Christos Lionis

Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice – an evidence-based international guide

Evidence suggests that the gut microbiota play an important role in gastrointestinal problems.

Cross-Cultural Adaptation and Validation of the Voice Handicap Index Into Greek

The objective was to culturally adapt and validate the Voice Handicap Index (VHI) to the Greek language. The study design used was a psychometric analysis. The VHI was translated into Greek with cultural adaptations to accommodate certain words. The translated version was then completed by 67 subjects with various voice disorders and by a control group of 79 subjects. All the participants also completed a self-rating scale regarding the severity of their voice disorder. Statistical analyses demonstrated high internal consistency and high test-retest reliability both for the overall VHI score and for the functional, physical, and emotional domains of the VHI. A moderate correlation was found between the VHI and the self-rating severity scale. The subjects in the control group had lower scores compared to the subjects with voice disorders for the overall VHI score and for the three domains. Based on the internal consistency values and the test-retest reliability, the Greek version of VHI is a valid and reliable measure for use by Greek subjects with voice disorders.

Long-Term Fish Intake Is Associated With Less Severe Depressive Symptoms Among Elderly Men and Women The MEDIS (MEDiterranean ISlands Elderly) Epidemiological Study

Objective: This work aims at exploring the association between fish intake and depressive symptoms, in older adults. Method: During 2005-2007, 1,190 men and women (>65 years) free living in various Greek islands and in Cyprus participated in the study. Depressive symptoms were assessed using the validated Geriatric Depression Scale (GDS), and foods intake through a Food Frequency Questionnaire. Results: Almost 70% of the participants scored above the depressive cutoff (i.e., GDS score > 5), with women having higher values. People classified under the 1st tertile of GDS score (i.e., GDS ≤ 5) were more educated, physically active, and report higher fish consumption. One portion increase of fish consumption per week was associated with 0.58 times (95% confidence interval: 0.45-0.73) lower likelihood of having GDS score above the clinical threshold, after various adjustments were made. Discussion: These findings may assist public health policy makers in better preventing emotional disorders among the elderly by promoting healthier eating habits.

Translation of the Neck Disability Index and validation of the Greek version in a sample of neck pain patients

BackgroundNeck pain is a highly prevalent condition resulting in major disability. Standard scales for measuring disability in patients with neck pain have a pivotal role in research and clinical settings. The Neck Disability Index (NDI) is a valid and reliable tool, designed to measure disability in activities of daily living due to neck pain. The purpose of our study was the translation and validation of the NDI in a Greek primary care population with neck complaints.MethodsThe original version of the questionnaire was used. Based on international standards, the translation strategy comprised forward translations, reconciliation, backward translation and pre-testing steps. The validation procedure concerned the exploration of internal consistency (Cronbach alpha), test-retest reliability (Intraclass Correlation Coefficient, Bland and Altman method), construct validity (exploratory factor analysis) and responsiveness (Spearman correlation coefficient, Standard Error of Measurement and Minimal Detectable Change) of the questionnaire. Data quality was also assessed through completeness of data and floor/ceiling effects.ResultsThe translation procedure resulted in the Greek modified version of the NDI. The latter was culturally adapted through the pre-testing phase. The validation procedure raised a large amount of missing data due to low applicability, which were assessed with two methods. Floor or ceiling effects were not observed. Cronbach alpha was calculated as 0.85, which was interpreted as good internal consistency. Intraclass correlation coefficient was found to be 0.93 (95% CI 0.84–0.97), which was considered as very good test-retest reliability. Factor analysis yielded one factor with Eigenvalue 4.48 explaining 44.77% of variance. The Spearman correlation coefficient (0.3; P = 0.02) revealed some relation between the change score in the NDI and Global Rating of Change (GROC). The SEM and MDC were calculated as 0.64 and 1.78 respectively.ConclusionThe Greek version of the NDI measures disability in patients with neck pain in a reliable, valid and responsive manner. It is considered a useful tool for research and clinical settings in Greek Primary Health Care.

Current prevalence of hepatitis A, B and C in a well-defined area in rural Crete, Greece

A seroepidemiological study was carried out in a geographically well‐defined area in rural Crete in order to determine the prevalence of A, B and C hepatitis markers in the local population. Serum samples were obtained from 257 subjects (94 males, 163 females), aged 15 years and over, who visited the primary health care services of the Spili Health Centre between July 1993 and March 1994, and from 164 subjects (83 males, 81 females) randomly selected from households in three neighbouring villages of the study area. In samples obtained from the Spili Health Centre, antibodies to hepatitis A virus (anti‐HAV) were detected in 234/244 (95.9%) subjects, antibodies to hepatitis B virus core antigen (HBcAb) were detected in 63/257 (24.5%) subjects and antibodies to hepatitis C virus (anti‐HCV) were detected in 28/257 (10.9%) subjects. The corresponding figures for those randomly selected from the villages were 135/154 (87.7%), 16/164 (9.8%) and 5/164 (3%) respectively. Hepatitis B surface antigen (HBsAg) was positive in three (1.2%) subjects from the first group, while none of those recruited from the villages were positive for HBsAg. Interestingly, hepatitis markers were closely associated with age. No subjects under the age of 15 years showed evidence of prior hepatitis A infection and approximately 20% of those between 15 and 44 years of age were also negative. By contrast, practically all subjects older than 44 years were anti‐HAV positive. Similarly, the majority of all those who were anti‐HCV positive were older subjects. Seroepidemiology of hepatitis in this well‐defined population seems to be different from other parts of Greece, at least for hepatitis B and C viruses. There is a very low prevalence of HBsAg and a very high incidence of anti‐HCV. Low exposure to HAV, as found in other parts of the country, was also found in the younger generation in this rural area of Crete.

Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme

BackgroundExcessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.MethodsGPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.ResultsA total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%.ConclusionA multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010

AIM Respiratory diseases are a public health issue throughout the world, with high prevalence and morbidity. This Research Needs Statement from the International Primary Care Respiratory Group (IPCRG) aims to highlight unanswered questions on the management of respiratory diseases that are of importance to practising primary care clinicians. METHODS An informal but inclusive consultation process was instigated in 2009. Draft statements in asthma, rhinitis, COPD, tobacco dependence, and respiratory infections were circulated widely to IPCRG members, other recognised experts, and representatives from a range of economic and healthcare backgrounds. An iterative process was used to generate, prioritise and refine research questions in each section. RESULTS Two overarching themes emerged. Firstly, there is a real need for research to be undertaken within primary care, which recruits patients representative of primary care populations, evaluates interventions realistically delivered within primary care, and draws conclusions that will be meaningful to professionals working within primary care. Secondly, international and national guidelines exist, but there is little evidence on the best strategies for implementing recommendations. Disease-specific research questions focus on effective and cost-effective ways to prevent disease, confirm the diagnosis, assess control, manage treatment, and empower selfmanagement. Practical questions about how to deliver this comprehensive agenda in diverse primary care settings are highlighted. CONCLUSIONS We hope that this Research Needs Statement will be used by clinicians and patients campaigning for answers to relevant questions, by researchers seeking funding to provide answers to these questions, and by funding bodies to enable them to prioritise research agendas.

The Edinburgh Postnatal Depression Scale: translation and validation for a Greek sample.

BackgroundEdinburgh Postnatal Depression Scale (EPDS) is an important screening instrument that is used routinely with mothers during the postpartum period for early identification of postnatal depression. The purpose of this study was to validate the Greek version of EPDS along with sensitivity, specificity and predictive values.Methods120 mothers within 12 weeks postpartum were recruited from the perinatal care registers of the Maternity Departments of 4 Hospitals of Heraklion municipality, Greece. EPDS and Beck Depression Inventory-II (BDI-II) surveys were administered in random order to the mothers. Each mother was diagnosed with depression according to the validated Greek version of BDI-II. The psychometric measurements that were performed included: two independent samples t-tests, One-way analysis of variance (ANOVA), reliability coefficients, Explanatory factor analysis using a Varimax rotation and Principal Components Method. Confirmatory analysis -known as structural equation modelling- of principal components was conducted by LISREL (Linear Structural Relations). A receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale.Results8 (6.7%) of the mothers were diagnosed with major postnatal depression, 14 (11.7%) with moderate and 38 (31.7%) with mild depression on the basis of BDI-II scores. The internal consistency of the EPDS Greek version -using Chronbachs alpha coefficient- was found 0.804 and that of Guttman split-half coefficient 0.742. Our findings confirm the multidimensionality of EPDS, demonstrating a two-factor structure which contained subscales reflecting depressive symptoms and anxiety. The Confirmatory Factor analysis demonstrated that the two factor model offered a very good fit to our data. The area under ROC curve AUC was found 0.7470 and the logistic estimate for the threshold score of 8/9 fitted the model sensitivity at 76.7% and model specificity at 68.3%.ConclusionOur data confirm the validity of the Greek version of the EPDS in identifying postnatal depression. The Greek EPDS scale could be used as a useful instrument in both clinical practice and research.

Measuring health inequalities in Albania: a focus on the distribution of general practitioners

BackgroundThe health workforce has a dynamically changing nature and the regular documentation of the distribution of health professionals is a persistent policy concern. The aim of the present study was to examine available human medical resources in primary care and identify possible inequalities regarding the distribution of general practitioners in Albania between 2000 and 2004.MethodsWith census data, we investigated the degree of inequality by calculating relative inequality indices. We plotted the Lorenz curves and calculated the Gini, Atkinson and Robin Hood indices and decile ratios, both before and after adjusting for mortality and consultation rates.ResultsThe Gini index for the distribution of general practitioners in 2000 was 0.154. After adjusting for mortality it was 0.126, while after adjusting for consultation rates it was 0.288. The Robin Hood index for 2000 was 11.2%, which corresponds to 173 general practitioners who should be relocated in order to achieve equality. The corresponding figure after adjusting for mortality was 9.2% (142 general practitioners), while after adjusting for consultation rates the number was 20.6% (315). These figures changed to 6.3% (100), 6.3% (115) and 19.8% (315) in 2004.ConclusionThere was a declining trend in the inequality of distribution of general practitioners in Albania between 2000 and 2004. The trend in inequality was apparent irrespective of the relative inequality indicator used. The level of inequality varied depending on the adjustment method used. Reallocation strategies for general practitioners in Albania could be the key in alleviating the inequalities in primary care workforce distribution.

Long-term tea intake is associated with reduced prevalence of (type 2) diabetes mellitus among elderly people from Mediterranean islands: MEDIS epidemiological study.

Purpose We sought to evaluate the link between long-term tea intake and prevalence of type 2 diabetes mellitus, in a sample of elderly adults. Materials and Methods During 2005-2007, 300 men and women from Cyprus, 142 from Mitilini, 100 from Samothraki, 114 from Kefalonia, 131 from Crete, 150 from Corfu and 103 from Zakynthos (aged 65 to 100 years) were enrolled. Dietary habits (including tea consumption) were assessed through a food frequency questionnaire. Among various factors, fasting blood glucose was measured and prevalence of (type 2) diabetes mellitus was estimated. Results 54% of the participants reported that they consume tea at least once a week (mean intake 1.6 ± 1.1 cup/day). The majority of the participants (98%) reported green or black tea consumption. The participants reported that they consume tea for at least 30 years of their life. After adjusting for various confounders, tea intake was inversely associated with lower blood glucose levels (b ± SEM per 1 cup: - 5.9 ± 2.6 mg/dL, p = 0.02). Moreover, multiple logistic regression revealed that moderate tea consumption (1 - 2 cups/day) was associated with 70% (95% CI 41% to 86%) lower odds of having (type 2) diabetes, irrespective of age, sex, body mass, smoking, physical activity status, dietary habits and other clinical characteristics. Conclusion The presented findings suggest that long-term tea intake is associated with reduced levels of fasting blood glucose and lower prevalence of diabetes, in a cohort of elderly people living in Mediterranean islands.