Croatian Medical Journal最新文献

Aim: To report on treatment outcomes in adult patients with spinal muscular atrophy type 3 (SMA3) who had their nusinersen treatment initiated in adulthood.

Methods: The study enrolled 11 adults treated with nusinersen for SMA3 at the Croatian National Referral Centre for Neuromuscular Disorders from 2019 to 2022. We prospectively collected validated SMA outcome measures: Revised Hammersmith score (RHS), Revised Upper Limb Module, and 6-minute walk test (6MWT) as motor function outcomes and the Individualized Neuromuscular Quality of Life questionnaire. Baseline outcomes were compared with the outcomes after three years of treatment.

Results: All patients reported subjective improvement, and 9/11 reported an increased quality of life. Overall, 10/11 patients experienced clinically significant improvement in at least one measured outcome, while the remaining 1 patient reported the absence of disease progression. The mean increase in RHS was 2.7 points (P=0.062), and the mean increase in 6MWT was 39.7 m (P=0.239). Younger age and shorter disease duration correlated with better treatment outcomes (r=-0.543 and r=-0.666, respectively). After the approval of risdiplam in 2022, a third of patients chose to switch therapies despite observed subjective and objective positive nusinersen treatment effects.

Conclusion: Nusinersen had a positive treatment effect despite missed doses during the COVID-19 pandemic. Although the most significant improvements can be expected in patients treated the earliest, nusinersen treatment can be beneficial even in long-standing SMA.

Aim: To assess awareness, knowledge, and preferences regarding palliative care in two Central European countries (Slovenia and Croatia) and the Austrian federal state of Styria. The study explored differences in the sources of information, public perceptions, and preferred settings for end-of-life care.

Methods: In this descriptive cross-sectional survey, we enrolled a community-based sample of adults (≥18 years) residing in the three regions. Propensity score matching was applied to balance demographic variables in the analysis. Overall and matched samples were reported for the three regions.

Results: The study enrolled 1586 respondents; 78.2% had at least heard of palliative care. In the matched sample (n=462), respondents from Austria had the highest awareness of palliative care goals (74.4%), and those from Slovenia had the highest preference for obtaining information from traditional media (54.4%). Opinions on death discussions varied significantly; in Austria, there was the highest percentage (69.5%) of respondents who felt death was insufficiently discussed in society. The preferred end-of-life care setting was home, with Austrians having the highest preference for this setting (70.8%).

Conclusion: The study revealed notable disparities in awareness, knowledge, and preferences regarding palliative care, although the sample size varied between countries. These differences should be addressed by tailored communication strategies and public health campaigns, which should align health care services with the preferences and needs of the population. The findings provide insights into how to improve end-of-life care and enhance public understanding of palliative services in three Central European regions.

Aim: To investigate the prevalence and predictors of self-perceived unmet health needs (UHN) in Croatia.

Methods: We used data from the European Health Interview Survey, conducted in 2019 on 5461 individuals. Dependent variables were different causes of UHN - long waiting times, financial problems, and problems with transportation, while independent variables were sex, age, marital status, region of residence, degree of urbanization of the respondent's place of residence, education level, quintile of household's income, self-perceived general health, self-reported chronic disease/condition, severity of bodily pain, consultation with a family doctor in the last 12 months, consultation with a specialist in the last 12 months, and perceived social support. An association between the variables was determined with a simple logistic regression and multiple logistic regression model.

Results: Socioeconomic variables such as low education, urban residence, and residence in the Adriatic Region, as well as several health-related factors (worse self-perceived health, higher perceived levels of bodily pain, consultation with a physician in the last 12 months, and lower perceived levels of social support) were associated with higher odds for unmet health needs.

Conclusion: Our findings highlight the need for continued reform and targeted initiatives in the Croatian health care system to improve health care access and equity. Addressing the underlying causes of UHN can help to ensure fair health care for all individuals and enhance overall health outcomes.

Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the respiratory system, neurological symptoms were reported both during acute and post-acute COVID-19. Notably, patients with no history of epilepsy or other neurological conditions developed new-onset refractory status epilepticus (NORSE) weeks, months, or even up to a year following the viral infection. While NORSE is uncommon, it carries a high mortality rate and can result in permanent epilepsy. Therefore, clinicians should consider the possibility of death or epilepsy development when treating individuals with NORSE who have recently contracted SARS-CoV-2. This article compiles comprehensive information on the mechanisms of epileptogenesis linked to SARS-CoV-2, the diagnosis of NORSE syndrome, its treatment options, and associated outcomes. Our aim was to enhance physicians' understanding of the virus's pathogenesis and increase the awareness of NORSE.

Aim: To ascertain whether Croatian respondents' knowledge on pain aligns with modern pain science, and determine the measurement properties of the Croatian version of the Concept of Pain Inventory for Adults (COPI-Adult).

Methods: A cross-sectional, online survey was used to collect the respondents' sociodemographic, clinical, and COPI-Adult (CRO) data (n = 509). A Pearson correlation coefficient test was used to assess the correlations between sociodemographic, clinical, and COPI-Adult (CRO) data. Confirmatory factor analysis and Cronbach's coefficient, based on classical test theory, were used to determine the measurement properties of the questionnaire.

Results: The average COPI-Adult (CRO) score was 35.91 ± 5.8 out of 52 and it was similar in respondents with (36.52±6.01) and without (35.36±5.57) formal medical/health care education. Respondents exhibited a reductionist understanding of pain as a result of structural damage. Higher COPI-Adult scores were very weakly correlated with formal medical/health care education, younger age, lower pain intensity, higher pain knowledge self-assessment, and higher education level. Formal medical education significantly moderately correlated with pain knowledge self-assessment (r=-0.425; P<0.001). One-factor COPI-Adult (CRO) model revealed significant factor loadings of each item (P<0.001) and good internal consistency (Cronbach α=0.803).

Conclusions: Croatian respondents' concept of pain aligns with their objective knowledge, but only partially with modern pain science. This indicates the need to bridge the gap between traditional and contemporary understandings of pain in the Croatian population. One-factor COPI-Adult (CRO) inventory serves as the first questionnaire for assessing the concept of pain among Croatian adults.

It is generally accepted that intraocular pressure (IOP) depends on the rate of aqueous humor production, system outflow resistance, and episcleral venous pressure. Therefore, control IOP values are expected to be within the strict and predictable limits in specific animal species, and there should be no vast differences between species. However, in the literature the control IOP values significantly vary (from potentially "hypotensive" to "hypertensive") within the same species, and especially between species depending on the measurement technique, head position in relation to the rest of the body, circadian rhythm, age, and topical and systemic drugs (anesthetics) applied. These variations make it difficult to compare different therapeutic approaches for intraocular hypertension, investigate the correlation between IOP and intracranial pressure, and determine target IOP values in glaucoma research. We recommend that different IOP physiology and pathophysiology studies take into account all the mentioned factors when describing IOP measurement methodology.

Aim: To assess the behavioral correlates of health literacy (HL) among university students of health sciences in Kosovo, irrespective of their sociodemographic characteristics.

Methods: This cross-sectional study, carried out in Kosovo in 2024, enrolled 470 students of health sciences from the universities of Prishtina and Gjakova (86% women; mean age: 20.7±2.7 years; response rate: 70%). We gathered HL data with the European Health Literacy Survey Questionnaire, as well as information on behavioral characteristics and sociodemographic factors. General linear model and binary logistic regression were used to assess the independent behavioral correlates of HL.

Results: In multivariable-adjusted general linear models controlling for all sociodemographic factors and behavioral characteristics, lower HL scores were positively associated with alcohol consumption (36 vs 38 in non-drinkers, P=0.024), low levels of physical exercise (36 vs 39 among students with high level of physical activity, P<0.001), obesity (35 vs 39 among normal-weight individuals, P=0.011), and a poorer health status (36 vs 37 among students with a better self-rated health status, P=0.031). Furthermore, fully adjusted logistic regression models revealed a positive and strong relationship of "inadequate and/or problematic HL" (scores: 0-33) with physical inactivity (OR=7.6, 95%CI=1.8-31.9) and especially obesity (OR=21.4, 95%CI=3.8-119.8).

Conclusions: Students with low HL may be more likely to engage in behaviors detrimental to health. There is need to enhance HL among future health professionals.