Academic cheating does not happen as an isolated action of an individual but is most often a collaborative practice. As there are few studies that looked at who are collaborators in cheating, we investigated medical students’ readiness to engage others in academic dishonest behaviours. In a cross-sectional survey study in Zagreb, Croatia, 592 medical students from the first, 3rd and 6th (final) study year anonymously answered a survey of readiness to ask family, friends, colleagues or strangers for help in 4 different forms of academic cheating or for 2 personal material favours. Stepwise multiple linear regression models (MLR) were used to evaluate potential factors influencing propensity for engaging others in these two types of behaviour. Many students would ask another person for help in academic cheating, from 88.8% to 26.9% depending on a cheating behaviour. Students would most often ask a family member or friend for help in academic cheating. The same “helpers” were identified for non-academic related behaviour – asking for personal material favours. More respondents, however, would include three or four persons for asking help in academic cheating than for routine material favours. Score on material favours survey was the strongest positive predictor of readiness for asking help in academic cheating (stepwise MLR model; beta = 0.308, P < 0.0001) followed by extrinsic motivation (compensation) and male gender, whereas intrinsic motivation, year of study and grade point average were weak negative predictors. Our study indicates that medical students are willing to engage more than one person in either close or distant relationships in academic cheating. In order to develop effective preventive measures to deter cheating at medical academic institutions, factors surrounding students’ preference towards academic cheating rather than routine favours should be further investigated.

Pulse wave velocity (PWV), a direct measure of arterial stiffness, is a promising biomarker of cardiovascular risk and a cardiovascular surrogate outcome. The resolution for detecting its smallest clinically significant change is dependent on the expected reproducibility, but there is currently no consensus on this. We estimated the PWV reproducibility in a range of intra-subject values that were observed over a 2 week period in a broad range of participants and under clinically relevant experimental conditions (two observers, morning/afternoon sessions, and number of visits) using SphygmoCor and Arteriograph devices. Each participant was recorded 12 times with each device over three visits, one week apart, and two morning and two afternoon recordings were taken per visit. The factors affecting reproducibility and the discrepancies between the consecutive PWV measurements for each device were also examined using multilevel mixed-effect models. We show that current PWV estimation guidance recommending 2 + 1 measurements is suboptimal because the PWV range was outside of the 1 m/s threshold for most of the participants, which is proposed as a minimal clinically important difference. The best reproducibility was yielded with median of four measurements and a 1.1 m/s threshold. Although PWV reproducibility and repeatability are frequently used interchangeably in studies, we demonstrated that despite their relative measures of variability (e.g., coefficient of variation) being comparable, their ranges revealed a clinically significant difference between them. We also found that different physiological variables were predictors of the discrepancy between the consecutive measurements made by the two devices, which is likely due to their distinct modes of operation. The evidence base for PWV reproducibility is limited, and more research is needed to deepen our understanding of the variation in arterial stiffness over time, as well as fluctuations within a population group and in an intervention setting.

Objectives: To evaluate the impact of the first COVID-19 lockdown in 2020 on the burnout and study satisfaction of medical students. Design: A cross-sectional study with a presurvey and postsurvey. Setting: University of Split School of Medicine (USSM), Split, Croatia. The lockdown in the COVID-19 pandemic lasted from late March to mid-May 2020. There was a full switch to e-learning at the USSM during this period, and all clinical teaching was stopped. Participants: Students enrolled in the 2019/2020 academic year. Data were collected before lockdown in December 2019 and January 2020 and again after the end of lockdown in June 2020. Primary and secondary outcome measures: Study satisfaction was assessed using the study satisfaction survey. Burnout was assessed using two instruments: Oldenburg Burnout Inventory and Copenhagen Burnout Inventory. We used Bayesian statistics to compare before-and-after differences. Results: 437 independent responses (77.2% response rate) were collected before and 235 after lockdown (41.5% response rate). 160 participant responses were eligible for pairing. There was no significant difference for both paired and unpaired participants in study satisfaction before (3.38 on a 1–5 scale; 95% credible interval (95% CrI) 3.32 to 3.44) and after (3.49, 95% CrI 3.41 to 3.57) lockdown. We found no evidence (Bayes factor (BF ₁₀ ) >3.00 as a cut-off value) for an increase in the level of burnout before and after lockdown, both in independent and paired samples. Conclusions: It seems that the first pandemic-related lockdown and a switch to e-learning did not affect burnout levels among medical students or their perception of their study programme. More insight is needed on the short-term and long-term effects of the COVID-19 pandemic on medical students and their education. Well-structured longitudinal studies on medical student burnout during the COVID-19 pandemic are needed.

Given that the self-perception of mental health is an important predictor of health outcomes and wellbeing, it is important to identify the indicators of mental health associated with alcohol consumption in order to reduce alcohol-related harms. This study used data from the cross-sectional RARHA SEAS survey (2015) in the Croatian general population, aged 18–64 years (n = 1500). Several aspects of drinking behaviors and alcohol-related harms were measured, as well as personal and sociodemographic factors. Logistic regression found a significant association between alcohol’s harm to others (AHTO) and poor self-rated mental health (SRMH) (OR = 0.752; 95% CI 0.601–0.941) in the total sample, as well as in the group of participants who rarely drank alcohol (OR = 0.504; 95% CI 0.322–0.787) in the last 12 months. More frequent consumers reported poor SRMH if they had at least one harmful effect from drinking (OR 0.538; 95% CI 0.295–0.980). Younger age, higher education, professional activity, and living with someone else in a household contributed to better SRMH. AHTO has been identified as a strong predictor of poor SRMH in the general population. Targeted public health and preventive measures are needed with specific approaches for different types of alcohol consumers.

Background and Objectives: Considering the link between childhood experiences with adult health and well-being, this study examined how living with a heavy drinker (HD) during childhood affected self-rated mental health (SRMH) in adulthood, while identifying risk and protective factors and assessing the prevalence within a regional context. Materials and Methods: Data (N = 11,113) were obtained from a cross-sectional DEEP SEAS survey (2021) of the general population, aged 18–64 years, in six countries (Croatia, Bosnia and Herzegovina, Slovenia, Austria, Hungary, and Italy). Results: A statistically significant difference in SRMH was found, related to the childhood experience of living with an HD (MD = −0.221, 95% CI −0.250–0.172, N = 10,886) and being negatively affected (MD = −0.216, 95% CI −0.311–0.122, N = 2978). The correlation analysis revealed that individuals who lived with an HD during childhood perceived poorer SRMH in adulthood, consistently across all observed countries. Subsequent logistic regression identified different predictors for SRMH between those who were negatively affected and those who were not. The relationship satisfaction (RAS) was the strongest predictor, significantly contributing to better SRMH, especially in the subgroup that was not negatively affected (OR 28.724, 95% CI 3.450–239.173). A high prevalence of individuals negatively affected was found, especially in Hungary (34.4%) and Croatia (26.5%). Conclusions: Growing up with someone who was a heavy drinker may have lasting negative consequences on SRMH, with a negative subjective evaluation of mental health in adulthood. Targeted public health and preventive measures are needed to protect those living with heavy drinkers.

Background/Objectives: Growing concern about narcissistic traits in younger generations and their effects on empathy, communication, and mental health underscores the need for focused research on medical students as future healthcare professionals. Medical training carries a substantial psychological burden that can compromise students’ well-being, professional development, and the future quality of patient care. Personality traits, including grandiose and vulnerable narcissistic dimensions, may shape susceptibility to such psychological distress. Therefore, this study aimed to examine narcissistic traits and their associations with psychological distress among Croatian medical students across study years and trait levels. Methods: In this cross-sectional study, 413 medical students from the University of Split completed self-administered questionnaires during mandatory classes. Narcissistic traits were assessed using the Pathological Narcissism Inventory (PNI) and psychological distress was measured with the Brief Symptom Inventory (BSI). High pathological narcissistic traits were operationally defined as scores within the highest quartile. Statistical analyses included correlation, comparative, and regression analyses. Results: Overall, pathological narcissistic traits were expressed at low to moderate levels and did not differ across academic years. High narcissistic traits were identified in 35% of students, with 15% exhibiting elevated levels of both grandiose and vulnerable dimensions, suggesting an overlap between the two dimensions. Gender differences emerged across both narcissistic dimensions, with women scoring higher on vulnerable and men scoring higher on grandiose narcissism. One-quarter of students met the criteria for clinically significant psychological distress, which was more prevalent in the earlier years of study. High levels of pathological narcissistic traits, particularly vulnerable traits, were significantly associated with clinically significant distress and elevated symptoms across nearly all BSI domains, most notably interpersonal sensitivity and paranoid ideation. Despite this burden, only a minority of distressed students reported seeking psychological help. Conclusions: Elevated pathological narcissistic traits are significantly associated with psychological distress in medical students. The high prevalence of distress, combined with low help-seeking rates, underscores the need for early identification strategies and structured mental health support within medical education. Addressing personality-related vulnerability factors may improve student well-being, enhance professional development, and, ultimately, elevate the quality of healthcare delivery.