Andrija Stampar Teaching Institute of Public Health

Heavy metals in agricultural systems pose a significant challenge to food security, especially in regions with long-term intensive land use. While the Pannonian Plain represents Croatia's primary breadbasket, accounting for a significant portion of the nation's cereal production, data on the soil-to-grain transfer of heavy metals and the associated human exposure risk are limited. The objective of this study was (i) to determine the concentrations of arsenic (As), cadmium (Cd), and lead (Pb) in agricultural soils and corresponding grains (wheat, barley, and maize) across four principal counties within the Pannonian region of Croatia; (ii) to evaluate the soil-to-grain transfer factors that varied regionally and among cereal types; and (iii) to assess the potential non-carcinogenic health risks for both adults and children highlighting differences in exposure due to body weight and consumption patterns. Soil and cereal grain samples were collected in 2019 and 2020, and metal concentrations were determined by ICP-MS after microwave acid digestion. The transfer of metals from soil to grain was estimated using the transfer factor (TF), while exposure assessment was conducted by calculating the estimated daily intake (EDI), hazard quotient (HQ), and hazard index (HI). Due to the nonlinear distribution of the data and the lack of strictly matched soil and grain samples, median metal concentrations pooled across all studied regions were used for exposure assessment. For As, a conservative approach was applied, assuming that 50% of the total As is in inorganic form. Additionally, a probabilistic risk assessment using Monte Carlo simulations was conducted to account for variability in body weight and cereal intake, providing a more comprehensive evaluation of potential exposure. The results showed differences in metal accumulation among cereal species, with wheat and barley tending to accumulate more Cd than maize, while As and Pb concentrations in grains were low for all crops studied. Although soil metal concentrations in Međimurje County were generally low, elevated TF values for As and Pb were observed, indicating enhanced soil-to-plant transfer under specific local soil conditions. In contrast, high soil metal concentrations in Slavonski Brod-Posavina County were associated with low TF values, suggesting limited bioavailability and restricted transfer to cereal grains. Both deterministic and probabilistic assessments indicated that the HQ and HI for adults and children were below 1, suggesting low non-carcinogenic risk from cereal consumption. These findings highlight pronounced regional and crop-specific differences in soil-to-plant metal transfer and confirm that low soil contamination does not necessarily imply low transfer potential, emphasizing the importance of integrated soil-plant-grain monitoring for food safety assessment.

Human activities inevitably affect natural ecosystems, the impact of which most often refers to negative factors resulting in the accumulation of toxic elements in environmental components. This study quantified the presence of 12 toxic elements (Cd, Co, Cr, Cu, Hg, Fe, Mn, Ni, Pb, Zn, As, and Se) in water, soil, and six melliferous plant species across the Republic of Croatia. Sampling sites were classified into four groups according to the dominant anthropogenic impact: agricultural areas, urban and traffic-affected zones, industrial vicinities, and forested hill regions. The results demonstrate the transfer of toxic elements from abiotic matrices into plants, indicating their potential as bioaccumulators. Soil contamination with toxic metals was identified as a relevant ecological risk factor, while contamination of melliferous plants highlights potential implications for human health through the production of honeybee-derived products. Element concentrations in water and soil were determined using three atomic absorption spectrometry techniques (FAAS, GFAAS, and CVAAS), whereas concentrations in floral samples of melliferous plants were measured using inductively coupled plasma mass spectrometry (ICP MS). The obtained results were interpreted in relation to natural background levels and the current national legislation. Anthropogenic impacts were further evaluated using environmental quality indices and bioaccumulation factors, revealing site-specific contamination patterns of both natural and anthropogenic origin.

Conventional measures such as maximal oxygen uptake (V˙O2max), although widely regarded as the gold standard, do not fully capture endurance performance. Therefore, this study investigated whether a 2.4 km Cooper test elicits measurable changes in blood-based biomarkers (decorin, hypoxanthine, N-terminal pro-B-type natriuretic peptide (NT-proBNP), brain-derived neurotrophic factor (BDNF)) and whether integrating these markers may improve performance prediction in a heterogeneous sample of runners. In this cross-sectional observational proof-of-concept study, thirty-three participants completed the 2.4 km Cooper test, with venous blood samples collected at baseline and post-test. Non-parametric statistical tests were used to assess biomarker changes (α = 0.05), with exploratory correlations evaluated using Spearman's ρ. To examine whether blood-based biomarkers provide information beyond conventional field-based predictors, Ridge regression with leave-one-out cross-validation (LOOCV) was applied to predict 10 km race time in a subsample of 24 participants who completed a 10 km race two weeks later. The Cooper test elicited significant post-test changes in decorin, hypoxanthine, and BDNF (all p < 0.001). Higher post-test decorin (ρ = -0.44, p = 0.010) and hypoxanthine (ρ = -0.37, p = 0.034) were associated with faster Cooper test performance. In Ridge regression analysis, adding post-test decorin to conventional predictors resulted in a minor reduction of 10 km race time prediction error. This study suggests that decorin may provide complementary information to a conventional field-based test in heterogeneous recreational runners. Post-test decorin marginally contributed to 10 km race performance prediction beyond established predictors, though external validation and comparison with directly measured V˙O2max are needed before practical application can be recommended.

A rise in infections associated with carbapenem-resistant Providencia species (CRPS) has been observed worldwide. This study presents a genomic analysis of CRPS isolates from four hospitals in Croatia and the outpatient setting, in order to determine the extent of the spread of CRPS in Croatia. In the present study, we applied a combination of phenotypic characterization and molecular analysis of resistance traits to determine the mechanisms and the routes of spread of CRPS. The antibiotic susceptibility testing was performed using disk-diffusion and broth dilution methods. The nature of extended-spectrum β-lactamases (ESBLs), carbapenemases, and fluoroquinolone resistance determinants was investigated by polymerase chain reaction (PCR). In order to obtain an insight into the whole resistome, selected isolates were subjected to the Interarray Genotyping Kit CarbaResist and whole genome sequencing (WGS). In total, 30 isolates were collected from four centers, located in different geographic regions of Croatia. There was uniform resistance to piperacillin-tazobactam, cefuroxime, expanded-spectrum cephalosporins (ESCs), imipenem, ertapenem, meropenem, and ciprofloxacin. Immunochromatographic testing and PCR revealed OXA-48 and NDM carbapenemase in 15 isolates, respectively. Phenotypic tests for ESBLs were positive in all OXA-48 and one NDM-positive organism (16 isolates). The isolates were categorized as extensively drug-resistant (XDR). OXA-48-producing isolates were susceptible only to ceftazidime-avibactam, whereas NDM producers were susceptible to cefiderocol and, in the majority of cases, also to amikacin. WGS identified a plethora of genes encoding resistance to aminoglycosides, such as aadA1 and aadA2, (aph(3″)-Ib and aph(6)-Id, sulfonamides sul1 and sul2, trimethoprim dfrA1, dfrA10, and dfrA12, tetracyclines tet(A) and tet(B), and chloramphenicol catA3 and catA5. Providencia spp., in spite of being a rare pathogen, should be included in the surveillance studies across the medical centers in Croatia.

Background/Objectives: Healthy lifestyle behaviors are major contributors to overall health and disease prevention. This cross-sectional study aimed to assess attitude toward a healthy lifestyle and its associations with lifestyle behaviors, body mass index (BMI), excess body weight, sociodemographic characteristics, and self-rated health in adults. Methods: The Attitudes toward a Healthy Lifestyle Questionnaire was administered to 570 Croatian adults between November and December 2025. Multiple linear and binary logistic regression models were used to examine associations between lifestyle behaviors (number of daily meals, sitting time, sleep duration), smoking and e-cigarette use, alcohol consumption, BMI, self-rated health, and attitude toward a healthy lifestyle. Results: The median attitude toward a healthy lifestyle score was 52.0 (IQR = 10), corresponding to 62% of the maximum possible score. A more positive attitude toward a healthy lifestyle was associated with a higher number of daily meals (β = 0.16, p = 0.001), longer sleep duration (β = 0.17, p < 0.001), lower sitting time (β = −0.11, p = 0.010), and lower BMI (β = −0.24, p < 0.001). Smoking was negatively associated with attitude toward a healthy lifestyle (β = −0.18; p < 0.001), while e-cigarette use was associated with fewer daily meals (β = −0.10; p = 0.025). Longer sleep duration increased the odds of excellent self-rated health (OR = 1.31, p = 0.014), and a more positive attitude toward a healthy lifestyle was associated with lower odds of excess body weight (OR = 0.92, p < 0.001). Conclusions: Attitude toward a healthy lifestyle is significantly associated with lifestyle behaviors, BMI, excess body weight, and self-rated health, highlighting the importance of psychological factors in promoting sustainable healthy lifestyles.

Intermittent claudication (IC) is the most frequent symptomatic manifestation of lower-extremity peripheral artery disease (PAD). Supervised exercise therapy (SET) and endovascular revascularization (ER) are established treatments, but their relative and combined effects on health-related quality of life (HRQoL) remain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing SET, ER, and ER+SET, with HRQoL as the primary outcome. Methods: Following PRISMA 2020, PubMed, Embase, and CENTRAL were used in December 2024. Eligible RCTs enrolled with IC (excluding critical limb-threatening ischemia) and reported validated HRQoL outcomes at ≥3 months. Two reviewers independently extracted data and assessed risk of bias using the Cochrane RoB 2.0 tool. Random-effects meta-analyses pooled standardized mean differences (SMDs) for HRQoL and mean differences (MDs) for walking distance. Results: Five RCTs (n = 728) were included. Compared with optimal medical therapy, both SET and ER improved HRQoL and walking distance. At 12 months, no significant effect was observed between SET and ER (SMD 0.02; 95% CI: −0.18 to 0.22). ER+SET was superior to SET alone (SMD 0.35; 95% CI: 0.12–0.57). Beyond 24 months, improvements were sustained with SET but attenuated with ER, accompanied by higher reintervention rates in ER-containing arms (approximately 20–30% by 2 years). Adverse events were rare (<1%). Conclusions: Given moderate-certainty evidence (GRADE), SET should remain the first-line therapy for intermittent claudication because it provides durable improvements in patient-centered outcomes with minimal harm. Endovascular revascularization (ER) can provide faster symptom relief, but its long-term benefits are constrained by restenosis and repeat procedures, particularly in femoropopliteal disease.

AimTo examine the associations between marital status, place of residence, self-reported health status, quality of life, and physical activity among older adults during the COVID-19 pandemic.Methods This cross-sectional study enrolled 962 participants aged 65 and older, surveyed between March 2020 and May 2023.Respondents were categorized according to marital status (married/living with a partner, single, divorced, widowed) and place of residence (own home vs nursing home).Standardized instruments were used: the Short Form Health Survey-36 for health status, the Personal Well-being Index for quality of life, and the Croatian short version of the International Physical Activity Questionnaire. ResultsRespondents who were married or living with a partner reported significantly higher levels of physical activity, better physical and mental health, and greater life satisfaction than single, divorced, or widowed respondents (P < 0.001).Community-dwelling respondents scored significantly higher on most health and quality-of-life indicators than nursing home residents, except for perceived future security. ConclusionMarital status and living arrangements significantly affected the self-perceived health, physical activity, and quality of life of older adults during the COVID-19 pandemic.The results emphasize the importance of social support and residential context in promoting healthy aging.

Introduction: Breaking, also known as breakdancing, has evolved from street culture to a structured sport, debuting in the 2024 Olympics. Despite its popularity, limited data exists on injury prevalence, types, and risk factors associated with acute and overuse injuries sustained from breaking. While existing studies offer insights into common injury patterns, they provide limited analysis of the specific mechanisms behind these injuries. This overview aims to classify acute and overuse injuries in breaking, reviewing 50 years of literature to identify risk factors and high-risk movements. Methods: The overview followed a predefined protocol using the PICO framework and was registered at OSF, targeting case reports and letters to the editor involving breakers. Databases searched included PubMed, ProQuest, Scopus, and EBSCO, covering literature from the 1970s to December 2023. Inclusion criteria were strictly case reports and letters to the editor that focused on injuries sustained from breaking. Results: A total of 41 papers were selected for inclusion after screening, reading and data extraction. Among these, 36 papers were reviewed in detail, encompassing acute and overuse injuries. The reported injuries involve high-impact movements, particularly affecting the upper extremities, head, neck, and back during spins, balancing, landing, and sliding. Acute injuries included fractures and dislocations, while chronic conditions involved soft tissue injuries, stress fractures, and nerve compressions. Risk factors identified in case reports included the lack of training supervision and specific breaking maneuvers like flips, spins, and balancing acts. Conclusion: This is the first overview of case reports and letters to the editor that categorizes breaking injuries based on these types of papers. It demonstrates the value of detailed medical diagnoses and standardized injury classification compared to self-reported injury data commonly found in surveys. Gaining a deeper understanding of injury mechanisms and risk factors could help promote safer practices as breaking continues to evolve as a competitive sport.

This contribution provides an overview of clinical ethics, examining the evolution of the field and its philosophical foundations. The evolution from the mid-1970s to the present day highlights clinical ethics as an interdisciplinary field where experts often collaborate to solve complex medical problems. Clinical ethics is embedded in medical practice, positioned at the intersection of medicine and philosophy, and grounded in various ethical and bioethical theories. Some problems in clinical ethics stem from underlying shortcomings within the healthcare system, while future challenges for the field are also underlined.