Rare Single Nucleotide and Copy Number Variants and the Etiology of Congenital Obstructive Uropathy: Implications for Genetic Diagnosis.

SIGNIFICANCE STATEMENT: Congenital obstructive uropathy (COU) is a prevalent human developmental defect with highly heterogeneous clinical presentations and outcomes. Genetics may refine diagnosis, prognosis, and treatment, but the genomic architecture of COU is largely unknown. Comprehensive genomic screening study of 733 cases with three distinct COU subphenotypes revealed disease etiology in 10.0% of them. We detected no significant differences in the overall diagnostic yield among COU subphenotypes, with characteristic variable expressivity of several mutant genes. Our findings therefore may legitimize a genetic first diagnostic approach for COU, especially when burdening clinical and imaging characterization is not complete or available. BACKGROUND: Congenital obstructive uropathy (COU) is a common cause of developmental defects of the urinary tract, with heterogeneous clinical presentation and outcome. Genetic analysis has the potential to elucidate the underlying diagnosis and help risk stratification. METHODS: We performed a comprehensive genomic screen of 733 independent COU cases, which consisted of individuals with ureteropelvic junction obstruction ( n =321), ureterovesical junction obstruction/congenital megaureter ( n =178), and COU not otherwise specified (COU-NOS; n =234). RESULTS: We identified pathogenic single nucleotide variants (SNVs) in 53 (7.2%) cases and genomic disorders (GDs) in 23 (3.1%) cases. We detected no significant differences in the overall diagnostic yield between COU sub-phenotypes, and pathogenic SNVs in several genes were associated to any of the three categories. Hence, although COU may appear phenotypically heterogeneous, COU phenotypes are likely to share common molecular bases. On the other hand, mutations in TNXB were more often identified in COU-NOS cases, demonstrating the diagnostic challenge in discriminating COU from hydronephrosis secondary to vesicoureteral reflux, particularly when diagnostic imaging is incomplete. Pathogenic SNVs in only six genes were found in more than one individual, supporting high genetic heterogeneity. Finally, convergence between data on SNVs and GDs suggest MYH11 as a dosage-sensitive gene possibly correlating with severity of COU. CONCLUSIONS: We established a genomic diagnosis in 10.0% of COU individuals. The findings underscore the urgent need to identify novel genetic susceptibility factors to COU to better define the natural history of the remaining 90% of cases without a molecular diagnosis.

Rapid clearance of tacrolimus blood concentration triggered by variant pharmacogenes.

WHAT IS KNOWN AND OBJECTIVE: Tacrolimus (TAC) is an immunosuppressant with large interpatient pharmacokinetic variability and a narrow therapeutic index. We report a case of acute cellular rejection (ACR) type IB with insufficient TAC blood concentrations (TAC C0 ). CASE SUMMARY: ACR developed on the eighth postoperative day of kidney transplantation. During this period, TAC C0 were insufficient. This referred pharmacogenetic assessment disclosed the patient as a CYP3A5 expresser and CYP3A4*1B carrier. According to the genotype, higher doses of TAC, 15 mg twice daily, were administered and targeted TAC C0 were achieved. WHAT IS NEW AND CONCLUSION: Our case presents an association of TAC rapid clearance and two alleles modifying greater CYP3A enzyme activity.

Levels of Depression and Anxiety and the Body Image of Female Patients on Renal Replacement Therapy.

BACKGROUND: Chronic kidney disease is a severe condition that can affect different dimensions of the patients' wellbeing. The aim of this study was to determine the role of the treatment type on the patients' levels of depression and anxiety as well as on their body image. SUBJECTS AND METHODS: A cross-sectional study was conducted on 146 respondents divided into three groups, 53 treated by hemodialysis (HD), 53 treated by kidney transplantation (TX), and 90 controls. Body image scale, PHQ-9 and GAD-7 were used to assess the patients. RESULTS: There was no difference in BIS between the groups HD and TX, nor between the TX and their age-matched controls. The TX group had lower levels of depression when compared to the HD group, and their levels of depression were similar to those of controls. No significant differences in anxiety were observed between the groups. CONCLUSION: Since the levels of depression are higher in the HD group, special attention should be given to these patients. Higher levels of psychological well-being in the transplant group is an additional factor why transplantation is the preferred method of treatment of CKD.

The Croatian version of the Body Image Scale: translation and validation.

AIM: To validate the Croatian translation of the Body Image Scale in breast cancer and chronic kidney disease patients. METHODS: The scale was administered to 172 breast cancer patients and to 89 chronic kidney disease patients. Measures of depression and anxiety were used to assess the convergent validity. Both groups were divided based on their treatment types. RESULTS: In both samples, the scale showed high internal consistency (Cronbach's Alpha 0.958 for breast cancer patients, 0.855 for chronic kidney disease patients) item-total correlations (0.72-0.88 for breast cancer patients, 0.46-0.65 for chronic kidney disease patients), and convergent validity. In the breast cancer group, the factor analysis showed a single-factor solution, while in the chronic kidney disease group it showed a two-factor solution. Good discriminant validity was obtained among breast cancer patients, with patients who underwent complete mastectomy scoring higher than patients who underwent partial mastectomy. The scale showed no discriminant validity among chronic kidney disease patients. CONCLUSION: The Croatian BIS shows good psychometric properties.

THE IMPACT OF POSITIVE ANTI-HBC MARKER ON PERMANENT DEFERRAL OF VOLUNTARY BLOOD DONORS IN EASTERN CROATIA AND ESTIMATION OF OCCULT HEPATITIS B VIRUS INFECTION RATE.

Recently an increase has been reported in the number of HBV transmissions from anti-HBc positive blood donors that were repeatedly negative in HBsAg and nucleic acid testing using the most sensitive tests available. The aim of the study was to show the effect of anti-HBc antibody testing performed in 2006 on permanent deferral of voluntary blood donors (VBDs), and to estimate occult hepatitis B infection (OBI) rate in this population after the introduction of mandatory molecular testing in the 2013-2016 period. More than 30,000 blood donations collected during the 2005-2007 period and more than 14,000 VBDs having donated blood during the 2013-2016 period after the introduction of molecular testing from eastern Croatia were included in the study. Serologic testing was performed with HBsAg assay throughout the study period, and anti-HBc assay was only performed in 2006. As part of the confirmatory algorithm testing, all HBsAg positive and unclear results were tested with molecular tests. Anti-HBc prevalence among VBDs in 2006 was 1.5%, with a rate of 1:197, whereas HBsAg prevalence was stable from 2005 to 2007 (0.04%, 0.1% and 0.1%, respectively). The calculated OBI rate from 2013 to 2016 was 1:30,250. Ten of 161 (12.4%) VBDs had serologic anti-HBc-only pattern. Anti-HBc testing in 2006 resulted in statistically more deferrals of VBDs compared to 2005 and 2007, and to the rest of Republic of Croatia. The strategy of universal anti-HBc testing of VBDs in addition to the existing HBsAg and molecular screening could be an additional measure to prevent HBV transmission by blood and blood components.

FEMALE SEXUAL FUNCTION OF HEALTHY WOMEN IN EASTERN CROATIA.

The aim was to evaluate sexual function of healthy women in Croatia and the possible impact of depression, anxiety, and sociodemographic factors. A total of 204 healthy women filled in a basic sociodemographic questionnaire, the Patient Health Questionnaire-9, Anxiety Disorder-7, and Female Sexual Function Index (FSFI). Almost half of study subjects (47.1%) reported at least some degree of sexual dysfunction defined as an FSFI score lower than 26.55. Study results suggest sexual dysfunction of women in Croatia as a still unrecognized problem. More room in research and in the public must be given to this issue.

Impedance cardiography as tool for continuous hemodynamic monitoring during cesarean section: randomized, prospective double blind study.

BACKGROUND: Impedance Cardiography (ICG) is a non-invasive tool for continuous hemodynamic monitoring. Aims of our study were to assess the utility of ICG to evaluate the hemodynamic impact of 6 mg (GL6) vs 8 mg (GL8) levobupivacaine combined with fentanyl in healthy patients undergoing elective cesarean section; secondary, to compare the duration and quality of analgesia and anesthesia. METHODS: Sixty-two women receiving combined spinal-epidural (CSE) for elective cesarean delivery were randomly allocated to GL6 or GL8 groups. Mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate (HR), stroke volume index (SVI) were recorded from Tbaseline to 31 min after CSE by ICG. Sensory and motor blocks, patients and surgeons satisfaction, neonatal data were also recorded. RESULTS: Fifteen of 32 patients in GL6 and 15 of 30 patients in GL8 experienced hypotension at T2 vs Tbaseline (P < .001) and SVRI reduction (P = .035 and P < .001 respectively). MAP, CI and SVRI were always slightly higher in GL6 vs GL8. HR and SVI remained stable until the end of surgery in all patients. Total ephedrine requirements was higher in GL8 (P = .010). The onset and offset time of sensory and motor block were similar in both groups, but the number of patients with motor block was lower in GL6 vs GL8 (P = .001). Patients and surgeon satisfaction scores, the number of patients needed systemic rescue doses, neonatal data were similar in both groups. CONCLUSIONS: ICG is a useful noninvasive tool to monitor continuously hemodynamics during cesarean section. The hemodynamic stability, the satisfying sensory block and rapid mobilization provided by low levobupivacaine dose may be particularly advantageous in obstetric patients. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03170427 . Retrospectively Registered (Date of registration: May 2017).

Hemodialysis-refractory metformin-associated lactate acidosis with hypoglycemia, hypothermia, and bradycardia in a diabetic patient with belated diagnosis and chronic kidney disease
.

Metformin is a first-line oral antidiabetic therapy for patients with type 2 diabetes mellitus. Metformin-associated lactate acidosis (MALA) is a well-known, life-threatening, but rare side effect of metformin therapy. Chronic kidney disease (CKD) patients have a much greater risk of MALA. We report the case of a severe refractory MALA despite hemodialysis (HD) treatment, associated with hypoglycemia, hypothermia, and bradycardia in a neglected and thus untimely-recognized CKD patient with type 2 diabetes mellitus. Despite the recent rehabilitation of metformin as a treatment of choice for type 2 diabetes mellitus, the drug should be prescribed with caution as it can be associated with life-threatening refractory acidosis, particularly in CKD patients. Moreover, HD treatment could occasionally be ineffective, resulting in a fatal outcome.
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Genetic variation in leptin and leptin receptor genes is a risk factor for idiopathic recurrent spontaneous abortion.

AIM: To determine whether maternal leptin (LEP) and leptin receptor (LEPR) gene polymorphisms are associated with idiopathic recurrent spontaneous abortion (IRSA). METHODS: This case-control association study conducted from 2010 to 2012 at the Department of Gynecology and Obstetrics, University Hospital Center Osijek and Clinical Institute of Medical Genetics Ljubljana included 178 women with a history of three or more IRSAs before the 22nd week of gestation and 145 women with at least two live births and no history of pathologic pregnancies during reproductive period. Polymorphisms of maternal LEP (rs7799039, rs2122627, rs11761556, rs10244329) and LEPR (rs1137101, rs7516341, rs1186403, rs12062820) were assessed by allele specific real-time polymerase chain reaction. Genotype distribution, allele frequencies, and frequency of haplotypes at LEP and LEPR genetic loci were determined. RESULTS: We observed more frequent genotype for rs7516341 (nominal P=0.034, odds ratio [OR] 0.61, 95% confidence interval [CI] 0.38-0.97) and rs1137101 (nominal P=0.048, OR 1.66, 95% CI 1.00-2.80) in the LEPR gene in patients than in controls, but these results did not remain significant after correction for multiple testing according to Bonferroni (adjusted P value threshold was set at 0.05). We did not observe differential distribution of genotype frequencies in the LEP gene between cases and controls. In patients with IRSA, GTCC haplotype in the LEPR gene locus was significantly less frequent than in controls (PP=0.00865, OR 0.45), contrary to ACTC haplotype (PP=0.0087, OR 1.98). CONCLUSIONS: We showed that genetic variability in the LEPR gene was associated with IRSA, warranting confirmation on a greater number of patients and pathogenesis investigation.

Red blood cell distribution width as a simple negative prognostic factor in patients with diffuse large B-cell lymphoma: a retrospective study.

AIM: To determine the prognostic value of baseline red blood cell distribution width (RDW) in diffuse large B cell lymphoma (DLBCL) patients. METHODS: Data from 81 DLBCL patients diagnosed from 2006 to 2013 at the University Hospital Center Osijek, Osijek, Croatia, were reviewed. We evaluated disease outcome, overall survival (OS) and event-free survival (EFS), and demographic, clinical and laboratory factors affecting outcome. Univariate analysis and Cox regression analysis were used. RESULTS: Median age of patients was 64 years, 29 were men (35.8%). Higher RDW levels (%) were found in patients with advanced Ann Arbor clinical stage (14.94±1.82 vs 13.55±1.54, P=0.001) and in those with poor response to therapy (14.94±1.82 vs 13.55±1.54, P=0.001). Patients with RDW>15% (cut-off was calculated by receiver operating characteristics) had significantly worse OS (median [range], 33 months [20-46] vs 74 months [65-82], P<0.001) and EFS (27 months [15-40] vs 68 months [59-77], P<0.001). Cox regression analysis showed that RDW>15% was an independent prognostic factor for OS (HR 3.654, 95% CI 1.128-11.836) and EFS (HR 2.611, 95% CI 1.012-6-739). CONCLUSION: High baseline RDW is an independent prognostic marker of poor outcome in patients with DLBCL. RDW could be an easily available and inexpensive marker for the risk stratification in patients with DLBCL.

Creatinine Clearance and Estimated Glomerular Filtration Rate--When are they Interchangeable.

Study goal was to examine which of glomerular rate equations is most suitable for prediction of creatinine clearance (CrCl). Using a retrospective review of data from 500 hospital patients we calculated glomerular filtration rate according to Cockcroft-Gault equation (C-G), Modification of Diet in Renal Disease Study equation (MDRD) and Chronic Kidney Disease Epidemiology Collaboration equation (CKD-EPI). We determined if results of these equations were compatible with CrCl, and does stage of kidney disease, body-mass index (BMI), diabetes or old age have an impact on their ability to predict creatinine clearance. All of the equations showed high correlations with CrCl, regardless of diabetes, overweight or old age. There was no significant difference (p<0.05) between diagnostic accuracy when comparing ROC plots for MDRD and CKD-EPIat CrCl cut offs of 60 ml/min/1.73 m2 and 90 ml/min/1.73 m2 when analyzing data for all patients, older patients (>65 years) and diabetics. The percentage of overweight patients (BMI > or = 25) in patients with normal CrCl and decreased GFR was 64.81% for C-G, 92.04% for MDRD and 91.36% for CKD-EPI. Large number of overweight patients with normal CrCl and decreased GFR would indicate that CrCl overestimates GFR in overweight patients. The simple correction in CrCl for obese subjects is purposed. Passing-Bablok regression showed agreement between CrCl and MDRD and CrCl and CKD-EPI only in cases of severely decreased GFR (G4 and G5 stage of chronic kidney disease). Only in these stages of chronic kidney disease can CrCl and MDRD or CrCl and CKD-EPI be used simultaneously.

Are there differences in students' school success, biorhythm, and daytime sleepiness depending on their school starting times?

Chronotype is a characteristic of a person in a certain point of one's lifetime and it slowly changes with age. Adolescents start to go to bed later while schools impose early starting hours, which may become a problem for students who are unable to adapt their circadian rhythm. The aim of this study was to determine if differences in school starting times affect the students' chronotype, school success, or daytime sleepiness. We tested a total of 1020 students from four high schools in Osijek, Croatia. The students had alternating school shifts (school starting hours 7 AM or 13 PM and 8 AM or 14 PM, every other week, alternatively, respectively). The participants were tested using the Epworth Sleepiness Scale and the Morningness--Eveningness Questionnaire. Earlier chronotypes were characteristic of the students starting school earlier, but without significant difference in daytime sleepiness in comparison with those starting school later. Differences were also found between different age and gender groups, female and older students having earlier chronotypes. Students going to school earlier showed better school success than the latter. In conclusion, the study shows that students starting school earlier also have earlier chronotypes, which might be consequence of the adaptation to one hour earlier school starting time.

[Consensus statement of the Croatian Society for Nephrology, Dialysis and Transplantation regarding the use of generic immunosuppressive drugs]. / Stav hrvatskog drustva za nefrologiju, dijalizu i transplantaciju bubrega prema uporabi generickih imunosupresiva u transplantaciji bubrega.

The use of generic immunosuppressive drugs may decrease the cost of immunosuppressive medication, although total cost sav- ings are still a matter of debate since patients need close monitoring after conversion from original to the generic formulation. A working group of the Croatian Society of Transplantation was established to develop recommendations on the use of generic immunosuppression in renal transplant recipients based on a review of the available data. Immunosuppressive drugs belong to the 'narrow therapeutic index' drugs, with huge pharmacokinetic variations secondary to the impact of food, other drugs, as well as of kidney and liver function. Failure to maintain an appropriate balance of immunosuppression seriously influences graft and patient survival. Published evidence supporting therapeutic equivalence of generic formulations is scarce or completely lacking. Different generic formulations may expose patients to uncontrolled product switching by pharmacists or general practitioners, which is very dangerous for patients, since generic preparations are not required to demonstrate bioequivalence with each other. The Croatian Society for Nephrology, Dialysis and Transplantation is not against the use of generic immunosuppressive drugs, but it requires close supervision of nephrologists and respecting the strict rules of their use. More efforts should be invested in education of primary care physicians as well as of patients to be aware of differences between the original and generic, as well as between different generic formulations.

Computer-aided evaluation of radiologist's reproducibility and subjectivity in mammographic density assessment.

Mammographic density is an independent risk of breast cancer. This study has evaluated the radiologists' reproducibility and subjectivity in breast density estimation and in order to decrease the radiologists' subjective errors the computer software was developed. The very good reproducibility existed in the strong correlation with the first and the second mammogram assessment after three month period for each radiologist (correlation coefficient 0.73-1, p < 0.001). The strong correlation was present in the case of all 5 radiologists when compared among themselves and compared with software aided MDEST-Mammographic Density Estimation (correlation coefficient 0.651-0.777, p < 0.001). Detected differences in glandular tissue percentage determination occurred in the case of two experienced radiologists, out of 5 (one radiologist with more than 5 year experience and one with more than 10 year experience, p < 0.01), but in the case of breast type determination (American College of Radiology-ACR I-IV), the detected difference occurred in one radiologist with the least experience (less than 5 years, p < 0.001). It can be concluded that the estimation of glandular tissue percentage in breast density is rather subjective method, especially if it is expressed with absolute percentage, but the determination of type of breast (ARCI-IV) depends on the radiologist's experience. This study showed that software aided determination of glandular tissue percentage and breast type can be of a great benefit in the case of less experienced radiologists.

[Posttransplantation anemia 6 months after kidney transplantation]. / Poslijetransplantacijska anemija sest mjeseci nakon presadivanja bubrega.

AIM: To determine the prevalence of anemia and risk factors that can affect on it six months after kidney transplantation (TX) at the University Hospital Osijek (KBCO) in period from 2007 to March 2012. METHODS: The study included 55 patients, mean age 49 +/- 11 (27 - 70) years, after deceased donor kidney TX in KBCO from 2007 to March 2012. Two grafts did not survive a week (one for sudden death and another for the renal artery thrombosis, in the first 24 hours, respectively). The method of the survey comprised of taking data from the medical records and statistical analysis (SPSS). RESULTS: Posttransplantation anemia (PTA) and is defined by serum hemoglobin (Hb) concentration less than 110 g/l at 3 months after TX. The prevalence of PTA was 28.85%. PTA was more frequent among women (P=0,025). Patients with PTA were significantly longer hospitalized (P=0.002). PTA was more frequent in patients with sepsis after TX (P=0,03), in those with dehiscent postoperative wound (P=0,021) and in the patients with acute kidney transplant rejection (P=0.004). Although delayed graft function was not found significantly related to the PTA, decreased kidney function indicating feature, i.e. number of hemodialysis (HD) needed after TX (P=0.004) and after HD duration (P=0,008), were associated with the PTA significantly. Furthermore, serum creatinine concentration, at the time of hospital release, were significantly higher in those with PTA (P=0.035). There is statistically significant correlation between mean Hb and cratininemia at 3 months after TX. Immunosuppressive drugs and other studied medication, frequently used by kidney transplanted patients, were not related to the PTA. The anemia required crythropoietin substitution in 20 of 53 patients, while 20 patients received blood transfusions. CONCLUSION: PTA presents a great problem among the kidney transplanted patients with prevalence in our patients similar to that in previously published reports. This study had confirmed some of the well known risk factors for anemia in kidney transplant patients, like gender and graft function, but also there had been noticed few risk factors that can be prevented, like dehiscent postoperative wound and sepsis. PTA often requires erythropoietin substitution and blood transfusions, increasing the expenses of kidney transplantation and posttransplantation treatment. Therefore, prevention of PTA is, both medically and economically, justifide.

[Impact of delayed graft function on renal function six months after kidney transplantation]. / Utjecaj odgodene funkcije bubreznog transplantata na funkciju sest mjeseci nakon transplantacije.

AIM: To determine prevalence of delayed graft function (DGF) in renal transplant patients at the Clinical Hospital Center in Osijek (KBCO) and its association with graft function 6 months after transplantation (TX). METHODS: The study included 55 patients, mean age 49 +/- 11 (27 - 70) years, after deceased donor kidney TX in KBCO from 2007 to March 2012. Two grafts did not survive a week (one for sudden death and another for the renal artery thrombosis, in the first 24 hours, respectively). The method of the survey comprised of taking data from the medical records and statistical analysis (SPSS). RESULTS: DGF, defined as the need for hemodialysis (HD) for more than 7 days after TX, was found in 28 of 53 recipients. DGF was more common in women (p=0.022). Patients with DGF had significantly higher creatininemia at discharge (p=0.003). Using multivariate analysis, none of the examined characteristics (recipient's gender, age at TX, basic renal illness, previous TX number, pretransplantation dialysis method and duration, donor's age and cause of death, number of HLA mismatches, cold ischemia duration and donor's creatininaemia, initial immunosuppressive therapy) showed significant impact on the occurrence of DGF. Patients with DGF did not differ from those without DGF in creatininemia 6 months after TX. CONCLUSION: The overall incidence of DGF was high and similar to that in previously published reports, but more common in women. In this study, previously known risk factors, like cold ischemia time and cause of death of the donor, were not associated with the development of DGF. Although DGF unfavorably impacts posttransplantation course, the study did not found its association with renal graft function 6 months after TX.

Sexual function in hemodialysis and post-renal transplant women in a relationship: a cross-sectional study.

PURPOSE: Difficulties in sexual functioning are very frequent in patients with chronic kidney disease (CKD). Sexual dysfunction (SD) can significantly diminish the quality of life (QOL) of affected individuals. The aim of this study was to determine the prevalence of SD in female patients undergoing chronic hemodialysis (CHD) and after renal transplantation (RTx) and to compare these groups with each other and with healthy control. METHODS: The survey was conducted among 123 female participants in a relationship, 28 of them undergoing CHD, 39 after RTx, and 56 healthy women without CKD. For the assessment of the sexual function and comorbidities, the Female Sexual Function Index (FSFI) questionnaire and Ifudu Comorbidity Index were used, respectively. RESULTS: Median age of all female participants was 60 (50-68). The median age of female CHD patients was 66 (61.3-72.8), RTx patients 56 (48-61), and the control group 59.5 (47.5-67.75). Among all participants, CHD female patients had the lowest scores in all sexual functioning domains. Compared to their age-adjusted control group, CHD patients had lower scores in desire, orgasm, and FSFI full score, whereas RTx patients had lower total FSFI scores and scores in all domains except for desire compared to their controls. Women with lower education, in marriage, and with more comorbidities had lower scores in sexual function domains. CONCLUSION: Our study shows that SD in female patients undergoing CHD treatment or those after RTx is substantially higher than that in healthy women. We suggest that female patient treated for CKD should have proper care regarding their sexual health, and differences in demographic and medical factors should be taken into consideration during the treatment management.

Association between Health Literacy and Prevalence of Obesity, Arterial Hypertension, and Diabetes Mellitus.

Background: Health literacy (HL) is linked to many health outcomes, including self-management of chronic diseases. The aim of this study was to assess the association of health literacy with the prevalence of obesity, arterial hypertension (AH), and type 2 diabetes mellitus (T2DM). Methods: This cross-sectional, single-center study included 500 patients (42.2% male and 57.8% females; median age, 63 years (interquartile range, 42−73)) hospitalized at General County Hospital in Pozega, Croatia, between July and October 2020. The Short Assessment of Health Literacy for Croatian Adults (SAHLCA-50) questionnaire was used. Descriptive statistics (median with interquartile range (IQR), frequency, and percentages) and binary logistic regression were utilized. Results: Patients with AH had an inadequate level of health literacy as compared to those without AH (32 vs. 40 points; Mann−Whitney U test, p < 0.001). Patients with T2DM scored 31 points versus 39 points in patients without T2DM (Mann−Whitney U test, p < 0.001). Patients suffering from both AH and T2DM scored 31 points versus 33 points in those with either AH or T2DM and 41 points in patients without AH and T2DM (Kruskal−Wallis test, p < 0.001). There were no statistically significant differences in SAHLCA-50 scores according to the patient body mass index. Conclusions: An inadequate level of health literacy is significantly associated with AH and T2DM but not with obesity. Male gender, low level of education, rural place of residence, retirement, and older age are significant predictors of inadequate health literacy.

Croatian Version of the Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50): Cross-Cultural Adaptation and Psychometric Evaluation.

(1) Background: Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) was originally designed for Spanish-speaking regions, and translations validated for several languages. The aim of the study was to adapt and verify the psychometric characteristics of SAHLSA-50 in the Croatian context; (2) Methods: The cross-sectional study included 590 respondents from the general population older than 18 years of age. Health literacy was measured by two scales: SAHLCA-50 and the Croatian version of the Newest Vital Sign screening test (NVS-HR), which was used as a measure of concurrent validity. Subjective Health Complaints (SHC) and Satisfaction with Life Scale (SWLS) questionnaires were also used to assess convergent validity; (3) Results: Internal consistency reliability of SAHLCA-50 was high and corresponds to the findings of the authors of the original research. The Cronbach alpha coefficient for SAHLCA-50 version was 0.91. The correlation of SAHLCA-50 with the NVS-HR test speaks in favor of concurrent validity. Correlation between health literacy and SHC speaks for convergent validity, just as was expected, while correlation with life satisfaction was not observed; (4) Conclusions: The SAHLCA-50 test can be a good and quick tool to assess health literacy of the adult population in the Croatian language. HL can affect the health and quality of life of the individual and the wider community.