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.

High Participation Rate in Mammography Screening: Experience from Croatia.

OBJECTIVE: The aim of the study was to analyse the results of three cycles of mammography screening (MS) in the Croatian National Programme (CNP) for Early Breast Cancer Detection for women aged 50­69 years in the Bjelovar-Bilogora County (BBC) from 2006­2014. METHODS: Data on women aged 50­69 screened during a 9-year period were obtained from the Croatian Cancer Registry and Institute of Public Health reports. Participation rate and performance indicators were examined. RESULTS: The total of 57,428 women were invited to mammography screening in BBC during a 9-year period and 31,402 mammograms in total were performed. The response rate of 84% in BBC was consistently higher than the national average of about 60% reported in 2007, 2013 and 2014. CONCLUSION: The National Programme in BBC has been carried out continuously for nine years with a higher response rate compared with the national average, as a result of additional efforts of the Croatian Institute of Public Health team, as well as good cooperation among all programme stakeholders. It was concluded that to achieve better results in the response of women to screening and consequently reduced mortality from breast cancer is possible through tailored health promotion activities.

Hyperbaric oxygen therapy in treating post-ischemic pain caused by polycythemia vera complications: a case report.

One of the complications of polycythemia vera (PV) can be acute thrombotic occlusion. The severity and prolonged duration of this condition can lead to nerve damage. In this case a 34-year-old male had thrombotic occlusions of the popliteal artery, resulting in chronic limb ischemia, which was treated with thrombectomy and amputation of one digit. The administered therapy consisted of hydroxyurea, analgesics, antidepressants and acetylsalicylic acid. When the patient was admitted he suffered from ischemic pain, he had developed an ulcer on his big toe and he was emotionally unstable, with suicidal thoughts. The patient was treated with 14 hyperbaric oxygen (HBO2) treatments in total. There was evident paint relief after four treatments and healing of the ulcerous tissue after three weeks. During the patient's medical examination eight months after the treatment, his condition was still satisfactory, with no presence of pain, ulcer or signs of depression, and with no changes in hemodynamics. This case provides additional evidence to the data for HBO2 use in ischemic pain management.

[A STUDY INVESTIGATING THE FACTORS OF INTERNET ADDICTION]. / ISTRAZIVANJE CIMBENIKA NASTANKA OVISNOSTI O INTERNETU.

The aim of the study was to explore the characteristics of Internet use among elementary school eighth-graders in the Bjelo- var-Bilogora County, to evaluate gender and sociodemographic differences, and to examine predictors for Internet addiction. The study included 437 (female 51%) eighth-graders, mean age 13.8 ± 0.5 years. An anonymous questionnaire was used to measure the participants' Internet use, the functions for which they used Internet, their parents' attitude towards the child's Internet use, and their signs of Internet addiction. Logistic regression was conducted to evaluate predictors for Internet addiction. The majority of children (71.5%) reported using Internet every day. Considering important risk factors of Internet addiction development, we found that 32% of children almost always stayed on-line longer than intended, 13% of boys and 4% of girls almost always neglected chores to spend more time on-line and 51.7% of children thought their life would be boring and uninteresting without the Internet. There was no significant difference between urban and rural students. In terms of the function for which they used the Internet, they were mostly engaged in on-line community/chat websites (70%), to listen to music and watch movies (81 %), and boys in gaming websites. Most of the students (43.4%) spent 1-2 hours daily on-line, 26.2% of students spent 3-4 hours on-line, and 9% spent more than 5 hours daily on-line. In conclusion, more public health preventive measures should be conducted to raise public awareness and concern about the negative effect of Internet use and Internet addiction, especially in the young population.

Croatian Translation and Validation of the Patient Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ).

Patient satisfaction is a crucial measure of the quality of healthcare, especially with regard to nursing services in hospital settings. Understanding and increasing patient satisfaction with nursing care is critical to improving overall healthcare and ensuring positive patient experiences during their hospital stay. The aim of this research was to evaluate the psychometric properties of the Croatian version of the Satisfaction with Nursing Care Quality Questionnaire (PSNCQQ), test the reliability and validity of the tool after translation, and investigate differences in patient satisfaction based on demographic variables, as well as their contribution to satisfaction with the quality of nursing care. After translation and adaptation, the Croatian version of the PSNCQQ was applied to 350 hospitalized patients (average age 51.19 years (range: 18-87)), of whom 194 (55.4%) were men and 156 (44.6%) were women. The results showed high internal consistency (Cronbach's α = 0.977) and confirmed the one-factor structure of the questionnaire, explaining 70.64% of the total variance. Confirmatory factor analysis supported the unidimensional model, showing strong fit indices (χ2 = 583.047, df = 149, p < 0.001, GFI = 0.861, AGFI = 0.818, NFI = 0.936, TLI = 0.946, CFI = 0.955, RMSEA = 0.080, PCLOSE < 0.001). In conclusion, the validation of the PSNCQQ in the Croatian language increases resources for evaluating and improving the quality of nursing care. This research lays the foundation for future studies and practical applications aimed at improving patient satisfaction and nursing care outcomes in Croatia, but there are also limitations to this study, including its one-institution scope, the possible influence of factors outside the current treatment on satisfaction, and the lack of comparison with objective clinical indicators.

The Influence of Participation in Pregnancy Courses and Breastfeeding Support Groups on Attitudes and Knowledge of Health Professionals about Breastfeeding.

Numerous factors affect the behavior, attitudes, and knowledge of health professionals about breastfeeding. The aim of this paper is to determine the impact of participation in pregnancy courses and breastfeeding support groups on the attitudes and knowledge of health professionals about breastfeeding. The study compares two groups of health professionals according to the results they achieved on a validated questionnaire of behavior, attitudes, and knowledge about breastfeeding. The authors did not make personal contact with the respondents, as the questionnaires were filled out online. The two groups of respondents differed according to the frequency of participation in pregnancy courses, that is, groups for breastfeeding support. The results are presented tabularly and graphically (frequencies and percentages), while differences in the results between the infrequent and regular participants are shown with the Mann-Whitney U test (asymmetric distribution). Better results on the questionnaire were achieved by those who regularly attended breastfeeding support groups (Mdn = 149, IQR = 11) in comparison to infrequent visitors (Mdn = 137, IQR = 23). The same is found for regular visitors of pregnancy courses (Mdn = 149, IQR = 15.75) in comparison to infrequent visitors (Mdn = 137, IQR = 23). The differences are statistically significant (p < 0.00). Partial correlation confirms a more significant influence of breastfeeding support groups (<0.00) than pregnancy courses (p = 0.34). Working in breastfeeding support groups had a statistically significant positive effect on the attitudes and knowledge of health professionals about breastfeeding. The topic of breastfeeding should be given more space and importance during pregnancy courses as well. Personal experience working in breastfeeding support groups and pregnancy courses should be incorporated into the training of medical students.

Deficiencies in the Intentions, Attitudes, and Knowledge of Future Healthcare Professionals Regarding Breastfeeding.

The aim of this study was to determine the level of knowledge, positive intentions, and attitudes regarding breastfeeding among university students. A validated questionnaire collected data from 236 students of the Faculty of Dental Medicine and Health Osijek about breastfeeding intentions, attitudes, and knowledge. Descriptive methods were used to present the students' results in terms of their intentions, attitudes, and knowledge. For each question included in the questionnaire, the maximum possible and maximum achieved numbers of points were calculated, as well as the percentage of points achieved in relation to the maximum possible number. Correlations between the results on individual scales of the questionnaire and the total results of the questionnaire are shown by Spearman's correlation coefficient. Questionnaire answers that were least in line with professional recommendations were selected and analyzed. We found that the areas that should be given special attention in the education of students are: the intention of breastfeeding for more than a year; the use of breaks for breastfeeding in the workplace; attitudes and knowledge about the quality of breast milk in relation to substitutes; attitudes about breastfeeding in public places and breastfeeding for more than two years; and the feeling of maternity and breastfeeding (compared to bottle feeding). The relationship between the results was considered in terms of intentions, attitudes, and knowledge in relation to the overall results of the questionnaire, and the authors' thoughts on the reasons behind the poorer results achieved for certain questions were presented.

Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise.

BACKGROUND: Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities. OBJECTIVE: This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030. METHODS: A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference. RESULTS: The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis. CONCLUSIONS: The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones.

Family history and parental recognition of overweight in Croatian children.

UNLABELLED: The aim of this study was to evaluate the perception of parents on the weight status of their offspring, particularly in relation to a family history of obesity and obesity-related illnesses. A cross-sectional study of 1,068 child-parent dyads sampled at school entry health examination was conducted (median age of the child 6.75 years, range 5.7-8.3 years, 50.3 % males). The parental perception of the weight status of their child was compared to the body mass index (BMI, kilogram per square meter), calculated from measured weight and height. Weight status (underweight, normal, overweight, and obese) was defined using the United States Centers for Disease Control and Prevention BMI for age reference charts. Backward multiple linear regression analysis was used to determine possible predictors of parental misclassification of overweight/obese children. Among this cohort of children, 12 % were overweight, 10.2 % obese, and 8.1 % were underweight. Only 24.8 % of obese children and 2.2 % of overweight children were considered "overweight" by their parents. A positive family history was not significantly associated with parental recognition of overweight. Parental misperception of overweight/obese children as being normal was related to the child BMI z-score (odds ratio (OR) 0.036; 0.012-0.111) and diabetes in family history (OR 3.187; 1.207-8.413). CONCLUSION: The majority of parents did not perceive their overweight/obese children as overweight. As having an obese family member or one who has suffered from an obesity-related illness does not increase the parental ability to recognize overweight in their children, strategies to increase public awareness about the importance of one's family medical history are needed.

Behaviour, Attitudes and Knowledge of Healthcare Workers on Breastfeeding.

The aim of this paper is to determine the current state of behavior, attitudes, and knowledge of health professionals about breastfeeding in Croatia. Data were collected via a breastfeeding behavior, attitudes, and knowledge questionnaire, which has already been validated and used in Croatia. The secondary aim is to identify differences in outcomes of respondents by occupation (nurses versus others health professionals). In the study, 374 health professionals participated (37 males and 337 females). Respondents completed the questionnaire online. Respondents were rarely involved in breastfeeding education. On the behavior scale, the worst answer was given to the question of advising mothers on breastfeeding after 24 months. On the attitude scale, the worst result was achieved in terms of public breastfeeding and the support of the child's father for the breastfeeding mother. Respondents demonstrated the worst knowledge of The International Code of Marketing of Breast-milk Substitutes and the use of medications while breastfeeding. There was no statistically significant difference between the results of respondents in relation to the occupation of the respondents. In the preparation of future breastfeeding education for health professionals in Croatia, particular attention should be given to these issues.

Oral Health Knowledge, Attitude, and Behavior of Nursing and Technical Students in Croatia.

OBJECTIVE: The aim of this study was to test knowledge, attitudes, and behavior of the students from the Bjelovar University of Applied Sciences in relation to oral health, and to determine the respectable differences between students of nursing and technical study programs. MATERIALS AND METHODS: Students were randomly selected to represent a convenient sample. A total of 140 students from nursing and technical studies were interviewed by using the World health organization Oral Health Questionnaire, adapted to fit the study purposes. STATISTICAL ANALYSIS: Descriptive statistics were used to determine frequency distribution and percentages for all variables. Pearson's Chi-square test was used to compare the proportions. A p-value less than 0.05 was considered to be statistically significant. RESULTS: The distribution of participants regarding gender was significantly different between the study programs (p = 0.000). Significant difference was also observed in their perceived socioeconomic status (p = 0.001). A significant difference was found between the study programs regarding the knowledge whether bad teeth could impair general health (p = 0.001), could tooth decay and periodontal disease may be prevented (p = 0.002), as well as the importance of regular dental check-ups for prevention of tooth decay (p = 0.028). There were significant differences regarding dietary habits and alcohol consumption in the past 30 days between the observed study programs (p = 0.000) while no significant differences were found regarding tobacco and tobacco product use (p = 0.170). CONCLUSION: Results obtained and presented in this paper show better knowledge and more favorable habits and behaviors among the students from nursing study program compared with the technical ones. Still all students' habits should be changed to improve oral health. To change attitudes and influence habits, effective oral health promotion programs are needed; not only in colleges, but also in primary and secondary schools.

DE-PASS Best Evidence Statement (BESt): modifiable determinants of physical activity and sedentary behaviour in children and adolescents aged 5-19 years-a protocol for systematic review and meta-analysis.

INTRODUCTION: Physical activity among children and adolescents remains insufficient, despite the substantial efforts made by researchers and policymakers. Identifying and furthering our understanding of potential modifiable determinants of physical activity behaviour (PAB) and sedentary behaviour (SB) is crucial for the development of interventions that promote a shift from SB to PAB. The current protocol details the process through which a series of systematic literature reviews and meta-analyses (MAs) will be conducted to produce a best-evidence statement (BESt) and inform policymakers. The overall aim is to identify modifiable determinants that are associated with changes in PAB and SB in children and adolescents (aged 5-19 years) and to quantify their effect on, or association with, PAB/SB. METHODS AND ANALYSIS: A search will be performed in MEDLINE, SportDiscus, Web of Science, PsychINFO and Cochrane Central Register of Controlled Trials. Randomised controlled trials (RCTs) and controlled trials (CTs) that investigate the effect of interventions on PAB/SB and longitudinal studies that investigate the associations between modifiable determinants and PAB/SB at multiple time points will be sought. Risk of bias assessments will be performed using adapted versions of Cochrane's RoB V.2.0 and ROBINS-I tools for RCTs and CTs, respectively, and an adapted version of the National Institute of Health's tool for longitudinal studies. Data will be synthesised narratively and, where possible, MAs will be performed using frequentist and Bayesian statistics. Modifiable determinants will be discussed considering the settings in which they were investigated and the PAB/SB measurement methods used. ETHICS AND DISSEMINATION: No ethical approval is needed as no primary data will be collected. The findings will be disseminated in peer-reviewed publications and academic conferences where possible. The BESt will also be shared with policy makers within the DE-PASS consortium in the first instance. SYSTEMATIC REVIEW REGISTRATION: CRD42021282874.

Distance learning in higher education during COVID-19: The role of basic psychological needs and intrinsic motivation for persistence and procrastination-a multi-country study.

Due to the COVID-19 pandemic, higher educational institutions worldwide switched to emergency distance learning in early 2020. The less structured environment of distance learning forced students to regulate their learning and motivation more independently. According to self-determination theory (SDT), satisfaction of the three basic psychological needs for autonomy, competence and social relatedness affects intrinsic motivation, which in turn relates to more active or passive learning behavior. As the social context plays a major role for basic need satisfaction, distance learning may impair basic need satisfaction and thus intrinsic motivation and learning behavior. The aim of this study was to investigate the relationship between basic need satisfaction and procrastination and persistence in the context of emergency distance learning during the COVID-19 pandemic in a cross-sectional study. We also investigated the mediating role of intrinsic motivation in this relationship. Furthermore, to test the universal importance of SDT for intrinsic motivation and learning behavior under these circumstances in different countries, we collected data in Europe, Asia and North America. A total of N = 15,462 participants from Albania, Austria, China, Croatia, Estonia, Finland, Germany, Iceland, Japan, Kosovo, Lithuania, Poland, Malta, North Macedonia, Romania, Sweden, and the US answered questions regarding perceived competence, autonomy, social relatedness, intrinsic motivation, procrastination, persistence, and sociodemographic background. Our results support SDT's claim of universality regarding the relation between basic psychological need fulfilment, intrinsic motivation, procrastination, and persistence. However, whereas perceived competence had the highest direct effect on procrastination and persistence, social relatedness was mainly influential via intrinsic motivation.

"Wounds Home Alone"-Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study.

BACKGROUND: Venous leg ulcers (VLUs), the most common type of leg ulcerations, have long healing times and high recurrence rates; reimbursement rules and a general shortage of nursing staff have put self-treatment into focus. The study aimed to investigate why and how patients with VLUs self-treat their ulcers. METHODS: Patients with VLUs (N = 32) were selected by criterion sampling for a multicentric qualitative study using semi-structured interviews. The interviews were analyzed via inductive qualitative content analysis. RESULTS: More than two-thirds of participants sometimes self-treated VLU and one quarter changed their prescribed treatment. Experiences were expressed through four themes as follows: (a) current local VLU therapy; (b) VLU self-treatment; (c) patient education; and (d) psychosocial issues. The main reasons for self-treatment were a lack of healthcare resources, reimbursement restrictions, and dissatisfaction with conventional treatment together with insufficient knowledge about the wound-healing process and possible side effects. No educational materials were provided for patients or caregivers. Many patients adopted homemade remedies. CONCLUSION: Patients with VLUs practice self-care due to limited healthcare availability, a low awareness of the causes of their condition, and the effects of therapy on VLU healing. Future educational intervention is needed to enhance self-treatment.

Relapse of Pleomorphic Adenoma from Childhood to Adulthood: Case Report.

Pleomorphic adenoma is rarely seen in childhood. After detailed literature search, we did not come across a case of frequent relapse of this benign tumor from childhood to adulthood. The World Health Organization defines relapse of pleomorphic adenoma as a histologically benign tumor that can have local or distant metastasis. There is one hypothesis how benign tumor can metastasize. According to this hypothesis, probably during the first operative procedure the tissue around the tumor becomes permeable for tumor cells, which can lead to implantation of tumor cells into the surrounding tissue. In this case report, we present a case of a 30-year-old woman with pleomorphic adenoma of the submandibular gland, which relapsed three times. The patient was first operated on in 1993, at the age of 7 years. The first two relapses occurred in 1998 and 2001, at the age of 12 and 15, respectively. The last relapse occurred in 2015, at the age of 29 years. All relapses were localized in the submandibular region on the right side of the neck, where the primary tumor had been operated on.

The role of school medicine doctors in health education in Croatia--past, present and future.

Croatia never had a separate vocation (occupation) of a health educator. Health education is one of the main tasks in the long tradition of preventive work of doctors-school medicine specialists. Additionally, in the school curriculum in the Republic of Croatia the health-educational contents are integrated into various subjects, and are conducted by teachers. However, there are requests to introduce a new subject into schools called Health Education. We asked physicians of school medicine their opinion on the introduction of this new subject. 30% of the physicians were dissatisfied with the current condition, 10% were satisfied, while there were no very satisfied school medicine doctors. They believe that health education goals are oriented solely to passing on knowledge (facts), while efforts are not done to change habits and attitudes of young people. They recognize themselves as persons mostly involved in health education in schools. Half of the school medicine doctors believe that the school curriculum should contain both a separate subject as well as integration of health education into other subjects. Before introducing any changes into healthcare or education system, it is necessary to examine the attitudes of students and parents, to direct the changes towards the promotion of the cooperation between the healthcare system, education, civil society, school and community where investing into the health of young people is done through comprehensive and holistic programmes.