Introduction. In May of 2012, we investigated a food-borne Clostridium perfringens outbreak in Slovenia involving a single kitchen and five venues, with 477 exposed persons.
Methods. In order to ...identify the causative agent, vehicle of infection and source of contamination, we conducted microbiological and environmental investigations and an analytical cohort study (n = 138).
Results. The case definition in the outbreak was met by 104 persons. Predominant symptoms were diarrhoea, nausea and abdominal cramps. Median incubation time and duration of illness were 12 and 22.5 hours respectively. Stool samples were collected from 18 persons and in 13 C. perfringens spores were present; enterotoxin was detected in 9 persons. PCR and PFGE analysis of isolates from a cook with earlier onset time, who did not consume the implicated food, and cases from four venues showed the same strain of C. perfringens type A (with cpe-gene), indistinguishable by PFGE analysis. No food samples could be obtained. An analytical study showed that one food item (French salad) was the most likely vehicle of infection (RR: 6.35; 95% CI: 1.62-24.90).
Conclusions. This was the largest C. perfringens outbreak in Slovenia to date. Proper analytical study in combination with detailed laboratory investigation with genotypisation enabled us to identify a causative agent, vehicle of infection and possible source of contamination. Fast response and interdisciplinary collaboration led to timely implementation of control measures. These have led to the kitchen acquiring new equipment and improving staff knowledge of risks and processes, thus reducing the likelihood of future reoccurrences
Uvod. V maju 2012 smo preiskovali izbruh okužb s Clostridium perfringens, prenesenih s hrano, v katerega so bile vpletene ena kuhinja in pet lokaciji s 477 izpostavljenimi osebami.
Metode. Da bi ugotovili povzročitelja, pot prenosa in vir kontaminacije, smo izvedli laboratorijsko in okoljsko preiskavo ter analitično kohortno raziskavo (n = 138).
Rezultati. Definiciji primera v izbruhu so ustrezale 104 osebe. Prevladujoči simptomi so bili: driska, slabost in trebušni krči. Mediana časa inkubacije in trajanja bolezni je bila 12 ur in 22,5 ure. Vzorci blata so bili odvzeti 18 osebam; pri 13 so bile prisotne spore C. perfringens, enterotoksin je bil zaznan pri 9 osebah. PCR- in PFGE-analiza izolatov kuharja z zgodnejšim časom pojava obolenja, ki ni užival impliciranih živil, in primerov s štirih lokacij sta pokazali enak sev C. perfringens tipa A (s cpe genom), ki se ni razlikoval pri analizi PFGE. Vzorcev živil ni bilo mogoče pridobiti. Analitična študija je pokazala, da je bila najverjetnejša pot prenosa okužbe eno izmed živil (francoska solata) (RT: 6,35; 95% IZ: 1,62-24,90).
Zaključek. To je bil največji izbruh s C. perfringens v Sloveniji do zdaj. Ustrezna analitična raziskava v kombinaciji s podrobno laboratorijsko preiskavo z genotipizacijo nam je omogočila identifikacijo povzročitelja, pot prenosa okužbe in mogoč vir kontaminacije. Hiter odziv in interdisciplinarno sodelovanje je pripeljalo do pravočasne implementacije nadzornih ukrepov. Ti so privedli do nabave nove opreme v kuhinji, izboljšanja znanja osebja o tveganjih in procesih ter s tem zmanjšali verjetnost za ponovitve v prihodnje
Objectives. Health-related quality of life (HRQoL) measures a patient’s subjective experience of his or her health status. We aimed to show how the presence of chronic diseases and satisfaction with ...family physicians (FPs) were associated with the HRQoL of a Roma population.
Methods. A cross-sectional study was carried out in May 2011 on a representative sample of 650 Roma living in Prekmurje, Slovenia. The EQ-5D questionnaire was used for measuring the HRQoL of the Roma. Demographical data, 12 groups of diseases diagnosed in the last 12 months and satisfaction with FPs were included in the questionnaire.
Results. The response rate was 88.3% (574), of which 56.4% were female, and the average age of the participants had a mean value of 40.2±12.7 years. The presence of cardiovascular problems with risk factors for them or presence of musculoskeletal disorders were strongly associated with the presence of pain (Cramer’s V = 0.40 and 0.46 respectively).There was a strong association between the presence of mental disorders and anxiety and depression (Cramer´s V = 0.58). The average satisfaction with the family physician was 3.9 (mean±1.10) on a five-point Likert scale. There was no significant association between HRQoL and satisfaction with the family physician.
Conclusions. Roma with chronic mental health problems had the lowest HRQoL in the Roma population. More attention should be paid to this subgroup of Roma in family medicine, and interventions should be provided. High satisfaction with their FPs is not associated with the observed quality of life variables
Uvod. Z zdravjem povezana kakovost življenja (HRQoL) je odraz pacientove subjektivne ocene lastnega zdravstvenega stanja. V naši raziskavi smo skušali ugotoviti, kakšen je vpliv nekaterih kroničnih bolezni in zadovoljstva z izbranim zdravnikom na HRQoL med romskim prebivalstvom.
Metode. Maja 2011 smo izvedli presečno raziskavo v reprezentativnem vzorcu 650 pomurskih Romov. HRQoL smo merili z vprašalnikom EQ-5D; vključili smo še demografske podatke, zadovoljstvo z izbranim družinskim zdravnikom in 12 bolezenskih stanj, ki so bila diagnosticirana v zadnjih 12 mesecih.
Rezultati. Odzivnost je bila 88,3-odstotna (574), 56,4 % je bilo žensk in povprečna starost sodelujočih je bila 40,2 +/- 12,7 leta. Nizek HRQoL v skupini s srčno-žilnimi boleznimi z dejavniki tveganja zanje in kostnomišičnimi boleznimi je bil močno povezan s prisotnostjo bolečine (Cramer z V = 0,40 in 0,46). V skupini z duševnimi težavami pa je bila močna povezava nizkega HRQoL s prisotnimi znaki anksioznosti in depresije (Cramer z V = 0,58). Povprečno zadovoljstvo z zdravnikom družinske medicine je bilo 3,9 (mediana +/- 1,10) na pettočkovni Likertovi lestvici. Ni bilo statistične povezave med HRQoL in zadovoljstvom z zdravnikom družinske medicine.
Zaključki. Romi s prisotnostjo duševnih težav imajo najnižji HRQoL v romskem prebivalstvu. Več pozornosti bi v družinski medicini morali posvetiti tej podskupini Romov. Zadovoljstvo z zdravnikom družinske medicine ni povezano z opazovanimi spremenljivkami kakovosti življenja
Background. Gastrointestinal disorders account for 7-10% of all consultations in primary care. General practitioners’ management of digestive disorders in Central and Eastern European countries is ...largely unknown.
Aims. To identify and compare variations in the self-perceived responsibilities of general practitioners in the management of digestive disorders in Central and Eastern Europe.
Methods. A cross-sectional survey of a randomized sample of primary care physicians from 9 countries was conducted. An anonymous questionnaire was sent via post to primary care doctors.
Results. We received 867 responses; the response rate was 28.9%. Over 70% of respondents reported familiarity with available guidelines for gastrointestinal diseases. For uninvestigated dyspepsia in patients under 45 years, the “test and treat” strategy was twice as popular as “test and scope”. The majority (59.8%) of family physicians would refer patients with rectal bleeding without alarm symptoms to a specialist (from 7.6% of doctors in Slovenia to 85.1% of doctors in Bulgaria; p<0.001). 93.4% of respondents declared their involvement in colorectal cancer screening. In the majority of countries, responding doctors most often reported that they order fecal occult blood tests. The exceptions were Estonia and Hungary, where the majority of family physicians referred patients to a specialist (p<0.001).
Conclusions. Physicians from Central and Eastern European countries understood the need for the use of guidelines for the care of patients with gastrointestinal problems, but there is broad variation between countries in their management. Numerous efforts should be undertaken to establish and implement international standards for digestive disorders’ management in general practice.
Uvod. 7-10 % vseh posvetov v primarni zdravstveni oskrbi se nanaša na bolezni prebavil. O zdravljenju bolezni prebavil s strani splošnih zdravnikov v Srednji in Vzhodni Evropi ni na razpolago veliko podatkov.
Cilji. Ugotoviti in primerjati razlike v samozaznani odgovornosti splošnih zdravnikov pri zdravljenju bolezni prebavil v Srednji in Vzhodni Evropi.
Metode. Naredili smo presečne ankete na randomiziranem vzorcu splošnih zdravnikov v primarni zdravstveni oskrbi iz devetih držav. Po pošti smo zdravnikom v primarni zdravstveni oskrbi poslali anonimni vprašalnik.
Rezultati. Prejeli smo 867 odgovorov, stopnja odzivnosti je bila 28,9 %. Več kot 70 % anketirancev je v odgovorih navedlo, da so seznanjeni z razpoložljivimi smernicami za bolezni prebavil. Za neraziskano dispepsijo pri bolnikih, mlajših od 45 let, je bila dvakrat bolj priljubljena strategija »testiranja in zdravljenja« kot pa strategija »testiranja in gastroskopije«. Večina (59,8 %) zdravnikov v primarni zdravstveni oskrbi bi bolnike z rektalnimi krvavitvami brez znakov alarma napotila k specialistu (od 7,6 % zdravnikov v Sloveniji do 85,1 % zdravnikov v Bolgariji; p<0.001). 93,4 % anketirancev je potrdilo svojo udeležbo pri presejalnih pregledih za odkrivanje raka debelega črevesa in danke. V večini držav so zdravniki najpogosteje poročali, da naročajo testiranje za odkrivanje prikritih krvavitev v blatu. Izjema pri tem sta bili Estonija in Madžarska, kjer večina zdravnikov v primarni zdravstveni oskrbi napoti paciente k specialistu (p<0.001).
Zaključki. Zdravniki iz Srednje in Zahodne Evrope razumejo potrebo po uporabi smernic za nego bolnikov z boleznimi prebavil, vendar pa je pri obravnavi veliko razlik med posameznimi državami. Treba si je prizadevati in sprejeti ukrepe za vzpostavitev in izvajanje mednarodnih standardov za obravnavo bolezni prebavil v splošni praksi.
Ob pojavu kronične bolezni, ki prizadene vsakega šestega od desetih odraslih, je treba poskrbeti tako za zdravstveno urejenost bolezni kot za obvladovanje čustvenih odzivov nanjo (jeza, strah, ...frustracije, žalost), ne nazadnje pa je treba ohraniti oz. (pre)oblikovati (nove) vloge na delovnem mestu, v družini in med prijatelji. Na poti iskanja primernih strategij obvladovanja kronične bolezni in življenja kroničnega bolnika ima zdravstveno osebje zelo pomembno vlogo. Obolelim bi morali ponuditi kakovostne zdravstvenovzgojne programe, ki se ne osredinjajo le na značilnosti kroničnih bolezni in na možnosti zdravljenja, marveč upoštevajo tudi človeško stisko ob sprejemanju kronične bolezni, pa tudi njen vpliv na preostala področja posameznikovega življenja. Raziskave kažejo, da ima pri vseh teh nalogah za obolele- ga zelo veliko vlogo sposobnost empatičnega komuniciranja zdravstvenega osebja.
The aim of our study was to assess the temporal association between the number of consultations in the primary health care unit due to respiratory diseases in children and the level of particular ...matter of 10 micrometres in diameter (PM10) pollution in the Zasavje region.
A time-trend ecological study was carried out for the period between 1 January 2006 and 31 December 2011. The daily number of first consultations for respiratory diseases among children in the Zasavje region was observed as the outcome. Poisson regression analysis was used to investigate the association between the observed outcome and the daily PM
concentrations, adjusted to other covariates.
The results showed that the daily number of first consultations were highly significantly associated with the daily concentrations of PM
in the Zagorje (p<0.001) and Trbovlje (p<0.001) municipalities. In the Hrastnik municipality, a significant association was not observed in all models.
It can be concluded that evidence of association between the daily PM10 concentration and the daily number of first consultations for respiratory diseases among children exists, indicating that there is still a need for public health activities in the sense of reduction of harmful environmental factors in the region. Additionally, on the basis of these results, it can be assumed that with some improvements linkage of existing health and environmental data in Slovenia in general could be feasible in identifying a grounded need for future public health action.
Namen: Namen študije je bil oceniti časovno povezanost med številom obiskov v primarnem zdravstvenem varstvu zaradi bolezni dihal pri otrocih in prašnimi delci premera 10 mikrometrov (PM10) v Zasavju.
Ekološka študija časovnega trenda je bila izvedena za obdobje od 1. januarja 2006 do 31. decembra 2011. Opazovani izid je bil dnevno število prvih obiskov zaradi bolezni dihal pri otrocih v Zasavju. Za oceno povezanosti med opazovanim izidom in dnevnimi koncentracijami PM10, standardizirano na preostale pojasnjevalne dejavnike, je bila uporabljena Poissonova regresijska analiza.
Rezultati so pokazali močno statistično povezanost med dnevnim številom prvih obiskov in dnevnimi koncentracijami PM
v občinah Zagorje (p < 0,001) in Trbovlje (p < 0,001). V občini Hrastnik nismo opazili značilne povezanosti pri vseh modelih.
Sklenemo lahko, da v Zasavju obstaja povezanost med boleznimi dihal pri otrocih in koncentracijo PM
, kar kaže na to, da je v tej slovenski regiji še vedno prisotna potreba po javnozdravstvenih ukrepih v smislu zmanjševanja škodljivih okoljskih dejavnikov. Dodatno lahko na podlagi rezultatov študije sklepamo, da bi bilo lahko v prihodnje v Sloveniji povezovanje okoljskih in zdravstvenih podatkov z nekaterimi izboljšavami uporabno pri ocenjevanju utemeljenih potreb za javnozdravstveno ukrepanje.
This multicentre, cross-sectional observational study aimed to determine the prevalence of depression among the working population of Slovenia and identify factors correlating with higher prevalence ...of depression. It was conducted in three occupational medicine practices within major Slovenian primary health care centres. The study population consisted of 1,474 respondents 73.7 % of the invited participants, 889 (60.3 %) men and 585 (39.7 %) women with mean age of (40.5±9.8) years who visited these practices for their regular check-ups from November 2010 to June 2012 and were asked to fill in a self-developed questionnaire and score depression on the Zung’s self-rating depression scale. According to the rating, 50 (3.4 %) respondents suffered from depression. In the multivariate analysis, depression correlated with the following independent variables: self-perceived exposure to chronic stress, positive family history of depression, and primary school education.
Namen raziskave je bil določiti prevalence depresije med delovno aktivno populacijo in odkriti morebitne dejavnike, povezane z večjo prevalence depresije. Izvedli smo multicentrično presečno opazovalno raziskavo v ambulantah medicine dela, prometa in športa v treh večjih zdravstvenih domovih v Sloveniji. Opazovana populacija je bila sestavljena iz zaporednih obiskov delavcev, ki so prišli na redni preventivni pregled od novembra 2010 do junija 2012. Podatke smo zbirali s pomočjo vprašalnika, depresijo pa smo ugotavljali na podlagi Zungovega vprašalnika. V vzorcu je bilo 1.474 (73,7 %) posameznikov, od katerih je bilo 889 (60,3 %) moških. Povprečna starost vzorca je bila (40,5±9,8) let. V vzorcu je bilo 590 (3,4 %) posameznikov z depresijo. V multivariatni analizi so bile naslednje spremenljivke neodvisno povezane s prisotnostjo depresije: izpostavljenost stresu, pozitivna družinska anamneza depresije in osnovnošolska izobrazba.
Recent efforts to increase Ascochyta blight resistance of pea have focused on the introduction of foreign genes by genetic engineering. The rpgip1 gene from Rubus idaeus was introduced by ...Agrobacterium-mediated transformation into Pisum sativum, cv. Baroness with the aim to increase pea resistance to fungal diseases. Notwithstanding this success, practical applications have to be preceded by the development of analytical methods for screening. Singleplex and multiplex PCR assays were employed to test primer efficiency in identifying the rpgip1 transgene in 11 pea genotypes. Five from ten primer combinations were effective in identifying transgene or insert sequences. PCR amplification using five other primer pairs revealed unspecific amplicons. According to in silico analyses, they arose from retrotransposons and pea genes including homologues of rpgip1. Two sets of primers were prepared with the aim of simultaneous amplification of different rpgip1 fragments. Fingerprints were sums of bands observed from individual pairs so the utility of multiplex assays was demonstrated. An additional advantage of multiplex PCR was clear differentiation between the transgene and endogenous pgip genes present in the donor species, R. idaeus. Sequencing of two PCR products confirms that no substantial rearrangements at the rpgip1 transgene arose during development of transgenic plants. However, a deletion occurred at 59 bp in the PGIP+VST line and a substitution at 392 bp in the PGIP line. The frequency of point mutations was not high (1.1 × 10-3) and comparable with the frequency expected for host genes based on the neutral theory of molecular evolution.
Novejši dosežki pri povečanju odpornosti graha na Ascochyta so povezani z uvajanjem tujih genov s pomočjo genskega inženiringa. Gen rpgip1 iz malinjaka (Rubus idaeus) je vključen v grah, cv. Baroness, s transformacijo z bakterijo Agrobacterium, da bi se povečalo odpornost graha na to glivično bolezen. Pred praktično uporabo te metode je potrebno razviti načine za spremljanje dedovanja tega transgena. Enojna in multipleks PCR sta bili uporabljeni za testiranje učinkovitosti začetnikov in za identificiranje transgena rpgip1 pri 11 genotipih graha. Pet od desetih začetnikov je bilo uporabnih za identifikacijo transgenov ali za vključevanje sekvenc. PCR namnoževanje z drugimi petimi začetniki je dalo nespecifične namnožke. Glede na in silico analize so ti nastali zaradi retrotranspozonov in grahovih genov, ki vključujejo homologe rpgip1. Dva seta začetnikov sta bila pripravljena za istočasno namnoževanje različnih odlomkov rpgip1. Elektroferogrami so bili vsote črt individualnih parov, tako je prikazana uporabnost multipleksnega poskusa. Dodatna prednost multipleksnega PCR je razločna diferenciacija med transgenom in genom pgip prisotnim v donorski vrsti R. idaeus. Sekvenciranje dveh PCR produktov potrjuje, da ni pri rpgip1 bistvenega prerazporejanja tekom razvoja transgenih rastlin. Toda pojavila se je delecija pri 59 bp v liniji PGIP+VST in substitucija pri 392 bp v liniji PGIP. Relativna pogostnost točkovnih mutacij ni bila visoka (1.1 × 10-3) in je bila primerljiva z pogostnostjo pri gostiteljivih genih, glede na nevtralno teorijo molekulske evolucije.
Diabetes prevalence and costs are rising on aglobal scale. Therefore, it is necessary to periodically conduct cost studies for assessing the healthcare burden impact. In Slovenia, the last type 2 ...diabetes cost assessment was conducted in 2006, not including all diabetes complication costs. The aim of this study was to revise, update and compare to previously published datadirect healthcare costs of type 2 diabetes in Slovenia with additional complications costs consideration.
The study was performed from the healthcare payer perspective using the bottom-up approach, was prevalence based and estimated direct medical costs.
We estimated total yearly direct medical costs of type 2 diabetes in Slovenia to 99,120,419 euro with annual per capita costs of 834.70 euro. The highest cost shares were attributed to cardiovascular complication costs (21,683,919 euro), diabetes co-medication (20,977,269 euro) and diabetes treatment medication (18,505,015 euro). Highest yearly costs per complication (all cases, all occurrences) were estimated for dialysis I and III (9,162,635 euro), stroke first year costs (4,951,306 euro) and congestive heart failure first year costs (4,879,533 euro). Yearly per one patient, the complication costs were highest for kidney transplantation, followed by dialysis I and III (78,621.25 euro and 36,797.73 euro)
In comparison to the costs published in the literature before, our estimated total yearly direct medical costs were comparable, although annual per capita costs were assessed lower than elsewhere. Further, regarding the complication costs estimations, our assessed expenses were comparable to those published in other countries.
Prevalenca in stroški sladkorne bolezni v globalnem merilu naraščajo. Zato je treba redno izvajati študije stroškovnega bremena za oceno vpliva na zdravstvo. V Sloveniji je bila zadnja študija bremena sladkorne bolezni tipa 2 izvedena leta 2006 in ni upoštevala vseh stroškov diabetičnih zapletov. Cilj te raziskave je bil pregledati, posodobiti in primerjati s prej objavljenimi podatki neposredne medicinske stroške sladkorne bolezni tipa 2 v Sloveniji z upoštevanjem dodatnih diabetičnih zapletov.
Študija je bila izvedena z vidika plačnika zdravstvenega varstva; uporabljen je bil pristop »bottom-up« s prevalenčnim vidikom in ocenjeni so bili neposredni medicinski stroški.
Letne neposredne medicinske stroške sladkorne bolezni tipa 2 smo ocenili na 99,120.419 evrov z 834,70 evra letnih stroškov na osebo. Najvišji delež je pripadal stroškom srčno-žilnih zapletov (21,683.919 evrov), stroškom sočasno uporabljenih zdravil (20,977.269 evrov) in stroškom antidiabetikov in inzulinov (18,505.015 evrov). Najvišji letni stroški za diabetični zaplet (vse ponovitve in vsi primeri) so bili ocenjeni za dializo I in III (9,162.635 evrov), prvo leto možganske kapi (4.951.306 evrov) in prvo leto srčnega popuščanja (4,879.533 evrov). Najdražji zaplet sladkorne bolezni (letno na posameznega bolnika) je bila transplantacija ledvic (78.621,25 evra), sledili sta dializa I in III (letno na osebo 36.797,73 evra).
V primerjavi s prej objavljenimi podatki v literaturi so v tej raziskavi objavljeni letni neposredni medicinski stroški primerljivi, čeprav so letni stroški na osebo ocenjeni nižje kot drugje. Prav tako so stroškovne ocene posameznih zapletov sladkorne bolezni primerljive s prej objavljenimi.
Epidemiological surveillance of gastrointestinal communicable diseases in Slovenia from 1999 to 2009 Introduction: The surveillance of infectious diarrhoea (ID) in Slovenia is based on the Law on ...Communicable Diseases (Official Gazette 33 / 06) and the Act on Registration (Official Gazette 16/99). The incidence of ID is based on passive notification. Methods: The epidemiological situation of infectious diarrhoea in Slovenia from 1999 to 2009 was estimated. The estimation was based on notifications. Results: From 1999 to 2009, the incidence of all ID inclusive of bacterial, viral and unknown etiology increased. The incidence of all ID increased for 61% from 1999 to 2009 in spite of decrease of incidence of bacterial ID. The incidence of viral enteritis increased: the incidence of rotavirus enteritis by 80% and the incidence of norovirus enteritis by 360%. On the contrary, the incidence of bacterial gastroenterocolitis decreased. The decrease in incidence was greatest for salmonella ID (71%), then E.coli ID (53%) and campylobacter ID (32%). The average incidence of all ID from 1999 to 2009 was 536 / 100 000 inhabitants. Conclusions: Notifications for all ID comprise a quarter of all the notifications of all infectious diseases and remain an important public health problem. PUBLICATION ABSTRACT
Although theoretically very effective and apparently quite straightforward, cardiovascular prevention leaves much to be desired in practice. Several reasons, including ethical, conceptual, ...psychological, and operative pitfalls (lifestyle changes are mostly ignored; drug therapy is too often prescribed with no good reason, and performed in an episodic or on/off way) are presented in this essay. Discussed are the grounds of these aberrations and suggested are some intuitive solutions, best achievable in family practice.
Preprečevanje srčno-žilnih bolezni je teoretično zelo učinkovito in na videz precej enostavno, vendar pa je treba v praksi na tem področju še marsikaj storiti. Prispevek opisuje razloge takšnega stanja, tj. etične, konceptualne in psihološke dejavnike ter težave pri izvajanju. Zdravljenje z zdravili prevečkrat predpišemo brez pravega razloga, poteka pa občasno in neredno. Prispevek obravnava vzroke teh slabosti in predlaga nekaj rešitev, ki jih najlaže ponudi družinska medicina.
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