Lilijana Šprah

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

BackgroundThe harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS).MethodsThe development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal).ResultsDESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making.ConclusionDESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.

Psychiatric readmissions and their association with physical comorbidity: a systematic literature review

BackgroundComorbidity between mental and physical disorder conditions is the rule rather than the exception. It is estimated that 25% of adult population have mental health condition and 68% of them suffer from comorbid medical condition. Readmission rates in psychiatric patients are high and we still lack understanding potential predictors of recidivism. Physical comorbidity could be one of important risk factors for psychiatric readmission. The aim of the present study was to review the impact of physical comorbidity variables on readmission after discharge from psychiatric or general inpatient care among patients with co-occurring psychiatric and medical conditions.MethodsA comprehensive database search from January 1990 to June 2014 was performed in the following bibliographic databases: Ovid Medline, PsycINFO, ProQuest Health Management, OpenGrey and Google Scholar. An integrative research review was conducted on 23 observational studies.ResultsSix studies documented physical comorbidity variables only at admission/discharge and 17 also at readmission. The main body of studies supported the hypothesis that patients with mental disorders are at increased risk of readmission if they had co-occurring medical condition. The impact of physical comorbidity variables on psychiatric readmission was most frequently studied in in patients with affective and substance use disorders (SUD). Most common physical comorbidity variables with higher probability for psychiatric readmission were associated with certain category of psychiatric diagnoses. Chronic lung conditions, hepatitis C virus infection, hypertension and number of medical diagnoses were associated with increased risk of readmission in SUD; Charlson Comorbidity Index, somatic complaints, physical health problems with serious mental illnesses (schizophrenia, schizoaffective disorder, personality disorders); not specified medical illness, somatic complaints, number of medical diagnoses, hyperthyroidism with affective disorders (depression, bipolar disorder). Co-occurring physical and mental disorders can worsen patient’s course of illness leading to hospital readmission also due to non-psychiatric reasons.ConclusionsThe association between physical comorbidity and psychiatric readmission is still poorly understood phenomenon. Nevertheless, that physical comorbid conditions are more common among readmitted patients than single admission patients, their association with readmission can vary according to the nature of mental disorders, characteristics of study population, applied concept of comorbidity, and study protocol.

Psychometric properties of the Slovenian version of temperament evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A): Temperament profiles in Slovenian university students

BACKGROUND TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego-Autoquestionnaire) is a self-rated instrument that measures five affective temperaments: depressive, cyclothymic, hyperthymic, irritable, and anxious. The aim of our study was to examine the psychometric characteristics of the Slovenian TEMPS-A and to ascertain if temperament profile is related to the professions chosen by Slovenian students. METHODS 892 Slovenian university students in six different professional fields (economics, geography, engineering, law, sports pedagogy and nursing) were included in our study. RESULTS Cronbachs reliability coefficients denoted acceptable internal consistency of the subscales. Principal component analysis revealed relatively good internal structure of the instrument. Nursing and geography students scored the highest on depressive temperament. Sports pedagogues as well as engineers demonstrated the most firm personality structure with distinctive hyperthymic temperament. Law students revealed the most irritable temperament, while nursing and law students scored the highest on anxious temperament. LIMITATIONS Sample of Slovenian students is not representative for general population. The structure of the sample was crucial as well, as it comprised mainly of younger students who just started their study. CONCLUSIONS The Slovenian version of the TEMPS-A proved to have relatively good internal consistency and internal structure. The questionnaire verified as a reliable and valid instrument and generally in line with previous studies. This study strengthens the perspective that professional areas could be associated with distinct affective temperament profile that could influence career decisions. The findings in students of economics, geography, and sport pedagogy are new as they have not been previously investigated by TEMPS researchers. The results open new possibilities for future research.

Relationship between affective temperaments and aggression in euthymic patients with bipolar mood disorder and major depressive disorder.

BACKGROUND So far there is a scarce of studies dealing with the relationship between different aspects of aggressive behaviour and affective temperaments among various mood disorders. The aim of the present study was to explore in a group of patients with affective mood disorders the relationship between affective temperaments and aggression. METHODS 100 consecutive outpatients in euthymic phase of mood disorders (46 with bipolar disorder-type I, 18 with bipolar disorder-type II and 36 with major depressive disorder) were self-assessed with the Aggression Questionnaire and the short version of Slovenian Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Autoquestionnaire (TEMPS-A). RESULTS The factorial analysis of the TEMPS-A subscales revealed 2 main factors: Factor 1 (prominent cyclothymic profile) consisted of cyclothymic, depressive, irritable, and anxious temperaments and Factor 2 (prominent hyperthymic profile) which was represented by the hyperthymic temperament, and by depressive and anxious temperaments as negative components. Patients with prominent cyclothymic profile got their diagnosis later in their life and had significantly higher mean scores on anger and hostility (non-motor aggressive behaviour) compared with patients with prominent hyperthymic profile. LIMITATIONS We included patients with different mood disorders, therefore the sample selection may influence temperamental and aggression profiles. We used self-report questionnaires which can elicit sociable desirable answers. CONCLUSION Anger and hostility could represent stable personality characteristics of prominent cyclothymic profile that endure even in remission. It seems that distinct temperamental profile could serve as a good diagnostic and prognostic value for non-motor aspects of aggressive behaviour.

The wellbeing of Slovenia's population by region: comparison of indicators with an emphasis on health

In broader definitions, wellbeing is commonly described as a multidimensional concept, defined by the state of happiness, health, and prosperity. However, due to various understandings of conceptual issues regarding wellbeing, professionals encounter a number of methodological problems connected with measuring it. Composite indicators are thus being increasingly used to measure populations wellbeing. Health is an important area of wellbeing and is connected with indicators similar to those used for measuring general wellbeing. This article uses composite indicators to compare various areas of wellbeing, and especially health-related wellbeing, among the twelve Slovenian statistical regions. The findings show great differences between Slovenian regions. In western Slovenia (the Central Slovenia, Soca, Coastal-Karst, and Upper Carniola regions), the level of wellbeing is generally high, and in eastern Slovenia (the Carinthia, Lower Sava, Mura, and Central Sava regions) it is lower. Except for minor deviations, the level of general wellbeing in the regions matches the level of health-related wellbeing.

Perceived Workplace Stress and Co-Occurrence of Health Problems and Burnout in Different Occupational Groups

Izvleček Izhodišča: Nekatere poklicne skupine so zaradi narave dela ranljivejše za razvoj poklicnega stresa, izgorelosti in psihofizičnih zdravstvenih težav. Cilj raziskave je bil opredeliti razlike v doživljanju poklicnega stresa ter proučiti sovpadanje zdravstvenih težav in izgorevanja pri zaposlenih v petih različnih poklicnih skupinah. Metode: V raziskavo je bilo vključenih 258 udeležencev, zaposlenih v gradbeni, zdravstveni in v predelovalni dejavnosti, razvrščenih v poklicne skupine: delavci v proizvodnji (N=56 (20%), 56% moških), administrativno osebje (N=58 (20%), 18% moških), zdravstveni (N=65 (23%), 16% moških), tehnični (N=51(18%), 87% moških) in vodstveni kadri (N=55 (19%), 68% moških). Udeleženci so izpolnili vprašalnike o sociodemografskih značilnostih, zdravstvenih težavah, stresu na delovnem mestu (OSI) in o izgorelosti (OLBI). Rezultati: V primerjavi z drugimi poklicnimi profili so delavci v proizvodnji in zdravstveni kadri izražali največjo stopnjo stresa na delovnem mestu. Pri zdravstvenih delavcih so prevladovali viri stresa, povezani z visokimi delovnimi zahtevami in omejeno avtonomnostjo, pri zaposlenih v proizvodnji pa izpostavljenost škodljivim okoljskim dejavnikom. Najpogostejše zdravstvene težave so bile utrujenost pri 56,9% zdravstvenih in 50% proizvodnih delavcev, glavoboli in težave z vidom pri 51,8% proizvodnih delavcih ter bolečine v kostno-mišičnem sistemu pri 48,2% proizvodnih delavcih. Pri zdravstvenih in administrativnih delavcih je bilo največ statistično pomembnih povezav med psihofizičnimi zdravstvenimi težavami in izgorelostjo. Približno desetina zaposlenih v vseh poklicnih skupinah je kazala znake visoke izgorelosti. Zaključki: Zdravstveni kadri in delavci v proizvodnji so se v primerjavi s preostalimi poklicnimi skupinami izkazali kot ranljivejši za razvoj prekomernega stresa na delovnem mestu. Sopojavljanje zdravstvenih težav in izgorelosti je bilo najizrazitejše pri tehničnih in zdravstvenih kadrih. Abstract Introduction: Some occupational groups are more prone to workplace stress, burnout and psychophysical health problems due to the nature of their work. The aims of this study were to compare health problems, workplace stress and burnout and to explore the associations between burnout and health among five occupational groups. Methods: Participants were 258 employees from building, health and industrial sectors assigned to occupational groups; industry workers (N=56 (20%), 56% males), administration workers (N=58 (20%), 18% males), healthcare workers (N=65 (23%), 16% males), technical staff (N=51(18%), 87% males) and managers (N=55 (19%), 68% males). They completed questionnaires assessing basic sociodemographic characteristics, health problems, The Occupational Stress Index (OSI) and The Oldenburg Burnout Inventory (OLBI). Results: Compared to other occupational profiles, industry and health workers experienced the highest levels of workplace stress. Health workers experienced the most stress regarding high work demands and low autonomy, while industry workers were characterized by a high exposure to noxious environments. The most frequent health complaints were: fatigue among 56.9% health workers and among 50% industry workers, headaches, eyesight problems among 51.8% industry workers and musculoskeletal problems among 48.2% industry workers. The most significant correlations between psychophysical health problems and burnout were found among health and administration workers. Ten percent of employees in all occupational groups displayed signs of high burnout. Conclusions: Of all occupational groups, health and industrial employees were at the highest risk for the development of adverse workplace stress. The co-occurrence of occupational burnout and health problems was the most evident in technical and health workers.

Psychometric properties of the Slovenian adaptation of the Revised Generic Occupational Stress Index Questionnaire (RG-OSI)

The Revised Generic Occupational Stress Index questionnaire (RG-OSI) employs the cognitive ergonomics approach that quantifies the burden of stressors on cognitive resources of the employee. The model is structured as a 2dimensional matrix, where each element is scored from 0 to 2 (sometimes with intermediate values of 0.5, 1.5 or 1.75) as a combination of various items based on multiple criteria. Due to uncommon scoring system of the questionnaire, our study aimed to explore the appropriateness of the existing scoring system and to get some information on validity of the scale on a Slovenian sample. The questionnaire has been applied on 349 Slovenian employees from different occupational groups and the data were analysed by means of correspondence analysis, classical reliability and item analysis and item response theory analysis. The results of correspondence analysis demonstrate that the response categories on individual variables are not always ordered. Furthermore, we conducted reliability analysis for scales, developed short versions of the scales, and obtained some preliminary information on their validity. The current study provides evidence that the described original scoring system in psychological measures may not be appropriate from the psychometric viewpoint.