rss_2.0Slovenian Journal of Public Health FeedSciendo RSS Feed for Slovenian Journal of Public Health Journal of Public Health Feed Women’s Satisfaction with Childbirth: A Literature Review of Measurement Properties<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Patient satisfaction is an important indicator of the quality of care provided. Evaluating women’s satisfaction with childbirth is essential to improving obstetric care and ensuring a positive experience for mothers and newborns. The tools used to measure women’s satisfaction with childbirth are very heterogeneous and multidimensional. Assessment tools used in practice should be tested and meet characteristics that are consistently validated.</p> <p>The aim is to identify currently available instruments measuring women’s satisfaction with childbirth and to evaluate their structure, content and psychometric properties.</p> </sec> <sec><title style='display:none'>Methods</title> <p>A systematic search for sources was carried out according to the criteria set. For the included studies, psychometric properties were assessed in accordance with the principles of the guideline for completing systematic reviews of patient-reported outcome measures, COSMIN.</p> </sec> <sec><title style='display:none'>Results</title> <p>The review included 31 studies that reported the psychometric properties of six measurement instruments (questionnaires, scales). Content validity, structural validity, internal consistency, reliability and cross-cultural validity were assessed for the included studies. The Childbirth Experience Questionnaire (CEQ/CEQ2) and Birth Satisfaction Scale - Revised (BSS-R) were the most commonly used questionnaires in the studies.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Thorough testing of tools measuring women’s satisfaction with childbirth, and adapting them to cultural and social contexts, is still essential. It is crucial that valid and reliable questionnaires are available for midwives in practice, for use in research, to inform clinical practice and for the results to help develop the services offered.</p> </sec> </abstract>ARTICLEtrue of Healthcare Workers Regarding Road Traffic Child Safety in South Bačka District, Serbia<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Healthcare workers (HCW) can have an important role in educating parents about child road safety, but research on the topic shows that they usually do not have adequate knowledge. Thus, the aim of our study was to analyze their knowledge in the field of child road safety.</p> </sec> <sec><title style='display:none'>Methods</title> <p>The cross-sectional study was conducted among HCW from South Bačka district, Serbia, using a specially created questionnaire for assessing knowledge on road traffic injuries in children.</p> </sec> <sec><title style='display:none'>Results</title> <p>The research involved the participation of 317 healthcare workers (86 physicians and 231 nurses). Healthcare workers from primary healthcare made up almost 70% of all respondents, followed by those from tertiary (21.8%) and secondary (11.3%) level institutions. The average percentage of correct answers on the knowledge test was 74.3% (mean=22.3, SD=4.0). Out of all respondents, HCWs employed in the paediatrics department had a significantly higher percentage of correct answers at 77.7% (mean=23.3, SD=3.4) compared to other health workers at 73% (mean=21.9, SD=4.1) (p=0.002). Association analysis demonstrated that HCW employed at paediatric departments on average scored 1.37 (95% CI: 0.40–2.33, p=0.006) points higher in comparison with other HCW.</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>This research demonstrated an unsatisfactory level of knowledge on child road safety by HCW, and the variability across different question domains, which underlines the need for continuous educations in order to improve their knowledge. Our results may serve in planning additional public health measures and can provide a reference for future studies.</p> </sec> </abstract>ARTICLEtrue Needs in the Process of Chemotherapy Provision in Pancreatic Cancer Patients from the Healthcare Provider Perspective: A Phenomenological Study in Greece<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Pancreatic cancer is the fourth leading cause of cancer death overall, with 1.5 years life expectancy and minimal therapeutic progress in the last decades. Despite the burden it causes, there is little research on the needs of this specific population. This study aimed to explore healthcare professionals’ views on providing care and patients’ unsatisfied needs.</p> </sec> <sec><title style='display:none'>Methods</title> <p>This qualitative descriptive study was carried out at a cancer hospital in Northern Greece. A total of 12 participants (6 physicians and 6 nurses), treating patients with pancreatic cancer undergoing chemotherapy, were recruited through purposive sampling and underwent face-to-face semi-structured interviews. Data were analyzed through the thematic analysis method in NVivo12 software.</p> </sec> <sec><title style='display:none'>Results</title> <p>The analysis highlighted two themes: “needs of patients with pancreatic cancer” consisted of 6 subthemes (“daily activities”, “symptoms management”, “psychological support”, “information needs”, “multidisciplinary care” and “end-of-life care”) and “needs of healthcare professionals” had 3 subthemes (“psychological support”, “education” and “organizational support”). Several symptoms are identified and affect the daily activities of these patients, and psychological support is important for the majority of them, even at the time of diagnosis. The participants express dissatisfaction with the absence of palliative care structures and services and stated that an interdisciplinary approach would improve the quality of care.</p> </sec> <sec><title style='display:none'>Conclusions</title> <p>Healthcare professionals report a wide range of unsatisfied needs of patients with pancreatic cancer, with the majority expressing their concerns about the complete lack of patient support in the last stages of their lives.</p> </sec> </abstract>ARTICLEtrue of Nutritional Intervention Led by Clinical Dietitian in Patients at Risk of Malnutrition at the Primary Healthcare Level in Slovenia - Evaluation Study<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Introduction</title> <p>Clinical dietitians play a crucial role in the nutritional support of patients at risk of malnutrition in primary care settings. The study aimed to evaluate the effect of an individualized nutritional intervention on clinically relevant outcomes for patients with chronic disease at nutritional risk.</p> </sec> <sec><title style='display:none'>Methods</title> <p>A longitudinal evaluation study was conducted in two Slovenian primary health centres. We used pre-test and post-test design. Patients with chronic disease were screened using the Malnutrition Universal Screening Tool and additional risk factors (≥70 years and BMI &lt;22 kg/m<sup>2</sup>; lower food intake in the last five days). Patients at nutritional risk were referred to a clinical dietitian for individual nutritional intervention. The effect of the nutritional intervention was assessed six months after the patients’ first visit with a clinical dietitian.</p> </sec> <sec><title style='display:none'>Results</title> <p>The sample included 94 patients. Nutritional risk was reduced significantly in high-risk and moderate-risk patients. In a subgroup of patients with a MUST score ≥1 (77 patients), body weight, BMI, Fat-Free Mass Index (FFMI), energy intake, and protein intake increased significantly (p&lt;0.001). At the same time, the phase angle significantly increased (p&lt;0.001), but there were no statistically significant changes in the improvement of grip strength. In a subgroup of patients with MUST score 0 (17 patients), we observed an increase in their median daily energy intake (p&lt;0.001) and median protein intake (p=0.003).</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Nutritional intervention delivered by a clinical dietitian improved patients’ nutritional intake and nutritional and functional status.</p> </sec> </abstract>ARTICLEtrue Factors Associated with Severe Systemic Allergic Reaction after Wasp Sting in Subjects with a History of European Hornet Sting Allergy<abstract> <title style='display:none'>Abstract</title> <sec><title style='display:none'>Aim</title> <p>To make the treatment approach in patients suffering a European hornet sting allergy reaction more personalized, preparing them also for possible future risks.</p> </sec> <sec><title style='display:none'>Methods</title> <p>In Slovenia an extended retrospective observational cohort epidemiological study about the natural history of Hymenoptera venom sensitivity is in progress. The study is based on data from the healthcare records of the University Clinic Golnik (UCG) and data collected by a questionnaire sent to patients from May 2019 to April 2021. For a pilot study, we selected patients who were referred to UCG because of an allergic reaction to European hornet sting and had been re-stung later by a wasp (n=68). The association between severe systemic allergic reactions (SSAR) after wasp sting and potential risk factors in subjects with a history of hornet sting allergy was assessed univariately using the likelihood ratio test.</p> </sec> <sec><title style='display:none'>Results</title> <p>Among 68 European hornet allergic patients 27 reacted with an SSAR and 41 reacted with a mild SAR. Among 27 patients with SSAR, 4 reacted with an SSAR also to a subsequent wasp sting. Among 41 patients with a mild European hornet sting SAR nobody reacted with an SSAR to a subsequent wasp sting. The association between the severity of the wasp SAR reaction in European hornet allergic patients was statistically significant (p=0.022).</p> </sec> <sec><title style='display:none'>Conclusion</title> <p>Our results suggest that patients with severe European hornet SAR should be considered for wasp venom immunotherapy or prophylactic prescription of epinephrine auto-injector as they are at risk for an SSAR also after wasp string.</p> </sec> </abstract>ARTICLEtrue the Era of Globalization Dictate a change in the Definition of Public Health?<abstract> <title style='display:none'>Abstract</title> <p>Globalization has a major impact on public health in all countries of the world. Unfortunately, there are attempts to treat global challenges in the field of public health separately from national ones, following the model of tropical medicine, where the focus of action was in fact primarily on the identification and control of tropical diseases. This was especially in the interest of countries that colonized certain areas in the tropical part of the world. Global health, which is to some extent the successor of tropical medicine, cannot be a separate entity. The lines between global health and public health are blurring. In essence, global health is just another aspect of public health, important both in terms of recognizing the situation and taking action to improve the situation. The problems are mostly no longer local or national, and, to a greater or lesser extent, already affect the entire population or threaten the health of future generations.</p> <p>Such a view of global health also requires different approaches. Of course, due to cultural and socio-economic characteristics, the field and method of work must be adapted to the specific local environment, but nevertheless, these are challenges that are present everywhere. Therefore, it is vital that we act decisively, with a united approach – regardless of where we live and at what stage of social development we are. The world has become one, so the division into public health and global public health has become meaningless.</p> </abstract>ARTICLEtrue Education with Simulations in Primary Care<abstract> <title style='display:none'>ABSTRACT</title> <p>The introduction of interprofessional primary care (IPC) as a model of collaborative patient care is increasingly vital in the context of complex healthcare systems and the growing needs of patients. Its benefits include improved patient outcomes, enhanced efficiency, and reduced costs. However, the successful implementation of IPC faces challenges due to the differences in training and backgrounds among healthcare professionals, emphasising the importance of effective teamwork and collaborative education.</p> <p>Educational approaches utilising simulations have gained prominence, particularly in addressing the challenges of interprofessional primary care. Notably, simulations facilitate team learning, enhancing team management and confidence, which ultimately leads to improved performance in real-life scenarios. They also contribute to patient safety by providing comprehensive training and creating a safe environment for professionals to practice and refine their skills without risking real patient harm.</p> <p>Moreover, simulations promote psychological safety, allowing healthcare workers to manage stress effectively and prepare for critical situations. Ethical considerations are met through simulation-based education, ensuring patient confidentiality, and creating a standardised and just learning environment for all students. Simulations contribute to promoting equity in medical education by providing equal access to high-quality training opportunities for all healthcare professionals.</p> <p>In conclusion, successful IPC implementation requires a comprehensive approach that includes interprofessional education and the integration of simulations as an essential component of the curriculum at all levels of healthcare education. This approach fosters effective communication, teamwork, and confidence among primary care teams, ultimately leading to improved patient care and outcomes.</p> </abstract>ARTICLEtrue of Anxiety and Depression Among Slovenian Breast Cancer Survivors Post-Treatment During the COVID-19 Pandemic: A Cross-Sectional Study<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Background</title> <p>Although anxiety and depression are important determinants of mental health, the literature in this area is sparse as most studies focus on the period during treatment. Mental health problems can affect cancer recovery as well as quality of life and survival. In this cross-sectional study, we investigated the prevalence of anxiety and depression in Slovenian cancer survivors after treatment and assessed the associated correlates during the COVID-19 pandemic.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>From September 2021 to January 2022, we collected data from 430 breast cancer survivors one to five years after receiving post-local treatment and (neo)adjuvant chemotherapy. We used the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression levels. Multivariate linear regression was used to identify factors associated with higher levels of anxiety and depression.</p> </sec> <sec> <title style='display:none'>Results</title> <p>Key findings from this study are increased levels of psychological distress and identification of relevant factors associated with those elevated levels. Approximately one-third of breast cancer survivors exhibited symptoms of elevated anxiety and depression, with one in eight meeting clinical thresholds. Multivariate linear regression revealed that age, lower quality of life, heightened fear of cancer recurrence (FCR), reduced resilience, limited social support, and unmet psychosocial and emotional needs correlated with increased anxiety symptoms. Additionally, lower quality of life, higher FCR, diminished resilience, and limited social support were associated with higher depression symptomatology.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>Our study of Slovenian breast cancer survivors one to five years post-treatment observed a significant increase in anxiety and depression symptoms, possibly exacerbated by the COVID-19 pandemic. The demographic and psychosocial factors identified in this study offer valuable insights for future research. The study emphasises the importance of recognising and addressing the psychological needs of breast cancer survivors and the need to follow them throughout their cancer journey.</p> </sec> </abstract>ARTICLEtrue Reported Indicator Surveys (PaRIS): Methodological Considerations of a Field Trial in Slovenia<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Introduction</title> <p>Healthcare systems collect little information about the experiences and outcomes of care from the perspectives of patients. Patient Reported Indicator Surveys (PaRIS) is an OECD initiative to measure the outcomes and experiences of people living with chronic conditions, who are managed in primary care.</p> </sec> <sec> <title style='display:none'>Objectives</title> <p>To evaluate the feasibility of the methodology employed in the Field Trial of the PaRIS survey in Slovenia and propose adjustments to enhance sampling in the Main Survey.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>In 2022, we conducted a cross-sectional observational study in 50 family medicine practices in Slovenia with a target of recruiting 70 patients per practice. We used the Slovenian version of the PaRIS questionnaires, and evaluated sampling and data collection.</p> </sec> <sec> <title style='display:none'>Results</title> <p>The sample contained 21 providers (42.0% response rate) and 454 patients (50.7% response rate). The provider sample did not differ from the population characteristics, while the patient sample differed significantly from the patient population. All providers completed the survey online, in 20.9±11.1 minutes and had 1.5±1.5 restarts. Most patients (74.9%) completed the survey online and needed 36.0±22.6 minutes, and the mean number of restarts was 1.4±2.2.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>Based on the results, we recommend conducting a methodology test for quality assessment studies before initiating the main survey. Legal issues should be addressed and considered early when developing the methodology. It is also necessary to be aware of the feasibility of the study in practice, to avoid a low participation rate.</p> </sec> </abstract>ARTICLEtrue of the Slovene Version of the Stop-Bang Questionnaire in a Primary Practice Setting<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Aim</title> <p>The aim of our study was to validate the Slovene translation of the STOP-BANG (SBQ) questionnaire for use in the primary practice setting.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>We recruited 158 randomly selected visitors at four primary practice clinics who came to the practice for any reason. Participants completed the Slovene SBQ and underwent type 3 respiratory polygraphy, which was analysed by an experienced somnologist. The SBQ was previously translated in to Slovene and validated for the sleep clinic.</p> </sec> <sec> <title style='display:none'>Results</title> <p>Of 158 participants, 153 had valid recordings. The mean age of the participants was 49.5 years (±13.0 years), and 47.7% were male. OSA was identified in 49.0% of the participants. The questionnaire, with a cutoff of ≥3, demonstrated an area under the curve of 0.823 for any OSA (REI≥5), 0.819 for moderate and severe OSA (REI≥15) and 0.847 for severe OSA (REI≥30). Sensitivity was 65.3%, 81.8%, and 90.0%, and specificity was 87.2%, 73.3% and 65.0% for any, moderate to severe and severe OSA, respectively.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>The Slovene translation of the SBQ is a reliable instrument for OSA risk stratification in the primary practice setting.</p> </sec> </abstract>ARTICLEtrue and Barriers to Scaling-Up Integrated Care for Arterial Hypertension and Type 2 Diabetes in Slovenia: Qualitative Study<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Introduction</title> <p>Arterial hypertension and type 2 diabetes are significant contributors to global non-communicable disease-related mortality. Integrated care, centred on person-centred principles, aims to enhance healthcare quality and access, especially for vulnerable populations. This study investigates integrated care for these diseases in Slovenia, providing a comprehensive analysis of facilitators and barriers influencing scalability.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>Qualitative methods, including focus group discussions and semi-structured interviews, were employed in line with the grounded theory approach. Participants represented various levels (micro, meso and macro), ensuring diverse perspectives. Data were collected from May 2019 to April 2020, until reaching saturation. Transcripts were analysed thematically using NVivo software.</p> </sec> <sec> <title style='display:none'>Results</title> <p>Nine categories emerged: Governance, Health financing, Organisation of healthcare, Health workforce, Patients, Community links, Collaboration/Communication, Pharmaceuticals, and Health information systems. Some of identified barriers were political inertia and underutilisation of research findings in practice; outdated health financing system; accessibility challenges, especially for vulnerable populations; healthcare workforce knowledge and burnout; patients’ complex role in accepting and managing their conditions; collaboration within healthcare teams; and fragmentation of health information systems. Peer support and telemedicine were the only two potential solutions identified.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>This study offers a comprehensive evaluation of integrated care for hypertension and type 2 diabetes in Slovenia, featuring insights into facilitators and barriers. These findings have implications for policy and practice. Monitoring integrated care progress, refining strategies, and enhancing care quality for patients with these two diseases should be priorities in Slovenia.</p> </sec> </abstract>ARTICLEtrue of Patient Safety Culture at the Primary Care Level: The Case of the Community Health Centre Ljubljana<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Background</title> <p>Patient safety is a crucial element of quality healthcare, and endeavours to enhance it are vital for attaining universal health coverage and improving patient outcomes. This study aimed to evaluate the perception of patient safety culture among staff at the Community Health Centre Ljubljana (CHCL).</p> </sec> <sec> <title style='display:none'>Methods</title> <p>A cross-sectional study was conducted in December 2022. All CHCL staff (N=1,564) from different professional groups were invited to participate in an anonymous electronic survey using the validated Slovenian version of the “Medical Office Survey on Patient Safety Culture” (MOSPSC). Mean percent positive scores for all items in each composite were calculated.</p> </sec> <sec> <title style='display:none'>Results</title> <p>The final sample included 377 participants (response rate, 24.1%), most of whom were women (91.5%, N=345) with different professional profiles. The mean age of the participants was 44.5 years (SD 11.1) with a mean work experience of 20.1 years (SD 12.1). The percentage of positive overall MOSPSC composite scores was 59.6%. A strong patient safety culture perception was identified in the following dimensions: Information exchange with other settings (93.5%), Organisational learning (90.2%), List of patient safety and quality issues (88.1%), Patient care tracking/follow-up (76.2 %) and Teamwork (75.0%). Weak patient safety culture was identified in the dimensions of Work pressure and pace (10.7%), Leadership support for patient safety (27.1%), Communication openness (40.9%), Office processes and standardisation (48.2%) and Overall ratings on quality and patient safety (49.4%).</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>CHCL leadership should address weaknesses, redesign processes, and implement strategies to reduce patient safety incidents. Establishing a just culture that encourages employees to report errors fosters transparency and facilitates learning from errors.</p> </sec> </abstract>ARTICLEtrue Validity and Cognitive Testing in the Development of a Motivational Interviewing Self-Assessment Questionnaire<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Aim</title> <p>To develop and content validate a self-assessment questionnaire on motivational interviewing (MI) practice as the first stages in forming the questionnaire to be used in cross-sectional studies involving practitioners conducting the MI-based alcohol screening and brief intervention (ASBI).</p> </sec> <sec> <title style='display:none'>Methods</title> <p>A comprehensive mixed methods approach included a literature review, 3 rounds of expert panel (EP) opinions (n=10), cognitive testing (CT) with 10 MI-based ASBI practitioners, and questionnaire piloting with 31 MI-based ASBI practitioners. Based on the EP opinions in the second round, content validity indices (CVIs) and the modified kappa coefficient (k*) were calculated, focusing on the relevance and understandability of questions and comprehensiveness and meaningfulness of the response options. This analysis was performed in 2020, at the conclusion of the national “Together for a Responsible Attitude Towards Alcohol Consumption” (“Skupaj za odgovoren odnos do pitja alkohola”, SOPA) project’s pilot implementation.</p> </sec> <sec> <title style='display:none'>Results</title> <p>On a scale level, CVI values based on universal agreement for the entire questionnaire were high for 3/4 categories (S-CVI-UA&gt;0.80), and CVI values based on average agreement were high across all categories (S-CVI-Ave&gt;0.90). At the item level, CVI values (I-CVI) were never &lt;0.50 (automatic item rejection), and the modified kappa value (k*) indicated poor validity for two items in the understandability category (k*=0.33). All problematic parts of the questionnaire were further tested and successfully modified based on the results of CT, and accepted in the third round of testing.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>The final version of the questionnaire demonstrated appropriate content validity for use in studies among Slovenian MI-based ASBI practitioners and is now ready for further psychometric testing.</p> </sec> </abstract>ARTICLEtrue Analysis of Telemonitoring Costs: A Case Study in Slovenian Primary Care<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Introduction</title> <p>Telemonitoring improves clinical outcomes in patients with arterial hypertension (AH) and type 2 diabetes (T2D), however, cost structure analyses are lacking. This study seeks to explore the cost structure of telemonitoring for the elderly with AH and T2D in primary care and identify factors influencing costs for potential future expansions.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>Infrastructure, operational, patient participation, and out-of-pocket costs were determined using a bottom-up approach. Infrastructure costs were determined by dividing equipment and telemonitoring platform expenses by the number of participants. Operational and patient participation costs were determined by considering patient training time, data measurement/review time, and teleconsultation time. The change in out-of-pocket costs was assessed in both groups using a structured questionnaire and 12-month expenditure data. Statistical analysis employed an unpaired sample t-test, Mann-Whitney U test, and chi-square test.</p> </sec> <sec> <title style='display:none'>Results</title> <p>A total of 117 patients aged 71.4±4.7 years were included in the study. The telemonitoring intervention incurred an annual infrastructure costs of €489.4 and operational costs of €97.3 (95% CI 85.7-109.0) per patient. Patient annual participation costs were €215.6 (95% CI 190.9-241.1). Average annual out-of-pocket costs for both groups were €345 (95% CI 221-469). After 12 months the telemonitoring group reported significantly lower out-of-pocket costs (€132 vs. €545, p&lt;0.001), driven by reduced spending on food, dietary supplements, medical equipment, and specialist check-ups compared to the standard care group.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>To optimise the cost structure of telemonitoring, strategies like shortening the telemonitoring period, developing a national telemonitoring platform, using patient devices, integrating artificial intelligence into platforms, and involving nurse practitioners as telemedicine centre coordinators should be explored.</p> </sec> </abstract>ARTICLEtrue, Validity and Responsiveness of the Slovenian Version of the Patient Evaluation Measure (PEM-Slo) in Patients with Wrist and Hand Disorders<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Introduction</title> <p>The Patient Evaluation Measure (PEM) is a region-specific patient reported outcome measure (PROM) for hand and wrist disorders, first introduced in English for patients with hand surgery in 1995. The purpose of the study was to assess the psychometric properties of the translated and cross-culturally adapted Slovenian version of PEM (PEM-Slo).</p> </sec> <sec> <title style='display:none'>Methods</title> <p>The study was designed as a single-centre observational prospective study conducted from July 2020 to March 2021. The psychometric evaluation was performed on fifty-one patients with miscellaneous hand and wrist disorders. Reliability was tested for internal consistency and test-retest reliability. Convergent and divergent validity, responsiveness, floor and ceiling effect, and interpretability with the determination of minimal detectable change (MDC) and minimal clinically important difference (MCID) were assessed.</p> </sec> <sec> <title style='display:none'>Results</title> <p>The PEM-Slo has excellent internal consistency (Cronbach’s α 0.932) and good to excellent test-retest reliability (intraclass correlation coefficient=0.874). Convergent validity was proved with high to moderate correlations of PEM-Slo with DASH, grip strength and self-care, usual activities, and pain EQ-5D-5L subscales, whereas no correlation of PEM-Slo with EQ-5D-5L mobility and anxiety/depression subscale confirmed divergent validity. The PEM-Slo responsiveness was high (standardised response mean=1.42, effect size=1.25). MDC was 18.01 and MCID was 17.31. No floor or ceiling effect was found.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>The PEM-Slo is a reliable, valid and responsive PROM for Slovenian-speaking patients with hand and wrist disorders.</p> </sec> </abstract>ARTICLEtrue, Severity and Characteristics of Patients’ Aggression in Acute Psychiatric Wards: Data from a Slovenian National Survey<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Aim</title> <p>To evaluate the incidence, severity and characteristics of aggressive behaviour in patients hospitalized in acute psychiatric wards, as well as the association between patient characteristics and the incidence of recurrent aggressive behaviour.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>A multicentre prospective study included all twelve acute wards in Slovenian psychiatric hospitals with a total capacity of 232 beds. Over five consecutive months, data on the number of treatment episodes involving aggressive behaviour and the number of aggressive incidents, their severity and characteristics were obtained using the Staff Observation Aggression Scale-Revised (SOAS-R). Patient- and event-based incident rates of verbal and physical aggression were calculated. The association between patient characteristics and recurrent aggressive behaviour was analysed. Patient characteristics data were extracted from hospital databases.</p> </sec> <sec> <title style='display:none'>Results</title> <p>3,190 treatment episodes were included during a 5-month period. Aggressive behaviour was observed in 13.4% of treatment episodes, and 922 aggressive incidents were recorded, which resulted in 3.98 incidents per 100 occupied bed days and 9.48 incidents per bed per year. 74.1% of incidents were severe, and more than half of incidents included physical aggression. 75.5% of incidents were directed against medical staff. 5.9% of treatment episodes were involved in multiple aggressive incidents. Compared to patients with single incidents, patients with recurrent aggression had a less frequent main diagnosis of substance use disorders and a longer duration of hospitalization.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>Monitoring the frequency and characteristics of aggressive behaviour allows comparisons with other studies and, more importantly, it is necessary for planning and assessing the effectiveness of preventative aggression management strategies.</p> </sec> </abstract>ARTICLEtrue Characteristics, Cross-Cultural Adaptation and Validation of the Slovenian Version of the Victorian Institute of Sports Assessments for Gluteal Tendinopathy Questionnaire (VISA-G)<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Introduction</title> <p>Greater trochanteric pain syndrome (GTPS) denotes several disorders around the lateral aspect of the hip. GTPS may develop in native hips as well as after total hip arthroplasty (THA). It is estimated that 5−12% of patients suffer from GTPS after primary THA. Despite the prevalence of GTPS, it is hard to diagnose and manage it properly. The VISA-G questionnaire was developed as a patient-reported outcome measurement tool for evaluation of GTPS. The aims of the present study were to evaluate the reliability of the VISA-G Slovenian and its construct and criterion validity.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>After the finalization of the VISA-G Slovenian translation procedure, 59 patients with a painful trochanteric region planned for THA filled in the VISA-G Slovenian at the hospital on two occasions 5−7 days apart. On the first occasion, each patient also filled in the EQ-5D-5L questionnaire and the Harris Hip Score (HHS) was completed by the physiotherapist.</p> </sec> <sec> <title style='display:none'>Results</title> <p>The VISA-G Slovenian was found to have a test-retest reliability of ICC 0.977; 95% CI [0.96; 0.986]. Internal consistency was assessed with Cronbach’s alpha 0.79. The statistically significant, but low, correlation between the HHS and VISA-G (r=0.48) was obtained. Concurrent validity of the VISA-G with the EQ-5D-5L showed moderate to strong correlations in Mobility, Self-Care, Usual Activities, Pain, EQ-5D-5L Index and EQ VAS, but low correlation in the Anxiety subscale. No floor and ceiling effect were obtained.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>The VISA-G Slovenian has excellent psychometric properties needed to measure gluteal tendinopathy-related disability of patients in Slovenia. Thus, we recommend using the questionnaire for measuring trochanteric hip pain.</p> </sec> </abstract>ARTICLEtrue Development and Evaluation of the Slovenian Version of the Early Childhood Oral Health Impact Scale (ECOHIS-SVN)<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Introduction</title> <p>There has been no valid and reliable instrument available to measure the impact of oral health on the quality of life of Slovenian preschool children. The main aim of this study was to develop and evaluate the validity and reliability of the first Slovenian instrument assessing Oral Health-Related Quality of Life (OHRQoL) preschool children: the ECOHIS-SVN.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>The ECOHIS-SVN was developed using forward-backward translations and with the participation of children aged under six and their parents. The children’s teeth were examined, and parents were asked to complete questionnaires, including the ECOHIS-SVN. The internal consistency of ECOHIS-SVN was evaluated through the calculation of Cronbach’s alpha (α), test-retest reliability with an intra-class-correlation coefficient (ICC), convergent validity with Spearman’s rank correlation (r) and criterion validity with the Mann-Whitney test. The association between the ECOHIS-SVN score and parents’ age, educational level, self-reported oral health and OHIP-SVN14 was estimated using multiple linear regression.</p> </sec> <sec> <title style='display:none'>Results</title> <p>In the study, 255 children participated, with a mean age of 4.8 years (±0.8). The ECOHIS-SVN questionnaire was completed by the parents of all 255 children and re-filled by 71 parents. The results of the total ECOHIS-SVN scale include α=0.85, ICC=0.85, and r=0.6-0.75. A statistically significant association was found between the ECOHIS-SVN and parents’ age and between the ECOHIS-SVN and parents’ OHIP-SVN14 in the whole group and in the subgroup of children with no teeth affected by cavitated caries (dmft=0) (p=0.025, p=0.028), respectively.</p> </sec> <sec> <title style='display:none'>Conclusion</title> <p>ECOHIS-SVN enables further studies to assess the OHRQoL of preschool children in the Slovenian-speaking population.</p> </sec> </abstract>ARTICLEtrue Development should Now Become a Priority for Health Systems in Europe<abstract> <title style='display:none'>ABSTRACT</title> <p>The vast majority of European countries are struggling to embrace nursing as a profession and as a science. There are still not enough nurses with bachelor’s degrees and advanced practical skills, and clinical specialisations for nurses are being developed at the master’s level. Attention should be paid to recognising nurses as an equal healthcare workforce who need to be empowered to advance their profession and be provided with professional development opportunities. Changes needed include improving pay and working conditions, providing opportunities to improve skills and professional recognition, empowering nurses to deliver care, and harnessing the power of technology to better support nurses. The declining interest in nursing education and the often stereotypical and condescending view of the role and work of nurses on the healthcare team should be a warning signal to all who are working on healthcare reform.</p> </abstract>ARTICLEtrue D Supplementation During COVID-19 Lockdown and After 20 Months: Follow-Up Study on Slovenian Women Aged Between 44 and 66<abstract> <title style='display:none'>ABSTRACT</title> <sec> <title style='display:none'>Introduction</title> <p>The main objective was to assess the impact of the COVID-19 pandemic on vitamin D supplementation habits and their changes in the follow-up, 20 months after the study in Slovenian premenopausal and postmenopausal women.</p> </sec> <sec> <title style='display:none'>Methods</title> <p>A cross-sectional study was conducted between March and May 2021. 176 healthy women aged 44 to 65 from the Central Slovenian region were included in the final analysis. Vitamin D status was determined by measuring 25(OH)D concentration. After 20 months an online follow-up questionnaire was sent out, to which 123 participants responded with complete data.</p> </sec> <sec> <title style='display:none'>Results</title> <p>Between March and May 2021, 61% of the participants were supplementing vitamin D. 55% of the supplementers and 88% of the non-supplementers had insufficient levels (total 25(OH)D &lt;75 nmol/L). After 20 months in the follow-up, it was found that 62% of participants were taking vitamin D supplements, but only 70% of those who had initially reported taking supplements were still doing so. In the follow-up 61% of participants stated that they started or increased vitamin D intake due to COVID-19.</p> </sec> <sec> <title style='display:none'>Conclusions</title> <p>Vitamin D supplementation increased 7-fold compared to pre-pandemic levels and remained at a high level after 20 months. However, a significant number of participants discontinued supplementation, and only one-fifth were taking vitamin D throughout the entire year. Supplementation is effective for vitamin D deficiency prevention only at the individual level, however due to low compliance it should not be the only strategy for preventing vitamin D deficiency in the population.</p> </sec> </abstract>ARTICLEtrue