University of Applied Health Sciences

Background/Objectives: Nasal irrigation with isotonic seawater is a known and oft-used treatment for nasal obstruction in patients with acute and chronic nasal inflammatory disease undergoing therapy with intranasal corticosteroids and antihistamine drugs. Nasal patency in healthy athletes is extremely important; however, to date, the effect of isotonic solutions for nasal irrigation in healthy athletes has not been tested. This randomized controlled trial aimed to investigate the potential synergy of physical exercise and nasal isotonic seawater on airflow and the subjective assessment of nasal patency in healthy, high-level athletes. Methods: The intervention group included 33 healthy athletes who used an isotonic seawater nasal spray daily, with a control group including 31 healthy athletes who did not use any sprays; both groups underwent identical seven-day training periods. The primary outcome measures were subjective NOSE questionnaire scores and secondary peak nasal inspiratory flow (PNIF) measures, while anthropometric and demographic variables were covariates. Results: A significant decrease in subjective nasal resistance scores was observed in the intervention group compared to the control group (binary logistic regression model, p = 0.006, RR 7.695), both in the first and second measurement interval. This effect increased with time (Friedman’s two-way analysis of variance, p < 0.001). Peak nasal inspiratory flow is positively affected by exercise but not by isotonic seawater spray intervention. Conclusions: The effects of nasal isotonic seawater irrigation during intense athletic training are beneficial on subjective nasal patency in the short term, while the effects on objective nasal patency are less clear.

Study Design Cross-sectional survey. Objective We explore the demographic factors amongst surgeons responsible for decision-making in the management of Grade I L4-5 degenerative lumbar spondylolisthesis(DLS). Methods A survey presenting three clinical scenarios of DLS with varying degrees of neurological compression and instability was distributed to the AOSpine members globally to ascertain surgical management preferences. Management options such as decompression only or decompression and fusion and the techniques that would be employed were presented to the responders. Results After dissemination, 479 surgeons responded to the survey. Direct decompression was preferred for all three scenarios with and without neurologic deficits(82.5, 81.2, and 56.8%), with the majority favoring open procedures over minimally invasive or endoscopic procedures. Notably, younger, less experienced, and fellowship-trained surgeons showed a higher inclination toward minimally invasive and indirect decompression methods. A strong preference for surgical fusion over decompression(75.2, 92.5 and 86.6%, respectively) was also significantly observed, reflecting a general consensus on the need to achieve segmental stability. Conclusion The results of this study demonstrate a pronounced preference for direct decompression and fusion among a group of global surgeons when treating L4-5 Grade I DLS across all demographics. This indicates a consensus on achieving decompression and stability; however, there are some trends indicating the impact of surgical management based on age, experience, and training of the treating providers. These findings suggest an evolution of surgical interventions toward less invasive techniques, particularly among younger surgeons, highlighting the need for global education to adopt innovative approaches in the management of DLS.

This study examines the prevalence of mental health problems among Croatian adolescent competing athletes, with a focus on gender differences. Mental health issues such as anxiety, depression, sleep disorders, and attention deficiency hyperactivity disorder (ADHD) are particularly relevant in this population due to the combined and simultaneous challenges of competitive sport and adolescence. Understanding gender-specific patterns is crucial for targeted interventions. A cross-sectional study involved 674 Croatian athletes (418 men, 256 women) aged 16–24 years from 43 sports. Data were collected using the Sports Mental Health Assessment Tool (SMHAT-1), which assessed 12 mental health concerns. Descriptive statistics, chi-square tests, effect size analysis with Cramér’s V, and power analysis were performed. The results showed significant gender-specific differences. Female athletes reported higher rates of anxiety (22.7% vs. 3.8%, p < 0.001), depression (25.4% vs. 5.3%, p < 0.001), alcohol use (27.0% vs. 7.7%, p < 0.001), ADHD (18.8% vs. 2.4%, p < 0.001), and post-traumatic stress disorder (8.2% vs. 1.2%, p < 0.001) compared to males. Gender-specific mental health interventions are crucial for improving sport performance and injury prevention. Further research should refine strategies to address vulnerabilities associated with gender and competitive sport environments.

Cartilage lesions do not heal spontaneously and predispose to osteoarthritis. Functional cartilage tissues, engineered using autologous chondrocytes, have a therapeutic advantage over conventional cellular therapies in preclinical studies. Here, we tested whether ex vivo maturation of engineered grafts for cartilage repair leads to improved patient benefit. Using autologous nasal chondrocytes (NCs), we tested whether implantation of in vitro–matured NC-tissue-engineered cartilage (N-TEC) versus undifferentiated NC-cell-activated matrices (N-CAM) in focal cartilage lesions would result in a superior clinical outcome. The prospective, randomized, parallel, open-label phase-2 trial (ClinicalTrials.gov, NCT02673905) enrolled 108 patients in five hospitals from four countries. Patients ranging in age from 30 to 46 years with full-thickness knee cartilage defects (size, 2.7 to 6.0 square centimeters) were equally randomized and treated with N-TEC or N-CAM. The primary preregistered outcome was the overall Knee Injury Osteoarthritis Outcome Score (KOOS) at 24 months. N-TEC, which underwent a longer NC culture time, was phenotypically, structurally, and functionally more like hyaline cartilage than N-CAM. The overall KOOS increased with clinical relevance in both groups compared with preoperative values. KOOS was higher at 24 months for N-TEC [85; interquartile range (IQR), 74 to 91] than for N-CAM (79; IQR, 65 to 85). N-TEC, but not N-CAM, was similarly effective in patients with larger defects or revision surgery. Radiologically, N-TEC resulted in a superior composition of both repair tissue and surrounding cartilage, whereas structural scores were similar. This trial validates the clinical efficacy of NC-based grafts for articular cartilage repair and supports the clinical relevance of engineering mature tissues, even for patients with more challenging cartilage defects.

Study Design Narrative Review. Objectives We aim to investigate the integration and impact of enabling technologies, such as augmented reality, virtual reality, mixed reality, navigation, robotics, and artificial intelligence within the domain of spinal surgery. Methods We made a literature review for articles that examined the progression of adoption from initial to subsequent adopters. We also analysed the key determinants that influence adopting these technologies into clinical settings. These include cost-effectiveness, ease of integration, patient acceptance, learning curves, and availability of training resources. Based on the available data a suggestion has been made on the adoption framework for clinical utility. Results These technological advancements have the potential to transform surgical practice, offering improved precision and efficiency. The journey toward widespread adoption presents challenges, which include the financial implications, the necessity for specialized training, and the complexities associated with integration. To navigate these hurdles, the study proposes recommendations aimed at improving cost efficiency, streamlining technology integration, investing in professional development, and nurturing a culture of innovation and research. Conclusions A framework has been established for the evaluation and integration of state-of-the-art technologies in spinal surgery, thereby maximizing their potential impact on surgical outcomes and patient welfare.

Background/Objectives: This study assessed the effects of 5G radiofrequency electromagnetic radiation (RF-EMR) at different frequencies (700 MHz, 2500 MHz, 3500 MHz) on the complete blood count (CBC), erythrocyte morphometry, and platelet activation after the short-term in vitro exposure of human blood. Methods: Blood samples from 30 healthy volunteers (15 men and 15 women, aged 25–40 years old) were collected at three intervals (14 days apart). For each collection, four tubes of blood were drawn per volunteer—two experimental and two controls. Experimental samples were exposed to 5G RF-EMR for 2 h at room temperature using a half-cone gigahertz transverse electromagnetic cell. The CBC was analysed via a haematology analyser, the erythrocyte morphometry was analysed using the SFORM program, and platelet activation was analysed via flow cytometry. Results: The CBC and platelet activation showed no significant differences between the experimental and control samples. However, the erythrocyte morphometry exhibited notable changes. At 700 MHz, the erythrocyte size, contour, and membrane roughness increased significantly for both sexes, with women’s cells showing greater sensitivity. At 2500 MHz, women exhibited an increased contour index and a decreased solidity and form factor. At 3500 MHz, women showed an increased contour index and outline but a decreased solidity, elongation, and form factor. Cluster analysis identified two erythrocyte subpopulations: smaller, rounder cells with smooth membranes and larger cells with rougher membranes. Conclusions: These results indicate that 5G RF-EMR exposure significantly alters erythrocyte morphometry. The strongest effects were observed at 700 MHz, where men exhibited greater membrane roughness, and women showed larger and rounder erythrocytes. These findings suggest that short-term in vitro 5G RF-EMR exposure disrupts the cytoskeleton, increasing membrane permeability and deformability.

Background/Objectives: This cross-sectional study aimed to produce an adapted Croatian version of the Negative Behaviors in Health Care Questionnaire and to validate it. Methods: The process comprised the translation, cultural adaptation, and psychometric evaluation of the questionnaire. Clinical specialists and qualified bilingual speakers participated in both forward and backward translation. Face validity was tested. The survey’s original developer approved the final version. The reliability of the questionnaire was assessed using the test–retest method and Cronbach’s alpha coefficient. Exploratory and confirmatory factor analyses and assessments of divergent and convergent validity were conducted. The collected data were analyzed using SPSS 21.0 and R, program version 3.5.2., for Windows. Results: A five-factor structure was obtained and confirmed via CFA, although not all fit coefficients were satisfactory. The internal consistency reliability was 0.86 for the contributing factors and the seriousness of aggression, 0.79 for the use of aggression, 0.95 for the fear of retaliation, and 0.83 for the frequency of aggression; in total, α = 0.88. Test–retest reliability was moderate. All correlations were statistically significant, and the correlation was the highest for seriousness (0.754) and frequency of aggression (0.725) and the lowest for contributing factors (0.528). Test–retest reliability was satisfactory. Statistically significant differences were found when comparing respondents by gender, age, work experience, education, and hierarchical position. Conclusions: The adapted, translated, and validated survey provides a valuable tool for assessing lateral and vertical aggression between and towards nurses in terms of contributing factors, frequency, severity, uses of aggression, and fear of retaliation.

Introduction: Mass media play a crucial role not only in informing the public but also in shaping public perception, educating, and enhancing the visibility of various professions, including nursing. Despite being the most populous healthcare profession, nursing remains underrepresented in media coverage. This imbalance affects the social status of the nursing profession and its public perception. Methods: This cross-sectional study utilized a validated questionnaire with high internal reliability (Cronbach’s alpha coefficients) to assess nurses’ perceptions of the media’s role in society and the nursing profession. Data were collected from 203 participants using an online survey employing the snowball sampling method. Statistical analyses included Welch ANOVA, t-tests, and hierarchical regression to predict the importance of media education. Results: Participants demonstrated positive perceptions of the media’s societal influence but identified a lack of adequate representation of nurses. Younger nurses and those with higher education levels emphasized the need for media education. Regression analysis revealed that perceptions of the media’s power and self-assessed media competencies were significant predictors of valuing media education. Conclusions: The findings highlight the need for integrating media literacy training into nursing education to enhance professional visibility and public engagement. This can empower nurses to actively contribute to shaping their professional image and addressing public misconceptions. Future research should expand the sample size and explore diverse healthcare settings to validate these findings.

Currently, there are no validated guidelines or recommendations for how to interpret cardiac biomarkers in the pediatric population. The most commonly used cardiac biomarkers are cardiac troponins and natriuretic peptides, but the clinical value of common cardiac biomarkers in pediatric laboratory medicine is restricted due to age- and sex-specific interpretations, and there are no standardized cut-off values. The results from the studies on reference values, as well as results from clinical studies, are difficult to compare with identical studies due to the heterogeneity of subject characteristics (gestational and chronological age, sex, pubertal status, menstrual cycle, exercise), assay characteristics (type of assay, generation of assay, analytical platform used), and experimental protocol characteristics (prospective or retrospective studies, reference population selection, patient population selection, inclusion and exclusion criteria, number of subjects). Future studies need to establish evidence-based cut-offs for specific indications to optimize utilization and standardize the interpretation of common cardiac biomarkers in neonates, children, and adolescents. The aim of this article was to summarize the current analytical and clinical limitations of cardiac troponins and natriuretic peptides in the pediatric population, as informed by the existing published literature.

Background The quality of life (QoL) in elderly post-stroke patients may deteriorate due to an interplay of physical and psychological impairments, compounded by social challenges stemming from these issues. Objective This study aimed to identify predictors of QoL in elderly post-stroke patients by evaluating their functional capabilities, depressive symptoms, and levels of social support. Methods A cohort of 122 individuals aged 65 and older, who had experienced a stroke, was assessed. Functional independence was gauged using the Functional Independence Measure (FIM), depressive states were evaluated with the Geriatric Depression Scale (GDS), and social support was quantified through the Social Support Scale (SSS). The WHOQOL-BREF questionnaire was employed to measure QoL. Results The FIM and GDS scores were significant predictors for WHOQOL-BREF domains 1 and 2 (adjusted R² = 0.522, p < 0.01; and adjusted R² = 0.586, p < 0.01, respectively). GDS alone was a significant predictor for domain 3 (adjusted R² = 0.236, p < 0.01), while all variables were significant predictors for domain 4 (adjusted R² = 0.315, p < 0.01). Conclusions Depression, motor function, and social support were identified as the primary predictors of QoL in elderly individuals after suffering a stroke.

Introduction Due to the rapid aging of the global population, new approaches are required to improve the quality of life of older people and to reduce healthcare system expenditures. One of the approaches that can be used is value-based healthcare. This article describes a value-based solution for older people who have suffered a myocardial infarction. Methods This solution combines the work of healthcare professionals and informal caregivers and the use of modern and user-friendly technologies to support the achievement of patients’ values. Patients older than 65 years who have suffered a myocardial infarction will be divided into control and intervention groups within a pre-post-controlled design research study. Members of the intervention group will be provided with a personalized plan developed by healthcare professionals and based on the results from the baseline questionnaire. Discussion Two ValueCare digital solution components will be developed: a mobile application for the participants and a web platform for the professionals, researchers, and informal caregivers. Together with smartwatches, which will track important health aspects, and applications, this approach would enable older people to improve their health through correct lifestyle choices and their professional and informal caregivers to track their progress. With the use of the described technology and the multidisciplinary approach, the unmet needs and values of participants could be achieved. Using this approach, it could be possible to reduce overall healthcare expenses through the active involvement of both older people and their informal caregivers through a shared decision-making process with healthcare professionals. Clinical trial registration The ISRCTN registry number is 25089186. The date of trial registration is 16/11/2021.

Aim: To ascertain whether Croatian respondents' knowledge on pain aligns with modern pain science, and determine the measurement properties of the Croatian version of the Concept of Pain Inventory for Adults (COPI-Adult). Methods: A cross-sectional, online survey was used to collect the respondents' sociodemographic, clinical, and COPI-Adult (CRO) data (n = 509). A Pearson correlation coefficient test was used to assess the correlations between sociodemographic, clinical, and COPI-Adult (CRO) data. Confirmatory factor analysis and Cronbach's coefficient, based on classical test theory, were used to determine the measurement properties of the questionnaire. Results: The average COPI-Adult (CRO) score was 35.91 ± 5.8 out of 52 and it was similar in respondents with (36.52±6.01) and without (35.36±5.57) formal medical/health care education. Respondents exhibited a reductionist understanding of pain as a result of structural damage. Higher COPI-Adult scores were very weakly correlated with formal medical/health care education, younger age, lower pain intensity, higher pain knowledge self-assessment, and higher education level. Formal medical education significantly moderately correlated with pain knowledge self-assessment (r=-0.425; P<0.001). One-factor COPI-Adult (CRO) model revealed significant factor loadings of each item (P<0.001) and good internal consistency (Cronbach α=0.803). Conclusions: Croatian respondents' concept of pain aligns with their objective knowledge, but only partially with modern pain science. This indicates the need to bridge the gap between traditional and contemporary understandings of pain in the Croatian population. One-factor COPI-Adult (CRO) inventory serves as the first questionnaire for assessing the concept of pain among Croatian adults.

Background and Objectives: The use of wearable fitness technology is a trend nowadays and has significant potential in promoting an active lifestyle among long-term care (LTC) residents. The objectives of this observational study were to examine the use of fitness trackers and smartwatches for monitoring physical activity and to analyze the relationship between the use of these technological solutions and the sociodemographic characteristics of LTC residents during the COVID-19 lockdown. Materials and Methods: Face-to-face interviews were conducted with 198 LTC residents stationed in eleven organizational units that provide long-term accommodation services for older adults in the city of Zagreb in Croatia. LTC residents aged 65 and older who receive the 1st level of accommodation services in the social care system according to their functional ability and health status were included in this study. Results: During the COVID-19 lockdown, 19.19% of LTC residents used wearable activity trackers. Gender (p = 0.0411) and education level (p = 0.0485) were recognized as significant sociodemographic predictors regarding the use of fitness trackers and smartwatches for monitoring physical activity. An odds ratio for gender of 0.454 (95% CI: 0.213–0.969) indicates that women have a 54.6% lower chance of using fitness trackers and smartwatches then men. The odds ratio for the education effects of 0.050 (95% CI: 0.003–0.980) demonstrates that there is a 95% lower chance of using fitness trackers and smartwatches for individuals with only elementary education as opposed to university graduates. Conclusions: The sociodemographic differences of LTC residents regarding the use of fitness trackers and smartwatches require further research, but they are also an incentive for the implementation of these technological solutions to protect the health of older adults.

This paper investigates the illegal activities that may negatively impact the environment in Croatia’s protected areas, particularly those associated with tourism. Failure Mode and Effects Analysis (FMEA) and sensitivity analysis are used to identify distinct high-risk activities specific to different park types. Coastal parks are found to be particularly vulnerable to maritime-related illegal activities, with high risk exposure from mooring vessels and swimming in prohibited areas. These parks also face significant risks from illegal fishing and the capture of strictly protected plants and animals, highlighting the need for enhanced marine ecosystem protection. Mountainous and forest parks face significant risks from fire-related activities, while wetland parks are sensitive to poaching and illegal fishing. Additionally, diverse landscape parks show increased vulnerability to littering, poaching, and the collection or harvesting of strictly protected plants and animals. The results underscore the necessity for tailored risk-management strategies that prioritize interventions based on park-specific challenges. By addressing the unique vulnerabilities of each park type, this study contributes insights into mitigating environmental threats posed by tourism and emphasizes the importance of continuous monitoring and adaptive management in protected areas.

Study Design Reliability study. Objectives The radiographic diagnosis of non-union is not standardized. Prior authors have suggested using a cutoff of <1 mm interspinous process motion (ISPM) on flexion-extension radiographs, but the ability of practicing surgeons to make these measurements reliably is not clear. Methods 29 practicing spine surgeons measured ISPM on 19 levels of ACDF from 9 patients. Surgeons relied on these measurements to report on fusion status. Inter-observer correlation co-efficients (ICC), standard error (SEM) and the minimum detectable difference (MD) of these measurements were calculated. We screened for clerical errors by checking measurements more than one standard deviation from the group mean. Results The ICC for ISPM was .76 (.64; .88) with a SEM of 1 mm and a MD of 2.76 mm. Agreement on fusion status was moderate, with an ICC of .6 (.44; .76). After screening for and removing clerical errors, the ICC improved to .82 (.71; .91), SEM improved to .83 mm, and MD improved to 2.29 mm. Six reviewers had an ICC >.9. The ICC from these high performing reviewers was .94 (.9; .97), SEM was .45 mm, and MD was 1.26 mm. Conclusions The MD of 2.29 mm in our study group was not precise enough to support a cutoff of <1 mm ISPM as the sole measurement technique in screening for non-union after ACDF, and there was only moderate agreement amongst surgeons on fusion status based on dynamic radiographs. More stringent techniques are necessary to avoid mis-diagnosing non-union in clinical studies. Future studies should consider auditing measurements to identify clerical errors.

Background/Objectives: Research on calcitonin-gene-related peptide (CGRP) in adult migraine is extensive, but its role in childhood migraine remains unclear. This study aimed to evaluate serum CGRP levels in children experiencing migraine and tension-type headache (TTH) during interictal periods, comparing these levels to age-matched healthy controls. Methods: A total of 66 migraine patients, 59 with TTH, and 53 controls were recruited and stratified by headache onset age: under 7, 7–12, and over 12 years. CGRP levels were quantified using enzyme-linked immunosorbent assay (ELISA). Results: The migraine patients showed significantly higher serum CGRP levels than both the TTH patients and the controls (p < 0.001), with no significant difference between the latter two groups. Among the migraine patients, those without aura (MO) exhibited higher CGRP levels than those with aura (MA). The CGRP levels were lower in the. MA patients whose headaches began between ages 7 and 12 compared to the subjects with MO, while no significant differences were found in the patients whose headaches began after age 12. Conclusions: These findings suggest that elevated serum CGRP is indicative of pediatric migraine, with variations based on migraine type and age of onset. The difference in CGRP in preadolescent migraineurs with and without aura suggest that CGRP levels may vary depending on age and on migraine type.

Background/Objectives: Celiac disease (CD) is a common immune-mediated, chronic systemic disorder that is treated with a strict, life-long gluten-free diet (GFD). In addition to gastrointestinal manifestations, CD also presents with a variety of extraintestinal symptoms, including significant neurological and neuropsychiatric symptoms. Among these neurological manifestations, motor dysfunctions are particularly notable. The aim of this study is to investigate the potential volumetric differences in brain structures, particularly the motor cortex and basal ganglia, between pediatric CD patients and healthy controls using the volBrain software AssemblyNet version 1.0. Methods: This prospective study included pediatric patients with CD who complained of neurological symptoms and were scheduled for brain magnetic resonance imaging (MRI). All children had been previously diagnosed with CD and their adherence to GFD was evaluated using the Biagi score. Brain MRIs were performed on all included patients to obtain volumetry at the onset of the disease. For volumetric and segmentation data, the volBrain software was used. Results: In total, 12 pediatric patients with CD were included, with a median duration of a GFD of 5.3 years at the time of the MRI examination. There were no statistically significant differences between patients compliant with the GFD and those non-compliant in terms of age or duration of GFD. Volumetric analysis revealed deviations in all patients analyzed, which involved either a decrease or increase in the volume of the structures studied. Conclusion: Despite the limited number of patients in this study, the initial findings support previously described neurological manifestations in patients with CD. Newly developed MRI tools have the potential to enable a more detailed analysis of disease progression and its impact on the motor cortex.

Abstarct Introduction Therapeutic erythrocytapheresis has some advantages over therapeutic phlebotomy, the standard treatment for cytoreduction in polycythemia and hemochromatosis. Erythrocytapheresis can be performed on different cell separators, each with its own characteristics. We present our experience of therapeutic erythrocytapheresis in the treatment of polycythemia and hemochromatosis with an analysis of the performance of cytoreduction, and a comparison between the characteristics of intermittent- and continuous-flow cell separators. Material and methods During a 20-year period, 1731 procedures were performed in 125 patients, 1634 (94.4%) with a Haemonetics MCS+ separator and 97 (5.6%) with a Spectra Optia system device. The performance of cytoreduction using the Haemonetics MCS+ separator was analysed in 442 procedures performed in 56 patients and the performance of the two apheresis devices was compared. Results Haemoglobin (Hb) and haematocrit (Hct) values were significantly reduced after erythrocytapheresis with the Haemonetics MCS+ device (Hb: 18.69%; Hct: 18.73%; p-values both <0.001). The reductions of Hb and Hct were significantly higher in the Haemonetics MCS+ procedure (p-value <0.001), but the Spectra Optia procedure depleted a significantly higher RBC volume (495 mL versus 442 mL) in a shorter time (18 min versus 36 min). Conclusion Both the Haemonetics MCS+ and Spectra Optia systems proved to be highly efficient and safe in RBC cytoreduction with short procedure times. Erythrocytapheresis reduces the frequency of necessary procedures thereby justifying its therapeutic use especially in eligible patients of working age.

The aim of this study is to translate, cross-culturally adapt, and validate the Croatian Athlete Psychological Strain Questionnaire (APSQ-Cro) as part of the Sport Mental Health Assessment Tool 1 (SMHAT-1) validation. We assessed the reliability and applicability of the APSQ-Cro among Croatian athletes. The international sports community is increasingly focused on mental health issues in athletes, highlighting the need for early detection tools like the Athlete Psychological Strain Questionnaire (APSQ) and SMHAT-1. We included 869 Croatian competing athletes across 54 sports who received a link to access the WEB-based questionnaire. The Croatian Olympic Board helped in distributing the questionnaires, aiming to reach as many and as diverse a group of registered competing athletes in Croatia as possible. Results showed a Cronbach’s alpha of 0.75 for the entire questionnaire, indicating acceptable reliability. An exploratory strategy of factor analysis was used to determine the underlying structure of the APSQ-Cro. For this purpose, the Kaiser–Meyer–Olkin (KMO) test and Bartlett’s test for sphericity were performed to ensure the suitability of the data. The KMO test ensured sampling adequacy, with a measure of 0.77 indicating suitability for factor analysis, while Bartlett’s test confirmed significant correlations among variables (χ² = 2779.155, df = 45, p < 0.001), validating the dataset’s appropriateness for data reduction techniques. The factor analysis, together with the Cattell scree test and varimax rotation, resulted in a two-factor structure for the APSQ-Cro. Factor 1 included items related to internal psychological struggles, while Factor 2 included items related to external pressures from the athletic environment. These two factors explained 53% of the variability, with Cronbach’s alphas of 0.75 and 0.88 for the respective factors. The APSQ-Cro is a valid and reliable tool for assessing distress in Croatian athletes. Croatian athletes’ sporting experience will be improved with the broad adoption of the APSQ-Cro, which can help detect early signs of psychological distress and subsequently improve mental health outcomes.