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Health care systems are complex entities with several stakeholders that include patients, health care providers, payers, regulators and government. For lay and professional public, the methodology of health care system performance analysis, result interpretation and translation to policy making is not well understood. Slovenian health care system performance results from a Swedish health care analyst (Euro Health Consumer Index 2012) and opportunities for improvement are discussed. We specifically addressed methodological challenges of international health care system performance comparisons.

Na zaznavanje zdravja, ki je uveljavljen kazalnik zdravja prebivalstva, vplivajo številne družbene determinante. Države se razlikujejo na kulturnem, političnem in ekonomskem področju, zato rezultatov tujih raziskav o zaznavanju zdravja v različnih družbenih razredih ne moremo neposredno prenesti na slovenske razmere. Namen raziskave je oceniti povezanost med zaznavanjem zdravja in družbenimi razredi pri odraslih prebivalcih Slovenije. Raziskava temelji na slovenski podatkovni bazi Countrywide Integrated Non-communicable Diseases Intervention (CINDI) Health Monitor, ki jo praviloma vsako 3. leto dopolnimo z rezultati nove presečne pregledne raziskave. Leta 2008 je bilo vrnjenih 7,633 (49.0%) od 15,591 poslanih vprašalnikov. Določili smo pogostost zaznavanja zdravja kot slabo. Za določitev povezanosti med zaznavanjem zdravja kot slabo in družbenimi razredi smo uporabili logistično regresijo. Na vprašanje o zaznavanju zdravja je odgovorilo 7,302 anketirancev, od katerih jih je 701 (9.6%) svoje zdravje zaznavalo kot slabo. Opazili smo jasen padec pogostosti zaznavanja zdravja kot slabo od 34.2% v spodnjem na 3.1% v višjem srednjem/višjem družbenem razredu. V neprilagojenem modelu logistične regresije je bila povezava med zaznavanjem zdravja in družbenim razredom značilna v vseh družbenih razredih. V modelu, ki je bil prilagojen na moteče spremenljivke, so anketiranci iz spodnjega družbenega razreda v primerjavi z anketiranci iz višjega družbenega razreda šestkrat pogosteje zaznavali zdravje kot slabo (RO=6.10, 95% IZ 3.34-11.16; p

Aims Heart failure (HF) burden is displaying significant inter‐regional differences within Europe and within countries. Due to limited data focusing on regional differences, our aim was to evaluate HF hospitalizations, readmissions, and mortality burden in Slovenian statistical regions. Methods and results The Slovenian National Hospitalization Discharge Registry was searched for HF hospitalizations in patients 20 years or over in the period 2004–12. Annual sex and age‐standardized HF hospitalizations, mortality, and HF readmissions rates were calculated for Slovenia and for each Slovenian statistical region. Trends were evaluated using ANOVA. Multiple mixed effect logistic regression models, which included statistical region, admission year, sex, age, intensive care unit treatment, and co‐morbidities as a fixed effect and hospital identifier as a random effect, were calculated for mortality and readmissions. Overall, 156 859 HF hospitalizations (55 522 where HF was coded as a main diagnosis and 43 606 as first HF hospitalizations) were recorded. Annual standardized rates varied considerably between statistical regions for main (220–511) and first HF hospitalization (392–721), 30 day (12.6–27.1) and 1 year mortality (66–117), and 30 day (31–80.8) and 1 year readmission (99–24) (per 100 000 patient years in 2012). Yearly decline in HF hospitalization rates was seen for national main (3.6; 0.001) and first (8.4; 0.083) HF hospitalizations, while individual regional main and first HF hospitalization trends mostly did not reach statistical significance. No relevant differences in mortality and readmission endpoints for statistical regions were seen when adjusted for patient demographics and specific co‐morbidities. Conclusions Significant regional differences in standardized HF hospitalization, mortality, and readmissions between the regions were seen. There were no differences in mortality and readmissions between statistical regions for individual similar patients.

Due to the complexity of heart failure (HF) and its treatment process, a high level of patient and informal caregiver engagement is required for management results. We aimed to explore the views of HF patients, informal caregivers, and healthcare professionals about personal experiences, perceived needs, and barriers to optimal HF management. A qualitative study using semi-structured interviews with HF patients (n = 32), their informal caregivers (n = 21), and healthcare professionals (n = 5) was conducted in the outpatient HF clinic in Slovenia in 2018. A content analysis method was used to analyze the data. Negative emotional response to disease and its limitations (especially the inability to continue with work) and changes in family roles were the most prevalent topics regarding the impact of HF on livelihood. Among the most common barriers to HF self-care, were the difficulties in changing lifestyle, financial difficulties due to the disease, traditional cuisine/lack of knowledge regarding a healthy diet and lack of self-confidence regarding physical activity. Despite psychological and social difficulties due to HF being highlighted by patients and informal caregivers, only healthcare professionals emphasized the need to address psychosocial aspects of care in HF management. Established differences could inform the implementation of necessary support mechanisms in HF management.

Introduction Electronic cigarettes (ECs) have generated extensive discussion about their role in smoking cessation. The Slovenia National Institute of Public Health's recommendations state that ECs are not to be recommended for smoking cessation or reduction. The aim of this study was to explore how healthcare professionals working in the field of preventive healthcare and smoking cessation in Slovenia communicate with and counsel patients regarding electronic cigarettes and smoking cessation or reduction. Methods A cross-sectional, web-based survey was conducted among healthcare professionals working in the field of preventive healthcare and smoking cessation in Slovenia. A total of 479 healthcare professionals were included in the analysis. Results While a minority of participants (12.7%) do or would recommend electronic cigarettes for smoking cessation or reduction in general, a higher proportion of participants (33.1%) would recommend electronic cigarettes to specific groups of patients. Knowledge on electronic cigarettes was the key determinant of differences in recommendations. Only a minority of participants (9.1%) reported availability of workplace guidelines/recommendations regarding counselling about electronic cigarettes. Conclusions Training programmes, educational materials and existing guidelines/recommendations regarding counselling about electronic cigarette use should be provided and distributed among healthcare professionals, together with efforts to ensure compliance to official guidelines/recommendations.

Background We aimed to assess the relationship between echocardiographic characteristics and mortality in patients with chronic obstructive pulmonary disease (COPD). Methods We prospectively studied 154 patients (mean age 71 ± 10 years, 71% male) with COPD. All patients underwent transthoracic Doppler echocardiography within 48 hours of hospital admission. Primary endpoint was all-cause mortality during a median period of 22 months. Results Mildly elevated tricuspid regurgitation pressure and mitral E/e′ ratio were the most commonly encountered echocardiographic abnormalities, observed in 60% and 56% of patients, respectively. In Kaplan-Meier analysis of survival, left atrial enlargement, E/e′ ratio > 8, right atrial enlargement, right ventricular dilation, decreased tricuspid annular plane systolic excursion, decreased tricuspid annular systolic velocity, and elevated tricuspid regurgitation velocity were associated with all-cause mortality (p < 0.05 for all). In the Cox proportional hazards analysis, the mitral E/e′ ratio (hazard ratio 1.048; 95% confidence interval 1.001–1.096) remained an independent echocardiographic predictor of survival after adjustment for age, COPD severity, and other baseline echocardiographic parameters. Conclusions Among patients with COPD, an abnormal mitral E/e′ ratio was an independent echocardiographic predictor of all-cause mortality. Echocardiographic evaluation of structural and functional cardiac abnormalities provides important prognostic information and should be used routinely in the assessment of patients with COPD. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound, 2016

Heart failure (HF) is a chronic condition with many imbalances, including nutritional issues. Next to sarcopenia and cachexia which are clinically evident, micronutrient deficiency is also present in HF. It is involved in HF pathophysiology and has prognostic implications. In general, most widely known micronutrients are depleted in HF, which is associated with symptoms and adverse outcomes. Nutritional intake is important but is not the only factor reducing the micronutrient availability for bodily processes, because absorption, distribution, and patient comorbidity may play a major role. In this context, interventional studies with parenteral micronutrient supplementation provide evidence that normalization of micronutrients is associated with improvement in physical performance and quality of life. Outcome studies are underway and should be reported in the following years.

Heart failure (HF) is a rapidly growing public health problem and the leading cause of morbidity, mortality, and hospitalization in populations > 65 years. The elderly HF patients have an increased prevalence of HF with preserved ejection fraction and comorbidities, may present with atypical symptoms and signs, have a higher risk for adverse drug reactions, and worse prognosis as compared with younger patients. Moreover, there is a lack of evidence-based therapies for this population because they are underrepresented in the clinical trials. The elderly are less likely to be evaluated by a cardiologist and to be treated in accordance with recommendations of the current HF guidelines. Although the treatment is improving, it is still suboptimal; therefore, HF in elderly patients requires mobilization of public health services and improvement of treatment strategies.

Aims Heart failure (HF) hospitalization rates are decreasing in western Europe, but little is known about trends in central and east European countries. We analysed the Slovenian national hospitalization database to determine the burden of HF hospitalization. Methods and results The Slovenian National Hospital Discharge Registry was searched for HF hospitalizations between 2004 and 2012 in patients aged ≥20 years. A total of 55 531 main HF hospitalizations (43 636 first HF hospitalizations) in 34 406 patients (median age 78 years, 55% female) were recorded. The most common co-morbidities were arterial hypertension (54.3%), atrial fibrillation (40.6%), diabetes mellitus (24.5%), and ischaemic heart disease (21.9%). The number of age-standardized main and first HF hospitalizations per 100 000 population decreased from 249 to 232 (7.1%, P = 0.002) and from 467 to 435 (6.8%, P = 0.074), respectively. Crude main and first HF hospitalization rates increased from 249 to 298 (19.8%, P < 0.001) and from 530 to 558 (5.4%, P = 0.100), respectively. After a first HF hospitalization, any HF readmission rates within 30, 60, and 90 days and at 1 year were 11.7, 17.2, 20.9, and 37.5%, respectively. Hospitalization trends were similar in both sexes and across all age groups. In a multivariate log binomial regression model, myocardial infarction, chronic kidney disease, diabetes mellitus, male sex, and year of admission were independently associated with higher HF readmission rates (P < 0.01 for all). Conclusions In Slovenia, standardized HF hospitalization rates have decreased but the crude HF hospitalization burden has increased. Readmissions were associated with established cardiovascular risk factors.

Objective: The aim of this study was to review and evaluate the evidence related to psychometric properties of the European Heart Failure Self-Care Behaviour Scale (EHFScBS) that was developed and tested to measure health maintenance behaviours of heart failure (HF) patients and translated into several languages. Methods: PRISMA guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect), to identify relevant studies. A literature search was undertaken in November 2015. An integrative review, aiming to bring together all evidence relating to the psychometric properties (validity, reliability) of the EHFScBS was conducted. Results: 13 eligible studies were included. The results showed content, discriminant and convergent validity of the 9-and 12-item scale across the samples, while the factor structure of both versions of the scale was inconsistent. Most commonly used reliability estimates (Cronbachs alpha) of the total scale were satisfactory. Conclusion: Overall, published data demonstrate satisfactory psychometric properties of the EHFScBS, indicating that the scale is a reliable and valid tool for measuring health maintenance behaviours of HF patients. Practice implications: Taking the findings regarding the factorial structure of the scale into account, we recommend the use of the total EHFScBS score or scores on specific items. (C) 2017 Elsevier B.V. All rights reserved. Funding Agencies|Slovenian Research Agency [J3-7405]

Background: Self-care is an important element in the comprehensive management of patients with heart failure. The European Heart Failure Self-Care Behaviour Scale (EHFScBS) was developed and tested to measure behaviours performed by the heart failure patients to maintain life, healthy functioning, and wellbeing. Aims: The purpose of this review was to evaluate the importance of factors associated with heart failure self-care behaviours as measured by the EHFScBS. Methods: Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were used to search major health databases (PubMed, Scopus and ScienceDirect). Obtained associating factors of heart failure self-care were qualitatively synthesised and the association levels of most commonly addressed factors were further explored. Results: We identified 30 studies that were included in the review; a diverse range of personal and environmental factors associated with self-care behaviours in heart failure patients were identified. Age, health-related quality of life, gender, education, New York Heart Association class, depressive symptoms and left ventricular ejection fraction were most often correlated with the EHFScBS score. Consistent evidence for the relationship between self-care behaviours and depression was found, while their association with New York Heart Association class and health-related quality of life was non-significant in most of the studies. Associations with other factors were shown to be inconsistent or need to be further investigated as they were only addressed in single studies. Conclusion: A sufficient body of evidence is available only for a few factors related to heart failure self-care measured by the EHFScBS and indicates their limited impact on patient heart failure self-care. The study highlights the need for further exploration of relationships that would offer a more comprehensive understanding of associating factors. Funding Agencies|Slovenian Research Agency [J3-7405]

The study of atmospheric air pollution research in complex terrains is challenged by the lack of appropriate methodology supporting the analysis of the spatial relationship between phenomena affected by a multitude of factors. The key is optimal design of a meaningful approach based on small spatial units of observation. The Zasavje region, Slovenia, was chosen as study area with the main objective to investigate in practice the role of such units in a test environment. The process consisted of three steps: modelling of pollution in the atmosphere with dispersion models, transfer of the results to geographical information system software, and then moving on to final determination of the function of small spatial units. A methodology capable of designing useful units for atmospheric air pollution research in highly complex terrains was created, and the results were deemed useful in offering starting points for further research in the field of geospatial health.

Aim: The aim of our study was to assess the temporal association between the number of consultations in the primary health care unit due to respiratory diseases in children and the level of particular matter of 10 micrometres in diameter (PM10) pollution in the Zasavje region. Methods: A time-trend ecological study was carried out for the period between 1 January 2006 and 31 December 2011. The daily number of first consultations for respiratory diseases among children in the Zasavje region was observed as the outcome. Poisson regression analysis was used to investigate the association between the observed outcome and the daily PM10 concentrations, adjusted to other covariates. Results: The results showed that the daily number of first consultations were highly significantly associated with the daily concentrations of PM10 in the Zagorje (p Conclusions: It can be concluded that evidence of association between the daily PM10 concentration and the daily number of first consultations for respiratory diseases among children exists, indicating that there is still a need for public health activities in the sense of reduction of harmful environmental factors in the region. Additionally, on the basis of these results, it can be assumed that with some improvements linkage of existing health and environmental data in Slovenia in general could be feasible in identifying a grounded need for future public health action.

Perception of healthy body size and composition differs considerably across the globe, ethnic groups, cultures, and even inside medical community. Although the concept of ideal body weight has evolved over the past decades, the observation that weight loss can have more deleterious effects within a short-term period than weight gain has remained rather consistent. Weight loss, as a prelude to cachexia, occurs frequently in a variety of disease states and meets the requirements of a global public health problem. Consequently, interventions to prevent and control chronic diseases require a comprehensive approach that targets a population as a whole and includes both prevention and treatment strategies. Around the globe, cachexia awareness campaigns and expanding the current public health priorities to highlight the cachexia magnitude and areas of interventions is necessary. Simultaneously, scientific efforts should provide us with more reliable estimates of body wasting and cachexia as well as pathophysiology of cachexia-associated death. As certain proportion of patients will, irrespective of preventive measures, eventually develop cachexia, a quest for effective remedy remains vital. © 2013 Springer-Verlag Berlin Heidelberg.

The aim of this study was to estimate the population burden of respiratory diseases in the Zasavje region of Slovenia that can be attributed to outdoor air pollution in order to gain relevant grounds for evidencebased public health activities. In 2008, 981 schoolchildren (age 6 to 12 years) were observed in a prevalence study. The prevalence of chronic respiratory diseases (CRD) and frequent acute respiratory symptoms (FARS) was related to the level of outdoor air pollution in the local environment (low, moderate and high pollution areas). Logistic regression was used as a method for statistical analysis. The prevalence of CRD was 3.0 % in low pollution areas, 7.5 % in moderate pollution areas, and 9.7 % in high pollution areas (p=0.005). After adjustment for the effects of confounders, 2.91-times higher odds for CRD were registered in high pollution areas in comparison to low pollution areas (p=0.017). The prevalence of FARS was: 7.8 % in low pollution areas, 13.3 % in moderate pollution areas and 15.9 % in high pollution areas (p=0.010). After adjustment for the effects of confounders, 2.02-times higher odds for FARS were registered in high pollution areas in comparison to low pollution areas (p=0.023). The study confirmed a significantly higher prevalence of CRD and FARS in children living in high pollution areas of Zasavje. These results at least partially prompted mutual understanding and cross-sectoral cooperation - prerequisites for solving complex problems involving the impact of air pollution on health.

Self-rated health (SRH) predicts outcome in patients with heart failure. Beta-blockers are known to improve health-related quality of life and reduce mortality in such patients. We aimed to evaluate the relation between SRH and adverse events during titration of beta-blockers in elderly patients with heart failure.The cardiac insufficiency bisoprolol study in the elderly (CIBIS-ELD) is a multicentre, double-blind trial, in which 883 patients aged ≥ 65 years with chronic heart failure (73 ± 6 years, 38% women, left ventricular ejection fraction [LVEF] 42% ± 14%) were randomised to bisoprolol or carvedilol. SRH was assessed at baseline and after 12 weeks, using a 5-grade descriptive scale: excellent, very good, good, fair, and poor.Median SRH at baseline and follow-up was good, but more patients reported fair/poor SRH at baseline (36% vs. 30%, p = 0.012). Women, beta-blocker-naïve patients, patients in NYHA class III/IV and those with PHQ-9 score ≥ 12 were more likely to report fair/poor baseline SRH (p0.001 for all). During follow-up, SRH improved in 34% of patients and worsened in 8% (p0.001). Adverse events were experienced by 64% patients and 38% experienced1 adverse event or serious adverse event, with higher prevalence in lower SRH categories. In a multivariate logistic regression model, SRH, age, distance achieved on the 6-min walk test and LVEF45% predicted adverse events (p0.05 for all).SRH is an independent predictor of adverse events during titration of beta-blockers and correlates with the proportion and number of adverse events per patient.

Background. Poor nutritional status and weight loss are associated with poor survival in patients with COPD. Surprisingly, only limited information is available in hospitalized patients. Aim. We evaluated relations between nutritional status, weight changes, nutritional intake, and all-cause mortality in hospitalized patients with COPD. Methods. The NutritionDay initiative is an ongoing multinational registry in 56 countries that collects a wealth of data, including weight trajectory and nutritional indices: body mass index (BMI), body weight changes within last 3 months, nutritional intake during last week and on the survey day. We have linked this information with all-cause in-hospital mortality. Results. 5518 patients with COPD (73±12 years, 56% men, BMI of 26.0±6.7 kg/m 2 ); 10% had BMI 40). Weight loss within the last 3 months was self-reported by 50% of patients. During the last week, 31% reported to eat less than half of what they normally eat; on the survey day, 52% ate half or less of their lunch/dinner. 30-day in-hospital mortality was 5%. Mortality was lowest in patients with normal food intake on survey day (2.3%) and during the week prior to the survey day (2.3%); if patients ate less than half, mortality increased to 12.4% and 9.2%, respectively (p Conclusions. Low BMI, weight loss and inadequate food intake are common in hospitalized patients with COPD and are associated with increased all-cause in-hospital mortality.

We aimed to assess the relationship between echocardiographic characteristics and mortality in patients with chronic obstructive pulmonary disease (COPD).We prospectively studied 154 patients (mean age 71 ± 10 years, 71% male) with COPD. All patients underwent transthoracic Doppler echocardiography within 48 hours of hospital admission. Primary endpoint was all-cause mortality during a median period of 22 months.Mildly elevated tricuspid regurgitation pressure and mitral E/e' ratio were the most commonly encountered echocardiographic abnormalities, observed in 60% and 56% of patients, respectively. In Kaplan-Meier analysis of survival, left atrial enlargement, E/e' ratio8, right atrial enlargement, right ventricular dilation, decreased tricuspid annular plane systolic excursion, decreased tricuspid annular systolic velocity, and elevated tricuspid regurgitation velocity were associated with all-cause mortality (p0.05 for all). In the Cox proportional hazards analysis, the mitral E/e' ratio (hazard ratio 1.048; 95% confidence interval 1.001-1.096) remained an independent echocardiographic predictor of survival after adjustment for age, COPD severity, and other baseline echocardiographic parameters.Among patients with COPD, an abnormal mitral E/e' ratio was an independent echocardiographic predictor of all-cause mortality. Echocardiographic evaluation of structural and functional cardiac abnormalities provides important prognostic information and should be used routinely in the assessment of patients with COPD. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:211-221, 2017.

Purpose In chronic obstructive pulmonary disease (COPD), cardiovascular system is involved but less is known about role of specific cardiac biomarkers. We aimed to investigate associations between N-terminal pro B-type natriuretic peptide (NT-proBNP) and troponin T during hospitalisation with 6-month outcome. Methods This was a prospective study conducted in consecutive patients hospitalized for an acute exacerbation of COPD. On admission, and at discharge, NT-proBNP and troponin T were measured, and echocardiography was performed. Hospitalisations and mortality were recorded for 6months after discharge. Results We included 127 patients (70±10years, 70% men, GOLD III/IV 87%). Left ventricular dysfunction was detected in 70 (55%) patients and diastolic dysfunction was the most common type (53 patients–42%). NT-proBNP and troponin T were elevated on admission in 60% and 36%, and at discharge in 28% and 19% of patients. During follow-up, 53 (42%) patients were hospitalized and 17 (13%) patients died. In Kaplan Meier analysis of survival curves, NT-proBNP on admission distinguished between deceased and surviving patients (p=0.011) whilst troponin T at discharge separated hospitalized and non-hospitalized patients (p=0.017). The adjusted Cox proportional hazard model confirmed these findings: discharge troponin T predicted hospitalisations (hazard ratio 2.89, 95% confidence interval 1.13–7.36) and admission NT-proBNP predicted mortality (hazard ratio 4.20, 95% confidence interval 1.07–14.01). Conclusions Elevated NT-proBNP at discharge and troponin T on admission predict outcome in patients hospitalized for an acute exacerbation of COPD.

Summary Background Chronic obstructive pulmonary disease (COPD) follows a slowly progressive natural course that can be accelerated by acute exacerbations, which frequently trigger admissions to hospital. Specific healthcare professional profiles such as that of discharge coordinator have been successful in reducing numbers of hospitalizations and need for medical care in patients with various chronic diseases, but data for COPD are sparse and inconclusive. This study was conceived to test whether coordinated discharge and post-discharge care could reduce re-hospitalizations and use of resources in patients with COPD. Methods/Design This ongoing single-center randomized controlled clinical trial, which began in November 2009, is enrolling COPD patients in Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages II IV, hospitalized because of acute exacerbation. Patients are randomized in a 1:1 fashion to the intervention group, which has care organized by a discharge coordinator, and a control group receiving the usual care. The primary endpoint of the study is the number of patients hospitalized because of worsening of COPD. Data are collected at baseline, at the time of hospital discharge, and at the following time-points after discharge: 48 hours, 7 10 days, 30 days, 90 days, and 180 days. Discussion In COPD patients requiring hospital admission, coordinated discharge appears a feasible option for improving patient and healthcare system-related outcomes. This study will provide evidence on the effectiveness of a discharge coordinator in patients hospitalized because of acute exacerbation of COPD and may give relevant guidance for implementation in clinical practice. Clinical trial registration number: NCT01225627

Background: Self-rated health predicts outcome in chronic disease, but such information is scarce in COPD. We aimed to assess self-rated health as an outcome predictor in carefully characterized patients with this condition. Methods: This was a prospective study in 127 clinically stable patients with COPD (64 6 8 years, 79% men, 82% Global Initiative for Chronic Obstructive Lung Disease stage II or III). Self-rated health was assessed using a 5-grade Likert scale ranging from very poor to very good. Results: During 26.0 6 4.9 months of follow-up, 78 patients experienced acute exacerbation, 39 were hospitalized, and 10 died. Poor or very poor self-rated health was reported by 19 patients (15%) and was more common in patients experiencing acute exacerbations (20% vs 6%, P 5 .027) and hospitalizations (19% vs 5%, P 5 .039). Kaplan-Meier curves demonstrated more acute exacerbations ( P 5 .003) and hospitalizations (P 5 .008) in patients with poor or very poor self-rated health. In a fully adjusted Cox model of proportional hazard, poor or very poor self-rated health remained predictive of acute exacerbations (hazard ratio [HR], 1.80; 95% CI, 1.03-3.11) and hospitalizations (HR, 1.93; 95% CI, 1.12-3.68) but not of death. Conclusions: This study suggests that self-rated health is predictive of acute exacerbations and hospitalizations. Although prediction of mortality was limited, the study is supportive of self-rated health testing in COPD.

BACKGROUND: Data on self-rated health (SRH) in patients with chronic obstructive pulmonary disease (COPD) are very limited; we therefore initiated this study to investigate the distribution of SRH and association with established parameters of disease severity. PATIENTS AND METHODS: We included 135 clinically stable patients with COPD (64 ± 8 years, 71% men, GOLD stage: II –59; III –55; IV –21) and 25 healthy control persons. SRH was evaluated using the 5-grade Likert scale (1-very poor to 5-very good). RESULTS: Patients with COPD had poorer SRH when compared with controls (3.0 ± 0.7 vs. 3.8 ± 0.6, P < 0.001). SRH decreased over GOLD stage (P = 0.016) and 27 (20%) patients reported poor or very poor SRH. In univariate analysis, GOLD stage (P = 0.022), Center for Epidemiologic Studies Depression (CES-D) score (P = 0.001), BODE index score (P < 0.001), score on the modified Medical Research Council (MMRC) dyspnea scale (P < 0.001) and 6-minute walk test (6MWT) distance (P < 0.001) determined poor or very poor SRH. In a multivariate model which included BODE index score, a CES-D score ≥ 16 (P = 0.013) and BODE index score (P = 0.012) determined poor or very poor SRH. In the model with individual components of the BODE index, a CES-D score ≥ 16 (P = 0.012), MMRC score of 3 or 4 (P = 0.019) and 6MWT distance ≤ 249 m (P = 0.019) determined poor or very poor SRH. CONCLUSION: In patients with COPD, SRH is worse than in healthy control persons and deteriorates over GOLD stage. Perception of health as poor or very poor is associated with psychological components (CES-D score) and disease severity (BODE index score, 6MWT distance and MMRC dyspnea score).

Diagnosing heart failure with preserved ejection fraction (HFpEF) in patients with chronic obstructive pulmonary disease (COPD) is difficult due to overlapping pathophysiological pathways, risk factors and clinical presentations. We investigated the prevalence and prognostic implications of coexisting HFpEF in patients hospitalized for acute exacerbation of COPD. A total of 116 consecutive patients with an acute exacerbation of COPD were evaluated for HFpEF and followed for an average period of 22 ± 9 months for the occurrence of death from any cause. HFpEF was diagnosed in 22 (19 %) patients with COPD, who were older, and also had higher LV mass, left atrial size, and mitral E/Ea ratio than those without HFpEF (p

At certain points during lifetime one needs to take a break and anniversaries seem to be made for that. This is chance for a thoughtful look back, to separate the grain from the chaff, and maybe to reconcile with the spirits of the past; all this to get the things done better in the future. Already at its foundation, Sanatorium for tuberculosis Golnik, nowadays University Clinic of Respiratory and Allergic Diseases Golnik, was sized for whole country and even beyond; the heritage still to follow in current days. The visionary way was felt at that time as addressing public health problems was in-house doctrine. This has translated to a long history of acknowledging the importance of not only up-to-date diagnostic and therapeutic service but also of preventive approach. In ancient Greece, these two approaches were epitomized by the daughters of Aesculapius, Panacea and Hygieia, goddess of healing and of health. 1 It is therefore not a mere chance that Aesculapius’

Background In the general population, poor self-rated health (SRH) is associated with malnutrition; however,these associations have not been studied in hospitalized patients. We aimed to evaluate SRH, indicators ofnutrition, nutritional status and their association with in-hospital mortality.Materials and methods The study is based on data from the nutritionDay, a multinational, multicentre Euro-pean-wide standardized 1-day cross-sectional survey of nutritional factors, food intake and in-hospital mortalityin hospitalized patients. A data set of surveys on SRH in 2010 and 2011 was used in the analysis.Results Complete sets of data were available for 28 106 patients (64 18 years, 50% men, 7% terminally ill).In relation to body mass index, 7% were undernourished and 16% were obese. Fair/poor SRH was reported by59% of patients and was associated with low food intake during the previous week or on survey day(P < 0 005). Thirty-day in-hospital mortality was 3%; in adjusted multivariate survival analysis, fair/poor SRH[hazard ratio (HR) 1 53, 95% confidence interval (CI) 1 14–2 05] and reduced food intake [nothing eaten (HR2 13, 95% CI 1 46–3 11) or not allowed to eat on nutritionDay (HR 2 01, 95% CI 1 30–3 11)] predicted fataloutcome. At particularly high risk were patients who rated their health poor and had reduced food intake on thesurvey day or within the previous week with relative risks of 7 37 and 8 80, respectively.Conclusions We demonstrated high prevalence of poor SRH and insufficient food intake in hospitalizedpatients. This was associated, particularly in combination, with increased risk of in-hospital mortality.Keywords Cross-sectional survey, mortality, nutritional intake, self-rated health.Eur J Clin Invest 2014; 44 (9): 813–824

Predictors of return to work after an acute myocardial infarction (AMI) are not fully established. In multivariate analysis adjusted for sex, age and type of intervention, only doctor's advice remained associated with return to work (HR 47.6, 95% CI 4.7–500). This suggests that doctor's advice is a comprehensive integration of patient interview, clinical examination, evidence based medicine and clinical experience, and thus the key predictor of return to work after AMI.

Objectives To test whether coordination of discharge from hospital reduces hospitalizations in patients with chronic obstructive pulmonary disease (COPD). Design Randomized controlled clinical trial. Setting Specialized pulmonary hospital. Participants Patients hospitalized for an acute exacerbation of COPD. Intervention Care as usual included routine patient education, supervised inhaler use, respiratory physiotherapy, and disease-related communication. The discharge coordinator intervention added assessment of patient situation and homecare needs. Patients and caregivers were actively involved and empowered in the discharge planning process, which was communicated with community medical professionals to provide continuity of care at home. Measurements The primary end-point of the study was the number of patients hospitalized because of worsening COPD. Key secondary end-points were time-to-COPD hospitalization, all-cause mortality, all-cause hospitalization, days alive and out of hospital, and health-related quality of life. Results Of 253 eligible patients (71 ± 9 years, 72% men, 87% GOLD III/IV), 118 were assigned to intervention and 135 to usual care. During a follow-up of 180 days, fewer patients receiving intervention were hospitalized for COPD (14% versus 31%, P = .002) or for any cause (31% versus 44%, P = .033). In time-to-event analysis, intervention was associated with lower rates of COPD hospitalizations (P = .001). A Cox model of proportional hazards, adjusted for sex, age, GOLD stage, heart failure, malignant disease, and long-term oxygen treatment, demonstrated that intervention reduced the risk of COPD hospitalization (hazard ratio 0.43, 95% confidence interval 0.24–0.77, P = .002). Conclusion Among patients hospitalized for acute COPD exacerbation, discharge coordinator intervention reduced both COPD hospitalizations and all-cause hospitalizations.

The aim of this study was to estimate the population burden of respiratory diseases in the Zasavje region of Slovenia that can be attributed to outdoor air pollution in order to gain relevant grounds for evidence-based public health activities. In 2008, 981 schoolchildren (age 6 to 12 years) were observed in a prevalence study. The prevalence of chronic respiratory diseases (CRD) and frequent acute respiratory symptoms (FARS) was related to the level of outdoor air pollution in the local environment (low, moderate and high pollution areas). Logistic regression was used as a method for statistical analysis. The prevalence of CRD was 3.0 % in low pollution areas, 7.5 % in moderate pollution areas, and 9.7 % in high pollution areas (p=0.005). After adjustment for the effects of confounders, 2.91-times higher odds for CRD were registered in high pollution areas in comparison to low pollution areas (p=0.017). The prevalence of FARS was: 7.8 % in low pollution areas, 13.3 % in moderate pollution areas and 15.9 % in high pollution areas (p=0.010). After adjustment for the effects of confounders, 2.02-times higher odds for FARS were registered in high pollution areas in comparison to low pollution areas (p=0.023). The study confirmed a significantly higher prevalence of CRD and FARS in children living in high pollution areas of Zasavje. These results at least partially prompted mutual understanding and cross-sectoral cooperation - prerequisites for solving complex problems involving the impact of air pollution on health., Namen raziskave je bilo oceniti breme bolezni dihal v Zasavju v Sloveniji, ki ga je mogoče pripisati onesnaženosti zunanjega zraka, da bi dobili ustrezno podlago za z dokazi podprte javnozdravstvene aktivnosti. Podatke smo zbrali v presečni raziskavi v začetku leta 2008 pri 981 otrocih, starih 6 do 12 let. Opazovali smo povezanost med prevalenco kroničnih bolezni dihal (KBD) in pogostih akutnih respiratornih simptomov (PARS) ter stopnjo onesnaženosti zunanjega zraka na območju stalnega prebivališča otrok (nizko, srednje in visoko onesnaženo območje). Podatke smo analizirali z metodo logistične regresije. Prevalenca KBD je bila: 3,0 % na območju z nizko, 7,5 % na območju s srednjo in 9,7 % na območju z visoko stopnjo onesnaženosti (p=0,005). Po upoštevanju motečih dejavnikov je bilo razmerje obetov med nizko in visoko onesnaženima območjema 2,91 v korist slednjega (p=0,017). Prevalenca PARS je bila: 7,8 % na območju z nizko, 13,3 % na območju s srednjo in 15,9 % na območju z visoko stopnjo onesnaženosti (p=0,010). Po upoštevanju motečih dejavnikov je bilo razmerje obetov med nizko in visoko onesnaženima območjema 2,02 v korist slednjega (p=0,023). Rezultati raziskave so tako potrdili značilno višjo prevalenco KBD in PARS pri otrocih, ki živijo na območjih Zasavja, ki so ocenjena kot visoko onesnažena. Ti rezultati so vsaj deloma sprožili medsektorsko razumevanje in sodelovanje, ki je zelo potrebno pri reševanju kompleksnih problemov vplivov onesnaženega zraka na zdravje.

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Aims In patients with chronic heart failure (CHF), there is limited information on self-rated health (SRH). We aimed to examine the distribution of SRH and whether SRH is associated with mortality in patients with stable CHF. Methods and results We enrolled 100 patients (71 ± 11 years, 54% men, left ventricular ejection fraction 47 ± 11%) in a prospective study with 48 months of follow-up. Self-rated health was assessed using a seven-grade descriptive scale: very good, good, quite good, average, quite poor, poor, and very poor. Median SRH was quite poor and the most frequent SRH (31 patients) was average. During an average follow-up of 1005 ± 507 days, 58 patients died. More patients in the group that rated their health as quite poor or worse died (70% vs. 43%, P = 0.008). In a Cox proportional hazard model, SRH as a seven-grade descriptive scale [hazard ratios (HR) 1.39, 95% CI 1.10–1.74] or as a median value (HR 2.13, 95% CI 1.23–3.69) predicted mortality. The association remained significant after adjustment for patient characteristics and biomarkers (P < 0.05 for both). Conclusion In patients with stable CHF, SRH independently predicts mortality. This suggests that SRH could be used in everyday clinical practice to obtain important prognostic information beyond clinical examination and laboratory work-up.

Self-rated health can be influenced by several characteristics of the social environment. The aim of this study was to evaluate the relationship between self-rated health and self-assessed social class in Slovenian adult population.The study was based on the Countrywide Integrated Non-communicable Diseases Intervention Health Monitor database. During 2004, 8,741/15,297 (57.1%) participants aged 25-64 years returned posted self-administered questionnaire. Logistic regression was used to determine unadjusted and adjusted estimates of association between poor self-rated health and self-assessed social class.Poor self-rated health was reported by 9.6% of participants with a decrease from lower to upper-middle/upper self-assessed social class (35.9 vs. 3.7%). Logistic regression showed significant association between self-rated health and all self-assessed social classes. In an adjusted model, poor self-rated health remained associated with self-assessed social class (odds ratio for lower vs. upper-middle/upper self-assessed social class 4.23, 95% confidence interval 2.46-7.25; P0.001).Our study confirmed differences in the prevalence of poor self-rated health across self-assessed social classes. Participants from lower self-assessed social class reported poor self-rated health most often and should comprise the focus of multisectoral interventions.

Patient's knowledge about the chronic condition is an important issue of successful patient management. Although it can be dependent upon individuals educational level, this should not determinate our effort in terms of patient education and self-management strategies. Whenever possible, we have to include patient caregivers to optimize implementation of key management strategies.

Beta blockers are underused and underprescribed in patients with chronic heart failure. This may be due to poor patient knowledge about their condition, pharmacological treatment and self-care management in case of deterioration. Nurse specialist has a decisive role in implementation of evidence based management which can have effects beyond patient care.