ZDRAVJE DELOVNO AKTIVNIH IN STAREJŠIH ODRASLIH HEALTH OF WORKING-AGE AND OLDER ADULTS Zbornik prispevkov z recenzijo Proceedings Edited by Ana Petelin Uredniški odbor Založbe Univerze na Primorskem Gregor Pobežin, UP Fakulteta za humanistične študije Ana Grdović Gnip, UP Fakulteta za management Vito Vitrih, UP FAMNIT in UP IAM Silva Bratož, UP Pedagoška fakulteta Simon Kerma, UP FTŠ – Turistica Ana Petelin, UP Fakulteta za vede o zdravstvu Janko Gravner, University of California Davis Krstivoje Špijunović, Učiteljski fakultet Užice Miloš Zelenka, Jihočeská univerzita v Českých Budějovicích in Univerzita Konštantína Filozofa v Nitre Jonatan Vinkler, UP Univerzitetna knjižnica in Založba Univerze na Primorskem Alen Ježovnik, Založba Univerze na Primorskem zdravje delovno aktivnih in starejših odraslih health of working-age and older adults Organizator Univerza na Primorskem | Fakulteta za vede o zdravju Università del Litorale | Facoltà di scienze della salute University of Primorska | Faculty of Health Sciences Partnerja konference Sponzorji Zdravje delovno aktivnih in starejših odraslih Health of working-age and older adults Edited by Ana Petelin 2024 Contents Barbara Artnik, Martin Ranfl 9 Oral Hygiene and the Use of Fluoride Toothpastes in Adults in Slovenia in 2019 Margareta Begić, Edina Pulić, Tatjana Njegovan - Zvonarević, Želimir Bertić, Mirjana Telebuh 21 Evaluation of Student Knowledge of Palliative Care Tija Božič, Tamara Poklar Vatovec 33 Eating Habits in Therapeutic Community Alenka Cergol, Nina Zlatič 41 The Importance of Cardiac Rehabilitation After a Heart Attack: Treatment of the Working and Elderly Population Anja Durjava, Martin Ranfl, Barbara Artnik 49 Oral Health-related Quality of Life in the Adult Population of Slovenia in 2019 Jera Gregorc, Giuliana Jelovčan, Miran Muhič 57 Some Aspects of the Lifestyle of Future Educators Urša Horvat, Manca Salmič, Denisa Manojlović Ivezić 67 The Effect of Pelvic Floor Muscle Exercises on Chronic Low Back Pain Marjeta Logar Čuček 77 The Use of Artificial Intelligence in the Field of Health for Working-age Adults and Older Adults Helena Olenik, Damir Hećimović 87 The Influence of Night Work on the Eating Habits of Workers Barbara Pantar 97 The Role of Medical Screening in Physiotherapy Ajda Plos, Mirko Prosen, Maša Černelič Bizjak 107 Bullying and Mobbing in Nursing: A Descriptive-interpretative Analysis Martin Ranfl, Anja Durjava, Barbara Artnik 117 Self-assessment of the Oral Health of Adults in Slovenia in 2019 Saša Šajn Lekše, Tomaž Čakš 125 Smoking habits of older adults in Slovenia – analysis of Quitline calls 8 ltsu daerld od naeg-ag rkino wf o lthea | h slih rad o rejših sta inih ktivnao vnoel d ravje zd https://doi.org/10.26493/978-961-293-397-5.9-20 Oral Hygiene and the Use of Fluoride Toothpastes in Adults in Slovenia in 2019 Barbara Artnik1, Martin Ranfl2 1 University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia 2 National Institute of Public Health, Regional Unit Murska Sobota, Murska Sobota, Slovenia Abstract Introduction: We present the results of the »National Oral Health Survey of Adults in Slovenia in 2019 «, which for the first time determined the level of oral health care in adults at the national level. The aim of our study was to assess the state of oral health in adults and make recommendations for its promotion. We report in detail the results and findings in relation to oral hygiene and fluoride use. Methods: The target population was adults aged 18–74 years. The gender- and age-representative sample comprised 3,200 adults (0.21% of the population in Slovenia). The survey was conducted using the EGOHID questionnaire. The data were weighted by gender, age and education. The results were analysed based on the number and proportion of people in the selected categories according to demographic variables (gender, age, education, living environment) and other variables (frequency of dental cleaning, etc.). The distribution of proportions between different groups (by gender, age, education and living environment) and comparisons were tested using the chi-square (χ2) test and the CCP test to compare proportions between different groups. Results: 71% of adults brushed their teeth regularly (at least twice a day), of which 81% were women and 60% men (χ2 test=49.879, p<0.001; CCP test, p<0.001). Only 59% of adults with at least primary education, 68% of adults with secondary education and 82% of adults with at least tertiary education brushed their teeth at least twice a day (χ2 test=24.965, p<0.001), but only compared to adults with at least tertiary education (CCP test, p<0.001). In rural areas, where 62% of adults regularly brushed their teeth, the proportion was lower than among adults in urban (78%) or suburban areas (76%) (χ2 test=26.466, p<0.001; CCP test, p<0.004). Most adults used toothpaste when brushing their teeth. Of these, 64% used toothpaste with fluoride, 14% used toothpaste without fluoride and 23% did not know whether their toothpaste contained fluoride. Dental floss was used regularly or occasionally by 64% of adults, an interdental brush was used regularly or occasionally by 52% of adults, and a tongue scraper was used regularly or occasionally by 23% of adults. Further statistical data are included in the paper. Discussion and conclusions: Brushing teeth at least twice daily with fluoride toothpaste and interdental brushing and/or flossing and tongue scraping once daily are recommended as effective measures to prevent oral disease. There is also a need to raise awareness of the importance of dental hygiene among the target population in terms of age, education and living environment. The results and recommendations for improving oral health are a step towards reducing the burden of oral diseases and costs in the (dental) healthcare system. Keywords: oral health, adults, oral hygiene, fluorides Introduction Oral health is an integral part of general health and has a significant impact 10 on the quality of life of individuals and society. Like other aspects of health, tsen oral health is determined by the individual, social and physical environment lesco (WHO, 2024). dad In Slovenia, we are following the trend of establishing a system for moni-na toring oral health indicators. With the results of the »National Oral Health ren ildh Survey of Adults in Slovenia in 2019«, the level of oral health care among adults cf o at national level was determined for the first time. The aim of our study was lth to assess the state of oral health in adults and make recommendations for its ea | hv promotion. iko stn In this article, we report in detail on the results and findings in relation to od oral hygiene, fluoride use and the use of (other) aids to maintain oral hygiene. la m ink tro Methods o ravje The study was designed as a cross-sectional epidemiological survey of the zd Health Interview Survey (HIS) type and was conducted according to the results of a pilot verification study (Šket, 2015). The study was conducted in spring 2019 on a representative sample of the general population aged 18–74 years, which included 3,200 adults (0.21% of the population in Slovenia). The survey was conducted using the EGOHID questionnaire (Bourgeois et al., 2008). The adults included in the study received an invitation to participate in the survey at a home address with a password to access the online questionnaire. For participants over 44 years of age, a written questionnaire was enclosed with the notification letter. Participants received a further postal reminder during the survey period. In our study, we analysed the frequency of tooth cleaning. When analysing, we combined the categories »brushing teeth twice or several times a day« and the categories »once a day«, »several times a week«, »once a week« and »never«, as regular tooth brushing means that teeth are brushed at least twice a day. We also asked whether respondents used toothpaste and, if so, whether it contained fluoride. We also investigated the use of other aids to maintain oral hygiene; we analysed how often adults in Slovenia use dental floss, an interdental brush and a tongue scraper. The results were analysed based on the number and proportion of people in the selected categories according to demographic variables (gender, age, education, living environment) and other variables necessary for research or planning further interventions (frequency of tooth cleaning, etc.). The data obtained in the study were weighted by gender, age and education, taking into account age groups of one year. The sample- and population-weighted data were analysed using the computer programme IBM SPSS Statistics for Windows, version 21.0 (IBM, 2020) and the programme R, version 3.6.0 (n.d.). The distributions of proportions between different groups (by gender, age, education and living environment) were tested using the chi-square (χ2) 11 test and the CCP test (Column Comparison Proportion test) to compare the 019 proportions between different groups. A confidence interval of 95% was used 2 in in both cases. ia ven slo in Results ltsu da in Frequency of Tooth Brushing stespa The results showed that 71% of adults brushed their teeth regularly (at least tho twice a day) (Figure 1). toe rido 1 % 0 % fluf o seu 3 % e 10 % thd nae ien More than twice a day yg hl 24 % rao Twice a day Once a day Several times a week Once a week Never 61 % Figure 1: Proportion of adults aged 18–74 years by frequency of tooth brushing. Broken down by gender, 81% of women and 60% of men brushed their teeth regularly (Figure 2); the differences between the proportions by gender were statistically significant (χ2 test=49.879, p<0.001; CCP test, p<0.001). In terms of age, the proportion of 25- to 34-year-olds stands out: 84% of people brushed their teeth regularly (Figure 2); the differences between the proportions by age were statistically significant (χ2 test=17.307, p=0.004), but only for the proportions in this age group compared to adults over 44 years of age (CCP test, p<0.05). It can be seen that the proportion of people who brushed their teeth regularly (at least twice a day) increased with the level of education (Figure 2). On-ly 59% of adults with at least primary education, 68% of adults with secondary education and 82% of adults with at least tertiary education brushed their teeth at least twice a day; the differences between the proportions according to educational level were statistically significant (χ2 test=24.965, p<0.001), but only in 12 comparison to adults with at least tertiary education (CCP test, p<0.001). ltsu 100 % da 90 % erld 80 % o At most once d 70 % a day naeg 60 % -ag 50 % rkin 40 % At least twice o w a day f 30 % o 20 % lthea 10 % | h 0 % l n t l slih Al en ears ears ears ears ears ears os her ban an ra Me m dary Rura d t m Ur o Wo –24 y –34 y –44 y –54 y –64 y –74 y ast hig Suburb 18 25 35 45 55 65 ary a Secon rejših Prim At le sta in Gender Age Level of education Living environment ih ktivna Figure 2: Proportion of adults aged 18–74 years by frequency of tooth o vn brushing, broken down by gender, age, education and living environment. oel d We also analysed the frequency of tooth brushing in relation to the living ravje zd environment. In rural areas, where 62% of adults regularly brush their teeth, the proportion was lower than among adults in urban (78%) or suburban areas (76%) (Figure 2); the differences between the proportions according to living environment were statistically significant (χ2 test=26.466, p<0.001; CCP test, p<0.004). Use of Fluoride Toothpaste Most adults aged 18–74 years (98%) used toothpaste when brushing their teeth. Of these, 64% used toothpaste with fluoride, 14% used toothpaste without fluoride and 23% did not know whether their toothpaste contained fluoride (Figure 3). Yes No I don't know 13 019 2 inia ven slo in Figure 3: Proportion of adults aged 18–74 years who use fluoride ltsu toothpaste. da in stespa The use of fluoride toothpaste was higher among adults with higher edu-tho cation. Fluoride toothpaste was used by a greater proportion of people with at toe least a high school education (70%) than people with a secondary school educa-rido tion (63%) or primary school education or less (56%); the differences in propor-fluf o tions by education were statistically significant (χ2 test=12.399, p=0.015). seue The differences between the proportions according to the use of fluoride-thd containing toothpaste by gender, age and living environment were not statisti-nae ien cally significant. yg hlrao Use of (Other) Oral Hygiene Aids Use of dental floss. We found that 36% of respondents did not use dental floss. The proportions of people by frequency of dental floss use, broken down by gender, education and living environment, are shown in Table 1. The differences between the proportions by gender were statistically significant (χ2 test=29.815, p<0.001). By age, the proportion of those who flossed was lowest among adults aged 45 years and older at 60%, lower than among younger adults aged 44 years or less, 70% of whom flossed; the differences between the two proportions by age were statistically significant (χ2 test=30.434, p=0.001). The frequency of flossing was higher among people with higher levels of education (Table 1); the differences between the proportions were statistically significantly greater among people with at least higher education Table 1: Frequency of dental floss use in adults aged 18−74 years by gender, education and living environment. Use of dental floss Yes (regularly) Occasional y No All 17% 47% 36% Men 13% 42% 45% Gender Women 21% 52% 27% Primary at most 9% 34% 58% Level of education Secondary 15% 46% 39% At least higher 24% 55% 20% Urban 19% 52% 29% Living environment Suburban 24% 45% 31% Rural 12% 44% 44% 14 (χ2 test=47.649, p<0.001; CCP test, p<0.006). Flossing also depended on the liv-ltsu ing environment (Table 1); the proportion of people in rural areas who did not daer floss was statistically significantly higher than those in urban or suburban are-ld od as (χ2 test=24.116, p<0.001; CCP test, p<0.018). naeg-a Use of interdental brushes. Among adults aged 18–74 years, 48% of adults g did not use an interdental brush. The proportions of people by frequency of in-rkino w terdental brush use by gender and age are shown in Table 2. f o lthea Table 2: Frequency of interdental brush use in adults aged 18−74 years | h slih by gender and age. rad o Use of interdental brushes rejših sta Yes (regularly) Occasional y No inih All 23% 29% 48% ktivna Men 23% 23% 54% o Gender vno Women 23% 36% 41% el d 18–24 12% 28% 61% ravje 25–34 12% 28% 60% zd 35–44 16% 39% 46% Age (years) 45–54 21% 29% 50% 55–64 43% 23% 34% 65–74 36% 23% 41% With regard to gender, the differences between the proportions who did not use an interdental brush were statistically significantly lower in women than in men (χ2 test=16.124, p<0.001; CCP test, p<0.001). In terms of age, a greater proportion of adults aged 55 years or older used an interdental brush regularly or occasionally, just over 60% of people, than adults aged 54 years or younger, where half or even a smaller proportion of people used an interdental brush; the differences between the proportions were statistically significant (χ2 test=68.444, p<0.001, CCP test, p<0.031). The differences between the proportions with regard to the use of an interdental brush, education and living environment were not statistically significant. Use of a tongue scraper. Among adults aged 18–74 years, a tongue scraper was not used by 74% of adults. The proportions of people who frequently use a tongue scraper by gender, education and living environment are shown in Table 3. Table 3: Frequency of tongue scraper use in adults aged 18−74 years by gender, education and living environment. Use of a tongue scraper 15 Yes (regularly) Occasional y No All 8% 18% 74% 019 2 in Men 6% 16% 78% ia Gender ven Women 10% 21% 70% slo Primary at most 0% 12% 88% in ltsu Level of education Secondary 8% 20% 72% da in At least higher 10% 17% 73% stespa Urban 11% 24% 65% tho Living Suburban 8% 16% 76% to environment e rid Rural 5% 15% 81% o fluf o The differences between the proportions of tongue scraper use by gen-seue der were not statistically significant. Regarding age, a greater proportion of thd younger adults aged 18 to 44 years used a tongue scraper regularly or occasion-nae ien ally, about one-third, compared with people aged 45 to 74 years, of whom on-yg hl ly about one-fifth used a tongue scraper; the differences between the propor-rao tions in the different age groups were statistically significant (χ2 test=21.866, p=0.016). The differences between the proportions depending on the education of the persons were statistically significant (χ2 test=12.297, p=0.015). A higher proportion of people with a higher level of education used a tongue scraper regularly or occasionally than people with a lower level of education (CCP test, p<0.05 or p<0.001). With regard to the living environment, the differences between the proportions were statistically significant (χ2 test=16.677, p=0.002). A greater proportion of adults from an urban environment regularly used a tongue scraper than those from a suburban or rural environment (CCP test, p<0.05). Discussion Frequency of Tooth Brushing The results of our 2019 study show relatively poor oral hygiene among adults aged 18–74 years in Slovenia, but the percentage of adults who brush their teeth regularly is similar or even slightly higher than the results of the 2016 study (Ranfl and Oikonomidis, 2018), which showed that 64% of adults aged 25–74 years in Slovenia brush their teeth regularly (at least twice a day). The results of that study also showed that adequate oral hygiene is related to the level of education of the population. The proportion of adults who brushed their teeth regularly was lowest among those with primary education (49%) and highest among adults with at least higher education (77%). The proportion of adults who brushed their teeth regularly was higher in urban areas (71%) and lower in rural areas (56%). Compared to our study, the results of our survey also show a 16 slightly higher proportion of people with higher education compared to people with lower education (high school or less) and of people from urban and sub-ltsu urban environments compared to people from rural environment. daer According to a 2014 national opinion survey by Delta Dental, 31% of ld od Americans do not brush their teeth regularly, which is comparable to the re-nae sults of our survey; 29% of adults between the ages of 18 and 74 do not brush g-ag their teeth regularly. rkino wf o Use of Fluoride Toothpaste lthea It is possible that the information we received about the fluoride content of | h toothpaste was not reliable and that people do not know if they are using flu-slih rad oride toothpaste. Nevertheless, based on the research results, we can estimate o that 80% of people use fluoride toothpaste and 20% of people use toothpaste rejših without fluoride. sta inih Use of (Other) Oral Hygiene Aids ktivnao vn Dental floss is used regularly or occasionally by a larger proportion of women oel d and people with at least a higher level of education. A third of people under 45 ravje and slightly less than half of people aged between 45 and 74 did not use den-zd tal floss. The proportion of people who did not floss was highest in rural areas, where it was statistically significantly higher than in urban or suburban areas. According to NHANES (National Health and Nutrition Examination Survey), 2011-2014 (CDC, 2020a; CDC, 2020b), 32% of adults, 26% of men and 37% of women in the US population aged 30 years and older floss daily, and 32% of adults do not floss (Fleming et al., 2018). According to a national survey by Delta Dental (2014), 20% of Americans do not floss. The two estimates differ due to different methodological approaches. Both studies and our research results show that women floss more frequently than men. The research results are surprising because according to the most recent data (Fleming et al., 2018), as many as 68% of American adults aged 30 years or older do not floss as recommended. In Slovenia, according to the data from our study, this figure is 83% of adults between the ages of 18 and 74. The results of our study show that a larger proportion of women and 55–74 year olds use interdental brush. The use of interdental brush was not dependent on education or living environment. We also found that a larger proportion of women, younger adults aged 18–44 years, people with higher levels of education and people from urban areas used the tongue scraper regularly or occasionally. Prevalence studies on the use of dental care appliances are very rare, and to our knowledge there are no studies that can be compared with our studies on the use of interdental brushes and tongue scrapers. Conclusions Effective measures to prevent dental disease include tooth brushing at least 17 twice a day for at least two minutes with fluoride toothpaste, brushing once a day with interdental brushes and/or dental floss and tongue scraping once a 019 2 day. It is also important to sensitise the target population to the importance of inia ven dental hygiene, depending on age, education and living environment. slo The results of our study are a step towards reducing the burden of den-in ltsu tal and oral diseases and costs in the (dental) health care system. An important da challenge for the future is the continuous monitoring of oral health and the in stes dental healthcare system in Slovenia based on oral health indicators in accord-patho ance with international recommendations, which will facilitate the planning of toe appropriate and effective programmes to improve oral health. We should pro-rido mote activities to improve oral health and raise awareness of the importance of fluf o oral health in the lives of individuals. Oral health is an important part of gen-seue eral health and has been shown to contribute to a better quality of life. thd The results and recommendations to improve oral health are a step to-nae ien wards reducing the burden of oral diseases and costs in the (dental) healthcare yg hl system. rao Acknowledgements The research was supported by the Slovenian Research Agency (research core funding No. P3-0429, Slovenian Research Programme for Comprehensive Cancer Control SLORApro and No. V3-1715, Analysis of Oral Health Indicators and Oral Health Promotion of Slovene Population). References BOURGEOIS, D. M., LLODRA, J. C., CHRISTENSEN, L. B., PITTS, N. B., OTTOLENGHI, L. and SENEKOLA, E., 2008. Health surveillance in Europe. Oral health interviews and clinical surveys: guidelines. Lyon: Uni- versity Lyon. [viewed 15 July 2024]. 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Com-lthea munity dentistry and oral epidemiology, vol. 43, no. 2, pp. 116–127. | h slih rad o rejših sta inih ktivnao vnoel d ravje zd https://doi.org/10.26493/978-961-293-397-5.21-32 Evaluation of Student Knowledge of Pal iative Care Margareta Begić1, Edina Pulić1, Tatjana Njegovan - Zvonarević1, Želimir Bertić2, Mirjana Telebuh1 1 University of Applied Health Sciences, Zagreb, Croatia 2 Faculty of Health Studies, University of Rijeka, Croatia Abstract Introduction: There has been an increase in the number of patients in palliative care due to better care for patients suffering from chronic diseases and cancer. Physiotherapists and occupational therapists are indispensable members of the palliative care team. The three-year curriculum at the Physiotherapy and Occupational Therapy Departments at university provides several courses covering basic knowledge of palliative care. The aim of this study is to establish how familiar physiotherapy and occupational therapy students are with palliative care and if they have different levels of knowledge in this area. The way in which physiotherapy and occupational therapy students gain additional knowledge of this topic and learn about palliative care will also be determined. Methods: 136 undergraduate occupational therapy students and 138 undergraduate physiotherapy students at the University of Applied Health Sciences in Zagreb participated in this study. All respondents filled in an online questionnaire about their knowledge of palliative care, which was created and made accessible on the Google Forms platform. Results: We expect that the results will provide a clear idea of the level of knowledge physiotherapy and occupational therapy students of all three years of study have about palliative care. The results of this study show similar levels of knowledge in physiotherapy and occupational therapy students. The presented results indicate a small difference between the two study groups (PT and OT), but it is not statistically significant. Discussion and conclusion: Results of this study could provide new ideas regarding formal and informal training of healthcare professionals, primarily physiotherapists and occupational therapists, in order to improve the quality of palliative care resulting in a higher quality of life of patients in palliative care. Keywords: students, physiotherapy, occupational therapy, palliative care. Introduction In accordance with demographic changes and the epidemiological picture of the development and occurrence of chronic incurable diseases, the number of palliative patients has been increasing. Therefore, it is necessary to provide healthcare professionals with palliative care education. In recent years, the challenges related to the provision of quality palliative care have been increasingly recognised. Empirical evidence suggests that palliative care services are not sufficiently available and only start in later stages of diseases (Centeno et al, 2016). More than half of the countries in the World Health Organization’s European Region include palliative medicine education in the health studies curricula (de Araujo and de Araujo, 2018). In many European countries, palliative care education is becoming a priority, especially in more developed countries (Centeno et al., 2016). The development of palliative care is gaining momen-tum also in the Republic of Croatia. However, regional inequality and a lack of 22 healthcare professionals in the field of palliative care are present. Understanding the current level of students’ palliative care knowledge ltsu da and attitudes is important for the analysis of future education (Sadhu et al., erld 2010) and the introduction of regular palliative care courses for all healthcare od professionals at universities. Attitudes and knowledge of palliative care should naeg be at a high level in all members of the multidisciplinary team participating in -ag palliative care, so that awareness of the importance of palliative care is accept-rkino w ed in society. f o The role of a physiotherapist (PT) in palliative care is primarily to iden-lthea | h tify, assess and plan the treatment of the patient’s functional needs and im-slih prove the patient’s quality of life (Marcant and Rapin, 1993) in cooperation with rad o other team members. Physiotherapy intervention for palliative patients is focused on respiratory exercises, therapeutic exercises to increase range of mo-rejših sta tion, strength, increase balance and coordination, walking exercises and other inih functional activities that are necessary in activities of daily living, physiotherapy analgesic procedures and interventions to prevent secondary complications ktivnao vn (Wilson et al. 2017) planned according to the patient’s current condition. Im-oel d proving the quality of life, functional ability and independence in activities of ravje daily living are an integral part of occupational therapy interventions (OTIs) in zd working with palliative patients. Occupational therapy procedures assess environmental and contextual factors (e.g. family and caregiver training, availability of certain facilities in the vicinity, social support), as well as personal factors (decreased endurance, increased anxiety) that limit the ability and satisfaction when performing the desired activities and plan an intervention in cooperation with the patient and their family. Occupational therapy interventions include functional assessment and defining rehabilitation goals, education about aids and ergonomic adaptation, training of patients and families, cooperation with team members in order to improve the patients’ quality of life (Njegovan-Zvonarević, 2018). Physiotherapists and occupational therapists in Croatia often remain un-recognised as members of the palliative team. Their role in the palliative team should be key for improving the quality of life of patients, as well as their families. Despite that, healthcare professionals, including physiotherapists and occupational therapists, may not have enough knowledge or additional training in palliative care (León Perilla and Joaquim, 2022). The aim of this study was to determine the extent of familiarity with palliative care among physiotherapy and occupational therapy students and to assess whether a statistically significant difference exists between their levels of knowledge. Methods Participants The study was conducted from 1 to 30 September 2023. The respondents filled 23 in an online questionnaire designed specifically for this study and posted on the Google Forms platform. In the introductory section of the questionnaire, re ac they were informed about the aim and purpose of the study. The study received a positive opinion from the Ethics Committee (KL: 602-03/24-18/337; URBR: lliative paf 251-379-10-24-02) on May 6, 2024 of the University of Applied Health Sciences oeg in Zagreb. Participation in the study was voluntary and the respondents could ledw withdraw at any time without providing an explanation. In accordance with o knt the General Data Protection Regulation (GDPR), which came into effect on 25 end May 2018, and which governs the protection of personal data of citizens of the stuf European Union, we guarantee the anonymity of personal data and the confion dentiality of the responses provided. atiolu A total of 274 respondents participated in the study, divided into 2 groups. eva One group consisted of 138 undergraduate students of physiotherapy (first-, second- and third-year students, Physiotherapy group – PT group), while the other study group (Occupational therapy group – OT group) was formed of 136 undergraduate students of occupational therapy (first-, second- and third-year students). All respondents were students at the University of Applied Health Sciences in Zagreb. The PT group consisted of 14 respondents who were first-year students (10%), 38 (28%) were second-year students, and 86 (62%) were third-year students. In the OT group, there were 58 respondents who were first-year students (43%), 24 (17%) were second-year students, and 54 (40%) were third-year students. Out of a total of 274 respondents, 72 (26%) were first-year students, 62 (23%) were second-year students, and the majority were third-year students (140 or 51%). In the PT study group (N=138), there were 36 men (26%) and 102 women (74%). In the OT study group, out of the total number of respondents (N=136), there were 10 men (7%) and 126 women (92%). Out of the total number of respondents in both study groups (PT and OT), 46 men (17%) and 228 women (83%) participated in the study. The average age of all respondents (N=274) was 22 years. The respondents from the PT group had an average age of 23 years, while the respondents from the OT group had an average age of 21 years (Table 3). Table 1. Distribution of respondents by gender. Gender PT OT Total PT+OT M 36 (26%) 10 (7%) 46 (17%) F 102 (74%) 126 (93%) 228 (83%) TOTAL M+F 138 (100%) 136 (100%) 274 (100%) M – male; F – female; total M+F – combined results for male and female respondents; PT – physiotherapy study group; OT – occupational therapy study group; total PT+OT – combined result for the physiotherapy and occupational therapy groups Table 2. Distribution of respondents by year of study. 24 Year of study PT OT Total PT+OT ltsu First year 14 (10%) 58 (43%) 72 (26%) daer Second year 38 (28%) 24 (17%) 62 (23%) ld o Third year 86 (62%) 54 (40%) 140 (51%) d na Total 138 (100%) 136 (100%) 274 (100%) eg-ag PT – physiotherapy study group; OT – occupational therapy study group; total PT+OT rkino – combined results for the physiotherapy and occupational therapy study groups; First year wf o – first year of study; Second year – second year of study; Third year – third year of study lthea | h Table 3. Distribution of respondents by age. slih rad N M SD o PT 138 23 6,28 rejših OT 136 21 2,94 sta in Total PT+OT 274 22 5,05 ih ktivna PT – physiotherapy study group; OT – occupational therapy study group; total FT+RT o – combined results for the physiotherapy and occupational therapy groups; N – number vnoel of respondents; M – median; SD – standard deviation d ravje zd Questionnaire The respondents filled in an online questionnaire designed for this study. The questionnaire was accessible on the Google Forms platform. In the introductory part of the questionnaire, they were informed about the aim and purpose of the study. The study received a positive opinion from the Ethics Committee of the University of Applied Health Sciences in Zagreb. The questionnaire was anonymous and the respondents could withdraw at any time while completing the questionnaire. The questionnaire consisted of two parts. The first part consisted of a structured questionnaire on general socio-demographic characteristics con- taining four questions: gender, age, course of study and year of study. For the second part of the questionnaire, we created the Assessment Index of Students’ Palliative Care Knowledge. The questionnaire comprised eight questions. Five of the questions were related to the perceived assessment of acquired knowledge of palliative care, and three questions were related to determining current knowledge of palliative care. The first five questions were rated on a Likert scale from 1 to 5, and the results range from 5 to 25. A higher score meant a higher perceived assessment of palliative care knowledge. The three remaining questions were evaluated separately, and were added due to the assumption that they are essential for determining the respondents’ current knowledge of palliative care. Statistical Analysis The results of the Assessment Index of Students’ Palliative Care Knowledge were processed using the statistical program IBM SPSS Statistics V23.0. The 25 Kolmogorov–Smirnov test was used to determine normality of distribution. re Differences in numerical variables between two independent groups were test-ac ed using the Mann–Whitney U test. The significance level was set at α=0.05. lliative The results of the three questions (gender, age, year of study) that were add-paf ed because of the assumption that they are important for determining the re-oeg spondents’ current knowledge of palliative care were presented according to ledwo the percentage of answers given by the respondents. kntend stu Results f on atiolu Results of Determining Current Knowledge of Palliative care eva Table 4. The respondents’ results when asked where they learned about palliative care. Proposed responses to the question: PT OT N (%) N (%) in secondary school 52 (36.96) 43 (31.62) at university 37 (28.26) 69 (50.73) from friends or family 34 (23.91) 17 (12.50) through the media 10 (7.25) 4 (2.94) through social media 1 (0.72) 3 (2.21) other 4(2.90) 0 (0) PT – physiotherapy group; OT – occupational therapy group; N (%) – number of respondents (percentage of respondents) When asked where they learned about palliative care, 69 respondents of the OT group (50.73%) confirmed that they learned about the existence of palliative care at university and 37 respondents of the PT group (28.26%) confirmed the same. The respondents’ most common response to the question Where did you learn about palliative care? is that they learned about the existence of palliative care in secondary school and this was the answer given by 52 respondents of the PT group, or 36.96% of them, and 43 respondents of the OT group, or (31.62%) of them (Table 4). In the respondents’ results for the question “Which patients belong to palliative care?” , the respondents from the OT group showed greater knowledge than the respondents from the PT group. As many as 108 respondents from the OT group, or (79.41%), answered that those were patients with a chronic incurable disease. The same answer was given by only 37 respondents of the PT group, or (26.81%) of them. In the respondents’ results for the question “Who makes up the palliative care team?” , 131 respondents (96.32%) from the OT group answered that all the specified experts (physician, specialist physicians, nurse, physiotherapist, cler-gyman, social worker, psychologist) belong to the palliative team, while the 26 same statement was confirmed by only (21.74%) of PT respondents, i.e. 30 of lts them. u daerld o Results of the Assessment Index of Students’ Palliative Care Knowledge d nae In the results of the perceived assessment of the respondents’ palliative care g-ag knowledge for the question “Do you know what palliative care is?” , “I do” and “I rkino fully know” were the answers given by as many as 98 respondents from the PT wf o group and 86 respondents from the OT group. The total score of the perceived lthea assessment of both examined groups (PT and OT) is 4 (Table 5). | h slih rad Table 5. The respondents’ answers to the question “Do you know what o palliative care is?” rejših sta in PT OT ih Proposed responses to the question: N (%) N (%) ktivna I don’t know at all 4 (2.90) 2 (1.47) o vn I am familiar with the term, but I don’t know exactly what it is 11 (7.97) 14 (10.29) oel d I somewhat know the meaning of the term 25 (18.12) 34 (25) I know the meaning of the term 57 (41.30) 73 (53.68) ravje zd I fully know the meaning of the term 41 (29.71) 13 (9.56) PT – physiotherapy group; OT – occupational therapy group; N (%) – number of respondents (percentage of respondents) In the respondents’ assessment results for the question about the necessity of including the Palliative Care course in the undergraduate study of PT and OT, 83 respondents (60.15%) of the total number of respondents of the PT group, stated that the course was necessary “to a large extent” and “to a very large extent”. In the OT group, 35 respondents (25.73%) of the total number of the OT group respondents gave answers in the above two categories . Table 6. The respondents’ results for the question “To what extent do you believe it is necessary to include the Palliative Care course in undergraduate studies?” PT OT Proposed responses to the question: N (%) N (%) not even a little 1 (0.72) 5 (3.68) to a small extent 9 (6.25) 30 (22.05) to an average extent 45 (32.61) 62 (48.53) to a large extent 55 (39.86) 25 (18.38) to a very large extent 28 (20.29) 10 (7.35) PT – physiotherapy group; OT – occupational therapy group; N (%) – number of respondents (percentage of respondents) In the respondents’ assessment results for the question about the necessity for additional palliative care training, the biggest difference in a particular 27 category of answers is in the category “to a very large extent”: 28 respondents re (20.44%) from the PT group believe that additional training in their profession ac is necessary to a very large extent, while 13 respondents from the OT group lliative (9.56% of them) thought the same (Table 7). paf oeg Table 7. The respondents’ results for the question “To what extent ledw do you believe your profession needs additional palliative care training?” o kntend Proposed responses to the question: PT OT stuf N (%) N (%) on not even a little 2 (1.46) 3 (2.21) atio to a small extent 10 (7.30) 20 (14.71) lu eva to an average extent 45 (32.85) 49 (36.03) to a large extent 52 (37.96) 51 (37.50) to a very large extent 28 (20.44) 13 (9.56) PT – physiotherapy group; OT – occupational therapy group; N (%) – number of respondents (percentage of respondents) The respondents’ results for the question about the need for a PT/OT in the palliative team, the biggest difference in answers between the two groups is in the category “to a very large extent”. In the PT group, 29 respondents (21.01%) gave this answer, while 6 respondents from the OT group (4.41%) answered the same (Table 8). The results on whether the respondents see themselves as a PT/OT working in palliative care show that only (19.57%) of respondents from the PT group, i.e. 27 out of 138 respondents, can see themselves working in palliative care to a “large extent” and to a “very large extent”. In the OT group, only 7 respondents (5.15%) out of 136 can see themselves working in palliative care “to a large extent”, and not a single respondent from this study group can see themselves working in palliative care “to a very large extent” (Table 9). Table 8. The respondents’ results for the question “To what extent do you believe a PT/OT is needed in the palliative team?” Proposed responses to the question: PT OT N (%) N (%) not even a little 1 (0.72) 7 (5.15) to a small extent 11 (7.90) 19 (13.97) to an average extent 48 (34.78) 49 (36.03) to a large extent 49 (35.51) 55 (40.44) to a very large extent 29 (21.01) 6 (4.41) PT – physiotherapy group; OT – occupational therapy group; N (%) – number of respondents (percentage of respondents) Table 9. The respondents’ results for the question “Can you see yourself as a PT/OT working in palliative care?” 28 Proposed responses to the question: PT OT N (%) N (%) ltsu da not even a little 29 (21.01) 48 (35.29) er to a small extent 34 (24.64) 72 (52.94) ld od to an average extent 48 (34.78) 9 (6.62) nae to a large extent 12 (8.70) 7 (5.15) g-a to a very large extent 15 (10.87) 0 (0) g rkino w PT – physiotherapy group; OT – occupational therapy group; N (%) – number of respondents f o (percentage of respondents) lthea | h Table 10. Perceived assessment of palliative care knowledge in both study slih groups (PT+OT) rad o rejših Questions posed in the questionnaire: IS AV 1–5 SD M sta PT 3.87 1.02 4 inih “Do you know what palliative care is?” OT 3.60 0.85 4 ktivna PT 3.70 0.91 4 o “To what extent do you believe it is necessary to include vno the palliative care course in undergraduate studies?” OT 3.04 0.92 3 el d “To what extent do you believe your profession needs PT 3.72 0.88 4 ravje additional palliative care training?” zd OT 3.38 0.92 3 “To what extent do you believe a PT/OT is needed PT 3.68 0.92 4 in the palliative team?” OT 3.25 0.93 3 “Can you see yourself as a PT/OT working in palliative PT 2.64 1.22 3 care?” OT 1.88 0.90 2 SG – study group; PT – physiotherapy group; OT – occupational therapy group; AV 1–5 – average 1–5; SD – standard deviation; M – median Table 10. presents the knowledge assessment index, i.e. the respondents’ perceived knowledge in both study groups (PT and OT). Across the two groups, the median, rated from 1 to 5, differs across all questions except for “Do you know what palliative care is?”, where the median was 4 in both groups. In the other questions, the PT group consistently had a median one point higher than the OT group. The lowest mode in both groups was observed for the question “Can you see yourself as a PT/OT working in palliative care?” (PT=3; OT=2). The results of the perceived assessments of the respondents’ acquired palliative care knowledge are described by the median and the standard deviation and show the minimum and maximum points (Table 11.). The presented results indicate a small difference between the two study groups (PT and OT), but the difference is not statistically significant (p=0.1411). Table 11. Results of perceived assessments of the respondents’ acquired palliative care knowledge 29 Study group Min Max M SD PT 10 25 17.51 3.69 re OT 9 21 15.14 2.21 ac lliative PT – physiotherapy group; OT – occupational therapy group; Min – minimum; Max – maximum; paf M – median; SD – standard deviation oeg ledwo Discussion knten Physiotherapy and occupational therapy are based on a holistic approach to pa-d tient care, including palliative care principles. Although the respondents in this stuf on study believe that they know well what palliative care is, they believe that more atio palliative care knowledge is necessary for physiotherapists and occupational lu eva therapists, and a smaller number of respondents from the OT group believe that palliative care should be included as a course in undergraduate studies The results of our study show that physiotherapy students believe to a greater extent than occupational therapy students that additional training in their work is necessary and required to a very large extent ( PT=20.44%, OT=9.56%). Greater knowledge and additional palliative care training enables provision of quality care and improvement of practical competencies ( Yie et al., 2023). Our study is in line with other research that emphasizes the need for additional knowledge of physiotherapists and occupational therapists in the field of palliative care, but it is not sufficiently expressed in practice (Fadare et al., 2014; Pascoe et al., 2018). In this study, a smaller number of OT group respondents can see themselves working in the field of palliative care (PT=19.57%, OT=5.15%) (Table 9). One of the reasons could be students’ discomfort when dealing with death and dying, as well as the prevailing health culture that still views death as a failure (Sadhu et al., 2010). Therefore, physiotherapists and occupational therapists may be less motivated for working in palliative care because the results of functional recovery are not as successful as in curative rehabilitation. The difference in the responses of occupational therapy students can be supported by an Indonesian study which found that many healthcare professionals are not well prepared, have low levels of confidence in providing palliative care services, and have issues with the communication skills required for end-of-life discussions (Huriah et al., 2021). Furthermore, some studies indicate that occupational therapy students are not clear about their role and contribution to the multidisciplinary team, palliative patients and their family members, and the community (Keesing & Rosenwax, 2011). Lack of awareness of the role of occupational therapy in palliative care is the main reason for insufficient participation in occupational therapy interventions (Pitzen, 2009). Likewise, our study has provided similar results. The rationale may be that undergraduate occupational therapy students have no experience working with palliative patients in practice, while physiotherapy students encounter chronically ill patients (neurological, rheu-matological, oncological and others) to a greater extent during their studies, 30 through clinical practice, even though they do not completely perceive them as palliative patients. ltsu PT and OT students should have access to a basic level of palliative care daer knowledge. Advanced training should enable mastering the skills for this type ld od of care, and should deepen the understanding of topics specific to this area. nae The reasons for the low interest in working in the field of palliative care among g-ag physiotherapy students can be explained by the more ubiquitous popularity of rkino jobs in other areas of physiotherapy (sports physiotherapy, orthopaedic phys-wf o iotherapy etc.), which include full recovery of patients after physiotherapy in-lthea terventions. In palliative care, the emphasis is on reducing the impact of the | h disease and treatment (reducing symptoms), increasing mobility and function-slih ra ality. Research highlights that the link between current, insufficient training d o and the perceived readiness of physiotherapists and occupational therapists to rejših work in palliative care points to the need for optimization of teaching in this sta in unique area (De Araujo and De Araujo, 2018). ih According to Centeno et al. (2014), universities should be encouraged to ktivnao adjust curricula according to demographic and social needs. In order for every vnoel country to have professional healthcare workers in a multidisciplinary team d in palliative care, it is necessary to set the primary goal of basic and additional ravje zd training in palliative care. With such level of education, physiotherapists and occupational therapists would respond professionally to the challenges that they face. Conclusions In conclusion, we can say that the majority of physiotherapy and occupational therapy students in this study possess good knowledge of palliative care as well as positive attitudes. In spite of this, only a small number of physiotherapy and occupational therapy students can see themselves working with palliative patients to a greater extent. One of the factors that could contribute to a high- er motivation of physiotherapy and occupational therapy students for working with palliative patients could be additional professional training through formal courses at undergraduate studies. The study programme could be en-riched with informal forms of education such as professional workshops, lectures, public forums etc., which would raise the level of education of physiotherapists and occupational therapists. References Centeno, C., Ballesteros, M., Carrasco, J.M. and Arantzamendi, M., 2016. Does palliative care education matter to medical students? The experience of attending an undergraduate course in palliative care. BMJ supportive & palliative care, vol. 6, no. 1, pp.128-134. Crowley, A.A. and Kulikowich, J.M., 2009. Impact of training on child care health consultant knowledge and practice. Pediatric Nursing, vol. 35, no. 2, pp 93-100. 31 De Araujo, L.Z.S. and de Araujo, C.Z.S., 2018. Importance of education in re ac palliative care. Palliative Medicine, vol. 23, no. 8, pp.754-766. lliative Fadare, J.O., Obimakinde. A.M., Afolayan, J.M., Popoola, S.O., Aduloju, T., paf and Adegun, P.T., 2014. Healthcare workers knowledge and attitude to-oeg ward palliative care in an emerging tertiary centre in South-west Nige-ledwo ria. Indian Journal Palliative Care. Vol. 20, no.1, pp 1-5. knt Huriah, T., Hidayah, N., And Mikami, A., 2021. Attitudes and Associated Fac-end tors towards Care for Dying Patients among Non-Palliative Care Nurs-stuf o es, Yogyakarta, Indonesia. Indonesian Journal of Nursing Practices, vol. n atio 5, no. 1, pp 9–16. lu eva Keesing, S., and Rosenwax, L., 2011. Is occupation missing from occupational therapy in palliative care? Australian Occupational Therapy Journal, vol. 58, no. 5, pp 329–336. León Perilla, V.M. and Joaquim, R.H.V.T., 2022. Educational needs and professional challenges of occupational therapists working in cancer palliative care. Revista Família, Ciclos de Vida e Saúde no Contexto Social (REFACS), vol. 10, no. 2, p 184 Marcant, D. and Rapin, C.H., 1993. Role of the physiotherapist in palliative care. Journal of pain and symptom management, Vol. 8, no. 2, pp.68-71. Njegovan Zvonarević, T., 2018. Radna terapija u palijativnoj skrbi. In: Pali-jativna skrb u zajednici Lončar, Z., Katić, M ; Jureša, V., i sur.. Zagreb: Medicinska naklada, 2018. str. 201-210. Pascoe, A., Breen, L.J., and Cocks, N.,2018. What is needed to prepare speech pathologists to work in adult palliative care? International journal of language & communication disorders, vol. 53, no. 3, pp 542-549. Sadhu, S., Salins, N.S. and Kamath, A., 2010. Palliative care awareness among Indian undergraduate health care students: A needs-assessment study to determine incorporation of palliative care education in undergraduate medical, nursing and allied health education. Indian journal of palliative care, vol. 16, no.3, p.154. Talbot-Coulombe, C. and Guay, M., 2020. Occupational therapy training on palliative and end-of-life care: scoping review. British Journal of Occupational Therapy, vol. 83, no. 10, pp. 609-619. Volberg, C., Fleck, P., Vradelis, P., Morin, A., Gschnell, M., & Pape, A.E. (2023). How to Enable Participation until the End of Life? A Survey of German Occupational Therapists Working in Palliative Care. Journal of Clinical Medicine, vol. 12, no. 16, p 5257. Wilson, C.M., Stiller, C.H., Doherty, D.J. and Thompson, K.A., 2017. The role of physical therapists within hospice and palliative care in the United States and Canada. American Journal of Hospice and Palliative Medicine®, vol. 34 , no. 1, pp.34-41. 32 Yie, K.C., Jamaludin, A., Aman, N.A., Zakaria, Z.F., and Vytialingam, N., 2023. Occupational therapists’ knowledge, attitude and perceived barri-ltsu ers regarding palliative care: A cross-sectional study in Malaysia. Perda-daer na International Journal of Health Sciences, vol. 1, pp 1-9. ld od naeg-ag rkino wf o lthea | h slih rad o rejših sta inih ktivnao vnoel d ravje zd https://doi.org/10.26493/978-961-293-397-5.33-39 Eating Habits in Therapeutic Community Tija Božič, Tamara Poklar Vatovec University of Primorska, Faculty of Health Sciences, Izola, Slovenia Abstract Introduction: We studied a group of men aged 21 to 34 years, who participate in a therapeutic community Skupnost Srečanje. Substance abusers face nutritional challenges, such as protein-energy malnutrition, vitamin deficiencies, exhaustion, and loss of muscle mass. Methods: We observed the participants’ eating habits and measured body composition using a bioelectrical impedance analyser. We analysed the weekly menu and assessed dietary intake using the OPEN program. The study involved seven men aged 21 to 34 years. Results: Participants were classified as overweight based on their body mass index (26.5 kg/m²). The percentages of body fat (19.43%) and visceral fat (4.79) were within recommended ranges, while muscle mass was higher than recommended (65.5 kg; recommended 45.1–52.9 kg), therefore they were considered to be of normal nutritional status. The dietary regime includes three main meals every five to seven hours, which is not ideal as the meals are energy-dense. Participants meet their minimum daily energy requirements of 13027 kJ (3102 kcal) compared to the recommended 13770 kJ (3,279 kcal) and adhere to nutrient guidelines. The high sodium intake (5286 mg compared to the recommended 2000 mg) is a cause for concern, mainly due to bread and processed meats. Discussion and conclusions: Participants strive to live healthily, but there is still much room for improvement. It is important to identify and change poor eating habits and apply this knowledge in life after the therapeutic community. Keywords: eating habits, dietary regime, healthy food promotion, nutrition in therapeutic community Introduction Substance addiction is well-known in society and is defined by diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) (Zou et al., 2017). Overcom-ing addiction is a complex process involving personal decisions, professional help and family support. There are many addiction treatment programmes available in Slovenia, of which we will focus on the therapeutic community Skupnost Srečanje in this article. Founded by the Italian priest Pierino Gelmini, this community serves as a therapeutic setting for substance abusers, where individuals learn to establish routines that include work, rest and healthy eating habits. The community provides three meals with specific food quantities that the participants prepare themselves (Blažič, 2007; Gelmini Pierino, 2014). Cunningham (2016) highlights nutritional issues among substance abusers, as chronic use leads to protein-energy malnutrition, vitamin deficiencies, exhaus-34 tion, and loss of muscle mass. Wiss (2019) adds that eating during abstinence is challenging due to new emotions and anxiety, often leading to overeating as lts a form of comfort, which explains weight gain after substance cessation. They u da also emphasize the importance of proper nutrition in addiction treatment, as erld o it reduces the consumption of unhealthy food, raises awareness of healthy eat-d na ing habits, and promotes recovery. Slovenian Ministry of Health (2008) warns eg-a that food is a source of energy for body functions and regeneration, but poor g rkin nutrition can increase the risk of high blood pressure, cholesterol, and blood o wf sugar, leading to various diseases. There is limited data on nutrition in thera-o peutic communities, but studies have shown that incorporating culinary pro-lthea grams and nutritional interventions can improve the eating habits and health | h slih status of the participants (Cowan and Devine, 2012; Moore, Gray, Wiss and rad Parker, 2016). Skupnost Srečanje provides a basic menu with the possibility to o adapt for special diets or allergies. Participants learn frugality and responsi-rejših sta bility towards food, as they are instructed to eat everything on their plate. At inih the beginning of each month, the participants decide whether they would like full meals or only half portions. At the present moment, every participant re-ktivnao ceives large meal portions, with one participant following a vegetarian diet. It vnoel is important to note that in all three meals, participants have unlimited access d to bread and fruit (personal testimony of the participants of Skupnost Srečan-ravje zd je, April 2, 2023). Methods In the theoretical part, we used a descriptive method and participant observation in the therapeutic community Skupnost Srečanje in Nova Gorica. We reviewed literature on eating habits and healthy eating recommendations available in databases. The empirical part included a quantitative study with body measurements (Tanita, BC730) and analysis of the weekly menu (OPEN) to assess participants’ dietary intake. Body composition measurements were taken in the morning, on an empty stomach, with 0.5 kg deducted for clothing. We collected data on eating habits from March 5 to April 23, 2023, analysed the weekly menu, and compared energy and nutrient needs with consumed meals. Data were analysed using Microsoft Excel and IBM SPSS Statistics. To test the statistical difference in nutritional and energy values of the menus, we used the Wilcoxon signed-rank test, and Spearman’s rank correlation coefficient to test the statistically significant correlation of anthropometric measurements. Seven men aged 21 to 34 years from the therapeutic community Skupnost Srečan-je in Nova Gorica participated in the study. Results The results of the participants’ body composition measurements were presented using descriptive statistics. The average age of participants is 24.6 ± 5.0 years, the average height is 1.80 ± 0.05 m, and body weight is 85.71 ± 6.29 kg. The body mass index (BMI) averages 26.51 ± 2.25 kg/m². The average muscle mass is 65.47 ± 2.80 kg, and the percentage of body fat ranges from 13.6% to 26.0%, 35 with an average of 19.43%. Visceral fat is on average 4.79 ± 2.48, and the aver-ityn age metabolic age is 27.0 ± 10.9 years. The average calculated basal metabolic umm rate (BMR) is 8606 kJ ± 374 kJ (2049 kcal ± 89 kcal). We analysed the statisti-co cal correlation between body composition parameters using Spearman’s corre-tic peua lation coefficient (r ), shown in Figure 1. The results showed a statistically sig-s er nificant, strong, positive correlation (r = 0.767; p < 0.05) between BMI (kg/m²) th s in and visceral fat. On the other hand, there was no statistically significant cor-bitsa h relation between BMI and muscle mass (r = 0.321; p = 0.482). The Wilcoxon g s test results show that the energy values of the provided menu are significant-eatin ly lower than the daily requirements (Z = -2.366; p < 0.05), meaning that the participants do not meet their daily energy needs with the provided menu. The average difference between daily requirements (3279 kcal/13770 kJ) and the consumed amount (3102 kcal/13,027.4 kJ) is minimal, indicating adequacy of energy needs. Statistically significant differences are shown between the consumed amount of protein and the provided menu (Z = -2.371; p = 0.018) and between the consumed amount and recommendations (Z = -2.366; p = 0.018), indicating that the consumed amount of protein is higher than recommended. There is also a statistically significant difference between recommendations, the provided menu, and the consumed amount of fat (Z = -2.366; p = 0.018), as participants did not meet the recommended fat intake. The average difference in consumed carbohydrates (M = 439.1 g) and recommendations (M = 443.8 g) is minimal. The consumed menus do not exceed recommendations for saturated fatty acids (Z = -2.366; p < 0.05), while there is no statistically significant difference between the consumed amount and recommendations for simple sugars (Z = -1.014; p = 0.310). Figure 3 shows the coverage of nutritional needs for each participant. The consumed dietary fibre (M = 37.9 g) is higher than recommended (M = 30.0 g) and the provided menu (M = 22.4 g). For sodium, there is a statistically significant difference between recommendations and the provided menu (Z = -2.530; p = 0.011) and between recommendations and the consumed amount (Z = -2.366; p < 0.05), indicating that both the consumed and provided sodium amounts exceed daily requirements. There is no statistically significant difference between recommendations and the provided menu for calcium (Z = -1.265; p > 0.05), although the consumed amount (1,334.1 mg) is higher than recommended (1000.0 mg). For cholesterol, both the provided menu (M = 360.6 mg) and the consumed amount (M = 361.3 mg) exceed recommendations (M = 300.0 mg) (Figure 2). 30,0 28,0 2) 26,0 36 BMI (kg/m 24,0 ltsu daerld o 22,0 d na 2,0 4,0 6,0 e 8,0 g-a Visceral fat (1-59) g rkino w Figure 1: Scatter plot of the correlation between BMI and Visceral Fat. f o lthea | h Consumed amount ol (mg) slih Offered menu rad o lester Recommended value Cho rejših sta Consumed amount inih Offered menu um (mg) ktivnao Recommended value Calci vnoel d Consumed amount ravje Offered menu zd um (mg) Sodi Recommended value 0,0 1.000,0 2.000,0 3.000,0 4.000,0 5.000,0 6.000,0 Figure 2: Average values of Sodium, Calcium, and Cholesterol. 70 60 50 40 30 20 10 - 1. member 2. member 3. member 4. member 5. member 6. member 7. member Average CHO (%) Protein (%) Fat (%) Sugars (%) Saturated fatty acids (%) Figure 3: Energy proportions of nutrients consumed by individual participants. Discussion Community participants have a set schedule with breakfast at 7:30 a.m., lunch 37 at 12:30 p.m., and dinner at 8:00 p.m., meaning that five to seven hours pass be-ityn tween meals. Skupaj za zdravje (2023) emphasizes that a regular eating sched-umm ule is crucial for health, as it helps overcome hunger and prevents unhealthy co tic snacking. They recommend three main meals and two snacks a day, with inter-peua vals of three to five hours. The therapeutic community’s schedule is not ideal, er th as the intervals between meals are too long, leading to overeating during main in meals, which are energy-dense, containing excess protein and fat, but insuffi-bitsa h cient carbohydrates. g eatin The body composition of participants showed that they have a good nutritional status, with an average BMI of 26.51 kg/m², which classifies them as overweight according to the World Health Organisation (2021). The percentages of body fat (19.43%) and visceral fat (4.79) are within recommended ranges, while muscle mass is above average (65.47 kg). Excessive muscle mass is a sign of a physically active lifestyle and can be considered a positive indicator of health. We observed a strong, positive correlation between BMI and visceral fat and high lean mass, which suggests that BMI alone may be a good indicator of nutritional status. The average offered menu in the community provides 9642.4 kJ (2295.8 kcal), while the amount consumed is 13027.4 kJ (3101.8 kcal), which is at the lower end of the daily energy requirements (13770.3 kJ or 3278.6 kcal). The average percentage of energy intake was 16% for protein, 27% for fat, of which 8 % were saturated fatty acids, and 57% for carbohydrates, of which 10% were simple sugars. Nutritional value of the participants aligns with recommendations. The consumed food exceeds the recommended values for cholesterol and sodium but meets the requirements for calcium and dietary fibre. Based on the analysed menus using the OPEN program, their nutritional value could be improved with a few changes. Adding an afternoon snack, such as nuts and fresh fruit or crackers with herb spreads, would reduce hunger, overeating and increase fat intake. For lunch, the amount of food could be reduced by serving a smaller portion of pasta (60 g of raw pasta per person) and replacing sausag-es with lean meats, such as turkey and chicken, which would also lower cholesterol and sodium. Limiting the use of salt in the preparation of soups, po-tatoes, and sauces, would also be beneficial. Potatoes, which are served daily, could be replaced with grain-based side dishes such as buckwheat, barley, cous-cous and polenta. It is necessary to consider the limitations of the bioimpedance device for determining visceral fat and calculating BMR, the small number of samples, and the constraints due to the short monitoring period. Conclusion 38 Participants in the therapeutic community Skupnost Srečanje generally meet their nutritional needs and have a good nutritional status. However, some im-lts provements are needed to promote healthier eating habits. A meal schedule u da with regular intervals between meals and appropriate portion sizes is recom-erld o mended. Reducing high sodium intake and ensuring a balanced intake of ma-d na cronutrients are also crucial for long-term health. eg-ag Education about healthy eating habits is essential to prevent unhealthy rkino eating behaviours after leaving the community. Further research on larger sam-wf o ples and longer observation periods is recommended to obtain a more compre-lth hensive understanding of the nutritional needs of substance abusers and the ea | h impact of nutrition on addiction recovery. slih rad o References rejših sta BLAŽIČ, Z., 2007. Zgodovina moje heroinske odvisnosti. Ljubljana: Mladinska inih knjiga. ISBN 978-86-11-17778-6. ktivna COWAN, J. A. and DEVINE, C. M., 2012. Process evaluation of an environ-o vno mental and educational nutrition intervention in residential drug-treat-el d ment facilities. Public Health Nutrition. July 2012. Vol. 15, no. 7, p. 1159– ravje 1167. DOI 10.1017/S1368980012000572. zd CUNNINGHAM, P., 2016. The use of sobriety nutritional therapy in the treatment of opioid addiction. J Addict Res Ther. 2016. Vol. 7, no. 3. DOI 10.4172/2155-6105.1000282 GELMINI P., 2014. Tako preprosto: navodila in nasveti za člane Skupnosti Srečanje. 4. dopolnjena izdaja. Ljubljana: Zavod Pelikan Karitas. MINISTRSTVO ZA ZDRAVJE, 2008a. Smernice zdravega prehranjevan-ja delavcev v delovnih organizacijah. Online. 2008a. Vol. 2008. Available from: https://www.gov.si/assets/ministrstva/MZ/DOKUMENTI/ DJZ-Preventiva-in-skrb-za-zdravje/Varovanje-in-krepitev-zdravja/preh- rana-in-tel-dej-np-DTS/prehrana-smernice/Smernice_zdravega_preh-ranjevanja_delavcev.pdf MOORE, K., GRAY, V., WISS, D. and PARKER, E., 2016. Hands-on Nutrition and Culinary Intervention within a Substance Use Disorder Residential Treatment Facility. Journal of the Academy of Nutrition and Dietetics. 1 September 2016. Vol. 116, no. 9, p. A20. DOI 10.1016/j.jand.2016.06.058. SKUPAJ ZA ZDRAVJE, 2023. Zdrava prehrana. Online. 2023. Available from: https://www.skupajzazdravje.si/kategorija/zdrava-prehrana/ [Accessed 25 June 2023]. WISS, D. A., 2019. The role of nutrition in addiction recovery: what we know and what we don’t. The assessment and treatment of addiction. 2019. P. 21–42. DOI 10.1016/B978-0-323-54856-4.00002-X. WORLD HEALTH ORGANISATION, 2021. Obesity and overweight. Online. 2021. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [Accessed 22 March 2023]. 39 ZOU, Z., WANG, H., D’OLEIRE UQUILLAS, F., WANG, X., DING, J. and itynu CHEN, H., 2017. Definition of Substance and Non-substance Addiction. mm Advances in Experimental Medicine and Biology. 2017. Vol. 1010, p. 21–41. co tic DOI 10.1007/978-981-10-5562-1_2. peuaer th in bitsa hg eatin https://doi.org/10.26493/978-961-293-397-5.41-47 The Importance of Cardiac Rehabilitation After a Heart Attack: Treatment of the Working and Elderly Population Alenka Cergol, Nina Zlatič General Hospital Izola, Izola, Slovenia Abstract Cardiac rehabilitation (CR) is a critical component of secondary prevention for patients recovering from acute myocardial infarction and other cardiovascular events. It aims to restore the patient’s functional capacity within social, familial, and work environments, promote healthy lifestyle changes, and prevent disease progression. The program emphasises the importance of a healthy lifestyle, medication management, and controlling risk factors such as hypertension, cholesterol levels, and diabetes. Patients are educated on the benefits of the Mediterranean diet, smoking cessation, and regular physical exercise. Our findings show that patients who complete the outpatient CR program report significant improvements in physical fitness, symptom reduction, and increased confidence in daily activities. These positive outcomes are crucial for the long-term maintenance of a healthy lifestyle and reducing the risk of future cardiovascular events. Continued support and development of such programs are vital for enhancing patient outcomes and quality of life. Keywords: rehabilitation, cardiology, heart attack, secondary prevention Introduction Ischaemic heart disease (IHD) is the leading cause of death worldwide. Within five years following an initial episode of myocardial infarction (MI), approximately 15 % of men and 22 % of women aged between 45 and 64, as well as 22 % of men and women over the age of 65 years, may experience another infarction, with an increased risk of morbidity and mortality (Menezes et al., 2014). Older individuals over 65 years have a higher likelihood of complications during MI and coronary revascularisation procedures compared to younger populations, which consequently leads to longer hospital stays and higher risks in subsequent clinical procedures. In the United States, 86 % of deaths from IHD occur in individuals over the age of 65 (Menezes et al., 2014b). The increasing incidence of IHD reflects a greater prevalence of risk factors such as type 2 diabetes, obesity, sedentary lifestyles, hypertension, and an ageing population. Research indicates that a sedentary lifestyle is a significant modifiable risk factor. More than 60 % of adults in the United States do not engage in regular physical activity, and 25 % are completely inactive. This sedentary lifestyle, combined with a hypercaloric diet, contributes to the metabolic syndrome (Menezes et al., 2014). Cardiac rehabilitation (CR) is an individualised, multidisciplinary treatment approach for patients with IHD. CR is designed to optimise the patient’s physical, psychological, and social function, aiming to slow down or even improve the progression of IHD (Servey and Stephens, 2016). Essentially, CR begins during hospitalisation in the first phase, involving 42 early mobilisation of stable patients to enable them to perform light daily activities. Due to increasingly shorter hospital stays, it is challenging to prepare ltsu da a detailed exercise programme within a few days, so the treatment is limited erld to a brief explanation of the disease and motivation for continued treatment. od The second phase of CR is the most crucial, which will be discussed further in naeg the following sections. The third phase is vital as it represents a true lifestyle -ag change that patients are encouraged to maintain over time. The quality of ser-rkino w vices provided during the second phase of CR is critical, with coronary associ-f o ations offering additional support to patients (Mampuya, 2012). lthea CR represents a structured and supervised process of secondary preven- | h slih tion and rehabilitation for cardiovascular patients. While acute hospital treat-rad o ment durations have decreased, rehabilitation programmes have been extended. Short-term spa programmes are being replaced by long-term outpatient rejših sta rehabilitation (Jug, 2024). Numerous studies highlight the long-term effective-inih ness of rehabilitation, which reduces symptoms such as chest pain, dyspnea, fatigue, and the risk of recurrent MI. It has been proven that regular and ap-ktivnao propriately prescribed physical activity extends life and reduces mortality by vnoel d 20–25 %. For coronary patients, it is crucial to incorporate regular, planned, and structured physical activity into their lifestyle to improve aerobic and mus-ravje zd cular capacity and maintain or enhance health (Vižintin Cuderman, 2017). In foreign CR programmes, patients are referred for MI, bypass surgery, stent placement, chronic stable angina pectoris, heart failure, pacemaker im-plantation, and defibrillator insertion. Common components include: physical exercise, dietary counselling, behavioural counselling, smoking cessation programmes, and health monitoring of blood pressure, lipid levels, and blood sugar. The positive effects of CR include reduced mortality, decreased incidence of depression (by approximately 40 %), improved functional capacity, increased exercise tolerance, weight loss, lipid control, reduced hospitalisations, and improved quality of life (Servey and Stephens, 2016). Studies indicate that distance from home to CR facilities is the primary reason for non-participation or dropout (Servey and Stephens, 2016). Women (due to fewer financial resources, transportation issues, and lack of social and emotional support), the elderly (despite being most in need of CR), racial and ethnic minorities are less likely to participate (Mampuya, 2012). In some larger countries, remote home-based CR has been implemented. It has been found that, compared to outpatient CR, there are no differences in effectiveness, and a higher percentage of patients complete the programme (Anderson et al., 2017). Rehabilitation after acute myocardial infarction involves a comprehensive approach, including individual risk assessment, prescribed physical activity, education and support, and psychological assistance. The main goals of cardiac rehabilitation (Ivanuša et al., 2015) are: 43 · restoring the patient’s functioning within social, family, and work environments; ..kc · encouraging patients to adopt lifestyle changes and take responsi-attart bility for their health; ea h · preventing disease progression. a fteran Therapeutic education is the most effective approach in cardiac rehabilitation, as it educates the patient about their condition with the aim of enabling bilitatioa them to take responsibility and autonomy in their own treatment and lifestyle rehcia changes. Cardiac patients need help in dealing with psychosocial and profes-rd sional challenges. Psychiatric conditions such as anxiety and depression are acf oe very common after coronary events and are associated with reduced exercise cn rta capacity, fatigue, and decreased quality of life (Mampuya, 2012). po imeth Overview of Cardiac Rehabilitation at Izola General Hospital In 2017, a new healthcare programme, »Ambulantna kardiološka rehabilitacija« (»Outpatient Cardiac Rehabilitation«) was introduced, based on the professional collaboration between the Univerzitetni klinični center Ljubljana (UKC Ljubljana) and the Zavod za zdravstveno zavarovanje Slovenije (ZZZS). The introduction of this new programme followed advancements in medicine and pharmacotherapy, particularly in the management of coronary patients. In-stead of stationary treatment at a spa resort, extended outpatient rehabilitation is now required for patients following the successful completion of acute myocardial infarction treatment in the hospital (Kos, 2020). The goal in Slovenia is to establish outpatient cardiac rehabilitation in every regional hospital. Thus, between 2017 and 2020, cardiovascular rehabilitation programmes were established at UKC Maribor and the general hospitals in Izola, Celje, Ptuj, Šmarješke Toplice, and Slovenj Gradec (Jug, 2024). Staff Composition To monitor, record, and account for the services performed within the new programme, ZZZS, in collaboration with the Internal Clinic of UKC Ljubljana, has defined a new list of outpatient cardiac rehabilitation services and a new calculation for planning and financing the new team, consisting of 5.30 full-time equivalents (FTEs). This includes 1.20 FTEs for a specialist doctor, 1.50 FTEs for a registered nurse or senior nurse, and 1.50 FTEs for a physiotherapist (Kos, 2020). Rehabilitation Process After an examination by a specialist doctor and a stress test, candidates are invited to the outpatient cardiac rehabilitation. An initial assessment is conducted, including measurements of height, weight (to calculate BMI), and waist cir-cumference. At the end of the rehabilitation, these measurements are repeated, 44 with the exception of body weight which is monitored weekly. Blood pressure management is crucial for cardiac patients. Patients are ltsu da taught to measure their blood pressure at home twice daily and as needed. erld Blood pressure is measured before and after exercise during rehabilitation. If od the blood pressure is too high or too low, or if there is nausea, chest tightness, naeg-a or any other discomfort, exercise is contraindicated. Blood pressure usually g drops by about 10 mmHg after physical exertion. rkino wf It is recommended that patients with myocardial infarction warm up o thoroughly before exercise, starting with approximately 10 minutes of whole-lthea body warm-up. The warm-up also aims to introduce patients to various flex- | h slih ibility and strength exercises they can continue at home after completing re-rad o habilitation. To enhance motivation, we use various aids such as elastic bands, hand weights or wrist and ankle weights, sticks, and balls. Stretching and rejših sta breathing exercises are also included to teach patients to perform exercises cor-inih rectly on their own. ktivna Global studies have shown that 36 visits or more are required to achieve o vn the desired effects, equating to 12 weeks of rehabilitation, three times a week oel d (Servey and Stephens, 2016). Patients who complete 36 sessions of cardiac reha-ravje bilitation have a 14 % lower risk of death compared to those who only complete zd 24 sessions, and a 47 % lower risk compared to those who only attend one session (Menezes et al., 2014). It is recommended that patients start physical exercise after a heart attack by participating in CR, which provides appropriate safety and supervision during exercise (Vižintin Cuderman, 2019). At General hospital Izola (SBI), we also follow these global standards. Patients typically attend rehabilitation 24 or 36 times, usually three times a week, occasionally twice. The patient’s heart function is monitored throughout the exercise with a monitor (Servey and Stephens, 2016). Each patient wears an elastic strap around the chest with an ECG monitor attached, which is connected to a computer via a Bluetooth system. Research has shown greater efficacy and progress with interval training on a cycle ergometer (Mampuya, 2012). Current guidelines recommend dynamic aerobic exercise, as it effectively and safely strengthens the heart and blood vessels. Larger muscle groups are gradually activated and the exercise is performed for 30 minutes or longer, with heart rate ranging from 50 to 90 % of maximum heart rate, or until the patient can no longer speak five words in a row without becoming breathless (Vižintin Cuderman, 2019). At SBI, we also use this form of exercise. Participants cycle for 180 to 240 seconds at higher intensity (80‒90 % maximum heart rate) and 120 seconds at lower intensity (50‒60 % heart rate), for a total of 45 minutes. An alternative is a combination of 20 minutes of interval training and 20 minutes of continuous exercise on a treadmill. Here, the incline and walking speed can be set for the patient and remain unchanged. The patient’s progress is continuously monitored throughout rehabilitation, and the exercise load is adjusted individually. As part of cardiac rehabilitation, there are three different lectures for patients, 45 including topics such as Healthy Eating by a dietitian, Coronary Disease by a ..k specialist doctor, and Physical Exercise by a physiotherapist. c attartea Conclusions h a An important emphasis is placed on secondary prevention to prevent or slow fteran the progression of cardiovascular complications. This includes the following measures: adopting a healthy lifestyle, pharmacological treatment, and man-bilitatioa aging risk factors. Essential steps include quitting smoking and alcohol con-rehcia sumption, following a Mediterranean diet, maintaining a healthy body weight, rd and engaging in regular physical exercise. Risk factor management involves acf oe controlling blood pressure below 140/90 mmHg, lowering LDL cholesterol to cn less than 1.8 mmol/L, and treating diabetes. Pharmacological treatment focus-rta po es on the introduction and adjustment of medications to prevent blood clots, imeth manage heart rhythm disturbances, heart failure, and the progression of ath-erosclerosis (Jug, 2017). CR after a heart attack is crucial for the working population. Research shows that CR is an effective secondary prevention approach (Fras, 2017 and Jug, 2017). We must not overlook the psychosocial aspect, as anxiety with pan-ic attacks (present in 60 % of people within six months post-heart attack) and depression (20 %) are common. Additionally, mood disorders and stress responses are frequently observed as these events represent a turning point for patients. Group exercises provide support for patients with similar life experiences, encouraging each other in recovery. Empowering patients to successfully cope with their illness and helping them achieve as much independence as possible is essential (Jug, 2017). Studies confirm that cardiac rehabilitation contributes to improved physical fitness and significantly enhances the psychosocial aspects of quality of life. Cardiac rehabilitation programmes increase life satisfaction and reduce anxiety and depression. It is important to continue supporting and developing these programmes, as they are crucial for maintaining the health and quality of life of patients who have experienced cardiovascular events (Anderson et al., 2016). Secondary prevention within cardiac rehabilitation plays a crucial role in improving the quality of life and functional capacity of both the working and older populations. Our results show that patients are highly satisfied with the progress achieved after completing outpatient cardiac rehabilitation. In addition to noticeable improvements in physical condition, such as better fitness and symptom reduction, patients also report greater confidence in performing daily activities. These positive outcomes are key to the long-term maintenance of a healthy lifestyle and reduced risk of recurrent cardiovascular events. References 46 ANDERSON, L., OLDRIDGE, N., THOMPSON, D. R., ZWISLER, A. D., RE-ES, K., MARTIN, N. and TAYLOR, R.R. 2016. Exercise-based cardiac ltsu rehabilitation for coronary heart disease: Cochrane systematic review daer and meta-analysis [online]. Journal of the American College of Cardiol-ld od ogy, vol. 67, no. 1, pp. 1‒12. [viewed 12 June 2024]. Available from: https:// nae pubmed.ncbi.nlm.nih.gov/26764059/ g-ag ANDERSON, L., SHARP, G.A., NORTON, R.J., DALAL, H., DEAN, S.G., rkino w JOLLY, K., COWIE, A., ZAWADA, A. and TAYLOR, R.S., 2017. Home-f o based versus centre-based cardiac rehabilitation [online]. Cochrane Da-lthea tabase of Systematic Reviews, n. 6. [viewed 12 June 2024]. Available | h from: http://dx.doi.org/10.1002/14651858.CD007130 slih rad FRAS, F. 2024. Preventiva bolezni srca in žilja v Sloveniji. 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Available from: https://zkdks.si/wp-content/uploads/2019/05/Priro%C4%8Dnik-za-koronarne-bolnike.pdf https://doi.org/10.26493/978-961-293-397-5.49-56 Oral Health-related Quality of Life in the Adult Population of Slovenia in 2019 Anja Durjava1, Martin Ranfl2, Barbara Artnik3 1 National Institute of Public Health, Regional Unit Maribor, Maribor, Slovenia 2 National Institute of Public Health, Regional Unit Murska Sobota, Murska Sobota, Slovenia 3 University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia Abstract Introduction: Problems with the oral cavity and/or teeth cause pain, discomfort and functional limitations of the oral cavity and/or teeth and affect quality of life. Oral health-related quality of life (OHRQoL) can assess the impact of oral health on a person’s life, self-image, social interactions and work performance. Methods: As part of the »National Oral Health Survey of Adults in Slovenia in 2019«, indicators of OHRQoL were monitored using a questionnaire among 3,200 adults in Slovenia aged 18 to 74 years. Participants received an invitation to the online survey by post, and a written questionnaire was included in the notification letter for people over 44 years of age. The OHRQoL questions related to the frequency of eating difficulties, feelings of tension due to oral and/or dental problems, problems performing daily tasks, dental pain, painful gums/mouth sore and limitations in social interactions due to the appearance of teeth. The results were analysed using demographic data. The chi-square (χ2) test and the CCP test were used to statistically analyse the differences between the categories. Results: 31.9% of adults occasionally or more often experienced a decrease in OHRQoL due to one or more limitations caused by oral and/or dental problems. Occasionally or more often, 27% of adults reported painful gums/mouth sore, 20% had difficulty eating and 19% felt tense due to oral and/or dental problems. 10% reported difficulties performing daily tasks and 12% reported dental pain; no differences were found between men and women. Adults over 54 years of age were more likely to have difficulties eating than younger people (χ2 test=22.434, p<0.001). A higher proportion of adults with less education reported limitations due to problems with the oral cavity and/or teeth. Difficulty eating was reported by 27% of adults with primary, 20% with secondary and 13% with at least tertiary education (χ2 test=11.388, p=0.003). 12% of adults with primary and secondary education and 6% with at least tertiary education reported difficulties performing daily tasks (χ2 test=6.491, p=0.039), and dental pain was reported by 19% of adults with primary, 13% with secondary and 9% with at least tertiary education (χ2 test=6.491, p=0.039). Similar differences in educational status were also found for limitations in social interactions due to dental appearance. Discussion and conclusions: OHRQoL is related to socioeconomic factors such as age and education, but not to gender. The proportion of people who rate their OHRQoL more negatively is higher among those over 44 years of age and those with less education. The differences in OHRQoL indicate that older people and people with less education are more at risk. Understanding the socioeconomic characteristics of populations with poorer OHRQoL is crucial for appropriate public health approaches to improve the oral health of the adult population in Slovenia. Keywords: quality of life, oral health, oral health care 50 Introduction ltsu Modern evidence-based references consider oral health as an integral part of daer general health. With their chewing, phonation and aesthetic functions, teeth ld od contribute significantly to a better quality of life and social interaction, and naeg their functional impairment has an impact on general health (WHO, 2003; -ag Ranfl et al., 2017; Baiju et al., 2017; Sischo and Broder, 2011). Oral health is there-rkino w fore not only the absence of disease in the oral cavity, but also enables individ-f o uals to carry out everyday activities and thus participate in interpersonal rela-lthea tionships (Baiju et al., 2017). | h Various oral health conditions represent a major public health problem slih rad due to their prevalence and their social, economic and psychological conse-o quences at individual and societal levels (Baiju et al., 2017; Johansson and Os-rejših sta terberg, 2015). These conditions cause pain and limitations in everyday tasks inih such as chewing, speaking and laughing, thus reducing the individual’s quality of life (Paredes-Rodriguez et al., 2016). ktivnao vn In 1988, Locker introduced the oral health-related quality of life oel d (OHRQoL) model, which led to the patient’s perspective being incorporated ravje into treatment (Locker, 1988). This is important because the biomedical view zd of health has also been developed into a biopsychosocial model in the field of oral health. OHRQoL is a concept that can be used to assess the impact of oral health on a person’s daily life, i.e. self-image, social interactions, educational and occupational performance, and more (Sischo and Broder, 2011). The assessment of OHRQoL varies throughout a person’s life and depends on several factors: Functional ability (chewing, speech), pain and discomfort (acute pain, chronic pain), psychological factors (satisfaction with appearance, self-image), and social factors (interpersonal relationships, communication) (Bennadi et al., 2013). People generally understand their health in a broader sense and not just as the presence or absence of disease. The subjective assessment of OHRQoL is also important because it affects the actions individuals take with regard to their health, which in turn is reflected in their health status. Finally, the assessment of OHRQoL is also important with regard to inequalities in access to dental care (Sischo et al., 2011). Research on OHRQoL is important to identify groups at increased risk of poor oral health (Kragt et al., 2016). Methods The data were collected as part of the cross-sectional survey »National Oral Health Survey of Adults in Slovenia in 2019«. A representative sample of 3,200 adults aged 18 to 74 years was included. The survey was conducted using the EGOHID questionnaire. The adults included in the study received an invitation to participate in the survey at a home address with a password to access the online questionnaire. For participants over the age of 44, a written questionnaire was enclosed with the notification letter. The survey took place in 51 spring 2019 and participants received a further postal reminder during the sur-019 vey period. 2 inia The data collected in the survey were analysed in »Microsoft Excel 2016 «. ven The data were weighted by gender, age and education, taking into account age slof groups of one year. The weighted data per sample and population were ana-on lysed using the computer software »IBM SPSS Statistics for Windows«, version latio pu 21.0 (IBM, 2020). poltu The OHRQoL questionnaire contained nine questions on the frequen-dae cy of dental problems when eating, the frequency of difficulties in performing th in daily tasks, the frequency of dental pain, the frequency of painful gums/mouth lifef sore and the frequency of avoiding conversations, the frequency of avoiding o social activities and the frequency of embarrassment about the appearance of lityau teeth. Respondents could choose between five response options on a 5-point q ated Likert scale (never, almost never, occasionally, often, very often). We defined -rel occasionally, often and very often as the most frequent occurrence of limita-lthea tions. Only people who answered all 6 questions on quality of life were includ-hlra ed in the further analysis. o The interpretation of the results is based on the number and percentage of people in the selected categories according to demographic variables such as gender, age, education and living environment. The distributions of proportions between different categories were tested using the chi-square (χ2) test and the CCP test (Column Comparison Proportion test) to compare the proportions between different groups. Results After the exclusion factor, which was taken into account in the further data analysis, the final sample size was 1,164 people. There were slightly more men (50.9%), and the age group with the most participants was between 35 and 54 years old (40.3%). Most participants had at least a secondary education (58.7%) and came from urban (35.1%) and rural (42.2%) living environment. Most of the participants had no limitations. 31.9% of adults experienced occasionally or more often impairment of OHRQoL due to at least one limitation caused by dental problems. There were differences in the prevalence of specific limitations, with the most common limitations being painful gums/ mouth sore (26.9%), 19.5% had difficulty eating and 19.1% felt tense due to oral and/or dental problems. 10% reported difficulty performing daily tasks and 12.7% reported dental pain. We also found differences in the prevalence of limitations in social interactions due to the appearance of teeth: 13.2% reported that they avoided smiling or laughing, 9.1% reported that they felt embarrassed about the appearance of their teeth (or dentures), and about 5% reported that they avoided conversations or social activities due to the appearance of their teeth. The detailed data are shown in Table 1. 52 Table 1: Prevalence of certain limitations that occurred occasionally lts or more often (N=1,164). u daerld Participants with occasional or more often limitations od (N) (%) naeg Painful gums/mouth sore 287 26.9 -ag Difficulty eating 220 19.5 rkino Felt tense 206 19.1 wf o Difficulty performing daily tasks 106 10.0 lthea Dental pain 143 12.7 | h Avoiding smiling/laughing 151 13.2 slih ra Avoiding conversations 56 5.0 d o Avoiding social activities 52 4.7 rejših Felt embarrassed 102 9.1 sta inih We found no differences between men and women who occasionally or ktivna more often experienced limitations in their daily lives due to oral and/or den-o vno tal problems. However, a slightly higher proportion of women reported feeling el d embarrassed occasionally or more often about the appearance of their teeth (or ravje dentures) (women 4%, men 2%; CCP test, p=0.042). zd Regarding age, the frequency of limitations in daily life due to oral and/or dental problems increased with age. The proportion of people with more frequent limitations in daily life was highest in the 55–74 age group, then gradually decreased and was lowest in the 18 –34 age group, as shown in Figure 1. In contrast, no differences were found in the avoidance of social interactions due to the appearance of the teeth in relation to the age of the participants. Painful gums/mouth sore Dental pain Difficulty performing daily tasks Felt tense Difficulty eating Felt embarrassed Avoiding social activities 55–74 years Avoiding conversations 35–54 years Avoding smiling/laughing 18–34 years 0% 5% 10% 15% 20% 25% 30% 35% Figure 1: Proportion of adults aged 18–74 years who were occasionally 53 or more often limited in their daily lives due to oral and/or dental problems, by age. 019 2 inia ven Painful gums/mouth sore slof o Dental pain n latio Difficulty performing daily tasks pu po Felt tense ltu dae Difficulty eating th in Felt embarrassed lifef o Avoiding social activities lity At least tertiary education au Avoiding conversations q Secondary education ated Avoiding smiling/laughing Primary education or less -rel lthea 0% 5% 10% 15% 20% 25% 30% 35% hlrao Figure 2: Proportion of adults aged 18–74 years who were occasionally or more often limited in their daily lives due to oral and/or dental problems, by education. A higher proportion of adults with lower levels of education reported being occasionally or more often limited in their daily lives by oral and/or dental problems (Figure 2), with statistically significant differences by education level only for the following statements: difficulty eating (χ2 test=11.388, p=0.003); difficulty performing daily tasks (χ2 test=8.251, p=0.016); and dental pain (χ2 test=6.491, p=0.039). Similarly, adults with a higher level of education (at least upper secondary school) were less likely to report problems in social interactions than adults with a lower level of education (primary school or less). Thus, there were statistically significant differences between the proportions of adults who reported occasionally or more often avoiding smiling or laughing (χ2 test=9.416, p=0.009), avoiding conversation (χ2 test=8.877, p=0.012) and avoiding social activities (χ2 test=10.773, p=0.01), while there were no statistically significant differences in whether they felt embarrassed about the appearance of their teeth (or dentures). The survey also analysed differences in OHRQoL by living environment. The highest proportion of adults from rural areas compared to urban and suburban areas reported occasional or more often limitations in daily life due to oral and/or dental problems, but only for difficulty eating (urban 17%, suburban 15%, rural 23%), and dental pain (urban 8%, suburban 14%, rural 15%). We found no differences in the frequency of avoidance of social interactions among adults by living environment. Discussion 54 The results of the present survey show that almost one third of the adult population in Slovenia occasionally or more often experiences a reduction in qual-ltsu ity of life due to oral and/or dental problems or avoids social contact because daer of these problems. A higher proportion of older people, people with lower lev-ld od els of education and people from rural areas experience some limitations in naeg their daily lives due to oral and/or dental problems, indicating inequalities in -ag OHRQoL according to the socioeconomic status of adults. rkino w In our study, we found no differences in daily life limitations due to oral f o and/or dental problems according to gender, which is consistent with the re-lthea sults of a study conducted in Brazil, which also showed no influence of gender | h on oral health-related quality of life (Zucoloto et al., 2016). slih rad o In addition to education, age is most strongly associated with differences in OHRQoL in adults. Our results are consistent with a study conducted in rejših sta Brazil on the impact of OHRQoL, which showed that, in addition to pain and inih the presence of a chronic disease, age also has an impact on oral health-related quality of life (Zucoloto et al., 2016). On the other hand, the results of a nation-ktivnao al survey in the United States did not show a linear relationship between age vnoel and oral health-related quality of life, but adults aged 50–64 years reported the d worst oral health-related quality of life (Rozier and Pahel, 2008). ravje zd Differences in the experience of limitations in daily life due to oral and/or dental problems according to educational level were also confirmed in a study of a North American sample: 62% of adults with primary education reported poor or average oral health-related quality of life, compared with 28% of adults with at least secondary education (Rozier and Pahel, 2008). Some of the differences in oral health-related quality of life suggest that older people and those with less education are more at risk. We believe that it is worthwhile to increase oral health promotion activities in order to reduce the differences in the prevalence of oral health-related limitations in daily life in the Slovenian adult population. Conclusions Oral health is an integral part of general health and has a major impact on quality of life. Almost one third of adults in Slovenia have occasional or more often limitations in daily life and occasionally or more often avoid social activities due to oral health problems. The OHRQoL is lower among older adults, adults with less education and people living in rural areas. Public dental health interventions should include oral health promotion activities for these vulnerable adults. Acknowledgements The research was supported by the Slovenian Research Agency (research core funding No. P3-0429, Slovenian Research Programme for Comprehensive Cancer Control SLORApro and No. V3-1715, Analysis of Oral Health Indicators and Oral Health Promotion of Slovene Population). 55 References 019 2 BAIJU, R. M, PETER, E., VARGHESE, N. O. and SIVARAM, R. Oral health inia and quality of life: current concepts. Journal of clinical and diagnostic reven search, vol. 11, no. 6, pp. ZE21–ZE26. slof on BENNADI, D. and REDDY, C. V. K., 2103. Oral health related quality of life. latio Journal of international society of preventive and community dentistry, pu po vol. 3, no. 1, pp. 1–6. ltu da INTERNATIONAL BUSINESS MACHINES CORPORATION (IBM), 2020. e th IBM SPSS Statistics for Windows (Version 21.0) [Computer software]. in IBM Corporation. lifef o JOHANSSON, G. and OSTERBERG, A. L., 2015. Oral health-related quality of lityau life in Swedish young adults. 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BMC Oral Health, vol. 16, pp. 55. 56 ltsu daerld od naeg-ag rkino wf o lthea | h slih rad o rejših sta inih ktivnao vnoel d ravje zd https://doi.org/10.26493/978-961-293-397-5.57-66 Some Aspects of the Lifestyle of Future Educators Jera Gregorc1, Giuliana Jelovčan2, Miran Muhič3 1 University of Ljubljana, Faculty of Education, Ljubljana, Slovenia 2 University of Primorska, Faculty of Education, Koper, Slovenia 3 University of Maribor, Faculty of Education, Maribor, Slovenia Abstract Introduction: The profession of preschool teacher is physically and mentally demanding. Physically, because they usually spend most of the day with more than 20 children in a small and relatively noisy room, where they often have to lift the children, bend down to them, hold them in suboptimal postures, etc., and mentally, because they have to perform pedagogical and administrative work, communicate with parents, coordinate with other professionals and deal effectively with stress. It is therefore important for preschool teachers to start early to adopt a healthy lifestyle, which makes an important contribution to maintaining good health. Factors that influence health often include diet, physical activity, sleep, weight stability, coping strategies, etc. Lifestyle shaping begins in childhood, but is also important in adolescence and the transition to adulthood, when future preschool teachers are at faculty. This paper therefore analyses selected aspects of the lifestyles of future Slovenian preschool teachers with the aim of examining the current situation, addressing potential gaps and identifying opportunities for appropriate support. Methods: 154 third-year students of Preschool Education at the Universities of Koper, Maribor and Ljubljana were included in the sample, 81 full-time and 73 part-time. A questionnaire (adapted from Maučec, 2017; Health of Slovenian Students, 2012) containing 39 questions on selected lifestyle indicators was used to collect data on students‘ daily migration patterns, weight maintenance, eating habits, sleep duration, avoidance of certain habits, e.g. smoking, taking painkillers, etc., time, frequency and intensity of physical activities, as well as their opinions on their knowledge and actual implementation of some aspects of a healthy lifestyle. Results: We found that 24% of students live within 2 km of the faculty and 10.4% live between 2 and 5 km. Others live further away. All those who live further than 2 km away travel to the faculty by bus or car. 75.3 % of students spend more than 4 hours a day on the road. 35.7 % of students are on the road for up to 1 hour, 31.2 % are on the road for 2 hours, 33.1 % are on the road for more than 3 hours, 75 % of all students are passive in traffic. 15.6% of students sleep less than 6 hours, 24% have poor or very poor knowledge of how to deal with stress, 33.1% of students are not physically active enough to stay healthy. 15.6% of students sleep less than 6 hours, 24% have poor or very poor knowledge of how to manage stress, 33.1% of students are not physically active enough to stay healthy. The average body weight increases by almost 2 kg over three years. The difference between knowledge of healthy lifestyle indicators and the actual situation shows a non-significant negative discrepancy. Discussion and conclusions: We believe that the current situation reflects a lack of awareness among students of the importance of healthy lifestyles, particularly in relation to the indicators of stress management, appropriate physical activity and choosing more active modes of transportation. The discrepancy between knowledge and 58 implementation shows that it is necessary to identify the causes of this discrepancy, develop strategies to increase motivation, include healthy ltsu d lifestyle content in courses, adapt the schedules of electives at faculties to a er favourable dates, introduce physical activity breaks and health protocols. ld od naeg Keywords: preschool teachers, promotion methods, lifestyle indicators. -ag rkino w Introduction f o In this article, we analyze various indicators of (un)healthy lifestyle habits lthea | h among students training to become pre-school teachers. Working as a pre-slih school teacher is demanding from a health perspective, involving long hours of rad o standing, lifting children, working in suboptimal positions (e.g., stooped posture, low chairs, etc.), which can lead to physical fatigue and stress (Cumming rejših sta et al., 2021), musculoskeletal pain (Gregorc and Dolenc, 2020), and exposure to inih infections, as young children, who are frequently ill, can transmit these infections to educators (Linnan et al., 2017). It is therefore important for prospec-ktivnao tive educators to develop a healthy lifestyle. This is because a healthy lifestyle, vnoel d which includes regular physical activity and a balanced diet, has a positive effect on an individual‘s general well-being (Snedden, 2019). Long-term relation-ravje zd ships between healthy habits and quality of life are key to understanding the impact of these factors on adult health (Visser et al., 2023; Lin et al., 2023). A person‘s lifestyle, i.e., a set of habits, behaviours, and activities that affect health and well-being, is formed throughout life, but most intensely during adolescence, i.e., the university years (González Moreno & Molero Jurado, 2024). During this stage of life, young people are exposed to various challenges and influences that can significantly affect their habits (Tabrizi et al., 2024). In order to effectively face the challenges, students first need knowledge about the harms of unhealthy habits and the long-term positive health effects of a healthy lifestyle in adulthood, knowledge about different techniques and strategies to cope with stress, how long, how intense, how often and what type of physical activity affects health, etc., and then they need to put all these activities, techniques and strategies into practise to be able to integrate them in-to their own habits. In this work, we investigated the extent to which students already put into practise their knowledge about the importance of a healthy lifestyle for their health. We analysed students‘ commuting behaviour, weight control, dietary behaviour, sleep times, avoidance of certain habits, timing, frequency and intensity of physical activity, as well as their opinion on their knowledge and actual implementation of some aspects of a healthy lifestyle. The aim of the study was to analyse selected factors affecting students‘ health and to causally relate them to the need for possible changes and additions to the teaching process at the faculty. Four research questions were posed: (1) How do students incorporate physical activity into their daily commuting routines? (2) What are the levels of physical (in)activity among students, and how do they manage stress and 59 pain? (3) What are the eating habits of students during their studies, how often rs do they take medication, and how do they control their body weight? (4) How atoc is the knowledge about certain aspects of a healthy lifestyle related to its imple-u ed mentation in practice? retu fuf o Methods lifestylee th A Sample of Participants f ots The statistical population consisted of all full-time and part-time third-year ec spa students of early childhood education at the University of Ljubljana, the Uni-em so versity of Maribor and the University of Primorska. The number of students enrolled in the academic year 2023/24 was determined for each faculty through the Higher Education Information System (VIS), i.e. a total of 344 students enrolled in the third year of preschool education in the academic year 2023/24. All 344 were invited to participate in the survey, but 154 (44.8%) of the questionnaires were returned in full, representing the realisation of the sample. Of the 154 students who participated in the survey, 81 were full-time students and 73 were part-time students. A Sample of Variables The questionnaire used in the survey consisted of 39 closed and semi-open questions divided into 4 sections. The first three sets were designed and adapted from Maučec (2017) and Health of Slovenian Students (2012), while the fourth set was developed by us. The first set included demographic and some personal data, namely information on the type and place of study, distance of temporary and permanent residence from the faculty attended, body mass and height (answered for all three years of study). The second group included questions on physical (in)activity, namely the number of hours they spend on average per day, the amount of time they spend actively/passively traveling, the number of hours they sleep, the amount of time they are moderately to highly physically active per week, etc. The second group included questions on physical (in)activity, namely the number of hours they spend on average per day, the amount of time they spend active/passive, the number of hours they sleep, the amount of time they are moderately to highly physically active per week, etc. The third domain included some health indicators such as diet (number of meals per day, which meal is most often skipped, how food is prepared, etc.), smoking, use of painkillers (frequency, reasons for use, etc.). The fourth area comprised two perspectives on selected aspects of health, namely ‚knowledge‘ and ‚reality‘. For the ‚knowledge‘ perspective, they were asked on a 5-point scale (1 - strongly dis-agree to 5 - strongly agree) about their knowledge of the importance of healthy eating, stress management, anxiety, their knowledge of overwork, etc. (e.g. I know how to eat healthily), and for the ‚reality‘ view they were asked on the 60 same 5-point scale how they put the selected aspects of their health into practice (e.g. I know how to eat healthily, how to deal with stress, how to deal with ltsu anxiety, etc.). For the fourth part, which we developed ourselves, we calculated daer the internal reliability using Cronbach‘s alpha, which resulted in a high inter-ld o nal reliability (α = 0.812). Content validity was ensured through a literature re-d nae view and the involvement of three experts who work and research in the field g-ag of healthy lifestyles in combination with exercise and are involved in the edu-rkino cation of students. wf o lthea The Organization and Process of Data Collection | h slih All students had the opportunity to complete the survey voluntarily. The ques-rad o tionnaire was developed using the online tool 1-ka. The survey was completed by all three authors of the paper, each at their faculty after or before the start of rejših sta the course. To conduct the survey, a generated QR code was projected onto the inih blackboard, which the students could read and answer the questions with their cell phones, which took them an average of 6 minutes and 29 seconds. ktivnao vnoel d Methods of Data Processing ravje The data were processed with SPSS version 28.0. Various statistical methods zd were used to analyse the data: descriptive statistics with frequency (n) and percentage distribution (%), mean values (PV) and standard deviation (SD). The intraclass correlation coefficient (ICC) was used to determine the agreement between knowledge and implementation of some healthy lifestyle indicators. The limit of statistical significance was set at p ≤ 0.05. Results The results of the survey, which investigated the extent to which students are already implementing their knowledge about the importance of a healthy life- style for staying healthy, are presented in a concise form in line with the research questions. How do students incorporate physical activity into their daily commuting routines? (1) To answer this question, several questions from the questionnaire were used and answered with the help of a cross-tabulation. To illustrate the cross-tabulations, we divided the students into 2 groups. The students who live within a radius of 2 km during their studies form the first group, the others the second. Traffic was divided into passive and active traffic. We also analyzed the time spent on traffic. Table 1: Showing the mode of daily migration of students according to distance from the faculty. Mode of transport N % 61 Active Passive Less 27 10 rs than 2 37 24 atoc 73% (within distance) 27% (within distance) u Distance km edre from the faculty More 0 117 tu than 2 117 76 fuf km 0% (within distance) 100% (within distance) o 100 27 127 (82,5%) lifestylee Total 154 17,5% (with- 82,5% th in distance) f (within distance) otsec Legend: % is calculated on the basis of the total number of students (N=154). The type spae of transportation (active or passive) is then calculated within the students who are up to 2 km m so and over 2 km away. Table 1 shows that 37 (24 %) of students live within a radius of 2 km of the college. Of these, 10 (27%) use passive transportation to get to the college. All students who live further than 2 km away travel to the college by bus or car and only walk to the college from the parking lot or bus stop. For a more detailed analysis, we also looked at time spent in traffic and found that 35.7% of students spend up to one hour, 31.2% up to two hours and 33.1% more than three hours on the road, with 75% of all students using passive transportation, which takes almost three hours on average. What are the levels of physical (in)activity among students, and how do they manage stress and pain? (2) To answer this question, we used questions about the average number of hours per day that students sit (including hours spent on passive transportation), sleep, and are moderately to highly physically active, and calculated means and standard deviations. We analyzed the questions on stress and pain management using frequency distributions. Table 2: Mean values of some aspects of students’ physical (in)activity. N M SD Number of hours of sitting per day (including passive transport) 154 8,4 4,3 Number of hours of sleep per day 154 7,4 1,0 Number of minutes of moderate to vigorous physical activity per week 154 206 197,9 Legend: M=mean; SD=standard deviation Table 2 shows that students sit for an average of almost 8.5 hours a day and sleep for just over 7 hours. On average, they engage in moderate to vigorous physical activity for a good 3 hours per week (206 minutes/week). A further analysis (frequency distribution of answers to the questions) revealed that 33.1% of students are not physically active enough to stay healthy (less than 180 minutes/week), 15.6% sleep less than 6 hours/day and 24% have 62 poor or very poor knowledge of how to deal with stress. What are the eating habits of students during their studies, how often do ltsu they take medication, and how do they control their body weight? (3) daer To answer this question, we used questions about the number of meals ld od per day, skipping meals, preparing meals, taking painkillers and weight con-naeg trol during their studies. -ag We found that 44.8% of all students eat up to 3 meals a day, and 14.9% eat 5 rkino w or more meals a day. 16.2% of students never skip a meal and 48.7% skip breakf o fast if they skip a meal. From Monday to Friday, 45% of students eat between 4 lthea and 8 cooked meals. 31.8% of students never take painkillers, 23.4% take one per | h month. 18.2% of students take painkillers at least once a week. slih rad o Table 3: Mean values of weight change and weight maintenance during rejših the study period. sta inih N Minimum Maximum M SD ktivnao Body mass 1st year (kg) 154 41 100 66,5 12,527 vno Body mass 2 nd year (kg) 154 42 110 67,4 13,248 el d Body mass 3 rd year (kg) 154 39 120 68,5 12,715 ravje zd Legend: M=mean; SD=standard deviation Table 3 shows that body mass increases by an average of 1 km per year during the study period, which corresponds to an average increase of 2 km over the duration of the study. How is the knowledge about certain aspects of a healthy lifestyle related to its implementation in practice? (4) To answer this question, we used two questions about student`s opinion on selected aspects of a healthy lifestyle, one on ‚knowledge‘ and one on ‚implementation‘. The two questions were asked on a 5-point scale (1 - strongly disa- gree to 5 - strongly agree) and were divided into different aspects of a healthy lifestyle. An intraclass correlation coefficient (ICC) was used to determine the agreement between the ratings of the two assessors. Table 4: Intraclass correlation coefficient between knowledge and practice of certain aspects of a healthy lifestyle. 95% CI F Test Measures ICC Lower Upper Bound Bound F df1 df2 Sig Single Measures ,369a ,225 ,498 2,172 153 153 <,001 Average Meas- ures ,540c ,367 ,665 2,172 153 153 <,001 Legend: A two-way mixed effects model was used, where people effects are random and measures effects are fixed. The single measures ICC represents the reliability for individual ratings, while the average measures ICC represents the reliability for the average of the ratings. The 95% 63 confidence interval (CI) indicates the range within which the true ICC value is expected to lie. The F value and associated degrees of freedom (df1, df2) provide the test statistic for assessing the rs significance of the ICC, with the p-value indicating the statistical significance of the results. atocu edre Table 4 shows that the results of the analysis demonstrate a moderate lev-tu el of reliability of the individual estimates (ICC = 0.369, 95% CI [0.225, 0.498], fuf o F(153,153)=2.172F(153,153) = 2.172F(153,153)=2.172, p<0.001p<0.001p<0.001). The statistical significance (p<0.001) indicates that the results are reliable and not lifestylee due to chance. This means that the reliability of the estimates between knowl-thf o edge and implementation is moderate. In practice, this means that there is a tsec moderate discrepancy between knowledge and implementation, which is also spaem indicated by the more comprehensive content analysis of the other data, par-so ticularly in relation to daily transportation choices, physical inactivity, diet and weight maintenance. Discussion The survey on the lifestyles of early childhood education students at three Slovenian universities revealed several important findings, which we have divided into three areas that we believe could be addressed in the future. The first area is active transportation or daily walking. The results of our study show that 24% of students live close to the college (within a 2 km radius), which gives them the opportunity to get around actively, e.g. by walking or cycling, but 37% do not use this. Furthermore, students do not use bicycles if they live further than 2 km from the college. Considering our findings that 33.1% of students are not sufficiently physically active to maintain their health (WHO, 2022), it would make sense to promote active transportation, which was confirmed in 29 of 35 studies by Wanjau et al. (2023) that the physical activity resulting from the use of active transportation leads to additional physical activity. The second area wish to address is ‚wellbeing‘, which includes stress management, sleep, nutrition and weight maintenance. We found that students sleep on average only 7 hours, that 24% have poor or very poor knowledge of stress management, that they gain a kilogram of weight every year and that 48% skip breakfast. Wellbeing can contribute to physical and mental health (Chin et al., 2019; Francis et al., 2019), which is why we would like to highlight this area in particular. The third area is so called »putting knowledge into practice«. Our data analysis shows that there is a positive correlation between perception of knowledge and putting healthy lifestyles into practice (Table 4). The correlation is on-ly evident in a broader content analysis, which shows a lack of self-criticism in putting healthy lifestyles into practice. N r. They believe they are very knowl-edgeable about the effects of sleep on the body, but sleep 7 hours or less. They say they are not very familiar with ways to manage stress, but at the same time 64 are very confident that their lifestyle is healthy. ltsu Conclusion daerld In conclusion, the results of the survey show that awareness and motivation for od a healthy lifestyle need to be increased among early childhood education stu-naeg-a dents. Faculties should play an active role in promoting healthy lifestyle hab-g its, as future educators influence children, and thus society as a whole, through rkino w their example. By better understanding and implementing healthy lifestyles, f o students will be better prepared for the physical and mental challenges of their lthea profession and will be able to provide better quality education to preschool | h slih children. rad o Acknowledgments rejših sta in In formulating the research problem and the questionnaire, we received a lot ih of support and encouragement from the NOO ULTRA 5.02 project Improving ktivna the digital skills and competences of (future) teachers for high-quality peda-o vno gogical work with young children. el d ravje zd References CHIN, M. K., ANDERSON, E., DE RIDDER, J. H., UVINHA, R. R. and DURSTINE, J. L., 2019. BRICS to BRICSCESS–A perspective for practical action in the promotion of healthy lifestyles to improve public health in five countries. Journal of Sport and Health Science, vol. 8, pp. 520. Available from: https://doi.org/10.1016/j.jshs.2019.07.008 CUMMING, T., WONG, S. and LOGAN, H., 2021. Early childhood educators’ well-being, work environments and ‘quality’: Possibilities for changing policy and practice. Australasian Journal of Early Childhood, vol. 46, no. 1, pp. 50-65. Available from: https://doi.org/10.1177/1836939120979064 FRANCIS, H. M., STEVENSON, R. J., CHAMBERS, J. R., GUPTA, D., NEW-EY, B. and LIM, C. K., 2019. A brief diet intervention can reduce symptoms of depression in young adults–A randomised controlled trial. PLoS One, vol. 14, pp. e0222768. Available from: https://doi.org/10.1371/journal. pone.0222768 GREGORC, J. and DOLENC, M., 2020. Kostno-mišična obolenja vzgojiteljev predšolskih otrok = Musculoskeletal disorders among preschool teachers. Zdravje delovno aktivne populacije: 4. znanstvena in strokovna kon-ferenca z mednarodno udeležbo, [18. september 2020], pp. 66–67. Available from: http://www.hippocampus.si/ISBN/978-961-293-017-2.pdf GONZÁLEZ MORENO, A. and MOLERO JURADO, MDM., 2024. Healthy lifestyle in adolescence: Associations with stress, self-esteem and the roles of school violence. Healthcare, vol. 12, no. 1, p. 63. Available from: https://doi.org/10.3390/healthcare12010063 65 JACKSON, C.L. and HU, F.B., 2020. Long-term associations of health-related behaviors with quality of life among adults. American Journal of rs ato Public Health, vol. 110, no. 5, pp. 642-648. Available from: https://doi. cu ed org/10.2105/AJPH.2019.305483 retu LIN, Y., HUANG, Y. and XI, X., 2023. Association between lifestyle behaviors fuf o and health-related quality of life among primary health care physicians in China: A cross-sectional study. Frontiers in Public Health, vol. 11, p. lifestylee 1131031. Available from: https://doi.org/10.3389/fpubh.2023.1131031 thf o LINNAN, L., ARANDIA, G., BATEMAN, L.A., VAUGHN, A., SMITH, tsec N., and WARD, D., 2017. The health and working conditions of wom-spaem en employed in child care. International Journal of Environmental Re-so search and Public Health, vol. 14, no. 3, p. 283. https://doi.org/10.3390/ ijerph14030283 SNEDDEN, T.R., SCERPELLA, J., KLIETHERMES, S.A., NORMAN, R.S., BLYHOLDER, L., SANFILIPPO, J., MCGUINE, T.A. and HEIDER-SCHEIT, B., 2019. Sport and physical activity level impacts health-related quality of life among collegiate students. American Journal of Health Promotion, vol. 33, no. 5, pp. 675–682. Available from: https://doi. org/10.1177/0890117118817715 TABRIZI, J.S., DOSHMANGIR, L., KHOSHMARAM, N., SHAKIBAZA-DEH, E., ABDOLAHI, H.M. and KHABIRI, R., 2024. Key factors affecting health promoting behaviors among adolescents: A scoping review. BMC Health Services Research, vol. 24, no. 1, p. 58. Available from: https://doi.org/10.1186/s12913-023-10510-x VISSER, P.M., ENES, C.C. and NUCCI, L.B., 2023. Association of health predictors with quality of life in children and adolescents. International Journal of Adolescent Medicine and Health, vol. 35, no. 4, pp. 339–346. Available from: https://doi.org/10.1515/ijamh-2023-0011 WANJAU, M.N., DALUGODA, Y., OBERAI, M., MÖLLER, H., STANDEN, C., HAIGH, F., MILAT, A., LUCAS, P. and VEERMAN, J.L., 2023. Does active transport displace other physical activity? A systematic review of the evidence. Journal of Transport & Health, vol. 31, p. 101631. Available from: https://doi.org/10.1016/j.jth.2023.101631 66 ltsu daerld od naeg-ag rkino wf o lthea | h slih rad o rejših sta inih ktivnao vnoel d ravje zd https://doi.org/10.26493/978-961-293-397-5.67-76 The Effect of Pelvic Floor Muscle Exercises on Chronic Low Back Pain Urša Horvat, Manca Salmič, Denisa Manojlović Ivezić University of Primorska, Faculty of Health Sciences, Izola, Slovenia Abstract Introduction: Chronic low back pain represents a major problem for the global population, as it adversely affects individualsòverall wellbeing, diminishes work productivity and leads to high treatment costs. Non-pharmacological treatment, including physiotherapy, is a key method for managing this type of pain condition. One of the less studied physiotherapy methods that potentially contributes to the management of chronic low back pain is pelvic floor muscle training, the effectiveness of which we evaluated through this literature review. Methods: In the systematic literature review, randomized controlled trials identified through the PubMed and Google Scholar databases were included. All studies, regardless of the year of publication, written in English language and meeting the inclusion criteria, were reviewed. These criteria included that the studies were randomized controlled trials, with participants being individuals with chronic lower back pain, and that the intervention involved pelvic floor muscle exercises. The quality of included studies was assessed using the PEDro scale. Results: Seven randomized controlled trials were included in the systematic literature review. Their methodological quality was rated as “fair” (> 4) according to the PEDro scale. The results of the studies showed that a treatment consisting of standard physiotherapy (electrotherapy, thermotherapy, ultrasound therapy, back muscle strengthening exercises) and pelvic floor muscle training significantly reduces pain and improves the functionality of people with chronic low back pain. Furthermore, this combination proved to be significantly more effective intervention than standard physiotherapy treatment alone. Nevertheless, the reduction in chronic low back pain is more pronounced when we add trunk stabilization exercises to standard treatment than when we add pelvic floor muscle exercises. Discussion and conclusions: The main finding of our literature review suggests that integrating pelvic floor muscle training into standard treatment represents an effective approach for reducing pain and improving functionality in individuals with chronic low back pain. More high-quality randomized controlled trials with a broader spectrum of participants are warranted in order to support the development of more precise guidelines for physiotherapeutic approaches in individual treatment. Additionally, research investigating the long-term effects of pelvic floor muscle training on chronic low back pain would be beneficial for a better understanding of its long-term therapeutic potential. Keywords: low back pain, pelvic floor muscles, exercise, physiotherapy treatment Introduction Low back pain is characterized by pain, muscle tension, or stiffness localized between the 12th rib and the gluteal fold (Hayden et al., 2021) and can radiate to 68 the lower extremities. Approximately 80% of people experience low back pain at least once in their lifetime (Wang et al., 2012). In 2% to 10% of cases, this pain ltsu can develop into chronic low back pain (CLBP), defined as pain persisting for daer more than three months (Alleva et al., 2016). The persistance of pain is often in-ld o fluenced not only by biological factors but also by psychological and social fac-d na tors (Knezevic et al., 2021). eg-ag Chronic low back pain (CLBP) represents a significant social issue, im-rkino pacting individual well-being and leading to high treatment costs, absentee-wf o ism or reduced productivity at work (Meucci et al., 2015). Early and effective lth treatment is therefore crucial. This may include invasive treatments such as su-ea | h rgeries and epidural steroid injections, or pharmacological approaches using slih non-opioid analgesics, nonsteroidal anti-inflammatory drugs, opioids, muscle rad o relaxants, and antidepressants (Alleva et al., 2016; Hong et al., 2022; Qaseem et rejših al., 2017). Additionally, non-pharmacological treatments are integral to mana-sta ging CLBP and include patient education about their condition and coping te-inih chniques, lifestyle modifications, progressive muscle relaxation, cognitive-be-ktivna havioral therapy and physiotherapy utilizing physical agents, manual therapy, o vn and various types of exercise, including pelvic floor muscle training (PFMT) oel d (Fernández-Rodríguez et al., 2022; Hong et al., 2022; Knezevic et al., 2021). ravje Pelvic floor muscles (PFM) are a group of muscles situated between the zd pubic bone, coccyx, and ischial tuberosities (Bi et al., 2013). These muscles are crucial for supporting pelvic organs, maintaining continence, and sexual function (Eickmeyer, 2017). They also play an important role in stabilizing the trunk and the sacroiliac joint, which, if unstable, can lead to the occurrence of CL-BP (Hodges et al., 2007; Lee et al., 2016; Pel et al., 2008). Due to the numerous functions of PFM, they are becoming increasingly important in physiotherapeutic treatment. PMFT, which involves repeated contractions and relaxations of the PFM and anal sphincter, is used to enhance the strength and coordination of these muscles (Hite and Curran, 2021). These exercises have shown benefits in preventing and treating urinary incontinence (Alouini et al., 2022), im- proving symptoms related to pelvic organ prolapse (Espiño-Albela et al., 2022), and enhancing sexual function in the postpartum period (Hadizadeh-Talasaz et al., 2019). This systematic literature review aims to determine the effectiveness of PFMT in managing CLBP. Methods Search Strategy The literature review included studies identified through the PubMed and Google Scholar databases, which were searched in October 2023. The search was conducted using keywords »pelvic floor« and »low back pain,« with the condition that both phrases must appear in the article title. The final search query in PubMed was: (»pelvic floor«[Title]) AND (»low back pain«[Title]) and in Google Scholar: allintitle: »pelvic floor« »low back pain«. 69 in Inclusion and Exclusion Criteria pakc All studies written in English that met the PICOS criteria were included, regar-baw dless of publication year (Methley et al., 2014). Studies were eliglible if they in-loicn volved participants with CLBP, included at least one of the experimental gro-ro hc up receiving pelvic floor muscle exercises, and compared the effectiveness of n o PFMT with a control group or reported data on pain intensity before and after isesc the intervention. Only randomized controlled trials were included. Exclusion exerle criteria included studies involving participants with other pathologies, experi-scu mental groups receiving additional treatments besides PFMT (except for stan-mro dard CLBP treatment), and studies that did not include any experimental gro-flo vic up performing PFMT. pelf ot fec Methodological Quality efeth The quality of the randomized controlled trials was assessed using the PEDro scale, which assigns a score from 0 to 10 (Maher et al., 2003). Studies scoring 9 to 10 were considered excellent, 6 to 8 were considered good, 4 to 5 were considered fair, and below 4 were considered poor quality. The average quality of the included randomized controlled trials was assessed as fair (average score: 4.28). Among these, two were of good quality, two were of fair quality, and three were classified poor quality. Results When the mentioned search term was entered in the databases, a total of 40 hits were displayed, 9 in PubMed and 31 in Google Scholar. After removing 3 duplicates, the titles and abstracts of the remaining 37 articles were reviewed. 9 articles met the inclusion criteria and were fully reviewed. Subsequently, 2 studies were excluded due to inappropriate language and population criteria. The remaining 7 studies were included in the literature review. The search and selection process is shown in Figure 1. Identification of studies via databases and registers n Records identified through atio database searching: Records removed before ▪ PubMed (n=9) screening: duplicate records ntific ▪ Google Scholar (n=31) removed (n=3) Ide Records screened Records excluded based after duplicate removal on the title or abstract review g (n=37) (n=28) 70 eenin Full-text excluded: lts Scr Full-text article assessed u wrong population (n=1) da for eligibility (n=9) wrong language (n=1) erld od naeg-ag d rkin Studies included o ude w in review (n=7) f o Incl lthea | h slih Figure 1: Searching and selecting studies for inclusion in the literature review. rad o Table 1 outlines the basic characteristics of seven studies that investi-rejših sta gated the effect of PFMT on CLBP. The studies found that combining PFMT inih with standard physiotherapy treatment resulted in better outcomes for managing CLBP compared to standard physiotherapy alone, which typically in-ktivnao vn cludes ultrasound therapy, transcutaneous electrical nerve stimulation, ther-oel d motherapy, infrared light therapy, shortwave diathermy, and various exercises for strengthening flexors, extensors, and trunk stabilizers (Bhatnagar and Sa-ravje zd hu, 2017; Bi et al., 2013; Dsingh and Kaur, 2020; Ghaderi et al., 2016; Kumar et al., 2015; Mohseni-Bandpei et al., 2011; Rathi, 2013). Adding PFMT to standard treatment improved initial and final pain scores and functionality in most included studies (Bhatnagar and Sahu, 2017; Bi et al., 2013; Dsingh and Kaur, 2020; Ghaderi et al., 2016; Kumar et al., 2015; Rathi, 2013). It also increased the endurance and strength of PFM (Ghaderi et al., 2016; Mohseni-Bandpei et al., 2011) and abdominal muscles (Ghaderi et al., 2016; Kumar et al., 2015). However, the combination of standard treatment with trunk stabilization exercises was found to be more effective in reducing CLBP than combining standard treatment with PFMT (Kumar et al., 2015). Table 1: Overview of included studies. Study Participants Pelvic floor muscle exercise program Main findings 8-week progressive program Pelvic floor muscle exercise group* showed Mohseni-20 subjects with (6x/day) greater improvement in endurance and -Bandpei chronic low back Contraction: 5-10 s strength of pelvic floor muscles than et al., 2011 pain (age = 20-50 standard treatment group (p < 0,001); pain years) Rest: 4 s Cycles: 4-10 and functionality improved the same in both groups (p < 0,01) Bhatnagar 30 subjects with 6-week progressive program Pelvic floor muscle exercise group* showed and Sahu, chronic low back Contraction: 6 s greater improvement in pain and func- 2017 pain (age = 25-50 Rest: 6 s tionality than standard treatment group years) Cycles: 25-100, 5/min (p < 0.05) 30 subjects with 4-week program (5x/week) Trunk stabilization exercise group showed Kumar et al., postpartum chron- Contraction: 3-5 s greater improvement in pain (p < 0.001), 2015 ic low back pain Rest: no information functionality (p < 0.05) and abdominal (age = 25-35 years) Cycles: no information muscle endurance (p < 0.05) than pelvic floor muscle exercise group* 27 subjects with 5-week progressive program 71 Dsingh sitting jobs and (3x/week) Pelvic floor muscle exercise group* and postural control exercise group showed in and Kaur, chronic low back Contraction: 6 s greater improvement in pain and function- pak 2020 pain Rest: 6 s c ality than standard treatment group ba (age = 18-45 years) Cycles: 5/min, 30 min w Pelvic floor muscle exercise group* showed loic 24-week progressive pro- n 47 subjects with gram (3x/week) greater improvement in pain (p = 0.045) ro Bi et al., 2013 chronic low back Contraction: 6 s and functionality (p = 0.034) than stand-hcn pain (age = 18-60 Rest: 6 s ard treatment group; strength and endur- o years) ance of the trunk muscles improved the ises Cycles: 25-100, 5/min c same in both groups exer Pelvic floor muscle exercise group* showed le 60 subjects with 12-week program (3x/week) greater improvement in strength and en-scu Ghaderi et urinary inconti- Contraction: 30% max vol- durance of the trunk stabilization muscles mr nence and chronic untary contraction o al., 2016 low back pain (age Rest: no information than standard treatment group (p < 0.05); flo = 45-60 years) Cycles: no information pain and functionality improved the same vic in both groups pelf 4-week progressive program o 30 subjects with Pelvic floor muscle exercise group* showed t (5x/week, 3x/day) fec Rathi, 2013 chronic low back Contraction: 5s or more greater improvement in pain and functi- ef onality than standard treatment group (p e pain (age = 20-40 Rest: 5 s or less th years) Cycles: 10 < 0.05) * Pelvic floor muscle exercise group also received standard treatment Discussion Through a systematic literature review, we aimed to determine the effectiveness of PFMT in individuals dealing with CLBP. The main finding of our systematic review was that PFMT significantly reduces CLBP. However, it was found that physiotherapy treatment combined with PFMT was not significantly more effective than standard physiotherapy treatment in all studies. Additionally, there were no significant differences observed in the method of execu-tion or duration of PFMT that would impact the effectiveness of treatment for patients with CLBP. The interventions in the included studies examined varying durations of PFM contractions, rest periods, and the overall length of the intervention. Regardless of the duration of PFM contraction or rest periods between them, all studies have consistently shown a significant reduction in CLBP. However, there is no consensus on the optimal length for such interventions – in the studies analysed, the intervention period ranged from 4 to 24 weeks, with all studies reporting pain reduction outcomes. In previous research where pelvic floor exercises were used to treat urinary incontinence, interventions typically lasted around 12 weeks, which was sufficient to improve PFM strength (McLean et al., 2013). PFMT has been proven effective when integrated with other interventions. In most of the reviewed studies (Bhatnagar and Sahu, 2017; Bi et al., 2013; Dsingh and Kaur, 2020; Ghaderi et al., 2016; Mohseni-Bandpei et al., 2011; Rathi, 2013), PFMT was used in combination with back or abdominal muscle strengthening exercises, except in one study (Kumar et al., 2015) where PFMT 72 was applied without other exercise interventions. Combining PFMT with core lts muscle strengthening exercises is reasonable to include in physiotherapeutic u da treatment of individuals with CLBP (Sapsford and Hodges, 2001) due to the in-erld dispensable connection between core muscles (especially the multifidus and od na transverse abdominal muscles) and PFM. The concurrent activation of these eg-a muscle groups enhances intra-abdominal pressure (Rathi, 2013). This increase g in pressure facilitates improved segmental stability, which is essential for mit-rkino w igating pain and functional impairment in individuals with CLBP (Kim and f o Lee, 2013). This could explain how PFMT impacts CLBP. There is still no con-lthea sensus on whether PFM strengthening alone affects CLBP or if the pain reduc- | h tion is a result of the strengthened core muscles that are simultaneously trained slih rad with PFM (Bernard et al., 2021). o In this systematic literature review, several limitations need to be con-rejših sta sidered. The interventions were relatively short-term. The included studies in-inih volved a small number of participants, and it is also worth noting the generally lower quality of the research. ktivnao vnoel d Conclusion ravje PFMT is a physiotherapy method used to adress various conditions, includ-zd ing urinary incontinence, symptoms associated with pelvic organ prolapse, and sexual function in the postpartum period. It is also gaining importance in the management of CLBP. The main finding of our literature review is that combining PFMT with standard treatment is an effective approach to reducing pain and improving functionality in individuals with CLBP. Additionally, in most of the studies, standard treatment augmented with PFMT was found to be more effective than standard treatment alone. In the future, more high-quality randomized controlled trials with a larger number of participants are needed on the topic of PFMT to contribute to the establishment of clearer guidelines for the physiotherapeutic management of individuals with CLBP. It would also be beneficial to conduct studies that observe the long-term effects of PFMT on CLBP. References ALLEVA, J., HUDGINS, T., BELOUS, J. and KRISTIN ORIGENES, A. (2016). Chronic low back pain. Disease-a-Month: DM, 62(9), 330–333. https:// doi.org/10.1016/j.disamonth.2016.05.012 ALOUINI, S., MEMIC, S. and COUILLANDRE, A. (2022). Pelvic Floor Muscle Training for Urinary Incontinence with or without Biofeedback or Electrostimulation in Women: A Systematic Review. International Journal of Environmental Research and Public Health, 19(5), 2789. https://doi. org/10.3390/ijerph19052789 BERNARD, S., GENTILCORE-SAULNIER, E., MASSÉ-ALARIE, H. and MOFFET, H. (2021). 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PLoS ONE, 7(12), e52082. https://doi.org/10.1371/journal.pone.0052082 76 ltsu daerld od naeg-ag rkino wf o lthea | h slih rad o rejših sta inih ktivnao vnoel d ravje zd https://doi.org/10.26493/978-961-293-397-5.77-86 The Use of Artificial Intel igence in the Field of Health for Working-age Adults and Older Adults Marjeta Logar Čuček University Clinical Centre Ljubljana, Surgical Clinic, Clinical Department of Maxillofacial and Oral Surgery, Ljubljana, Slovenia Abstract Introduction and purpose: Artificial intelligence (AI) brings numerous positive effects that extend to various aspects of human life. It can be understood as a “machine system” that, for a set of goals defined by humans, can make forecasts, formulate recommendations, or take decisions in real or virtual environments with varying degrees of autonomy. It pushes the boundaries both in technological capabilities and in the manner in which it is used, also in healthcare. It is crucial to perceive AI not as a substitute for human work, but as a tool that can help employees achieve more favourable work outcomes, improve cost-effectiveness, and better understand complex medical data. The implementation of AI in healthcare services requires a critical assessment of the ethical and legal aspects of its use. The purpose of the research is to identify the opportunities and significance of using artificial intelligence in the field of healthcare for working-age adults and older adults. Content presentation: The demands for improvement and higher quality of healthcare services are increasing. Automated solutions are vital in order to achieve this goal, and artificial intelligence can play a significant role. Development is focused on building models based on extensive databases of successfully solved healthcare cases. A prerequisite for the introduction of new technologies is the transformation of traditional clinical information systems with limited data analysis capabilities. This includes digitalisation of data from various levels of healthcare, enabling a machine-readable electronic health record. Research indicates that the use of AI in healthcare is becoming increasingly common, with applications ranging from screening and triage to clinical risk prediction and faster, more accurate diagnoses. Using time analysis of a patient’s health issues, genetics, and lifestyle, AI can recommend a personalized treatment plan, including appropriate medication and high-quality care. AI can also function as a virtual healthcare assistant, providing patients with relevant information about their condition and thereby improving their engagement in their treatment plan. AI can also aid in the development of more effective drugs with fewer side effects. The use of modern information technology is also defined by telemedicine applications, which include remote healthcare consultations, diagnostics, and treatment. Advantages include integrated patient care regardless of their physical location, availability of patient data for expert consultations, and the possibility of remote notification of changes in health status in chronic diseases. AI can also simplify administrative tasks in healthcare institutions, and in this way contribute to speed, efficiency, and cost reduction, resulting in overall financial benefits to the healthcare system. Priorities to be addressed in the future include education, research and exploiting the potential of AI at all levels of study in healthcare, and creating opportunities to build on knowledge. Leaders should build organisational structures that enable healthcare staff to be involved in all phases of AI, from development to 78 implementation. Conclusions: Developing skills in new technologies in healthcare requires new knowledge and building trust in AI. While this ltsu technology improves workplaces and processes, it is important to ensure daer that the humanity of the work environment and the relationship with ld od patients of different generations is not diminished. naeg-ag Keywords: healthcare, development of new technologies, education, rkino quality of life wf o lthea Introduction | h Artificial intelligence (AI) has entered our lives. Should we stop its develop-slih rad ment in fear of the “new master” of the future? In reality, we humans have o largely set our own limits and created our own worries with regard to the en-rejših vironment, the individual and society as a whole. We only need to use the new sta in tools offered by technology to develop our potential and to retain a real meas-ih ure of humanity and reason while taking responsibility. ktivnao Researcher Neher (2023) and her colleagues have defined artificial intelli-vnoel d gence (AI) as a “machine system” that can make predictions, recommendations or decisions in real or virtual environments for a set of human-defined goals. ravje zd AI’s capability brings many positive impacts to humanity in various fields: improving education, optimising business processes, advancing agriculture and environmental protection, responding faster to natural disasters, integrating renewable energy, global communication, financial security, medicine (Villani, 2018). In the field of healthcare, AI has great potential. Healthcare systems around the world are facing demographic changes, new technologies, increased patient expectations and healthcare workforce shortages. These factors are in turn contributing to the difficulty of balancing growing healthcare needs with limited financial and other resources (Posnett, 2022; Logar Čuček, 2023). The changes call for reforms and awareness-raising on the concept of value-based healthcare (VHBC) (Etges et al., 2022). It is thus important to understand where new technology can increase the efficiency of health services with the aim of saving lives and improving quality of life (Reddy et al., 2019; Gopal et al, 2019; Chen and Decary, 2020). Reddy and colleagues (2019) state that AI has made great progress with the development of network algorithms called deep neural networks, natural language processing, computer vision and robotics. The use of these techniques has already been actively implemented in healthcare services. It should be stressed, though that at present AI cannot fully replace employees in the provision of healthcare services. However, AI can be utilised to support the prediction, detection and management of health conditions (Harwich and Laycock, 2018). The two authors cited above also state that “these applications are key to reducing the strain on the healthcare system, improving the quality of care and patient outcomes, while at the same time reducing costs” (Harwich 79 and Laycock, 2018, p. 9). ltsu In order to fully reap the benefits of AI in healthcare, it is vital to be daer aware of the main barriers to implementing this technology. These are main-ld od ly data access issues, data quality and the certification of AI algorithms (Har-na wich and Laycock, 2018). This means collecting large volumes of the right ltsu types of data in the right formats, increasing their quality, and ensuring se-daeg cure access to them (Gopal, 2019). The recommendations for data collection -ag state that for most healthcare related AI strategies, what matters are large vol-rkino w umes of data, their digitisation and machine readability, and the quality of r fo the data, determined by the quality of the extraction, analysis and further lthea use. It is important that all AI-related data is collected in one place (Chen and hf od Decary, 2020). fiele For the use of AI in healthcare, in addition to providing experience on th in the usefulness of the new technology, it is also important to formally educate ecen staff on AI to help with their basic understanding and reduce fear of the new lig tel technology (He et al, 2019; Abdullah and Fakieh, 2020; Salah-Pico and Yang, inlia 2022; Chen and Decary, 2020). It is key to the adoption of AI as a support for problem solving and identifying solutions (Nancy, 2019; Ronquillo et al., 2021), rtificaf but it cannot replace the poor usability of AI systems, which make tools diffi-o seue cult to use and place additional burdens on employees (Reddy et al., 2019). The th trust of healthcare staff in the reliability of AI is also enhanced by the transpar-ency and interpretation of the results provided by the new tools (Veale, 2018). Data security must be ensured or, in other words, standards should be developed to assess safety and effectiveness of AI (Shah et al., 2019; He et al, 2019; Pe-dro, 2020; Salas-Pico and Yang, 2022). This article briefly describes the mechanisms that enable AI systems to generate clinically meaningful outcomes; and then presents how AI can be applied in the field of health of working-age and older adults. Integrating Artificial Intelligence Into Healthcare Delivery – A Vision for Service Transformation How AI Works Artificial Intelligence (AI) in healthcare does not work by itself, but on the basis of an ever-growing volume of data. They can only be addressed by AI-based processing (Laukka et al., 2022). Given this data, AI-enabled devices are mainly divided into two categories (Jiang et al., 2017). The first includes machine learning (ML) techniques that analyse structured data: imaging, genetic and electro-physiological data. In healthcare applications, ML procedures attempt to clus-ter patient characteristics or infer the likelihood of disease outcomes (Darcy et al., 2016; Cato et al., 2020). The second category includes natural language processing methods that extract information from unstructured data, i.e., clinical records, peer-reviewed and scientific medical journals, to complement struc-80 tured medical data. Natural language processing techniques attempt to convert text into machine-readable structured data that can then be analysed using AI ltsu machine learning techniques (Jiang et al., 2017). daerld There are three types of AI techniques that are used in medical applica-od tions. The classical machine learning (ML) technique builds algorithms to an-naeg alyse data that include patient “characteristics”, e.g. age, gender, clinical symp- -ag toms, etc., sometimes including health outcomes as disease indicators, patient rkino w survival times and quantitative disease levels, e.g. tumour size. More recent f o deep learning techniques address multi-layer neural networks; they are used lthea for speech recognition, image recognition, text understanding, etc. Natural | h language processing (NLP) methods help to convert unstructured narrative slih rad text into structured, machine-readable text to enable information extraction o (Jiang et al., 2017; He et al., 2019). Depending on the desire to incorporate re-rejših sults, ML algorithms can be divided into two categories, namely supervised sta in and unsupervised learning (Jiang et al., 2017). AI also raises concern, mainly ih due to its ability to modify its behaviour and act autonomously with minimal ktivnao human input; however, it is currently still unable to operate without human su-vnoel pervision (Zlatanova and Veljković, 2023), and most importantly, it lacks a sub-d jective essence (Ferrarelli, 2023). ravje zd Promoting and Maintaining Health, Prevention The ageing population, the need for specialised care and more care programmes, the emergence of chronic diseases and lifestyle-related health problems, the demands for active involvement of patients in their treatment and more convenient care options, and value-added services dictate the need for new strategies in healthcare: prevention, diagnosis and optimal care (Gopal et al., 2019). AI could be used to identify individuals or groups predisposed to certain diseases and provide them with timely and effective treatment. For instance, in the elderly, AI could be used to identify cognitive decline due to neu- rodegeneration, which is distinct from the expected memory impairment common in the elderly (Zlatanova, 2023). Wearable devices, smartphones, etc., are one of the options to maintain health, already perceived as medical devices that can monitor health-related information, for example by measuring vital signs, physical fitness, dietary calories, exercise (Giordano et al., 2021). With the use of AI, the large amount of data obtained can be analysed (similarities and differences) to enable the planning of diets, breaking of bad habits for instance in diabetes maintenance or even prevention. By detecting the signs of vision loss as a consequence of diabetes, timely treatment of the underlying disease and its consequences could be provided (Zlatanova, 2023). At the same time, individuals with certain health problems that eventually develop into complications could be identified (Necher et al., 2023). It can be concluded that the collection of a large amount of data and its analysis using AI support allows for timely diagnosis and subsequent treatment; this approach can also act as a preventive measure, as by abandoning certain lifestyle habits, potential health problems 81 can be avoided. However, it is to the detriment of the individual and the health system that this data remains isolated and often untapped (lack data accessibil-ltsu ity and sometimes questionable quality, lack of incentives), rather than being daer integrated within existing processes (Gopal et al., 2019). ld od na lts Quality Clinical Diagnosis, Decision-Making and Personalised Patient u dae Care g-ag Using AI, all healthcare professionals and patients can easily access state-of-rkino the-art diagnostics, treatments, development of therapies tailored to the needs wr of the individual (Shah et al., 2019). In the future, AI tools will be refined, soft-fo lth ware will be upgraded and databases will be improved (Watson, 2024). ea hf The types of diseases that AI communities are most concerned with are od cancer, diseases of the nervous system and cardiovascular diseases. This se-fiele lection is not surprising as all three diseases are major causes of death. Accu-th inec rate and early diagnoses can be achieved with AI support, enabling improve-en lig ments in the analysis processes of structured data and unstructured records; tel the latter requiring conversion into a machine-readable electronic medical re-inlia cord (Jiang et al., 2017, Topol, 2019). AI algorithms can help reduce potential human cognitive biases to aid clinical decision making through accurate di-rtificaf o agnosis (Dilsizian and Siegel, 2014; Giordano, et al., 2021; Brown et al., 2023). seue Indeed, research has shown a synergistic effect: when physician and AI work th together, better outcomes are achieved (He et al., 2019). Especially in the diagnostic phase and later on, AI also contributes to clinical decisions by processing written information, which, together with patient data and the processing of existing professional and scientific medical literature, helps in the diagnosis and recommendations on treatment options (Hernandez et al., 2017; Giordano et al., 2021). At the same time, AI supports the implementation of personalised patient care and monitoring (Chen and Decary, 2020). The digitisation of medical records, the proliferation of smartphones and fitness monitoring are enabling access to digital technologies and, at the same time, the use of AI for patient monitoring, for instance patient sleep patterns, blood pressure, heart rate, etc. can be obtained in ways that have not been available before (Reddy et al., 2019). The virtual use of the listed assistants can also help in communicating health status, especially for elderly people outside the hospital setting, use of medication, analysis of patients’ health status (Seibert et al., 2021). By obtaining patient information and analysing data, AI can also help reduce queues in emergency clinics (Yousefi et al., 2018). The potential of generative AI support in health and patient care for healthcare diagnoses, planning goals and interventions should also be mentioned. However, it has been shown that AI is still not specific enough and requires human critical reflection and verification (Gosak et al., 2024). The use of robots in patient care, especially for the elderly, has become a 82 major focus, helping to reduce health risks. Robots can be used to remind the elderly to perform regular activities, take medication, and guide them in their ltsu da environment (Reddy et al., 2019). erld However powerful AI techniques may be, the process of patient care be-od na gins and ends with clinical activities (Jiang et al., 2017). A similar conclusion eg-a was reached by researchers Laukka et al. (2022) in interviews conducted with g rkin nurse managers and developers of digital services. The interviewees felt that o wf specialised healthcare will have several positive implications for work, servic-o lth es and organisation. ea | h slih Potential Roles of AI in Clinical Settings and a Look to the Future rad o The application of AI in clinical settings does not take place only in oncology, rejših cardiology and neurology, but also in other areas of healthcare (He et al., 2019). sta in AI technology can aid triage or screening by selecting priority radiographs ih based on the most probable disease (Tang et al, 2018). It can help in identify-ktivnao ing risks to eyesight, differentiating between patients who urgently need face-vnoel to-face examination and those who are not at risk (triage), diagnosing disease, d quantifying vascular stenosis in cardiac imaging (Pelcyger, 2017; De Fauw et ravje zd al., 2018; Kermany et al., 2018; Giordano et al., 2021; Brown et al., 2023). In the future, AI technologies will be most rapidly applied in the fields of radiology, ophthalmology, dermatology and pathology, mainly due to their powerful imaging and visual components with the possibility of automated analysis. However, according to some researchers (He et al., 2019), internal medicine and surgery will be somewhat later entrants into the AI world; the former because it requires the integration of different types of data and the latter because of the procedural components. The integration of AI into the clinical setting will require the alignment of healthcare workers and developers regarding the goals. The future will also require staff to be cross-trained with all colleagues at different levels of competence (He et al., 2019). Conclusions Successful integration of AI into health systems relies on digitised and analysed data collected in an AI-related database. It is in healthcare that the adoption of digital innovation is at its lowest level compared to other sectors. It will be necessary to move beyond the capture of paper-based patient data, which limits the effectiveness of treatment in several respects: information analysis, productivity and the efficient use of resources to carry out higher-value tasks. Data digitalisation will make it possible to use these resources more efficient-ly and to gain deeper insights into patients’ health and care. Only once digitisation has been implemented will it be possible to carry out the processes that are the domain of AI. Interoperability will need to be established in health-83 care systems to enable the exchange, integration and retrieval of health infor-lts mation. This does not allow unhindered access to patient data, but rather pa-u da tient-centred treatment, which will reduce inefficient healthcare services and erld thus the cost of treatment. Older people should also be involved in the formu-od lation of recommendations for the future development of AI technologies in na ltsu the context of ensuring human rights. The need to empower them through ac-daeg cess to information and communication technology and digital literacy will -ag need to be highlighted, as will the need to ensure the safe use of AI in law and rkino in technology. wr fo Artificial intelligence will remain and go beyond its current stage of de-lthea velopment: in the future, AI tools will be refined and improved as software and hf od the databases it uses evolve. 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Examples of currently developing AI uses in the field of medicine. In: TEKAVČIČ VEBER, M. and KOVAČIČ, M., eds. Artificial intelligence and the rights of older persons. Ljubljana: Litteralis, d. o. o., p. 23. https://doi.org/10.26493/978-961-293-397-5.87-95 The Influence of Night Work on the Eating Habits of Workers Helena Olenik1, Damir Hećimović2 1 Triglav zavarovalnica, Ljubljana, Slovenia 2 Ortopedska bolnišnica Valdoltra, Ankaran, Slovenia Abstract Introduction: Certain professions require constant readiness and shift work, so night shifts are inevitable and necessary. Such work is often very stressful and requires a great deal of concentration from the employees. Performing night work causes employees to change day to night, which leads to many changes in the body and can worsen the quality and standard of life. Working at night can increase the risk of many health problems and conditions due to a changed sleep rhythm and a changed diet. Methods: In the article, we were interested in the connection between performing night work and workers‘ nutrition during the night shift. For searching, we used the PubMed database using the keywords „ eating at work at night“, „ nutrition at the workplace“, and „ night work nutrition“ for scientific literature published in the period from 2018 to 2023. As search criteria, we considered accessibility of the full text of the article and searching for articles in English. Results: With proper nutrition and adequate nutrition at the workplace, we can influence productivity, reduce fatigue, and improve concentration at the workplace, enabling us to perform tasks more successfully and with high quality. The active working population is a group at risk in terms of eating habits at the workplace. In the research, we found that workers who work in shifts, especially night shifts have a disordered eating rhythm, low intake of fruits and vegetables, high-energy intake of inadequate nutrients, and too high a proportion of sugar and salt in the diet. Research articles also describe hormonal disturbances, increased subjective hunger, stomach problems, and increased sleepiness in shift workers. It turns out that it would be very good to introduce and adopt new healthy eating habits in the work environment. Discussion and conclusions: Fulfillment of conditions such as a balanced diet, sufficient amount of sleep, concern about mental state, and sufficient amount of physical activity are some of the key factors in ensuring good concentration and sufficient amount of energy for work. Proper nutrition at the workplace during the shifts and in night shifts, when the employee is doing his work, also has a great impact on the well-being and health of the workers. In this area, it would be necessary to carry out some more research into the connection between night and shift work and its impact on the quality of life of workers. In such types of training, it is good to implement multidisciplinary cooperation of experts from major fields of work, such as the fields of nutrition, exercise, and medicine. Keywords: eating at work at night, nutrition at the workplace, night work nutrition. Introduction Certain professions require employees to work night shifts, which are essential for maintaining uninterrupted services 24/7. Shift work involves working 88 outside of the regular daytime schedule, including late evenings, early mornings, and overnight hours. Approximately 20% of the global workforce is en-ltsu gaged in some form of shift work, which can be quite demanding and requires da exceptional concentration from employees. Working night shifts can disrupt erld o the body’s natural rhythm and lead to various health issues, impacting over-d na all quality of life. One of the primary challenges of shift work is managing a eg-a healthy diet and lifestyle alongside irregular eating and sleeping patterns. Shift g rkin workers are at a higher risk for health problems, dietary imbalances, obesi-o wf ty, disrupted sleep and eating patterns, and other related health issues. Night o lth work is defined in Article 150. (ZDR-1, 2013). It is the type of work done between ea | h 11 p.m. and 6 a.m. the next day. If the working schedule specifies a night shift, slih eight continuous hours between 10 pm and 7 am on the following day are con-rad o sidered night work. Article 151. The ZDR-1 (2013) defines the rights of workers who perform night work or work at night. Employees who work night shifts are rejših sta entitled to special protections, including extended holiday entitlement, proper inih nutrition during work hours, and skilled supervision of the work or production process. If a personal physician determines that a night shift worker‘s health ktivnao may deteriorate, the employer must assign them suitable daytime work. Night vnoel work is limited to one week unless the employee gives written consent to work d nights for a longer period. If the employee does not have organized transpor-ravje zd tation to and from work, the employer may not assign him to night work (Da-ta, 2024). Methods In our research, we focused on examining the relationship between night shift work and the dietary habits of workers. Our approach involved a descriptive method, which included a critical review of literature obtained from the PubMed database using specific keywords such as „eating at work at night,“ „nutrition at the workplace,“ and „night work nutrition.“ We specifically sought scientific literature published between 2018 and 2023, with a focus on freely ac- cessible full-text articles in English. Data collection occurred between January and March 2024, resulting in a qualitative analysis of 9 articles. Results Studies conducted by Cunha et al., (2020) have demonstrated that non-shift workers exhibit poorer glucose tolerance after evening meals, which can disrupt the endogenous circadian cycle at night. Various factors, including sleep restriction, reduced brain glucose utilization, and insulin resistance, may contribute to abnormal glucose metabolism. The findings of the study suggest that night-time food consumption may not be metabolically optimal. This is particularly pertinent for shift workers, as elevated triglyceride levels pose a significant risk for ischemic heart disease. The study also noted heightened triglyceride levels following the consumption of a high-fat meal at 5:00 and 6:00 am, indicating a potential link to increased triglyceride concentrations in the bloodstream of shift workers. Furthermore, the type and frequency of meals 89 consumed by night workers appear to be more influenced by habit and time s availability than by appetite. Nonetheless, it is essential to establish better nu-rkero tritional choices by taking into account metabolic considerations, person-wf o al habits, and individual preferences. Quian et al., (2022) have indicated that bitsa the timing of meals can significantly impact mood levels related to depression hg and anxiety, particularly during simulated night work. A recent cross-section-eatine al study involving 502,494 individuals revealed that an unhealthy diet is associ-thn ated with poorer sleep quality and overall mental well-being. Many individuals orko have reported consuming poor-quality diets characterized by high-carbohy-wth drate meals. ig nf o A systematic review by authors Clark et al., (2023) incorporated studies on ecen total energy intake and dietary patterns associated with day work, shift work, flu and rotating shift work revealed that individuals in the rotating shift workers ineth group recorded a higher average 24-hour energy intake. Rotating shift workers tended to have irregular and more frequent meals, engage in more snacking or eating at night, consume lower amounts of core foods, and have a higher intake of discretionary foods. This pattern was associated with an increased risk of cardiometabolic conditions among rotating shift workers. This study by authors Gupta et al., (2020) examined the effects of consuming a meal during a simulated night shift on driving performance. It was observed that driving performance was impaired from 01:30 to 07:30, particularly for those who consumed a meal compared to those who had a snack or didn‘t eat at all during the night. Those who consumed a meal showed significant impairment during their commute home, indicating that reducing food intake during the night shift could potentially improve safety. Additionally, participants who consumed a snack did not report feeling excessively full throughout the night shift, suggesting that consuming a snack could be a viable option for satisfying hunger during the night shift. The study also revealed an increase in subjective sleepiness during the night shift, with the highest levels reported at 04:00. Notably, participants who consumed a meal during the night shift experienced greater sleepiness compared to those who had a snack. The findings suggest that opting for a snack during the night shift may be more beneficial for post-shift driving performance than consuming larger meals. Furthermore, the study demonstrated that consuming either one or three low-glycemic index meals during the night shift did not negatively impact glucose regulation, un-like fasting. Conversely, providing high-glycemic-index meals during the night shift led to an anticipated increase in glucose levels. In summary, the results indicate that choosing low-glycemic index meals, regardless of frequency, could be a favorable option over fasting during night shifts, promoting better glucose regulation. The aim of the study by Garrido et al., (2021) was to examine the connection between circadian disruption, eating patterns, sleep behaviors, and dyslipidemia indicators in night shift workers. The study employed a randomized, 90 double-blind, crossover-controlled clinical trial and involved 36 overweight female nurses working fixed night shifts (12 x 36 hours). The average age of the ltsu participants was 39.4 years, and their average nighttime sleep duration was 5.76 daer hours. ld od The findings revealed a correlation between reduced nighttime sleep dura-naeg tion and increased levels of very-low-density lipoprotein cholesterol (VLDL-C) -ag by 2.75 mg/dL and triacylglycerides by 3.62 mg/dL. Conversely, each addition-rkino al hour of sleep was associated with a 3.06 mg/dL increase in high-density lipo-wf o protein cholesterol (HDL-C) levels. In summary, insufficient nighttime sleep lthea and high social jet lag were identified as risk factors for dyslipidemia, while be- | h ing a late chronotype and having a longer interval between the last meal and slih rad sleep onset were deemed protective factors against dyslipidemia. o Chronic circadian disruption, such as occurs during rotating shift work, rejših sta and insufficient sleep are each independently associated with poor health out-inih comes, including obesity and glucose intolerance. This is the thesis of authors McHill et al., (2022), in a 32-day in-laboratory study, examined seventeen ktivnao healthy young adults to evenly distribute sleep, wakefulness, and energy in-vnoel take throughout all phases of the circadian cycle. Our carefully controlled cond ditions allowed us to measure subjective hunger, appetite, and food preference, ravje zd indicating that other factors may contribute to the negative health effects associated with shift work. Table 1 contains comprehensive overviews of the studies used, including their research objectives, methodologies, and results. Table 1: Overview of studies. Author(s) and year Aim of research Methodology Results This study aimed to A night meal with a compare the acute ef- higher percentage of fect of a high-protein/ protein and a lower per- moderate carbohydrate centage of carbohydrates Cunha et al., 2020 versus low-protein/ controlled, randomized, led to minor postprandi-high-carbohydrate meal crossover clinical trial al glucose levels during served at night on the the night shift but exert- postprandial metabol- ed no effect on the meta- ic response of male night bolic response of the fol- workers. lowing meal. The aim was to conduct a systematic review of the literature and to as- The meta-analysis did not produce significant Saulle et al., 2018 sess the relationship be- systematic review of the tween night shift and literature results on the prevalence overweight and obesi- of obesity in the popula- ty among health profes- tion of nurses 91 sionals. s The findings of the study are decreases in most rkero measured outcomes of wf To uncover the impact subjective hunger, appe- o of hunger, dietary pref- bits tite, and food preference a erences, and physiologi- randomized, crossover h McHill et al., 2022 in our highly controlled g cal appetitive hormones, clinical trial studied healthy indi- conditions likely suggest eatin that other mechanisms e viduals th promote the observed n o adverse health conse- rko quences of shift work. wt The short duration of hig nighttime sleep and high nf This study aimed to eval- social jetlag are risk fac- oe uate the relationship be- c tors for dyslipidemia, en tween proxy for circa- randomized, dou- whereas the late type and flu Garrido et al., 2021 dian disruption, eating ble-blind, crossover-con- in the longer time inter- e habits, sleep character- trolled clinical trial th istics, and dyslipidemic val between the last meal parameters. and sleep onset appear to be protective factors for dyslipidemia. Participants experi- This study focuses on the enced weight loss by re- qualitative aspects of this placing their dinner with Sooriyaarachchi et al., intervention, aiming to randomized controlled the MR. This study of- 2023 explore the experiences clinical trial with quali-fers valuable insights for and perceptions of shift tative interviews tailoring future work- workers who participat- place-based dietary in- ed in the trial. terventions for this vul- nerable population. Author(s) and year Aim of research Methodology Results This study evaluated the effect of fasting com- High meal GI but not pared with the consump- higher meal frequency tion of meals with dif- during the night shift in- creased in female night Suyoto et al., 2023 ferent combinations of randomized cross-over glycemic index and fre- trial shift workers. Results for quency (1 or 3 times) 1 low-GI meal during the during the night shift night shift were not dif- on continuous glucose ferent from a glucose monitoring metrics profile after no meal. Shift workers often ex- perience a misalignment between the central cir- These findings of- cadian clock and daily fer a proof-of-concept environmental/behavio- demonstration of an ev- Qian et al., 2022 ral cycles, and circadian parallel-design rand- idence-based meal tim- misalignment can neg- omized clinical trial ing intervention that atively affect mood and may prevent mood vul- nerability in shift work 92 emotional well-being in non-shift workers and settings. shift workers ltsu Driver safety dur- da This study investigated ing the simulated com- er the relationship between ld Laboratory study and mute home is greater fol- o food intake during the d Gupta et al., 2020 night shift and simulat- underwent four simulat- lowing the night shift if na ed night shifts. a snack, rather than a eg ed driving performance -a meal, is consumed dur- g post-shift. ing the shift. rkino This review investigates wf how rotating shift work o schedules affect die- lth This review highlights ea tary energy intake and | h dietary patterns com- that dietary intake in ro- tational shift workers is slih pared with regular day ra potentially higher in cal- d Clark et al., 2023 and fixed shift sched- Systematic Review and o ules. In addition, intrap- Meta-Analysis ories and features differ- ent eating patterns as a rejših erson energy intake and consequence of rotating sta dietary pattern compari- shift work schedules. in sons within rotating shift ih schedules were investi- ktivna gated. o vnoel d Working irregular hours, such as in-shift work, presents distinct challenges for maintaining a healthy lifestyle due to disruptions in eating and sleep-ravje zd ing patterns. Studies have shown that shift workers face an increased risk of dietary imbalances and health issues, including obesity. Even with similar daily energy intake as those who work regular hours, shift workers are 23% more likely to become obese. Being overweight or obese is associated with various chronic conditions and metabolic complications. (Sooriyaarachchi et al., 2023). Shift work may have a significant impact on the health of the worker and has been connected to unhealthy lifestyles. Saulle et al., (2018) are authors that suggest more high-quality studies with a larger number of participants should be conducted to determine if there is a real link between exposure to night shifts and weight gain or obesity. Discussion Shift work presents a great challenge in ensuring regular and healthy eating. During the nighttime shift, the use of caffeine and snacks is more frequent, and it is very difficult for the human body to adapt to such a rhythm of work. Shift work is an important risk factor for obesity, sleep disorders, high blood pressure, and cardiovascular diseases. The longer the shift work lasts, the greater the risks. Inadequate nutrition (improper eating habits, excessive consumption of sugar, frequent unhealthy snacks), lack of sleep, low physical activity, negative emotions, and increased stress pose greater health risks. The related body weight increases the risk of various cardiovascular diseases, diabetes, diseases of the musculoskeletal system, and cancer. Obesity is associated with various functional limitations: limited mobility and flexibility, low endurance, and a greater number of acquired injuries when performing strenuous tasks. All these negative health factors are interconnected and intertwined and cause problems for shift workers in all areas of life (Drenovec and Vošner, 2023). Re-93 search suggests that consuming low-glycemic index meals, regardless of fres quency, may be a beneficial option for managing glucose levels during night rkero shifts, potentially supporting improved glucose regulation (Suyoto et al., 2023). wf o Studies have shown that getting an insufficient amount of nighttime sleep and bitsa experiencing high social jet lag can increase the risk of dyslipidemia. On the hg other hand, being a “night owl” and having a longer time gap between the last eatine meal and bedtime seem to have protective effects against dyslipidemia.(Gar-thn rido et al., 2021). We have drawn the following conclusions from our review orko of the articles. In certain professions, night shifts are an unavoidable reality. wthig Working at night can lead to an increased risk of numerous health issues, in-nf cluding obesity and diabetes. Night workers often experience difficulties with oecen insomnia, reduced concentration and cognitive abilities, digestive problems, flu and challenges in managing their personal lives due to differing work and rest ineth schedules from their loved ones. The dietary habits of shift workers typically involve excessive fat consumption and insufficient fiber, fruits, and vegetables. In addition to sleep, physical activity, and mental well-being, maintaining a balanced diet is crucial for a healthy lifestyle (Kranjc, 2022). Hence, it is crucial to give careful consideration to the arrangement of shift schedules, ensuring that the physiological, psychological, and social needs of employees are du-ly acknowledged. Further research is required to formulate strategies tailored to the needs of shift workers, as well-designed measures can mitigate the adverse impacts of shift work (Lavrič and Štukovnik, 2021According to the research, driver safety during the simulated commute home is improved following the night shift when a snack, rather than a meal, is consumed during the shift (Gupta et al., 2020). The findings offer a proof-of-concept demonstration of an evidence-based meal timing intervention that may prevent mood vulnerability in shift work settings. Future studies are required to establish if changes in meal timing can prevent mood vulnerability in night workers (Quian et al., 2022). Conclusion Shift work entails following a schedule that divides the day into equal parts or multiple shifts, which can be either fixed or variable. All types of shift work disrupt the body‘s natural circadian rhythm, leading to health issues, particularly sleep disturbances. 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A triage physical therapist must be trained in a timely manner to identify signs and symptoms of a serious illness other than neuromusculoskeletal disorders. The screening process allows the physiotherapist to detect warning signs – red flags that require additional medical attention. The reason for doubt and referral to a specialist doctor may also be an unexpected outcome or unresponsiveness of symptoms to physiotherapeutic treatment. Methods: A descriptive literature search method in the PubMed and CINAHL databases between November 2023 and March 2024 was conducted. The review included open access of randomized controlled trials and systematic reviews published since 2018. We searched using the search string of keywords or their combinations in English: direct access, physiotherapy, red flags . Results: The review included 12 studies investigating the effects and implications of self-referral options or access to physiotherapy without referral to a doctor. The authors mostly report a decrease in the number of referrals to specialist doctors, a decrease in drug consumption, an improvement in the patient’s satisfaction with medical care, and thus a reduction in treatment costs. Discussion and conclusions: A physical therapist has a responsible task in the process of ensuring the patient’s basic right to appropriate, safe, and quality treatment. Physiotherapeutic treatment is based on a physiotherapeutic examination, which must exclude as clearly as possible the presence of serious illnesses or detect individuals in whom serious illnesses have not yet been detected. The screening process helps physiotherapists determine the degree of doubt about whether the patient in question is suitable for physiotherapeutic treatment and choose the most effective physiotherapeutic procedure. Keywords: screening, red flags, physiotherapy, physiotherapeutic diagnosis Introduction Musculoskeletal Conditions Musculoskeletal pain problems including osteoarthritis, low back pain, shoulder pain and neck pain in ageing population are leading causes for disability globally (Murray et al., 2010). This group of diseases is characterized by persistent pain, and limited functional and psycho-social abilities. Musculoskeletal (MSK) disease is second most common cause for primary care visits and work absentisem in Slovenia (Ministrstvo za zdravje, 2023). Evidence show that they often relapse and become long-term conditions (Dunn et al., 2006). As such, they are a growing challenge for primary care and a huge economic burden of 98 the healthcare system worldwide. In Slovenia, they represent 5 % of all healthcare costs which is 0,4 % of gross domestic product (GDP) between 2016 - 2018 ltsu (Sedlak et al., 2021). daerld od Direct Access naeg Traditionally patients with MSK conditions are referred by general practition- -ag ers (GP) to physiotherapists which usually results in a delay in care. Recently, rkino w in some countries a new healthcare pathway to access physiotherapy services f o as the first contact was developed. Direct access (DA) to physiotherapy is an or-lthea ganizational model, where patients have the possibility to self refer, to directly | h seek physiotherapist and is available and well accepted in several countries in-slih ra cluding the Netherlands, United Kingdom, Australia, Brazil and most of USA d o (Piscitelli et al., 2018). However, there are variations in how direct access ser-rejših vice is being utilized in practice (National assocciation of primary care, 2015). sta in The professional workforce delivering first contact in DA healthcare ih model are physiotherapists with extended skills who assess and manage pa-ktivnao tients with MSK conditions (Ojha et al., 2014). Direct access increases the pro-vnoel fessional responsibility of physiotherapists and requires additional knowledge d (Vignaud et al., 2023). The essential part of the physiotherapeutic assessment ravje zd at first contact is to make sure that the patient is an appropriate candidate for physical therapy (Finucane et al., 2020). Evidence show that the effects of DA are promising: reduction of work-load for GP, reduction in costs for the patient and the healthcare system, and improvement in healthcare indicators e.g. quality of life and disability (Ojha et al., 2014). Medical Screening As an essential part of this process, the therapist should screen for medical diseases and detect signs and sympthoms of a non-MSK disease or a disease which can mimic a MSK dysfunction (Goodman et al., 2018). Detecting warning signs - red flags requires therapists‘ vigilance and advanced clinical reasoning skills. Considering evidence supporting red flags and the patients individual profile the therapist determines his level of concern and decides on clinical action. The patient can be treated, treated and referred or only referred (Finucane et al., 2020). Historically, red flags were used to define serious pathologies, but it is still not clear which red flags should be considered. There is a lack of evidence which red flags are informative, especially when used in isolation (Finucane et al., 2020). Furthermore, the need for screening also create factors such as visceral pain mechanism, side effects of medication and comorbidities. Even without direct access, screening is necessary if the patient is unresponsive on treatment, the therapist experienced an unexpected outcome or the patient might 99 not report symptoms or concern because of fear or discomfort (Goodman et py al., 2018). aerth The aim of this study was to investigate the effects and impact of self-refo ysi eral options and access to physiotherapy without referal from a doctor on pa-ph ing tients, physiotherapists and healtcare system. inn ree scla Methods iced m A literature search in the PubMed and CINAHL databases between Novem-f ole ber 2023 and March 2024 was conducted to identify studies evaluating direct roe access services in physiotherapy primary care settings. The review included th open access to full texts of randomized controlled trials and qualitative studies published since 2018. We searched using the search string of keywords or their combinations in English language, “direct access”, “physiotherapy”, “red flags”. To be eligible for inclusion, studies had to evaluate primary care, and direct access services to physiotherapy for adults with musculoskeletal conditions in terms of clinical outcomes (pain, functional disability) and/or socio-economic factors (patient satisfaction, healthcare costs). We excluded texts in other languages than English, letters, protocols and studies that were not fully available. This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) 2020 statement (Page, et al., 2021). Results The review was done by a physiotherapist who attained recognized education qualification including medical screening which meets the educational requirements for first contact practitioners. n atio Records identified through database searching (n=167) PubMed (n= 61) and Cinahl (n=106) ntificIde Title screened after duplicate records were removed Excluded articles by title (n=151) (n=131) g eenin Abstract screened Abstract excluded (n=131) (n=111) Scr 010 Full text articles reviewed Excluded full text (n=20) (n=8) ltsu daerld od d naeg Included in review -a ude g (n=12) Incl rkino wf o lthea Figure 1: PRISMA flow diagram. | h slih A total of 167 articles were initially retrieved through the literature re-rad o search in PubMed and CINAHL databases. After duplicates had been removed rejših 151 titles were screened. Subsequently, 151 abstracts of articles were assessed for sta eligibility of which 20 articles were selected for full text review. Twelve articles inih were subjected to analysis in this study. The main reason for exclusion were ar-ktivna ticles evaluating conditions in healthcare systems where the direct access ser-o vn vice to physiotherapy has not yet been implemented in their healthcare system. oel d The flow diagram of literature search is outlined in figure 1. ravje With the exception of two randomized controlled studies, three includ-zd ed studies were qualitative by design and seven were systematic reviews. They all investigated community in primary care settings, and direct access to physiotherapist-led service for MSK conditions. Characteristics of the 12 studies are presented in Table 2. Table 2: Characteristics of included studies. First author (year) Study design Aims of the study Findings DA had a high referral accuracy To compare the effectiveness, safe- and a reduction in the rate of re-ty, and the accuracy of DA com- turn visits; Gallotti et al. Systematic re- pared to the physician-led mod- DA is a safe, less expensive, reliable (2023) view el of care for the management of triage and management model of patients with musculoskeletal dis- care that results in higher levels of orders. satisfaction for patients compared to the traditional medical model. Referrals to orthopedics were sub- Downie et al. Qualitative To evaluate the DA service pre- stantially reduced; the extended (2019) study senting the first 2 years of data. scope physiotherapists asked for a GP review in 1% of patients. Self-referral patients were aware that their plan benefits included re- duced cost for self-referral and felt 1 To identify factors associated with confident in selecting DA, they also 10 Alshareef et al. Qualitative patients’ decisions to access physi- (2023) study cal therapy through self-referral or had negative beliefs about the effectiveness of pharmacological treat- pya provider-referral. ments and surgery, and previously erth had positive direct or indirect ex- o ysi periences with physical therapy. ph Lower health care utilization (im- ing aging procedures, medicament pre- inn To synthesize evidence regarding scriptions), lower off-work time; ree Babatunde outcomes of DA; Regarding outcomes there was not scl Systematic re- a et al. to describe current models of DA; a large difference between DA or ic view ed (2020) to determine characteristics of the GP-led care; mf patients using DA. Patients were younger, slightly ole more educated and with better ro socio-economic status. eth To explore the evidence regard- DA showed less physiotherapy Piscitelli et al. Systematic re- ing feasibility, costs, safety and pa- treatments, visits to physicians, im- (2018) view tient satisfaction in DA compared aging performed and drug con-to other organizational healthcare sumption, patients were more satis-models. fied with DA service. Harvey-Sulli- To explore the impact of DA and van et al. Systematic re- self-referral pathway on inequali- Self-referral pathways risk widen- (2024) view ties in healthcare use. ing inequalities in healthcare use. To identify, appraise, and synthe- From the patients’ perspective size existing literature to assess there was no effect on pain, but they described better quality of life Cattrysse et al. Systematic re- the impact of DA for patients pre- and functioning. (2024) view senting with various MSK disor- ders with focus on outcomes from Providers detected higher treat-the perspectives of the patient, the ment compliance. provider, and society. There was a reduced waiting time, lower health costs. Findings suggest that physiothera- Ho-Henriks- Randomized To determine whether physiother- pists-led care might reduce health-son et al. controlled apists as primary assessors in pri- care costs, it seems to lead to fewer (2022) pragmatic trial mary care are cost-effective alternative compared to GP-led care. physician consultations and radi- ography. First author (year) Study design Aims of the study Findings DA is acceptable to all health- care professionals and patients, but Igwesi-Chido- To understand the experiences of there is necessary to ensure effec-be et al. Qualitative patients, GPs, physiotherapist and tive communication among health- (2021) study clinical commissioners on DA. care professionals and patients and to clarify the scope of physiothera- pists. DA can free GPs to focus on more complex health conditions. To evaluate the effects of DA on Patients with MSK disorders in DA Gagnon et al. Randomized clinical outcomes in patients with had better clinical outcomes (low- (2020) controlled trial MSK disorders compared to those er levels of pain), had fewer return in the usual care group. visits to usual care service. To compare evidence regarding DA to physical therapy is more Hon et al. Systematic re- costs and clinical outcomes be- cost-effective, the results show few- (2021) view and me- tween direct access and physi- er visits than physician-first ac- ta-analyses cian-first systems in US civilian cess and patients described greater 2 health services. functional improvement. 10 To appraise the evidence of the Demont et al. Systematic re- impact of DA in terms of efficacy, DA to physiotherapy seems a (2019) view health care costs, patients’ satis- promising model to improve effi- ltsu faction and compliance. ciency of care and reduce costs. daerld od Discussion naeg-a The purpose of this study was to investigate whether physiotherapy profes-g rkin sion could contribute to decreasing the burden of chronic MSK conditions on o wf health care system. Physical therapists are one of the healthcare professionals o lth that are most assessed for managing pain and disability related to MSK condi-ea | h tions (Alsharref et al., 2023). slih ra In almost half of EU countries and most of the US patients can use direct d o access to physiotherapy services, which is also known as self-referral direct-rejših ly to a first contact practitioner without seeing a GP (Demont et al., 2019; Ba-sta in batunde et al., 2020; Ho-Henriksson et al., 2022; Harvey-Sullivan et al., 2024). ih Several studies have suggested positive effects of DA model of care on cost-ef-ktivnao fectiveness, clinical outcomes (e.g. patient’s satisfaction, pain intensity, quali-vnoel ty of life) and safety. Direct access is less expensive in terms of medication and d imaging procedures use and due to fewer visits, it reduces waiting and off-work ravje zd time (Piscitelli et al., 2018; Babatunde et al., 2020; Hon et al., 2020; Ho-Henriksson et al., 2022; Gallotti et al., 2023; Cattrysse et al., 2024). However, Cattrysse et al. (2024) reported that DA did not reduce pain intensity compared to Gagnon et al. (2020) who reported a significantly decrease in pain intensity. There is evidence that DA contributes to improving clinical outcomes such as quality of life, disability and patient satisfaction (Piscitelli et al., 2018; Catrrys-se et al., 2024). Furthermore, DA is promising approach to decrease GPs work load, since some studies suggest reduced physician consultations (Downie et al., 2019), fewer referrals to orthopedics and return visits (Gagnon et al., 2020; Gallotti et al., 2023). However, the existing evidence should be interpreted with caution when ensuring effective implementation of DA into practice (Igwesi-Chadobe et al., 2021). The DA model of care tends to cause inequality in health care use, suggesting that it depends on age, gender, ethnicity, and education level of the patients. White, younger, educated women, from less deprived backgrounds tend more likely to self-refer (Harvey-Sullivan et al., 2024). Additionally, Igwesi-Chidobe et al. (2021) reports poor public awareness about DA pathway and the scope of physiotherapy which indicates that there is a need to improve multidisciplinary communication, patient awareness, and public health literacy. A systematic review by Lin et al. (2018) identifies eleven recommendations for best care for MSK disorders from high-quality clinical practice guidelines as follows: care should be patient-centered, practitioners should screen patients for serious pathology and red flags, physical assessment for spinal pain 3 should include neurological screening test and the patient progress evaluat-10 ed with validated measures. Furthermore, they recommend patient education, pyaer addressing physical activity in patient management, discouraging radiological tho imaging unless serious diseases are detected and manual therapy in combina-ysi ph tion with other approaches should be therapists` first choice strategy to man-ingin age patients with MSK disorders. n ree Direct access model is safe (Gallotti et al., 2023) and shows rare risk for sclaic adverse effects in the whole physiotherapy practice not just related to MSK con-ed mf ditions (Piscitelli et al., 2018). ole Regardless of all the benefits of DA a lot of countries in Europe including roeth Slovenia still do not adopt this model. Nevertheless, the physiotherapists community in Slovenia is increasing its role and competence and offer postgradu-ate program. In addition, some physiotherapists have already achieved international musculoskeletal certification acquiring advanced knowledge and skills following the International Federation of Orthopedic Manipulative Physical Therapy standards. Existing evidence from a cross-sectional study by Souter et al. (2019) suggests that post-professional specialization is a mainstay for developing advanced clinical, decision making, and reasoning skills level. According to our knowledge, this is the first study in Slovenia that reports the importance of screening for red flags and serious diseases in physiotherapy management of MSK disorders and furthermore, suggests how physiotherapists can contribute to health care efficiency and utilization. This review has some limitations. First, the research was performed on-ly in two databases, and some relevant article may not have been included. Second, most of the included studies were conducted in countries (e.g. United Kingdom, USA) where DA is already adopted and screening process is an essential part of each physiotherapy assessment. However, their health care systems were initially facing same problems as in Slovenia. Conclusion Activity and participation limitations caused by chronic MSK conditions can aggravate other diseases, cause poor mental health and reduce quality of life which is why the need for better-targeted care and improved efficiency in the management of MSK conditions is growing. There is evidence which support that healthcare system could benefit from physiotherapists with advanced knowledge and skills including screening for red flags or serious diseases. 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Musculoskeletal care, vol. 21, no. 4, pp. 1592-1600. rejših sta inih ktivnao vnoel d ravje zd https://doi.org/10.26493/978-961-293-397-5.107-116 Bullying and Mobbing in Nursing: A Descriptive-Interpretative Analysis Ajda Plos1, Mirko Prosen2, Maša Černelič Bizjak2 1 Health Education Center, Health Center, Grosuplje, Slovenia 2 University of Primorska, Faculty of Health Sciences, Izola, Slovenia Abstract Introduction: The shortage of healthcare staff in Slovenia has been a topic of debate for many years, which is being intensified by the ageing of the population. Healthcare organisations are facing a shortage of nurses and other nursing staff. The challenge is further compounded by an unsupportive environment, often with bullying present. Negative acts of bullying have a wide range of negative consequences for the victim and those around them. Colleagues who witness bullying or mobbing may also suffer because they may be unable or unwilling to defend the victim against the attacker. Staff turnover brings not only financial problems to an organization but also a reduction in the quality of work and negative outcomes for those entering the health system. The aim of this research is to gain an in-depth insight into the experience of workplace bullying in nursing, and how nurses respond to negative acts of bullying. Methods: Qualitative descriptive interpretive methods were employed to collect data from nine nurses across all levels of healthcare through semi-structured interviews. The data was then processed using thematic analysis of qualitative data. Results: During the in-depth interview, the interviewees provided detailed accounts of their personal experiences with bullying and shared their perspectives on the issue. Five themes emerged from the data analysis: (1) causes of bullying, (2) experiences of bullying in the workplace, (3) characteristics of both perpetrators and victims, (4) strategies for responding to and coping with bullying, and (5) consequences of bullying. Discussion and conclusions: To improve conditions in healthcare and reduce bullying, organisations need to make changes such as explicitly respecting zero-tolerance policies, educating staff, and investing in strengthening relationships within teams. Key words: nurses; perpetrator; victim; relationships; mobbing Introduction Terms, such as intimidation, bullying and mobbing are often used interchange-ably in the workplace. Intimidation involves actions designed to instil fear and undermine confidence. Bullying consists of repeated acts of intimidation, such as persistent criticism or exclusion, targeting an individual over an extended period, making it difficult for the victim to defend themselves. (Einarsen idr., 2020; Johnson, 2021). Mobbing is a form of psychological harassment characterized by frequent, systematic incidence occurring at least weekly for extend time period ( Difazio et al., 2019; Einarsen et al., 2020; Johnson, 2021). Nursing have some of the highest levels of workplace bullying and mobbing (International Council of Nurses, 2017; Johnson, 2018). A 2020 pilot study found that, 35.4% of Slovenian nurses experience some sort of intimidation, bullying or mobbing (Plos et al., 2022). Such negative behaviours affect victims, their families, colleagues but and healthcare organization. Indirectly affecting 810 everyone interacting with the healthcare system. It leads to a decline in nursing care quality, increased professional errors, longer patient hospital stays, and ltsu higher rates of falls and mortality. (Al-Ghabeesh in Qattom, 2019; Anusiew-daer icz idr., 2020; International Council of Nurses, 2017; Kozakova idr., 2018; Ster-ld o giannis, 2019). Additionally, bullying contributes to higher staff turnover, in-d na creased sick leave and decreased work productivity (Bloom, 2019). Slovenia has eg-ag faced severe shortage of nurses for many years, primarily due to poor working rkin conditions and negative organisational climate. Nurses often avoid workplac-o wf es with inadequate conditions, lack of support, and frequent bullying (Maze, o lth 2020). According to Slovenia’s Employment Relations Act, employers must ea | h implement measures to prevent all forms of workplace violence (ZDR-1, 2013). slih rad o Purpose and Objectives rejših This study aimed to understand how nurses perceive bullying in the workplace sta in by investigating their personal experiences and dynamics of such incidents. ih Additionally, the study examined the characteristics of perpetrators and vic-ktivnao tims of bullying in nursing. Understanding how nursing staff respond to bully-vno ing incidents was another critical aspect of this research. Finally, it investigated el d the perceived causes of workplace bullying among healthcare workers. ravje zd Materials and Methods Study Design The study used a qualitative, descriptive-interpretive method to examine the thoughts, behaviour and understanding of individuals (Smythe, 2012). This method was chosen due to its relevance to the research objectives and its effectiveness in analysing complex nursing experiences. It is adaptable, and allows for practical conclusions to be drawn whilst maintaining methodological integrity (Elliott and Timulak, 2021; Thompson Burdine et . al., 2021). Participants Participants were recruited via healthcare professional groups in social networks for accessibility and relevance. Respondents received information on the study’s purpose, objectives, and process. Using purposive sampling, the study selected nurses who had experienced workplace bullying within the past 12 months. Ten nurses met the criteria and agreed to participate. Before the study, all participants provided written consent covering the study’s purpose, process, risks, benefits, confidentiality, interview duration, and the option to withdraw or skip questions, ensuring informed and voluntary participation per ethical standards. One interview was excluded due to inappropriate content. This left nine participants with an average age of 34 years (range: 26-48). Of these, eight were registered nurses and one was a secondary nurse. Four worked in primary healthcare, two in secondary, and three in tertiary care. 9 Data Collection 10 s Data were collected in December 2023 using in-depth, semi-structured inter-lysia views in Slovene, conducted via Zoom, lasting up to 35 minutes each, without na third-party presence until data saturation was reached. The interviews explored workplace bullying, including perpetrator and victim characteristics, triggers, pretative ter and impacts. The researcher prepared guiding questions in advance and asked -in follow-up questions during the interview (Creswell in Creswell, 2017). riptive esc d Data Analysis : agn rsi Thematic analysis was used to analyse the data, examining patterns and differ-u n ences (Kiger in Varpio, 2020). Texts were transcribed and read multiple times ing to understand bullying among nurses. Themes and sub-themes were identified bbino m through open coding, determined through author discussions, with line-by-d nag line coding. To ensure trustworthiness, criteria of credibility, transferability, llyin reliability, and confirmability were applied (Bryman, 2016). bu Results Data analysis identified five themes: (1) causes of bullying, (2) experiences of bullying in the workplace, (3) characteristics of both perpetrators and victims, (4) strategies for responding to and coping with bullying, and (5) consequences of bullying. Causes of Bul ying Respondents consistently cited the organizational environment, characterized by low morale and poor working conditions, as a major risk factor for bullying. They noted that poor management, unclear responsibilities, and rigid hierarchies contribute to a bullying atmosphere. Effective management in communication, relationship-building, and work quality is crucial. Bullying tends to occur where intimidation is tolerated and reports are ignored or mishandled. Two interviewees noted that complaints about bullying are often dismissed. Nothing gets resolved in a way that calms the situation or prevents it from happening again. Whether it will happen again to other employees or not, that seems less important (dmst-48). When asked about trigger for intimidation, all nine interviewees cited, that it was related to the nature of the work and the organisation’s inadequate performance. Bullying can occur when victims point highlight organizational issues, during stressful periods, or due to understaffing. Two participants cited understaffing as the primary cause. Most interviewees suggested that bullying occurs because of the nurse’s role as a link between the patient and the doctor. 0 Most believe intimidation often stems from the aggressor’s personal frus-11 tration or disrespect for nurses. They note that bullying is less common in environments where management regularly address complaints, fosters positive ltsu da staff relations, and where unit managers are professionally qualified. erld od na Experiences of Bullying in the Workplace eg-a Interviewees reported that bullying among nursing is relatively common, quite g rkin normal. Two described it as a constant aspect of the profession, to which wit-o wf nesses typically do not respond. All nine interviewees found bullying to be o lth an unnecessary source of stress and many of them cannot respond in a con-ea | h trolled manner. Most interviewees experienced bullying during work process, slih with attacks often being personal nature. The perpetrator aimed to discrim-rad o inate, humiliate or undermined the victim’s autonomy and responsibilities. Four interviewees described threats related to the victim’s employment and ca-rejših sta reer, while two reported experiencing discrimination related to their use of pa-inih rental rights. In one case, the interviewee’s supervisor assigned a low performance rating, hindering her promotion due to her maternity leave throughout ktivnao the year. In the second case, the assault occurred when interviewee tells super-vnoel visor about pregnancy. d ravje zd What really shocked me was when I got pregnant and went to announce it to supervisor; she literally called me a “chicken,” questioning why I got pregnant and complaining that there were already so few staff in the department … I just lowered my head and quietly went working … Then the supervisor came up to me, started shout-ing at me in front of colleagues and patients, saying that if I always kept my head down and stayed silent, I would never take care of my children (sms-33). Interviewee also reported being indirectly coerced into working nights after returning from maternity leave, as department leader scheduled her primarily for afternoons, limiting her time with her young children. She was also threatened with termination for frequent childcare absences and faced repeated un-announced home visit to check on her. The most frequent form of bullying reported was verbal abuse including insults, intimidation, and threats of violence, in one instance even death threats. Non-verbal acts were also noted, including two cased where perpetrators intruded into the victim’s personal space. One interviewee described a particularly traumatic event involving the forwarding of a patient’s sick note, which was mishandled by a colleague as instructed by physician. He stopped me in the middle of the corridor, at the entrance to the health centre… entered my personal space. . and he said, ‘that sick note didn’t go through’. And I said, ‘I did my job’. My voice was shaking because I was really, really afraid of him. And he basically pointed fingers towards me as if he was going to smack me … may-111 be he stopped himself a centimetre from smacking me in the fore-s head. And he said, “it’s your fault for not having checked” (dm-lysia sp-34). na pretative Characteristics of Both Perpetrators and Victims ter-in Interviewees agree that health workers, especially nurses, are the most riptive frequent perpetrators, using their authority and support from those in higher esc d positions. Perpetrators were described as manipulative, superior, and seeking : agn to impress others. Interviewees believed they use bullying as a defense mech-rsiu anism when feeling threatened. Large part of them noted that perpetrators of-n ing ten lack empathy and professional competence, and may bully due to dissatis-bbino faction or perceived personal failures. md nag Well, they seem insecure and have problems they don’t outward-llyin ly show. When you think about it… They don’t express their issues bu in other ways or talk about them. It seems they display them in this manner. (dmst-32). The interviewees described victims as non-conflicted, submissive, and helpful individuals who are more likely to be bullied. They described that victim are targeted for highlighting irregularities and are typically in subordinate positions, such as new employees. Many believe that victims may stand out due to their appearance, personal traits, or age. Two interviewees noted that younger nurses handle bullying more effectively and view hierarchy different-ly than older generations . A larger part of the interviewees indicated that individuals who are more sovereign in their speech and have strong communication skills are more resistant to bullying. Strategies for Responding to and Coping with Bullying Interviewees consistently seek support from trusted colleagues, friends, and family when dealing with bullying. Most try to stop the attacks through con-scious, controlled behaviour. Additionally, large part of respondents actively addresses the bullying by setting boundaries with the perpetrator, viewing this as a learnable skill. Two participants found speaking with a supervisor effective, while two others successfully confronted the perpetrator. Besides direct confrontation, seven respondents manage bullying by avoiding conflicts or adjusting their priorities. Four interviewees moved from workplaces with frequent bullying to those with less. They cited a sense of mission, good colleague relationships, proximity to home, and financial considerations as reasons for staying in their previous jobs. 211 A significant factor was the salary. I had a relatively high salary in the intensive care unit, which contributed to my decision to stay ltsu (dmsp-32). daerld od Consequences of Bullying naeg-a Interviewees reported that workplace negatively affects both their profession-g al and private lives. Most of them feel less satisfied with their work, which can rkino w lead to doubts about their career choice. Additionally, reporting bullying is ra-f o re due to the belief that it worsens the situation. lthea | h They report that bullying decreases their performance by impairing con-slih centration, prolonging task completion, increasing fear of mistakes, and reduc-rad o ing self-confidence. Interviewees discuss their tendency to ruminate on past rejših events. sta inih It affects job satisfaction. Because, well, it impacts you that day and ktivna also leaves some consequences for a few days afterwards when you o vn keep thinking about it. You can’t just leave it and say, “Oh, it’s noth-oel d ing.” (dmsp-26). ravje zd Most individuals reported stress-related symptoms both physically mentally. They expressed fear of returning to work and facing the perpetrator. Bullying effects included prolonged insomnia, persistent rumination, and physical symptoms such as stomach pain, loss of appetite, and diarrhoea. Interviewees suggest that bullying can be reduced through organizational-level interventions, such as establishing clear reporting channels and enforcing zero tolerance policies. They emphasize the need for fostering good colleague relations, clear communication and effective staff management. Education on effective communication, types of bullying and actionable steps is considered crucial. One interviewee suggests including practical exercises in training, while two others stress the importance of personal action, including anonymous discussions and self-development. Discussion The study aimed to explore nurses’ experiences with workplace bullying, focusing on the perpetrator’s characteristics, causes of bullying, and the victims’ responses. Similar to other researchers, we found that tolerance of bullying and poor leadership foster conditions that allow bullying to thrive in organisations (Anusiewicz et al., 2020; Hartin et al., 2020; Shorey and Wong, 2021). Nurses may view their superiors as incompetent at addressing bullying, which leads to acceptance of such behaviour (Bloom, 2019; Hartin et al., 2020). They feel stuck in a system that is lenient towards perpetrators (Shorey in Wong, 2021). Bullying frequently stems from the perpetrators’ egocentrism and immaturity (Shorey and Wong, 2021; Yosep et al., 2022). As per Shorey in Wong (2021) power 3 imbalances, ineffective leadership, employee differences and high-stress envi-11 ronments contribute to bullying. This problem is notably prevalent in health-s lysi care settings, where bullying can be seen as a leadership approach (Edmonson a na in Zelonka, 2019). According to Bloom (2019) qualitative study, generational differences pretative ter affect the prevalence of bullying. Younger generations of nurses often com- -in municate more directly and assertively, whereas older generations tend to be riptive submissive. esc d The study found that work-related bullying is the most common form ex- : agn perienced by nurses, aligning with Johnson (2021). Lateral violence is often re-rsiu n ported in nursing (Bambi idr., 2018; Johnson, 2018; Krakar, 2021)). A pilot study ing in Slovenia conducted in Slovenia (Plos et al., 2022), also indicated that majori-bbino ty of nurses viewed colleagues as the primary perpetrators, consistent with our md findings. nag Nurses often see bullying as part of the job and refrain from reporting llyin bu due to the fear of further attacks (Rosi idr., 2020; Shorey in Wong, 2021). As in present study, Shorey in Wong, (2021) emphasize social support as an important coping mechanism. Bullying negatively impacts on quality of life, and can cause short- and long-term disorders, such as anxiety, stress, depression, and psychosomatic issues (Anusiewicz idr., 2020; Shorey in Wong, 2021; Zulkarnain idr., 2023). It may also lead to disminished self-confidence and increased self-doubt, affecting decision-making and patients care quality (Mammen et. al., 2018; Mammen et al., 2023). Nurses find bullying distracts them, reducing concentration and productivity (Anusiewicz idr., 2020; Shorey in Wong, 2021). Many nurses continue working despite bullying because positive experiences and relationships outweigh the negative, a conclusion also found in Bloom’s research (Bloom, 2019). Addressing bullying and mobbing in healthcare requires organizational action. Nurses advocate that for leadership to promote effective com- munication, enforce rules, and provide education on identifying, preventing and managing bullying (Shorey in Wong, 2021). Conclusion Bullying is a common source of stress in nursing. It is primarily caused by inadequate management and acceptance of bullying behaviours, including mobbing by organisational leaders. Nurses often experience bullying by colleagues and other healthcare professionals, though is less common from patients, their families, or external partners. Perpetrators are often described as arrogant and driven by a need to assert power and status, frequently misusing their positions. Nurses may respond to bullying either actively or passively but often continue to work despite it due to their commitment to social support and the sense of mission in their roles. Bullying negatively affects nurses’ personal lives 4 and health, sometimes causing them to question their career choice. It can al-11 so harm healthcare performance, leading to longer patient treatment and hos-lts pitalization, increased errors, falls and mortality rates. u da With ageing population and growing healthcare needs for older adults, erld o there will be an increased demand for qualified nurses in the coming years. To d na prevent nurse attrition, organisations must create a supportive work environ-eg-a ment by reducing workplace bullying. Implementing training communication, g rkin handling bullying and stress, and other organizational strategies can improve o wf the workplace climate. o lthea | h References slih rad AL OMAR, M., SALAM, M., AL-SURIMI, K. 2019. Workplace bullying and o its impact on the quality of healthcare and patient safety. Hum Resour rejših Health 17(1): 1–8. sta inih AL-GHABEESH, S. H., QATTOM, H. 2019. Workplace bullying and its pre-ktivn ventive measures and productivity among emergency department nurs-ao vn es. BMC Health Serv Res 19(1): 1-9. oel d ANUSIEWICZ, C. 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Jama 310(20): 2191-2194. sta in YOSEP, I., HIKMAT, R., MARDHIYAH, A. 2022. Types of Nursing Inter-ih vention to Reduce Impact of Bullying and Aggression on Nurses in the ktivna Workplace. Healthcare (Switzerland) 10(8). o vno ZULKARNAIN, Z., GINTING, E. D. J., NOVLIADI, F., PASARIBU, S. P. el d 2023. Workplace bullying and its impact on quality of work life. KON-ravje TAKT- Journal of Nursing & Social Sciences related to Health & Illness zd 25(1): 385-390. https://doi.org/10.26493/978-961-293-397-5.117-124 Self-assessment of the Oral Health of Adults in Slovenia in 2019 Martin Ranfl1, Anja Durjava2, Barbara Artnik3 1 National Institute of Public Health, Regional Unit Murska Sobota, Murska Sobota, Slovenia 2 National Institute of Public Health, Regional Unit Maribor, Maribor, Slovenia 3 University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia Abstract Introduction: Self-assessment of oral health is a subjective but important indicator of an individual’s oral health. The aim of the study was to determine the level of self-assessed oral health in Slovenia. Methods: The » National Oral Health Survey of Adults in Slovenia in 2019 « was conducted on a sample of 3,200 adult residents of Slovenia aged between 18 and 74 years. Participants received an invitation to participate in the online survey by post, and a written questionnaire was enclosed with the notification letter for people over 44 years of age. The self-assessment of oral health was evaluated using the question: » How do you rate your oral health? «, possible answers were: » Very good «, » Good «, » Fair «, » Poor «, » Very poor «. The extreme categories were combined for the statistical analysis. The data were analysed according to demographic data. We tested the distributions of proportions between different groups (by gender, age, education and living environment) using the chi-square test and the Column Comparison Proportion (CCP) test to compare proportions between different groups. Results: 60% of respondents rated their oral health positively, 12% of whom rated it as » very good «. 8% of respondents rated their oral health as » poor « or » very poor «. 62% of women rated their oral health positively, compared to 57% of men. Conversely, the proportion of those who rated their oral health negatively was higher among men than women (10% compared to 6%); the difference is statistically significant (CCP test, p=0.021). The proportion of people who rated their oral health negatively was lowest among adults with the highest level of education (8% of adults with at least primary education, 10% of adults with secondary education and 4% of adults with at least tertiary education). Discussion and conclusions: Self-assessed oral health is related to socioeconomic factors such as gender, education and living environment. The level of oral health of Slovenian adults, based on self-assessment, is not high. A significant proportion of adults in Slovenia rate their oral health negatively, which is a major problem. Given the observed prevalence of negative self-assessment of oral health, it can be estimated that in addition to the more than 117,000 people who rate their oral health negatively, there are also more than 480,000 who rate their oral health as » fair «. It can be assumed that they occasionally have problems with their oral health. The proportion of people who rate their oral health negatively is higher among men, people over the age of 44, people with a lower level of education (mainly primary education) and people living in rural areas. These groups can be considered particularly vulnerable in terms of oral health. Adequate oral health care plays a key role in maintaining and strengthening oral health. Inadequate frequency of tooth brushing and irregular visits to the dentist lead to the development of oral diseases, pain, discomfort and ultimately tooth loss with all its consequences. These are also the groups on which preventive measures should be 8 focused in the future. 11 lts Keywords: oral health, oral health self-assessment, dental health surveys, u da oral hygiene, oral health care erld od n Introduction aeg-a Oral health is an integral part of general health and has a significant impact on g rkin an individual’s quality of life. The World Health Organization (WHO) defines o wf oral health as the state of the mouth, teeth and orofacial structures that ena-o lth bles individuals to perform essential functions such as eating, breathing and ea | h speaking, and encompasses psychosocial dimensions such as self-confidence, slih well-being and the ability to socialise and work without pain, discomfort and rad o embarrassment (WHO, 2024). This definition indirectly reflects the broader definition of health, which includes physical, mental and social well-being. The rejših sta understanding and approach to oral health has evolved over time. In the past, inih oral health was seen as a separate and independent aspect from general health, with diseases of the oral cavity primarily associated with impaired chewing ktivnao vn function. Today, however, oral health is seen as an inseparable part of general oel d health, with the psychological and social dimension increasingly recognised. ravje Individuals assess their health on the basis of their culture, their per-zd ception of health, but also on the basis of their experiences, expectations and the environment in which they live and work (Jylhä, 2009). Although self-rated health is essentially a subjective judgement, research shows that it also reflects objective health status, making it a very suitable indicator for measuring health at a global level (Wu et al., 2003). In addition, this indicator serves as a good predictor of future health outcomes and hospitalisations in patients with heart failure (Benyamini et al., 2004; Farkas et al., 2009). Self-assessment of oral health is a similar indicator that focuses on and summarises a person’s subjective level of oral health. It has an independent effect from the self-assessment of general health, and both self-assessments independently influence a person’s life satisfaction and self-esteem (Benyamini et al., 2004). The da-ta show that the self-assessment of oral health reflects the clinical condition of the oral cavity. Known clinical factors related to oral cavity diseases (such as the DMFT index or orthodontic irregularities) influence the self-assessment of oral health. In addition, self-assessment is also associated with more subjective phenomena such as temporomandibular joint problems (Kojima et al., 2013). By using the self-assessment of oral health indicator, epidemiological research can easily obtain data on the level of oral health in the population. This enables the adaptation of existing or the development of new public health measures targeting the most disadvantaged population groups. In addition, such an indicator can serve as a benchmark for population-level interventions and for monitoring treatment outcomes (Lawal, 2015). Methods 911 In 2019, we conducted a nationwide study on the oral health of adults based on a representative sample stratified by gender and age. The sample, consisting of 019 2 around 3,200 adults aged 19 to 74 years, was compiled by the Statistical Office of inia the Republic of Slovenia (SURS) using simple random sampling from the Cen-ven slo tral Population Register. The study was designed as a cross-sectional study and in lts used the EGOHID questionnaire, which contained both demographic inforu da mation and a self-assessment of oral health. The adults included in the study re-f o ceived an invitation to participate in the survey at a home address with a pass-lthea h word to access the online questionnaire. For participants over the age of 44, a lra written questionnaire was enclosed with the notification letter. The survey took oe thf place in spring 2019 and participants received a further postal reminder dur-ot ing the survey period. en ssm Participants were asked: »How do you rate your oral health?« and could sse-af choose between the following answers: »Very good«, »Good«, »Fair«, »Poor« or sel »Very poor«. Due to the relatively low proportion of people in the worst category, we summarised the categories based on the respondents’ self-assessed values in order to achieve a clearer presentation. The data were weighted according to gender, age and education. Statistical analysis using the computer software »IBM SPSS Statistics for Windows«, version 21.0 (IBM, 2020), allowed us to analyse the baseline data on the prevalence of the different oral health assessments across socioeconomic and demographic indicators. We tested the distributions of proportions between different groups (by gender, age, education and living environment) using the chi-square (χ2) test and the Column Comparison Proportion (CCP) test to compare proportions between different groups. A confidence interval of 95% was used in both cases. Results The final sample of respondents who answered the question on self-rated oral health was N=1153, with women slightly outnumbering men (56% vs. 44%). The proportion of adults aged 18 to 74 who rated their oral health positively was 59.8%, while the proportion of people who rated their oral health as poor was 7.8% (Figure 1). This means that more than 117,000 Slovenians had problems with their oral health. 1% 7% 12% Very good 0 Good 12 32% Fair lts Poor u daer Very poor ld o 48% d naeg-ag rkino wf Figure 1: Proportion of adults aged 18−74 years by self-rated oral health. o lthea | h The self-assessment of oral health was better among women: the propor-slih tion of women who rated their oral health positively (very good and good) was rad o 62.4%, compared to 57.4% of men. Among women, 31.9% rated their oral health as moderate and 5.7% as poor or very poor. Among men, 32.8% rated their oral rejših sta health as moderate, and 9.8% as poor or very poor. The difference in the pro-inih portion of poorly rated oral health by gender was statistically significant (CCP test, p=0.021). ktivnao vn As far as age is concerned, the positive self-assessment of oral health de-oel d creases with increasing age. The proportion of people who rated their oral ravje health as good or very good was highest in the youngest group (18–24 years) at zd 69.1% and gradually decreased to 49.9% in the 65–74 age group. The difference between younger (18–34 years) and older (55–74 years) age groups was statistically significant (χ2 test=25.64, p=0.01; CCP test, p<0.001). It is noteworthy that the proportion of those who rated their oral health as moderate increased with age (Figure 2). The self-assessment of oral health also varied depending on the level of education. For people with a basic level of education, the proportion of people who self-rated their oral health as good was 49.8%, compared to 71.0% for people with at least a higher level of education. The differences between the groups were statistically significant (χ2 test=21.41, p=0.001, test CCP, p<0.001). 80% 70% 60% 50% 40% 30% 20% 10% 0% 18–24 years 25–34 years 35–44 years 45–54 years 55–64 years 65–74 years (Very) good Fair (Very) poor 1 Figure 2: Proportion of adults aged 18−74 years by self-rated oral health 12 by age. 019 2 As the level of education increased, the proportion of people who rated their inia oral health as moderate gradually decreased (Figure 3), compared with 4% in ven the group of people with tertiary education; the difference was statistically sig-slo in nificant (test CCP, p=0.007). ltsu daf 80% o lthea 70% hlra 60% oe thf 50% oten 40% ssm sse 30% -af sel 20% 10% 0% Primary Secondary Tertiary (Very) good Fair (Very) poor Figure 3: Proportion of adults aged 18−74 years by self-rated oral health by education level. Residents in urban environments rated their oral health positively in 67.4% of cases, while this proportion was 63.1% in suburban areas and 52.8% in rural environments. The differences were statistically significant (χ2 test=19.48, p=0.001). Conversely, the proportion of people with poor self-rated oral health was highest in rural environments (10.4%), followed by suburban environments (7.7%) and lowest in urban environments (4.5%). Discussion The collected results show that the level of oral health as determined by the residents through self-assessment is not high. A significant proportion of the Slovenian population rated their oral health as poor or very poor. This trend was more pronounced among men, older people, people with a lower level of education and people living in rural environments. Interestingly, this is consistent with the findings on general self-rated health, which suggest a link between general health behaviours and self-perceived oral health (Vinko, 2018). Maintaining and improving oral health is closely linked to individual care practises. Regular tooth brushing, at least twice a day with a toothpaste containing the recommended fluoride concentration (1450 ppm), plays a crucial role in maintaining oral health (Ranfl et al., 2015). The Scandinavian countries, which traditionally place great emphasis on 2 good oral health, report a relatively high prevalence of a positive self-assessment 12 of oral health. In a Swedish study of adults aged 16 − 74 years, the prevalence of good self-rated oral health was 75%, with self-rated oral health in younger re-ltsu da spondents being similar to our study, but significantly better in older groups erld (Molarius et al., 2014). Among older adults (65 − 74 years) in Brazil, the prev-od alence of poor self-rated oral health (moderate, poor, very poor) was 46.6%, naeg slightly lower than in Slovenia. In another Brazilian study of adults aged 20 − 59 -ag years, the prevalence of poor oral health (moderate, poor, very poor) was 33.2%, rkino w which is better than the results of the study of older adults and similar to our f o results (Luchi et al., 2013). It is noteworthy that in this study, the proportion of lthea poor self-assessment increased with age, with higher rates observed in wom- | h en (Luchi et al., 2013). The results showed that self-rated oral health in younger slih rad and middle-aged groups is comparable to that of other countries, but is worse o in older adults. rejših sta On the one hand, self-assessment of oral health is a summarising meas-inih ure that provides information on how patients perceive their oral health and its overall level. At the same time, however, these results also reveal existing ktivnao vn inequalities in oral health. Despite the numerous determinants that influence oel d oral health, we cannot ignore the importance of personal care, adequate tooth ravje brushing and (preventive) check-ups. Proper self-care plays a crucial role in zd maintaining oral health. Irregular or inadequate tooth brushing leads to dental caries and inflammation of the periodontal tissues, causing pain, discomfort and difficulty eating, communicating and participating in social activities. Un-treated conditions can eventually lead to tooth loss, further complicating daily life. These problems have a direct impact on the functions that make up oral health. Individuals with problems require a certain level of dental care, which may vary geographically or financially. Given the link between self-assessment of oral health and clinical indicators, it makes sense to include self-assessment in the design and planning of health programmes (Atala-Acevedo et al., 2023). Monitoring oral health through self-assessment can also serve as a measure of access to dental care, while trends over time allow an assessment of the effectiveness of interventions to improve and strengthen oral health. Conclusions As the results on self-rated oral health show, there are some particularly vulnerable groups: Men, older people, people with a lower level of education and people from rural environments as well as people with a lower socioeconomic status. This fact should be taken into account when developing and designing materials to promote oral health in the future. Existing materials and activities should be adapted accordingly in order to achieve greater success with the target groups. Acknowledgements 3 The research was supported by the Slovenian Research Agency (research core 12 funding No. P3-0429, Slovenian Research Programme for Comprehensive Cancer Control SLORApro and No. V3-1715, Analysis of Oral Health Indica-019 2 in tors and Oral Health Promotion of Slovene Population). ia ven slo in References ltsu ATALA-ACEVEDO, C., MCGRATH, R., GLENISTER, K., CAPURRO, D., daf o BOURKE, L., SIMMONS, D., MORGAN, M. and MARIÑO, R., 2023. lthea Self-rated oral health as a valid measure of oral health status in adults hlra living in rural Australia. Healthcare (Basel, Switzerland), vol. 11, no. 12, oe pp. 1721. thf ot BENYAMINI, Y., LEVENTHAL, H. and LEVENTHAL, E. A., 2004. Self-rat-en ssm ed oral health as an independent predictor of self-rated general health, sse-a self-esteem and life satisfaction. Social science & medicine, vol. 59, no. 5, f sel pp.1109–1116. FARKAS, J., NABB, S., ZALETEL-KRAGELJ, L., CLELAND, J. G. and LAIN-SCAK, M., 2009. Self-rated health and mortality in patients with chronic heart failure. European journal of heart failure, vol. 11, no. 5, pp. 518– 524. INTERNATIONAL BUSINESS MACHINES CORPORATION (IBM), 2020. BM SPSS Statistics for Windows (Version 21.0) [Computer software]. IBM Corporation. JYLHÄ, M. 2009. What is self-rated health and why does it predict mortality? Towards a unified conceptual model. Social science & medicine, vol. 69, no. 3, pp. 307–316. KOJIMA, A., EKUNI, D., MIZUTANI, S., FURUTA, M., IRIE, K., AZUMA, T., TOMOFUJI, T., IWASAKI, Y. and MORITA, M., 2013. Relationships between self-rated oral health, subjective symptoms, oral health behav- ior and clinical conditions in Japanese university students: a cross-sectional survey at Okayama University. BMC Oral health, vol. 13, pp. 62. LAWAL, F. B, 2015. Global self-rating of oral health as summary tool for oral health evaluation in low-resource settings. Journal of international society of preventive & community dentistry, vol. 5, no. Suppl 1, pp. S1–S6. LUCHI, C. A., PERES, K. G., BASTOS, J. L. and PERES, M. A., 2013. Inequalities in self-rated oral health in adults. Revista de saude publica, vol. 47, no. 4, pp. 740–751. MOLARIUS, A., ENGSTRÖM, S., FLINK, H., SIMONSSON, B. and TEGEL-BERG, A., 2014. Socioeconomic differences in self-rated oral health and dental care utilisation after the dental care reform in 2008 in Sweden. BMC Oral health, vol. 14, pp. 134. RANFL, M., OIKONOMIDIS, C., KOSEM, R. and ARTNIK, B., 2015. Vzgo-4 ja za ustno zdravje: prehrana in higiena: strokovna izhodišča. Ljubljana: 12 Nacionalni inštitut za javno zdravje. VINKO, M., 2018. Samoocena zdravja. In: VINKO, M., KOFOL BRIC, T., KO-ltsu da ROŠEC, A., TOMŠIČ, S. and VERDELJA, M., eds. Kako skrbno za zdra-erld vje? Z zdravjem povezan vedenjski slog prebivalcev Slovenije 2016; Lju-od bljana: Nacionalni inštitut za javno zdravje. naeg-a WORLD HEALTH ORGANIZATION (WHO), 2024. Oral health [online]. g [viewed 5 July 2024]. Available from: https://www.who.int/health-topics/ rkino w oral-health#tab=tab_1 f o lth WU, S., WANG, R., ZHAO, Y., MA, X., WU, M., YAN, X. and HE, J., 2013. ea | h The relationship between self-rated health and objective health status: a slih population-based study. BMC Public health, vol. 13, pp. 320. rad o rejših sta inih ktivnao vnoel d ravje zd https://doi.org/10.26493/978-961-293-397-5.125-134 Smoking habits of older adults in Slovenia – analysis of Quitline cal s Saša Šajn Lekše1, Tomaž Čakš2 1 Community Health Centre Ljubljana, Ljubljana, Slovenia 2 National Institute of Public Health, Ljubljana, Slovenia Abstract Introduction: Older smokers have a higher risk of serious health complications and death. Quitting smoking in old age has many benefits, but older adults are often overlooked. Literature published in the last five years cites various percentages of older smokers worldwide, between 8 to 12 % of people over the age of 65. World No Tobacco Day 2023 states that cessation interventions should also target older smokers. An analysis of 10 European countries showed that changes in legislation did not reduce the prevalence of smoking among people over 65 years of age. Methods: A qualitative content analysis of secondary sources was used. The data were obtained from the recorded summaries of calls to the Slovenian telephone line for smoking cessation (Quitline) in 2022. A purposeful sample of the records of anonymous telephone conversations with people over 60 years of age was used. Results: 43 older adults contacted Quitline in one year and two main themes have been identified: factors that facilitate smoking (theme 1) and factors that facilitate non-smoking (theme 2). Caller average age was 67 years, smoking for more than 45 years, 20 cigarettes a day. They all had at least one experience of quitting. They mostly relapsed due to stressful life changes. Smoking is perpetuated through boredom or lack of activity. In several callers, counsellors detected signs that may point to psychiatric health problems. Older adults often smoke while drinking coffee. Women prefer to smoke alone. Many of them still smoke indoors. The most frequently mentioned health problems were: arterial hypertension, old myocardial infarction, shortness of breath, cough, COPD, asthma, diabetes. Health and saving money were the most common motivational factors for quitting. They often wanted quick quitting solutions. Discussion and conclusions: Less than a half of older smokers know smoking is harmful. They believe quitting would not improve their health and passive smoking is not harmful to others. A lower education level indicates less knowledge. The main factors in maintaining smoking are addiction and loneliness. When an older smoker calls Quitline, it is crucial to work on their loneliness. We advise directing older adults to assistance programs in their local environment. Everyone who comes in contact with older smokers should be able to identify their specific needs and be able to provide appropriate help. Quitline should always be offered as one of the options. Keywords: older adults, smoking, cessation, Quitline Introduction Smoking in old age is a public health problem. Older smokers are more suscep-tible to a more severe course of disease and have a higher risk of serious complications and death. There are many benefits to quitting smoking at any age, 6 but older smokers are often overlooked. Newer tobacco and nicotine products 12 may mislead them despite their long-term effects still being uncertain (Yao et al., 2021). Research shows that 8-12 % of people over the age of 65 still smoke, ltsu more likely to be male than female. World No Tobacco Day 2023 highlighted daer the need to focus cessation interventions on older smokers, as health risks only ld od increase with longer smoking duration. An analysis of 10 European countries naeg showed that changes in tobacco legislation reduced the prevalence of smoking -ag in the age group of 50-64 years, but not in those over 65 (Stival et al., 2022, Yao rkino et al., 2021, Satre et al., 2020, Viana et al., 2019, Jamal et al., 2018,). wf o A large Chinese prospective cohort study demonstrated a statistically sig-lthea nificant reduction in the risk of death from all cancers, stroke, and cardiovas- | h cular disease when older smokers quit smoking (Lam et al., 2007). slih rad Focus groups of older people in the USA revealed they use newer nicotine o products to abandon traditional cigarettes and as an alternative way to avoid rejših sta smoking restrictions. Their beliefs about the safety of e-cigarettes were incor-inih rect. The promotion of e-cigarettes was seen as a way of renormalizing smoking and immediate action is needed regarding the advertising of alternative nico-ktivnao tine products at the global level. At the moment this encourages dual use and vnoel does not contribute to reducing nicotine addiction (Cataldo et al., 2015). d In England they examined how older smokers were treated in primary ravje zd health care. They found that smokers older than 75 years were less likely to report deciding to quit or asking their GP for help. Primary care physicians addressed the smoking problem equally in all age groups, but those over 70 were more likely not to receive advice about nicotine replacement therapy (NRT) or other forms of cessation assistance (Jordan et al., 2017). The Slovenian National Institute of Public Health (NIJZ, 2022) reports more than 50 % of smokers wish to quit. Many of them cannot succeed on their own. In Slovenia, they can choose between group and individual counselling at our Health Promotion Centers in Community Health Centers (insurance covered). Prescription drugs or over-the-counter NRT can be used in the form of patches, oral sprays or chewing gum. The cost of NRT is comparable to the cost of nicotine products. Telephone counselling lines are also available to help users quit smoking in accordance with World Health Organization (WHO) guidelines and recommendations. The first such line was established in 1982 in Australia, followed by other English-speaking countries in the following decade. 53 countries have an active quitline today. (WHO, 2014). Quitlines use three main approaches: motivational interviewing, cognitive behavioral therapy, and acceptance and commitment therapy (Liau, 2022). Counsellors on the line come from various areas of expertise, mostly psy-chology and medicine. Students in their final years are encouraged to participate. Before allowed to answer calls, they receive training in theoretical content (harmfulness of smoking, addiction treatment, and counselling techniques) and conducting telephone consultations. Callers receive information about the 7 benefits of not smoking, available quitting methods, tips on quitting, and sup-12 port in maintaining abstinence. The telephone number, 080 27 77, is published lls on packaging of tobacco and nicotine products. The line operates every day be-ace tween 7:00 a.m. and 10:00 a.m. and between 5:00 p.m. and 8:00 p.m. (NIJZ, itlinu 2022). qf os The aim of this article was to describe habits of older people regarding lysia the use of tobacco and nicotine products as reported during calls to the Slove-na – nian quitline. The purpose of the research was to lay the foundations for plan-ia ven ning specific and effective interventions for the age group over 65 through un-slo derstanding the smoking habits of older adults. in ltsu daer Methods ld of A qualitative content analysis of secondary sources was used. Calls are not re-o bits corded due to maintaing complete anonymity, so the data for the analysis was a hg obtained from manually recorded reports of all Quitline calls as written by kino counselors in 2022. According to the Act on Data Collections in the Field of sm Health Care, NIJZ is authorized to collect data through administrative databases and research and the callers were not asked for their permission. Sampling In 2022, 27 counsellors logged a total of 799 phone calls. There were 385 serious sessions that were carried out to the end, and 59 calls where otherwise serious counselling sessions ended prematurely. 371 calls were made by daily or occasional smokers seeking help to quit. More callers were male. Their average age was 34.5 years, and most calls were recorded on weekday afternoons. The few-est calls were made on Saturday mornings. A purposive sample of 43 call reports was used, as subjectively recorded by counsellors who spoke with a person older than 60 years at least once. The chosen age limit was 60 years or higher, due to this age being one of the retire- ment conditions in Slovenia (valid for women). Calls where the actual age in years was not given were included when callers stated to be retired/older. Content Analysis The reports, recorded manually on paper in the first months of 2022, and later in the form of a Microsoft Excel sheet, were transcribed into a uniform format and combined into one file. Using deductive coding as proposed by Mayring (2014), we identified two main themes: factors that facilitate smoking and factors that facilitate non-smoking. Results The identified themes were further divided into categories shown in Picture 1. 812 Smoking habits of older adults ltsu daerld o Factors that facilitate smoking Factors that facilitate non-smoking d naeg-ag rkino wf ▪ nicotine addiction o ▪ caffeine consumption ▪ poor physiological lthea ▪ boredom ▪ health | h ▪ disability/limitations ▪ mental health slih ▪ poor social network ▪ financial struggles rad o ▪ loneliness ▪ tobacco legislation ▪ poor social network ▪ health system use rejših ▪ social network ▪ sta poor mental health inih Figure 1: Themes and categories. ktivnao vnoel Quantitative data connected to callers’ tobacco use are summarised in d Table 1. ravje zd Table 1: Quitline caller data. Quitline cal s with older smokers N MIN MAX Number of calls/year 43 (23 male) 0 (March) 7 (Sep - Oct) Age average (years) 67,1 60 89 Average smoking duration (years) 45,37 1 50 Average use of cigarettes per day 20,09 1,5 40 Theme 1: Factors That Facilitate Smoking All callers were regular smokers, except one who could maintain abstinence for 2 consecutive days. One call was made on day 10 after quitting to report progress and one call of an ex-smoker on behalf of their family. All were classic cigarettes users, no one indicated they might be using newer nicotine products. Two male callers did ask for information on those. Most have been smoking for decades, only one started smoking 1 and a half years ago after retirement. All but one had at least one experience of quitting. While only three callers shared information on how they first started smoking, it is interesting that both male callers stated they became smokers while in the army. Considering the social norms in the 20th century we can assume most of them started smoking out of curiosity and a desire to be accepted by their social circle since smoking was much more socially acceptable and accessible in the past. 9 “She started smoking because of the ‘trend’” Female, 60, a smoker for 40 12 years lls “He started in the army. .” Male, 60, a smoker for 40 years ace itlin Among the reasons for relapsing callers most often cited some kind of u qf stressful event or major life change: retirement, loss of a family member, rela-os tionship problems. Only one caller stated that the attempt to quit was a result lysiana of change in tobacco legislation. The reports of relapsing after a single cigarette – ia are of particular concern, as well as receiving advice from a health profession-ven al that sudden cessation is bad for health. slo in “Started again 2 years ago when her husband died.” Female, 60, a smok-ltsu er for 45 years daerld “… but then she smoked a cigarette at a New Year’s party and the story re-of o peated itself .. ” Female, 60, a smoker for 40 years bitsa “In the past, she stopped smoking for 18 days because she didn’t have mon-hg kin ey, and then the doctor advised her that sudden quitting was bad, so she started o sm again.” Female, 66, a smoker for 50 years “He quit 2 or 3 times in the past, but gained weight, which tempted him back to smoking. . He read an interview with a doctor who warned about quitting and weight gain, which is now worrying him. .” Male, 75, a smoker for 59 years Among the current reasons for smoking callers most often mentioned boredom or too much free time. It is a worrying fact that loneliness, anxiety and stress are so often cited as reasons for continuing the habit. “In the spring and summer, he has enough work in the garden, but in the winter he smokes out of boredom.” Male, 63, a smoker for 30 years “[smokes] whenever he has a free hand.” Male, 64, a smoker for 50 years “He has been retired for 1 year and now smokes even more than in the past.” Male, 60, a smoker for 40 years “Her need for cigarettes is strongest in the morning ... but smokes more in the evening - mainly because she is much busier during the day.” Female, 71, a smoker for 30 years Older adults very often smoke while drinking coffee, indicating a strong coffee-cigarette connection. Despite raising awareness about the dangers of secondhand smoke, many still smoke indoors. No greater tendency towards preferring morning or evening hours was observed, the frequency of smoking depended more on having other activities. No one explicitly stated they smoked at night which would indicate a very strong addiction. Women preferred to smoke alone rather than while having company, which may indicate they are well aware of the decreasing social acceptability of smoking. We can also assume that since the proportion of smokers in their age group is usually lower than among younger generations, they no longer have many smoking 0 peers. 13 “If he drinks coffee in a pub, 3 cigarettes, otherwise 1.” Male, 64 years old, a smoker for 50 years ltsu da “He walks a lot, but that he often rushes back home after a walk to light a erld o cigarette.” Male, 75, a smoker for 59 years d nae “When at home she smokes the most, but when she’s in company she doesn’t g-ag smoke as much.” Female, 62, a smoker for 44 years rkino “Only smokes outside, doesn’t smoke if visiting someone.” w Female, 60, a f o smoker for 40 years lthea Five callers openly stated they were facing mental health problems and | h slih were being treated by a psychiatrist, mostly as outpatients. Some have also rad o been hospitalised at least once. Several callers who did not confirm any mental health problems might be at risk of suffering from a mental health problem as rejših sta noted by the counsellors. inih “She says she is often depressed.” Female, 72, a smoker for 40 years ktivna “Then she starts explaining how her neighbour destroys her plants and o vno throws things at her door. . She says once the police intervened, but blamed her el d for being a danger to the children of this neighbour. . she also turned up the mu-ravje sic on the radio, which was so loud that I couldn’t hear her and she couldn’t hear zd me either. . “ Female, 63, a smoker for 1.5 years “He’s been in a wheelchair for three years. Says he’s nervous and that’s why he smokes. .Suddenly he starts talking about other things. I turn the conversation back to smoking - he doesn’t answer, says he’s afraid to say it out loud. Because it is very difficult for him being disabled, I advise him to get psychological help, but he does not see the point.” Male, no information on age, a smoker for 45 years “Asking about e-cigarettes, their price, why I don’t know the price of e-cigarettes and where to buy them, who I am, am I even a doctor, where do I work, why don’t I want to give personal information, that anonymous people are evil, madmen, murderers. Why do we sell cigarettes, allow prostitution…” Male, no information on age, no information on smoking duration “It is very difficult to speak with him, he forgets the questions or the purpose of him calling. He says he smokes 15 cigarettes a day, is a widower. In the background, the television is on. He cannot explain why he cal ed our phone number and shows obvious signs of dementia.” Male, 89, no information on smoking duration “She’s alone during the week, she doesn’t have any friends, lately she’s completely out of willpower. . I ask about suicidal thoughts, she denies them. .” Female, 71, a smoker for 30 years Theme 2: Factors That Facilitate Non-Smoking The most common physiological health problems were: cardiovascular diseases (arterial hypertension, old myocardial infarction, . .), lung diseases (difficul-131 ty breathing, cough, COPD, asthma), diabetes. In 7 cases, the counsellors on lls the phone referred the caller to their GP, in 2 cases to a psychiatrist and in 2 cas-ace es to a psychologist. In most cases they were advised to call other helplines for itlinu psychological support or given numbers of Health Promotion Centers. qf os “He is also a cardiac patient and is noticing breathing problems.” Male, 72, lysia a smoker for 20 years na – “He says he had a heart attack a while ago while smoking and drinking cof-ia ven fee.” Male, 70, a smoker for 50 years slo in “In the past he stopped smoking for a year due to health problems, now ltsu again for the same reason (elevated blood pressure, coughing, heart).” Male, no daer information on age, a non-smoker for 10 days at time of call ld of “Says that she also has quite a few health problems - diabetes, elevated o bitsa blood pressure, knee problems .. ” Female, 71 years old, a smoker for 30 years hg kin “. .[when he smokes] it is suffocating him, also has other health problems.” o sm Male, 64, a smoker for 48 years Health was the most common motivational factor for quitting smoking, and right after it, saving money. Only a few indicated that others had encouraged them to quit. “Her main motivation is health - a pulmologist advised her to stop smoking, and due to her low pension, she is motivated by the money she could save.” Female, no information on age “He also calculated how much he spent on cigarettes over the years and decided to put 100 € away every month”. Male, no information on age, smoked for 45 years, non-smoker for 10 days at the time of call “Besides health, her main motivation is saving money (she mentions that she has exactly 6 € until pension, and had to decide whether to buy bread or cigarettes).” Female, 71, a smoker for 30 years “The nurse told him to stop smoking” Male, no information on age, a smoker for 50 years Older smokers mostly showed a high level of motivation, but with a great variety of techniques they deemed acceptable. They often wanted quick fixes - medication or NRT. Despite the frequent mention of loneliness, there was little interest in group workshops. “Wants to stop smoking right away, but he is not ready to change any-thing. . Asked me about IQOS and NRT.” Male, a smoker for 30 years “I try to motivate him for different activities, but nothing convinces him …. At the end, he asks for advice on medication …” Male, 72, a smoker for 20 years “I tell him about the workshops in Heath Promotion Centres but he keeps asking what I think about acupuncture. .” Male, 74, no information on smoking duration 213 “She wants to stop completely on September 1, 2022. . Suitable for proactive counselling, but she couldn’t decide on it so quickly.” Female, 72, no information lts on smoking duration u daer “I advise her to talk to a psychiatrist about quitting and to set a date by ld o which she would reduce the number of cigarettes ... I also tell her about other op-d nae tions but she is not interested.” Female, no information on age, no information g-ag on smoking duration rkino wf o Discussion lthea It is a worrying fact that up to 18 % of residents of nursing homes still smoke. | h Only a good half of them (56 %) know that smoking is harmful. 44 % of nursing slih rad homes smokers believe that quitting smoking would not improve their health. o 48 % also believe that inhaling their cigarette smoke will not harm a non-smok-rejših er (Carosella et al., 2002). A lower level of education means they know less sta in about the harmful effects of smoking (Rutten et al., 2008). These data show that ih the attitudes of older adults towards smoking are often incorrect and they need ktivnao to be continuously reminded of the benefits of non-smoking. vnoel d In our study, in addition to nicotine addiction loneliness emerged as a predominant phenomenon that promotes smoking. Belgian qualitative re-ravje zd search describes loneliness as an elusive, intangible phenomenon. Older adults had difficulty describing feelings of loneliness. It was seen as a normal part of the aging process, defined by loss, limitation and lack of meaning. They described experiences of feeling out of touch with the world and feeling isolated in a literally and figuratively shrinking world. Loneliness has been described as a feeling of being unable to change one’s situation, feeling deep sadness and a lack of self-worth in one’s environment (Pageau et al., 2022). It is very important to anticipate loneliness well before old age. Those at risk need to be actively sought out because the ones we don’t see are most likely the most isolated. Quitline is a good starting point for empowering an old- er person to deal with their loneliness. It is good practice to direct older smokers to all available forms of help in their local environment. The anonymity of Quitline does not allow for monitoring the success of the interventions used, but similar counselling can be carried out by all professionals working with older adults. Due to the frequent contact of older adults with the healthcare system these are mostly health workers. They should identify older smokers, motivate them to quit and direct them to various assistance programs. When it is clear that health problems of older adults can be attributed to smoking, it is necessary to address it at every visit. Smokers who have never thought of quitting are extremely rare, but even their attitudes can be changed with compel-ling arguments. When considering financial or social hardship, it makes sense to strengthen co-operation between health and social care systems and non-governmen-tal organisations. Reducing living costs by quitting smoking can greatly improve quality of life. Financial problems increase stress which in turn reduces 313 the motivation to quit (Siahpush et al., 2003). lls The key to reducing the prevalence of older smokers is a strong and effec-ace tive interdisciplinary co-operation of all who work with this population, which itlinu should be well co-ordinated at all levels. All participants should have a good qf o knowledge of the availability of quitting interventions in Slovenia and specific s lysi needs of the individual older smoker. ana – ia ven Conclusions slo Older smokers have different needs than other age groups. Everyone who works in ltsu with older smokers should be able to identify these needs and provide appro-daer priate help to enable abstinence as soon as possible. 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Zdravje delovno aktivnih in starejših odraslih Health of Working-Age and Older Adults Zbornik prispevkov z recenzijo | Proceedings Uredila | Edited by Ana Petelin Recenzenti | Reviewers Jasmina Irena Barać, Zala Jenko Pražnikar, Žiga Kozinc, Denisa Manojlović Ivezić, Melita Peršolja, Ana Petelin, Nastja Podrekar Loredan, Doroteja Rebec, Darjan Smajla, Boštjan Žvanut Oblikovanje in prelom | Design and Typesetting Jonatan Vinkler Izdajatelj | Published by Založba Univerze na Primorskem | University of Primorska Press Titov trg 4, 6000 Koper • hippocampus.si Koper • 2024 Glavni urednik | Editor-in-Chief Jonatan Vinkler Vodja založbe | Managing Editor Alen Ježovnik © 2024 Avtorji | Authors Elektronska izdaja | Electronic Edition http://www.hippocampus.si/ISBN/978-961-293-397-5.pdf http://www.hippocampus.si/ISBN/978-961-293-398-2/index.html https://doi.org/10.26493/978-961-293-397-5 Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID 214022915 ISBN 978-961-293-397-5 (PDF) ISBN 978-961-293-398-2 (HTML) Document Outline Petelin, Ana. 2024. Ed. Zdravje delovno aktivnih in starejših odraslih | Health of the Working-Age and Older Adults. Zbornik prispevkov z recenzijo | Proceedings. Koper: University of Primorska Press. Contents Barbara Artnik, Martin Ranfl | Oral Hygiene and the Use of Fluoride Toothpastes in Adults in Slovenia in 2019 Abstract Introduction Methods Results Frequency of Tooth Brushing Use of Fluoride Toothpaste Use of (Other) Oral Hygiene Aids Discussion Frequency of Tooth Brushing Use of Fluoride Toothpaste Use of (Other) Oral Hygiene Aids Conclusions Acknowledgements References Margareta Begić, Edina Pulić, Tatjana Njegovan - Zvonarević, Želimir Bertić, Mirjana Telebuh | Evaluation of Student Knowledge of Palliative Care Abstract Introduction Methods Participants Questionnaire Statistical Analysis Results Results of Determining Current Knowledge of Palliative care Results of the Assessment Index of Students’ Palliative Care Knowledge Discussion Conclusions References Tija Božič, Tamara Poklar Vatovec | Eating Habits in Therapeutic Community Abstract Introduction Methods Results Discussion Conclusion References Alenka Cergol, Nina Zlatič | The Importance of Cardiac Rehabilitation After a Heart Attack: Treatment of the Working and Elderly Population Abstract Introduction Overview of Cardiac Rehabilitation at Izola General Hospital Staff Composition Rehabilitation Process Conclusions References Anja Durjava, Martin Ranfl, Barbara Artnik | Oral Health-related Quality of Life in the Adult Population of Slovenia in 2019 Abstract Introduction Methods Results Discussion Conclusions Acknowledgements References Jera Gregorc, Giuliana Jelovčan, Miran Muhič | Some Aspects of the Lifestyle of Future Educators Abstract Introduction Methods A Sample of Participants A Sample of Variables The Organization and Process of Data Collection Methods of Data Processing Results Discussion Conclusion Acknowledgments References Urša Horvat, Manca Salmič, Denisa Manojlović Ivezić | The Effect of Pelvic Floor Muscle Exercises on Chronic Low Back Pain Abstract Introduction Methods Search Strategy Inclusion and Exclusion Criteria Methodological Quality Results Discussion Conclusion References Marjeta Logar Čuček | The Use of Artificial Intelligence in the Field of Health for Working-age Adults and Older Adults Abstract Introduction Integrating Artificial Intelligence Into Healthcare Delivery – A Vision for Service Transformation How AI Works Promoting and Maintaining Health, Prevention Quality Clinical Diagnosis, Decision-Making and Personalised Patient Care Potential Roles of AI in Clinical Settings and a Look to the Future Conclusions References Helena Olenik, Damir Hećimović | The Influence of Night Work on the Eating Habits of Workers Abstract Introduction Methods Results Discussion Conclusion References Barbara Pantar | The Role of Medical Screening in Physiotherapy Abstract Introduction Musculoskeletal Conditions Direct Access Medical Screening Methods Results Discussion Conclusion References Ajda Plos, Mirko Prosen, Maša Černelič Bizjak | Bullying and Mobbing in Nursing: A Descriptive-interpretative Analysis Abstract Introduction Purpose and Objectives Materials and Methods Study Design Participants Data Collection Data Analysis Results Causes of Bullying Experiences of Bullying in the Workplace Characteristics of Both Perpetrators and Victims Strategies for Responding to and Coping with Bullying Consequences of Bullying Discussion Conclusion References Martin Ranfl, Anja Durjava, Barbara Artnik | Self-assessment of the Oral Health of Adults in Slovenia in 2019 Abstract Introduction Methods Results Discussion Conclusions Acknowledgements References Saša Šajn Lekše, Tomaž Čakš | Smoking habits of older adults in Slovenia – analysis of Quitline calls Abstract Introduction Methods Sampling Content Analysis Results Theme 1: Factors That Facilitate Smoking Theme 2: Factors That Facilitate Non-Smoking Discussion Conclusions Colophone