Zdravstveno Varstvo最新文献

Introduction: Arterial hypertension (AH) and type 2 diabetes (T2D) represent a significant burden for the public health system, with an exceptionally high prevalence in patients aged ≥65 years. This study aims to test the acceptability, clinical effectiveness, and cost-effectiveness of telemonitoring in elderly patients with AH and T2D at the primary care level.

Methods: A m ulti-centre, prospective, randomized, controlled t rial w ill be conducted. Patients a ged ≥ 65 y ears with AH and T2D will be randomized in a 1:1 proportion to a mHealth intervention or standard care group. Patients in the intervention group will measure their blood pressure (BP) twice weekly and blood glucose (BG) once monthly. The readings will be synchronously transmitted via a mobile application to the telemonitoring platform, where they will be reviewed by a general practitioner who will indicate changes in measurement regimen or carry out a teleconsultation. The primary endpoint will be a change in systolic BP (SBP) and glycated haemoglobin (HbA1c) relative to standard care up to 12 months after inclusion. Secondary endpoints will be a change in other observed clinical variables, quality-of-life indexes, and costs.

Expected results: Telemonitoring will be an acceptable method of care associated with significant reductions in SBP and HbA1c levels and an increase in quality-of-life indexes in the intervention group. However, the cost-effectiveness threshold (incremental cost-effectiveness ratio below €25,000/quality-adjusted life year) might not be reached.

Conclusion: This study will provide new evidence for scaling up telemonitoring network at the primary care level and modifying telemonitoring protocols to achieve the best clinical and cost-effective outcomes.

Climate change is one of the biggest threats to public health. Sustainability is characterized by using resources wisely in a way that protects finite resources and the environment, and takes into account the needs of our planets' inhabitants in the future. Sustainability in health care should be considered as a seventh domain of quality, as it can lead to improvement of patient outcomes, and more capacity for health care workers to engage in quality improvement and thereby improve the quality of care. The carbon footprint of primary care is high, mainly due to prescribing medication, but also due to the transport of patients to hospitals and primary care services for interventions requested by family medicine. Other causes are the transport of staff and supplies, consumables and staff involved in laboratory analysis and radiation, medical and non-medical equipment, clinical and non-clinical waste, heating and cooling systems and other activities. Small adjustments in these areas could significantly decrease the carbon footprint of primary care practices. The suggested steps for primary care to achieve a more sustainable practice are fostering research, raising awareness, reducing the burden on primary care, engaging in quality improvement, and leadership and advocacy. Each individual primary care practice has the potential to be a leader and role model for sustainable health care. With the implementation of interventions to reduce carbon footprints, primary care could set an example within the health sector and for patients. This could significantly raise the awareness of the public about the need to take actions for a greener health system.

Background: As of writing, there are no publications pertaining to the prediction of COVID-19-related outcomes and length of stay in patients from Slovene hospitals.

Objectives: To evaluate the length of regular ward and ICU stays and assess the survival of COVID-19 patients to develop better prediction models to forecast hospital capacity and staffing demands in possible further pandemic peaks.

Methods: In this retrospective, single-site study we analysed the length of stay and survival of all patients, hospitalized due to the novel coronavirus (COVID-19) at the peak of the second wave, between November 18th 2020 and January 27th 2021 at the University Clinic Golnik, Slovenia.

Results: Out of 407 included patients, 59% were male. The median length of stay on regular wards was 7.5 (IQR 5-13) days, and the median ICU length of stay was 6 (IQR 4-11) days. Age, male sex, and ICU stay were significantly associated with a higher risk of death. The probability of dying in 21 days at the regular ward was 14.4% (95% CI [10.9-18%]) and at the ICU it was 43.6% (95% CI [19.3-51.8%]).

Conclusion: The survival of COVID-19 is strongly affected by age, sex, and the fact that a patient had to be admitted to ICU, while the length of hospital bed occupancy is very similar across different demographic groups. Knowing the length of stay and admission rate to ICU is important for proper planning of resources during an epidemic.

Introduction: Remote consultations in general practice can be very useful form of telemedicine, which is basically a way to exchange medical information to improve the clinical health of patients when the patient and their general practitioner (GP) are not on the same place at the same time. This concept was developed in the 1980s to provide health care to patients who lived in remote areas.

Methods: We were interested in researching what kind of remote consultations are available in general practice and what is the usage of these methods. We used four keywords - remote consultation and general practice or family medicine or primary care - and we searched in four different scientific databases: Medline-PubMed, Scopus, Web of Science and IEEX Xplore.

Results: We used a PRISMA diagram to identify studies and search the four main databases, we investigated 48 full text articles and when we applied our inclusion and exclusion criteria, 12 studies were included in this systematic review.

Conclusions: This systematic review covers the topics of remote consultation versus a traditional or classic physical consultation. Studies have shown its importance prior to the COVID-19 pandemic, and its value while in the mist of the pandemic then caring for infected patients. We have found that remote consultation is necessary, but it must be an improvement on the previous system. Teleconsultations can reduce the number of visits, especially during lockdown situations, with both patients and GPs satisfied with the method, but we should not forget that a physical consultation cannot be fully replaced by a remote consultation due to the limitations of the latter.

Aim: To analyse if body mass index (BMI) could be used as a fast proxy indicator of poor oral hygiene habits (POHH) among the adult population with diabetes mellitus.

Methods: Adults, aged 25-74, from the Slovenian 2016 nationwide cross-sectional survey based on the Countrywide Integrated Non-Communicable Disease Intervention (CINDI) Health Monitor methodology, who reported being diabetic, were included in the study (n=560). We assessed the relationship between POHH and BMI, adjusted to confounders, using multiple binary logistic regression.

Results: In the total sample, the POHH prevalence was 50.9%. Taking into account BMI, POHH prevalence in participants with normal BMI values was only 37.8%, in the overweight group it was 1.22-times higher (46.0%), while in the obese group it was 1.63-times higher (61.6%) (p<0.001). Also, the odds for POHH were 2.64-times higher in the obese group in comparison to the normal BMI group (95% CI: 1.55-4.51; p<0.001). After adjustment for confounders, this OR decreased only moderately (OR=2.45; 95% CI: 1.35-4.44; p=0.003).

Conclusions: BMI could be used as a readily assessable, fast, simple, and cheap tool indicating higher odds for having POHH among the diabetic population. By defining the high-risk group it could be easier for physicians and dentists to take further referrals and actions for promoting oral health in this group. The suggested tool can save time and could have an important positive impact on the quality of life of diabetics, as well as on health expenditures.

Introduction: Education about food safety is important for public health, and the best place to provide it is a university environment. The aim of the research was to assess food safety knowledge and self-reported food handling practices among students in Serbia.

Methods: The research was performed from October to December 2020, using an electronic survey among students at the University of Belgrade, University of Niš, and University of Novi Sad.

Results: The average students' age was 21 (SD=1.7), and genderwise the proportion was 54% women and 46% men. The average score for self-reported food handling practices was 45.7% (SD=15.7), and for food safety knowledge 57.9% (SD=15.7). The results showed that students whose field of study is health-related (e.g. nutrition, chemistry, biology, medicine and pharmacy) had the highest score for self-reported food handling practices (48.8%) and for food safety knowledge (57.7%). As for age, the senior students showed the highest score for food safety (57.2%), followed by third-year students (53.8%), second-year (51.9%), and first-year students (49.9%).

Conclusions: The first-year students and those whose field of the study was not health-related showed the lowest score in the answers to the questions about food handling practices and food safety knowledge. However, the longer students study, the more knowledge they have, which is not the case for those whose studies are non-health-related.

Health literacy refers to skills and knowledge that enable individuals to navigate health-related information environments, to function in healthcare systems, and to practice behaviors that lead to better health outcomes. Accordingly, health literacy is one of the major preoccupations of public health scholars, policies, and strategies. However, it is a complex, multidimensional, and dynamic concept that incorporates different kinds of health-related skills and knowledge. This editorial briefly presents dimensions, levels, and domains of health literacy and discusses a growing need to acknowledge health literacy as a context-specific concept that includes various forms with context-specific conceptualizations. More specifically, it focuses on three health literacy forms that are gaining attention, namely e-health literacy, vaccine literacy, and mental health literacy. By emphasizing the importance of health literacy research for this journal and in general this editorial calls for increasing engagement in this field and invites further contributions on the topic.

Introduction: Despite the high prevalence of malnutrition in patients at all levels of healthcare, early prevention and treatment of malnourished patients are often neglected and overlooked in clinical practice. The aim of this systematic literature review was to identify the factors considered most important by healthcare professionals in the identification and treatment of malnourished patients or those at risk of malnutrition.

Methods: A systematic literature review of qualitative research was conducted. Documents published in scientific journals in English from 2011 to 2021 were searched in the PubMed (MEDLINE), CINAHL and ProQuest databases. The results were analysed with a thematic analysis of qualitative research findings.

Results: From the search set of 1010 results, 7 sources were included in the final analysis. Factors identified by health professionals as important in the identification and treatment of malnourished patients in clinical practice were grouped into five themes: unclear organizational structure; indefinite structure of nutritional care; poor continuity of nutritional care; lack of knowledge and skills of health professionals; lack of time and human resources.

Conclusions: Health policy must provide resources for nutritional care for patients at all levels of health care on the initiative of the highest professional bodies at the state level. To improve the nutritional care of patients in clinical practice, the management of health care institutions must promote and enable the professional and organizational establishment of clinical nutrition as a regular medical activity of the institution, develop clinical nutritional pathways, and promote evidence-based clinical practice and interprofessional collaboration.

Introduction: Among physiotherapists, work-related musculoskeletal disorders (WMSDs) are the most common health problem. This study aimed to provide evidence for planning evidence-based health promotion programmes for ensuring and maintaining adequate physical fitness (PF) to decrease WMSDs among physiotherapists which would have started already during the study.

Methods: A cross-sectional study involved the participation of a total of 100 physiotherapy students and 62 physiotherapists. Observed variables were prevalence of WMSDs in the last 12 months, lasting >3 days during physiotherapeutic activities and five PF components: body composition, cardiorespiratory and muscle endurance, muscle strength, and flexibility. A chi-square test and binary logistic regression were used as the main analytical methods.

Results: Prevalence of WMSDs in physiotherapists was 63.9% (the most common locations: lower back, shoulders, neck), while in physiotherapy students it was 46.5% (the most common locations: lower back, neck, upper back) (p=0.031). Among the PF components, the results showed statistically significantly worse flexibility among students compared to physiotherapists (about two thirds of students had poor or very poor results of flexibility testing) (p=0.002) in comparison to physiotherapists. A statistically significant positive association between WMSDs and PF was observed only between knee pain and poor cardiorespiratory endurance (OR=4.03 with 95% CI 1.12-14.58; p=0.033).

Conclusion: The study showed poor flexibility among students indicating that it is necessary to direct them to perform activities that will increase the extensibility of muscles. The awareness of this problem should be increased. A specific role should be played by staff involved in clinical practice.

Introduction: The purpose of the study was to analyse the impact of the COVID-19 pandemic on the healthcare of the orthopaedic patient, i.e. numbers of hip and knee replacement surgeries, 90-day mortality, waiting times and outpatient clinic visits.

Methods: The Hip (HR) and Knee Replacement (KR) records from The National Arthroplasty Registry of Slovenia in the pandemic year 2020 were compared to the year 2019. To compare reasons for revision and 90-day mortality the Chi-square test was used. The median values of the number of operations and waiting times were compared with the 95% confidence intervals. The number of outpatient clinic visits was tested with the Wilcoxon Signed Ranked test.

Results: All operations fell by 19%, from 7825 to 6335. The number of Primary Total HR declined from 3530 to 2792 (21%) and the number of Primary KR from 3191 to 2423 (24%). The number of hip revisions declined by 10% and knee revisions by 25%. We did not find differences in 90-day mortality (p=0.408). Outpatient clinic visits fell from 228682 to 196582 (14%) per year. Waiting times increased by 15% for HR and by 12% for KR.

Conclusion: There was an inevitable drop in the number of surgeries and outpatient clinic visits in the spring and autumn lockdown. With the reorganisation of the orthopaedic service in Slovenia, the number of KR and HR stayed at a relatively high level despite the pandemic. An epidemiological model and mechanisms for the reduction of waiting times could overcome the impact of the epidemic.