This multi-centre cross-sectional study explored associations between prevalence of depression and exposure to intimate partner violence (IPV) at any time in patients' adult life in 471 participants ...of a previous IPV study. In 2016, 174 interviews were performed, using the Short Form Domestic Violence Exposure Questionnaire, the Zung Scale and questions about behavioural patterns of exposure to IPV. Family doctors reviewed patients' medical charts for period from 2012 to 2016, using the Domestic Violence Exposure Medical Chart Check List, for conditions which persisted for at least three years. Depression was found to be associated with any exposure to IPV in adult life and was more likely to affect women. In multivariable logistic regression modelling, factors associated with self-rated depression were identified (p < 0.05). Exposure to emotional and physical violence was identified as a risk factor in the first model, explaining 23% of the variance. The second model explained 66% of the variance; past divorce, dysfunctional family relationships and a history of incapacity to work increased the likelihood of depression in patients. Family doctors should consider IPV exposure when detecting depression, since lifetime IPV exposure was found to be 40.4% and 36.9% of depressed revealed it.
Family history (FH) is an important part of the patients' medical history during preventive management at model family medicine practices (MFMP). It currently includes a one (or two) generational ...inquiry, predominately in terms of cardiovascular diseases, arterial hypertension, and diabetes, but not of other diseases with a probable genetic aetiology. Beside family history, no application-based algorithm is available to determine the risk level for specific chronic diseases in Slovenia.
A web application-based algorithm aimed at determining the risk level for selected monogenic and polygenic diseases will be developed. The data will be collected in MFMP; approximately 40 overall with a sample including healthy preventive examination attendees (approximately 1,000). Demographic data, a three-generational FH, a medical history of acquired and congenital risk factors for the selected diseases, and other important clinical factors will be documented.
The results will be validated by a clinical genetic approach based on family pedigrees and the next-generation genetic sequencing method. After the risk of genetic diseases in the Slovenian population has been determined, clinical pathways for acting according to the assessed risk level will be prepared.
By means of a public health tool providing an assessment of family predisposition, a contribution to the effective identification of people at increased risk of the selected monogenic and polygenic diseases is expected, lessening a significant public health burden.
In 1996 the World Health Organization declared intimate partner violence (IPV) the most important public health problem. Meta-analyses in 2013 showed every third female globally had been a victim of ...violence. Experts find screening controversial; family medicine is the preferred environment for identifying victims of violence, but barriers on both sides prevent patients from discussing it with doctors.
In July 2014, a qualitative study was performed through semi-structured interviews with ten family doctors of different ages and gender, working in rural or urban environments. Sound recordings of the interviews were transcribed, and the record verified. The data were interpreted using content analysis. A coding scheme was developed and later verified and analysed by two independent researchers. The text of the interviews was analysed according to the coding scheme.
Two coding schemes were developed: one for screening, and the other for the active detection of IPV. The main themes emerging as barriers to screening were lack of time, staff turnover, inadequate finance, ignorance of a clear definition, poor commitment to screening, obligatory follow-up, risk of deterioration of the doctor-patient relationship, and insincerity on the part of the patient. Additionally, cultural aspects of violence, uncertainty/ helplessness, fear, lack of competence and qualifications, autonomy/negative experience, and passive role/stigma/ fear on the part of the patients were barriers to active detection.
All the participating doctors had had previous experience with active detection of IPV and were aware of its importance. Due to several barriers to screening for violence they preferred active detection.
Izhodišča: V času epidemije covida-19 v Sloveniji je bilo potrebno celotni teoretični del pouka družinske medicine izvesti po spletu.
Metode: Pouk družinske medicine smo prilagodili izvedbi preko ...videokonferenčnega sistema. Dodali smo aktualne teme o epidemiji, uvedli redne domače naloge, povečali uporabo spletne učilnice in vzpostavili možnost foruma. Uporabili smo nove metode, na primer predavanje z “obrnjeno učilnico”, problemsko usmerjeno učenje s kliničnimi vinjetami in video-posvet o pouku sporazumevanja. Posebej se je obnesla metoda igrifikacije oz. uvedba kviza v pouk.
Rezultati: Kakovost, prednosti in nevarnosti spletnega pouka smo ocenili z anketo študentov in mnenjem pedagogov. Študenti so ocenili, da je pouk dobro potekal, sodobne metode so jim ugajale, predlagali pa so več kliničnih primerov in predstavitev najpogostejših stanj v družinski medicini. Spletni pouk so ocenili enako visoko kot klinične vaje. Pedagogi so navedli visoko lastno motivacijo in inovativnost pri spremembi pouka, poudarili prednost časovne prilagodljivosti, po drugi strani pa časovno zahtevnost spletnega poučevanja. V prihodnosti bi lahko s pomočjo spletnega poučevanja določen delež študentov opravljal klinične vaje v domačem okolju, s čimer bi potrebovali manj mentorjev v Ljubljani. Spletno poučevanje ponuja možnost učenja modernih veščin zdravnika družinske medicine (npr. videoposvet), aktivacije študentov (npr. igra vlog) ter omogoči ustvarjanje repozitorija učnih gradiv in sodelovanje gostov iz tujine. Slabost pa je odsotnost osebnega stika s študenti ter neustreznost za učenje kliničnih veščin.
Zaključek: Ob takojšnjem prehodu na spletno poučevanje smo preizkusili nove metode pouka, ugotovili nekatere prednosti in pomanjkljivosti. Te izkušnje bodo pomembne za spremembe pouka v naslednjih letih.
To estimate the prevalence of exposure to domestic violence in primary care patients in Slovenia and determine the associated factors.
In a systematic cross-sectional survey, 70 physicians from 70 ...family medicine practices from urban and rural settings conducted interviews with every fifth patient from January 15 to February 15, 2010.
Of 2075 patients (98.8% response rate), 372 (17.9%) were exposed to psychological or physical violence in the family in the last five years. Factors that increased the chances of exposure to psychological and physical violence were female sex (odds ratio OR, 3.27; 95% confidence interval CI, 2.24-4.76; Plt;0.001; OR, 4.52; 95% CI, 2.83-7.20; Plt;0.001, respectively) and formal divorce (OR, 2.08; 95% CI, 1.35-3.21; P=0.001; OR, 2.72; 95% CI, 1.73-4.29; Plt;0.001, respectively). Factors that decreased the chances of exposure to psychological violence were age of 65 years or above (OR, 0.56; 95% CI, 0.33-0.96, P=0.035) and single status (OR, 0.43; 95% CI 0.21-0.86, P=0.016), while age of 65 years or above (OR, 0.43; 95% CI, 0.23-0.79, P=0.007) and parenting of two children (OR, 0.51; 95% CI, 0.29-0.90, P=0.020) decreased the chances of exposure to physical violence.
We found the rate of exposure to psychological and physical violence of 17.9%, which indicates that this problem is a serious public health issue that needs to be addressed by adequate measures. The identified risk and protective factors could serve as a valid guidance for family physicians dealing with physical violence.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND Cigarette smoking affects cancer risk and cardiovascular risk. Smoking cessation is very beneficial for health. This study aimed to evaluate an early individualized integrated ...rehabilitation program and standard rehabilitation program for smoking cessation in breast cancer patients. MATERIAL AND METHODS This prospective study included 467 breast cancer patients (29-65 (mean 52) years of age) treated at the Institute of Oncology Ljubljana from 2019 to 2021 and were followed longer than 1 year. The control group and intervention group included 282 and 185 patients, respectively. Three questionnaires were completed by patients before and 1 year after the beginning of oncological treatment. The intervention group received interventions according to the patient's needs, while the control group underwent standard rehabilitation. The data obtained from the survey were analyzed using the chi-square test and analysis of variance. RESULTS In total, 115 patients were tobacco smokers before the beginning of cancer treatment. There were no differences between the intervention and control group in the prevalence of smoking before the treatment. Before the cancer treatment, smoking was present in the intervention group in 22% and in control group in 27% (P=0.27). One year after the beginning of cancer treatment, smoking was present in the intervention group in only 10% of cases, while it was present in control group in 20% of cases. Smoking was significantly less common in the intervention group than in the control group (P=0.004). CONCLUSIONS Smoking cessation was more common after early integrated rehabilitation than after standard rehabilitation.
Intimate partner violence (IPV) is yet to be fully acknowledged as a public health problem in Slovenia. This study aimed to explore the health and other patient characteristics associated with ...psychological IPV exposure and gender-related specificity in family clinic attendees.
In a multi-centre cross-sectional study, 960 family practice attendees aged 18 years and above were recruited. In 689 interviews with currently- or previously-partnered patients, the short form of A Domestic Violence Exposure Questionnaire and additional questions about behavioural patterns of exposure to psychological abuse in the past year were given. General practitioners (GPs) reviewed the medical charts of 470 patients who met the IPV exposure criteria. The Domestic Violence Exposure Medical Chart Check List was used, collecting data on the patients' lives and physical, sexual and reproductive, and psychological health status, as well as sick leave, hospitalisation, visits to family practices and referrals to other clinical specialists in the past year. In multivariate logistic regression modelling the factors associated with past year psychological IPV exposure were identified, with P<0.05 set as the level of statistical significance.
Of the participants (n=470), 12.1% (n=57) were exposed to psychological IPV in the previous year (46 women and 11 men). They expressed more complaints regarding sexual and reproductive (p=0.011), and psychological and behavioural status (p<0.001), in the year prior to the survey. Unemployment or working part-time, a college degree, an intimate relationship of six years or more and a history of disputes in the intimate relationship, increased the odds of psychological IPV exposure in the sample, explaining 41% of the variance. In females, unemployment and a history of disputes in the intimate relationship explained 43% of the variance.
The prevalence of psychological IPV above 10% during the past year was similar to earlier studies in Slovenia, although the predominance of better-educated people might be associated with lower tolerance toward psychological abuse. GPs should pay special attention to unemployed patients and those complaining about family disputes, to increase early detection.
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Intimate partner violence (IPV) can be considered a leading public health problem affecting approximately 50% of women during the course of their lifetimes. This study was carried out with the aim of ...re-testing the prevalence data and providing sufficient grounds for decision-makers in family medicine in Slovenia to adopt much-needed protocols for IPV management in the field.
In January 2012, every tenth general practitioner (GP) registered in Slovenia, of a total of 958, was invited to participate in a multi-centre cross-sectional study, and 9.4% of them, working in 90 family practices, agreed to participate. From February 1 to March 1, 2012, they asked every fifth family practice attendee aged 18 years and above, regardless of gender, to participate in the study. The short version of Domestic Violence Exposure Questionnaire was administered to 2572 patients.
In the sample, there were more women (62.9% (n = 1617)). The average age of all the participants was 49.0 ± 16.1 years. Of 2572 participants (95.3% response rate), 17.1% people had been exposed to either emotional or both physical and emotional abuse. The prevalence of psychological violence was 10.3%, and that of concurrent physical and psychological abuse 6.8%, with all the patients exposed to physical IPV disclosing concurrent psychological violence. Female gender and previous formal divorce were risk factors identified in all three multivariate logistic regression models. The odds of concurrent physical and psychological and either type of IPV exposure in patients were lessened by an age of 65 years or above. The odds for either type of IPV were also lower in single people, while in concurrent physical and psychological IPV exposure, living in urban settings acted as a protective factor.
In Slovenian family practice attendees, an IPV exposure prevalence of approximately 17% should be considered a valid estimation.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND Biomedical discourse dominates research literature and media accounts of menopause.Symptoms of menopause and psychosocial, cultural and interpersonal interactions inevitably influence the ...quality of life.In this article, different views on menopause are presented: from the standpoints ofwomen, men, and medical experts. Treatment decisions can be made between hormonalreplacement therapy and other, less researched remedies. Shared decision makingsignificantly improves adherence to treatment and facilitates better treatment outcomes.This can be made possible if the patient is adequately informed about the benefits and risksof the therapy. A trusting relationship between the doctor and patient and excellentcommunication between them is a key to better outcomes. The article brings an overviewof some of the research on quality of life in menopause, and counselling concerninghormonal replacement therapy. CONCLUSIONS Quality of life in menopause is a result of many factors and therefore it is very individual.Hormone replacement therapy is one of the possibilities of improvement. Therefore, it isessential that a woman is adequately informed about all the advantages and risks of thehormonal replacement therapy. Only an informed patient can be a partner in shareddecision making about the improvement of quality of life
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