HEALTH SEEKING BEHAVIOUR IN GENERAL POPULATION WITH PSYCHOLOGICAL SYMPTOMS

Background: Health seeking behaviour is a complex construct in patients with psychological symptoms. The aim of this study was to determine a one-month prevalence of psychological symptoms in Slovenian general population and to identify correlates of health seeking behaviour. Subjects and methods: This study was conducted in a representative sample of 1,002 randomly selected Slovenian citizens, stratified according to sex and age. We used a method of computer assisted telephone interview (CATI). The questionnaire consisted of demographic questions, questions about the prevalence and duration of preselected symptoms in the past month (irritability, nervousness), questions about the presence of chronic diseases, EQ-5D questionnaire and the questions on health seeking behaviour (self-treatment, lay advice seeking and medical advice seeking). Results: The self-reported prevalence of psychological symptoms in the past month was 38.0% (381/1,002). Multivariate analysis for the presence of self-reported psychological symptoms revealed that female sex, higher age, the presence of chronic disease, primary education, lay-advice seeking, pain and the presence of anxiety/depression on EQ-5D questionnaire were independently associated with psychological symptoms. Conclusions: Psychological symptoms are a major public health problem in Slovenian general adult population and the selfreported utilization of professional health care services by Slovenian population is high. Other patterns such as lay referral system might have a crucial influence on the final decision to seek medical help

Attitudes of Slovenian family practice patients toward changing unhealthy lifestyle and the role of family physicians: cross-sectional study

Aim To assess patients’ attitudes toward changing unhealthy lifestyle, confidence in the success, and desired involvement of their family physicians in facilitating this change. Methods We conducted a cross-sectional study in 15 family physicians’ practices on a consecutive sample of 472 patients (44.9% men, mean age (± standard deviation) 49.3 ± 10.9 years) from October 2007 to May 2008. Patients were given a self-administered questionnaire on attitudes toward changing unhealthy diet, increasing physical activity, and reducing body weight. It also included questions on confidence in the success, planning lifestyle changes, and advice from family physicians. Results Nearly 20% of patients planned to change their eating habits, increase physical activity, and reach normal body weight. Approximately 30% of patients (more men than women) said that they wanted to receive advice on this issue from their family physicians. Younger patients and patients with higher education were more confident that they could improve their lifestyle. Patients who planned to change their lifestyle and were more confident in the success wanted to receive advice from their family physicians. Conclusion Family physicians should regularly ask the patients about the intention of changing their lifestyle and offer them help in carrying out this intention

The effect of carbon dioxide on near-death experiences in out-of-hospital cardiac arrest survivors: a prospective observational study

Introduction: Near-death experiences (NDEs) are reported by 11-23% of cardiac arrest survivors. Several theories concerning the mechanisms of NDEs exist - including physical, psychological, and transcendental reasons - but so far none of these has satisfactorily explained this phenomenon. In this study, we investigated the effect of partial pressures of O2 and CO2, and serum levels of Na and K on the occurrence of NDEs in out-of-hospital cardiac arrest survivors. Methods: A prospective observational study was conducted in the three largest hospitals in Slovenia. Fifty-two consecutive patients (median age 53.1 years, 42 males) after out-of-hospital cardiac arrest were included. The presence of NDEs was assessed with a self-administered Greyson\u27s NDE scale. The initial partial pressure of end-tidal CO2, the arterial blood partial pressures of O2 and CO2 and the levels of Na and K in venous blood were analysed and studied. Univariate analyses and multiple regression models were used. Results: NDEs were reported by 11 (21.2%) of the patients. Patients with higher initial partial pressures of end-tidal CO2 had significantly more NDEs (P < 0.01). Patients with higher arterial blood partial pressures of CO2 had significantly more NDEs (P = 0.041). Scores on a NDE scale were positively correlated with partial pressures of CO2 (P = 0.017) and with serum levels of potassium (P = 0.026). The logistic regression model for the presence of NDEs (P = 0.002) explained 46% of the variance and revealed higher partial pressures of CO2 to be an independent predictor of NDEs. The linear regression model for a higher score on the NDE scale (P = 0.001) explained 34% of the variance and revealed higher partial pressures of CO2, higher serum levels of K, and previous NDEs as independent predictors of the NDE score. Conclusions: Higher concentrations of CO2 proved significant, and higher serum levels of K might be important in the provoking of NDEs. Since these associations have not been reported before, our study adds novel information to the field of NDEs phenomena

Near-death experiences and electrocardiogram patterns in out-of-hospital cardiac arrest survivors: a prospective observational study

Aim. To determine the effect of several factors, that are a part of cardiac arrest and resuscitation, on the incidence of neardeath experiences (NDEs). Methods. We conducted a prospective observational study in the three largest hospitals in Slovenia in a consecutive sample of patients after out-of-hospital primary cardiac arrest. The presence of NDE was assessed with the self-administered Greyson’s near-death experiences scale. The electrocardiogram pattern at the beginning of resuscitation was recorded. Main outcome measure was the presence of near-death experiences. Univariate analysis was used. Results. The study included 52 patients. There were 42 (80.8%) males in the sample; median age ± standard deviation of the patients was 53.1 ± 14.5 years. Near-death experiences were reported by 11 (21.2%) patients. Patients with ventricular fibrillation had significantly less NDEs than other patients (12.2% vs. 54.5%, P = 0.006). Patients with pulseless electrical activity had significantly more NDEs than others (60.0% vs. 11.9%, P = 0.003). Patients with asystole and pulseless electrical fibrillation had significantly more NDEs than patients who had ventricular fibrillation and ventricular tachycardia (60.0% vs. 11.9%, P = 0.003). Patients with at least one defibrillation attempt had significantly less near-death experiences than others (62.5% vs. 13.6%, P = 0.007). Conclusion. Our study found a possible correlation between electrocardiogram pattern in cardiac arrest patients and the incidence of near-death experiences. Further studies should address this problem in larger samples

Quality indicators of cardiovascular disease prevention for primary care in Slovenia

Aim: National validation of quality indicators for cardiovascular prevention in primary care in Slovenia and comparison with a set of internationally validated indicators. Methods: A list of indicators derived from guidelines, recommendations and good clinical practice was developed internationally within a wider Epa-cardio study. In each participating country a panel of national experts were recruited to assess the indicators using a Delphi Technique methodology in two rounds for clarity, validity and feasibility. In Slovenia, 14 national experts, all general practitioners with special interest in cardiovascular diseases, were recruited. Results: Most of validated indicators belonged to the health-care management of people with established cardiovascular disease. Fewer numbers of indicators were validated for primary prevention, mostly on life style recording and advice. Only very few indicators on outcome measures (level of risk factors) were validated. No indicators of patients’ involvement or new risk factors, such as socioeconomic circumstances, got consensus. Conclusion: Slovenia validated more indicators than the international study, especially indicators of primary prevention. The experts did not achieve consensus on indicators of patients’ perspective, despite the paradigm of family medicine that the patient is in the centre of care. Validated indicators can now be tested for systematic quality assessment of cardiovascular prevention in the country

Uporabnost pisne informacije o zdravilu (PMIL) in informacije o zdravilih, ki jih poda strokovnjak

Background: The Patient information leaflet (PIL) is an important source of information for every patient. Little is known about whether patients read the PIL and whether it contains useful information. Other sources of drug-related information are professionals (a family practitioner, a pharmacist and a nurse). Informing patients on drugs improves their compliance. The aim of the study was to identify the usefulness of PIL from the perspective of the patient, to assess professionals as a source of drug-related information and to suggest changes that can improve informing and therefore patients\u27 compliances. Methods: Four focus group interviews were conducted across different primary health care centres in the North East of Slovenia. Focus groups were composed of randomly selected patients (in total 20) who were willing to express their views on PILs, on other drug information sources and on possible improvements. A qualitative analysis of the data was based of the transcription of the audiotapes. Results: Patients read the PILs selectively. They were most interested in side effects, contraindications and the purpose of the prescribed drug. Participants reported that the language in PILs is too scientific. In the case they do not understand PILs or they recognise some of the side effects, a majority of participants decide to contact a family physician first, and less frequently a pharmacist or a nurse. A family physician is considered to be the most trustworthy source of information and patients think that pharmacists could play a more active role in patients% education. Conclusion: Current PILs offer enough partial information to patients but need some improvements in terms of better legibility and access to the most crucial information. PIL does not enable a comprehensive information with respect to patient%s health status. Most reliable source of information is considered to be a family practitioner. Pharmacists could play a more active role in the education of patients.Izhodišče: Informacija o zdravilu za bolnika (PMIL) je pomemben vir informacij o zdravilih. Manj je znano, ali bolniki ta navodila berejo in, ali pri tem dobijo potrebne informacije. Bolniki dobivajo ustrezne informacije tudi od strokovnjakov (zdravnik, farmacevt, medicinska sestra). Informiranje bolnika o zdravilu je pomemben dejavnik, ki pozitivno vpliva na komplianco. Namen študije je preveriti uporabnost PMIL z vidika bolnika in ugotoviti, katerim drugim virom informacij o zdravilih bolniki zaupajo ter predlagati izboljšave, ki bodo pri bolnikih povečale informiranost in s tem komplianco. Metode: 4 fokusne skupine so bile oblikovane v različnih zdravstvenih zavodih v severovzhodni Sloveniji. Udeleženci, skupaj 20, so bili naključni bolniki, ki so bili pripravljeni izraziti svoja stališča o PMIL, o drugih virih informacij o zdravilih in o možnih spremembah. Pogovori so bili posneti in po prepisu je bilo besedilo analizirano po kakovosti. Rezultati: Bolniki berejo PMIL selektivno: najbolj jih zanimajo stranski učinki, kontraindikacije in namen, zakaj se zdravilo uporablja. Bolniki so poudarili, da je jezik v PMIL preveč strokoven. Če ne razumejo prebranega ali prepoznajo stranski učinek, se večina bolnikov odloči poiskati izbranega zdravnika in precej manjkrat medicinsko sestro ali farmacevta. Zdravnik jim je najbolj zanesljiv vir informacij. Menijo pa, da bi farmacevti lahko zavzemali bolj dejavno vlogo pri poučevanju o zdravilih. Zaključek: PMIL nudi zadosti delnih odgovorov, vendar bolniki v njem ne dobijo celovite informacije o zdravilu glede na svoje zdravstveno stanje, zato ga nimajo kot zadostni vir informacij. V PMIL pogrešajo večji poudarek ključnim informacijam in boljšo čitljivost besedila. Najbolj zanesljiv vir informacij o zdravilih je zanje družinski zdravnik. Farmacevti bi lahko prevzeli dejavnejšo vlogo pri poučevanju bolnikov

The Effect of Demographic Characteristics on Self-Medication Patterns: A Cross-Sectional Nationwide Study from Slovenia

Self-medication is defined as the use of medicines without medical supervision to treat one’s own ailment. It is a part of a help-seeking behaviour that depends on socio-cultural and personal factors, which is why people react to the illness differently and also take different measures to cope with it. The aim of this study was to explore the Slovenian citizens’ attitudes towards self-medication. The study included a random sample of 1,000 Slovenian inhabitants, stratified to all Slovenian regions. This was a postal survey. Participants were mailed a self-administered questionnaire about attitudes towards self-treatment. In the statistical analysis we used independent t-test and c 2-test. We received 410 responses (41.0% response rate). In the past year, 389 (94.9%) respondents practiced self-medication. Most respondents (209, 52.1%) supported and used it in everyday life. The majority of the respondents (274, 77.2%) practiced self-medication when symptoms emerged. When symptoms lasted for one week or less, 210 (56.5%) of the respondents practising self-medication visited their doctor. The respondents agreed mostly with the statement that their doctor had a positive relationship towards self-medication. Younger people were more confident about the absolute safety of self-medication whereas older people were more certain that they could practice it no matter what disease they might have. As self-medication is very common among Slovenian population and various demographic factors affect the opinions about it and the reasons for its use and also a doctor-patients communication about it, it is important that doctors, especially those in primary health care settings always ask about its use. This is of a particular importance when dealing with older and retired patients, which are more likely to suffer from more chronic diseases and use alternative medicine, which is a common part of self-medication. Also, it is important to educate young people about possible unsafe practice of self-medication

Vprašalnik za samooceno kompetenc zdravnika družinske medicine na področju izboljševanja kakovosti

Aim: To perform a cross-cultural adaptation of the Quality Improvement Competency Self Assessment (QICS) questionnaire for family physicians into the Slovenian language and to validate it in a representative sample of Slovenian FPs. Methods: This cross-sectional observational postal survey was conducted in a random sample of 398 Slovenian FPs. We used the QICS questionnaire that was developed on the basis of the new Quality Improvement Competency Framework for family medicine. The QICS questionnaire consists of 37 items included in six domains. The questions can be answered on a five-point Likert scale. The validity of the translation was provided by the backward translation from Slovenian to the English language and by the reference group consisting of experienced FPs in the consensus process. The reliability of the questionnaire was assessed by Cronbach’s alpha coefficient and Spearman rho to determine the test-retest reliability (the questionnaire was sent to the physicians in the sample twice in a period of two weeks). Results: The final sample consisted of 100 (25.1%) family physicians, out of which 71 (71.0%) were women. Mean age of the sample was 43.3 ± 9.6 years. Mean score of the QICS questionnaire was 127.0 ± 30.1 points (first round) and 127.8 ± 30.6 points (second round). Cronbach’s alpha scores were 0.984 (first round) and 0.988 (second round). Spearman’s rho for the summary score of the whole scale was 0.829 with p < 0.001. Conclusion: The Slovenian version of the QICS questionnaire proved to be a valid and reliable tool for selfassessment of quality improvement competencies by FPs in terms of continuous professional development.Namen: Izvesti medkulturno prilagoditev vprašalnika o samoocenjevanju kompetenc zdravnika družinske medicina na področju izboljševanju kakovosti (vprašalnik QICS) in ga validirati na reprezentativnem vzorcu slovenskih zdravnikov družinske medicine. Metode: Ta presečna opazovalna raziskava je bila izvedena v naključnem vzorcu 398 slovenskih zdravnikov družinske medicine. Uporabili smo vprašalnik QICS, ki je bil razvit na podlagi novega teoretičnega okvira izboljševanja kakovosti v družinski medicini. Vprašalnik QICS je sestavljen iz 37 vprašanj, vključenih v šest področij. Na vprašanja je mogoče odgovoriti po petstopenjski Likertovi lestvici. Veljavnost prevoda je bila zagotovljena z dvosmernim prevodom in s pomočjo referenčne skupine, ki so jo sestavljali izkušeni zdravniki družinske medicine. Zanesljivost vprašalnika smo ocenjevali s pomočjo koeficienta Cronbach alfa in koeficienta Spearman rho za ugotavljanje časovne stabilnosti (vprašalnik je bil poslan zdravnikom v vzorcu dvakrat v razmiku dveh tednov). Rezultati: Končni vzorec je bil sestavljen iz 100 (25,1 %) zdravnikov družinske medicine, od katerih je bilo 71 (71,0 %) žensk. Povprečna starost vzorca je bila 43,3 ± 9,6 leta. Povprečno število točk na vprašalniku QICS je bilo 127,0 ± 30,1 (prvo pošiljanje) in 127,8 ± 30,6 (drugo pošiljanje). Cronbach alfa je bil 0,984 (prvo pošiljanje) in 0,988 (drugo pošiljanje). Spearman rho je bil 0,829 s p < 0,001. Zaključki: Slovenska različica vprašalnika QICS je zanesljivo in veljavno orodje za samooceno kompetenc zdravnikov družinske medicine na področju izboljševanja kakovosti v sklopu stalnega podiplomskega izobraževanja oz. stalnega strokovnega dograjevanja