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Background: Health-related quality of life (HRQoL) is measuring a patient's experience of his health status and represents an outcome of medical interventions. Existing data proves that a healthy lifestyle is positively associated with HRQoL in all age groups. Patients with a high risk for cardiovascular disease typically led an unhealthy lifestyle combined with risk diseases. We aimed to analyse these characteristics and their reflection in HRQoL. Methods: A cross-sectional study in 36 family practices, stratified by location and size. Each practice invited 30 high-risk patients from the register. Data were obtained from medical records and patient questionnaire. The EQ-5D questionnaire and the VAS scale were used for measuring the patient%s HRQoL as an independent variable. Results: 871 patients (80.6% response rate) were included in the analysis. 60.0% had 3-4 uncontrolled risk factors for CVD. The average VAS scale was 63.2 (SD 19.4). The correlation of EQ-5D was found in the number of visits in the practice (r=-0.31, p

Introduction: One of the aims of health care reform in Montenegro is to strengthen primary care. An important step forward is the implementation of specialty training in family medicine (FM). The aim of this article is to evaluate the implementation of specialty training in family medicine in Montenegro, regarding the content, structure and methods, by the first generation of trainees and the coordinator of the training. Methods: A questionnaire was sent by mail in July and August 2017 to all 26 eligible trainees who started specialty training in 2013. Twenty-two of the 26 trainees (84.6%) responded. The questionnaire consisted of closed and open-ended questions related to the evaluation of the training. A descriptive quantitative and qualitative analysis with predefined themes and a semi-structured interview with the coordinator were carried out. Results: The process of training in FM was assessed positively by both trainees and the coordinator. The positive assessment included that the specialisation course offered modern design through modules and practice, and trainees both improved their existing knowledge and skills and acquired new ones necessary for everyday work. The coordinator emphasised the importance of the introduction of new teaching methods and formative assessment, the important role of mentors, and the involvement of Slovenian colleagues in the teaching process and supervision of the programme. Conclusions: The implementation of speciality training in FM in Montenegro was successful. Several assessment methods were used that can be further developed in individual structured feedback, which could stimulate the continual improvement of trainees% knowledge and competencies.

Objective: 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 35to 65 and women aged 45 to 70 with body mass index higher than 25 kg/m2 and high risk for cardiovascular diseases or with body mass index higher than 30 kg/m2 were 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 participantsć weightlowered 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.

Problem: The main objectives of this study were to identify differences in thepsychosocial 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-TraumaticStress 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 inthe 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 smokingrates well above the Slovenian average, need further attention. (Abstract truncated at 2000 characters)

Objectives: 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 torear range life on the other side. Izhodišče: Za uspešno zdravljenje diabetesa je zelo pomembna bolnikova sposobnost za samooskrbo. Bolniki vsakodnevno sprejemajo odločitve, kako vključiti priporočila zdravljenja v svoje življenje, ne da bi pri tem trpela kakovost njihovega življenja. Raziskava predstavlja, kakšne ovire v sodelovanju pri zdravljenju občutijo sladkorni bolniki. Metode: Uporabljena jebila kvalitativna metodologija s petimi fokusnimi skupinami bolnikov in eno skupino strokovnjakov z osrednjega področja Slovenije. Prepis posnetka je bil dvojno neodvisno analiziran z uporabo metode bazalne teorije z določitvijo kod kot osnovnih analiznih enot in združevanjem kod v teme in kategorije. Rezultati: Bolnikova stališča do bolezni se po postavitvi diagnoze sčasoma spreminjajo. K prilagoditvi na drugačne življenjske okoliščine in k ponovnemu obvladovanju življenja pripomorejo znanje o bolezni in lastne izkušnje v zveziz boleznijo. Prijatelji in družina ne podpirajo vedno zdravljenja sladkorne bolezni. Nekateri bolniki v družbi zanikajo bolezen, ker jo čutijo kot stigmo. Sladkorna tudi vpliva na bolnikovo delovno sposobnost in finančno blagostanje. Pri premagovanju ovir je zelo pomembno vzajemno zaupanje z zdravnikom in zdravnikovo iskreno zanimanje za težave bolnika. Bolniki odklanjajo presplošne nasvete in pričakujejo, da jim bo zdravnik pomagal razviti sposobnost samooskrbe in obvladovanje bolezni. Na sposobnost samooskrbe pa vplivajo tudi dobra organiziranost bolnikovega življenja in njegove osebnostne lastnosti. Razprava: Raziskava predstavlja ovire za bolnikovo zavzetost za zdravljenje, kot jih doživlja bolnik. Bolniki čutijo pravico do občasne opustitve priporočenega zdravljenja, posebej v določenih družabnih in življenjskih okoliščinah. Ravnovesje med željami bolnika, delovnimi zahtevami in priporočili za zdravljenje na eni strani ter k bolniku usmerjena individualna podpora zdravnika ob bolnikovi prilagoditveni sposobnosti na drugi strani lahko izboljša zdravstveno oskrbo.

Problem: The study addresses basic personality traits with soldiers who reportlower bio-psycho-social-wellbeing and burnout and therefore perform poorer working effectiveness and motivation. Perception of one''s health and physical well-being may be used as a measure of one''s health condition and consequently a predictor of higher mortality and greater need for health services. Used diagnostic strategy conceptualizes health as a bio-psycho-social well-being and provides broader insight on interdependence among stress, burnout and organizational climate. Method: Self-rated health questionnaire, Eysenck''s personality scales (EPQ-Revised), Folkman-Lazarus Ways of coping questionnaire and Maslach Burnout inventory were administered. Responses of 390 persons were analyzed. Participants were divided into three groups - healthy (SK1-Z), less healthy (by sick leave criteria, injuries were not included; SK2-B) and persons on missions abroad. Members of the third group meet all health criteria and are exposed to special working conditions, since serving abroad. Data was analyzed by statistical package SPSS (v 17.0, SPSS Inc.): performed were t-test, Mann-Whitney''s test, Kruskal-Wallis'' test, Factor analysis (PC-analysis, Kaiser''s normalization) and correlation coefficients. Results: Interpretation is based upon presumption about veracity of responses; nevertheless the possibility of denial is mentioned. Assuming sincere responses, one distinctive key factor burnout is identified. The highest burnout scores have soldiers serving missions and the lowest healthy group (depersonalization: ?2=21,756; p=0,000; reduced personal accomplishment: ?2=7,088; p=0,029; emotional exhaustion: ?2=6,316; p=0,043). Differences between healthy and less healthy persons are explained by personality traits (such as psychosomatic prone personality, neuroticism and psychoticism). Persons serving missions abroad are cynical, macho and distrustful. Burnout (cynicism, lower personal accomplishment) is a symptom ofdestroyed bio-psycho-social well-being and may develop into absenteeism or quitting the job. Conclusion: A redefinition of selection process for admission in the Slovenian Armed Forces is proposed, to test the basic personality traits and release candidates who exceed values for neuroticism and psychoticism, which could reduce the use of less appropriate coping strategies, depersonalization and emotional fatigue and increase work efficiency. Learning interpersonal skills and using protective strategies (noncompetitive physical activities, hobbies) may reduce the functioning of non-changeable (stable) working conditions and requirements. Necessary emotions-focused coping within macho subculture could be achieved by strengthening group cohesion and quality of relationships, thereby creating social support within the collective. Problem: Študija odgovarja na vprašanje, katere osebnostne lastnosti izstopajopri vojakih, ki poročajo o slabšem bio-psiho-socialnem blagostanju, dosegajo višje vrednosti izgorevanja in so posledično manj učinkoviti pri deluin 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 storitvah. 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: ?2=21,756; p=0,000; delovna neučinkovitost: ?2=7,088; p=0,029; čustvena izčrpanost: ?2=6,316; p=0,043). Razlike med SK1-Z in SK2-B pojasnjujemo z osebnostnimi značilnostmi (zaprtost/odprtost mišljenja, nevrotičnost) in t.i. psihosomatskonaravnanostjo. 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 pogojevin 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.

Background: Studies have shown that the level of patient adherence to osteoporosis treatment is similar to that for other chronic diseases, i.e. approx. 50%. The observed constant decrease in adherence is due to a lack of motivation for long-term treatment. The purpose of our study was to determine the level of patient adherence to once-weekly bisphosphonate, the most commonmedication prescribed for osteoporosis treatment. Methods: A retrospective cohort study was conducted among female patients with primary osteoporosis, who were included in the study by 14 randomly selected Slovene family physicians on the basis of diagnosis classification in a computer-based patient list. For the adherence analysis, the patients were followed for 13 months after the initiation of treatment with once-weekly bisphosphonate. Results: Among the 334 questionnaires returned, 124 met the criteria for the analyisis of patient adherence to once-weekly bisphosphonate therapy. Over the studied 13-month period, the percentage of patients adheringto therapy dropped to 62.9 %. The observed patient compliance was not related to age, level of education, marital status or household size. Thegreatest decrease in adherence was noticed in the first month after treatment initiation due to perceived side effects. Later on, the most common reason for abandoning treatment was failure to ask for a new prescription. Theadherence level of approx. 80 %, reported by the participating doctors, was overestimated. Conclusions: Adherence of patients to osteoporosis therapy tends to be overestimated. The adherence level decreases over time and the proportion of patients abandoning treatment increases, mostly because of side effects and failure of patients to have their prescription refilled. Patients should therefore be monitored for medication adherence and motivated for treatment. Izhodišča: Zavzetost bolnikov za zdravljenje osteoporoze je po študijah podobna kot pri drugih kroničnih boleznih in se giblje okoli 50 %. Za dolgotrajno zdravljenje je značilno stalno padanje zavzetosti zaradi zmanjšanemotiviranosti za zdravljenje. Zanimalo nas je, kakšna je zavzetost zazdravljenje osteoporoze z najpogosteje predpisovanimi zdravili - enotedenskim bisfosfonatom. Metode: Izvedli smo retrospektivno kohortno raziskavo med bolnicami s primarno osteoporozo, ki jih je na osnovi šifriranihdiagnoz v računalniškem izpisu opredeljenih bolnikov vključilo 14 naključno izbranih zdravnikov družinske medicine v Sloveniji. V analizi smo spremljali 13-mesečno obdobje po uvedbi enotedenskega bisfosfonata. Rezultati:Ustrezno izpolnjenih je bilo 334 vprašalnikov, med njimi jih je 124 ustrezalo merilom za analizo zavzetosti. V 13-mesečnem obdobju se je zavzetostzmanjševala do končne vrednosti 62,9 %. Zavzetost ni bila odvisna odstarosti, izobrazbe ali zakonskega stanu bolnic, niti od števila ljudi v skupnem gospodinjstvu. Največji padec je bil prvi mesec po uvedbi zdravila zaradi stranskih učinkov. Kasneje je bil najpogostejši razlog za opustitev zdravljenja to, da bolnica ni prišla po recept. Sodelujoči zdravniki so ocenili, da 80 % njihovih bolnic vztraja pri zdravljenju. Zaključki: Pri zdravljenju osteoporoze precenjujemo bolnikovo zavzetost za zdravljenje, ki počasi upada, delež bolnikov, ki opustijo zdravljenje, pa se sčasoma povečuje,predvsem na račun stranskih učinkov in dejstva, da preprosto ne pridejo po zdravilo. Bolnike je potrebno spremljati in motivirati za zdravljenje.