Estimating the Fiscal Effects of Public Pharmaceutical Expenditure Reduction in Greece.

The purpose of the present study is to estimate the impact of pharmaceutical spending reduction on public revenue, based on data from the national health accounts as well as on reports of Greece's organizations. The methodology of the analysis is structured in two basic parts. The first part presents the urgency for rapid cutbacks on public pharmaceutical costs due to the financial crisis and provides a conceptual framework for the contribution of the Greek pharmaceutical branch to the country's economy. In the second part, we perform a quantitative analysis for the estimation of multiplier effects of public pharmaceutical expenditure reduction on main revenue sources, such as taxes and social contributions. We also fit projection models with multipliers as regressands for the evaluation of the efficiency of the particular fiscal measure in the short run. According to the results, nearly half of the gains from the measure's application is offset by financially equivalent decreases in the government's revenue, i.e., losses in tax revenues and social security contributions alone, not considering any other direct or indirect costs. The findings of multipliers' high value and increasing short-term trend imply the measure's inefficiency henceforward and signal the risk of vicious circles that will provoke the economy's deprivation of useful resources.

The role of the non-smoker in enforcing smoke-free laws.

Compliance with laws making certain environments smoke free has focused mainly on smokers' behavior, while the role of non-smokers has scarcely been investigated. Our cross-sectional study interviewed 4043 adults (2037 smokers and 2006 non-smokers) in the general population of Greece during April 2009. Non-smokers reported that they would actively work for compliance with the law. The non-smokers were older, more educated (odds ratio, OR 1.4), and were more likely to be annoyed by the smell of environmental tobacco smoke (OR 2.4) or report that it irritates their eyes (OR 1.8). Policymakers should evaluate how non-smokers could actively support smoke-free laws through reporting of violations using media campaigns that inform them of their rights, and other measures.

Insomnia and its correlates in a representative sample of the Greek population.

BACKGROUND: Insomnia is a major public health concern affecting about 10% of the general population in its chronic form. Furthermore, epidemiological surveys demonstrate that poor sleep and sleep dissatisfaction are even more frequent problems (10-48%) in the community. This is the first report on the prevalence of insomnia in Greece, a southeastern European country which differs in several socio-cultural and climatic aspects from the rest of European Community members. Data obtained from a national household survey (n = 1005) were used to assess the relationship between insomnia symptoms and a variety of sociodemographic variables, life habits, and health-related factors. METHODS: A self-administered questionnaire with questions pertaining to general health and related issues was given to the participants. The Short Form-36 (Mental Health subscale), the Athens Insomnia Scale (AIS) as a measure of insomnia-related symptoms, and the International Physical Activity Questionnaire (IPAQ) were also used for the assessment. RESULTS: The prevalence of insomnia in the total sample was 25.3% (n = 254); insomnia was more frequent in women than men (30.7% vs. 19.5%) and increased with age. Multiple regression analysis revealed a significant association of insomnia with low socio-economical status and educational level, physical inactivity, existence of a chronic physical or mental disease and increased number of hospitalizations in the previous year. CONCLUSIONS: The present study confirms most findings reported from other developed countries around the world regarding the high prevalence of insomnia problems in the general population and their association with several sociodemographic and health-related predisposing factors. These results further indicate the need for more active interventions on the part of physicians who should suspect and specifically ask about such symptoms.

Physical activity may promote sleep in cardiac patients suffering from insomnia.

Data obtained from a national household survey in Greece (n=1005) were used to assess the relationship between physical activity and insomnia in a group of subjects suffering from several major disabling physical illnesses. A self-administered questionnaire with questions pertaining to general health and related issues was given to the participants. The Short Form-36, the Athens Insomnia Scale (AIS), and the International Physical Activity Questionnaire (IPAQ) were included in the assessment. Half (49.5%) of the participants had moderate or vigorous physical activity and 33.4% had a chronic somatic disease. The prevalence of insomnia in the total sample was 25.3% (n=254); subjects having moderate or vigorous physical activity were 56% less likely to have insomnia in univariate analysis. Multiple analysis revealed a significant interaction of physical activity with heart failure or myocardial ischemia (OR=0.054, 95% CI: 0.003-0.95), indicating that subjects having moderate or vigorous physical activity and heart failure or myocardial ischemia had lower odds for having insomnia compared to individuals with heart problems and low physical activity levels. Consequently, cardiac patients suffering from insomnia seem to benefit from physical exercise. Since sleep disorders are quite frequent in cardiac patients and may result in both physical and psychological complications which deteriorate even further their quality of life and health, our results need replication in this particularly vulnerable population.

The Diet-Lifestyle Index evaluating the quality of eating and lifestyle behaviours in relation to the prevalence of overweight/obesity in adolescents.

We sought to develop an index that incorporated various dietary and lifestyle behaviours that are associated with overweight/obesity status in adolescents. We assigned discrete scores into each component of the proposed index. The Diet-Lifestyle Index ranged from 11 to 57. We examined the accuracy of the index in relation to adolescents' body mass status using a sample of 2,008 students. The mean score of the index was 30.9+/-5.2 for boys and 31.4+/-4.7 for girls. The index was inversely associated with the odds of being obese/overweight (odds ratio = 0.93, 95% confidence interval=0.90-0.96), after adjusting for age and gender. Particularly, an 11/57-unit increase of the index was associated with a 6% and 9% decrease in the odds of being overweight/obesity in boys and girls, respectively (P<0.001). Thus, the proposed Diet-Lifestyle Index could be a useful tool in a primary healthcare setting for preventing obesity in adolescence.

Overweight/obesity and factors associated with body mass index during adolescence: the VYRONAS study.

AIM: To describe overweight and obese adolescents and to determine any correlations between an adolescent's body mass index (BMI) with personal (age, gender), lifestyle (sedentary/sport activities, smoking status) and parental (smoking status, BMI, number of cars) characteristics. METHODS: Cross-sectional data on weight, height and various characteristics from 2008 Greek adolescents (12- to 17-year olds, 50.85% boys), measured in 2005-2007, were used. RESULTS: Almost 1 in 5 (19.2%) boys and 1 in 7 (13.2%) girls 12-17 years of age were overweight while 4.4% of the boys and 1.7% of the girls were obese. The adolescents' age, mother's smoking status, father's and mother's BMI predicted boys' and girls' BMI (b = 0.551, 0.203, 0.110, 0.495 for boys, b = 0.233, 0.187, 0.180, 0.531 for girls, respectively, p < or = 0.05). Univariate analysis revealed that television watching/using personal computer/playing video games and playtime were not correlated with BMI, while an inverse association of exercising for > or = 5 h/week and BMI was found in both boys and girls (b =-1.098, -0.528, p = 0.005, 0.004 respectively). CONCLUSION: The results of our study underline the high prevalence of obesity during adolescence in Greece. Age and parental unhealthy behaviour (increased BMI and maternal smoking status) were positive predictors of increased BMI of adolescents in both genders.

Parental Body Mass Index in association with the prevalence of overweight/obesity among adolescents in Greece; dietary and lifestyle habits in the context of the family environment: the Vyronas study.

The objective of this study was to evaluate whether Parental Body Mass Index is associated with overweight/obesity in a sample of Greek adolescents, taking into consideration dietary and lifestyle habits. The Vyronas study is a cross-sectional health and nutrition survey. During 2004/2005, 2008 schoolchildren were selected. BMI was calculated for both parents and adolescents. A semi-quantitative Food Frequency Questionnaire was applied. Results demonstrated that there is a strong positive association between the parental overweight/obesity status and their offspring's BMI. Some dietary and lifestyle habits seem to affect boys and girls BMI in relation to parental status differently.

Environmental tobacco smoke in hospitality venues in Greece.

BACKGROUND: Exposure to environmental tobacco smoke is a major threat to public health. Greece, having the highest smoking prevalence in the European Union is seriously affected by passive smoking. The purpose of this study was to measure environmental tobacco smoke (ETS) exposure in the non smoking areas of hospitality venues and offices in Greece and to compare the levels of exposure to levels in the US, UK and Ireland before and after the implementation of a smoking ban. METHODS: Experimental measurements of particulate matter 2.5 microm (PM2.5), performed during a cross sectional study of 49 hospitality venues and offices in Athens and Crete, Greece during February - March 2006. RESULTS: Levels of ETS ranged from 19 microg/m3 to 612 microg/m3, differing according to the place of measurement. The average exposure in hospitality venues was 268 microg/m3 with ETS levels found to be highest in restaurants with a mean value of 298 microg/m3 followed by bars and cafes with 271 microg/m3. ETS levels were 76% lower in venues in which smoking was not observed compared to all other venues (p < 0.001). ETS levels in Greek designated non-smoking areas are similar to those found in the smoking sections of UK hospitality venues while levels in Ireland with a total smoking ban are 89% lower and smoke-free communities in the US are 91 - 96% lower than levels in Greece. CONCLUSION: Designated non-smoking areas of hospitality venues in Greece are significantly more polluted with ETS than outdoor air and similar venues in Europe and the United States. The implementation of a total indoor smoking ban in hospitality venues has been shown to have a positive effect on workers and patrons' health. The necessity of such legislation in Greece is thus warranted.

General Practice as a career choice among undergraduate medical students in Greece.

BACKGROUND: Although General Practice (GP) was recognized as a medical specialty in Greece in 1986, the number of GPs is insufficient to cover needs and only few medical graduates choose GP as a career option. In the present study we investigated the profile of medical students in terms of their decisions regarding specialization and the possible association of career choices different from GP with the status of undergraduate training regarding GP. METHODS: The sample consisted of final year students in the Medical School of the University of Athens, Greece. Students filled in a self-reported questionnaire focusing on medical specialization, and GP in particular. RESULTS: Response rate was 82.5% with 1021 questionnaires collected, out of 1237 eligible medical students. Only 44 out of the 1021 (4.3%) respondents stated that GP is -or could be- among their choices for specialty. The most popular medical specialty was General Surgery (10.9%), followed by Cardiology (9.6%), Endocrinology (8.7%) and Obstetrics-Gynaecology (8.3%). The most common criterion for choosing GP was the guaranteed employment on completion of the residency (54.6%) while a 56.6% of total respondents were positive to the introduction of GP/FM as a curriculum course during University studies. CONCLUSION: Despite the great needs, GP specialty is currently not a career option among undergraduate students of the greater Medical University in Greece and is still held in low esteem. A university department responsible for undergraduate teaching, promotion and research in GP (where not available) is essential; the status of undergraduate training in general practice/family medicine seems to be one of the most important factors that influence physician career choices regarding primary care specialties.