Constructing a coronary scale for ischemic heart disease: case-control study. (33/274)

AIM: To develop a scale measuring proneness to ischemic heart disease. METHODS: Ischemic heart disease was angiographically documented in 187 men. In 187 matched controls the diagnosis of ischemic heart disease was ruled out by examination of medical records and history data, and when necessary, clinical examination and specialized diagnostic procedures. Item analysis of the Eysenck Personality Questionnaire (EPQ) was performed on 100 men with ischemic heart disease and their male controls, and then a replication study was performed on the remaining 87 pairs. RESULTS: A Coronary Scale was constructed from 8 EPQ items significantly and consistently different between the groups. Most of these items were drawn from the neuroticism scale. The Coronary Scale yielded significant correlations with emotionally saturated psychological variables. CONCLUSION: Coronary Scale may be useful in everyday practice to select patients with ischemic heart disease and those who are at higher risk to develop disease. It could be used for detecting a high-risk group of emotionally labile subjects to concentrate efforts for prevention of coronary disease.  (+info)

Information from primary care: its importance and value. A comparison of information from Slovenia and England and Wales, viewed from the 'Health 21' perspective. (34/274)

BACKGROUND: The WHO have set health standards in the form of 21 targets--Health 21--and the EU are developing a set of health indicators whereby national health status can be measured. Data from Slovenia and from England and Wales assessing information systems in primary care and their capacity to deliver the requirements of these initiatives have been examined. In both countries, primary care is provided through a state-led service. METHODS: Consultation data from the annual report of the Department of Health Slovenia (1999) are compared in respect of relevant targets with data from the Fourth National Morbidity Survey (1992) in England and Wales. Consultation rates were standardized to the European Union 15 country population (1998). RESULTS: Consultation rates in females were similar in the two countries whereas in males rates were higher in Slovenia. The proportionate distributions of consultations by chapter of the International Classification of Diseases (ICD) were similar in both countries, respiratory (17%) and musculoskeletal (9%) disorders ranked first and second. For eye diseases, injury and poisoning, factors influencing health status (e.g. medical examination). proportions were higher in Slovenia: for mental disorders higher in England and Wales. The relativity of male to female consultation rates was broadly similar with higher rates in females in most ICD chapters. These differences are considered in detail against the background of WHO targets. CONCLUSIONS: Data gathered systematically from the surveillance of consultations in primary care are important to the measurement of WHO 'Health 21' targets.  (+info)

Factors influencing home visits in Slovenian general practice. (35/274)

BACKGROUND: There is great variability in home visiting rates in Europe. The European General Practice Research Workshop (EGPRW) has conducted a pilot quantitative international study on home visits and developed a questionnaire, which has not yet been tested on a national level. In Slovenia, home visiting is decreasing, but the factors influencing home visiting by GPs in the country have not yet been examined. OBJECTIVES: The purpose of this study was to test the feasibility of the questionnaire on home visiting developed by EGPRW and to study home visiting in Slovenia. METHODS: A random representative sample of 165 Slovenian GPs were given a questionnaire, developed on the basis of former EGPRW projects. Each of the respondents provided data on 10 consecutive home visits made during office hours, data on his/her practice and number of consultations during the registration period. Multivariate modelling of home visits per working week as the dependent variable was performed. RESULTS: A 71% response rate was achieved, and the data from 1151 requests for home visits and 1015 completed home visits were analysed. The average number of home visits per working week was 2.5, with wide variation among the respondents (0-10, SD 1.89). Older GPs, trainees, GPs from rural areas and those with a higher proportion of elderly patients carried out more home visits. The selected logistic regression model fits the data well according to established criteria. CONCLUSION: It is possible to use the questionnaire developed by EGPRW on a national scale and to obtain representative valid national data. The home visiting rate in Slovenia is low compared with rates in other countries. Rural location of practice, GP's age, trainee status and the number of older patients on the list are the most important predictors of the home visiting rate.  (+info)

GPs facing reluctant and demanding patients: analysing ethical justifications. (36/274)

BACKGROUND: Several studies have explored the physicians' preferred actions when facing a reluctant or a demanding patient, but only a few studies have explored the physicians' justifying reasons. OBJECTIVE: The aim of this study was to assess how GPs would act and how they would justify their choice. METHOD: A postal questionnaire with questions about preferred actions and justifying reasons was sent to a random sample of GPs in Slovenia (n = 160) and Sweden (n = 200) using four vignettes: (i). a healthy patient reluctant to quit smoking; (ii). a healthy patient demanding an X-ray; (iii). a pulmonary cancer patient reluctant to quit smoking; and (iv). a pulmonary cancer patient demanding immunotherapy. RESULTS: The majority of GPs would bring up the question about smoking with the patients reluctant to quit. They justified their choice by referring to promotion of medical benefit and to protection from harm. Swedish GPs were less inclined to bring up smoking than were their Slovenian colleagues. Those who would not bring up the question referred to respect for self-determination and an enhanced relationship as their justifying reasons. With reference to the demanding patients, a minority of GPs would grant the healthy patient's request for an X-ray that was not medically motivated. The answers were similar with respect to the seriously ill patient requesting non-medically motivated immunotherapy. Slovenian GPs were much more inclined to grant the request than were their Swedish colleagues. Enhancing the relationship and respect for self-determination were the most important reasons for granting the demands. When the demands were denied, the GPs mostly referred to promotion of fair distribution of resources. CONCLUSION: Many of the GPs considered their patients' right to self-determination less important than other values, e.g. the obligation to promote medical benefit, to protect from harm, to distribute public resources fairly and to enhance the patient-physician relationship.  (+info)

Renal replacement therapy in Slovenia: annual report 2001. (37/274)

The total number of end-stage renal failure patients treated by renal replacement therapy increased, from 1435 at 31 December 2000 to 1542 at 31 December 2001 (7.5% increase). At the end of 2001, 771 p.m.p. end-stage renal failure patients were treated by renal replacement therapy in Slovenia, 73% of them with haemodialysis, 7.4% with peritoneal dialysis and 19.7% had a functioning graft. Incident (new) patients in 2001 were 144 p.m.p. The number of haemodialysis patients increased by 7% compared with the year before, the number of patients on peritoneal dialysis decreased by 3.4% and the number of patients with a functioning graft increased by 13.9%. The gross mortality rate of dialysis patients was stable between the years and was 10.4% in 2001. Erythropoietin therapy was prescribed to 87.3% of dialysis patients (88.9% of haemodialysis patients and 71.7% of patients on peritoneal dialysis). The number of dialysis patients positive for hepatitis B or hepatitis C virus is relatively low, 3.2% of all dialysis patients; an increased number of MRSA-positive dialysis patients is observed in 2001 (2.9% of all dialysis patients). The epidemiology of renal replacement therapy in Slovenia is in general comparable with that of the countries of the European Union.  (+info)

Fragile X premutation in women with sporadic premature ovarian failure in Slovenia. (38/274)

BACKGROUND: Fragile X premutation carriers are at increased risk of premature ovarian failure (POF), which is usually defined as menopause before the age of 40 years. METHODS: We evaluated 83 women with sporadic premature ovarian failure, treated at the Department of Obstetrics and Gynaecology, University Medical Centre, Ljubljana, between 1991 and 2001. There was no family history of mental retardation in any of the patients. They were phenotypically normal and had normal female karyotype (46,XX), without a past history of pelvic surgery, chemotherapy or autoimmune diseases. RESULTS: The premutation in the FRAXA locus was found in four of the women screened (4.8%; 95% confidence interval 1.9-11.7). This prevalence (1 in 21) was statistically significantly higher than expected in the female Caucasian population. CONCLUSION: In this study we have confirmed an important association between FRAXA premutation and the pathogenesis of POF. This result has practical implications for genetic counselling and fertility treatment.  (+info)

Management of lower urinary tract infection in women by Slovene GPs. (39/274)

BACKGROUND: Uncomplicated lower urinary tract infection (LUTI) is one of the most common infections treated in general practice. Although nationwide treatment guidelines for LUTI are increasingly available, most European countries, including Slovenia, have not yet set such guidelines. OBJECTIVES: Our aim was to describe Slovene GPs' management of uncomplicated LUTIs and to analyse doctor and surgery characteristics that influence this management. METHOD: A written case vignette accompanied by open-ended questions regarding doctors' decisions (i.e. investigations and laboratory tests ordered, treatment options, advising sick leave, advice for treatment and follow-up procedures) and questions about doctor and surgery characteristics was sent to a representative sample of Slovene GPs. RESULTS: The response rate was 129/171 (75.4%). There were large variations in management of LUTI: 17.8% of GPs ordered various additional laboratory tests; 57% of GPs prescribed trimethoprim/sulfamethoxazole and 37% norfloxacin; 30% of GPs prescribed a drug for 10-14 days; and 53.5% of GPs put the patient on sick leave of 1-10 days duration. Doctors with heavier workloads and those who have to wait for laboratory results for >24 h ordered more additional investigations. CONCLUSIONS: Effective strategies for quality improvement are needed, together with practice guidelines. The influence of a heavier workload on management of LUTI and the impact of the accessibility of laboratory tests should be explored in future research.  (+info)

Mutational spectrum of congenital adrenal hyperplasia in Slovenian patients: a novel Ala15Thr mutation and Pro30Leu within a larger gene conversion associated with a severe form of the disease. (40/274)

OBJECTIVE: To analyse the mutational spectrum, the associated haplotypes and the genotype-phenotype correlation, and to design a reliable and rational approach for CYP21 mutation detection in Slovenian congenital adrenal hyperplasia (CAH) patients. DESIGN: Molecular analysis of the CYP21 gene was performed in 36 CAH patients and 79 family members. METHODS: Southern blotting, sequence-specific PCR amplification (PCR-SSP), sequence-specific oligonucleotide hybridisation (PCR-SSO) and sequencing were used to detect CYP21 gene deletions, conversions and point mutations. RESULTS: CYP21 gene deletion was the most frequent mutation (36.4%). Large gene conversions detectable only by Southern blotting represented 12.1%, and gene conversions involving the promoter region represented 7.6% of the mutated alleles. The most frequent point mutations were: intron 2 splice mutation 16.7%, Ile172Asn mutation 7.6%, Gln318Stop 7.5% and Pro30Leu 12.2% of alleles. A correlation between the genotype and the clinical phenotype similar to those described for large populations was observed. The finding of Pro30Leu mutation linked to a gene conversion could explain the simple virilising (SV) phenotype in compound heterozygotes for the Pro30Leu and a severe mutation. In two siblings with a salt wasting form of CAH (SW-CAH), a novel mutation Ala15Thr was found on the allele characterised by Pro30Leu mutation and gene conversion involving the promoter region. CONCLUSIONS: Our genotyping approach allowed reliable diagnosis of CAH in the Slovenian population. The high frequency of CYP21 gene aberrations on Pro30Leu positive alleles justified systematic searching for a gene conversion in the promoter region using the PCR-SSP reaction.  (+info)