Sustainable household capability of young adults: Role of parental norms

This paper aims to investigate the influence of two types of parental norms, descriptive and injunctive, on young adults' sustainable attitudes and sustainable household capability through the application of the Knowledge-Attitude-Behaviour (KAB) theory. Empirical research was conducted by an online questionnaire on a sample of 356 young adults in Croatia aged 18 to 28. The results confirmed that young adults had high levels of sustainable knowledge and attitudes. They exhibited a high tendency towards saving water and energy, and a low tendency towards sustainable and green household purchases and recycling and reusing as integral practices of sustainable household capability. The results proved the adequacy of the KAB theory in the context of sustainable knowledge, attitudes, and behaviour, affirming the theory's assumptions in terms of sustainable household capability among young adults. The results also confirmed that young adults' sustainable knowledge had a strong significant positive impact on sustainable attitudes, that sustainable attitudes had a significant positive impact on sustainable behaviour in the context of sustainable household capability, and that sustainable knowledge had an indirect significant positive impact on sustainable behaviour in the context of sustainable household capability. Considering parental norms, the results confirmed a significant positive impact of descriptive parental norms related to sustainable parental behaviour on the practices constituting sustainable household capability of young adults. At the same time, injunctive parental norms were shown to have a limited impact on both attitudes and behaviours in the context of capability. Given that previous research brought contradictory and inconclusive findings that lead to misinterpretation in the research field, the results bring a comprehensive and transparent understanding and an overview of sustainable behaviour among young adults in the context of their sustainable household capability.

A brief retrospective of the history of neurosurgery in Croatia

The beginnings of neurosurgery in Croatia date to the end of the 19th century when Teodor Wickerhauser performed the first craniotomy in the country in 1886. Exactly 60 years later, in 1946, Danko Riessner founded a separate neurosurgical ward in Zagreb and is therefore considered the founder of Croatian neurosurgery. His main scientific contribution was a paper on the shifting of brain masses, published in 1939. The Department of Neurosurgery at the University of Zagreb was founded in 1974 as one of the first institutions of its kind in Southeast Europe. Finally, the Croatian Neurosurgical Society was founded in 1992 to promote the neurosurgical profession and science at the national level. This historical vignette aimed to provide a brief chronology of the most important events and notable people in the history of Croatian neurosurgery, as well as to commemorate its founders and highlight its development from the beginning to its current state of proficiency and expertise.

Spatiotemporal Analysis of Stranded Loggerhead Sea Turtles on the Croatian Adriatic Coast

This study investigates the spatiotemporal trends of loggerhead turtles along the Croatian Adriatic coast by using stranding data and post-mortem analyses. Information on 620 loggerhead turtles (Caretta caretta), collected in the period between 2010 and 2022, has been analysed. Seasonal stranding variations reveal distinct patterns, indicating season-specific abundance and age-specific mortality in different areas, particularly in the key neritic habitat of the northern Adriatic. The analysis identifies four critical areas in the northeast and central Adriatic showing high stranding densities and provides regional managers with a tool with which to effectively conserve and manage this species. Fishing-induced mortality, collision with vessels, and potential cold stunning are identified as major threats to loggerhead turtles. Post-mortem investigations reveal that longline fishing gear and collisions with vessels are significant age-specific mortality contributors, underscoring the need for targeted conservation efforts in high-risk areas. The study acknowledges potential biases in strandings records but highlights the importance of post-mortem investigations in understanding mortality causes. The findings provide valuable insights for improving conservation strategies, emphasizing the importance of focused surveillance and conservation efforts in identified high-risk locations to mitigate human-turtle interactions.

Regional air quality study by assessing trace metal atmospheric deposition

This study addresses the atmospheric deposition of trace elements investigated in Albania, Croatia and Macedonia in 2010 as part of the European Moss Study. This study provides data on the concentration of ten metals (Cd, Cr, Cu, Ni, Pb, V, Zn, Fe, Al, and Li) in naturally growing mosses. In general, all concentration data follow a lognormal distribution. Cd, Cr, Ni, and Zn show strong fluctuations in the moss samples from Albania and Macedonia, and Pb, Fe, and Al in the mosses from Croatia. The concentrations of Cd, Cu, and Zn were higher in the samples from Croatia than in those from Albania and Macedonia; the concentrations of Cr, Ni, V, Fe, Al, and Li were higher in the samples from Albania than in those from Croatia and Macedonia; and a higher concentration of Pb was found in the samples from Macedonia. The observed relationship between the concentration of lithogenic elements (Al, Fe, and V) and the air quality index (AQI) confirms that moss species have a high capacity to retain atmospheric deposition particles. The anthropogenic emission sources of these elements from local and long-range transport were considered to be the most important factors affecting air quality in the studied areas.

Excess Mortality Stratified by Age and Sex for Croatia and Croatian Counties during the 2020-2021 COVID-19 Pandemic

Excess mortality is often used to estimate the effect of a certain crisis on the population. It is defined as the number of deaths during a crisis exceeding the expected number based on historical trends. Here, we calculated excess mortality due to the COVID-19 pandemic for Croatia in the 2020-2021 period. The excess was calculated on the national and county level for different age and sex categories. In addition to the absolute number, the excess mortality was also expressed as a ratio of excess deaths to the predicted baseline and excess mortality rate. We showed that using both measures is necessary to avoid incorrect conclusions. The estimated excess mortality on the national level was 14,963, corresponding to an excess percentage of 14.3%. With respect to sex, there was a higher excess mortality rate for men compared to women. An exponential relationship was observed between age and the excess mortality rate.These trends wee representative of most counties as well, with large variations in the magnitude of the effect. However, there were also exceptions to the general rule. The reasons for these deviations were discussed in terms of between-county differences in demographic structure, population density and special events that took place during the pandemic.

An Overview of Tick-Borne Encephalitis Epidemiology in Endemic Regions of Continental Croatia, 2017-2023

Tick-borne encephalitis (TBE) represents an important public health problem in Europe. We analyzed the epidemiology of TBE based on data from humans, animals, and Ixodes ricinus ticks in endemic regions of continental Croatia. In the period from 2017 to 2023, cerebrospinal fluid (CSF) and serum samples of 684 patients with neuroinvasive diseases, 2240 horse serum samples, and 300 sheep serum samples were tested for TBEV. In addition, 8751 I. ricinus ticks were collected. CSF samples were tested using RT-PCR. Serological tests (serum, CSF) were performed using commercial ELISA, with confirmation of cross-reactive samples by a virus neutralization test. Eighty-four autochthonous human TBEV cases were confirmed. The majority of patients were in the age group of 40-69 years (58.3%) with a male predominance (70.2%). TBE showed a bimodal seasonality with a large peak in April-August and a small one in October-November. In addition to humans, TBEV IgG antibodies were found in 12.2% of horses and 9.7% of sheep. Seasonal tick abundance corresponds to the reported number of human infections. Continental Croatia is still an active natural focus of TBE. Continuous monitoring of infections in humans, sentinel animals, and ticks is needed for the implementation of preventive measures.

Tumor and Tumor-like Lesions in Red Foxes (Vulpes vulpes) from Croatia

The red fox, found on all continents except Antarctica, occupies diverse habitats. In Croatia, it is an indigenous wild species with a population density of 0.7 animals per square kilometer. While tumors in wild animals from the Canidae family are scarce, the true prevalence and diversity of tumors are likely underestimated due to limited research. So far, a limited number of tumors have been observed among the red fox population, either in their natural habitat or in captivity. As part of the National Rabies Control Program, we examined 1890 red fox carcasses over a four-year period. Our focus was on identifying abnormalities on the skin and internal organs that suggest potential neoplastic proliferation. Five red foxes, three males and two females, were found to have growths resembling potential tumors. Their age distribution spanned from 2 to 7 years. Microscopic investigation revealed two collagenous hamartomas, two Meibomian gland adenomas, and one intra-abdominal teratoma within a cryptorchid testis. This retrospective study aims to provide a comprehensive description of tumor and tumor-like lesions observed in free-range red foxes from Croatia, marking the first research of its kind in Croatia.

Seroepidemiology of Herpes Simplex Viruses Type 1 and 2 in Pregnant Women in Croatia

Background and Objectives: Herpes simplex viruses (HSV-1 and HSV-2) are one of the most widespread causes of human viral infections. In Croatia, only two published studies have analyzed the seroprevalence of HSV infections in childbearing-aged and pregnant women (2005-2010), while more recent data are lacking. This study aimed to analyze the prevalence and risk factors for HSV-1 and HSV-2 infections among pregnant women in Croatia in the period from 2011 to 2021. Materials and Methods: This study included 667 pregnant women aged 16-45 years submitted for HSV-1 and HSV-2 serology testing. Serum samples were initially screened for HSV-1 and HSV-2 IgM and IgG antibodies using a commercial ELISA test with a confirmation of HSV-2-positive samples using an immunoblot assay. Results: The overall IgG seroprevalence rates were 69.9% for HSV-1 and 3.8% for HSV-2. A significant gradual increase in the HSV-2 seroprevalence with age was observed from 0.5% in participants under 30 years to 8.3% in participants above 40 years. The HSV-1 seroprevalence was stable up to 40 years (70.0 and 68.3%, respectively), with an increase to 86.1%, but this difference did not reach statistical significance. Area of residence (urban or suburban/rural), geographic region (continental or coastal), and obstetric history (normal pregnancy or unfavorable obstetric history) were not associated with HSV-1 and HSV-2 seroprevalence. Older age was found to be a significant risk factor for HSV-2 seropositivity in both univariate and multivariate risk analysis. Conclusions: HSV-1 infection is widely prevalent among pregnant women with a stable trend over time. However, a declining trend in the HSV-2 seroprevalence was observed compared to 2005-2010. Serological screening in pregnant women is important in identifying seronegative women who are susceptible to HSV infection as well as seropositive women who are at risk for genital herpes recurrence during delivery.

A discussion of gender, ethnicity, and intersectionality, at the Serb Business Association forum

Qualitative transdisciplinary research has contributed to the development of a dynamic scientific area that is best suited to analyze real-life data from real people. To determine how ethnicity and gender intersect to shape the social worlds of the participants in a Serb business discussion forum, I apply two theoretical orientations based on ethnomethodology: Conversation Analysis (CA) and membership categorization analysis (MCA). I analyze 15 videos with predominantly female Serb discussants. My findings from this project reveal a significant presence of stigma in the perceptions of Serb ethnicity in Croatia. I argue that due to patriarchal values as a type of cultural cache, Serb women experience demeaning gender categories in various areas of their lives. To improve this situation, it is suggested that there is a need for feminist ethics of care and a coalition with men.

Prevalence of JC Polyomavirus in Patients with Neuroinvasive Disease of Unknown Etiology in Croatia

Background and Objectives: John Cunningham polyomavirus (JCPyV) is a highly prevalent virus in the human population. The prevalence of JCPyV in patients with central nervous system disorders has not been examined extensively. The aim of this study was to analyze the prevalence of JCPyV DNA/antibodies in patients with neuroinvasive diseases (NID) of unknown etiology. Materials and Methods: The study included 132 patients with NID (febrile headache, meningitis, encephalitis) tested from January 2021 to December 2022. The control group consisted of 47 asymptomatic individuals. In patients with NID, serum and cerebrospinal fluid (CSF) samples were collected in the acute phase of the disease. CSF samples were tested for JCPyV DNA (PCR), while serum samples were tested for JCPyV IgG antibodies (ELISA). In controls, serum samples were tested for JCPyV IgG antibodies (ELISA). Results: JCPyV DNA was not detected in any of the CSF samples from patients with NID. JCPyV IgG antibodies were detected in 88.6% of patients and 74.5% of controls (p < 0.001). In the patients' group, a significant difference in the IgG prevalence was observed between males (94.6%) and females (81.0%). In addition, significant differences in the seropositivity between age groups were found. The lowest seroprevalence (28.6%) was in patients less than 20 years, followed by a sharp increase in the 20-29-year group (69.2%), after which the seroprevalence remained stable (90.0-94.1%) in patients up to 69 years. All patients older than 70 years were JCPyV IgG-seropositive. No significant difference in the seroprevalence was found in patients presenting with febrile headache (81.6%), meningitis (93.3%), or meningoencephalitis (91.3%). No difference in the seropositivity between genders was found in controls. Although the seropositivity steadily increased in older participants, these differences were not significant. Analyzing the JCPyV antibody levels in patients with NID, the median antibody titers differed significantly between groups, ranging from 248 AU/mL (younger age groups) to 400 AU/mL (older age groups). Conclusions: Higher seroprevalence in the patients' group highlights the need to further investigate the possible association of JCPyV and NID.

Knowledge and Attitudes of Cannabidiol in Croatia among Students, Physicians, and Pharmacists

Due to cannabidiol's health benefits and absence of serious side effects, its use is constantly growing. This is a survey-based cross-sectional study that was conducted to determine Croatian pharmacists', physicians', and students' knowledge and attitudes about cannabidiol (CBD). Two questionnaires were created, one for students and the other for physicians and pharmacists. Our participants (in total 874: 473 students and 401 physicians and pharmacists) generally had positive attitudes towards CBD therapy as approximately 60% of them believe that CBD treatment is generally efficacious. Participants had positive attitudes toward the therapeutic value of CBD, especially pharmacists and pharmacy students (63.8% and 72.2%, respectively). Pharmacists were significantly more convinced that CBD could reduce the use of opioids prescribed for chronic pain (p < 0.05). Only 17.5% of students had read scientific papers about CBD, compared to a significantly higher percentage of physicians and pharmacists (43.0% and 47.8%, respectively) (p < 0.05). This study revealed a gap in knowledge regarding CBD, since 89.3% of pharmacists and physicians, as well as 84.8% of students, believe they need more education about CBD. We conclude that it is important to improve the educational curricula so that medical professionals can recommend CBD use to their patients when needed.

Pseudoexfoliative Syndrome in Cataract Surgery-A Quality Register Study and Health Economic Analysis in the Split-Dalmatia County, Croatia

PURPOSE

To investigate the impact of pseudoexfoliation (PEX) syndrome on intraoperative phacoemulsification (PHACO) parameters and assess the economic cost of PHACO surgery for cataracts in patients with and without PEX syndrome.

METHODS

This was a retrospective quality register study on 5889 patients (6236 eyes) who underwent PHACO cataract surgery in the Eye Clinic, Clinical Hospital Centre Split, Croatia, over a 7-year period (May 2015 to December 2022), in accordance with the Guidelines of the Helsinki Declaration and approval from the Research Ethics Committee of the University Hospital Centre Split, Croatia. Inclusion criteria were patients with either presenile or senile cataract or cataract related to PEX syndrome who undertook PHACO procedure by the same experienced surgeon using the same PHACO device (Infiniti Vision System, Alcon Laboratories, Inc., Fort Worth, TX, USA). Eyes were categorized according to PEX presence- (PEX group) or absence (Group without PEX). The following recorded data about intraoperative PHACO parameters were collected: Cumulative Dissipated Energy (CDE), Ultrasound total time, PHACO time, torsional time, aspiration time, estimated fluid used, and duration of the surgical procedure. In the economic analysis, all PHACO parameters were considered, with a specific focus on the duration of the surgical procedure, costs associated with additional medical materials and devices, complications during surgery, and surgery procedure Diagnosis-Related Group (DRG) codes.

RESULTS

A total of 4535 cases were eligible for inclusion in the study, 278 (6.13%) were diagnosed with PEX and 4257 (93.87%) had no PEX. Significantly higher PHACO parameters were observed in the PEX group. Similarly, a statistically significant increase in the values of all PHACO parameters was observed with the increase in nuclear lens density. Intraoperative complications were more frequent in the PEX group. Zonular weakness requiring the use of a capsular tension ring (CTR) and posterior capsular rupture occurred 30 and 13 times more often, respectively, in the PEX group. The expected cost of the PHACO procedure was found to be 1.4 times higher in patients with PEX, compared to those without PEX, for all types of nuclear cataract.

CONCLUSIONS

All PHACO parameters are significantly higher in patients with PEX. The costs associated with PHACO surgery for cataracts are greater for patients with PEX and are not covered by the present DRG codes, which highlights the need to accordingly adjust the DRGs for PHACO procedures in PEX patients, in order to maintain the quality of healthcare provided for these vulnerable patients.

A Large-Scale Outbreak of Trichinellosis from Infected Wild Boar Meat in Croatia and the Role of Real-Time PCR Assays in Confirming the Source of the Disease

BACKGROUND

Trichinellosis in Croatia posed a significant health concern during the 1990s, followed by a notable improvement in the epidemiological situation. However, in 2017, there was a resurgence, with 37 recorded cases in 3 outbreaks and 3 sporadic cases. The source of this epidemic was homemade meat products derived from wild boar meat, leading to 26 infections.

METHODS

At the beginning of the outbreak and during the treatment of the patients, the medical and epidemiological records prepared throughout the investigation and over the course of patient treatment were reviewed. The recovery of the first-stage (L1) larvae from suspect meat products was achieved by artificial digestion. The molecular identification of the isolated larvae was performed by multiplex PCR. The molecular identification of the meat used to prepare the meat products was performed by real-time PCR assays.

RESULTS

The epidemic started in early 2017. In total, 71 exposed persons were documented: 26 with clinical symptoms and 3 hospitalised in two cities in different counties. The L1 burden in three different meat products was from 5.25 to 7.08 larvae per gram (LPG), and T. spiralis was determined as the aetiological agent of the outbreak. The molecular and biological identification confirmed that implicated meat products were made solely from wild boar meat.

CONCLUSIONS

Although trichinellosis is no longer a frequent occurrence in Croatia, several cases are still registered nearly every year. Wild boar meat poses an important risk factor for human health if compulsory testing is not conducted before consumption, especially if the meat products are consumed without proper thermal processing.

nov., isolated from a noble pen shell (Pinna nobilis) population in Croatia

Introduction

Shortly before the mass mortality event of the noble pen shell (Pinna nobilis) population in the south-eastern Adriatic coast, two rapidly growing Mycobacterium strains CVI_P3T (DSM 114013 T, ATCC TSD-295 T) and CVI_P4 were obtained from the organs of individual mollusks during the regular health status monitoring.

Methods

The strains were identified as members of the genus Mycobacterium using basic phenotypic characteristics, genus-specific PCR assays targeting the hsp65 and 16S rRNA genes and the commercial hybridization kit GenoType Mycobacterium CM (Hain Lifescience, Germany). MALDI-TOF mass spectrometry did not provide reliable identification using the Bruker Biotyper Database.

Results and discussion

Genome-wide phylogeny and average nucleotide identity (ANI) values confirmed that the studied strains are clearly differentiated from their closest phylogenetic relative Mycobacterium aromaticivorans and other validly published Mycobacterium species (ANI ≤ 85.0%). The type strain CVI_P3T was further characterized by a polyphasic approach using both phenotypic and genotypic methods. Based on the phenotypic, chemotaxonomic and phylogenetic results, we conclude that strains CVI_P3T and CVI_P4 represent a novel species, for which the name Mycobacterium pinniadriaticum sp. nov. is proposed.

Renal Denervation in the Treatment of Resistant Hypertension and Difficult-to-Control Hypertension - Consensus Document of the Croatian Hypertension League - Croatian Society of Hypertension, Croatian Cardiac Society, Croatian Endovascular Initiative, Croatian Society for Diabetes and Metabolic Diseases, Croatian Renal Association, and Croatian Society of Family Physicians of the Croatian Medical Association

Renal denervation (RDN) as a method of treating arterial hypertension (AH) was introduced in Croatia in 2012. A multidisciplinary team and a network of hospitals that diagnose and treat patients with severe forms of AH were established, and a very strict diagnostic-treatment algorithm was prepared. At monthly meetings patients with truly resistant hypertension who were candidates for RDN were discussed. According to the 2021 ESH position statement and 2023 ESH guidelines, RDN is considered an alternative and additional, not a competitive method of treating patients with various forms of AH which must be performed by following a structured procedure and the patient's preference should be considered. In view of the changes in the global scientific community, the Croatian Hypertension League brings this consensus document on RDN conducted with radiofrequency-based catheter, the only currently available method in Croatia. In this document, exclusion and inclusion criteria are shown, as well as three groups of patients in whom RDN could be considered. The new diagnostic-treatment algorithm is prepared and follow-up procedure is explained. In Croatia, RDN is reimbursed by the national insurance company, thus pharmacoeconomic analyses is also shown. Criteria required by an individual centre to be approved of RDN are listed, and plans for prospective research on RDN in Croatia, including the Croatian registry for RDN, are discussed.

Subjective Well-Being and Self-Assessed Health of Adolescents: A Longitudinal Cohort Study

BACKGROUND

The aim of this study was to investigate the stability and predictors of subjective well-being and self-perceived health in adolescents over a two-year period, focusing on the importance of mental health in overall well-being.

METHODS

Participants in this longitudinal cohort study were surveyed at the ages of 15 (n = 441) and 17 (n = 354) through questionnaires. The data were analyzed using both descriptive and inferential statistical methods. Hierarchical regression was employed to investigate significant predictors of subjective well-being. The subjective well-being and self-perceived health dimensions showed a consistent level of stability throughout the two-year period of secondary education. Additionally, there was a significant correlation between well-being at the beginning and end of this education period. Furthermore, self-perceived health dimensions, particularly general health, vitality, and mental health, were positively associated with well-being at the end of secondary education, highlighting their role in overall subjective well-being. The regression analysis revealed that self-perceived health factors, notably "General health" and "Mental health", significantly predicted overall subjective well-being, enhancing the model's explanatory power beyond gender and economic status. Nevertheless, baseline subjective well-being has the strongest predictive effect on final well-being.

CONCLUSIONS

This study highlights the importance of psychological and health factors, particularly mental health, that affect the overall well-being of adolescents and emphasizes the need to focus on and improve these factors in order to improve subjective well-being.

Women's sexual abuse: forensic-gynecologic expertise experiences

PURPOSE

Women sexual violence as a gynecological, social-criminological and gynecological problem has no declining trend in developing and developed countries, including in Croatia.

METHODS

From my own 23-year forensic-gynecological expertises practice, along with the results of legally completed examples of sexual abuses, as a contribution to this problem, which is also read from other works.

RESULTS

Of the cases of sexual abuses (n = 31) with a median age of 37 years, gynecological-forensic expertise proved and confirmed 67.7% of sexual abuses criminal cases with a significant problem of inadequate primary gynecological procedure, most often due to insufficient gynecological examination and medical documentation in high 64.5%, as well as late sexual abuses report in 51.6%. Of all cases of sexual abuses, 6 (19.4%) required primary surgical care due to bleeding and lacerations of the genitals, there were no reported cases of sexual abuses in pregnancy, and no deaths related to sexual abuses. The problems that can affect the forensic-gynecological evaluation of sexual abuses victims are: inadequate and insufficient primary medical documentation immediately after sexual abuses, late reports of sexual abuses, after several days, months and years in the reproductive age of women, with a late primary examination and an almost difficult to prove objective gynecological examination and inadequate education of gynecologists in primary examination.

CONCLUSION

In conclusion, it should be mentioned that the mentioned medical problems can be solved by constant education of all professional medical participants, permanent court experts with experience, coordination and subordination of expert gynecological and forensic societies in cooperation with the state attorney's office, courts and police, and social service.

Self-reported HPV vaccination status and HPV vaccine hesitancy in a nationally representative sample of emerging adults in Croatia

Introduction

The aim of this study was to determine self-reported human papillomavirus (HPV) vaccination status among emerging adults in Croatia, intention to get the HPV vaccine among unvaccinated individuals and correlates of HPV vaccine hesitancy.

Methods

Data were collected via a cross-sectional survey based on a probabilistic national sample. The sample included 1,197 individuals aged 18-25 years (50.6% were women) who were recruited from November 2021 to February 2022 as part of the commercial online panel. Analyses included 981 participants who correctly answered two "attention trap" questions using descriptive statistics and multivariate analyses. The data were post-hoc weighted for gender and age and adjusted for clustering effect. To adjust standard errors for the sampling design, multivariate analyses were carried out using the complex samples module in the IBM SPSS 27 statistical software package.

Results

Overall, 18.3% of participants (25.0% of women and 11.7% of men) reported that they were HPV vaccinated, while 21.9% did not know their HPV vaccination status. Of those vaccinated, 65.6% were women. The odds of being HPV-vaccinated were significantly higher among female participants. Among the unvaccinated, 35.4% expressed a willingness to get the vaccine. The odds of vaccination hesitancy were significantly lower among women, participants who reported a higher perceived risk of STIs, those who recognized that HPV could result in cervical cancer, and significantly higher among those who were more religious.

Conclusion

Our findings suggest a need to increase HPV vaccination uptake in Croatia through raising awareness about HPV vaccine effectiveness and also through the implementation of strategies to make vaccination more available.

Case report: Crigler-Najjar syndrome type 1 in Croatia-more than a one in a million: a case series

Crigler-Najjar syndrome (CNS) is an exceedingly rare autosomal recessive disease with an estimated incidence of 1 in a million live births. CNS type 1 (CNS1) is the most severe form, characterized by severe unconjugated hyperbilirubinemia since birth due to the absence of hepatic uridine 5'-diphosphate glucuronyltransferase (UGT1A1) activity. Daily phototherapy (PT) and liver transplant (LT) are the mainstays of therapy. Here, we present a higher-than-expected incidence of CNS1 in Croatia (6,1 in a million). In the last 31 years, we treated eight CNS1 patients from five families with no reported consanguinity. Four patients are descendants of an isolated enclave in Kosovo with a small gene pool and a high potential for inbreeding. Severe unconjugated hyperbilirubinemia was verified in a neonatal period and PT was initiated. Four patients underwent LT from living-related donors. One of them had unsuccessful hepatocyte transplantation earlier. LT was successful in three patients, and one patient died due to primary graft dysfunction. Four patients are currently treated with 9-12 h daily PT with inconsistent disease control, and gradually increasing bilirubin. One patient developed kernicterus before LT, while others have normal psychomotor development and no neurologic impairment. Genetic testing of the UGT1A1 gene in six patients from three families revealed three different homozygous mutations (c.722_723 delAG, c.717_718 delAG, and c.1021 C >T), all previously described in other populations. There is a possibility of the founder effect as an explanation for the higher incidence of CNS1 in at least a subgroup of Croatians.

Consumption of psychotropic drugs in Croatia before and during the COVID-19 pandemic: a 10-year longitudinal study (2012-2021)

PURPOSE

This longitudinal study aimed to examine the trends in antipsychotics, antidepressants, anxiolytics, and hypnotics/sedatives consumption in Croatia over a 10-year period (2012-2021). The study also assessed whether the COVID-19 pandemic had an impact on the yearly consumption of psychotropic drugs.

METHODS

Data were collected from Croatian Agency for Medicinal Products and Medical Devices (HALMED) and presented as defined daily doses per 1000 inhabitants per day (DDD/TID). The consumption before (2012-2019) and during the COVID-19 pandemic (2020-2021) was compared with interrupted time series analysis.

RESULTS

There was an increase in total consumption of analyzed psychotropic drugs in Croatia between the years 2012 and 2021, from 115.47 DDD/TID in 2012 to 155.50 DDD/TID in 2021. An increasing trend was observed in the consumption of all 4 analyzed groups of medicines (antipsychotics, anxiolytics, hypnotics and sedatives, and antidepressants). Anxiolytics accounted for 59% (68.29/115.47 DDD/TID), and hypnotics and sedatives for 8.5% (9.76/115.47 DDD/TID) of total consumption in 2012. At the end of a 10-year period, hypnotics and sedatives represented 12% (19.05/155.50 DDD/TID) and anxiolytics 54% (83.53/155.50 DDD/TID) of psychotropic drugs consumption. The total consumption of psychotropic drugs was not significantly different before and during COVID-19 pandemic (estimate ± standard error = 5.029 ± 6.899, t = 0.729, P = 0.490).

CONCLUSION

Croatia had a high, continuously increasing consumption of psychotropic drugs. National anxiolytics consumption was one of the highest globally, while consumption of antidepressants was rather low compared to other high-income countries. The COVID-19 pandemic did not seem to influence the yearly utilization of psychotropic drugs in Croatia.

Estimation of the annual effective dose from exposure to radon in drinking water in Croatia

Radon is known as the main source of radiation for the general public. Results of extensive measurements of radon in water samples collected from private wells, natural springs and public water supply in Croatia are presented and annual effective doses are estimated. Measurements were performed by two different methods: the emanometry method (by using the AlphaGUARD instrument with additional AquaKIT module) and/or the liquid scintillation method (by using LSC TriCarb 2900). Water samples were collected in public water supplies in urban areas as well as private wells and springs in rural areas. The obtained average radon activity concentration based on the extensive measurement of almost 1000 water samples is 4.1 ± 1.9 Bq/l, with a minimum value of 0.2 and maximum value of 36 Bq/l respectively. The wide range of measured values is a consequence of the source of the water sample (ground/natural water versus treated water) as well as the geological structures around the water source. All estimated ingestion doses due to radon assuming consumption of 2 l of water per day from the observed source were within the interval 6.3-36.8 μSv (with calculated average and standard deviation 19.3 ± 10.3 μSv) for the water consumption from private wells and natural springs and 2.4-40.0 μSv (with calculated average and standard deviation 13.0 ± 10.5 μSv) for the water consumption from the public water supplies.

The Role of Mental Health and Delinquent Behaviors in the Cycle of Sexual Violence Among Croatian Adolescents: A Longitudinal Exploration with Replication

The "cycle of violence" perspective links the experience of being a victim of violence with later aggressive or violent behavior. While the association between victimization and aggression is relatively established, the mechanisms involved in the cycle of violence are less understood. The current study considered the role of mental health and delinquency on the pathway between sexual victimization and sexual aggression in two independent longitudinal samples of Croatian adolescents (Mage at baseline = 16 years). Using data from the first panel (six data waves, 2015-2018; n = 1289), structural equation modeling analysis pointed to a psychosocial mechanism, a combination of symptoms of depression/anxiety and delinquency, that mediated the link between the experience of sexual victimization and self-reported sexual aggression. We also observed a significant role of family environment in this psychosocial mechanism. The pattern of findings was partially replicated in the second panel with five waves of data (2015-2017; n = 750). The study's results can help inform conversations around designing policies to prevent and address peer sexual violence among Croatian adolescents.

First Report of Hemp Fusarium Wilt Caused by Fusarium oxysporum in Croatia

Wilted hemp (Cannabis sativa L.) plants were observed in August 2019 in commercial fields around Osijek, Croatia. Plants and roots with disease symptoms were collected. The single-spored isolates produced septate cottony white to light pink aerial mycelium and purple undersurface on potato dextrose agar (PDA). Smooth and hyaline hyphae were branched and septate. Macroconidia were fusiform to sickle-shaped with foot-shaped basal cells, elongated apical cells and three to five septa. Sequencing of the internal transcribed spacer and the partial elongation factor 1-α gene identified the species as Fusarium oxysporum. Artificial infection fulfills Koch's postulates, producing plants which show stunted growth and wilt symptoms similar to those observed in the commercial fields. Control seedlings remained symptomless and healthy. To the best of our knowledge, this is the first report of hemp Fusarium wilt causing F. oxysporum in Croatia. Considering that F. oxysporum has been reported in main field crops in Croatia, the presence of this pathogen could cause economically significant hemp production decreases, especially in humid and cold springs and susceptible varieties.

Inner Peace needs of male psychiatric patients in post-war Croatia are associated with their needs to clarify open issues in their life and their needs for forgiveness

Background

More than 25 years after the end of the Balkan war, many people belonging to the post-war population are still traumatized by the war events and have been treated for post-traumatic stress disorder or other psychiatric diagnoses. We were interested in their Inner Peace needs, how these relate to indicators of mental health, and their needs to clarify open processes in their lives and to forgive and be forgiven.

Materials and methods

In a cross-sectional survey with standardized questionnaires (i.e., SpNQ, PCL-M, HADS, and BMLSS), 638 male patients who were treated in seven psychiatric centers in Croatia were enrolled. 68% were diagnosed with PTSD and 32% had other psychiatric diagnoses. Most had actively participated in the Balkan war (79%), and 60% for the whole war period.

Results

Strong needs to "immerse into beauty of nature" were stated by 47%, to "dwell at a place of quietness and peace" by 66%, and to "find inner peace" by 57%. These Inner Peace needs were highest in men treated with PTSD diagnoses as compared to men with other psychiatric diagnoses and were slightly lower in men who were active during the whole war period as compared to shorter phases of war participation. Regression analyses with Inner Peace needs as a dependent variable revealed that Clarification/Forgiveness needs were the best predictor, with further influences of PTSD symptoms and life satisfaction, explaining altogether 49% of the variance. The best predictors of their PTSD symptoms were life satisfaction, perceived burden, depressive symptoms, Inner Peace needs, religious trust, and duration of war participation, explaining 60% of the variance.

Conclusion

In Croatian male war participants in clinical treatment decades after the war, Inner Peace needs indicate their ongoing intention to let go of their disturbing experiences and to find states of inner peace, particularly at specific places of quietness and peace. These needs can be considered metaphors for longing for wholeness, integrity, and safety, in contrast to the ongoing impact of unresolved issues. Thus, apart from psychotherapeutic treatment, sheltered places of nature, inspiration, and reconciliation might be elements to improve the difficult situation of post-war victims still suffering from their experiences.

Genes Involved in DNA Damage Cell Pathways and Health of the Oldest-Old (85+)

Some sources report a connection of cellular senescence with chronic pathological conditions; however, the association between particular cellular processes and general health is rarely examined. This study aims to test the relationship of general health with DNA damage pathways that play a crucial role in senescence. The association of ten selected SNPs with subjective and objective general health and functional ability indicators has been tested in 314 oldest-old people from Croatia. Multivariate logistic regression was employed to simultaneously test the impact of variables potentially influencing targeted health and functional ability variables. The best model, explaining 37.1% of the variance, has six independent significant predictors of functional ability scores: rs16847897 in TERC, rs533984 in MRE11A, and rs4977756 in CDKN2B, chronic disease count, Mini-Mental State Examination scores, and age at surveying. In conclusion, the examined ten loci involved in DNA damage repair pathways showed a more significant association with self-rated health and functional ability than with the number of disease or prescribed medicaments. The more frequent, longevity-related homozygote (GG) in rs16847897 was associated with all three aspects of self-assessments-health, mobility, and independence-indicating that this TERC locus might have a true impact on the overall vitality of the oldest-old persons.

Knowledge and Attitudes towards Epilepsy of Croatian General Student Population and Biomedical Students: A Cross-Sectional Study

Epilepsy causes a significant burden to patients as it is linked with various somatic and psychiatric comorbidities, social issues, impaired quality of life, and increased mortality. Improving the population's knowledge and attitudes about epilepsy patients could be beneficial as it could raise social awareness and lead to more social support for patients. For those reasons, a survey-based cross-sectional study was conducted to determine Croatian students' knowledge and attitudes toward epilepsy. A previously developed survey questionnaire was adapted for the Croatian setting and distributed online to the students (n = 544). Croatian students generally had positive attitudes towards people with epilepsy (median score 28.0, interquartile range 29.0-26.0, with the minimum possible score being 0.0 and the maximum 30.0), with the female gender (B (male) = 0.664 (95% CI -1.158, -0.170), p = 0.009), biomedical education (B (other) = -0.442, (95% CI -0.823, -0.061), p = 0.023), and personal experience in the form of witnessing the seizure (B = 0.519 (95% CI 0,098, 0.940), p = 0.016) as predictors of more favorable attitudes. Overall knowledge was satisfactory concerning most items, with the exception of first aid measures and risk factors. Educational intervention targeting bio-medical students and other students who might, in their future professional lives, be responsible for people suffering from epilepsy is needed to improve the gaps in their knowledge.

Sexual abuse of children - some recommendations from a forensic gynaecologist's expert experience

Prompt and better primary examination of victims accompanied by meticulous note-taking in cases of suspected child sexual abuse are needed to improve both conviction rates and to avoid inappropriate criminal investigations and proceedings. The majority of child sexual abuse victims are female. More training is needed for gyaecologists in this field.

Current Status of Vector-Borne Diseases in Croatia: Challenges and Future Prospects

Different vector-borne pathogens are present or have (re-)emerged in Croatia. Flaviviruses tick-borne encephalitis (TBEV), West Nile (WNV), and Usutu (USUV) are widely distributed in continental regions, while Toscana virus (TOSV) and sandfly fever viruses are detected at the Croatian littoral. Recently, sporadic clinical cases of Tahyna orthobunyavirus (TAHV) and Bhanja bandavirus infection and seropositive individuals have been reported in continental Croatia. Acute infections and serologic evidence of WNV, TBEV, USUV, and TAHV were also confirmed in sentinel animals and vectors. Autochthonous dengue was reported in 2010 at the Croatian littoral. Lyme borreliosis is the most widely distributed vector-borne bacterial infection. The incidence is very high in northwestern and eastern regions, which correlates with numerous records of Ixodes ricinus ticks. Acute human Anaplasma phagocytophilum infections are reported sporadically, but there are many records of serologic evidence of anaplasmosis in animals. Mediterranean spotted fever (Rickettsia conorii) and murine typhus (Rickettsia typhi) are the main rickettsial infections in Croatia. Human leishmaniasis is notified sporadically, while serologic evidence of leishmaniasis was found in 11.4% of the Croatian population. After the official eradication of malaria in 1964, only imported cases were reported in Croatia. Since vector-borne diseases show a growing trend, continuous monitoring of vectors is required to protect the population from these infections.

Sex estimation using orbital measurements in the Croatian population

The aim of this study was to test the sexual dimorphism of orbital measurements in the Croatian population using multi-slice computed tomography (MSCT) images. We have retrospectively taken 414 head CT scans of adults from Croatian clinical hospitals in Split and Zagreb (214 males and 200 females) with slice thickness < 1 mm and no pathological or traumatic changes that could affect the measurements. DICOM files were imported into Stratovan Checkpoint Software and viewed in 2D and 3D using semi-transparent 3D volume rendering. Eight standard measurements were calculated based on twelve orbital landmarks (six paired). Principal component analysis (PCA) was used to explore sexual and regional differences, and linear discriminant analysis was used to develop sex classification models. The PCA showed separation based on sex and region, and additional analysis demonstrated that females and males in Split and Zagreb differed in four orbital measurements (P ≤ 0.001). Only those measurements that did not show regional differences were further analyzed, and all showed statistically significant sexual dimorphism. The accuracy of univariate functions for sex estimation ranged from 53.43 to 71.88%, and for multivariate function, the accuracy was 73.45%. The orbital measurements of the Croatian population showed restricted forensic significance for sex classification. On the other hand, we have shown that they can have a potential for exploring the inter- and intra-population differences.

Detection of Bhanja Bandavirus in Patients with Neuroinvasive Disease of Unknown Etiology in Croatia

BACKGROUND

Although the Bhanja bandavirus (BHAV) is widely distributed in some European countries, human infections are rarely reported. This study analyzed the prevalence of BHAV antibodies in patients with neuroinvasive diseases of unsolved etiology.

METHODS

A total of 254 Croatian patients who developed neurological symptoms during the four consecutive arbovirus transmission seasons (April 2017-October 2021) were tested. Cerebrospinal fluid (CSF) and urine samples were tested using RT-qPCR. In addition, CSF and serum samples were tested using a virus neutralization test.

RESULTS

BHAV RNA was not detected in any samples, while neutralizing (NT) antibodies were detected in serum samples of 53/20.8% of patients (95% CI = 16.0-26.3). In two patients, BHAV NT antibodies were detected in the CSF, indicating a recent infection. Both patients were inhabitants of rural areas in continental Croatia, and one reported a tick bite two weeks before symptoms onset. The seropositivity was high in all age groups (15.2-29.1%). The majority of seropositive patients (94.3%) resided at altitudes less than 200 m above sea level. The prevalence rates correlated positively with population density and negatively with certain climate parameters (temperature, number of hot/warm days).

CONCLUSIONS

The presented results indicate that BHAV is distributed in Croatia. Further studies are needed to determine the clinical significance of this neglected arbovirus.

Increasing water temperature of the largest freshwater lake on the Mediterranean islands as an indicator of global warming

Global warming has been monitored for many years. The increase in air temperature and changes in the distribution and frequency of high temperatures are recorded continually. Lakes are one of the important water resources for aquatic ecosystems and water supply, which are significantly affected by global warming. The increase in lake water temperature increases the evaporation from the free lake surface, lowering the lake level, and changes the water quality. In the last few decades, analysis of changes in lake water temperature has been increasing. In situ measurements of water temperature in Vrana Lake on Cres island (Croatia), the largest freshwater lake on the Mediterranean islands, were analysed over 43 years. The results showed that the mean annual lake surface water temperature (LSWT) increased by 0.47 °C decade-1 (p < 0.0001). The increase in the mean annual lake summer surface water temperature (July-September) was 0.44 °C decade-1 (p < 0.0001), and the maximum annual LSWT was 0.56 °C decade-1 (p < 0.0001). All these amounts are in accordance with the published data on the increase in water temperature in the investigated European lakes. The number of days with LSWT higher than 25 °C increased by almost 9 d decade-1. An increase in the minimum LSWT (0.17 °C decade-1) corresponding to isothermal conditions was also determined but was not statistically significant. The minimum mean monthly LSWT increased by 0.36 °C decade-1 (p < 0.0001). Because the increase in water temperature can negatively affect the lake's ecosystem, and become a threat to safe water supply; LSWT, thermal stratification and evaporation should be continuously monitored. The impacts of climate warming on the lake stratification and aquatic ecosystems need to be further investigated.

Thiotrichasumpichi sp. nov. - a new species of Thiotrichinae (Lepidoptera, Gelechiidae) from south-eastern Europe

Thiotrichasumpichisp. nov. is described from Greece and Croatia. The systematic position of the new species within Thiotricha is discussed based on external and genitalia characters and from DNA barcodes of the mitochondrial COI gene (cytochrome c oxidase 1). Adults, details of external morphology, and male and female genitalia of the new species are illustrated.

Microhabitat partitioning between sympatric intertidal fish species highlights the importance of sediment composition in gravel beach conservation

Gravel beaches in the Mediterranean ecoregion represent an economically important and unique habitat type. Yet, burgeoning tourism, intensive coastal development and artificial nourishment of beaches may jeopardize their ecological communities. To date, species that reside on gravel beaches and the consequences of beach alterations are poorly understood, which hampers the development of a sustainable coastal tourism industry along the region's shorelines. Using a simple collection method based on dredging buckets through the intertidal section of beaches, we quantified the microhabitat association of two sympatric clingfish species in the genus Gouania at seven natural and an artificial gravel beach based on sediment characteristics. We hypothesized that slender (G. pigra) and stout (G. adriatica) morphotypes would partition interstitial niche space based on sediment size, which may affect the vulnerability of the species to changes in gravel beach composition due to coastal development. We detected substantial differences in gravel composition within and among the sampled beaches which suggests scope for microhabitat partitioning in Gouania. Indeed, we found significant relationships between species identity and the presence/absence and abundance of individuals in hauls based on their positioning on PC1. Our results suggest that modifications of gravel beaches through coastal development, including beach nourishment, intensifying coastal erosion, or artificial beach creation, may have detrimental consequences for the two species if sediment types or sizes are altered. We posit that, given the simplicity and efficacy of our sampling method and the sensitivity of Gouania species to prevailing gravel composition, the genus could serve as an important indicator for gravel beach management in the Mediterranean ecoregion.

Emergence of Echinococcus multilocularis in Central Continental Croatia: A Human Case Series and Update on Prevalence in Foxes

Human alveolar echinococcosis (HAE), caused by the metacestode stage of Echinococcus multilocularis, has emerged in many European countries over the last two decades. Here, we report the first data on the new HAE focus with increasing incidence in central Croatia, describe its clinical presentation and outcomes in diagnosed patients, and provide an update on the prevalence and geographic distribution of Echinococcus multilocuaris in red foxes. After the initial case in 2017 from the eastern state border, from 2019 to 2022, five new autochthonous HAE cases were diagnosed, all concentrated in the Bjelovar-Bilogora County (the county incidence in 2019 and 2021: 0.98/10⁵, in 2022: 2.94/10⁵/year; prevalence for 2019-2022: 4.91/10⁵). The age range among four female and two male patients was 37-67 years. The patients' liver lesions varied in size from 3.1 to 15.5 cm (classification range: P2N0M0-P4N1M0), and one patient had dissemination to the lungs. While there were no fatalities, postoperative complications in one patient resulted in liver transplantation. In 2018, the overall prevalence of red foxes was 11.24% (28/249). A new focus on HAE has emerged in central continental Croatia, with the highest regional incidence in Europe. Screening projects among residents and the implementation of veterinary preventive measures following the One Health approach are warranted.

First Report of Charcoal Rot Caused by Macrophomina phaseolina on Hemp in Croatia

The production of industrial hemp (Cannabis sativa) has had a sharp increase in the past five years in Croatia (Mihelcic 2017). Production has been in constant increase, from 1560 ha in 2015 to 2476 ha in 2019 (PAAFRD). In August 2019, numerous (~1.5%) premature wilted hemp plants (cultivar Fibranova) were observed in commercial fields in Vladislavci (45.4646950° N, 18.5674770° E), around Osijek, Croatia. Diseased plants showed symptoms of chlorosis, rapidly wilting, necrosis and prematurely dying. The stalk of diseased plants was completely desiccated, while internal tissues were spongy and fluffy. Near the soil line, discoloration of the stalk with small spherical to oblong black microsclerotia was detected. Roots were necrotic with brown-gray areas. Twenty root and crown segments of the infected plants (2- to 3-mm long pieces) were surface sterilized with 2% NaOCl for 5 min, rinsed three times with sterile distilled water, and plated on potato dextrose agar (PDA, pH 6.2) media, containing 250 mg per liter of chloramphenicol to inhibit bacterial growth (Zveibil and Freeman 2005). The culture plates were incubated at 28 ± 2°C for 7 days in the dark and purified to obtain a pure culture that produces numerous, dark, hard, ovoidal-shaped sclerotia, averaging 140 x 52 μm (n=50). The single sclerotium isolate produced flat light to dark gray colonies with entire margins. Based on field symptoms, colony and microsclerotia morphology, the fungus was identified as Macrophomina phaseolina (Tassi) Goid (Marquez et al. 2021). Total DNA from the isolate was extracted with Extract-N-Amp Plant PCR Kit (Sigma-Aldrich Co., USA). To confirm morphological identification, part of the TEF 1-alpha gene region was amplified using EF1-728F (Carbone and Kohn 1999) and EF2 (O'Donell et al. 1998). The sequence of the isolate MP1 (212 bp - GenBank accession no. OQ389757), showed 100% nucleotide sequence identity to the reference sequence of M. phaseolina GenBank sequence MG434668 (Casano et al. 2018). Eighteen hemp plants (cv. Fibranova) were sown in six plastic pots (three hemp plants per pot) for the pathogenicity test. Ten-day-old M. phaseolina culture (isolate MP1) was used for inoculum preparation. Each pot of one-week-old plant was irrigated with 100 ml of a microsclerotia suspension (105 microsclerotia/ml)(Abied et al. 2018). Plants were held at 28°C and 70% relative humidity in a growth chamber (aralab, Fitoclima 10.000 HP) with a 16-hour photoperiod. Pots with control plants were irrigated with the same amount of sterile distilled water. Ten weeks after inoculation percentage of wilted plants was 77.78%. In the control variant all plants were healthy. M. phaseolina was reisolated from inoculated plants and morphologically identified. With the liberalization of the law, hemp production in Croatia is increasing, which could result in general disease problems and the disease caused by M. phaseolina. Charcoal rot will be expressed in years with dry and warm summers (Lodha and Mawar 2020), and relatively short, cool, rainy winters (Nevo et al. 2012), which has become common in the last decade in Croatia. To our knowledge, this is the first report of M. phaseolina on hemp in Croatia. The authors declare no conflict of interest.

Retrieving planktonic foraminifera from lithified rocks, examples from the Eocene limestones and marls (External Dinarides, Croatia)

Paleoecologic (paleoclimatologic) and biostratigraphic studies of pelagic and deep-water deposits rely on the identification of planktonic foraminifera. Here we report and compare the results of planktonic foraminiferal assemblages from the Middle Eocene indurated limestones and marls collected in the External Dinarides extracted with acetic acid of different concentrations (50%, 60%, 70% and 80%) and different reaction (exposure) times. The deposits originated within the Dinaric foreland basin, have been assigned to the so-called Transitional beds and Flysch, and are characterized by different ratio of carbonate content and degree of lithification. The aim of this paper is to compare the efficiency of the laboratory procedures for obtaining isolated specimens and to evaluate the impact of preparation procedure on the quality of tests (complete test vs. secondary dissolution effects). For each acetic concentration we assessed:(1)the effectiveness of the treatment in terms of the time required for successful extraction of planktonic foraminifera, and(2)the degree of dissolution by analyses of dissolution proxies, including the weight percentage of sieved residues after disaggregation and preservation features of the tests. Our results indicate that accurate taxonomic analysis of carbonate rocks requires the use of 60% acetic acid for a shorter reaction time, and hydrogen peroxide methods for marls.

Organ Donation in Croatia: The Importance of a National Champion, a Comprehensive Plan, and International Collaborations

The Republic of Croatia is a global leader in organ donation and transplantation despite having fewer resources and more modest healthcare expenditures than other countries in the European Union. The results of an extensive literature review were combined with expert input in an iterative multi-step data collection and evaluation process designed to assess trends in Croatian organ donation and transplantation and identify key elements, policy changes, and drivers of the system that have contributed to its success. Multiple sources of evidence were used in this study, including primary documents, national and international transplantation reports, and insights from critical informants and content experts. The results highlight several key organizational reforms that have substantially improved the performance of the Croatian transplant program. Our findings emphasize the importance of strong central governance led by an empowered national clinical leader acting under the direct auspices of the Ministry of Health and a comprehensive and progressive national plan. The Croatian transplant system is notable for its integrated approach and efficient manner of managing scarce health resources. Collectively, the results suggest that Croatia has become nearly self-sufficient due to its systematic implementation of the guiding principles for organ donation and transplantation.

Interspecies transmission of porcine-originated G4P[6] rotavirus A between pigs and humans: a synchronized spatiotemporal approach

As a leading viral cause of acute gastroenteritis in both humans and pigs, rotavirus A (RVA) poses a potential public health concern. Although zoonotic spillover of porcine RVA strains to humans is sporadic, it has been detected worldwide. The origin of chimeric human-animal strains of RVA is closely linked to the crucial role of mixed genotypes in driving reassortment and homologous recombination, which play a major role in shaping the genetic diversity of RVA. To better understand how genetically intertwined porcine and zoonotic human-derived G4P[6] RVA strains are, the present study employed a spatiotemporal approach to whole-genome characterization of RVA strains collected during three consecutive RVA seasons in Croatia (2018-2021). Notably, sampled children under 2 years of age and weanling piglets with diarrhea were included in the study. In addition to samples tested by real-time RT-PCR, genotyping of VP7 and VP4 gene segments was conducted. The unusual genotype combinations detected in the initial screening, including three human and three porcine G4P[6] strains, were subjected to next-generation sequencing, followed by phylogenetic analysis of all gene segments, and intragenic recombination analysis. Results showed a porcine or porcine-like origin for each of the eleven gene segments in all six RVA strains. The G4P[6] RVA strains detected in children most likely resulted from porcine-to-human interspecies transmission. Furthermore, the genetic diversity of Croatian porcine and porcine-like human G4P[6] strains was propelled by reassortment events between porcine and porcine-like human G4P[6] RVA strains, along with homologous intragenotype and intergenotype recombinations in VP4, NSP1, and NSP3 segments. Described concurrent spatiotemporal approach in investigating autochthonous human and animal RVA strains is essential in drawing relevant conclusions about their phylogeographical relationship. Therefore, continuous surveillance of RVA, following the One Health principles, may provide relevant data for assessing the impact on the protectiveness of currently available vaccines.

Paleopathological Changes in Animal Bones from Croatian Archaeological Sites from Prehistory to New Modern Period

A special part of archaeology, so-called archaeozoopathology or veterinary paleopathology is dedicated to studies of paleopathological changes in animal remains and contributes to the knowledge of ancient veterinary medicine and the history of diseases. In our study, we analyze paleopathological changes determined by gross observation and diagnostic imaging in the animal material originating from eight archaeological sites in Croatia. A standard archaeozoological analysis was carried out and specimens with visually detected macrostructural changes were radiographed. In total, 50 animal remains with altered macrostructure were identified in the archaeozoological material excavated from 2010 to 2022 at eight archaeological sites in Croatia. According to the taxonomic analysis, most of the bones with macrostructural changes originated from cattle (N = 27, 54% of the total number of bones with macrostructural changes), followed by the bones of small ruminants (N = 12, 24%) and pigs (N = 8, 16%). The horse, carnivore and chicken were represented with one bone each (2%). Radiological examination showed that three samples (6%) had a regular bone macrostructure, i.e., no pathological changes were visible upon radiological examination. The majority (64%) of pathologically altered bones are a consequence of keeping/working, followed by traumatic causes (20%). Changes in the oral cavity were found in 10% of specimens. Our study showed that gross examination will continue to be the primary method for the identification of pathologically altered remains in archaeozoological material. However, diagnostic imaging techniques such as radiography should be implemented to confirm or exclude suspected alterations and to help the classification of the specimen by etiology.

Leptospirosis and characterization of Leptospira isolates from patients in Koprivnica-Križevci County, Croatia from 2000-2004

Introduction

Leptospirosis, caused by spirochetes of the genus Leptospira , is present in the Koprivnica-Križevci County area, Croatia. Clinical manifestation can range from asymptomatic, short-term mild, non-specific febrile disease, to severe forms with high mortality rates.

Aim

The aim of the study was to valuate culture in front of microscopic agglutination test (MAT) for diagnosis of infection, and to evaluate clinical and laboratory features of the disease. Moreover, we want to characterize Leptospira strains involved in infection in Koprivnica-Križevci County, Croatia.

Methods

We included 68 patients with clinical presentation consistent with leptospirosis collected in a 5-year period (2000-2004). Clinical samples (blood, urine and cerebrospinal fluid, CSF) were inoculated in Kolthoff's medium; species of isolated Leptospira strains was determined with Tm of real-time PCR, serogroup/serovar with MAT and NotI-RFLP analysis. Demonstration of specific antibodies in patients' sera was done using microscopic agglutination test.

Results

Leptospira was isolated from the blood of 14/51(27.5 %) patients and the most often identified serogroup/serovar was Icterohaemorrhagiae (8/10, 80%) followed by Grippotyphosa (10%). Regarding to species level, 8/10 isolated belonged to L. interrogans sensu stricto and one to L. kirschneri species. MAT was carried out on 51 patients with suspected leptospirosis, and was positive in 11/51(21.5 %) patients. Most of our patients presented with moderate severe symptoms, were hospitalized from August to October, and were infected mainly during the work or recreation in our county. The frequency of particular clinical features and pathological laboratory findings correlated with the severity of the clinical condition.

Conclusions

Leptospirosis can be confirmed microbiologically, culture and MAT contributed almost equally to the diagnosis of infection. Serovar Icterohaemorrhagiae was found as the dominant one, and L. interrogans sensu stricto as dominant species in our county. Epidemiological data shown that leptospirosis occurs seasonally, affects the rural population, and most commonly is presented with moderate severe clinical course.

Croatian mothers were 11 times more likely to give their newborn infants formula in hospital if they had used it for their older children

AIM

We determined the prevalence and predictors of formula supplementation for healthy, term newborn infants in hospital.

METHODS

A cross-sectional study was conducted from 1 June to 21 October 2020 among Croatian women who gave birth to healthy newborn infants of ≥37 weeks gestation and birth weight of ≥2,500g at the University Hospital of Split, Croatia. The mothers completed a questionnaire on hospital infant feeding practices and breastfeeding self-efficacy. Multinomial logistic regression investigated associations between perinatal factors and formula supplementation.

RESULTS

We approached 392 mothers, and 355 (90.6%) were included: 286 (80.6%) said their newborn infant received formula in hospital and it was at their request in 173/286 (60.5%) of cases. The adjusted analyses identified factors associated with an increased odd ratios (OR) and 95% confidence intervals (CI) for formula supplementation. These were: no previous breastfeeding experience (OR 9.42, 95% CI 3.51-25.28), breastfeeding difficulties in hospital (OR 9.12, 95% CI 3.46-24.09) and older children who received formula during their birth hospitalisation (OR 11.51, 95% CI 4.4-30.1). Mothers were not routinely notified of the risks.

CONCLUSION

An unacceptably high proportion of healthy newborn infants received formula in hospital.

The Attitudes and Practices Regarding COVID-19 among General Practitioners from Croatia and Bosnia and Herzegovina: A Cross-Sectional Study

Attitudes toward COVID-19 (coronavirus disease 2019) prevention and control may have influenced general practitioners' (GPs') work during the COVID-19 pandemic. The present study aimed to investigate the attitudes and practices of GPs from Croatia and Bosna and Herzegovina regarding COVID-19 prevention and control as well as the factors which may have influenced them. A cross-sectional study using a self-administered, anonymous questionnaire was conducted between February and May of 2022 on 200 Croatian and Bosnian GPs. The study revealed that the attitudes and practices of the surveyed GPs regarding COVID-19 prevention and control were satisfactory. The Croatian GPs reported a larger number of positive attitudes toward COVID-19 prevention and control (p = 0.014), while no significant differences in practices were established. Among the Croatian GPs, more positive attitudes toward COVID-19 prevention and control were reported by participants who had finished a formal education on the prevention of infectious diseases and occupational safety (p = 0.018), while among the Bosnian GPs, more positive attitudes were reported by older GPs (p = 0.007), males (p = 0.026), GPs with a longer length of service (p = 0.005), GPs who had finished a formal education on the prevention of infectious diseases and occupational safety (p < 0.001), GPs who had finished a formal education on adequate hand hygiene (p < 0.001), and GPs who had finished a formal education on COVID-19 prevention for GPs (p = 0.001). Considering GPs' practices regarding COVID-19 prevention and control, among the Croatian GPs, more positive practices were reported by older GPs (p = 0.008), females (p = 0.002), GPs who had a partner (p = 0.021), GPs who were specialists in family medicine (p = 0.014), GPs with a longer length of service (p = 0.007), and GPs who had finished a formal education on the prevention of infectious diseases and occupational safety (p = 0.046), while among the Bosnian GPs, no significant correlations were determined. The general practitioners' sociodemographic and employment characteristics strongly influenced their attitudes and practices regarding the prevention and control of COVID-19. The cultural differences between Croatia and Bosnia and Herzegovina, as well as the organizational specificities of their healthcare systems, probably modified the observed differences in the individual patterns of associations between the outcome and explanatory variables in the surveyed neighboring countries.

Prevalence of alcohol consumption among high school students: A cross-sectional study

AIM

This study addresses the risk and protective factors for alcohol consumption among medical-technology high school students. The specific objectives of the study were to analyse standard influences on excessive alcohol consumption (influence of parents and upbringing) and possible modern influences, represented by social networks and internet use.

DESIGN

A cross-sectional analysis.

METHODS

The sample included the entire cohort of third-year students attending high school in Varaždin (n = 1,352). Data were collected using an anonymous questionnaire. The bivariate analysis used an independent t test and a Chi-squared test. The multivariate analysis used logistic regression. The study was conducted from September 2018 to February 2019.

RESULTS

Alcohol consumption was most prevalent among vocational students, followed by college-preparatory students and medical-technology students. Style of parenting and maternal authority have a positive influence on less alcohol use among students. The results showed that smartphone ownership and internet use do not correlate with alcohol use among high school students.

CHRONIC MEDICAL CONDITIONS IN CROATIAN WAR VETERANS COMPARED TO THE GENERAL POPULATION: 25 YEARS AFTER THE WAR

Many published reports have documented an increased prevalence of chronic medical conditions among veterans, but there were only a few studies that compared these increases with the general population. The aim of this study was to determine differences in chronic medical conditions between Croatian war veterans and the general population. This study included two groups of subjects, i.e. 1453 participants who are Croatian war veterans and 1429 participants from the general population. Medical history, physical examination, laboratory tests and specific diagnostic procedures were taken during systematic physical examination in both groups. The prevalence of hypertension, diabetes, hyperlipidemia, hypothyroidism and hyperthyroidism, chronic obstructive pulmonary disease, coronary heart disease, malignancy, psychiatric diseases, cholelithiasis, nephrolithiasis, smoking and alcohol consumption was analyzed. Croatian war veterans were found to be more likely to develop hypertension than individuals in the general population (29.5% vs. 24.3%), as well as diabetes (7.3% vs. 3.8%), hyperlipidemia (56.4% vs. 27.3%), hyperthyroidism (3.1% vs. 0.8%), coronary heart disease (4.3% vs. 1%), malignancy (4.1% vs. 2.2%), psychiatric diseases (15.4% vs. 1.1%), and alcohol consumption (53% vs. 29%). Significant difference was found in favor of the general population for hypothyroidism (14.3% vs. 8%). There were no differences in the prevalence of chronic obstructive pulmonary disease, cholelithiasis, nephrolithiasis, and smoking. Our findings confirmed the hypothesis of a higher prevalence of cardiovascular diseases, malignancy and psychiatric diseases among Croatian war veterans and emphasized the need of better control of their medical conditions.

EPIDEMIOLOGICAL CHARACTERISTICS AND FACTORS ASSOCIATED WITH MORTALITY IN SEVERELY BURNED PATIENTS - CROATIAN NATIONAL BURN CENTER REPORT

The authors conducted a single-center retrospective study during the last 6.5 years. The study aimed to describe demographic data of burn patients in the Croatian Burn Center and investigate factors affecting mortality for the first time after the Center was established. The study included 109 severely burned patients with a total body surface area (TBSA) burned ≥20%, admitted to the burn intensive care unit. The relationship between the fatal outcome and age, sex, comorbidity, mechanism of injury, TBSA burned, and inhalation injury was investigated. The mean patient age was 54.50±20.21 years and the mean TBSA burned was 42.48±18.64%, with the mortality rate of 50%. The results demonstrated that patients with 2 or more comorbidities compared with those with no comorbidities had a higher chance of lethal outcome (p<0.0001). With an increase of TBSA by 1%, the odds of lethal outcome are expected to increase by 7% (p<0.0001). Other variables included in the analysis did not show statistical significance. TBSA percentage is a well-known predictor of mortality and numerous studies indicate an association between comorbidities and mortality but there are conflicting results about other demographic factors and injury characteristics.

Circadian (re)colonisation dynamics of macroinvertebrates in an isolated karst spring

Freshwater ecosystems, especially springs, are highly sensitive to environmental changes. They are also excellent natural laboratories because of their stable conditions, reducing the number of variables to be considered in field studies. We examined the composition, dynamics and colonisation patterns of macroinvertebrates with respect to canopy coverage and time of day in which available areas are actively colonised. We used artificial substrates that mimicked the natural habitat structure at an isolated karst spring and recovered exposed substrates every 12 h. Physico-chemical parameters of water did not differ significantly regardless of canopy cover. The most numerous representatives and the pioneering champions were larvae of Baetidae (Ephemeroptera) and Chironomidae (Diptera). Simuliidae were also among the most successful pioneering species. Most observed groups more actively colonised substrates in the closed canopy area. Oligochaeta and Gammarus fossarum were more numerous on substrates in the open canopy area. Individuals of all analysed groups showed day-night migration patterns and were more active at night. Coleoptera (Elmis sp.) were the poorest (re)colonisers among the analysed taxa.

Metal bioaccumulation in stygophilous amphipod Synurella ambulans in the hyporheic zone: The influence of environmental factors

Given the increasing need to protect vulnerable freshwater ecosystems and make them more resilient to human use and climate change, biomonitoring of the hyporheic zone (HZ), which plays a critical role in pollution attenuation, is essential. The aim of the present study was to assess the potential of the amphipod species Synurella ambulans as a bioindicator of metal contamination in the HZ of the Sava River (Croatia). Amphipods were collected during the four seasons at two sampling sites (average sampling depth 55 cm) differing in type (agricultural and urban) and intensity (diffuse and point source contamination) of anthropogenic influence, one located upstream (Medsave), and the other downstream (Jarun) of the wastewater treatment plant discharge. Concentrations of Al, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, Rb, Sn, Zn, Ca, K, Mg and Na were measured in the interstitial water, sediments and specimens of S. ambulans by HR ICP-MS. Physicochemical parameters (temperature, DO, O₂ saturation, pH, conductivity, alkalinity, total water hardness, COD_KMnO4, nutrients) were measured in the interstitial water, while organic carbon was measured in the interstitial water and sediments. Metal concentrations in interstitial water and sediments were below thresholds set by environmental quality standards. Metal concentrations in S. ambulans were classified as follows: higher at the Jarun site (Al, Cr, Fe, Ni, Pb, Sn), higher at the Medsave site (Cd, Cu, Rb) and mostly comparable at both sites (Co, Mn, Zn). Bioaccumulation factors were generally higher at Jarun, with average values ranging from 322 to 143,278 L kg^-1. Bioaccumulation of metals in S. ambulans depended on various environmental factors, with metal exposure level and dissolved macro elements showing the strongest association with metals accumulated in S. ambulans. The findings provided the first evidence on the suitability of S. ambulans as a good bioindicator of chronic metal contamination in the HZ.

Absence of Hepatitis E Virus (HEV) Circulation in the Most Widespread Wild Croatian Canine Species, the Red Fox (Vulpes vulpes) and Jackal (Canis aureus moreoticus)

Hepatitis E virus (HEV) can infect a wide range of domestic and wild animals, and the identification of new host species is reported successively worldwide. Nevertheless, its zoonotic potential and natural transmission, especially in wildlife remains unclear, primarily due to the discrete nature of HEV infections. Since the red fox (Vulpus vulpus) is the most widespread carnivore worldwide, and has been recognized as a potential HEV reservoir, its role as a potent host species is of increasing interest. Another wild canine species, the jackal （Canis aureus moreoticus）, is becoming more important within the same habitat as that of the red fox since its number and geographical distribution have been rapidly growing. Therefore, we have chosen these wild species to determine their potential role in the epidemiology and persistence of HEV in the wilderness. The main reason for this is the finding of HEV and a rather high HEV seroprevalence in wild boars sharing the same ecological niche as the wild canine species, as well as the risk of the spread of HEV through red foxes into the outskirts of cities, where possible indirect and even direct contact with people are not excluded. Therefore, our study aimed to investigate the possibility of natural HEV infection of free-living wild canines, by testing samples for the presence of HEV RNA and anti-HEV antibodies to gain better epidemiological knowledge of the disease. For this purpose, 692 red fox and 171 jackal muscle extracts and feces samples were tested. Neither HEV RNA nor anti-HEV antibodies were detected. Although HEV circulation was not detected in the tested samples, to our knowledge, these are the first results that include jackals as a growing and important omnivore wildlife species for the presence of HEV infection in Europe.

What Constitutes a "Good Death"?-A Representative Cross-Sectional Survey Among the General Public in Croatia

Understanding the attitudes of a particular society on a "good death" is important when it comes to end-of-life decision-making and palliative care. In the Republic of Croatia no systematic research has been done on the attitudes of the general population about the concept of a "good death". This cross sectional survey was conducted on a three-stage random sample, stratified by regions, counties and locations within those counties (N = 1203) during November and December, 2019. ANOVA, to determine differences, factor analysis and multiple regression analysis were used. The most important characteristics of a good death outlined by the respondents were: the absence of pain, the presence and unencumberedness of family and loved ones, the importance of a sense of fulfilment and meaning in life in this regard, reconciliation with God, the presence of awareness and sobriety, and the possibility of treatment.

Impact of Climate Changes on the Natural Prevalence of Fusarium Mycotoxins in Maize Harvested in Serbia and Croatia

Ongoing climate change may affect the susceptibility of plants to attacks by pathogenic, mostly mycotoxigenic fungi with a consequent increase in the presence of mycotoxins. Fusarium fungi represent one of the most important producers of mycotoxins, and are also important pathogens of agricultural crops. Therefore, the main aim of the study was to estimate the impact of weather parameters on the natural occurrence of Fusarium mycotoxins, such as deoxynivalenol (DON), fumonisins B₁ and B₂ (FUMs), zearalenone (ZEN), T-2, and HT-2 toxins (T-2/HT-2) in maize samples harvested from two neighboring countries, Serbia and Croatia, during a four-year production period (2018-2021). The frequency and contamination level of examined Fusarium mycotoxins varied by maize year of production and could be linked to weather conditions per investigated country. Among them, FUMs were found to be the most common contaminants (84-100%) of maize in both Serbia and Croatia. Additionally, a critical assessment of Fusarium mycotoxins occurrence in the last 10 years (2012-2021), for both Serbia and Croatia, was done. Results pointed out the highest contamination of maize from 2014, especially with DON and ZEN, in connection to extreme levels of precipitation observed in both Serbia and Croatia, whereas FUMs occurred with high prevalence from each of the ten investigated years.