Croatian Medical Journal最新文献

Aim: To evaluate whether adding a medical assistant (MA) during team substitutions improves workload, access to care, preventive activities, and staff-reported working conditions in Zagreb family medicine practices.

Methods: This case-control study involved 60 family medicine practices: 30 with an integrated MA during summer vacation team substitutions and 30 controls. Patient contacts, task distribution, and health care professionals' feedback were assessed. The MAs involved were medical or nursing students in their final years, who undertook non-medical tasks under supervision by health care staff.

Results: Teams with an MA demonstrated a significant 10.55% increase in total patient contacts, responded to significantly more patient emails and phone calls, and performed significantly more preventive and chronic disease panels. Furthermore, MAs in these teams resolved up to 39% of consultations without the need for patients to directly contact health personnel. Healthcare professionals in these teams reported improved job satisfaction, reduced work-related stress, and better overall working conditions than the control group.

Conclusion: Integrating an MA during team substitutions is a promising strategy for enhancing operational efficiency and improving health care standards in family medicine practices. MAs have the potential to address administrative challenges and promote patient-centered care.

Aim: To assess whether miRNA expression can be a biomarker for distinguishing between hyperplastic and adenomatous polyps and colon cancer tissues.

Methods: The study involved 40 colon adenocarcinoma (CA) tissue samples, 40 low-grade adenomatous (A) polyps, and 40 hyperplastic (HP) polyps. The samples were formalin-fixed and paraffin-embedded. Quantitative real-time polymerase chain reactions were used to determine the expression levels of miR-21, miR-200c, and miR-145.

Results: miR-145 expression was significantly lower in the CA than in both the A and HP groups (P=0.012 and P=0.004, respectively) and in the A than in the HP group (P=0.028). miR-200c expression was higher in the CA than in the A (P=0.008) and HP groups (P=0.009), while no difference was observed between the A and HP groups (P=0.624). miR-21 showed a stepwise increase across the groups, with the highest levels in the CA, followed by the A and HP groups (P<0.001 for both CA vs A and CA vs HP; P=0.037 for A vs HP).

Conclusion: The study revealed dysregulated expression of miR-145 and miR-21 in colon polyps and cancer tissue, showing that these miRNAs may be used to distinguish between hyperplastic and adenomatous polyps and predict colorectal cancer.

Aim: To investigate the association between early inflammatory markers: neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), and C-reactive protein/albumin ratio (CAR) and the Cobb angle in adolescent idiopathic scoliosis (AIS).

Methods: This multicenter case-control study (2017-2024) enrolled 419 patients with AIS (Cobb angle >10°) and 381 age- and sex-matched controls (Cobb angle 0°). We collected demographic data, curve characteristics, and laboratory parameters (white blood cells [WBC], NLR, MLR, PLR, and CAR) at the time of initial diagnosis, before treatment initiation or infection. The Cobb angle was measured by two independent radiologists blinded to clinical data.

Results: Compared with controls, AIS patients had significantly higher WBC, neutrophil, lymphocyte, and monocyte counts, CRP, NLR, and CAR, and lower platelets, PLR, and calcium levels (all P<0.05). CAR and NLR values increased with greater Cobb angle. In contrast, mean platelet volume did not differ between the groups.

Conclusion: This is the first study to evaluate CAR in AIS, demonstrating its significant association with the Cobb angle, alongside NLR and MLR. As inexpensive and readily available markers, CAR and NLR may help in diagnosing AIS, but their role in risk stratification and disease monitoring requires confirmation in future prospective studies.

Aim: To explore the effect of Croatia's 2013 Primary Care Payment Reform on patient care.

Methods: The performance of one rural family practitioner group practice in Breznica was assessed one year before and one year after implementation. Using an exploratory case study design with quantitative methods, we examined outcome variables linked to the new payment model. Drawing on publicly available activity reports, we conducted linear regression analyses to identify potential associations.

Results: We observed changes in most incentivized outcomes, notably increases in preventive check-ups and decreases in hospital referrals. Some indicators, such as the increase in prescribing despite financial disincentives, remain inconclusive and highlight the need for further investigation.

Conclusions: These findings are preliminary but provide valuable hypotheses for guiding more rigorous, longitudinal, and multi-site studies.

Aim: To compare intracytoplasmic sperm injection (ICSI) outcomes between oligoasthenoteratozoospermic (OAT) men with recurrent assisted reproductive technology (ART) failures who underwent ICSI using sperm from the ejaculate on the day of a planned microdissection testicular sperm extraction (m-TESE) vs sperm obtained via m-TESE.

Methods: We reviewed the outcomes of men who underwent ICSI using either ejaculate or m-TESE due to OAT and recurrent ART failure at the Department of Reproductive Endocrinology, Gülhane Training and Research Hospital, between November 2016 and January 2024. The study enrolled 172 men: 66 men in the ejaculate group and 106 in the m-TESE group. All patients had fewer sperm parameters in two subsequent semen analyses.

Results: The groups did not significantly differ in terms of female (P=0.631) or male (P=0.655) age. Sperm was obtained from 76/106 men in the m-TESE group (69.81%). The embryo transfer rate on day three was significantly higher in the m-TESE group (32.2% vs 8.3%; P=0.003), whereas, on day five, it was significantly higher in the ejaculate group (61.7% vs 37.9%; P=0.015). The ejaculate group had significantly higher overall pregnancy rates (59.1% vs 33%; P=0.001) and overall live birth rates (37.9% vs 22.6%; P=0.031).

Conclusion: In recurrent ICSI failure, the reproductive success of ejaculate was higher than that of m-TESE. If it contains motile spermatozoa, the ejaculate before m-TESE could be considered even in severe OAT patients with two or more ART/ICSI failures.

Aim: To review the available research on the association between personality traits and specialty choice.

Methods: A systematic search of MEDLINE, ERIC, Scopus, PsycINFO, and Web of Science was performed in June 2022 and updated on August 18, 2025. Studies were eligible if they examined the association between personality traits and specialty choice among medical students and graduates using validated psychological tests. The protocol was registered at the Open Science Framework (https://osf.io/su6md). Screening, eligibility assessment, and data extraction were performed independently by two reviewers.

Results: A total of 9212 articles were retrieved, of which 61 met the inclusion criteria. Considerable heterogeneity in study design, instruments used, and outcomes assessed precluded quantitative synthesis. Most studies indicated associations between personality traits and specialty choice, although findings were inconsistent. Surgery was the most frequently assessed specialty, with several studies reporting higher impulsivity, higher extraversion, higher openness to new experiences, and a lower desire to work with people among students choosing surgery. Psychiatry, internal medicine, and family medicine were also frequently examined, but associations varied across studies. Methodological limitations were common, including reliance on cross-sectional designs, inconsistent measurement tools, and underreporting of psychometric properties.

Conclusion: Evidence suggests a relationship between personality traits and specialty choice; however, this evidence remains weak due to methodological shortcomings. Future studies should apply standardized measurements for both personality traits and specialty choice, with larger and more diverse samples.

Aim: To assess the prevalence of fragility fractures after denosumab discontinuation and to identify the factors affecting treatment adherence.

Methods: We retrospectively reviewed the medical records of 3876 osteoporosis patients who were treated with denosumab at Trakya University Osteoporosis Clinic between 2015 and 2021. A total of 210 patients who received at least two regular doses of denosumab were eligible for inclusion. Patients were categorized as denosumab-adherent and denosumab-non-adherent. Adherence was defined as receiving the six-month scheduled dose with a maximum delay of up to eight weeks.

Results: Overall, 124 (59.05%) patients were denosumab-adherent and 86 patients (40.95%) were denosumab-non-adherent. New fragility fractures were identified in 32 patients: 17 in the denosumab-adherent group and 15 in the denosumab-non-adherent group. The groups did not significantly differ in the risk or types of new fractures, irrespective of patients' fracture history.

Conclusions: Our findings suggest that some fractures after denosumab discontinuation may stem from the natural progression of osteoporosis rather than from the rebound effect. Still, unscheduled treatment discontinuation should be prevented.

Aim: To compare the overall mortality of Croatian male and female Olympic athletes who represented Yugoslavia or Croatia in the Olympic Games from 1948 to 2016 with the mortality of the general Croatian population standardized by age, sex, and time period.

Methods: Overall mortality analysis included 652 male and 158 female Olympians. The cause-specific analysis included 642 male Olympians; due to the small sample size, this analysis was not possible for female Olympians. Information on causes of death was obtained from specialized registers of countries where deaths occurred, if available. Alternatively, data were obtained by interviews with families or acquaintances of the deceased, based on the World Health Organization verbal autopsy principles. Croatian general population mortality data were obtained from the Croatian Bureau of Statistics and World Health Organization's databases. Overall and disease-specific standardized mortality ratios (SMR) were calculated.

Results: At the endpoint of the study, 2 female and 142 male Olympians had died. Overall mortality was lower for women (SMR 0.23; P=0.013) and men (SMR 0.56; P<0.001) compared with the general population. Male Olympians had significantly reduced mortality from cardiovascular (SMR 0.51; P<0.001), neoplastic (SMR 0.55; P<0.001), respiratory (SMR 0.24; P=0.003), and digestive (SMR 0.42; P=0.015) causes of death.

Conclusions: Croatian male and female Olympians experience reduced overall mortality compared with the Croatian general population. Croatian male Olympians have reduced cardiovascular, neoplastic, digestive, and respiratory mortalities compared with the Croatian general population.