Addressing barriers to the prevention, diagnosis and treatment of hepatitis B and C in the face of persisting fiscal constraints in Europe: report from a high level conference.

In the WHO-EURO region, around 28 million people are currently living with chronic viral hepatitis, and 120,000 people die every year because of it. Lack of awareness and understanding combined with the social stigma and discrimination exacerbate barriers related to access to prevention, diagnosis and treatment services for those most in need. In addition, the persisting economic crisis has impacted on public health spending, thus posing challenges on the sustainable investment in promotion, primary and secondary prevention, diagnosis and treatment of viral hepatitis across European countries. The Hepatitis B and C Public Policy Association in cooperation with the Hellenic Center for Disease Prevention and Control together with 10 partner organizations discussed at the Athens High Level Meeting held in June 2014 recent policy developments, persisting and emerging challenges related to the prevention and management of viral hepatitis and the need for a de minimis framework of urgent priorities for action, reflected in a Call to Action (Appendix S1). The discussion confirmed that persisting barriers do not allow the full realisation of the public health potential of diagnosing and preventing hepatitis B and C, treating hepatitis B and curing hepatitis C. Such barriers are related to (a) lack of evidence-based knowledge of hepatitis B and C, (b) limited access to prevention, diagnosis and treatment services with poor patient pathways, (c) declining resources and (d) the presence of social stigma and discrimination. The discussion also confirmed the emerging importance of fiscal constraints on the ability of policymakers to adequately address viral hepatitis challenges, particularly through increasing coverage of newer therapies. In Europe, it is critical that public policy bodies urgently agree on a conceptual framework for addressing the existing and emerging barriers to managing viral hepatitis. Such a framework would ensure all health systems share a common understanding of definitions and indicators and look to integrate their responses to manage policy spillovers in the most cost-effective manner, while forging wide partnerships to sustainably and successfully address viral hepatitis.

Central-line-associated bloodstream infections, multi-drug-resistant bacteraemias and infection control interventions: a 6-year time-series analysis in a tertiary care hospital in Greece.

BACKGROUND: Central-line-associated bloodstream infections (CLABSIs) are serious healthcare-associated infections with substantial morbidity and hospital costs. AIM: To investigate the association between the incidence of CLABSIs, the implementation of specific infection control measures, and the incidence of multi-drug-resistant (MDR) bacteraemias in a tertiary care hospital in Greece from 2013 to 2018. METHODS: Analysis was applied for the following indices, calculated monthly: CLABSI rate; use of hand hygiene disinfectants; isolation rate of patients with MDR bacteria; and incidence of bacteraemias [total Gram-negative carbapenem-resistant Acinetobacter baumanii, carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae; and Gram-positive meticillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci]. FINDINGS: The total number of bacteraemias from carbapenem-resistant Gram-negative pathogens was significantly correlated with an increased CLABSI rate for all (total) hospital departments [incidence rate ratio (IRR) 1.17, 95% confidence interval (CI) 1.05-1.31, P=0.006] and the adult intensive care unit (ICU) (IRR 1.37, 95% CI 1.07-1.75, P=0.013). In the adult ICU, every increase in the incidence of each resistant Gram-negative pathogen was significantly correlated with a decreased CLABSI rate (carbapenem-resistant A. baumanii: IRR 0.59, 95% CI 0.39-0.90, P=0.015; carbapenem-resistant K. pneumoniae: IRR 0.48, 95% CI 0.25-0.94, P=0.031; carbapenem-resistant P. aeruginosa: IRR 0.54, 95% CI 0.33-0.89, P=0.015). The use of hand disinfectants was correlated with a decreased CLABSI rate 1-3 months before the application of this intervention for all (total) hospital departments (IRR 0.80, 95% CI 0.69-0.93, P=0.005), and for scrub disinfectants in the current month for the adult ICU (IRR 0.34, 95% CI 0.11-1.03, P=0.057). Isolation of patients with MDR pathogens was not associated with the incidence of CLABSIs. CONCLUSION: Hand hygiene was associated with a significant reduction in the incidence of CLABSIs at the study hospital. Time-series analysis is an important tool to evaluate infection control interventions.

Prescribed-drug utilization and polypharmacy in a general population in Greece: association with sociodemographic, health needs, health-services utilization, and lifestyle factors.

PURPOSE: Our aim was to analyze, in a multivariate framework, how sociodemographic, health-service utilization, health needs, and lifestyle risk factors influence drug utilization and polypharmacy (PP) in a general population in Greece. METHODS: The cross-sectional study took place in 2006. In total 1,005 individuals (> 18 years old) of 1,388 who were approached (response rate 72.4%) were interviewed by trained interviewers. Thirty-seven reported only over-the-counter (OTC) drug use and were excluded. The final sample was 968 individuals. Multivariable logistic regression and multinomial regression analyses were conducted to determine the predictors of drug use and PP at a significance level of p < 0.05. RESULTS: The results revealed a high rate of drug use and PP. Drug use and PP were more common among women and increased with age. Advanced age 65+ [odds ratio (OR) 11.6), university education (OR 2.3), visits to physician (OR 2.2), comorbidity (OR 6.8), or poor physical and mental health were associated with higher likelihood of using drugs. Minor (two to three drugs) and major (four or more drugs) PP depended on comorbidity, physical health, and increased age. Furthermore, visits to physicians (OR 1.1), smoking (OR 3.0), and obesity (OR 3.8) increased the likelihood of major PP. CONCLUSIONS: Overall, drug utilization and PP depended on health needs followed by education, utilization of health services, and age. Social disparities do persist and, after adjustments for health needs and obesity, had a significant influence on PP.

Compliance with a healthy lifestyle in a representative sample of the Greek population: preliminary results of the Hellas Health I study.

OBJECTIVES: To investigate lifestyle health behaviours, such as smoking, physical activity, weight status and dietary habits, in a representative sample of the adult Greek population. STUDY DESIGN: Cross-sectional, household interviews (Hellas Health I survey, 2006). METHODS: A stratified representative sample (n = 1005, 483 males, 522 females) of the Greek adult population (mean age 47.39 years, median age 46 years, range 18-99 years) was interviewed. Self-reported demographic and lifestyle behaviour data were obtained. The Food Frequency Questionnaire (FFQ) was used to record dietary habits, and a Mediterranean score was derived from the FFQ to assess adherence to the Mediterranean diet. A higher Mediterranean score indicates greater adherence to the Mediterranean diet. Physical activity was evaluated using the International Physical Activity Questionnaire. RESULTS: Smoking is highly prevalent in the Greek population (43.1%), particularly among people aged 18-36 (52.9%) and 37-56 years (51.9%). Smoking prevalence was 52.4% in men and 34.5% in women (P < 0.001). In total, 54.1% of men and 45.3% of women were classified as physically active (P = 0.007). The proportion of physically active subjects decreased with age (P for trend<0.001). The prevalence of obesity was higher in women (18.3%) than men (14.3%, P < 0.001), and increased with age (P for trend<0.001). Men were found to have higher Mediterranean scores than women (27.09 vs 26.14, P < 0.05). Dietary habits also differed between younger and older participants, and the Mediterranean score increased with age. CONCLUSIONS: The prevalence rates for smoking, physical inactivity and obesity are high, and compliance with the Mediterranean diet is low in Greece. Nationwide interventions focused on health promotion and primary prevention are urgently needed.

Health-related lifestyle behaviours, socio-demographic characteristics and use of dental health services in Greek adults.

OBJECTIVE: To investigate the association between certain socio-demographic characteristics, health-related lifestyle behaviors and the use of dental services in Greek adult population. BASIC RESEARCH DESIGN: A total of 1,005 adults from all the geographical areas of Greece were randomly selected and interviewed. Gender, age, place of residence, marital and socioeconomic status, educational level, obesity, smoking, physical inactivity, adherence to Mediterranean diet were recorded and associated with the use of dental services. RESULTS: Almost one half of the participants (47%) visited a dentist during the past 12 months. Only 31.7% of the visits were for a regular dental check up. Subjects belonging to high socioeconomic status were 1.86 times more likely to visit a dentist in the past 12 months, while those aged more than 56 years and with low educational level were less likely to visit a dentist in the past 12 months with odds ratios equal to 0.63 and 0.73, respectively. Physically inactive (OR = 0.59; 95% CI: 0.38-0.93) and obese subjects (OR = 0.48; 95% CI: 0.24-0.97) were less likely to visit the dentist for a regular dental check up. Additionally, high socioeconomic status and healthier diet were associated with greater likelihood for visiting the dentist for a regular dental check up. CONCLUSIONS: Socio-demographic factors including age, education and social status are strong determinants of dental health services utilization in Greece. In addition, health-related lifestyle behaviors and conditions such as healthy diet, physical activity and obesity might be good predictors of regular check up or symptomatic dental visits.

Modelling nutritional services in relation to the health status of older individuals living on Mediterranean islands.

INTRODUCTION: The world's population is ageing and it has been suggested that improvements to health, wellbeing and lifespan can be attributed to improved standards of living, especially regarding diet and nutritional status. The impact of nutritional services provided by a dietician on an older population's health status has not been well evaluated or documented. This study sought to determine whether an association exists between available nutritional services and older people's health status in selected Greek islands and the Cyprus Republic. METHODS: During 2010, information on nutritional services provided in 9 Greek Islands and the Cyprus Republic was retrieved through interviews of almost all dieticians (n=88) working on these islands. The health status (ie prevalence of hypertension, diabetes, hypercholesterolemia, obesity) of the older population studied (aged >65 years) was retrieved from the Mediterranean Islands Study (MEDIS). RESULTS: The main reasons for an older person's visit to a dietician was for the treatment of diabetes (79%), hypercholesterolemia (75%) and obesity (70%); 90% of older individuals visited the dietician on a physician's recommendation and 45% of them completed their consultations. The longer the presence of a dietician on an island, the lower the likelihood of observing the prevalence of hypertension (OR=0.59, 95% CI=0.36-0.94), hypercholesterolemia (OR=0.66, 95%CI=0.46-0.95), diabetes (OR=0.77, 95%CI=0.61-0.96) and obesity (OR=0.66, 95%CI=0.45-0.95) above the median rate of the population studied. Financial concerns and a long distance from home to the dieticians' office were the major reasons for ceasing visits to the dietician. CONCLUSIONS: Enhancing nutritional services within the healthcare system may contribute to reducing the burden of disease among older adults and, consequently, improve their quality of life.

Family correlates of adolescents' emotional/behavioural problems: evidence from a Greek school-based sample.

AIM: To investigate the associations of some family characteristics with adolescents' self-reported emotional/behavioural problems. METHODS: Questionnaires were administered to a Greek nation-wide random sample of adolescents (N = 1194) aged 11-18 years and their parents (N = 973) in 2003. The present analysis included the questionnaires completed by mothers and their offspring (639 families). Adolescents' emotional/behavioural problems, as measured by the Strengths and Difficulties Questionnaire, were assessed in relation to family socioeconomic status and residence type, parental marital status, educational attainment and subjective mental health, family cohesion and parent-child relations. RESULTS: The analysis showed that parental marital status other than being married, poor parent-child relations and low levels of maternal subjective mental health were independently correlated with significantly more adolescents' emotional/behavioural problems. CONCLUSION: Family factors are potential determinants of adolescent emotional/behavioural problems and therefore are potential targets for prevention and/or intervention.

Adolescent smoking and health-related behaviours: interrelations in a Greek school-based sample.

BACKGROUND: Although several studies have reported findings concerning the interrelationship between smoking and specific health behaviours, little research has investigated how smoking behaviour may be associated with a cluster of health-related behaviours. The present study was an effort to extend previous research through assessing smoking status, patterns of physical and sedentary activity, as well as eating behaviours and diet quality, in order to gain some insight regarding the relationship between cigarette smoking and a cluster of health behaviours in a Greek sample of adolescents. METHODS: A sample of 2008 students (1021 male and 987 female, 12-17 years of age, 7th-12th grade) was selected from all schools of a representative Athens suburb in Greece. All children completed a questionnaire that was developed for the purposes of the study which retrieved information about age, sex, school class, individual and family smoking status, dietary habits and physical activity. Various statistical tests were performed. RESULTS: Age, playtime, consumption of soft drinks and foods from school canteens were positively associated with smoking status while the consumption of fruit juice, dairy products for breakfast and the frequency of breakfasts were inversely associated the aforementioned dependent variable. CONCLUSIONS: This study supports the interrelationships between multiple lifestyle behaviours and tobacco use in adolescents. Future research is needed in order to elaborate on the nature of these relations, especially for those at higher risk.

Knowledge of and attitudes towards family planning and early detection of breast and cervical cancer in two female populations in Greece.

This paper presents the results of surveys of contraceptive use, the frequency of induced abortions, the use of the Papanicolaou smear test and knowledge about the practice of breast self-examination in two female populations, characterized by a different socioeconomic level. There exist similar trends, as well as some remarkable differences between the two populations. Both of these populations included a high proportion of women who had undergone at least one abortion. Withdrawal and condom use were the most common contraceptive methods. About one third of women of the two populations had had a smear Pap-test carried out during the last year. 53.8% of the women in the population I and a 44.8% of the population II stated that they know how to practice breast self-examination.

Remote access to an expert system for infectious diseases.

An expert-system antibiotic information database was developed in order to help non-specialist doctors to choose the appropriate treatment for patients with infectious diseases. Fifty doctors conducted a pilot trial of the database, using modern access and the telephone network. During an eight-month study period, 1053 queries were received. The range of duration of the queries was 130-350 s. Of the queries, 473 (45%) were for particular patients with an infectious disease. The response rate to a questionnaire mailed out to the users at the end of the project was 100%. All doctors, even those who had limited experience with computers, found it easy to understand and to use the database.

Health reform in Greece: planning and implementation of a national health system.

The health system in Greece has for many years been in a state of continuous crisis. The basic aspects of this crisis involve: a fragmented administrative framework; low level of public expenditure; a significant private sector; inadequate hospitals; skewed manpower; and, a low level of primary care. In 1983, the National Health System (ESY) was established, as an effort to improve the above situation. This article presents the context of the ESY and the situation of the health system prior to and after the establishment of the ESY. The conclusion drawn is that many of the goals of the ESY have not been achieved or only partly achieved, and that a number of the above serious problems still persist.

Relative survival of terminal cancer patients in home versus hospital care.

A non-randomized study was undertaken in 1980-1982 to compare the effectiveness of home care versus hospital care for patients suffering from terminal stages of malignant diseases at a large cancer hospital in Pireaus, Greece and in the surrounding community. The survival pattern of 101 patients with malignant disease at various stages enrolled in a home care program for terminal patients was compared with the survival pattern of a matched comparison group of an equal number of hospital treated cancer patients. The two groups were matched for age, sex, time of initial diagnosis, primary tumor and stage of the disease at the time of diagnosis. The comparison of the survival curves was done using the logrank test taking into account censored observations. The results indicate that, under the conditions prevailing while this study was undertaken, home care was less effective compared to hospital care when survival was used as the only outcome criterion.

Alpha 1-antitrypsin and cancer of the pancreas.

Serum levels of alpha-1-antitrypsin (alpha 1-AT) were measured and phenotypes were determined in 47 patients with cancer of the pancreas and in 160 hospital controls. The mean value of alpha 1-AT (+/- SEM) in cases with cancer of the pancreas was 486 (+/- 18) mg/100 ml, and it was significantly higher than the corresponding mean value in controls, which was 434 (+/- 13) mg/100 ml (p approximately 0.02). The frequency distribution of the cases of pancreatic cancer by alpha 1-AT phenotype was: M1M1 49%, M1M3 21% and other phenotypes 30%, whereas the corresponding frequency distribution among controls was: M1M1 53%, M1M3 21% and other phenotypes 26%; the two distributions are clearly compatible (p greater than 0.50).

Information sources and level of knowledge of contraception issues among Greek women and men in the reproductive age: a country-wide survey.

OBJECTIVE: Good reproductive health depends to a great extent on how well informed people are on contraception issues. Contrary to the situation existing in many European countries, in Greece there has been a lack of studies investigating how well informed Greek women and men are. Also, the sources on which they draw are equally important. The aim of this study was to examine the knowledge of Greek women and men on issues of contraception, with the ultimate goal of identifying which groups should be the focus of prevention planning programs. METHOD: A country-wide survey was conducted through a self-administered questionnaire. The sample, numbering 1500 people, was representative of the Greek population aged 16-45 years. RESULTS: A key finding was that only a small percentage of the respondents were able to answer correctly 50% or more of the questions on knowledge of basic contraceptive issues (30.6% of women and 14.7% of men). Regarding sources of information, media and friends were reported as the primary sources of information for men of all ages and young women. The gynecologist becomes a significant source of consultation for women only after the age of 25 years. Even then, only 4% of women visiting a gynecologist do so to obtain information on prevention of pregnancy. The majority of women asking professional advice have already experienced an unwanted pregnancy. CONCLUSION: The need for health education is apparent, especially for young people.

Alpha 1-antitrypsin levels and phenotypes and hepatitis B serology in liver cancer.

Serum levels of alpha 1-antitrypsin (alpha 1 AT) were measured by radial immunodiffusion and phenotypes were determined by electrofocusing in acrylamide gel in 39 patients with hepatocellular carcinoma (HCC) positive for serum hepatitis B surface antigen (HBsAg), 41 patients with HCC negative for serum HBsAg, and 160 age- and sex-matched hospital controls. There was no difference between the control series and either of the two HCC groups with respect to alpha 1 AT phenotype pattern; also, there was no evidence of association between HCC and either the M2 allele or any of the alpha 1 AT deficiency phenotypes. However, HCC cases negative for HBsAg had significantly higher serum alpha 1 AT values (mean 665 +/- 26 mg 100 ml-1) than HCC cases positive for HBsAg (mean 571 +/- 23 mg 100 ml-1), who in turn, had significantly higher alpha 1 AT values than hospital controls (mean 434 +/- 13 mg 100 ml-1). These results indicate that in Greece, as in other high HCC incidence countries, genetically determined alpha 1 AT deficiency is not aetiologically important; the increase of serum alpha 1 AT is an important correlate of HCC with possible aetiologic significance and diagnostic potential and HBsAg-positive HCC and HBsAg-negative HCC are manifest differently as well as being aetiologically distinct.