Lijana Zaletel-Kragelj

Self-rated health and mortality in patients with chronic heart failure.

In patients with chronic heart failure (CHF), there is limited information on self‐rated health (SRH). We aimed to examine the distribution of SRH and whether SRH is associated with mortality in patients with stable CHF.

Distribution of self-rated health and association with clinical parameters in patients with chronic obstructive pulmonary disease

SummaryBACKGROUND: Data on self-rated health (SRH) in patients with chronic obstructive pulmonary disease (COPD) are very limited; we therefore initiated this study to investigate the distribution of SRH and association with established parameters of disease severity. PATIENTS AND METHODS: We included 135 clinically stable patients with COPD (64 ± 8 years, 71% men, GOLD stage: II –59; III –55; IV –21) and 25 healthy control persons. SRH was evaluated using the 5-grade Likert scale (1-very poor to 5-very good). RESULTS: Patients with COPD had poorer SRH when compared with controls (3.0 ± 0.7 vs. 3.8 ± 0.6, P < 0.001). SRH decreased over GOLD stage (P = 0.016) and 27 (20%) patients reported poor or very poor SRH. In univariate analysis, GOLD stage (P = 0.022), Center for Epidemiologic Studies Depression (CES-D) score (P = 0.001), BODE index score (P < 0.001), score on the modified Medical Research Council (MMRC) dyspnea scale (P < 0.001) and 6-minute walk test (6MWT) distance (P < 0.001) determined poor or very poor SRH. In a multivariate model which included BODE index score, a CES-D score ≥ 16 (P = 0.013) and BODE index score (P = 0.012) determined poor or very poor SRH. In the model with individual components of the BODE index, a CES-D score ≥ 16 (P = 0.012), MMRC score of 3 or 4 (P = 0.019) and 6MWT distance ≤ 249 m (P = 0.019) determined poor or very poor SRH. CONCLUSION: In patients with COPD, SRH is worse than in healthy control persons and deteriorates over GOLD stage. Perception of health as poor or very poor is associated with psychological components (CES-D score) and disease severity (BODE index score, 6MWT distance and MMRC dyspnea score).

Population groups at high risk for poor oral self care: the basis for oral health promotion

SummaryObjectives:Identification of population groups at high risk for poor oral self-care in adults was needed in order to enable more focused planning of oral health promotion actions in Slovenia.Methods:The study was based on the national health behaviour database in adults aged 25-64. Data collected in 2001 were used. The sample size was 15,379. The overall response rate was 64 %, and 8,392 questionnaires were eligible for oral self-care assessment. A complex indicator based on oral hygiene, frequency of visiting a dentist, and nutritional habits was derived. The outcome of interest was poor oral self-care. Logistic regression was used to test multivariate associations between several factors (gender, age, educational level, social class, etc.) and poor oral self-care.Results:The overall prevalence of poor oral self-care was 6.9 %. The odds for this outcome were higher for men (ORmales vs. females = 7.49, p < 0.001), (or participants with the lowest educational levels (ORuncompleted primary vs. university = 5.95, p < 0.001; ORprimary vs. university = 4.95, p < 0.001), and for participants from the lowest social classes (ORlower vs. upper-middle = 6.20, p < 0.001; ORlabour vs. upper-middle = 4.05, p = 0.001).Conclusions:Special attention should be paid to oral health promotion for men, for those with low educational level, and for those belonging to the lowest social classes.

A Prevalence Study on Outdoor Air Pollution and Respiratory Diseases in Children in Zasavje, Slovenia, as a Lever to Trigger Evidence-Based Environmental Health Activities

The aim of this study was to estimate the population burden of respiratory diseases in the Zasavje region of Slovenia that can be attributed to outdoor air pollution in order to gain relevant grounds for evidencebased public health activities. In 2008, 981 schoolchildren (age 6 to 12 years) were observed in a prevalence study. The prevalence of chronic respiratory diseases (CRD) and frequent acute respiratory symptoms (FARS) was related to the level of outdoor air pollution in the local environment (low, moderate and high pollution areas). Logistic regression was used as a method for statistical analysis. The prevalence of CRD was 3.0 % in low pollution areas, 7.5 % in moderate pollution areas, and 9.7 % in high pollution areas (p=0.005). After adjustment for the effects of confounders, 2.91-times higher odds for CRD were registered in high pollution areas in comparison to low pollution areas (p=0.017). The prevalence of FARS was: 7.8 % in low pollution areas, 13.3 % in moderate pollution areas and 15.9 % in high pollution areas (p=0.010). After adjustment for the effects of confounders, 2.02-times higher odds for FARS were registered in high pollution areas in comparison to low pollution areas (p=0.023). The study confirmed a significantly higher prevalence of CRD and FARS in children living in high pollution areas of Zasavje. These results at least partially prompted mutual understanding and cross-sectoral cooperation - prerequisites for solving complex problems involving the impact of air pollution on health.

Seat-belt use and non-use in adults in Slovenia.

Aim:To identify population groups at risk of non-use of seat belts in front and rear seats in order to enable more focused planning of preventive actions in Slovenia.Methods:The national health behaviour survey of 15,379 adults aged 25–64, carried out in 2001; response rate 64 %; 9,043 questionnaires eligible for analysis. The observed outcomes: non-use of seat belts in the front and rear seats. Logistic regression was used for relating gender, age, education level, socio-economic factors and geographical region to the observed outcomes.Results:Non-use of seat belts in the front seats: 5.7 %; the highest odds: males (ORmales vs. females = 1.89, p < 0.001), aged 25–29 (OR25–29 vs. 50–59 = 2.68, p < 0.001), the lowest education level (ORuncompleted primary vs. university education = 2.77, p = 0.001), upper social class (ORupper vs. lower = 3.54, p = 0.0 14), western Slovenia (ORwestern vs. eastern = 1.31, p = 0.027). Non-use of seat belts in the rear seats: 65.2 %; the highest odds: aged 25–29 (OR25–29 vs. 60–64 = 2.83, p < 0.001), vocational (ORvocational vs. university education = 1.36, p = 0.005) and secondary education level (ORsecondary vs. university education = 1.36, p = 0.003), western Slovenia (ORwestern vs. eastern = 1.37, p < 0.001).Conclusions:Both observed outcomes are a problem particularly in younger age groups with secondary education level or lower, living in western Slovenia; non-use of seat belts in the front seats also in males and in upper social class.

Results of CINDI Health Monitor surveys in Slovenia as a tool for development of effective healthy nutrition and physical activity intervention programmes

Aim: The study was conducted aiming at assessing the prevalence of several selected health behaviours and on identifying population groups at very high risk for them in the adult population. The present study focused on unhealthy nutrition related to obesity and diabetes (UNROD) and insufficient physical activity (IPA). High-quality basis for working out strategies, guidelines and plans for public health action in Slovenia was planned to be prepared. Subjects and methods: The data originate from the national survey carried out in 2001 on health behaviour of 15,379 adults aged 25–64 based on Countrywide Integrated Non-communicable Diseases Intervention (CINDI) Health Monitor (CHM) methodology. The overall response rate of the mailed questionnaire was 64%, with 9,043 questionnaires being eligible for analysis. Binary multiple logistic regression was used to determine the impact of gender, age, education, employment, self-assessed social class, type of residence community and geographical region on the occurrence of UNROD and IPA. Results: The highest odds for UNROD were registered in men [odds ratio (OR)men vs. women=1.35, p<0.001], aged 25–29 (OR25–29 vs. 60–64=2.72, p<0.001), participants with primary education level (ORprimary vs. university education=2.20, p<0.001), heavy workers in rural economy (ORheavy work in rural economy vs. pensioner=1.85, p<0.001), participants self-classified in labour social class (ORlabour vs. upper=1.89, p=0.026); residents of rural communities (ORrural vs. urban residence community=1.26, p<0.001), and participants from the eastern region of Slovenia (OReastern vs. central=1.43, p<0.001). The highest odds for IPA were registered in women (ORwomen vs. men=1.57, p<0.001), aged 25–29 (OR25–29 vs. 50–59=1.65, p<0.001), participants with the lowest education level (OR uncompleted primary education vs. secondary=1.47, p<0.001), participants self-classified in the lowest social class (OR lower vs. upper=2.18, p=0.040); residents of urban communities (ORurban vs. rural residence community=1.70, p<0.001), and participants from the central region of Slovenia (ORcentral vs. eastern=1.32, p<0.001). Conclusions: Groups at highest risk for UNROD and IPA were successfully identified with the above-described methodology and presented to decision makers as evidence for public health policy. CHM surveys proved to be a good tool in developing effective healthy nutrition and physical activity intervention programmes.

Validation of the Slovenian version of multiple sclerosis quality of life (MSQOL-54) instrument

Abstract Purpose To cross-culturally adapt and validate Multiple Sclerosis Quality of Life-54 (MSQOL-54) instrument. Methods The study which enrolled 134 Slovenian multiple sclerosis (MS) patients was conducted from March to December 2013. The internal consistency of the MSQOL-54 instrument was evaluated by Cronbach’s alpha coefficient (α), and its dimensionality assessed by the principal component analysis (PCA). Results The whole instrument had high internal consistency (α=0.88), as well as the majority of its twelve subscales (α=0.83-0.94). The results of the PCA showed two components with eigenvalue greater than 1, explaining 59.4% of the cumulative variance. Further results indicated good construct validity of the instrument with the physical health-related-quality-of-life subscales loading highly on the physical component, and mental health-related-quality-of-life subscales loading highly on the mental component. Conclusion The Slovenian version of the MSQOL-54 instrument proved to be an internally consistent and accurate tool, well accepted by the Slovenian MS patients. The adequate psychometric properties warrant the scientifically sound version of the MSQOL-54 instrument, which is from now on at disposal to all health professionals dealing with MS patients in Slovenia.