Levels of depression, anxiety and subjective happiness among health sciences students in Croatia: a multi-centric cross-sectional study.

BACKGROUND: Previous studies have shown that symptoms of depression and anxiety were highly prevalent among health sciences students. This may lead to other professional and personal difficulties and a decrease in individuals' well-being. This study aimed to analyze levels of depression, anxiety and subjective happiness among health sciences students in Croatia. METHODS: We conducted a cross-sectional study in 10 higher education institutions in Croatia during March 2023. Eligible participants were health sciences students. Participants filled out an online survey consisting of sociodemographic questions and validated scales for determining the levels of depression (9-question Patient Health Questionnaire, PHQ-9), anxiety (General Anxiety Disorder 7-item scale, GAD-7), and happiness (Subjective Happiness Scale, SHS). RESULTS: Of 7460 invited students, 2137 students participated in the study (29% response rate). There were 41.4% of students that exhibited at least mild depressive symptoms, with 8% of students exhibiting moderately severe symptoms and 1.8% severe depressive symptoms. Mild anxiety was found in 36.8%, moderate anxiety in 23.9% and severe anxiety in 15.8% of students. The median SHS score was 19 (15.25-22). Women students had significantly higher levels of depression (p < 0.001) and anxiety (p < 0.001) than their men peers. Students in earlier study years showed higher levels of depression, anxiety and lower levels of subjective happiness compared to those in later study years. Students with lower self-assessed financial status had higher levels of depression (p < 0.001) and anxiety (p < 0.001). Students that failed an academic year had higher levels of depression (p < 0.001), but lower levels of anxiety (p = 0.005). CONCLUSION: In this study, we have shown that health sciences students exhibit high levels of depression and anxiety, at rates exceeding those in the general population reported in other studies. Our results may help educational institutions to put greater effort into the battle against mental health stigma, foster acceptance of mental health issues and encourage students to seek help when needed. Adequate mental health services are needed at universities to promote timely diagnosis and treatment of mental health problems.

PREDICTORS OF SEXUAL SATISFACTION: AN INTERNATIONAL STUDY.

The aim of this cross-cultural study was to examine predictors of sexual satisfaction. For the present analysis, we used a large-scale sample database that included 8821 individuals from 4 countries. All participants completed the same questionnaires, which were designed to capture numerous important variables that have been shown to correlate with sexual satisfaction. According to our results, predictors of sexual satisfaction were classified into four general categories (demographic factors, psychological factors, sociocultural factors, and pathophysiological factors). Our international study found statistically significantly higher satisfaction among homosexual participants, participants aged 18 to 23 years, those with a higher level of education, in a relationship, with a current sexual partner, in a current partnered (unmarried) relationship, and without a diagnosed sexual or mental disorder. At the same time, we found that the correlation between sexual satisfaction and the different predictors varieed considerably across countries, which calls for further research.

The Risk Assessment of Pesticide Ingestion with Fruit and Vegetables for Consumer's Health.

Pesticides are chemicals used in agriculture to protect crops from pests. In addition to protection during cultivation, they are also used after harvesting to extend the shelf life of products. Postharvest control stands out, especially when it comes to products imported from distant countries, resulting in increased concentration of pesticides and risk to human health consuming such products. In this study, analyses of pesticide residues were performed on 200 samples of fruits and vegetables. Pesticide residues were identified and quantified in 30 out of 200 samples. Study results revealed imazalil to be the most frequently detected pesticide. Risk assessment was performed on the obtained results, and it was carried out separately for adults and for children under 6 years of age. Imazalil showed the highest ARfD percentage for adults (max% ARfD 251%), and these values were especially high on risk assessment for children, where they amounted up to max% ARfD 1087%. The study of imazalil impact was performed on 16 Swiss albino mice divided into two groups and 4 subgroups. Experimental group animals were treated with the corresponding NOAEL dose of imazalil (10 mg/kg) for 28 days. Body weight was measured before each pesticide application on a digital electronic Sartorius scale. Peripheral blood analysis was performed after 28-day animal exposure to pesticides. Animals were anesthetized, blood samples were obtained by cardiac puncture, and red blood cell (RBC) count, hemoglobin (Hb) concentration, and white blood cell (WBC) count were determined by standard hematological methods. The organs for determination of imazalil concentration were extracted immediately upon animal sacrifice and stored in a freezer at -80°C until analysis. Results show difference in gain weight, and an increase in WBC count was recorded in the experimental group as compared with a control group of animals. The highest imazalil levels were recorded in adipose tissue (45.2‰) which proves tendency to accumulate.

VERIFICATION OF AUTHENTICITY OF GINKGO BILOBA L. LEAF EXTRACT AND ITS PRODUCTS PRESENT ON THE CROATIAN MARKET BY ANALYSIS OF QUANTITY AND RATIO OF GINKGO FLAVONE GLYCOSIDES (QUERCETIN, KAEMPFEROL AND ISORHAMNETIN) TO TERPENE TRILACTONES TO THE EFFECT OF UNMASKING COUNTERFEIT DRUGS ENDANGERING PATIENT HEALTH.

Ginkgo biloba L. is the eldest plant growing on the Earth; preparations made of its leaves and seeds represent an integral part of the Chinese medicine for over a millennium. The plant species was first discovered by Linnaeus in 1771, its name thereby originating from the Latin words bis (two) and lobus (lobe), which duly illustrate the specific shape of its leaf. Contemporary Ginkgo biloba L. plant based pharmaceuticals mostly comprise extracts recovered from leaves harvested during fall, when the concentration of active components reaches its peak. Recent investigations have managed to establish the chemical composition of the plant leaf, together with the mechanisms underlying its beneficial effects on rheological profile of the blood and acceleration of its flow. High price of these preparations and their vast popularity have soon become an incentive for counterfeiting Ginkgo biloba L. extracts and the release of bogus drugs comprising cheaper extracts coming from other plants. Namely, modern Ginkgo biloba L.-based medicinal products and food supplements comprise extracts recovered from the plant leaf that get to be standardized according to its key pharmacological active components, most often flavone glycosides (represented in the share of 22%-27%) and terpene trilactones (represented in the share of 6%-7%). The flavonoids that predominate such preparations and are most relevant from the pharmacological standpoint are quercetin, kaempferol and isorhamnetin, their total amount and mutual ratios, thereby being an unquestionable indicator of the extract authenticity. Therefore, most of the analyses aiming at verifying the authenticity of a given Ginkgo biloba L.-based product boil down to the analysis of these parameters. Counterfeiting involves partial or full replacement of the Ginkgo biloba L. extract (GBE) with a cheaper plant extract of a similar composition, the latter occasionally being enriched with an additional amount of flavonoids, most often quercetin, not originating from the Ginkgo biloba L. plant. The aim of this study was to verify the authenticity and quality of Ginkgo biloba L.-based products circulating on the Croatian market. To that effect, 10 samples of products produced by various manufacturers were analyzed in a certified laboratory. The parameters based on which the authenticity of the preparations was assessed were the shares of aglycones of typical ginkgo flavone glycosides, that is to say, quercetin, kaempferol and isorhamnetin, and mutual ratios of the established quantities of quercetin to kaempferol as the key clues to unmasking Ginkgo extracts counterfeiting. The amount of ginkgo flavone glycosides was established using high performance liquid chromatography. The analysis proved 80% of the samples analyzed to be conformant to the label statements as regards the total amount of flavone glycosides and their mutual ratios. In 20% of the samples, the ratio of quercetin to kaempferol deviated from normal values; on top of that, the presence of the phytoestrogen genistein, one of the components typically comprised by the Sophora japonica L. plant, was also proven, documenting counterfeiting of the GBE and its replacement by the Sophora japonica L. extracts in the samples under consideration. Due to the untrue label statements descriptive of these products, the information on the presence of pharmacologically active genistein was neglected to be mentioned despite its unfavorable health impact that can be expected in some consumer groups. The results of this study indicated the frequency of counterfeiting the Ginkgo biloba L.-based products found on the Croatian market to be deemed substantial. Therefore, a more rigorous and more thorough control of these products and sanctioning of irresponsible manufacturers and distributers is proposed, so as to contribute to a higher market representation of high-quality products, as well as to avoid health risks and downsize the rate of their counterfeiting.

Measuring Healthcare Quality - Paradigm of Medqual.

Medical activity is assumed to be service activity the effects of which can be measured. The SERVQUAL scale was used as a starting point for our research, which resulted in a new, adopted scale called MEDQUAL. The MEDQUAL scale aims to measure the quality of healthcare provided by medical staff of one hospital department instead of the overall quality of hospital services or parts of services on which medical staff in one department has no influence. The study was conducted in a clinical hospital department in Croatia and included 300 respondents (169 patients and 131 medical staff members). The MEDQUAL scale, designed and tested in the study, showed high reliability in all established dimensions, i.e. trust in doctors (Cronbach's Alpha 0.923), nursing professionalism (0.913), medical professionalism (0.938), and departmental organization (0.810). The scale proposed evaluates both patient satisfaction with the quality of healthcare received and medical staff satisfaction with the quality of healthcare provided. The results were comparable to the groups of respondents, departments, and institutions with potential longitudinal studies of this phenomenon. MEDQUAL is a simple, repeatable and cost-effective scale, applicable to almost all departments and used for measuring the quality of healthcare services both provided and received, the aim of which is to contribute to the assessment of healthcare quality and its improvement.

Physical and Sedentary Activity Among Facebook Users in Croatia.

The aim of the research was to examine the level of physical activity of users of the social network in Croatia, the relation of the sociodemographic characteristics and the level of physical activity compared to the time spent on the following activity. The study involved 333 respondents who are active users of Facebook (FB). The short version of the IPAQ questionnaire and BMI Calculator were used to assess the physical activity of respondents. This research has determined that the BMI index (BMI) ranges from 16.04 to 42.25, average 24.00. The total level of physical activity of the participants, expressed through the Metabolic equivalent task (MET) is high, and according to the MET category the participants are in the high level of involvement category or HEPA active. There is a statistically significant correlation between the overall results obtained with the IPAQ compared to the MET category, BMI, quality of life and self-assessment of health in FB users. Participants spend on average 5 hours per day sitting during a week, and there is statistically significant correlation between the overall results of the IPAQ compared to the MET category and the time spent sitting. IN CONCLUSION: that involvement in social networks for participants in this study does not disturb the level of physical activity.

MONKEY BITES AND INJURIES IN THE ZAGREB ANTIRABIES CLINIC IN 2014.

- Travelling around the world and visiting distant places and countries (especially national parks, parks of nature, natural resorts, etc.) sometimes may result in animal bites and injuries from the species which are not usually represented as the source of human rabies cases, such as monkeys. In the last ten to fifteen years, monkey bites and injuries present an unpleasant experience and cause a lot of problems for travelers and tourists when travelling to India, Thailand, Indonesia or Bali because they have to seek a medical facility for wound treatment, tetanus prophylaxis, antimicrobial therapy and rabies postexposure prophylaxis (PEP). In 2014, 706 persons were registered at the Zagreb Antirabies Clinic as having sustained bites by various animals, ten of them reported to have been bitten or injured by monkeys. Nine of them sustained injuries during their travel to India, Thailand, Indonesia and Bali. All injuries occurred when they wanted to pet or tried to feed monkeys, or refused to give them food. Most of the monkeys were macaques, capuchins, or of unknown type. Only one monkey bite recorded in the city of Zagreb occurred in the Zagreb ZOO while a professional animal handler was feeding a capuchin monkey in the cage. He did not receive rabies PEP, but instead, the capuchin monkey was put under veterinary supervision. All other patients started with PEP in the countries where the injuries occurred and continued/completed it at the Zagreb Antirabies Clinic. They received antirabies vaccine only (PVRV, RABIPUR) upon 5-dose regimen (Essen scheme) and 2-1-1 (Zagreb scheme) regimen. None of them contracted rabies. After many years, monkeys were the animal species immediately following dogs and cats in the official report of the Zagreb Antirabies Clinic, which was quite surprising. Usually, monkey bites and injuries do not present a serious problem in daily routine because they occur sporadically.

PRESENCE OF CITRININ IN GRAINS AND ITS POSSIBLE HEALTH EFFECTS.

BACKGROUND: Citrinin is a mycotoxin produced by several species of the genera Aspergillus, Penicillium and Monascus and it occurs mainly in stored grain. Citrinin is generally formed after harvest and occurs mainly in stored grains, it also occurs in other plant products. Often, the co-occurrence with other mycotoxins is observed, especially ochratoxin A, which is usually associated with endemic nephropathy. At the European Union level, systematic monitoring of Citrinin in grains began with the aim of determining its highest permissible amount in food. Thus, far the systematic monitoring of the above mentioned mycotoxin in Croatia is yet to begin. MATERIALS AND METHODS: The main goal of this study was to determine the presence of Citrinin in grains sampled in the area of Medimurje, Osijek-Baranja, Vukovar-Srijem and Brod-Posavina County. For the purpose of identification and quantification of citrinin, high performance liquid chromatograph (HPLC) with fluorescence was used (Calibration curve k > 0.999; Intra assay CV = 2.1%; Inter assay CV = 4.3%; LOQ < 1 µg/kg). RESULTS: From the area of Medimurje County, 10 samples of corn and 10 samples of wheat were analyzed. None of the samples contained Citrinin (<1 µg/kg). From the area of Osijek-Baranja and Vukovar-Srijem County, 15 samples from each County were analyzed. The mean value for the samples of Osijek-Baranja County was 19.63 µg/kg (median=15.8 µg/kg), while for Vukovar-Srijem County the mean value of citrinin was 14,6 µg/kg (median=1.23 µg/kg). From 5 analyzed samples from Brod-Posavina County, one of the samples contained citrinin in the amount of 23.8 µg/kg, while the registered amounts in the other samples were <1 µg/kg. CONCLUSION: The results show that grains from several Counties contain certain amounts of Citrinin possibly indicating a significant intake of citrinin in humans. It must be stated that grains and grain-based products are the basis of everyday diet of all age groups, especially small children, where higher intake of citrinin can occur. Consequently, we emphasize the need for systematic analysis of larger amount of samples, from both large grains and small grains, especially in the area of Brod-Posavina County, in order to obtain more realistic notion of citrinin contamination of grains and to asses the health risk in humans.

NITRATE IN LEAFY GREEN VEGETABLES AND ESTIMATED INTAKE.

BACKGROUND: Vegetarian diets are rich in vegetables. Green leafy vegetables are foods that contain considerable amounts of nitrate, which can have both positive and negative effects on the human body. Their potential carcinogenicity and toxicity have been proven, particularly after the reduction of nitrate to nitrite itself or just serving as a reactant with amines and/or amides in the formation of N-nitroso compounds -N-nitrosamines and other nitrogen compounds which may have high levels of nitrate. The aim of this study was to determine whether there is a significant difference, considering the location and seasonal sampling period, in the level of nitrate in certain types of green vegetables, all in order to be able to assess their intake, and possible impact on human health, especially knowing that exposure to nitrate can be potentially higher for vegetarian population group. MATERIALS AND METHODS: For this purpose, the sampling of 200 different leafy green vegetables was conducted, all of which could be found in free sale in the Republic of Croatia. The sampling was conducted during two seasonal periods - the spring and autumn period. In the springtime, lettuce (sem), spinach (pinacho), kale (kale), chard (mangel) and cabbage (brassica) were sampled, and in autumn lettuce, spinach, kale, chard and arugula. Samples were analyzed using high performance liquid chromatography (HPLC) with UV detection. RESULTS: The results from the spring sampling phase were in the range of 603 mg/kg for cabbage - 972 mg/kg for chard, and for autumn phase of 1.024 mg/kg for chard to 4.354 mg/kg for the arugula. The results showed that there were significant differences (p <0.05) for most of the samples analyzed, considering the sampling locations and time period. CONCLUSION: The results indicate that the analyzed vegetables contain significant amounts of nitrate in their composition, which represents relatively significant, but still acceptable intake into the human body.

THE INCIDENCE OF JACKAL BITES AND INJURIES IN THE ZAGREB ANTI RABIES CLINIC DURING THE 1995-2014 PERIOD.

Rabies is a zoonotic disease (a disease transmitted to humans from animals) that is caused by a virus. The disease affects domestic and wild animals, and is spread to people through close contact with infectious material, usually saliva, via bites or scratches. Rabies is present on all continents with the exception of Antarctica, but more than 95% of human deaths occur in Asia and Africa. Once the symptoms of the disease have developed, rabies is nearly always fatal. People are usually infected following deep bite or scratch by an infected animal. Dogs are the main host and transmitter of rabies. They are the source of infection in all of the estimated 55 000 human rabies deaths annually in Asia and Africa. Bats are the source of most human rabies deaths in the Americas. Bat rabies has also recently emerged as a public health threat in Australia and Western Europe. Human deaths following exposure to foxes, raccoons, skunks, jackals, mongooses and other wild carnivore host species are very rare. In the Zagreb Anti Rabies Clinic, from 1995 to 2014, there were 18,094 patients bitten by various animals, but only 2 cases were caused by jackals. One was imported (from France), and the other was from Croatia. The incidence of jackal injuries during the observed period was extremely low, accounting for 0.011% of all animals. When the imported case is excluded, the incidence was 0.0055%. Accordingly, it is concluded that jackal bites and injuries are exceptionally low and that they pose no risk for patients who present routinely to the Zagreb Anti Rabies Clinic. Therefore, it is justified that jackal as an animal species be classified in the group of 'other animals', when officially reported.

CURRENT PERSPECTIVES OF POTTER'S GLOBAL BIOETHICS AS A BRIDGE BETWEEN CLINICAL (PERSONALIZED) AND PUBLIC HEALTH ETHICS.

In the context of modern scientific and technological developments in biomedicine and health care, and the potential consequences of their application on humans and the environment, Potter's global bioethics concept resurfaces. By actualizing Potter's original thoughts on individual bioethical issues, the universality of two of his books, which today represent the backbone of the world bioethical literature, "Bioethics--Bridge to the Future" and "Global Bioethics: Building on the Leopold Legacy", is emphasized. Potter's global bioethics today can legitimately be viewed as a bridge between clinical personalized ethics on the one hand and ethics of public health on the other.

Nursing evaluation of diabetes self-management in tertiary healthcare settings in Croatia.

BACKGROUND: Systematic and efficient education on patient self-management behaviour represents one of the key approaches to diabetes treatment. The aim of this paper was to evaluate the current process and content of nursing assessment of illness self-management behaviour in persons with diabetes treated at a tertiary healthcare facility. SUBJECTS AND METHODS: Electronic patient records of N=15,116 persons with type 2 diabetes (51.3% men) who took part in nursing evaluation and education throughout 2011 were collected. The patients' mean age was 65.0±11.1 years, with mean diabetes duration of 12.6±8.3 years; they were mostly treated with oral anti-diabetic drugs (38.4%) or insulin therapy (38.5%). The likelihood of non-participation in the nursing evaluation was predicted based on a number of patient characteristics using a multivariate logistic regression. RESULTS: The nurses mostly rated the patients' self-management knowledge and real-life application of that knowledge as appropriate; however, in a large number of patients, the nursing evaluation was not evidenced in the electronic patient record. Multivariate logistic regression revealed that longer diabetes duration, insulin treatment and better glyceamic control as measured by glycated haemoglobin were associated with a higher likelihood of participating in a nursing evaluation and diabetes re-education. CONCLUSION: Diabetes specialist nurses may use informal criteria when deciding which type 2 diabetes patients to interview about diabetes knowledge and self-care. Participative research on the processes of nurses' decision-making may be needed.

Can Croatian medicine do without palliative medicine?--Study investigating the need for formal education.

The aim of this study was to determine the public's, i.e. citizens' attitude on one hand, and health-care professionals' attitude on the other, regarding the public education in palliative care. Also, the assessment of health-care professionals' attitude regarding the need to establish a sub-specialty in palliative medicine in Croatia was performed. The study was carried out during 2007 and 2008 in the capitals of 7 Croatian counties, involving 2353 participants. Two types of anonymous questionnaire were distributed. Citizens were surveyed at public places, business offices, waiting rooms, while health-care professionals were surveyed in medical centers. The survey was conducted personally by the authors, i.e. "face to face" with the respondents. The collected data were entered into a database and analyzed, taking into account the anonymity, privacy and data confidentiality. The response rate was 99% for the public and 97% for health-care professionals. 44% of the public thought that educating the public in palliative care is absolutely necessary, and 42% that it is mostly necessary; compared with 47% of health-care professionals who thought education was absolutely necessary, and 45% who thought it is mostly necessary. In addition, health-care professionals were asked about their opinion regarding the establishment of a sub-specialty in palliative medicine and 76% of respondents considered it absolutely necessary. Both the public and health-care professionals recognize the need for public education in palliative care. The authors wish to especially emphasize health-care professionals' perception of a great need for the establishment of an official medical curriculum and a medical sub-specialty in palliative medicine.

Testing of the bactericidal action of products based on the "hydronic" technology ("informed glass") on ATCC strains of pathogenic Gram-positive and Gram-negative bacteria and yeasts (Staphylococcus aureus, Escherichia coli, and Candida albicans).

BACKGROUND: Scientific experiments were conducted with drinking water kept in "ordinary, everyday-use" glasses (drinking tumblers) and the so-called "informed" glasses (drinking tumblers), a patent-protected product supposed to have an effect on the "structure, vitality and memory of water," for which the manufacturer claims to have a wide range of positive effects on the health of patients with chronic medical problems, especially a "revitalizing" effect on water and the body (blue informed glass), additional metabolic effects such as facilitating weight loss (green informed glass), and a stress-relieving action (red informed glass). According to the claims of the patent owner, a Slovenian inventor Vili Poznik, by the use of the "orgone methodology," various transcendental, vitalizing information is purportedly coded and inscribed into the glass; this action is additionally enforced by the addition of the "magic life" symbol--a specially designed energy condenser which, together with the selected information, is permanently introduced into the liquid contained in the glass. The process of selection and transfer of information is a production secret known only to the inventors of the original "hydronic technology" for the discovery of which they have been awarded numerous prizes at innovation fairs, among others, a gold medal and a Crystal Globe at INPEX XVI exhibition in Pittsburgh, PA, in 2000. RESEARCH OBJECTIVES: The aim of this research was to test the claims for informed glasses with respect to the bacteriocidal actions that have been claimed for these products. MATERIALS AND METHODS: Given that the manufacturer attributes to the products produced by the "hydronic" technology--besides the effects on organoleptic properties of the drinking water consumed (which are subjective and liable to suggestion)--a broad bactericidal action against bacteria, yeasts, and molds but does not state a single scientific proof, the efficacy and bactericidal action of the products based on the hydronic technology were tested using standardized microbiological tests in a certified laboratory. Respecting the principle of a single-blinded test for each of 5 samples of each type of informed glass, the growth reduction factor (RF; difference log: colony forming unit per mL [cfu/mL] of control glass and log cfu/mL of each informed glass) was determined after arbitrarily set time intervals of 0, 2, 4, 6, and 8 hours in spring water experimentally contaminated with standardized ATCC strains. RESULTS: While the blue informed glass produced statistically significant bacterocidal action on all strains of the bacteria tested under normal daylight conditions, this effect did not occur with the red and green informed glasses. In the other conditions (complete darkness and exposures to ultraviolet light), any effects noted were negligible. CONCLUSIONS: The results indicate rather a possible photocatalytic action of a currently unknown and undeclared component, introduced accidentally or added intentionally during the manufacture of the glass, rather the action caused by the effects of applying "orgone technology."