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Aim. This study aimed to evaluate a new project of the Slovene Ministry of Health - the Family Medicine Model Practices (MPs) Project in Slovenia, and to show its effectiveness in the management of asthma and COPD by family medicine practice teams, consisting of a family physician, a nurse practitioner and a practice nurse.

Background: Detection and registration of high risk for cardiovascular diseases (CVD) by assessing individual’s absolute cardiovascular risk is recommended in clinical guidelines. Effective interventions to reduce cardiovascular risk are available, but not optimally implemented. The aim of this study was to assess the quality of cardiovascular risk-factor recording and lifestyle counselling in high-risk patients in European primary care and to identify factors related to these clinical processes.Methods: An international cross-sectional observational study was conducted in stratified samples of primary care practices in nine European countries. Patient records were audited, using a structured data-abstraction tool based on internationally developed quality indicators. To identify factors associated with the recording, additional data were collected in a patient survey. Descriptive and multilevel data analyses were conducted.Results: In 268 general practices across Europe, 3723 records of individuals at high risk for cardiovascular diseases were audited. We found important variations in the quality of documentation of risk factors and lifestyle interventions. Recording of risk factors was best for blood pressure (92.5% of audited records, 95% CI 0.89–0.96). Lifestyle advice was recorded best for smoking cessation (65.6%, 95% CI 0.58–0.73) and worst for physical activity (38.8%, 95% CI 0.31–0.47). Of the study population, 50.6% (0.42–0.59) had elevated blood pressure levels, 59.8% (0.51–0.69) had total cholesterol >5 mmol/l, and 30.5% (0.22–0.39) were smokers. Multivariate analyses showed that recording of risk factors and counselling were related to specific patient characteristics more than to country effects.Conclusions: Analysis of different country results can be helpful for developing quality-improvement strategies.

Efficiency of community based intervention programme on keeping lowered weightObjective:To establish the effectiveness of community based intervention on lowering and sustaining weight.Methods:We performed a longitudinal retrospective study in three primary care centres in Slovenia. 333 men aged 35 to 65 and women aged 45 to 70 with body mass index higher than 25 kg/m2and high risk for cardiovascular diseases or with body mass index higher than 30 kg/m2were included. The data for the analysis were extracted from the forms of National cardio-vascular disease prevention programme. Long-term follow-up of their weight was performed 12 to 24 months after the intervention.Results:The inclusion criteria fulfilled 250 (75%) participants. During the programme the participants' weight lowered by a mean 6.7 kg from 95.5±15.1 to 88.8±14.7 kg (7.1% of the entry body weight, 95% CI: -7.2 to -6.1 %). One to two years after the intervention 62.8% of the participants could not keep the weight they achieved during the intervention phase. Mean regain of the weight was 1.6 kg, (23% of the lost weight, 95% CI: 0.8 to 2.4 kg). Initial body weight of people, who long-term succeeded to keep achieved weight was higher than initial body weight of those people, who regained weight after the programme (t=3.490, P= 0.001) Gender and age did not show any statistically significant impact on long-term weight gain.Conclusions:The intervention programme was successful by the criteria that weight reduction should be at least 5-10%. Majority of the participants could not sustain the reduced weight, but the mean weight gain was less than one fourth of the weight, lost in the intervention period. Besides the interventions for weight reduction also the longterm programmes for sustaining the achieved weight loss are very important.

Intra- and inter-personal factors of psychosocial status in Slovenian military personnel with regard to their traumatic event experienceProblem:The main objectives of this study were to identify differences in the psychosocial status of military personnel who had and who had no traumatic event experience, and to screen for potential mental health vulnerability related to post-traumatic stress.Methods:390 military personnel were included in the study, with 103 of them reporting traumatic event experience. The Mini-International Neuropsychiatric Interview Screening for Post-Traumatic Stress Disorder, the CAGE instrument, the Eysenck Personality Scales, the Folkman-Lazarus Ways of Coping Questionnaire, the Rosenberg Self-Esteem scale and self-evaluative questions about important relationships were administered.Results:The respondents who reported traumatic event experience (TEE) also reported a significantly higher frequency of other stressful events, a significantly more frequent past history of depression (16.5 % of respondents with TEE and 6.2 % of respondents without TEE) and significantly higher risky alcohol drinking; the latter, however, is not higher than the estimate for the total Slovenian population (10.7 % of respondents with TEE and 2.7 % of participants without TEE). Respondents with TEE smoke less frequently than respondents who reported no TEE (46.6 % vs. 60.1 %), and more often rely on self in stressful situations. There was no significant difference between the respondents with reported TEE and those without TEE in their personality traits, coping styles, and self-esteem, or in the majority of job- and family-related factors. No difference was found between male and female personnel as concerns intra-personal factors and in stress-related behaviour.Conclusions:Intra-personal factors (personality, coping styles, and self-esteem) of military personnel indicate good personal potential for resilience. Stress-related substance (ab)use, especially smoking rates well above the Slovenian average, need further attention. Professional support needs to be promoted, especially in female personnel, who are less likely than men to seek social support in times of stress, and in military personnel exposed to cumulative stressors.

Adherenca Pri Zdravljenju Osteoporoze z Enkrat Mesečnim BisfosfonatomIzhodišča:Adherenca pri zdravljenju kroničnih bolezni, zlasti tistih, ki ne povzročajo simptomov, predstavlja problem. Zanimalo nas je, kakšna je adherenca pri enkrat mesečnem jemanju bisfosfonata za zdravljenje osteoporoze, kakšen je vpliv podpornega programa na adherenco ter kakšna so stališča bolnic in njihovih zdravnikov o pomenu zdravljenja osteoporoze ter podpornega programa.Preiskovanci in metode:V raziskavi je sodelovalo 329 bolnic s primarno osteoporozo. 6-mesečno adherenco pri zdravljenju smo ugotavljali na podlagi števila predpisanih škatlic zdravila. Kot vir podatkov nam je služil zdravstveni karton splošne medicine. Stališča bolnic o osteoporozi in podpornem programu za osteoporozo smo ugotavljali s pomočjo strukturiranega intervjuja, stališča zdravnikov pa s pomočjo vprašalnika, izdelanega za namen te raziskave.Rezultati:Bolnice z osteoporozo so bile v povprečju stare 70,9 let (SD 10,0 let). Na 7-stopenjski Likertovi skali so ocenile pomembnost zdravljenja osteoporoze z oceno 6,23 (SD 1,28), zdravniki pa z oceno 6,22 (SD 0,83). Ugotovili smo, da je 6-mesečna adherenca pri zdravljenju z enkrat mesečnim odmerkom bisfosfonata 90,6 %. Boljšo adherenco pri zdravljenju je napovedovala višja stopnja šolske izobrazbe (razmerje obetov: 2,17, 95-odstotni interval zaupanja 1,33-3,55) ter pozitivno stališče bolnic do zdravljenja osteoporoze (razmerje obetov: 1,74, 95-odstotni interval zaupanja 1,27-2,38). Sodelovanje v podpornem programu ni vplivalo na boljšo adherenco pri zdravljenju, čeprav so ga bolnice in zdravniki ocenili kot koristnega.Zaključki:Adherenca pri zdravljenju z enkrat mesečnim odmerkom bisfosfonata je visoka. Pomemben dejavnik, ki je napovedoval adherenco, je prepričanje bolnic, da je zdravljenje osteoproze zelo pomembno.

Patients' adherence to treatment of diabetes mellitusObjectives:Diabetes is a chronic disease where patient's ability for self management is very important. Patients are every day taking decisions how to integrate treatment recommendations into their lives without impacting the quality of life. The aim of this study was to explore participants' perceived barriers to adherence to treatment.Methods:A qualitative study with five focus groups of patients with Type 2 diabetes and one group of experts on diabetes mellitus was performed in the central area of Slovenia. The transcribed text was independently analysed by principles of grounded theory with codes merging into themes and categories.Results:Time changes patients' attitudes toward disease. Good education about the disease and their own experience with the disease help patients to adapt to different life situations and to regain control in their life. Family and friends are not always supportive to diabetes treatment. Some patients deny having disease in social encounters because they feel stigmatised. Diabetes also challenges patient's working ability and financial welfare. Patients also emphasise that mutual trust with physician and his true interest in patients' problems is very important for good results of medical care. They refuse universal advice and expect that the doctor helps them to develop self-management skills and coping with the disease. Additional prerequisites for good self management are also adequate organisation of life and adequate personal characteristics of the patients.Discussion:This study offers additional insights into patients' views of the barriers to adherence. Patients feel empowered for occasional departure from recommended treatment in some social and life situations. Better medical care could be the result of good balance between social expectations of the patients, treatment and working demands on one side and individualised support of the physician with patients' own capacity to rearrange life on the other side.

Osebnostne Značilnosti in Strategije Spoprijemanja S Stresom, Povezane Z Zdravjem in Izgorelostjo Pri Vojakih Slovenske VojskeProblem:Študija odgovarja na vprašanje, katere osebnostne lastnosti izstopajo pri vojakih, ki poročajo o slabšem bio-psiho-socialnem blagostanju, dosegajo višje vrednosti izgorevanja in so posledično manj učinkoviti pri delu in manj motivirani za delo. Občutenje lastnega zdravja je okvirno merilo za zdravstveno stanje posameznika, slaba samoocena zdravja pa je napovedni dejavnik povečane umrljivosti in večje potrebe po zdravstvenih toritvah. Uporabljena diagnostična strategija operacionalizira koncept zdravja, kje bio-psiho-socialno blagostanje, na eni strani ter prinaša možnost za nove ugotovitve o povezanosti stresa in izgorevanja, (samoocen) zdravja in organizacijskega ozračja na drugi strani.Metoda:Študija je potekala med letoma 2006 in 2008. Uporabili smo vprašalnik za samooceno zdravstvenega stanja, Eysenckove osebnostne lestvice, Folkman-Lazarusovo lestvico Načini spoprijemanja s stresom in lestvico izgorevanja Maslachove. Analizirali smo odgovore 390 pripadnikov Slovenske vojske, ki smo jih razdelili v skupino zdravih (SK1-Z), manj zdravih (po merilu bolniške odsotnosti zaradi bolezni; SK2-B) in skupino udeležencev njihovih misij. Ti izpolnjujejo vsa merila zdravja (na eni strani), so pa izpostavljeni posebnim delovnim obremenitvam (delo v tujini).Za obdelavo podatkov smo uporabili statistični paket SPSS (v 17.0, SPSS inc.): izvedli smo t-test, Mann-Whitneyev test, Kruskal-Wallisov test, faktorsko analizo (PC-analiza, rotacija Varimax, Kaiserjeva normalizacija) in korelacijske izračune.Rezultati:Rezultate razlagamo na osnovi predpostavke, da so udeleženci odgovarjali verodostojno, opozorimo pa tudi na možnost zanikanja in/ali odpora. Ključni dejavnik razlikovanja med skupinami je izgorelost, pri kateri najvišje vrednosti dosegajo vojaki na misijah, najnižje pa skupina zdravih vojakov (razosebljenje: X2=21,756; p=0,000; delovna neučinkovitost: X2=7,088; p=0,029; čustvena izčrpanost: X2=6,316; p=0,043). Razlike med SK1-Z in SK2-B pojasnjujemo z osebnostnimi značilnostmi (zaprtost/odprtost mišljenja, nevrotičnost) in t.i. psihosomatsko naravnanostjo. Za udeležence misij so značilni cinizem, mačizem in nezaupanje. Izgorelost (cinizem, nizka delovna učinkovitost) je znak izčrpanega/okvarjenega bio-psiho-socialnega blagostanja, ki lahko vodi v absentizem ali zapustitev poklica/dela.Zaključek:Predlagamo spremembo oz. dopolnitev izbirnega postopka za sprejem v Slovensko vojsko s testom temeljnih osebnostnih lastnosti ter izločanje kandidatov, ki presegajo normirane vrednosti za nevrotičnost in psihotičnost, kar bi lahko zmanjšalo uporabo manj ustreznih strategij spoprijemanja s stresom, depresonalizacijo in čustveno izčrpanost ter povečalo delovno učinkovitost. Učenje veščin v medosebnih odnosih in prevzemanje varovalnih strategij (netekmovalne fizične dejavnosti, konjički) lahko ublaži delovanje nespremenljivih delovnih pogojev in zahtev. Potrebno usmerjenost na čustva ob siceršnji mačistični subkulturi bi bilo mogoče doseči s krepitvijo skupinske povezanosti in kakovosti odnosov v enotah, s čimer bi oblikovali socialno podporo znotraj kolektiva.