Dimitra Sifaki-Pistolla

Geoepidemiology and space–time analysis of Primary biliary cirrhosis in Crete, Greece

The prevalence of Primary biliary cirrhosis varies in different geographical areas. This might reflect genetic or environmental risk factors. We aimed to define Primary biliary cirrhosis prevalence and incidence, describe patients spatial distribution, generate prediction maps and detect any possible routing pattern of time‐spatial appearance of the disease in Crete, Greece.

PTSD, burnout and well-being among rescue workers: Seeking to understand the impact of the European refugee crisis on rescuers

Individuals who perform rescue and recovery duties, as part of their daily work activities, confront diverse stressors that can affect their mental state and overall well-being. The study aimed to assess the prevalence and the factors associated with self-assessed PTSD, perceived well-being and burnout among rescue workers operating at Lesvos during the European refugees crisis. 217 rescuers participated in the study, while the PTSD Checklist-Civilian Version (PCL-C), the Maslach Burnout Inventory (MBI) and the Well-being Index (WHO-5) were utilized. The prevalence of self-assessed PTSD and perceived burnout syndrome was 17.1% and 57% respectively, while 72.8% of the rescuers reported low levels of perceived well-being. Self-assessed PTSD was positively correlated with perceived burnout and inversely correlated with perceived well-being. Perceived burnout was also inversely correlated with perceived well-being. A number of significant predictors were identified for self-assessed PTSD, perceived burnout and well-being, including: family status, age, duration of shifts, collection of dead adults or dead children bodies. The impact of the refugee crisis is visible on the rescue workers that offer rescue and first aid services. There is an urgent need for implementing effective interventions focusing on the identified determinants in order to enhance the occupational psychological burden of rescuers.

Approaches to teach evidence-based practice among health professionals: an overview of the existing evidence

Health care professionals’ adoption of evidence-based practice (EBP) remains limited, although most health care professionals are familiar with EBP and believe in its value. This systematic review aimed to bring together the best methods used to teach EBP to health professionals. The authors conducted a systematic search for the period 2005–2015 (an update of the search took place in October 2016) using PubMed interface (Medline). MeSH terms as well as free-text keywords were used. Studies were analyzed and evaluated by title and abstract. Those studies which fulfilled the inclusion criteria were assessed by full text. References of articles were also taken into consideration for identifying relevant studies not found through algorithm search. Twenty articles were found to be relevant. The majority of the studies were conducted among nurses (n=7) and physicians (n=6), and only a few among professionals from mixed disciplines (n=5). Two studies were conducted among chiropractors (n=1) and faculty members from a naturopathic and classical Chinese medicine institution (n=1). Researchers used a variety of different approaches, which varied with respect to duration and organization. We divided interventions into two categories. Single interventions included either a workshop, or a journal club, or a conference, or a lecture, or online learning tools, whereas multiple interventions included a combination of these approaches. An increase in EBP competencies and attitudes was reported in nine studies. Teaching methods for optimizing EBP among health professionals could become a robust standardized procedure of the medical educational curricula and lifelong learning of health care professionals.

Geoepidemiology of hepatocellular carcinoma in the island of Crete, Greece. A possible role of pesticides

Geoepidemiological data of hepatocellular carcinoma (HCC) are lacking. Crete has a genetically homogeneous population and is suitable for studies to identify a possible contribution of environmental factors in HCC.

Assessing refugee healthcare needs in Europe and implementing educational interventions in primary care: a focus on methods

The current political crisis, conflicts and riots in many Middle Eastern and African countries have led to massive migration waves towards Europe. European countries, receiving these migratory waves as first port of entry (POE) over the past few years, were confronted with several challenges as a result of the sheer volume of newly arriving refugees. This humanitarian refugee crisis represents the biggest displacement crisis of a generation. Although the refugee crisis created significant challenges for all national healthcare systems across Europe, limited attention has been given to the role of primary health care (PHC) to facilitate an integrated delivery of care by enhancing care provision to refugees upon arrival, on transit or even for longer periods. Evidence-based interventions, encompassing elements of patient-centredness, shared decision-making and compassionate care, could contribute to the assessment of refugee healthcare needs and to the development and the implementation of training programmes for rapid capacity-building for the needs of these vulnerable groups and in the context of integrated PHC care. This article reports on methods used for enhancing PHC for refugees through rapid capacity-building actions in the context of a structured European project under the auspices of the European Commission and funded under the 3rd Health Programme by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). The methods include the assessment of the health needs of all the people reaching Europe during the study period, and the identification, development, and testing of educational tools. The developed tools were evaluated following implementation in selected European primary care settings.

Lung cancer and annual mean exposure to outdoor air pollution in Crete, Greece

The increasing burden of lung cancer (LC) in Crete, Greece, has raised certain concerns about the potential association of environmental risk factors with LC. The aim of this study was to assess outdoor air pollution (OAP) and the risk for LC mortality for the first time in Crete using LC primary data. 5057 LC cases (diagnosed from 1992 to 2013) were obtained from the Cancer Registry of Crete (http://www.crc.uoc.gr) and followed up until 2014. The age-standardized incidence and mortality rates (ASIR) were calculated. Data on OAP indicators [particulate matter (PM)2.5, between 2.5 and 10 &mgr;m (PM2.5–10), PM10, PM2.5 absorbance (black carbon measure), nitrogen dioxide (NO2), and nitrogen oxides (NOx)] were collected. Spatial statistics were calculated and the binary logistic regression model was constructed at &agr;=0.05 in IBM SPSS 24 and ArcMap 10.3.1. LC in Crete accounts for 40.2 new cases/100 000/year for both sexes (ASIRmales=73.1 new cases/100 000/year; ASIRfemales=11.8 new cases/100 000/year). Annual median estimates of environmental concentrations in Crete were as follows: PM2.5=20.7 (±1.5) µg/m3, PM10=38.9 (±2.5) µg/m3, PM2.5–10=59.6 (±3.7) µg/m3, PM2.5 absorbance=1.2 (±0.3)×10−5/m, NO2=15.2 (±3.8) µg/m3, and NOx=20.1 (±4.9) µg/m3. A statistically significant association was observed between OAP and LC mortality (mean correlation coefficient=0.75; P<0.05). The highest risk for 5-year LC mortality was found in the major urban centers and several south-east and north-west rural regions of Crete (relative risk=3.2, 95% confidence interval=1.6–4.7). OAP seems to be an important determinant of LC mortality. Targeted interventions should be performed in the high-risk areas.

Analysis of Heart Rate Variability by Applying Nonlinear Methods with Different Approaches for Graphical Representation of Results

There is an open discussion over nonlinear properties of the Heart Rate Variability (HRV) which takes place in most scientific studies nowadays. The HRV analysis is a non-invasive and effective tool that manages to reflect the autonomic nervous system regulation of the heart. The current study presents the results of HRV analysis based on 24-hour Holter ECG signals of healthy and unhealthy subjects. Analysis of heart intervals is performed with the use of original algorithms and software, developed by the authors, to quantify the irregularity of the heart rate. The main aim is the formation of the parametric estimate of patients’ health status, based on mathematical methods that are applied on cardiac physiology. The obtained results show that the analysis of Holter recordings by nonlinear methods may be appropriate for diagnostic, forecast and prevention of the pathological cardiac statuses. Different approaches of graphical representation and visualization of these results are used in order to verify this.

Operational integration in primary health care: patient encounters and workflows

BackgroundDespite several countrywide attempts to strengthen and standardise the primary healthcare (PHC) system, Greece is still lacking a sustainable, policy-based model of integrated services. The aim of our study was to identify operational integration levels through existing patient care pathways and to recommend an alternative PHC model for optimum integration.MethodsThe study was part of a large state-funded project, which included 22 randomly selected PHC units located across two health regions of Greece. Dimensions of operational integration in PHC were selected based on the work of Kringos and colleagues. A five-point Likert-type scale, coupled with an algorithm, was used to capture and transform theoretical framework features into measurable attributes. PHC services were grouped under the main categories of chronic care, urgent/acute care, preventive care, and home care. A web-based platform was used to assess patient pathways, evaluate integration levels and propose improvement actions. Analysis relied on a comparison of actual pathways versus optimal, the latter ones having been identified through literature review.ResultsOverall integration varied among units. The majority (57%) of units corresponded to a basic level. Integration by type of PHC service ranged as follows: basic (86%) or poor (14%) for chronic care units, poor (78%) or basic (22%) for urgent/acute care units, basic (50%) for preventive care units, and partial or basic (50%) for home care units. The actual pathways across all four categories of PHC services differed from those captured in the optimum integration model. Certain similarities were observed in the operational flows between chronic care management and urgent/acute care management. Such similarities were present at the highest level of abstraction, but also in common steps along the operational flows.ConclusionsExisting patient care pathways were mapped and analysed, and recommendations for an optimum integration PHC model were made. The developed web platform, based on a strong theoretical framework, can serve as a robust integration evaluation tool. This could be a first step towards restructuring and improving PHC services within a financially restrained environment.

History of the Cretan cohort of the Seven Countries Study.

The Seven Countries Study (SCS) was initiated in mid 1950 in the University of Minnesota by Professor Ancel Keys with the last follow-up carried out in 2010. Collaborators from seven countries were recruited and developed the first cross-cultural prospective study on coronary heart disease (CHD) in men, with different occupations and sociocultural background. The SCS included 12,763 males aged 40-59 years distributed in 16 cohorts among countries from the United States of America, Northern Europe, Southern Europe and Japan. The main aim of the present report is to shortly present the history of the SCS and describe the cohort in Crete (started in 1960, repeated every 10 years up to 2010) , the study findings as well as their strengths and weaknesses. The participants in the cohort of Crete had the highest longevity rate, the lowest CHD, cancer and dementia mortality in comparison to those in the other 15 participating cohorts. Those impressive findings seem to be related to dietary habits, physical activity and the lifestyle of the population of Crete. The dietary intake in Crete had major differences from all other cohorts and even those from the Mediterranean countries. The main reason for those distinct dietary differences seems to be the fasting recommendations of the Christian Orthodox Church followed strictly by the majority of men participating in the SCS in 1960.

Distress and burnout in young medical researchers before and during the Greek austerity measures: forerunner of a greater crisis?

PurposeDistress and burnout are strongly correlated with austerity and financial recessions. Aim of this study was to assess distress and burnout among young medical researchers (YMR) in Greece before and during the financial crisis.MethodsIn total 2050 YMR affiliated in all the nursing and medical departments of Greece were enrolled (1025 in Period A: 2008 and 1025 in Period B: 2017). Distress and burnout were measured via DASS-21 and Maslach Burnout Inventory (MBI) questionnaires.ResultsBefore the crisis, prevalence of distress and burnout among young medical researchers was 24 and 20%, respectively. During the financial crisis distress prevalence increased significantly (56%), while there has also been a tremendous increase in burnout occurrence (60%). Specific sociodemographic characteristics presented significantly increased rate of change (females, singles and divorced/widowers, living with family members, volunteers, smokers and heavy alcohol consumers). Distress and burnout scales were positively correlated (Spearman’s r = 0.81; p = 0.01). Depression scores shifted from normal to moderate (rate of change = 13.1%), anxiety levels increased from normal to severe (rate of change = 14.3%) and tension/stress scores elevated from normal to severe (rate of change = 20.2%).ConclusionsIt is evident that the current financial crisis and working conditions have a strong impact on health status of young medical researchers in Greece. The observed increased trends and the identified predictors could guide targeted and comprehensive interventions towards tackling distress among the medical researchers not only in Greece but also in other countries suffering from financial crisis.