Angelos A. Papadopoulos

Assessing the socio-economic and demographic impact on health-related quality of life: evidence from Greece

Objectives:The impact of socioeconomic status on health has been extensively studied and studies have shown that low socio-economic status is related to lower values of various health and quality-of-health measures. The aim of this study was to assess the influence of demographic and socio-economic factors on health- related quality of life (HRQoL).Methods:A cross-sectional study was carried out in 2003 using a representative sample of a Greek general population (n = 1007, 18+ years old), living in Athens area. Multivariate stepwise linear regression analyses were performed to investigate the influence of socio-demographic and economic variables on HRQoL, measured by eight scales of the SF-36. Interaction effects between socioeconomic status (SES) and demographic variables were also performedResults:Females and elderly people were associated with impaired HRQoL in all SF-36 scales. Disadvantaged SES i. e. primary education and low total household income was related to important decline in HRQoL and a similar relation was identified among men and women. Only the interaction effects between age and SES was statistically significant for some SF-36 scales. Multiple regression analyses produced models explaining significant portions of the variance in SF-36 scales, especially physical functioning.Conclusions:The analysis presented here gives evidence of a relationship existing between SES and HRQoL similar to what has been found elsewhere. In order to protect people from the damaging effects of poverty in health it is important to formulate health promotion educational programs or to direct policies to empower the disposable income etc. Helping people in disadvantaged SES to achieve the good health that people in more advantaged SES attained would help to prevent the widening of health inequalities.

Predictors of health-related quality of life in type II diabetic patients in Greece

BackgroundDiabetes Mellitus (DM) is a major cause of morbidity and mortality affecting millions of people worldwide, while placing a noteworthy strain on public health funding. The aim of this study was to assess health-related quality of life (HRQOL) of Greek Type II DM patients and to identify significant predictors of the disease in this patient population.MethodsThe sample (N = 229, 52.8% female, 70.0 years mean age) lived in a rural community of Lesvos, an island in the northeast of the Aegean Archipelagos. The generic SF-36 instrument, administered by trainee physicians, was used to measure HRQOL. Scale scores were compared with non-parametric Mann-Whitney and Kruskal-Wallis tests and multivariate stepwise linear regression analyses were used to investigate the effect of sociodemographic and diabetes-related variables on HRQOL.ResultsThe most important predictors of impaired HRQOL were female gender, diabetic complications, non-diabetic comorbidity and years with diabetes. Older age, lower education, being unmarried, obesity, hypertension and hyperlipidaemia were also associated with impaired HRQOL in at least one SF-36 subscale. Multivariate regression analyses produced models explaining significant portions of the variance in SF-36 subscales, especially physical functioning (R2 = 42%), and also showed that diabetes-related indicators were more important disease predictors, compared to sociodemographic variables.ConclusionThe findings could have implications for health promotion in rural medical practice in Greece. In order to preserve a good HRQOL, it is obviously important to prevent diabetes complications and properly manage concomitant chronic diseases. Furthermore, the gender difference is interesting and requires further elucidation. Modifying screening methods and medical interventions or formulating educational programs for the local population appear to be steps in the correct direction.

Effect of three bowel preparations on video-capsule endoscopy gastric and small-bowel transit time and completeness of the examination

Objective. Video capsule endoscopy fails to visualize the caecum in about 20% of patients. The aim of this study was to investigate the effect of different bowel preparations on video capsule endoscopy gastric- (GTT) and small-bowel transit time (SBTT) and the rate of caecal visualization. Material and methods. We retrospectively examined 186 consecutive capsule endoscopy videos undertaken over a 3-year period, excluding cases with diabetes mellitus or gastric surgery (n=28), cases with unknown bowel preparation and those with unreadable data CDs (n=27). Sixty-seven (36%) patients were prepared with a liquid diet (CL), 54 (29%) with sodium phosphate (PS) and 65 (35%) with polyethylene glycol (PEG). Two independent, experienced investigators examined the videos. Results. No difference was found in GTT among CL, PS and PEG preparations (25, 6.7–116.2 min, 34.75, 4.1–125 min, 35, 6.1–128.6 min, respectively, p=0.29). The caecum was visualized in 56/67 (83.6%), 44/54 (81.5%) and 53/65 (81.5%) patients who received CL, PS and PEG, respectively (p=0.9). In the cases where capsule endoscopy reached the caecum, no difference was observed in SBTT among patients that received CL, PS and PEG (264.4±85.9 min, 296.7±79.5 min, 291.3±84 min, respectively, p=0.11). Conclusions. Bowel preparations for capsule endoscopy do not have a significant effect on gastric and small-bowel video capsule transit time and the rate of caecum visualization.

Symptomatic eosinophilic gastritis cured with Helicobacter pylori eradication

Eosinophilic gastroenteritis is a disorder of unknown aetiology, characterised by eosinophilic infiltration of the gastric and intestinal mucosa and peripheral eosinophilia. To date, only two cases have reported the coexistence of Helicobacter pylori gastritis and eosinophilic gastroenteritis. In none of these cases was a causal association between these two entities documented.1,2 We present a case of eosinophilic gastritis cured with H pylori eradication therapy. A 44 year old woman presented with a two month history of vomiting, nausea, and crampy abdominal pain. Her past medical history included idiopathic thrombocytopenic purpura, splenectomy at the age of 11 years, hyperlipidaemia, hypertension, diabetes mellitus type II, and depression. Her medication included valsartan, atenolol, …

Effects of Ageing on Small Bowel Video-Capsule Endoscopy Examination

OBJECTIVES:The effects of ageing on small bowel video-capsule endoscopy (VCE) studies have not been studied prospectively yet.METHODS:We prospectively investigated 120 consecutive VCE studies. Patients were divided into three age groups: <40, 40–64, and ≥65 yr. Two independent investigators examined the completion of the examination and measured the VCE gastric transit time (GTT), small bowel transit time (SBTT), and the proportion of VCE SBTT without clean intestinal mucosa. They also recorded study findings.RESULTS:We examined the videos of 32 (26.7%), 36 (30%), and 52 (43.3%) patients aged under 40, 40–64, and over 64 yr, respectively. VCE completion (cecum visualized) rate was similar in the three groups (81.2%, 77.8%, and 78.8%, respectively, P= 0.96). There was no difference in GTT (P= 0.22) and in SBTT (P= 0.8) among the three age groups. Although in univariate analysis, there was a trend (P= 0.057) for higher proportion of SBTT without clean mucosa in patients over 64 yr (22.65 [12.42–32.22]%) versus patients under 40 (12.65 [4.57–30.7]%) and patients aged 40–64 yr (12.55 [6.12–31.32]%), multivariate linear regression analysis has not confirmed this difference. Older patients had significantly less erosions and normal studies, but they had more angiodysplasias (P < 0.05). All four tumors were detected in the elderly.CONCLUSIONS:Ageing does not affect the completion rate and the quality of bowel preparation for VCE. However, elderly patients have fewer normal studies and more angiodysplasias and tumors in the small bowel.

Effects of alpha-glucosidase inhibitors on mouth to caecum transit time in humans.

The alpha-glucosidase inhibitors acarbose and miglitol have been successfully used to control postprandial hyperglycaemia in diabetics. They probably work by slowing carbohydrate digestion and absorption, but their effect on mouth to caecum transit time has not been studied. The effect acarbose (100 mg), miglitol (100 mg), and placebo on mouth to caecum transit time (380 kcal breakfast with 20 g of lactulose) was investigated in 18 normal volunteers using breath hydrogen analysis. Both miglitol and acarbose significantly increased breath hydrogen excretion (F2,34 = 6.31, p = 0.005) and shortened the mouth to caecum transit time (F2,34 = 3.49, p = 0.04) after breakfast compared with placebo. There was a significant negative correlation between breath hydrogen excretion and mouth to caecum transit time suggesting that with shorter transit times significantly more carbohydrates were spilled into the colon. These results indicate that alpha-glucosidase inhibitors accelerate mouth to caecum transit time by inducing carbohydrate malabsorption.

Reliability and Validity of the Greek QLQ-C30 and QLQ-MY20 for Measuring Quality of Life in Patients with Multiple Myeloma

Objectives. The aim of this study was to assess the psychometric properties of the Greek EORTC QLQ-C30 and QLQ-MY20 instruments. Method. A sample of myeloma patients (N = 89) from two tertiary hospitals were surveyed with the QLQ-C30, QLQ-MY20 and various demographic and disease related questions. The previously validated Greek SF-36 instrument was used as a “gold standard” for health-related quality of life (HRQoL) comparisons. Hypothesized scale structure, internal consistency reliability (Cronbachs alpha) and various forms of construct validity (convergent, discriminative, concurrent and known-groups) were assessed. Results. Multitrait scaling confirmed scale structure of the QLQ-C30 and QLQ-MY20, with good item convergence (96% and 72%) and discrimination (78% and 58%) rates. Cronbachs α was >0.70 for all but one scale (cognitive functioning). Spearmans correlations between similar QLQ-C30 and SF-36 scales ranged between 0.35–0.80 (P < 0.001). Expected interscale correlations and known-groups comparisons supported construct validity. QLQ-MY20 scales showed comparatively lower correlations with QLQ-C30 functional scales, and higher correlations with conceptually related symptom scales. Conclusions. The observed psychometric properties of the two instruments imply suitability for assessing myeloma HRQoL in Greece. Future studies should focus on generalizability of the results, as well as on specific issues such as longitudinal validity and responsiveness.

Dramatic Decline of Acute Appendicitis in Greece over 30 Years: Index of Improvement of Socioeconomic Conditions or Diagnostic Aids?

Background and Aims: There are several reports showing a continuing fall in the incidence of acute appendicitis in the western countries. Our aim was to study the trend of the incidence of acute appendicitis in the Greek population over 30 years. Methods: We analyzed the data referring to the years 1970–1999 on the incidence and mortality of acute appendicitis for the entire Greek population. Data were retrieved from the Annual Bulletin for the Social Welfare and Health Statistics of the National Statistics Service of Greece. In this database, acute appendicitis was a hospital discharge diagnosis. Results: Over the study period, there was a 75% decrease of the age-standardized incidence of acute appendicitis from 652/100,000 to 164/100,000. The median female-to-male ratio of hospitalized patients for appendicitis of the study period (1970–1999) fell progressively from 1.27 in the year 1970 to 0.93 in the year 1999. The case fatality rates remained constant, ranging below 0.09 deaths per 100 appendicitis cases. Conclusion: There is a significant decline of the incidence of acute appendicitis in the Greek population over the years 1970–1999. This time trend is probably related to the improvement of the socioeconomic conditions over the same period and not to the introduction of new diagnostic aids.

Depression, quality of life and primary care: a cross-sectional study.

Objective: To estimate the presence of depression and impairment of quality of life in primary care and identify correlations with demographics and chronic diseases. Materials and methods: 500 people (220 men) that visited the Gytheio Health Center, Greece, participated in the study answering a study questionnaire that included demographic and somatometric data, medical history, the Zung self-rating depression scale (SDS-Zung) and the Short Form 12 (SF-12) scale for quality of life evaluation with a mental component scale (MCS) and a physical component scale (PCS). Results: 163 persons (32.6% of the study population) had SDS-Zung scores over 50 indicating depressive symptomatology. Of those 22% of the study population (70% women) had no awareness of their problem and were under no treatment; 80 (16% of the study population) had mild depressive symptoms (SDS-Zung: 53.12 ± 0.6 [95% CI]) and physical impairment: MCS12: 44.32 ± 1.9 (95% CI), PCS: 39.16 ± 2.2 (95% CI) (p < 0.005) and 23 (4.6% of study population) had moderate symptoms (SDS-Zung: 63.82 ± 1.34 [95% CI]), with mental and physical impairment: MCS12: 36.99 ± 1.88 (95% CI), PCS: 34.83 ± 5.12 (95% CI) (p < 0.005) adjusted for age, sex and co-morbidities. Arthritis and COPD were associated with depressive symptomatology and physical impairment (p < 0.05) and coronary heart disease and congestive heart failure with physical impairment (p < 0.005). Patients under anti-depressive medication had significant depressive symptomatology and decreased quality of life (p < 0.0005). Conclusion: The prevalence of both depressive symptomatology and impairment of quality of life is significant and primary care with simple, validated tools can be the setting for identifying and helping such patients.

Hospitalization rates for cholelithiasis and acute cholecystitis doubled for the aged population in Greece over the past 30 years

Objective. Gallbladder disease is becoming increasingly prevalent in Western countries and is a common cause of hospitalization. The objective of this study was to determine time trends in cholelithiasis and acute cholecystitis for hospitalization and disease case fatality in Greece between 1970 and 1998. Material and methods. Data were obtained from the Annual Bulletin for the Social Welfare and Health Statistics of the National Statistics Service of Greece. Percentage changes in time trends were estimated by comparing the median values of the initial (1970–78) to the last (1989–98) 10-year study period for cholelithiasis and acute cholecystitis at discharge and for all deaths attributed to the disease. Results. Over the study period, age-standardized hospitalization rates for cholelithiasis increased. The median hospitalization rate between the initial and last (178 and 258 per 100,000 of the population, respectively) 10-year study period increased by 44.7%, but peaked to 70.1% and 208.3% for the 70–79 and >80 years age groups, respectively. Case fatality rate declined by 56.8% and the median value was 0.24 per 100 patients hospitalized during the last 10-year period. Conclusions. Hospitalization rates for cholelithiasis and/or acute cholecystitis increased by 45%, and doubled for elderly patients, while the case fatality rate of the disease halved in Greece over the past 30 years.