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Mantadaki AE, Linardakis M, Tsakiri M, Baliou S, Fragkiadaki P, Vakonaki E, Tzatzarakis MN, Tsatsakis A, Symvoulakis EK. Benefits of Quercetin on Glycated Hemoglobin, Blood Pressure, PiKo-6 Readings, Night-Time Sleep, Anxiety, and Quality of Life in Patients with Type 2 Diabetes Mellitus: A Randomized Controlled Trial. J Clin Med 2024; 13:3504. [PMID: 38930033 PMCID: PMC11205103 DOI: 10.3390/jcm13123504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Diabetes is a rapidly growing global morbidity issue with high prevalence, and the associated dysglycemia leads to complications. Patients with type 2 diabetes mellitus (T2DM) often experience elevated anxiety levels, affecting their quality of life and diabetes management. This study investigated quercetin, a nutraceutical and potential senolytic with antioxidant activity, to detect its possible positive effect on the bio-clinical measurements and routine health of patients with T2DM. Methods: This prospective randomized controlled trial (RCT) investigated the clinical usefulness of quercetin in patients with T2DM receiving non-insulin medications. One hundred participants were stratified by age and sex (1:1) and randomized to control (n = 50) or intervention (n = 50) groups. The control received standard care only, while the intervention received 500 mg quercetin daily for 12 weeks, followed by an 8-week washout and a final consecutive 12-week supplementation period (total: 32 weeks), as adjunct to their usual care. Comprehensive health assessments, including blood analyses, were conducted at baseline and study termination. Quality of life and anxiety were assessed using the 36-item Short Form Health Survey (SF-36) and Short Anxiety Screening Test (SAST-10). Results: Eighty-eight patients with T2DM concluded the trial. Compared with the control, glycated hemoglobin (HbA1c) levels showed a significant decrease (Δ%-change: -4.0% vs. 0.1%, p = 0.011). Quercetin also significantly improved PiKo-6 readings (FEV1: 5.6% vs. -1.5%, p = 0.002), systolic blood pressure (-5.0% vs. -0.2%, p = 0.029), night-time sleep (11.6% vs. -7.3%, p < 0.001), anxiety levels (SAST-10) (-26.2% vs. 3.3%, p < 0.001), and quality of life (SF-36) (both physical and mental components, p < 0.001). Conclusions: Based on the current open-label study, quercetin appears to be a promising supplement for T2DM, providing lifestyle and care support. Further research is warranted to shift this potential from clinical usefulness and feasibility to multidisciplinary evidence.
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Affiliation(s)
- Aikaterini E. Mantadaki
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.L.); (E.K.S.)
| | - Manolis Linardakis
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.L.); (E.K.S.)
| | - Maria Tsakiri
- Iatrica, Local Unit of Lab Analysis and Diagnostics Network, 71303 Heraklion, Greece;
| | - Stella Baliou
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Persefoni Fragkiadaki
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Elena Vakonaki
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Manolis N. Tzatzarakis
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Aristidis Tsatsakis
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Greece or (S.B.); (P.F.); (E.V.); (M.N.T.); (A.T.)
| | - Emmanouil K. Symvoulakis
- Clinic of Social and Family Medicine, Department of Social Medicine, School of Medicine, University of Crete, 70013 Heraklion, Greece; (M.L.); (E.K.S.)
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Sbarouni V, Petelos E, Kamekis A, Tzagkarakis SI, Symvoulakis EK, Lionis C. Discussing issues of health promotion and research in the context of primary care during the ongoing austerity period: an exploratory analysis from two regions in Greece. Med Pharm Rep 2020; 93:69-74. [PMID: 32133449 PMCID: PMC7051814 DOI: 10.15386/mpr-1346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 06/04/2019] [Accepted: 09/16/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Greece, both Primary Health Care (PHC) system and National Health System (NHS) in general, were plagued by several inefficiencies even prior to the financial crisis; the imposed austerity measures dramatically worsened the level of health provision and access, especially for vulnerable social groups, resulting in an exacerbation of existing disparities and access gaps. AIM AND METHODS The current branch study was conducted in two regions of Greece, namely Crete and Epirus, with the main aim of eliciting responses to gather baseline information regarding crucial PHC-related aspects, using questionnaires with dichotomous questions. Directors or managers (physicians who have been assigned administrative/governance duties), of the Primary Health Care Centres (PHCCs) in two Greek geographic and administrative regions of Crete and Epirus, were invited to participate and to contribute to the investigation of issues on the provision of prevention and health promotion services, e-health topics and primary care research. Thirty directors/managers were approached and twenty-eight agreed to participate. Data processing and analysis of the responses was performed for the completed questionnaires. RESULTS Data analysis did not demonstrate a surprisingly substantial deviation in the average score of positive responses of directors/managers in the PHCCs of Crete in comparison to those of directors/managers in the PHCCs of Epirus. The findings show that several gaps exist in terms of prevention and health promotion resources and activities in both regions, while e-health, electronic health record (EHR) and telemedicine services are poorly developed. CONCLUSION The study confirms that the Greek PHC is characterized by several inefficiencies, which may affect the quality of the services provided. An overall deficit has been emerged for PHCCs in both regions, a fact that indicates crucial points lacking in terms of overall PHC provision, thus adversely impacting upon living conditions, health quality and prevention.
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Affiliation(s)
- Vicky Sbarouni
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Elena Petelos
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Apostolos Kamekis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
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Lionis C, Anastasaki M. Family Practice Research in low-resource settings: what we have missed and what we have to know. Fam Pract 2019; 36:253-254. [PMID: 30544193 DOI: 10.1093/fampra/cmy121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
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KRAS and BRAF Mutation Status in Patients with Sporadic Colorectal Cancer: Data from Two Different Mediterranean Countries. Int J Biol Markers 2018; 26:276-7. [DOI: 10.5301/jbm.2011.8874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2011] [Indexed: 11/20/2022]
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Lionis C, Papadakis S, Tatsi C, Bertsias A, Duijker G, Mekouris PB, Boerma W, Schäfer W. Informing primary care reform in Greece: patient expectations and experiences (the QUALICOPC study). BMC Health Serv Res 2017; 17:255. [PMID: 28381224 PMCID: PMC5382510 DOI: 10.1186/s12913-017-2189-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 03/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background Primary health care is the cornerstone of a high quality health care system. Greece has been actively attempting to reform health care services in order to improve heath outcomes and reduce health care spending. Patient-centered approaches to health care delivery have been increasingly acknowledged for their value informing quality improvement activities. This paper reports the quality of primary health care services in Greece as perceived by patients and aspects of health care delivery that are valued by patients. Methods This study was conducted as part of the Quality and Costs of Primary Care in Europe (QUALICOPC) study. A cross-sectional sample of patients were recruited from general practitioner’s offices in Greece and surveyed. Patients rated five features of person-focused primary care: accessibility; continuity and coordination; comprehensiveness; patient activation; and doctor–patient communication. One tenth of the patients ranked the importance of each feature on a scale of one to four, and nine tenths of patients scored their experiences of care received. Comparisons were made between patients with and without chronic disease. Results The sample included 220 general practitioners from both public and private sector. A total of 1964 patients that completed the experience questionnaire and 219 patients that completed the patient values questionnaire were analyzed. Patients overall report a positive experiences with the general practice they visited. Several gaps were identified in particular in terms of wait times for appointments, general practitioner access to patient medical history, delivery of preventative services, patient involvement in decision-making. Patients with chronic disease report better experience than respondents without a chronic condition, however these patient groups report the same values in terms of qualities of the primary care system that are important to them. Conclusions Data gathered may be used to improve the quality of primary health care services in Greece through an increased focus on patient-centered approaches. Our study has identified several gaps as well as factors within the primary care health system that patient’s perceive as most important which can be used to prioritize quality improvement activities, especially within the austerity period. Study findings may also have application to other countries with similar context and infrastructure.
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Affiliation(s)
- Christos Lionis
- Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.
| | - Sophia Papadakis
- Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Chrysanthi Tatsi
- Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Antonis Bertsias
- Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | - George Duijker
- Faculty of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Wienke Boerma
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
| | - Willemijn Schäfer
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, Netherlands
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Opportunities and barriers to enhance research capacity and outputs among academic family physicians in the Arab world. Prim Health Care Res Dev 2015; 17:98-104. [PMID: 26687846 DOI: 10.1017/s1463423615000377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM To explore the current status of academic primary care research in Arab countries and investigate the barriers to its adequate implementation. BACKGROUND Research is an essential building block that ensures the advancement of the discipline of Family Medicine (FM). FM research thus ought to be contributed to by all family physicians; nevertheless, its development is being hindered worldwide by several challenges. The amount of research conducted by academic academic family physicians and general practitioners is scant. This phenomenon is more pronounced in the Arab countries. METHODS An online questionnaire was emailed to all academic family physicians practicing in member Arab countries of the World Organization of Family Doctors WONCA-East Mediterranean Region. FINDINGS Seventy-six out of 139 academic family physicians from eight Arab countries completed the questionnaire. Around 75% reported that they are required to conduct research studies, yet only 46% contributed to at least one publication. While 75% and 52.6% disclosed their interest in participating in a research team and in leading a research team respectively, 64.5% reported being currently involved in research activities. Of all, 56% have attended a research ethics course. Lack of training in research, the unavailability of a healthcare system that is supportive of research, insufficient financial resources, and the unavailability of electronic health records were perceived as major barriers in conducting FM research. CONCLUSION Although many physicians in Arab academic institutions expressed enthusiasm to conduct research projects, FM research infrastructure remains to be weak. This demonstrates the need for immense efforts from different parties particularly governments and academic institutions.
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Tsiachristas A, Lionis C, Yfantopoulos J. Bridging knowledge to develop an action plan for integrated care for chronic diseases in Greece. Int J Integr Care 2015; 15:e040. [PMID: 27118957 PMCID: PMC4843177 DOI: 10.5334/ijic.2228] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 10/05/2015] [Accepted: 10/07/2015] [Indexed: 11/20/2022] Open
Abstract
The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the 'memorandum and peripheral' Eurozone countries (i.e., Greece, Spain, Portugal and Ireland), which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this. The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage. Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan can only be decided by Greek policy makers in close cooperation with other health and social care partners. This is the appropriate time for doing so.
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Affiliation(s)
- Apostolos Tsiachristas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Christos Lionis
- Clinic of Social and Family Medicine, Medical School, University of Crete, Greece
| | - John Yfantopoulos
- School of Economics and Political Science, University of Athens, Greece
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Klemenc-Ketis Z, Kurpas D, Tsiligianni I, Petrazzuoli F, Jacquet JP, Buono N, Lopez-Abuin J, Lionis C. Is a practice-based rural research network feasible in Europe? Eur J Gen Pract 2015; 21:203-9. [DOI: 10.3109/13814788.2015.1046376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
Reporting and publishing research from a country with limited research capacity experiences from an editor Christos Lionis as chief and associate editor that serves certain European and International biomedical journals presents key issues that researchers need to be aware when they prepare, present and submit their work to maximise their chances of publication. Sufficient reporting and all the steps: (a) Planning ahead or thinking about the type or research, (b) Choosing a suitable journal, (c) Considering what before submission – are discussed in the article. However, a successful publication with an impact factor in a well-recognized journal is not only achieved by the fundamental steps that the author needs to undertake but also by certain “secrets” which are presented within the paper. Common pitfalls when research is reported will be highlighted by the author, while recommendations for a successful reporting of the research findings. To what extent publishing with impact factor is a blessing or a curse would be also approached within the paper. The information that this article provides is based on personal experiences of an editor in certain biomedical journals but it is important not to forget that in clinical practice it is critical to be passionate about discoveries to make an effect in regards to the patients’ benefits.
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Affiliation(s)
- Christos Lionis
- MD PhD FRCGP (Hon), Professor of General Practice and Primary Care at the School of Medicine, University of Crete, Greece
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Maltezou HC, Lionis C. The financial crisis and the expected effects on vaccinations in Europe: a literature review. Infect Dis (Lond) 2015; 47:437-46. [PMID: 25739315 DOI: 10.3109/23744235.2015.1018315] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Starting in 2008 several European countries experienced a financial crisis. Historically, diseases whose prevention and treatment depend highly on the continuity of healthcare re-emerge during political and financial crises. Evidence suggests that the current financial crisis has had an impact on the health and welfare of Europeans and that population health status and morbidity as well as mortality patterns may change in the coming years. At the same time decisions about expenditure for health services may impact the ability of public health providers to respond. It is expected that the current crisis will further exacerbate socioeconomic and health inequalities and novel vulnerable groups will emerge in addition to existing ones. We review the available evidence and discuss how the current crisis may have an impact on vaccine-preventable diseases and influence vaccination coverage rates in Europe.
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Affiliation(s)
- Helena C Maltezou
- From the 1 Department for Interventions in Health Care Facilities, Hellenic Center for Disease Control and Prevention , Athens
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Iatraki E, Simos PG, Lionis C, Zaganas I, Symvoulakis EK, Papastefanakis E, Panagiotakis S, Pantelidakis H, Papadopoulos K, Tziraki C. Cultural adaptation, standardization and clinical validity of the test your memory dementia screening instrument in Greek. Dement Geriatr Cogn Disord 2014; 37:163-80. [PMID: 24157823 DOI: 10.1159/000355376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To adapt and standardize the Test Your Memory (TYM) dementia screening instrument in Greek. METHODS Normative data on the Greek version of the TYM were obtained from a community sample of 239 adults aged 21-92 years. Clinical validity was assessed in a cohort of 134 Neurology Clinic patients. Concurrent validity was examined through comparisons with the Mini-Mental State Examination (MMSE) and the Greek Everyday Function Scale. RESULTS Correlations between the TYM and the MMSE were 0.73 and 0.82 in the community and patient samples, respectively. Scores on both tests were moderately associated with everyday functional capacity. Using age- and education-corrected cutoff scores ranging from 26/50 to 45/50 points, the sensitivity of the TYM for Alzheimer's disease detection was found to be higher than that of the MMSE (0.82 vs. 0.70), although its specificity was lower (0.71 vs. 0.90). CONCLUSION Findings are consistent with previous reports in a variety of cultural settings supporting the potential utility of the TYM as a dementia screening tool.
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Affiliation(s)
- Eliza Iatraki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
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What Greece can learn from UK primary care experience and empirical research. Br J Gen Pract 2013; 62:543. [PMID: 23265217 DOI: 10.3399/bjgp12x656928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Klinis S, Markaki A, Kounalakis D, Symvoulakis EK. Monitoring reasons for encounter via an electronic patient record system: the case of a rural practice initiative. Int J Med Sci 2012; 9:704-7. [PMID: 23091407 PMCID: PMC3477679 DOI: 10.7150/ijms.4999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 09/17/2012] [Indexed: 11/29/2022] Open
Abstract
The objective of this brief communication was to tabulate common reasons for encounter in a Greek rural general practice, as result of a recently adopted electronic patient record (EPR) application. Twenty encounter reasons accounted for 3,797 visits (61% of all patient encounters), whereas 565 other reasons accounted for the remaining 2,429 visits (39%). Number one reason for encounter was health maintenance or disease prevention seeking services, including screening examinations for malignancies, immunization and provision of medical opinion reports. Hypertension, lipid disorder and ischemic heart disease without angina were among the most common reasons for seeking care. A strengths/weaknesses/opportunities/threats (SWOT) analysis on the key role of an EPR system in collecting data from rural and remote primary health care settings is also presented.
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Affiliation(s)
| | - Adelais Markaki
- 2. Department of Social Medicine, Faculty of Medicine, University of Crete, Greece
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Lionis CD, Vardavas CI, Symvoulakis EK, Papadakaki MG, Anastasiou FS, Antonopoulou MD, Apostolakis CM, Dimitrakopoulos SA, Fountakis GI, Grammatikopoulos IA, Komninos JD, Kounalakis DK, Ladoukaki ES, Makri KV, Petraki CS, Ploumis NG, Prokopiadou DP, Stefanaki IN, Tsakountakis NA, Tsiligianni IG, Tzortzis EN, Vasilaki AA, Vasilopoulos TK, Vrentzos GE. Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece. BMC FAMILY PRACTICE 2011; 12:136. [PMID: 22145678 PMCID: PMC3266196 DOI: 10.1186/1471-2296-12-136] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 12/06/2011] [Indexed: 11/10/2022]
Abstract
Background Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece. Methods The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GP's from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25, 000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST). Results The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 ± 3.9 vs. 21.1 ± 5.7; p = 0.029). Conclusions The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.
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Affiliation(s)
- Christos D Lionis
- Department of Social Medicine, Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, PO Box 2208, Postal Code 71003, Greece.
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Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, Fineberg H, Garcia P, Ke Y, Kelley P, Kistnasamy B, Meleis A, Naylor D, Pablos-Mendez A, Reddy S, Scrimshaw S, Sepulveda J, Serwadda D, Zurayk H. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010; 376:1923-58. [PMID: 21112623 DOI: 10.1016/s0140-6736(10)61854-5] [Citation(s) in RCA: 2720] [Impact Index Per Article: 194.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Julio Frenk
- Harvard Schoolof Public Health, Office of the Dean, Kresge Building, Room 1005, 677 Huntington Avenue, Boston, MA 02115, USA.
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