Background: Service-learning (SL) has gained increasing relevance in nursing education as an approach that bridges academic learning and community engagement. However, there is limited evidence on its long-term impact in European contexts, particularly in transition countries. Aim: This study explored the long-term perceived benefits of an SL course implemented in an undergraduate nursing program in Croatia. Methods: A mixed-methods design was used. Quantitative data were collected using the validated SELEB scale (a = 0.91) from 28 former students 6 years after course completion. Thematic analysis of open-ended responses complemented quantitative results. Results: The highest perceived benefit was reported in the domain of critical thinking (M = 5.71), and the lowest in interpersonal skills (M = 6.39), where lower scores indicate greater benefit. While Friedman's test showed significant differences among subscales (x2 (5) = 15.57, p = 0.008), posthoc comparisons did not retain significance after Bonferroni correction. Qualitative data identified five themes: professional development, teamwork, emotional growth, obstacles, and civic engagement. Conclusion: The findings confirm that SL fosters lasting professional and personal competencies in nursing students, even years after course completion. These results highlight the value of integrating SL into nursing curricula and demonstrate its applicability across diverse educational settings. (c) 2025 Organization for Associate Degree Nursing. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Background/Objectives: Sarcopenia is a growing public health challenge in older adults, being associated with functional decline, frailty, and increased mortality. The SARC-F questionnaire is a widely recommended screening tool for sarcopenia; however, no validated Croatian version has been available so far. This study aimed to translate, culturally adapt, and validate the Croatian version of the SARC-F questionnaire for older adults. Methods: In a cross-sectional design, 153 participants aged ≥ 65 years from Zagreb and Bjelovar were enrolled between March and September 2025. Psychometric evaluation included internal consistency (Cronbach's α), test-retest reliability (intraclass correlation coefficient, ICC), item-total correlations, and split-half reliability. Convergent validity was assessed via correlations with handgrip strength (HGS), Short Physical Performance Battery (SPPB), and timed up-and-go (TUG) tests. Known groups and construct validity were also examined. Results: The Croatian SARC-F showed good internal consistency (Cronbach's α = 0.76; 95% CI: 0.70-0.82), with item-total correlations ranging from 0.34 (falls) to 0.80 (stairs) and excellent test-retest reliability (ICC = 0.86). Strong correlations were found with SPPB (ρ = -0.50; p < 0.001), TUG (ρ = 0.50; p < 0.001), and handgrip strength (ρ = -0.42; p < 0.001), supporting convergent validity. An exploratory factor analysis indicated a unidimensional structure explaining 43% of the variance. Conclusions: The Croatian version of SARC-F is a reliable, valid, and clinically feasible tool for identifying older adults who are at risk of sarcopenia. The results support its use in national screening and cross-cultural research across Europe.
OBJECTIVE:The objective was to evaluate the trajectories of hematoma resolution and functional improvement after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH), model the temporal pattern of cSDH resolution, and identify factors associated with favorable outcomes. METHODS:This real-world multicenter retrospective study included cSDH patients treated with MMAE at 24 centers between 2019 and 2024. Hematoma thickness was measured at baseline and at follow-up intervals (1-4 weeks, 1-3 months, 3-6 months, 6-12 months, and > 12 months after embolization). Resolution patterns were modeled using exponential decay functions. Modified Rankin Scale (mRS) scores assessed functional outcomes. Good functional outcome was defined as mRS score ≤ 2. Resolution patterns were modeled using exponential decay functions to estimate time to 50% and 80% reduction. Patients were categorized as complete resolution (≥ 99%) or by quartile of the remaining distribution (substantial [73%-98%], moderate [53%-73%], partial [27%-53%], minimal [< 27%]). The primary outcome was good functional status (mRS score ≤ 2). RESULTS:The authors analyzed a total of 1781 patients with 2295 cSDHs who underwent MMAE. The mean ± SD age was 72.8 ± 12.4 years and 68.1% of patients were male. The initial mean hematoma thickness was 15.31 ± 6.53 mm, decreasing to 5.24 ± 5.91 mm at final follow-up (mean reduction 64.3% ± 42.1%). Resolution followed an exponential decay pattern, with an estimated time to 50% reduction of 1.8 months and to 80% reduction of 8.9 months. Complete resolution occurred in 1031 of 2224 patients (46.4%) with complete follow-up. The median (IQR) mRS score improved from 1 (0-3) at baseline to 0 (0-2) at > 12 months. Good functional outcomes were more common in patients with complete versus minimal resolution (68.9% vs 35.0%, p < 0.001). Achieving ≥ 73% resolution within 90 days was associated with better outcomes (good outcome in 76.9% of those with ≥ 73% resolution vs 67.3% in those without, p < 0.001). Neurological deterioration was the strongest predictor of lack of good outcome (23.7% in patients with neurological deterioration vs 82.4% without, p < 0.001). CONCLUSIONS:After MMAE for cSDH, reduction in hematoma thickness follows a predictable exponential decay pattern. Greater extent (≥ 80%) and faster timing (within 90 days) of resolution are valuable prognostic indicators. Functional outcomes improve progressively through 6-12 months after the procedure. The relationship between resolution extent and functional outcomes provides quantitative benchmarks for evaluating treatment response.
Green urban renewal requires coordination among climate adaptation, water management, biodiversity conservation, and spatial planning within coherent policy frameworks. This study presents a structured analytical framework for evaluating how nature-based solutions (NbS) and natural water retention measures (NWRM) are represented in local and national policy documents relevant to green urban renewal, using Zagreb, Croatia, as a case study. The analysis combined qualitative content analysis, semi-quantitative assessment, and comparative policy-coherence analysis of strategic, planning, and legislative documents. Recent strategic documents showed the broadest documentary coverage of climate adaptation, biodiversity conservation, sustainable water management, and green infrastructure, whereas legislative and statutory planning documents contained more function-specific provisions. Economic feasibility, adaptive management, and several implementation-related provisions were less consistently represented. Cross-level comparison further identified stronger alignment between several recent Zagreb strategic documents and national climate and water policy documents. The study contributes a structured adaptation of IUCN-derived criteria for cross-level policy-document analysis; its applicability in other legal and urban contexts requires comparative testing.
Introduction. Physical inactivity represents a majorpublic health concern, contributing to the developmentof numerous chronic diseases.Aim. The aim of this study was to simplify the ExerciseMotivation Inventory-2 (EMI-2) using exploratoryand confirmatory factor analysis in order to identifya new, meaningful factor structure that effectively explains the underlying motives for physical activityamong university students.Methods. The study was conducted on 1,304 studentsof the University of Zagreb (65.7% female).The Croatian version of the EMI-2 questionnaire wasemployed, comprising 54 items designed to assessvarious intrinsic and extrinsic motives for exercise,which in the original English version are grouped into14 factors. Data were analyzed using exploratoryfactor analysis (EFA) to identify latent factors, followedby confirmatory factor analysis (CFA) to verifythe factor structure. Reliability was assessed usingCronbach’s alpha coefficient.Results. The exploratory factor analysis initially identifiedeight factors; however, the scree plot suggesteda three-factor solution encompassing psychological,social, and health-related motives for exercise. Thesimplified model demonstrated high internal consistency(Cronbach’s alpha: psychological motives = 0.934;social motives = 0.919; health motives = 0.922). Theconfirmatory factor analysis confirmed the validity ofthe model with acceptable fit indices (CFI = 0.92; NFI= 0.91; IFI = 0.92), while regression analysis indicatedthat these factors significantly predicted students’leisure-time physical activity.Conclusions. The simplified version of the EMI-2 providesa reliable and valid tool for assessing motives forphysical activity, particularly within the student population.Simplifying the factor structure facilitates itsuse in both research and practical settings, supportingthe development of targeted intervention programsaimed at promoting physical activity. The findingshighlight the importance of psychological, social, andhealth-related motives in understanding and improvingphysical activity behaviors. Future research shouldexamine the applicability of this model across differentpopulations to confirm its universal relevance.
