A qualitative exploration of travel-related risk behaviours of injection drug users from two Slovene regions

This qualitative study of travel-related risk behaviours of Slovene injection drug users was based on interviews with individuals enrolled in drug addiction treatment programmes run by three regional centres for prevention and treatment of drug addiction. The primary objective of the study was to analyse behaviour patterns and practices of injection drug users during travel

COMMUNICATION OF DOCTOR WITH MIGRANTS AND REFUGEES

Važnost komunikacije između pacijenta i liječnika temelj je uspješnog liječenja i upravo je zato sastavni dio preddiplomskog studija medicine, kao i poslijediplomskog osposobljavanja. Mogućnost komunikacije iznimno je važna u međukulturnim odnosima. Liječnici prigodom prevladavanja jezičnih barijera kod migranata i izbjeglica moraju uzeti u obzir i pacijentova sociokulturna uvjerenja, jezične barijere i moguću prisutnost latentnih infekcija te kroničnih bolesti. Kao i pri liječničkom pregledu predstavnika većinske populacije, komunikaciju treba individualno prilagoditi i u slučaju liječenja predstavnika migranata odnosno izbjeglica. Pritom treba uzeti u obzir da ni neverbalna komunikacija nije univerzalna. Liječnici i zdravstveni djelatnici prigodom premošćivanja jezičnih barijera najčešće se služe laičkim tumačima koji u načelu olakšavaju komunikaciju, ali istraživanja su pokazala da mogu imati i negativnu ulogu. Rjeđe se koriste internetskim prevoditeljskim alatima, priručnicima i rječnicima. Bez obzira na pacijentovu kulturnu pozadinu i jezične barijere, liječnik i njegovi suradnici od početka moraju graditi odnos povjerenja zasnovan na međusobnom poštovanju. Liječnici kod pružanja zdravstvene skrbi migrantima moraju uzeti u obzir i specifične stresne čimbenike koji su povezani s migracijom i utječu na pojavnost duševnih smetnji, kao i kad migranti i izbjeglice dulje borave u državi domaćinu. U članku su najprije predstavljeni opći zaključci u vezi s izbjegličkom problematikom u Europi s naglaskom na komunikaciju. Opisana je problematika tumača i kulturnih posrednika. Autorice na kraju posebno upozoravaju na podcijenjeno vrednovanje mentalnog zdravlja izbjeglica.Proper communication is crucial for successful treatment, and therefore it is an integral part of both undergraduate study and postgraduate training in medicine. The ability to communicate is very important in intercultural relations. When overcoming language barriers with migrants and refugees, physicians need to consider the patient socio-cultural beliefs, language barriers, and possible presence of latent infection and chronic diseases. Just as in medical examination of subjects from the majority population, communication should be individually adjusted when treating representatives of migrants and refugees. Thereby, it must be taken into account that non-verbal communication is not universal. For overcoming language barriers, physicians and health professionals mostly use services of lay interpreters who, in general, facilitate communication, but studies have shown that they may also have a negative role. Online translation tools, handbooks and dictionaries are used less frequently. Regardless of the patient cultural background and language barriers, the physician and his/her associates must build a trustful relationship based on mutual respect from the very beginning. When providing health care to migrants, physicians must take into account the specifi c stress factors associated with migration and their impact on the incidence of mental disorders, as well as long stays of migrants and refugees in the host country

Primary care for the Roma in Europe : position paper of the European forum for primary care

Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations. At local level, establishing collaboration with Roma organisations helps primary care to improve mutual relations and quality of care. Mediation has proved to be an effective tool. Skills training of primary care practitioners may enhance their individual competences. Research and international sharing of experiences are further tools to improve primary care for the Roma people

Palliative care in primary care: European Forum for Primary Care position paper

Aim: The aim of this position paper is to assist primary health care (PHC) providers, policymakers, and researchers by discussing the current context in which palliative health care functions within PHC in Europe. The position paper gives examples for improvements to palliative care models from studies and international discussions at European Forum for Primary Care (EFPC) workshops and conferences. Background: Palliative care is a holistic approach that improves the quality of life of patients and their families facing problems associated with terminal illness, through the prevention and relief of suffering by means of early identification and diligent assessment and treatment of pain and other problems, whether physical, psychosocial, or spiritual. Unfortunately, some Europeans, unless they have cancer, still do not have access to generalist or specialist palliative care. Methods: A draft of this position paper was distributed electronically through the EFPC network in 2015, 2016, and 2017. Active collaboration with the representatives of the International Primary Palliative Care Network was established from the very beginning and more recently with the EAPC Primary Care Reference Group. Barriers, opportunities, and examples of good and bad practices were discussed at workshops focusing on palliative care at the international conferences of Southeastern European countries in Ljubljana (2015) and Budva (2017), at regular conferences in Amsterdam (2015) and Riga (2016), at the WONCA Europe conferences in Istanbul (2015), Copenhagen (2016), and Prague (2017), and at the EAPC conference in Madrid (2017). Findings: There is great diversity in the extent and type of palliative care provided in primary care by European countries. Primary care teams (PCTs) are well placed to encourage timely palliative care. We collected examples from different countries. We found numerous barriers influencing PCTs in preparing care plans with patients. We identified many facilitators to improve the organization of palliative care.info:eu-repo/semantics/publishedVersio

Sledenje bolnikov z rakom

Cancer is a disease with nearly the highest incidence and also the most frequent cause of death in humans today. Cancer burden is getting higher every year. However, due to early detection of cancer, more efficient and less harmful treatment, the survival of cancer patients is improving. Consequently, also the percentage of cancer survivors is significantly on the rise and, in the developed world, this percentage amounts to 3% of total population there. Cancer survivors require careful follow-up also after completed cancer treatment. These patients are not followed up only because of recurrence risk (locoregional or distant recurrence) but also because of late sequelae and undesired effect of treatment (physical, psychological and social) as well as of increased risk for developing secondary cancers. There is an urgent need to make people aware of the importance of healthy lifestyle and of early detection of secondary malignancies as well as of late sequelae of cancer treatment. The patients and their relatives should be informed that, for hereditary cancers, genetic testing is available, while for the detection of other cancers, screening methods (mammography, coloscopy) are used. Cancer survivors more frequently develop other non-malignant diseases. With the increasing number of cancer survivors and considering that cancer is becoming a chronic disease, it is indispensable that the team who is in charge of comprehensive care of cancer survivors includes, in addition to an oncologist and family doctor, also experts of other disciplines, such as nurses specialized in oncology nursing and psychologists.Rak postaja najpogostejša bolezen in tudi najpogostejši vzrok smrti sodobnega človeka. Breme te bolezni se iz leta v leto povečuje. Na račun zgodnjega odkrivanja in učinkovitejšega ter varnejšega zdravljenja pa se izboljšuje tudi preživetje bolnikov z rakom. To povzroča strmo naraščanje števila preživelih od raka, tako da v razvitem svetu predstavljajo okrog 3 % celotne populacije. Preživeli od raka potrebujejo skrbno spremljanje zdravstvenega stanja tudi po končanem onkološkem zdravljenju. Ne sledimo jih le zaradi nevarnosti ponovitve bolezni (lokoregionalne ali oddaljene), temveč tudi zaradi poznih posledic in neželenih učinkov zdravljenja (fizičnih, psihičnih, socialnih) ter povečanega tveganja zbolevanja za drugimi (sekundarnimi) raki. Ozavestiti jih je treba o zdravem načina življenja in zgodnjem odkrivanju sekundarnih rakov ter tudi o poznih posledicah zdravljenja. Za nekatere vrste raka, ki so dedno pogojene, so na voljo metode genetskega testiranja, predvsem pa je bolnike in svojce treba poučiti o presejalnih metodah (npr. mamografija, kolonoskopija). Preživeli od raka tudi pogosteje od ostale populacije zbolevajo za drugimi, nemalignimi obolenji. Ob vse večjem številu preživelih od raka in v času, ko rak postaja kronična bolezen, je nujno, da se v celostno oskrbo poleg onkologa in družinskega zdravnika vključijo tudi strokovnjaki drugih specialnosti, npr. visoko izobražene medicinske sestre, usmerjene v onkologijo, in psihologi

Follow-Up of Cancer Patients

Rak postaja najpogostejša bolezen in tudi najpogostejši vzrok smrti sodobnega človeka. Breme te bolezni se iz leta v leto povečuje. Na račun zgodnjega odkrivanja in učinkovitejšega ter varnejšega zdravljenja pa se izboljšuje tudi preživetje bolnikov z rakom. To povzroča strmo naraščanje števila preživelih od raka, tako da v razvitem svetu predstavljajo okrog 3 % celotne populacije. Preživeli od raka potrebujejo skrbno spremljanje zdravstvenega stanja tudi po končanem onkološkem zdravljenju. Ne sledimo jih le zaradi nevarnosti ponovitve bolezni (lokoregionalne ali oddaljene), temveč tudi zaradi poznih posledic in neželenih učinkov zdravljenja (fizičnih, psihičnih, socialnih) ter povečanega tveganja zbolevanja za drugimi (sekundarnimi) raki. Ozavestiti jih je treba o zdravem načina življenja in zgodnjem odkrivanju sekundarnih rakov ter tudi o poznih posledicah zdravljenja. Za nekatere vrste raka, ki so dedno pogojene, so na voljo metode genetskega testiranja, predvsem pa je bolnike in svojce treba poučiti o presejalnih metodah (npr. mamografija, kolonoskopija). Preživeli od raka tudi pogosteje od ostale populacije zbolevajo za drugimi, nemalignimi obolenji. Ob vse večjem številu preživelih od raka in v času, ko rak postaja kronična bolezen, je nujno, da se v celostno oskrbo poleg onkologa in družinskega zdravnika vključijo tudi strokovnjaki drugih specialnosti, npr. visoko izobražene medicinske sestre, usmerjene v onkologijo, in psihologi.Cancer is a disease with nearly the highest incidence and also the most frequent cause of death in humans today. Cancer burden is getting higher every year. However, due to early detection of cancer, more efficient and less harmful treatment, the survival of cancer patients is improving. Consequently, also the percentage of cancer survivors is significantly on the rise and, in the developed world, this percentage amounts to 3% of total population there. Cancer survivors require careful follow-up also after completed cancer treatment. These patients are not followed up only because of recurrence risk (locoregional or distant recurrence) but also because of late sequelae and undesired effect of treatment (physical, psychological and social) as well as of increased risk for developing secondary cancers. There is an urgent need to make people aware of the importance of healthy lifestyle and of early detection of secondary malignancies as well as of late sequelae of cancer treatment. The patients and their relatives should be informed that, for hereditary cancers, genetic testing is available, while for the detection of other cancers, screening methods (mammography, coloscopy) are used. Cancer survivors more frequently develop other non-malignant diseases. With the increasing number of cancer survivors and considering that cancer is becoming a chronic disease, it is indispensable that the team who is in charge of comprehensive care of cancer survivors includes, in addition to an oncologist and family doctor, also experts of other disciplines, such as nurses specialized in oncology nursing and psychologists

Attitudes to Illness and Use of Health Services by Economic Immigrants in Slovenia

Cilj Ispitati stavove imigranata iz zemalja bivše Jugoslavije u Sloveniju o zdravlju, brigu o vlastitom zdravlju i njegovu procjenu, te o čimbenicima koji utječu na to kako se oni koriste uslugama zdravstvene skrbi za sprječavanje i liječenje bolesti. Postupci Primijenjeno je kvalitativno istraživanje s pomoću upitnika ETHNIC (Explain, Treatment, Healers, Negotiation, Intervention, Collaboration – objasniti, liječiti, iscijeliti, pregovarati, djelovati, surađivati). Analizirani su podatci pribavljeni razgovorom s 27 ekonomskih imigranata koji su jedan za drugim posjetili ambulantu između 15 svibnja i 15 kolovoza 2005. Rezultati Kvalitativna analiza razgovora upućuje da ispitanici svoje zdravstvene probleme većinom doživljavaju kao posljedicu teškoga rada, neprimjerenih uvjeta rada i stanovanja i stresa. Najvažniji razlozi zbog kojih su potražili liječničku pomoć bili su strah od fizičkoga oštećenja i briga hoće li moći financijski pomagati obiteljima kod kuće. Postoje brojni financijski i smještajni problemi koji stoje na putu vođenja zdrava života i povinovanja liječničkim savjetima. Spominjana je i slaba komunikacija sa zdravstvenim radnicima. Kolege radnici s posla viđeni su kao važan izvor potpore, a odnos s poslodavcima kao negativan čimbenik. Zaključak Prvi korak prema poboljšanju zdravlja imigranata jest prepoznavanje čimbenika koji utječu na njihovu uporabu zdravstvene skrbi i stavove prema bolesti. Poboljšanje sanitarnih i higijenskih uvjeta u kojima oni žive i upoznavanje s njihovim osnovnim zdravstvenim problemima poboljšalo bi kvalitet skrbi za njihovo zdravlje na razini primarne zdravstvene zaštite.Aim To analyze the attitudes of immigrants from former Yugoslav republics to Slovenia toward illness, concerns about and perception of health status, and factors that influence their use of health services for the prevention and treatment of illness. Methods We used a qualitative approach, employing the ETHNIC (Explain, Treatment, Healers, Negotiation, Intervention, Collaboration) questionnaire. We analyzed data from interviews with 27 economic immigrants who consecutively came to a general practice office from May 15 to August 15, 2005. Results Qualitative analysis of the interview showed that health problems were largely understood as consequences of hard work, poor working and housing conditions, and stress. Fear of disability and concern about financial support for their family were important factors why they sought medical help. There were many financial and housing obstacles to leading a healthy lifestyle and following doctors’ advice. Inadequate communication with health care professionals was also mentioned. Coworkers were an important source of support, whereas the worker-employer relation appeared to be a negative factor. Conclusion Identifying factors that influence health care utilization and attitudes about illness is a first step toward improving health care among immigrants. Improving the sanitary and hygienic aspects of their lives and becoming familiar with their basic health problems will improve quality of treatment at the primary care leve

Prediction of depression in European general practice attendees: the PREDICT study

Background Prevention of depression must address multiple risk factors. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression. However, we lack reliable and valid methods of risk estimation. This protocol paper introduces PREDICT, an international research study to address this risk estimation. Methods/design This is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months. Prevalence of depression is assessed at baseline and each follow-up point. Consecutive attendees between April 2003 and September 2004 who were aged 18 to 75 were asked to take part. The possibility of a depressive episode was assessed using the Depression Section of the Composite International Diagnostic Interview. A selection of presumed risk factors was based on our previous work and a systematic review of the literature. It was necessary to evaluate the test-retest reliability of a number of risk factor questions that were developed specifically, or adapted, for the PREDICT study. In a separate reliability study conducted between January and November 2003, consecutive general practice attendees in the six participating European countries completed the risk factor items on two occasions, two weeks apart. The overall response rate at entry to the study was 69%. We exceeded our expected recruitment rate, achieving a total of 10,048 people in all. Reliability coefficients were generally good to excellent. Discussion Response rate to follow-up in all countries was uniformly high, which suggests that prediction will be based on almost a full cohort. The results of our reliability analysis are encouraging and suggest that data collected during the course of PREDICT will have a satisfactory level of stability. The development of a multi-factor risk score for depression will lay the foundation for future research on risk reduction in primary care. Our data will also provide the necessary evidence base on which to develop and evaluate interventions to reduce the prevalence of depression

QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care

Contains fulltext : 96249.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: The QUALICOPC (Quality and Costs of Primary Care in Europe) study aims to evaluate the performance of primary care systems in Europe in terms of quality, equity and costs. The study will provide an answer to the question what strong primary care systems entail and which effects primary care systems have on the performance of health care systems. QUALICOPC is funded by the European Commission under the "Seventh Framework Programme". In this article the background and design of the QUALICOPC study is described. METHODS/DESIGN: QUALICOPC started in 2010 and will run until 2013. Data will be collected in 31 European countries (27 EU countries, Iceland, Norway, Switzerland and Turkey) and in Australia, Israel and New Zealand. This study uses a three level approach of data collection: the system, practice and patient. Surveys will be held among general practitioners (GPs) and their patients, providing evidence at the process and outcome level of primary care. These surveys aim to gain insight in the professional behaviour of GPs and the expectations and actions of their patients. An important aspect of this study is that each patient's questionnaire can be linked to their own GP's questionnaire. To gather data at the structure or national level, the study will use existing data sources such as the System of Health Accounts and the Primary Health Care Activity Monitor Europe (PHAMEU) database. Analyses of the data will be performed using multilevel models. DISCUSSION: By its design, in which different data sources are combined for comprehensive analyses, QUALICOPC will advance the state of the art in primary care research and contribute to the discussion on the merit of strengthening primary care systems and to evidence based health policy development

ECCO Essential Requirements for Quality Cancer Care: Primary care.

ECCO Essential Requirements for Quality Cancer Care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to cancer patients. They are written by European experts representing all disciplines involved in cancer care. This paper concerns the integration of primary care into care for all cancers in Europe. Primary care integration