Health impact assessment of agriculture and food policies: lessons learnt from the Republic of Slovenia. (41/274)

The most important public health priority in agricultural policy-making is currently food safety, despite the relatively higher importance of food security, nutrition, and other agricultural-related health issues in terms of global burden of disease. There is limited experience worldwide of using health impact assessment (HIA) during the development of agriculture and food policies, which perhaps reflects the complex nature of this policy sector. This paper presents methods of HIA used in the Republic of Slovenia, which is conducting a HIA of proposed agricultural and food policies due to its accession to the European Union. It is the first time that any government has attempted to assess the health effects of agricultural policy at a national level. The HIA has basically followed a six-stage process: policy analysis; rapid appraisal workshops with stakeholders from a range of backgrounds; review of research evidence relevant to the agricultural policy; analysis of Slovenian data for key health-related indicators; a report on the findings to a key cross-government group; and evaluation. The experience in Slovenia shows that the HIA process has been a useful mechanism for raising broader public health issues on the agricultural policy agenda, and it has already had positive results for policy formation. HIA is one useful approach to more integrated policy-making across sectors, but clearly it is not the only mechanism to achieve this. A comparison of the approach used in Slovenia with HIA methods in other countries and policy contexts shows that there are still many limitations with HIA application at a government level. Lessons can be learnt from these case studies for future development and application of HIA that is more relevant to policy-makers, and assists them in making more healthy policy choices.  (+info)

Patients' recommendation of doctor as an indicator of patient satisfaction. (42/274)

OBJECTIVES: To determine whether patients' recommendation of their family doctor to others correlates with patient satisfaction scores, and to investigate other factors influencing patients' recommendation of doctor. DESIGN: Self-administered patient questionnaire. SETTING: Thirty-six family practice clinics, Slovenia. PATIENTS AND METHODS: A total of 2160 consecutive adult patients attending the clinics were approached to complete a self-administered questionnaire, to be returned in a prepaid envelope. The questionnaire included validated tools, such as the EUROPEP questionnaire on patient satisfaction and gathered data on health-related quality of life, patient demographic, socio-economic and health characteristics, and attitudes and experience of health services. Patients also selected a response to the statement "I can strongly recommend my family doctor to my friends" on a five-point scale, from strongly disagree to strongly agree. RESULTS: Overall, 92% of respondents were in agreement with the statement that they would strongly recommend their family doctor to their friends. Patient satisfaction in the group of patients strongly agreeing with the statement was 11.1 points higher than that for the group responding they agreed only (92.4 versus 81.3 points; P<0.001). Multivariate analysis showed that 51.5% of the variation in the response to the statement could be explained by patient, doctor, and practice characteristics investigated. CONCLUSION: Higher agreement with the statement "I can strongly recommend my family doctor to my friends" was shown to be associated with higher patient satisfaction with the doctor's working style, with some patient demographic characteristics, aspects of patients' health care utilisation, and some doctor characteristics. Using a simple question regarding recommendation of the doctor to friends can be used as a surrogate measure of patient satisfaction, but should be interpreted with caution.  (+info)

Eighty years of the Slovenian Institute of Public Health: challenges for the future. (43/274)

Eighty years after the first national public health institution was founded in Slovenia, the Institute of Public Health of the Republic of Slovenia (IPHRS) endeavors to meet ever-growing national demands. With the independence of Slovenia in 1991, new tasks had to be tackled, many of which were initially coupled with typical difficulties of a postcommunist country in transition. Also, increasing demands of the European Union (EU) and other international partners had to be met. The IPHRS monitors the health of the Slovenian population and its determinants and contributes to planning and implementation of population-based interventions for the better health of the whole nation. The diversity of the IPHRS activities is mirrored by the organization's internal complexity, multi-disciplinary approach, and links to various sectors. Currently, activities are organized within five centers: Center for Population Health Research; Center for Health Care Organization, Economics and Informatics; Center for Environmental Health; Center for Communicable Diseases; and Center for Health Promotion. The IPHRS is the key national institution in public health research, which is an integral part of all the areas covered by the Institute. The IPHRS also provides education programs in the field of public health. In the near future, it will be important to sustain current activities while integrating into the new program of Community action in the field of public health as well as contributing to the response to challenging public health issues in the wider context of the whole European region. Our aim is to integrate the Institute's activities in the programs relevant to public health issues of outstanding importance in this European sub-region. The IPHRS, given the geographic position and recent history, can act as an intermediate between the public health networks in EU and other countries in the sub-region.  (+info)

Cadmium measurements in blood and hair of occupationally non-exposed military recruits and in the foods of plant origin produced in Slovenia. (44/274)

AIM: To determine cadmium content in the most frequently consumed foods of plant origin grown in different regions of Slovenia, assess cadmium content in the biological materials (blood and hair) from Slovenian young men, and verify the hypothesis that the cadmium pollution of the environment varies across regions in Slovenia. METHODS: We analyzed cadmium concentration in 982 composite samples of foods of plant origin, and determined the cadmium burden in the population by analyzing cadmium content in whole blood and hair samples from 742 randomly selected healthy men aged 18-26 years. RESULTS: There were significant differences in cadmium content in the analyzed foods with respect to the regions in Slovenia where were the foods of plant origin were produced (p<0.001). The median cadmium content in 463 blood specimens was 0.5 microg/L, and 4 ng/g in 245 hair specimens. Cadmium content in the blood and hair samples from study participants varied significantly across regions in Slovenia (p<0.001 and p<0.003, respectively). Cadmium content in foods of plant origin and cadmium burden in the blood showed only a weak correlation (Spearman's r=0.13), whereas the correlation between cadmium content in the foods and hair was much stronger (Spearman's r=0.55). CONCLUSION: Our research confirmed the hypothesis of regionally different environmental pollution with cadmium, and clearly showed the connection between cadmium burden in foods and in population in Slovenia.  (+info)

Unlinked anonymous monitoring of human immunodeficiency virus prevalence in high- and low-risk groups in Slovenia, 1993-2002. (45/274)

AIM: To determine the prevalence of human immunodeficiency virus (HIV) infection in high-risk groups, ie, injecting drug users, patients with sexually transmitted infections, and men who have sex with men, and compare it with the prevalence determined in low-risk group, ie, pregnant women. METHODS: Residual sera from specimens obtained from patients with sexually transmitted infections and pregnant women were sampled in syphilis serology laboratories. Saliva specimens were voluntarily obtained from injecting drug users entering methadone maintenance program and once per year from men who have sex with men, at one of their meeting sites. Specimens were labeled only with the type of sentinel population, sampling year, sentinel site code, sex, and age group. Specimens were frozen and stored at -20 degrees C and tested annually for anti-HIV antibodies. RESULTS: A cumulative total of 1,172 saliva specimens were collected from injecting drug users during 1995-2002, 774 saliva specimens from men who have sex with men during 1996-2002, 6,612 serum specimens from patients with sexually transmitted infections during 1993-2002, and 49,652 serum specimens from pregnant women during 1993-2002. The national annual HIV prevalence estimates for injecting drug users varied between 0% and 0.7% in 2000, for men who have sex with men between 0% in 2002 and 3.4% in 1998, and for patients with sexually transmitted infections from 0% (most calendar years) to 0.5% in 1995. Among specimens obtained from pregnant women, only one tested anti-HIV positive (in 1999), so the prevalence estimate was 0.01% for the particular year. CONCLUSION: The prevalence of HIV infection in low-risk heterosexual population is very low and has consistently remained below 5% in all groups with high-risk behavior, including men who have sex with men, who are the most affected population group in Slovenia.  (+info)

Undetermined deaths: are they suicides? (46/274)

AIM: To investigate the characteristics of undetermined deaths by examining similarities and differences between undetermined deaths and other death categories, such as suicides, fatal traffic accidents, and remaining deaths. METHODS: The group of undetermined deaths was compared to other death categories with respect to sex, age, marital status, and month of death of the deceased. A total yearly number of 18.508 deaths in Slovenia in 2001 was analyzed. RESULTS: Significantly more men died in fatal traffic accidents and committed suicide than from undetermined causes. Persons dying in fatal traffic accidents and committing suicides were significantly younger than those dying from undetermined causes of death, whereas persons dying from remaining causes of death were older. The marital status profiles of persons dying from undetermined causes and those committing suicides were similar. Also, undetermined deaths and suicides were both more likely to occur in April and May. CONCLUSION: Underestimation of actual number of suicides could be assumed, given the similarities with the group of undetermined deaths in both seasonality and marital status. As some differences were obtained between the two groups in sex and age, we may conclude that some cases of older women suicides are concealed within the undetermined deaths group.  (+info)

Case report: fatal poisoning with Colchicum autumnale. (47/274)

INTRODUCTION: Colchicum autumnale, commonly known as the autumn crocus, contains alkaloid colchicine with antimitotic properties. CASE REPORT: A 76-year-old man with a history of alcoholic liver disease and renal insufficiency, who mistakenly ingested Colchicum autumnale instead of wild garlic (Aliium ursinum), presented with nausea, vomiting and diarrhea 12 hours after ingestion. On admission the patient had laboratory signs of dehydration. On the second day the patient became somnolent and developed respiratory insufficiency. The echocardiogram showed heart dilatation with diffuse hypokinesia with positive troponin I. The respiratory insufficiency was further deteriorated by pneumonia, confirmed by chest X-ray and later on by autopsy. Laboratory tests also revealed rhabdomyolysis, coagulopathy and deterioration of renal function and hepatic function. The toxicological analysis disclosed colchicine in the patient's urine (6 microgram/l) and serum (9 microgram/l) on the second day. Therapy was supportive with hydration, vasopressors, mechanical ventilation and antibiotics. On the third day the patient died due to asystolic cardiac arrest. DISCUSSION AND CONCLUSION: Colchicine poisoning should be considered in patients with gastroenterocolitis after a meal of wild plants. Management includes only intensive support therapy. A more severe clinical presentation should be expected in patients with pre-existing liver and renal diseases. The main reasons for death are cardiovascular collapse, respiratory failure and leukopenia with infection.  (+info)

Prevalence of genital Chlamydia trachomatis infection in the general population of Slovenia: serious gaps in control. (48/274)

OBJECTIVES: One of the objectives of the first national survey of sexual lifestyles, attitudes, and health in Slovenia was to estimate the prevalence of and risk factors for genital Chlamydia trachomatis infection in Slovenian adults aged 18-49 years. METHODS: Data were collected over 1999-2001 from a probability sample of the general population by face to face interviews and anonymous self administered questionnaires. Respondents were invited to provide a first void urine (FVU) specimen for polymerase chain reaction testing for C trachomatis infection. We compared the results to the equivalent British survey. RESULTS: 1447 individuals contributed FVU specimens (82.6% of survey respondents, 55.3% of those eligible). C trachomatis infection was diagnosed in 3.0% of men and 1.6% of women. Prevalence was highest in men and women aged 18-24 years (4.1% for both). Individuals reporting first heterosexual intercourse before the age of 16, unprotected sexual intercourse with at least one heterosexual partner during the preceding year, concurrent heterosexual relationships during the preceding year, and five or more lifetime heterosexual partners had a higher prevalence. The association was statistically significant only for five or more lifetime partners (adjusted OR 3.0; 95% CI 1.3 to 6.9; p = 0.01). CONCLUSIONS: A relatively high prevalence of genital C trachomatis infection among 18-24 year old Slovenians, in the presence of relatively low risk sexual behaviour and low reported incidence rates of chlamydia infection, suggest serious gaps in the diagnosis and treatment of the condition. The results provide support for the introduction of chlamydia screening in Slovenia.  (+info)