Abstract: The early detection of cervical cancer with a Papanicolaou (Pap) smear has resulted in a great decline of mortality rates in developed countries, a progress suggesting that general practice may have a crucial role in promoting screening. This study explores the impact of general practitioners on women's adherence to Pap screening recommendations in a rural area of Crete, Greece. A cross-sectional study was conducted during 2006 in a rural area of 3,000 inhabitants, where access to primary care is free of charge. A random sample of 120 women (response rate=97.5%) aged 35-75 years were interviewed about Pap smear uptake within 6 years and the influence of health professionals on their screening intentions. Adequate screening was defined according to the American Cancer Society guidelines. Multiple logistic regression analysis was applied to estimate odds ratios. About 40.8% of the respondents had been screened according to the guidelines. However, only 10.8% were recommended to have a Pap smear within the last year and 4.2% were informed about human papilloma virus. Having visited the primary care clinics for prevention or the availability of a general practitioner to consult regularly did not affect the likelihood of being screened. Both the adequate and occasional screening rates were positively associated with a history of gynecological problems and with age less than 55 years. No disparities were observed regarding socio-economic status. Despite free provision of primary care, current preventive practice has not influenced women's screening behavior. National policy to support organized cancer screening and physician' training are necessary for effective early detection of cancer.
Abstract: BACKGROUND: The population in the Gaza Strip has been living under chronically stressful conditions as a result of the ongoing Israeli-Palestinian conflict. OBJECTIVES: To identify health complaints reported by attendants consulting primary care physicians in the Gaza Strip. METHODS: The study took place in 10 governmental primary health care centres and 5 clinics of the United Nations Relief and Works Agency in the Gaza Strip, during autumn 2005. Self-reported health complaints were recorded through face-to-face interviews with 956 respondents using a validated and reliable questionnaire. RESULTS: Abdominal pain and headache were the most frequent complaints reported among patients aged 18 to 44 years, accounting for 23.3% and 22.7% of total complaints in males and females, respectively. Fatigue and joint pain were the most common complaints among patients aged 45 years and above, accounting for 26% and 33.9% of total complaints in males and females, respectively. CONCLUSIONS: The most common complaints, as reported by patients attending PHC facilities were stress-related and could be attributed to the ongoing conflict and high level of violence and uncertainty in the area. These complaints present a challenge to primary care providers in their efforts to improve the everyday quality of life of Palestinian residents with scarce means and resources.
Abstract: ABSTRACT: BACKGROUND: The aim of the current study was to assess the reliability and validity of the Greek translation of the Short Anxiety Screening Test (SAST), for use in primary care settings. The scale consists of 10 items and is a brief clinician rating scale for the detection of anxiety disorder in older people, particularly, in the presence of depression. METHODS: The study was performed in two rural primary care settings in Crete. The sample consisted of 99 older (76 +/- 6.3 years old) people, who fulfilled the participating criteria. The translation and cultural adaptation of the questionnaire was performed according to international standards. Internal consistency using the Cronbach alpha coefficient and test-retest reliability using the intraclass correlation coefficient (ICC) was used to assess the reliability of the tool. An exploratory factor analysis using Varimax with Kaiser normalisation (rotation method) was used to examine the structure of the instrument, and for the correlation of the items interitem correlation matrix was applied and assessed with Cronbach alpha. RESULTS: Translation and backtranslation did not reveal any specific problems. The psychometric properties of the Greek version of the SAST scale in primary care were good. Internal consistency of the instrument was good, the Cronbach alpha was found to be 0.763 (P <0.001) and ICC (95% CI) for reproducibility was found to be 0.763 (0.686 to 0.827). Factor analysis revealed three factors with eigenvalues >1.0 accounting for 60% of variance, while the Cronbach alpha was >0.7 for every item. CONCLUSIONS: The Greek translation of the SAST questionnaire is comparable with that of the original version in terms of reliability, and can be used in primary healthcare research. Its use in clinical practice should be primarily as a screening tool only at this stage, with a follow-up consisting of a detailed interview with the patient, in order to confirm the diagnosis.
Abstract: The aim of the present study was to test the psychometric properties of the Quality of Life Questionnaire (QLQ-C30, version 3.0) in a sample of ambulatory cancer patients, mostly low educated and coming from rural areas of the island of Crete. The sample consisted of 188 lung, breast and colorectal cancer patients. Their quality of life (QoL) has been evaluated twice: before and after the first therapeutic intervention. Alpha coefficients ranged from 0.88 to 0.98. Inter-scale correlations were more substantial between the physical, role and fatigue scales. Mean score differences between groups of patients with different performance status (PS) were statistically significant for most of the sub-scales. Instead the patients with stable PS after treatment showed worse functioning in five from the nine sub-scales. For those whose PS has deteriorated, their subjective evaluation indicated deterioration only for physical, role and social functioning. In this sample of mainly ambulatory cancer patients, the instrument has high coefficients of reliability and good clinical validity. However, the results related to its sensitivity are not very consistent. It has proven able to detect clinically significant changes after the therapeutic intervention only for the patients who deteriorated over time and for three specific dimensions of QoL: physical, role and social functioning.
Abstract: Considerable controversy currently exists in the literature concerning the mode of catheter placement and its impact on the technical success of peritoneal dialysis (PD). We decided to compare the impact of the surgical versus the percutaneous insertion technique on peritoneal dialysis catheter (PDCs) complications and survival. Our study population comprised 152 patients in whom 170 PDCs were inserted between January 1990 and December 2007 at the main PD unit on the island of Crete. Eighty four catheters were surgically placed (S group) and 86 were placed percutaneously by nephrologists (N group). The total experience accumulated was 4997 patient-months. The overall complications did not differ between the two groups. Only early leakage was more frequent in N group than S group (10.3 versus 1.9 episodes per 1000 patient-months; p < 0.001). However, it was easily treated and did not constitute a cause of early catheter removal. Catheter survival was 91.1%, 80.7%, and 73.2%, in the S group versus 89.5%, 83.7%, and 83.7% for the N group at 1, 2, and 3 years, respectively (p = 0.2). Catheter survival has significantly increased over the last decade. Factors positively affecting PDC survival appeared to be the use of mupirocin for exit site care and the utilization of the coiled type of catheter, practices implemented mainly after 1999. Peritonitis-free survival and patient survival were not associated with the mode of placement, while in Cox regression analysis, were longer in patients treated with automated PD. The placement mode did not affect PD outcomes. Percutaneous implantation proved a safe, simple, low cost, immediately available method for PDC placement and helped to expand our PD program.
Abstract: The purpose of this exploratory study was to assess occupational profile, level of performance, and on-the-job training needs of nursing staff employed in all government primary health care centers in rural Crete, Greece. The translated, culturally adapted, and validated Greek version of the Training Needs Assessment questionnaire was used. There were no significant differences between 2-year degree graduates (LPNs) and 3- or 4-year degree graduates (RNs, midwives, and health visitors) in terms of importance for 28 of 30 assigned tasks, whereas level of performance did not differ in any tasks. Significant training needs were reported by all staff, mainly in research/audit and clinical skills. Systematic overview of skill deficits in relation to skill requirements should be implemented by regional health authorities to enhance delivery of on-the-job training targeting group-specific, local needs.
Abstract: OBJECTIVE: Numerous studies have identified a reduced health-related quality of life (QoL) in patients with urinary incontinence (UI). The aim of this study was to assess and compare QoL in women with UI in the island of Crete, Greece, and in Turkey. METHODS: Incontinent women from two community-based primary health care (PHC) groups (Greece and Turkey) and one outpatient clinic-based group were studied. RESULTS: A total of 231 (24.7%) women out of 932 women from the PHC group in Greece and Turkey reported UI whereas another 38 incontinent women visited the secondary care outpatient clinic. Mean Incontinence Quality of Life questionnaire (I-QoL) total score of women visiting PHC centers was 73.8 (SD = 23.5). There was significant difference among the three groups regarding I-QoL total and subscale scores, with women from the Greek community-based group having the highest score (mean = 81.8, SD = 20.7, P < 0.001). Impaired QoL was significantly associated with severity (P < 0.001), incontinence type (P = 0.026), seeking secondary care, and Turkey as sample setting (P < 0.001). CONCLUSION: Urinary incontinence is a frequent problem for women visiting PHC centers, affecting negatively their quality of life. Besides incontinence severity, Turkey as place of residence emerged as another essential predictor of impaired quality of life, suggesting that other social and cultural factors may also play an important role.
Abstract: PURPOSE: To report the incidence, microbial spectrum, and outcome of cataract operation related endophthalmitis cases from 2000 to 2008 in the Department of Ophthalmology, University Hospital of Heraklion, Crete. METHODS: Retrospective, observational case series collected from the files of the University Eye Clinic of Heraklion. RESULTS: From 2000 to 2008, 23 eyes of 23 patients with endophthalmitis after cataract surgery were reported. Vitreous specimens were obtained in all cases. Twelve were cultured positive, 8 with gram-positive bacteria, and 4 with gram-negative bacteria. Ten patients were treated medically, 13 surgically, and 2 finally underwent enucleation of the affected globe. Fourteen (60.8%) eyes of the total 23 managed in our hospital, achieved a final visual acuity of 1/10 or better and 9 lower than 1/10. Five eyes ended up with no light perception. CONCLUSIONS: We provide an overview of cataract operation related endophthalmitis cases managed in our clinic during the past 9 years.
Abstract: BACKGROUND: The burden of musculoskeletal disorders (MSD) on the general health and well-being of the population has been documented in various studies. The objective of this study was to explore the association between MSD and the quality of life and mental health of patients and to discuss issues concerning care seeking patterns in rural Greece. METHODS: Patients registered at one rural Primary Care Centre (PCC) in Crete were invited to complete the Nordic Musculoskeletal Questionnaire (NMQ) for the analysis of musculoskeletal symptoms, together with validated instruments for measuring health related quality of life (SF-36) and mental distress (GHQ-28). RESULTS: The prevalence rate of MSD was found to be 71.2%, with low back and knee pain being the most common symptoms. Most conditions significantly impaired the quality of life, especially the physical dimensions of SF-36. Depression was strongly correlated to most MSD (p < 0.001). Multiple logistic analyses revealed that patients who consulted the PCC due to MSD were likely to have more mental distress or impaired physical functioning compared to those who did not. CONCLUSION: Musculoskeletal disorders were common in patients attending the rural PCC of this study and were associated with a poor quality of life and mental distress that affected their consultation behaviour.
Abstract: The Greek version of the social capital questionnaire (SCQ-G) was evaluated in a sample of 521 adults drawn from three different urban areas in Greece. Exploratory factor analysis followed by multi-trait scaling yielded six factors: Participation in the Community, Feelings of Safety, Family/Friends Connections, Value of Life and Social Agency, Tolerance of Diversity, and Work Connections. The factor solution is similar to the patterns identified originally in Australia and the US. Variations suggest that social capital does not share the same structure in different countries. The SCQ-G is a useful scale to measure individual-level social capital in Greece. Social capital measurement tools should be validated in each cultural or national setting in which they are used.
Abstract: We present the assessment of chronic exposure of the rural population of Helia Peloponnesus, Greece to banned organochlorine pesticides, hexachlorocyclohexane (HCH), and 1,1,1-trichloro-2,2-bis(4-chlorophenyl)ethane (DDT), using hair analysis. A total of 222 head hair samples were collected and analyzed for the presence of those organochlorine pesticides and their metabolites or isomers. Gas chromatography coupled to mass spectrometry was used to measure the levels of the pollutants. The median concentrations of alpha-HCH, hexachlorobenzene, lindane, ortho para 1,1-dichloro-2,2-bis-(4-chlorophenyl)ethylene (opDDE), para para 1,1-dichloro-2,2-bis(4-chlorophenyl)ethylene (ppDDE), ortho para 1,1-dichloro-2,2-bis(4-chlorophenyl)ethane (opDDD), para para 1,1-dichloro-2,2-bis(4-chlorophenyl)ethane (ppDDD) + ortho para 1,1,1-trichloro-2,2-bis(4-chlorophenyl)-ethane, and para para 1,1,1-trichloro-2,2-bis(4-chlorophenyl)-ethane were determined at 40.4, 19.7, 124.2, 6.2, 7.8, 73.1, 8.0, and 5.7 pg/mg. The median concentration of total HCHs and DDTs were 117.8 pg/mg and 9.4 pg/mg, respectively. The levels of total HCHs were much higher than the levels of DDTs in the hair samples of the studied population. This may be attributed to the presence of lindane, a pesticide officially banned in 2002. It is interesting to see that DDTs are still traced in samples despite their use being banned for more than three decades. There was no difference in the levels of the detected pesticides in hair sampled from men or women. The concentration of HCHs remains high and relatively stable across the age groups, suggesting constant exposure until very recently. The concentration of the total DDTs and the parent compound, pp-DDT presents a statistically significant decreasing trend across the age groups.
Abstract: BACKGROUND: Crete has been of great epidemiological interest ever since the publication of the Seven Countries Study. In 1988 a well-defined area of rural Crete was studied, with only scarce signs of coronary heart disease (CHD) despite the unfavorable risk profile. The same population was re-examined twelve years later aiming to describe the trends of CHD risk factors over time and discuss some key points on the natural course of coronary heart disease in a rural population of Crete. METHODS AND RESULTS: We re-examined 200 subjects (80.7% of those still living in the area, 62.4 +/- 17.0 years old). The prevalence of risk factors for CHD was high with 65.9% of men and 65.1% of women being hypertensive, 14.3% of men and 16.5% of women being diabetic, 44% of men being active smokers and more than 40% of both sexes having hyperlipidaemia. Accordingly, 77.5% of the population had a calculated Framingham Risk Score (FRS) > or = 15%, significantly higher compared to baseline (p < 0.001). The overall occurrence rate for CHD events was calculated at 7.1 per 1000 person-years (95% confidence interval: 6.8-7.3). CONCLUSION: The study confirms the unfavorable risk factor profile of a well defined rural population in Crete. Its actual effect on the observed incidence of coronary events in Cretans remains yet to be defined.
Abstract: STUDY OBJECTIVES: The regulation of arousal and pupillary functions may be intimately linked via activity in the nucleus locus coeruleus. In this preliminary study, we tested the validity of the gradual pupillary miosis during 5 minutes in darkness, as a quantitative physiologic index of the arousal state of the brain. DESIGN: Cross-sectional assessment of 2 groups with between-group comparison and correlational analyses within the patient group. PARTICIPANTS: Eleven unmedicated male patients recently diagnosed with obstructive sleep apnea (OSA) with no comorbid conditions who had undergone polysomnography to assess OSA severity and sleep variables, and 11 sex- and age-matched healthy controls. INTERVENTIONS: Sampling of the resting pupil diameter (RPD) over 5 minutes in darkness in the morning and in the afternoon hours, using an infrared video pupillometer. MEASUREMENTS AND RESULTS: The RPD was smaller, indicating a lower level of arousal, in the patient group compared with controls in both the morning and the afternoon; the RPD showed a significant circadian reduction in the afternoon only in the patient group. Within the patient group, the RPD correlated negatively with Epworth Sleepiness Scale scores and Arousal Index and positively with the lowest oxygen saturation during the night. Controlling for the effect of body mass index, the relationship between RPD and subjective sleepiness was lost, whereas the relationship with most of the objective indexes of OSA severity was improved. CONCLUSIONS: The 5-minute pupillary miosis in darkness holds promise as a simple, fast-to-administer, valid, and sensitive test for the objective assessment of excessive daytime sleepiness.
Abstract: As there is little information on the factors that influence fracture union following intramedullary nailing of the tibia we retrospectively investigated patient-, injury- and treatment-related factors in 161 patients with closed or grade I open fractures of the tibial diaphysis. The patients were reviewed until clinical and radiological evidence of union at a mean of 13.3 months (4 to 60). Multivariate statistical analysis using a Cox proportional hazards model showed that the risk of failure of union increased by 2.38 times for highly comminuted fractures, by 3.14 times when nail dynamisation was applied, and by 1.65 times when the locking screws failed. In fractures with no or only minimal comminution the risk of nonunion increased if the post-reduction gap was > or = 3 mm.
Abstract: The expression of proliferating cell nuclear antigen (PCNA) was studied in plasma cells in bone marrow biopsies from patients with multiple myeloma (MM) using a double immunostaining method. In the same samples, microvessel density (MVD), after staining with anti-CD34 antibodies, was determined before and after chemotherapy. The correlation of PCNA expression and MVD with other myeloma parameters (clinical stage, bone marrow plasma cell infiltration and serum interleukin-6 (IL-6)) was also investigated. The study population included 51 newly diagnosed MM patients, 15 patients in plateau phase after treatment and 15 normal controls. Pretreatment mean +/- SE values of PCNA, MVD, plasma cell infiltration and serum IL-6 were significantly higher than post treatment values and controls. Pretreatment PCNA expression correlated significantly with bone marrow MVD (p<0.05) plasma cell infiltration (p<0.01) and IL-6 (p<0.01). These findings show that the proliferative activity of plasma cells is related to the angiogenic activity in the bone marrow of multiple myeloma patients. Both PCNA and MVD correlate with markers of disease activity thus may provide additional information when included in the initial evaluation of myeloma bone marrow biopsies.
Abstract: BACKGROUND: Fibrosis is a common consequence of chronic liver diseases irrespective of aetiology. Metalloproteinases play an important role in the fibrotic process participating in the balance between collagen synthesis and degradation. We examined whether matrix gelatinases and stromelysins are similarly involved in the development of viral (HCV, HBV) and non-viral (NASH) liver diseases. METHODS: Hepatic mRNA levels of matrix metalloproteinase MMP-2, MMP-9, MMP-10 and MMP-11 isolated from liver biopsies were measured by semi-quantitative RT-PCR. Seventy-three patients were examined in this study: non-diseased controls (10), patients with chronic hepatitis B (14), chronic hepatitis C (33) and non-alcoholic steatohepatitis (16). RESULTS: A significant increase of MMP-9 and MMP-10 expression was found in patients with non-viral (non-alcoholic steatohepatitis) liver disease. Patients with chronic hepatitis B and hepatitis C showed an increase in MMP-2 mRNA expression compared to controls. Moreover, chronic hepatitis B and hepatitis C patients had significantly different mRNA expression patterns. CONCLUSIONS: These findings indicate that matrix metalloproteinases are differentially involved in the fibrotic process of viral and non-viral chronic liver diseases. Differences exist between HBV and HCV chronic hepatitis. Differences between early and late fibrosis indicate that in future studies, careful staging of patients is mandatory for interpretation of results.
Abstract: The frequency and severity of crop protection product (pesticide) contamination of peaches grown conventionally were compared with those of peaches grown by integrated crop management (ICM). The peach samples (n = 150) were collected preharvest (June-August 2001) from both conventional (n = 55) and ICM (n = 95) cultivations from the Pella and Imathia districts of Macedonia, Northern Greece. The residue levels of selected insecticides, fungicides and acaricides in peach samples were determined by gas chromatography-mass spectrometry following solid-phase extraction. The concentrations of all detected pesticides were lower than the maximum residue limits (MRLs) in all peach samples grown with the ICM system (p<0.001). However, chlorpyrifos residues at levels higher than the MRLs were detected in four peach samples (i.e. 7% of the total samples) grown by the conventional system. Comparing the results for both cultivation methods with the reported average percentage (3.6%) of fruit samples with pesticide residues above the MRLs (European Union report for Greece in 2001), it was concluded that the initial implementation of the ICM in Greece was successful. The present study indicates that ICM cultivation has a higher efficiency in terms of product safety and quality. Furthermore, the results suggest that the application of conventional cultivation requires continuous monitoring of various crop protection product levels.
