in der bisherigen Unfallrekonstruktion stellt das Treffen von fundierten Aussagen zur precrash Phase eine Schwierigkeit dar, wie z. B. die genaue Ausgangsgeschwindigkeit. Deshalb sind zum Teil ungesicherte Annahmen notwendig, um eine precrash Phase rekonstruieren zu können. Bisher ist in Unfalldatenbanken zu jeweils einem analysierten Unfall eine einzelne mögliche precrash Phase dokumentiert, so wie der Unfall möglicherweise ablief. Weitere mögliche Varianten der precrash Phasen, die ebenso zu selben Unfall geführt hätten bleiben unberücksichtigt. Um detaillierte Aussagen zum tatsächlichen Nutzungsgrad eines Systems in einem realen Unfall abzuleiten, wird ein automatisiertes Simulationstool vorgestellt, welches mit Hilfe stochastischer Methoden auf mögliche Varianten an precrash Phasen schließt, die zum selben realen Unfall führen. Für das Tool dienen als Eingangsgröße rekonstruierte Unfälle, die in den precrash Phasen zum Teil Informationsdefizite aufweisen. Hierbei variiert die Monte Carlo Methode, ein Zufallszahlengenerator, die unterschiedlichen Ausprägungen von ausgewählten Einflussparametern entsprechend deren Häufigkeit. Dieses Tool kompensiert somit die Informationsdefizite in precrash Phasen und baut zugleich eine synthetische Unfalldatenbank mit Varianten an precrash Phasen auf, mit dem Ziel, die Vorunfallphase statistisch repräsentativ und unabhängig von einer konkreten Rekonstruktionsvariante abzubilden. In anschließenden Simulationen jeweils mit den soeben variierten precrash Phasen werden die unterschiedlichen Auswirkungen eines vorausschauenden Systems ermittelt. Die verschiedenen Einflüsse eines Systems werden auch hier mit der Monte Carlo Methode berücksichtigt, wie z. B. die Reaktionszeit des Fahrers auf eine Warnung. Im Falle eines Systemeingriffes ist eine mögliche Veränderung der Unfallschwere bzw. wahrscheinlichen Verletzungsschwere zu betrachten. Mit dieser vorgestellten Methodik ist der tatsächliche Nutzen eines vorausschauenden Systems für die Unfallbeteiligten noch genauer feststellbar, da das Simulationstool ein breites mögliches Spektrum an precrash Phasen und Systemauswirkungen betrachtet.

<p>Hronična bolest bubrega (HBB) je zdravstveni problem koji se javlja &scaron;irom sveta i povezana je sa visokim kardiovaskularnim komorbiditetom i smrtno&scaron;ću. Veliki porast broja bolesnika koji imaju terminalnu bubrežnu slabo&scaron;ću (TBS) nastaje kao posledica eksponencijalnog porasta broja bolesnika čija je slabost bubrega posledica hipertenzije i dijabetesa, kao i porasta broja starih sa TBS. Zbog toga vi&scaron;e od 50% bolesnika sa HBB umire zbog kardiovaskularnih bolesti i pre započinjanja lečenja metodama za zamenu funkcije bubrega. Utvrditi kliničke karakteristike bolesnika sa i bez kontrastom indukovane nefropatije (pre svega varijable bubrežne funkcije definasane pomoću AKIN i RIFLE kriterijuma) podvrgnutih kardiohirur&scaron;kim operacijama, potom utvrditi postojanje razlike u mortalitetu i postoperativnom morbiditetu između bolesnika sa i bez kontrastom indukovane nefropatije, a koji se podvrgavaju kardiohirur&scaron;koj operaciji i takođe utvrditi prediktore mortaliteta i morbiditeta kod bolesnika sa prethodnom kontrastom indukovanom nefropatijom koji se podvrgavaju kardiohirur&scaron;koj operaciji. Studija je koncipirana kao retroprospektivna opservaciona studija u ukupnom trajanju od pet godina retrospektivnog perioda i pola godine prospektivnog perioda kojim su obuhvaćene dve grupe bolesnika: I grupa - pacijenti sa kontrastom indukovanom nefropatijom (CIN) i II grupa - pacijenti bez CIN; koji su podvrgnuti kardiohirur&scaron;kim operacijama (koronarna, valvularna, kombinovana hirurgija i ostale) na Institutu za kardiovaskularne bolesti Vojvodine u Sremskoj Kamenici. Od ukupnog broja operisanih pacijenata u ovom perioda (oko 5000 bolesnika) u ovu studiju je uključeno 1269 bolesnika. U na&scaron;oj studiji ukupno je analizirano 1269 bolesnika koji su svrstani u dve grupe. Prvu grupu je činilo 59 (4,6%) pacijenata koji su koronarografisani (dijagnostička, terapijska) i razvili CIN te su upućeni u istoj hospitalizaciji po indikaciji konzilijuma na koronarnu, valvularnu i kombinovanu hirurgiju. Drugu grupu je činilo 1210 (95,4%) bolesnika kod kojih nakon koronarografije nije razvijena kontrastom indukovana nefropatija, a takođe su tokom iste hospitalizacije operisani. Kriterijumi za uključivanje pacijenata u studiju su svi punoletni bolesnici koji su upućeni na kardiohirur&scaron;ke operacije (koronarna, valvularna, kombinovana i ostale). CIN je definisan kao porast vrednosti kreatinina unutar pet dana nakon koronarografije za 25% u odnosu na vrednost kreatina pre koronarografije. Praćene su preoperativne, operativne i postoperativne karakteristike bolesnika sa CIN i bolesnika bez CIN. U disertaciji su kori&scaron;ćene mere deskriptivne statistike: aritmetička sredina, standardna devijacija, medijana, kvartili, frekvence i procenti. Za poređenje srednjih vrednosti varijabli dve populacije primenjen je test za nezavisne uzorke i Man-Vitnijev test. Povezanost kategorijskih varijabli ispitana je pomoću Hi-kvadrat testa za tabele kontigencije ili pomoću Fi&scaron;erovog testa. Određivanje uticaja promenljivih na ishod lečenja izvr&scaron;en je primenom univarijantne i multivarijantne binarne logističke regresije, koja je poslužila i za pravljenje nove varijable (modela) za procenu ishoda lečenja. Prediktivni kvalitet varijabli na ishod ocenjen je pomoću ROC krivih. Za određivanje dužine preživljavanja primenjena je Kaplan-Meier analiza preživljavanja. Uticaj varijabli na preživljavanje izvr&scaron;en je na osnovu Coxove regresione analize. Za statistički značajnu testa uzeta je vrednost p&lt;0,05. Statistička obrada podataka izvedena je primenom statističkog paketa SPSS 17. Dokazana je statistička značajnost u ispitivanim grupama u pogledu akutizacije bubrežne insuficijencije (p=0,007). Broj bolesnika sa akutizacijom bubrežne insuficijencije u grupi CIN je bio 3 (5,1%), a u grupi bez CIN je 6 (0,5%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu perikardnog izliva (p=0,046). Statističku značajnost treba uslovno prihvatiti jer je broj bolesnika sa perikardnim izlivom u grupi sa CIN bio samo 1 (1,7%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu mortaliteta (p&lt;0,0005). Broj umrlih u grupi pacijenata sa CIN je 8 (13,6%), a u grupi pacijenata bez CIN je 23 (1,9%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu AKIN kriterijuma (p&lt;0,0005). Broj bolesnika bez AKIN kriterijuma u grupi sa CIN bio je 29 (49,2%), a u grupi pacijenata bez CIN je 1210 (100,0%). U Stadijumu 1 AKIN kriterijuma broj bolesnika u grupi sa CIN bio je 26 (44,1%), a u grupi bolesnika bez CIN je 0 (0,0%). U Stadijumu 2 AKIN kriterijuma broj bolesnika u grupi sa CIN bio je 1 (1,7%), a u grupi bolesnika bez CIN bio je 0 (0,0%). U Stadijumu 3 AKIN kriterijuma broj bolesnika u grupi sa CIN bio je 3 (5,1%), a u grupi bolesnika bez CIN bio je 0 (0,0%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu RIFLE kriterijuma (p&lt;0,0005). Broj bolesnika bez RIFLE kriterijuma u grupi sa CIN bio je 0 (0,0%), a u grupi pacijenata bez CIN bio je 1169 (96,6%). U riziku (Risc) RIFLE kriterijuma broj bolesnika u grupi sa CIN bio je 51 (86,4%), a u grupi bolesnika bez CIN bio je 41 (3,4%). U o&scaron;tećenju (Injury) RIFLE kriterijuma broj bolesnika u grupi sa CIN bio je 5 (8,5%), a u grupi bolesnika bez CIN bio je 0 (0,0%). U stabost (Failure) RIFLE kriterijuma broj bolesnika u grupi sa CIN bio je 3 (5,1%), a u grupi bolesnika bez CIN bio je 0 (0,0%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu broja komplikacija (p&lt;0,0005). Broj bolesnika bez komplijacija u grupi sa CIN bio je 39 (66,1%), a u grupi pacijenata bez CIN bio je 1027 (84,9%). Broj bolesnika sa 1 komplijacijom u grupi sa CIN bio je 12 (20,3%), a u grupi pacijenata bez CIN bio je 146 (12,1%). Broj bolesnika sa 2 komplijacije u grupi sa CIN bio je 6 (10,2%), a u grupi pacijenata bez CIN bio je 20 (1,7%). Broj bolesnika sa 3 komplijacije u grupi sa CIN bio je 1 (1,7%), a u grupi pacijenata bez CIN bio je 11 (0,9%). Broj bolesnika sa 4 komplijacije u grupi sa CIN bio je 1 (1,7%), a u grupi pacijenata bez kontrastom indukovane nefropatije bio je 6 (0,5%). Dokazana je statistička značajnost u ispitivanim grupama na osnovu MACE komplikacija (p&lt;0,0005). Broj bolesnika sa MACE komplikacijama u grupi sa CIN bio je 20 (33,9%), a u grupi pacijenata bez CIN bio je 183 (15,1%). Akutna bubrežna slabost je relativno česta komplikacija kardiohirur&scaron;kih operacija. Posebno su ugroženi bolesnici sa visokim preoperativnim rizikom, u na&scaron;oj studiji pacijenti sa prethodnim CIN-om, kod kojih je akutizacija bubrežne slabosti znatno učestalija. Kardiohirur&scaron;ki bolesnici kod kojih nastane akutna bubrežna slabost imaju, kao i u na&scaron;oj studiji, vi&scaron;e postoperativnih komplikacija, produžen boravak u jednici intenzivne nege, kao i rizik za nastanak hronične bubrežne bolesti.</p> / <p>Chronic kidney disease (CKD) is a healthcare problem that occurs worldwide and is associated with high cardiovascular comorbidity and mortality. A large increase in the number of patients with terminal renal failure (TRF) occurs as a result of an exponential increase in the number of patients whose renal failure is due to hypertension and diabetes, as well as an increase in the number of elderly with TRF. As a result, more than 50% of patients with CKD die from cardiovascular disease even before starting treatment with kidney replacement therapy. To determine the clinical characteristics of patients with and without contrast-induced nephropathy (CIN) (renal function parameters defined by AKIN and RIFLE criteria) undergoing cardiac surgery, to determine the difference in mortality and postoperative morbidity between patients with and without CIN who are submitted to cardiac surgery and also to determine predictors of mortality and morbidity in patients with CIN undergoing cardiac surgery. The study was conceived as a retroprospective observational study with a total duration of five years of retrospective period and half a year of prospective period which included two groups of patients: Group I - patients with contrast-induced nephropathy (CIN) and Group II - patients without CIN; who underwent cardiac surgery (coronary, valvular, combined surgery and other) at the Institute for Cardiovascular Diseases of Vojvodina in Sremska Kamenica. Out of the total number of operated patients in this period (about 5000 patients), 1269 patients were included in this study. In our study, a total of 1269 patients were analyzed, which were classified into two groups. The first group consisted of 59 (4.6%) patients who underwent coronary angiography (diagnostic, therapeutic) and developed CIN and were submitted to surgery in the same hospitalization as indicated by heart team. The second group consisted of 1210 (95.4%) patients who did not develop CIN after coronary angiography but were also operated on during the same hospitalization. Criteria for inclusion of patients in the study are: all adult patients who are referred for cardiac surgery (coronary, valvular, combined and other). CIN was defined as a at least 25% increase in creatinine value within five days after coronary angiography compared to creatine value before coronary angiography. Preoperative, operative and postoperative characteristics of patients with CIN and patients without CIN were analyzed. Statistical analyses included measures of descriptive statistics: arithmetic mean, standard deviation, median, quartiles, frequencies and percentages. To compare the mean values of the variables of the two populations, t-test for independent samples and the Mann-Whitney test were applied. The correlation of categorical variables was examined using the Chi-square test for contingency tables or using the Fisher test. The influence of variables on the treatment outcome was determined by applying univariate and multivariate binary logistic regression, which also served to create a new variable (model) for assessing the treatment outcome. The predictive quality of outcome variables was assessed using ROC curves. Kaplan-Meier survival analysis was used to determine survival length. The influence of variables on survival was performed based on Cox regression analysis. For a statistically significant test, the value of p &lt;0.05 was taken. Statistical data processing was performed using the statistical package SPSS 17. Statistical significance was observed in the examined groups regarding the acutization of renal failure (p = 0.007). The number of patients with acute renal failure in the CIN group was 3 (5.1%), and in the group without CIN it was 6 (0.5%). Statistical significance was observed between the examined groups based on pericardial effusion (p = 0.046). Statistical significance should be conditionally accepted because the number of patients with pericardial effusion in the group with CIN was only 1 (1.7%). Statistical significance was demonstrated in the examined groups based on mortality (p &lt;0.0005). The number of deaths in the group of patients with CIN was 8 (13.6%), and in the group of patients without CIN it was 23 (1.9%). Statistical significance was demonstrated in the examined groups based on the AKIN criteria (p &lt;0.0005). The number of patients without AKIN criteria in the group with CIN was 29 (49.2%), and in the group of patients without CIN it was 1210 (100.0%). In Stage 1 of the AKIN criterion, the number of patients in the group with CIN was 26 (44.1%), and in the group of patients without CIN it was 0 (0.0%). In Stage 2 of the AKIN criterion, the number of patients in the group with CIN was 1 (1.7%), and in the group of patients without CIN it was 0 (0.0%). In Stage 3 of the AKIN criterion, the number of patients in the group with CIN was 3 (5.1%), and in the group of patients without CIN it was 0 (0.0%). Statistical significance was demonstrated between the examined groups based on the RIFLE criteria (p &lt;0.0005). The number of patients without RIFLE criteria in the group with CIN was 0 (0.0%), and in the group of patients without CIN it was 1169 (96.6%). In the Risk of the RIFLE criterion, the number of patients in the group with CIN was 51 (86.4%), and in the group of patients without CIN it was 41 (3.4%). In the Injury of the RIFLE criterion, the number of patients in the group with CIN was 5 (8.5%), and in the group of patients without CIN it was 0 (0.0%). In the Failure of the RIFLE criterion, the number of patients in the group with CIN was 3 (5.1%), and in the group of patients without CIN it was 0 (0.0%). Statistical significance was demonstrated in the examined groups based on the number of complications (p &lt;0.0005). The number of patients without complications in the group with CIN was 39 (66.1%), and in the group of patients without CIN it was 1027 (84.9%). The number of patients with 1 complication in the group with CIN was 12 (20.3%), and in the group of patients without CIN it was 146 (12.1%). The number of patients with 2 complications in the group with CIN was 6 (10.2%), and in the group of patients without CIN it was 20 (1.7%). The number of patients with 3 complications in the group with CIN was 1 (1.7%), and in the group of patients without CIN it was 11 (0.9%). The number of patients with 4 complications in the group with CIN was 1 (1.7%), and in the group of patients without contrast-induced nephropathy it was 6 (0.5%). Statistical significance was demonstrated between the examined groups based on MACE complications (p &lt;0.0005). The number of patients with MACE complications in the group with CIN was 20 (33.9%), and in the group of patients without CIN it was 183 (15.1%). Acute renal failure is a relatively common complication of cardiac surgery. Vulnerable patients are particularly at risk, in our study patients with previous CIN, in whom the acutazation of renal failure is significantly more frequent. Cardiac surgery patients who develop acute renal failure have, as demonstrated in our study, more postoperative complications, prolonged stay in the intensive care unit, as well as the risk of developing chronic kidney disease.</p>