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Detection of sarcopenia in patients with liver cirrhosis using the bioelectrical impedance analysis
No full textUvod: Bioelektrična impedancija (BIA, engl. bioelectrical impedance analysis) je metoda procjene sastava tijela. Cilj istraživanja bio je utvrditi njenu točnost u detekciji sarkopenije u bolesnika s cirozom jetre. Kao referentna metoda korišten je indeks skeletnog mišićnog tkiva (SMI, engl. skeletal muscle index) na razini trećeg lumbalnog kralješka (L3-SMI) dobiven korištenjem višeslojne kompjutorizirane tomografije. Ispitanici i metode: Bolesnici s cirozom jetre uključeni su u razdoblju od listopada 2019. do ožujka 2022. te su praćeni do siječnja 2023. Njihovi BIA parametri uspoređeni su s vrijednostima L3-SMI te su korištenjem ROC (engl. receiver operating characteristic curve) analize predložene granične vrijednosti BIA parametara u detekciji sarkopenije. Temeljem dobivenih kliničkih karakteristika analizirani su i ishodi bolesnika. Rezultati: Uključeno je ukupno 106 bolesnika. Pronašli smo značajnu korelaciju između BIA parametara i L3-SMI. Odredili smo granične vrijednosti od ≤11,1 kg/m2 za BIA-SMI (Se 73%, Sp 66%, AUROC 0,737, p < 0,001) i ≤5,05° za PA (Se 79%, Sp 60%, AUROC 0,762, p < 0,001) u detekciji sarkopenije. Relativni rizik od smrti bio je 2,2 puta veći u bolesnika sa skeletno-mišićnom masom (SMM, engl. skeletal muscle mass) ≤36,5 kg. SMM je ujedno pokazao značajnu povezanost s ishodima u Kaplan-Meierovoj analizi. Zaključak: Ova neinvazivna i jednostavna metoda, koja je pokazala dobre dijagnostičke mogućnosti i vrlo dobro predviđanje ishoda, mogla bi ispuniti potrebu za brzim i pristupačnim otkrivanjem sarkopenije u bolesnika s cirozom jetre.Background: Bioelectrical impedance analysis (BIA) is a body composition assessment method. We aimed to determine its accuracy in the detection of sarcopenia in patients with liver cirrhosis (LC), using skeletal muscle index (SMI) at the level of third lumbar vertebra (L3- SMI) obtained using the multislice computed tomography as the reference method. Patients and methods: Patients with LC were enrolled in the period October 2019–March 2022 and follow-ups were conducted until January 2023. Their BIA parameters were compared against L3-SMI, and BIA cut-off values were proposed using AUROC analysis. Patients underwent outcome analysis based on obtained clinical characteristics. Results: A total of 106 patients were included. We found a fair correlation between BIA parameters with the L3-SMI.We determined cut-off values of ≤11.1 kg/m2 for BIA-SMI (Se 73%, Sp 66%, AUROC 0.737, p < 0.001) and ≤5.05° for phase angle (PA) (Se 79%, Sp 60%, AUROC 0.762, p < 0.001) in the detection of sarcopenia. The relative risk of death was 2.2 times higher in patients with skeletal muscle mass (SMM) ≤36.5 kg. SMM was significantly associated with outcome in Kaplan–Meier analysis. Conclusion: This non-invasive and simple method that showed fair performances and a very good outcome prediction could provide for the unmet need for fast and affordable detection of sarcopenia in patients with LC and should be further evaluated
State as patron – commissions and acquisitions of artwork for interiors of public institutions in Croatia from the early 1950s to the end of the 1960s
No full textUmjetnička djela naručena i otkupljena za interijere javnih ustanova od strane države tijekom 1950-ih i 1960-ih čine značajan, ali još uvijek nedovoljno istražen segment hrvatske povijesti umjetnosti. U kontekstu poslijeratne obnove i izgradnje države među brojnim važnim investicijama bile su i javne građevine čiji su interijeri opremljeni suvremenim umjetničkim djelima. Likovni umjetnici, arhitekti i dizajneri, vođeni idejama modernizama i „sinteze svih umjetnosti“ ostvarili su niz projekata u kojima je javnosti predstavljen suvremeni umjetnički izraz, ali i zahtjevi jugoslavenske (kulturne) politike. Disertacija donosi analizu i interpretaciju kulturne politike FNRJ-a/SFRJ-a i NR/SR Hrvatske iz rakursa otkupa umjetnina i opremanja interijera, istraživanje mehanizama otkupa i narudžbi likovnih djela, povijesnoumjetnički kontekst i povijest uređenja interijera javnih ustanova, razmatranje i kontekstualizaciju istaknutih radova, komparativne primjere te tipologiju likovnih djela.This doctoral thesis focuses on the relationship between the state and art based on the commission and acquisition of artwork for the interior spaces of public institutions in the territory of the People's Republic (NR) and the Socialist Republic (SR) of Croatia from the early 1950s to the late 1960s. The works of art commissioned from contemporary artists or acquired throughout the 1950s and 1960s for the purpose of interior design of public, or social institutions, as they were called at the time, form a significant, but still largely under-researched, segment of Croatian art history. Commissions, tenders and acquisitions of art have a prominent role in the context of post-war reconstruction and the formation of a new state, as evidenced by the aesthetic quality of some of the completed works, and a vast number of works that have only partially been preserved today or segmentally dealt with in literature, museum documentation and archival material. The number and quality of the works offer themselves today as testimonies of a range of state initiatives in the period from the 1950s to the 1960s especially those that were launched in order to ensure that a percentage of investment construction funds in the entire Federal People's Republic of Yugoslavia (FNRJ), that is, the Socialist Federal Republic of Yugoslavia (SFRJ) was used for the acquisition of artworks. In addition, the artistic quality also represents the artist's active consideration and commitment to the adoption of the so-called synthesis of all arts. This concept signified a unification of architecture, fine arts and design into a unique, total work of art. Since the artworks in this thesis primarily relate to paintings and sculptures commissioned or acquired for buildings of representative public characteristics, the research focused primarily on artistic furnishing of public interiors (governmental, cultural, sports and health institutions, military, tourist, catering and transportation facilities, and factories, company branches and banks) which have been analysed within the context of Yugoslav social ownership and a range of legal acts and by-laws passed in the researched period. The corpus of artworks on which the research was conducted includes a wide scope of media and different functions of buildings, and since the largest client was the state, i.e. state administration, institutes, associations, cooperatives, companies and other institutions financed from the state budget, the research topic and interpretation have been subject to a broad historical, cultural and artistic analysis. The first chapter (Introduction) provides an overview of previous research directly or indirectly linked to the topic of the thesis, the sample and methodology as well as research limitations, which have mostly been related to the issue of availability of archival documents. The chapter concludes with the research goal and hypotheses. The hypotheses are the following: 1) the acquisition and commission of artwork in Yugoslavia and the Republic of Croatia during the 1950s and 1960s were initiated and heavily regulated by the state; 2) the concept of artistic synthesis, or more specifically, the integration of architecture and fine arts, is advocated on all levels of government administration and state institutions that were responsible for culture and art; 3) cultural policy, ideological agendas of the state and the type of public institution impact the use of iconographic, formal and stylistic features of artworks and the level of the artistic synthesis; 4) due to their number, quality and socio-political circumstances the acquired and commissioned artworks for public interiors in the 1950s and 1960s represent an important segment in Croatian art history. The second chapter of the thesis (Socio-historical context and cultural policy of FNRJ/SFRJ and NR/SR of Croatia) presents the socio-historical and political context in Croatia and Yugoslavia between the Second World War and the 1970s. The chapter explains the definitions of ideology, culture and cultural policy that form the basis of the state's political decisions of the time as well as a political and cultural framework from within which the artworks have been analysed. The chapter ends with a brief overview of the cultural policies in the People's /Socialist Republic of Croatia and the Federal People's Republic of Yugoslavia or, the Socialist Federal Republic of Yugoslavia, which includes the period of the so-called agitprop culture, an institutional implementation of cultural policy in the 1950s and 1960s and the reforms and censorship of the early 1970s. Within the legislative framework, the Yugoslav cultural policy objectives were to protect cultural heritage, incentivise the production of artworks through the organisation of events and otherwise, supervise and educate artists, experts and cultural workers, while maintaining control of the entire field of artistic and intellectual creativity. The development of cultural policies from the end of the Second World War to the early 1970s had several phases. In the first phase, from 1945 to 1951/1952, also called the period of "agitprop culture," the Yugoslav cultural policy exercised strict supervision and intense ideological pressure on culture. This could be felt in the production, acquisitions and commissions of artworks especially during 1948 and 1949, when the acquired art represented predetermined partisanship, particular ideas and connective affinities among all Yugoslav peoples. In other words, the socially engaged message of these works could be interpreted in a rather straightforward fashion. The second phase of Yugoslav cultural policy came after the temporary cessation of Agitprop (until the reactivation of the Ideology Committee). Although this phase saw a gradual liberalization, decentralization and bureaucratization of the artistic and cultural field of production, especially after the Sixth Congress of the Communist Party of Yugoslavia (1952), in the 1950s and 1960s Yugoslav cultural policy was completely dependent on the state-party policy, which meant that state's cultural institutions exercised exclusive control of the field. This also meant there were coexisting tendencies – one was an increased openness towards expressions of high modernism - abstract and new post-war figurative forms, especially in public art and monuments, and the other was the retention of a clear ideological and memorial function of art, very often manifested as socialist realism. Following the early liberalization process and lowered ideological pressure, the early 1950s saw an individualization of artistic expression, and various works of art of moderate and radical modernist tendencies appeared on the art scene, which, despite numerous debates and resistance, were supported by the state through exhibitions, scholarship, public acquisition and commission. In the early 1960s, the highest echelons of the government denounced the dominant position of abstract art, which in 1962 and 1963 led to changes in the acquisition policy. The restricted freedom of artistic expression did not, however, continue in the second half of the decade when the state encouraged both institutionally and financially the development of art that could be characterised as supporting modernist tendencies. The third chapter of the thesis provides an overview of the post-war art in Croatia, or more specifically, an overview of artistic developments and debates, cultural and political upheavals and overviews of artistic forms, styles and movements, mostly socialist realism and abstract art, which marked the post-war art scene and which were particularly significant in the context of the commission and acquisition of artworks for the interior spaces of specific state institutions. The overview begins with the cultural and political context of post-war art and a series of important speeches by statesmen and artists on the role and position of art - from adherence to the ideological program of the state to the freedom of artistic creation. The chapter also gives an account of important exhibitions that served as testing grounds for the affirmation of new artistic expressions and events that spurred a number of critical reviews. These exhibitions include Archaic Surrealism (1952) by Antun Motika, Miljenko Stančić and Josip Vaništa (1952), American Experience (1953) by Edo Murtić, the exhibition of painters from the EXAT 51 group (1953), Salon 54 (1954) and the 1 st Didactic Exhibition: Abstract Art (1957). One segment of the chapter provides a brief overview and definitions of artistic forms, styles, movements and protagonists in post-war art in Croatia, while other focus more on the ideological aspects of socialist realism and abstract art and their significance concerning the specific geopolitical position of Yugoslavia. The fourth chapter, entitled The Synthesis of Fine Arts – the Development of the Concept and Its Influence on Art in Public Interiors in the 1950s and 1960s in Croatia, deals with the history of the concept "synthesis of fine arts" from the 19th century to the 1960s, particularly focusing on the post-war period in the international context and the Socialist Republic of Croatia. It was a complex idea that most often implied the unification of architecture, design and applied arts, painting and sculpture into a unique work of art. The chapter provides an explanation of the institutional framework of the concept of synthesis, and based on the research of archival material and the then-current periodicals it offers a reconstruction of the debates about the synthesis of all arts that took place during artists' meetings, at exhibitions and conferences and in magazines published in the period in question. It also highlights the significance of the synthesis of fine arts in the theoretical concept of gestalt theory. The fifth chapter, entitled Instruments of the Acquisition and Commission of Artworks for the Interiors of Public Institutions in the Territory of the People's/ Socialist Republic of Croatia in the 1950s and 1960s offers an unprecedentedly thorough reconstruction and explanation of the role of institutionalized cultural activities in the 1950s and 1960s (state administration, foundations, academies, state master workshops and professional associations and cooperatives) in the history of acquisition and commission policies regarding artworks in Yugoslavia and Croatia. The chapter goes on to explore in detail the state acquisition and commissioning process and the instruments, the impact of cultural policy on the acquisition and commission of artworks in the context of the expenditures for culture from the annual federal /republican budget, in the context of cultural and socio-political developments and legal acts and by-laws on the allocation of a percentage for artworks within investment construction project budgets. An important aspect of the chapter represents the investigation into the work of acquisition committees at the federal, republican and local levels of government, which often decided the fate of artists, the allocation of funds to numerous museum and gallery institutions, but also influenced the visual presentation of government in public buildings. The composition of the committees was also indicative of and depended on the country's cultural policy. In the post-war period, the committees were often made up of state administration employees, people imposed by the party, but also experts in culture such as art historians. In the early 1950s, they were largely made up of visual artists, and members of professional art associations who were sometimes accused of irregularities in following the procedures of purchasing and commissioning artworks. Apart from the association, the commissioning process was also greatly influenced by the State's Master Workshops as independent institutions which, due to considerable grants, favourable working conditions and the buildings they owned, were the only ones able to realize large orders, and thus influence the form and content of the works. Attempts to regulate the aforementioned instruments were the subject of numerous debates, as well as proposals for regulations, decrees and recommendations, especially during the 1950s. Considering the proliferation of proposals and legal acts in a single decade, artistic commissions and acquisitions for the interiors of public institutions embody a dynamic relationship between art and the state. The sixth and biggest chapter of the thesis offers a typology of artworks commissioned and acquired for public buildings of various functions. Sub-chapters contain an analysis and interpretation of a considerable number of diverse works of art situated in the interiors of administrative, military and educational institutions, cultural, and health institutions, catering establishments, shops, branches of banks and post offices, transport infrastructure facilities, factories, associations and societies, tourist architecture and residences of the President of the Socialist Federative Republic of Yugoslavia. Although the typology has been created based on several criteria, including the type of work, location, client and motivation for the integration of art and architecture, the research of archival and museum documentation, periodicals, in situ buildings and previous research is given in sub-chapters by the type of public institutions in order to combine in one place the similarities and differences of artworks situated in the interiors of particular institutions that depended on socio-political circumstances. Each function of the building is presented within its context, with numerous examples which represent an overview of acquisitions and commissions for the interior, an example selected for its aesthetic and sociopolitical significance, which provides an in-depth analysis and interpretation of the work. They are also presented through a comparative example in other Yugoslav republics. At the end of the chapter, there is a short list of examples divided according to the proposed typology. At the very end, in addition to the list of references, the doctoral dissertation includes appendices (various archival documents) and a list of works in the interiors of public institutions in Croatia in the 1950s and 1960s. The list contains known information about the location, author, year, type of work and technique, client, selected works of literature related to the work, and a photograph (if the work has been preserved or if there is photo documentation). Additionally, each work has a note related that usually includes information about the architect of the building, the collaborators and the degree of preservation of the work. The research carried out for this thesis has resulted in the first comprehensive analysis, contextualisation, interpretation and valorisation of artworks produced for public interiors in Croatia in the 1950s and 1960s. It also provides an insight into the role of the state as a client, and numerous aspects of cultural and acquisition policies that have not been addressed so far. New information is provided about numerous unknown or lesser-known works of painting and sculpture commissioned and acquired for the interiors of public institutions. Consequently, the results include the attribution and dating of ten artworks. The contribution of the research comes in the form of typology and a list of artworks in the interiors of public institutions that were commissioned or acquired in the 1950s and 1960s with some examples from the 1940s and 1970s). The systematization and interpretation of the material and the critical analysis of primary and secondary sources expand on the previous knowledge about the art of the 1950s and 1960s and fragmentarily researched works of art
Behavioral approach to safe public transportation system
No full textSustavi javnog prijevoza ključni su za funkcioniranje modernih gradova, omogućavajući povezivanje urbanih i ruralnih područja te smanjenje prometnih gužvi i onečišćenja. Učinkovitost ovih sustava ovisi o čimbenicima poput redovitosti, brzine, ekonomičnosti i, najvažnije, sigurnosti. Kvalitetna infrastruktura, sigurnosni protokoli i pouzdana vozila osiguravaju gospodarski rast i kvalitetu života, a rast potražnje zahtijeva kontinuirani razvoj i prilagodbu sustava potrebama korisnika. Sigurnost putnika ključna je za uspješan sustav javnog prijevoza. Ponašanje korisnika, vođeno osjećajem sigurnosti i čimbenicima poput dobi, spola i povjerenja u sustav, značajno utječe na prevenciju nesreća. Strah od kriminala također može odvratiti pojedince od korištenja javnog prijevoza, naglašavajući važnost edukacije i jasno definiranih sigurnosnih mjera. Primjenom cjelovitog pristupa i spoznaja iz biheviorizma, doktorski rad temeljen na prethodnim djelomičnim istraživanjima nastojao je utvrditi varijable koje najpouzdanije predviđaju sigurnost u javnom prijevozu. Primarno istraživanje provedeno na 506 ispitanika pokazalo je kako demografski čimbenici i osobine ličnosti značajno utječu na svijest o sigurnosti. Starije osobe i žene, posebno iz ranjivih skupina, izražavaju veću zabrinutost, dok empatični i odgovorni pojedinci pokazuju veću prilagodbu sigurnosnim zahtjevima. Okruženje, poput osvjetljenja i dizajna stanica, dodatno oblikuje percepciju sigurnosti, kao i društvene norme koje potiču pridržavanje sigurnosnih pravila. Rezultati su potvrdili kako svijest o sigurnosti pozitivno utječe na sigurno ponašanje. Edukacija i informiranost povećavaju usvajanje sigurnih navika, dok percipirana osjetljivost i ozbiljnost rizika motiviraju putnike na oprez. Percipirana ozbiljnost dugoročno jača kulturu sigurnosti u javnom prijevozu. Prikupljeni primarni podaci nisu potvrdili značajnu povezanost između svijesti o sigurnosti i osobnih izdataka za prijevoz. Za razvoj sigurnog sustava javnog prijevoza preporučuje se integrirani pristup: edukacija putnika, poboljšanje infrastrukture, obuka zaposlenika te jačanje društvenih normi i podrške. Osvijetljene stanice, vizualni podsjetnici i obučeno osoblje mogu povećati percepciju sigurnosti i smanjiti rizike, dok poticanje sigurnosne kulture doprinosi održivosti sustava. Sustavi javnog prijevoza ključni su za funkcioniranje modernih gradova, omogućavajući povezivanje urbanih i ruralnih područja te smanjenje prometnih gužvi i onečišćenja. Učinkovitost ovih sustava ovisi o čimbenicima poput redovitosti, brzine, ekonomičnosti i, najvažnije, sigurnosti. Kvalitetna infrastruktura, sigurnosni protokoli i pouzdana vozila osiguravaju gospodarski rast i kvalitetu života, a rast potražnje zahtijeva kontinuirani razvoj i prilagodbu sustava potrebama korisnika. Sigurnost putnika ključna je za uspješan sustav javnog prijevoza. Ponašanje korisnika, vođeno osjećajem sigurnosti i čimbenicima poput dobi, spola i povjerenja u sustav, značajno utječe na prevenciju nesreća. Strah od kriminala također može odvratiti pojedince od korištenja javnog prijevoza, naglašavajući važnost edukacije i jasno definiranih sigurnosnih mjera. Primjenom cjelovitog pristupa i spoznaja iz biheviorizma, doktorski rad temeljen na prethodnim djelomičnim istraživanjima nastojao je utvrditi varijable koje najpouzdanije predviđaju sigurnost u javnom prijevozu. Primarno istraživanje provedeno na 506 ispitanika pokazalo je kako demografski čimbenici i osobine ličnosti značajno utječu na svijest o sigurnosti. Starije osobe i žene, posebno iz ranjivih skupina, izražavaju veću zabrinutost, dok empatični i odgovorni pojedinci pokazuju veću prilagodbu sigurnosnim zahtjevima. Okruženje, poput osvjetljenja i dizajna stanica, dodatno oblikuje percepciju sigurnosti, kao i društvene norme koje potiču pridržavanje sigurnosnih pravila. Rezultati su potvrdili kako svijest o sigurnosti pozitivno utječe na sigurno ponašanje. Edukacija i informiranost povećavaju usvajanje sigurnih navika, dok percipirana osjetljivost i ozbiljnost rizika motiviraju putnike na oprez. Percipirana ozbiljnost dugoročno jača kulturu sigurnosti u javnom prijevozu. Prikupljeni primarni podaci nisu potvrdili značajnu povezanost između svijesti o sigurnosti i osobnih izdataka za prijevoz. Za razvoj sigurnog sustava javnog prijevoza preporučuje se integrirani pristup: edukacija putnika, poboljšanje infrastrukture, obuka zaposlenika te jačanje društvenih normi i podrške. Osvijetljene stanice, vizualni podsjetnici i obučeno osoblje mogu povećati percepciju sigurnosti i smanjiti rizike, dok poticanje sigurnosne kulture doprinosi održivosti sustava.Public transportation systems are essential for the functioning of modern cities, enabling the connection of urban and rural areas while reducing traffic congestion and pollution. The efficiency of these systems depends on factors such as regularity, speed, cost-effectiveness, and, most importantly, safety. Quality infrastructure, safety protocols, and reliable vehicles ensure economic growth and quality of life, while increasing demand necessitates the continuous development and adaptation of systems to meet user needs. Passenger safety is critical for the success of public transportation systems. User behavior, guided by a sense of security and factors such as age, gender, and trust in the system, significantly influences accident prevention. Fear of crime can also deter individuals from using public transportation, underscoring the importance of education and clearly defined safety measures. Through a comprehensive approach and insights from behaviorism, this doctoral thesis, based on prior partial studies, aimed to identify variables that most reliably predict safety in public transportation. A primary study conducted on 506 respondents revealed that demographic factors and personality traits significantly influence safety awareness. Older individuals and women, especially those from vulnerable groups, express greater concerns, while empathetic and responsible individuals demonstrate higher adaptability to safety requirements. Environmental factors, such as lighting and station design, further shape perceptions of safety, as do social norms that encourage adherence to safety rules. Results confirmed that safety awareness positively impacts safe behavior. Education and awareness campaigns promote the adoption of safe habits, while perceived vulnerability and seriousness of risks motivate passengers to exercise caution. Perceived seriousness also strengthens the culture of safety in public transportation over the long term. The collected primary data did not confirm a significant correlation between safety awareness and personal transportation expenses. To develop a safe public transportation system, an integrated approach is recommended: passenger education, infrastructure improvement, employee training, and the reinforcement of social norms and support. Well-lit stations, visual reminders, and trained personnel can enhance the perception of safety and reduce risks, while fostering a culture of safety contributes to the sustainability of the system. Building a robust communication strategy that informs passengers about safety practices can greatly enhance safety awareness. Regularly updated information on safety protocols, potential hazards, and emergency procedures should be easily accessible. Developing targeted training programs for public transport staff can equip them to handle various safety scenarios effectively. This training should encompass conflict resolution, first aid, and crisis management skills to increase overall responsiveness. Furthermore, integrating technology into safety protocols, such as mobile applications that provide real-time alerts about safety issues, could empower passengers. This approach not only informs users about potential dangers but also creates a community of safety-minded individuals who actively participate in promoting safety. Research indicates that the integration of smart technologies in public transportation can lead to enhanced safety and more positive passenger experiences. Regular safety audits of public transportation systems can help identify potential risks and ensure that safety protocols are being followed. These audits should involve external safety experts who can provide unbiased assessments and recommendations. Encouraging public feedback on safety measures enhances cooperation and allows authorities to adapt more quickly to emerging concerns. Utilizing surveys and suggestion boxes in stations can facilitate this engagement process. Community involvement in safety initiatives can foster a culture of collective responsibility for passenger safety. Organizing community workshops focused on safety awareness can increase engagement and educate the public about best practices. Furthermore, partnership with local schools to educate students about safe transportation habits can instill lifelong safety awareness in future generations. Addressing broader societal issues, such as poverty and access to public transportation, can be integral to improving safety. Communities with limited resources may experience higher crime rates, which can negatively impact perceptions of safety in public transport systems. Thus, holistic approaches that include socio-economic improvements, alongside transportation safety measures, are necessary. Supporting local economic development initiatives can enhance community stability and, consequently, the safety of public transport systems. It is essential also to recognize the role of emergency response services in ensuring public transport safety. Collaborating with local police or emergency services can create a comprehensive safety strategy, leading to improved incident management. Training sessions that include first responders can enhance coordination during emergencies, ensuring that protocols are clear and practiced. Furthermore, fostering a culture where passengers hold each other accountable for safe behavior can strengthen collective safety awareness. Passengers should feel empowered to speak up about unsafe practices without fear of repercussions. Campaigns that promote this kind of active engagement can create communities invested in maintaining safety standards. In addition, using social media and digital platforms to disseminate safety information allows for quicker outreach and greater public awareness. Engaging influential figures to advocate for safety measures can help spread awareness and encourage participation in safety initiatives. Routine safety drills and public demonstrations can also serve as practical educational opportunities for both staff and passengers. Therefore, it is crucial to establish clear metrics for evaluating safety awareness and behavioral changes among passengers. Ultimately, the goal of enhancing safety in public transportation transcends mere compliance with regulations; it is about building trust among users. By prioritizing a behavioral approach, it can be created environment where safety awareness thrives and accidents are minimized
Distribution of lymphocytes and their association with the secretion of pro-inflammatory and anti-inflammatory cytokines in pregnant women with gestational diabetes
No full textCilj: Gestacijski dijabetes (GD) definiran je kao hiperglikemija koja se prepoznaje prvi puta
tijekom trudnoće, a njegova je incidencija u porastu. Cilj istraživanja bio je ispitati razlike u
omjerima imunoloških stanica (NKT/NK-stanica, B1/B2-limfocita, pomagačkih/citotoksičnih Tlimfocita) između trudnica s GD-om i zdravih trudnica te odrediti razinu proupalnih i
protuupalnih biljega (IL-6, TNF-α, IL-10, adiponektin) i njihove genske varijante povezane s
imunološkim odgovorom te usporediti rezultate s rutinskim biokemijskim i hematološkim
parametrima.
Nacrt studije: Istraživanje je ustrojeno kao presječno istraživanje te je u njemu sudjelovalo 162
trudnice u trećem trimestru trudnoće. Ispitanice su podijeljene u 4 skupine: trudnice s GD-om
bez komplikacija, trudnice s GD-om i dodatnim komplikacijama, kontrolna skupina trudnica
(koje nisu razvile GD) bez komplikacija i kontrolna skupina trudnica (trudnice koje nisu razvile
GD) s komplikacijama.
Ispitanici i metode: Venska je krv uzorkovana trudnicama u trećem trimestru trudnoće te su
učinjene analize koje su obuhvatile određivanje kompletne krvne slike i diferencijalne krvne
slike, glukozu, lipide, C-reaktivni protein, imunoglobuline, hormone (inzulin, C-peptid), vitamine
(B12, folna kiselina), NT-proBNP, željezo, feritin, HbA1c, interleukin (IL)-6, IL-10, TNF-α,
adiponektin, imunofenotipizaciju limfocita protočnom citometrijom i genotipizacija varijanti
gena rs266729 (AdipoQ), rs1800629 (TNF-α), rs1800896 (IL-10) i rs1800796 (IL-6) metodom
lančane reakcije polimeraze u stvarnom vremenu.
Rezultati: Nema statistički značajne razlike u omjerima NKT/NK-stanica, B1/B2-limfocita i
pomagačkih/citotoksičnih limfocita između trudnica s GD-om i zdravih trudnica, međutim kod
trudnica s GD-om omjer je B1/B2-limfocita bio niži kod visokih vrijednosti IL-6 te u značajnoj
negativnoj vezi s adiponektinom. Različiti omjeri imunoloških stanica bili su povezani s drugim
biokemijskim parametrima, poput lipida i hormona. Određene genske varijante (SNP)
povezane su s povećanim rizikom od razvoja GD-a. Genotip CG u rs1800769 u genu za IL-6 i
genotip CC u rs266729 u genu AdipoQ pokazali su se čimbenicima rizika za razvoj GD-a. Nisu
pronađene značajne povezanosti između ispitivanih genotipova i izmjerenih koncentracija
adiponektina, IL-6, IL-10 i TNF-α.
Zaključak: Genotip CG u rs1800769 u genu za IL-6 i genotip CC u rs266729 u genu AdipoQ
povezani su s rizikom za razvoj GD-a, a omjer B1/B2-limfocita u značajnoj je vezi s
vrijednostima adiponektina kod trudnica s GD-om.Objective: Gestational diabetes (GD) is defined as hyperglycemia that is recognized for the
first time during pregnancy, and its incidence is increasing. The aim of the research was to
examine the differences in the ratios of immune cells (NKT/NK-cells, B1/B2-lymphocytes,
helper/cytotoxic T-lymphocytes) between pregnant women with GD and healthy pregnant
women, and to determine the level of pro-inflammatory and anti-inflammatory markers (IL-6 ,
TNF-α, IL-10, adiponectin) and their genetic variants associated with the immune response,
and also compare the results with routine biochemical and hematological parameters.
Study draft: The research was organized as a cross-sectional study, and 162 pregnant women
in the third trimester participated in the research. The test subjects were divided into 4 groups:
pregnant women with GD without complications, pregnant women with GD and additional
complications, a control group of pregnant women (who did not develop GD) without
complications and a control group of pregnant women (pregnant women who did not develop
GD) with complications.
Subjects and methods: Venous blood was sampled from pregnant women in the third trimester
of pregnancy and analyzes were performed that included determination of complete blood
count and differential blood count, glucose, lipids, C-reactive protein, immunoglobulins,
hormones (insulin, C-peptide), vitamins (B12, folic acid), NT-proBNP, iron, ferritin, HbA1c,
interleukin (IL)-6, IL-10, TNF-α, adiponectin, immunophenotyping of lymphocytes by flow
cytometry and genotyping of polymorphisms rs266729 (AdipoQ), rs1800629 (TNF-α),
rs1800896 (IL-10) and rs1800796 (IL-6) by the polymerase chain reaction method.
Results: There is no statistically significant difference in the ratios of NKT/NK-cells, B1/B2-
lymphocytes and helper/cytotoxic lymphocytes between pregnant women with GD and healthy
pregnant women, however, in pregnant women with GD, the ratio of B1/B2-lymphocytes was
lower with high values of IL-6 and in a significantly negative relationship with adiponectin.
Different ratios of immune cells were associated with other biochemical parameters, such as
lipids and hormones. Single nucleotide polymorphisms (SNPs) are associated with an
increased risk of developing GD. The CG genotype in rs1800769 in the IL-6 gene and the CC
genotype in rs266729 in the AdipoQ gene were shown to be risk factors for the development
of GD. No significant associations were found between the genotypes for adiponectin, IL-6, IL10 and TNF-α and the measured concentrations of these cytokines.
Conclusion: The CG genotype in rs1800769 in the IL-6 gene and the CC genotype in rs266729
in the AdipoQ gene are associated with the risk of developing GD, and the ratio of B1/B2-
lymphocytes is significantly related to adiponectin values in pregnant women with GD
Association between dynamics of Suppression of Tumorigenicity 2 concentration in serum and ischemic stroke outcome
No full textUvod: Moždani udar (MU) je vodeći uzrok invaliditeta i smrtnosti diljem svijeta. U kliničkoj praksi, prognoza se temelji na kliničkim, neuroslikovnim i laboratorijskim parametrima od kojih niti jedan nije dovoljno osjetljiv i specifičan da omogući ranu prognozu i olakša donošenje terapijskih odluka. Neuroupala je sve više prepoznata kao ključni čimbenik u patofiziologiji ishemijskog MU-a (IMU) pri čemu biljezi poput proteina supresora tumorogenosti 2 (ST2) postaju važni pokazatelji upalnih odgovora koji mogu utjecati na napredovanje oštećenja neurona i ukupni ishod bolesnika.
Cilj: Cilj ovog istraživanja bio je utvrditi može li dinamika otpuštanja upalnog serumskog biljega ST2 predvidjeti ishod IMU-a uz procjenu korisnosti kliničkih, neuroslikovnih i rutinskih laboratorijskih parametara u ishodu IMU-a.
Metode: Provedeno je prospektivno, longitudinalno, opservacijsko istraživanje kod ispitanika s akutnim IMU-om, kod kojih je mjerena koncentracija ST2 i zabilježeni su klinički, neuroslikovni i rutinski laboratorijski parametri, u sedam vremenskih točaka, počevši od prijema (T0), a zatim u uzastopnim 24-satnim intervalima (T1−T6). Nakon 90 dana od početka IMU-a, praćeni su funkcionalni ishod prema modificiranoj Rankinovoj ljestvici (0−2 za dobar i 3−6 za loš ishod) te mortalitet svih uzroka.
Rezultati: U istraživanje je uključeno 20 ispitanika s IMU-om, od kojih je nakon 90 dana 15 imalo loš ishod, a osam je preminulo. Ispitivanje dinamike otpuštanja ST2 pokazalo je najvišu koncentraciju u T1, nakon čega je uslijedio postupni pad. Značajne razlike u koncentracijama ST2 između skupina s dobrim i lošim ishodom, kao i preživjelih i umrlih, nakon 90 dana, pronađene su u većini točaka mjerenja, s najvećom prognostičkom točnošću u T1 (medijan 38 sati) pri vrijednosti >18,9 μg/L. Statistički značajne razlike između istih skupina također su uočene u vrijednostima NIHSS skora (prema engl. National Institutes of Health Stroke Scale), koncentracijama C-reaktivnog proteina (CRP), albumina, vrijednostima PNI-a (prema engl. Prognostic Nutritional Index) i broju trombocita, kao i u volumenu infarkta mozga (VIM).
Zaključak: Rezultati istraživanja potvrdili su značaj dinamike ST2 u ishodu IMU-a, otvarajući mogućnost ispitivanja njegove kliničke primjene osobito u ranim fazama IMU-a, gdje bi ST2 kao biljeg mogao značajno unaprijediti skrb bolesnika. Od kliničkih parametara, NIHSS skor, VIM, a dijelom i PNI, pokazali su se dobrima za prognozu ishoda. Rutinski laboratorijski testovi, osim CRP-a, nisu se pokazali korisnima u praćenju dinamike niti u prognozi ishoda.Introduction: Stroke is a leading cause of disability and mortality worldwide, with significant public health consequences. In clinical practice, prognosis relies on clinical, neuroimaging, and laboratory parameters, none of which are sufficiently sensitive or specific to enable early prognosis and facilitate treatment decisions. The pathophysiology of ischemic stroke (IS) increasingly recognizes neuroinflammation as a key factor, and biomarkers like suppression of tumorigenicity 2 (ST2) are emerging as important indicators of inflammatory responses that may influence the progression of neuronal damage and overall patient outcomes.
Aim: This study aimed to determine whether the dynamics of the release of the inflammatory serological biomarker ST2 could predict IS outcome, alongside of assessing the usefulness of clinical, neuroimaging, and routine laboratory parameters in predicting IS outcomes.
Methods: A prospective, longitudinal, observational study was conducted involving patients with acute IS. ST2 concentrations and clinical, neuroimaging, and routine laboratory parameters were measured at seven time points, starting at admission (T0), followed by consecutive 24-hour intervals (T1−T6). After 90 days from the onset of IS, functional outcomes were assessed using the modified Rankin Scale (0−2 for good outcome and 3−6 for poor outcome), along with all-cause mortality.
Results: The study included a total of 20 IS patients. After 90 days, 15 patients had poor outcomes, and eight patients died. The analysis of ST2 release dynamics showed the highest concentration at T1, followed by a gradual decline. Significant differences in ST2 concentrations between the groups with good and poor outcomes and between survivors and deceased were found in most measurement points, with the highest prognostic accuracy at T1 (median 38 hours) at a cutoff value of >18.9 μg/L. Additionally, statistically significant differences between the same groups were observed in National Institutes of Health Stroke Scale (NIHSS), C-reactive protein (CRP) and albumin concentrations, prognostic nutritional index (PNI), platelet counts, and infarct volume (IV).
Conclusion: The study's findings confirmed the importance of ST2 dynamics in the outcome of IS, opening avenues for exploring its clinical application, particularly in the early stages of IS, where ST2 as a biomarker could significantly enhance patient care. Among clinical parameters, NIHSS, IV and, to a lesser extent, PNI proved effective for outcome prediction. At
the same time, routine laboratory tests, except for CRP, did not show usefulness in monitoring dynamics or predicting outcomes
The impact of socio-emotional factors and financial difficulties on the choice of exit strategy in a family business
No full textIstaknuta istraživanja u području obiteljskog poduzetništva sugeriraju da obiteljska poduzeća, osim financijskih ciljeva (maksimizacija financijskog bogatstva) slijede i nefinancijske ciljeve. Nefinancijski ciljevi obiteljskih poduzeća u današnjoj su znanstvenoj literaturi objedinjeni pod krovnim pojmom socio-emocionalnog bogatstva. Na temelju uzorka mikro, malih i srednjih poduzeća u Hrvatskoj ova doktorska disertacija istražuje neekonomske pokretače ponašanja poduzetnika predstavljene socio-emocionalnim bogatstvom koji utječu na namjeru prodaje poduzeća kao strategije izlaska iz obiteljskog poduzeća te empirijski utvrđuje povezanost ključnih socio-emocionalnih čimbenika na donošenje odluke o prodaji poduzeća odnosno zadržavanju pod obiteljskom kontrolom. Rezultati univarijatnih i multivarijatnih logističkih regresijskih modela u ovom istraživanju pokazuju kako postoji negativna povezanost socio-emocionalnog bogatstva na namjeru prodaje poduzeća. Ustanovljena je statistički značajna negativna povezanost s dimenzijama koje predstavljaju Obnovu obiteljskih veza dinastičkom sukcesijom i Emocionalnu povezanost članova obitelji. Ovo istraživanje empirijski istražuje povezanost namjera prodaje poduzeća kod vlasnika obiteljskih poduzeća kada se poduzeće suočava s financijskim poteškoćama. Nalazi ove studije upućuju na to da ne postoje statistički značajne razlike u financijskim poteškoćama, mjerene Altmanovim Z-rezultatom, s obzirom na namjeru prodaje poduzeća.Highlighted research in the field of family entrepreneurship suggests that family businesses pursue not only financial goals (maximizing financial wealth) but also non-financial objectives. In contemporary scientific literature, the non-financial goals of family businesses are consolidated under the umbrella concept of socio-emotional wealth. Based on a sample of micro, small, and medium-sized enterprises in Croatia, this doctoral dissertation examines the non-economic drivers of entrepreneurial behavior represented by socio-emotional wealth, which influence the intention to sell the business as an exit strategy from the family firm. It empirically determines the relationship between key socio-emotional factors and the decision to sell the business or retain it under family control. The results of univariate and multivariate logistic regression models in this study indicate a negative relationship between socio-emotional wealth and the intention to sell the business. A statistically significant negative correlation was found with the dimensions representing the Renewal of Family Bonds through Dynastic Succession and the Emotional Attachment of Family Members. This study empirically investigates the relationship between the intention to sell the business among family business owners when the company is facing financial distress. The findings of this study suggest that there are no statistically significant differences in financial distress, measured by Altman’s Z-score, concerning the intention to sell the business
The relationship between Instagram use and appearance satisfaction in adolescents : an experience sampling method approach
No full textDosadašnja istraživanja pokazuju kako medijski sadržaj koji prikazuje ideal ljepote snižava zadovoljstvo izgledom. Tripartitni model utjecaja pretpostavlja kako vanjski čimbenici djeluju na to da pojedinac internalizira taj ideal i da se s njim uspoređuje, što pridonosi nižem zadovoljstvu izgledom, no on ne objašnjava kratkoročne promjene u pojedincima. Kratkoročne učinke medija objašnjava Model diferencijalne osjetljivosti na učinke medija, koji postulira kako su efekti koje mediji izazivaju u pojedincu određeni njegovim osobnim obilježjima, ali i da ta obilježja mogu mijenjati iste. Integracijom postavki navedena dva modela osmišljen je Model medijskog efekta Instagram sadržaja na zadovoljstvo izgledom. Njime se pretpostavlja način na koji sadržaj na Instagramu može djelovati na trenutno zadovoljstvo izgledom adolescenata. Istraživanje je provedeno sa srednjoškolcima u Hrvatskoj, aplikacijom ExpiWell, putem koje su 10 dana 4 puta dnevno prikupljani podatci o Instagram sadržaju i trenutnom zadovoljstvu izgledom. Dobiveni podaci analizirani su višerazinskim modeliranjem. Rezultati pokazuju kako prikazi ljudi ne doprinose značajno trenutnom zadovoljstvu izgledom, no dobiveni prosječni efekt je snažniji kod adolescenata koji više vrednuju vlastiti izgled. Rezultati ukazuju kako prikazi ljudi ne doprinose značajno socijalnoj usporedbi. U slučajevima kada se adolescenti usporede s osobom koju su vidjeli, izvještavaju o značajno nižem trenutnom zadovoljstvu izgledom te je taj efekt snažniji kod mlađih adolescenata. Rezultati pokazuju kako ni prikazi vršnjaka ni prikazi slavnih osoba ne doprinose značajno trenutnom zadovoljstvu izgledom, no efekt prikaza slavnih osoba snažniji je kod adolescenata koji manje vrednuju vlastiti izgled. Rezultati ukazuju kako sami prikazi ljudi na Instagramu nemaju, ali socijalna usporedba ima značajan efekt na trenutno zadovoljstvo izgledom adolescenata. Dobivene spoznaje pružaju podlogu za daljnja istraživanja efekata korištenja društvenih mreža na svakodnevno funkcioniranje adolescenata te ukazuju na važnost uključivanja adolescenata u pripremu istraživanjaPrevious research shows that portrayals of the beauty ideal in the media lowers appearance satisfaction. The Tripartite Influence Model assumes that external factors influence the individual to internalize this ideal and compare with it, which contributes to lower appearance satisfaction, but it does not explain short-term changes in individuals. The short-term effects of the media are explained by the Differential Susceptibility to the Media Effects Model, which postulates that the effects caused by the media on an individual are determined by their's characteristics but also that these characteristics can change them. Based on the integration of the propositions of the two models, the Model of Media Effect of Instagram Content on Appearance Satisfaction was designed. It hypothesizes how content on Instagram can influence adolescents' state appearance satisfaction. The research was conducted with high school students in Croatia using the ExpiWell application, through which data on Instagram content and state appearance satisfaction was collected 4 times a day for 10 days. The obtained data were analyzed by multilevel modeling. The results show that depictions of people do not significantly contribute to state appearance satisfaction, but the average effect is stronger in adolescents with higher appearance evaluation. The results indicate that depictions of people do not significantly contribute to social comparison. In cases where adolescents compare themselves to a person they have seen, they report significantly lower state appearance satisfaction, and this effect is stronger in younger adolescents. The results show that neither depictions of peers nor depictions of celebrities contribute significantly to state appearance satisfaction, but the effect of depictions of celebrities is stronger in adolescents with lower appearance evaluation. The results indicate that depictions of people on Instagram alone don't, but social comparison has a significant effect on adolescents' state appearance satisfaction. The knowledge obtained provides a basis for further research into the effects of using social media on the daily functioning of adolescents and indicates the importance of including adolescents in the preparation of research
THE DEVELOPMENT OF BASIC SILHOUETTES OF WOMEN'S CLOTHING ADAPTED TO THE FUNDAMENTAL PRINCIPLES OF SUSTAINABILITY IN FASHION
No full textOdrživi razvoj od velike je važnosti za proizvodne procese kako bi se očuvala ekologija i prirodni resursi zbog čega se razvio pristup u dizajnu odjeće koji poštuje aspekte održivog razvoja i koncepta bez otpada što je temeljna postavka ovog doktorskog rada. U Uvodu se ističe važnost zadovoljavanja pet osnovnih kriterija tijekom dizajnerskog procesa kao što je estetika odjevnog predmeta, pristalost, ekonomska isplativost, međukrojni gubitak i mogućnost proizvodnje. U poglavlju Pregled tematike objašnjava se pojam silueta odjeće, njihov razvoj kroz povijesna razdoblja do danas. Opisan je rad dizajnera kojima je silueta ženske odjeće ključni element u njihovim modnim kolekcijama, s naglaskom na siluete oblika „T“, „A“,“ X„ i „I“, koje se u doktorskom radu postavljaju u fokus temeljnih postavki istraživanja. Opisuju se tipovi i konstitucije ženskog tijela koji u području dizajna imaju ključnu ulogu prilikom odabira odjeće i formiranjem osobnog stila pojedinaca, krojne slike te je objašnjen pojam međukrojnog gubitka, opisan je kriterij pristalosti odjeće, pojam, metode i primjena koncepta bez otpada, naglašava se važnost komunikacije među potrošačima te se pojašnjava računalni program Clo3D koji svoju primjenu nalazi u području dizajna. Cilj ovog doktorskog rada je analizirati postojeće metode koncepta bez otpada i predložiti novu metodu u dizajnu za osnovne siluete ženske odjeće uz maksimalno iskorištenje tkanine, razviti održive smjernice za dizajn i novu metodu osnovnih silueta ženske odjeće te izraditi dizajnersku kolekciju temeljenu na osnovnim siluetama ženske odjeće prema dobivenim smjernicama nove metode. Sukladno ciljevima postavljene su i hipoteze istraživanja. Predstavljen je i opisan plan, varijable i metode istraživanja. Kao rezultat istraživanja razvijena je nova TAXI metoda koncepta bez otpada koja se temelji na dizajnu osnovnih silueta ženske odjeće s maksimalno mogućim iskorištenjem tkanine u svrhu održivosti. Ovim sveobuhvatnim konceptom po načelu održivosti temeljni krojevi se prilagođavaju maksimalnom mogućem iskorištenju tkanine, estetskim kriterijima i pristalosti s ciljem unaprjeđenja proizvodnih procesa prema načelima kružnog gospodarstva.Sustainable development is of great importance for production processes in order to preserve ecology and natural resources, which is why an approach has been developed in clothing design that respects aspects of sustainable development and the zero-waste concept, which is the basic premise of this doctoral thesis. The Introduction highlights the importance of meeting five basic criteria during the design process, such as garment aesthetics, fit, economic profitability, cut loss and manufacturability. The topic overview chapter explains the concept of clothing silhouettes and their development through historical periods until today. The work of designers for whom the silhouette of women's clothing is a key element in their fashion collections is described, with an emphasis on the silhouettes of the shapes "T", "A", "X" and "I", which are placed in the focus of the basic settings of the research in the doctoral thesis. The types and constitutions of the female body are described, which in the field of design play a key role when choosing clothes and forming the personal style of individuals, garment cut images, and the concept of intercut loss is explained. The criterion of clothing fit, the concept, methods and application of the no-waste concept are described, the importance of communication between consumers and the computer program Clo3D is emphasized, which finds its application in the field of design. The aim of this doctoral thesis is to analyze the existing methods of the zero-waste concept, to propose a new design method for basic silhouettes of women's clothing with maximum use of fabric, to develop sustainable design guidelines and a new method of basic silhouettes of women's clothing, and to create a design collection based on basic silhouettes of women's clothing according to obtained guidelines of the new method, and research hypotheses were set in accordance with the goals. The research plan, variables and methods are presented and described. As a result of the research, a new TAXI method of the zero-waste concept was developed, which is based on the design of basic silhouettes of women's clothing with the maximum possible use of fabric for the purpose of sustainability. With this comprehensive concept based on the principle of sustainability, basic cuts are adapted to the maximum possible use of fabric, aesthetic criteria and fit with the aim of improving production processes according to the principles of the circular economy
Testing the Deficit Model and the Contextual Model of Vaccine Hesitancy
No full textU suvremenom društvenom kontekstu u kojemu odluke o cijepljenju te sumnje u sigurnost i učinkovitost cjepiva predstavljaju izazov za područje javnog zdravstva, izrazito je naglašena važnost da se kroz sociološku perspektivu istraže specifičnosti jedne uglavnom medicinske teme poput oklijevanja prema cjepivima. Nedavna pandemija je naglasila da sumnje u sigurnost i učinkovitost cjepiva otkrivaju kompleksnost odnosa znanosti i društva, odnosno javnog razumijevanja znanosti. Stoga je ova disertacija usmjerena na istraživanje odnosa oklijevanja prema cjepivima, pismenosti, vjerovanja u teorije zavjera o cjepivima, nepovjerenja u zdravstveni sustav, religioznosti i političke orijentacije kroz prizmu dvaju dominantnih socioloških modela znanosti i znanja: modela deficita i kontekstualnog modela. Model deficita pripisuje oklijevanje nedostatku znanja i znanstvene pismenosti, a kontekstualni model naglašava ulogu sociokulturnih i drugih čimbenika. Kvantitativnim istraživanjem na nacionalnom uzorku od 1306 sudionika istraživanja i primjenom modeliranja strukturnih jednadžbi (SEM), analizirana je povezanost spomenutih varijabli. Rezultati su pokazali da je oklijevanje više povezano s kontekstualnim varijablama poput vjerovanja u teorije zavjera o cjepivima, nego sa dobrim poznavanjem znanstvenih i zdravstvenih činjenica. Dodatno, disertacija se bavi kompleksnom dinamikom oklijevanja, pri čemu se rezultatima ističu razlike i specifičnosti oklijevanja. Zaključno na temelju rezultata naglašavamo važnost uzimanja u obzir da sumnje u sigurnost i učinkovitost cjepiva ne proizlaze nužno zbog samih cjepiva ili manjeg poznavanja empirijski potvrđenih činjenica. Kada se u obzir uzmu drugi aspekti koji se s oklijevanjem povezuju i koje smo uvidima istaknuli, naglašava se važnost interdisciplinarne suradnje, kojima će se premostiti dosadašnja ograničenja istraživanja i pružiti dublji uvidi u specifičnosti oklijevanja prema cjepivima i javnog razumijevanja znanosti.In today’s society, where decisions about vaccination and doubts about the safety and effectiveness of vaccines pose challenges not just for public health but for all aspects of society, it’s crucial to explore vaccine hesitancy from a sociological perspective. Historically, vaccines have contributed to eradicating smallpox, nearly eliminating polio, and reducing the incidence of diseases such as tetanus or measles. Nevertheless, despite the well-known success of vaccines, the recent pandemic highlighted a persistent societal and healthcare challenge – vaccine hesitancy – which has existed since the earliest days of vaccination. In this dissertation, vaccine hesitancy is broadly defined as general uncertainty about vaccines, although common definition proposed by World Health Organization group sees vaccine hesitancy as a delay in making a vaccination decision, reflecting a spectrum between outright refusal and partial acceptance. In many public health campaigns, vaccine hesitancy is often viewed as consequence of insufficient information (Goldenberg, 2016). This perspective presupposes that people are “uninformed” and that simply providing them with knowledge, like wielding a magic wand, will eliminate all doubts and negative attitudes toward vaccines. It also appears, at least implicitly, in arguments that attribute negative attitudes toward science in general, or toward vaccination in particular, to so-called “unthinking” laypersons. The recent pandemic made it clear that many countries struggled to reach their vaccination goals, despite public health campaigns and efforts by scientists to inform people about vaccine’s safety. This reveals that concerns about vaccines go beyond knowing evidence-based facts and point to a deeper, more complex relationship between science and society. In addition to “uninformed citizens” and anti-vaccination narratives, the pandemic was also characterized by excessive dissemination of both information and misinformation in traditional and contemporary media, as well as the lack of trust in broad spectre of institutions. This is especially relevant given that conspiratorial anti-vaccine narratives are particularly appealing to those who, in light of the aforementioned context, are disinclined to trust information coming from authorities such as scientists, healthcare professionals or political representatives. By defining the issue of vaccine hesitancy solely as a problem of insufficient information, this broader context can be overlooked. Consequently, what appears to be a purely medical topic needs to be situated within a sociological framework that recognizes vaccine hesitancy as a part of the broader relationship between science and society. Such a perspective underscores the importance of additional variables in shaping negative attitudes toward science in general, and more specifically, toward vaccine-related issues. With this in mind, dissertation titled Testing the Deficit Model and the Contextual Model of Vaccine Hesitancy, focuses on understanding the relationship between vaccine hesitancy and various factors such as scientific and health literacy, belief in vaccine conspiracy theories, distrust in the healthcare system, religiosity, and political identification. The research is framed using two models of public understanding of science: the deficit model, which attributes hesitancy to a lack of knowledge or scientific literacy, and the contextual model, which emphasizes the role of social, cultural and other aspects relevant for vaccine hesitancy. The deficit model helps explain how scientific literacy shapes “lay” attitudes toward science, assuming that a better-informed public will be more positively disposed toward scientific findings (Miller, 1983,1998). This model primarily focuses on shortfall in “textbook” knowledge, which purportedly leads to scepticism (Sturgis & Allum, 2004). In the deficit model, scientific literacy bridges scientists and the public by emphasizing reliable information, critical thought, factual knowledge and education. Critics note that ambiguous definitions complicate measuring scientific literacy universally. Moreover, Goldenberg (2016) points out that misunderstanding science does not alone explain reluctance or refusal of vaccines; rejection may reflect deeper resistance to the values underlying scientific consensus. Contrary to the deficit model, the so-called contextual model suggests that knowledge is accumulated and applied within specific sociocultural contexts. This perspective emerged as a critique of the traditional positivist view of how scientific and technological information shapes public understanding of science in general, and vaccine hesitancy in specific. It challenges the central assumptions of the deficit model and underscores the plurality of knowledge that informs attitudes toward science and technology in general (Sturgis & Allum, 2004). Some scholars (Brossard and Lewenstein, 2009) explain that people are not “empty containers” but instead filter scientific information through their life experiences, thereby connecting individual and social factors to the issue of vaccine hesitancy and public understanding of science in general. In this light, some authors highlight trust in scientific expertise as crucial for contextualizing scientific knowledge (Rosman & Grösser, 2024). The emphasis lies on the applicability and social embeddedness of knowledge, where a person’s motivation to absorb new scientific insights is shaped by perceived benefits and relevance of science within their social milieu (Eisendel, 2000; Felt, 1999; Wynne, 1992). In this dissertation, studies have been highlighted which indicate that the link between scientific knowledge and attitudes toward science is not straightforwardly linear, but rather contextualized by various domains of knowledge and sociocultural variables. Based on previous research and empirical evidence, this dissertation sets out several key objectives. First, it aims to explain vaccine hesitancy by testing two models of public understanding of science, focusing on the role of scientific and health literacy, conspiracy beliefs, distrust in healthcare, religiosity, and political orientation. Second, it explores how vaccine hesitancy differs between well-established childhood immunizations and newer COVID-19 vaccines, recognizing that the pandemic has introduced additional factors—such as adherence to public health measures and information overload—for consideration. Finally, from a sociological perspective, the dissertation seeks to generate practical insights for public health interventions and campaigns designed to reduce vaccine hesitancy. To achieve the objectives of this dissertation, a quantitative data collection method was employed. The study population included citizens of the Republic of Croatia aged 18 to 65, stratified by region, settlement size, gender, and age (N=1306). Specifically, an online quantitative survey was conducted using a probabilistic sample stratified by age, gender, settlement size, and region. The Ipsos agency was commissioned to carry out the data gathering, which took place through the CAWI (Computer-Assisted Web Interviewing) method using Ipsos’s online panel. This decision was largely influenced by the pandemic context (2022) which includes a series of lockdowns and a rise in COVID-19 cases, that led to the conclusion that conducting an online panel survey would be the safest and most efficient way to protect public health and maintain research efficacy. The questionnaire, constructed from the measurement scales discussed in this dissertation, required approximately 20 minutes to complete and omitted open-ended questions to reduce the time burden on participants and facilitate straightforward quantitative coding. This study employed several measurement scales to capture various dimensions related to vaccine hesitancy, scientific and health literacy, vaccine conspiracy beliefs, distrust in healthcare systems, religiosity, and political identification. Vaccine hesitancy toward childhood vaccines was measured using the WHO’s Vaccine Hesitancy Scale (VHS), consisting of ten items assessing attitudes about vaccine importance, efficacy, safety, and the credibility of vaccine-related information. Hesitancy toward COVID-19 vaccines, on the other hand, was assessed through the OC19-VHS scale, which was specifically developed to gauge public attitudes relating to COVID-19 vaccine safety and effectiveness. To evaluate scientific literacy, the well-known Oxford Scientific Literacy Scale was employed. Health literacy was measured using HLS-EU-Q6, a concise, six-item scale that focuses on people’s ability to interpret health information and follow medical instructions. Beyond these measures, the study also incorporated a scale designed to assess belief in vaccinerelated conspiracy theories. Distrust in the healthcare system was evaluated with the Revised Health Care System Distrust Scale (RHCSDS), which distinguishes between trust in the system’s competence and reliability, and distrust in its moral and ethical values. Finally, two additional variables, religiosity and political identification, were captured through single-item measures. Religiosity was gauged through a 10-point scale where higher numbers represent a stronger sense of religious identity. Political identification was also measured through a 10- point scale extending from left-leaning views to right-leaning ones. A set of few hypotheses has been formulated, positing that greater levels of literacy reduce vaccine hesitancy, whereas stronger beliefs in conspiracy theories, higher religiosity, elevated distrust, and right-wing political orientations are likely to increase it. In parallel, a moderating effect of distrust and conspiracy beliefs is anticipated, implying that the beneficial role of literacy in mitigating vaccine hesitancy would weaken among individuals exhibiting moderate or high levels of distrust or belief in vaccine-related conspiracy theories. The analytical approach in this dissertation is structured around Structural Equation Modelling (SEM), applied to investigate the complex interplay of factors influencing vaccine hesitancy. The SEM approach was chosen due to its capacity to estimate multiple interrelated paths simultaneously, allowing for a more comprehensive examination of direct, indirect, and moderated effects. A critical aspect of the analytical procedure involves parcelling, a technique used to optimize the measurement model by reducing the number of indicators per latent variable. This method was employed to create composite indicators for scientific literacy, health literacy, and institutional trust, thereby enhancing the stability of parameter estimates and mitigating issues related to measurement error. The parcelling strategy followed the item-to-construct balance approach, ensuring that each parcel adequately represented the theoretical construct without distorting its underlying structure. Moderation analysis played a central role in testing the hypothesis that healthcare distrust and conspiracy beliefs weaken the expected negative relationship between literacy and vaccine hesitancy. This was conducted using multiplicative interaction terms, wherein moderator variables (institutional distrust and conspiracy beliefs) were centered before interaction terms were computed to prevent multicollinearity. The model evaluation relied on multiple goodnessof-fit indices, such as the Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), and the chi-square test of model fit. This approach allowed for a more refined understanding of how structural skepticism and ideological resistance shape vaccine attitudes beyond simple knowledge deficits. The findings suggest that higher levels of scientific and health literacy are only weakly associated with lower vaccine hesitancy. Moreover, when other factors are considered, it appears that they have a much stronger association with vaccine hesitancy. Additionally, the dissertation examines the specific context of hesitancy regarding the groups that appear to have higher levels of hesitancy, while paying particular attention to the specific challenges related to COVID-19 vaccines. The study underscores that addressing vaccine hesitancy and rebuilding public trust in experts is not simply a matter of introducing scientific facts about vaccines. Rather, it requires and understanding of the broader social, cultural and individual factors that shape public attitudes toward vaccines and public understanding of science. The dissertation calls for interdisciplinary collaboration to address the current research gaps and provide deeper insights into the complexities of vaccine hesitancy and public understanding of science
Reflective Model of Adherence to Non-Pharmaceutical Interventions in Preventing the COVID-19 Pandemic Based on the Normalization Process Theory
No full textPozadina istraživanja: Nefarmaceutske mjere (NFM) smanjuju prijenos infekcije COVID-19. Pridržavanje NFM-a u skladu s Teorijom procesa normalizacije (NPT) u koherentnim i prikladnim društvenim podskupinama korištenjem PLS-SEM reflektivnog mjernog modela do sada nije procijenjena. Metode: U veljači 2021. ispitanici - studenti medicine i osobe s poremećajima ovisnosti o drogama u liječenju kao koherentne (na temelju kontinuirane distribucije vjerojatnosti) u odnosu na prikladne skupine (na temelju pogodnosti, a ne jednake vjerojatnosti) sastavljene od putnika i osoba sumnjivih na COVID-19 iz Splitsko-dalmatinske županije (n = 656) popunili su anketne upitnike. U drugom dijelu istraživanja anketne upitnike su ispunili kronični bolesnici liječeni u dnevnim bolnicama (endokrinološka, respiracijski centar, hematološka i onkološka) KBC “Split” u razdoblju od svibnja do lipnja 2021. godine (n = 155). Modeliranje strukturnih jednadžbi parcijalnih najmanjih kvadrata (PLS-SEM) korišteno je za mjerenje reflektivnog modela procjene pridržavanja NFM-a prema NPT. Rezultati: Procjena reflektivnog modela PLS-SEM pružila je faktore specifične za dvije skupine u inverznim odnosima koji su odredili pridržavanje NFM-a s izvrsnom prilagodbom (χ 2 = 1,292, df = 1; P = 0,297, CFI = 1, TLI = 0,997, RMSEA = 0,011 (90% CI 0–0,105), RMSEA P = 0,604, SRMR = 0,008, Hoelter CN (α = 0,05) = 2322,757). Procjena kovarijance značajnih negativnih faktora (-0,716) otkrila je obrnuti odnos između prvog (pridržavanje NPI-a i internog lokusa kontrole [LoC] (0,640)) i drugog faktora; mlada odrasla dob (≤25) i najviši stupanj obrazovanja (1362). Kako je prvi faktor rastao, drugi je imao tendenciju pada. LoC je očekivani potencijalni mehanizam kojim spol (ML spol = −0,017, SE = 0,007, P < 0,016) i pripadnost koherentnim podskupinama (ML skupina = −0,008, SE = 0,003, P = 0,015) mogu proizvesti neizravni učinak pridržavanja NFM-a. U daljnjoj analizi primjenili smo postupak binomijalne regresijske analize da bi smo testirali dobiveni reflektivni PLS-SEM model pridržavanja NFM-a na kliničkom uzorku kroničnih bolesnika u dnevnom liječenju. Uključili smo tri prediktora (latentne varijable) iz dobivenog reflektivnog modela: dob, stručna sprema i Rooterov upitnik kontrole ponašanja. Dodali smo tri nove latentne varijable za koje smo pretpostavljali da mogu utjecati na pridržavanje NFM-a: trajanje bolesti, odbijanje liječenja tijekom COVID-19 pandemije i preboljenje infekcije COVID-19. Usporedimo li PLS-SEM reflektivni model pridržavanja NFM-a u homogenim i prigodnim skupinama s multinomijalnim regresijskim modelom pridržavanja NFM-a u skupini kroničnih bolesnika razvidno je da je PLS-SEM model imao izvrsno pristajanje. Tim je modelom objašnjen doprinos dobi (R2=0.452, 45.2% objašnjene varijance), stručne spreme (R2=0.391,39.1% objašnjene varijance) i vanjskog lokusa kontrole ponašanja (R2=0.109, 10,9% objašnjene varijance) u pridržavanju NFM-a. U skupini kroničnih bolesnika pomoću dva statistički značajna prediktora: preboljenje COVID-19 infekcije i tendencija eksternalnoj-vanjskoj kontroli ponašanja objašnjavaju se samo 14.9% varijance pridržavanja NFM-a. Prediktorske varijable kao što su dob i edukacija nemaju statistički značajan učinak na pridržavanje NFM-a u kroničnih bolesnika, dok je njihov doprinos u normalizaciji ponašanja u homogenim i prigodnim skupinama građana bez kroničnih oboljenja bio izuzetno značajan. Zaključak: Koherentne podskupine imale su izraženiju tendenciju integracije NFM-a u svakodnevni život. Grupni čimbenici koji olakšavaju normalizaciju bili su visoko obrazovani mlađi odrasli ljudi s tendencijom prema vanjskom LoC-u. Prediktorske varijable kao što su dob i edukacija nemaju statistički značajan učinak na pridržavanje NFM-a u kroničnih bolesnika, dok je njihov doprinos u normalizaciji ponašanja u homogenim i prigodnim skupinama građana bez kroničnih oboljenja bio izuzetno značajan. Tendencija vanjskoj kontroli ponašanja (external LoC) činila je kronične bolesnike prijemčljivijima za slijeđenje uputa i sklonijima pridržavanju i normalizaciji NFM-a u svakodnevnom životu. Razumijevanje ovih čimbenika omogućava stručnjacima da poboljšaju usklađenost prilagođavanjem javnozdravstvenih intervencija za ciljane društvene podskupine, kao i upravljanje u sadašnjim i budućim pandemijama. Naš reflektivni PLS-SEM model pridržavanja NFM-a temeljen na Teoriji procesa normalizacije mogao bi poslužiti kao teoretska i kvantitativna alternativa biomedicinskom modelu koji se koristi u planiranju javnozdravstvenih intervencija.Background: (Non-pharmaceutical interventions (NPIs) reduce the transmission of COVID-19. The adherence to NPIs has not yet been assessed using the Normalization Process Theory (NPT) in coherent and appropriate social subgroups through a PLS-SEM reflective measurement model. (Methods: (In February 2021, respondents - medical students and individuals undergoing drug addiction treatment, as coherent groups (based on continuous probability distribution) and convenience groups (based on convenience rather than equal probability) made of travelers and suspected COVID-19 cases from Split-Dalmatia County (n = 656) completed survey questionnaires. In the second phase, chronic patients treated in day hospitals (endocrinology, respiratory center, hematology, and oncology) at the Clinical Hospital Center Split participated between May and June 2021 (n = 155). Partial Least Squares Structural Equation Modeling (PLS-SEM) was employed to measure the reflective model of NPI adherence based on NPT. (Results: (The PLS-SEM reflective model evaluation provided two groups of specific factors with inverse relationships determining adherence to NPIs, demonstrating excellent model fit (χ 2 = 1,292, df = 1; P = 0,297, CFI = 1, TLI = 0,997, RMSEA = 0,011 (90% CI 0–0,105), RMSEA P = 0,604, SRMR = 0,008, Hoelter CN (α = 0,05) = 2322,757). The covariance analysis of significant negative factors (-0.716) revealed an inverse relationship between the first factor (adherence to NPIs and internal locus of control [LoC] (0.640)) and the second factor (young adult age (≤25) and higher education level (1362)). As the first factor increased, the second tended to decrease. LoC is a potential mechanism through which gender (ML gender = −0.017, SE = 0.007, P < 0.016) and coherent subgroup affiliation (ML group = −0.008, SE = 0.003, P = 0.015) can indirectly produce an influenced NPI adherence effect. Further analysis involved binary regression analysis to test the reflective PLS-SEM model to NPT adherence on a clinical sample of chronic patients in day treatment. Three predictors (latent variables) from the reflective model—age, education level, and Rotter's locus of control scale—were included, alongside three additional latent variables hypothesized to influence NPI adherence: disease duration, treatment refusal during the COVID-19 pandemic, and previous COVID-19 infection recovery. (Comparison between the PLS-SEM model for NPI adherence in homogeneous and convenience groups and the multinomial regression model for NPI in chronic patients revealed that the PLS-SEM model exhibited excellent fit. It explained the contribution of age (R² = 0.452, 45.2% of variance explained), education level (R² = 0.391, 39.1% of variance), and external LoC (R² = 0.109, 10.9% of variance explained) in adherence to NPIs. (In chronic patients, adherence to NPIs was explained by two significant predictors—previous COVID-19 infection recovery and a tendency towards external LoC—accounting for only 14.9% of variance in NPI adherence. Predictors like age and education statistically did not significantly affect NPI adherence among chronic patients, although their contribution was highly significant for behavior normalization in homogeneous and convenience groups without chronic illnesses. (Conclusion: (Coherent subgroups demonstrated a stronger tendency to integrate NPIs into daily life. Group factors facilitating normalization included highly educated young adults with a tendency toward external LoC. Predictors like age and education statistically did not significantly affect NPI adherence among chronic patients, though they were crucial for behavior normalization in in homogeneous and convenience groups without chronic illnesses. (The tendency toward external behavioural control (external LoC) made chronic patients more receptive to following instructions and normalizing NPIs in everyday life. (Understanding these factors allows professionals to improve compliance by tailoring public health interventions to targeted social subgroups and managing current and future pandemics. Our reflective PLS-SEM model of NPIs adherence based on NPT could serve as a theoretical and quantitative alternative to the biomedical model commonly used in public health intervention planning.