Abstract: INTRODUCTION: Thyroid nodules are a common diagnostic challenge mainly because of the need to exclude thyroid malignancy. The aim of this study was to evaluate the usefulness of demographic, ultrasonographic and scintigraphic findings in differentiating benign from malignant thyroid lesions in patients presenting with thyroid nodules. MATERIALS AND METHODS: 941 patients, who presented with palpable thyroid nodules and underwent at least one fine-needle aspiration biopsy (FNAB), were retrospectively evaluated. RESULTS: The thyroid was assessed by ultrasonography (US) in 796 patients and by scintigraphy (SC) in 774 patients. The final diagnostic outcome was established after surgery (n=183) or after a minimum of one-year clinical follow-up period. Higher rates of malignancy were observed in male gender (p<0.001), in patients presenting with a solitary nodule in US (p<0.001), in nodules with maximum diameter > or =4.5 cm in US (p=0.024) and in nodules detectable by SC (p=0.006). There were no statistical differences in the rates of malignancy among cystic, solid or mixed nodules in US or among "hot", "warm" or "cold" nodules in SC. CONCLUSIONS: Male gender, solitary nodule and nodule diameter > or =4.5 cm can serve as adjuncts to FNAB in predicting the risk of thyroid malignancy in patients presenting with thyroid nodules.
Abstract: OBJECTIVE: The aim of this study was to explore the process of dyadic benefit finding after myocardial infarction. METHODS: For the purposes of the study, a qualitative methodology using intepretative phenomenologic analysis was used. Semistructured interviews were conducted with 11 couples. Patients were predominantly male, aged between 50 and 70 years, and partners were aged between 45 and 64 years. All couples were married. RESULTS: In terms of the patients, the following themes emerged: a catalyst for change/wake-up call; change of life philosophy; being protected/being invincible; humanistic attitudes. With regard to the spouses, the following themes emerged: active search for benefit/failure to find benefit and improvement of relationship. CONCLUSION: The study revealed no compatibility in the process of benefit finding between patients and spouses. Clinical implications for cardiac rehabilitation interventions are discussed.
Abstract: The promised revitalisation of Primary Health Care (PHC) is happening at a time when the contradictions and unfairness of the global economic system have become clear, suggesting that the current system is unsustainable. In the past two decades one of the most significant impediments to the implementation of comprehensive PHC have been neoliberal economic policies and their imposition globally. This article interrogates what will be required for Primary Heath Care to flourish. PHC incorporates five key principles: equitable provision of services, comprehensive care, intersectoral action, community involvement, and appropriate technology. This article considers intersectoral action and comprehensiveness and their potential to be implemented in the current global environment. It highlights the constraints to intersectoral action through a case study of nutrition in the context of globalisation of the food chain. It also explores the challenges to implementing a comprehensive approach to health that are posed by neo-liberal health sector reforms and donor practices. The paper concludes that even well-designed health systems based on PHC have little influence over the broader economic forces that shape their operation and their ability to improve health. Reforming these economic forces will require greater regulation of the national and global economic environment to emphasise people's health rather than private profit, and action to address climate change. We argue that revitalisation of PHC and progress towards health equity are unlikely without strong regulation of the market. The further development and strengthening of social movements for health will be key to successful advocacy action.
Abstract: INTRODUCTION: Fine Needle Aspiration Biopsy (FNA) is a method widely used in the assessment of thyroid nodules. The main aim of this 18-year retrospective study was the investigation of the diagnostic value of FNA cytology in thyroid malignancy. SUBJECTS AND METHODS: We retrospectively reviewed 1376 patients who underwent 1938 FNAs from 1987 to 2004 in the Department of Endocrinology, "Hippokration" General Hospital, Thessaloniki, Greece. Of them 178 subsequently underwent total or subtotal thyroid resection and a pathology report was available. RESULTS: FNA cytology shows a sensitivity of 76.2% and a specificity of 90.5% for thyroid malignancy, with a significant agreement between FNA cytology and the histology following resection surgery (Cohen's method, p<0.05). There was a considerable improvement in the diagnostic value of FNA cytology during the sub-period 1996-2004 as compared to the sub-period 1987-1995. CONCLUSIONS: 1) FNA is a reliable diagnostic method in the assessment of thyroid malignancy, 2) a non-diagnostic FNA should always be repeated, 3) meticulous follow-up is mandatory, even after a cytological result of benign hyperplasia and 4) increased experience can improve the diagnostic value of FNA in thyroid malignancy.
Abstract: BACKGROUND: Traumatic stress symptoms have only recently been studied in association with medical treatment procedures. PURPOSE: The study examined associations of physical and psychological functioning during hospitalization to symptoms of traumatic stress after cardiac surgery. METHODS: One hundred thirteen patients admitted for coronary artery bypass grafting participated in the study. Symptoms of traumatic stress were assessed one and six months after surgery, with the Impact of Event Scale. Preoperative stress and ruminative thinking, length of preoperative waiting, duration of surgery, and postoperative recovery indices (length of stay in the intensive care unit, cognitive functioning during intensive care, length of stay in the hospital) were examined. RESULTS: Ten percent of the patients reported severe (> 19) symptoms of avoidance, and five percent reported severe symptoms of intrusion in both follow-ups. Hierarchical regression analyses showed that preoperative stress was positively associated to avoidance symptoms in both follow-ups (p < .01). Preoperative stress and ruminative thinking was positively associated to intrusion symptoms one month after surgery (p < .01). Disease related factors were not related to symptoms of traumatic stress during the postoperative period. CONCLUSION: This study highlights the role of preoperative surgery-related stress as a risk factor for traumatic stress in the postoperative period.
Abstract: A prospective study was conducted to determine risk factors for fungal colonization, drug susceptibility, and association with invasive fungal infections (IFIs) in a neonatal unit. On admission and weekly thereafter, surveillance fungal cultures were taken from mouth, rectum, and trachea of neonates with expected stays of > 1 week. Fungal colonization was detected in 72 (12.1%) of 593 neonates during 12 months. CANDIDA ALBICANS was isolated from 42% of colonized neonates. Although early colonization (age 1.3 +/- 0.2 days) was found in 2.5% of the neonates, late colonization (age 17.6 +/- 1.4 days) was noted in 14.2% of neonates hospitalized for > 5 days. Neonates born vaginally were at higher risk for early colonization than those delivered after cesarean section ( P = 0.01). By multivariate logistic regression, very low birthweight was the only independent risk factor for late colonization. Ten IFIs (nine candidemias) were diagnosed, yielding a rate of 1.1%. These episodes occurred in 6.9% of colonized neonates, compared with 0.76% of noncolonized neonates ( P = 0.002). C. ALBICANS was susceptible to azoles, but some non- ALBICANS CANDIDA spp. exhibited decreased susceptibility to these drugs.
Abstract: OBJECTIVE: The aim of this study was to determine the influence of preoperative physical and psychosocial functioning on quality of life 1 and 6 months after coronary artery bypass grafting (CABG). METHODOLOGY: The study used a prospective design. A total of 157 patients admitted for elective CABG in a Greek city hospital participated in the study. RESULTS: Results showed significant improvements in the quality of life of the patients after CABG [F(2, 95)=36.337; P<.001]. Structural equation modeling analyses showed that preoperative psychological distress was the only preoperative predictor of quality of life at 1 month (beta=-.22; P<.01) and at 6 months (beta=-.28; P<.001) after the operation. CONCLUSION: Results highlight preoperative distress as a screening criterion to identify patients likely to benefit less from cardiac surgery.
Abstract: BACKGROUND: Burnout poses a substantial problem for physicians' well-being and for the quality of health care. The role of workload in comparison to subjective work characteristics has been rarely studied. The purpose of this study was to explore the associations of burnout with workload and subjective work characteristics in internal medicine specialists and residents. METHODS: A cross-sectional study using an anonymous mailed survey was used. Some 103 specialists and 143 residents participated in the study. Burnout was measured using the Maslach Burnout Inventory. Subjective work characteristics included perceived job demands in terms of time pressure, mental effort and emotional labor. Workload was assessed in terms of average number of hours worked per week. RESULTS: Emotional exhaustion in medical specialists was only predicted by perceived job demands [odds ratio 3.7 (CI 1.7-7.9), P<0.001]. Emotional exhaustion in medical residents was only predicted by emotional labor [odds ratio 1.9 (CI 1.2-3.0), P=0.003]. Depersonalization among medical specialists was only predicted by emotional labor [odds ratio 2.7 (CI 1.1-6.7), P=0.032], while depersonalization among medical residents was only predicted by number of hours worked per week [odds ratio 1.1 (CI 1.1-1.2), P=0.007]. DISCUSSION: Perceived working conditions were more important than workload in explaining the variance in burnout. In addition, burnout in medical specialists and residents was linked to different characteristics of their working environment.
Abstract: OBJECTIVE: To investigate the risk factors associated with nosocomial acquisition of imipenem-resistant Acinetobacter baumannii (IRAB) among pediatric intensive care patients. A retrospective case control study was conducted in a pediatric intensive care unit (PICU). PATIENTS AND PARTICIPANTS: Cases were children in whom IRAB was isolated from any clinical specimen obtained at least 48 h following admission to PICU. Controls were children without IRAB matched to cases in 2:1 ratio. Twenty-six cases were matched with 52 controls according to the chronological order of admission. MEASUREMENTS AND RESULTS: Between July 2001 and December 2003, 52 (62%) of 84 clinical A. baumannii isolates were found nonsusceptible to imipenem (MIC > or = 8 microg/ml). Demographic variables, comorbid conditions, clinical picture at admission, invasive procedures, use of antimicrobials and other drugs were analyzed as potential risk factors. Use of carbapenems and other beta-lactams, aminoglycosides, ranitidine, mechanical ventilation, central venous or urinary catheters and length of stay in PICU were among the factors significantly associated with IRAB acquisition in the univariate analysis. By multivariate analysis, however, only aminoglycoside use and length of stay in the PICU were independent risk factors. CONCLUSIONS: Acquisition of IRAB by PICU patients was independently associated with aminoglycoside use and prolonged stay in the unit. Studies of evaluation of infection control policies need to be pursued.
Abstract: PURPOSE: The emotionally taxing nature of health-care work has been increasingly recognized. In parallel, the field of work and family has been searching for more specific antecedents of both work interference with family (WFI) and family interference with work (FWI). The current study aims to examine the relationship between surface acting and hiding negative emotions with WFI and FWI among Greek health-care professionals. DESIGN/METHODOLOGY/APPROACH: The research is a cross-sectional study of 180 Greek doctors and 84 nurses using self-report measures. FINDINGS: Results indicated that, for doctors, surface acting at work was positively related to WFI and, for nurses, surface acting at home was positively related to FWI. RESEARCH LIMITATIONS/IMPLICATIONS: The respondents were sampled on a convenience basis and the non-random procedure may have introduced unmeasured selection effects. The present study is cross-sectional and thus the postulated relationships cannot be interpreted causally. PRACTICAL IMPLICATIONS: Emotional management training and opportunities for emotional decompression for Greek health-care professionals should be explored. In terms of medical education, the need to train students to understand and cope with emotional demands is an important first step. This research highlights the need for communication-skills training courses facilitating emotional awareness and emotional management. ORIGINALITY/VALUE: These findings position emotional labour as an important antecedent of both WFI and FWI.
Abstract: A statement prepared by groups at the European Social Forum held in Florence in 2002 declares health to be a fundamental and universal right, a right that is being denied by current neoliberal policies. The statement presents some essential principles for maintaining or restoring this right through a European network.
Abstract: BACKGROUND: The aim of this study was to assess the flow characteristics in ophthalmic arteries and to detect their possible relationships to those in the common and internal carotid arteries. METHODS: Sixty healthy subjects (age range 20-74 years) with normal vascular findings, stratified by age and sex were recruited to the study. A colour Doppler ultrasound examination of the neck arteries was performed, followed by a colour Doppler ultrasound examination of the 120 ophthalmic arteries included. Peak systolic velocity, end diastolic velocity and resistance index (RI) of the common carotid, internal carotid and ophthalmic arteries, as well as the insonation depth of the ophthalmic arteries were measured. RESULTS: The mean values (standard deviation) of the measured parameters for the ophthalmic arteries were: insonation depth: 38.38 mm (2.60 mm), peak systolic velocity: 34.71 cm/sec (6.38 cm/sec), end diastolic velocity: 7.95 cm/sec (1.70 cm/sec), resistive index: 0.77 (0.04). The resistance index of the ophthalmic arteries was, in all cases, greater than that of the ipsilateral common carotid artery which in turn, was greater than that of the internal carotid. The value of the index in the ophthalmic arteries, when the circulation is normal in the extra- and intracranial arteries is rarely lower than 0.70. CONCLUSIONS: When an inversion of the ratio between the resistance index of the ophthalmic artery and that of the common carotid or an index value lower than 0.70 in the ophthalmic artery is observed, further investigation is needed as this situation cannot be considered normal. The resistance index seems to be the most reliable parameter for the estimation of normal circulation in ophthalmic arteries.
Abstract: AIM: Effective treatment of secondary hyperparathyroidism (HPTH) with intravenous (i.v.) administration of calcitriol in hemodialysis patients. PATIENTS AND METHODS: The current study evaluates the use of i.v. calcitriol dosing in relation to the severity of the HPTH in 35 hemodialysis patients with serum phosphate < 6.5 mg/dl. Arbitrarily, patients with plasma IPTH levels (intact PTH) between 288 and 576 pg/ml (288 pg/ml = four-fold the upper normal limit) were given initially 1 microg i.v. calcitriol at the end of each dialysis (group A, n = 15). Patients with IPTH between 577 and 864 pg/ml received 2 microg i.v. calcitriol (group B, n = 10) and patients with IPTH more than 865 pg/ml were given 3 - 4 microg i.v. calcitriol (group C, n = 10). As IPTH levels decreased, the dose of i.v. calcitriol was also decreased gradually. Patients were followed-up for 4 months after the end of calcitriol treatment. RESULTS: During the i.v. calcitriol treatment period, the observed plasma IPTH concentrations compared with the baseline values were significantly lower (p < 0.01 for A and B group and p < 0.05 for C group) from the sixth month onwards in group A and C and from the third month onwards in group B. At the 12th month of follow-up, all patients being off i.v. calcitriol treatment for four months, a sharp and significant increase (p < 0.01 for group A and B and p < 0.05 for group C) of plasma IPTH was recorded in all three groups of patients. Alkaline phosphatase was also gradually decreased in all studied groups. Serum Ca and P remained unchanged in most patients. CONCLUSION: In conclusion, the study presented here demonstrates that the titration of i.v. calcitriol dosage according to the severity of HPTH is an effective and safe treatment of HPTH in chronic hemodialysis patients. It also shows that parathyroidectomy could be avoided in the majority of patients with severe HPTH, if an appropriate dose of calcitriol not aggravating hyperphosphatemia is administered.
Abstract: BACKGROUND: Diabetes mellitus is a common disease in developed countries, but in Greece national figures on its prevalence are lacking. OBJECTIVES: The aim of this study was to identify the burden of known diabetes mellitus through its estimation in the area of responsibility of the Spili Health Centre, based on the health information system that had been established in Primary Health Care in rural Crete. METHOD: The diagnosis of diabetes was retrospectively documented by reviewing all medical records (n = 47151) at the Spili Health Centre and its five regional outposts during the period 1/6/1988-1/7/1993. The diagnostic criteria of WHO were used to establish the diagnosis. RESULTS: After excluding the patients who had died, we found 210 patients with diabetes mellitus. Thirty cases were evaluated with OGTT because of mild but not diagnostic elevations of fasting plasma glucose, on more than one occasion. The prevalence of diabetes after age and sex standardization of that for the European population was estimated at 1.52% (1.31% in males and 1.68 in females). CONCLUSIONS: Our study shows that: 1) the role of the GPs and one appropriate information system in measuring the prevalence of known diabetes mellitus are now considered important within the Greek context; 2) diabetes mellitus seems not to be a rare disease in rural Crete. The estimated prevalence appears to be similar to the prevalence rates reported in other areas of rural Greece.
Abstract: The frequency of exfoliation syndrome (EXS) was investigated in a group of Greek patients undergoing extracapsular cataract surgery. Five hundred and nine (509) consecutive cataract patients without any other manifest ocular abnormality were prospectively examined for the presence of EXS. Patients were clinically divided into 3 groups: group I (EXS group) consisted of patients in whom exfoliation material deposition could be seen; Group II (possible EXS group) comprised patients who demonstrated a number of pigmentary signs and group III (normal subjects) comprised patients with senile cataract and no sign of EXS. EXS was found in 140 (28%) of our patients, possible EXS in 119 (23%) and the rest (49%) had no evidence of EXS. Patients with EXS were older (mean age 73.8) when compared to the possible EXS group (70 years) and the control group (64.7 years). The IOP was significantly higher in patients with EXS (mean 15.5 mmHg versus 14.3 mmHg in the other two groups). Blue irides were significantly more common in patients with EXS (19%) than in the possible EXS group (14%) and the controls (4%). EXS is common in Greek cataract patients and this study has identified a large group of patients who may be at an early stage of development of the condition. EXS may predispose to the development of cataract in Greek patients.
Abstract: This article reviews the history of screening in the elderly, the conditions that should be considered, whether or not screening in the elderly is of benefit, whether we should look for disability or diseases and where screening should take place. Thirteen conditions are discussed: hearing loss and anaemia in some detail. Both disability and precise diagnostic criteria are considered. The place where screening is best carried out depends on the mobility of the subject and the nature of the particular screening tests selected for the 13 conditions. The desirability of screening was assessed on the following criteria: prevalence of the condition, severity of the problem, acceptability by the patient of the screening test, false positive rate, consequences of making a false positive diagnosis, the false negative rate and the consequences of this error, the effect of treatment, the cost of the screening test and the burden on the health services produced by the screening test. The criteria were scored 1-5 on a scale defined for each assessment, with higher scores favouring screening. We provide evidence that screening may be worthwhile for: need for chiropody, varicose veins/ulcer, hearing loss, obesity, visual impairment, hypothyroidism, hypertension, anaemia and diabetes mellitus. However, the assessments discussed in this paper need to be tested prospectively in randomised controlled trials.
