Anastas Philalithis

Variations in prevalence of attention deficit hyperactivity disorder worldwide

Attention deficit hyperactivity disorder (ADHD) is among the most common, intensely investigated, and yet diagnostically controversial neurobehavioral conditions of childhood. The prevalence of ADHD has been reported with great variations among different studies, ranging from 2.2% to 17.8%. The aim of this review was to investigate the variables that influence the prevalence of ADHD and to derive a best estimate for the prevalence of the disorder. We reviewed all the 39 studies on ADHD prevalence appearing in the Pubmed and published since 1992. These studies indicate that ADHD is more common in boys than girls, in younger than older children and adolescents, in one-setting rather than two-setting screening studies, in studies based on DSM-IV rather than DSM-III-R criteria. Additional factors that may well influence prevalence rates include source of information and assessment of clinical impairment. In conclusion, our findings suggest that population characteristics, methodology features, ethnic and cultural differences and diagnostic criteria involved in studies affect the prevalence of ADHD. Standardized designs may lead to firm conclusions on the true prevalence of ADHD, the estimation of which seems impossible to be achieved by reviewing the already existing literature.

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

BackgroundAlthough 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.MethodsThe 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.ResultsResponse 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.ConclusionDespite 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.

Prevalence of multiple behavioral risk factors for chronic diseases in adults aged 50+, from eleven European countries - the SHARE study (2004)

OBJECTIVE To estimate the prevalence and the associations between multiple behavioral risk factors (MBRFs) for chronic diseases in European adults. METHOD Data from 26,743 individuals, aged 50+years, participating in the Survey of Health, Ageing and Retirement in Europe (SHARE) (2004/05) were used. MBRFs included physical inactivity, high body weight, smoking habits and risky alcohol consumption. Estimations were based on weights according to the complex sampling design. RESULTS In total, 71.2% of individuals were physically inactive, while 59.8% had high body weight. 53.4% had 2+ MBRFs, while males presented higher prevalence of MBRF clusters than females (P < 0.001). Females displayed lower odds of increased alcohol consumption (OR = 0.16, P < 0.001) and higher odds of physical inactivity (OR = 1.47, P < 0.001) than males. Individuals who lived alone, compared to living with a partner and those with more, compared to fewer education years, exhibited a significantly higher and lower, respectively, mean MBRF score (P < 0.001). CONCLUSION The prevalence of MBRFs was considerably high in this sample of European adults, while not living alone and having higher education may prove protective. These findings could be used for the design of primary healthcare programs by health professionals.

Attention‐deficit/hyperactivity disorder in schoolchildren in Crete

AIM To explore the prevalence of attention-deficit/hyperactivity disorder (ADHD) in 7-y-old child residents of Crete, Greece. METHODS The study combined information from both parents and teachers for 1708 elementary school children attending the first grade in 101 classes of 55 primary schools. A two-stage screening process was employed, including the ADHD test and a rating scale of student behaviour. Parents completed the ADHD test and teachers the rating scale of student behaviour. RESULTS Both questionnaires were completed for 1285 (75.2%) children. Among them, 84 children (6.5%; 95% CI 5.2-7.9%) met the study criteria for ADHD. The estimated prevalence was 8.8% for boys (95% CI 6.6-11.0%) and 4.2% for girls (95% CI 2.6-5.7%). No significant differences were observed regarding urban, semi-urban or rural residence. CONCLUSION By using a combination screening procedure, both the ADHD prevalence among first-grade schoolchildren in Crete and the gender differences in prevalence were found to be comparable to those reported from other countries. The methods used and the problems faced illustrate the challenges involved in conducting population-based studies of ADHD.

Development of the Social Capital Questionnaire in Greece.

The Greek version of the social capital questionnaire (SCQ-G) was evaluated in a sample of 521 adults drawn from three different urban areas in Greece. Exploratory factor analysis followed by multi-trait scaling yielded six factors: Participation in the Community, Feelings of Safety, Family/Friends Connections, Value of Life and Social Agency, Tolerance of Diversity, and Work Connections. The factor solution is similar to the patterns identified originally in Australia and the US. Variations suggest that social capital does not share the same structure in different countries. The SCQ-G is a useful scale to measure individual-level social capital in Greece. Social capital measurement tools should be validated in each cultural or national setting in which they are used.

Seroprevalence of hepatitis A, B and C markers in Greek warship personnel

A seroepidemiological study was conducted to assess the seroprevalence of hepatitis A, B and C markers in 285 males (mean age: 24.4 ± 4.4 years) aboard a Greek warship. Two hundred and sixty three serum samples were tested. None was found to be positive for HAV antibodies, three persons (1.1%) were positive for HBsAg, four persons (1.5%) were positive for anti-HBc and one person (0.4%) was positive for anti-HCV. Forty-five persons (17.1%) had developed titles anti-HBs >10 IU/L. The establishment of a vaccination policy against hepatitis A among warship personnel is strongly recommended.

Individual determinants of primary healthcare utilisation in Gaza Strip, Palestine

Objectives: To examine the extent to which primary care patients are using the primary healthcare (PHC) services in Gaza Strip, Palestine, and to determine the factors that are associated with the use of these services. Methods: Using Andersen’s behavioural model, the authors interviewed 956 PHC attendees. Patients were questioned about predisposing factors: age, sex, marital status, education, work status, household size, life events (psychological and financial), perceived living conditions and health locus of control. Enabling factors included urbanisation and household income. Need factors included self-rated health. Healthy lifestyle was measured by two variables: smoking and physical activity. Outcome factors were measured by patients’ satisfaction with PHC. Results: The study revealed that the majority of interviewed patients (64.7%) reported high use (>3 times per 6 months) of PHC within the 6-month period before the interview. The main factors found to be associated with high use of PHC were older age, married and divorced/widowed status, perceived bad living conditions, not working, high level of income, poorly rated health status and current smoking habit. Conclusions: Gazean primary care patients are high users of PHC services. The increased use of these services is associated with the basic predisposing, enabling and needs factors and with the unique bad living conditions. Tobacco use was another aspect associated with high use of PHC. Effective health management, based on promoting a healthy lifestyle, is needed. The findings of this study can be used to improve health service planning and guide decision-makers towards healthcare resource allocation according to healthcare needs.

Epidemiologic profile of otorhinolaryngological, head and neck disorders in a tertiary hospital unit in Greece: a challenge for general practitioners?

BackgroundIn Greece, primary care is still developing. The aim of this study was to define the epidemiologic profile of common otorhinolaryngological, head and neck disorders in order to help general practitioners to deal with them in a primary care future.MethodsA total of 6771 patients attended the Otorhinolaryngology emergency department of the University General Hospital of Heraklion (Crete), between January and December 2004. All cases were included in this retrospective study. The registry of the Otorhinolaryngology emergency department was analysed and age, sex, seasonality and clinical diagnosis were tabulated. All patients were evaluated by Otorhinolaryngologists. The classification of the cases was based on the main symptom or clinical sign that conditioned the reason for seeking care. Diagnoses were also coded according to the International Classification of Diseases (ICD-10).ResultsThe male to female ratio was 1:1. The mean age for females was 36.3 years standard deviation (SD): 21.1 and for males was 36.8 years (SD = 22.0). Eight hundred eighty six patients (13.1%) formed the paediatric sub-group. Over 60% of the cases were classified in ten major groups of diagnosis. Acute tonsillitis (12.3%) and acute pharyngitis (9.0%) were the most common causes of all medical visits, followed by otitis media (7.6%) and external ear canal obstruction by ear wax (6.2%). Oedema of the larynx was detected in 0.4%. A negative diagnosis of otorhinolaryngological, head and neck disorder was formulated in 553 patients (8.2%). Hospitalization rate was 5.2%. The highest rate of visits was registered in March.ConclusionMost patients used the facility as a primary care service. Real emergencies were a minority. Recovering data about which areas of Otorhinolaryngology deserve more emphasis might help primary health care providers to diagnose and manage the common otorhinolaryngological, head and neck disorders properly.

Unintentional Injuries among School-Aged Children in Palestine: Findings from the National Study of Palestinian Schoolchildren (HBSC-WBG2006)

Purpose. This study describes the nonfatal injuries among adolescents in Palestine. Methods. The 2006 Palestinian Health Behaviour in School-aged Children (HBSC) is a cross-sectional survey. Students of grades 6, 8, 10, and 12 completed a modified version of the international HBSC questionnaire, resulting in 15,963 students (47.3% boys and 52.7% girls) included in this study (56.9% from the West Bank and 43.1% from Gaza). Results. Of the total 15,963 adolescents, 47.6% were injured, with boys (53.5%) being statistically higher than girls (42.1%) (). The prevalence of those injured more than once decreased by age and was also found significantly higher in boys than in girls (27.3% and 17.9%, resp.) (). Children living in low FAS families showed significantly lower ratios of injuries than those living in moderate and high FAS families (). Injuries while biking were significantly higher among boys (46.3%) than girls (41.7%) (), and injuries while walking/running were more prevalent among girls (32.5%) than boys (28.0%) (). Conclusion. Despite these considerably high rates, injury remains relatively underappreciated. Results of this study are useful to develop a national injury prevention program aimed at enhancing the safety of Palestinian adolescents.

Social capital and regular alcohol use and binge drinking in adolescence: A cross-sectional study in Greece

Aims: The purpose of this study is to examine the gender-specific associations of different dimensions of individual-level social capital with regular alcohol consumption and binge drinking in 16–17 years old adolescents in Crete, Greece. Methods: Of the 835 randomly selected students, 708 completed the Youth Social Capital Scale and the Health Behaviours in School-aged Children (HBSC) questionnaire from April through June 2008 and 650 (92%) were included in this analysis. The outcome of interest was regular alcohol use and binge drinking. A gender specific backward stepwise logistic multivariate regression was performed adjusted for potential confounders. Findings: For both boys and girls, higher score on some structural social capital subscales was associated, per unit increase, with increased likelihood of regular drinking. Neighbourhood connections were also associated with increased binge drinking in girls. Cognitive social capital subscales were associated with decreased likelihood of binge drinking in girls. For both genders, total social capital-score was positively associated with the probability of regular, but not of binge drinking. Conclusions: Cognitive and structural social capital dimensions have different patterns of association with regular and binge alcohol use in adolescent boys and girls. Social capitals dimensions should receive greater emphasis for the design of effective preventive interventions in adolescence, particularly in the light of an increasing prevalence of alcohol consumption in modern societies.