Levels of depression, anxiety and subjective happiness among health sciences students in Croatia: a multi-centric cross-sectional study

BACKGROUND

Previous studies have shown that symptoms of depression and anxiety were highly prevalent among health sciences students. This may lead to other professional and personal difficulties and a decrease in individuals' well-being. This study aimed to analyze levels of depression, anxiety and subjective happiness among health sciences students in Croatia.

METHODS

We conducted a cross-sectional study in 10 higher education institutions in Croatia during March 2023. Eligible participants were health sciences students. Participants filled out an online survey consisting of sociodemographic questions and validated scales for determining the levels of depression (9-question Patient Health Questionnaire, PHQ-9), anxiety (General Anxiety Disorder 7-item scale, GAD-7), and happiness (Subjective Happiness Scale, SHS).

RESULTS

Of 7460 invited students, 2137 students participated in the study (29% response rate). There were 41.4% of students that exhibited at least mild depressive symptoms, with 8% of students exhibiting moderately severe symptoms and 1.8% severe depressive symptoms. Mild anxiety was found in 36.8%, moderate anxiety in 23.9% and severe anxiety in 15.8% of students. The median SHS score was 19 (15.25-22). Women students had significantly higher levels of depression (p < 0.001) and anxiety (p < 0.001) than their men peers. Students in earlier study years showed higher levels of depression, anxiety and lower levels of subjective happiness compared to those in later study years. Students with lower self-assessed financial status had higher levels of depression (p < 0.001) and anxiety (p < 0.001). Students that failed an academic year had higher levels of depression (p < 0.001), but lower levels of anxiety (p = 0.005).

CONCLUSION

In this study, we have shown that health sciences students exhibit high levels of depression and anxiety, at rates exceeding those in the general population reported in other studies. Our results may help educational institutions to put greater effort into the battle against mental health stigma, foster acceptance of mental health issues and encourage students to seek help when needed. Adequate mental health services are needed at universities to promote timely diagnosis and treatment of mental health problems.

Tendencies towards emigration and their association with introversion and ethnocentrism among final-year medical students from Osijek, Croatia: a cross-sectional study

BACKGROUND

The migration of healthcare workers is attracting growing attention worldwide. Attitudes towards emigration develop over the years, and it is possible that, in addition to social factors, they are influenced by the characteristics of a person's personality and the sense of belonging to the social environment. This study aimed to determine the tendencies of final-year medical students' from Osijek, Croatia, towards emigration after graduation and after specialization, as well as their specialty preferences and to investigate whether introversion and ethnocentrism have an impact on attitudes toward leaving the country in search of employment elsewhere.

METHODS

A cross-sectional study was conducted among final-year (6th year) medical students from Osijek, Croatia, in two consecutive academic years - 2014/2015 and 2015/2016. Students completed a questionnaire about sociodemographic characteristics, academic and scientific performance, preferences about their future medical career, the medical specialty of choice, emigration tendencies after graduation and specialization, ethnocentrism and introversion.

RESULTS

There were 124 students who participated in the study (response rate: 96%). A quarter of participants agreed that they are likely or very likely to emigrate after graduation (25.0%) or after specialization (23.39%). Variables associated with the intention to emigrate were specialty preferences (students that prefer endocrinology and psychiatry had the highest emigration tendencies), academic year in which the participants were included (students included in 2014/2015 were more prone to emigrate after specialization, p = 0.060), prior involvement in scientific projects (students with experience in scientific projects expressed higher tendencies to emigrate after graduation, p = 0.023), and ethnocentrism (higher ethnocentrism was associated with a lower tendency towards emigration after specialization, Spearman's rho = -0.191).

CONCLUSION

Our finding that a quarter of final-year medical students from the Faculty of Medicine Osijek were considering emigrating from Croatia in search of employment elsewhere after graduation or specialization is not as high as in previous Croatian studies or studies conducted in other European countries. Even though these data may be encouraging, considering the lack of physicians in Croatia, interventions are needed to prevent permanent emigration to protect the future functioning of the Croatian health system. Furthermore, our study did not find significant associations between levels of introversion and ethnocentrism and tendency to emigrate from Croatia. It seems that the phenomenon covering the emigration of students is more complex and influenced by many other factors which were not included in our study.

Most systematic reviews that used the term "update" in title/abstract were not an updated version

OBJECTIVES

To analyze whether articles labelled as systematic reviews or meta-analyses (SRs/MAs) in the title and used terms "updated" or "update" in the title or abstract are indeed a report of an updated version of a previously existing SR/MA.

STUDY DESIGN AND SETTING

We searched PubMed for SRs/MAs, using descriptors updated/update in the title/abstract published in 2018-2019. We analyzed how the articles used the term "update"/"updated" and whether the previous version of SR was referenced. We surveyed authors who indicated that the SR was an updated version, but there was no reference to the original SR.

RESULTS

Among 1,118 included articles, most (N = 716; 64%) used the term "update" only to denote that an SR includes recent data. Among 47 authors eligible for survey, 15 replied (32%). Six authors (40%) stated that their article was an updated version and gave reference to the previous version, while 9 authors (60%) stated that their SR was not an updated version of a previous SR.

CONCLUSION

Most SRs that used the term "update" in title/abstract were not an updated version of an SR. Authors should use the descriptor "update"/"updated" in their title/abstract only to refer to a new version of an SR to avoid ambiguity.

Levels of Depression and Anxiety and the Body Image of Female Patients on Renal Replacement Therapy

BACKGROUND

Chronic kidney disease is a severe condition that can affect different dimensions of the patients' wellbeing. The aim of this study was to determine the role of the treatment type on the patients' levels of depression and anxiety as well as on their body image.

SUBJECTS AND METHODS

A cross-sectional study was conducted on 146 respondents divided into three groups, 53 treated by hemodialysis (HD), 53 treated by kidney transplantation (TX), and 90 controls. Body image scale, PHQ-9 and GAD-7 were used to assess the patients.

RESULTS

There was no difference in BIS between the groups HD and TX, nor between the TX and their age-matched controls. The TX group had lower levels of depression when compared to the HD group, and their levels of depression were similar to those of controls. No significant differences in anxiety were observed between the groups.

CONCLUSION

Since the levels of depression are higher in the HD group, special attention should be given to these patients. Higher levels of psychological well-being in the transplant group is an additional factor why transplantation is the preferred method of treatment of CKD.

The Croatian version of the Body Image Scale: translation and validation

Aim

To validate the Croatian translation of the Body Image Scale in breast cancer and chronic kidney disease patients.

Methods

The scale was administered to 172 breast cancer patients and to 89 chronic kidney disease patients. Measures of depression and anxiety were used to assess the convergent validity. Both groups were divided based on their treatment types.

Results

In both samples, the scale showed high internal consistency (Cronbach's Alpha 0.958 for breast cancer patients, 0.855 for chronic kidney disease patients) item-total correlations (0.72-0.88 for breast cancer patients, 0.46-0.65 for chronic kidney disease patients), and convergent validity. In the breast cancer group, the factor analysis showed a single-factor solution, while in the chronic kidney disease group it showed a two-factor solution. Good discriminant validity was obtained among breast cancer patients, with patients who underwent complete mastectomy scoring higher than patients who underwent partial mastectomy. The scale showed no discriminant validity among chronic kidney disease patients.

Conclusion

The Croatian BIS shows good psychometric properties.

Importance of the big-five in the future medical specialty preference

BACKGROUND

The most crucial decision in the physician's career after graduation is undoubtedly the choice of specialization. It is conditioned by many factors such as intellectual challenges, clinical experience, economic and social influences. The aim of this study was to determine whether personality traits affect the choice of medical specialty at the University of Osijek, Croatia.

METHODS

This cross-sectional study included a total of 407 medical students. To assess the personality traits, the IPIP Big-Five questionnaire was used.

RESULTS

There were no differences in four of the five personality traits of the Big-Five questionnaire when comparing the groups based on their specialty preference: extroversion, agreeableness, conscientiousness, and emotional stability. A significant difference was found for openness to experience (intellect/imagination) trait, where students who preferred psychiatry specialties achieved the highest score, and those who chose public health specialties scored the lowest. We observed no significant effect between gender and specialty preference based on personality traits.

CONCLUSIONS

We could not attribute the differences in personality traits to specialty preference. Medical students with higher scores on agreeableness and openness (intellect/imagination) scales were more inclined to psychiatric specialties, and more conscientiousness students preferred the anesthesiology and emergency medicine specialties. Even if variations in personality traits do not exist across different specialties, many other factors influence specialty preference.

Circadian Typology and Personality Dimensions of Croatian Students of Health-Related University Majors

The aim of this study was to determine the relationship between circadian preferences and personality dimensions among 712 students of three different majors from the Faculty of Medicine, Osijek: medical students (MD), nursing students (RN) and medical laboratory diagnostics students (MLD). For the measurement of personality dimensions, the IPIP50 Big-Five questionnaire was used. The circadian preference of students was assessed using the reduced morningness-eveningness questionnaire (rMEQ). Several significant results were observed and there was a significant difference in circadian preference among the three tested groups, with RN students scoring highest on the morningness scale and MLD students scoring the lowest. RN students scored significantly higher on agreeableness and conscientiousness than the other two groups. On the other hand, MD students scored higher on intellect than the MLD students. MLD students scored the lowest on emotional stability scales. Morning type students had higher conscientiousness and emotional stability scores. These results imply that circadian preference and personality traits are crucial elements of medical professionals' wellbeing. With this paper, we would like to raise awareness about common personality traits and adherence to certain circadian orientations in medical professionals as a motivation to introduce a more flexible view towards strict time and task divisions in everyday practice.

The Impact of the Circadian Genes CLOCK and ARNTL on Myocardial Infarction

The circadian rhythm regulates various physiological mechanisms, and its disruption can promote many disorders. Disturbance of endogenous circadian rhythms enhances the chance of myocardial infarction (MI), showing that circadian clock genes could have a crucial function in the onset of the disease. This case-control study was performed on 1057 participants. It was hypothesized that the polymorphisms of one nucleotide (SNP) in three circadian clock genes (CLOCK, ARNTL, and PER2) could be associated with MI. Statistically significant differences, estimated by the Chi-square test, were found in the distribution of alleles and genotypes between MI and no-MI groups of the CLOCK (rs6811520 and rs13124436) and ARNTL (rs3789327 and rs12363415) genes. According to the results of the present study, the polymorphisms in the CLOCK and ARNTL genes could be related to MI.

High levels of depression and anxiety among Croatian medical and nursing students and the correlation between subjective happiness and personality traits

High levels of stress, anxiety, and depression are commonly reported among medical students. The aim of this study was to determine the levels of depressive and anxiety symptoms among medical and nursing students at the University of Osijek, Croatia and their relation to subjective happiness and personality traits. This cross-sectional study included a total of 562 students. To assess the levels of depression and anxiety, the PHQ-9 (The Patient Health Questionnaire), GAD-7 (Generalized Anxiety Disorder), SHS (Subjective Happiness Scale), and IPIP Big-5 questionnaires were used. A very high prevalence of both anxiety (54.5%) and depressive (60.2%) symptoms was found among medical and nursing students. Subjective happiness most strongly correlated with emotional stability and extraversion, also emotional stability correlated negatively with anxiety and depression. Nursing students scored higher on subjective happiness and in the domain of conscientiousness, but lower on depression. The differences in depression and anxiety could not be attributed to personality traits. Although the reported symptoms were mostly mild in intensity, we believe that this represents a significant public mental health concern. Appropriate measures should be taken to motivate students to seek help for their symptoms and to increase the availability of mental health services for students.

Circadian clock genes and circadian phenotypes in patients with myocardial infarction

PURPOSE

Human physiological activities and diseases are under the control of the circadian rhythm. There are strong epidemiological associations between disrupted circadian rhythms, sleep duration and diseases. Sleep disorders are associated with vascular outcomes, such as myocardial infarction (MI).

METHODS

We conducted an association study of genotype-phenotype interaction, to determine which circadian clock gene variants might be associated with the circadian phenotypes in patients with MI. In the present study, we analyzed the allele frequencies of 10 single nucleotide polymorphisms in four circadian clock genes in two independent samples: MI patients and controls. Chronotype was assessed using the Morningness - Eveningness Questionnaire (MEQ) and daytime sleepiness using the Epworth Sleepiness Scale (ESS).

RESULTS

Chronotype was associated with the ARNTL genetic variant rs12363415 in MI patients. The polymorphisms rs11932595 of the CLOCK gene and rs934945 of the PER2 gene were associated with daytime sleepiness in the patient group.

CONCLUSION

Our data suggest that genetic variations in some circadian clock genes might be related to circadian phenotype (i.e., chronotype and daytime sleepiness) in patients with myocardial infarction.

Circadian clock genes and myocardial infarction in patients with type 2 diabetes mellitus

Disruption of circadian clock may trigger the onset of diabetes mellitus and myocardial infarction. Type 2 diabetes mellitus (T2DM) is well-known risk factors for cardiovascular diseases and myocardial infarction. We performed a case-control study, where we explored the possible association between single nucleotide polymorphisms in three circadian rhythm genes (ARNTL, CLOCK, and PER2) and myocardial infarction in 657 patients with T2DM. The study group consisted of 231 patients with myocardial infarction and T2DM and a control group of 426 T2DM patients. We hypothesized that variations in the circadian rhythm genes in patients with T2DM could be an additional risk factor for myocardial infarction. The statistically significant difference was found in allelic (p = 1.1 × 10-5) and genotype distribution (p = 1.42 × 10-4) between two groups of the rs12363415 at the ARNTL gene locus. We provide evidence that genetic variability in the ARNTL gene might be associated with myocardial infarction in patients with T2DM.

ASSOCIATION OF CIRCADIAN RHYTHM WITH MYOCARDIAL INFARCTION

- Cardiovascular diseases are the world's leading cause of death. Human physiologic activities and state during illness are under the control of circadian rhythm. The aim of the study was to determine the potential association of chronotype and daytime sleepiness with susceptibility to myocardial infarction. We conducted a case-control study on 200 patients hospitalized due to myocardial infarction and 200 healthy controls. Systematic information on the past and present medical history was obtained from all participants. Chronotype was assessed using the Morningness-Eveningness Questionnaire (MEQ), and daytime sleepiness was assessed by the Epworth Sleepiness Scale (ESS). The mean age of the study population was 64±13 years, and 54.5% were male. There was no significant difference in MEQ (58.88±6.52 vs. 58.46±7.78, p=0.601) or ESS (5 (interquartile range, IQR 4-7.5) vs. 6 (IQR 3-8), p=0.912) score between patients and controls. Nevertheless, we found statistically significant differences related to risk factors for cardiovascular diseases, such as hypertension, dyslipidemia, and diabetes mellitus. However, there was no association of MEQ and ESS score with myocardial infarction in the study population.

Are there differences in students' school success, biorhythm, and daytime sleepiness depending on their school starting times?

Chronotype is a characteristic of a person in a certain point of one's lifetime and it slowly changes with age. Adolescents start to go to bed later while schools impose early starting hours, which may become a problem for students who are unable to adapt their circadian rhythm. The aim of this study was to determine if differences in school starting times affect the students' chronotype, school success, or daytime sleepiness. We tested a total of 1020 students from four high schools in Osijek, Croatia. The students had alternating school shifts (school starting hours 7 AM or 13 PM and 8 AM or 14 PM, every other week, alternatively, respectively). The participants were tested using the Epworth Sleepiness Scale and the Morningness--Eveningness Questionnaire. Earlier chronotypes were characteristic of the students starting school earlier, but without significant difference in daytime sleepiness in comparison with those starting school later. Differences were also found between different age and gender groups, female and older students having earlier chronotypes. Students going to school earlier showed better school success than the latter. In conclusion, the study shows that students starting school earlier also have earlier chronotypes, which might be consequence of the adaptation to one hour earlier school starting time.

Morphology and viscoelastic properties of sealing materials based on EPDM rubber

In this applicative study, the ratio of active and inactive filler loadings was the prime factor for determining the dynamic-mechanical behaviour of ethylene-propylene-diene monomer rubbers. Scanning electron microscopy was used to study the structure of reinforced dense and microcellular elastomeric materials. The effects of filler and blowing agent content on the morphology of composites were investigated. Microcellular samples cured in salt bath show smaller cells and uniform cell size compared with samples cured in hot air. Dynamic-mechanical thermal analysis showed appreciable changes in the viscoelastic properties by increasing active filler content, which could enable tailoring the material properties to suit sealing applications.

Assessment of Efficiency of Repellent Formulations with N,N-diethyl-m-toluamide in Laboratory Conditions

The affinity of N,N-diethyl-m-toluamide) (DEET) for various polymers that are potential inert carriers (PEG, PVP, NaCMC, PAA) was studied. Mixtures of DEET and the polymers were prepared and analysed for DEET vapour release using head space analysis. Polyvinylpyrrolidone (PVP) showed the highest affinity for DEET. Several insect repellent formulations in the form of a hydrogel, an o/w cream and a stick were prepared with 5% w/w DEET and either 1% w/w or no PVP. The release of DEET from the formulations was investigated by Head Space gas-mass spectrometry at 32 degrees C. The degree of absorption of DEET through the skin was evaluated by applying these topical preparations to shaved rabbit skin and measuring DEET content in the blood samples by gas-mass spectrometry at various time intervals after application. Based on these results the pharmacokinetic parameters were determined. The minimum penetration of DEET through rabbit skin was obtained with a hydrogel containing PVP as a carrier. The biological efficiency of repellent formulations containing 5% DEET (w/w) was evaluated for repellency using the mosquito Aedes aegypti. The results demonstrated that the hydrogel formulation based on polyacrylic acid containing 5% DEET (w/w) supplemented with 1% PVP (w/w), could serve as a suitable vehicle for repellent preparations containing DEET.

Hydrophilic gels containing chlorophyllin-loaded liposomes: development and stability evaluation

The aim of this study was to develop and characterize hydrophilic gels containing chlorophyllin(CHL)-loaded liposomes as well as to evaluate their stability. Two different CHL-loaded liposome dispersions using non-hydrogenated and hydrogenated soybean lecithin were prepared, characterized for their particle size, polydispersity index and trapping efficiency and incorporated in Carbopol 940 NF hydrogel. The gels obtained were analyzed for flow properties, pH values and CHL content. The control liposome-free gel was obtained by incorporating the CHL solution in the hydrogel. The stability of the gels was evaluated in terms of rheological properties, pH values and CHL content during 6 months' storage at 20 +/- 2 degrees C. Suitable gel formulations for topical use were obtained revealing shear-thinning plastic flow behaviour without significant thixotropy during the whole period of examination. High yield values of the samples during the whole period indicated a long-term stability of the gel formulations. The gel formulations expressed a mild acid value acceptable for topical preparations. After 6 months' storage the CHL content was highest in the gel containing non-hydrogenated lecithin liposomes, followed by the gel containing hydrogenated lecithin liposomes and liposome-free gel, indicating that the encapsulation of CHL in liposomes led to a greater stability of CHL.

Polymer-stabilized emulsion systems: structural characteristics and physical stability evaluation

In the course of investigation of the effects of polymeric emulsifier (Simulgel A) on the structural characteristics and physical stability (during storage time) of semisolid o/w emulsion systems with different emulsifier concentrations, dispersed droplets of an internal oil phase (4.5-11.5 microm size) were discovered. The degree of dispersity was increased along with increasing polymeric emulsifier concentration (from 1 to 5% m/m), which was shown by microscopic analysis. Experiments were also carried out using pH, electrical conductivity, and rheological (rotational and oscillatory) measurements. Emulsion samples expressed a mild acid value acceptable for topical preparations during a 6-month period. Electrical conductivity of fresh samples ranged from 0.423 to 2.009 mS/cm and after a 6-month period this slightly increased to 0.663-2.890 mS/cm. All emulsion samples revealed plastic flow behavior in fresh state, with changes in flow pattern during storage time. Viscoelastic properties defined by the oscillatory rheometry results were in good correlation with parameters of rotational rheometry and degree of internal phase dispersity. High yield stress values (flow tests) and favorable low values of damping factor (oscillatory studies) both indicated good internal structuring and long-term stability of sample containing 3% m/m of polymeric emulsifier.