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Open access

Eva Arvidsson, Rob Dijkstra and Zalika Klemenc-Ketiš

Abstract

The easy access to data from electronic patient records has made using this type of data in pay-for-performance systems increasingly common. General practitioners (GPs) throughout Europe oppose this for several reasons. Not all data can be used to derive good quality indicators and quality indicators can’t reflect the broad scope of primary care. Qualities like person-centred care and continuity are particularly difficult to measure. The indicators urge doctors and nurses to spend too much time on the registration and administration of required data. However, quality indicators can be very useful as starting points for discussions about quality in primary care, with the purpose being to initiate, stimulate and support local improvement work. This led to The European Society for Quality and Patient Safety in General Practice (EQuiP) feeling the urge to clarify the different aspects of quality indicators by updating their statement on measuring quality in Primary Care. The statement has been endorsed by the Wonca Europe Council in 2018.

Open access

Polona Rus Prelog, Maja Rus Makovec, Marijana Vidmar Šimic, Tanja Premru Sršen and Mitja Perat

Abstract

Background

Depression, anxiety and fear of childbirth have numerous consequences for women and their developing offspring. Insecure attachment in close adult relationships is considered to be a risk factor for depressive symptoms. This study aims to gain further insight into the risk factors for depressive and anxiety symptoms in nulliparous women during the third trimester of pregnancy regarding the main contextual relations, with an emphasis on partner attachment.

Methods

A group of 325 nulliparas in the third trimester of pregnancy was enrolled in a childbirth preparation program. The following instruments were applied: Experiences in Close Relationships-Revised, the Edinburgh Depression Scale, the Zung Anxiety Scale, and a questionnaire regarding fear of childbirth. Three separate multiple linear regression models were built to explore the associations between demographic, social and attachment variables and mental health functioning.

Results

Highly educated nulliparas and those with a higher level of co-workers’ emotional support experienced a lower level of anxiety when other predictors in the model were held constant. Of all the predictors in the model, only attachment anxiety and co-workers’ support were statistically significantly associated with the level of depression. Attachment anxiety was significantly associated with all three mental health indicators (level of depression, anxiety and fear of childbirth).

Conclusions

The results suggest that intimate attachment anxiety could be a key contextual factor for mood and anxiety mental health functioning during the third trimester of pregnancy, accessible to change. Our results could facilitate the formulation of interventions for reducing antenatal depressive symptoms.

Open access

Mina Brajović, Mark Bellis, Andreja Kukec, Nataša Terzić, Adriana Baban, Dinesh Sethi and Lijana Zaletel-Kragelj

Abstract

Background

Aiming at generating evidence for formulating targeted and cost-effective public health interventions for the effective control of alcohol use (AU) in emerging adults in South Eastern Europe. The study’s objective was to assess if alcohol users experience adverse childhood experiences (ACE) more often than non-users, and to identify which ACE victims are the most vulnerable to AU.

Methods

The data was collected in 2010–2012 in two cross-sectional studies conducted in university settings in Montenegro and Romania (overall response rate 89.1%). In the present study, 3,283 students were included. The international ACE Study Questionnaires were used as a base for study instruments for collecting information on ACEs, health behaviours, and socio-economic factors. The association between AU and individual ACEs, adjusted to background factors, was assessed by using logistic regression.

Results

From the child maltreatment group, three ACEs were included in the final model as statistically significantly associated with AU, all of them from physical neglect/abuse types: frequently being hit so hard to have marks or being injured (OR=1.68; p=0.012), frequently being spanked (OR=1.38; p=0.012), and frequently having no person to take to the doctor if necessary (OR=0.58; p=0.031). From the household dysfunction group, two ACEs were included in the final model: exposure to mental health problems in the household (OR=2.85; p<0.001), and living with a problematic drinker/alcoholic (OR=1.51; p=0.019).

Conclusions

The effect of exposure to ACEs on AU persists into emerging adulthood. This should be considered when developing cost-effective response to AU burden through targeted interventions, in particular in settings with scarce resources.

Open access

Manushaqe Selmani Bukleta, Dashnor Bukleta, Mimoza Selmani and Milan Kuhar

Abstract

Introduction

Edentulism and prosthodontic care are very common, especially in the elderly. The study investigated the treatment with complete dentures (CDs) and acrylic removable partial dentures (ARPDs) among people receiving new prosthodontic treatment in the Primary Health Centres of the three regions in Kosovo from 2002 to 2013.

Methods

The data on ARPDs delivery and CDs delivery was obtained from the archives of primary health centres from three Kosovo regions (Prizren, Peje, Ferizaj) from 2002 to 2013. The data was analysed concerning year of treatment, type of dentures, jaw, age, gender and urban or rural origin of the patients. The trend of treatment was determined, and the binomial logistic regression model was used for predicting odds of ARPD versus CD treatment by year of treatment and patient characteristics.

Results

From 2002 to 2013, 9,478 patients received 11,655 CDs and 4,401 ARPDs. Delivery of CDs significantly increased by 57.45 dentures per year (R2=0.609) and delivery of ARPDs by 30.39 dentures per year (R2=0.569). Each year the odds for ARPD versus CD increased by 4.2% (95% CI: 3.0%–5.4%). Younger patients have higher odds for ARPD rather than CD and odds for ARPD are decreasing as the age of patients rises. The gender, residence, and jaw all had a significant impact on prosthodontic treatment too.

Conclusions

In Primary Health Centres of Kosovo, there is a trend for higher frequencies of both dentures (more obvious for ARPD), and the frequency is highly dependent on the age of patients.

Open access

Robert Čecho, Viera Švihrová, Dominika Čecho, Martin Novák and Henrieta Hudečková

Abstract

Introduction

Published research studies in Central Europe have been mostly oriented toward occupational stress among schoolteachers. The aim of this study is to investigate the level of occupational stress in kindergarten teachers and to specify psychosocial risks associated with their work.

Methods

The study was conducted by using a Meister questionnaire and a Psychosocial risk questionnaire. The data collection was obtained from kindergarten teachers in 2017. The survey link with request was sent to participants via email. A total 287 questionnaires from 67 kindergarten schools were collected.

Results

192 (66.9%) teachers perceived their work as mentally burdensome. Teachers who perceived their work as mentally non-burdening were more likely to report autonomy in their work (p=0.001), fair performance evaluation (p=0.010), sufficient family time (p=0.005), a health-protected workplace (p=0.000) and absence of violence and bullying (p=0.042). Teachers with a university degree perceiving work as mentally burdensome reported that their work was not adequately assessed (p=0.034). Teachers over 45 years of age with school practice of over 20 years reported injustice in evaluating work performance against younger colleagues (p=0.000).

Conclusion

Kindergarten teachers reported overloading, time pressure, and high responsibility, but considered their work interesting. However, changing the way teachers work in schools can reduce teacher resignation and improve teachers’ well-being.

Open access

Jure PUC, Petra Obadić, Vanja Erčulj, Ana Borovečki and Štefan Grosek

Abstract

Objective

To survey university students on their views concerning the respect for autonomy of patients and the best interest of patients in relation to the withholding of resuscitation.

Methods

A cross-sectional survey among university students of medicine, nursing, philosophy, law and theology of the first and the final study years at the University of Ljubljana and the University of Zagreb was conducted during the academic year of 2016/2017. A questionnaire constructed by Janiver et al. presenting clinical case vignettes was used.

Results

The survey response rates for students in Ljubljana and Zagreb were 45.4% (512 students) and 37.9% (812 students), respectively. The results of our research show statistically significant differences in do-not resuscitate decisions in different cases between medical and non-medical students in both countries. Male and religious students in both countries have lower odds of respecting relatives’ wishes for the withholding of resuscitation (odds ratio 0.49–0.54; 95% confidence interval). All students agreed that they would first resuscitate children if they had to prioritize among patients.

Conclusions

Our study clearly shows that gender, religious beliefs, and type of study are important factors associated with the decisions pertaining to the respect for autonomy, patient’s best interest, and initiation or withholding of resuscitation.

Open access

Irena Klavs, Mojca Serdt, Aleš Korošec, Tatjana Lejko Zupanc, Blaž Pečavar and

Abstract

Introduction

In the third Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute care hospitals, we estimated the prevalence of all types of HAIs and identified factors associated with them.

Methods

Patients were enrolled into a one-day cross-sectional study in November 2017. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors.

Results

Among 5,743 patients, 4.4% had at least one HAI and an additional 2.2% were still treated for HAIs on the day of the survey, with a prevalence of HAIs of 6.6%. The prevalence of pneumoniae was the highest (1.8%), followed by surgical site infections (1.5%) and urinary tract infections (1.2%). Prevalence of blood stream infections was 0.3%. In intensive care units (ICUs), the prevalence of patients with at least one HAI was 30.6%. Factors associated with HAIs included central vascular catheter (adjusted odds ratio [aOR] 4.1; 95% confidence intervals [CI]: 3.1–5.4), peripheral vascular catheter (aOR 3.0; 95% CI: 2.3–3.9), urinary catheter (aOR 1.8; 95% CI: 1.4–2.3).

Conclusions

The prevalence of HAIs in Slovenian acute care hospitals in 2017 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.

Open access

Vojko Strojnik and Branko Gabrovec

Abstract

Introduction

This paper aimed to review the effect of physical activity and exercise in frail older persons. As the process which leads to frailty and disability can be slowed down or even completely reversed, it can be appropriate for early interventions.

Methodology

A literature search was conducted in the following databases: PubMed, Cochrane, Embase, Cinahl and UpToDate. The criterion in selecting the literature was that articles were published from 2002 to 2017. From 620,043 initial hits, 25 publications were selected.

Results

Physical activity and exercise in frail elderly are effective and relatively safe and may reverse frailty.

Conclusion

Different exercise interventions in frail elderly persons can increase strength and power, improve balance and reduce fall incidence resulting in greater quality of life. From this perspective, physical exercise interventions should become daily routine in frail elderly persons.

Open access

Sanela Slavkovic, Spela Golubovic, Matilda Vojnovic and Congor Nadj

Abstract

Introduction

Multiple sclerosis (MS) results in a wide range of disabilities. The effects of cognitive and motor dysfunctions are significant and affect level of functioning in people with MS.

Objective

The aim of the research was to determine the common contribution of neurological, motor and cognitive status to the overall functioning of MS patients.

Method

The sample consisted of 108 subjects with RRMS. The instruments used in the research included: The General Questionnaire, the World Health Organization Disability Assessment Schedule, the Audio Recorded Cognitive Screen, Paced Auditory Serial Addition Test, the Nine Hole Peg Test, the 25 Foot Walk Test, and the Expanded Disability Status Scale.

Results

Subjects with a mild neurological deficit had a higher level of current functioning in all domains (a lower WHODAS 2.0 score) than subjects with a moderate neurological deficit (r=0.43, p<0.001). We found a positive correlation between the level of cognitive impairment and motor deficits of both upper and lower extremities and the level of neurological deficit (p<0.001). Subjects with lower neurological deficits had significantly lower WHODAS 2.0. scores, i.e. better motor abilities of both upper and lower extremities than subjects with moderate neurological deficits (p<0.001). The greatest contribution to explaining the overall level of current functioning of people with MS had subjects’ age, cognitive abilities and motor abilities of the upper extremities.

Conclusion

Inverse relationship of neurological, motor and cognitive status affects the overall daily functioning of people with MS, requiring planning of comprehensive programs in the rehabilitation of people with MS.

Open access

Mirjam Rogl Butina, Igor Švab, Barbara Perić and Igor Bartenjev

Abstract

Introduction

Most data related to cutaneous melanoma survivors’ health behaviour comes from epidemiological studies and is predominantly concerned with safe-sun behaviour and self-examination. Data regarding other changes of health behaviour are scarce and so are qualitative studies in this realm. The aim of our research is to acquire insight into the experiences of patients with cutaneous melanoma in Slovenia. How did they react to the diagnosis, which changes did they introduce in their health behaviour and how do they assess the role of family doctors?

Methods

Using the qualitative approach of collective case reports, a demographically diverse group of patients with different forms and stages of cutaneous melanoma was selected. Semi-structured interviews conducted by a psychologist were recorded and transcribed verbatim. For data processing, the approach of Qualitative Content Analysis was applied.

Results

We integrated interviewees’ experiences after the diagnosis of cutaneous melanoma in several subcategories: either they did not introduce any changes or they mentioned changing their habits when exposed to the sun and performing skin self-examination; they also emphasized their ways of dealing with stress and raising awareness about melanoma among family members and friends. The role of family doctors in the prevention and care appears unclear; even contradictory.

Conclusion

We obtained insight into the experiences of Slovenian patients with cutaneous melanoma. The interviewees prioritised safe behaviour in the sun, strengthening of psychological stability and raising awareness about melanoma. Findings will be used in the creation of a structured questionnaire for national epidemiological survey.