The Croatian Translation of Flos Medicinae: From Health Instructions with Medicinal Plants to Contemporary Phytotherapy.

Medieval European medicine relied on monasteries where ancient medical works were transcribed. Trade routes to the East and the influence of Arab medicine, which supplemented the knowledge of Greco-Roman physicians, enabled the foundation and development of the Salerno Medical School, whose most famous work is Flos medicinae: Regimen sanitatis Salernitanum. This medical textbook, written in verse and drawn up on the basis of ancient sources and empirical experiences of Salerno physicians, contains rules on how to preserve health, on diseases and the use of medicinal plants for medicinal purposes. The work was originally written in Latin, and was translated into Croatian by Franciscan Father Emerik Pavic' (1768). It was the first medical book in the Croatian language. This paper provides an insight into the importance of Regimen sanitatis Salernitanum in medieval medicine and its influence on European medical literature through many translations, commentaries and analyses. In this context, ten recipes from the Croatian translation of Flos medicinae were researched and analysed which contain medicinal plants most of which grow in Croatia, and which were in use at that time: fig, fennel, anise, mallow, peppermint, sage, rue, nettle, celandine and willow. Most of the listed herbal drugs are used in contemporary phytotherapy and some of them have the potential for further research. The paper also deals with the particularities of the Croatian translation of this medical textbook, which can be used for further multidisciplinary research involving medicinal and pharmaceutical historians, botanists and philologists.

Traceability of Croatian extra virgin olive oils to the provenance soils by multielement and carbon isotope composition and chemometrics.

A capacity to determine the provenance of high-value food products is of high scientific and economic interest. With the aim to develop a tool for geographical traceability of Croatian extra virgin olive oils (EVOO), multielement composition and 13C/12C isotope ratio in EVOO as well as the geochemistry of the associated soils were analysed in samples collected from three regions along the Croatian Adriatic coast. Soil geochemistry was shown to influence the transfer and elemental composition of EVOO. The most discriminating variables to distinguish EVOO from different regions were S, Mo, Rb, Mg, Pb, Mn, Sn, K, V and δ13C. The predictive models achieved high sensitivity and specificity, especially when carbon isotope composition was added. The results suggest that interregional geographical traceability of Croatian EVOO is possible based on matching their multielement composition with that of the soils in the provenance area.

Overview of Dioscorides' recipes in Croatian books of folk recipes.

The aim of this paper is to present an overview of Dioscorides' recipes from his work De materia medica which are found in Croatian folk medicine preserved in books of folk recipes called ljekaruse. The particularities of five published and analysed Croatian books of folk recipes from the 17 th and 18 th century are examined. Recipes with drugs of herbal and animal origin, which are most often mentioned in Croatian books of folk recipes, and which were available in folk medicine at the time, are compared with those from Dioscorides' work. Many herbal drugs described in books of folk recipes are today used in contemporary phytotherapy, and modern biomedical research reveals new bioactive substances and confirms new and potential biological activities in medicinal plants used in folk medicine, which is the basis for further study of De materia medica by Dioscorides and ethnomedicinal collections. Croatian books of folk recipes are a valuable resource for multidisciplinary study, including for medicinal and pharmaceutical historians, philologists and ethnologists.

A Qualitative Study on the Position and Role of Volunteers in Integrated Care-An Example of Palliative Care in Croatia.

Volunteers have been present in palliative care since its inception. With the development of palliative care systems, their role and position are changing. Given growing long-term care needs and limited resources in health and social care, volunteers are becoming an important resource in meeting these needs. In Croatia, palliative care has been developing as an integrated care model since 2014. To assess the position and the role of volunteers, we analyzed legislative documents from healthcare and social care and conducted a focus group with volunteers in palliative care. We found that volunteers provide support from the social aspect of care, for the patient and the family. The formal palliative care system involves them as partners in the provision of care, even though this cooperation is informal. The main determinants of their activities are an individualized approach, flexibility, a community presence, and project funding. In conclusion, these determinants allow them to react quickly to identified needs, but with them come some uncertainties of their sustainability. Their activities could indicate what needs to be integrated between health and social care and in what areas. Volunteers both fill in gaps in the system and are ahead of the system, and by doing this they develop new processes around identified unmet needs.

Spatio-temporal monitoring of mercury and other stable metal(loid)s and radionuclides in a Croatian terrestrial ecosystem around a natural gas treatment plant.

The natural gas industry bears a certain contamination risk to human and biota due to, among others, mercury, arsenic, and naturally occurring radioactive material content in gas. We tracked multiple stabile metal(loid)s and radionuclides within the natural gas treatment plant Molve, Croatia, ecosystem during the last decade through a comprehensive monitoring of soil, earthworms, moss, livestock (blood, milk, hair, urine, and feces from cows), and wildlife animals (brain, muscle, liver, and kidney of European hare and pheasant). The level of mercury and other stable metal(loid)s has shown temporal variation, but without an obvious trend. The found spatial differences in soil and earthworms were based on the differing soil characteristics of the sampled locations and exceeded the maximal allowable concentration of arsenic and zinc for agricultural soil. The status of essential copper, selenium, and zinc in cows, hares, and pheasants inclined towards deficiency. The measured stable metal(loid) levels in soil and animal samples were generally in the same range of values reported in earlier decades from the same area or non-polluted areas across Europe. The consumption of local cow and game products (e.g., milk, meat) can be considered safe for human health, although game offal is advised to be avoided as a food item due to the low risk of lead and cadmium's adverse effects. Although the activity concentrations of some radionuclides in moss were higher than reported for pristine areas, transfer from soil to moss was assessed as average (except for lead-210). Radiological risk to human and biota around the gas treatment plant Molve was estimated as negligible.

A History of the Midwifery Profession in the Republic of Croatia.

INTRODUCTION: It can be said that midwifery is as old as humankind because there has always been someone who accompanied women in childbirth. The purpose of this article is to present the history of midwifery on the present-day territory of the Republic of Croatia, from prehistoric ages to the present. METHOD: Historical methodologies were used for the study. An analysis of available literature and archives was carried out. RESULTS: For many centuries, midwifery was in the hands of formally uneducated but skilled women. Midwives had professional autonomy until the 1960s when obstetricians took full control of maternal care, and midwives became their assistants. DISCUSSION: Although midwives in the Republic of Croatia are more educated today than at any time in history, in practice, they do not have professional autonomy in the field of work that they are entitled to under Directive 2005/36/EC.

Spirituality, Personality, and Emotional Distress During COVID-19 Pandemic in Croatia.

This study examined the association between spiritual quality of life (QoL), spiritual coping, emotional distress, and personality during the COVID-19 pandemic lockdown in a convenience sample of Croatian adults (n = 2,860, 80.6% women). Participants completed an online questionnaire that collected information on sociodemographic characteristics, distress (the Depression, Anxiety, and Stress Scale 21), spiritual coping and spiritual QoL (the WHO Quality of Life-Spirituality, Religiousness, and Personal Beliefs), and personality (the International Personality Item Pool). The hierarchical regression analysis demonstrated that personality traits, especially emotional stability, were the most significant predictors of mental health outcomes. Spiritual coping styles were a predictor of worse, while spiritual QoL of better psychological outcomes. Results demonstrate the complex relations between different aspects of spirituality/religiosity with personality and emotional outcomes and suggest that distress motivates the engagement of spiritual coping in times of disaster.

Prevalence of enteric opportunistic pathogens and extended-spectrum cephalosporin- and carbapenem-resistant coliforms and genes in wastewater from municipal wastewater treatment plants in Croatia.

Extended-spectrum ß-lactamase (ESBL)- and carbapenemase-producing Enterobacterales are a critical global health problem and wastewater treatment plants (WWTPs) can promote their spread into the environment; yet their efficacy is not well characterized. Here, we have used conventional culturing to monitor coliform bacteria and quantitative PCR to monitor 2 ESBL and 5 carbapenemase (CP) genes and 4 enteric opportunistic pathogens (EOPs) in the influent and effluent of 7 Croatian WWTPs in two seasons. In general, levels of total, cefotaxime- and carbapenem-resistant coliforms were significantly reduced but not eliminated by conventional treatment in most WWTPs. Most WWTPs efficiently removed EOPs such as K. pneumoniae and A. baumannii, while E. coli and Enterococcus spp. were reduced but still present in relatively high concentrations in the effluent. ESBL genes (blaTEM and blaCTX-M-32) were only slightly reduced or enriched after treatment. CP genes, blaKPC-3, blaNDM and blaOXA-48-like, were sporadically detected, while blaIMP and blaVIM were frequently enriched during treatment and correlated with plant size, number or size of hospitals in the catchment area, and COD effluent concentration. Our results suggest that improvements in wastewater treatment technologies are needed to minimize the risk of environmental contamination with top priority EOPs and ARGs and the resulting public health.

IODINE STATUS AND THYROID FUNCTION IN LACTATING WOMEN AND INFANTS - A SURVEY IN THE ZAGREB AREA, CROATIA.

Lactating women (LW) and infants have high dietary iodine requirements and are at risk of iodine deficiency. The aim of the study was to assess iodine status and thyroid function in LW and their breastfed infants in Zagreb, Croatia. The study included 133 LW and breastfed infant pairs. Urinary iodine concentration (UIC) and thyroid function parameters were measured in all subjects. In LW, breast milk iodine concentration (BMIC) was measured and iodine and salt rich food frequency questionnaire data were collected. Results of analysis indicated that 99.2% of the LW used iodized salt in household and 20.4% used iodine-containing vitamin and mineral supplements. Median (IQR) UIC was 75 µg/L (19.0-180.5 µg/L) in LW and 234 µg/L (151.0-367.5 µg/L) in infants, whereas BMIC was 121 µg/kg (87.8-170.8 µg/kg). Multivariate regression analysis revealed BMIC to be a significant predictor of infant UIC (p<0.001). Positive correlation was recorded between LW and infant thyroid function. This was the first study in Croatia demonstrating BMIC to be a reliable biomarker of iodine status during lactation and predicting iodine intake in breastfed infants. The study confirmed that mandatory salt iodization in Croatia ensured sufficient dietary iodine for LW and optimal iodine intake for breastfed infants via breast milk.

A Reminder of Skin Cancer During the COVID-19 Pandemic.

The year 2020 has been marked by the coronavirus disease 2019 (COVID-19) pandemic, caused by an RNA virus called SARS-COV2 (severe acute respiratory syndrome coronavirus). The fight against this epidemic has become the center of our daily clinical practice as well as of our private lives, in which avoiding infection has become one of our most important goals. Even though COVID-19 is a potentially lethal disease, especially for the elderly and people with chronic diseases, it did not cause all the other life-threatening diseases to vanish. On the contrary, many scheduled medical activities and procedures, especially preventive and non-urgent internal and surgical activities, had to be postponed due to COVID-19 crisis. This interruption in the health care system can negatively affect the diagnosis and management of our patients with other health issues, namely malignant skin tumors, of which melanoma is the most aggressive. In this letter, we as dermatovenereologists from the Croatian Referral Centre of The Ministry of Health for Melanoma needed to express our concern regarding the increasing number of patients with delayed diagnosis of skin cancer, with special emphasis on melanoma detection and treatment. In the last few months, a large number of our newly-diagnosed patients with melanoma, as well as those with non-melanoma skin cancers, reported that they had noticed a suspicious skin lesion a few months ago but decided not to seek help from dermatologist due to the worrisome epidemiologic situation. In the current environment, clinical skin examination may be viewed as less important and thus postponed, but neglecting melanoma throughout the virus outbreak may lead to increased rates of morbidity, mortality, and consequently a greater financial burden for the health system (1). There are several reasons for such a relaxed attitude towards skin health in our patients. Unlike cardiac, pulmonary, or digestive difficulties, which patients consider life-threatening and for which they seek emergency care despite the coronavirus pandemic, skin tumors do not cause great subjective or significantly noticeable objective symptoms. Moreover, all of the skin tumors and especially melanoma , mostly present as small changes of just a few millimeters in diameter in the early stage at which they are prognostically most favorable. For the average person with no medical education, such small lesions usually do not cause any concern as they have no awareness of the fact that small and inconspicuous skin lesions may be dangerous and potentially even lethal. According to the recommendations concerning patient management during COVID-19 pandemic, oncological examinations should still be performed regularly (2). In spite of that, the cancelation of appointments, especially by patients who are being monitored for high-risk lesions, is inevitable when COVID-19 is disrupting everyone's lives. With the pandemic evolving and no clear solutions in sight, now is the time to emphasize the importance of self-examination and teledermatology in early melanoma diagnosis. Even though diagnosing and managing pigmented skin lesions usually requires face-to-face examinations and dermoscopy as a crucial tool in early melanoma detection, in these times, and especially for people with a higher risk of SARS-COV2 infection, remote communication could prevent delays resulting in worse prognosis and could also eliminate the risk of infecting healthcare workers. Moreover, teledermatology can also be initiated by doctors asking patients to monitor lesions between clinical visits (3). However, we should not rely solely on this technology but should instead assess every patient individually and insist on a face-to-face examination for those at greater risk, with the aim that, if necessary, surgery be performed in timely manner. The collaboration between general practitioners and dermatologists represents an important aspect of achieving the most rational and effective health care in terms of performing triage of patients who can be assessed by teledermatology as well as referring to hospital centers those who need face-to-face examination and further treatment. During the first breakout of the epidemic in March 2020, the multidisciplinary team for melanoma from the Croatian National Referral Melanoma Centre provided recommendations for the management of patients with melanoma during COVID epidemic, designed according to the guidelines of the National Comprehensive Cancer Network (NCCN) (4) and considering the specifics of health care and clinical practice in the Republic of Croatia. Due to epidemic circumstances, preventive actions such as Euromelanoma and many other campaigns that included massive preventive skin examinations of the population and which were conducted for years by Croatian dermatologists throughout the country, could not be organized this year. This is particularly worrisome because on average about 800 patients are diagnosed with melanoma annually in Croatia, of which 60 during public health preventive actions. Despite these circumstances, we were able to maintain public awareness of the importance of early skin cancer recognition by sending the message through different media such as newspapers, television, and social media (Facebook and Instagram). We find that now more than ever it is essential to remind and teach the population about the importance of regular monthly skin self-examinations and recognition of atypical lesions. Clearly, a thorough dermatological examination includes full skin examination from head to toe. Herein we would also like to remind our readers that most skin cancers develop in the head and neck area, which is the most UV-exposed part of the body. Therefore, despite the epidemic conditions, the removal of patients' masks and thorough inspection of the face is mandatory. We find it most practical and efficient to perform the body and scalp examination first, followed by the face examination after the patient gets dressed. Prior to removal of the mask, we ask the patient not to talk during close examination. Even though this could make dermoscopic examination harder to perform, we strongly suggest wearing a protective shield and mask during close examination whenever possible. Between patients, the examining room should be disinfected and ventilated. As doctors, we live in uncertain times when we are heavily burdened by the currently unstoppable COVID epidemic, always awaiting new instructions from the state administration every day and wondering whether perhaps tomorrow we dermatologists will be assigned solely to the service of patients with COVID-19. In the end, we would like to once again remind you that despite the ravaging COVID pandemic and all the epidemiological measures that come with it, other diseases still exist. It is expected of us to draw attention to the still growing incidence of skin cancers and the serious consequences that can occur as a result of a delayed diagnosis.

Reconstructing genetic histories and social organisation in Neolithic and Bronze Age Croatia.

Ancient DNA studies have revealed how human migrations from the Neolithic to the Bronze Age transformed the social and genetic structure of European societies. Present-day Croatia lies at the heart of ancient migration routes through Europe, yet our knowledge about social and genetic processes here remains sparse. To shed light on these questions, we report new whole-genome data for 28 individuals dated to between ~ 4700 BCE-400 CE from two sites in present-day eastern Croatia. In the Middle Neolithic we evidence first cousin mating practices and strong genetic continuity from the Early Neolithic. In the Middle Bronze Age community that we studied, we find multiple closely related males suggesting a patrilocal social organisation. We also find in that community an unexpected genetic ancestry profile distinct from individuals found at contemporaneous sites in the region, due to the addition of hunter-gatherer-related ancestry. These findings support archaeological evidence for contacts with communities further north in the Carpathian Basin. Finally, an individual dated to Roman times exhibits an ancestry profile that is broadly present in the region today, adding an important data point to the substantial shift in ancestry that occurred in the region between the Bronze Age and today.

Temporal impacts of pile burning on vegetation regrowth and soil properties in a Mediterranean environment (Croatia).

Burning slash piles is common in the Mediterranean regions to manage the unwanted biomass. This work aims to study the effect of two experimental pile burns ((moderate (MS) and high severity (HS)) conducted in Croatia on vegetation and soil compared to an unburned treatment (UB). We studied vegetation cover (VC), soil water repellency (SWR), mean weight diameter (MWD), water-stable aggregates (WSA), pH, electrical conductivity (EC), soil organic matter (SOM), the total content of calcium (Ca), aluminium (Al), silicon (Si), and iron (Fe), available phosphorus (P2O5) and potassium (K2O). The impacts of the burn were studied 5 days after burning (DAB), 3, 8, 12, and 15 months after burn (MAB). The results showed that VC was significantly higher in UB than in MS 5 DAB-15MAB. SWR was significantly higher in the smallest soil fractions (<0.25 mm) in burn treatments than in the UB on 5 DAB and 3 MAB. Also, 3 MAB, MWD and WSA were significantly lower in the burned treatments than in UB. pH was significantly higher in HS than in UB 3, 12 and 15 MAB, while EC was significantly higher in HS than in UB, 5 DAB, 3 and 15 MAB. MS and HS did not significantly affect SOM content. Total Ca was significantly higher in burn treatments than in UB 5 DAB-12 MAB. Total Al and Si were significantly higher in UB than in HS (5 DAB-15MAB), while total Fe was significantly higher in UB than in HS 5 DAB, and 8-15 MAB. P2O5 was significantly higher in HS than in UB from 3 to 15 MAB, while K2O was significantly higher in MS and HS than in UB 5 DAB. Soils need more time to recover from pile burning disturbance, likely due to the soil poor natural conditions, therefore this type of management is detrimental.

Phosphogypsum and its potential use in Croatia: challenges and opportunities.

Phosphogypsum (PG) is a waste by-product (residue) originating from the production of phosphoric acid and phosphate fertilisers. PG contains chemical and radioactive impurities, which is why it is mostly stockpiled in controlled areas. Worldwide, only about 15 % of PG is recycled or reused. Today, policies and business strategies prioritise sustainable development through circular economy, which certainly includes PG. This provides new opportunities for Croatia to manage its PG and make an effort to use it as an additive in different industries, such as agriculture and construction. Due to its chemical and radiological properties, PG can potentially cause problems for the environment and human health. Hence, before using PG, detailed knowledge of potential hazards is necessary to protect people and the environment. The aim of this review is to summarise available data on Croatian PG, compare them with other countries, and to identify knowledge gaps and the lack of data on potential hazardous substances in PG in order to assess the opportunities of using PG in Croatia.

Elite Croatian junior taekwondo competitors: morphological characteristics and body composition reference values / Competidores croatas de taekwondo junior de élite: características morfológicas y valores de referencia de composición corporal

SUMMARY: The main purpose of this study was to determine the body composition and anthropometric reference values of male and female junior Croatian taekwondo competitors according to official weight category. Additional aim of the study was to identify possible differences in variables between the weight categories. The sample comprised 247 junior participants of the national taekwondo championships divided into male (N=121) and female (N=126). The variable sample was defined by a set of 8 measurements: Body height (cm), Body mass (kg), Body mass index, Body fat (%), Body fat (kg), Muscle mass (kg), Lean body mass (kg) and Total body water (%). Results confirm previous studies proving that younger taekwondo practitioners have higher levels of body fat than their more experienced peers (seniors). Significant differences were only found between lean and heavy categories. Male junior taekwondo athletes show total body water percentages from 57.4 to 74.8 %, with significantly lower percentages in higher weight categories, while female athletes in heigher categories demonstrate a worrying level of hydration status, therefore endangering their performance and overall health. As the first paper that investigates the reference values of junior taekwondo athletes but based on official weight categories it is especially important as each weight category warrant different body composition requirements, as seen from significant differences across different variables. Future studies should include motor abilities inspection throughout the weight categories and possible use of calculation of metabolic age.

RESUMEN: El objetivo principal de este estudio fue determinar la composición corporal y los valores de referencia antropométricos de los competidores croatas masculinos y femeninos de taekwondo junior según la categoría oficial de peso. Además, se analizó identificar las posibles diferencias en las variables entre las categorías de peso. La muestra estuvo compuesta por 247 participantes junior de los campeonatos nacionales de taekwondo divididos en hombres (N = 121) y mujeres (N = 126). La muestra variable se definió mediante un conjunto de 8 medidas: altura corporal (cm), masa corporal (kg), índice de masa corporal, grasa corporal (%), grasa corporal (kg), masa muscular (kg), masa corporal magra (kg) y agua corporal total (%). Los resultados confirmaron estudios previos que demuestran que los practicantes de taekwondo más jóvenes tienen niveles más altos de grasa corporal que sus pares más experimentados (personas mayores). Solo se encontraron diferencias significativas entre las categorías magra y pesada. Los atletas masculinos de taekwondo junior muestran porcentajes de agua corporal total del 57,4 al 74,8 %, con porcentajes significativamente más bajos en las categorías de peso más alto, mientras que las atletas femeninas en las categorías más altas, demuestran un nivel preocupante de estado de hidratación, poniendo en peligro su rendimiento y salud en general. Como el primer artículo que investiga los valores de referencia de los atletas de taekwondo junior, pero basado en categorías de peso oficiales, es especialmente importante ya que cada categoría de peso garantiza diferentes requisitos de composición corporal, como se puede observar en las diferencias significativas entre las diversas variables. Los estudios futuros deberían incluir un análisis de las habilidades motoras en todas las categorías de peso y el posible uso del cálculo de la edad metabólica.

Ethnopharmacology in the History of Traditional Midwifery and Obstetrics in Inland Croatia.

Our review of the history of midwifery, obstetrics and gynecology in inland and coastal areas in northeast Croatia revealed a rich body of data on the use of ethnopharmacology in folklore traditional and approbated midwifery and obstetrics from the 18th to the 20th century. In this study, 42 plants, 4 animal preparations and 1 mineral preparation were presented in an approach to women's health during the history of obstetrics and midwifery.

Genome-wide analysis of nearly all the victims of a 6200 year old massacre.

Paleogenomic and bioanthropological studies of ancient massacres have highlighted sites where the victims were male and plausibly died all in battle, or were executed members of the same family as might be expected from a killing intentionally directed at subsets of a community, or where the massacred individuals were plausibly members of a migrant community in conflict with previously established groups, or where there was evidence that the killing was part of a religious ritual. Here we provide evidence of killing on a massive scale in prehistory that was not directed to a specific family, based on genome-wide ancient DNA for 38 of the 41 documented victims of a 6,200 year old massacre in Potocani, Croatia and combining our results with bioanthropological data. We highlight three results: (i) the majority of individuals were unrelated and instead were a sample of what was clearly a large farming population, (ii) the ancestry of the individuals was homogenous which makes it unlikely that the massacre was linked to the arrival of new genetic ancestry, and (iii) there were approximately equal numbers of males and females. Combined with the bioanthropological evidence that the victims were of a wide range of ages, these results show that large-scale indiscriminate killing is a horror that is not just a feature of the modern and historic periods, but was also a significant process in pre-state societies.

Adolf Thierry and the first pharmaceutical factory in Southeast Europe.

The paper explores the beginnings of pharmaceutical industry development in Croatia and the establishment of the first pharmaceutical factory in Southeast Europe. Adolf Thierry de Chateauvieux (St. Pölten, 1854 - Pregrada, 1920), a nobleman hailing from France, immigrated to Croatia at the end of the 19 th century. He bought the Angjelu cuvaru ( Guardian Angel ) pharmacy (1892) in the small town of Pregrada and established the first pharmaceutical factory (1894) in this part of Europe. The factory had an equipped laboratory, a production facility, a storage room for raw materials and balsams, a room for packaging and shipping finished products and a commercial office. Production was mainly based on herbal remedies. The most famous were Thierry's Balsam and Thierry's Centifolia Ointment, both registered and patented in London (1900). By virtue of Adolf Thierry's entrepreneurial spirit and skilful product advertisement, his medicinal preparations were distributed across Europe, America, India and Africa, a testament to which is the well-preserved and researched documentation.

How Healthy Are Health-Related Behaviors in University Students: The HOLISTic Study.

The aim of this cross-sectional study was to assess the health-related behaviors among university students, with emphasis on health sciences students from Croatia, Italy, Lebanon, Poland, Romania, Spain and Turkey. We included 6222 students in Medicine, Dentistry, Nursing, Pharmacy, Nutrition and Dietetics, Sports Sciences, Veterinary, and Economics enrolled between April 2018 and March 2020. We assessed dietary patterns, sleeping habits, physical activity and perceived stress among students by means of validated questionnaires. The median age ranged between 19 and 24 years, smoking prevalence between 12.0% and 35.4%, and body mass index (BMI) ranged between 21.1 and 23.2 kg/m2. Breakfast was less often and more often consumed daily in Turkey (36.7%), and Italy (75.7%), respectively. The highest Mediterranean diet score was recorded in Spain and Italy, and the lowest in Turkey, followed by students from Croatia, Lebanon, Poland and Romania. Sleep duration, physical activity and stress perception also differed between countries. Multivariable regression analysis revealed a small, but positive association between BMI and several characteristics, including age, female gender, smoking, physical activity, mobile phone use, and perceived stress. A negative association was found between BMI and sleep duration on non-working days. Self-rated health perception was positively associated with female gender, breakfast, physical activity, and time spent studying, and negatively with BMI, smoking and stress. Our results demonstrated diverse habits in students from different countries, some of which were less healthy than anticipated, given their educational background. Greater emphasis needs to be placed on improving the lifestyle of these adolescents and young adults, who will be tomorrow's healthcare workers.

Identification of Neonatal Infant Pain Assessment Tools as a Possibility of Their Application in Clinical Practice in Croatia: An Integrative Literature Review.

OBJECTIVES: This article presents an integrative review of the literature with the aim of identifying instruments already in existence for measuring neonatal infant pain with a view to exploring possibilities of applying them in clinical practice in Croatia. DESIGN: An integrative review. DATA SOURCES: The databases searched included MEDLINE, Cinahl Cochrane Library, and Science Direct. The search was limited to available full-text articles in English published between 1990 and 2020. The studies were selected according to the PRISMA strategy and evaluated based on the methodologic framework proposed by Whittemore and Knafl. REVIEW/ANALYSIS METHODS: The research identified 13 scales for assessing pain in neonatal infants, including 5 one-dimensional and 8 multidimensional scales that assess acute and prolonged pain in preterm and full-term infants. RESULTS: Overall, the articles in this review confirm that pain is a multidimensional phenomenon and that professionals should consider other specific characteristics of the neonatal infant population while measuring pain. CONCLUSIONS: Our review showed that various tools exist assessing pain in neonatal infants that could be used in clinical practice in Croatia. However, it is difficult to determine the most appropriate instrument at this stage, as the choice depends on various factors that still need to be considered. The decision on which pain scale to use or which is more appropriate should be based on further psychometric tests, its accuracy, and ease of use.

Molecular Characterization of ß-Lactam Resistance and Antimicrobial Susceptibility to Possible Therapeutic Options of AmpC-Producing Multidrug-Resistant Proteus mirabilis in a University Hospital of Split, Croatia.

This study was performed to elucidate genetic relatedness and molecular resistance mechanisms of AmpC-producing multidrug-resistant Proteus mirabilis isolates in University Hospital of Split (UHS), and define efficient antibiotics in vitro. A total of 100 nonrepeated, consecutive, amoxicillin/clavulanate- and cefoxitin-resistant P. mirabilis isolates were collected, mostly from urine (44%) and skin and soft-tissue samples (30%). They were all positive in cefoxitin Hodge test and negative for extended spectrum beta-lactamase production. Pulsed field gel electrophoresis identified four clusters and two singletons, with 79% of isolates in dominant cluster. Molecular characterization and I-CeuI analysis of representatives revealed blaCMY-16 gene located on chromosome, and insertion element ISEcp1 positioned 110 pb upstream of blaCMY-16 starting codon. They also harbored blaTEM-1, except one with blaTEM-2. They were all resistant to trimethoprim-sulfamethoxazole, all but one to quinolones, and 81% to all aminoglycosides, while 77% were susceptible (S) and 22% intermediate (I) to piperacillin/tazobactam, and 4% were S and 68% I to cefepime. Only 15% were S to ceftolozane/tazobactam. Meropenem, ertapenem, ceftazidime/avibactam, temocillin, and fosfomycin were 100% efficient in vitro. This is the first report of blaCMY-16 gene in P. mirabilis from hospital samples in Croatia. The findings are in accordance with Italian and Greek reports. The clonal nature of outbreak suggests the high potential of clonal spread. Alternative agents should be considered to spare carbapenem usage.