Epidemiološki kazalci kažejo, daje rak v Sloveniji veliko javnozdravstveno breme. Rak je med vzroki smrti na prvem mestu pri moških in na drugem mestu pri ženskah. Za zagotavljanje primerne oskrbe ...bolnikov z rakom v bodoče je nujna primerna kadrovska zasedba, saj zadostni in primerno usposobljeni človeški viri predstavljajo osnovo za celostno izvajanje onkološke oskrbe v Sloveniji. V okviru Ciljnega raziskovalnega projekta Analiza stanja in ocena kadrovskih potreb za izvajanje zdravljenje raka v Republiki Sloveniji je bil razvit fleksibilen napovedovalni model za načrtovanje potrebnega zdravstvenega osebja za zdravljenje raka in paliativno oskrbo onkoloških bolnikov. Narejena je bila ocena kadrovskih potreb za kratkoročno obdobje do 2021 ter dolgoročno obdobje do leta 2030. V rezultatih so prikazane ocene kadrovskih potreb na podlagi podatkov o številu novih primerov raka za vse rake skupaj in za pogoste rake, to je rak debelega črevesa in danke, rak pljuč, rak dojke, rak prostate ter skupaj za ostale rake. Kadrovske ocene za izvajanje zdravljenje raka so bile izračunane za vsako navedeno lokacijo raka glede na vrsto zdravljenja ter po poklicnih skupinah v zdravstvu. Kadrovske potrebe za paliativno oskrbo so bile narejene na podlagi podatkov o umrljivosti za vse rake skupaj po nivojih paliativne oskrbe. Predstavljena metodologija omogoča različnim deležnikom v kratkoročnem 5-letnem obdobju hitre izračune letnih kadrovskih potreb le na podlagi podatkov o incidenci in umrljivosti, na daljša obdobja in v primeru večjih sprememb v zdravstvenem sistemu pa omogoča poglobljeno analizo kadrovskih potreb in testiranje različnih scenarijev.
Izhodišče: Rak ustnega predela zajema področja ustnice, ustne votline in ustnega dela žrela in v Sloveniji predstavlja eno najpogostejših malignih bolezni. Namen raziskave je bil prikazati breme raka ...ustnega predela v tridesetletnem obdobju (1985–2014) v Sloveniji.Metode: Iz baze podatkov Registra raka Republike Slovenije smo pridobili podatke (incidenca, preživetje) o vseh primerih raka ustno-žrelnega predela (C00–C14) v letih 1985–2014. Analizo bremena raka ustnega predela smo pripravili za tri osnovna primarna mesta: ustnico (C00.0–2), ustno votlino (C00.3–9, C02.0–3 in C02.8–9, C03, C04, C05.0 in C05.8–9, C06) in ustni del žrela (C01, C02.4, C05.1–2, C09, C10). Časovne trende števila novih primerov raka po posameznem mestu smo prikazali v obliki deleža povprečne letne spremembe grobe incidenčne stopnje.Rezultati: Pridobili smo podatke o 9.442 primerih raka ustno-žrelnega predela za obdobje 1985–2014. V končno analizo smo vključili vse primere raka ustnega predela (N = 7.190). Med preiskovanci je bilo 83,4 % moških in 16,6 % žensk. Povprečna starost preiskovancev ob postavitvi diagnoze je bila 59,8 let ± 11,3. Največ primerov raka ustnice je v starostni skupini nad 80 let, največ primerov raka ustne votline in ustnega dela žrela pa v starostni skupini 55–59 let. Pri vseh treh skupinah raka je večji delež moških kot žensk. Največ primerov raka ustnice odkrijemo v omejenem stadiju, največ raka ustne votline in ustnega dela žrela v razširjenem stadiju. Najboljše je preživetje bolnikov z rakom ustnice, najslabše pri bolnikih z rakom ustnega dela žrela. Tridesetletni časovni trend raka prikazuje upadanje števila primerov raka ustnice, nasprotno pa število primerov raka ustne votline in ustnega dela žrela narašča.Zaključek: Rak ustnega predela je eden pomembnejših javnozdravstvenih, socialnih in ekonomskih problemov sodobne družbe. Zgodnje odkrivanje raka prispeva k izboljšanju preživetja in h kakovosti življenja bolnikov, zato je potrebno še posebno pozornost posvečati obvladovanju te bolezni.
ABSTRACT Aim To evaluate the incidence, severity and characteristics of aggressive behaviour in patients hospitalized in acute psychiatric wards, as well as the association between patient ...characteristics and the incidence of recurrent aggressive behaviour. Methods A multicentre prospective study included all twelve acute wards in Slovenian psychiatric hospitals with a total capacity of 232 beds. Over five consecutive months, data on the number of treatment episodes involving aggressive behaviour and the number of aggressive incidents, their severity and characteristics were obtained using the Staff Observation Aggression Scale-Revised (SOAS-R). Patient- and event-based incident rates of verbal and physical aggression were calculated. The association between patient characteristics and recurrent aggressive behaviour was analysed. Patient characteristics data were extracted from hospital databases. Results 3,190 treatment episodes were included during a 5-month period. Aggressive behaviour was observed in 13.4% of treatment episodes, and 922 aggressive incidents were recorded, which resulted in 3.98 incidents per 100 occupied bed days and 9.48 incidents per bed per year. 74.1% of incidents were severe, and more than half of incidents included physical aggression. 75.5% of incidents were directed against medical staff. 5.9% of treatment episodes were involved in multiple aggressive incidents. Compared to patients with single incidents, patients with recurrent aggression had a less frequent main diagnosis of substance use disorders and a longer duration of hospitalization. Conclusion Monitoring the frequency and characteristics of aggressive behaviour allows comparisons with other studies and, more importantly, it is necessary for planning and assessing the effectiveness of preventative aggression management strategies.
Background: Vaginal delivery is the most important risk factors for development of faecal incontinence, which significantly affects quality of life. Foreign studies show OASIS occur at 20 to 40 % of ...vaginal deliveries. In Slovenia we recognize sphincter injuries at 1.7 % of deliveries, while true incidence of OASIS in our population remains unknown. Caesarean section prevents anal sphincter injuries. Known risk factors in foreign studies include prolonged second stage of labour, fetal weight > 3500 g, malpresentation, forceps delivery, maternal age more than 35 years at the time of first delivery, first delivery. Few women complain about defecatory problems in puerperium unless they are directly asked about them, so true incidence of such injuries is grossly underestimated. Previously compensated anal sphincter dysfunction can clinically manifest as late as in menopause. The most probable cause is atrophy of muscle and fibrous tissue of pelvic floor and anal sphincter due to lack of estrogen support in this period. With anal ultrasound we tried to determine the incidence of occult damage to anal sphincter in primiparas after vaginal delivery and the relation of injury to symptoms 6 weeks after delivery and identify possible risk factors in our population. We also tried to find out how many patients with anal sphincter injury become symptomatic immediately after deliv- ery. Methods: From January to June 2009 we examined 26 primiparas after vaginal delivery in the Ljubljana Maternity Hospital with anal ultrasound and compared various data about the delivery from our national delivery form. We excluded all patients with caesarean section, recognized anal sphincter injury at the time of the delivery or previous anorectal surgery, history of irritable bowel syndrome or pre-existing inflammatory bowel disease. All patients completed a bowel-function questionnaire, which included questions about faecal urgency and involuntary passing of gas, liquid or solid stools, before and six weeks after delivery. Faecal urgency was defined as inability to hold passing of stools for more than 5 minutes, anal incontinence as partial or complete inability to control passing of winds, liquid or formed stools. Patients were examined with 7 MHz 360-degrees rotating probe on the second or third day after delivery. With the probe we identified the U-shaped puborectalis muscle, then slowly extracted the probe through the anal canal towards the anus. We examined ultrasound im- age of puborectalis muscle, internal anal sphincter, longitudinal muscle and external anal sphincter. Internal anal sphincter (IAS) appears as a uniform hypoechoic circle, which is surrounded by heterogenous hyperechoic circle of external anal sphincter (EAS). External anal sphincter defect was defined as hypoechoic gap of various size in hyperechoic circle, that enlarges with voluntary contraction. Internal anal sphincter defect was defined as a gap in hypoechoic circle. All patients were contacted by telephone 6 weeks after delivery to complete the same ques- tionnaire again. Deliveries were managed by midwives according to standard active delivery management protocols the Ljubljana Maternity Hospital. All episiotomies were mediolateral. Information about pregnancy and delivery was obtained with patient’s consent from national delivery forms. We analysed use of analgesia at the delivery, induction and stimulation of labour, difference in body mass index (BMI) before pregnancy and before the delivery, duration of labour, fetal weight and head circumference and maternal age. Results: We found signs of external anal sphincter injury in 12 (46 %) out of 26 patients examined, all of them had only external sphincter injury. None of them had any de novo symptoms regarding defecation or problems restraining winds or stool 6 weeks after delivery (Table 1). There was no significant statistic difference for use of analgetics, stimulation of labour, vacuum extraction and episiotomy. There might be a difference in maternal age, but data was insufficient due to small number of patients. Conclusions: With our research we showed that incidence of sphincter injuries at vaginal delivery in our hospital is underestimated, as we found occult anal sphincter injury in 12 out of 26 patients. The number of patients was small so we were not able to estimate the importance of various possible risk factors for OASIS. All analysed cases showed no significant statistic difference due to small number of patients in the study. All patients were asymptomatic 6 weeks after delivery, but how many of them develop symptoms in later life remains unknown.
DEEP INFILTRATING ENDOMETRIOSIS Martina Ribič-Pucelj
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
02/2018, Volume:
78
Journal Article
Peer reviewed
Open access
Background: Endometriosis is not considered a unified disease, but a disease encompassing three differ- ent forms differentiated by aetiology and pathogenesis: peritoneal endometriosis, ovarian ...endometriosis and deep infiltrating endometriosis (DIE). The disease is classified as DIE when the lesions penetrate 5 mm or more into the retroperitoneal space. The estimated incidence of endometriosis in women of reproductive age ranges from 10–15 % and that of DIE from 3–10 %, the highest being in infertile women and in those with chronic pelvic pain. The leading symptoms of DIE are chronic pelvic pain which increases with age and correlates with the depth of infiltration and infertility. The most important diagnostic procedures are patient’s history and proper gynecological examination. The diagnosis is confirmed with laparoscopy. DIE can affect, beside reproductive organs, also bowel, bladder and ureters, therefore adi- tional diagnostic procedures must be performed preopertively to confirm or to exclude the involvement of the mentioned organs. Endometriosis is hormon dependent disease, there- fore several hormonal treatment regims are used to supress estrogen production but the symptoms recurr soon after caesation of the treatment. At the moment, surgical treatment with excision of all lesions, including those of bowel, bladder and ureters, is the method of choice but requires frequently interdisciplinary approach. Surgical treatment significantly reduces pain and improves fertility in inferile patients. Conclusions: DIE is not a rare form of endometriosis characterized by chronic pelvic pain and infertility. Medical treatment is not efficient. The method of choice is surgical treatment with excision of all lesions. It significantly reduces pelvic pain and enables high spontaneus and IVF preg- nacy rates.Therefore such patients should be treated at centres with experience in treatment of DIE and with possibility of interdisciplinary approach.
Background: Streptococcus agalactiae (group B streptococcus, GBS) is the leading cause of invasive neonatal infections in the developed world. We present epidemiological and clinical characteristics ...of invasive GBS disease among Slovenian neonates between 2003 and 2013. Methods: A retrospective cohort study was performed. Children aged 0–90 days with invasive GBS disease, born in Slovenia and hospitalized in the University Medical Centre Ljubljana were included. Cases were identified concurrently from (i) hospital and (ii) microbiological databases. Medical records from mothers and children were reviewed and relevant data extracted. The incidence rate was calculated based on the national vital statistics data and expressed per 1000 live births. Results: Altogether, 144 children were included in the analysis, 72.9 % (n = 105) based on hospital database and 27.1 % (n = 39) based on microbiological database. Among them, 47.9 % (n = 69) were girls and 52.1 % (n = 75) boys. Among the cases with available data, 54.5 % (n = 73) were born at term and 45.5 % (n = 61) were preterm. Early-onset disease (0–6 days) was present in 74.3 % (n = 107) of patients; 95.3 % (n = 102) of them became ill during the first 3 days of life. Late-onset disease (7–90 days) was present in 25.7 % (n = 37) of patients. Outcome data was available for 134 children. Neonatal mortality rate was 4.5 % (n = 6). Periventricular leukomalacia (PVL) or intraventricular haemorrhages Grade III/IV (IVH 3/4) were detected in 17.9 % (n = 24). Severe outcomes (death or PVL or IVH 3/4) were detected in 22.4 % (n = 30) children. Cumulative incidence rate was 0.72/1000 live births; 0.53/1000 for early-onset and 0.18/1000 for late-onset disease. Risk factors for early-onset disease were present in 47.9 % (n = 68) mothers in labour. Intrapartum antibiotic prophylaxis was delivered to 16.9 % (n = 24) of mothers. Conclusions: High incidence of invasive neonatal GBS disease was detected in Slovenia. Although low mortality was observed, brain pathology concordant with long-term adverse outcome was confirmed in a high proportion of patients. The application of intrapartum antibiotic prophylaxis in cases of known risk factors was suboptimal, especially among preterm deliveries. Approximately half of the patients were born to mothers without any risk factors. A comprehensive national strategy for the prevention of invasive GBS disease is warranted in Slovenia.
The aim of our study was to determine the self-reported incidence and prevalence of running-related injuries among participants of the 18
Ljubljana Marathon, and to identify risk factors for their ...occurrence.
A customized questionnaire was distributed over registration. Independent samples of t-test and chi-square test were used to calculate the differences in risk factors occurrence in the injured and non-injured group. Factors which appeared significantly more frequently in the injured group were included further into multiple logistic regression analysis.
The reported lifetime running injury (absence >2 weeks) incidence was: 46% none, 47% rarely, 4% occasionally, and 2% often. Most commonly injured body regions were: knee (30%), ankle and Achilles' tendon (24%), foot (15%), and calf (12%). Male gender, running history of 1-3 years, and history of previous injuries were risk factors for life-time running injury. In the season preceding the event, 65% of participants had not experienced any running injuries, 19% of them reported minor problems (max 2 weeks absenteeism), but 10% and 7% suffered from moderate (absence 3-4 weeks) or major (more than 4 weeks pause) injuries. BMI was identified as the solely risk factor.
This self-reported study revealed a 53% lifetime prevalence of running-related injuries, with the predominate involvement of knee, ankle and Achilles' tendon. One out of three recreational runners experienced at least one minor running injury per season. It seems that male gender, short running experience, previous injury, and BMI do increase the probability for running-related injuries.
Uvod. Presejanje novorojencev v Sloveniji se je začelo leta 1979 s presejanjem za fenilketonurijo (PKU). Leta 1981 je bil v program presejanja dodan še kongenitalni hipotireoidizem (CH). Cilj te ...raziskave je analiza podatkov presejanja novorojencev v Sloveniji v obdobju med letoma 1993 in 2012 za PKU ter med letoma 1991 in 2012 za CH. Metode. Vzorci krvi so bili odvzeti petim novorojencem med tretjim in petim dnem življenja. Pri presejanju za PKU se uporablja fluorometrična metoda, presejanje za CH pa poteka z metodo DELFIA. Rezultati. Od leta 1993 do leta 2012 je bil presejalni test za PKU izveden pri 358.831 novorojencih. Pri 57 otrocih je bil PKU potrjen. Pri 427.396 novorojencih med letoma 1991 in 2012 je bil izveden presejalni test za CH. Pri 184 otrocih je bil CH potrjen. V navedenih obdobjih je bila incidenca PKU 1:6769 in incidenca CH 1:2323. Zaključki. Uspešna implementacija presejanja novorojencev za PKU in CH je imela pomembno vlogo pri preprečevanju resnih zapletov pri obolelih otrocih. Smiselno bi bilo v program presejanja vključiti nove metabolne bolezni.
Introduction. Newborn screening in whole Slovenia started in 1979 with screening for phenylketonuria (PKU). Congenital hypothyroidism (CH) was added into the programme in 1981. The aim of this study ...was to analyse the data of neonatal screening in Slovenia from 1993 to 2012 for PKU, and from 1991 to 2012 for CH.
Methods. Blood samples were collected from the heels of newborns between the third and the fifth day after birth. Fluorometric method was used for screening for PKU, CH screening was done by dissociationenhanced lanthanide fluorescent immunoassay (DELFIA).
Results. From 1993 to 2012, from 385,831 newborns 57 were identified with PKU. 184 newborns out of 427,396 screened from 1991 to 2012, were confirmed for CH. Incidences of PKU and CH in the periods stated are 1:6769 and 1:2323, respectively.
Conclusions. Successful implementation of newborn screening for PKU and CH has helped in preventing serious disabilities of the affected children. Adding screening for new metabolic diseases in the future would be beneficial.
Uvod. Presejanje novorojencev v Sloveniji se je začelo leta 1979 s presejanjem za fenilketonurijo (PKU). Leta 1981 je bil v program presejanja dodan še kongenitalni hipotireoidizem (CH). Cilj te raziskave je analiza podatkov presejanja novorojencev v Sloveniji v obdobju med letoma 1993 in 2012 za PKU ter med letoma 1991 in 2012 za CH. Metode. Vzorci krvi so bili odvzeti petim novorojencem med tretjim in petim dnem življenja. Pri presejanju za PKU se uporablja fluorometrična metoda, presejanje za CH pa poteka z metodo DELFIA. Rezultati. Od leta 1993 do leta 2012 je bil presejalni test za PKU izveden pri 358.831 novorojencih. Pri 57 otrocih je bil PKU potrjen. Pri 427.396 novorojencih med letoma 1991 in 2012 je bil izveden presejalni test za CH. Pri 184 otrocih je bil CH potrjen. V navedenih obdobjih je bila incidenca PKU 1:6769 in incidenca CH 1:2323. Zaključki. Uspešna implementacija presejanja novorojencev za PKU in CH je imela pomembno vlogo pri preprečevanju resnih zapletov pri obolelih otrocih. Smiselno bi bilo v program presejanja vključiti nove metabolne bolezni.
Cilj: Utvrditi uticaj biometeoroloških faza na incidencu suicida sobzirom na dob, pol, mesto stanovanja, dane u nedelji, mesece u godini, te način izvršenja suicida. Metode: Komparativna analiza ...podataka ispitanika o suicidima (s obzirom na period, mesece i dane u nedelji, mesto stanovanja, dob, pol, prosečnu starost) dobijenih iz Policijske uprave Kragujevac za period 2004-2008. godine i svakodnevnih biometeoroloških faza za grad Kragujevac dobijenih od Republičkog hidrometeorološkog zavoda (RHMZ) Srbije. Rezultati: U posmatranom periodu dogodila su se 144 suicida (14/100.000 stanovnika godišnje). Najviše suicida dogodilo se u 2005. (36), a najmanje u 2007. (24) godini; najviše u januaru i junu (po 18), a najmanje u avgustu (7). Tri četvrtine slučajeva bili su iz urbanog okruženja. Tri četvrtine slučajeva su bili muškarci i to najviše u dobnim grupama 41-45 i 51-55 godina (po 11), a jedna četvrtina slučajeva bile su žene, najviše u starosnoj grupi 61-65 godina života (7). Ukupna je prosečna starost iznosila 54,66 godina. Dve trećine svih suicida izvršeni su vešanjem (93) (od čega su dve trećine bili muškarci), a jedna šestina vatrenim oružjem (88% su bili muškarci). Najviše suicida dogodilo se u biometeorološkim fazama 4 i 9 (po 38), što čini više od polovine svih suicida. Zaključak: Statističkim metodama dobijena je značajna korelacijaizmeđu biometeoroloških faza i incidence suicida, a najviše se suicida desilo u fazama stabilnog sunčanog vremena i naglog prodorafrontova, s naglom promenom vremenske situacije. Preporuka ovog rada jeste striktno poštovanje upozorenja iz svakodnevne bioprognoze koju daje RHMZ Srbije, pa u ovim vremenskim prilikama posebnu pažnju treba obratiti na sve osobe sa suicidalnim tendencijama.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
PDF
