Valerija Bralić Lang

Physical activity (PA) is one of the most important factors for promoting health as well as preventing and treating various conditions and diseases that top the list of causes of morbidity and mort...

Background/Objectives: To evaluate the short-term effects of structured physical activity (PA), alone or combined with dietary counselling, in early-stage chronic kidney disease (CKD) patients managed in primary healthcare (PHC). Methods: This non-randomised controlled study was conducted in Croatia from 1 September to 30 November 2025. Ninety adults aged 40–75 years with early-stage CKD were allocated to three groups: structured PA, combined PA and dietary counselling, or control. Interventions included kinesiologist-led PA and, in the combined group, dietitian-led Mediterranean/plant-based counselling. Outcomes included estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (ACR), cardiometabolic risk factors, behavioural measures, quality of life, and sleep quality. Statistical significance was set at p < 0.01. Results: Seventy-eight participants completed follow-up. Changes in eGFR did not differ between groups (p = 0.310). Mean ± standard deviation changes in ACR were −1.10 ± 6.37, −0.86 ± 2.88, and +1.18 ± 3.13 in the PA, combined, and control groups, respectively (p = 0.017, not meeting the prespecified significance threshold). Significant between-group differences were observed for selected patient-reported and PA outcomes, including emotional well-being, energy/fatigue, role limitations due to emotional problems, sedentary time, and total PA (all p ≤ 0.006). Conclusions: Structured PA, with or without dietary counselling, improved PA behaviour and selected patient-reported outcomes in early-stage CKD managed in PHC but did not demonstrate significant short-term effects on kidney-related outcomes. These findings support the feasibility of integrating lifestyle-oriented interventions into PHC as part of integrated CKD care, while larger, longer-term studies are needed.

Aims: To determine the prevalence of non‐adherence to antihypertensive medicines and to identify demographic and behavioral factors associated with non‐adherence in subjects enrolled in the May Measurement Month (MMM) 2023, as part of the permanent public health action Hunting the silent killer.Methods: In this cross‐sectional opportunistic screening, the original MMM questionnaire was extended by adding questions related to salt intake, mobile phones, and adherence, which was assessed using the validated 5‐item Medication Adherence Report Scale (scores ≥23 indicating adherence). Out of 10 488 subjects enrolled in MMM 2023 in Croatia, this analysis included 8739 subjects who were enrolled in 329 community pharmacies and had three BP measurements using the same device.Results: Among 4964 HT participants, 68.2% were adherent. Non‐adherence was more common among men, urban residents, and younger individuals. Female sex (OR = 1.29) and rural residence (OR = 1.21) were associated with higher adherence. Non‐adherence was significantly associated with poorer BP control (p < 0.05). Forgetfulness and missing doses were the most frequently reported behaviors.Conclusion: Nearly one‐third of HT patients in Croatia are nonadherent to prescribed medicines, contributing to suboptimal BP control. Routine adherence screening and tailored interventions, particularly for younger men and urban dwellers, are urgently needed to improve cardio‐kidney‐metabolic outcomes.

The aim of this cross-sectional study was to determine the prevalence of the impostor phenomenon among family medicine residents (FMRs) and its connection with sociodemographic factors and clinically relevant symptoms of depression, anxiety, and stress. During July 2023, 158 first-year FMRs were invited to fill out an anonymous online questionnaire containing sociodemographic data, history of psychiatric disorders, Clance Impostor Phenomenon Scale (CIPS), and the 21-item Depression Anxiety Stress Scale (DASS-21). Seventynine participants responded (50 % response rate) and 59 reported some level of impostor feelings. Clinically relevant symptoms of depression were reported by 17, anxiety by 23, and stress by 20 participants. All 59 participants whose responses indicated impostor feelings above normal also had higher scores for depression, anxiety, and stress (pU test). Despite a small sample with uneven gender distribution and self-reported scales, our study found a significant association between the impostor phenomenon and negative mental outcomes. We believe that the impostor phenomenon among FMRs can be addressed effectively with interventions like peer support, mentoring, and practicing self-compassion if started early during medical study and specialisation.

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide, including in Croatia. Since most patients have multiple disorders and diseases caused largely by the same risk factors, and as it is essential to approach each patient as a person with all disorders, today, we are talking about a new paradigm—cardio-renal-metabolic (CKM) syndrome and cardio-renal-metabolic health, which necessarily includes brain health. Elevated systolic blood pressure, LDL cholesterol, smoking, obesity, diabetes, impaired renal function or chronic kidney disease, which all stem from insufficient physical activity, an unhealthy diet with excessive intake of table salt, and air pollution, are the leading causes of overall morbidity and mortality from CKM diseases, especially mortality from CVD. Experts from various fields key to CKM health have written this document with the aim of integrating it as part of the national plan for the prevention of chronic non-communicable diseases with a focus on CVD, which should become mandatory and be based on the existing guidelines of professional societies.

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality worldwide, including in Croatia. Since most patients have multiple disorders and diseases caused largely by the same risk factors, and as it is essential to approach each patient as a person with all disorders, today we are talking about a new paradigm - cardio-renal-metabolic (CKM) syndrome and cardio-renal-metabolic health, which necessarily includes brain health. Elevated systolic blood pressure, LDL cholesterol, smoking, obesity, diabetes, impaired renal function or chronic kidney disease, which all stem from insufficient physical activity, unhealthy diet with excessive intake of table salt, and air pollution, are the leading causes of overall morbidity and mortality from CKM diseases, especially mortality from CVD. Experts from various fields key to CKM health have written this document with the aim of integrating it as part of the national plan for the prevention of chronic non-communicable diseases with a focus on CVD, which should become mandatory and be based on the existing guidelines of professional societies.

Background: Pulse wave velocity (PWV) is a known predictor of target organ damage, cardiovascular disease and overall mortality. The aim of this study was to compare the PWV values in subjects with prediabetes, a non-dipper profile and arterial hypertension with their values in healthy subjects. Methods: A total of 301 subjects, aged 40–70 years, without diabetes mellitus were included in this cross-sectional study (150 with prediabetes). They underwent a 24 h ambulatory blood pressure monitoring (ABPM). Subjects were divided into three hypertension groups (A = healthy, B = controlled hypertension, C = uncontrolled hypertension). Dipping status was determined according to ABPM results, and PWV was measured by an oscillometric device. Prediabetes was defined as having 2 separate fasting plasma glucose (FPG) measurements between 5.6 and 6.9 mmol/L. Results: The highest PWV values were found in group C (9.60 ± 1.34 vs. 8.46 ± 1.01 in group B vs. 7.79 ± 1.10 in group A; p < 0.001), in subjects with prediabetes (8.98 ± 1.31 m/s vs. 8.26 ± 1.22 m/s; p < 0.001) and in prediabetic non-dippers among age groups (p = 0.05). In the multivariate regression model age, blood pressure, nocturnal indices and FPG were shown as independent predictors of PWV values. Conclusion: Significantly higher PWV values were found in subjects with prediabetes and non-dipping profiles in all three examined hypertension groups.

Up to 80% of antibiotics are prescribed in the community. An assessment of prescribing by indication will help to identify areas where improvement can be made. A point prevalence audit study (PPAS) of consecutive respiratory tract infection (RTI) consultations in general practices in 13 European countries was conducted in January–February 2020 (PPAS-1) and again in 2022 (PPAS-4). The European Surveillance of Antibiotic Consumption quality indicators (ESAC-QI) were calculated to identify where improvements can be made. A total of 3618 consultations were recorded for PPAS-1 and 2655 in PPAS-4. Bacterial aetiology was suspected in 26% (PPAS-1) and 12% (PPAS-4), and an antibiotic was prescribed in 30% (PPAS-1) and 16% (PPAS-4) of consultations. The percentage of adult patients with bronchitis who receive an antibiotic should, according to the ESAC-QI, not exceed 30%, which was not met by participating practices in any country except Denmark and Spain. For patients (≥1) with acute upper RTI, less than 20% should be prescribed an antibiotic, which was achieved by general practices in most countries, except Ireland (both PPAS), Croatia (PPAS-1), and Greece (PPAS-4) where prescribing for acute or chronic sinusitis (0–20%) was also exceeded. For pneumonia in adults, prescribing is acceptable for 90–100%, and this is lower in most countries. Prescribing for tonsillitis (≥1) exceeded the ESAC-QI (0–20%) in all countries and was 69% (PPAS-1) and 75% (PPAS-4). In conclusion, ESAC-QI applied to PPAS outcomes allows us to evaluate appropriate antibiotic prescribing by indication and benchmark general practices and countries.

Alcoholic liver cirrhosis (ALC) is the most common indication for liver transplantation (LT) in Croatia and presents a risk factor for the development of hepatocellular carcinoma (HCC). However, genetic susceptibility has not yet been systematically studied. We aimed to investigate the contribution of the risk polymorphisms PNPLA3 rs738409, EGF rs4444903, TM6SF2 rs58542926, MTHFR rs1801133, previously identified in other populations and, additionally, the contribution of Notch-related polymorphisms (NOTCH1 rs3124591, NOTCH3 rs1043996 and rs1044116, NOTCH4 rs422951). The study included 401 patients. The ALC group consisted of 260 LT candidates, 128 of whom had histopathologically confirmed HCC, and 132 of whom were without HCC. The control group included 141 patients without liver disease. Genotyping was performed by PCR using Taqman assays. The patients’ susceptibility to ALC was significantly associated with PNPLA3 rs738409, TM6SF2 rs58542926, and NOTCH3 rs1043996 polymorphisms. These polymorphisms remained significantly associated with ALC occurrence in a logistic regression model, even after additional model adjustment for sex and age. Cirrhotic patients with the PNPLA3 GG genotype demonstrated higher activity of ALT aminotransferases than patients with CC or CG genotypes. The susceptibility to the development of HCC in ALC was significantly associated with PNPLA3 rs738409 and EGF rs4444903 polymorphisms, and logistic regression confirmed these polymorphisms as independent predictors.