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Uvod: Jedna od potencijalnih prijetnji sigurnosti pacijenata je dijeljenje lijekova, što je oblik samo-liječenja. Ovaj je projekt analizirao učestalost, percepciju rizika i čimbenike povezane s dijeljenjem analgetika na recept. Metode: Proveli smo dva kvalitativna i jedno presječno kvantitativno istraživanje. Prvo kvalitativno istraživanje provedeno je polu-strukturiranim intervjuima među 15 liječnika zaposlenih u hrvatskim Ambulantama za liječenje boli. Drugo kvalitativno istraživanje je bilo provedeno u fokus skupnim raspravama s 40 ispitanika. Bili su uključeni odrasli u dobi od ≥18 godina koji su dobili recept za analgetik najmanje jednom u životu. Provedeno je šest zasebnih fokus skupina s kojima se raspravljalo o percepciji rizika povezanih s dijeljenjem receptnih analgetika među pacijentima. Osim toga, ispitanici su bili ispunili dva upitnika o demografskim podacima, osobnom ponašanju povezanim sa dijeljenjem analgetika i njihovim stavovima o rizicima povezanim s dijeljenjem analgetika na recept. Presječno kvantitativno istraživanje je bilo provedeno u 10 ordinacija obiteljske medicine u Hrvatskoj među 1000 pacijenata kojima su liječnici najmanje jednom u životu propisali analgetike. Upotrijebljen je upitnik za prikupljanje podataka o intenzitetu boli pacijenata, navikama dijeljenja analgetika na recept, čimbenicima koji su povezani s takvim ponašanjem, percepcijom rizika povezanih s tim ponašanjem i demografskim podacima. Logistička regresija provedena je kako bi se analizirali neovisni čimbenici povezani sa davanjem drugim osobama i uzimanjem od drugih osoba analgetika na recept. Rezultati: Među liječnicima, dvanaestero ih se bilo susrelo s pacijentom koji dijele analgetike na recept s drugim pacijentima kojima nije namijenjen recepta. Većina liječnika smatra da je dijeljenje receptnih analgetika rizično i negativno ponašanje. U drugom kvalitativnom istraživanju u upitniku 55% ispitanika je bilo navelo da dijele receptne analgetike, a naknadno u raspravama fokusnih skupina 76% ih je bilo priznalo takvo ponašanje. Ispitanici su prepoznali određene rizike povezane s dijeljenjem analgetika na recept, spomenuli brojne razloge za uključivanje u takvo ponašanje i ukazali na određene pozitivne aspekte takvog ponašanja. U presječnom kvantitativnom istraživanju ustanovljeno je da 61% pacijenata iz ordinacije obiteljske medicine dijeli analgetike na recept, bilo da se radi o davanju drugoj osobi (42%) i/ili o uzimanju od druge osobe (54%). Neovisni pozitivni prediktori za davanje analgetika na recept drugim osobama su bili: anamneza dijeljenja lijekova na recept koji nisu analgetici, pružanje informacija o lijekovima na recept koji idu uz taj lijek, ne čitanje uputa za lijek, subjektivna percepcija zdravlja i smanjena svjesnost o štetnosti povezane sa davanjem analgetika na recept drugoj osobi. Neovisni pozitivni prediktori za uzimanjem analgetika na recept od druge osobe su bili: mlađa životna dob, priopćavanje pojedinosti o lijeku koji se daje, sklonost čitanju uputa o lijeku, pristrana procjena osobnog zdravlja i percepcija da je alternativna medicina sigurnija opcija od konvencionalne medicine. Zaključak: Dijeljenje receptnih analgetika vrlo je zastupljeno među pacijentima u obiteljskoj medicini. Edukacija pacijenta i veća uključenost liječnika u prepoznavanju tog ponašanja navedeni su kao potencijalne mjere za sprečavanje dijeljenja analgetika na recept. Potrebno je osmisliti i afirmirati preventivne intervencije., Background: One of the potential threats to patient safety is the sharing of medication among patients, which is form of self-medication. This project analyzed frequency, perception of risks and factors associated with sharing prescription analgesics. Methods: For this project we were conducted two qualitative and a cross-sectional research. The first qualitative study was conducted by semi-structured interviews among 15 PMPs employed in Croatian pain clinics. Second qualitative study was conducted by focus group discussions with 40 participants. Adults aged ≥18 years who had received a prescription for an analgesic at least once in a lifetime were included. Six separate focus groups were conducted to discuss participants’ perception of risks associated with sharing of prescription analgesics among patients. Additionally, participants filled out two questionnaires on demographic data, their own behavior regarding sharing analgesics, and their attitudes about risks associated with sharing prescription analgesics. A cross-sectional study was conducted in 10 outpatient family medicine practices in Croatia amongst 1000 patients to whom their physicians have prescribed analgesics at least once in their lives. A questionnaire was used to collect data about patients’ pain intensity, prescription analgesic sharing habits, factors associated with this behavior, perception of risks associated with the conduct and demographic data. Logistic regression was conducted to analyze independent factors associated with lending and borrowing prescription analgesics. Results: Among PMPs, twelve have seen patients who share their prescription analgesics with other patients for whom prescription is not intended. Most PMPs consider prescription analgesics sharing a risky and negative behavior. In second qualitative study in a questionnaire, 55% of the participants indicated that they personally shared prescription analgesics, while subsequently in the focus group discussions, 76% confessed to such behavior. Participants recognized certain risks related to sharing of prescription analgesics, mentioned a number of reasons for engaging in such behavior, and indicated certain positive aspects of such behavior. In the cross-sectional research we found that 61% of patients in family medicine practices engage in sharing prescription analgesics, whether it was lending (42%) and/or borrowing (54%). Independent predictors of lending prescription analgesics were as follows: history of sharing prescription medication other than analgesics, providing information regarding the medication alongside the prescription medication itself, not reading package insert that accompanies medication, subjective perception of personal health and decreased awareness of personal harm associated with prescription analgesic sharing. Independent predictors of prescription analgesic borrowing were as follows: younger age, communicating details regarding the medication that was given, scanning of package insert accompanying the medication, biased subjective perception of personal health and perceiving alternative medicine as a safer option over conventional medicine. Conclusion: Sharing prescription analgesics is highly prevalent amongst patients in family medicine. Patient education and more involvement of physicians in identifying this behavior were cited as potential remedies for preventing sharing of prescription analgesics. Preventive interventions should be conceived and established.

In the COVID-19 pandemic, we have witnessed an impressive speed in the development of effective vaccines approved for human use, based on clinical studies comparing their efficacy to placebo. A head-to-head comparison of the neutralizing antibody (NAb) responses elicited by four vaccines used in Europe during 2021 (BNT162b2, mRNA-1273, ChAdOx nCoV-19, Ad26.COV2.S) and their comparison to NAb responses in convalescents showed that while the amount was comparable, NAbs induced by natural infection were of superior quality. The highly scattered immune responses elicited by the four vaccines were equalled by booster mRNA vaccination, reaching the highest, plateau level of NAb at the population level. Equally high NAbs were induced in convalescents after a single injection of either vaccine. The use of wild-type virus as a challenge in the NAb determination revealed that NAbs produced by disease were better activators of the complement system than NAbs induced by vaccination. The contribution of spike protein-specific IgGs to the SARS-CoV-2 neutralization was lower in convalescents compared to vaccinees, indicating that those who recovered from COVID-19 were armed with antibodies of additional specificities and/or classes that contributed to virus neutralization. Such findings point to the need to re-examine the correctness of certain epidemiological measures applied in the current epidemic. We also highlight the importance of a standardized approach in assessing humoral immunity by the usage of the most comprehensive assays as early as possible in future epidemics.

Coronavirus disease 2019 (COVID-19) pandemic resulted in global healthcare crises and strained health resources, both in the acute and chronic phase of the disease. Similarly to post-acute viral syndromes described in survivors of other virulent coronavirus epidemics, there are increasing reports of persistent and prolonged symptoms after acute COVID-19. These reports and studies have helped contribute to the recognition of post-COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4 weeks from the onset of symptoms. Here, we provide a comprehensive review of different manifestations of post-COVID conditions and propose a framework for the identification of patients at higher risk for post- COVID and their coordinated management through dedicated COVID-19 outpatient clinics.

Intenzivan uzgoj agruma u Republici Hrvatskoj započinje u drugoj polovici 20. stoljeća, a danas su prema uzgojnim površinama i prinosima u domaćoj proizvodnji treća voćna kultura. Kao i sve kultivirane biljke, agrumi su podložni napadu entomofaune. Podredu Sternorrhyncha koji obuhvaća lisne buhe, štitaste moljce, lisne i štitaste uši pripadaju neki od najštetnijih kukaca koji su u prošlosti prouzročili propadanje čitavih plantaža agruma diljem svijeta. Razvojem svjetskih tržišta raste i međunarodna trgovina poljoprivrednim proizvodima. Kukci iz ovog podreda se lako prenose sadnim materijalom. S obzirom da je u posljednjih 20 godina i u Hrvatskoj otkriveno nekoliko novih štetnih organizama koji su regulirani EU zakonodavstvom, potpuno je jasno da niti naš teritorij nisu zaobišle ove negativne posljedice globalizacije. Stoga je cilj ovog rada bio pregledom literature istražiti koje su sve vrste kukaca iz podreda Sternorrhyncha štetnih na agrumima prisutne u Republici Hrvatskoj i usporediti ga sa zemljama s najvećom proizvodnjom agruma u svijetu, a nakon toga nadopuniti popis nalazima vlastitog faunističkog istraživanja u nasadima agruma u Republici Hrvatskoj, s posebnim osvrtom na novoutvrđene i karantenske vrste te izdvojiti potencijalno najštetnije. Faunističko istraživanje je provedeno u razdoblju od 2015. do 2020. godine u šest obalnih županija od Dubrovačko-neretvanske do Istarske županije. Ukupno je prikupljeno 1.495 uzoraka biljnog materijala iz kojih je izrađeno 1.416 trajnih mikroskopskih preparata. Determinirane su 22 vrste kukaca iz podreda Sternorrhyncha kojima domaćini mogu biti agrumi, od toga pet vrsta štitastih moljaca, sedam vrsta lisnih uši i deset vrsta štitastih uši. Utvrđena je prisutnost karantenske vrste štitastog moljca Aleurocanthus spiniferus Quaintance, 1903 i regulirane nekarantenske vrste Parabemisia myricae (Kuwana) 1927. U različitim tipovima nasada prvi put je na agrumima pronađeno pet vrsta lisnih uši i jedna vrsta štitaste uši. Aphis craccivora Koch, 1854, Aphis fabae Scopoli, 1763, Aphis gossypii Glover, 1877, Aphis neri Boyer de Fonscolombe, 1841, Aulacorthum solani Kaltenbach, 1843 i Pulvinaria floccifera (Westwood, 1870) su duže vremena prisutne u hrvatskoj entomofauni, ali su sada prvi put nađene na agrumima. Najveći broj vrsta (17) pronađen je u Dubrovačko-neretvanskoj i Splitsko-dalmatinskoj županiji (16) u kojima se nalazi glavnina proizvodnje agruma u Hrvatskoj, stoga je i statistička obrada podataka ograničena na ove dvije županije. Veći intenzitet šteta u proizvodnim nasadima agruma zabilježen je na tri lokacije u kojima je izostala primjena agrotehničkih mjera i mjera zaštite. U jednom od takvih nasada u Dubrovačko-neretvanskoj županiji prvi put je otkriven i štitasti moljac A. spiniferus. Za vrijeme istraživanja ovaj štitasti moljac se konstantno širio te je otkriven i u Splitsko-dalmatinskoj županiji. Provedeno istraživanje je prvi put objedinilo rezultate prisutnosti i raširenosti kukaca iz podreda Sternorrhyncha na agrumima u Hrvatskoj. Introduction: Citrus plants have been grown on the Croatian side of the Adriatic since the Middle Ages but intensive production started in the second half of 20th century. Satsuma mandarin is the 3rd important fruit culture in Croatia, following apple and olive with total growing areas of 2.100 hectares and annual fruit production from 20.000-65.000 tones in five year period. As all cultivated plants, species belonging to genus Citrus L. and Poncirus Raf. are susceptible to impact of entomofauna. Suborder Sternorrhyncha within the Hemiptera order comprises of four Superfamilies: Psylloidea, Aleyrodoidea, Aphidoidea and Coccomorpha. Many insects which may feed on citrus plants fall within the said superfamilies. Their direct damages on plants are manifested as vigour deteriorating and late tree dying. Indirect damage is pour commercial value of fruits due to sooty mold settled on honeydew excreted by these insects. On the other hand, more harmful to plants are insects which, apart from ability to cause direct and indirect damage, are vectors of plant diseases like Citrus tristeza virus, Citrus greening disease or Huanglongbing and virus like disease Citrus chlorotic dwarf. Former records show that vectors of the mentioned plant diseases like aphid Aphis (Toxoptera) citricidus (Kirkaldy) 1907, psyllid Trioza erytreae (Del Guercio 1918) and whitefly Parabemisia myricae (Kuwana) 1927 are already present in the Mediterranean part of EU in countries with considerable citrus production. It is important fact because planting material of host plants, although accompanied by plant passport, may freely circulate through EU territory and represent a potential source of infection. Up to now, several faunistic researches were conducted and check lists in Croatia were made for aphids, whiteflies and scale insects. There were no complete faunistic research for psyllids and its general status in Croatia is still unknown. Furthermore, previous faunistic research of insects from the suborder Sternorrhyncha only partially covered plants belonging to genus Citrus and Poncirus. Therefore the aim of this research was to make the inventory of insects from the suborder Sternorrhyncha in citrus production areas in Croatia in order to gain complete status of distribution of these insects and to provide scientific and sound support in case of accidentally imported quarantine pests. Materials and methods: Literature research was done to gain image about distribution of the 73 chosen important insects from the suborder Sternorrhyncha that may feed on citrus plants. These insects (11 psyllids, 14 whiteflies, 19 aphids i 29 scale insects), according to the literature data, are classified as a quarantine, economic or secondary pests on citrus plants. Research was conducted for 15 countries which, according to FAO, have the biggest production and export of citrus fruits in the Mediterranean, Asia, South Africa, North and South America. Research was also done for Croatia and neighbouring countries Slovenia and Montenegro. In addition, six year faunistic research (2015-2020) in citrus production areas in Croatia was done. During that period 266 sites in total were inspected, of which 181 orchards, 69 backyards and 16 nurseries and garden centres. Visual inspections and sampling were conducted from April till November in six counties in coastal part of Croatia on ten plant species belonging to genus Citrus and Poncirus. Targeted psyllids were investigated on 105 locations. Whiteflies were found on 112 locations where 289 samples were taken. Aphids were found on 228 locations where 639 samples were taken and scale insects were found on 185 locations where 518 samples were taken. Host plants in orchards, backyards and nurseries and garden centres were visually inspected with help of 10x hand magnifier. Vast majority of locations were inspected at least two times during the six year period. Due to presence of planting material of citrus and ornamental plants originating in other EU countries, nurseries and garden centres were inspected at least once every year. In case of suspected infestation, sample of infested plant material or insects were taken for laboratory slide preparation. Methods of sampling nymphs and adults of psyllids are described by Hodkinson and White (1979) and Ossiannilsson (1992). Infested plant material with puparium and pupal case of whiteflies were taken according to the methods described by Martin (1987, 1999) and Hodges and Evans (2005). Infested plant material and adults of aphids were taken according to the method described by Blackman and Eastop (2000). Infested plant material with adult females of scale insects were taken according to the methods described by McKenzie (1967), Kosztarab and Kozár (1988), Gill (1988, 1997) and Watson and Chandler (1999). For slide preparation of psyllids modified method by Watson and Chandler (1999) was used. Whiteflies were slide mounted according to modified method by Šimala (2008) with individual phases described in method by Watson and Chandler (1999). For slide preparation of aphids methods described by Martin (1983) and Blackman and Eastop (2000) were used. Scale insects were slide mounted according to modified method by Masten Milek (2007) with individual phases described in method by Watson and Chandler (1999). After that microscopic identification according to relevant morphological keys for every group of insects was done. In case of finding of Trioza species, identification key by Hollis (1984) would be used. Since at the moment there is no relevant key for Diaphorina species, identification is done according to description by Yang (1984). For identification of puparium and pupal case of whiteflies, identification keys by Martin et al. (2000), Suh (2010), Dubey and Ko (2012) and Wang et al. (2014) were used. Identification of aphids were done according to keys by Blackman and Eastop (2000). For identification of scale insects identification keys by Gill (1988, 1997), Camporese and Pellizzari (1994), Williams and Watson (1990), Williams and Granara de Willink (1992) were used. For all species found during faunistic research, dominance, constancy and ecological significance indices were calculated for orchards, backyards and nurseries and garden centres in every county. Biodiversity for every locality was calculated using biodiversity indices (Shannon-Wiener Index, Simpson Index, and Sörenson Index). In order to determine if there is a difference between type of growing site (orchards, backyards and nurseries and garden centres) and county (only for Dubrovačko-neretvanska and Splitsko-dalmatinska), number of species in every group of insects and number of individuals from every group of insects were subjected to analysis of variance. Mean values were ranked based on Duncan's Multiple Range test with the protection level of 95% (p