Did past economic prosperity affect the health related quality of life predictors? A longitudinal study on a representative sample of Slovenian family medicine patients.

BACKGROUND: Health related quality of life (HRQOL) as an important measure of medical outcomes has been shown to be associated with demographic factors and the most common mental and chronic somatic diseases. This study's aim was to identify factors predicting changes in HRQOL over a follow-up period in a representative sample of Slovenian family medicine patients. METHODS: In a longitudinal multi-centred study between 2003 and 2005, data were collected from 1118 consecutive attendees from 60 family medicine practices in Slovenia on quality of life, socio-demographic factors and the presence of mental disorders, with follow-up after 6 and 24 months. Retrospective information on chronic diseases was obtained from patients` health records. In three time-sequential multiple linear regression models, data on 601 patients (53.8%) was analysed to determine factors associated with each component score of quality of life. RESULTS: At baseline the patients were 48.58 (SE = 0.58) years of age, over half were women (386 (64.2%)) and most were Slovenian (548 (91.2%)). Quality of life was seen to improve over the two-year period. Factors significantly and consistently associated with a better mental component score of quality of life were social support, satisfactory circumstances in patients` household and absence of anxiety. Major life events in the past year and depression were shown to be risk factors for mental and physical components, while level of education, absence of long-term disability and chronic pain were identified as predictors of the physical component. CONCLUSIONS: Detection and successful treatment of depression and anxiety has a potential to lead to improved quality of life in family medicine attendees; family physicians should be alert for the early onset of these conditions, knowing that symptoms of chronic pain, depression and anxiety often overlap in patients. Poorly educated patients and those lacking social support and/or satisfactory household circumstances should be recognised and empowered, and appropriate coping mechanisms should be introduced.

Attitudes toward professionalism in medical students and its associations with personal characteristics and values: a national multicentre study from Slovenia raising the question of the need to rethink professionalism.

Background: Professionalism is becoming one of the main competencies that all medical students should develop during their education. The attitudes of medical students to professionalism in the study process can change, depending on the curriculum and methods of teaching. Factors associated with attitudes to professionalism can be divided into the characteristics of the physician and the context, eg, education about professionalism and the health system; however other student characteristics are also important. This study focused on the factors associated with attitudes toward professionalism and took into account student demographic characteristics, personality and their personal values. Methods: A convenience sampling method was employed in the academic year 2015-2016 in the fourth and final year medical students at the two Medical Faculties in Slovenia. The instrument consisted of questionnaires examining the Big Five personality traits questionairre (BFQ), the scale of personal values and demographic and family background data. The outcome measure was the validated professionalism attitude scale (PAS). Results: A total of 323 students participated, of which 101 (31.3%) were men and 222 (68.7%) were women. The samples of the two faculties did not differ in any demographic characteristics and were analyzed together. Of the personal values, partner/love, profession/work and sport activity were significantly associated with the total score of the PAS (ß=0.22, p=0.033; ß=0.24, p=0.003; ß=0.17, p=0.040, respectively). After the adjustments for the BFQ dimensions, only profession/work kept significance (ß=0.19, p=0.016). Women scored significantly higher on attitudes toward professionalism (total PAS score: Mw=93.4±5.1, Mm=89.1±9.8, p=0.001), and this significance remained in multivariate modeling (ß=-0.20, p=0.001). Of the hereditary traits, only acceptability was associated with attitudes toward professionalism (ß=0.25, p<0.001). Conclusions: It seems that personal characteristics and values are important in students` concept of their future professional behavior. Further research will show whether these patterns are prerequisites for enrollment in the study process.

Quality of life in patients with depression, panic syndrome, other anxiety syndrome, alcoholism and chronic somatic diseases: a longitudinal study in Slovenian primary care patients.

AIM: To analyse the correlates between the quality of life and chronic diseases and socio-demographic characteristics of patients in family medicine with a special emphasis on depression, panic syndrome, other anxiety syndrome and alcoholism. METHODS: In a longitudinal study, the data set of 516 family practice attendees recruited from 60 family practices was analysed. Depression, panic syndrome, other anxiety syndrome and alcoholism were diagnosed using appropriate diagnostic interviews. Quality of life was assessed using the SF-12 questionnaire, measuring a mental health score and a physical health score. Data about the number of chronic somatic diseases were obtained from the patients' medical records. RESULTS: Physical health score was negatively associated with higher age (ß = -0.25, p < 0.001), depression (ß = -0.20, p < 0.001) and number of chronic somatic diseases (ß = -0.10, p < 0.016) and positively associated with higher education level (ß = 0.21, p < 0.001), single marital status (ß = 0.09, p < 0.022) and better financial status (ß = 0.14, p < 0.001). Linear regression explained 31.8 % of the variance (R(2) = 0.318; p < 0.001). Similarly, mental health score was negatively associated with depression (ß = -0.45, p < 0.001) and panic syndrome (ß = -0.07, p < 0.001) and positively associated with male gender (ß = 0.10, p < 0.015) and better financial status (ß = 0.13, p < 0.001). Linear regression explained 45.5 % of the variance (R (2) = 0.455; p < 0.001). CONCLUSIONS: In family medicine, special attention should be directed to major depression, panic syndrome and number of chronic somatic diseases as they are associated with poorer quality of life.

The pattern of physical comorbidity and the psychosocial determinants of depression: a prospective cohort study on a representative sample of family practice attendees in Slovenia.

Objectives This study aims to present the patterns of physical comorbidity in depressed patients and factors strongly associated with depression in a representative sample of Slovenian family practice attendees.Methods Medical data was obtained for 911 general practice attendees. Of them, 221 (24.3%) were diagnosed as depressed. The depressive states of the subjects were evaluated using the Composite International Diagnostic Interview (CIDI). Physical comorbidity was assessed with a questionnaire covering the most common health problems in the Slovenian adult population. Several psycho-social factors were also analysed.Results Those variables significantly related to ICD depression were included in multivariate binary logistic regression analysis, adjusted by age, gender and education. The calculation included the chi-square, odds ratio (OR) with confidence interval (95% CI) and P-value. A P-value < 0.05 was marked as statistically significant.Conclusions There was no significant difference in the number of concurrent chronic diseases in depressed and non-depressed subjects. The risk of depression was increased by the presence of several concomitant factors. The burden of somatic co-morbidity was shown to be smaller than the impact of psychosocial determinants, which also acted as protective factors: the feeling of safety at home and the absence of problems in intimate relationships. The abuse of alcohol and drugs by a family member and current poor financial situation were strongly associated with depression. The impact of concurrent incontinence and chronic bowel disease was also important, though somewhat weaker.