Indoor air quality and sick building syndrome in a university setting: a case study in Greece.

The perceived Indoor Air Quality (IAQ), the prevalence of Sick Building Syndrome (SBS) symptoms and its contributing risk factors were assessed in a university during the period of the economic crisis in Greece. Data was collected from 613 employees via questionnaires. Hierarchical linear regression analysis was performed. The most prevalent perceived IAQ complaints were 'Dust and dirt' (63.2%), 'Room temperature too low' (24.9%) and 'Varying room temperature' (24.4%). The most frequently reported SBS symptom was 'Fatigue' (34.1%). The prevalence of General, Mucosal and Dermal symptoms was 40.8%, 19.8% and 8.1%, respectively. Several contributing risk factors were identified, such as IAQ Discomfort Scale, atopy, sleep problems, female, exposure to biological and chemical agents, PC-use, Psychosocial Work Scale and job satisfaction. Poor perceived IAQ and high prevalence of SBS symptoms were reported from the university staff in a temperate climate country. SBS seemed to be multifactorial.

Discrepancies and misconceptions of perceived colorectal cancer screening barriers between primary health professionals and unscreened population. A comparative study in Greece.

PURPOSE: Our study aimed to compare the views of healthy eligible unscreened adults, to those of primary care providers in Greece, about colorectal cancer (CRC) screening perceived barriers. METHODS: A sample of 791 unscreened adults (50-75 years) from a recent nationwide health survey in Greece were interviewed about CRC screening barriers, and the main reason for not adhering to colonoscopy and fecal occult blood test (FOBT) was assessed. Results were compared to a concurrent survey of 161 primary care professionals (PCPs) from the same region and the agreement with the general population was assessed with odds ratios (OR) and 95% confidence intervals (CI). RESULTS: General population stated as a primary barrier for colonoscopy, at a significant higher frequency than the PCPs (p<0.001), lack of symptoms (44.5 vs 5.7%), negligence (14.2 vs 3.8%) and lack of PCP recommendation (9.2 vs 2.5%). PCPs were more likely to agree for fear of pain of colonoscopy (OR:19.6, 95%CI 9.3-41.4), fear of cancer diagnosis (OR:17.7, 95%CI 10.8-29.1), and embarrassment (OR:13.8, 95%CI 8.1-23.6). Regarding FOBT, the most frequent barrier for the unscreened population compared to PCPs (p<0.001), was lack of symptoms (38.2 vs 3.9%), followed by unawareness of the test (22.9 vs 55.2%) and lack of PCP recommendation (13% vs 12.3%). The only barrier that PCPs agreed at significantly lower frequency was the lack of physician recommendation (OR:0.3; 95%CI 0.2-0.4). CONCLUSIONS: PCPs do not share the same views as the general population about CRC screening barriers in Greece. PCPs should focus counseling on patient perceived barriers in order to promote adherence.

Low vaccination coverage of Greek Roma children amid economic crisis: national survey using stratified cluster sampling.

Background: Research on Roma health is fragmentary as major methodological obstacles often exist. Reliable estimates on vaccination coverage of Roma children at a national level and identification of risk factors for low coverage could play an instrumental role in developing evidence-based policies to promote vaccination in this marginalized population group. Methods: We carried out a national vaccination coverage survey of Roma children. Thirty Roma settlements, stratified by geographical region and settlement type, were included; 7-10 children aged 24-77 months were selected from each settlement using systematic sampling. Information on children's vaccination coverage was collected from multiple sources. In the analysis we applied weights for each stratum, identified through a consensus process. Results: A total of 251 Roma children participated in the study. A vaccination document was presented for the large majority (86%). We found very low vaccination coverage for all vaccines. In 35-39% of children 'minimum vaccination' (DTP3 and IPV2 and MMR1) was administered, while 34-38% had received HepB3 and 31-35% Hib3; no child was vaccinated against tuberculosis in the first year of life. Better living conditions and primary care services close to Roma settlements were associated with higher vaccination indices. Conclusions: Our study showed inadequate vaccination coverage of Roma children in Greece, much lower than that of the non-minority child population. This serious public health challenge should be systematically addressed, or, amid continuing economic recession, the gap may widen. Valid national estimates on important characteristics of the Roma population can contribute to planning inclusion policies.

Economic crisis, restrictive policies, and the population's health and health care: the Greek case.

The global economic crisis has affected the Greek economy with unprecedented severity, making Greece an important test of the relationship between socioeconomic determinants and a population's well-being. Suicide and homicide mortality rates among men increased by 22.7% and 27.6%, respectively, between 2007 and 2009, and mental disorders, substance abuse, and infectious disease morbidity showed deteriorating trends during 2010 and 2011. Utilization of public inpatient and primary care services rose by 6.2% and 21.9%, respectively, between 2010 and 2011, while the Ministry of Health's total expenditures fell by 23.7% between 2009 and 2011. In a time of economic turmoil, rising health care needs and increasing demand for public services collide with austerity and privatization policies, exposing Greece's population health to further risks.

Primary health care and general practice attachment: establishing an undergraduate teaching network in rural Greek health centers.

CONTEXT: Exposure of undergraduate medical students to general practice and community healthcare services is common practice in the international medical curricula. Nevertheless, proponents of the hospital and biotechnology based paradigm, which is still dominant within the medical academic environment, question both the scope and the setting of this training procedure. Regarding the latter, the quality of teaching is often questioned in settings such as rural primary health centers, where health professionals have neither incentives nor accredited training skills. Therefore, the success of community based medical education depends substantially on the procedures implemented to involve non-academic staff as clinical teachers. ISSUE: This report describes the steps taken by the Aristotle University of Thessaloniki (AUTH) Medical School to establish and maintain a Rural Primary Health Care (PHC) Teaching Network in order to implement community oriented PHC and GP undergraduate medical education. A multi-professional teachers' network of healthcare staff, working in Rural Primary Health Centers, has been chosen, in order to expose students to the holistic approach of PHC. The enrollment of teachers to the Teaching Network was solely on a voluntary basis. The novelty of this procedure is that each professional is approached personally, instead through the Health Center (HC) that usually offers this service as a package in similar activities. In an attempt to attract health professionals committed to medical education, a self-selection procedure was adopted. Collaboration with the medical school was established but it was characterized by the School's inability to compensate teachers. A series of 'Training the Trainers' seminars were completed during the first implementation period in order to enhance the awareness of health professionals regarding undergraduate teaching in PHC; to present the educational needs of medical students; to expose them to the principles of medical teaching; and to strengthen their communication skills. LESSONS LEARNED: Setting up sustainable community oriented medical education activities in a more or less unfriendly environment is a difficult task that calls for wisely selected functional steps. Pilot educational activities determine the quality of the implemented programs by evaluating difficulties and constraints. Recruiting teachers on a voluntary basis proved to be critical in enhancing the quality of this educational activity, and overcoming distance constraints. The educational activities which were offered created a homogenous group of PHC teachers with explicit educational aims and objectives.

Pandemic's Experience Questioning Capitalistic Dominance Comment on "Ensuring Global Health Equity in a Post-pandemic Economy".

Reflecting on the up-to-date global experience of the coronavirus disease 2019 (COVID-19) pandemic is of crucial importance in order to draw conclusions needed for the design of policies aiming the prevention of new epidemics and the effective protection, preparedness and response of any new emerging. Ongoing environmental destruction, excess mortality by COVID-19 and non-COVID diseases reflecting the dismantlement and commodification of both public health services and healthcare services, deep economic crisis, increasing and deepening social inequalities are the main characteristics raised by the pandemic. The causes of the causes of all these are the dominant rules of the capitalistic system, driven mainly by the unlimited greed for profit on the expenses of the majority of the society. The effectiveness of any proposed correction of this system is discussed and the need for another society responding to the needs of the population is argued.

The COVID-19 Pandemic and the Private Health Sector: Profiting without Socially Contributing.

The COVID-19 pandemic necessitated the mobilization of all available health care resources, including private, for-profit ones. The aim of this multiple methods study (combination of document and secondary data analysis) was to assess government regulations facilitating the private health sector's participation in the COVID-19 response in Greece. During the pandemic, the government made three successive increases in private providers' reimbursement fees, provided additional financial incentives to private providers, and allocated €280 million of emergency funding for the private sector's involvement in the national COVID-19 response. In response, private hospitals made available on average 2.2% of their total bed capacity per epidemic wave for the treatment of COVID-19 patients and 1.7% of their total bed capacity for the treatment of non-COVID-19 patients transferred from National Health System (NHS) hospitals. In 2020 the five largest health care corporate groups maintained their revenues, while in 2021 they increased them by 18.7%-a striking comparison with the 9% recession experienced by the Greek economy in 2020 and its 8.4% recovery in 2021. In a time of an acute public health crisis, private health care providers responded to society's pressing health care needs by insulating their facilities from COVID-19 patients and NHS patient transfers, minimizing their social contribution and safeguarding their revenues and profits.

Low birth weight and prenatal exposure to indoor pollution from tobacco smoke and wood fuel smoke: a matched case-control study in Gaza Strip.

Maternal exposure to environmental tobacco smoke (ETS) is a major health hazard as it contains lower doses of the toxins that smokers' inhale. Prenatal exposure to wood fuel smoke has been linked to delivering low birth weight (LBW) infants. The study aims to assess the association between prenatal exposure to ETS and wood fuel smoke and LBW. A case-control study in ratio 1:1 was conducted in two hospitals with obstetric services in Gaza Strip. Subjects were selected during May-June and July-August 2007 from attenders of Mbarak Hospital and Shifa Medical Centre, respectively. 184 (41.2%), and 79 (17.7%) out of 446 participants were exposed to environmental tobacco smoke and wood fuel smoke, respectively. Adjusted maternal exposure to ETS (especially the number of cigarettes smoked, water pipe and wood fuel smoke) was associated with LBW infants. Cigarette smoke exhibits an independent dose-response risk of LBW after adjusting for confounders. Prenatal exposure to cigarette smoke indoors is related to a reduction in birth weight of infants of -237 g (95% CI: -415, -58) for pregnant women exposed to 1-20 cigarettes per day and -391 g (95% CI: -642, -140) for exposure to more than 20 cigarettes per day. Exposure to wood fuel smoke exhibits a reduction of infants' adjusted mean birth weight by -186 g (95% CI: -354, -19). Prenatal exposure to passive smoking and wood fuel smoke are independently associated with LBW. Both these factors are modifiable exposures that could possibly lead to a reduction of delivering LBW infants.

Payments and quality of care in private for-profit and public hospitals in Greece.

BACKGROUND: Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged. METHODS: Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003. RESULTS: PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities. CONCLUSIONS: In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision.

Satisfaction and Perceived Barriers of General Practice Residents in Relation to Their Educational Needs Coverage During Residency in Greece.

Objectives: This study aimed to assess satisfaction and report on perceptions of General Practice (GP) residents during residency in Greece, through an online questionnaire at a national level. Material and methods:A mixed type method study was shaped. Both quantitative analysis and a quasiqualitative approach were used, while information from an open-ended question was processed. The study included answers of GP residents recruited with a national sample pool technique. Results:There were 177 responders from 430 registered residents. Using a grading system from 1 to 10, the median value showing how much satisfied the participants were during their training was 4.48 (95% CI 4.16-4.79), while GP logbook was regarded as useful (median value 6.29, 95% CI 5.84-6.73). The training program was reported as insufficient to prepare residents for their future work as primary health care physicians, with a median rating of 4.09 (95% CI 3.78-4.41). The overall educational gain was regarded as poor compared to residents' expectations, with a median rating of 4.71 (95% CI 4.38-5.07). From free text responses of 83 participants, an organized educational program based on logbook skill acquirement with interaction between coordinator and resident emerged as a priority. Conclusion: Understanding general practitioners' perceptions, satisfaction level and expectations may help to design reform initiatives and cover their educational needs during residency in a holistic manner. Experience from local settings may be useful to offer more comprehensive messages. In a rapidly changing health environment, quickly collecting and analyzing emerging data appears to be a practical way for correcting decisions and avoiding previous errors.

National Survey of Morbidity and Risk Factors (EMENO): Protocol for a Health Examination Survey Representative of the Adult Greek Population.

BACKGROUND: Main causes of death in Greece are cardiovascular diseases (CVDs), malignant neoplasms, respiratory diseases, and road traffic crashes. To assess the population health status, monitor health systems, and adjust policies, national population-based health surveys are recommended. The previous health surveys that were conducted in Greece were restricted to specific regions or high-risk groups. OBJECTIVE: This paper presents the design and methods of the Greek Health Examination Survey EMENO (National Survey of Morbidity and Risk Factors). The primary objectives are to describe morbidity (focusing on CVD, respiratory diseases, and diabetes), related risk factors, as well as health care and preventive measures utility patterns in a random sample of adults living in Greece. METHODS: The sample was selected by applying multistage stratified random sampling on 2011 Census. Trained interviewers and physicians made home visits. Standardized questionnaires were administered; physical examination, anthropometric and blood pressure measurements, and spirometry were performed. Blood samples were collected for lipid profile, glucose, glycated hemoglobin, and transaminases measurements. The survey was conducted from May 2013 until June 2016. RESULTS: In total, 6006 individuals were recruited (response rate 72%). Of these, 4827 participated in at least one physical examination, 4446 had blood tests, and 3622 spirometry, whereas 3580 provided consent for using stored samples for future research (3528 including DNA studies). Statistical analysis has started, and first results are expected to be submitted for publication by the end of 2018. CONCLUSIONS: EMENO comprises a unique health data resource and a bio-resource in a Mediterranean population. Its results will provide valid estimates of morbidity and risk factors' prevalence (overall and in specific subdomains) and health care and preventive measures usage in Greece, necessary for an evidence-based strategy planning of health policies and preventive activities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10997.

Symptoms of traumatic stress after coronary artery bypass grafting.

BACKGROUND: Traumatic stress symptoms have only recently been studied in association with medical treatment procedures. PURPOSE: The study examined associations of physical and psychological functioning during hospitalization to symptoms of traumatic stress after cardiac surgery. METHODS: One hundred thirteen patients admitted for coronary artery bypass grafting participated in the study. Symptoms of traumatic stress were assessed one and six months after surgery, with the Impact of Event Scale. Preoperative stress and ruminative thinking, length of preoperative waiting, duration of surgery, and postoperative recovery indices (length of stay in the intensive care unit, cognitive functioning during intensive care, length of stay in the hospital) were examined. RESULTS: Ten percent of the patients reported severe (> 19) symptoms of avoidance, and five percent reported severe symptoms of intrusion in both follow-ups. Hierarchical regression analyses showed that preoperative stress was positively associated to avoidance symptoms in both follow-ups (p < .01). Preoperative stress and ruminative thinking was positively associated to intrusion symptoms one month after surgery (p < .01). Disease related factors were not related to symptoms of traumatic stress during the postoperative period. CONCLUSION: This study highlights the role of preoperative surgery-related stress as a risk factor for traumatic stress in the postoperative period.

Acquisition of imipenem-resistant Acinetobacter baumannii in a pediatric intensive care unit: A case-control study.

OBJECTIVE: To investigate the risk factors associated with nosocomial acquisition of imipenem-resistant Acinetobacter baumannii (IRAB) among pediatric intensive care patients. A retrospective case control study was conducted in a pediatric intensive care unit (PICU). PATIENTS AND PARTICIPANTS: Cases were children in whom IRAB was isolated from any clinical specimen obtained at least 48 h following admission to PICU. Controls were children without IRAB matched to cases in 2:1 ratio. Twenty-six cases were matched with 52 controls according to the chronological order of admission. MEASUREMENTS AND RESULTS: Between July 2001 and December 2003, 52 (62%) of 84 clinical A. baumannii isolates were found nonsusceptible to imipenem (MIC > or = 8 microg/ml). Demographic variables, comorbid conditions, clinical picture at admission, invasive procedures, use of antimicrobials and other drugs were analyzed as potential risk factors. Use of carbapenems and other beta-lactams, aminoglycosides, ranitidine, mechanical ventilation, central venous or urinary catheters and length of stay in PICU were among the factors significantly associated with IRAB acquisition in the univariate analysis. By multivariate analysis, however, only aminoglycoside use and length of stay in the PICU were independent risk factors. CONCLUSIONS: Acquisition of IRAB by PICU patients was independently associated with aminoglycoside use and prolonged stay in the unit. Studies of evaluation of infection control policies need to be pursued.

Quality of life after coronary artery bypass grafting: evaluating the influence of preoperative physical and psychosocial functioning.

OBJECTIVE: The aim of this study was to determine the influence of preoperative physical and psychosocial functioning on quality of life 1 and 6 months after coronary artery bypass grafting (CABG). METHODOLOGY: The study used a prospective design. A total of 157 patients admitted for elective CABG in a Greek city hospital participated in the study. RESULTS: Results showed significant improvements in the quality of life of the patients after CABG [F(2, 95)=36.337; P<.001]. Structural equation modeling analyses showed that preoperative psychological distress was the only preoperative predictor of quality of life at 1 month (beta=-.22; P<.01) and at 6 months (beta=-.28; P<.001) after the operation. CONCLUSION: Results highlight preoperative distress as a screening criterion to identify patients likely to benefit less from cardiac surgery.

Burnout in internal medicine physicians: Differences between residents and specialists.

BACKGROUND: Burnout poses a substantial problem for physicians' well-being and for the quality of health care. The role of workload in comparison to subjective work characteristics has been rarely studied. The purpose of this study was to explore the associations of burnout with workload and subjective work characteristics in internal medicine specialists and residents. METHODS: A cross-sectional study using an anonymous mailed survey was used. Some 103 specialists and 143 residents participated in the study. Burnout was measured using the Maslach Burnout Inventory. Subjective work characteristics included perceived job demands in terms of time pressure, mental effort and emotional labor. Workload was assessed in terms of average number of hours worked per week. RESULTS: Emotional exhaustion in medical specialists was only predicted by perceived job demands [odds ratio 3.7 (CI 1.7-7.9), P<0.001]. Emotional exhaustion in medical residents was only predicted by emotional labor [odds ratio 1.9 (CI 1.2-3.0), P=0.003]. Depersonalization among medical specialists was only predicted by emotional labor [odds ratio 2.7 (CI 1.1-6.7), P=0.032], while depersonalization among medical residents was only predicted by number of hours worked per week [odds ratio 1.1 (CI 1.1-1.2), P=0.007]. DISCUSSION: Perceived working conditions were more important than workload in explaining the variance in burnout. In addition, burnout in medical specialists and residents was linked to different characteristics of their working environment.