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Individual and contextual factors of nulliparas’ levels of depression, anxiety and fear of childbirth in the last trimester of pregnancy: intimate partner attachment a key factor?

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
Measuring quality in primary healthcare – opportunities and weaknesses

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
Classification of primary caesarean sections in labor and its usefulness for analysis of Slovenian perinatal data

Abstract

Objective

To determine the usefulness of a novel classification of indications for caesarean section (CS) in labour in recognizing differences in clinical practice in different maternity units.

Methods

Data from the National Perinatal Information System (NPIS) for 2013 and 2014 were used to classify indications for CS in nulliparous women with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses within 14 Slovenian maternity units into foetal distress and different sub-groups of dystocia according to use and dosage of oxytocin. Chi-square test was used for statistical comparison between units (P≤0.05 significant).

Results

There were 13,572 deliveries and 1,567 (12.0%) CS in nulliparous patients with spontaneous onset of labour at ≥37 weeks with single cephalic foetuses in Slovenia during the study period. Rates of CS in this group of women differed significantly among different maternity units (from 4.1% to 20.9%; P<0.001) suggesting significant differences in clinical practice. The most common indication for CS was cephalopelvic disproportion, which was diagnosed with different frequency in different units (from 11.2% to 45.9%; odds ratio 6.72; 95% confidence interval 3.10– 14.71; P<0.001).

Conclusions

It is possible to use NPIS data to retrospectively classify indications for CS. Such classification reveals significant differences among maternity units and could allow for a meaningful analysis of CS rates in different hospitals leading to evidence-based initiatives to decrease the incidence of primary CS.

Open access
Frailty assessment scales for the elderly and their application in primary care: A systematic literature review

Abstract

Background

The increase in the elderly population is causing changes and challenges that demand a comprehensive public health response. A specific characteristic of the elderly is their frailty. Today’s problems with identifying levels of frailty are being resolved by numerous tools in the form of frailty assessment scales. This systematic review establishes which frailty assessment scales for the elderly are being used and what their applicability in primary care is like in Slovenia and around the world.

Methods

Documents published after 2010 were searched for in the PubMed database using keywords and other specific criteria.

Results

A total of 177 search hits were obtained based on various search strings. The final analysis included 28 articles, of which three were systematic literature reviews. These three covered quantitative studies, mainly consisting of observational cross-sectional surveys or cohort studies. Three other studies featured non-systematic literature reviews. Quantitative studies (mainly cross-sectional surveys or cohort studies) prevailed among the remaining 22 articles. One study had a qualitative design (Delphi method). The main outcome measures observed by all studies were frailty assessment scales for the elderly, the majority of which were evaluated on a sample of the elderly.

Conclusions

None of the assessment scales examined are used as the gold standard for primary care. A variety of tools are being used in clinical practice to assess frailty in elderly patients, highlighting the need for standardization and guidelines. This requires evaluating the current assessment scales in terms of validity and reliability, and suitably improving them.

Open access
Health behaviour changes of cutaneous melanoma survivors in Slovenia – a qualitative study

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.

Open access
Influence of cognitive and motor abilities on the level of current functioning in people with multiple sclerosis

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
Management of frailty at individual level: Narrative review of physical activity from the European perspective of joint action on frailty – JA advantage

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
Prevalence of and factors associated with healthcare-associated infections in Slovenian acute care hospitals: Results of the third national survey

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
Designing of diving technologies – process approach

Abstract

This article is a brief description of a new methodology1 for utilising the Nx – SCR CRABE SCUBA rebreather 2. This new approach differs from that described in a previous article [1,2]. The new methodology is based on a Polish theory3 mainly consisting of deterministic methods4 of modelling semi-closed circuit rebreathers. Further research5 can henceforth be carried out in a more reliable and efficient manner than ever before.

Open access
On a method for supporting visual identification of underwater objects

Abstract

The search and detection of objects under water is carried out by groups of specialised divers. However, their time underwater and their ability to penetrate the depths are limited. For these reasons, the use of unmanned underwater vehicles equipped with technical observation equipment, including TV cameras, is becoming increasingly popular for these tasks. Video images from cameras installed on vehicles are used to identify and classify underwater objects. The process of recognition and identification of objects is tedious and difficult and requires the analysis of numerous sequences of images, and so it is desirable to automate this process. In response to these needs, this article presents the concept of identification of underwater objects based on visual images from an underwater body of water sent from an unmanned underwater vehicle to a base vessel. The methods of initial processing of the observed images from an underwater area as well as the method of searching for selected objects in these images and their identification with the use of the Hough transform will be described. Furthermore, the paper presents the results of the preliminary processing and identification of the observed images following a deconvolution operation.

Open access