Human papillomavirus knowledge and vaccine acceptability among adolescents in a Greek region.

OBJECTIVES: The aim of this research was twofold: (1) develop an instrument to assess knowledge regarding human papillomavirus (HPV) and its vaccine and utilize this instrument to measure knowledge levels of Greek adolescents in Lyceum schools of Western Thessaloniki; and (2) examine the associations of the resultant knowledge measure scores with sociodemographic characteristics. STUDY DESIGN: Cross-sectional survey with complex sampling design. METHODS: A total of 268 students of three Lyceum schools in Western Thessaloniki responded anonymously to a questionnaire during February-March 2013. The instrument was developed by literature review. Answers of respondents to individual questions were initially presented in terms of absolute and relative frequencies. Knowledge items were presented by gender along with appropriate chi-squared tests. Next, the development and validation of a knowledge score was pursued with Rasch analysis. Raw scores of dichotomous true/false items were converted to interval-level adjusted student scores, and the reliability and validity of the model were assessed. Finally, the effect of sociodemographic variables on the knowledge measure was explored by multivariate linear regression. RESULTS: Analysis of individual items documented low knowledge for both female and male students along with a limited role of doctors as information agents and little associated encouragement toward vaccination. Vaccine uptake was low with many young girls being largely unwilling to vaccinate in the future primarily due to the fear of side-effects and lack of information. Person location parameters (knowledge scores) were derived from a Rasch model with satisfactory reliability and validity. The resultant validated measure confirmed the low knowledge levels of Greek students. Nationality and birthplace seemed to affect knowledge level. CONCLUSIONS: Further improvement and validation of the knowledge measure used in this study can assist nationwide surveys in order to examine student knowledge regarding HPV and its vaccine. Our findings also stress the exacerbated need for effective nationwide educational campaigns aiming to inform adolescents about HPV and the associated vaccine. Appropriate incentives should also be given to physicians to increase their involvement. Parents and students should be thoroughly informed about the value of research similar to ours, in order to increase survey participation rates.

Cost-effectiveness of losartan in diabetic nephropathy: a Greek perspective.

BACKGROUND: Diabetic nephropathy is the primary cause of end-stage renal disease (ESRD), which involves substantial economic burden. The primary objective of this study was to estimate the potential effect of losartan on the costs associated with ESRD in patients with diabetic nephropathy in a Greek setting. A secondary aim was to approximate the direct health care cost of renal replacement therapy (RRT) in Greece. METHODS: A cost-effectiveness analysis was performed to compare losartan with placebo in patients with type 2 diabetes and nephropathy. Clinical data were derived from the RENAAL study. All costs were calculated from the perspective of the Greek social insurance system, in 2003 euros. Future costs were discounted at 3%. The time horizon was 3.5 years. Extensive sensitivity analyses were performed. RESULTS: The reduction in the number of ESRD days over 3.5 years in patients treated with losartan reduced ESRD-related costs by 3,056.54 euros, resulting in net cost savings of 1,665.43 euros per patient. Net cost savings increase thereafter, increasing to 2,686.48 euros per patient over a period of 4.0 years. The results were robust under a wide range of plausible assumptions. The weighted mean daily cost of RRT was estimated at 90.97 euros per patient. The total economic burden of RRT for the year 2003 has been estimated at 304.773 million euros. CONCLUSIONS: This study demonstrated that treatment of patients with diabetic nephropathy in Greece with losartan is cost-effective, as it leads to important savings for the social insurance system by slowing the progression to ESRD.