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Igor Svab

Publications and source records attributed to Igor Svab.

14 recordsLinked to original sources
PubMed2006

Prediction of depression in European general practice attendees: the PREDICT study.

BACKGROUND: Prevention of depression must address multiple risk factors. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression. However, we lack reliable and valid methods of risk estimation. This protocol paper introduces PREDICT, an international research study to address this risk estimation. METHODS/DESIGN: This is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months. Prevalence of depression is assessed at baseline and each follow-up point. Consecutive attendees between April 2003 and September 2004 who were aged 18 to 75 were asked to take part. The possibility of a depressive episode was assessed using the Depression Section of the Composite International Diagnostic Interview. A selection of presumed risk factors was based on our previous work and a systematic review of the literature. It was necessary to evaluate the test-retest reliability of a number of risk factor questions that were developed specifically, or adapted, for the PREDICT study. In a separate reliability study conducted between January and November 2003, consecutive general practice attendees in the six participating European countries completed the risk factor items on two occasions, two weeks apart. The overall response rate at entry to the study was 69%. We exceeded our expected recruitment rate, achieving a total of 10,048 people in all. Reliability coefficients were generally good to excellent. DISCUSSION: Response rate to follow-up in all countries was uniformly high, which suggests that prediction will be based on almost a full cohort. The results of our reliability analysis are encouraging and suggest that data collected during the course of PREDICT will have a satisfactory level of stability. The development of a multi-factor risk score for depression will lay the foundation for future research on risk reduction in primary care. Our data will also provide the necessary evidence base on which to develop and evaluate interventions to reduce the prevalence of depression.

Adolescent↗
PubMed2006

Specialist training of Slovene family physicians.

UNLABELLED: Family medicine in Europe started to develop in the 1960s with the introduction of obligatory specialist training. Slovenia is a country with a long tradition of family medicine specialist training, but up until 2002 this was neither elaborated on nor conducted by peers in general practice/family medicine. When the country's socialist system started to transform due to political reforms, Slovenia began to modify its system in order to meet the criteria of the European Union. One of the changes was the introduction of a new healthcare system with an influential Medical Chamber responsible for postgraduate training in all specialities. A new model for vocational training in family medicine was established in 2002, following the recommendations of the European Union of General Practitioners (UEMO). According to the new programme, which lasts 4 years, trainees spend half of their training in a hospital setting and half in general practice, where they are supervised by a trainer in practice. This article describes the legal process of introducing new forms of specialist training in Slovenia, and its content. CONCLUSION: A comparison with UEMO countries shows that the new model is comparable to other countries.

Curriculum↗
PubMed2006

Attitudes of Roma toward smoking: qualitative study in Slovenia.

AIM: To understand the reasons for widespread smoking behavior among Roma in Slovenia for the purpose of developing successful smoking cessation interventions. METHOD: A qualitative focus group approach using a combination of pre-structured and open-ended questions was applied to collect the data from the representative members of the Roma community in southern Slovenia. The discussions were audiotaped and transcribed, and the collected data analyzed according to qualitative content analysis theory. RESULTS: The content analysis revealed that smoking was a strong part of the cultural, ethnic, and individual identity of the Roma. Even children smoked. Doctor's advice to quit smoking was usually not followed and the attempts to quit were usually unsuccessful. Difficult financial situation was never mentioned as a possible motive to quit. Roma held a tenacious belief that the harmful effects of smoking were in the hands of destiny and did not associate the smoking-related illness with the habit. CONCLUSIONS: Traditional strategies for smoking cessation are largely ineffective among the Roma because of their different attitudes toward smoking. Therefore, innovative and culturally acceptable methods need to be developed.

Adolescent↗
PubMed2006

Prevalence of and risk factors for self-reported sexually transmitted infections in Slovenia in 2000.

AIM: To estimate the prevalence of self-reported sexually transmitted infections (STIs) and examine the associations between self-reported STIs and sociodemographic and behavioral factors among sexually active Slovenians aged 18-49 years. METHODS: Data were collected during 1999-2001 from a probability sample of the general population at respondents' homes by a combination of face-to-face interviews and anonymous self-administered questionnaires. Statistical methods for complex survey data were used to account for stratification, clustered sampling, and weighing. RESULTS: The proportion of sexually active Slovenian population that reported ever being diagnosed with an STI, excluding pelvic inflammatory disease and vaginal discharge for women, was 5.5% for men and 5.1% for women. Gonorrhea was the most commonly self-reported STI among men (3.7%) and hepatitis B among women (1.7%). Independent risk factors associated with self-reported STIs included having concurrent heterosexual relationships during lifetime [adjusted odds ratio (AOR) for men 3.3 (CI 1.3-8.6) and for women 2.3 (CI 1.0-5.3)], ever having paid for sex for men (AOR 4.0, CI 1.5-10.7), and having at least 10 lifetime heterosexual partners for women (AOR 4.7, CI 1.7-13.0). CONCLUSION: Our estimates of lifetime prevalence of self-reported STIs in a probability sample of Slovenian men and women aged 18 to 49 indicate a substantial national burden of STIs. The results could be used in shaping national STI prevention and control policies and strategies. Identification of risk factors associated with self-reported STIs provide a basis for targeting prevention and control efforts to individuals at higher risk.

Adolescent↗
PubMed2005

Community actions against alcohol drinking in Slovenia--a Delphi study.

AIM: To define the national strategy and public actions to reduce alcohol related harm, based on societal consensus. BACKGROUND: Alcohol abuse is an avoidable behaviour that can threaten health. In Slovenia, only a few public campaigns against drinking alcohol are under way. It is important to establish which community measures are acceptable to society in Slovenia in order to reduce alcohol-related risks. METHODS: A Delphi study with 45 professionals from different disciplines was conducted. Participants offered many suggestions to improve the current situation. After three rounds of questionnaires, 86 participant statements were accepted as a consensus. RESULTS: Actions such as: state monopolies, alcohol taxation, legislative restrictions on availability and purchase of alcohol, age-related restriction on sales, drink-driving laws, school-based alcohol education and media information campaigns are most likely to be achieved by consensus. The main target populations for implementation of alcohol-related educational programs are children, young people and employees. CONCLUSIONS: As a result of the study, a number of community actions against drinking alcohol that could be acceptable for society can now be suggested. They vary across different target populations, change agents (individuals, organizations and institutions) and methods of implementation.

Adolescent↗
PubMed2005

Continuation of hormone replacement therapy in Slovenia: a prospective, randomized, controlled trial--1-year follow-up.

OBJECTIVES: To evaluate the influence of educational intervention on the hormone replacement therapy (HRT) continuation rate in Slovenia after the publication of WHI results. METHODS: We enrolled 125 early postmenopausal women in a 12-month prospective, randomized, controlled, multicentric study in Slovenia. The study group women (n=62) attended educational lectures; the control group women (n=63) did not. Data were collected from three types of questionnaire: before starting HRT, at follow-up visits at 3, 6, 9 and 12 month, after the educational lecture (study group). The continuation rate was measured on the basis of women's self-reports. The results were analyzed according to the "intention-to-treat" principle. The Cox proportional hazard model was used for the final analysis. RESULTS: A gynecologist's suggestion, climacteric symptoms and quality of life were the prevailing reasons for starting HRT. The prevailing factors affecting continuation of HRT were: no or irregular previous OC use (hazard ratio 3.7), no educational lectures (hazard ratio 2.0) and climacteric disorders as the reason for start HRT (hazard ratio 2.1). In the women who discontinued HRT within the first 3 months, the fear of endometrial cancer, breast cancer and bleeding problems were statistically more significant than other factors (P=0.034). In the women who stopped HRT use within 6-12 months, the fear of breast and endometrial cancers increased substantially (P=0.002). CONCLUSIONS: Previous OC use and educational lectures on menopausal problems and HRT significantly improve the HRT continuation rate. The main reason for discontinuing HRT is fear of breast cancer, intensified by media.

Adult↗
PubMed2004

Changing research culture.

Although there is general agreement that family medicine has a lot to offer to the health care system, the academic dimension is still not widely understood. There are two main reasons why family medicine needs to develop its scientific potential: to address the true nature of the discipline, and to help in its recognition. The academic establishment benefits from academic family medicine by gaining new questions that are necessary to be answered and by gaining new research approaches.Many problems are encountered when introducing family medicine into the academic arena. Two main strategies for developing family medicine research can be identified. The first is to adapt to the existing structure of the academic world by claiming equal rights with the developed disciplines, collaborating with other university departments in their research projects, publishing articles in established journals, and participating in established faculty development programs. The other, more demanding, strategy is to introduce changes to the academic arena by developing specific research questions, by collaborating on research within family medicine, and by developing family medicine's own success criteria for academic excellence. The two approaches are not mutually exclusive. The World Organization of Family Doctors plays an important role in supporting both approaches through its international affiliations and contacts with policy makers.

Biomedical Research↗
PubMed2004

Academic medicine: what does an outsider have to offer?

One of the many problems of academic medicine is its detachment from actual health problems of the population. Family medicine has a potential of bridging this gap. The paper describes the positive experience from introducing family medicine as a new academic discipline to the medical school in Slovenia. Its introduction was of benefit to family medicine, which has received recognition and has experienced a rapid academic growth. Medical academic establishment has benefited by being exposed to new ideas in research and education. The key to success was the fact that the academic world accepted a newcomer to its midst and that the newcomer managed to integrate its principles into the rules of the academic environment. The next step in this process is to apply some of the positive experiences of the family medicine department to the curriculum reform of the entire faculty.

Academic Medical Centers↗
PubMed2004

General practice east of Eden: an overview of general practice in Eastern Europe.

AIM: To review the status of family medicine in Eastern European countries, specifically the position of the discipline within the health care system, its academic status, and expected trends in the development of the discipline. METHODS: We used available data in the literature and information gathered from personal contacts with members of European Society of General Practice/Family Medicine (ESGP/FM) expert groups, European Academy of Teachers in General Practice (EURACT), and European General Practice Research Network (EGPRN). Personal interviews with key informants from countries that do not have members in these organizations were used. We also performed a Medline search using terms "primary health care" and "family medicine". RESULTS: It was difficult to get standardized information about the issues addressed. In some countries, contact persons and articles were impossible to find. Because of that, information from some countries is lacking (e.g. Belarus, Ukraine, the Kavkaz states and Central Asian republics). The information from the 14 countries showed that family medicine was formally widely recognized as a specific discipline. In 13 of them, there were some programs of vocational training. In 10 countries, academic recognition has resulted in rapid development in the past two decades, especially after 1989, but in Bulgaria and Moldova we found no evidence of family medicine departments. CONCLUSION: The position of general practice in most Central and Eastern European countries is formally adequate, but a lot of effort will still be needed to achieve the desired level of its recognition and quality.

Europe, Eastern↗
PubMed2003

Introducing performance-based assessment of family physicians.

Slovenia has implemented a new final summative assessment for vocational training in family medicine. As all family medicine trainees work independently in practice, the assessment is focused on actual performance. The preparation included a literature search, consultation with foreign experts, consultation with tutors and trainees in general practice and testing the assessment with experienced practitioners. The assessment includes three elements: (1) a trainee's report with data on population served, audit of practice and family profiles; (2) a visit to the trainee's practice which includes sitting in with the trainee, and assessment of patients' records, equipment and premises; (3) the final assessment, which includes an MCQ written test, OSCE stations, and an oral exam with discussion about the candidate's report, presentation of five cases from his/her practice and one question by each examiner to assess problem-solving skills. Initial experience has been favourable but further work is needed for evaluation of the assessment.

Clinical Competence↗
PubMed2003

Factors influencing home visits in Slovenian general practice.

BACKGROUND: There is great variability in home visiting rates in Europe. The European General Practice Research Workshop (EGPRW) has conducted a pilot quantitative international study on home visits and developed a questionnaire, which has not yet been tested on a national level. In Slovenia, home visiting is decreasing, but the factors influencing home visiting by GPs in the country have not yet been examined. OBJECTIVES: The purpose of this study was to test the feasibility of the questionnaire on home visiting developed by EGPRW and to study home visiting in Slovenia. METHODS: A random representative sample of 165 Slovenian GPs were given a questionnaire, developed on the basis of former EGPRW projects. Each of the respondents provided data on 10 consecutive home visits made during office hours, data on his/her practice and number of consultations during the registration period. Multivariate modelling of home visits per working week as the dependent variable was performed. RESULTS: A 71% response rate was achieved, and the data from 1151 requests for home visits and 1015 completed home visits were analysed. The average number of home visits per working week was 2.5, with wide variation among the respondents (0-10, SD 1.89). Older GPs, trainees, GPs from rural areas and those with a higher proportion of elderly patients carried out more home visits. The selected logistic regression model fits the data well according to established criteria. CONCLUSION: It is possible to use the questionnaire developed by EGPRW on a national scale and to obtain representative valid national data. The home visiting rate in Slovenia is low compared with rates in other countries. Rural location of practice, GP's age, trainee status and the number of older patients on the list are the most important predictors of the home visiting rate.

Aged↗
PubMed2003

Management of lower urinary tract infection in women by Slovene GPs.

BACKGROUND: Uncomplicated lower urinary tract infection (LUTI) is one of the most common infections treated in general practice. Although nationwide treatment guidelines for LUTI are increasingly available, most European countries, including Slovenia, have not yet set such guidelines. OBJECTIVES: Our aim was to describe Slovene GPs' management of uncomplicated LUTIs and to analyse doctor and surgery characteristics that influence this management. METHOD: A written case vignette accompanied by open-ended questions regarding doctors' decisions (i.e. investigations and laboratory tests ordered, treatment options, advising sick leave, advice for treatment and follow-up procedures) and questions about doctor and surgery characteristics was sent to a representative sample of Slovene GPs. RESULTS: The response rate was 129/171 (75.4%). There were large variations in management of LUTI: 17.8% of GPs ordered various additional laboratory tests; 57% of GPs prescribed trimethoprim/sulfamethoxazole and 37% norfloxacin; 30% of GPs prescribed a drug for 10-14 days; and 53.5% of GPs put the patient on sick leave of 1-10 days duration. Doctors with heavier workloads and those who have to wait for laboratory results for >24 h ordered more additional investigations. CONCLUSIONS: Effective strategies for quality improvement are needed, together with practice guidelines. The influence of a heavier workload on management of LUTI and the impact of the accessibility of laboratory tests should be explored in future research.

Adult↗
PubMed2003

Eighty years of the Slovenian Institute of Public Health: challenges for the future.

Eighty years after the first national public health institution was founded in Slovenia, the Institute of Public Health of the Republic of Slovenia (IPHRS) endeavors to meet ever-growing national demands. With the independence of Slovenia in 1991, new tasks had to be tackled, many of which were initially coupled with typical difficulties of a postcommunist country in transition. Also, increasing demands of the European Union (EU) and other international partners had to be met. The IPHRS monitors the health of the Slovenian population and its determinants and contributes to planning and implementation of population-based interventions for the better health of the whole nation. The diversity of the IPHRS activities is mirrored by the organization's internal complexity, multi-disciplinary approach, and links to various sectors. Currently, activities are organized within five centers: Center for Population Health Research; Center for Health Care Organization, Economics and Informatics; Center for Environmental Health; Center for Communicable Diseases; and Center for Health Promotion. The IPHRS is the key national institution in public health research, which is an integral part of all the areas covered by the Institute. The IPHRS also provides education programs in the field of public health. In the near future, it will be important to sustain current activities while integrating into the new program of Community action in the field of public health as well as contributing to the response to challenging public health issues in the wider context of the whole European region. Our aim is to integrate the Institute's activities in the programs relevant to public health issues of outstanding importance in this European sub-region. The IPHRS, given the geographic position and recent history, can act as an intermediate between the public health networks in EU and other countries in the sub-region.

Forecasting↗