Zdravstveno Varstvo最新文献

Introduction: To assess long-term changes in body mass index (BMI) and weight status among girls from Eastern Poland between 1986 and 2021.

Methods: Data were obtained from repeated cross-sectional, population-based surveys conducted in Eastern Poland in 1986, 1996, 2006, 2016, and 2021. The study included 14,825 girls aged 8, 13, and 17 years, recruited from the same schools across survey waves. Body height and body mass were measured by trained personnel using standardised procedures, and BMI was calculated. Weight status categories (underweight, normal weight, overweight and obesity) were defined using international BMI cut-off points. Statistical analyses included analysis of variance and post hoc comparisons.

Results: Between 1986 and 2021, the largest increase in BMI was observed among 13-year-old girls (+1.66 kg/m²), followed by 8-year-olds (+1.14 kg/m²), while a decrease occurred among 17-year-olds (-1.13 kg/m²). The prevalence of underweight declined among 8- and 13-year-olds by 2.70 and 3.15 percentage points, respectively, but increased among 17-year-olds by 1.85 percentage points. In parallel, the combined prevalence of overweight and obesity increased across all age groups: 19.89 percentage points among 8-year-olds, 10.66 among 13-year-olds, and 3.87 among 17-year-olds, with the greatest increases occurring in recent survey periods.

Conclusions: Over the past 35 years, BMI distribution among girls in Eastern Poland has shifted towards higher values, accompanied by a rise in overweight and obesity. The increase in underweight among older adolescents may reflect psychosocial pressures. These findings highlight the need for age-specific public health strategies addressing both excessive and insufficient body mass.

The environment in which we are born, live, work, and age is an important determinant of human health. This review summarises key epidemiological studies conducted over the past 15 years at the Department of Public Health, Faculty of Medicine, University of Ljubljana, in collaboration with experts in public health, clinical medicine, and other health and environmental disciplines. Methodological approaches for linking health and environmental data, including advanced spatial epidemiological methods to assess the impact of ambient air pollutants on respiratory diseases and diabetes, were highlighted. Considering the observed health outcomes among children and adolescents, new tools were developed and validated to estimate the prevalence of asthma and sleep-related problems among youths. In adults, the review examines the lifetime prevalence of first and recurrent systemic allergic reactions to bee venom among beekeepers, emphasising the need for effective risk-management strategies. Overall, the studies demonstrated the value of integrating health and environmental data to better understand and address public health challenges in Slovenia. The findings underscore the importance of interdisciplinary collaboration in developing evidence-based public health policies to mitigate environmental health risks and promote a high quality of life for present and future generations.

Introduction: There is a growing concern that terminally ill cancer patients may be receiving aggressive management at the end of life. This study aimed to evaluate the use of aggressive management (anticancer treatment and medical care) in patients with advanced cancer in their last month of life and to evaluate the influence of specialist palliative care on it.

Methods: This retrospective study included adult patients with advanced solid cancers treated at the Institute of Oncology Ljubljana who died between January 2015 and December 2019. Multiple logistic regression models were used to assess the association between the aggressiveness of anticancer treatment and medical care, the year of death, age at death, sex, prognosis, type of cancer and inclusion of specialist palliative care.

Results: We included 1,736 patients in our analysis. 538 (31%) patients received at least one anticancer treatment modality. There was an increasing use of chemotherapy and novel systemic therapies. A significant predictor for aggressive anticancer treatment (OR 0.96; 95% CI 0.95-0.97) and medical care (OR 0.96; 95% CI 0.95-0.97) was younger age. Inclusion into the specialist palliative care was strongly associated with less aggressive anticancer treatment (OR 0.19; 95% CI 0.12-0.31) and medical care (OR 0.25; 95% CI 0.15-0.40).

Conclusions: In the last month of life, there was an increasing use of chemotherapy and novel systemic therapies, especially in younger patients. Inclusion in specialist palliative care was associated with less aggressive end-of-life management.

Introduction: This study aims to assess the effectiveness of biological therapies in reducing migraine-related symptom burden and functional disability, including reductions in monthly migraine days, pain intensity, and analgesic consumption, among patients with migraine in Slovenia.

Methods: This retrospective study analysed 92 adult patients with migraine receiving prophylactic biological treatment at the University Medical Centre Ljubljana. Average number of monthly migraine days (MMD), average analgesic consumption, pain intensity (VAS), and functional disability score (MIDAS) were collected before treatment and after 3 and 12 months. Statistical analysis involved the Friedman test to assess changes over time, followed by Wilcoxon tests with Bonferroni correction for post hoc comparisons.

Results: 83 patients completed 12 months of treatment. Significant reductions (p < 0.001) were observed in MMD (median 10 vs. 2 days), analgesic consumption, VAS scores (median 8 vs. 4), and MIDAS scores after 3 months (median 19 vs. 2), sustained at 12 months. Treatment discontinuation occurred in 9 patients due to inefficacy or side effects. Most patients tolerated biologics well, with mild adverse effects reported.

Conclusions: Biological therapies significantly reduced migraine-related symptom burden and functional disability, including decreases in migraine frequency, pain intensity, and analgesic use, in a Slovenian migraine cohort. These findings support the use of biologics as effective and safe options for migraine prevention in real-world clinical practice.

Introduction: This study aimed to develop a suitable instrument for assessing excessive daytime sleepiness (EDS) in Slovenian children and adolescents by translating the ESS-CHAD and psychometrically validating its Slovenian version (ESS-CHAD-SI).

Methods: The ESS-CHAD was translated and back-translated according to established cross-cultural adaptation guidelines, and content validity was assessed by eleven experts from relevant clinical and research disciplines. A nationwide sample of 3,314 adolescents (≈52% females), with an overall mean age of 15.4±1.7 years, completed the questionnaire. Reliability was evaluated using Cronbach's α and Guttman's λ2, and construct validity was examined using exploratory and confirmatory factor analyses.

Results: All items met the predefined thresholds for content relevance, while clarity indices were acceptable for the majority of items. Factor analyses indicated that a two-factor model provided a better fit to the data than the original unidimensional structure, distinguishing between passive sleepiness and more clinically concerning manifestations of sleepiness. The ESS-CHAD-SI demonstrated adequate internal consistency.

Conclusions: The ESS-CHAD-SI is a reliable, valid, and culturally adapted instrument for assessing excessive daytime sleepiness in Slovenian adolescents. The identified two-factor structure enhances its clinical and public health relevance by enabling differentiation between sleepiness related to modifiable sleep behaviours and potentially pathological somnolence. The scale is suitable for use in school-based screening, clinical practice, and epidemiological research.

Introduction: Vaccine hesitancy remains a major global public health challenge. Psychological models, such as the 7C vaccination readiness scale, aim to identify key psychological determinants of vaccine uptake. While the scale has shown validity in various cultural contexts, its psychometric properties have not yet been evaluated in Slovenia.

Methods: This study assessed the psychometric properties, convergent validity, and criterion validity of the Slovenian version of the 7C scale using a representative sample of 1,350 adults via confirmatory factor analysis (CFA), correlation coefficients, and regression analyses.

Results: The bifactor model showed mixed psychometric properties. CFA revealed a weak model fit, with two items showing inadmissible estimates; these were removed. The revised model showed improved estimation and acceptable, though still suboptimal, fit indices. Convergent validity was supported by significant correlations between the general vaccination readiness factor and conspiracy beliefs, while individual components showed weaker associations. Criterion validity analyses showed that the general factor was the strongest predictor of vaccination intention, with calculation and compliance also contributing. The 7C model explained more variance in vaccination intention than the 5C model, suggesting greater utility. Despite structural limitations, the scale demonstrates practical value and offers recommendations for refinement.

Conclusions: The Slovenian version of the 7C scale proved to be a valuable tool for predicting vaccination intention. The general factor was a robust predictor, and calculation and compliance showed additional validity. However, components like complacency and constraints need revision to improve model fit. With refinement, the 7C scale holds promise for research and public health applications across contexts.

Introduction: To compare the number and reasons for self-perceived barriers to accessing primary health care (PHC) services between Roma/Egyptian and ethnic Albanians.

Methods: 533 adults (mean age: 45±18 years; ≈60% women) reporting barriers to accessing PHC services were recruited consecutively during a nationwide survey in October 2024 across all four regions of Albania, using probability-proportional-to-size sampling. A semi-structured questionnaire was administered by trained interviewers inquiring about the number and reasons for self-perceived barriers to accessing PHC services, health characteristics, and sociodemographic factors. General linear models and binary logistic regression were employed to assess the association between perceived barriers and ethnic groups.

Results: 444 (≈83%) participants were ethnic Albanians, whereas the remaining 89 (≈17%) individuals belonged to other ethnic groups, including Roma (n = 57), Egyptians (n = 30), and Gorani or Macedonians (n = 2). Overall, cost and waiting time were the most common barriers. Roma/Egyptian minorities faced more cultural and language issues, whereas Albanians reported higher distrust and service-related expectations. The crude mean number of barriers to accessing PHC services was higher among Roma/Egyptian minorities than among Albanians (1.8 vs. 1.6, respectively; P = 0.04). The multivariable-adjusted odds of reporting ≥ 2 barriers to accessing PHC services were 93% higher among Roma/Egyptian minorities than in Albanians (P = 0.03).

Conclusions: Roma/Egyptian minorities experience more barriers in accessing PHC services than ethnic Albanians. However, the cost of services constitutes the main barrier across both groups. Conversely, communication-related barriers affect mainly Roma/Egyptian minorities, whereas Albanians perceive more systemic barriers. In Albania, there is a need for targeted, equity-focused interventions.

Introduction: To evaluate data on users, the characteristics of admission, placement and discharge of individuals in secure units. These are locked units in special residential institutions in the social care sector.

Methods: A total population descriptive study was performed. In April 2024, a questionnaire comprising 72 items was sent to all six institutions with secure units in the field of mental health and intellectual disabilities. Data from 2023 were gathered. Descriptive and univariate analysis were applied.

Results: A total of 64% of users were male, and the mean age was 54.3 years. The vast majority of users (98%) were admitted involuntarily and deprived of their legal capacity (67%). The largest proportion of users were admitted following admission into a psychiatric hospital (44%), admission to open units of the same institution (34%) and living in the community (10%). The mean length of stay in the secure unit was 64.01 months. During the placement in secure units, 14% of users were admitted to a psychiatric hospital. Only 17% users were discharged from secure units, with 81% taking place later, while 19% discharges took place before the expiry of a court order. The most common location of discharge was the open unit of the same institution (79%).

Conclusions: The results highlight high rates of involuntary admissions, prolonged stays and limited transitions to community care, raising public health and human rights concerns. The findings call for a shift in focus from expanding institutional capacity towards improving discharge practices and strengthening community-based support.

Introduction: Our objective was to identify clusters of lifestyle risk factors among Serbian adults and assess associations with socio-demographic characteristics and self-rated health.

Methods: The sample included 7,885 adults aged 18 and over from the 2019 Serbian National Health Survey, who provided information on all four lifestyle risk factors (smoking, physical inactivity, low fruit and vegetable intake and risky drinking). The Two-Step Cluster Analysis was used to identify different health-related lifestyle clusters. Logistic regression models were used to assess the association of obtained clusters with socio-demographic characteristics and self-rated health.

Results: Five distinct clusters of lifestyle risk factors were identified: Healthy lifestyle (cluster 1), Low fruit and vegetable intake (cluster 2), Physical inactivity (cluster 3), Smoking and other risk factors (cluster 4), Risky drinking and other risk factors (cluster 5). Multi-risk groups (cluster 4, cluster 5) exhibit specific socio-demographic characteristics (men, younger adults, living alone, less educated). Adults in unhealthy lifestyle clusters were more likely to report poor self-rated health than adults in the healthy lifestyle cluster.

Conclusions: Individuals who were men, younger, living alone, less educated and those with poor self-reported health were more likely to engage in clusters of lifestyle risk factors and represent high-priority population groups for multiple health behaviour change interventions.

The forthcoming United Nations General Assembly High-Level Meeting on noncommunicable diseases and mental health offers a crucial opportunity to advance global health governance. This editorial argues that while the draft declaration represents a vital step forward, its potential to address global mental health needs is complicated by several paradoxes that merit careful consideration. First, its targets for financing and access may not fully reflect the ambition needed to overcome systemic underinvestment. Second, the "integration paradox" champions a cohesive approach while setting different types of targets for mental health and NCDs. Finally, an implementation paradox is evident in the ongoing focus on individual behavior rather than on the upstream social and commercial determinants of health. Using Slovenia's experience as a national case study, we illustrate how these global challenges can complicate efforts to translate high-level commitments into national reality. We conclude that for the UN Political Declaration to be truly transformative, it must inspire a shift from cautious frameworks to more ambitious financing, authentic integration, and the political courage to prioritise population needs over siloed institutional legacies.