Prevalance of and risk factors for hospital-acquired infections in Slovenia-results of the first national survey, 2001.

A one-day survey was conducted in all (19) Slovenian acute-care hospitals in October 2001 to estimate the prevalence of all types of hospital-acquired infections (HAIs) and to identify predominant micro-organisms and risk factors. Among 6695 patients surveyed, the prevalence of patients with at least one HAI was 4.6%. The prevalence of urinary tract infections was highest (1.2%), followed by pneumonia (1.0%), surgical wound infection (0.7%), and bloodstream infection (0.3%). In intensive care units (ICUs) the prevalence of patients with at least one HAI was 26.9% and the ratio of episodes of HAI per number of patients was 33.3%. One or more pathogens were identified in 55.8% of HAIs episodes. Among these, the most frequently single isolated micro-organisms were Staphylococcus aureus (18.2%) and Escherichia coli (10.2%). Risk factors for HAI included central intravascular catheter (adjusted odds ratio (OR) 3.2; 95% confidence intervals (CI) 2.1-4.9), peripheral intravascular catheter (adjusted OR 1.7; 95% CI 1.2-2.4), urinary catheter (adjuster OR 2.4; 95% CI 1.6-3.4), and hospitalization in ICUs (adjusted OR 2.5; 95% CI 1.4-4.3). The results provide the first national estimates for Slovenia.

Time series analysis of births of children with orofacial clefts.

Observation of the dates when children with orofacial clefts were born, gives the impression that they were born in clusters, between which there were intervals of different duration. An analysis was therefore undertaken of the period between 1972 to 1997 when 1112 such children were born. For diagnostic checking of stationarity of the time series the Box-Ljung test was used. Since it was found that the time series was stationary, analysis of autocorrelation function was performed. The results confirmed the impression that children with clefts are born in clusters, between which there are gaps of different duration. This suggests that the birth of a child with a cleft is not a random and independent event.

Anxiety and depression during hospital treatment of exacerbation of chronic obstructive pulmonary disease.

This study investigated the prevalence, risk factors and rate of recognition of anxiety and depression in 50 patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). Using the Primary Care Evaluation of Mental Disorders questionnaire, 13 patients were identified as having depression, four had anxiety and eight had a combination of the two. Patients with anxiety and/or depression had a significantly higher partial pressure of oxygen and pH, and a lower partial pressure of carbon dioxide, in arterial blood on admission, more severe dyspnoea after a 6-min walk test and less improvement of dyspnoea from admission to discharge than COPD patients without anxiety and/or depression. Two patients were referred to a mental health specialist during their hospitalization, indicating a low rate of recognition. The results suggest that patients with mental disorders are referred and admitted to hospital earlier in the course of a COPD exacerbation due to earlier and more intense perception of dyspnoea.

Frequent attenders in general practice: quality of life, patient satisfaction, use of medical services and GP characteristics.

OBJECTIVE: To determine the predictors of frequent attendance in general practice. DESIGN: A postal survey using a questionnaire including instruments for measuring patient satisfaction (EUROPEP), quality of life (EUROQOL), anxiety and depression (DUKE-AD). SETTING: Primary health care in Slovenia. PATIENTS: A representative sample of 2160 adult patients. MAIN OUTCOME MEASURES: Number of contacts with the health care services, levels of self-care, patient satisfaction scores, quality of life scores, well-being scores, presence of chronic condition. RESULTS: Frequent attenders were more likely to have lower educational status, were more satisfied with their GP, had higher scores of anxiety and depression, and lower perceived quality of life. They were more likely to have a chronic disease. Frequent attenders were less likely to try self-care and more likely to use health services. They were more likely to visit more experienced GPs, GPs working a greater distance from other GPs and GPs who did not use the appointment system. The multivariable modelling explained 19.7% of the variation; 16.9% was attributed to patient characteristics and 3.1% to GP characteristics. CONCLUSIONS: The study confirmed that lower education levels, chronicity and higher use of other health services are predictors of higher attendance.

Private practice in Slovenia after the health care reform.

BACKGROUND: Slovenia is one of the many post-socialist countries which started its reorientation of the health care system in the early 1990s. One of the aspects of the reform was the introduction of independent practice, which is performed either as a purely private practice on the basis of out of pocket payment or through contract with the National Health Insurance. A combination of both is also possible. In 1992 and 1993 the first physicians started to work in that way. The physicians that took this opportunity belonged to three main groups: dentists, primary health care physicians and secondary care specialists. The groups differ regarding their style of work and possibilities for running a profitable service. No studies have been done to evaluate the success of their decision. OBJECTIVES: The aim of the study was to evaluate the motives for leaving salaried posts, practice organization, perceived improvements and satisfaction with their choice of the practitioners who started to work independently in Slovenia in 1992 and 1993. METHODS: An anonymous questionnaire was sent to all self-employed physicians that started their independent practice in 1992 and 1993. A 54.5% response rate was achieved. The analysis of non-responders has shown that they did not differ significantly according to sex, location of practice, speciality or method of payment, from the responders. RESULTS: The analysis shows that the reported reasons for choosing independent practice are not different across the groups. Possibility for greater income was not reported as a major reason for leaving public service. There are important differences in organization of work: general practitioners reported spending more time on patient contacts and administration than the other two groups; they also work exclusively for the National Health Insurance, which is not the case for the other two groups. The perceived areas of improvement differ substantially. Regardless, the overall satisfaction with their choice is high (over 90% would make the same decision again), the general practitioners are the most dissatisfied group. CONCLUSIONS: The analysis shows that self-employed physicians in Slovenia represent three different groups with different positions regarding how they earn their money. Their expectations have largely been met, since they claim that the doctor/patient relationship is better, as well as some conditions for the patients. A follow-up study that would take into account the long-term effects of privatization, and analysis of economic functioning and patient satisfaction would be necessary in order to verify these claims.