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1.
Genski polimorfizmi adhezijskih molekul in vnetnih genov ter progresija ateroskleroze karotidnih arterij pri sladkorni bolezni tip 2
Dražen Popović, 2017, doktorsko delo/naloga

Opis: Ateroskleroza je kronično vnetno dogajanje, za katero je značilno nalaganje leh, sestavljenih iz penastih celic, celic imunskega sistema, celic vaskularnega endotelija, ravnih mišičnih celic, trombocitov, zunajceličnega matriksa in z maščobami bogatega jedra z nekrozami in s fibroznim okolnim tkivom. Zapleti ateroskleroze so glavni vzrok obolevnosti in smrti v razvitem svetu. Sladkorna bolezen je pomemben dejavnik tveganja za razvoj ateroskleroze. Ključno patološko dogajanje pri aterosklerozi je poškodba endotelija arterijske stene oziroma vnetni odgovor, ki ga poškodba sproži. Poškodba spodbudi endotelijske celice k izločanju vazoaktivnih in adhezijskih molekul, citokinov in rastnih dejavnikov. Ugotovljena je zvišana raven adhezijskih molekul pri bolnikih z napredovalo aterosklerozo in s sladkorno boleznijo. Pomembna v razvoju ateroskleroznih sprememb bi lahko bila vloga genskih označevalcev, vpletenih v vnetni odgovor. Postavili smo hipotezo, da genski označevalci, ki uravnavajo vnetni odgovor, vplivajo na nastanek ateroskleroznih sprememb in napredovanje ateroskleroze karotidnih arterij pri bolnikih s sladkorno boleznijo tipa 2 (SB tipa 2). Z asociacijsko raziskavo smo ugotavljali povezavo med polimorfizmom K469E (rs 5498) gena za ICAM 1, polimorfizmom G241A (rs 1799969) gena za ICAM 1, polimorfizmom C373G (Leu125Val, rs 668) gena za PECAM 1, polimorfizmom –1082 G/A (rs18000896) gena za interlevkin 10 (IL 10), polimorfizmom –1159 A/C (rs3212227) gena za interlevkin 12 (IL 12), polimorfizmom –607 C/A (rs1946518) gena za IL 18 in polimorfizmom –137 G/C (rs187238) gena za IL 18 ter ultrazvočnimi označevalci ateroskleroze, napredovanjem ultrazvočnih označevalcev ateroskleroze in stabilnostjo leh v vratnih arterijah. V raziskavo smo vključili 795 preiskovancev; 595 je bilo bolnikov s SB tipa 2 in 200 preiskovancev v kontrolni skupini brez SB tipa 2. Preiskovanci so bili slovenskega rodu in niso bili v sorodu. Odvzeli smo jim kri za biokemijske in molekularnogenetske preiskave ter izvedli doplersko preiskavo karotidnih arterij. Preiskovanci so izpolnili vprašalnik z anamnestičnimi podatki. Primerjava ultrazvočnih označevalcev ateroskleroze je pokazala statistično pomembno višje vrednosti v debelini intime in medije (DIM) karotidnih arterij (p = 0,03), v seštevku debeline leh (p = < 0,001) in v številu segmentov z lehami (p = 0,01) v skupini bolnikov s SB tipa 2. Prav tako so bile statistično pomembno višje vrednosti pri kontrolnem pregledu v letnem prirastku DIM karotidnih arterij (p = 0,02), Δ števila segmentov z lehami (p = 0,03) in Δ seštevka debeline leh (p = 0,02) v skupini bolnikov s SB tipa 2. Ugotovili smo povezavo med genotipom EE K469E (rs5498) polimorfizma za ICAM 1 in višjo vrednostjo seštevka debeline leh (p = 0,04), prisotnostjo nestabilnih leh (p = 0,01) in večjim letnim prirastkom DIM karotidnih arterij (p = 0,04) pri bolnikih s SB tipa 2. Rezultati niso pokazali statistično pomembne povezave med ultrazvočnimi označevalci ateroskleroze in genotipi polimorfizma G241A (rs1799969) gena za ICAM 1 pri bolnikih s SB tipa 2. Statistično pomembna razlika je bila ugotovljena med genotipom GG polimorfizma C373G (rs668) gena za PECAM 1 in prisotnostjo leh v karotidni arteriji (p = 0,03). Genotipi polimorfizma rs668 gena za PECAM 1 na druge ultrazvočne označevalce ateroskleroze niso vplivali enako kot na napredovanje ateroskleroznih sprememb. Za genotipa GA in AA polimorfizma G1082A (rs1800896) gena za IL 10 so bile značilne statistično pomembno stabilnejše lehe glede na genotip GG (p = 0,03). Genotipi polimorfizma rs1800896 gena za IL 10 na druge ultrazvočne označevalce ateroskleroze karotidne arterije niso vplivali enako kot na napredovanje ateroskleroze. V raziskavi nismo ugotovili povezave med ultrazvočnimi označevalci ateroskleroze in genotipi polimorfizma C1159A (rs3212227) gena za IL 12 pri bolnikih s SB tipa 2. Prav tako nismo ugotovili povezave med genotipi polimorfizma C607A (rs1946518) in G137C (rs187238) gen
Ključne besede: sladkorna bolezen, progresija ateroskleroze, ultrazvočni označevalci ateroskleroze, polimorfizem, ICAM 1, PECAM 1, interlevkin 10, interlevkin 12, interlevkin 18
Objavljeno: 26.04.2017; Ogledov: 0; Prenosov: 0
.pdf Polno besedilo (10,21 MB)

2.
Using movies in family medicine teaching
Zalika Klemenc-Ketiš, Igor Švab, 2017, izvirni znanstveni članek

Opis: Introduction: Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians’ competencies as listed in the Educational Agenda produced by the European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies. Methods: A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach. Results: The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies. Conclusions: All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education.
Ključne besede: family practice, medical education, narration, professional competences, movies, family medicine, education, EURACT
Objavljeno: 06.04.2017; Ogledov: 89; Prenosov: 0
.pdf Polno besedilo (665,34 KB)

3.
The effect of an educational intervention in family phisicians on self-rated quality of life in patients with medically unexplained symptoms
Vojislav Ivetić, Klemen Pašić, Polona Selič, 2017, izvirni znanstveni članek

Opis: Introduction: Medically unexplained symptoms (MUS) are very common in family medicine, despite being a poorly-defined clinical entity. This study aimed to evaluate the effect of an educational intervention (EI) on self-rated quality of life, treatment satisfaction, and the family physician-patient relationship in patients with MUS. Methods: In a multi-centre longitudinal intervention study, which was performed between 2012 and 2014, patients were asked to rate their quality of life, assess their depression, anxiety, stress and somatisation, complete the Hypochondriasis Index, the Medical Interview Satisfaction Scale and the Patient Enablement Instrument for assessing the physician-patient relationship, before and after the EI. Results: The mean values before and after the intervention showed that after the EI, patients with MUS gave a lower (total) mean rating of their health issues and a higher rating of their quality of life, and they also had a more positive opinion of their relationship with the physician (p<0.05). However, there were no differences in the (total) rating of treatment satisfaction before and after the EI (p=0.423). Significant differences in the symptoms in patients with MUS before and after the intervention were confirmed for stress, somatisation and hypochondriasis (p<0.05). Conclusions: It could be beneficial to equip family physicians with the knowledge, skills and tools to reduce hypochondriasis and somatisation in MUS patients, which would improve patients’ self-rated health status.
Ključne besede: medically unexplained symptoms, family medicine, educational intervention, quality of life, treatment satisfaction, family physician-patient relationship
Objavljeno: 06.04.2017; Ogledov: 75; Prenosov: 0
.pdf Polno besedilo (955,23 KB)

4.
The role of the psychosocial dimension in the improvement of quality of care
Irena Makivić, Janko Kersnik, Zalika Klemenc-Ketiš, 2016, pregledni znanstveni članek

Opis: The aim of our systematic review was to analyse the published literature on the psychosocial dimension of care in family medicine and its relationship with quality of care. We wanted to find out whether there is any evidence on the psychosocial approach in (family) medicine. The recommended bio-psycho-social approach, besides the biomedical model of illness, takes into account several co-influencing psychological, sociological and existential factors. An online search of nine different databases used Boolean operators and the following selection criteria: the paper contained information on the holistic approach, quality indicators, family medicine, patient-centred care and/or the bio-psycho-social model of treatment. We retrieved 743 papers, of which 36 fulfilled our inclusion criteria. Including the psychosocial dimension in patient management has been found to be useful in the prevention and treatment of physical and psychiatric illness, resulting in improved social functioning and patient satisfaction, reduced health care disparities, and reduced annual medical care charges. The themes of patient-centred, behavioural or psychosocial medicine were quite well presented in several papers. We could not find any conclusive evidence of the impact of a holistic biopsycho-social-approach. Weak and variable definitions of psychosocial dimensions, a low number of welldesigned intervention studies, and low numbers of included patients limited our conclusions.
Ključne besede: general practice, social problems, psychosocial care, quality of health care, reviews
Objavljeno: 05.04.2017; Ogledov: 55; Prenosov: 0
.pdf Polno besedilo (744,29 KB)

5.
The impact of patientʼs socio-demographic characterictics, comorbidities and attitudes on flu vaccination uptake in family practice settings
Andrej Kravos, Lucija Kračun, Klara Kravos, Rade Iljaž, 2015, izvirni znanstveni članek

Opis: Objectives: In Slovenia, the role of family physicians in primary care and preventive procedures is very important. Influenza vaccination rates in Slovenia are low. The reasons for low vaccination rates in Slovenia were not clear. We suppose that patient’s beliefs and attitudes are important factors. We assessed patients’ opinions regarding the acceptance of flu vaccination by their family physicians and their beliefs and attitudes about flu and vaccination. The aim was to check out factors that influence the decision to take the vaccine in family physician offices. Methods: This was a cross-sectional, multicenter, observational study in the Styria region in Slovenia. We included patients from seven family physicians during regular office visits. They filled in a questionnaire about their general demographic data and attitudes regarding influenza and vaccination. The main outcome was the decision to be vaccinated. Results: The logistic regression model identified five predictors for influenza vaccination, namely: heart disease, previous vaccination, an agreement with the beliefs ‘the vaccination is an efficient measure to prevent influenza’, ‘after the vaccination there are usually no important side effects’ and ‘the vaccination is also recommended for a healthy adult person’. The belief that vaccinations harm the immune system is negatively associated with vaccination. Conclusions: Patients’ beliefs are an important factor to decide for vaccination or not. Family physician teams should discuss with patients their beliefs and concerns about vaccination.
Ključne besede: vaccination, influenza, family practice, attitudes, chronic diseases
Objavljeno: 05.04.2017; Ogledov: 50; Prenosov: 0
.pdf Polno besedilo (187,94 KB)

6.
Self-assessment questionnaire for family doctors' assessment of quality improvement competencies
Zalika Klemenc-Ketiš, Primož Kuhar, Janko Kersnik, Genc Burazeri, Katarzyna Czabanowska, 2014, izvirni znanstveni članek

Opis: Aim: To perform a cross-cultural adaptation of the Quality Improvement Competency Self Assessment (QICS) questionnaire for family physicians into the Slovenian language and to validate it in a representative sample of Slovenian FPs. Methods: This cross-sectional observational postal survey was conducted in a random sample of 398 Slovenian FPs. We used the QICS questionnaire that was developed on the basis of the new Quality Improvement Competency Framework for family medicine. The QICS questionnaire consists of 37 items included in six domains. The questions can be answered on a five-point Likert scale. The validity of the translation was provided by the backward translation from Slovenian to the English language and by the reference group consisting of experienced FPs in the consensus process. The reliability of the questionnaire was assessed by Cronbach’s alpha coefficient and Spearman rho to determine the test-retest reliability (the questionnaire was sent to the physicians in the sample twice in a period of two weeks). Results: The final sample consisted of 100 (25.1%) family physicians, out of which 71 (71.0%) were women. Mean age of the sample was 43.3 ± 9.6 years. Mean score of the QICS questionnaire was 127.0 ± 30.1 points (first round) and 127.8 ± 30.6 points (second round). Cronbach’s alpha scores were 0.984 (first round) and 0.988 (second round). Spearman’s rho for the summary score of the whole scale was 0.829 with p < 0.001. Conclusion: The Slovenian version of the QICS questionnaire proved to be a valid and reliable tool for selfassessment of quality improvement competencies by FPs in terms of continuous professional development.
Ključne besede: clinical competence, family medicine, self-assessment, quality improvement
Objavljeno: 05.04.2017; Ogledov: 55; Prenosov: 0
.pdf Polno besedilo (363,48 KB)

7.
Quality of life and patient satisfaction with family practice care in a roma population with chronic conditions in northeast Slovenia
Erika Zelko, Igor Švab, Danica Rotar-Pavlič, 2015, izvirni znanstveni članek

Opis: Objectives: Health-related quality of life (HRQoL) measures a patient's subjective experience of his or her health status. We aimed to show how the presence of chronic diseases and satisfaction with family physicians (FPs) were associated with the HRQoL of a Roma population. Methods: A cross-sectional study was carried out in May 2011 on a representative sample of 650 Roma living in Prekmurje, Slovenia. The EQ-5D questionnaire was used for measuring the HRQoL of the Roma. Demographical data, 12 groups of diseases diagnosed in the last 12 months and satisfaction with FPs were included in the questionnaire. Results: The response rate was 88.3% (574), of which 56.4% were female, and the average age of the participants had a mean value of 40.2+-12.7 years. The presence of cardiovascular problems with risk factors for them or presence of musculoskeletal disorders were strongly associated with the presence of pain (Cramer's V = 0.40 and 0.46 respectively). There was a strong association between the presence of mental disorders and anxiety and depression (Cramer's V = 0.58). The average satisfaction with the family physician was 3.9 (mean+-1.10) on a five-point Likert scale. There was no significant association between HRQoL and satisfaction with the family physician. Conclusions: Roma with chronic mental health problems had the lowest HRQoL in the Roma population. More attention should be paid to this subgroup of Roma in family medicine, and interventions should be provided. High satisfaction with their FPs is not associated with the observed quality of life variables.
Ključne besede: quality of life, Roma, patient satisfaction
Objavljeno: 05.04.2017; Ogledov: 38; Prenosov: 0
.pdf Polno besedilo (232,60 KB)

8.
Pogostost bolezenskih simptomov pri odraslem prebivalstvu Slovenije in dejavniki, ki so povezani z njihovim pojavljanjem
Nina Pivec, Tamara Todorović, Zalika Klemenc-Ketiš, Janko Kersnik, 2014, izvirni znanstveni članek

Opis: Namen: Namen raziskave je bil ugotoviti, kateri bolezenski simptomi se najpogosteje pojavljajo pri odraslem prebivalstvu Slovenije in določiti njihovo prevalenco in dejavnike, ki nanjo vplivajo. Metode: Raziskava je bila presečna opazovalna in je potekala s pomočjo računalniško podprtega telefonskega anketiranja - CATI. Vključena sta bila 1002 prebivalca, stara med 15 in 90 let. Telefonski intervju je zajemal vprašanja o pojavnosti 23 bolezenskih simptomov, njihovem trajanju in o demografskih podatkih. Izsledki: Slovensko prebivalstvo ima najpogosteje težave z bolečinami v hrbtenici (409 oseb - 40,8 %), bolečinami v sklepih (334 oseb - 33,4 %), s prekomerno utrujenostjo (308 oseb - 30,7 %), z živčnostjo (285 oseb - 28,4 %), glavobolom (280 oseb - 27,9 %), razdražljivostjo (261 oseb - 26,1 %) in z nespečnostjo (259 oseb - 25,8 %). Statistično pogosteje so se bolezenski simptomi pojavljali pri ženskah, starejših, nižje izobraženih, ljudeh z nižjim osebnim dohodkom, nezaposlenih, upokojenih in tistih z znano kronično boleznijo. Neodvisna napovedna dejavnika za prisotnost vsaj enega bolezenskega simptoma sta ženski spol in prisotnost kronične bolezni. Sklepi: Slovensko prebivalstvo je znatno obremenjeno z bolezenskimi simptomi, saj 77,3 % vprašanih bremeni vsaj en bolezenski simptom. Raziskava je odkrila skupine prebivalstva, ki so bolezenskim simptomom še posebej podvržene (ženske, starejši, kronični bolniki, ljudje z nižjim socioekonomskim statusom) in katerim bi morala biti namenjena še posebna pozornost na ravni primarnega zdravstvenega varstva in preventivne dejavnosti.
Ključne besede: bolezenski simptomi, prevalenca, napovedni dejavniki, slovensko prebivalstvo, Slovenija
Objavljeno: 05.04.2017; Ogledov: 46; Prenosov: 0
.pdf Polno besedilo (254,92 KB)

9.
Maternal perceptions of and responses to child sexual abuse
Zlatka Rakovec-Felser, Lea Vidovič, 2016, izvirni znanstveni članek

Opis: Background: Several researches indicate that most child victims delay disclosing of sexual abuse for significant periods of time. There are numerous reasons as to why children are avoiding the disclosure of the abuse. The aim of this study was to determine how a mother’s response to a child’s allegations impacts the child’s willingness to disclose sexual abuse. Methods: We conducted a retrospective quantitative and qualitative analysis of 73 court-referred cases of child sexual abuse which have been disclosed in Slovenia in the last ten years. All the child victims included in the study were female and the perpetrators adult male persons. The expert opinions were made by the same expert. Results: We realized that, at the occurrence of abuse, the child victims were from 4 to 15 years old and their mean age was at 11. 5 years. About two-thirds of children were victims of the intra-familial type (61.6%) and a little more than one third of extra-familial type of sexual abuse (38.4%). The group of victims with the support of their mothers needed about 9 months to disclose the secret, while the delay of the disclosure in the cases without the support of mothers was much longer (M=6.9 years). Conclusion: For female child victims of sexual abuse the perceived protective attitude of their mothers is very important. Especially when the sexual abuse happened in the family, the mother’s support can attribute to stop the ongoing abuse, eliminate its immediate effects and decrease its likely negative long-term outcome.
Ključne besede: child sexual abuse, disclosure, maternal response
Objavljeno: 05.04.2017; Ogledov: 42; Prenosov: 2
.pdf Polno besedilo (889,29 KB)

10.
Health beliefs and practices among Slovenian Roma and their response to febrile illnesses
Danica Rotar-Pavlič, Erika Zelko, Janko Kersnik, Verica Lolič, 2011, izvirni znanstveni članek

Opis: Introduction: When the Roma fell ill in the past, they used herbal home remedies to treat diseases. If the remedy failed to cure the illness, they called the local healer. Today, most Roma visit physicians. This study investigates health beliefs and practices held by the Roma people in Slovenia and their response to febrile illnesses. Methods: Field interviews using a semi-structured questionnaire were conducted in the vicinity of Kočevje. Sociodemographic data were gathered and recorded manually, and the interviews were tape recorded. Qualitative analysis was performed by three researchers. Special attention was paid to data validation. Results: The majority of Roma are not acquainted with thermometers and therefore do not use them. About onethird of the interviewees knew what the normal body temperature should be. Only 15% of the Roma population take their body temperature when they are feeling unwell. One-half visit their physicians. More than half of the population take paracetamol or aspirin when they feel feverish. More often, they resort to tea and emphasize the healing effect of sweating. Conclusion: The Roma beliefs and practices regarding health and fever are instructive and show how impoverished a narrow biomedical approach can be. Failure to use technical devices, such as thermometers, and lack of familiarity with the numerical values defining the border between normal and elevated body temperature, nonetheless do not mean that the Roma take inappropriate measuresin response to illness. Illnesses (including fever) can also be recognized without these tools and can be appropriately responded to by drinking teas, using compresses, and taking fever-reducing medications.
Ključne besede: Roma, illness, thermometer, fever, activity, doctor
Objavljeno: 05.04.2017; Ogledov: 46; Prenosov: 0
.pdf Polno besedilo (236,53 KB)

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