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Sigal AR, Cardinali-Re BA, Campana L, Lopez-Santi P, Iomini P, Zanoni CA, Salcerini M, Pozzer L, Traghetti M, Pulido L, Piñeiro DJ, Rosende A, Garcia-Zamora S. [Self-perception of smoking cessation skills among Cardiology residents in Argentina]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:82-87. [PMID: 38046230 PMCID: PMC10688411 DOI: 10.47487/apcyccv.v4i3.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/23/2023] [Indexed: 12/05/2023]
Abstract
Objective To evaluate the self-perception of cardiology residents in Argentina regarding their abilities to help their patients stop smoking, as well as their opinions about their knowledge and skills in this area. Materials and methods A cross-sectional study was carried out using secondary data from a study carried out in five Latin American countries and Spain, focusing on the information provided by cardiology residents in Argentina. Discrete variables were expressed as median and interquartile range, and categorical variables were expressed as percentages, and were analyzed using the chi-square test or Fisher's exact test, depending on the relative frequency of the expected values. Results 447 residents participated; 87.5% routinely provided brief advice to quit smoking, and 11.6% used validated questionnaires to assess the degree of addiction. Furthermore, 32.1% stated that they prescribed pharmacological treatment, but 53.1% were only familiar with a single drug. When asked about their self-perception of getting their patients to stop smoking, the median response was 5 (scale from 1 to 10); only 13.7% responded with a score of 8 or more. Conclusions The present study suggests that cardiology residents in Argentina recognize the importance of carrying out smoking cessation interventions, but a high proportion of them do not feel qualified to do so.
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Affiliation(s)
- Alan R Sigal
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Braian Abel Cardinali-Re
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Lucas Campana
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Pilar Lopez-Santi
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Pablo Iomini
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Celeste A Zanoni
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Mariana Salcerini
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Leandro Pozzer
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Manuel Traghetti
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
| | - Laura Pulido
- Servicio de Neumonología, Hospital Italiano de Rosario, Rosario, Argentina. Servicio de Neumonología Hospital Italiano de Rosario Rosario Argentina
| | - Daniel José Piñeiro
- Facultad de Medicina, Universidad de Buenos Aires (UBA), Buenos Aires, Argentina. Universidad de Buenos Aires Facultad de Medicina Universidad de Buenos Aires (UBA) Buenos Aires Argentina
| | - Andrés Rosende
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
- Servicio de Neumonología, Hospital Italiano de Rosario, Rosario, Argentina. Servicio de Neumonología Hospital Italiano de Rosario Rosario Argentina
| | - Sebastián Garcia-Zamora
- Consejo Argentino de Residentes de Cardiología (CONAREC), Buenos Aires, Argentina. Consejo Argentino de Residentes de Cardiología (CONAREC) Buenos Aires Argentina
- Servicio de Cardiología, Sanatorio Delta, Rosario, Argentina. Servicio de Cardiología Sanatorio Delta Rosario Argentina
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2
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Kastaun S, Viechtbauer W, Leve V, Hildebrandt J, Funke C, Klosterhalfen S, Lubisch D, Reddemann O, Raupach T, Wilm S, Kotz D. Quit attempts and tobacco abstinence in primary care patients: follow-up of a pragmatic, two-arm cluster randomised controlled trial on brief stop-smoking advice - ABC versus 5As. ERJ Open Res 2021; 7:00224-2021. [PMID: 34322551 PMCID: PMC8311137 DOI: 10.1183/23120541.00224-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/23/2021] [Indexed: 11/14/2022] Open
Abstract
We developed a 3.5-h training for general practitioners (GPs) in delivering brief stop-smoking advice according to different methods (ABC, 5As). In a pragmatic, cluster randomised controlled trial our training proved effective in increasing GP-delivered rates of such advice (from 13% to 33%). In this follow-up analysis we examined the effect of the training and compared ABC versus 5As on patient-reported quit attempts and point prevalence abstinence at weeks 4, 12 and 26 following GP consultation. Follow-up data were collected in 1937 smoking patients - independently of the receipt of GP advice - recruited before or after the training of 69 GPs. At week 26, ∼70% of the patients were lost to follow-up. All 1937 patients were included in an intention-to-treat analysis; missing outcome data were imputed. Quit attempts and abstinence rates did not differ significantly from pre- to post-training or between patients from the ABC versus the 5As group. However, ancillary analyses showed that patients who received GP advice compared to those who did not had two times higher odds of reporting a quit attempt at all follow-ups and abstinence at week 26. We reported that our training increases GP-delivered rates of stop-smoking advice, and the present analysis confirms that advice is associated with increased quit attempts and abstinence rates in patients. However, our training did not further improve these rates, which might be related to patients' loss to follow-up or to contextual factors, e.g. access to free evidence-based cessation treatment, which can hamper the transfer of GPs' advice into patients' behaviour change.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Dept of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Verena Leve
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Funke
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stephanie Klosterhalfen
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Diana Lubisch
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Olaf Reddemann
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Tobias Raupach
- Institute for Medical Education, University Hospital Bonn, Bonn, Germany
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Stefan Wilm
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Daniel Kotz
- Institute of General Practice (ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
- Dept of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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3
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Kastaun S, Leve V, Hildebrandt J, Funke C, Klosterhalfen S, Lubisch D, Reddemann O, McRobbie H, Raupach T, West R, Wilm S, Viechtbauer W, Kotz D. Training general practitioners in the ABC versus 5As method of delivering stop-smoking advice: a pragmatic, two-arm cluster randomised controlled trial. ERJ Open Res 2021; 7:00621-2020. [PMID: 34322552 PMCID: PMC8311138 DOI: 10.1183/23120541.00621-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/10/2020] [Indexed: 11/05/2022] Open
Abstract
This study assessed the effectiveness of a 3.5-h training session for general practitioners (GPs) in providing brief stop-smoking advice and compared two methods of giving advice - ABC versus 5As - on the rates of delivery of such advice and of recommendations of evidence-based smoking cessation treatment during routine consultations. A pragmatic, two-arm cluster randomised controlled trial was carried out including a pre-/post-design for the analyses of the primary outcome in 52 GP practices in Germany. Practices were randomised (1:1) to receive a 3.5-h training session (ABC or 5As). In total, 1937 tobacco-smoking patients, who consulted trained GPs in these practices in the 6 weeks prior to or following the training, were included. The primary outcome was patient-reported rates of GP-delivered stop-smoking advice prior to and following the training, irrespective of the training method. Secondary outcomes were patient-reported receipt of recommendation/prescription of behavioural therapy, pharmacotherapy or combination therapy for smoking cessation, and the effectiveness of ABC versus 5As regarding all outcomes. GP-delivered stop-smoking advice increased from 13.1% (n=136 out of 1039) to 33.1% (n=297 out of 898) following the training (adjusted odds ratio (aOR) 3.25, 95% CI 2.34-4.51). Recommendation/prescription rates of evidence-based treatments were low (<2%) pre-training, but had all increased after training (e.g. behavioural support: aOR 7.15, 95% CI 4.02-12.74). Delivery of stop-smoking advice increased non-significantly (p=0.08) stronger in the ABC versus 5As group (aOR 1.71, 95% CI 0.94-3.12). A single training session in stop-smoking advice was associated with a three-fold increase in rates of advice giving and a seven-fold increase in offer of support. The ABC method may lead to higher rates of GP-delivered advice during routine consultations.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Verena Leve
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christian Funke
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Stephanie Klosterhalfen
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Diana Lubisch
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Olaf Reddemann
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hayden McRobbie
- University of New South Wales, National Drug and Alcohol Research Centre, Randwick, Australia
- Lakes District Health Board, Rotorua, New Zealand
| | - Tobias Raupach
- Dept of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert West
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Stefan Wilm
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Dept of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Daniel Kotz
- Institute of General Practice (Ifam), Centre for Health and Society (chs), Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Behavioral Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
- Dept of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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4
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When primary care providers and smokers meet: a systematic review and metasynthesis. NPJ Prim Care Respir Med 2021; 31:31. [PMID: 34075057 PMCID: PMC8169673 DOI: 10.1038/s41533-021-00245-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Primary Care Providers (PCPs) often deal with patients on daily clinical practice without knowing anything about their smoking status and willingness to quit. The aim of this metasynthesis is to explore the PCPs and patients who are smokers perspectives regarding the issue of smoking cessation within primary care settings. It relies on the model of meta-ethnography and follows thematic synthesis procedures. Twenty-two studies are included, reporting on the view of 580 participants. Three main themes emerge: (i) What lacks, (ii) Some expectations but no request, and (iii) How to address the issue and induce patients' motivation. Our results reveal a global feeling of a lack of legitimacy among PCPs when it comes to addressing the issue of tobacco and smoking cessation with their patients, even though they have developed creative strategies based on what is at the core of their practice, that is proximity, continuity, long-term and trustworthy relationship.
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5
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Jiménez-Ruiz CA, Chatkin JM, Morais A, Zabert G, Rosa P, Gea J, Cavalcanti Lundgren FL, Boléo-Tomé JP, Araújo AJD, Borrajo C, Buljubasich D, Garcia Rueda M. Consensus Document on Medical Faculty Education on the Treatment of Smoking. Arch Bronconeumol 2020; 56:806-811. [PMID: 32513588 DOI: 10.1016/j.arbres.2020.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/06/2020] [Accepted: 04/26/2020] [Indexed: 11/23/2022]
Abstract
We report the results of a consensus reached by an expert group of representatives from different medical societies in Latin America on the objectives, competencies (knowledge, and skills), content, and duration of smoking cessation education in Latin American medical schools. The document discusses the following aspects: epidemiology, nicotine dependence, factors for initiation and maintenance of tobacco use, smoking-related disorders, diagnosis, minimal intervention, non-pharmacological and pharmacological interventions for smoking cessation, and prevention of smoking.
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Affiliation(s)
- Carlos A Jiménez-Ruiz
- Presidente de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR); Unidad Especializada en Tabaquismo, Hospital Clínico San Carlos, Madrid, España.
| | - Jose Miguel Chatkin
- Presidente Sociedade Brasileira Pneumologia e Tisiologia; Medicina Interna/Pneumologia, Escola de Medicina PUCRS, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brasil
| | - Antonio Morais
- Presidente Sociedade Portuguesa Pneumologia; Centro Hospitalar Universitário São João, Oporto, Portugal; Faculdade de Medicina do Porto, Oporto, Portugal; i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Oporto, Portugal
| | - Gustavo Zabert
- Presidente de Asociación Latinoamericana del Tórax; Facultad de Ciencias Médicas, Universidad Nacional de Comahue, Argentina
| | - Paula Rosa
- Serviço de Pneumologia, Hospital Vila França de Xira, Vila Franca de Xira, Portugal
| | - Joaquim Gea
- Facultad de Medicina, Universidad Pompeu Fabra, Barcelona, España
| | | | | | - Alberto José de Araújo
- Departamento de Tabaquismo de la Asociación Latinoamericana de Tórax (ALAT), Montevideo, Uruguay
| | - Cristina Borrajo
- Núcleo de Estudos e Tratamento do Tabagismo, Instituto de Doenças do Tórax, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Marcos Garcia Rueda
- Servicio de Neumología, Hospital Regional Universitario Carlos Haya, Málaga, España
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6
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Tsiligianni I, Oikonomou N, Papaioannou A, Tatsioni A, Gougourelas D, Birka S, Domeyer PRJ, Tsimtsiou Z. Exploring primary care physician experiences conducting practice-based research on adult vaccination: a qualitative evaluation study in Greece. Fam Pract 2020; 37:828-833. [PMID: 32779702 DOI: 10.1093/fampra/cmaa063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Research in primary care is necessary to empower its role in health systems and improve population health. OBJECTIVE The aim of this evaluation study was to assess the experiences of primary care physicians who participated as researchers in a multi-centre, mixed-methodology study on adult vaccination supported by a newly established practice-based research network. METHODS Twenty-three physicians participated as researchers, operating in their own practices in 10 different prefectures of Greece. After the completion of the study, they were asked to reflect on their experiences in the research by providing written responses to the questions on the evaluation tool of the study. The open-ended questions were analyzed using thematic content analysis. RESULTS Mean age of the researchers was 42.9 years old (±3.9, min 35, max 49) and 11 (47.8%) were male. Six themes emerged as beneficial for the participating researchers: (i) raised awareness of patients' needs, (ii) enhancement of clinical practice and services offered, (iii) positive impact on the doctor-patient relationship, (iv) personal satisfaction, (v) enrichment of their curriculum vitae and (vi) improvement of research skills. All researchers were interested in participating in future studies. CONCLUSION The experience of conducting clinical research on adult vaccination in their own practices within a network was reported to be very rewarding. The benefits gained from their participation could be a valuable tool in promoting research and enhancing the quality of primary health care.
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Affiliation(s)
- Ioanna Tsiligianni
- Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.,Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
| | - Nikolaos Oikonomou
- Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.,School of Social Sciences, Hellenic Open University, Patra, Greece
| | - Anastasia Papaioannou
- Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.,Health Centre of N. Makri, Athens, Greece
| | - Athina Tatsioni
- Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.,Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dimitrios Gougourelas
- Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.,Health Center of Goura, Korinthia, Greece
| | - Sofia Birka
- Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.,Health Centre of Evosmos, Thessaloniki, Greece
| | - Philippe-Richard J Domeyer
- Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.,School of Social Sciences, Hellenic Open University, Patra, Greece
| | - Zoi Tsimtsiou
- Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.,Health Centre of Evosmos, Thessaloniki, Greece.,Department of Hygiene, Social-Preventive Medicine and Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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7
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Girvalaki C, Mechili EA, Papadakis S, Nikitara K, Demin A, Trofor A, Lila A, Harutyunyan A, Saliaj A, Dimitrievska D, Lozano FR, Bakh-Turidze G, Ayesta J, Przewozniak K, Cattaruzza MS, Zdraveska M, Lovše M, Kilibarda B, Stoyka O, Behrakis P, Bizel P, Starchenko P, Spahija S, Radu-Loghin C, Vardavas CI. Current practices and perceived barriers to tobacco-treatment delivery among healthcare professionals from 15 European countries. The EPACTT Plus project. Tob Prev Cessat 2020; 6:6. [PMID: 32548343 PMCID: PMC7291907 DOI: 10.18332/tpc/115033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The latest evidence-based Guidelines for Treating Tobacco Dependence highlight the significant role of healthcare professionals in supporting smokers interested to quit. This study aimed to identify the current practices of healthcare professionals in Europe and perceived barriers in delivering tobacco treatment to their patients who smoke. METHODS In the context of EPACTT-Plus, collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine) worked for the development of an accredited eLearning course on Tobacco Treatment Delivery available at http://elearning-ensp.eu/. In total, 444 healthcare professionals from the wider European region successfully completed the course from December 2018 to July 2019. Cross-sectional data were collected online on healthcare professionals’ current practices and perceived barriers in introducing tobacco-dependence treatment into their daily clinical life. RESULTS At registration, 41.2% of the participants reported having asked their patients if they smoked. Advise to quit smoking was offered by 47.1% of the participants, while 29.5% reported offering assistance to their patients who smoked in order to quit. From the total number of participants, 39.9% regarded the lack of patient compliance as a significant barrier. Other key barriers were lack of: interest from the patients (37.4%), healthcare professionals training (33.1%), community resources to refer patients (31.5%), and adequate time during their everyday clinical life (29.7%). CONCLUSIONS The identification of current practices and significant barriers is important to build evidence-based guidelines and training programs (online and/or live) that will improve the performance of healthcare professionals in offering tobacco-dependence treatment for their patients who smoke.
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Affiliation(s)
- Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Enkeleint A Mechili
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece.,Department of Healthcare, Faculty of Health, University of Vlora, Vlore, Albania
| | - Sophia Papadakis
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Andrey Demin
- Institute of Leadership and Healthcare Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Antigona Trofor
- University of Medicine and Pharmacy 'Grigore T.Popa', Iasi, Romania.,AER PUR Romania, Bucharest, Romania
| | - Arben Lila
- Kosovo Advocacy and Development Center, Prishtina, Kosovo
| | - Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Aurela Saliaj
- Department of Healthcare, Faculty of Health, University of Vlora, Vlore, Albania
| | | | - Francisco Rodriguez Lozano
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Comité Nacional de Prevención del Tabaquismo, Madrid, Spain
| | | | | | - Krzysztof Przewozniak
- Foundation 'Smart Health - Health in 3D', Warsaw, Poland.,Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Sofia Cattaruzza
- Department of Public Health & Infectious Diseases, Sapienza University, Rome, Italy.,SITAB, Società Italiana di Tabaccologia, Rome, Italy
| | | | - Mihaela Lovše
- Slovenian Coalition for Tobacco Control, Ljubljana, Slovenia
| | | | | | - Panagiotis Behrakis
- George D. Behrakis Research Laboratory, Athens, Greece.,Hellenic Cancer Society, Athens, Greece
| | | | - Polina Starchenko
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | | | - Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium.,Medical School, University of Crete, Heraklion, Greece
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8
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Girvalaki C, Papadakis S, Mechili EA, Nikitara K, Demin A, Trofor AC, Lila A, Harutyunyan A, Saliaj A, Dimitrievska D, Lozano FR, Bakhturidze G, Ayesta J, Przewoźniak K, Cattaruzza MS, Zdraveska M, Lovše M, Kilibarda B, Stoyka O, Behrakis P, Bizel P, Starchenko P, Spahija S, Radu-Loghin C, Vardavas CI. Impact of the ENSP eLearning platform on improving knowledge, attitudes and self-efficacy for treating tobacco dependence: An assessment across 15 European countries. Tob Induc Dis 2020; 18:40. [PMID: 32435174 PMCID: PMC7233524 DOI: 10.18332/tid/120188] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In 2018, the European Network for Smoking Cessation and Prevention (ENSP) released an update to its Tobacco Treatment Guidelines for healthcare professionals, which was the scientific base for the development of an accredited eLearning curriculum to train healthcare professionals, available in 14 languages. The aim of this study was to evaluate the effectiveness of ENSP eLearning curriculum in increasing healthcare professionals' knowledge, attitudes, self-efficacy (perceived behavioral control) and intentions in delivering tobacco treatment interventions in their daily clinical routines. METHODS We conducted a quasi-experimental pre-post design study with 444 healthcare professionals, invited by 20 collaborating institutions from 15 countries (Albania, Armenia, Belgium, Italy, France, Georgia, Greece, Kosovo, Romania, North Macedonia, Russia, Serbia, Slovenia, Spain, Ukraine), which completed the eLearning course between December 2018 and July 2019. RESULTS Healthcare professionals' self-reported knowledge improved after the completion of each module of the eLearning program. Increases in healthcare professionals' self-efficacy in delivering tobacco treatment interventions (p<0.001) were also documented. Significant improvements were documented in intentions to address tobacco use as a priority, document tobacco use, offer support, provide brief counselling, give written material, discuss available medication, prescribe medication, schedule dedicated appointment to develop a quit plan, and be persistent in addressing tobacco use with the patients (all p<0.001). CONCLUSIONS An evidence-based digital intervention can be effective in improving knowledge, attitudes, self-efficacy and intentions on future delivery of tobacco-treatment interventions.
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Affiliation(s)
- Charis Girvalaki
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
| | - Sophia Papadakis
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Enkeleint A. Mechili
- Medical School, University of Crete, Heraklion, Greece
- Department of Health Care, Faculty of Public Health, University ‘Ismail Qemali’ Vlore, Vlora, Albania
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
| | - Andrey Demin
- Institute of Leadership and Healthcare Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Antigona C. Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- AER PUR Romania, Bucharest, Romania
| | - Arben Lila
- Kosovo Advocacy and Development Center, Pristina, Kosovo
| | - Arusyak Harutyunyan
- Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Aurela Saliaj
- Department of Health Care, Faculty of Public Health, University ‘Ismail Qemali’ Vlore, Vlora, Albania
| | | | - Francisco Rodriguez Lozano
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Comité Nacional de Prevención del Tabaquismo, Madrid, Spain
| | | | | | - Krzysztof Przewoźniak
- Foundation ‘Smart Health – Health in 3D’, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Maria Sofia Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
- Società Italiana di Tabaccologia (SITAB), Rome, Italy
| | | | - Mihaela Lovše
- Slovenian Coalition for Public Health, Environment and Tobacco Control, Maribor, Slovenia
| | - Biljana Kilibarda
- Institute of Public Health of Serbia ‘Dr Milan Jovanović Batut’, Belgrade, Serbia
| | | | - Panagiotis Behrakis
- George D. Behrakis Research Laboratory, Athens, Greece
- Hellenic Cancer Society, Athens, Greece
| | | | - Polina Starchenko
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | | | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- Medical School, University of Crete, Heraklion, Greece
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9
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Kastaun S, Leve V, Hildebrandt J, Funke C, Becker S, Lubisch D, Viechtbauer W, Reddemann O, Hempel L, McRobbie H, Raupach T, West R, Kotz D. Effectiveness of training general practitioners to improve the implementation of brief stop-smoking advice in German primary care: study protocol of a pragmatic, 2-arm cluster randomised controlled trial (the ABCII trial). BMC FAMILY PRACTICE 2019; 20:107. [PMID: 31351460 PMCID: PMC6660716 DOI: 10.1186/s12875-019-0986-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 06/27/2019] [Indexed: 11/10/2022]
Abstract
Background The German clinical guideline on tobacco addiction recommends that general practitioners (GPs) provide brief stop-smoking advice to their patients according to the “5A” or the much briefer “ABC” method, but its implementation is insufficient. A lack of training is one barrier for GPs to provide such advice. Moreover, the respective effectiveness of a 5A or ABC training regarding subsequent delivery of stop-smoking advice has not been investigated. We developed a training for GPs according to both methods, and conducted a pilot study with process evaluation to optimize the trainings according to the needs of GPs. This study aims at evaluating the effectiveness of both trainings. Methods A pragmatic 2-arm cluster randomised controlled trial with a pre-post data collection will be conducted in 48 GP practices in North Rhine-Westphalia (Germany). GPs will be randomised to receive a 3.5-h-training in delivering either 5A or ABC, including peer coaching and intensive role plays with professional actors. The patient-reported primary outcome (receipt of GP advice to quit: yes/no) and secondary outcomes (recommendation rates of smoking cessation treatments, group comparison (5A versus ABC): receipt of GP advice to quit) will be collected in smoking patients routinely consulting their GP within 4 weeks prior, and 4 weeks following the training. Additional secondary outcomes will be collected at 4, 12 and 26 weeks following the consultation: use of cessation treatments during the last quit attempt (if so) since the GP consultation, and point-prevalence abstinence rates. The primary data analysis will be conducted using a mixed-effects logistic regression model with random effects for the cluster variable. Discussion If the training increases the rates of delivery of stop-smoking advice, it would offer a low-threshold strategy for the guideline implementation in German primary care. Should one method prove superior, a more specific guideline recommendation can be proposed. Trial registration German Clinical Trials Register (DRKS00012786); registered on 22th August 2017, prior to the first patient in. Electronic supplementary material The online version of this article (10.1186/s12875-019-0986-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sabrina Kastaun
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany.
| | - Verena Leve
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Jaqueline Hildebrandt
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Christian Funke
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Stephanie Becker
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Diana Lubisch
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Olaf Reddemann
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany
| | - Linn Hempel
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Hayden McRobbie
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.,The Dragon Institute for Innovation, Auckland, New Zealand
| | - Tobias Raupach
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany.,Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Robert West
- Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Daniel Kotz
- Institute of General Practice, Addiction Research and Clinical Epidemiology Unit, Medical Faculty of the Heinrich-Heine-University Düsseldorf, Werdener Str. 4, 40227, Düsseldorf, Germany.,Research Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK.,Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
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10
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Peleki T, Girvalaki C, Lozano F, Radu-Loghin C, Nguyen D, Harutyunyan A, Bakhturidze G, Trofor A, Demin A, Stoyka O, Tsiou C, Papadakis S, Vardavas CI, Behrakis PK. Short-term impact of the EuroPean Accredited Curriculum on Tobacco Treatment Training (EPACTT) program. Tob Prev Cessat 2018; 4:28. [PMID: 32411854 PMCID: PMC7205079 DOI: 10.18332/tpc/92484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/20/2018] [Accepted: 06/21/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this pilot study was to assess the short-term effectiveness of the EuroPean Accredited Curriculum on Tobacco Treatment Training intervention in improving health care providers' knowledge, attitudes and self-efficacy related to tobacco dependence treatment. METHODS A pre-post pilot study was conducted. The two-day training intervention took place in Brussels in April 2016. Health care professionals from six European countries (Russia, Ukraine, Georgia, Armenia, Romania and Greece) were purposively invited to participate in the study. Evaluation was performed before the intervention, immediately after, and at approximately two months following the intervention. Changes in outcomes of interest were examined before and after exposure to the intervention program. RESULTS In all, 47 health care professionals participated in the training of which 40 completed the evaluation surveys. Significant increases in providers' self-efficacy and perceived behavioral control related to tobacco treatment delivery were documented immediately following the training and at the 2 months follow-up. Significant improvement in provider knowledge and attitudes were observed in some items assessed. CONCLUSIONS The results demonstrate that training is able to improve provider self-efficacy related to tobacco treatment delivery in this cross-national European sample of health care professionals. Additional research is required to examine the generalizability of our findings.
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Affiliation(s)
- Theodosia Peleki
- National and Kapodistrian University of Athens, School of Health Sciences, Department of Medicine, Athens, Greece
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Charis Girvalaki
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- Clinic of Social and Family Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Francisco Lozano
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Cornel Radu-Loghin
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Dominick Nguyen
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | | | | | - Antigona Trofor
- University of Medicine and Pharmacy ‘Grigore T.Popa’, Iasi, Romania
| | - Andrey Demin
- Federal State Funded Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University under the Ministry of Health of the Russian Federation, Russia
| | | | | | - Sophia Papadakis
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Constantine I. Vardavas
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
- Institute of Public Health, American College of Greece, George D Behrakis Research Lab, Hellenic Cancer Society, Athens, Greece
| | - Panagiotis K. Behrakis
- Institute of Public Health, American College of Greece, Athens, Greece
- George D Behrakis Research Lab, Hellenic Cancer Society, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
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11
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Papadakis S, Girvalaki C, Vardavas C, Pipe AL, Cole A, Tsiligianni I, Petridou E, Lionis C. Factors associated with rates of tobacco treatment delivery by General Practitioners in Greece: Missed opportunities for prevention? Tob Induc Dis 2018; 16:21. [PMID: 31516421 PMCID: PMC6659564 DOI: 10.18332/tid/90822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study investigates the clinic-, provider- and patient-level factors associated with delivery of 4 (Ask, Advise, Assist, Arrange) elements of the 5As approach to smoking cessation in general practice in Greece. METHODS We conducted a secondary analysis of data derived from a quasi-experimental study (The TiTAN Crete study) among general practitioners (GPs) in Crete, Greece in 2015–2016. Twenty-four GPs and a cross-sectional sample of 1301 smokers from their practices were surveyed. This paper reports on the results of the multi-level modelling conducted to examine predictors of 4As delivery. RESULTS Our analysis found clinic characteristics, including the presence of an electronic medical record, being located in a rural setting, and being in private practice were significantly associated with increased rates of tobacco treatment delivery. Female GPs were more likely than males to arrange follow-up (AOR 3.38, 95%CI 1.11, 10.35). Our analysis found a variety of patient-level factors were positively associated with tobacco treatment delivery, including: longer smoking history; presence of a smoking related illness; readiness to quit smoking; and symptoms or a diagnosis of anxiety, depression or other mental health illness. Other patient-level factors were negatively associated with tobacco treatment delivery, including level of education and reason for visit. Patients seen in clinic for episodic care were less likely to be ‘asked’ (AOR 0.22, 95%CI 0.12, 0.39), ‘advised’ (AOR 0.22, 95%CI 0.13, 0.38), and receive ‘assistance’ (AOR 0.36, 95%CI 0.19, 0.66) compared to patients seen in clinic for a medical examination. CONCLUSIONS Providers are significantly more frequently delivering tobacco treatment to a sub-group of high-risk patients compared to other tobacco users in their clinical practice. This results in missed opportunities for early intervention and disease prevention.
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Affiliation(s)
- Sophia Papadakis
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece.,Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Charis Girvalaki
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece
| | - Constantine Vardavas
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece
| | - Andrew L Pipe
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Adam Cole
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Ioanna Tsiligianni
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece
| | - Eleni Petridou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, Department of Medicine, University of Crete, Heraklion, Greece
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