Ancient gene flow from early modern humans into Eastern Neanderthals.

It has been shown that Neanderthals contributed genetically to modern humans outside Africa 47,000-65,000 years ago. Here we analyse the genomes of a Neanderthal and a Denisovan from the Altai Mountains in Siberia together with the sequences of chromosome 21 of two Neanderthals from Spain and Croatia. We find that a population that diverged early from other modern humans in Africa contributed genetically to the ancestors of Neanderthals from the Altai Mountains roughly 100,000 years ago. By contrast, we do not detect such a genetic contribution in the Denisovan or the two European Neanderthals. We conclude that in addition to later interbreeding events, the ancestors of Neanderthals from the Altai Mountains and early modern humans met and interbred, possibly in the Near East, many thousands of years earlier than previously thought.

Personal wellbeing, work ability, satisfaction with life and work in psychiatrists who emigrated from Croatia.

BACKGROUND: A significant number of citizens, including a great proportion of doctors, both psychiatrists and doctors of other specialties, decided to emigrate from Croatia after Croatia entered the EU in 2013. Aim of research was to investigate possible differences in satisfaction with life and work between 3 groups: emigrants psychiatrists (EP), emigrants physicians of other specialties (E), and psychiatrists currently working in Croatia (C). SUBJECTS AND METHODS: Personal Wellbeing Index (PWI), Work Ability Index (WAI) and some qualitative research questions were used in an anonymous online survey which was conducted in autumn 2019. Link to the survey was shared on different social networks, while 138 physicians were approached directly by e-mail. Response rate: 87% for EP group (representative sample for group of psychiatrist emigrants from Croatia), 48% for E group, and 28% for C group. In total, 62 physicians, 44 of them emigrants (20 EP and 24 E). This study was voluntarily led. Psychiatrists from our sample emigrated mostly to Scandinavia in 65% of cases and to West Europe in 30% of the cases. Other physicians emigrants from our sample emigrated to Middle Europe in 29%, to West Europe in 25%, and to Scandinavia in 42% of the cases. RESULTS: Satisfaction with standard of life, future security and life achievements are significantly higher in EP than in C. Satisfaction with integration in community and satisfaction with close relationships are significantly higher in E than in EP. WAI score of the 3 groups placed them all in the same category "good work ability". For all emigrants and their family members, major challenges after emigration were found to be communication (language), integration into the community, and loss of friends and family connections. 70% of emigrants plan to return to Croatia in the future, depending on better living conditions (income), change in the political situation in Croatia (reduction of corruption), and change in people's mentality. CONCLUSIONS: This voluntary study showed high satisfaction with life and good work ability among psychiatrists who emigrated from Croatia, together with some challenges for them and their family members with language, work, integration into the community, and loss of friends and family connections. Majority plan to return to Croatia depending on political and economic changes in Croatia.

Childhood vaccine refusal and hesitancy intentions in Croatia: insights from a population-based study.

Considering that programmatic data suggest a recent rise in vaccine refusal in Croatia, this study, first of its kind in Southeast Europe, aimed to estimate the prevalence, and sociodemographic, and sociocultural determinants of childhood vaccine refusal and hesitancy (CVRH) intentions among Croatian adults. Multi-stage stratified population-based survey included 1000 individuals aged 18-88 years (Mage = 47.7, SD = 17.8), of whom 51.7% were women. The outcome, a categorical indicator, distinguished among individuals who would approve vaccinating their children (vaccine accepting), those who would approve some but not all vaccines (vaccine hesitant), and those who would refuse vaccination (vaccine refusing). A sizeable minority of participants was characterized by childhood vaccine refusal (10.6%) and hesitancy intentions (19.5%). In a multivariate assessment controlling for parenthood, the odds of vaccine hesitancy were significantly increased by a younger age (AOR = 1.96-3.03, p < .01). Religiosity (AOR = 1.12, p < .05) and the use of alternative medicine (AOR = 2.85, p < .001) increased the odds of vaccine refusal. However, individual characteristics seem to be relatively poor predictors of CVRH intentions in Croatia. Following the social contagion model, future research should move beyond individual-level approach and take into account social interaction and social network effects.

Therapeutic drug monitoring and the conservative management of chronic tuberculous empyema: case report and review of the literature.

BACKGROUND: Chronic tuberculous empyema (CTE) is a rare and unusual, low grade and protracted, infection of the pleural space resulting in marked thickening, even calcification of the visceral and parietal pleura. Historically its management has been extraordinarily challenging. Differential penetration of anti-TB drugs into the pleural space has resulted in acquired drug resistance and surgery to remove the empyema or close a complicating bronchopleural fistula (BPF) has been technically difficult or unacceptably hazardous. On the basis of limited experience, the combination of tube thoracostomy or catheter drainage and high-end dosing of anti-TB drugs has been recommended as an initial approach to these lesions. Herein we report the first well documented case of closure of a BPF and cure of a CTE using this approach. The chances of a favorable outcome are improved, we suggest, by using therapeutic drug monitoring (TDM) to guide high-end drug dosing. CASE PRESENTATION: An 84 year old male immigrant to Canada from Croatia was diagnosed with a CTE after he developed a BPF. The diagnosis was made 62 years after what was, in retrospect, an episode of tuberculous pleurisy. He was treated with computed tomography-guided catheter drainage and TDM-guided high-end dosed anti-TB drugs (serum and pleural fluid drug concentrations) over a 10 month period. Sustained closure of the BPF and mycobacteriologic cure of the CTE was achieved. Drug concentrations in the present case and all other reported cases are summarized and interpreted. CONCLUSION: When serum concentrations of the anti-TB drugs isoniazid, pyrazinamide and ethambutol at the high end of the normal range are achieved, pleural fluid concentrations at the low end of the normal range may be anticipated in CTE. Though highly protein bound drugs such as rifampin and moxifloxacin appear to penetrate CTEs less well, their free concentrations in the pleural space may be proportionately higher on account of lower protein concentrations. Interventional radiology and TDM increase the chances that conservative management of CTE will be successful.

Validation of the Croatian and Lebanese Revised Illness Perception Questionnaires for Healthy People (IPQ-RH).

The absence of Croatian- and Arabic-language measures to assess illness representations has contributed to lack of research among Croatian and Lebanese populations. Utilising the robust confirmatory factor analysis (CFA) approach, this study aimed to validate Croatian and Arabic versions of the Revised Illness Perception Questionnaire for Healthy People (IPQ-RH) in the breast and cervical cancer contexts, and compared these illness perceptions among Croatian and Lebanese women living in Australia. Forward and back-translated versions of the IPQ-RH were administered in Croatian to Croatian-born (n = 238), and Arabic to Lebanese-born (n = 240) women. The IPQ-RH illness perceptions were assessed for each cancer type, and the Negative Affect (NA) subscale of the Positive and Negative Affect Schedule (PANAS) assessed discriminant validity. The CFA method demonstrated acceptable models across the Croatian and Lebanese IPQ-RH measures. The internal reliabilities for the IPQ-RH subscales were adequate and the subscales had low correlations with the NA subscale of the PANAS, indicating that the IPQ-RH measures are largely distinguishable from negative affective dispositions. These findings demonstrate that the Croatian and Lebanese IPQ-RH breast and cervical cancer measures have a factor structure similar to the originally developed IPQ-RH scale and provide further support for the theoretically developed illness representations.

Urban and rural fitness level: comparison between Italian and Croatian students.

The goal of this study was to investigate the differences in physical fitness in relation to urban or rural living environment and between two countries: Italy and Croatia. Over 14,000 students were tested during physical education (PE) lessons. Croatian students were taller and heavier than Italian students, with women achieving better results in flexibility. Urban students were fitter in abdominal strength than rural students. Age seemed to be the major factor influencing the performance. This study's results indicate a trend: urban students performed "indoor" tests better than rural students; the opposite may be true for rural students. Living environment, socio-economic-status, or cultural correlation differences could be decreased during school experiences. Thus, PE programs could train all people toward an adequate, age-based fitness level.

Correlates of men's sexual interest: a cross-cultural study.

INTRODUCTION: Low sexual desire has been studied more extensively in women than in men. AIM: The study aims to analyze the correlates of distressing lack of sexual interest and the self-assessed reasons for the lack of sexual interest among heterosexual men from three countries. METHODS: A web-based survey was completed by 5,255 men aged 18-75 years from Portugal, Croatia, and Norway. MAIN OUTCOME MEASURES: We used an item that assesses lack of sexual interest from the British NATSAL 2000. Anxiety and depression were measured with the SCL-ANX4 and SCL-DEP6. Relationship intimacy was measured using a five-item version of the Emotional Intimacy Scale. A shortened version of the Sexual Boredom Scale was used to assess proneness to sexual boredom in relation to the duration of relationship, and personal distress was evaluated using an item created for this study. RESULTS: Distressing lack of sexual interest lasting at least 2 months in the previous year was reported by 14.4% of the participants. The most prevalent comorbidity among these men was erectile difficulty (48.7%). Men with low confidence levels in erectile function, not feeling attracted to the partner, and those in long-term relationships were more likely to have experienced lack of sexual interest than were men with high confidence levels and those who felt attracted to their partner and those in shorter-term relationships. Professional stress was the most frequently reported reason for lack of sexual interest. Sexual boredom as a result of a long-term relationship was significantly and negatively correlated with the level of intimacy (r = -0.351, P < 0.001) and sexual satisfaction (r = -0.497, P < 0.001). CONCLUSIONS: Distressing lack of sexual interest in heterosexual men was associated with a number of intrapersonal (self-confidence in erectile function, stress), interpersonal (relationship duration, partner attractiveness), and sociocultural variables.

Water consumption in Iron Age, Roman, and Early Medieval Croatia.

Patterns of water consumption by past human populations are rarely considered, yet drinking behavior is socially mediated and access to water sources is often socially controlled. Oxygen isotope analysis of archeological human remains is commonly used to identify migrants in the archeological record, but it can also be used to consider water itself, as this technique documents water consumption rather than migration directly. Here, we report an oxygen isotope study of humans and animals from coastal regions of Croatia in the Iron Age, Roman, and Early Medieval periods. The results show that while faunal values have little diachronic variation, the human data vary through time, and there are wide ranges of values within each period. Our interpretation is that this is not solely a result of mobility, but that human behavior can and did lead to human oxygen isotope ratios that are different from that expected from consumption of local precipitation.

Identification of a novel CRYBB2 missense mutation causing congenital autosomal dominant cataract.

PURPOSE: To identify the genetic defect in a four-generation Croatian family presenting with autosomal dominant cataract. METHODS: Genome-wide linkage analysis with 250K single nucleotide polymorphism (SNP) arrays was performed using DNA from one unaffected and seven affected individuals. Mutation screening of candidate genes was performed by bidirectional Sanger sequencing. RESULTS: Evidence for linkage was observed for eight genomic regions. Among these was a locus on chromosome 22 which encompasses the ß-crystallin gene cluster. This cluster includes four genes, namely beta-crystallin B1 (CRYBB1), beta-crystallin B2 (CRYBB2), beta-crystallin B3 (CRYBB3), and beta-crystallin A4 (CRYBA4). A novel sequence variant was found in the CRYBB2 gene (p.Arg188His). This variant cosegregated with the disease phenotype in all affected individuals but was not present in the unaffected family members and 100 healthy control subjects. CONCLUSIONS: We report a novel missense mutation, p.Arg188His, in CRYBB2 associated with congenital cataract in a family of Croatian origin. This variant is the most COOH-terminal missense mutation in CRYBB2 that has been identified so far.

Could disappearance of endemic (Balkan) nephropathy be expected in forthcoming decades?

BACKGROUND/AIMS: An epidemiological survey of endemic nephropathy (EN) was performed in endemic Croatian areas and the current prevalence was compared to that reported for the same villages several decades ago. METHODS: A total of 2,487 adult farmers from 6 endemic villages and 3 non-endemic villages were enrolled. An extensive epidemiological questionnaire, clinical examination and laboratory analyses of blood and urine were performed. According to the modified WHO criteria, participants were classified into diseased, suspected of having EN, and those at risk of developing EN. RESULTS: The overall prevalence of EN in the Croatian areas was 1.0%, ranging between 0.3 and 2.3% in different villages. Those suspected of having EN amounted to 3.9%. In the endemic villages a decreasing trend in the prevalence of EN was observed comparable to the results obtained in previous surveys. It is interesting to note that no EN patients were recorded in the endemic village of Dubocac. CONCLUSION: The prevalence of EN in the endemic Croatian areas appears to be decreasing. For the first time, we failed to detect any EN patients in a village that was previously considered endemic, which might indicate that EN is diminishing.

Changing cultures, changing cuisines: Cultural transitions and dietary change in Iron Age, Roman, and Early Medieval Croatia.

Food is well-known to encode social and cultural values, for example different social groups use different consumption patterns to act as social boundaries. When societies and cultures change, whether through drift, through population replacement or other factors, diet may also alter despite unchanging resource availability within a region. This study investigates the extent to which dietary change coincides with cultural change, to understand the effects of large-scale migrations on the populations' diets. Through stable carbon and nitrogen isotope analysis of Iron Age, Roman, and Early Medieval human bone collagen, we show that in Croatia large-scale cultural change led to significant changes in diet. The isotopic evidence indicates that Iron Age diet consisted of C(3) foodstuffs with no isotopic evidence for the consumption of C(4) or marine resources. With the Roman conquest, marine resources were added to the diet, although C(3) foodstuffs continued to play an important role. In the Early Medieval period, this marine component was lost and varying amounts of C(4) foodstuffs, probably millet, were added to the otherwise C(3) diet. In both of these transitions it is likely that the changes in diet are related to the arrival of a new people into the area.

Has anyone seen it? Health care in Croatian elections.

Over the past decade, public opinion surveys have shown that Croats are deeply dissatisfied with their health care system and asses it to be one of the most important issues. However, health care hardly makes it into any political discourse in Croatia. This study analyzes the results of a public opinion survey conducted before the 2007 parliamentary elections to find out what the public sentiment on health care performance in Croatia is and to analyze the reasons why health care is not addressed by political actors. Evidence suggests that while health care is the most salient issue today, the public often understands it poorly. Thus, in a political environment of competing issues, and given the complexity of tacking health care in the policy arena, politicians strategically avoid discussing the issue.

Analysis of the soft tissue profile in Croatians with normal occlusions and well-balanced faces.

The aim of the study was to test the hypothesis that there is no difference between the soft tissue profile of Croatian and white North American adults. Facial profile photographs were taken of 110 Croatians (52 males and 58 females) with normal occlusions and well-balanced faces (age 22-29 years). The findings were also compared with a white Brazilian group. An independent Student's t-test (P < 0.05) was used to compare the soft tissue parameters of Croatians with those of North Americans and to assess gender differences. The soft tissue profile measurements that showed significant gender dimorphism (P < 0.001) were the true vertical line [(TVL)-nasal tip (NT)] and TVL-point B, indicating that the males had slightly greater nasal prominence (mean difference: 1.32 mm) and deeper labial sulci (mean difference: 2.04 mm) compared with the females. The upper lip was the same for both genders (1.25 mm), while the lower lip was 0.97 mm more prominent in females than in males. All soft tissue variables, except TVL-NT showed significant differences between Croatian and white American female subjects (P = 0.096). For male subjects, nasolabial angle was the only variable that showed no statistically significant difference between the two populations. A universal standard of facial aesthetic is not applicable to diverse white populations. These differences should be considered in diagnosis and treatment planning for Croatians, together with their individual characteristics.

Economic participation and national self-identification of refugees in the Netherlands.

This study examines whether refugees self-identify as a member of the host society. We use survey data of more than 2,500 Somali, Iraqi, Afghani, Iranian, and ex-Yugoslavian refugees in the Netherlands. The results show that economic participation in the host country is positively related to refugees' national self-identification. In addition, we find that refugees' social ties with Dutch natives are associated with national self-identification and that the relationship between economic participation and national self-identification is partially explained by these social ties. Perceived discrimination is not related to refugees' national self-identification. Implications of these findings for debates on immigration and integration are discussed.

An international cross-cultural study of nursing students' perceptions of caring.

BACKGROUND: Single studies suggest that nursing students perceive caring as more an instrumental than expressive behaviour and indicate some differences between caring perceptions in junior and senior nursing students. However, there are limited studies investigating caring perceptions in nursing students across multiple cultures. OBJECTIVE: To determine perceptions of caring in Slovene, Croatian, Chinese and Russian nursing students and explore whether there are statistically significant differences in perceptions of caring between countries and between first and third-year nursing students. DESIGN: A cross-sectional descriptive study design was used. SETTINGS AND PARTICIPANTS: The study included 604 nursing students enrolled in first and third year in seven different nursing faculties in four countries: Slovenia; China; Croatia; and the Russian Federation. METHODS: The 25-item Caring Dimension Inventory (CDI-25) was used to measure caring perceptions. We also included demographic questions regarding age, gender, country, year of study and type of study. Demographic data were analysed using descriptive analysis while a two-way analysis of variance (ANOVA) adjusted for unequal sample sizes was performed together with a post hoc analysis of the results. RESULTS: The results of two-way ANOVA showed that both main effects (country and year of study) were statistically significant, as well as their interaction at the 0.05 significance level. The main effect for country was F(3, 596) = 3.591, p < 0.0136 indicating a significant difference in CDI-25 between Slovenia (M = 108.9, SD = 9.2), Russian Federation (M = 107.1, SD = 8.2), China (M = 102.8, SD = 9.7) and Croatia (M = 110.0, SD = 8.6). CONCLUSIONS: Perceptions of caring in nursing students differ across countries, probably due to different educational systems, curricula, cultural differences and societal values. Implementing caring theories in nursing curricula could help students to cultivate caring during their education.

Migrants' perceptions of using interpreters in health care.

BACKGROUND: The number of foreign-born people who do not share a common language has increased due to extensive international migration, which will increase in the future. There is limited knowledge about the users' perceptions of interpreters in health care. AIM: To describe how individuals from former Yugoslavia, living in Sweden, perceived the use of interpreters in Swedish healthcare services. METHOD: A phenomenographic approach was employed. Data were collected by semi-structured interviews during 2006-2007 with 17 people, aged 29-75 years, from former Yugoslavia, living in Sweden. FINDINGS: Three descriptive categories were identified: (1) prerequisites for good interpretation situations; (2) the interpretation situation - aspects of satisfaction or dissatisfaction; and (3) measures to facilitate and improve the interpreter situation. The interpreter's competence, attitude, appearance and an appropriate environment are important prerequisites for interpretation. The interpreter was perceived as being a communication aid and a guide in the healthcare system in terms of information and practical issues, but also as a hindrance. A desirable professional interpreter was perceived as highly skilled in medical terminology and language, working in face-to-face interaction. CONCLUSION: Using an interpreter was perceived as a hindrance, though also needed in communication with healthcare staff and as a guide in the healthcare system. Face-to-face interaction was preferred, with the interpreter as an aid to communication. As part of individual care planning it is important to use interpreters according to the patients' desires. Healthcare organizations and guidelines for interpreters need to be developed in order for patients to have easy access to highly skilled professional interpreters.

Moyamoya disease in Europeans.

BACKGROUND AND PURPOSE: We describe the clinical, diagnostic, and outcome features of a cohort of white patients with idiopathic moyamoya disease treated in a German institution. METHODS: Our cohort included 21 white patients with moyamoya disease. Clinical and diagnostic features were obtained by retrospective chart review; follow-up information and outcome were obtained prospectively. We used the Kaplan-Meier methods to estimate stroke risk by treatment status. RESULTS: The mean age at onset of symptoms was 31 years. The female predominance was 4.25:1. In our cohort, the initial symptom was a cerebral ischemic event in all patients. There was no patient with a hemorrhage at onset; only one patient experienced subarachnoidal hemorrhage in the further course of disease. The Kaplan-Meier risk for recurrent stroke was very high after the first ischemic event and smaller after angiographic diagnosis. The 5-year-Kaplan-Meier risk of recurrent stroke was 80.95% after the first ischemic event for all patients. Most subsequent ischemic events appeared in the first 2 years after symptom onset. Eleven patients (52.3%) underwent neurosurgical revascularizing procedures. After surgery, the Kaplan-Meier risk of perioperative or subsequent stroke was 27.27% within the first month and was stable thereafter. CONCLUSIONS: Clinical features and course of moyamoya disease of whites analyzed in this German study are comparable to American results. Moyamoya disease in whites differs clearly from Asian moyamoya disease in timing of onset of vasculopathy and lower rate of hemorrhages.

When we feel good and bad about ourselves: self-esteem memories across cultures.

Young adults in the United States, Croatia, and China described personal episodes of times when they felt especially good or bad about themselves. These self-esteem memories were either recent (episodes that occurred during the previous 4 weeks) or remote (episodes that occurred between the ages of 10 and 15). Systematic content differences between memories of positive and negative self-worth were apparent primarily for remote rather than for recent memories. Across cultures, long-lasting positive memories frequently represented achievement themes, whereas negative memories frequently represented social themes. Links between achievement success and positive self-regard, and between social distress and negative self-regard, are explained using theories of self-esteem and autobiographical memory.

Ethnohistorical processes and demographic structure of the island of Rab, Croatia.

The present paper aims at describing the most relevant background data on geomorphological, economic, ethnohistoric and demographic features of the island of Rab. They show the most important population movements to the island that affected its population structure. This work, as a part of the holistic anthropological research of morphological, physiological, genetic and socio-cultural variables which have been carried out on the island of Rab, seeks to identify both internal and external impulses of change and/or continuity of the island population structure within a wider socio-cultural and historical context.

Characterization of ADME genes variation in Roma and 20 populations worldwide.

The products of the polymorphic ADME genes are involved in Absorption, Distribution, Metabolism, and Excretion of drugs. The pharmacogenetic data have been studied extensively due to their clinical importance in the appropriate drug prescription, but such data from the isolated populations are rather scarce. We analyzed the distribution of 95 polymorphisms in 31 core ADME genes in 20 populations worldwide and in newly genotyped samples from the Roma (Gypsy) population living in Croatia. Global distribution of ADME core gene loci differentiated three major clusters; (1) African, (2) East Asian, and (3) joint European, South Asian and South American cluster. The SLCO1B3 (rs4149117) and CYP3A4 (rs2242480) genes differentiated at the highest level the African group of populations, while NAT2 gene loci (rs1208, rs1801280, and rs1799929) and VKORC1 (rs9923231) differentiated East Asian populations. The VKORC1 rs9923231 was among the investigated loci the one with the largest global minor allele frequency (MAF) range; its MAF ranged from 0.027 in Nigeria to 0.924 in Han Chinese. The distribution of the investigated gene loci positions Roma population within the joined European and South Asian clusters, suggesting that their ADME gene pool is a combination of ancestral (Indian) and more recent (European) surrounding, as it was already implied by other genetic markers. However, when compared to the populations worldwide, the Croatian Roma have extreme MAF values in 10 out of the 95 investigated ADME core gene loci. Among loci which have extraordinary MAFs in Roma population two have strong proof of clinical importance: rs1799853 (CYP2C9) for warfarin dosage, and rs12248560 (CYP2C19) for clopidogrel dosage, efficacy and toxicity. This finding confirms the importance of taking the Roma as well as the other isolated populations`genetic profiles into account in pharmaco-therapeutic practice.