RESUMEN
BACKGROUND: Musculoskeletal disorders (MSDs) account as a reason for frequent consultations in primary care. However, the magnitude of the problem at the GP's clinic, the patterns of pain and the consulting behaviour has not been sufficiently explored. OBJECTIVES: The aim of this study was to report on patterns of pain relevant to MSDs and explore the co-morbidities and consulting behaviour in rural primary care settings in Crete. METHODS: Three primary care centres (PCCs) of Crete were selected for a study period of 2 weeks. Every visitor, aged 20-75 years, regardless of the reason for visiting the facility was invited to participate. The Greek version of the general Nordic questionnaire for the analysis of musculoskeletal disorders (NMQ) was used for data collection. RESULTS: A total of 455 subjects answered the NMQ. Three hundred and seventy-six (82.6%) of the study population reported having one or more symptoms during the previous year. Low back (56.9%), neck (34.1%), shoulder (29.9%) and knee (27.9%) were the commonest sites of pain. In almost half cases (48.6%), the complaints about pain were accompanied by activity restrictions. Multivariate statistical analysis showed significant correlations with increasing age and female gender (P < 0.05). Common chronic conditions were associated with co-morbidities from the musculoskeletal system. Only one-third of those who reported MSDs had consulted their GPs for the same problems within the previous year. CONCLUSIONS: MSDs are highly prevalent among rural population in Crete but fewer patients seek care than those who report symptoms.
Asunto(s)
Enfermedades Musculoesqueléticas/fisiopatología , Dolor/fisiopatología , Derivación y Consulta , Adulto , Anciano , Femenino , Grecia , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud , Población Rural , Encuestas y CuestionariosRESUMEN
BACKGROUND: In 2001, the newly established Regional Health and Welfare System of Crete commissioned the first needs' assessment study of nursing personnel employed in the public sector of primary health care (PHC). AIM: To capture the profile and professional needs of nursing staff working in Health Centers throughout the island of Crete and explore variations in nursing practice by educational preparation. METHODS: A newly developed, psychometrically tested questionnaire, was administered to all nursing staff in 14 rural Health Centers. FINDINGS: Vacancy rates are high, indicating a serious staffing deficit. The type of degree earned (2-year vs. 3 or 4-year program) does not differentiate nursing practice, with only two exceptions (obtaining a patient's history and counselling patients). The majority of respondents assess their existing knowledge and skills as 'adequate' while indicating a strong desire for continuing education. Job satisfaction is high in terms of interactions with clients and community recognition, while it is rated 'low' in terms of daily interactions with colleagues and support from work environment. CONCLUSION: Cretan nursing staff in PHC operate within a restricted and task-orientated framework. Their educational preparation has little effect in practice role variations and professional needs. The Regional Health and Welfare System of Crete should address daily supervision and support issues, on-the-job training, continuing education needs, while taking immediate action to avoid potential turnover of existing staff and to aggressively recruit young, qualified nursing staff who will choose a career in PHC nursing.
Asunto(s)
Actitud del Personal de Salud , Evaluación de Necesidades/organización & administración , Personal de Enfermería , Atención Primaria de Salud/organización & administración , Adulto , Factores de Edad , Actitud Frente a la Salud , Competencia Clínica/normas , Educación Continua en Enfermería/organización & administración , Femenino , Grecia , Humanos , Satisfacción en el Trabajo , Masculino , Persona de Mediana Edad , Rol de la Enfermera , Investigación Metodológica en Enfermería , Personal de Enfermería/educación , Personal de Enfermería/organización & administración , Personal de Enfermería/psicología , Selección de Personal , Reorganización del Personal , Autonomía Profesional , Regionalización , Servicios de Salud Rural , Autoeficacia , Percepción Social , Encuestas y Cuestionarios , Recursos HumanosRESUMEN
BACKGROUND: During the last two decades Greece has moved towards a national health system. However, in a country with limited economic resources the necessity for reducing the increasing costs of the health care services by an effective use of available human resources, such as community volunteers, becomes inevitable. This paper reports the findings of a pilot study on attitudes and perceptions of primary-care staff towards voluntary work for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) patients. METHODS: Of the 300 primary-care professionals who are serving the health centres of the largest area of Athens, a sample of 153 was selected. The population surveyed was predominately female (n = 104, 69.3%) and most of them (n = 77, 50.7%) were between 31 and 40 years of age. A 28-item questionnaire was used, especially designed to investigate attitudes and perceptions of primary health care (PHC) professionals regarding the contribution of volunteers to HIV/AIDS-related programmes. RESULTS: Most of the respondents (n = 131, 85.6%) reported little or no experience of caring for HIV/AIDS patients and only 14 (9%) reported participation in any voluntary programmes. Eighty-eight per cent of patients (n = 135) consider the participation of volunteers in AIDS programmes as very useful and the vast majority of the participants pointed out the usefulness of the participation of health professionals and other influencing persons in voluntary programmes. Participants also suggested that sharing time with HIV patients and families, offering emotional support and practical help and distributing information leaflets for the general population should be the volunteers' contribution in AIDS-related programmes. The PHC professionals' role in voluntary programmes is considered by the 91 respondents (59.5%) as 'planning and organizing', for 66 (43.1%), 'coordinating' and for 37 (24.2%), 'supporting'. Although the majority of the participants (n = 90, 58.8%) said they would participate as a volunteer in an AIDS-related programme, only one-third of the total sample (n = 48, 31.4%) agree with the statement that they have a professional duty to support such a type of programme. CONCLUSIONS: Primary-care workers present little experience in caring for HIV/AIDS patients or participating in volunteer programmes and mainly positive attitudes and perceptions to voluntary work. Continuing educational programmes together with awareness activities may increase the involvement of primary-care professionals in the effective management of AIDS in Greece.
Asunto(s)
Actitud del Personal de Salud , Infecciones por VIH/enfermería , Personal de Enfermería/psicología , Atención Primaria de Salud , Voluntarios/psicología , Adulto , Femenino , Grecia , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Investigación Metodológica en Enfermería , Personal de Enfermería/educación , Proyectos Piloto , Prejuicio , Atención Primaria de Salud/métodos , Encuestas y Cuestionarios , Salud UrbanaRESUMEN
BACKGROUND: A study was carried out in Greece with the aim of assessing the prevalence of chronic venous insufficiency (CVI) in Greece and to discuss the role of general practice in the epidemiology, early diagnosis, and initial management of this disease. DESIGN: a prevalence study was carried out in rural Greece between January 17 and December 30, 1997. SETTING: 13 GPs, 11 of those working in 13 rural primary health centers, 1 in the University Hospital of Heraklion and 1 private sector from different Greek districts were invited to participate in the study. PARTICIPANTS AND METHODS: patients with the following criteria were entered into the study: weight, pain, cramps, burning, itching, formication and swelling. Complete information about patients' history was collected by the general practitioners (GPs) who used a semi-structured questionnaire. The diagnosis of CVI was established with Doppler ultrasound. RESULTS: Data were based on 6,119 questionnaires and GPs observed 4,502 randomly selected patients. The diagnosis of CVI was established in 993 patients and its prevalence was found to be 11.9% in males and 39.8% in females. Varicose veins were the most frequent clinical finding in patients with vein reflux and diabetes mellitus was the most common co-existing disease in males and hypertension in females. CONCLUSIONS: The prevalence of venous insufficiency (VI) appears to be a frequent health problem in general practice in Greece. It requires further investigation in order to explore the observed differences between various groups.
Asunto(s)
Insuficiencia Venosa/diagnóstico , Insuficiencia Venosa/terapia , Anciano , Presión Sanguínea/fisiología , Índice de Masa Corporal , Enfermedad Crónica , Comorbilidad , Enfermedad Coronaria/complicaciones , Enfermedad Coronaria/epidemiología , Complicaciones de la Diabetes , Diabetes Mellitus/epidemiología , Medicina Familiar y Comunitaria , Femenino , Grecia/epidemiología , Humanos , Hipertensión/complicaciones , Hipertensión/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Prevalencia , Atención Primaria de Salud , Factores de Riesgo , Vena Safena/diagnóstico por imagen , Vena Safena/fisiopatología , Factores Sexuales , Fumar , Estadística como Asunto , Ultrasonografía Doppler , Insuficiencia Venosa/epidemiologíaAsunto(s)
Diabetes Mellitus/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Enfermedad Coronaria/epidemiología , Femenino , Grecia/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , ObesidadRESUMEN
The aim of the study was to assess the discriminative power of cytokine interleukin 6 (IL-6) between transudative and exudative pleural and peritoneal effusions, and to compare IL-6 with common acute phase proteins in serous effusion differentiation. One hundred and forty-five consecutive patients with pleural or peritoneal effusion underwent diagnostic parecentesis. Patients were categorized in three groups. Malignant effusion (group A) 56 patients, non-malignant effusion (group B) 46 patients and transudate (group C) 43 patients. Serum and effusion levels of IL-6, C-reactive protein (CRP), alpha2-macroglobuline (alpha2-MG), alpha1-antitrypsin (alpha1-AT) and alpha1-acid glycoprotein (alpha1-AG) were determined. Serum IL-6 levels were significantly higher in groups A and B in comparison to group C (p<0.001 and 0.001, respectively). In addition, serum IL-6 levels were higher in group A compared to group B (p<0.001), while the studied acute phase proteins were not significantly different. All the studied parameters were higher in the effusions of groups A and B compared to group C. At a cut-off value of 72.1 fmol/ml IL-6 had a sensitivity of 82.6-89.3%, specificity of 88.4-90.7% and positive predictive value of 90.7-94.6% among the three groups. Our results suggest that IL-6 at levels > or =72.1 fmol/ml, alpha1-AT at > or =170 mg/dl and alpha1-AG at > or =52.3 mg/ml give strong evidences for malignancy in exudates.
Asunto(s)
Proteínas de Fase Aguda/análisis , Líquido Ascítico/inmunología , Interleucina-6/análisis , Derrame Pleural Maligno/inmunología , Derrame Pleural/inmunología , Adulto , Anciano , Anciano de 80 o más Años , Líquido Ascítico/etiología , Biomarcadores/análisis , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Derrame Pleural/etiología , Derrame Pleural Maligno/etiología , Análisis de Regresión , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: A school-based immunization survey was used to assess vaccination coverage of a population of children in the region of three Primary Health Care Centres in rural Crete. METHODS: The medical charts of 771 (92.6% of the total) students attending primary schools at the municipalities of Archanes and Hersonissos in the district of Heraklion, and Neapolis in the district of Lasithi, as well as the charts of 438 (68.9% of the total) students attending the secondary school at Neapolis, Lasithi, were obtained. The immunization records from these charts were then compiled and analysed. All information was based on the standardized procedures of the Spili Health Centre, Crete. The age-specific vaccination rate was calculated for children of both primary and secondary school age. RESULTS: The vaccination coverage against diphtheria and tetanus was high (82%, 1035 pupils had received the fifth dose) for both groups of students, while the coverage for pertussis was incomplete, especially the fifth dose, which had been received by only 17% (n = 131) of the children of primary school age and 4.3% (n = 19) of the children of secondary school age. In total, 638 of the children of primary school age (82.7%) and 257 (58.7%) of the children of secondary school age were immunized against measles. The corresponding numbers and the percentages of children of primary and secondary school age immunized against mumps and rubella were: 75.6% (n = 583) and 36.3% (n = 159) for mumps, and 74.7% (n = 576) and 32% (n = 140) for rubella. CONCLUSION: Immunization coverage of schoolchildren in the studied areas is inadequate in a number of instances. This appears to be most pronounced in children of secondary school age. The school-based immunization survey, which is an accurate and inexpensive tool for assessing vaccination coverage, is suggested as an appropriate means for primary health care workers in Greece to develop further and increase the immunization rate.
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Medicina Familiar y Comunitaria , Atención Primaria de Salud , Salud Rural , Estudiantes/estadística & datos numéricos , Vacunación/estadística & datos numéricos , Adolescente , Distribución por Edad , Niño , Femenino , Grecia , Encuestas de Atención de la Salud , Accesibilidad a los Servicios de Salud , Humanos , MasculinoRESUMEN
BACKGROUND: Diabetes mellitus is a common disease in developed countries, but in Greece national figures on its prevalence are lacking. OBJECTIVES: The aim of this study was to identify the burden of known diabetes mellitus through its estimation in the area of responsibility of the Spili Health Centre, based on the health information system that had been established in Primary Health Care in rural Crete. METHOD: The diagnosis of diabetes was retrospectively documented by reviewing all medical records (n = 47151) at the Spili Health Centre and its five regional outposts during the period 1/6/1988-1/7/1993. The diagnostic criteria of WHO were used to establish the diagnosis. RESULTS: After excluding the patients who had died, we found 210 patients with diabetes mellitus. Thirty cases were evaluated with OGTT because of mild but not diagnostic elevations of fasting plasma glucose, on more than one occasion. The prevalence of diabetes after age and sex standardization of that for the European population was estimated at 1.52% (1.31% in males and 1.68 in females). CONCLUSIONS: Our study shows that: 1) the role of the GPs and one appropriate information system in measuring the prevalence of known diabetes mellitus are now considered important within the Greek context; 2) diabetes mellitus seems not to be a rare disease in rural Crete. The estimated prevalence appears to be similar to the prevalence rates reported in other areas of rural Greece.
Asunto(s)
Comparación Transcultural , Diabetes Mellitus/epidemiología , Atención Primaria de Salud/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Prueba de Tolerancia a la Glucosa , Grecia/epidemiología , Humanos , Lactante , Masculino , Persona de Mediana EdadRESUMEN
The synthetic antiglucocorticoid RU486 has multiple effects on the immune system. We have recently reported that RU486 suppresses normal lymphocyte proliferation and downregulates interleukin-2 receptors (IL-2R) by decreasing the accumulation of the beta-chain IL-2R mRNA in normal human lymphocytes in culture. To further explore the mechanism of the immunoregulatory actions of RU486, in the present study, we investigated the effects of this molecule on the release of lymphokines from phytohemagglutinin (PHA)-activated normal human peripheral blood lymphocytes (NPBL) in culture. We have found that RU486 differentially regulates the release of lymphokines from PHA-activated NPB lymphocytes. Specifically, RU486 (at concentrations of 1-100 nM) exerts pure antagonist actions by almost completely reversing the inhibitory effects of the glucocorticoid dexamethasone (Dex) on the release of monocyte/macrophages-derived lymphokines, such as IL-1, IL-6, IL-8 and tumor necrosis factor-alpha (TNF-alpha). Dex decreased in a dose-dependent manner the release of the above four lymphokines, with an ID50 of 0.9 +/- 0.1, 4.76 +/- 0.4, 9.8 +/- 1.8, and 1.16 +/- 0.2 nM for IL-1, IL-6, IL-8 and TNF-alpha, respectively. Conversely, RU486 exhibits both agonist and antagonist effects on the release of T-lymphocyte-derived lymphokines. RU486 given alone, exerts agonist/glucocorticoid effects, by decreasing in a dose-dependent manner the release of IL-2 and -3. The maximal inhibitory effect of RU486 was observed at 10 nM and was 64.5 +/- 4.3% of the control value, (n = 6, P < 0.02) for IL-2 and 59.2 +/- 6.3% (n = 6, P < 0.02) for IL-3. The ID50 of RU486 for the release of IL-2 and -3 were 14.6 +/- 2.0 and 11.6 +/- 1.9 nM, respectively, i.e. almost similar with those of Dex. Interestingly, when high doses of RU486 (1 microM) were combined with Dex RU486 exhibited antagonist actions by significantly counteracting the inhibitory effects of Dex on IL-2 and -3 release. In conclusion, the antiglucocorticoid RU486 exhibits complex regulatory actions on lymphokine secretion, dependent upon the type of the lymphokine-producing cell. A pure antagonist effect was observed on the release of monocyte-derived IL-1, IL-6, IL-8 and TNF-alpha. However, when RU486 was given alone it acted as a glucocorticoid agonist on the secretion of T-lymphocyte-derived IL-2 and -3, while combined with the agonist (Dex) it exhibits antagonist effects on the release of the above lymphokines.(ABSTRACT TRUNCATED AT 400 WORDS)
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Dexametasona/antagonistas & inhibidores , Interleucinas/metabolismo , Activación de Linfocitos , Linfocitos/efectos de los fármacos , Mifepristona/farmacología , Factor de Necrosis Tumoral alfa/metabolismo , Células Cultivadas , Dexametasona/farmacología , Humanos , Linfocitos/inmunología , FitohemaglutininasRESUMEN
A research project in primary health care has been in progress since 1988 in an agricultural area of Crete, with the aim of surveying the cardiovascular risk profile and following the incidence of cardiovascular disease in the population over time. In the present paper we have investigated the mortality rates and the causes of death in 1989 and 1990 of the population of the Agios Vassilios county (n = 7758). Furthermore, whenever possible, we have checked the accuracy of the certified causes of death against the case record system introduced in 1988 in the health centre. During 1989 and 1990, 267 subjects died in the research area, 234 of whom were > 65 years old. Diseases of the circulatory system (mostly congestive heart failure) accounted for 46% of all deaths. The corresponding figure for neoplasms was 18%. The standardized mortality from ischaemic heart disease was found to be very low in both men and women, 37.9 and 41.9 per 100,000 per year, respectively, in comparison with that of Greece as a whole in 1989, 140.0 and 59.5, respectively. These figures were considerably lower than those reported in 1988 from for example Sweden, 303.6 and 153.3, respectively. The standardized mortality from cerebrovascular disease in Agios Vassilios county was found to be somewhat lower than the national figures in 1989, 118.1 and 107.0 in males and females versus 135.7 and 142.1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Enfermedades Cardiovasculares/mortalidad , Certificado de Defunción , Adolescente , Adulto , Factores de Edad , Anciano , Causas de Muerte , Niño , Preescolar , Femenino , Grecia/epidemiología , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Factores de Riesgo , Población Rural , Factores SexualesRESUMEN
The effects of the antiglucocorticoid RU486 on the expression of low and high affinity interleukin-2 receptors (IL-2R) in phytohaemagglutinin (PHA)-activated human peripheral blood lymphocytes were investigated. We demonstrated that RU486 inhibits in a dose-dependent way the expression of both classes of IL-2R, thereby mimicking the effects of the glucocorticoid agonist dexamethasone. The maximal effect on the low affinity binding sites was observed at 10 microM (28 +/- 2% of control, P less than 0.001) and on the high affinity IL-2R at 1 microM (from 2938 +/- 74 to 437 +/- 108 binding sites per cell, P less than 0.001). This inhibition of IL-2R expression occurs at a pretranslational level since RU486 decreased the accumulation of beta-chain IL-2R mRNA transcripts. Our data support the concept that the antiglucocorticoid RU486 at pharmacological concentrations can exert agonistic-immunosuppressive effects.
PIP: The effects of RU-486, which has anti-glucocorticoid properties, on expression of the interleukin-2 receptors (IL-2R) in human lymphocytes were examined in terms of its dose effect on 2 types of binding sites, and its suppression of beta-chain IL-2R messenger RNA production. Human peripheral lymphocytes stimulated with phytohemagglutinin (PHA) were incubated with the synthetic glucocorticoid dexamethasone and with RU-486 at various doses. Synthesis of 2 types of IL-2R was measured by immunofluorescence assay of the alpha chain. RU-486 inhibits in a dose- dependent fashion the expression of both classes of IL-2R, acting like an agonist. Maximal suppression was seen at a concentration of 10 mcM for the low affinity binding site, and at 1 mcM for the high affinity rate. Messenger RNA was determined by extracting RNA, fractioning it by electrophoresis on agarose gel, and hybridizing with cDNA probes inserted with a plasmid. RU-486 significantly lowered the accumulation of beta-chain IL-2R mRNA transcripts. Thus RU-486 at pharmacological concentrations acts like a glucocorticoid agonist with immunosuppressive effects.