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

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

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

Erasmus exchange in the field of family medicine in Slovenia

Objective. The purpose of this paper is to analyze the Erasmus exchange of students at the University of Ljubljana, Department of family medicine in the period from 2005 to 2010. The beginnings of an Erasmus exchange in the field of family medicine in Europe are described. Ljubljana Medical School has currently 60 bilateral agreements with universities or medical faculties in the EU and EFTA countries. Materials and methods. We collected data of all students who come from the foreign faculties to the Department of family medicine and those from Slovenia who went to study abroad. In addition to basic descriptive statistics, we used the elements of qualitative analysis, where we reviewed the reports of the Slovenian Erasmus students, who went on exchange in the field of family medicine. Results. Department of family medicine cooperated with 14 foreign medical schools since 2005. 42 Slovenian students went on academic exchange in the field of family medicine. 21 foreign students came to Department of family medicine in Ljubljana. Female students were more frequent in exchange compared with male students. The largest proportion of students went abroad in 2009. Most foreign students visited Department of Family medicine in Ljubljana in 2011. Reports of students show that they learned a lot. Students were able to compare the organization of health care in a foreign country and Slovenian health care system. Conclusion. Erasmus exchange has proven to be an important addition to the existing educational system. Students are acquainted with the progress of health care in Europe in this way. They are able to compare the benefits and disadvantages of foreign health care systems with home health care organization

Kakovost življenja v povezavi s kroničnimi boleznimi in z zadovoljstvom z oskrbo zdravnika družinske medicine med romskim prebivalstvom v SV Sloveniji

Objectives: Health-related quality of life (HRQoL) measures a patient\u27s subjective experience of his or her health status. We aimed to show how the presence of chronic diseases and satisfaction with family physicians (FPs) were associated with the HRQoL of a Roma population. Methods: A cross-sectional study was carried out in May 2011 on a representative sample of 650 Roma living in Prekmurje, Slovenia. The EQ-5D questionnaire was used for measuring the HRQoL of the Roma. Demographical data, 12 groups of diseases diagnosed in the last 12 months and satisfaction with FPs were included in the questionnaire. Results: The response rate was 88.3% (574), of which 56.4% were female, and the average age of the participants had a mean value of 40.2+-12.7 years. The presence of cardiovascular problems with risk factors for them or presence of musculoskeletal disorders were strongly associated with the presence of pain (Cramer\u27s V = 0.40 and 0.46 respectively). There was a strong association between the presence of mental disorders and anxiety and depression (Cramer\u27s V = 0.58). The average satisfaction with the family physician was 3.9 (mean+-1.10) on a five-point Likert scale. There was no significant association between HRQoL and satisfaction with the family physician. Conclusions: Roma with chronic mental health problems had the lowest HRQoL in the Roma population. More attention should be paid to this subgroup of Roma in family medicine, and interventions should be provided. High satisfaction with their FPs is not associated with the observed quality of life variables.Uvod: Z zdravjem povezana kakovost življenja (HRQoL) je odraz pacientove subjektivne ocene lastnega zdravstvenega stanja. V naši raziskavi smo skušali ugotoviti, kakšen je vpliv nekaterih kroničnih bolezni in zadovoljstva z izbranim zdravnikom na HRQoL med romskim prebivalstvom. Metode: Maja 2011 smo izvedli presečno raziskavo v reprezentativnem vzorcu 650 pomurskih Romov. HRQoL smo merili z vprašalnikom EQ-5Dvključili smo še demografske podatke, zadovoljstvo z izbranim družinskim zdravnikom in 12 bolezenskih stanj, ki so bila diagnosticirana v zadnjih 12 mesecih. Rezultati: Odzivnost je bila 88,3-odstotna (574), 56,4 % je bilo žensk in povprečna starost sodelujočih je bila 40,2 +/- 12,7 leta. Nizek HRQoL v skupini s srčno-žilnimi boleznimi z dejavniki tveganja zanje in kostnomišičnimi boleznimi je bil močno povezan s prisotnostjo bolečine (Cramer z V = 0,40 in 0,46). V skupini z duševnimi težavami pa je bila močna povezava nizkega HRQoL s prisotnimi znaki anksioznosti in depresije (Cramer z V = 0,58). Povprečno zadovoljstvo z zdravnikom družinske medicine je bilo 3,9 (mediana +/- 1,10) na pettočkovni Likertovi lestvici. Ni bilo statistične povezave med HRQoL in zadovoljstvom z zdravnikom družinske medicine. Zaključki: Romi s prisotnostjo duševnih težav imajo najnižji HRQoL v romskem prebivalstvu. Več pozornosti bi v družinski medicini morali posvetiti tej podskupini Romov. Zadovoljstvo z zdravnikom družinske medicine ni povezano z opazovanimi spremenljivkami kakovosti življenja

Frailty assessment scales for the elderly and their application in primary care: A systematic literature review

The increase in the elderly population is causing changes and challenges that demand a comprehensive public health response. A specific characteristic of the elderly is their frailty. Today’s problems with identifying levels of frailty are being resolved by numerous tools in the form of frailty assessment scales. This systematic review establishes which frailty assessment scales for the elderly are being used and what their applicability in primary care is like in Slovenia and around the world

Patients’ perception of differences in general practitioners’ attitudes toward immigrants compared to the general population: Qualicopc Slovenia

Globally, the number of immigrants is rising every year, so that the number of immigrants worldwide is estimated at 200 million. In Slovenia, immigrants comprise 6.5% of the overall population. Immigrants bring along to a foreign country their cultural differences and these differences can affect immigrants’ overall health status and lead to chronic health conditions. The aim of this study was to identify patients’ perception of general practitioners’ (GPs’) attitudes toward immigrants in Slovenia