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Health-related quality of life in paediatric arterial hypertension : a cross-sectional study
Tadej Petek, Tjaša Hertiš, Nataša Marčun-Varda, 2018, izvirni znanstveni članek

Opis: Background: The prevalence of paediatric hypertension is increasing worldwide, especially due to the childhood obesity epidemic, and is an important public-health concern. While the Health-Related Quality of Life (HRQoL) was already shown to be impaired in the adult hypertensive population, a scarcity of data still exists on HRQoL in paediatric hypertensive patients. Our purpose was thus to assess the HRQoL of children and adolescents with arterial hypertension, using self- and proxy-reports, and to determine the correlations between child and parent questionnaire scores. Methods: The Paediatric Quality of Life Inventory™ 4.0 Generic Core Scales were administered via post to children and adolescents, aged 5-18 years, with primary or secondary arterial hypertension and parents as proxy-reports. Patients were recruited from a paediatric nephrology unit in a tertiary hospital, using an out-patient clinic visit registry. Healthy school children and adolescents from a local primary school, aged 6 to 15 years, and their parents formed the control group. HRQoL group comparisons were calculated with independent samples t-test and child-parent correlations with the Pearson’s r correlation coefficient. Results: In total we recruited 139 patient and 199 control group participants as self- and proxy-reports. Scores from self- as well as proxy-reports indicated a significantly lower overall HRQoL in the paediatric hypertensive population (95% CI for mean score difference: − 11.02, − 2.86 for self- and − 10.28, − 2.67 for proxy-reports; p = .001). In self-reports, lower physical (95% CI: -13.95, − 4.89; p = <.001), emotional (95% CI: -12.96, − 2.38; p = .005), school (95% CI: -11.30, − 0.42; p = .035), and psychosocial functioning scores were observed (95% CI: -10.34, − 1.89; p = .005). Parent proxy-reports were lower in physical (95% CI: -14.31, − 5.39; p = <.001), emotional (95% CI: -12.39, − 2.60; p = .003) and psychosocial scores (95% CI: -9.36, − 1.34; p = .009). Pearson’s r values ranged between 0.62 to 0.79 in patient and 0.56 to 0.80 in control sample (p < .001). Interestingly, hypertensive children reported lower social functioning scores than hypertensive adolescents (p < .001). Conclusions: This cross-sectional study gives insight into the detrimental impact of hypertension on children’s and adolescents HRQoL, which may inform public health experts. Furthermore, it shows that clinicians should aim to improve patients’ physical and psychosocial well-being throughout their development.
Ključne besede: arterial hypertension, paediatric, health-related quality of life, PedsQL
Objavljeno v DKUM: 26.10.2018; Ogledov: 1259; Prenosov: 114
.pdf Celotno besedilo (745,16 KB)
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Implementing quality indicators for diabetes and hypertension in family medicine in Slovenia
Zalika Klemenc-Ketiš, Igor Švab, Tonka Poplas-Susič, 2017, izvirni znanstveni članek

Opis: Introduction: A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article was to assess the quality of diabetes and hypertension management. Methods: We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators. Results: Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices. Conclusion: First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.
Ključne besede: family practices, healthcare quality indicator, diabetes mellitus, hypertension, Slovenia
Objavljeno v DKUM: 03.11.2017; Ogledov: 989; Prenosov: 309
.pdf Celotno besedilo (424,82 KB)
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Hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in patients with recurrent variceal hemorrhage
Peter Popović, Andrej Zore, Katarina Šurlan Popović, Manca Garbajs, Pavel Skok, 2013, izvirni znanstveni članek

Opis: Purpose.The purpose of this study was to determine the incidence and predictors of hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy (ET) in the elective treatment of recurrent variceal hemorrhage. Methods. Seventy patients were treated with elective TIPS and fifty-six patients with ET. Median observation time was 46.28 months in the TIPS group and 42.31 months in the ET group. Results. 30 patients (42.8%) developed clinically evident portosystemic encephalopathy in TIPS group and 20 patients (35.6%) in ET group. The difference between the groups was not statistically significant (P=0.542; X2 test). The incidence of new or worsening portosystemic encephalopathy was 24.3% in TIPS group and 10.7% in ET group. Multivariate analysis showed that ET treatment (P=0.031), age of >65 years (P=0.022), pre-existing HE (P=0.045), and Childs class C (P=0.051) values were independent predictors for the occurrence of HE. Conclusions. Procedure related HE is a complication in a minority of patients treated with TIPS or ET. Patients with increased age, preexisting HE, and higher Child-Pugh score should be carefully observed after TIPS procedure because the risk of post-TIPS HE in these patients is higher.
Ključne besede: veins, dilated veins, rebleeding, portacaval encephalopathy, liver, cirrhosis, portal hypertension, transjugular intrahepatic portosystemic shunt
Objavljeno v DKUM: 14.06.2017; Ogledov: 817; Prenosov: 306
.pdf Celotno besedilo (1,18 MB)
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Evaluation of arterial hypertension control in family practice in Slovenia
Marjetka Pal, Branimir Leskošek, Marjan Pajntar, Polonca Ferk, 2014, izvirni znanstveni članek

Opis: Objective: We performed a study on almost 20,000 Slovene patients with arterial hypertension (AH) to evaluate age- and gender-dependent blood pressure control, differences in the rate of AH control in the period 2002-2008, and to validate a potential impact of selected quality indicators on blood pressure control. Methods: The study was conducted as a part of the "Quality of Healthcare in Slovenia" project, in agreement with the National Medical Ethics Committee of the Republic of Slovenia. Appropriate statistical analyses were performed and the results evaluated. Results: Arterial hypertension control was relatively high (55.8%, 95% CI: 55.1-56.5) in the period 2002-2008 and improved significantly during that period. Based on our statistical model, the improved AH control in year 2006 compared to 2002 is particularly due to lower initial blood pressure values before treatment. Uncontrolled AH was largely attributed to uncontrolled systolic blood pressure. We found positive association between AH control and the frequency of blood pressure control in less than six-month time intervals. Conclusions: According to our results, AH control in family practice in Slovenia is relatively high compared to other European countries, but the results refer only to patients visiting their family medicine physicians.
Ključne besede: arterial hypertension, epidemiology, treatment, quality indicators
Objavljeno v DKUM: 10.05.2017; Ogledov: 847; Prenosov: 69
.pdf Celotno besedilo (250,99 KB)
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Simulation analysis of economic burden in hypertension and myocardial infarction treatment with beta blockers
Maja Atanasijević-Kunc, Jože Drinovec, Barbara Guštin, Aleš Mrhar, 2012, izvirni znanstveni članek

Opis: Background: Hypertension has become a very frequent chronic disease worldwide and Slovenia is no exception. It is defined as a serious risk factor for developing different cardiovascular diseases. Several important studies proved that cardiovascular diseases are the main reason of deaths in more than 50 % of cases in the developed countries. All mentioned facts are indicating that treatment costs in patients with hypertension and cardiovascular diseases represent an important economic burden, which cannot be neglected. It may also be expected that in the next few decades the situation will become even worse. The reasons are the expected earlier disease development due to unhealthy life style and the fact that people live longer and populations are growing older. The mentioned facts have motivated the study, which would enable the estimation of patients’ number in the observed population and the evaluation of economic burden when using beta blockers, drugs which have become an important choice in antihypertensive treatment and are also used in patients with different cardiovascular complications. The projections indicating the expected trends of mentioned problems in the forthcoming decades would also be of interest. Methods: To answer some of the indicated questions, a simulation model was developed, which enabled the prediction of patients with hypertension and the influence of this disease to the development of myocardial infarction. Modeling was performed using the available statistical data and published studies. Main attention was devoted to the circumstances in Slovenia, but the results were also verified using the available data for some other countries. Combination of simulation results with demographic data enabled the estimation of the number of patients observed. In addition, expenses for the observed groups of patients were evaluated and, based on that, the economic burden was estimated. The mentioned expenses include hospitalizations, drugs required and the estimated mortality-related expenses. The developed model was accomplished with dynamical mathematical structure predicting the development of population number in Slovenia in the forthcoming decades, taking into account that the demographic properties remain unchanged. Also the observation of potential scenario regarding patients’ number and thus expected economic burden distribution among younger and older population is made possible. Results: In the paper simulation results are presented which enable the estimation of patients with hypertension and their connection with those who have experienced myocardial infarction. It is possible to observe the prevalence and the number of patients in Slovenia by age. In addition, economic burden associated with the observed groups of patients is calculated taking into account needed drugs, hospitalizations and patient mortality. In such circumstances it is possible to expect that in the group of one million people approximately 264,000 are patients with hypertension for whom, when healed optimally with beta blockers, over EUR 13 million is needed per year. In the same group of one million people are also patients with myocardial infarction. Among them 11 % experienced infarction within the current year. This amounts to more than 22,000 such patients and over EUR 22 million needed for them each year. In the case of unchanged statistical demographic characteristics in the future, it can be expected that in 50 years relative economic burden for active population would become twice as high as it is now. Conclusions: For optimal treatment, hospitalization and due to mortality more than EUR 35 million per year would be needed for patients with hypertension (around 260,000 patients) and for those who have experienced myocardial infarction (around 22,000) if observing the population of one million people. As the population is growing older, it can be expected that the relative economic burden will become significantly greater for active population in the forthcoming decades.
Ključne besede: hypertension, myocardial infarction, beta blockers, economic burden, modelling, simulation
Objavljeno v DKUM: 28.03.2017; Ogledov: 702; Prenosov: 48
.pdf Celotno besedilo (809,50 KB)
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Modelling of the risk factors and chronic diseases that influence the development of serious health complications
Maja Atanasijević-Kunc, Jože Drinovec, Simona Ručigaj, Aleš Mrhar, 2008, izvirni znanstveni članek

Opis: Background: Some chronic diseases, like diabetes type 2 and hypertension, and risk factors, such as obesity, hypercholesterolemia, and smoking, are strongly correlated with the potential development of serious health complications that can threaten a patient's life or significantly influence the quality of life, while at the same time representing an enormous economic burden. Such complications include, for example, stroke, coronary heart disease, peripheralarterial vascular disease, end-stage renal disease and congestive heart failure. Methods: For a quantitative evaluation of the mentioned patient groups, the age distribution and an estimation of the treatment expenses a dynamic mathematical model was developed, where special attention was devoted to its structure, as it should enable the sequential construction and representation of different forms of data information. The model was realized in the Matlab program package with the Simulink Toolbox. Conclusions: A dynamic mathematical model is described that enables the observation of patients (in percentage terms) with diabetes type 2 and obesity, as well as those who smoke, have hypercholesterolemia and hypertension and all possible combinations of these problems, related to their age. Taking into account the Slovenian demographic data and annual treatment expenses, we were able to quantitatively evaluate these factors, not only in Slovenia but also in other developed regions where the demographic and economic situations are similar. It is also possible to extend the model to patients with serious complications, also taking into account the population dynamics, which is the goal of the next steps in our investigation. Regarding the presented results, it is estimated that from a group of a million people, those requiring treatment for diabetes type 2 cost as much as € 19.5 millions per year, since the treatment of one patient for one year is € 355. If all the sufferers requiring such treatment were located, as a consequence of more systematic medical examinations, an additional € 16 millions would be needed. In this group of one million people, as many as 40 % are expected to develop hypercholesterolemia, of which 26 % are diagnosed and treated adequately. The annual cost for the treatment of one patient is 313, which means that for a group of a million people the costs would be € 82 millions per year. An additional € 43.5 millions would be needed if all the sufferers with hypercholesterolemia were treated. Another chronic disease is hypertension. The annual cost for treating one patient is estimated to be € 271, and so for a group of a million people the treatment costs would be € 69.5 millions. If this were extended to include so far undiscovered sufferers with this chronic disease an additional € 14.5 millions would be needed.
Ključne besede: modelling, simulation, diabetes type 2, obesity, smoking, hypercholesterolemia, hypertension
Objavljeno v DKUM: 28.03.2017; Ogledov: 685; Prenosov: 84
.pdf Celotno besedilo (1,10 MB)
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Makroanevrizma retinalne arterije pri bolniku z arterijsko hipertenzijo
Matejka Masten, Mojca Hudovernik, Dušica Pahor, 2014, strokovni članek

Opis: Namen: Namen prispevka je prikazati primer bolnika z makroanevrizmo retinalne arterije ob neurejeni sistemski arterijski hipertenziji. Poročilo o primeru: 48-letni bolnik je bil sprejet na naš oddelek zaradi poslabšanja vidne ostrine desnega očesa. Navajal je dvojne slike in zamegljen centralni del vidnega polja. Sicer se je zdravil zaradi arterijske hipertenzije. Drugih zdravstvenih težav ni imel. Predstavljeni so klinični potek, diagnostični pristop in zdravljenje bolnika z makroanevrizmo retinalne arterije. Zaključek: Pri zdravljenju bolnika z makroanevrizmo retinalne arterije je pomemben celosten pristop. Za čim uspešnejši končni izid zdravljenja bolnikov je poleg zdravljenja očesne simptomatike potrebno tudi zdravljenje sistemskih dejavnikov tveganja. Za opredelitev natančne vloge laserske fotokoagulacije, intravitrealne aplikacije plina, kirurških vitreoretinalnih tehnik, uporabo Nd:YAG ali argon laserja in intravitrealne aplikacije anti-VEGF zdravil v zdravljenju makroanevrizme retinalne arterije bodo potrebne še dodatne raziskave.
Ključne besede: macroaneurysm, retinal haemorrhage, macular oedema, arterial hypertension
Objavljeno v DKUM: 30.12.2015; Ogledov: 949; Prenosov: 57
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Pulzni tlak pri bolnikih z arterijsko hipertenzijo v Sloveniji
Marjetka Pal, Marjan Pajntar, Branimir Leskošek, Jože Drinovec, Polonca Ferk, 2011, izvirni znanstveni članek

Opis: Namen: Namen naše študije je bil določiti porazdelitev pulznega tlaka (PP), sistoličnega (SBP) in diastoličnega (DBP) krvnega tlaka v odvisnosti od spola in starosti ter ugotoviti odnos med PP, SBP in DBP. Analizirali smo podatke za 19972 bolnikov z arterijsko hipertenzijo v Sloveniji. Metode: Podatke o meritvah arterijskega krvnega tlaka (SBP, DBP) na nadlahti smo pridobili pri več kot 360 družinskih zdravnikih iz zdravstvenih kartotek bolnikov. Večino podatkov smo zbrali v obdobju 2002-2006. Rezultati: Povprečen PP je bil (71,2 +- 16,9) mmHg, povprečen SBP (172,8 +- 18,1) mmHg in povprečen DBP (101,6 +- 10,4) mmHg. Analiza z linearno regresijo je pokazala statistično značilno povezavo PP tako s starostjo (p < 0,001) kot tudi s spolom (p < 0,001). Pulzni tlak je naraščal s starostjo, pri moških in ženskah podobno. Ženske so imele statistično značilno višji PP (p < 0,001) kot moški v starostnem obdobju 35-65 let, razlika pa je bila manj izrazita po 80. letu starosti. Pulzni tlak je v črki U podobnem odnosu z DBP ter v skoraj linearnem odnosu s SBP. Zaključek: Rezultati naše študije kažejo, da je PP pri slovenskih bolnikih z arterijsko hipertenzijo odvisen tako od spola kot od starosti bolnika, na osnovi česar želimo spomniti na pomen upoštevanja PP pri načrtovanju antihipertenzivnega zdravljenja.
Ključne besede: pulse pressure, arterial hypertension, epidemiology, Slovenia
Objavljeno v DKUM: 10.07.2015; Ogledov: 2348; Prenosov: 48
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