Health-related quality of life of general practitioners - family physicians in South-eastern Europe

Introduction An insight into the health-related quality of life (HRQL) provides information on the extent of activities and everyday functioning restriction by deteriorated health. Objective The purpose of the paper was to analyze the HRQL of general practitioners-family physicians of the Southeastern Europe and compare it with HRQL of controls, the subjects of the same educational background, geographical area, sex and age, but different working activities. Method The study "Health-related quality of life of general practitioners-family physicians in the South-eastern Europe" (HERQUL study) was performed in Serbia, Republic of Srpska, Montenegro, Macedonia and Bulgaria during February- September 2004. Study instrument was a standardized generic questionnaire for the measurement of HRQL SF-36, which subject's health status assesses across eight different domains. Results The study included 1141 doctors (337 male and 804 female) and the same number of controls. The deteriorated physical health affected HRQL of controls, but more significantly of physicians. The deteriorated mental health affected HRQL of both physicians and controls regardless of age and sex. The lowest HRQL scores of physicians due to lowered vitality was reported in all studied countries, excluding subjects from Montenegro. Better social functioning HRQL domain was recorded in males regardless of profession. The deteriorated physical and mental health as well as social functioning mostly influenced HRQL of physicians aged 55-59, and in controls this applied to those older than 60, regardless of sex. Emotional health HRQL domain scores were better in the control group than in physicians, regardless of sex. Conclusion Studies of physicians' HRQL, particularly doctors of general practitioners-family physicians, are scarce. The results of the HERQUL study could be the impetus to obtain support for the improvement of HRQL of this important group of health professionals from the relevant government institutions

Two decades of the journal of Serbian medical association 'General practice': Analysis of the journal content in the first decade of publishing

Objective and Method:, With regard to twenty years after publishing of the first issue of the journal 'General practice' (in October 1995), authors in this paper present the ten years analysis (1995-2004) of all published manuscripts which appeared in 19 issues during the first decade, according to the manuscript category, year of publishing, and Health institutions and region from which the first author originates. In total, 260 papers were published, originated from 60 Health institutions in Europe and even USA. Results: Manuscript category of all published papers showed the following distribution: • Original papers -26.5%, • Reports -32.3%, • Reviews and Educational articles - 32.7%, • Case reports - 8.5%. Conclusion: Territorial distribution of Serbian authors shows that 2/3 of authors are from Belgrade, and 1/3 from different towns of Serbia, while 1.5% of all papers originated from abroad

Risk factors for chronic noncontiguous diseases: Twelve-week prospective study

Risk factors (RF) of chronic noncontiguous diseases (CND) are mutual and cannot be observed individually since there is an inter-reaction (interaction of RF in various combinations), what makes so-called personality risk profile for development of particular disease. Almost all CND belong to the group of preventable diseases, because their course may be influenced and changed through RF modification and reduction. Bad habits also contribute to CND incidence. CND prevention is the first priority of primary health care physicians. The main objective of our study was to detect RF in patients during everyday activities of general practitioner, to estimate the risk of CND within the existing RF combination, to show the results of 12-week active monitoring of population with RF of CND, and with already present CND; while the secondary goal was to assess how much population is interested in active collaboration as well as to evaluate the qualification of general medicine teams for work based on defined methodology. The study was multicentric, prospective and interventional. The study included 2086 subjects, aged from 25-64 years, and it was carried out in 17 health centers throughout Serbia in the period January-April 2002. The subjects were selected by method of open clinical experiment. Thereafter, 12-week medical intervention was initiated involving non-pharmacological and pharmacological treatment. The first control was scheduled after 8, and the second after 12 months of intervention. Congruence χ2 test, ANOVA for repeated measurements and Logistic regression were used for statistical data processing. Out of a total of 2086 subjects, the following proportion of them reported specific diagnosis in their medical histories: 77% of them reported arterial hypertension (HTA), 68% - increased body mass (BMI>27Kg/m2), 66% - hyperlipoproteinemia (HLP), 34% - diabetes mellitus (DM), 56% - inadequate physical activity (PA), and 23% - cigarette smoking (CS). On the basis of RF number and combination for genesis and development of CND in our sample, 74.7% of variability (development or risk) may be accounted for angina pectoris (AP), 74.2% for DM+HTA, 70.0% for DM, 79.9% for HTA, 80.8% for myocardial infarction (Ml), and 85.8% of variability (development or risk) for cerebrovascular insult (CVI). Twelve-week intervention resulted in reduction of HTA, HLP, glucose, and PC (p<0.001) levels as well as lower BMI and PA (p<0.5). To accomplish the aforementioned goals, continuous mutual activity of an individual, his/her family, health service and community is required, along with occasional evaluation of the obtained results

HEALTH-RELATED QUALITY OF LIFE OF GENERAL PRACTITIONERS – FAMILY PHYSICIANS IN SOUTH-EASTERN EUROPE

Introduction An insight into the health-related quality of life (HRQL) provides information on the extent of activities and everyday functioning restriction by deteriorated health. Objective The purpose of the paper was to analyze the HRQL of general practitioners–family physicians of the Southeastern Europe and compare it with HRQL of controls, the subjects of the same educational background, geographical area, sex and age, but different working activities

Rating on life valuation scale

Introduction: World Health Organization (WHO) Articles of Association defines health as the state of complete physical, mental and social well-being and not merely the absence of disease. According to this definition, the concept of health is enlarged and consists of public and personal needs, motives and psychological nature of a person, education, culture, tradition, religion, etc. All these needs do not have the same rank on life valuation scale. Objective: The objective of our study was ranking 6 most important values of life out of 12 suggested. Method: Questionnaire about Life Valuation Scale was used as method in our study. This questionnaire was created by the Serbian Medical Association and Department of General Medicine, School of Medicine, University of Belgrade. It analyzed 10% of all citizens in 18 places in Serbia, aged from 25 to 64 years, including Belgrade commune Vozdovac. Survey was performed in health institutions and in citizens’ residencies in 1995/96 by doctors, nurses and field nurses. Results: A total of 14,801 citizens was questioned in Serbia (42.57% of men, 57.25% of women), and 852 citizens in Vozdovac commune (34.62% of men, 65.38% of women). People differently value things in their lives. On the basis of life values scoring, the most important thing in people’s life was health. In Serbia, public rank of health was 4.79%, and 4.4% in Vozdovac commune. Relations in family were on the second place, and engagement in politics was on the last place. Conclusion: The results of our study in the whole Serbia and in Vozdovac commune do not differ significantly from each other, and all of them demonstrated that people attached the greatest importance to health on the scale of proposed values. Relationships in family were on the second place, and political activity was on the last place. High ranking of health and relationships in family generally shows that general practitioners in Serbia take important part in primary health care and promotion of health care management. They have responsibility to preserve and enhance health of a person, family and society as a whole

The effect of medicamentous and non-medicamentous therapy on lowering risk factors for cardiovascular and cerebrovascular episodes in an interventional study

Introduction In a chain of cardiovascular episodes, risk factors (RF) and bad habits represent the first link. Objective The purpose of the study was to determine, during six months, on four examinations (the first, and three follow-ups after the second, fourth and sixth month), the following: physical activity (PA) alteration and the number of cigarettes smoked; the effect of antihypertensive betablockers and ACE inhibitors on systolic and diastolic arterial tension; the effect of metmorfin therapy on BMI, glycaemia, total cholesterol level (TCL) and triglycerides in diabetics compared to healthy individuals; the effect of hypolipidaemics on blood TCL and triglycerides in patients with angina pectoris (AP); the effect of betablocker therapy on TCL. Method This was a multicentric interventional study. Secondary prevention of coronary disease and cerebrovascular conditions was applied in the first half of 2005. There were 185 general practitioners from 38 health centers in Serbia, and patients of both sexes were included with the verified diagnosis of coronary disease and/or cerebrovascular condition. They had demographic data verified as well as data of being genetically (non)predisposed for AP, hypertension, myocardial infarction, stroke and diabetes mellitus. Descriptive and differential statistical methods were used for study result analysis. Results Out of 1,189 patients, there were 51.4% of women and 48.6% of men. The average age was 59.45±9.77 years. The population was homogeneous by sex and the factor of being genetically (non)predisposed for AP. There was a significant difference in examinations in four contacts in PA and cigarette smoking (p<0.0001). Systolic and diastolic pressure, TCL and triglycerides were significantly decreased by medicaments (p<0.05) and more significantly so associated with nonmedicamentous measures (p<0.001). Metmorfin significantly decreased the glycaemic level (p<0.001) both in diabetics and patients with a reduced tolerance level to glucose. In patients who took betablockers, there was lowering of TCL. Conclusion Taking medicaments significantly lowers RF, and more significantly so when associated with a non-medicamentous therapy

Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients

Abstract Introduction: Fatigue, anxiety and depression are very frequent symptoms in patients with rheumatoid arthritis (RA). Goals: In this study we evaluated the influence of socioeconomic characteristics, therapy and comorbidities on the self-reported high fatigue, anxiety and depression in patients with RA. Method: Multicenter cross-sectional study was performed in 22 health institutions in Serbia during the period from April-August 2014 in population of older RA patients. Self-reported patients health status was measured by: Fatigue Assessment Scale, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Treatment modalities were defined as: (1) non-steroidal anti-inflammatory drugs (NSAIDs) and/or analgesics and/or corticosteroids; (2) synthetic disease-modifying antirheumatic drugs (DMARDs) alone or in combination with corticosteroids and/or NSAIDs and (3) any RA treatment which includes biologic DMARDs. Results: There were significant predictors of high depression: synthetic DMARDs therapy in combination with corticosteroids and/or NSAIDs, physiotherapist self-payment, frequent taxi use, alternative treatment and employment status. The need for another person's assistance, supplemental calcium therapy and professional qualifications were the predictors of a high fatigue, whereas the age above 65 years had the protective effect on it. Anxiety was an independent high fatigue predictor. The predictors of a high anxiety were: gastroprotection with proton-pump inhibitors and patient occupation. Conclusion Socioeconomic predictors of self-reported high depression, anxiety or fatigue are different for each of the mentioned outcomes, while accompanied with the basic RA treatment they exclusively explain a high depression. The anxiety, jointed with the socioeconomic variables and supplemental therapy, is a significant fatigue predictor in RA patients

Relationship between respiratory symptoms and satisfaction with inhaled asthma medication

Introduction: Asthma is the chronic inflammatory disease of the airways, and the inhalation treatment is the most convenient way to deliver the medication directly to the airways. Objective: The aim of our study was to evaluate the relationship between respiratory symptom scores in asthmatic outpatients and their satisfaction with inhaled asthma medication. Method: In 124 patients, (39 males; mean age 45±18 years; mean forced expiratory volume in one second (FEV1) 71.8±23.4% predicted), respiratory symptoms were determined by 4-item questionnaire for most frequent asthma symptoms - cough, wheezing, dyspnea and chest tightness (all of them graded from 1 - without symptoms, 2 - mild, 3 - moderate, and 4 - severe symptoms), with overall score (from 4 to 16), as well as by scale for assessment of sinonasal symptoms − the 20-item sinonasal outcome test (SNOT-20) (in 65 out of 124 patients). SNOT-20 scores ranged from 0 to 5, where higher score indicated more manifested symptom. Patients’ satisfaction was measured by standardized "Satisfaction with Inhaled Asthma Treatment Questionnaire" (SATQ), which scores were calculated for the overall satisfaction as well as for individual domains (effectiveness of treatment, easy application, medication burden, and side-effects and related worries). The bigger the score the better the satisfaction, and vice versa. Results: The highest degree of correlation with overall satisfaction scores was found (using the Pearson’s coefficient of linear correlation) for the scores of wheezing (r=-0.271; p=0.002). SNOT-20 scores best correlated with side-effects and worries domain scores. Conclusion: The severity of respiratory symptoms in the asthmatics is strongly correlated with satisfaction with inhaled medication. Improving the asthmatic symptoms Results in enhancement of their satisfaction with inhaled medication and compliance