Zaviralci natrij-glukoznega prenašalnega sistema 2 (SGLT-2) so najnovejša skupina zdravil za zdravljenje sladkorne bolezni tipa 2, ki so v klinični uporabi zadnjih nekaj let. V proksimalnih tubulih ...ledvic zmanjšajo reabsorpcijo glukoze, ki se zato izloči z urinom. Zato se zniža koncentracija glukoze v krvi in nastopi ugodni vpliv na urejenost glikemije, obenem pa s tem ne povečajo tveganja za hipoglikemijo. Zaviralci SGLT-2 imajo tudi ugodne presnovne učinke, in sicer znižajo telesno maso, krvni tlak in koncentracijo sečne kisline v serumu. Upočasnijo tudi napredovanje začetne diabetične ledvične bolezni. Za nekatere predstavnike so tudi pokazali, da pomembno zmanjšujejo pojavnost srčno-žilnih dogodkov in zapletov, vendar mehanizem še ni v celoti raziskan in je predmet intenzivnega preučevanja. Redko povzročijo resne neželene učinke. V prispevku je opisan mehanizem delovanja zaviralcev SGLT-2, njihov vpliv na urejenost glikemije in drugo: presnovni učinki, vpliv na pojavnost srčno-žilnih bolezni in najpogostejši neželeni učinki ter možnosti predpisovanja zaviralcev SGLT-2 v Sloveniji.
Although the concept of integrated care for non-communicable diseases was introduced at the primary level to move from disease-centered to patient-centered care, it has only been partially ...implemented in European countries. The aim of this study was to identify and compare identified facilitators and barriers to scale-up this concept between Slovenia and Belgium.
This was a qualitative study. Fifteen focus groups and fifty-one semi-structured interviews were conducted with stakeholders at the micro, meso and macro levels. In addition, data from two previously published studies were used for the analysis. Data collection and analysis was initially conducted at country level. Finally, the data was evaluated by a cross-country team to assess similarities and differences between countries.
Four topics were identified in the study: patient-centered care, teamwork, coordination of care and task delegation. Despite the different contexts, true teamwork and patient-centered care are limited in both countries by hierarchies and a very heavily skewed medical approach. The organization of primary healthcare in Slovenia probably facilitates the coordination of care, which is not the case in Belgium. The financing and organization of primary practices in Belgium was identified as a barrier to the implementation of task delegation between health professionals.
This study allowed formulating some important concepts for future healthcare for non-communicable diseases at the level of primary healthcare. The results could provide useful insights for other countries with similar health systems.
The aim of our study was to examine the scabies incidence in the Croatian population and to analyse potential related factors.
This mixed ecological study is based on a retrospective medical record ...review. National data from communicable disease reports was sourced and analysed for an 11-year period (2007-2017), with more focus on the period 2014-2017. Descriptive statistics were used to calculate trends. Differences between the groups were studied using Chi-square test and Kendall's tau (τ) correlation coefficient. Levels of significance were set at p<0.05 or p<0.01.
From 2007 to 2017, scabies infestation in Croatia increased by 6-fold, particularly affecting children and young adults (19 years or younger). In the period 2014-2017, border counties which are part of migration flows were the counties with the highest average scabies incidences. A linear trend of increase in the number of tourists, immigrants and scabies infestations was noted on the national level for the analysed period, although a significant association was not observed. Regarding outbreaks of scabies within institutions, more than 80% of outbreaks occurred in institutions for adults. In the capital, Zagreb, the crude incidence rate increased 3-fold between 2014 and 2017.
The increased incidence of scabies, large disparities between counties, and prolonged outbreaks within families due to under-recognition and misdiagnoses points to a need for increased awareness among health practitioners. To the best of our knowledge, this is the first recent epidemiologic analysis on this topic, not only in Croatia but within the wider geographic region as well.
Background. Hormonal replacement therapy (HRT) after menopause can affect cardiovascular system in a positive and negative way. Positive effects are exerted through estrogenic action on metabolic ...risk factors, such as lipids, glucose and insulin metabolism, as well as direct arterial effects, reducing atherogenesis. Negative effects are dose-dependent transient increase in coagulation activation and adverse vascular remodelling. Observational studies suggested that HRT might have a beneficial effect on the incidence of coronary heart disease, which is not in line with later randomized clinical trials. The main difference between both types of the studies is that participants in observational trials were in their fifties and in average ten years younger compared to randomized trials. Post-hoc analysis of the Women’s Health Initiative trial found a trend toward cardioprotective HRT in younger patients. Conclusions. HRT is currently not recommended for the primary coronary prevention. But in women with menopausal symptoms, which are at the initiation of HRT younger than 60 years and are less than 10 years after menopause, HRT does seem not to increase cardiovascular events. Initiation of HRT early after menopause may reduce cardiovascular risk.
Particulate matter (PM) is a major component of urban air pollution and has a significant effect on human health. Natural PM sources are volcanic eruptions, dust storms, forest and grassland fires, ...living vegetation and sea spray. Traffic, domestic heating, power plants and various industrial processes generate significant amounts of anthropogenic PM. PM consists of a complex mixture of solid and liquid particles of organic and inorganic substances suspended in the air. The chemical composition of particles is very complex and depends on emission sources, meteorological conditions and their aerodynamic diameter. Several epidemiological studies have demonstrated that exposure to PM of varying size fractions is associated with an increased risk of respiratory and cardiovascular diseases. Adverse health effects have been documented from studies of both acute and chronic exposure. The most severe effects in terms of overall health burden include a significant reduction in life expectancy by a several months for the average population, which is linked to long-term exposure to moderate concentrations of PM. Nevertheless, numerous deaths and serious cardiovascular and respiratory problems have also been attributed to short-term exposure to peak levels of PM. Although many studies attribute greater toxicity to smaller size fractions, which are able to penetrate deeper into the lung, the molecular mechanisms and the size fractions of the PM that are responsible for the observed diseases are not completely understood.
Prašni delci so eden najpogostejših onesnaževal zraka in imajo velik vpliv na zdravje ljudi. Kemijska sestava prašnih delcev je zelo zapletena in je odvisna od vira emisij, meteoroloških okoliščin in od aerodinamskega premera delcev. Naravni izvori prašnih delcev so vulkanski izbruhi, puščavski pesek, naravni požari in morska sol. Promet, domača kurišča, termoelektrarne in industrijski obrati pa so glavni vir antropogenih prašnih delcev. Prašni delci so sestavljeni iz zapletene mešanice trdnih in tekočih delcev, sestavljenih iz organskih in anorganskih snovi. Številne epidemiološke študije so pokazale, da je izpostavljenost prašnim delcem različnih velikosti povezana s povečanim tveganjem za razvoj dihalnih in srčno-žilnih obolenj. Škodljiv učinek na zdravje je bil ugotovljen na osnovi raziskav, ki so proučevale akutno, in na osnovi raziskav, ki so proučevale kronično izpostavljenost prašnim delcem. Najbolj škodljiv učinek prašnih delcev je skrajšanje življenjske dobe povprečne populacije za nekaj mesecev, kar je povezano z dolgoročno izpostavljenostjo prašnim delcem zmernih koncentracij. Kljub temu pa so vzroki za številne smrti in resne dihalne ter srčno-žilne bolezni povezane s kratkoročno izpostavljenostjo visokim koncentracijam prašnih delcev. Številne raziskave pripisujejo večje negativne učinke na zdravje ljudi manjšim prašnim delcem, ker lahko globlje prodrejo v pljuča. Kljub številnim raziskavam še ni popolnoma pojasnjeno, kateri prašni delci so ključni za povzročene neželene učinke in prek katerih molekularnih mehanizmov sprožajo neželene učinke.
Migraine is associated with significant morbidity and a significantly negative impact on the quality of life. A better understanding of the economic impact of migraine is becoming increasingly ...important. This paper aims to shed light on absenteeism and presenteeism costs of migraine in Slovenia.
We use the administrative national-level database on sick leave due to migraine for 2016. The absenteeism cost estimate is based on the number of patients with migraine on physician-determined sick leave and average daily labour costs. We calculate productivity costs from a social perspective regardless of who incurs them. Data from the national registry on sick leave are coupled with data from a web-based self-reported survey to also include the cost of presenteeism. MIDAS and WPAI presenteeism items were used and several different scenarios were designed to assess presenteeism costs.
We estimated annual absenteeism costs per absentee due to migraine at the amount of EUR 531 in 2016 using the NIPH's administrative data on sick leave. Annual absenteeism costs per absentee due to migraine based on self-reported data amounted to EUR 626. The estimated annual presenteeism costs per patient range from EUR 344 - 900.
Estimating the economic burden of a disease is becoming increasingly important. This paper is an insight into the absenteeism and presenteeism costs of migraine in Slovenia.
Pobudo »Alergijski rinitis in njegov vpliv na astmo« – (angl. Allergic Rhinitis and its Impact on Asthma, ARIA) – so leta 1999 ustanovili na delavnici Svetovne zdravstvene organizacije – World Health ...Organization (WHO). Njeni prvotni cilji so bili: 1. predlagati novo klasifikacijo alergijskega rinitisa, 2. spodbujati koncept večobolevnosti pri astmi in rinitisu ter 3. skupaj z vsemi deležniki razviti smernice, namenjene globalni uporabi v vseh državah in vsem skupinam bolnikov. Pobuda ARIA se uporablja v 70 državah, trenutno pa se osredinja na uporabo novih tehnologij za individualizirano in napovedno medicino. Mreža MASK – nadzorna mreža MACVIA (Proti kroničnim boleznim za aktivno staranje, franc. – Contre les Maladies Chroniques pour un Vieillissement Actif) in ARIA (angl. ARIA Sentinel NetworK) uporablja mobilno tehnologijo za razvoj klinične poti, ki bi bolnikom, multidisciplinarnim ekipam zdravnikov in raziskovalcem omogočila nadzor rinitisa in astme. Mobilna aplikacija (Android in iOS) je na voljo v 20 državah in 15 jezikih. Uporablja vizualno analogno lestvico za oceno nadzora nad simptomi in oceno delovne zmožnosti in ponuja sistem, ki pomaga pri kliničnem odločanju. Aplikacija omogoča povezovanje z zdravnikom ali drugimi zdravstvenimi delavci. Ta strategija upošteva priporočila Evropskega partnerstva za inovacije za aktivno in zdravo staranje (angl. European Innovation Partnership on Active and Healthy Ageing, EIP on AHA). Cilj novega pristopa pobude ARIA je zagotoviti aktivno in zdravo življenje bolnikov z rinitisom ne glede na njihovo starost, spol ali družbenogospodarski položaj zato, da bi se zmanjšali zdravstvena in družbena neenakost, ki sta posledici te bolezni.
Pojavnost kardiometabolnih bolezni je dosegla pandemične razsežnosti, zato se čedalje večja pozornost posveča tudi z življenjskim slogom pogojenemu zdravju prebivalstva, še posebej načinu ...prehranjevanja in vnosu določenih skupin živil. Številne epidemiološke raziskave so dokazale, da je uživanje pijač z dodanim sladkorjem povezano z nastankom debelosti, sladkorne bolezni in srčno-žilnih bolezni, dodatno je tudi dober pokazatelj posameznikovega nezdravega življenjskega sloga. Pijače z dodanim sladkorjem so vir tako imenovanih »praznih kalorij«, ki nimajo hranilne vrednosti in predstavljajo največji dodatni vir energije in vnosa dodanih sladkorjev, še posebej fruktoze. Zmanjšanje vnosa pijač z dodanim sladkorjem dokazano vodi v znižanje telesne mase in zmanjšanje tveganja za nastanek kardiometabolnih bolezni. Uživanje pijač z dodanim sladkorjem je uvrščeno kar med 15 najpogostejših dejavnikov tveganja med kazalci nezdravega življenjskega sloga. Posledično je smiselno intenzivno ozaveščanje o pomembnosti opustitve uživanja pijač z dodanim sladkorjem, še posebej pri osebah s povečanim tveganjem za presnovne bolezni in mladih z nezdravim življenjskim slogom. V prispevku so opredeljene pijače z dodanim sladkorjem, opisana je njihova povezava z debelostjo, sladkorno boleznijo in srčno-žilnimi boleznimi ter možni zdravi nadomestki.
Health-related quality of life (HRQoL) is measuring a patient's experience of his health status and represents an outcome of medical interventions. Existing data proves that a healthy lifestyle is ...positively associated with HRQoL in all age groups. Patients with a high risk for cardiovascular disease typically led an unhealthy lifestyle combined with risk diseases. We aimed to analyse these characteristics and their reflection in HRQoL.
A cross-sectional study in 36 family practices, stratified by location and size. Each practice invited 30 high-risk patients from the register. Data were obtained from medical records and patient questionnaire. The EQ-5D questionnaire and the VAS scale were used for measuring the patient's HRQoL as an independent variable.
871 patients (80.6% response rate) were included in the analysis. 60.0% had 3-4 uncontrolled risk factors for CVD. The average VAS scale was 63.2 (SD 19.4). The correlation of EQ-5D was found in the number of visits in the practice (r=-0.31, p<0.001), the socioeconomic status (r=-0.25, p=0.001), age (r=-0.27, p=0.001) and healthy diet (r=0.20, p=0.006). In a multivariate model, only physical activity among lifestyle characteristics was an independent predictor of HRQoL (p=0.001, t=3.3), along with the frequency of visits (p<0.001, t=-5.3) and age (p=0.025, t=-2.2).
This study has been performed on a specific group of patients, not being "really sick", but having less optimal lifestyle in many cases. Encouragement to improve or keep healthy lifestyle, especially physical activity, is important, not only to lower the risk for CVD, but also to improve HRQoL.
V članku se osredotočamo na izkušnjo doživljanja kronične bolezni in soočanja z njo. Zanimalo nas je, kako se oblikujejo bolnikove strategije soočanja z boleznijo in od katerih dejavnikov je ...odvisen stil prilagajanja bolezni. Opiramo se na rezultate kvantitativne in kvalitativne raziskave bolnikov s kronično revmatično boleznijo. Rezultati raziskave kaežjo, da obstajata različni skupini bolnikov, ki se razlikujeta po stopnji udeležbe v socialnem svetu, po načinu reševanja težav in po prilagoditvi življenjskega stila na bolezen. Naklo- njenost družbenega okolja in empatičen odnos z bližnjimi bistveno pripomorejo k uspešni prilagoditvi bolnika na bolezen.
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