Aim. Youth and young adults with type 1 diabetes are at a great risk for developing depression and diabetes specific distress, therefore, systematic psychological screening is recommended. Routine ...psychological screening was implemented in Slovene diabetes clinic for children, adolescents and young adults in 2012. One-year results are presented.
Methods. Adolescents and young adults (N = 159, aged 11 - 25 years), attending the obligatory yearly educational outpatient visit at University Children’s Hospital, Ljubljana, Slovenia, were examined using questionnaires measuring depression (depression scale from Slovene version of Trauma Symptom Checklist for Children) and diabetes distress (Diabetes Distress Screening Scale). Six additional items were included to assess the fear of hypoglycemia and family support. Socio-demographic and diabetes-related data were collected. Questionnaires were analyzed by a psychologist, and the patients that scored above cut-off point were invited to an individual psychological assessment.
Results. Of the sample, 1.3 % reached the threshold for elevated depressive symptoms, and 32.7 % reported significant diabetes distress. The need for psychological support from a specialist was expressed by 5.0 %. There were statistically significant associations between all psychological variables; moreover, better glycemic control was associated with lower diabetes distress and better family support. Nine patients (5.7 %) started with psychological treatment according to the referrals after screening.
Conclusions. The results after one year of psychological screening in Slovene type 1 diabetes population displayed small rates of depression and a large proportion of diabetes distress. Only a small percentage of patients attended the offered individual psychological assessment.
Namen raziskave. Pri mladih s sladkorno boleznijo tipa 1 je prisotno večje tveganje za razvoj depresivne motnje, pogosto pa ti bolniki poročajo tudi o obremenjenosti s sladkorno boleznijo. Zato se priporoča psihološko presejalno testiranje. V letu 2012 smo presejalno testiranje za mladostnike in mlade odrasle uvedli tudi v Sloveniji ter prve rezultate predstavili v tej raziskavi.
Metode. Rednega letnega edukacijskega pregleda na Kliničnem oddelku za endokrinologijo, diabetes in bolezni presnove Pediatrične klinike se je udeležilo 175 mladostnikov in mladih odraslih, starih od 11 do 25 let. Od teh jih je 159 rešilo presejalni vprašalnik, ki je ocenjeval depresivne simptome (lestvica depresije iz vprašalnika o travmatiziranosti otrok in mladostnikov) in obremenjenost s sladkorno boleznijo (presejalna lestvica za oceno obremenjenosti s sladkorno boleznijo). Dodanih je bilo šest postavk za oceno strahu pred hipoglikemijo in podporo družine. Zbrali smo podatke o sladkorni bolezni in sociodemografskem ozadju. Psiholog je pregledal vprašalnike in podal kratko mnenje, mladostnike in odrasle, ki so presegli kritično število točk, pa smo povabili na posvet in dodatno obravnavo k psihologu.
Rezultati. Rezultate, ki pomenijo povečano tveganje za depresijo, je doseglo 1,3 % udeležencev, 32,7 % udeležencev pa je poročalo o pomembni obremenjenosti s sladkorno boleznijo. Željo po psihološki obravnavi je izrazilo 5 % preiskovanih. Prisotna je bila statistično pomembna povezanost med vsemi psihološkimi parametri. Dobra presnovna urejenost je bila povezana z manjšo obremenjenostjo s sladkorno boleznijo in boljšo podporo družine. Devet (5,7 %) mladih je po presejalnem psihološkem testiranju pričelo obravnavo pri psihologu.
Zaključki. Prvo leto presejalnega psihološkega testiranja mladih s sladkorno boleznijo tipa 1 je pokazalo nizek delež udeležencev z depresivnimi simptomi in visok delež pacientov, ki so izrazito obremenjeni s sladkorno boleznijo. Le majhen delež udeležencev se je odzval na povabilo na obravnavo pri psihologu in začel obravnavo.
Type 1 diabetes is a chronic autoimmune disease that affects mainly young people. In the last 50 years, a steady increase of the T1D incidence in the young is reported worldwide, with an average 4 % ...increase annually. In addition, the mean age at the diagnosis is decreasing. Studies show that good metabolic control is important not only for delaying the chronic complications of diabetes but also for improving the quality of life of patients and their families. Continuous education, together with modern technology, is crucial in achieving these goals. Longitudinal data on glycated hemoglobin (HbA1c), along with the data on severe hypoglycemia and severe diabetic ketoacidosis, can describe the quality of care in a defined population. Two national reference diabetes centres taking care of children, adolescents and young adults with diabetes in Israel and Slovenia are described.
Sladkorna bolezen tipa 1 je kronično avtoimuno obolenje, ki najpogosteje prizadene mlade ljudi. Incidenca bolezni zadnjih 50 let narašča po vsem svetu, v povprečju je letni porast incidence ocenjen na 4 %, ob tem pa starost bolnikov ob času diagnoze pada. Raziskave kažejo, da je dobra presnovna urejenost bolnikov s sladkorno boleznijo zelo pomembna, saj je s tem mogoče odložiti pozne zaplete bolezni ter izboljšati kvaliteto življenja bolnikov in njihovih družin. Neprekinjena edukacija bolnikov skupaj z možnostmi moderne tehnologije lahko prispeva k izboljšanju njihove presnovne urejenosti. Presnovno urejenost spremljamo z določanjem glikoziliranega hemoglobina (HbA1c) ter s številom težkih hipoglikemij in ketoacidoz na populacijo pacientov v določenem časovnem obdobju. V prispevku sta opisana dva nacionalna referenčna centra za obravnavo otrok, mladostnikov in mladih odraslih s sladkorno boleznijo v Izraelu in Sloveniji.
Sladkorna bolezen tipa 1 je kronično avtoimuno obolenje, ki najpogosteje prizadene mlade ljudi. Incidenca bolezni zadnjih 50 let narašča po vsem svetu, v povprečju je letni porast incidence ocenjen ...na 4 %, ob tem pa starost bolnikov ob času diagnoze pada. Raziskave kažejo, da je dobra presnovna urejenost bolnikov s sladkorno boleznijo zelo pomembna, saj je s tem mogoče odložiti pozne zaplete bolezni ter izboljšati kvaliteto življenja bolnikov in njihovih družin. Neprekinjena edukacija bolnikov skupaj z možnostmi moderne tehnologije lahko prispeva k izboljšanju njihove presnovne urejenosti. Presnovno urejenost spremljamo z določanjem glikoziliranega hemoglobina (HbA1c) ter s številom težkih hipoglikemij in ketoacidoz na populacijo pacientov v določenem časovnem obdobju. V prispevku sta opisana dva nacionalna referenčna centra za obravnavo otrok, mladostnikov in mladih odraslih s sladkorno boleznijo v Izraelu in Sloveniji.
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.
Primary health care systems (PHCS) can be highly effective at meeting the healthcare needs of people with chronic or multiple morbidity. Under the right conditions it is also the best setting to ...assess health more generally and to intervene when health risks are identified. For people with an established chronic disease, primary care is also the natural setting to coordinate care and to ensure that patients receive the right balance of specialist vs. generalist input - care that is effectively coordinated can improve the overall quality of care by minimising the need for unnecessary and costly acute care, and by improving patient satisfaction. But how is it possible to measure the configuration of a health system and how do the essential features of health systems relate to quality of care? This paper provides an overview of how this might be approached and discusses the challenges therein.
Sistemi primarnega zdravstvenega varstva so lahko zelo učinkoviti pri zadovoljevanju zdravstvenih potreb ljudi s kroničnimi ali več sočasnimi boleznimi. Pod pravimi pogoji so tudi najboljše okolje za splošno oceno zdravja ter za izvajanje ukrepov, ko prepoznamo tveganja za zdravje. Za ljudi s kroničnimi boleznimi je primarno zdravstvo tudi naravno okolje za usklajevanje nege in zagotavljanje ravnovesja med specialistično in splošno oskrbo. Zdravstvena nega, ki je učinkovito usklajena, lahko izboljša splošno kakovost tako, da stremi k zmanjševanju potreb po nepotrebni in dragi akutni negi ter k izboljšanju zadovoljstva bolnikov. Toda, kako izmeriti konfiguracijo zdravstvenega sistema in ugotoviti, na kakšen način bistvene značilnosti zdravstvenih sistemov odražajo v kakovosti zdravstvene nege? V prispevku predstavljamo možne pristope in razpravljamo o izzivih, ki se nanašajo nanje.
Food Safety Shaw, Ian C
2012, 2012., 2013., 2012-09-17
eBook, Book
Food safety is a modern concept. Remarkably, it is only in the last 200 years that such concepts as foodborne germs, and the means of combating them (such as antiseptics and refrigeration), have been ...popularised. Yet in the 21st Century, consumers in the developed world do not accept that the food which they purchase and consume might carry a risk of making them ill – that our food should be safe is something we all take for granted.Food safety is a multi-faceted subject, using microbiology, chemistry, standards and regulations and risk management to address issues involving bacterial pathogens, chemical contaminants, natural toxicants, additive safety, allergens and more. In Food Safety: The Science of Keeping Food Safe, Professor Ian C. Shaw introduces these topics with wit and practical wisdom, providing an accessible guide to a vibrant and constantly evolving subject. Each chapter proceeds from introductory concepts and builds towards a sophisticated treatment of the topic, allowing the reader to take what knowledge is required for understanding food safety at a range of levels.Illustrated with photographs and examples throughout, this book is the ideal starting point for students and non-specialists seeking to learn about food safety issues, and an enjoyable and stylish read for those who already have an academic or professional background in the area.
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