The 2017 Primary Health Care (PHC) reform in Greece: Improving access despite economic and professional constraints?

Between 2010 and 2018 Greece was subject to a bailout programme by international creditors and three successive Economic Adjustment Programmes (EAP). These involved large-scale austerity measures and drastic reductions in public sector spending including healthcare. Within this context and in line with the international best practice guidelines for primary care, in August 2017 the left-wing SYRIZA government passed a law for the reform of the Primary Health Care (PHC) sector. The reform introduced the establishment of Local Health Units and the embedded notion of the 'family doctor' as the first pillar of healthcare provision. These reforms aimed to strengthen primary care and to improve access to publicly provided primary care services. Despite the promising claims, the reform was a subject of criticism and failed to engage key stakeholder groups and to be delivered within the original timeline. The aim of this paper is to present the chronicle of the reform, its current status at a national level and its implementation challenges. To address current implementation hindrances, the reform of the Greek PHC sector is expected to undergo systemic changes, including factoring in the scheme's funding needs after 2021, with the successive government reconsidering its future form.

The effects of age and gender on the weight and use of schoolbags.

PURPOSE: To examine age and gender differences in schoolbag use and to compare findings in Greece with those of other countries. METHOD: Schoolbag weight and carrying characteristics were assessed in 703 boys and girls aged 6 to 14 years. RESULTS: Multinomial logistic regression models showed that younger students (6-8 years) were almost 5 more times more likely to carry heavier schoolbags than older students (p < 0.05). Similarly, more girls than boys carried heavier bags, and girls were twice more likely to experience fatigue symptoms when carrying schoolbags compared with boys (p < 0.05). The mean schoolbag weight was 12.4% of the student's body weight and moderately heavier than that reported for other countries. CONCLUSIONS: Younger children are in greater need for education about schoolbag weight compared with older ones. There is also evidence that girls might experience more problems when carrying their schoolbag compared with boys.

Reliability of spinal range of motion in healthy boys using a skin-surface device.

OBJECTIVE: The purpose of this study was to examine the interrater and intrarater reliability of spinal extension and flexion measurements using a skin-surface (Spinal Mouse; Idiag, Voletswil, Switzerland) instrument. METHODS: Spinal curvature was measured during standing, full flexion, and full extension in 81 healthy children (10.6 +/- 1.7 years) by 3 raters on 2 separate occasions. Intraclass correlation coefficients (ICCs) and standard errors of measurement were used to examine between-day and interrater reliability for thoracic, lumbar, and hip range of motion. RESULTS: The intrarater ICCs ranged from 0.61 to 0.96, and the interrater ICCs ranged from 0.70 to 0.93. The standard error of measurement ranged from 0.61 degrees to 13.18 degrees . CONCLUSION: Evaluation of spinal range of motion measures in children using the Spinal Mouse demonstrates fair to high reliability.

Disc-like herniation in association with gas collection in the spinal canal: CT evaluation.

Gas production as a part of disk degeneration can occur but rarely causes nerve compression syndromes. Few cases have been reported in which lumbar intraspinal epidural gas cause nerve root compression symptoms. We present 12 cases of gas collection in the spinal canal that were presented to the orthopaedic out-patient department with symptoms of low back pain and sciatica. CT showed the presence of free epidural gas collections adjacent to or over the affected nerve roots. Relief of symptoms was noted with the change of positions, lying down or sleeping. In this study, we conclude that the presence of lumbar intraspinal epidural gas that causes radicular compressing phenomena, can be easily detected with the use of CT.

Predicting moral behavior in physical education classes: an application of the theory of planned behavior.

This study aimed to examine the potential of the Theory of Planned Behavior to predict moral behavior in primary school physical education classes. Primary school children (N=611) completed a questionnaire including the Theory of Planned Behavior variables. Also, 21 teachers filled in an adapted version of Horrocks' Prosocial Play Behavior Inventory which assesses five moral behavior facets. Hierarchical regression analysis showed that attitudes toward moral behavior and perceived behavioral control were significant predictors of intention towards moral behavior (54%). Intention and perceived behavioral control predicted teacher-reported moral behavior (41%). The present results indicated that the theory provides a valuable framework for study of primary school children's moral behavior.

A socio-technical analytical framework on the EHR-organizational innovation interplay: Insights from a public hospital in Greece.

The healthcare sector globally is confronted with increasing internal and external pressures that urge for a radical reform of health systems' status quo. The role of technological innovations such as Electronic Health Records (EHR) is recognized as instrumental in this transition process as it is expected to accelerate organizational innovations. This is why the widespread uptake of EHR systems is a top priority in the global healthcare agenda. The successful co-deployment though of EHR systems and organizational innovations within the context of secondary healthcare institutions is a complex and multifaceted issue. Existing research in the field has made little progress thus emphasizing the need for further research contribution that will incorporate a holistic perspective. This paper presents insights about the EHR-organizational innovation interplay from a public hospital in Greece into a socio-technical analytical framework providing a multilevel set of action points for the eHealth roadmap with worldwide relevance.

MR cholangiography in the evaluation of patients with duodenal periampullary diverticulum.

OBJECTIVE: This retrospective study evaluates the relationship between periampullary duodenal diverticula and the common bile duct (CBD). MATERIALS AND METHODS: The patients were examined with HASTE breath hold MR cholangiography (MRC) using a 1 T Siemens Expert Plus Scanner. Axial T2-weighted images were also obtained in all patients. RESULTS: From the 66 patients, only 23 clearly depicted to have deverticula, while 31 patients were suspected to have diverticula and for the rest 12 patients, the MRC results were negative. From these 66 patients, the 18 patients proved to have stones in the CBD. CONCLUSION: MRC has very low sensitivity in the detection of duodenum diverticula, but is the method of choice to evaluate their relationship with the distal part of the CBD.

Arachnoid cyst of the frontal part of the temporal lobe producing exopthtalmos CT and MRI evaluation.

Twenty-three patients with an arachnoid cyst in the frontal part of the temporal bone, which produced exopthtalmos, were evaluated with CT and MRI. The majority of the patients had the peak of the bowing of the bony orbit wall in the posterior third (20/23) and only three in the middle. Arachnoid cyst are classified as small (13/23), medium (5/23) or large (5/20) size. Exopthtalmos are also classified as mild, moderate or large. CT and MRI clearly revealed the exopthtalmos, the bone remodelling process and the relationship of the orbit muscles, optic nerve and posterior bony wall of the orbit.

A thematic review and a policy-analysis agenda of Electronic Health Records in the Greek National Health System.

The increasing pressure to improve healthcare outcomes and reduce costs is driving the current agenda of governments at worldwide level and calls for a fundamental reform of the status quo of health systems. This is especially the case with the Greek NHS (National Health System), a system in continuous crisis, and with the recent ongoing financial turbulence under intensive scrutiny. Technological innovations and Electronic Health Records (EHR) in particular, are recognised as key enablers in mitigating the existing burdens of healthcare. As a result, EHR is considered a core component in technology-driven reform processes. Nonetheless, the successful implementation and adoption of EHR proves to be a challenging task due to a mixture of technological, organisational and political issues. Drawing upon experiences within the European Union (EU) healthcare setting and the Greek NHS the paper proposes a conceptual framework as a policy-analysis agenda for EHR interventions in Greece. While the context of discussion is Greece, the paper aims to also derive useful insights to healthcare policy-makers around the globe.