Slovenian adaptation of the original AUDIT-C questionnaire

How effective are health messages/warnings in improving knowledge and awareness of alcohol-related harm? The Slovenian case on using a mobile app

BACKGROUND

Consumers generally lack access to information on alcoholic beverages, in spite of it being readily available for food and non-alcoholic beverages. Given the rights of consumers, and as with other products harmful to the population, there have been increasing calls for health warnings to be placed on alcoholic beverages, similar to those implemented on tobacco products. The aim of our research was to assess whether knowledge and awareness of the risks and harms associated with alcohol can be improved with a mobile app.

METHODS

Intervention was conducted using VKJ mobile app, which enables users to scan the barcode of an alcoholic beverage and receive feedback on its labelled alcohol content and estimated energy value. At each search, eleven different health messages/warnings about the risks and harms of alcohol are also displayed randomly, rotating on the screen. A survey was conducted before and after the intervention, to assess the knowledge and awareness of the risks and harms associated with drinking alcohol.

RESULTS

Significant differences were found for eight of the twelve tested statements. The improvement was seen to a greater extent in the group of high-risk drinkers. The results also showed that the vast majority of participants (78%) who were exposed to the health messages supported mandatory labelling of alcoholic beverages with information on ingredient listing and energy value, and 72% would like to have health warnings on alcohol products.

CONCLUSIONS

The use of a mobile app can be an option to improve knowledge and raise awareness of the risks and harms related to alcohol.

Peer Support as Part of Scaling-Up Integrated Care in Patients with Type 2 Diabetes and Arterial Hypertension at the Primary Healthcare Level: A Study Protocol

Introduction

Type 2 diabetes (T2D) and arterial hypertension (AH) are among the greatest challenges facing health systems worldwide and require comprehensive patient-centred care. The key to successful management in chronic patients is self-management support, which was found to be only weakly implemented in Slovenia. The aim of the study is to develop an evidence-based model of peer support for people with T2D and AH at the primary healthcare level in Slovenia, which could represent a potential solution for upgrading integrated care for these patients.

Methods

A prospective interventional, mixed-methods pilot study will begin by recruiting approximately 40 eligible people with T2D and AH through purposive sampling. The participants will receive structured training, led by a specialist nurse, to become trained peer supporters. Each will voluntarily share their knowledge and experience at monthly group meetings with up to 10 people with T2D and AH over a three-month period in the local community. Data will be collected through interviews and focus groups and questionnaires about socio-demographic and clinical data, knowledge about T2D and AH, participants’ quality of life, level of empowerment and acceptability of the intervention.

Expected results

The study will provide an evidence-based model for integrating peer support into the local community. It is expected that the intervention will prove feasible and acceptable with educational, psychosocial and behavioural benefits.

Conclusion

Peer support through empowerment of people with T2D and AH, family members and other informal caregivers in the local community could scale-up the integrated care continuum and contribute to sustainability of the healthcare system.

Telemonitoring of elderly with hypertension and type 2 diabetes at the primary care level: Protocol for a multicentric randomized controlled pilot study

Introduction

Arterial hypertension (AH) and type 2 diabetes (T2D) represent a significant burden for the public health system, with an exceptionally high prevalence in patients aged ≥65 years. This study aims to test the acceptability, clinical effectiveness, and cost-effectiveness of telemonitoring in elderly patients with AH and T2D at the primary care level.

Methods

A m ulti-centre, prospective, randomized, controlled t rial w ill be conducted. Patients a ged ≥ 65 y ears with AH and T2D will be randomized in a 1:1 proportion to a mHealth intervention or standard care group. Patients in the intervention group will measure their blood pressure (BP) twice weekly and blood glucose (BG) once monthly. The readings will be synchronously transmitted via a mobile application to the telemonitoring platform, where they will be reviewed by a general practitioner who will indicate changes in measurement regimen or carry out a teleconsultation. The primary endpoint will be a change in systolic BP (SBP) and glycated haemoglobin (HbA1c) relative to standard care up to 12 months after inclusion. Secondary endpoints will be a change in other observed clinical variables, quality-of-life indexes, and costs.

Expected results

Telemonitoring will be an acceptable method of care associated with significant reductions in SBP and HbA1c levels and an increase in quality-of-life indexes in the intervention group. However, the cost-effectiveness threshold (incremental cost-effectiveness ratio below €25,000/quality-adjusted life year) might not be reached.

Conclusion

This study will provide new evidence for scaling up telemonitoring network at the primary care level and modifying telemonitoring protocols to achieve the best clinical and cost-effective outcomes.

Quality of Life and Health Status in Middle-aged Presumed Healthy Slovenian Family Practice Attendees

Background

There is a gap in our knowledge of health-related quality of life (HRQoL) in a population presumed healthy, so this study aimed to assess the associations between HRQoL, demographics and clinical variables.

Methods

The participants were attendees, presumed healthy, at 40 pre-selected model family medicine practices (MFMPs), aged between 30 and 65 years and recruited during a preventive check-up in 2019. Each MFMP pragmatically invited 30 attendees to voluntarily participate. The EQ-5D questionnaire was administered as a measure of HRQoL; the independent variables were demographic characteristics, smoking, alcohol consumption, stress perception, physical activity, signs of depression, cardiovascular risk, body mass index, blood pressure values, and blood sugar and lipidogram laboratory test values. Ordinal logistic regression was used to calculate associations between self-assessed quality of life, demographics, and clinical variables, with P<0.05 set as statistically significant.

Results

Of 986 participants, 640 (64.9%) were women and 346 (35.1%) men, aged 42.7±8.6 years. The average values for the EQ-5D-3L were 0.91±0.15. In the multivariate model, a positive association between adequate physical activity (p=0.003), and a negative association between higher age (p<0.001), female gender (p=0.009), signs of depression (p<0.001), stress (p=0.013), and EQ-5D score were identified.

Conclusion

Given that physical activity was shown to be positively associated with HRQoL, it is of the utmost importance for family physicians to motivate their middle-aged patients, especially women and those with signs of depression and excessive stress, to adopt a more rigorously physically active lifestyle.

Development of an Algorithm for Determining of Genetic Risk at the Primary Healthcare Level - A New Tool for Primary Prevention: A Study Protocol

INTRODUCTION

Family history (FH) is an important part of the patients' medical history during preventive management at model family medicine practices (MFMP). It currently includes a one (or two) generational inquiry, predominately in terms of cardiovascular diseases, arterial hypertension, and diabetes, but not of other diseases with a probable genetic aetiology. Beside family history, no application-based algorithm is available to determine the risk level for specific chronic diseases in Slovenia.

METHODS

A web application-based algorithm aimed at determining the risk level for selected monogenic and polygenic diseases will be developed. The data will be collected in MFMP; approximately 40 overall with a sample including healthy preventive examination attendees (approximately 1,000). Demographic data, a three-generational FH, a medical history of acquired and congenital risk factors for the selected diseases, and other important clinical factors will be documented.

RESULTS

The results will be validated by a clinical genetic approach based on family pedigrees and the next-generation genetic sequencing method. After the risk of genetic diseases in the Slovenian population has been determined, clinical pathways for acting according to the assessed risk level will be prepared.

CONCLUSION

By means of a public health tool providing an assessment of family predisposition, a contribution to the effective identification of people at increased risk of the selected monogenic and polygenic diseases is expected, lessening a significant public health burden.

Risk for malnutrition in family practice non-attenders living in the community: A cross-sectional study from Slovenia

OBJECTIVES

The aim of this study was to determine the prevalence of malnutrition and the factors associated with malnutrition in a population of family practice non-attenders. This would enable us to recognize the extent of the problem and anticipate the measures needed to improve the current situation.

METHODS

This was a cross-sectional observational study in a family medicine setting. Participants were adults living in the community (≥18 y of age) who had not visited their chosen family physician in the previous 5 y (non-attenders) and who were able to participate in the study. Through the electronic system, we identified 2025 non-attenders. Data were collected by community nurses in the participants' homes. The main outcome measure was the Malnutrition Universal Screening Tool.

RESULTS

The sample consisted of 1641 participants (81% response rate). Increased risk for malnutrition was determined in 216 participants (13.2%; 95% confidence interval, 11.6-14.9). The multivariate model showed a significant association of increased risk for malnutrition with age and body mass index interaction (P = 0.022); number of chronic diseases (P = 0.001); poor assessment of current health (P = 0.001); a feelings of loneliness (P <0.001); and increased pain intensity (P = 0.003).

CONCLUSION

A screening program at the primary health care level could help identify patients at risk for malnutrition early. This could be followed by appropriate nutrition support, which may help to reverse or halt the malnutrition trajectory and the negative outcomes associated with poor nutritional status.

Differences in alcohol consumption habits between Roma and non-Roma in Northeastern Slovenia

Introduction: Slovenia has a high level of alcohol consumption. Comparisons of the alcohol drinking habits of the Roma and non-Roma population have yielded conflicting results. The aim of this research was to compare alcohol consumption habits between Roma and non-Roma in a sample population in Northeastern Slovenia. Methods: We conducted a cross-sectional study in which we included 100 representatives of Roma and 100 representatives of non-Roma population, aged 18 to 65 years. The questionnaire used included demographic data (gender, age, marital status, education, and employment) and the AUDIT (Alcohol Use Disorders Identification Test) questionnaire. Two logistic regression models (teetotallers/drinkers and non-hazardous drinkers/other drinkers) were used for the comparison of drinking habits. Results: Roma scored lower on overall AUDIT score (4.51) than non-Roma (4.56). Roma and non-Roma differ significantly regarding teetotallers (39.0% vs. 16.0%) and non-hazardous drinkers (38.0% vs. 64.0%). Ethnicity was identified to have a statistically significant impact on the studied drinking behaviour: teetotallers (p < 0.001) and non-hazardous drinkers (p = 0.015). Discussion and conclusion: Our aim was to look at the differences between the two groups rather than obtain representative data on the population. Our research also casts a doubt on whether the AUDIT scale is suitable for measuring alcohol abuse.

Alcohol Drinking Among the Students of the University of Maribor, Slovenia

Background

Hazardous and harmful alcohol drinking is an important health, social and economic issue in Slovenia amongst all age groups. While drinking in Slovenia has been well researched amongst elementary and high school students, there is a lack of research on drinking amongst university students.

Methods

We conducted a cross-sectional study among first- and fourth-year students of the University of Maribor, Slovenia, attending the mandatory preventive health check between October 2009 and May 2010. During this health check, they filled in a non-anonymous lifestyle questionnaire. AUDIT–C questionnaire on alcohol use and questions on smoking and illicit drug use were also included.

Results

3.130 students were included in the analysis, 1219 (38.9%) were males. There were 871 (27.8%) students that were screened as risky drinkers. The highest percentage of risky drinkers attended the Faculty for Wood Technology and the lowest the Faculty for Health Sciences. Students, recognized as healthier by the physicians, reported risky drinking significantly less often (p=0.015). Students with higher BMI reported risky drinking significantly more often (p=0.012). Variables, proved to be independently associated with the risky drinking in the multivariate analysis, were: bad health status (p=0.044), male sex (p<0.001), daily consumption of fried food (p=0.017), smoking (p<0.001), illicit drugs (p<0.001), attending the Faculty for Civil Engineering (p=0.006), not attending the Faculty for Health Sciences (p=0.002)

Conclusions

While the prevalence of risky drinking among students in this study is high, a structured preventive programme should be implemented for students, which will include also illicit drug use and smoking.

Focus points in prevention actions against legal substances' abuse

AIM

To determine the factors associated with alcohol and tobacco abuse in Slovenian general population.

MATERIAL AND METHODS

We performed an observational cross-sectional study in a representative sample of 1002 Slovenian inhabitants in June 2011. It was performed using a method of computer-assisted telephone interview. The telephone interview consisted of questions about the prevalence and duration of preselected health-related symptoms in the past month, questions about the presence of chronic diseases, question about the presence of current smoking, EQ-5D questionnaire and AUDIT-C questionnaire.

RESULTS

Risky drinking was found in 103 (14.3 %) of the sample and smoking was found in 226 (22.6 %) of the sample. Men reported risky drinking more often when compared with women (17.7 vs. 10.5 %, P = 0.007). Multivariate analysis showed that male sex, current tobacco smoking, lower education level, self-reported presence of anxiety/depression and self-reported presence of muscle pain and excessive fatigue in the past month were independently associated with risky drinking and that male sex, lower education and income, the presence of chronic disease, self-reported problems in daily activities, risky drinking, self-reported troubles in sleeping and restless leg syndrome were independently associated with current tobacco smoking.

CONCLUSION

Risky alcohol drinking and smoking are still major public health problems in Slovenia and are associated with known demographic risk factors but also with some symptoms of somatoform disorders. These findings should be incorporated into the guidelines for family physicians as the important focus points for screening and intervening against legal substances' abuse in their patients.