Relationship between obesity index and cardiovascular risk in primary care patients on Crete, Greece: a data driven sub-analysis.

BACKGROUND: The present sub-analysis aimed to examine the relationship between obesity index and cardiovascular risk among primary care attendees. STUDY DESIGN: Stratified random sampling was previously used to recruit general practitioners, practicing on Crete island, Greece, whose patients were then enrolled. METHODS: Initial sample included 815 primary care attendees (55.7% women; mean age 65.2 years; range 40-98 years). Due to missing values regarding 13 participants, data from 802 patients were included for the current analysis. Body measurements (weight, height), among other bio-clinical parameters, were recorded upon practice visit. The 10-year cardiovascular disease risk was estimated using the European Society of Cardiology (and other societies), 10-year Systematic Coronary Risk Estimation and multivariate linear regression was used to assess relationships between Obesity Index and cardiovascular disease risk. RESULTS: Higher risk is shown to be significantly related with male gender, older age, unemployed/retired status, urban area of living or smoking (p<0.05), as well as with higher levels of obesity index (stand. beta=0.048, p=0.028). CONCLUSIONS: Obesity Index may be useful for cardiovascular disease risk prediction and correction at the primary care settings, since obesity is easily addressed during the first medical contact.

Robustness of the EUROPEP questionnaire as regards data quality, reliability, and construct validity: The Greek experience before and after the economic crisis.

OBJECTIVES: To assess the data quality, reliability, and construct validity of the Greek EUROPEP and to examine the instrument's robustness in terms of its psychometric properties in a pre- and post-economic crisis period. METHODS: Taking into account the two key factors that affect the accuracy and quality of survey data, that is the representativeness of the sample selected from the population, and the response rate, four hundred ninety-two and five hundred thirty-two patients (492 and 532 patients) pre- and post-crisis, respectively, consulting GPs at 16 Primary Health Care Centers (PHCCs) in Greece were invited to complete the Greek EUROPEP. We assessed item missing, ceiling and floor effects, and used factor analysis to assess the structure of the 23 items of the EUROPEP. Scales were tested for reliability and construct validity. We further examined if the scales of EUROPEP need to be refined, taking into account the external validity across economic crises. RESULTS: Factor analysis identified three groups of questions that formed scales with satisfactory internal consistency reliability, and validity. The clinical behavior scale, the support, and services scale, and the organization of care scale, all met the criterion of 0.7 for Cronbach's alpha. All scales were found to have a significant correlation with the majority of the examined variables. Moreover, the EUROPEP was found to be robust in effectively detecting differences in patients' views over time in different economic contexts. CONCLUSIONS: The study identified three scales in the Greek EUROPEP-questionnaire with satisfactory psychometric properties, and its Greek version could be used in the recent primary health care (PHC) reform in this country.

Vaccination coverage of general practitioners: a cross-sectional study from Greece.

OBJECTIVES: Vaccination coverage of general practitioners (GPs) is important for their own and for their colleagues' and patients' protection and has been associated with the coverage of the general population. Our study aims to evaluate the vaccination practices of GPs in Crete, Greece. STUDY DESIGN: Cross-sectional, questionnaire-based survey. METHODS: All practicing GPs in Crete (n = 294) were surveyed either by questionnaires or by phone call. We assessed the vaccination coverage and practices for influenza, measles, hepatitis B, and pertussis (booster Tdap dose) and the reasons for nonvaccination for influenza. RESULTS: A total of 260 (88% response rate) GPs participated. Vaccination rates were 56% for influenza (current season), 26% for measles (two doses), 68% for hepatitis B (three doses), and 18% for the booster dose with Tdap. Negligence (47%) and perceived low risk (29.6%) were the most common reasons for nonvaccination for influenza. History of natural measles infection was reported by 169 (65%) GPs, but none of the interviewed 31 provided laboratory confirmation. GPs with self-reported natural measles infection were less vaccinated than their peers (10% vs 55%, P < 0.001). Finally, 23 of 130 (18%) GPs contacted by phone falsely reported vaccination with Tdap in their childhood, when Tdap was not yet available. CONCLUSION: This study revealed insufficient vaccination rates and misconceptions among GPs that should be the focus of future evidence-based interventions with potential to significantly improve vaccination coverage of GPs and indirectly of their patients.

The Therapeutic Potential of the Essential Oil of Thymbra capitata (L.) Cav., Origanum dictamnus L. and Salvia fruticosa Mill. And a Case of Plant-Based Pharmaceutical Development.

This review performs a comprehensive assessment of the therapeutic potential of three native herbs of Crete (Thymbra capitata (L.) Cav., Salvia fruticosa Mill. and Origanum dictamnus L.), their phytochemical constituents, health benefits and issues relevant to their safety, within a translational context. Issues discussed comprise: 1) Ethnopharmacological uses of the three herbs, reviewed through an extensive search of the literature; 2) Systematic analysis of the major phytochemical constituents of each plant, and their medicinal properties; 3) To what extent could the existing medicinal properties be combined and produce an additive or synergistic effect; 4) Possible safety issues. We conclude with a specific example of the use of a combination of the essential oils of these plants as an effective anti-viral product and the experience gained in a case of a plant-based pharmaceutical development, by presenting the major steps and the continuum of the translational chain.

Lifestyle, anthropometric, socio-demographic and perinatal correlates of early adolescence hypertension: The Healthy Growth Study.

BACKGROUND AND AIMS: Various lifestyle, anthropometric, socio-demographic and perinatal characteristics have been separately associated with elevated blood pressure in children and adolescents. The aim of this study was to simultaneously evaluate all potential risk factors and to identify the most dominant correlates of early adolescence hypertension in a large group of school children 9-13 years old. METHODS AND RESULTS: A cross-sectional study with 1444 schoolchildren 9-13 years old, having full data on lifestyle, anthropometric, socio-demographic and perinatal indices, as well as blood pressure measurements. Early adolescents born large for their gestational age (LGA) (OR, 95% C.I. 0.49 (0.25-0.97)), those with higher levels of moderate to vigorous physical activity (MVPA) (OR, 95% C.I. 0.71 (0.53-0.96)) and those of a higher socioeconomic status (SES) (OR, 95% C.I. 0.51 (0.33-0.79)), had lower risk of hypertension, compared with their counterparts with appropriate birth weight, low levels of PA and with low SES respectively, independently of the variables used in the multivariate model. On the other hand, overweight and obese early adolescents (OR, 95% C.I. 2.61 (1.88-3.62)), those with central obesity (OR, 95% C.I. 1.75 (1.12-2.73)) and those having a hypertensive father (OR, 95% C.I. 1.93 (1.20-3.12)) had higher risk of hypertension compared with normal weight early adolescents and those without a family history of hypertension. CONCLUSIONS: Among the parameters examined, early adolescence abnormal body weight and central obesity, low PA, non LGA, low SES family and family history of hypertension were found to be independently associated with higher risk of hypertension. The identified correlates of early adolescence hypertension can be used by public health initiatives for early detection and management of this major public health problem, prioritizing early adolescents and families at the highest possible risk for hypertension.

Citizen Preferences for Primary Health Care reform in Greece.

BACKGROUND: The Greek National Health System is currently pursuing the strengthening of Primary Health Care (PHC). Citizen preferences for healthcare service utilization, their views on structural reform of the current system, and the profiling of those in favor of PHC are essential in planning a reform that respects citizens' needs. However, data on this topic in the country are scarce. The present study maps citizen preferences for health care reform in the primary care sector in Greece. METHODS: In March 2017, a sample of 1,002 citizens were surveyed by telephone. The survey was repeated with a different sample of 1,001 persons in October 2017. Both samples were defined via a random multistage selection process using a quota for the municipality of residence, sex, and age. Responders were asked to rate their satisfaction with the existing healthcare system and to rank their preferences as to the most important elements of future structural reform. Barriers to accessing healthcare services and in the implementation of structural reform as well as actual healthcare services utilization were also recorded. A logistic regression model was used to identify sample characteristics independently associated with the most requested reform. RESULTS: Citizens preferred to visit physicians -as outpatients- in their private practices (50.5 % in March and 44 % in October) rather than in public health services (17.8 % and 18 %, respectively). For 86.9 % and 85.6 %, respectively, structural reform of the current health system was considered "very" or "extremely necessary". The introduction of family physicians in the system was the most requested reform (48 % and 49.4 %, respectively). Citizens in older age groups were more likely to request the implementation of family physicians (25-39 years old: OR: 2.14, 95 % CI: 1.36-3.37; 40-54 years old: OR: 2.89, 95 % CI: 1.85-4.52; 55-64 years old: OR: 3.62, 95 % CI: 2.27-5.78; and over 65 years old: OR: 3.32, 95 % CI: 2.10-5.26). Male responders were 23 % less likely (OR: 0.77, 95 % CI: 0.63-0.93) to be in favor of this reform, after controlling for the other variables in the model. CONCLUSIONS: Both survey streams reveal the growing demand for structural reform in the current healthcare system. Strengthening PHC is the most requested reform. Older and female citizens were more likely to be in favor of this reform. Integrating the private sector in developing a comprehensive PHC system, enhancing existing public health services, and increasing public awareness of the advantages of PHC should be considered critical elements of a high-quality PHC system. HIPPOKRATIA 2019, 23(3): 111-117.

Single-payer or a multipayer health system: a systematic literature review.

OBJECTIVES: Healthcare systems worldwide are actively exploring new approaches for cost containment and efficient use of resources. Currently, in a number of countries, the critical decision to introduce a single-payer over a multipayer healthcare system poses significant challenges. Consequently, we have systematically explored the current scientific evidence about the impact of single-payer and multipayer health systems on the areas of equity, efficiency and quality of health care, fund collection negotiation, contracting and budgeting health expenditure and social solidarity. STUDY DESIGN: This is a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. METHODS: A search for relevant articles published in English was performed in March 2015 through the following databases: Excerpta Medica Databases, Cumulative Index of Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online through PubMed and Ovid, Health Technology Assessment Database, Cochrane database and WHO publications. We also searched for further articles cited by eligible papers. RESULTS: A total of 49 studies were included in the analysis; 34 studied clinical outcomes of patients enrolled in different health insurances, while 15 provided a qualitative assessment in this field. CONCLUSION: The single-payer system performs better in terms of healthcare equity, risk pooling and negotiation, whereas multipayer systems yield additional options to patients and are harder to be exploited by the government. A multipayer system also involves a higher administrative cost. The findings pertaining to the impact on efficiency and quality are rather tentative because of methodological limitations of available studies.

Systematic review: probiotics in the management of lower gastrointestinal symptoms - an updated evidence-based international consensus.

BACKGROUND: In 2013, a systematic review and Delphi consensus reported that specific probiotics can benefit adult patients with irritable bowel syndrome (IBS) and other gastrointestinal (GI) problems. AIM: To update the consensus with new evidence. METHODS: A systematic review identified randomised, placebo-controlled trials published between January 2012 and June 2017. Evidence was graded, previously developed statements were reassessed by an 8-expert panel, and agreement was reached via Delphi consensus. RESULTS: A total of 70 studies were included (IBS, 34; diarrhoea associated with antibiotics, 13; diarrhoea associated with Helicobacter pylori eradication therapy, 7; other conditions, 16). Of 15 studies that examined global IBS symptoms as a primary endpoint, 8 reported significant benefits of probiotics vs placebo. Consensus statements with 100% agreement and "high" evidence level indicated that specific probiotics help reduce overall symptom burden and abdominal pain in some patients with IBS and duration/intensity of diarrhoea in patients prescribed antibiotics or H. pylori eradication therapy, and have favourable safety. Statements with 70%-100% agreement and "moderate" evidence indicated that, in some patients with IBS, specific probiotics help reduce bloating/distension and improve bowel movement frequency/consistency. CONCLUSIONS: This updated review indicates that specific probiotics are beneficial in certain lower GI problems, although many of the new publications did not report benefits of probiotics, possibly due to inclusion of new, less efficacious preparations. Specific probiotics can relieve lower GI symptoms in IBS, prevent diarrhoea associated with antibiotics and H. pylori eradication therapy, and show favourable safety. This study will help clinicians recommend/prescribe probiotics for specific symptoms.

Prevalence of childhood hypertension and hypertension phenotypes by weight status and waist circumference: the Healthy Growth Study.

PURPOSE: The aim of the present study was to report for the first time the prevalence of hypertension and its phenotypes in obese children and in children with central obesity in a large sample of Greek children. METHODS: A regionally representative sample of 2263 schoolchildren (50.3% boys) (9-13 years) having full data on blood pressure assessment, physical examination, anthropometric, and physical activity participated in a cross-sectional study in Greece. RESULTS: Prevalence of stage 1 and 2 hypertension, of isolated systolic hypertension (ISH) and of combined systolic or diastolic hypertension, was significantly higher for obese children and children on the 3rd tertile of waist circumference in the total sample, as well as in each gender separately. ISH was the most prevalent phenotype reaching 24.3% in obese children and 17.5% in children on the highest tertile of waist circumference. Obese children and children on the highest tertile of waist circumference had 6.31 times and 3.94 times, respectively, higher likelihood to have abnormal systolic or diastolic blood pressure (SBP or DBP) than their normal-weight counterparts. CONCLUSIONS: Prevalence of hypertension and especially ISH in obese children and in children with central obesity in Greece are among the highest reported in Europe. Future public health initiatives should aim to prevent or tackle several underlying factors related to childhood hypertension, focusing primarily on children with excess body weight.

Patients' intention to consume prescribed and non-prescribed medicines: A study based on the theory of planned behaviour in selected European countries.

WHAT IS KNOWN AND OBJECTIVE: Polypharmacy has a significant impact on patients' health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care. METHODS: A multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews. RESULTS AND DISCUSSION: The percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients' intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed. WHAT IS NEW AND CONCLUSION: This study shows that parameters such as patients' beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients' behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines.

Association between Siesta (Daytime Sleep), Dietary Patterns and the Presence of Metabolic Syndrome in Elderly Living in Mediterranean Area (Medis Study): The Moderating Effect of Gender.

OBJECTIVES: Several lifestyle parameters including diet, physical activity and sleep were associated in isolation with the presence of Metabolic Syndrome (MetS) in adults, to date there is a paucity of studies which evaluated their combined role aging populations and especially with respect to gender. Therefore, the aim of the present study was to provide a global consideration of the lifestyle factors associated with MetS among elderly individuals. DESIGN: Cross-sectional observational study. SETTING: 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece. PARTICIPANTS: during 2005-2015, 2749 older (aged 65-100 years) from were voluntarily enrolled in the study. MEASUREMENTS: Dietary habits, energy intake, physical activity status, socio-demographic characteristics, lifestyle parameters (sleeping and smoking habits) and clinical profile aspects were derived through standard procedures. The presence of MetS was defined using the definition provided by NCEP ATP III (revised) and cluster analysis was used to identify overall dietary habit patterns. RESULTS: The overall prevalence of MetS in the study sample was 36.2%, but occurred more frequently in females (40.0% vs. 31.8%, respectively, p=0.03). Individuals with MetS were more likely to sleep during the day (89.4% vs. 76.8% respectively, p=0.039) and frequent 'siesta' was positively linked to the odds of MetS presence in females (Odds Ratio (OR) =3.43, 95% Confidence Intervals (CI): 1.08-10.9), but not for men (p=0.999). The lower carbohydrate (i.e., 45.2% of total daily energy, 120±16gr/day) dietary cluster was inversely associated with the odds for MetS presence, but only for men (OR=0.094, 95%CI: 0.010-0.883). CONCLUSIONS: Lifestyle parameters including sleep and diet quality are strongly associated with the presence of MetS in elderly cohort, but different their level of influence appears to be different, depending on gender. Further research is needed to better consider the role of lifestyle characteristics in the management of MetS in clinical practice.

Using Participatory Learning & Action (PLA) research techniques for inter-stakeholder dialogue in primary healthcare: an analysis of stakeholders' experiences.

PLAIN ENGLISH SUMMARY: It is important for health care workers to know the needs and expectations of their patients. Therefore, service users have to be involved in research. To achieve a meaningful dialogue between service users, healthcare workers and researchers, participatory methods are needed. This paper describes how the application of a specific participatory methodology, Participatory Learning and Action (PLA) can lead to such a meaningful dialogue. In PLA all stakeholders are regarded as equal partners and collaborators in research.During 2011-2015, a European project called RESTORE used PLA in Austria, Greece, Ireland, The Netherlands and the UK to investigate how communication between primary health care workers and their migrant patients could be improved.Seventy eight migrants, interpreters, doctors, nurses and other key stakeholders (see Table 2) participated in 62 PLA sessions. These dialogues (involving discussions, activities, PLA techniques and evaluations) were generally 2-3 h long and were recorded and analysed by the researchers.Participants reported many positive experiences about their dialogues with other stakeholders. There was a positive, trusting atmosphere in which all stakeholders could express their views despite differences in social power. This made for better understanding within and across stakeholder groups. For instance a doctor changed her view on the use of interpreters after a migrant explained why this was important. Negative experiences were rare: some doctors and healthcare workers thought the PLA sessions took a lot of time; and despite the good dialogue, there was disappointment that very few migrants used the new interpreting service. ABSTRACT: Background In order to be effective, primary healthcare must understand the health needs, values and expectations of the population it serves. Recent research has shown that the involvement of service users and other stakeholders and gathering information on their perspectives can contribute positively to many aspects of primary healthcare. Participatory methodologies have the potential to support engagement and dialogue between stakeholders from academic, migrant community and health service settings. This paper focuses on a specific participatory research methodology, Participatory Learning and Action (PLA) in which all stakeholders are regarded as equal partners and collaborators in research.Our research question for this paper was: "Does the application of PLA lead to meaningful engagement of all stakeholders, and if so, what elements contribute to a positive and productive inter-stakeholder dialogue?". Methods We explored the use of PLA in RESTORE, a European FP7-funded project, during 2011-2015 in 5 countries: Austria, Greece, Ireland, the Netherlands and the UK. The objective of RESTORE was to investigate and support the implementation of guidelines and training initiatives (G/TIs) to enhance communication in cross-cultural primary care consultations with migrants.Seventy eight stakeholders (migrants, interpreters, doctors, nurses and others - see Table 2) participated in a total of 62 PLA sessions (discussions, activities, evaluations) of approximately 2-3 h' duration across the five sites. During the fieldwork, qualitative data were generated about stakeholders' experiences of engagement in this dialogue, by means of various methods including participatory evaluations, researchers' fieldwork reports and researcher interviews. These were analysed following the principles of thematic analysis. Results Stakeholders involved in PLA inter-stakeholder dialogues reported a wide range of positive experiences of engagement, and very few negative experiences. A positive atmosphere during early research sessions helped to create a sense of safety and trust. This enabled stakeholders from very different backgrounds, with different social status and power, to offer their perspectives in a way that led to enhanced learning in the group - they learned with and from each other. This fostered shifts in understanding - for example, a doctor changed her view on interpreted consultations because of the input of the migrant service-users. Conclusion PLA successfully promoted stakeholder involvement in meaningful and productive inter-stakeholder dialogues. This makes it an attractive approach to enhance the further development of health research partnerships to advance primary healthcare.

Implementing guidelines and training initiatives to improve cross-cultural communication in primary care consultations: a qualitative participatory European study.

BACKGROUND: Cross-cultural communication in primary care is often difficult, leading to unsatisfactory, substandard care. Supportive evidence-based guidelines and training initiatives (G/TIs) exist to enhance cross cultural communication but their use in practice is sporadic. The objective of this paper is to elucidate how migrants and other stakeholders can adapt, introduce and evaluate such G/TIs in daily clinical practice. METHODS: We undertook linked qualitative case studies to implement G/TIs focused on enhancing cross cultural communication in primary care, in five European countries. We combined Normalisation Process Theory (NPT) as an analytical framework, with Participatory Learning and Action (PLA) as the research method to engage migrants, primary healthcare providers and other stakeholders. Across all five sites, 66 stakeholders participated in 62 PLA-style focus groups over a 19 month period, and took part in activities to adapt, introduce, and evaluate the G/TIs. Data, including transcripts of group meetings and researchers' fieldwork reports, were coded and thematically analysed by each team using NPT. RESULTS: In all settings, engaging migrants and other stakeholders was challenging but feasible. Stakeholders made significant adaptations to the G/TIs to fit their local context, for example, changing the focus of a G/TI from palliative care to mental health; or altering the target audience from General Practitioners (GPs) to the wider multidisciplinary team. They also progressed plans to deliver them in routine practice, for example liaising with GP practices regarding timing and location of training sessions and to evaluate their impact. All stakeholders reported benefits of the implemented G/TIs in daily practice. Training primary care teams (clinicians and administrators) resulted in a more tolerant attitude and more effective communication, with better focus on migrants' needs. Implementation of interpreter services was difficult mainly because of financial and other resource constraints. However, when used, migrants were more likely to trust the GP's diagnoses and GPs reported a clearer understanding of migrants' symptoms. CONCLUSIONS: Migrants, primary care providers and other key stakeholders can work effectively together to adapt and implement G/TIs to improve communication in cross-cultural consultations, and enhance understanding and trust between GPs and migrant patients.

Lung cancer and tobacco smoking in Crete, Greece: reflections from a population-based cancer registry from 1992 to 2013.

BACKGROUND: The Cancer Registry of Crete is a regional population database that collects cancer morbidity/mortality data along with several risk factors. The current study assessed the geographical variation of lung cancer among ever and never smokers in Crete during the last 20 years. METHOD: Lung cancer patient records (1992-2013) including information on medical history and smoking habits were obtained from the Cancer Registry of Crete. Age-Adjusted Incidence Rates (AAIR), prevalence of smoking among lung cancer patients and the Population-Attributable Fraction (PAF%) of tobacco smoking were estimated. Kaplan-Meier curves, grouped per smoking status were constructed, and spatio-temporal analyses were carried out to assess the geographical variations of lung cancer and smoking (a = 0.05). RESULTS: New lung cancer cases in Crete accounted for 9% of all cancers (AAIRboth genders = 40.2/100,000/year, AAIRmales = 73.1/100,000/year, AAIRfemales = 11.8/100,000/year). Ever smokers presented significantly higher incidence compared to ex-smokers (p = 0.02) and never smokers (p < 0.001). The highest increase was observed in ever smokers (AAIR1992 = 19.2/100,000/year, AAIR2013 = 25.4/100,000/year, p = 0.03), while never smokers presented the lowest increase from 1992 to 2013 (AAIR1992 = 5.3/100,000/year, AAIR2013 = 6.8/100,000/year, p = 0.2). The PAF% of lung cancer mortality is 86% for both genders (males: 89%, females: 78%). AAIRs ranged from 25 to 50/100,000/year, while significant geographical differences were observed among the municipalities of Crete (p = 0.02). Smokers living in the south-east urban regions presented higher risk of dying from lung cancer (RR = 2.2; 95%CI = 1.3-3.5). CONCLUSIONS: The constant increase of lung cancer rates among both genders, especially in females, outlines the need for targeted, geographically-oriented, life-style preventive measures. Design of population-based screening programs, tobacco awareness campaigns and smoking cessation programs in lung cancer hot spots could be guide by these findings.

Reporting effectiveness of an extract of three traditional Cretan herbs on upper respiratory tract infection: results from a double-blind randomized controlled trial.

ETHNOPHARMACOLOGICAL RELEVANCE: Observations from the island of Crete, Greece suggest that infusions of traditional Cretan aromatic plants, well known for their ethnopharmacological use in Eastern Mediterranean region and Near East, could be effective in the prevention and treatment of upper respiratory tract infections, including viral-induced infections. The aim of this study was to report the effectiveness of an essential-oil extract of three Cretan aromatic plants in the treatment of cases with an upper respiratory tract infection. MATERIALS AND METHODS: A double blind randomized controlled trial was implemented between October 2013 and February 2014. An essential-oil extract of Cretan aromatic plants in olive oil (total volume of 15ml of essential oil per litre of olive oil) was administered as 0.5ml soft gel capsules, twice a day, for 7 days. Placebo treatment was 0.5ml olive oil in soft gel capsules. Eligible patients were those presenting for clinical examination in the selected setting with signs and symptoms of upper respiratory tract infection that had begun within the previous 24 hours. Real-Time Polymerase Chain Reaction (PCR) was used for the detection of respiratory viruses. The primary outcome was the severity and duration of symptoms of upper respiratory tract infection, assessed using the Wisconsin Upper Respiratory System Survey (WURSS-21) questionnaire. A secondary outcome of interest was the change in C-reactive protein (CRP) status. RESULTS: One hundred and five patients completed the study: 51 in the placebo group, and 54 in the intervention (treated) group. Baseline characteristics were similar in the two groups. No statistically significant differences were found in symptom duration or severity between the two groups, although small and clinically favorable effects were observed. When the analysis was restricted to subjects with a laboratory-documented viral infection, the percentage of patients with cessation of symptoms after 6 days of treatment was 91% in the intervention group and 70% in the control group (p=0.089). At baseline, one third of the patients in each group had elevated CRP levels. At follow-up, the respective proportions were 0% in the intervention group and 15% in the placebo group (p=0.121). The data were also in a favorable direction when 50% and 80% symptom reduction points were considered for specific virus types. CONCLUSIONS: Compared with placebo the essential-oil extract of three Cretan aromatic plants provided no detectable statistically significant benefit or harm in the patients with upper respiratory illness, although descriptive differences were identified in favorable direction mainly in the virus-positive population.

Revised Healthy Lifestyle-Diet Index and associations with obesity and iron deficiency in schoolchildren: The Healthy Growth Study.

BACKGROUND: The Healthy Lifestyle-Diet Index (HLD-index), previously developed to assess the degree of adherence to dietary and lifestyle guidelines for primary schoolchildren, was revised according to updated recommendations. Τhe association of the revised HLD-index (R-HLD-index) with obesity and iron deficiency (ID) was also examined. METHODS: A representative sample of 2660 primary schoolchildren from Greece (9-13 years old) participating in the 'Healthy Growth Study' was examined. Twelve components related to dietary and lifestyle patterns were used to develop the R-HLD-index. Scores from 0 up to 4 were assigned to each one of these components, giving a total score ranging from 0 to 48. The associations between the R-HLD-index, obesity and ID were examined via logistic regression analysis. RESULTS: The total score of the R-HLD-index calculated for each one of the study participants was found to range between 2 and 32 units, with higher scores being indicative of a healthier lifestyle and better diet quality. After adjusting for potential confounders, logistic regression analysis showed that an increase in the R-HLD-index score by one unit was associated with 6% lower odds for obesity. However, no significant association was observed between the R-HLD-index score and ID. CONCLUSIONS: The R-HLD-index may be a useful tool for public health policy makers and healthcare professionals when assessing diet quality and lifestyle patterns of primary schoolchildren. Identification of children with lower scores in the R-HLD-index and its individual components could guide tailored made interventions targeting specific children and behaviors.

The Problem Areas in Diabetes (PAID) scale: psychometric evaluation survey in a Greek sample with type 2 diabetes.

Several instruments have been developed for the assessment of emotional distress in patients with diabetes. The Problem Areas in Diabetes Scale (PAID) is a brief self-report scale that evaluates diabetes-related distress. There is a lack of validated instruments for the evaluation of psychological aspects in patients with diabetes in Greek language. The current study was conducted to translate and adapt the PAID scale in Greek language and to evaluate the psychometric properties in two different study populations of patients with diabetes. The aim of this study was to translate the Problem Areas in Diabetes (PAID) scale into Greek, adapt it culturally to Greece and determine its psychometric properties. The translation process included two forward translations, reconciliation, backward translation and pre-testing steps. The validation incorporated the exploration of internal consistency (Cronbach's alpha), test-retest reliability (interclass correlation coefficient), construct validity (exploratory factor analysis) and responsiveness (Spearman correlation coefficient). Participants included 101 consecutive patients from a rural primary healthcare centre and 101 patients from an urban hospital. All patients completed the PAID scale and the Short Form-36 (SF-36) version 2. Internal consistency considered good (Cronbach's alpha = 0.948). Interclass correlation coefficient was 0.942 (95% CI 0.915-0.961). Factor analysis yielded three factors: 'Diabetes-related emotional problems' (51.79% variance, Cronbach's alpha = 0.910), 'Food-related problems' (9.55% variance, Cronbach's alpha = 0.824) and 'Social support-related problems' (5.96% variance, Cronbach's alpha = 0.704). Screen plot test and conceptual congruency of items supported a three-factor solution. Total PAID showed a negative correlation with both SF-36 mental component summary (r = -0.733, P < 0.0001) and SF-36 physical component summary (r = -0.594, P < 0.0001). Our findings indicate that the Greek version of the PAID questionnaire is reliable and valid for patients with diabetes mellitus in Greece.