Efficient SARS-CoV-2 variant detection and monitoring with Spike Screen next-generation sequencing.

The emergence and rapid spread of SARS-CoV-2 prompted the global community to identify innovative approaches to diagnose infection and sequence the viral genome because at several points in the pandemic positive case numbers exceeded the laboratory capacity to characterize sufficient samples to adequately respond to the spread of emerging variants. From week 10, 2020, to week 13, 2023, Slovenian routine complete genome sequencing (CGS) surveillance network yielded 41 537 complete genomes and revealed a typical molecular epidemiology with early lineages gradually being replaced by Alpha, Delta, and finally Omicron. We developed a targeted next-generation sequencing based variant surveillance strategy dubbed Spike Screen through sample pooling and selective SARS-CoV-2 spike gene amplification in conjunction with CGS of individual cases to increase throughput and cost-effectiveness. Spike Screen identifies variant of concern (VOC) and variant of interest (VOI) signature mutations, analyses their frequencies in sample pools, and calculates the number of VOCs/VOIs at the population level. The strategy was successfully applied for detection of specific VOC/VOI mutations prior to their confirmation by CGS. Spike Screen complemented CGS efforts with an additional 22 897 samples sequenced in two time periods: between week 42, 2020, and week 24, 2021, and between week 37, 2021, and week 2, 2022. The results showed that Spike Screen can be applied to monitor VOC/VOI mutations among large volumes of samples in settings with limited sequencing capacity through reliable and rapid detection of novel variants at the population level and can serve as a basis for public health policy planning.

Well-being of family physicians during COVID-19 pandemic in Slovenia.

BACKGROUND: During the COVID-19 pandemic, family physicians (FPs) served as the the initial point of contact for patients potentially infected with the virus, necessitating frequent updates to treatment protocols. However, practices also faced organizational challenges in providing care to other patients who also needed their medical attention. The pressure on FPs increased and affected their well-being. The international PRICOV-19 study, titled "Primary care in times of COVID-19 pandemic," investigated how FPs functioned during the COVID-19 pandemic. This article examines the correlation between various organizational and structural COVID-19-related variables and the well-being of FPs in Slovenia. METHODS: Between October 2020 and January 2021, we conducted an online cross-sectional survey. The questionnaire was distributed to 1040 Slovenian FPs and 218 family medicine (FM) trainees. Part of the questionnaire assessed the cooperation and well-being of FPs. The Mayo Clinic Well-being Index was used for the assessment. FP's well-being was also assessed descriptively by asking open-ended questions about maintaining mental health during the pandemic. Potential factors associated with FPs' well-being were identified using a multivariate linear regression method. RESULTS: The final sample comprised 191 participants (response rate 14.1%). The mean value ± standard deviation of the Mayo Well-being Index was 3.3 ± 2.6 points. The FPs with the poorest well-being had 5-15 years of work experience and worked in a practice where work could not be distributed in the absence of a co-worker without compromising the well-being of colleagues. Physical activity was identified as the most common method of maintaining mental health among FPs. CONCLUSIONS: The results of the study suggest that targeted interventions are needed to support FPs mid-career, increase resilience in practice, promote strong team dynamics, and prioritise physical activity in healthcare. Addressing these aspects can contribute to the well-being of individual FPs and the overall health of the healthcare workers.

Nutritional Challenges in Nursing Homes: Pilot Study on Macronutrient Intake and Status of Vitamins D and B12.

Older adults living in nursing homes (NH) are considered a population group that could be at risk in terms of nutrition, even more so than their community-dwelling peers. Evidence on the nutritional status of NH residents is scarce, as they are commonly excluded from population-based dietary studies. This is also the case in Slovenia. In the presented pilot study, we assessed the intake of macronutrients as well as the intake and status of vitamin D and vitamin B12 on a sample of NH and NH daycare center users to explore the need for a larger representative study. The pilot study included 37 participants from three Slovenian NH (20 participants) and their daycare centers (17 participants). Daycare centers offer daytime care services for older adults, where users are also provided with major meals during their stay. Intakes of energy and nutrients were estimated by three 24 h dietary records. Fasting blood samples were collected for the assessment of vitamin D and vitamin B12 status. Over 90% of the participants had daily energy and protein intakes below recommendations (reference values: energy intake: males 2100 kcal and females 1700 kcal; protein intake > 1 g/kg body mass). The males' median daily intakes of vitamin D were 1.7 µg (1.5 µg females), and 2.3 µg for vitamin B12 (2.0 µg females). None of the participants had adequate vitamin D intake (>20 µg), and 92.3% males and 87.5% females had inadequate vitamin B12 intake (<4 µg). The prevalence of vitamin D deficiency (serum 25-OH-D conc. < 30 nmol/L) was 100% among NH residents and 53% among NH daycare center users. The prevalence of vitamin B12 deficiency was found in 20% of NH residents. The study results highlighted that certain nutrients might be critical in this population, especially among NH residents; however, a more thorough investigation with the inclusion of other important markers of nutritional status should be performed on a larger, representative sample to support the development and implementation of appropriate public health interventions.

Sequencing analysis of SARS-CoV-2 cases in Slovenian long-term care facilities to support outbreak control.

Introduction: Residents of long-term care facilities (LTCFs) are at high risk of morbidity and mortality due to COVID-19, especially when new variants of concern (VOC) emerge. To provide intradisciplinary data in order to tailor public health interventions during future epidemics, available epidemiologic and genomic data from Slovenian LTCFs during the initial phases of the COVID-19 pandemic was analyzed. Methods: The first part of the study included SARS-CoV-2 reverse-transcription Real-Time PCR (rtRT-PCR) positive LTCF residents, from 21 facilities with COVID-19 outbreaks occurring in October 2020. The second part of the study included SARS-CoV-2 rtRT-PCR positive LTCF residents and staff between January and April 2021, when VOC Alpha emerged in Slovenia. Next-generation sequencing (NGS) was used to acquire SARS-CoV-2 genomes, and lineage determination. In-depth phylogenetic and mutational profile analysis were performed and coupled with available field epidemiological data to assess the dynamics of SARS-CoV-2 introduction and transmission. Results: 370/498 SARS-CoV-2 positive residents as well as 558/699 SARS-CoV-2 positive residents and 301/358 staff were successfully sequenced in the first and second part of the study, respectively. In October 2020, COVID-19 outbreaks in the 21 LTCFs were caused by intra-facility transmission as well as multiple independent SARS-CoV-2 introductions. The Alpha variant was confirmed in the first LTCF resident approximately 1.5 months after the first Alpha case was identified in Slovenia. The data also showed a slower replacement of existing variants by Alpha in residents compared to staff and the general population. Discussion: Multiple SARS CoV-2 introductions as well as intra-facility spreading impacted disease transmission in Slovenian LTCFs. Timely implementation of control measures aimed at limiting new introductions while controlling in-facility transmission are of paramount importance, especially as new VOCs emerge. Sequencing, in conjunction with epidemiological data, can facilitate the determination of the need for future improvements in control measures to protect LTCF residents from COVID-19 or other respiratory infections.

Slovenian Memory Clinic Organization with the Introduction of Potential New Alzheimer's Disease Treatment.

Slovenia, situated in Central Europe with a population of 2.1 million, has an estimated 44,278 individuals with mild cognitive impairment due to Alzheimer's disease or mild Alzheimer's dementia, rendering them potential candidates for disease-modifying treatment (DMT), such as lecanemab. We identified 114 potential candidates whose real-life expenses for diagnostic process surmount to more than €80,000. Treating all potential candidates nationwide would amount to €1.06 billion, surpassing Slovenia's entire annual medication expenditure for 2022 (€743 million). The introduction of DMTs and the associated logistics, along with potential complications, will significantly change societal, professional, and patient approach to treatment of Alzheimer's disease.

Biological treatment approach to inflammatory bowel disease is similar in academic and nonacademic centres - prime time for decentralisation of inflammatory bowel disease care?

BACKGROUND: With the increasing number of inflammatory bowel disease (IBD) patients, it is difficult to manage them within specialised IBD teams in academic medical centres: many are therefore treated in nonacademic IBD centres. It is unclear whether the time to introducing biologics is the same in both settings. AIM: We aimed to compare treatment approach with biologics in academic vs. nonacademic centres. METHODS: We analysed Slovenian national IBD registry data (UR-CARE Registry, supported by the European Crohn's and Colitis Organisation), which included 2 academic (2319 patients) and 4 nonacademic IBD (429 patients) centres. RESULTS: The disease phenotype was similar in both settings. In total, 1687 patients received 2782 treatment episodes with biologics. We observed no differences in treatment episodes with TNF-alpha inhibitors (60% vs. 61%), vedolizumab (24% vs. 23%), or ustekinumab (17% vs. 16%) in academic compared to nonacademic centres ( P  = 0.949). However, TNF inhibitors were less often the first biologic in academic centres (TNF inhibitors: 67.5% vs. 74.0%, vedolizumab: 20.3% vs. 17.9%, ustekinumab: 12.1% vs. 8.1%; P = 0.0096). Consequently, more patients received ustekinumab (29.8% vs. 18.3%) and vedolizumab (17.4% vs. 13.5%) and fewer TNF inhibitors (52.7% vs. 68.2%) for Crohn's disease in academic compared to nonacademic centres, with no such differences for ulcerative colitis. The time to initiation of the first biologic from diagnosis was short and similar in both settings (11.3 vs. 10.4 months, P  = 0.2). CONCLUSION: In this nationwide registry analysis, we observed that biological treatment choice was similar in academic and nonacademic settings. These findings support the decentralisation of IBD care.

Prevalence of Helicobacter pylori infection among Slovenian children and adolescents: A prospective cohort study.

BACKGROUND: Helicobacter pylori (H. pylori) infection is primarily acquired in childhood and is notably influenced by socioeconomic variances across different geographical regions. The aim of this study is to assess the prevalence of H. pylori infection in Slovenian children and to identify potential risk factors that facilitate the infection. MATERIALS AND METHODS: Between 2019 and 2022, we conducted a multi-center prospective cross-sectional study among healthy children residing in three different administrative regions in Slovenia. H. pylori infection status was determined using a monoclonal antibody-based stool antigen test (SAT). A standardized questionnaire was designed to evaluate the influence of various H. pylori-associated risk factors, including demographics and socioeconomic, housing and sanitation conditions. RESULTS: During the 3-year period, we recruited a total of 421 children and adolescents (age range 2-18 years, mean age 10.29 ± 4.95 years). Overall, 46 (10.9%) were diagnosed with H. pylori infection. No associations were found between H. pylori prevalence rates and increasing age, sex, parental education level, country of birth of the child or their parents, number of household members, household income, having a dishwasher, owning a pet, duration of breastfeeding, fruit intake frequency, drinking tap water, and handwashing practices. The only parameters associated with an increased risk of infection were the location of the school (p < 0.001) and living in an urban area (p = 0.036). The odds of infection were approximately 4.77 times higher if the child attended school in the Central Slovenian compared to other regions (OR = 4.77; 95% CI 0.87-2.34). CONCLUSIONS: This is the first study providing information on the prevalence of H. pylori infection among Slovenian children and adolescents. Using SAT, we have shown that the burden of H. pylori infection in our pediatric population is low; however, it seems to depend on regional rather than socioeconomic factors.

Eggs sampling as an effective tool for identifying the incidence of viruses in honey bees involved in artificial queen rearing.

The Carniolan honey bee (Apis mellifera carnica) plays an essential role in crop pollination, environment diversity, and the production of honey bee products. However, the health of individual honey bees and their colonies is under pressure due to multiple stressors, including viruses as a significant threat to bees. Monitoring various virus infections could be a crucial selection tool during queen rearing. In the present study, samples from all developmental stages (eggs, larvae, pupae, and queens) were screened for the incidence of seven viruses during queen rearing in Slovenia. The screening of a total of 108 samples from five queen breeders was performed by the RT-qPCR assays. The results showed that the highest incidence was observed for black queen cell virus (BQCV), Lake Sinai virus 3 (LSV3), deformed wing virus B (DWV-B), and sacbrood virus (SBV). The highest viral load was detected in queens (6.07 log10 copies/queen) and larvae (5.50 log10 copies/larva) for BQCV, followed by SBV in larvae (5.47 log10 copies/larva). When comparing all the honey bee developmental stages, the eggs exhibited general screening for virus incidence and load in queen mother colonies. The results suggest that analyzing eggs is a good indicator of resilience to virus infection during queen development.

Whole genome sequencing and molecular epidemiology of methicillin-resistant Staphylococcus aureus isolated from patients with bacteraemia in Slovenia.

PURPOSE: Data on the molecular epidemiology of methicillin-resistant Staphylococcus aureus isolates from patients with bacteraemia in Slovenia are lacking. The aim of this study was to phenotypically and genotypically investigate 82 MRSA strains isolated from patients with bloodstream infections in central Slovenia between 2019 and 2022. METHODS: Whole-genome sequencing of selected strains was performed to characterize the strains based on sequence typing, antimicrobial resistance, toxin, and virulence factors genes. RESULTS: Most MRSA carried SCCmec II (63.4%), followed by SCCmec IV (34.1%) and SCCmec V (2.5%). A high proportion of strains belonging to the ST225 lineage (45.1%) was observed, followed by ST97 (18.3%), ST2883 (15.9%), ST22 (9.8%), ST5 (3.7%), and the ST1, ST398 and ST45 lineages (2.4% each). Sixteen different spa types were identified, predominantly ST225-t003 (31.7%), ST97-t359 (15.9%), and ST2883-t4336 (14.6%). None of the strains carried Panton-Valentine leukocidin, exfoliative toxins, or toxic shock toxin. All MRSA strains were susceptible to linezolid, rifampicin, vancomycin, teicoplanin, and trimethoprim-sulfamethoxazole. MRSA strains were resistant to erythromycin, clindamycin, tetracycline and gentamicin, with a frequency of 74.4%, 74.4%, 8.5%, and 1.2%, respectively. CONCLUSION: This study demonstrates that bacteraemia in central Slovenia is caused by diverse MRSA lineages. Identification of newly emerged lineages should be followed in the future to detect changes in the molecular epidemiology of MRSA in our country.

Slovenia's national HIV PrEP programme: Evaluation of real-world implementation.

BACKGROUND: The aim of our study was to evaluate real-world implementation of Slovenia's national HIV PrEP programme, which is fully covered by our national health insurance. METHODS: In retrospective cohort study we analysed the data from all men who have sex with men (MSM) who were enrolled in PrEP programme of our clinic between 1 January 2022 and 31 December 2022. RESULTS: A total of 190 MSM with an average age of 36.7 years were included in our analysis. 151 (79.5%) decided for event-driven PrEP and 39 (20.5%) opted for daily PrEP. Self-reported adherence was 95%. Among eligibility criteria, unprotected sex was the most common one, followed by one or more STIs in the past, use of chemsex and use of HIV post-exposure prophylaxis in the past. No new cases of HIV infection and no significant deterioration of kidney or liver function were observed during the follow-up. Sixty-seven episodes of STIs were diagnosed and treated. Gonorrhea (32), chlamydia (14), and Mpox (10) were the most common ones. CONCLUSIONS: PrEP was successfully implemented into everyday clinical practice, proving to be both safe and effective. High number of diagnosed STIs suggests that the PrEP programme, combined with STI screening and vaccination, provides a strong public health impact among MSM in Slovenia.

Bovine Tuberculosis in Wild Boar (Sus scrofa) in Slovenia.

Mycobacteria of the Mycobacterium tuberculosis complex (MTC) are capable of infecting a wide variety of animals. Wild boar (Sus scrofa) has been recognized as an important wildlife reservoir for bovine tuberculosis. We screened wild boar in Slovenia for the presence of (1) Mycobacterium bovis in tissues and (2) antibodies to M. bovis in blood samples. In 2016 and 2017, 1284 tissue samples from 676 wild boar were subjected to cultivation. In 2018 and 2019, blood samples from 132 wild boar were examined using an ELISA kit. None of the MTC species were isolated from the tissue samples, and no antibodies to M. bovis were detected in the blood samples. Several nontuberculous mycobacteria (NTM), identified by 16S rRNA sequencing and/or matrix-assisted laser desorption ionization time-of-flight mass spectrometry, were found in the tissues of 9.8% of the wild boar: Mycobacterium nonchromogenicum, Mycobacterium peregrinum/Mycobacterium septicum, Mycobacterium avium, Mycobacterium engbaekii, Mycobacterium arupense, Mycobacterium algericum, Mycobacterium bohemicum, Mycobacterium confluentis, Mycobacterium flavescens, Mycobacterium fortuitum, Mycobacterium thermoresistibile, and Mycobacterium vaccae. Species-level identification was not possible for 21.2% of the isolates. At the time of the study, wild boar in Slovenia were not at risk from bTB; the significance of the presence of NTM in wild boar remains to be clarified and evaluated from a One Health perspective.

A Lonelier World after COVID-19: Longitudinal Population-Based Study of Well-Being, Emotional and Social Loneliness, and Suicidal Behaviour in Slovenia.

Background and Objectives: The impact of coronavirus disease 2019 (COVID-19) goes beyond the consequences of the infectious disease, especially as the measures taken to prevent the spread of the virus have had a very profound impact on people's social relationships and everyday lives. Several studies have investigated these effects, but there is a lack of longitudinal studies in Central Europe. Objective: The aim of our study was to observe changes in well-being, loneliness, and suicidal behaviour before, during, and after the COVID-19 pandemic using the same population-based cohort. Materials and Methods: A representative sample of 440 participants completed online questionnaires at four time points: 2019 (wave 0), 2021 (wave 1), 2022 (wave 2), and 2023 (wave 3). Results: The results show significant changes in the levels of well-being and loneliness over these periods. In particular, both social and emotional loneliness increased during the pandemic, while emotional loneliness increased to a greater extent without further decreases. Well-being appeared to increase after pandemic-related restrictions diminished but decreased again one year later. No significant changes concerning suicidal ideation were observed. Conclusions: Our study suggests that the COVID-19 pandemic changed the way in which people perceive their well-being and especially their relationships with others. From the data, we can conclude that people's worldview is now lonelier than before the pandemic.

Beyond diagnosis: Investigating factors influencing health-related quality of life in older people with type 2 diabetes in Slovenia.

AIMS: To examine the present state of health-related quality of life (HRQOL) among elderly individuals with type 2 diabetes (T2D) receiving integrated care and identify risk factors associated with low HRQOL. METHODS: A multi-centre cross-sectional survey among elderly individuals with T2D, treated in Slovenian urban and rural primary care settings was performed. HRQOL was investigated using EuroQol 5-dimension (EQ-5D) questionnaire and Appraisal of Diabetes Scale (ADS). Furthermore, socio-demographic, clinical, and laboratory data were collected. Low HRQOL was defined as EQ-5D utility score <10%. Statistical analysis was performed using univariate and multivariate binary logistic regression statistics. RESULTS: Examining 358 people with median age of 72 (range 65-98) years and with a mean EQ-5D utility score of 0.80, the study found that lower HRQOL correlated with older age, higher body mass index (BMI), lower education, elevated depressive symptoms, increased challenges across all EQ-5D dimensions, and less favourable appraisal of diabetes. When considering age, gender, education, and HbA1c, the main predictors of low HRQOL were BMI (OR 1.35, 95% CI 1.04-1.76, p = 0.025) and ADS score (OR 1.63, 95% CI 1.13-2.35, p = 0.009). CONCLUSIONS: To improve HRQOL, integrated care models should consider interventions that target mental health, obesity prevention, chronic pain management, diabetes education, self-management, and treatment plan personalisation.

Opioid analgesics prescribing trends 2010-2019 in Slovenia: National database study.

OBJECTIVE: Significant increases in global opioid use have been reported in recent decades. This study analyzed opioid utilization in outpatient care in Slovenia between 2010 and 2019. METHODS: This retrospective cross-sectional study performed a nationwide database analysis of all outpatient opioid analgesic prescriptions based on Slovenian health insurance claims data. Prevalence was defined as the number of recipients prescribed at least one opioid per 1000 inhabitants. Opioid consumption was presented as the total number of dispensed prescriptions per 1000 inhabitants and dispensed defined daily doses (DDD) per 1000 inhabitants for each year analyzed. RESULTS: The age-standardized prevalence of opioid recipients decreased by 21.5% during the study period. Total opioid consumption decreased both in the number of prescriptions (-9.2%) and DDD (-5.4%). Tramadol consumption decreased in terms of the number of prescriptions (-12.2%) and DDD (-2.7%), whereas prescriptions for strong opioids increased (10.2%) and DDDs decreased (-16.2%). The results suggest less intensive prescribing of strong opioids and more intensive prescribing for tramadol. The most frequently used strong opioids were fentanyl and oxycodone/naloxone. CONCLUSIONS: The prevalence of opioid recipients and opioid consumption is decreasing in Slovenia. Further research is needed to understand whether this finding reflects safe use or underuse of these important analgesics.

Molecular characterization of extended-spectrum ß-lactamase-producing Escherichia coli isolated from lower respiratory tract samples between 2002 and 2019 in the Central Slovenia region.

BACKGROUND: Antibiotic resistance is one of the most serious global health problems and threatens the effective treatment of bacterial infections. Of greatest concern are infections caused by extended-spectrum ß-lactamase-producing Escherichia coli (ESBL-EC). The aim of our study was to evaluate the prevalence and molecular characteristics of ESBL-EC isolated over an 18-year pre-COVID period from lower respiratory tract (LRT) samples collected from selected Slovenian hospitals. OBJECTIVES AND METHODS: All isolates were identified by MALDI-TOF and phenotypically confirmed as ESBLs by a disk diffusion assay. Using a PCR approach, 487 non-repetitive isolates were assigned to phylogroups, sequence type groups, and clonal groups. Isolates were also screened for virulence-associated genes (VAGs) and antimicrobial resistance genes. RESULTS: The prevalence of ESBL-EC isolates from LRT in a large university hospital was low (1.4%) in 2005 and increased to 10.8% by 2019. The resistance profile of 487 non-repetitive isolates included in the study showed a high frequency of group 1 blaCTX-M (77.4%; n = 377), blaTEM (54.4%; n = 265) and aac(6')-Ib-cr (52%; n = 253) genes and a low proportion of blaSHV and qnr genes. Isolates were predominantly assigned to phylogroup B2 (73.1%; n = 356), which was significantly associated with clonal group ST131. The ST131 group accounted for 67.6% (n = 329) of all isolates and had a higher number of virulence factor genes than the non-ST131 group. The virulence gene profile of ST131 was consistent with that of other extraintestinal pathogenic E. coli (ExPEC) strains and was significantly associated with ten of sixteen virulence factor genes tested. Using ERIC-PCR fingerprinting, isolates with the same ERIC-profile in samples from different patients, and at different locations and sampling dates were confirmed, indicating the presence of "hospital-adapted" strains. CONCLUSION: Our results suggest that the ESBL-EC isolates from LRT do not represent a specific pathotype, but rather resemble other ExPEC isolates, and may be adapted to the hospital environment. To our knowledge, this is the first study of ESBL-EC isolated from LRT samples collected over a long period of time.

Suicide Methods in Slovenia - Characteristics andTime Trends 2001-2020.

Background: Between 2001 and 2020, Slovenia lost 8,952 lives due to suicides, two thirds of them by hanging. Aim: To analyze trends in suicide methods between 2001 and 2020 and to explore relationships between suicide methods and selected sociodemographic characteristic. Methods: We focused on methods accounting for 95.7% of all suicides. We performed joinpoint regression to examine changes in suicide rates by respective methods and multivariate logistic regression analyses to study sociodemographics associated with specific suicide methods. Results: A gender-specific annual decrease in suicide rates was observed in all methods except for sharp objects and jumping or lying in front of a moving object. Age was statistically significant in the use of firearms and jumping or lying in front of a moving object, while gender was significant in all methods. Associations were found between education, marital status, region of residence, and various suicide methods. Limitations: The results are potentially culturally specific. Conclusion: Certain sociodemographics seem to be associated with the selection of the method.

Prevalence of mental disorders and high rates of absenteeism from work among healthcare professionals in Slovenia: a retrospective study.

OBJECTIVES: To investigate the prevalence of mental disorders and the higher rates of absenteeism from work among healthcare workers employed in Slovenia by analysing the prevalence of sick leave and medication prescriptions for treatment of mental health and behavioural disorders from 2015 to 2020. DESIGN: Retrospective analysis of nationwide data on absenteeism and prescription of medications for treatment of mental health and behavioural disorders (anxiolytics, antipsychotics, antidepressants). SETTING: National databases of the National Institute of Public Health in Slovenia. PARTICIPANTS: All employed healthcare workers (35 008 in December 2020): dentists, midwives, nurses, nursing assistants, pharmacists and physicians in Slovenia from 2015 to 2020. RESULTS: The most time spent on sick leave by male healthcare workers aged >50 was for 'neoplasms' (71.50 days on average), followed by 'mental health and behavioural disorders' (62.08 days on average). Female healthcare workers under 40 years old spent the most time on sick leave for 'pregnancy, childbirth, and the postpartum period (puerperium)', causing an average of 58.38 days of sick leave. From 2015 to 2020, the highest increase in prescribed medications for treatment of mental health and behavioural disorders was among nursing assistants (an increase of 38.42%), pharmacists (an increase of 29.36%) and nurses (an increase of 26.61%); since the COVID-19 pandemic, an increase of 12.36% was found among dentists, an increase of 11.51% among pharmacists and an increase of 11.36% among nurses. CONCLUSION: The prescription of medications for treatment of mental health and behavioural disorders was on the rise from 2015 to 2020. The importance of employee health to individuals and society necessitates the systematisation of effective prevention programmes as well as programmes to assist those in need, especially health workers, whose work contributes significantly to maintaining public health.

Impact of the COVID-19 pandemic on acute coronary syndrome hospital admission and management in Slovenia.

AIMS: We evaluated the effects of the COVID-19 pandemic on hospital admission and quality of care for acute coronary syndrome. METHODS AND RESULTS: Data for all patients admitted to hospital care for acute coronary syndromes in Slovenia (nationwide cohort) between 2014 and 2021 were obtained by merging the national hospital database, national medicines reimbursement database and population mortality registry using unique identifying numbers. Using interrupted time series analysis, we assessed the impact of the COVID-19 pandemic on hospital admission rates and quality of care (in-hospital and 30-day mortality, reperfusion and secondary preventive medication uptake). Data were fitted to segmented regression models with March 2020 as the breakpoint. Data on 21 001 patients were included (7057 ST-elevation myocardial infarction (STEMI), 7649 non-ST elevation myocardial infarction (NSTEMI) and 6295 unstable angina). Hospital admissions for STEMI remained stable (92 patients; +1 patient per month, p=0.783), whereas the pandemic was associated with a significant reduction in NSTEMI (81 patients; -21 patients per month, p=0.015) and unstable angina admissions (47 patients; -28 patients per month, p=0.025). In patients with STEMI, the pandemic did not affect reperfusion rates (0.29%, (95% CI) -1.5% to 2.1%, p=0.755) or in-hospital mortality (0.1%, (95% CI) -0.9% to 1.1%, p=0.815), but was associated with a significant negative trend for secondary preventive medication uptake (-0.12%, (95% CI) -0.23% to -0.01%, p=0.034). CONCLUSION: In Slovenia, hospital admissions for STEMI remained stable throughout the COVID-19 pandemic, but NSTEMI and unstable angina admissions dropped significantly. While mortality and reperfusion rates were not affected, the pandemic was associated with a continual negative time trend for the uptake of secondary preventive medication.

The safety of patient management in family medicine in Slovenia during Covid-19: a cross-sectional study.

BACKGROUND: During the Covid-19 pandemic, family medicine practices (FMPs) changed to improve safety against new coronavirus infections for both patients and employees. Protocols for treating patients with suspected Sars-Cov-2 infections were established to protect medical staff and other patients from being infected. However, these protocols also led to increased safety risks, such as delays in treating patients with other medical conditions. This exploratory study aimed to investigate safety risks in treating patients in FMPs during the Covid-19 pandemic and to suggest improvements to prevent Covid-19 in FMPs in Slovenia. METHODS: A cross-sectional study was rolled out in FMPs in Slovenia as part of the international Pricov-19 study. Data collection on safety management during the Covid-19 pandemic in FMPs in Slovenia took place from November 2020 until January 2021 using a self-administered online survey for FP working in Slovenia. A chi-square test, ANOVA, independent samples t-test or bivariate correlation test was performed to explore associations regarding the safety of patients' management variables. RESULTS: From the 191 participating family physicians (FPs) (15.2% response rate), 54.8% reported having treated patients with fever (not Covid-19) late due to the new protocols at least once, and 54.8% reported patients with urgent conditions having been seen late at least once due to not coming. In the suburbs and rural environments FPs more often reported that at least once patient with a fever (not Covid-19) was seen late due to the protocol (p = 0.017) and more often reported that at least once patient with an urgent condition was seen late due to not coming to their FP (p = 0.017). The larger the practice, the more they reported that at least once a patient with fever (not Covid-19) was seen late due to the protocol (p = 0.012) and the more they reported at least once a patient with an urgent condition was seen late due to not coming to their FP (p = 0.012). CONCLUSION: Covid-19 affected the safety of patient management in FMP in Slovenia. The most common problem was foregone care. Therefor, protocols for chronic patient management in the event of epidemics need to be established.

HIV-1 subtype diversity and phylogenetic insight into non-B subtype transmission in Slovenia, 1989-2013.

INTRODUCTION: Disease progression, drug resistance mutations, and treatment strategies may vary by HIV-1 subtype. This study determined HIV-1 subtypes circulating in Slovenia, a Central European country with an HIV-1 epidemic driven by men who have sex with men, focusing on molecular epidemiology of non-B subtypes. METHODS: A total of 367 HIV-1 sequences were included. Subtype was assigned by employing eight different HIV subtyping tools coupled with maximum likelihood phylogenetic analyses. RESULTS: The subtyping tools COMET, jpHMM, and REGA 3.0 exhibited the best performance on the dataset studied. Phylogenetic analyses showed a 14.7% prevalence of non-B subtypes, with subtype A detected most frequently (4.9%), followed by CRF02_AG (2.4%), subtype C (1.1%), subtypes D, G, and CRF01_AE (0.8% each), and subtypes F and CRF22_01A1 (0.3% each). A subtype could not be assigned to 12 sequences (3.3%), indicating potential unique recombinant forms. Non-B subtypes were significantly associated with a heterosexual route of transmission and infection acquired in Eastern Europe, Africa, or Asia. CONCLUSION: In a country where subtype B is predominant, non-B subtypes were observed in one out of seven patients, a non-negligible proportion, which underlines the importance of systematic surveillance of HIV subtype diversity and the corresponding molecular epidemiology.