ABSTRACT:The aim of the study was to assess the association between atmospheric air pollution and respiratory diseases in children on the level of small spatial units in the Zasavje. The health and environmental data were obtained for the period between January 1 and December 31, 2011. Studied small spatial units were designed on the basis of estimated level of atmospheric air pollution and digital maps and boundaries of local communities and settlements. The impact of atmospheric air pollution on respiratory diseases was analysed by using the Bayesian models. Considering the identified deficiencies, the presented methodolgy can often be used to identify areas with a higher health risks.
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Ministry of Health, Republic of Slovenia. Background Cardiac rehabilitation (CR) is a complex intervention, providing supervised exercise training, risk factor control, and secondary prevention. Centre-based outpatient CR provides the necessary structure to accomodate the delivery of several preventive interventions, but the quality of secondary prevention may vary. The present study sought to assess the impact of CR on the improvement and between-center variation of the quality of secondary prevention. Methods Data were extracted from the Slovenian National CR Registry for patients who completed CR between 2017 and 2020. A composite quality score (CQS) was calculated adjudicating one point for each of the following: non-smoking status, body mass index <25 kg/m2, systolic blood pressure <130 mmHg, low-density lipoprotein (LDL) cholesterol <1.4 mmol/L, antiplatelet therapy, and high-potency statin/combined lipid-lowering therapy. Predictors of CQS improvement were assessed using mixed-effects ordinal logistic regression model acknowledging the hierarchical nesting of patients within centres. Results A total of 1,952 patients from 5 centres were included (mean age 59.4±10.8 years; 22% women). Mean CQS improved from 3.16±1.11 to 3.53±1.21 (p<0.001), with CR associated with an OR 1.72 (95% confidence interval [CI] 1.49-2.00) for CQS improvement (Figure). Improvement of CQS was also positively associated with increasing number of sessions >12 (e.g., OR 6.06 [3.29-11.14] for 12-24 sessions) and total number of co-morbidities (OR 1.40 [95%CI 1.33-1.48]), and negatively associated with male sex (OR 0.78 [95%CI 0.65-0.92]), high cardiac risk (OR 0.83 [95%CI 0.68-0.99]), age >60 years (e.g., OR 0.62 [95% CI 0.41-0,94] for age group 60-69 years), and referral diagnosis other than STEMI (e.g., OR 0,56 [95%CI 0.39-0,72] for non-infarction coronary artery disease). Random-effects partitioning attributed 68.8% of variance to patient-level factors and 19.8% to between-center variability. Conclusions Centre-based CR is associated with improved quality of secondary prevention; factors affecting quality improvement range from patient-level (e.g., age and sex) to mode of provision (e.g., number of sessions). Up to one fifth of the variation, however, can be attributed to between-center variationm.
Ponudba zdravih in uravnoteženih obrokov v šolah, poleg izobraževanja in ozaveščanja otrok o pomenu zdrave prehrane, predstavlja pomemben javnozdravstveni ukrep. Prispevek prikazuje opis sistema organizirane šolske prehrane v Sloveniji ter primerjavo s trinajstimi državami v Evropi. Slovenija sodi med države s preko sedemdeset letno tradicijo šolske prehrane. Področje je urejeno z zakonodajo, vzgojno-izobraževalni zavodi pa imajo zagotovljene človeške, finančne in prostorske vire, ki omogočajo načrtovanje, pripravo in razdeljevanje šolskih obrokov. Ureditev in pristopi zagotavljanja obrokov v času pouka se v Evropi razlikuje od države do države in so odvisni od različnih dejavnikov. Večina držav ima decentralizirano ureditev, kjer se odgovornost za zagotavljanje šolske prehrane prenese na ustanovitelja (lokalno skupnost) in vzgojno-izobraževalni zavod. Slovenija sodi med države, ki ima poleg celovite organiziranosti ukrepa šolske prehrane in subvencioniranja obrokov zakonodajno urejeno tudi strokovno spremljanje s svetovanjem, ki ga sistematično in usklajeno izvaja Nacionalni inštitut za javno zdravje.
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency and Ministry of Health of the Republic of Slovenia Background The coronavirus (COVID19) pandemic has disrupted the provision of health care, including cardiac rehabilitation. Reduced healthcare provision has been associated with reduced accessibility, wheares patients’ perspectives – such as COVID19-related anxiety, stress and obsessive thinking – have been less thouroghly addressed. Methods This was a cross-sectional study of COVID19-related anxiety, stress and obsessive thinking in consecutive patients undergoing outpatient cardiac rehabilitation after myocardial infarction at two centres — a general hospital catering a predominantly rural area and a university hospital in an urban area. From April to October 2021 we captured patients’ clinical and socio-economic characteristics, and resposes to the Hospital Anxiety and Depression Scale (HADS) as well as to three dedicated COVID19-related questionnaires – the Coronavirus Anxiety Scale, the Obsession with COVID-19 Scale and a customized COVID-19 Stress Scale. Results We included 109 patients (mean age 59±10 years, 20% women). Fifteen (13.8%) and eleven (11%) patients reached a HADS treshold for depression and anxiety, respectively. Pateints expressed most concenrs regarding the safety of COVID19 vaccinces (60.6%) on the COVID19 Stress Scale, sleeping disturbances (14.8%) on the Coronavirus Anxiety Scale, and fear of interacting with infected people (30.3%) on the Obsession with COVID-19 Scale. No significant differences were observed between respondents from the general and the university hospital. HADS score and social status—but not age, sex and clinical characteristics—were associated with scores on the COVID-19-specific questionnaires; HADS-anxiety domain score remained an independent predictor of COVID19-related stress (p=0.009), obsessive thinking (p<0.001) and anxiety (p=0.009) after multivariate adjustment. Conclusions Patients undergoing cardiac rehabilitation expressed relatively low levels of COVID19-related stress and anxiety. Higher levels of COVID19-related stress, anxiety, and obsessive thinking were observed in patients with higher levels of anxiety, but not in association with demographic or clinical characteristics.
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Slovenian Research Agency Ministry of Health, Slovenia. Background The coronavirus-19 (COVID-19) pandemic has severely disrupted the provision of cardiac rehabilitation (CR), with responses ranging from outright closure of CR centres to adapting CR provision to the diversion of resources and changing public health guidance. Using interrupted time-series analysis, we sough to estimate the impact of the COVID-19 pandemic the quality centre-based CR. Methods Quality indicators for 1,268 patients undergoing centre-based CR after a myocardial infarction were extracted from the national CR registry, and summarized with a composite quality score (i.e., adjudicating one point for each: antithormbotic therapy, high-potency statin therapy, low-density lipoprotein cholesterol [LDL-C] <1.4 mmol/L, systolic blood pressure <130 mmHg, body mass index <25 kg/m2, non-smoking status, >20% improvement in exercise capacity from baseline). Composite quality scores were aggregated on monthly time units; an interrupted time series of 52 time points was constructed, with breakpoint defined on 1 March 2020. Using Prais-Winsten (autoregressiove order 1) segmented regression, change in level and time trend of the composite quality score were estimated, with 95% confidence intervals [95%CI]. Results After the pandemic outbreak, waiting times for CR increased (from 56 [IQR 36-82] to 75 [IQR 58-102] days, p<0.001), while duration of CR (from 100 [SD 58] to 90 [SD 67] days) and number of sessions (from 33 [SD 7] to 28 [SD 9]) decreased (p<0.001 for both). The outbreak of COVID-19 was associated with a non-significant change in level (+0.370 [95%CI -0.207; 0.946] points, p=0.204) and a significant change in trend (-0.0438 [95%CI -0.0841; -0.0437] points/per month, p=0.034) of the composite quality score. Patterns for estimates did not change significantly after adjustment for number of sessions and/or duration of CR. See Figure 1. Conclusons The COVID-19 pandemic has affected the quality of centre-based CR, with a trainsient (non-significant) increase followed by a persistent (significant) trend of decreasing quality of CR provision. Our findings suggest the need for intensifying the quality of secondary prevetive care during CR in the forthcoming post-pandemic recovery.
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