What Is the Smallest Change in Pulse Wave Velocity Measurements That Can Be Attributed to Clinical Changes in Arterial Stiffness with Certainty: A Randomized Cross-Over Study.

Pulse wave velocity (PWV), a direct measure of arterial stiffness, is a promising biomarker of cardiovascular risk and a cardiovascular surrogate outcome. The resolution for detecting its smallest clinically significant change is dependent on the expected reproducibility, but there is currently no consensus on this. We estimated the PWV reproducibility in a range of intra-subject values that were observed over a 2 week period in a broad range of participants and under clinically relevant experimental conditions (two observers, morning/afternoon sessions, and number of visits) using SphygmoCor and Arteriograph devices. Each participant was recorded 12 times with each device over three visits, one week apart, and two morning and two afternoon recordings were taken per visit. The factors affecting reproducibility and the discrepancies between the consecutive PWV measurements for each device were also examined using multilevel mixed-effect models. We show that current PWV estimation guidance recommending 2 + 1 measurements is suboptimal because the PWV range was outside of the 1 m/s threshold for most of the participants, which is proposed as a minimal clinically important difference. The best reproducibility was yielded with median of four measurements and a 1.1 m/s threshold. Although PWV reproducibility and repeatability are frequently used interchangeably in studies, we demonstrated that despite their relative measures of variability (e.g., coefficient of variation) being comparable, their ranges revealed a clinically significant difference between them. We also found that different physiological variables were predictors of the discrepancy between the consecutive measurements made by the two devices, which is likely due to their distinct modes of operation. The evidence base for PWV reproducibility is limited, and more research is needed to deepen our understanding of the variation in arterial stiffness over time, as well as fluctuations within a population group and in an intervention setting.

The Relationship between Alcohol Drinking Indicators and Self-Rated Mental Health (SRMH): Standardized European Alcohol Survey (SEAS).

Given that the self-perception of mental health is an important predictor of health outcomes and wellbeing, it is important to identify the indicators of mental health associated with alcohol consumption in order to reduce alcohol-related harms. This study used data from the cross-sectional RARHA SEAS survey (2015) in the Croatian general population, aged 18-64 years (n = 1500). Several aspects of drinking behaviors and alcohol-related harms were measured, as well as personal and sociodemographic factors. Logistic regression found a significant association between alcohol's harm to others (AHTO) and poor self-rated mental health (SRMH) (OR = 0.752; 95% CI 0.601-0.941) in the total sample, as well as in the group of participants who rarely drank alcohol (OR = 0.504; 95% CI 0.322-0.787) in the last 12 months. More frequent consumers reported poor SRMH if they had at least one harmful effect from drinking (OR 0.538; 95% CI 0.295-0.980). Younger age, higher education, professional activity, and living with someone else in a household contributed to better SRMH. AHTO has been identified as a strong predictor of poor SRMH in the general population. Targeted public health and preventive measures are needed with specific approaches for different types of alcohol consumers.

The effects of experimental, meteorological, and physiological factors on short-term repeated pulse wave velocity measurements, and measurement difficulties: A randomized crossover study with two devices.

Background: Large longitudinal studies with repeated pulse wave velocity (PWV) measurements, a direct measure of arterial stiffness, are required to realize the full potential of arterial stiffness in clinical practice. To facilitate such studies it is important to increase the power of a study by reducing within-subject variability of PWV, and to ease the use of a PWV device in clinical settings by minimizing PWV measurement difficulties. Methods: We systematically investigated experimental setting and meteorological conditions, as well as physiological factors and participant characteristics, to determine whether and to what extent they affected: between- and within-subjects variability of PWV recordings, and measurement difficulties of a particular device. We conducted a 2-week longitudinal block-randomized cross-over study with two blinded observers and two commonly used devices: applanation tonometry SphygmoCor CvMS and oscillometric Arteriograph to assess carotid-femoral (cfPWV) or aortic (PWVao) PWV, respectively. Our sample had uniform and wide-spread distribution of age, blood pressures, hypertensive status and BMI. Each participant (N = 35) was recorded 12 times over 3 visiting days, 7 days apart. On each day, recordings were made twice in the morning (7-10 a.m.) and afternoon (16-18 p.m.). Data were analyzed using multilevel mixed-effects models, separately for each device. Results: In addition to age and mean arterial pressure (MAP) that strongly affected both cfPWV and PWVao, other significant factors appeared to indicate a measurement approach. cfPWV as a more direct measure of arterial stiffness was additionally affected by hypertension status, outdoor temperature, interaction of MAP with outdoor temperature and the order of visit, with MAP within-subject variability contributing on average 0.27 m/s to difference in repeated measurements at 5°C and 0.004 m/s at 25°C. PWVao measurements derived at a single brachial site were more dependent on age than cfPWV and also depended on personal characteristics such as height and sex, and heart rate; with within-subject MAP variability adding on average 0.23 m/s to the difference in repeated measures. We also found that female sex significantly increased, and recording in afternoon vs. morning significantly decreased measurement difficulties of both devices. Conclusion: We identified factors affecting PWV recordings and measurement-difficulties and propose how to improve PWV measuring protocols.

Impact of the first COVID-19 lockdown on study satisfaction and burnout in medical students in Split, Croatia: a cross-sectional presurvey and postsurvey.

OBJECTIVES: To evaluate the impact of the first COVID-19 lockdown in 2020 on the burnout and study satisfaction of medical students. DESIGN: A cross-sectional study with a presurvey and postsurvey. SETTING: University of Split School of Medicine (USSM), Split, Croatia. The lockdown in the COVID-19 pandemic lasted from late March to mid-May 2020. There was a full switch to e-learning at the USSM during this period, and all clinical teaching was stopped. PARTICIPANTS: Students enrolled in the 2019/2020 academic year. Data were collected before lockdown in December 2019 and January 2020 and again after the end of lockdown in June 2020. PRIMARY AND SECONDARY OUTCOME MEASURES: Study satisfaction was assessed using the study satisfaction survey. Burnout was assessed using two instruments: Oldenburg Burnout Inventory and Copenhagen Burnout Inventory. We used Bayesian statistics to compare before-and-after differences. RESULTS: 437 independent responses (77.2% response rate) were collected before and 235 after lockdown (41.5% response rate). 160 participant responses were eligible for pairing. There was no significant difference for both paired and unpaired participants in study satisfaction before (3.38 on a 1-5 scale; 95% credible interval (95% CrI) 3.32 to 3.44) and after (3.49, 95% CrI 3.41 to 3.57) lockdown. We found no evidence (Bayes factor (BF10) >3.00 as a cut-off value) for an increase in the level of burnout before and after lockdown, both in independent and paired samples. CONCLUSIONS: It seems that the first pandemic-related lockdown and a switch to e-learning did not affect burnout levels among medical students or their perception of their study programme. More insight is needed on the short-term and long-term effects of the COVID-19 pandemic on medical students and their education. Well-structured longitudinal studies on medical student burnout during the COVID-19 pandemic are needed.

No difference in the intention to engage others in academic transgression among medical students from neighboring countries: a cross-national study on medical students from Bosnia and Herzegovina, Croatia, and Macedonia.

AIM: To asses if the level of intention to engage others in academic transgressions was comparable among medical students from five schools from neighboring Southern-European countries: Croatia, Bosnia and Herzegovina, and Macedonia; and medical students from western EU studying at Split, Croatia. METHODS: Five medical schools were surveyed in 2011, with ≥87% of the targeted population sampled and a response rate of ≥76%. Students' intention to engage a family member, friend, colleague, or a stranger in academic transgression was measured using a previously validated the Intention to Engage Others in Academic Transgression (IEOAT) questionnaire and compared with their intention to ask others for a non-academic, material favor. Data on students' motivation measured by Work Preference Inventory scale, and general data were also collected. Multiple linear regression models of the intention to engage others in a particular behavior were developed. RESULTS: The most important determinants of the intention to engage others in academic transgression were psychological factors, such as intention to ask others for a material favor, or students' motivation (median determinant's ß of 0.18, P≤0.045 for all), whereas social and cultural factors associated with the country of origin were either weak (median ß of 0.07, P≤0.031) or not relevant. A significant proportion of students were aware of the ethical violations in academic transgressions (P≤0.004 for all transgressions), but a large proportion of students also perceived academic cheating as a collective effort and were likely to engage people randomly (P≤0.001 for all, but the most severe transgression). This collective effort was more pronounced for academic than non-academic behavior. CONCLUSION: Culture differences among neighboring Southern-European countries were not an important determinant of the intention to engage others in academic cheating.

Antimicrobial susceptibility of clinically isolated anaerobic bacteria in a University Hospital Centre Split, Croatia in 2013.

Anaerobic bacteria play a significant role in many endogenous polymicrobial infections. Since antimicrobial resistance among anaerobes has increased worldwide, it is useful to provide local susceptibility data to guide empirical therapy. The present study reports recent data on the susceptibility of clinically relevant anaerobes in a University Hospital Centre (UHC) Split, Croatia. A total of 63 Gram-negative and 59 Gram-positive anaerobic clinical isolates from various body sites were consecutively collected from January to December 2013. Antimicrobial susceptibility testing was performed using standardized methods and interpreted using EUCAST criteria. Patient's clinical and demographic data were recorded by clinical microbiologist. Among 35 isolates of Bacteroides spp., 97.1% were resistant to penicillin (PCN), 5.7% to amoxicillin/clavulanic acid (AMC), 8.6% to piperacillin/tazobactam (TZP), 29.0% to clindamycin (CLI) and 2.9% to metronidazole (MZ). Percentages of susceptible strains to imipenem (IPM), meropenem (MEM) and ertapenem (ETP) were 94.3. Resistance of other Gram-negative bacilli was 76.0% to PCN, 8.0% to AMC, 12.0% to TZP, 28.0% to CLI and 8% to MZ. All other Gram-negative strains were fully susceptible to MEM and ETP, while 96.0% were susceptible to IPM. Clostridium spp. isolates were 100% susceptible to all tested antibiotics except to CLI (two of four tested isolates were resistant). Propionibacterium spp. showed resistance to CLI in 4.3%, while 100% were resistant to MZ. Among other Gram-positive bacilli, 18.2% were resistant to PCN, 9.1% to CLI and 54.5% to MZ, while 81.8% of isolates were susceptible to carbapenems. Gram-positive cocci were 100% susceptible to all tested antimicrobials except to MZ, where 28.6% of resistant strains were recorded. Abdomen was the most common source of isolates (82.5%). The most prevalent types of infection were abscess (22.1%), sepsis (14.8%), appendicitis (13.9%) and peritonitis (6.6%). Twenty four patients (19.7%) received empiric antimicrobial therapy. One hundred and one patients (82.8%) had polymicrobial aerobic/anaerobic isolates cultivated from the same specimens. Almost all aerobic bacteria were of endogenous origin and showed fully susceptible antimicrobial profile; only 8.7% (9/104) were multiresistant and considered as hospital acquired. Based on our findings, ß-lactam/ß-lactamase inhibitor combinations and metronidazole remain useful antimicrobials for empiric treatment of anaerobic infections, while carbapenems should be reserved for situations were multidrug resistant, aerobic or facultative Gram-negative bacteria are expected. However, a certain percentage of resistant isolates were observed for each of these agents. Therefore, periodic resistance surveillance in anaerobes is highly recommended in order to guide empirical therapy.

Who would students ask for help in academic cheating? Cross-sectional study of medical students in Croatia.

BACKGROUND: Academic cheating does not happen as an isolated action of an individual but is most often a collaborative practice. As there are few studies that looked at who are collaborators in cheating, we investigated medical students' readiness to engage others in academic dishonest behaviours. METHODS: In a cross-sectional survey study in Zagreb, Croatia, 592 medical students from the first, 3rd and 6th (final) study year anonymously answered a survey of readiness to ask family, friends, colleagues or strangers for help in 4 different forms of academic cheating or for 2 personal material favours. Stepwise multiple linear regression models (MLR) were used to evaluate potential factors influencing propensity for engaging others in these two types of behaviour. RESULTS: Many students would ask another person for help in academic cheating, from 88.8% to 26.9% depending on a cheating behaviour. Students would most often ask a family member or friend for help in academic cheating. The same "helpers" were identified for non-academic related behaviour - asking for personal material favours. More respondents, however, would include three or four persons for asking help in academic cheating than for routine material favours. Score on material favours survey was the strongest positive predictor of readiness for asking help in academic cheating (stepwise MLR model; beta = 0.308, P < 0.0001) followed by extrinsic motivation (compensation) and male gender, whereas intrinsic motivation, year of study and grade point average were weak negative predictors. CONCLUSIONS: Our study indicates that medical students are willing to engage more than one person in either close or distant relationships in academic cheating. In order to develop effective preventive measures to deter cheating at medical academic institutions, factors surrounding students' preference towards academic cheating rather than routine favours should be further investigated.

Long-term improvement in coping skills following multimodal treatment in war veterans with chronic PTSD.

Due to the long-lasting and resistant symptoms characteristic of chronic combat posttraumatic stress disorder (PTSD), its treatment is complex and often requires a tailored therapeutic approach incorporating both psychotherapy and pharmacotherapy. A multimodal approach of psychoeducative, sociotherapeutic, and dynamically oriented trauma-focused groups is described. We assessed the short- and long-term effectiveness of this therapeutic program by monitoring its impact on PTSD symptoms, depression, neurotic symptoms, coping skills, and quality of life for three years. The findings revealed short-term reduction in the symptoms of PTSD and depression, while the long-term results were manifested as the increased use of all coping mechanisms and a greater level of obsession.

Succinylcholine use in adult anesthesia - A multinational questionnaire survey.

There are no definitive evidence based standards regarding use of succinylcholine (SCh) for anesthesia induction. However, there is a global trend toward eliminating SCh not only in elective, but also in emergency surgery in adults. The aim of the study was to survey the use of SCh in adult elective and emergency anesthesia practice in several European countries and the United States by questionnaire. One hundred and seventy anesthesiologists out of 201 possible, from six institutions in five countries (Croatia, Bosnia and Herzegovina, Hungary, United Kingdom, and the United States) anonymously completed the questionnaire about their use of SCh. The questionnaire was structured to assess the respondents': frequency of use of SCh in adult surgery (elective and emergency), reasons for use or rejection of SCh, positive and negative attributes of SCh, and observed side effects in their practice. Differences in use were tested using X2-test when appropriate. There was a significant difference in the use of SCh between countries for elective surgery with the lower use in UK and Hungary (chi2=45.8, p <0.001). One hundred and seventeen (69%) use it regularly. In emergency surgery 165 (97%) anesthesiologists use it without any significant difference among countries (chi2=2.13, p<0.711). The top indications for SCh use were anticipated difficult intubation/ventilation (74%), caesarean section (54%), and obesity and/or hiatus hernia (49%). The top reasons against SCh use were adequate substitutes (87%), fear of arrhythmias (45%), and anaphylaxis (19%). The most desirable reported drug features were: rapid onset (88%), short duration (64%), and effective relaxation (61%). Forty-six per cent of the surveyed anesthesiologists stated they had never experienced a complication with its use. The most frequently reported side effects were myalgias (47%), bradycardias (42%), and prolonged blockade (39%). Allergic reactions were reported by 13%, and asystole by 12% of physicians. From our survey it is possible to conclude that succinylcholine is still regularly used, at least by surveyed anesthesiologists in Europe and USA, in adult anesthesia practice, especially in elective surgery for which it may be least suited. This reflects the discrepancies between the international guidelines for the use of SCh and the clinical practice of many anesthesiologists in different countries. The regional differences in SCh usage may be considered through anesthesia cultures and practice variations depending on country.