Marko Kolšek

Specialist training of Slovene family physicians

Family medicine in Europe started to develop in the 1960s with the introduction of obligatory specialist training. Slovenia is a country with a long tradition of family medicine specialist training, but up until 2002 this was neither elaborated on nor conducted by peers in general practice/family medicine. When the countrys socialist system started to transform due to political reforms, Slovenia began to modify its system in order to meet the criteria of the European Union. One of the changes was the introduction of a new healthcare system with an influential Medical Chamber responsible for postgraduate training in all specialities. A new model for vocational training in family medicine was established in 2002, following the recommendations of the European Union of General Practitioners (UEMO). According to the new programme, which lasts 4 years, trainees spend half of their training in a hospital setting and half in general practice, where they are supervised by a trainer in practice. This article describes the legal process of introducing new forms of specialist training in Slovenia, and its content. Conclusion: A comparison with UEMO countries shows that the new model is comparable to other countries.

Qualitative Study on Community and Primary Health Care Involvement on Alcohol and Tobacco Actions in Seven European Countries

Alcohol and tobacco use are important determinants of illness and have important country-specific dimensions. Its important to also consider them at community and primary health care (PHC) levels. A collaborative qualitative research (Delphi study and focus groups methodology) was conducted during the process of 10 new countries joining the European Union (EU) and implemented in culturally socio-economically different European countries: four EU (Belgium, Brussels region; Hungary, Pest County; Italy, Friuli Venezia Giulia region; Latvia, Riga region; Slovenia, Ljubljana region) and two Eastern European countries (Bulgaria, Sofia region; Russia, St. Petersburg region). Countries were chosen from the WHO international project according to the criteria noted in the application for EU INCO-COPERNICUS funding. Focus groups were conducted among lay people and PHC professionals in order to identify factors that influence (facilitate and prevent or minimize) PHC management of alcohol- and tobacco use–related problems. A Delphi study was conducted among four different groups in order to develop tasks for instances to be involved in community health policies. There are some limitations of such a qualitative study; e.g., such studies give ideas that cannot simply be transformed to actions in every country. In order to manage tobacco-and alcohol-related problems a comprehensive community-based approach, that also include PHC teams and policymakers, would be supported in participating countries.

Opinions of Slovenian family physicians on medically unexplained symptoms: A qualitative study

Objectives To determine the views of Slovenian family physicians on medically unexplained symptoms (MUS) and learn more about potential types of treatment for such patients. Methods Five focus groups, comprising 24 family medicine physicians (FMPs) from two Slovenian University centres, were convened. Conversations were led towards the research objectives by professionally trained researchers and followed a preliminarily established protocol. Qualitative content analysis of audio and transcripts of the discussions was performed using ATLAS.ti software to establish categories (‘codes’) relevant to issues regarding MUS. Results Slovenian FMPs emphasized the importance of good communication and trust between physicians and patients with MUS. Systemic barriers to effective management of MUS arising from the Slovenian health system were highlighted. FMPs stressed the need for more education in the recognition and treatment of MUS in primary care. From the discussions, 64 codes comprising broader research fields of MUS were developed, then grouped into a further eight categories: communication; doctor–patient relationship; causes of MUS; patient characteristics; physician characteristics; courses of action so far; positive relationship with patients; proposals for treatment. Conclusions The results are valuable in terms of investigating the treatment of patients with MUS in Slovenia, thereby opening new avenues of research on the subject of MUS.

Slovenian Adaptation of the Original Audit-C Questionnaire

Background: Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire as a screening instrument for identification of hazardous and harmful drinkers give some false-positive and negative results. Changes of answers decrease the number of false results. Methods: Changes in second and third questions with theoretical simulation of possible answers’ combinations was made; cutoff scores have to be changed. Study with original and adapted AUDIT-C was conducted among 298 students to analyze the differences. Results: Adapted Slovenian version of AUDIT-C gives less false-positive and less false-negative results. Conclusions: Changes of AUDIT-C questionnaire that give less false results means less potential disharmony in doctor–patient relationship, less unnecessary questioning, less time spent inadequately, and also less missed hazardous drinkers.

The Drinking Habits of Users of an Alcohol Drinking Screening Website in Slovenia

Abstract Background Alcohol consumption in Slovenia is one of the highest in Europe. In Slovenia there were a few epidemiological studies on drinking habits among adult population, but none of them has used the AUDIT questionnaire or the Internet for research. Objective The aim of this study was to analyse the drinking habits of the visitors of our website www.nalijem.si, which included an anonymous questionnaire for self-assessment of alcohol drinking. Methods A cross sectional survey was conducted between January 2010 and December 2013. The front page of our website included an invitation to fill in the anonymous web-based questionnaire; a part of it was the AUDIT 10 questionnaire. Everyone who filled in the questionnaire completely received an individualized feedback on his drinking. Results 54.020 persons visited our website, 15.817 (29.3%) of them started to fill in the questionnaire, 12.800 (80.9%) filled it in completely. In the analysis, 9.087 (71.0%) persons were included who completed the questionnaire for themselves. There were 37.1% (N=3.373) women and 62.9% (N=5.714) men. The average age was 33 years, the majority was employed (59.7%, N=5.222). The minority drank alcohol 2-4 times per month (32.8%, N=2.977) and most of them (64.5%, N=5.869) drank more than 3 units of alcohol per one occasion on a typical day. The average AUDIT 10 score was 11.7 for men, 8.1 for women. Conclusions A large percentage of participants were identified as hazardous and harmful drinkers, which should be a matter of serious concern.

Prevention of post-herpetic neuralgia using transcutaneous electrical nerve stimulation

SummaryBackgroundPost-herpetic neuralgia (PHN) is the most common complication of herpes zoster (HZ) and is difficult to treat. The role of antiviral agents and nonpharmacologic procedures in preventing PHN is not entirely clear. Recent retrospective study showed that transcutaneous electrical nerve stimulation (TENS) may completely prevent PHN. The aim of our study was to identify predictors for PHN and evaluate the treatment with antiviral agents and TENS.MethodsWe conducted a multicenter prospective, randomized intervention study in patients with a new onset of HZ. Immunocompromised patients were excluded. Patients were randomly assigned to four groups (TENS, Antiviral agents, TENS and Antiviral agents, and Control Group). At the inclusion, the following criteria were recorded: age, gender, duration of pain before the onset of the rash, the number of efflorescence, the intensity of pain, and the analgesic prescribed. During the follow-up, we recorded a spontaneous pain sensation, pain intensity, and presence of allodynia, hyperalgesia, or paraesthesia.ResultsWith each additional year of age, the odds for the presence of PHN with unchanged values of other predictors increase (odds ratio (OR) = 1.03 [1.01; 1.05], p = 0.001). The same is true for the initial intensity of the pain (OR = 1.25 [1.09; 1.43], p = 0.002). The odds for acute and subacute herpetic neuralgia are greater than for PHN. The odds for subacute herpetic neuralgia are the lowest in the group treated with TENS (OR = 0.15 [0.05; 0.47], p = 0.001).ConclusionsPHN cannot be completely prevented. TENS as a single therapy was found the most successful among the tested treatments in reducing the incidence of subacute herpetic neuralgia.ZusammenfassungGrundlagenPost-Zoster-Neuralgie (PZN) ist die häufigste Komplikation des Herpes Zoster (HZ) und ist schwer zu behandeln. Die Rolle von antiviralen Mitteln und nicht- pharmakologischen Verfahren bei der Verhinderung von PZN ist nicht umfassend geklärt. Eine aktuelle retrospektive Studie hat gezeigt, dass Transkutane Elektrische Nervenstimulation (TENS) PZN vollständig verhindern kann. Das Ziel unserer Studie war es, Prädiktoren für PZN zu identifizieren und die Behandlung mit antiviralen Mitteln und TENS zu bewerten.MethodikWir haben eine multizentrische, prospek-tive randomisierte Interventionsstudie bei Patienten mit neuem Auftreten eines HZ durchgeführt. Immunsupprimierte Patienten wurden ausgeschlossen. Die Patienten wurden randomisiert vier Gruppen (TENS, antivirale Mittel, TENS und antivirale Mittel, Kontrollgruppe) zugeordnet. Die Auswertung erfolgte anhand folgender Kriterien: Alter, Geschlecht, Dauer der Schmerzen vor dem Einsetzen des Hautausschlags, die Anzahl von Ausblühungen, die Intensität von Schmerzen und die Anzahl verschriebener schmerzstillender Mittel. Während des Follow-up verzeichneten wir spontane Schmerzempfindungen, Schmerzintensität und das Vorhandensein von Allodynia, Hyperalgesie oder Parästhesie.ErgebnisseMit jedem Lebensjahr steigen die Chancen für das Vorhandensein von PZN mit unveränderten Werten anderer Prädiktoren (OR = 1,03 [1,01; 1,05], p = 0,001). Das gleiche gilt für die anfängliche Intensität des Schmerzes (OR = 1,25 [1,09; 1,43], p = 0,002). Die Chancen für eine akute und subakute Zoster-Neuralgie sind größer als für PZN. Die Chancen für eine subakute Zoster-Neuralgie sind am niedrigsten in der Gruppe, die mit TENS (OR = 0,15 [0,05; 0,47], p = 0,001) behandelt wurde.SchlussfolgerungenPZN kann nicht vollständig verhindert werden. TENS als Einzeltherapie ist die erfolgreichste unter den getesteten Behandlungen bei der Verringerung der Häufigkeit von subakuter Neuralgie.

Adherence factors to paperless primary healthcare: a focus group study

Abstract Background: Information and communication technology (ICT) and paperless practices have been shown to improve “existing processes in the workplace” “as well as being an important component of modern primary healthcare”. The aim of our study was to analyse the attitudes of health-care professionals and patients with regard to paperless practice and the most frequently used information and communication technology tools in Slovenian primary healthcare. Methods and participants: Qualitative methodology using focus groups of 22 primary care physicians, 14 nurses and 18 patients. Results: The areas recognised by all participants as important for further information and communication technology development were: computer-supported decision making, accessibility and completeness of personal e-health data, emergency cases, support for chronic disease management, ICT related time savings, e-prescriptions and e-discharge letters. The most important identified barriers impeding the use of ICT were: the heavy workload of primary care physicians and nurses, health insurance reimbursement rules and duplication of work using both paper and electronic health records. Conclusions: This study highlighted a number of strengths of ICT use in primary care as well as numerous areas where changes in procedures and improvement of ICT tools to support them are needed. Izvleček Izhodišča: Informacijsko-komunikacijska tehnologija (IKT) in brezpapirno delo lahko izboljšata obstoječe delovne procese in so pomembna sestavina sodobnega osnovnega zdravstva. Namen študije je bil analizirati stališča zdravstvenega osebja in pacientov glede brezpapirne ambulante in najpogostejše uporabljene informacijskokomunikacijske tehnologije v slovenskem osnovnem zdravstvu. Metode in preiskovanci: Kvalitativna metodologija fokusnih skupin z 22 zdravniki iz osnovnega zdravstva, s 14 ambulantnimi sestrami in z 18 bolniki. Rezultati: Področja, ki so jih vsi udeleženci prepoznali kot pomembna za nadaljnji razvoj IKT, so: računalniško podprto odločanje, dostopnost in popolnost osebnih zdravstvenih podatkov, nujni primeri, podpora pri obravnavi kroničnih bolezni, prihranki časa z uporabo IKT, e-recept in e-odpustno pismo. Najpomembnejše ovire za uporabo IKT so: velike delovne obremenitve zdravnikov in sester v osnovnem zdravstvu, pravila zdravstvene zavarovalnice, podvajanje dela z uporabo papirnatih in elektronskih zdravstvenih kartotek. Zaključki: Študija je poudarila številne prednosti uporabe IKT v osnovnem zdravstvu in tudi številna področja, na katerih so potrebni spremembe v procesih in izboljšanje podpornih orodij IKT.

Alcohol Drinking Among Students of the University of Ljubljana

Abstract Background. Hazardous and harmful alcohol drinking is an important health, social and economic issue in Slovenia, also amongst adolescents and young adults. While drinking in Slovenia has been well researched amongst elementary and high school students, there exists a lack of research on drinking amongst young adults attending university. Methods. Cross sectional study. First year students of the University of Ljubljana attending the mandatory preventive health check between October 2009 and May 2010 filled out a non-anonymous lifestyle questionnaire. AUDIT-C screening questionnaire on alcohol use and questions on smoking and illicit drug use were also included. Multivariate and multilevel methods were used to analyse the data. Results. 7221 students filled out the questionnaire, of those 38.5 % male and 61.5 % female. 87.3 % of students have drunk alcohol at some point in the last year. Amongst the students, 23.1 % were hazardous or harmful drinkers. 61.4 % of students have been drunk at least once in the last year. 11.8 % of the students were abstainers. Male students, smokers and students with drug experience have higher odds of being harmful or hazardous drinkers. Student level variables account for most of the variability in harmful and hazardous drinking; only 2 % of the variability was due to differences across universities. Conclusions. Students of the University of Ljubljana drank alcohol in large quantities. There was a marked link between hazardous drinking, smoking and drug use. Results of this study show the need for the formation of suitable preventive measures that would change drinking behaviour amongst the student population. Izvleček Izhodišča. Tvegano in škodljivo pitje alkohola v Sloveniji predstavlja velik zdravstveni, socialni in ekonomski problem, tudi med mladimi. V Sloveniji obstajajo temeljite raziskave o pitju alkohola med osnovnošolci in srednješolci, medtem ko so podatki o pitju alkohola med študenti pomanjkljivi. Metode. Presečna študija. Študentje prvih letnikov rednega študija Univerze v Ljubljani, ki so prišli na obvezni redni preventivni zdravstveni pregled med oktobrom 2009 in majem 2010, so izpolnili neanonimni vprašalnik o življenjskem slogu. Ta je vseboval tudi standardizirani vprašalnik o pitju alkohola AUDIT-C ter vprašanji o kajenju in izkušnjah z drogo. Podatki so bili analizirani z multivariatnimi in večnivojskimi metodami. Rezultati. Vprašalnik je izpolnilo 7.221 študentov, 38,5 % moških in 61,5 % žensk. V zadnjem letu je alkohol pilo 87,3 % študentov. Tvegano ali škodljivo pije 23,1 % študentov. V zadnjem letu se je vsaj enkrat opilo 61,4 % študentov. Abstinentov je 11,8 %. Večji obet za tvegano in škodljivo pitje imajo študenti moškega spola, kadilci in študenti z izkušnjami z drogo. Večino variance v tveganem in škodljivem pitju alkohola pojasnimo z dejavniki na ravni študentov, razlike med fakultetami pa pojasnijo samo 2 % skupne variance. Sklepi. Študentje Univerze v Ljubljani alkohol pijejo prekomerno. Med kajenjem, izkušnjami z drogo in tveganim ali škodljivim pitjem je jasna povezava. Rezultati raziskave kažejo na potrebo po pripravi ustreznega preventivnega programa, s katerim bi zmanjšali porabo alkohola med študenti

A long-term preventive project on alcohol drinking in Slovenia

The alcohol drinking problems in Slovenia are briefly described and the process of the first part of a long-term national alcohol drinking preventive population-based project called ‘Message from the bottle’, which has been run by the Department of Family Medicine at the Medical Faculty, University of Ljubljana, is explained. Its long-term aims are to reframe understanding of alcohol issues, to change the social climate on alcohol and to reduce alcohol-related harm. Different products have been prepared: postcards, brochures, posters for different kinds of exhibitions, an animated health-promotion film, a manual for primary healthcare physicians and workshops for physicians and nurses to learn about counselling for health behaviour change. In conclusion, future planned activities are described.

Alcohol Drinking Among the Students of the University of Maribor, Slovenia

Abstract Background. Hazardous and harmful alcohol drinking is an important health, social and economic issue in Slovenia amongst all age groups. While drinking in Slovenia has been well researched amongst elementary and high school students, there is a lack of research on drinking amongst university students. Methods. We conducted a cross-sectional study among first- and fourth-year students of the University of Maribor, Slovenia, attending the mandatory preventive health check between October 2009 and May 2010. During this health check, they filled in a non-anonymous lifestyle questionnaire. AUDIT-C questionnaire on alcohol use and questions on smoking and illicit drug use were also included. Results. 3.130 students were included in the analysis, 1219 (38.9%) were males. There were 871 (27.8%) students that were screened as risky drinkers. The highest percentage of risky drinkers attended the Faculty for Wood Technology and the lowest the Faculty for Health Sciences. Students, recognized as healthier by the physicians, reported risky drinking significantly less often (p=0.015). Students with higher BMI reported risky drinking significantly more often (p=0.012). Variables, proved to be independently associated with the risky drinking in the multivariate analysis, were: bad health status (p=0.044), male sex (p<0.001), daily consumption of fried food (p=0.017), smoking (p<0.001), illicit drugs (p<0.001), attending the Faculty for Civil Engineering (p=0.006), not attending the Faculty for Health Sciences (p=0.002) Conclusions. While the prevalence of risky drinking among students in this study is high, a structured preventive programme should be implemented for students,which will include also illicit drug use and smoking. IZVLEČEK Uvod. Tvegano in škodljivo pitje alkohola je pomembna zdravstvena, socialna in ekonomska tema v Sloveniji, ki se dotika vseh starostnih skupin prebivalstva. Pitje alkohola je dobro raziskano med osnovnošolci in srednješolsko mladino, malo pa je podatkov o pitju alkohola med študenti. Metode. Izvedena je bila presečna raziskava med študenti prvih in četrtih letnikov Univerze v Mariboru, ki so obiskali obvezni preventivni zdravniški pregled med oktobrom 2009 in majem 2010. V okviru tega pregleda so izpolnili tudi neanonimni vprašalnik o življenjskem slogu, ki je med drugim vključeval vprašalnik AUDIT-C za oceno pitja alkohola ter vprašanja glede kajenja in rabe prepovedanih drog. Rezultati. V analizo je bilo vključenih 3130 študentov, od tega je bilo 1219 (38,9 %) moških. S presejalnim testom je bilo prepoznanih 871 (27,8 %) tveganih pivcev. Največji odstotek tveganih pivcev je bil med študenti višje lesarske šole, najnižji pa med študenti visoke zdravstvene šole. Med študenti, ki so jih zdravniki opredelili za bolj zdrave, je bilo statistično značilno manj tveganih pivcev (p=0,015). Med študenti s povišanim indeksom telesne mase je bilo statistično značilno več tveganih pivcev (p=0,012). Spremenljivke, ki so bile pri multivariantni analizi neodvisno povezane s tveganim pitjem, so bile slabo zdravstveno stanje (p=0,044), moški spol (p<0,001), vsakodnevno uživanje ocvrte hrane (p=0,017), kajenje (p<0,001), raba prepovedanih drog (p<0,001), študij na Fakulteti za gradbeništvo (p=0,006) in ne biti študent Visoke zdravstvene šole (p=0,002). Zaključek. Glede na ugotovljen velik odstotek tveganih pivcev bi bilo treba za študente uvesti strukturiran preventivni program za zmanjšanje pitja alkohola, ki bi vključeval tudi aktivnosti v zvezi s kajenjem in prepovedanimi drogami.