Bojan Miletic

Background/Objectives: Dynamic balance during the Y-Balance Test (YBT) relies on coordinated multi-joint control of the lower extremity. Although hip muscle strength is considered important for YBT performance, the relative contribution of individual hip muscle groups remains insufficiently understood. This study aimed to examine the associations between isometric hip abduction, external rotation, and extension strength and YBT performance in healthy adults. Methods: In this cross-sectional study, 104 healthy adults underwent assessment of isometric hip abduction, external rotation, and extension strength using strap-stabilized handheld dynamometry. Hip extension strength was measured in the prone position with the knee flexed to 90°. Strength values were normalized and expressed as joint torque (Nm/kg). YBT performance was assessed in the anterior, posteromedial, and posterolateral directions and as a composite score. Associations were examined using Pearson correlation coefficients. To account for the dependency of bilateral measurements, a linear mixed model (LMM) was used to evaluate the collective and independent contribution of hip strength components to YBT performance, with sex, age, and BMI included as covariates. Results: All hip strength measures showed significant positive correlations with YBT performance (r = 0.19–0.49, p < 0.05). Hip extension strength demonstrated the strongest associations, particularly with posterolateral reach (r = 0.49). After adjustment for demographic covariates, sex was the strongest predictor of YBT performance across all directions (β = 7.8–8.9, p < 0.001), with males achieving higher scores than females. Hip extension and abduction strength were significant predictors of posterolateral reach (p < 0.05), whereas no hip strength variable independently predicted anterior reach or composite score after adjustment for demographic factors. No significant differences in YBT performance were observed between limbs. Conclusions: Sex was the strongest predictor of YBT performance in healthy adults. Hip extension and abduction strength were independently associated with posterolateral reach performance after controlling for demographic factors, suggesting that the association between hip muscle strength and dynamic balance may be direction-specific. These findings highlight the importance of accounting for sex when interpreting the relationship between hip strength and YBT performance.

Background/Objectives: Cardiovascular diseases remain one of the major public health challenges in Croatia, with coronary artery disease (CAD) as the most prevalent. The uneven development and concentration of healthcare facilities in urban areas suggest that rural regions lag in providing adequate healthcare. Methods: This quantitative, retrospective study included 732 patients diagnosed with acute coronary syndrome (ACS) who were treated between 1 January 2014 and 31 December 2023 at Ogulin General Hospital, Croatia. Data were extracted from the hospital information system, and statistical analyses were performed, with p < 0.05 considered significant. Results: The analysis showed a decreasing trend in hospitalizations of patients with STEMI (Z = −3.574; p < 0.001) and an increase in hospitalizations of patients with NSTEMI (Z = 3.124; p = 0.002). No seasonal (χ² = 26.33; p = 0.238) or gender differences (χ² = 3.348; p = 0.188) were observed. A significant association between age and ACS occurrence was observed (χ² = 57.35; p < 0.001). The proportion of patients transferred to another health institution for further treatment was low (39.21%), particularly among patients with STEMI (12.89%). Conclusions: The results of this study indicate changes in the dynamics of ACS occurrence during the observed ten-year period. The number of hospitalizations is decreasing significantly, with a very low number of transfers of patients with STEMI; at the same time, there is an increase in hospitalizations of patients with NSTEMI. The study did not show statistically significant seasonal or gender differences in the incidence of ACS, while the incidence of NSTEMI increases with the age of the patients. These results emphasize the need for further improvement in the organization of healthcare for patients with ACS in the rural area served by Ogulin General Hospital.

Summary: We present here the case of a 30-year-old patient with severe avulsion injuries who had a successful reconstruction with extracellular matrix (ECM), split-thickness skin graft (STSG), and vacuum-assisted closure therapy, highlighting the benefits of these innovative treatments in complex trauma care. Avulsion injuries caused by trauma result in the tearing of soft tissues (skin and subcutaneous tissue) with exposed neurovascular structures, tendons, muscles, and bone, and pose a major challenge for surgical treatment. Conventional methods often include necrectomy and primary closure, STSG, and local or distant (free) flaps. The new approaches we propose include the use of ECM with STSG and vacuum-assisted closure therapy, which offered promising results: shorter surgical time, faster recovery and healing, equal or better aesthetic and functional outcome, and no loss of function in the donor area. The ECM acts as a biocompatible scaffold that promotes cell migration and tissue regeneration, which is crucial for wound healing.

INTRODUCTION: Sleep is not a passive state, but a vital process that ensures the renewal and regulation of the whole organism, especially the brain. Sleep disorders, which are increasingly prevalent among nurses and shift technicians, have a significant impact on their mental health and cognitive functions, increasing the risk of developing various health problems. RESEARCH OBJECTIVES: The aim of this study was to investigate the impact of shift work on the perceived sleep quality of nurses and technicians, with an emphasis on the differences between those who work in shifts and those who work in one shift, and to compare mental health and the incidence of chronic diseases between these two groups. METHODS: The research included a survey of 299 nurses and technicians in the Republic of Croatia, of which 190 were included in the analysis. The data were collected through an anonymous online questionnaire that included sociodemographic questions, the Pittsburgh Sleep Quality Scale, the Depression, Anxiety and Stress Scale, and questions about chronic diseases. Statistical analysis was conducted using the t-test and the Chi-square test to investigate the impact of shift work on sleep quality and mental health. RESULTS: The results showed that shift-working MS/MTs had poorer perceived sleep quality with an average PSQI score of 8.9 versus 6.6 in single-shift workers. Although participants in shifts had a higher presence of symptoms of depression, anxiety and stress, the difference in the incidence of chronic diseases between the two groups was not statistically significant. Therefore, while shift work negatively affects sleep quality, the effect on mental health and the incidence of chronic diseases has not been confirmed. CONCLUSION: The study showed that shift work significantly impairs the quality of sleep of nurses and technicians, while the differences in the levels of depression, anxiety and the incidence of chronic diseases were not statistically significant. These results indicate the need for further research and adaptation of working conditions in order to reduce the negative consequences of shift work on health.

Aim: This study aimed to determine the basic epidemiological characteristics of patients with stroke who were hospitalised at the General Hospital and the Hospital for Homeland War Veterans in Ogulin over a ten-year period.Materials and methods: A retrospective analysis ofdata from the hospital information system was conducted, encompassing all patients diagnosed with stroke at Ogulin General Hospital between January 1, 2014, and December 31, 2023.Results: A total of 1521 patients were diagnosed witha stroke. Of these, 81.7% were diagnosed with an ischaemic stroke. No statistically significant difference was found in the frequency of strokes between men andwomen (p = 0.233). The highest proportion of patients,39.7%, was in the 70- to 80-year age group. Most strokeswere recorded in January (147), while the fewest occurred in April (107). A total of 13.7% of patients diagnosed with a stroke were transferred to another hospital facility.Discussion: The study highlights stroke as a significantproblem in the rural region of Ogulin, primarily due tolimited resources. Early interventions, improved infrastructure, and standardised protocols are needed to reduce mortality and disability.

Background: Ageing is accompanied by physical, psychological and social changes that can negatively affect the quality of life of older adults. Loneliness is one of the most important psychosocial problems in later life and is closely related to lower life satisfaction. The aim of this study was to investigate the relationship between subjective loneliness and quality of life in older adults in Primorje-Gorski Kotar County, taking into account gender and living arrangements. Methods: A convenience sample of 153 adults aged 63 years and older participated in the study. Quality of life was assessed using the Personal Well-Being Index-Adult (PWI-A), and loneliness was measured using the short version of the UCLA Loneliness Scale. Statistical analyses included descriptive statistics, Spearman correlation and Mann–Whitney U test, performed in Statistica 14.0. Results: A significant negative correlation was found between loneliness and quality of life (r = −0.448; p < 0.01). A significant negative correlation was found between loneliness and quality of life (r = −0.448; p < 0.01). Women reported significantly higher levels of subjective well-being than men (p < 0.05), while no significant gender difference was observed for loneliness. No significant differences were found based on living arrangement (living alone vs. with others) (p > 0.05). Conclusions: The results confirm that loneliness significantly affects the subjective well-being of older adults. Gender differences were observed in subjective well-being but not in loneliness. Living arrangement did not show a strong influence. These results emphasize the need for targeted strategies and psychosocial interventions aimed at reducing loneliness and improving quality of life in ageing populations.

Background: The SARS-CoV-2 pandemic raised concerns about severe asthma (SA) patients, especially those on biological therapy. While initial fears of increased risks diminished for the general asthma population, a subset of severe cases undergoing specific treatments continued to be closely monitored. Our study aimed to evaluate COVID-19 occurrence, asthma exacerbations, hospitalizations, and outcomes in severe asthma patients. Methods: This multicenter study gathered data from 237 adult severe asthma patients in Croatia and Serbia to assess COVID-19 impact compared to the general population. Participants received omalizumab, mepolizumab, benralizumab, or reslizumab. Data on demographics, clinical features, and COVID-19 were collected. COVID-19 symptoms and diagnostic testing were assessed as described. Results: No demographic differences were seen between COVID-19-positive and -negative groups, with eosinophilic asthma prevailing. Among patients with SA treated with biologics, the occurrence of COVID-19 did not differ significantly from that in the general population, and biologic therapy was not associated with more severe disease or higher mortality. Importantly, no meaningful differences were observed among different biologics regarding COVID-19 outcomes. Vaccination was associated with a reduction in severe cases and hospitalizations. Conclusions: Biologic therapy for severe asthma appears safe during the COVID-19 pandemic. Patients receiving biologics did not experience worse outcomes than the general population, and no biologic was linked to poorer COVID-19 prognosis. Vaccination further contributed to protection against severe disease.

Background: Immunisation is one of the most effective public health interventions. However, parental knowledge and attitudes strongly influence vaccination decisions, particularly in the context of widespread misinformation. Methods: A cross-sectional study was conducted in 2025 in two paediatric clinics of the Primorje-Gorski Kotar County Health Centre, Croatia. A total of 320 parents of preschool-aged children (0–6 years) participated, of whom 79.7% were mothers. Data were collected through a structured, anonymous 26-item questionnaire distributed via QR code. Descriptive and inferential statistical analyses were applied, including chi-square tests, correlations, t-tests, and ANOVA. Results: The majority of parents (85.9%) reported vaccinating their children regularly, and 70.3% considered vaccination essential for disease prevention. Fear of side effects (59.1%) was the leading reason for hesitancy. Paediatricians were the most trusted source of information (89.4%), followed by the internet (60.3%). Parents with higher education and income expressed significantly more favourable attitudes towards vaccination (p < 0.01). Satisfaction with information provided by healthcare professionals was positively associated with confidence in vaccination, whereas the number of children was not a significant factor. Conclusion: Parents generally hold positive attitudes towards childhood immunisation, but persistent concerns about safety and misinformation remain. Strengthening communication and educational efforts by healthcare professionals—especially among parents with lower educational levels—is essential for maintaining public trust and high vaccination coverage. As emphasised in previous Croatian work, communication is central to improving vaccine confidence.

Background: Ageing is accompanied by physical, psychological and social changes that can negatively affect the quality of life of older adults. Loneliness is one of the most important psychosocial problems in later life and is closely related to lower life satisfaction. The aim of this study was to investigate the relationship between subjective loneliness and quality of life in older adults in Primorje-Gorski Kotar County, taking into account gender and living arrangments. Methods: A random sample of 153 adults aged 65 years and older participated in the study. Quality of life was assessed using the Personal Wellbeing Index – Adult (PWI-A) and loneliness was measured using the short version of the UCLA Loneliness Scale. Statistical analyses included descriptive statistics, Spearman correlation and Mann-Whitney U test, performed in Statistica 14.0. Results: A significant negative correlation was found between loneliness and quality of life (r = –0.448; p < 0.01). A significant negative correlation was found between loneliness and quality of life (r = –0.448; p < 0.01). Women reported significantly higher levels of subjective well-being than men (p < 0.05), while no significant gender difference was observed for loneliness. No significant differences were found based on living arrangement (living alone vs. with others) (p > 0.05). Conclusions: The results confirm that loneliness significantly affects the subjective well-being of older adults. Gender differences were observed in subjective well-being but not in loneliness. Living arrangement did not show a strong influence. These results emphasize the need for targeted strategies and psychosocial interventions aimed at reducing loneliness and improving quality of life in ageing populations.

Introduction: National preventive screening program, such as mammography for women aged 50–69 years, are essential for detecting malignancies at the earliest stage and improving cure rates. Healthcare workers are the most effective promoters of public health prevention programmes. This study examines the response of healthcare workers in Croatia to the program they help promote. Materials and Methods: The study involved 102 female healthcare workers aged 50–72 years in Istria County (Croatia). This study was conducted using a 13-question questionnaire created using Google Form. The data were processed using Microsoft Excel and Statistics 14.0.0.15, adhering to ethical principles and maintaining respondent privacy. Results: The study showed a response rate of 92% among healthcare workers who had received an invitation to undergo mammography screening. The response rate was significantly higher than the average response rate of 60% among the general population of women in Croatia. The main reasons for non-response were practical reasons such as acute illness, lack of information, and working hours. Long-term health education and promotion, better information and advertising, and more flexible working hours have been suggested to increase response rates. Conclusion: Healthcare workers showed higher participation in mammography screening than the general population, reflecting a strong awareness of prevention. Removing practical barriers and improving information could enhance healthcare workers’ motivation to promote these programs and increase their participation in the general population.