The easy access to data from electronic patient records has made using this type of data in pay-for-performance systems increasingly common. General practitioners (GPs) throughout Europe oppose this ...for several reasons. Not all data can be used to derive good quality indicators and quality indicators can’t reflect the broad scope of primary care. Qualities like person-centred care and continuity are particularly difficult to measure. The indicators urge doctors and nurses to spend too much time on the registration and administration of required data. However, quality indicators can be very useful as starting points for discussions about quality in primary care, with the purpose being to initiate, stimulate and support local improvement work. This led to The European Society for Quality and Patient Safety in General Practice (EQuiP) feeling the urge to clarify the different aspects of quality indicators by updating their statement on measuring quality in Primary Care. The statement has been endorsed by the Wonca Europe Council in 2018.
Confidentiality is one of the oldest ethical principles in healthcare. However, confidentiality in adolescent healthcare is not a universally-accepted doctrine among scholars. The ethical ...acceptability of confidential services in adolescents' healthcare is based on perceptions of adolescent maturity and an appreciation of its importance to adolescents' access and utilization of healthcare services. Despite legal policies that promote adolescents' rights, physicians' attitudes toward adolescent confidentiality can be a determining factor in their ultimate decision to protect adolescents' confidentiality.
A new Attitude towards Adolescent Confidentiality Scale was developed based on the results of a qualitative interview study. This new instrument was administered to a sample of 152 physicians working at school pediatric and gynecology departments in 13 primary healthcare institutions in Belgrade. Principal component analysis was applied to determine the main components of the scale. Reliability was assessed by calculating Cronbach alpha and mean inter-item correlations.
Psychometric analysis of the final 19-item version of the scale showed a high level of reliability (Cronbach alpha of 0.83). Principal component analysis showed four components, which present subscales of the instrument: Confidentiality in clinical situation, Iimportance of confidentiality, Adolescent maturity, and Communication with parents.
The instrument showed satisfactory levels of reliability and validity. The results of the scale dissemination may be a valuable tool for needs assessment for future educational interventions and training programs that will raise physicians' awareness of the importance of adolescent confidentiality.
Italy is the main recipient of asylum seekers in the European region, and Sicily is their first point of arrival. This geographical position creates a large job for Health Authorities to identify and ...deal with the health of immigrants. This study evaluates the prevalence of disease among asylum seekers, assessing which are associated factors.
A cross-sectional study was conducted to analyse demographic and clinical data in an Acceptance Centres for Asylum Seekers from February 2012 to May 2013. All variables that were found to be significant on unvariable analysis for the most frequent pathologies were included in a multivariable logistic regression model.
Post-traumatic stress disorders with 17.4% and major depression with 7.3% were the most frequent diseases. The factors associated with post-traumatic stress disorders among asylum seekers were: major depression diagnosis (OR=2.91, p=0.004), Pakistan as a country of origin (OR=3.88, p<0.001), the largest number of medical visits (OR=1.02, p=0.033) and refugee status (OR=1.97, p=0.036). The variables linked with the diagnosis of major depression from the multivariable analysis were: suffering from post-traumatic stress disorders (OR=3.83, p<0.001), Pakistan as a country of origin (OR=3.45, p=0.004) and the highest number of visits to psychologist (OR=1.15, p<0.001).
The mental wellbeing of asylum seekers needs special attention, and interventions should be done to prevent the consolidation of psychiatric morbidity. A short psychological screening after the arrival might prove helpful here. Moreover, carefully designed longitudinal studies should be carried out when political recommendations try to change the organization of psychological and healthcare services.
Roma populations’ low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. ...A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations.
At local level, establishing collaboration with Roma organisations helps primary care to improve mutual relations and quality of care. Mediation has proved to be an effective tool. Skills training of primary care practitioners may enhance their individual competences. Research and international sharing of experiences are further tools to improve primary care for the Roma people.
Reprising The 2017 American Library Association Outstanding Academic Title award-winning A-Z Guide to Food As Medicine, this new edition explores the physiological effects of more than 250 foods, ...food groups, nutrients, and phytochemicals in entries that include:
Definition and background information such as traditional medicinal use, culinary facts, and dietary intake and deficiency information
Scientific findings on the physiological effects of foods, food groups, and food constituents
Bioactive dose when known, such as nutrient Dietary Reference Intakes focusing on 19-to-50-year-old individuals
Safety highlights, such as nutrient Tolerable Upper Intake Levels
A health professional's comprehensive nutrition handbook that includes all nutrients, nutrient functions, "good" and "excellent" sources of nutrients, nutrient assessment, and deficiency symptoms, as well as summaries of foods, food groups, and phytochemicals.
New to the Second Edition:
Disease- and condition-focused Index that leads readers to foods used to manage specific conditions and diseases
Focus on practical recommendations for health maintenance and disease prevention, including tables, insets, and updated scientific findings on more than a dozen new foods
Accompanying teaching aids and lesson plans available online at http://www.crcpress.com
Features:
Dictionary-style summaries of the physiological effects of foods, food groups, nutrients, and phytochemicals alphabetically listed for quick access
Approximately 60 B & W images of foods; informational tables and insets that define or illustrate concepts such as drug terminologies, classes of phytochemicals, and medicinal aspects of foods and of a plant-based diet
Over 1,000 scientific references from peer-reviewed sources, including The Academy of Nutrition and Dietetics Evidence Analysis Library, and position statements of major health organizations
Objectives. The aim of the study is to assess the weight loss programme with regards to the long-term effectiveness of weight reduction and weight maintenance, using completion rate and BMI, blood ...sugar, cholesterol and blood pressure levels as outcomes. The aim of the study also includes identifying the factors associated with adherence to the programme.
Methods. The programme was developed by a multidisciplinary team. It included 6 months of introduction and another 18 months of maintenance. The data for 397 participants was collected after 24 months.
Results. 346 participants have completed the introduction and 123 have completed the programme. In the introduction, the average weight loss was 12% of the initial weight. The participants, who completed the full programme, lost 9.4% of their initial weight. The participants also significantly (p<0.05) reduced their blood sugar and cholesterol levels, as well as their blood pressure. The factors associated with adherence to the programme are: age over 50, lower educational levels, lower initial weight and higher weight loss in the introduction.
Conclusions. The multi-disciplinary approach to obesity treatment was effective for a selected group of people. The proportion of dropouts was relatively high, but still low compared to similar programmes. Group treatment and mutual support are of a great importance in bringing about and maintaining the changes.
Izhodišča. Namen raziskave je bil opredeliti kratkoročno in dolgoročno uspešnost programa glede na vztrajanje v njem, ITM, vrednost krvnega sladkorja, holesterola in krvnega tlaka pri udeležencih, ki so program zaključili. Želeli smo tudi opredeliti dejavnike, ki napovedujejo vztrajanje v programu.
Metode. V programu sodeluje multidisciplinarni tim strokovnjakov: zdravnik, diplomirana medicinska sestra, fizioterapevt in profesor telesne vadbe. Program ima dva dela: 6-mesečni shujševalni del in 18-mesečni vzdrževalni del. V program se je vključilo 397 udeležencev po nasvetu osebnega zdravnika. Podatke smo ocenili po 24 mesecih.
Rezultati. Prvi, shujševalni del programa je zaključilo 346 udeležencev, od tega jih je 123 zaključilo celotni program. V shujševalnem delu je bilo povprečno znižanje teže za 12% začetne teže, pri tistih, ki so zaključili vzdrževalni program, pa za 9,4% začetne teže. Udeležencem se je po dveh letih statistično pomembno (p<0,05) znižala vrednost krvnega sladkorja in holesterola, prav tako sta se znižala tudi sistolični in diastolični krvni tlak. Dejavniki, ki so vplivali na daljše vztrajanje v programu, so bili starost nad 50 let, nižja izobrazba, nižja vstopna teža in večja izguba kilogramov v prvem delu programa.
Zaključek. Z raziskavo smo želeli dokazati, da je multidisciplinarni pristop zdravljenja debelosti za tiste, ki zaključijo program v celoti, učinkovit. Delež tistih, ki so program zaključili predčasno, je relativno visok, vendar v primerjavi z ostalimi podobnimi programi še vedno nizek. Izkazalo se je, da so pogost stik s strokovnjakom, skupinska obravnava ter podpora ljudem z enakimi težavami izrednega pomena pri spreminjanju in vzdrževanju sprememb.
Izhodišča. Namen raziskave je bil opredeliti kratkoročno in dolgoročno uspešnost programa glede na vztrajanje v njem, ITM, vrednost krvnega sladkorja, holesterola in krvnega tlaka pri udeležencih, ki ...so program zaključili. Želeli smo tudi opredeliti dejavnike, ki napovedujejo vztrajanje v programu.
Uvod. Namen študije je predstaviti projekt Ministrstva za zdravje, referenčne ambulante, ki poteka v Sloveniji, in prikazati rezultate obravnave bolnikov z astmo in KOPB s strani tima, ki je ...dopolnjen in ga sestavljajo zdravnik, diplomirana medicinska sestra in zdravstveni tehnik.
Aim. This study aimed to evaluate a new project of the Slovene Ministry of Health - the Family Medicine Model Practices (MPs) Project in Slovenia, and to show its effectiveness in the management of ...asthma and COPD by family medicine practice teams, consisting of a family physician, a nurse practitioner and a practice nurse.
Methods. A total of 107 family practices with 203122 patients joined the project during the first year of its initiation. The effectiveness of the program in disease management was analysed in two phases according to the registration of family practices. The number of patients registered and the number of asthma and COPD patients (existing and newly detected) by model practice teams were being reported. Descriptive analyses were used to describe the study populations. Prevalence by diseases and phases was established after the initial round of data collection. Chi square (χ
) test was used to analyse the difference between the phases.
Results. The frequency of asthma was 2.12%, while the frequency of COPD was 1.15% throughout the study period. For both diseases, more than 30% of patients were newly diagnosed.
Conclusions. The project of implementing Family Medicine MPs in the area of COPD has given first positive results and the project is still ongoing to its full implementation.
Uvod. Namen študije je predstaviti projekt Ministrstva za zdravje, referenčne ambulante, ki poteka v Sloveniji, in prikazati rezultate obravnave bolnikov z astmo in KOPB s strani tima, ki je dopolnjen in ga sestavljajo zdravnik, diplomirana medicinska sestra in zdravstveni tehnik.
Metode. V prvem letu je bilo v projekt vključenih 107 ambulant z 203.122 opredeljenimi pacienti (glavarina). Uspešnost programa obravnave pacientov je bila analizirana dvofazno, ob prvi in naslednji vključitvi ambulant v projekt. Vse referenčne ambulante so poročale o številu opredeljenih bolnikov (glavarina) in o številu bolnikov z astmo in KOPB (že obstoječih in med presejanjem novo odkritih bolnikov). Deskriptivna analiza je bila uporabljena za opis obravnavane populacije. Prevalenca po boleznih je bila prikazana ločeno v prvi in drugi fazi analize. Test hi-kvadrat je prikazal razlike med obema fazama raziskave.
Rezultati. V opazovanem obdobju je bila pogostnost astme med opazovano populacijo 2,12%, pogostnost KOPB pa 1,15%. Tako med bolniki z astmo kot med bolniki s KOPB je bila bolezen novo odkrita pri več kot 30% bolnikov.
Zaključek. Projekt implementacije referenčnih ambulant, ki je še v razvoju, je na področju obravnave bolnikov s KOPB in astmo pokazal prve pozitivne rezultate.
Introduction. Besides participation in the primary prevention, screening as secondary prevention is an important requirement for primary care services. The effect of this work is influenced by the ...characteristics of individual primary care practices and doctors’ screening habits, as well as by the regulation of screening processes and available financial resources. Between 1999 and 2009, a managed care program was introduced and carried out in Hungary, financed by the government. This financial support and motivation gave the opportunity to increase the number of screenings.
Method. 4,462 patients of 40 primary care practices were screened on the basis of SCORE risk assessment. The results of the screening were compared on the basis of two groups of patients, namely: those who had been pre-screened (pre-screening method) for known risk factors in their medical history (smoking, BMI, age, family cardiovascular history), and those randomly screened. The authors also compared the mortality data of participating primary care practices with the regional and national data.
Results. The average score was significantly higher in the pre-screened group of patients, regardless of whether the risk factors were considered one by one or in combination. Mortality was significantly lower in the participating primary practices than had been expected on the basis of the national mortality data.
Conclusion. This government-financed program was a big step forward to establish a proper screening method within Hungarian primary care. Performing cardiovascular screening of a selected target group is presumably more appropriate than screening within a randomly selected population. Both methods resulted in a visible improvement in regional mortality data, though it is very likely that with pre-screening a more cost-effective selection for screening may be obtained.
Uvod. Poleg primarne preventive je presejanje kot sekundarna preventiva pomemben člen pri storitvah osnovnega zdravstvenega varstva. Na uspešnost tovrstnega dela vplivajo značilnosti posameznih splošnih ambulant varstva in pripravljenost zdravnikov za izvajanje presejalnih pregledov kot tudi ureditev procesov presejanja in razpoložljivih finančnih virov. Med leti 1999 in 2009 je bil v Madžarski uveden in izpeljan program vodene oskrbe, ki ga je financirala vlada. Ta finančna podpora in spodbuda je omogočila priložnost za povečanje števila presejalnih pregledov.
Metode. 4462 pacientov iz 40 splošnih ambulant je bilo vključenih v presejalni pregled v sklopu ocene tveganja SCORE. Rezultate presejanja se je primerjalo na podlagi dveh skupin pacientov, in sicer tistih, ki so bili predhodno presejani (metoda predhodnega presejanja) za znane dejavnike tveganja v njihovi zdravstveni anamnezi (kajenje, indeks telesne mase, starost, zgodovina srčno-žilnih obolenj) ter tistih, ki so bili presejani naključno. Avtorji so primerjali tudi podatke sodelujočih splošnih ambulant o smrtnosti z regionalnimi in nacionalnimi podatki.
Rezultati. Povprečen rezultat je bil bistveno višji v predhodno presejani skupini pacientov, ne glede na to, ali so bili dejavniki tveganja upoštevani posamično ali v kombinaciji. Smrtnost je bila bistveno nižja pri sodelujočih splošnih ambulantah, kot je bilo pričakovati na podlagi nacionalnih podatkov o smrtnosti.
Zaključek. Ta program, ki ga je financirala država, je pomenil velik korak naprej k ustanovitvi ustrezne metode presejanja znotraj madžarskega sistema osnovne zdravstvene oskrbe. Izvajanje presejanja za ogroženost srčnožilnega sistema pri izbrani skupini je očitno bolj primerno od naključnih pregledov. Obe metodi sta vidno prispevali k izboljšanju regionalnih podatkov o smrtnosti, čeprav je precej verjetno, da se s predhodnim presejanjem doseže bolj stroškovno učinkovita izbira presejanj.
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