Πρωτοβάθμια Φροντίδα Υγείας by ELEGEIA GREEK ASSOCIATION OF GP's

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Primary Health Care Ôñéìçíéáßá ¸êäïóç ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞò Quarterly edited by the Greek Association of General Practitioners Ôüìïò 13, Ôåý÷ïò 3, Éïýëéïò - ÓåðôÝìâñéïò 2001, Volume 13, Number 3, July - September 2001

Ôçò Óýíôáîçò 113

Å.Á. Èçñáßïò: 13° ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò Âñáâåõèåßóá Åñãáóßá óôï Äéáãùíéóìü "Ä. ºêêïõ"

116

Å. Óêëçñüò, Á. Óùôçñüðïõëïò, É. ÐáðáúùÜííïõ, Å. Êôþñïõ, Å. ÔæéáíÜêçò, Â. Ößëç, Ó. ×áëêéÜ, Ð. ÊïõñÜêïò: ÌåëÝôç ðáñáãüíôùí ðïõ åðéäñïýí óôç ñýèìéóç ôçò áñôçñéáêÞò ðßåóçò õðåñôáóéêþí áóèåíþí Åðáéíåèåßóåò Åñãáóßåò óôï Äéáãùíéóìü "Ä. ºêêïõ"

121

Á. Ìðáôßêáò, Í. ÁíôùíÜêçò, Ê. ËéÜðçò, Å. ÐáðïõôóéäÜêçò, Å. ×áñéôÜêç, Í. ÐáðáäÜêçò, A. Êáñüêçò, ×. ËéïíÞò: Ç åðáíáëáìâáíüìåíç óõíôáãïãñáößá äåßêôçò ðôù÷Þò (åëëéðïýò) éáôñéêÞò öñïíôßäáò: ìéá ðéëïôéêÞ ìåëÝôç óå Ýíá ÊÝíôñï Õãåßáò ôçò ÊñÞôçò

127

Ó. ÁñãõñéÜäïõ, ×. Ìåëéóóïðïýëïõ, Á. ×áñßóç, ×. ËõãéäÜêçò, Ä. ÊáöåôæÞò, Á. Êïæáäßíïò, Á. ÁíôùíéÜäçò, Ó. ÑÜëëç, Ê. ×ïõ÷ïýëç, Ë. ÖùôéÜäïõ, Ã. Ãåùñãïýóç, Â. Ìïó÷ïêÜñöç: ¸íá ìïíôÝëï ïëéóôéêÞò ðñïóÝããéóçò ôïõ Ãåíéêïý Éáôñïý óôïõò áóèåíåßò ìå áããåéáêü åãêåöáëéêü åðåéóüäéï Âñáâåõèåßóåò Åëåýèåñåò Áíáêïéíþóåéò

136

Ã. ÌáíôæïõñÜíçò, Ð. Êïóêåñßäïõ, ×. Öëïýäá, Ì. Ìáñáãêüò: ÅíçìÝñùóç êáé ðñüëçøç ôïõ íïóçëåõôéêïý-ðáñáúáôñéêïý ðñïóùðéêïý ãéá ôá ëïéìþäç íïóÞìáôá óôïí åñãáóéáêü ÷þñï

140

Ó. ÁñãõñéÜäïõ, Ì. ÐåñåíôæÞ, Ä. Óááôæüãëïõ, ×. Ìåëéóóïðïýëïõ, Á. Ïñöáíßäçò, ×. ËõãéäÜêçò, Ã. Íáëìðáíôßäçò, Ê. Êùíóôáíôéíßäïõ, ×. ËõãéäÜêç, Â. Ìïó÷ïêÜñöç, É. ÊÜëöá, Ã. Ãåùñãïýóç: ÐáñçãïñçôéêÞ öñïíôßäá êáñêéíïðáèþí: ¸íáò óçìáíôéêüò êáé óõ÷íüò ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý

147

È. Ðáõëïðïýëïõ, É. ÐáðáúùÜííïõ, Ç. ÌáñãÝëïò, È. Ãïõëéþôç, ×. Ðåæïý, Ó. ×áëêéÜ, Å. Óêëçñüò: Äéá÷åßñéóç êõíÜã÷çò óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò Åðáéíåèåßóåò Åëåýèåñåò Áíáêïéíþóåéò

153

Â. Ðáðáãåùñãßïõ, Âáñ. Ðáðáãåùñãßïõ, Áñ. Ôóá÷ïõñßäçò, Ê. Ãñßâïõ: Åðéðïëáóìüò õðåñâÜëëïíôïò âÜñïõò (Þ êáé ðá÷õóáñêßáò), äéáôñïöéêÝò óõíÞèåéåò êáé äéáôñïöéêÞ áãùãÞ óå ìáèçôéêïýò ðëçèõóìïýò ôïõ íïìïý ×áëêéäéêÞò

161

Áéê. Ãáôïðïýëïõ, Ã. Ôóßñïò, Ðáí. Âïúëá, ×. Âüóóïõ, Ã. ÊïñäÜôïò, Ð. Áèáíáóüðïõëïò, Ä. Áäáìüðïõëïò: ÌÝôñçóç äåéêôþí çðáôßôéäáò Â óå ôñåéò ïìÜäåò: ðïëõìåôáããéæüìåíïõò - åñãáæüìåíïõò óå äçìüóéï íïóïêïìåßï - êñáôïýìåíïõò êëåéóôÞò öõëáêÞò

ÅÍÔÕÐÏ ÊËÅÉÓÔÏ ÁÑÉÈ. ÁÄÅÉÁÓ 451/91 ÊÄÁ ÅËËÇÍÉÊÇ ÅÔÁÉÑÅÉÁ ÃÅÍÉÊÇÓ ÉÁÔÑÉÊÇÓ Ðáðáäéáìáíôïðïýëïõ 4, 115 28 ÁÈÇÍÁ

ISSN 1105-7432

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ÐÅÑÉÅ×ÏÌÅÍÁ Ôçò Óýíôáîçò Å.Á. Èçñáßïò: 13° ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò ............................................................................................................................... 113 Âñáâåõèåßóá Åñãáóßá óôï Äéáãùíéóìü "Ä. ºêêïõ" Å. Óêëçñüò, Á. Óùôçñüðïõëïò, É. ÐáðáúùÜííïõ, Å. Êôþñïõ, Å. ÔæéáíÜêçò, Â. Ößëç, Ó. ×áëêéÜ, Ð. ÊïõñÜêïò: ÌåëÝôç ðáñáãüíôùí ðïõ åðéäñïýí óôç ñýèìéóç ôçò áñôçñéáêÞò ðßåóçò õðåñôáóéêþí áóèåíþí .............................................. 116 Åðáéíåèåßóåò Åñãáóßåò óôï Äéáãùíéóìü "Ä. ºêêïõ" Á. Ìðáôßêáò, Í. ÁíôùíÜêçò, Ê. ËéÜðçò, Å. ÐáðïõôóéäÜêçò, Å. ×áñéôÜêç, Í. ÐáðáäÜêçò, A. Êáñüêçò, ×. ËéïíÞò: Ç åðáíáëáìâáíüìåíç óõíôáãïãñáößá äåßêôçò ðôù÷Þò (åëëéðïýò) éáôñéêÞò öñïíôßäáò: ìéá ðéëïôéêÞ ìåëÝôç óå Ýíá ÊÝíôñï Õãåßáò ôçò ÊñÞôçò ................................................................................................................................................................................ 121 Ó. ÁñãõñéÜäïõ, ×. Ìåëéóóïðïýëïõ, Á. ×áñßóç, ×. ËõãéäÜêçò, Ä. ÊáöåôæÞò, Á. Êïæáäßíïò, Á. ÁíôùíéÜäçò, Ó. ÑÜëëç, Ê. ×ïõ÷ïýëç, Ë. ÖùôéÜäïõ, Ã. Ãåùñãïýóç, Â. Ìïó÷ïêÜñöç: ¸íá ìïíôÝëï ïëéóôéêÞò ðñïóÝããéóçò ôïõ ãåíéêïý éáôñïý óôïõò áóèåíåßò ìå áããåéáêü åãêåöáëéêü åðåéóüäéï ............................................................................................................................................ 127 Âñáâåõèåßóåò Åëåýèåñåò Áíáêïéíþóåéò Ã. ÌáíôæïõñÜíçò, Ð. Êïóêåñßäïõ, ×. Öëïýäá, Ì. Ìáñáãêüò: ÅíçìÝñùóç êáé ðñüëçøç ôïõ íïóçëåõôéêïý ðáñáúáôñéêïý ðñïóùðéêïý ãéá ôá ëïéìþäç íïóÞìáôá óôïí åñãáóéáêü ÷þñï ........................................................................................ 136 Ó. ÁñãõñéÜäïõ, Ì. ÐåñåíôæÞ, Ä. Óááôæüãëïõ, ×. Ìåëéóóïðïýëïõ, Á. Ïñöáíßäçò, ×. ËõãéäÜêçò, Ã. Íáëìðáíôßäçò, Ê. Êùíóôáíôéíßäïõ, ×. ËõãéäÜêç, Â. Ìïó÷ïêÜñöç, É. ÊÜëöá, Ã. Ãåùñãïýóç: ÐáñçãïñçôéêÞ öñïíôßäá êáñêéíïðáèþí. ¸íáò óçìáíôéêüò êáé óõ÷íüò ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý ................................................................................................... 140 È. Ðáõëïðïýëïõ, É. ÐáðáúùÜííïõ, Ç. ÌáñãÝëïò, È. Ãïõëéþôç, ×. Ðåæïý, Ó. ×áëêéÜ, Å. Óêëçñüò: Äéá÷åßñéóç êõíÜã÷çò óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò .............................................................................................................................. 147 Åðáéíåèåßóåò Åëåýèåñåò Áíáêïéíþóåéò Â. Ðáðáãåùñãßïõ, Âáñ. Ðáðáãåùñãßïõ, Áñ. Ôóá÷ïõñßäçò, Ê. Ãñßâïõ: Åðéðïëáóìüò õðåñâÜëëïíôïò âÜñïõò (Þ êáé ðá÷õóáñêßáò), äéáôñïöéêÝò óõíÞèåéåò êáé äéáôñïöéêÞ áãùãÞ óå ìáèçôéêïýò ðëçèõóìïýò ôïõ íïìïý ×áëêéäéêÞò ............ 153 Áéê. Ãáôïðïýëïõ, Ã. Ôóßñïò, Ðáí. ÂïÀëá, ×. Âüóóïõ, Ã. ÊïñäÜôïò, Ð. Áèáíáóüðïõëïò, Ä. Áäáìüðïõëïò: ÌÝôñçóç äåéêôþí çðáôßôéäáò Â óå ôñåéò ïìÜäåò: ðïëõìåôáããéæüìåíïõò - åñãáæüìåíïõò óå äçìüóéï íïóïêïìåßï - êñáôïýìåíïõò êëåéóôÞò öõëáêÞò ...................................................................................................................................................... 161

CONTENTS Editorial E. Thireos: 13th National Congress of General Practice ................................................................................................................................... 113 Awarded Paper in the Memory of Prof. "D. Ikkos" S. Skliros, A. Sotiropoulos, I. Papaioannou, E. Ktorou, E. Jianakis, B. Fili, S. Chalkia, P. Kourakos: Study of factors that influence the control of the arterial blood pressure in hypertensive patients ........................................................ 116 The Second Awarded Papers in the Memory of Prof. "D. Ikkos" A. Batikas, N. Antonakis, K. Liapis, E. Papoutsidakis, E. Charitaki, N. Papadakis, C. Lionis: Repeat prescription as an indicator of poor clinical care: a room for improívement in rural General Practice in Greece ...................................... 121 S. Argriadou, H. Melissopoulou, A. Charisi, H. Lygidakis, D. Kafetzis, A. Kozadinos, A. Antoniadis, S. Ralli, K. Houhouli, L. Fotiadou, G. Giorgousi, V. Moshokarfi: A model for a holistic approach from general practitioners to patients suffering from stroke .................................................................................................................................................................................... 127 Awarded Freestanding Papers G. Mantzouranis, P. Koskeridou, C. Flouda, M. Marangos: Education regarding infection risks and preventive measures of Health Care Workers in the workplace ........................................................................................................................................... 136 S. Argyriadou, M. Perentzi, D. Saatzoglou, H. Melissopoulou, A. Orfanidis, H. Lygidakis, G. Nalbandidis, K. Konstantinidou, H. Lygidaki, V. Moshokarfi, P. Kalfa, G. Georgousi: Palliative care for Cancer patients. An important and frequent role of the general practitioner ............................................................................................................................. 140 Th. Paulopoulou, I. Papaioannou, H. Margelos, Th. Goulioti, Ch. Pezou, E. Skliros: The management of acute pharyngitis in primary health care ................................................................................................................................................................................. 147 The Second Awarded Freestanding Papers V. Papageorgiou, Var. Papageorgiou, Ar. Tsachouridis, E. Grivou: The prevalence of excess weight and obecity, dietary habits and dietary education in school populations from Chalkidiki County ........................................................................... 153 E. Gatopoulou, G. Tsiros, P. Voila, Ch. Vossou, G. Kardatos, P. Athanasopoulos, D. Adamopoulos: Measuring of Hepatitis B indexes in three groups: multitransfusioners, public hospital employees, and prisoners in closed prison .... 161

Ôüìïò 13, Ôåý÷ïò 3, 2001

Å. Èçñáßïò

THÓ ÓÕÍÔÁÎÇÓ EDITORIAL Primary Heatlh Care, Volume 13, Number 3, 113-115, 2001 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 13, Ôåý÷ïò 3, 113-115, 2001

13O ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò Ñüäïò, 18-22 Áðñéëßïõ 2001 Å.Á. Èçñáßïò

Ôï 13ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò ðñáãìáôïðïéÞèçêå óôï îåíïäï÷åßï Hilton Rodos Resort, óôç Ñüäï áðü 18-22 Áðñéëßïõ 2001 êáé áðïôÝëåóå êáé ðÜëé ôïí ôüðï óõíÜíôçóçò ôùí Ãåíéêþí éáôñþí êáé ôùí ößëùí ôçò ÃåíéêÞò ÉáôñéêÞò áð' üëç ôçí ÅëëÜäá. ÌåôÜ ôïõò ÷áéñåôéóìïýò êáé ôéò ðñïóöùíÞóåéò êáôÜ ôçí åíáñêôÞñéá ôåëåôÞ, áêïëïýèçóå ç åíáñêôÞñéá äéÜëåîç ðïõ, üðùò åßèéóôáé, Þôáí ç âñáâåõèåßóá åñãáóßá ìå ôï âñáâåßï "Ä. ºêêïõ" óôï 12ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò, ìå èÝìá "ÁíÜëõóç êáé áîéïëüãçóç ÷áñáêôçñéóôéêþí ôùí ðåñéëÞøåùí óôá ÐáíåëëÞíéá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò (1989-99)" êáé ïìéëçôÞ ôïí ê. Í. ÑáæÞ. Ç óôñïããõëÞ ôñÜðåæá ìå èÝìá: "ÁíÜðôõîç ôïõ Åèíéêïý ÓõóôÞìáôïò Õãåßáò óôçí êáôåýèõíóç ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò/ÃåíéêÞ ÏéêïãåíåéáêÞ ÉáôñéêÞ", ìå óõíôïíéóôÞ ôïí Ðñüåäñï ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞò (ÅËÅÃÅÉÁ) ê. Ì.Ð. Ìåñêïýñç êáé åéóçãçôÝò ôïí ÂïõëåõôÞ ÄùäåêáíÞóïõ êáé ôÝùò Õðïõñãü Õãåßáò êáé Ðñüíïéáò ê. Ä. Êñåìáóôéíü, ôïí ÂïõëåõôÞ Êéëêßò êáé Ãåíéêü Éáôñü ê. Ê. Êéëôßäç, ôïí Áíôéðñüåäñï ôïõ ÓÖÅÅ ê. Í. ÌáíáóÜêç êáé ôïí ôÝùò ÄéïéêçôÞ ôïõ ÉÊÁ ê. Ã. Óïëùìü, ðñáãìáôïðïéÞèçêå óå ìéá êáôÜìåóôç áßèïõóá. Óôï ãüíéìï ðñïâëçìáôéóìü ðïõ áíáðôý÷èçêå ðáñåíÝâçóáí ìå ôï ó÷ïëéáóìü ôïõò ï Õðïõñãüò Õãåßáò êáé Ðñüíïéáò ê. Á. Ðáðáäüðïõëïò êáé ï ÔïìåÜñ÷çò Õãåßáò ôçò ÍÝáò Äçìïêñáôßáò ê. Í. ÊáêëáìÜíçò. Áðü ôéò ôïðïèåôÞóåéò üëùí ôùí ïìéëçôþí êáôÝóôç *18-22 Áðñéëßïõ 2001, Îåíïäï÷åßï Hilton Rodos Resort, Ñüäïò

óáöÝò, üôé Ýíá Óýóôçìá Õãåßáò ðïõ äåí âáóßæåôáé óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò äåí ìðïñåß íá áíôáðïêñéèåß óôéò áðáéôÞóåéò êáé áíÜãêåò ôùí ÅëëÞíùí ðïëéôþí. ÌÝóá ó' Ýíá ôÝôïéï óýóôçìá, ï ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý ïöåßëåé íá åßíáé êåíôñéêüò. Óôéò õðÜñ÷ïõóåò óõíèÞêåò, ç óõæÞôçóç ãéá ôç ÃåíéêÞ ÉáôñéêÞ óÞìåñá åßíáé üóï ðïôÝ Üëëïôå åðßêáéñç. Ïé áðáñáßôçôåò ðñïûðïèÝóåéò ãéá ôçí áíÜðôõîç êáé åäñáßùóÞ ôçò óôçí ÅëëÜäá, ðñÝðåé íá áðïôåëÝóïõí ôï âáóéêü êïñìü ôïõ êÜèå ðñïâëçìáôéóìïý, ìå Üîïíá óêÝøçò êáé ðñùôïâïõëéþí ôçí ßäéá ôçí ÅËÅÃÅÉÁ. Éäéáßôåñá ìÜëéóôá, ðïõ ï ðñïâëçìáôéóìüò áõôüò äåí öáßíåôáé íá áããßæåé ôï ìåãáëýôåñï ôìÞìá ôùí Ãåíéêþí Éáôñþí, áí èåëÞóåé íá êñßíåé êáíåßò áðü ôç ìéêñÞ óõììåôï÷Þ ôùí óõíáäÝëöùí óå äõï êåíôñéêÞò óçìáóßáò åêäçëþóåéò ôïõ óõíåäñßïõ. Ôç äéÜëåîç ôïõ Åðßêïõñïõ ÊáèçãçôÞ ôïõ Ðáíåðéóôçìßïõ ÊñÞôçò ê. ×. ËéïíÞ ìå èÝìá "ÓçìáíôéêÝò ðñïôåñáéüôçôåò ãéá ôç ÃåíéêÞ/ÏéêïãåíåéáêÞ ÉáôñéêÞ óôçí ÅëëÜäá óÞìåñá" êáé ôç óôñïããõëÞ ôñÜðåæá ìå èÝìá "Åêðáßäåõóç êáé äÝóìç ðáñå÷ïìÝíùí õðçñåóéþí áðü ôï Ãåíéêü Éáôñü" ìå óõíôïíéóôÞ ôïí Ðñüåäñï ôçò ÅËÅÃÅÉÁ ê. Ì.Ð. Ìåñêïýñç êáé åéóçãçôÝò ôïí ÁíáðëçñùôÞ ÊáèçãçôÞ ôïõ Ðáíåðéóôçìßïõ ÊñÞôçò ê. Á. ÖéëáëÞèç, ôïí ÊáèçãçôÞ óôïí ÔïìÝá Ïéêïíïìéêþí ôçò Õãåßáò ôçò ÅèíéêÞò Ó÷ïëÞò Äçìüóéáò Õãåßáò ê. É. Êõñéüðïõëï, ôïí Åðßêïõñï ÊáèçãçôÞ ê. ×. ËéïíÞ, ôïí Ðñüåäñï êáé Ãåíéêü ÄéåõèõíôÞ ôïõ ÐåÓÕ ÓôåñåÜò ÅëëÜäáò ê. Ã. ÔóÜêï êáé ôïí Áíôéðñüåäñï Á´ ôçò ÅëëçíéêÞò ¸íùóçò ÃåíéêÞò ÉáôñéêÞò ê. Ä. Ìé÷Üëç. Ôï åðéóôçìïíéêü ðñüãñáììá ôïõ óõíåäñßïõ, 113

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

óôï ïðïßï õðÞñ÷áí äéáëÝîåéò êáé áðü äýï îÝíïõò ðñïóêåêëçìÝíïõò ïìéëçôÝò, ðåñéåëÜìâáíå: 11 óôñïããõëÝò ôñÜðåæåò, 8 äéáëÝîåéò, 196 åëåýèåñåò áíáêïéíþóåéò êáé 164 áíáñôçìÝíåò áíáêïéíþóåéò (poster). Ôá èÝìáôá ôùí óôñïããõëþí ôñáðåæþí êáé ôùí äéáëÝîåùí Þôáí:

Å. Èçñáßïò

óêåêëçìÝíï ïìéëçôÞ ôïí W. Maerz. · Ôï åýñïò ôùí êáôáèëéðôéêþí äéáôáñá÷þí. Óýã÷ñïíåò èåñáðåõôéêÝò ðñáêôéêÝò. · Ëïéìþîåéò óôçí êáèçìåñéíÞ ðñáêôéêÞ. · Äõóðåøßá: Áðü ôç äéáöïñïäéÜãíùóç ôçò íüóïõ óôçí ðñüêëçóç ôçò èåñáðåßáò. Ïé åñãáóßåò ôïõ óõíåäñßïõ Ýêëåéóáí ìå ôçí áðïíïìÞ ôùí âñáâåßùí, ôá ïðïßá Ýëáâáí:

ÓôñïããõëÝò ôñÜðåæåò · Õðåñëéðéäáéìßåò - ËÞøç êëéíéêþí áðïöÜóåùí üôáí óõíõðÜñ÷ïõí êáé Üëëïé ðáñÜãïíôåò êéíäýíïõ. · ÃåíéêåõìÝíï Üã÷ïò. Ç áíôéìåôþðéóÞ ôïõ óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. · Óõíäõáóìïß áíôéõðåñôáóéêþí öáñìÜêùí óôçí ðñÜîç: ôï ðáñÜäåéãìá ôùí áMEA ìå õäñï÷ëùñïèåéáæßäç. · ÁíÜðôõîç ôïõ Åèíéêïý ÓõóôÞìáôïò Õãåßáò óôçí êáôåýèõíóç ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò/ÃåíéêÞ ÏéêïãåíåéáêÞ ÉáôñéêÞ. · ÄéáãíùóôéêÞ ðñïóðÝëáóç êáé èåñáðåßá åëéêïâáêôçñéäßïõ ôïõ ðõëùñïý áðü ôïí Ãåíéêü Éáôñü. · Áíáæçôþíôáò ôç èÝóç ôùí áíáóôïëÝùí ôùí õðïäï÷Ýùí ôçò áããåéïôáóßíçò ÉÉ óôç óýã÷ñïíç áíôéìåôþðéóç ôçò õðÝñôáóçò. · Åêðáßäåõóç êáé äÝóìç ðáñå÷ïìÝíùí õðçñåóéþí áðü ôï Ãåíéêü Éáôñü. · Íåþôåñá áíôééóôáìéíéêÜ êáé ï ñüëïò ôïõò óôá áëëåñãéêÜ íïóÞìáôá. · Èåñáðåßá ×ñüíéáò ÁðïöñáêôéêÞò ÐíåõìïíïðÜèåéáò. Ï ñüëïò ôïõ Ãåíéêïý Éáôñïý. · Ç ðñüëçøç ôùí ìéêñïáããåéáêþí êáé ìáêñïáããåéáêþí åðéðëïêþí ôïõ Óáê÷áñþäïõò ÄéáâÞôç. ÄéáëÝîåéò · Malpractice in Primary Care, ìå ðñïóêåêëçìÝíï ïìéëçôÞ ôïí Giora Almagor. · ÓçìáíôéêÝò ðñïôåñáéüôçôåò ãéá ôç ÃåíéêÞ/ ÏéêïãåíåéáêÞ ÉáôñéêÞ óôçí ÅëëÜäá óÞìåñá. · ÓõæåõãìÝíï åìâüëéï êáôÜ ôïõ ìçíéããéôéäüêïêêïõ. Ç ðñþôç ðñáãìáôéêÞ ëýóç ãéá ôçí ðñüëçøç ôçò ìçíéããßôéäïò ôýðïõ C. · ÊñéôÞñéá åðéëïãÞò õðïëéðéäáéìéêÞò áãùãÞò óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, ìå ðñï114

Âñáâåßï Êáèçãçôïý "Ä. ºêêïõ" ÌåëÝôç ðáñáãüíôùí ðïõ åðéäñïýí óôç ñýèìéóç ôçò áñôçñéáêÞò ðßåóçò õðåñôáóéêþí áóèåíþí. Å. Óêëçñüò, Á. Óùôçñüðïõëïò, É. ÐáðáúùÜííïõ, Å. Êôþñïõ, Å. ÔæéáíÜêçò, Â. Ößëç, Ó. ×áëêéÜ, Ð. ÊïõñÜêïò. ¸ðáéíïé Êáèçãçôïý "Ä. ºêêïõ" Ç åðáíáëáìâáíüìåíç óõíôáãïãñáößá äåßêôçò ðôù÷Þò (åëëéðïýò) éáôñéêÞò öñïíôßäáò: ìéá ðéëïôéêÞ ìåëÝôç ó' Ýíá ÊÝíôñï Õãåßáò ôçò ÊñÞôçò. Á. Ìðáôßêáò, Í. ÁíôùíÜêçò, Ê. ËéÜðçò, Å. ×áñéôÜêç, Í. ÐáðáäÜêçò, Á. Êáñüêçò, ×. ËéïíÞò. ¸íá ìïíôÝëï ïëéóôéêÞò ðñïóÝããéóçò ôïõ Ãåíéêïý Éáôñïý óôïõò áóèåíåßò ìå áããåéáêü åãêåöáëéêü åðåéóüäéï. Ó. ÁñãõñéÜäïõ, ×. Ìåëéóóïðïýëïõ, Á. ×áñßóç, ×. ËõãéäÜêçò, Ä. ÊáöåôæÞò, Á. Êïæáäßíïò, Á. ÁíôùíéÜäçò, Ó. ÑÜëëç, Ê. ×ïõ÷ïýëç, Ë. ÖùôéÜäïõ, Ã. Ãåùñãïýóç, Â. Ìïó÷ïêÜñöç. Âñáâåßá åëåõèÝñùí áíáêïéíþóåùí ÅíçìÝñùóç êáé ðñüëçøç ôïõ íïóçëåõôéêïýðáñáúáôñéêïý ðñïóùðéêïý ãéá ôá ëïéìþäç íïóÞìáôá óôïí åñãáóéáêü ÷þñï. Ã. ÌáíôæïõñÜíçò, Ð. Êïóêåñßäïõ, ×. Öëïýäá, Ì. Ìáñáãêüò. ÐáñçãïñçôéêÞ öñïíôßäá êáñêéíïðáèþí: ¸íáò óçìáíôéêüò êáé óõ÷íüò ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåáéêïý Éáôñïý. Ó. ÁñãõñéÜäïõ, Ì. ÐåñåíôæÞ, ×. Ìåëéóóïðïýëïõ, Á. Ïñöáíßäçò, ×. ËõãéäÜêçò, Ã. Íáëìðáíôßäçò, Ê. Êùíóôáíôéíßäïõ, ×. ËõãéäÜêç, Â. Ìïó÷ïêÜñöç, É. ÊÜëöá, Ã. Ãåùñãïýóç. Äéá÷åßñéóç êõíÜã÷çò óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. È. Ðáõëïðïýëïõ, É. ÐáðáúùÜííïõ, Ç. ÌáñãÝëïò, È. Ãïõëéþôç, ×. Ðåæïý, Ó. ×áëêéÜ, Å. Óêëçñüò. ¸ðáéíïé åëåõèÝñùí áíáêïéíþóåùí Åðéðïëáóìüò õðåñâÜëëïíôïò âÜñïõò (Þ/êáé ðá÷õóáñêßáò), äéáôñïöéêÝò óõíÞèåéåò êáé äéáôñïöéêÞ áãùãÞ óå ìáèçôéêïýò ðëçèõóìïýò ôïõ íïìïý ×áëêéäéêÞò. Â. Ðáðáãåùñãßïõ, Âáñ. Ðáðá-

Ôüìïò 13, Ôåý÷ïò 3, 2001

Å. Èçñáßïò

ãåùñãßïõ, Áñ. Ôóá÷ïõñßäçò, Ê. Ãñßâïõ. ÌÝôñçóç äåéêôþí çðáôßôéäáò Â óå ôñåéò ïìÜäåò: ðïëõìåôáããéæüìåíïõò - åñãáæüìåíïõò óå äçìüóéï íïóïêïìåßï - êñáôïýìåíïõò êëåéóôÞò öõëáêÞò. Áéê. Ãáôïðïýëïõ, Ã. Ôóßñïò, Ðáí, Âïúëá, ×. Âüóóïõ, Ã. ÊïñäÜôïò, Ð. Áèáíáóüðïõëïò, Ä.

Áäáìüðïõëïò. Âñáâåßï Êáèçãçôïý "Ã. Ìåñßêá" Åêôßìçóç ôùí áíáãêþí õãåßáò êáé öñïíôßäáò õãåßáò ôùí çëéêéùìÝíùí óôçí êïéíüôçôá. Å. Ãéáííáêüðïõëïò

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ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Å. Óêëçñüò êáé óõí.

ÂÑÁÂÅÕÈÅÉÓÁ ÅÑÃÁÓÉÁ ÓÔÏ ÄÉÁÃÙÍÉÓÌÏ "Ä. ÉÊÊÏÕ" AWARDED PAPER IN THE MEMORY OF PROF. D. IKKOS Primary Heatlh Care, Volume 13, Number 3, 116-120, 2001 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 13, Ôåý÷ïò 3, 116-120, 2001

ÌåëÝôç ðáñáãüíôùí ðïõ åðéäñïýí óôç ñýèìéóç ôçò áñôçñéáêÞò ðßåóçò õðåñôáóéêþí áóèåíþí Å. Óêëçñüò, Á. Óùôçñüðïõëïò, É. ÐáðáúùÜííïõ, Å. Êôþñïõ, Å. ÔæéáíÜêçò, Â. Ößëç, Ó. ×áëêéÜ, Ð. ÊïõñÜêïò

Ðåñßëçøç Óêïðüò: Óêïðüò ôçò ðáñïýóçò ìåëÝôçò áðïôåëåß ç åêôßìçóç ðáñáãüíôùí ðïõ ðéèáíüí óõìâÜëëïõí óôçí áðïññýèìéóç ôçò áñôçñéáêÞò ðßåóçò óå õðåñôáóéêïýò áóèåíåßò. Ïé ðáñÜãïíôåò ïé ïðïßïé ìåëåôÞèçêáí áöïñïýí êõñßùò óôïí áóèåíÞ êáé ïé ïðïßïé åßíáé áíåîÜñôçôïé áðü ôç óõììüñöùóÞ ôïõ óôï èåñáðåõôéêü ó÷Þìá. Áóèåíåßò êáé ìåèïäïé: ÌåëåôÞèçêáí 151 äéáäï÷éêïß áóèåíåßò ìå ðñùôïðáèÞ õðÝñôáóç õðü öáñìáêåõôéêÞ áãùãÞ ðïõ ðáñáêïëïõèïýíôáé óôï Ê.Õ. ÍåìÝáò. Óå üëïõò ôïõò áóèåíåßò ðïõ ðåñéåëÞöèçóáí óôç ìåëÝôç óõìðëçñþèçêå åéäéêü åðéäçìéïëïãéêü äåëôßï êáôáãñáöÞò äçìïãñáöéêþí óôïé÷åßùí áíèñùðïìåôñéêþí óôïé÷åßùí êáé áôïìéêïý éóôïñéêïý. Ç óôáôéóôéêÞ áíÜëõóç ôùí äåäïìÝíùí Ýãéíå ìå Pearson's x 2 ïne way ANOVA. ðïëõðáñáãïíôéêÞ áíÜëõóç Ýãéíå ìå Linear Regression Analysis ÁðïôåëÝóìáôá: ÌåëåôÞèçêáí 92 (60,9%) Üíäñåò êáé 59 (39,1%) ãõíáßêåò. Ç ìÝóç çëéêßá ±SD ôïõ äåßãìáôïò Þôáí 68,01 (±9,76), (95% CI: 66,99-69,58) Ýôç. Äåí õðÞñîå äéáöïñÜ óôáôéóôéêÜ óçìáíôéêÞ óôçí çëéêßá ìåôáîý áíäñþí êáé ãõíáéêþí (69,61±9,76 vs 66,22±9,57, p= 0,7). H ìÝóç ÓÁÐ Þôáí 144,65±18,61 êáé ç ìÝóç ÄÁÐ 81,89±9,7 mgHg. Äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ ìåôáîý ìÝóçò ÓÁÐ (146,Ï7±19,7 vs 142,44±16,7 \ p = 0,244) êáé ìÝóçò ÄÁÐ (81,52±9,8 vs 82,46±9,6 \ p= 0,565), óå Üíäñåò êáé ãõíáßêåò. Ôï ìÝóï ÂÌÉ ôïõ äåßãìáôïò Þôáí 27,3±3,5 Kg/m 2 êáé äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ ìåôáîý áíäñþí êáé ãõíáéêþí (27,28±3,07 vs 27,34±4,28, p= 0,925). Áññýèìéóôïé üóïí áöïñÜ óôï åðßðåäï ôçò ÁÐ Þôáí 71 Üôïìá (47%), 44 Üíäñåò (62%) êáé 27 ãõíáßêåò (68%). Äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ üóïí áöïñÜ óôï öýëï. Ç ìÝóç ÓÁÐ Þôáí 159±14,81 mmHg êáé ç ìÝóç ÄÁÐ 86,2±9,57 mmHg. Ç ìÝóç çëéêßá 69,42±10,01, ôï ìÝóï ÂÌÉ 26,97±3,65 Kg/m2. Ìå ôç ÷ñÞóç ìïíôÝëïõ ãñáììéêÞò ðáëéíäñüìçóçò ôï ýøïò ôçò ÓÁÐ óå õðåñôáóéêïýò áóèåíåßò ó÷åôßóôçêå ìå ôç ÷ñÞóç áëêïüë (Beta= 0,215, p= 0,008) åíþ ôçò ÄÁÐ ó÷åôßóôçêå áñíçôéêÜ ìå ôçí çëéêßá (Beta= -0,227, p= 0,005). ÓõìðåñÜóìáôá: Óýìöùíá ìå ôá áðïôåëÝóìáôá ôçò ìåëÝôçò ìáò ç áíáãêáéüôçôá ìåßùóçò ôçò ÷ñÞóçò ôïõ áëêïüë óôïõò õðåñôáóéêïýò áóèåíåßò, åßíáé õøçëÞò óçìáóßáò êáé èá óõìâÜëëåé óôçí êáëýôåñç ñýèìéóç êáé êáôÜ óõíÝðåéá óôç ìåßùóç ôçò íïóçñüôçôáò êáé ôçò èíçôüôçôáò.

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ÅéóáãùãÞ Ç õðÝñôáóç áðïôåëåß Ýíá áðü ôá óçìáíôéêüôåñá ðñïâëÞìáôá äçìüóéáò õãåßáò åîáéôßáò ôçò õøçëÞò óõ÷íüôçôáò áíåýñåóÞò ôçò óôïí ðëçèõóìü, üóï êáé åîáéôßáò ôçò õøçëÞò íïóçñüôçôáò êáé èíçôüôçôáò ðïõ ôç ÷áñáêôçñßæåé1. Ôéò ôåëåõôáßåò äýï äåêáåôßåò Ý÷åé óçìåéùèåß áîéïóçìåßùôç ðñüïäïò óôçí áíôéìåôþðéóç ôçò õðÝñôáóçò, ãåãïíüò ðïõ öÜíçêå áðü ôç ìåßùóç ôùí áããåéáêþí åãêåöáëéêþí êáé ôùí óôåöáíéáßùí åðåéóïäßùí. ÓçìáíôéêÞ óõìâïëÞ óôïí ôïìÝá áõôü ðñüóöåñå ç åõñåßá ÷ñÞóç ôùí íåüôåñùí áíôéõðåñôáóéêþí öáñìÜêùí, üóï êáé ç êáëýôåñç ðáñáêïëïýèçóç ôùí õðåñôáóéêþí áóèåíþí ðïõ óôçñßæåôáé óå óáöåßò êáé ãåíéêÜ áðïäåêôÝò êáôåõèõíôÞñéåò óõóôÜóåéò2. ¼ìùò óýìöùíá ìå ôá äéåèíÞ äåËÝîåéò êëåéäéÜ: ÐáñÜãïíôåò êéíäýíïõ, áñôçñéáêÞ õðÝñôáóç ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå óôï äéáãùíéóìü "Ä. ºêêïõ" óôá ðëáßóéá ôïõ 13ïõ Ðáíåëëçíßïõ Óõíåäñßïõ ÃåíéêÞò ÉáôñéêÞò (Ñüäïò, 8-22 Áðñéëßïõ 2001) êáé âñáâåýèçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Å. Óêëçñüò, Äçìïêñáôßáò êáé ÍÝóôïñïò 32, ÁéãÜëåù Ô.Ê. 122 44, Ôçë.: (010) 5693387, Fax: (07460) 22227

Ôüìïò 13, Ôåý÷ïò 3, 2001

Å. Óêëçñüò êáé óõí.

Study of factors that influence the control of the arterial blood pressure in hypertensive patients. S. Skliros, A. Sotiropoulos, I. Papaioannou, E. Ktorou, E. Jianakis, B. Fili, S. Chalkia, P. Kourakos Summary Aim: The aim of this study is to evaluate the factors which may contribute to the deregulation of the arterial blood pressure in hypertensive patients. The factors that have been studied mostly concern the patient and are independent from the patients compliance with their therapeutic scheme. Patients and methods: 151 patients with primary hypertension, under medical supervision at the health center of Nemea participated in this study. All participants completed a registration card which contained special epidemiological, demographic and anthropometric data as well as a personal medical history. The statistical analysis of this data was based on Pearson's X2 one way ANOVA. A multifactor analysis was taken by Linear Regression Analysis. Results: The mean age was 69,42 years, the mean BMI was 26,97±3,65 Kg/m2 and after using the Linear Regression Analysis the level of the SAP in hypertensive patients was related to alcohol abuse (Beta= 0,215, p= 0,008) but the level of the DAP was negatively related to age (Beta= -0,227, p= 0,005). Conclusion: According to the results of our study the necessity of decreasing alcohol abuse for hypertensive patients is of great importance and will contribute to an efficient control of the arterial pressure which will minimize the morbidity and mortality rate. Key words: Risk factors, hypertension H.C. of Nemea

äïìÝíá Ýíá óçìáíôéêü ðïóïóôü áóèåíþí ìå õðÝñôáóç ðáñáìÝíïõí áññýèìéóôïé ìïëïíüôé ëáìâÜíïõí èåñáðåõôéêÞ áãùãÞ3. Óçìáíôéêïß ðáñÜãïíôåò ðïõ åðçñåÜæïõí ôï ðïóïóôü ñýèìéóçò ôçò áñôçñéáêÞò ðßåóçò áðïôåëëïýí áöåíüò ç õðïôßìçóç ôïõ ðñïâëÞìáôïò áðü ìÝñïõò ôùí ãéáôñþí, êáé áöåôÝñïõ ðáñÜãïíôåò ðïõ áöïñïýí óôïí áóèåíÞ êáé êõñßùò ç êáêÞ óõììüñöùóç óôï èåñáðåõôéêü ó÷Þìá4-5. Óêïðü ôçò ðáñïýóçò ìåëÝôçò áðïôåëåß ç åêôßìçóç ðáñáãüíôùí ðïõ ðéèáíüí óõìâÜëëïõí óôçí áðïññýèìéóç ôçò áñôçñéáêÞò ðßåóçò óå õðåñôáóéêïýò áóèåíåßò. Ïé ðáñÜãïíôåò ïé ïðïßïé ìåëåôÞèçêáí áöïñïýí êõñßùò óôïí áóèåíÞ êáé ïé ïðïßïé åßíáé áíåîÜñôçôïé áðü ôç óõììüñöùóÞ ôïõ óôï èåñáðåõôéêü ó÷Þìá.

èñùðïìåôñéêþí óôïé÷åßùí êáé áôïìéêïý éóôïñéêïý.

ÌÝôñçóç áñôçñéáêÞò ðßåóçò (ÁÐ) Ç ìÝôñçóç ôçò ÁÐ ðñáãìáôïðïéÞèçêå ìå õäñáñãõñéêü óöõãìïìáíüìåôñï óå ôñåéò äéáäï÷éêÝò áíÜ äßëåðôï ìåôñÞóåéò. Ïé ìåôñÞóåéò Ýãéíáí óå êáèéóôÞ èÝóç ìåôÜ ðåíôÜëåðôç áíÜðáõóç êáé ìåôÜ ôï ðÝñáò çìéþñïõ áðü ôçí ðüóç êáöåúíïý÷ïõ ñïöÞìáôïò Þ êáðíßóìáôïò ìå õðïâáóôáæüìåíï ôï ðñïò ìÝôñçóç Üêñï. ÉêáíïðïéçôéêÞ ñýèìéóç ôçò ÁÐ ÷áñáêôçñßóèçêå ç ôéìÞ ôçò óõóôïëéêÞò ÁÐ (ÓÁÐ) <140 mmHg, êáé ôçò äéáóôïëéêÞò ÁÐ (ÄÁÐ) <90 mmHg. Óå áóèåíåßò ìå Óáê÷áñþäç ÄéáâÞôç (ÓÄ) ïé áíôßóôïé÷åò ôéìÝò Þôáí 135/85 mmHg, óýìöùíá ìå ôá êñéôÞñéá ôçò JNC VI.2

Äåßêôçò ìÜæáò óþìáôïò O êáèïñéóìüò ôïõ äåßêôç ìÜæáò óþìáôïò (ÂÌÉ) Ýãéíå ìå ôïí ðñïóäéïñéóìü ôïõ ýøïõò êáé ôç ìÝôñçóç ôïõ âÜñïõò óþìáôïò ìå ôïí ôýðï: ÂÌÉ = ÂÜñïò/ýøïò2.

Óáê÷áñþäçò äéáâÞôçò Ç ýðáñîç ÓÄ äéáðéóôþèçêå åßôå áðü ôï éóôïñéêü ëÞøçò áíôéäéáâçôéêÞò áãùãÞò (äéóêßá-éíóïõëßíç), åßôå áðü ôçí áíåýñåóç äõï äéáäï÷éêþí ôéìþí ãëõêüæçò íçóôåßáò > 140 mg/dl.

Áóèåíåßò êáé ìÝèïäïé

ÊÜðíéóìá - áëêïüë

ÌåëåôÞèçêáí 151 äéáäï÷éêïß áóèåíåßò ìå ðñùôïðáèÞ õðÝñôáóç õðü öáñìáêåõôéêÞ áãùãÞ ðïõ ðáñáêïëïõèïýíôáé óôï Ê.Õ. ÍåìÝáò. Óå üëïõò ôïõò áóèåíåßò ðïõ ðåñéåëÞöèçóáí óôç ìåëÝôç óõìðëçñþèçêå åéäéêü åðéäçìéïëïãéêü äåëôßï êáôáãñáöÞò äçìïãñáöéêþí óôïé÷åßùí áí-

Ïé áóèåíåßò áíÜëïãá ìå ôç ÷ñÞóç êáðíïý êáôçãïñéïðïéÞèçêáí óå ìç êáðíéóôÝò, ðñþçí êáðíéóôÝò, ìÝôñéïõò êáðíéóôÝò (<20 óéãáñÝôôá/ ìÝñá) êáé âáñåßò êáðíéóôÝò (>20 óéãáñÝôôá/ìÝñá). AíÜëïãá, ãéá ôç ÷ñÞóç áëêïüë êáôçãïñéïðïéÞèçêáí óå ìç ðüôåò (<10gr áëêïüëçò/åâäï117

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Å. Óêëçñüò êáé óõí.

ìÜäá), óå Þðéïõò ðüôåò (<150gr áëêïüëçò/åâäïìÜäá), óå ìÝôñéïõò ðüôåò (<300gr áëêïüëçò/åâäïìÜäá), êáé âáñåßò ðüôåò (>300gr áëêïüëçò/åâäïìÜäá). Ç çìåñÞóéá êáôáíÜëùóç áëêïüë õðïëïãßóèçêå âÜóåé ôùí ðëçñïöïñéþí ãéá ôçí çìåñÞóéá êáôáíÜëùóç ìðýñáò, êñáóéïý, ëéêÝñ, óýìöùíá ìå ôïí ôýðï: áëêïüë= 1/7x [(0,04Ì x 12) + (0,15Ê x 4) + (0,45Ë x 1,5) +28,35]. ¼ðïõ Ì= ìðýñá, Ê= êñáóß, Ë= ëéêÝñ.

Óôïí ðßíáêá 1 ðáñïõóéÜæåôáé ç ó÷Ýóç ìåôáîý êáðíßóìáôïò êáé ÓÁÐ êáé ÄÁÐ. Äåí ðáñáôçñÞèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ ìåôáîý ôùí ôåóóÜñùí êáôçãïñéþí êáðíéóôþí. Óôïí ðßíáêá 2 ðáñïõóéÜæåôáé ç ó÷Ýóç ìåôáîý ÷ñÞóçò áëêïüë êáé ÓÁÐ êáé ÄÁÐ. ÐáñáôçñÞèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ ôüóï óôç ÓÁÐ üóï êáé óôç ÄÁÐ óôéò 4 êáôçãïñßåò ÷ñçóôþí áëêïüë.

ÓôáôéóôéêÞ áíÜëõóç

Óáê÷áñþäçò äéáâÞôçò

Ç óôáôéóôéêÞ áíÜëõóç ôùí äåäïìÝíùí Ýãéíå ìå Pearson's x 2 ãéá ðïéïôéêÜ äåäïìÝíá óå ðßíáêåò 2 x 2 Þ 2 x 3. Ôá ðïóïôéêÜ äåäïìÝíá êáé ç óýãêñéóç ôùí ìÝóùí ôéìþí Ýãéíå ìå ôç äïêéìáóßá One way ANOVA. ÐïëõðáñáãïíôéêÞ áíÜëõóç Ýãéíå ìå Linear Regression Analysis, ÷ñçóéìïðïéþíôáò óáí åîáñôçìÝíç ìåôáâëçôÞ ôç ÓÁÐ êáé óáí áíåîÜñôçôåò ìåôáâëçôÝò ôï öýëï, ôçí çëéêßá, ôïí ÓÄ, ôï êÜðíéóìá, ôï ÂÌÉ êáé ôç ÷ñÞóç áëêïüë. Ïìïßùò ðñáãìáôïðïéÞèçêå áíÜëõóç ãéá ôç ÄÁÐ. Óôáôéóôéêþò óçìáíôéêÞ èåùñÞèçêå êÜèå ôéìÞ p £0,05.

ÓÄ åß÷áí 21 Üôïìá. Ç ìÝóç ÓÁÐ Þôáí 141,05±18,9 mmHg Ýíáíôé 145,23±18,58 (p=0,341). Ç ìÝóç ÄÁÐ Þôáí 79±9,98 Ýíáíôé 82,35±9,61 (p=0,142).

ÁðïôåëÝóìáôá ÌåëåôÞèçêáí 92 (60,9%) Üíäñåò êáé 59 (39,1%) ãõíáßêåò. Ç ìÝóç çëéêßá ±SD ôïõ äåßãìáôïò Þôáí 68,01 (±9,76), (95% CI: 66,99-69,58) Ýôç. Äåí õðÞñîå äéáöïñÜ óôáôéóôéêÜ óçìáíôéêÞ óôçí çëéêßá ìåôáîý áíäñþí êáé ãõíáéêþí (69,61±9,76 vs 66,22±9,57, p=0,7). H ìÝóç ÓÁÐ Þôáí 144,65±18,61 êáé ç ìÝóç ÄÁÐ 81,89±9,7 mgHg. Äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ ìåôáîý ìÝóçò ÓÁÐ (146,07±19,7 vs 142,44±16,7/p=0,244) êáé ìÝóçò ÄÁÐ (81,52±9,8 vs 82,46±9,6/p=0,565), óå Üíäñåò êáé ãõíáßêåò. Ôï ìÝóï ÂÌÉ ôïõ äåßãìáôïò Þôáí 27,3 ± 3,5 Kg/m2 êáé äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ ìåôáîý áíäñþí êáé ãõíáéêþí (27,28±3,07 vs 27,34±4,28, p=0,925). Noñìïâáñåßò Þôáí 48 Üôïìá (25 Üíäñåò - 23 ãõíáßêåò), åíþ õðÝñâáñïé ðá÷ýóáñêïé 103 Üôïìá (67 Üíäñåò - 36 ãõíáßêåò, p=0,058). 118

Ñýèìéóç áñôçñéáêÞò ðßåóçò Áññýèìéóôá üóïí áöïñÜ óôï åðßðåäï ôçò ÁÐ Þôáí 71 Üôïìá (47%), 44 Üíäñåò (62%) êáé 27 ãõíáßêåò (68%). Äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ üóïí áöïñÜ óôï öýëï. Ç ìÝóç ÓÁÐ Þôáí 159±14,81 mmHg êáé ç ìÝóç ÄÁÐ 86,2±9,57 mmHg. Ç ìÝóç çëéêßá 69,42±10,01, ôï ìÝóï ÂÌÉ 26,97±3,65 Kg/m2. Áðü ôïõò äéáâçôéêïýò áóèåíåßò 7 (33,3%) Þôáí áññýèìéóôïé ìå ìÝóç ôéìÞ ÓÁÐ 161±19,09 mmHg (p=0,88) êáé ìå ìÝóç ôéìÞ ÄÁÐ 85,71±9,2, (p=0,81). Ìå ôç

Ðßíáêáò 1. Ó÷Ýóç êáðíßóìáôïò êáé áñôçñéáêÞò ðßåóçò Êáôçãïñßá

Ìç êáðíéóôÝò Ðñþçí êáðíéóôÝò ÌÝôñéïé êáðíéóôÝò Âáñåßò êáðíéóôÝò

79 43 18 11

ÓÁÐ (±SD)

ÄÁÐ (±SD)

143,63±17,83 81,92±9,10 143,49±20,70 80,05±11,74 148,67±19,24 82,89±7,75 149,95±14,63 * 87,18±6,11**

*F = 1,578, p = 0,211, **F = 3,695, p = 0,058

Ðßíáêáò 2. Ó÷Ýóç áëêïüë êáé áñôçñéáêÞò ðßåóçò Êáôçãïñßá

ÓÁÐ (±SD)

ÄÁÐ (±SD)

<10gr/åâäïìÜäá 58 141,90±17,26 81,71±9,66 <150gr/åâäïìÜäá 76 144,50±17,01 80,37±8,41 <300gr/åâäïìÜäá 13 153,08±23,09 89,69±7,65 >300gr/åâäïìÜäá 4 160,00±39,16* 88,00±23,49 ** *F = 4,691, p = 0,032, **F = 4,219, p = 0,007

Å. Óêëçñüò êáé óõí.

÷ñÞóç ìïíôÝëïõ ãñáììéêÞò ðáëéíäñüìçóçò (Linear Regression Analysis) ôï ýøïò ôçò ÓÁÐ óå õðåñôáóéêïýò áóèåíåßò ó÷åôßóôçêå ìå ôç ÷ñÞóç áëêïüë (Beta= 0,215, p= 0,008) åíþ ôçò ÄÁÐ ó÷åôßóôçêå áñíçôéêÜ ìå ôçí çëéêßá (Beta= -0,227, p= 0,005).

ÓõæÞôçóç Ç õðÝñôáóç áðïôåëåß óçìáíôéêü ðáñÜãïíôá êéíäýíïõ ãéá óôåöáíéáßá íüóï êáé áããåéáêÜ åãêåöáëéêÜ åðåéóüäéá êáé ìéá áðü ôéò ìåãáëýôåñåò ðñïêëÞóåéò ãéá ôïí éáôñü, áëëÜ êáé ãéá ôéò õãåéïíïìéêÝò áñ÷Ýò áðïôåëåß ç ñýèìéóç ôçò ôüóï óå áôïìéêü üóï êáé óå ðëçèõóìéáêü åðßðåäï. Ç åðßðôùóç ôçò áññýèìéóôçò áñôçñéáêÞò ðßåóçò õðïëïãßæåôáé óå 40-45% ôïõ óõíüëïõ ôùí õðåñôáóéêþí áóèåíþí, ïé ïðïßïé âñßóêïíôáé õðü öáñìáêåõôéêÞ áãùãÞ óýìöùíá ìå ôá äåäïìÝíá ôçò äéåèíïýò âéâëéïãñáößáò3. ÅðéäçìéïëïãéêÝò ìåëÝôåò Ý÷ïõí ðáñïõóéÜóåé áðïôåëÝóìáôá ðïõ áöïñïýí óôïí Ýëåã÷ï ôçò õðÝñôáóçò, ôá ïðïßá äéáöÝñïõí óçìáíôéêÜ. Óå ìéá ìåëÝôç óôçí Éóðáíßá6 ôï ðïóïóôü ôùí áóèåíþí ìå ñõèìéóìÝíç ÁÐ Þôáí 35% åÜí êáé óáöþò Ý÷åé âåëôéùèåß óõãêñéôéêÜ ìå ôï 1982 üðïõ Þôáí 5%. Óôç NHANES3, ìüíï ôï 29% ôùí Áìåñéêáíþí áóèåíþí åß÷áí ñõèìéóìÝíç ÁÐ óå åðßðåäá êÜôù áðü <140 mmHg7. Óôçí Éôáëßá óå áãñïôéêü ðëçèõóìü8 3çò çëéêßáò ôï ðïóïóôü åëÝã÷ïõ ôçò ÁÐ Þôáí 11%, åíþ óå ãáëëéêÞ ìåëÝôç9 ðïõ ðñáãìáôïðïéÞèçêå óôçí ðñùôïâÜèìéá öñïíôßäá õãåßáò ôï ðïóïóôü Þôáí 24,4%. ×áìçëüôåñá åðßðåäá åëÝã÷ïõ ôçò ÁÐ Ý÷ïõí ðáñïõóéáóôåß áðü ôçí Üëëç ìåñéÜ óå ÷þñåò ôçò Áóßáò. Óôçí Êßíá ìüíï ôï 4,1% ôùí õðåñôáóéêþí óôá áóôéêÜ êÝíôñá êáé ôï 1,2% ôùí õðåñôáóéêþí óôéò áãñïôéêÝò ðåñéï÷Ýò Ý÷ïõí ñõèìéóìÝíç ÁÐ10. Óå ìåëÝôç óå áãñïôéêü ðëçèõóìü óôçí ÅëëÜ11 äá ôï ðïóïóôü ñýèìéóçò ôùí õðåñôáóéêþí áóèåíþí ðïõ ëÜìâáíáí èåñáðåõôéêÞ áãùãÞ Þôáí 49%, ðïóïóôü ðïõ áíôéóôïé÷åß óôï 27% ôïõ óõíüëïõ ôïõ õðåñôáóéêïý ðëçèõóìïý. Óôç ìåëÝôç ìáò ôï ðïóïóôü ñýèìéóçò ôùí õðåñôáóéêþí áóèåíþí åßíáé ðáñáðëÞóéï (53%). Óå ìéá äéá÷ñïíéêÞ ìåëÝôç ðïõ ðñáãìáôïðïéÞèçêå óôï Ä. ×áóßùí ôï ðïóïóôü ñýèìéóçò ôùí õðåñôáóéêþí áóèåíþí áðü 28,04% äéáìïñöþèçêå óôï

Ôüìïò 13, Ôåý÷ïò 3, 2001

60,85% óôç äéÜñêåéá ìéáò ðåíôáåôßáò12 ðïõ ïäÞãçóå óå óôáôéóôéêÜ óçìáíôéêÞ ìåßùóç ôùí èáíÜôùí áðü áããåéáêü åãêåöáëéêü åðåéóüäéï êáé ïîý Ýìöñáãìá ôïõ ìõïêáñäßïõ. Ôá áßôéá ôçò êáêÞò ñýèìéóçò ôçò ÁÐ áíáæçôïýíôáé óå ðáñÜãïíôåò ðïõ áöïñïýí óôïí áóèåíÞ áëëÜ êáé óôçí õðïåêôßìçóç ôïõ ðñïâëÞìáôïò áðü ôïí éáôñü. Óôç ìåëÝôç ìáò ìåëåôÞèçêáí êõñßùò äéÜöïñïé ðáñÜãïíôåò ðïõ áöïñïýí óôïí áóèåíÞ. Ç ìüíç óôáôéóôéêÜ óçìáíôéêÞ åðßäñáóç ôåêìçñéþèçêå ãéá ôç ÷ñÞóç ôïõ áëêïüë, åíþ ôï êÜðíéóìá êáé ç ðá÷õóáñêßá äåí öÜíçêå íá åðéäñïýí óôç ñýèìéóç ôçò ÁÐ. Ôï êÜðíéóìá áí êáé ðñïêáëåß ïîåßá áýîçóç ôçò ÁÐ êáé ðéèáíüí óå õðåñôáóéêïýò âáñåßò êáðíéóôÝò íá áðïñõèìßæåé ôçí ÁÐ13 óôç ìåëÝôç ìáò äåí öáßíåôáé íá Ý÷åé ôÝôïéïõ åßäïõò åðßäñáóç. Ïìïßùò êáé ç ðá÷õóáñêßá, ðïõ åßíáé ãíùóôü üôé ó÷åôßæåôáé ìå áýîçóç ôçò ÁÐ êáé õðÝñôáóç14. ÐïëëÝò ìåëÝôåò Ý÷ïõí äåßîåé üôé ç ìÝôñéá áðþëåéá âÜñïõò ìðïñåß íá ïäçãÞóåé óå ìç áíáãêáéüôçôá öáñìáêåõôéêÞò áãùãÞò15. Óå õðåñôáóéêïýò áóèåíåßò ìå åëåã÷üìåíç õðÝñôáóç ç áðþëåéá 3,5 kg ïäÞãçóå ôï 59,5% áð' áõôïýò íá åßíáé íïñìïôáóéêïß, åíþ åß÷áí óôáìáôÞóåé ôç öáñìáêåõôéêÞ áãùãÞ16. Áðü ôçí Üëëç ìåñéÜ, ðïëëÝò åðéäçìéïëïãéêÝò ìåëÝôåò Ý÷ïõí äåßîåé ó÷Ýóç ìåôáîý õøçëÞò êáôáíÜëùóçò áëêïüë êáé õðÝñôáóçò áíåîÜñôçôá áðü Üëëïõò ðáñÜãïíôåò êéíäýíïõ, üðùò ôï êÜðíéóìá, ôçí ðá÷õóáñêßá17, ôï öýëï, êáé ôç öõëÞ. Ðéèáíïß ìç÷áíéóìïß ãéá ôçí áýîçóç ôçò ÁÐ áðü ôï áëêïüë åßíáé ç ìåßùóç ôùí åðéðÝäùí ìáãíçóßïõ, ç áýîçóç ôùí êáôå÷ïëáìéíþí êáé ç áýîçóç ôçò äñáóôçñéüôçôáò ôïõ óõìðáèçôéêïý óõóôÞìáôïò. Ôï áëêïüë ðñïêáëåß áýîçóç ôçò ÁÐ ôüóï óå õðåñôáóéêïýò üóï êáé óå íïñìïôáóéêïýò áóèåíåßò18. Óôç ìåëÝôç ìáò öÜíçêå üôé ç ÷ñÞóç ôïõ áëêïüë óõíäåüôáí óôáôéóôéêÜ óçìáíôéêÜ ìå ôá åðßðåäá ôçò ÓÁÐ, ãåãïíüò ðïõ öáßíåôáé íá åðéäñÜ óôç ñýèìéóç ôçò ÁÐ. ¸ôóé, ãéá ôïí êáëýôåñï Ýëåã÷ï êáé ñýèìéóç ôçò ÁÐ óå õðåñôáóéêïýò áóèåíåßò ÷ñåéÜæïíôáé áêüìá ðñïóðÜèåéåò. Óýìöùíá ìå ôá áðïôåëÝóìáôá ôçò ìåëÝôçò ìáò ç áíáãêáéüôçôá ìåßùóçò ôçò ÷ñÞóçò ôïõ áëêïüë óôïõò õðåñôáóéêïýò áóèåíåßò, åßíáé õøçëÞò óçìáóßáò êáé èá óõìâÜëëåé óôçí êáëýôåñç ñýèìéóç êáé êáôÜ óõíÝðåéá óôç ìåßùóç ôçò íïóçñüôçôáò êáé ôçò èíçôüôçôáò.

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ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Å. Óêëçñüò êáé óõí.

Âéâëéïãñáößá 1. N. Kaplan, Clinical Hypertension, Seventh Edition. Williams and Wilkins Baltimore 1998 2. Joint National Committee. Detection, Evaluation and Treatment of High blood pressure. The sixth report of the JNC on the detection evaluation and treatment of high blood pressure. Arch. Inter. Med. 1997, 24:2413-2446. 3. M. Rowland, J. Roberts. Blood pressure levels and Hypertension in persons ages 6-74 years, United States 1976-80. Vital Healt Stat 1982, 84:82-1250. 4. G.M. Sharkness, D.A. Snow. The patients view of Hypertension and compliance. Am. J. Prev. Med. 1992, 141-146. 5. Å. Óêëçñüò, Á. Óùôçñüðïõëïò, Ê. Óðåñäïýëçò. Áßôéá ðñïóÝëåõóçò áóèåíþí ìå ïîåßá áðïñýèìéóç áñôçñéáêÞò ðßåóçò ï ñüëïò ôïõ Ãåíéêïý Éáôñïý. Ð.Ö.Y. 1999, 11:99-103. 6. M.J. Tormo, C. Novarro, M.D. Chirlaque, D. Perez-Flores. Prevalence and control of hypertension in the south east of Spain: a radical but still insufficient improvement. Eur. J. Epidemiol. 1997, 13:301-8. 7. P.J. Mulrow. Detection and control of hypertension in the population: the United States experience. Am. J. Hypertens. 1998, 11:744-6. 8. M. Prencipe, A.R. Casini, M. Santini, et al. Prevalence, awareness, treatment and control of hypertension in the elderly: results from a population survey. J. Hum. Hypertens. 2000, 14:825-30. 9. B. Chamontin, L. Poggi, T. Lang, et al. Prevalence, treatment and control of hypertension in the French population: data from a survey on

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high blood pressure in General Practice. Am. J. Hypertens. 1998, 11:754-62. H. Ueshima, X.H. Zhang, S.R. Choudhury. Epidemiology of hypertension in China and Japan. J Humman Hypertens. 2000, 14:765-69. G.S. Stergiou, G.C. Thomopoulou, J.I. Skeva, T.D. Mountokalakis. Prevalence, awareness, treatment and control of hypertension in Greece: the Didima study. Am. J. Hypertens. 1999, 12:954-965. Á.Ì. NÜôóçò, É. Ðáðáíßêïò, ×.Ê. Óéáìüðïõëïò. Ç áðïôåëåóìáôéêÞ áíôéõðåñôáóéêÞ áãùãÞ ìåéþíåé ôïí êßíäõíï åãêåöáëéêïý êáé óôåöáíéáßáò íüóïõ. Ð.Ö.Y. 1999, 11:150-159 A. Gropelli, D.M.A. Giorgi, S. Omboni, et al. Persistent blood pressure increase induced by heavy smoking. J Hypertens 1992, 10:495-499. S. McMahon, S. Cutler, E. Brittain, et al. Obesity and hypertension epidemiological and clinical issues. Eur. Heart J. 1987, 8:57-70. R. Stamler, J. Stamler, R. Grimm, et al. Nutritional Therapy for high blood pressure: Final report of a four year randomized controlled trial: JAMA 1987, 257:1484-1491. H.G. Lungford, M.D. Blaufox, A. Oberman, et al. Dietary therapy slows the recum of hypertension after stopping prolonged medication. JAMA 1985, 253:657-664. A.L. Klatsky. Blood pressure and Alcohol Intalce: In Laragh SH and Brenner BM eds Hypertension: Pathophysiology, Diagnosis and management 2d ed. New York Raven Press 1995, pp 2649-2667. H. Malhorta, S. Mehta, D. Mathur, et al. Pressor effects of alcohol in normotensive and hypertensive subgects. Lancet 1985, 2:584-586.

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Á. Ìðáôßêáò êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅÑÃÁÓÉÁ ÓÔÏ ÄÉÁÃÙÍÉÓÌÏ "Ä. ÉÊÊÏÕ" THE SECOND AWARDED PAPER IN THE MEMORY OF PROF. D. IKKOS Primary Heatlh Care, Volume 13, Number 3, 121-126, 2001 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 13, Ôåý÷ïò 3, 121-126, 2001

Ç åðáíáëáìâáíüìåíç óõíôáãïãñáößá äåßêôçò ðôù÷Þò (åëëéðïýò) éáôñéêÞò öñïíôßäáò: ìéá ðéëïôéêÞ ìåëÝôç óå Ýíá ÊÝíôñï Õãåßáò ôçò ÊñÞôçò Á. Ìðáôßêáò1,4, Í. ÁíôùíÜêçò2,4, Ê. ËéÜðçò3, Å. ÐáðïõôóéäÜêçò3, Å. ×áñéôÜêç3, Í. ÐáðáäÜêçò1, A. Êáñüêçò4, ×. ËéïíÞò4 Ðåñßëçøç ÅéóáãùãÞ: Ç ÅëëÜäá êéíÞèçêå ôéò ðñïçãïýìåíåò äõï äåêáåôßåò óôçí õëïðïßçóç åíüò Åèíéêïý ÓõóôÞìáôïò Õãåßáò ðïõ Ýäéíå Ýìöáóç óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò êáé ìÝ÷ñé óÞìåñá Ý÷ïõí äéáôõðùèåß áñêåôïß ðñïâëçìáôéóìïß ãéá ôïí ôñüðï ðïõ èá äéáóöáëéóôåß ç ðáñï÷Þ ïëïêëçñùìÝíçò êáé õøçëÞò ðïéüôçôáò öñïíôßäáò õãåßáò. Ç óõíôáãïãñáößá èåùñÞèçêå ìéá óçìáíôéêÞ äñáóôçñéüôçôá óôá ÊÝíôñá Õãåßáò (Ê.Õ.) áãñïôéêþí ðåñéï÷þí ôçò ÅëëÜäáò êáé áíáðôý÷èçêáí îå÷ùñéóôÜ Éáôñåßá ôá ðñïçãïýìåíá ÷ñüíéá óå ðïëëÜ Ê.Õ. ÷ùñßò ôçí áðáñáßôçôç ôåêìçñßùóç ôçò áðïôåëåóìáôéêüôçôÜò ôïõò. Ç ðéëïôéêÞ áõôÞ åñãáóßá äéåñåõíÜ ôç ÷ñÞóç ìáêñï÷ñüíéáò êáé åðáíáëáìâáíüìåíçò óõíôáãïãñáößáò óå Ýíá ôÝôïéï éáôñåßï åíüò Ê.Õ. óôçí áãñïôéêÞ ÊñÞôç åíþ óõã÷ñüíùò áíáöÝñåé ôéò ðñùôïâïõëßåò ðïõ áíáëÞöèçêáí ãéá ôç âåëôßùóç ôçò õðÜñ÷ïõóáò êáôÜóôáóçò. Õëéêü – ÌÝèïäïò: Ôï õëéêü ôçò ìåëÝôçò áðïôÝëåóáí 75 åðáíáëáìâáíüìåíåò óõíôáãïãñáöÞóåéò ðïõ ðñáãìáôïðïéÞèçêáí óôï Éáôñåßï Óõíôáãïãñáößáò (É.Ó.) ôïõ ÊÝíôñïõ Õãåßáò ÐåñÜìáôïò ôçí ðåñßïäï 29 Éïõíßïõ – 6 Éïõëßïõ 2000. Ìéá ïìÜäá öïéôçôþí ôïõ ÔìÞìáôïò ÉáôñéêÞò ôïõ Ðáíåðéóôçìßïõ ÊñÞôçò, Ýëáâå óõíåíôåýîåéò áðü ôá Üôïìá ðïõ ÷ñçóéìïðïßçóáí áõôÞ ôçí õðçñåóßá êáé êáôÝãñáøå ôï éáôñéêü éóôïñéêü ôïõò óå Ýíá ðñïäïêéìáóìÝíï åñùôçìáôïëüãéï. ÁðïôåëÝóìáôá: Óå 37 ðåñéðôþóåéò (49%) ôá Üôïìá ðïõ ðñïóÞëèáí óôï éáôñåßï Þôáí ïé ßäéïé ïé áóèåíåßò, åíþ óôéò õðüëïéðåò ç óõíôáãïãñÜöçóç Ýãéíå äé’ áíôéðñïóþðïõ. Ôá ðïéï óõ÷íÜ óõíôáãïãñáöïýìåíá öÜñìáêá áöïñïýóáí ôéò øõ÷éáôñéêÝò äéáôáñá÷Ýò (17 Üôïìá, 22,6%) êáé áêïëïõèïýóáí ç õðÝñôáóç (15 Üôïìá, 20%) êáé ï óáê÷áñþäçò äéáâÞôçò (10 Üôïìá, 13,3%). ÓõíôáãïãñáöÞèçêáí ðÜíù áðü 60 äéáöïñåôéêïý åßäïõò öáñìÜêùí. Ïé áóèåíåßò ðáñïõóßáæáí ðïëëáðëÞ íïóçñüôçôá êáé äå ÷ñçóéìïðïéïýóáí óõ÷íÜ ôéò õðçñåóßåò ðñùôïâÜèìéáò êáé äåõôåñïâÜèìéáò öñïíôßäáò. Ç áíÜëõóç êáé óõæÞôçóç ôùí áðïôåëåóìÜôùí áõôþí, ïäÞãçóå óôçí áíôéêáôÜóôáóç ôïõ É.Ó. áðü äõï óõìâïõëåõôéêÜ éáôñåßá üðïõ óÞìåñá ïé éáôñïß ðñùôïâÜèìéáò öñïíôßäáò åîåôÜæïõí êëéíéêÜ ôá Üôïìá ðïõ ôïõò åðéóêÝðôïíôáé, ðáñÝ÷ïíôáò éáôñéêÝò óõìâïõëÝò ðÝñá áðü ôç óõíôáãïãñáößá. ÓõìðåñÜóìáôá: Ç åðáíáëáìâáíüìåíç óõíôáãïãñáößá ðïõ ðñáãìáôïðïéåßôáé óÞìåñá óôá Ê.Õ., óõíäÝåôáé ìå áíåðáñêÞ êáé ÷áìçëÞò ðïéüôçôáò öñïíôßäá õãåßáò óôç ÃåíéêÞ ÉáôñéêÞ. Ç ðáñÝìâáóç ãéá ôç âåëôßùóç ôçò ðáñïýóáò êáôÜóôáóçò öáßíåôáé íá åßíáé áðïôåëåóìáôéêÞ. 1

ÊÝíôñï Õãåßáò ÐåñÜìáôïò, 2ÊÝíôñï Õãåßáò Áíùãåßùí, 3ÖïéôçôÝò ÔìÞìáôïò ÉáôñéêÞò Ðáíåðéóôçìßïõ ÊñÞôçò, 4ÊëéíéêÞ ÊïéíùíéêÞò êáé ÏéêïãåíåéáêÞò ÉáôñéêÞò ÐáíåðéóôÞìéïõ ÊñÞôçò

ÅéóáãùãÞ Ç ÅëëÜäá êéíÞèçêå ôéò ðñïçãïýìåíåò äõï äåêáåôßåò óôçí õëïðïßçóç åíüò Åèíéêïý ÓõóôÞìáôïò Õãåßáò ðïõ Ýäéíå Ýìöáóç óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò (ÐÖÕ) êáé óôç ÃåíéêÞ ÉáôñéêÞ. Ðáñ’ üëï ðïõ ãßíïíôáé êáôÜ êáéñïýò ðñïóðÜèåéåò ãéá ôç âåëôßùóç áõôïý ôïõ óõóôÞìáôïò áõôÝò åðéêåíôñþíïíôáé êõñßùò óôçí ïñãÜíùóç êáé óôç äéïßêçóç ôùí õðçñåóéþí õãåßáò óôçí ÐÖÕ1. Ç áðïôåëåóìáôéêüôçôá êáé ç äõíáôüôçôá ôçò ÃåíéêÞò ÉáôñéêÞò êáé ôçò ÐÖÕ íá áíôéìåôùðßóïõí ôçí áõîçìÝíç æÞôçóç õðçñåóéþí õãåßáò, êáèþò êáé ïé åëëåßøåéò ðïõ ðáñïõóéÜæïõí ôá ÊÝíôñá Õãåßáò ôüóï óôçí ïñãÜíùóç ôùí õðçñåóéþí õãåßáò üóï êáé óôçí ðáñï÷Þ ïëïêëçñùìÝíçò öñïíôßäáò, êýñéá ìå ôç ìïñöÞ õðçñåóéþí ðñüëçøçò ôçò íüóïõ êáé ãåíéêüôåñá ËÝîåéò êëåéäéÜ: åðáíáëáìâáíüìåíç óõíôáãïãñáößá, áãñïôéêÞ ðåñéï÷Þ, ÃåíéêÞ ÉáôñéêÞ ÕðïâïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå óôï äéáãùíéóìü "Ä. ºêêïõ" óôá ðëáßóéá ôïõ 13ïõ Ðáíåëëçíßïõ Óõíåäñßïõ ÃåíéêÞò ÉáôñéêÞò (Ñüäïò, 8-22 Áðñéëßïõ 2001) êáé âñáâåýèçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ ðåñéïäéêïý ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Á. Ìðáôßêáò, ÊÝíôñï Õãåßáò ÐåñÜìáôïò, ÑÝèõìíï, Ô.Ê. 74052, Ôçë.: (08340) 22294 121

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Á. Ìðáôßêáò êáé óõí.

Repeat prescription as an indicator of poor clinical care: a room for improívement in rural General Practice in Greece A. Batikas, N. Antonakis, K. Liapis, E. Papoutsidakis, E. Charitaki, N. Papadakis, C. Lionis Summary Background: As Greece moves during the last two decades towards a national health care system, which give emphasis to the development of primary care system, many worry how to ensure that quality of care is assessed. Repeat prescribing has been seen as an important activity by the Greek primary care centers in rural Greece and special services have been developed during the last few years. This paper investigates the use of long-term repeat prescriptions in a surgery offered prescribing services at one Primary Health Centre in rural Crete and reports the actions undertaken towards to the improvement of the current situation. Methods: A sample of 75 repeats prescriptions (35.7%) which were carried-out in the "prescribing" surgery of the Perama Health Centre between June 29 and July 6, 2000, was issued. Subjects who used these services were interviewed by a group of medical students and a short medical history was recorded in a pretested form. Results: In 37 cases (49%) the patient himself addressed the services, while in the remaining somebody represented him. The drugs for mental disorders prescribed most frequently (17 subjects, 22.6%), and they were followed by these for hypertension (15, 20%) and diabetes mellitus (10, 13.3%). More than 60 different drugs were prescribed. Patients reported common chronic disease profiles and very low hospital and primary health care usage. Actions were undertaken included the restructure of the "prescribing" surgery services into two consulting rooms, where primary care physicians offer clinical investigations and advises additionally to the repeat prescribing requests. Conclusion: This pilot study revealed that repeat prescription provided in a specific form in primary care centers addresses a highly susceptible group which was not being adequately monitored, and probably its a indication of poor clinical care in General Practice. Interventions to improve the current conditions seem to be effective within the Greek primary care setting. Key words: Prescription, rural area, General Practice

ðñïáãùãÞò ôçò õãåßáò, ôñïöïäïôïýí óõæçôÞóåéò ðïõ óõ÷íÜ ðáñïõóéÜæïíôáé óôïí çìåñÞóéï ôýðï êáé ôá ìÝóá ìáæéêÞò åíçìÝñùóçò. Ðáñüëï ðïõ áñêåôÝò åðéóçìÜíóåéò ãéá ôçí õöéóôÜìåíç êáôÜóôáóç Ý÷ïõí ôåêìçñéùèåß ìå áíáöïñÝò êáé ìå åñåõíçôéêÞ åñãáóßá, åíôïýôïéò ìéá óõóôçìáôéêÞ áîéïëüãçóç ôçò óõìâïëÞò ôçò ÃåíéêÞò ÉáôñéêÞò êáé ãåíéêÜ ôçò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò ìÝ÷ñé óÞìåñá äåí Ý÷åé ãßíåé ìå ôç ëåéôïõñãßá ôùí Ê.Õ.2. Ç óõíôáãïãñáößá êáèéåñþèçêå ùò ìéá óçìáíôéêÞ äñáóôçñéüôçôá ôçí ïðïßá óõíôçñåß ìÝ÷ñé óÞìåñá ç ëåéôïõñãßá åíüò îå÷ùñéóôïý éáôñåßïõ. Äõóôõ÷þò êáìßá ìÝ÷ñé óÞìåñá ðñïóðÜèåéá áíÜëõóçò ôùí äåäïìÝíùí ôçò êßíçóçò êáé ìåôñÞóåéò ôçò áðïôåëåóìáôéêüôçôáò áõôÞò ôçò äñáóôçñéüôçôáò äåí Ý÷åé äçìïóéåõôåß. Áíôßèåôá ôï èÝìá ôïõ åëÝã÷ïõ ôçò óõíôáãïãñáößáò óôçí ÐÖÕ öáßíåôáé íá áðïôåëåß ìéá õøçëÞ ðñïôåñáéüôçôá ôïõ Õðïõñãåßïõ Õãåßáò êáé Ðñüíïéáò ìå ôïí áñìüäéï 122

Õðïõñãü íá äçëþíåé ðñüóöáôá üôé ïé áëëáãÝò óôçí ÐÖÕ, áíÜìåóá óå Üëëá, óôï÷åýïõí óôçí åîÜëåéøç ðñáêôéêþí üðùò ôá éáôñåßá óõíôáãïãñáößáò óôá ÊÝíôñá Õãåßáò (ïìéëßá óôï Îåíïäï÷åßï “Metropolitan”, ÁèÞíá 9 Äåêåìâñßïõ 2001). Åðßóçò ôï ßäéï èÝìá áðáó÷ïëåß óõ÷íÜ ôç äéåèíÞ âéâëéïãñáößá êáé ôç ÃåíéêÞ ÉáôñéêÞ óôéò äéÜöïñåò ÷þñåò ôçò Åõñþðçò2,3. ¸ôóé Þôáí öõóéêü íá åîåôÜóïõìå ôç ÷ñÞóç åðáíáëáìâáíüìåíçò óõíôáãïãñáößáò óå Ýíá ôÝôïéï éáôñåßï åíüò Ê.Õ. óôçí áãñïôéêÞ ÊñÞôç êáé ðáñÜëëçëá íá áîéïëïãÞóïõìå ôéò ðñùôïâïõëßåò êáé ôéò ðáñåìâÜóåéò ðïõ áðáéôïýíôáé ãéá ôç âåëôßùóç ôçò õðÜñ÷ïõóáò êáôÜóôáóçò. Åðßóçò áíÜìåóá óôïõò óôü÷ïõò ôçò ìåëÝôçò áõôÞò Þôáí êáé ç ãåíéêüôåñç óõæÞôçóç ôçò áðïôåëåóìáôéêüôçôáò áõôÞò ôçò äñáóôçñéüôçôáò êáé ôùí ìåèüäùí êáé ôùí ìÝôñùí ðïõ ìéá åðüìåíç åñåõíçôéêÞ ìåëÝôç èá åîåôÜóåé.

Ðëçèõóìüò ìåëÝôçò êáé ÌÝèïäïé

Ôï õëéêü ôçò ìåëÝôçò áðïôÝëåóáí 75 åðéóêÝøåéò ãéá åðáíáëáìâáíüìåíåò óõíôáãïãñáöÞóåéò ðïõ ðñáãìáôïðïéÞèçêáí óôï Éáôñåßï Óõíôáãïãñáößáò (É.Ó.) ôïõ ÊÝíôñïõ Õãåßáò ÐåñÜìáôïò (ÊÕÐ) ôéò þñåò 09.30 ð.ì. Ýùò 11.30 ð.ì. óå äéÜóôçìá óõíå÷üìåíùí ðÝíôå (5) çìåñþí áðü ôçò 29 Éïõíßïõ Ýùò 6 Éïõëßïõ 2000. Ìéá ïìÜäá öïéôçôþí ôïõ ÔìÞìáôïò ÉáôñéêÞò ôïõ Ðáíåðéóôçìßïõ ÊñÞôçò ðïõ ðñáãìáôïðïéïýóáí ôçí ðñáêôéêÞ ÜóêçóÞ ôïõò óôçí ÐñùôïâÜèìéá Öñïíôßäáò Õãåßáò, Ýëáâå óõíåíôåýîåéò áðü ôïõò åðéóêÝðôåò ôïõ éáôñåßïõ áõôïý êáé êáôÝãñáøå ôï éáôñéêü éóôïñéêü ôïõò óå Ýíá ðñïäïêéìáóìÝíï åñùôçìáôïëüãéï4. Ïé óõíôáãïãñáöÞóåéò áõôÝò åêðñïóùðïýí ôï 35% ôïõ óõíüëïõ (Í=210) ðïõ ðñáãìáôïðïéÞèçêáí ôçí ðåñßïäï ôçò ìåëÝôçò. Óôï åñùôçìáôïëüãéï êáôáãñÜöïíôáí ôï ïíïìáôåðþíõìï, ç çìåñïìçíßá ãÝííçóçò, ôï öýëï, ï ôüðïò êáôïéêßáò, ç ïéêïãåíåéáêÞ êáôÜóôáóç, ç ìüñöùóç, ôï åðÜããåëìá, ïé óõíÞèåéåò, ôá íïóÞìáôá ãéá ôá ïðïßá æçôïýíôáí óõíôáãÞ êáèþò êáé ôá öÜñìáêá ðïõ ëáìâÜíïíôáí. Åðß-

Ôüìïò 13, Ôåý÷ïò 3, 2001

Á. Ìðáôßêáò êáé óõí.

óçò óçìåéùíüôáí åÜí ç óõíôáãïãñÜöçóç ãéíüôáí äéá áíôéðñïóþðïõ Þ ü÷é. Ïé åðéóêÝðôåò áðáíôïýóáí åðßóçò óôçí åñþôçóç ðüóï óõ÷íÜ åðéóêÝðôïíôáí ôïí éáôñü ðïõ ôïõò ðáñáêïëïõèåß óôï äéÜóôçìá åíüò ÷ñüíïõ. Ôá íïóÞìáôá ðïõ áíÝöåñáí óôï éóôïñéêü ôïõò ïé áóèåíåßò ðïõ ðñïóÞëèáí ãéá óõíôáãïãñÜöçóç êáôáãñÜöçêáí êáé ôáîéíïìÞèçêáí êáôÜ ôçí Ýíáôç áíáèåþñçóç ôçò Äéåèíïýò ôáîéíüìçóçò êáêþóåùí êáé íïóçìÜôùí (ICD-9)5 .ÌåëåôÞèçêå åðßóçò ç óõí-íïóçñüôçôá ôùí áóèåíþí. Ôá öÜñìáêá ðïõ óõíôáãïãñáöÞèçêáí ôáîéíïìÞèçêáí óýìöùíá ìå ôç äéåèíÞ ôáîéíüìçóç öáñìÜêùí óôçí ÐñùôïâÜèìéá Öñïíôßäá (ICPC)6.

ÓôáôéóôéêÞ áíÜëõóç Ôá äåäïìÝíá êáôá÷ùñÞèçêáí óå âÜóç Excel 2000 êáé áðü åêåß áíáëýèçêáí. ¸íá õðüäåéãìá ëïãéóôéêÞò áíÜëõóçò ðáëéíäñüìçóçò åöáñìüóèçêå Ý÷ïíôáò óáí åîáñôçìÝíç ìåôáâëçôÞ ôç ìéêñÞ óõ÷íüôçôá ðáñáêïëïýèçóçò (êáìßá Þ ìéá öïñÜ ôï ÷ñüíï) êáé åîáñôçìÝíåò ôçí çëéêßá, ôï öýëï êáé ôç äéÜãíùóç êáôÜ ICD-9.

ÁðïôåëÝóìáôá Áðü ôïõò 75 åðéóêÝðôåò ôïõ É.Ó. ïé 32 (42%) Þôáí Üññåíåò êáé ïé 42 (58%) èÞëåéò. Ôï ìåãáëýôåñï ðïóïóôü 56 Üôïìá (75%) Þôáí çëéêßáò Üíù ôùí 50 åôþí (Ðßíáêáò 1). Ïé 35 óôïõò 75 (46%) Þôáí áóöáëéóìÝíïé óôïí ÏÃÁ, 21 (28%) óôï ÉÊÁ, 7 (9,5%) óôï Äçìüóéï êáé 7 (9,5%) óå Üëëá ôáìåßá. Áðü ôï óýíïëï ôùí áóèåíþí ðïõ åß÷áí ðñïóÝëèåé óôï É.Ó. ïé 28 (37%) êáôïéêïýóáí óå ÄçìïôéêÜ Äéáìåñßóìáôá ðïõ åîõðçñåôïýíôáé êõñßùò áðü ôï ÊÝíôñï Õãåßáò ÐåñÜìáôïò åíþ ïé õðüëïéðïé ðñïóÝñ÷ïíôáí áðü ðåñéï÷Ýò Ðåñéöåñåéáêþí Éáôñåßùí. ¼óïí áöïñÜ ôï åðÜããåëìá ïé ðåñéóóüôåñïé 14 (18%) Þôáí óõíôáîéïý÷ïé êáé áêïëïõèïýóáí ïé áãñüôåò Þ/êáé êôçíïôñüöïé 11 (14%). ÓõíôáãïãñáöÞèçêáí ðÜíù áðü 60 äéáöïñåôéêïý åßäïõò öáñìÜêùí. Óå 37 ðåñéðôþóåéò (49%) ôá Üôïìá ðïõ ðñïóÞëèáí óôï éáôñåßï Þôáí ïé ßäéïé ïé áóèåíåßò, åíþ óôéò õðüëïéðåò ç óõíôáãïãñÜöçóç Ýãéíå äé’ áíôéðñïóþðïõ. Ïé ðéï óõ÷íÝò êáôçãïñßåò íïóçìÜôùí ðïõ ïé åðéóêÝðôåò áíÝöå-

ñáí óôï éóôïñéêü ôïõò êáé ãéá ôá ïðïßá ãéíüôáí óõíôáãïãñÜöçóç Þôáí: ç êáôçãïñßá VII (íïóÞìáôá ôïõ êõêëïöïñéêïý óõóôÞìáôïò, 31 ðåñéðôþóåéò, 41%), êáôçãïñßá V (øõ÷éêÝò äéáôáñá÷Ýò, 17, 22%), êáôçãïñßá VI (íïóÞìáôá ÊÍÓ êáé áéóèçôçñßùí ïñãÜíùí, 14, 18%), êáé êáôçãïñßá ÉÉÉ (íïóÞìáôá ôïõ ìåôáâïëéóìïý êáé èñÝøçò, 13, 17%) (Ðßíáêáò 2). ¼óï áöïñÜ ôç óõíõðÜñ÷ïõóá íïóçñüôçôá, ïé 7 óôïõò 75 áóèåíåßò åß÷áí ôñßá Þ êáé ðåñéóóüôåñá íïóÞìáôá ðïõ áöïñïýóáí êõñßùò ôá íïóÞìáôá ôïõ êõêëïöïñéêïý óõóôÞìáôïò (êýñéïò åêðñüóùðïò ç õðÝñôáóç), ôá íïóÞìáôá ôïõ ìåôáâïëéóìïý (èõñåïåéäÞ áäÝíá, óáê÷áñþäçò äéáâÞôçò), ôéò øõ÷éêÝò äéáôáñá÷Ýò êáé ôá íïóÞìáôá ôïõ êåíôñéêïý íåõñéêïý óõóôÞìáôïò. Áðü äõï íïóÞìáôá ôáõôü÷ñïíá âñÝèçêáí íá ðÜó÷ïõí 19 óôïõò 75 áóèåíåßò ðïõ óôçí ðëåéïíüôçôÜ ôïõò åß÷áí ìå óåéñÜ óõ÷íüôçôáò: íïóÞìáôá ôïõ êõêëïöïñéêïý óõóôÞìáôïò (õðÝñôáóç, óôåöáíéáßá íüóï), íïóÞìáôá ôïõ ìåôáâïëéóìïý (óáê÷áñþäçò äéáâÞôçò), ôéò øõ÷éêÝò äéáôáñá÷Ýò êáé ôá íïóÞìáôá ôïõ êåíôñéêïý íåõñéêïý óõóôÞìáôïò (Ó÷Þìá 1). ¸íá ìåãÜëï ðïóïóôü ôùí áóèåíþí 21 (28%) áíÝöåñáí üôé åðéóêåðôüôáí ôïí èåñÜðïíôá éáôñü ôïõò ëéãüôåñï óõ÷íÜ áðü ìéá öïñÜ ôïí ÷ñüíï, åíþ 18 (24%) ôùí åðéóêÝðôïíôáí ìéá öïñÜ åôçóßùò (Ðßíáêáò 3). Ôï öÜóìá íïóçñüôçôáò ôùí áóèåíþí ðïõ åðéóêåðôüôáí ôïí èåñÜðïíôá éáôñü ëéãüôåñï áðü ìéá öïñÜ ôùí ÷ñüíï áöïñïýóå ôéò øõ÷éêÝò äéáôáñá÷Ýò, ôá íïóÞìáôá ôïõ êõêëïöïñéêïý óõóôÞìáôïò, ôá íïóÞìáôá ôïõ ìåôáâïëéóìïý êáé ôá íïóÞìáôá ôïõ áíáðíåõóôéêïý óõóôÞìáôïò (Ó÷Þìá 2). Ôá ðïéï óõ÷íÜ óõíôáãïãñáöïýìåíá öÜñìáêá (óýíïëï 118) ìå âÜóç ôçí ôáîéíüìçóç êáôÜ ICPC áöïñïýóáí ôá íïóÞìáôá ôïõ ìåôáâïëéóìïý

Ðßíáêáò 1. ÊáôáíïìÞ åðéóêåðôþí áíÜ çëéêéáêÞ ïìÜäá. ÇëéêéáêÞ ÏìÜäá

Áñéèìüò

0-10 11-20 21-30 31-40 41-50 51-60 61-70 71-80 81 +

1 1 5 7 5 13 15 23 5

Óýíïëï

75 123

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Á. Ìðáôßêáò êáé óõí.

Ðßíáêáò 2. ÍïóçìÜôá ôùí áóèåíþí ìå âÜóç ôçí ôáîéíüìçóç ôïõ ICD-9 Êáôçãïñßá íïóÞìáôïò ICD-9

Õðïêáôçãïñßá íïóçìÜôùí

N. Êõêëïöïñéêoý (VII)

ÕðÝñôáóç Óôåöáíéáßá íüóï ¢ëëá Ìåßæ. Øõ÷ïó. Óõíäñ. Äéáôáñá÷Ýò ôïõ óõíáéóèÞìáôïò Íåõñþóåéò, Üã÷ïò Äéáôáñá÷Ýò ¾ðíïõ Óáê÷áñþäçò ÄéáâÞôçò ÈõñåïåéäÞò áäÝíáò

Øõ÷éêÝò äéáôáñá÷Ýò (V)

Í. Ìåôáâïëéóìïý (III) Í. Êåíôñéêïý Íåõñéêïý ÓõóôÞìáôïò êáé Áéóèçôçñßùí (VI) Í. Áíáðíåõóôéêïý (VIII)

Óõ÷íüôçôá áíÜ êáôçãïñßá 31/75

15/75

13/75 14/75

×ñüíéá âñïã÷ßôéäá ¢óèìá

Í. ÄÝñìáôïò (XII) ÄéÜöïñá

5/75 4/75 16/75

êÜ óçìáíôéêü âáèìü ôï ìéêñü áñéèìü ðáñáêïëïýèçóçò (ðñïãñáììáôéóìÝíçò öñïíôßäáò) ôùí áôüìùí ôçò ìåëÝôçò áðü éáôñïýò ðñùôïâÜèìéáò öñïíôßäáò õãåßáò.

ÓõæÞôçóç - ðáñÝìâáóç á) ÓõæÞôçóç ôùí åõñçìÜôùí Ó÷Þìá 1. ÓõíõðÜñ÷ïõóá íïóçñüôçôá óôá Üôïìá ôçò ìåëÝôçò.

Ðßíáêáò 3. Óõ÷íüôçôá ðáñáêïëïýèçóçò ôùí áóèåíþí áðü ôïí èåñÜðïíôá ôïõò éáôñü Óõ÷íüôçôá åðßóêåøçò

Áñéèìüò áôüìùí

Ëéãüôåñï áðü 1 öïñÜ ôïí ÷ñüíï 1 öïñÜ ôïí ÷ñüíï ÊÜèå 6 ìÞíåò ÊÜèå 3 ìÞíåò Óõ÷íüôåñá

21 18 16 10 10

Óýíïëï

(21, 18%), ôéò øõ÷éêÝò äéáôáñá÷Ýò (19, 16%), ôá íïóÞìáôá ôïõ êõêëïöïñéêïý (19, 16%), ôá íïóÞìáôá ôïõ ÊÍÓ (14, 12%) êáé ôá íïóÞìáôá ôïõ ìõïóêåëåôéêïý óõóôÞìáôïò (13, 11%) (Ðßíáêáò 4). Áðü ôçí áíÜëõóç ôïõ õðïäåßãìáôïò ëïãéóôéêÞò ðáëéíäñüìçóçò ðïõ åöáñìüóáìå êáíÝíáò áðü ôïõò ðáñÜãïíôåò ðïõ ÷ñçóéìïðïéÞèçêáí ùò áíåîÜñôçôåò ìåôáâëçôÝò äåí åñìÞíåõáí óå óôáôéóôé124

Ç ìåëÝôç ìáò Þôáí ðéëïôéêÞ êáé óáöþò äéÜöïñïé ðåñéïñéóôéêïß ðáñÜãïíôåò èá ðñÝðåé íá óõæçôçèïýí ðñéí ôç ãåíßêåõóç ôùí áðïôåëåóìÜôùí ôçò. ÔÝôïéïé ðáñÜãïíôåò åßíáé ç ðåñéïñéóìÝíç ÷ñïíéêÞ äéÜñêåéÜ ôçò (åðôÜ çìÝñåò åðß äõï þñåò çìåñçóßùò êáé óå Ýíá ìüíï ÊÝíôñï Õãåßáò), ç áðïõóßá ìÝôñùí åêôßìçóçò ôçò éêáíïðïßçóçò ôùí áóèåíþí, ôçò ðïéüôçôáò æùÞò ôïõò êáèþò êáé åðéëåãìÝíùí âéïëïãéêþí äåéêôþí ñýèìéóçò ôùí ÷ñüíéùí íïóçìÜôùí (üðùò óáê÷áñþäçò äéáâÞôçò, õðÝñôáóç ê.Ü.). Ôá ðåñéóóüôåñá Üôïìá óôá ïðïßá óõíôáãïãñáöÞèçêáí öÜñìáêá åß÷áí çëéêßá ìåãáëýôåñç ôùí 50 åôþí êáé ôï åýñçìá áõôü åßíáé óõìâáôü ìå ôç äïìÞ ôïõ ðëçèõóìïý ôçò ðåñéï÷Þò åõèýíçò ôïõ ÊÕÐ êáé ôçí õøçëÞ íïóçñüôçôá êáé æÞôçóç õðçñåóéþí õãåßáò ðïõ óõíïäåýåé ôç äçìïãñáöéêÞ ãÞñáíóÞ ôïõ. Ôï ìåãÜëï ðïóïóôü áôüìùí ðïõ ðñïóÝñ÷ïíôáé óôï ÊÝíôñï Õãåßáò êáèáñÜ ãéá óõíôáãïãñÜöçóç êáé ðñïÝñ÷ïíôáé áðü Üëëåò áðïìáêñõóìÝíåò ðåñéï÷Ýò ðïõ õðÜãïíôáé óå ÐåñéöåñåéáêÜ Éáôñåßá, ðñáãìáôïðïéåßôáé ëüãù ôçò áíÜãêçò

Ôüìïò 13, Ôåý÷ïò 3, 2001

Á. Ìðáôßêáò êáé óõí.

Ó÷Þìá 2. ÍïóÞìáôá áóèåíþí ìå ÷áìçëÞ óõ÷íüôçôá (ëéãüôåñï áðü ìéá öïñÜ ôï ÷ñüíï) ðáñáêïëïýèçóçò.

Ðßíáêáò 4. ÖÜñìáêá ôùí ïðïßùí ç óõíôáãïãñÜöçóç æçôÞèçêå óôç ìåëÝôç ìáò (ôáîéíüìçóç êáôÜ ICPC) Êáôçãïñßá êáôÜ ICPC T P K N L A R D B X Å S Óýíïëï

Áñéèìü Í. ÅíäïêñéíéêÜ êáé ÌåôáâïëéêÜ Øõ÷éêÝò äéáôáñá÷Ýò Í. Êõêëïöïñéêïý Í. Êåíôñéêïý Íåõñéêïý ÓõóôÞìáôïò Í. Ìõïóêåëåôéêïý ÃåíéêÜ êáé ìç êáèïñéóìÝíá Í. Áíáðíåõóôéêïý Í. Ðåðôéêïý Í. Áßìáôïò Í. Ãåííçôéêïý ÓõóôÞìáôïò ÈçëÝùí Í. Ïöèáëìþí Í. ÄÝñìáôïò

21 19 19 14 13 8 7 5 4 3 3 2 118

éáôñéêÞò ãíùìÜôåõóçò ãéá ôçí åðáíáëáìâáíüìåíç óõíôáãïãñáößá óå ÷ñüíéá íïóÞìáôá óå óõíäõáóìü ìå ôçí Ýëëåéøç åéäéêåõìÝíùí éáôñþí óôá åí ëüãù éáôñåßá. Óôç ìåëÝôç ìáò âñÝèçêå åðßóçò üôé ó’ Ýíá õøçëü áñéèìü áôüìùí ç óõíôáãïãñÜöçóç ãéíüôáí äéá áíôéðñïóþðïõ (51%). Ôï åýñçìá áõôü óõìöùíåß ìå áíÜëïãï ôçò ìåëÝôçò ôïõ ÊÝíôñïõ Õãåßáò Áíùãåßùí óôï ÑÝèõìíï üðïõ, ç äéá áíôéðñïóþðïõ óõíôáãïãñáößá áíôéóôïé÷ïýóå óå ðïóïóôü 35,4%7. Ôá ðéï óçìáíôéêÜ åõñÞìáôá ôçò ðéëïôéêÞò áõôÞò ìåëÝôçò Þôáí: á) ç ðïëëáðëÞ íïóçñüôçôá ðïõ óõíïäåýåé ôá Üôïìá ðïõ æçôïýóáí óõíôáãïãñáößá (ïé ðåñéóóüôåñïé áðü áõôïýò áíÝöåñáí óôï éáôñéêü ôïõò éóôïñéêü 2 Þ 3 ÷ñüíéá íïóÞìáôá

êýñéá ôïõ êáñäéáããåéáêïý óõóôÞìáôïò Þ ôùí ìåôáâïëéêþí êáé øõ÷éêþí äéáôáñá÷þí), â) ç Ýëëåéøç åëÜ÷éóôçò öñïíôßäáò êáé äÝóìçò õðçñåóéþí óôïõò ìéóïýò êáé Üíù (39 óôïõò 75) ðïõ ðñïóÝñ÷ïíôáí. Ôá äõï áõôÜ åõñÞìáôá ôçò ðéëïôéêÞò ìáò ìåëÝôçò, âñßóêïíôáé óå óõìöùíßá ìå Üëëåò ðïõ äéåîÞ÷èçóáí óå ÅõñùðáúêÝò ×þñåò3,8,9 êáé óõíçãïñïýí üôé õðçñåóßåò ôïõ ôýðïõ É.Ó. åßíáé äåßêôçò ðôù÷Þò éáôñéêÞò öñïíôßäáò êáé óõíôçñïýí îåðåñáóìÝíåò ìÜëëïí ðñáêôéêÝò. Ìéá åðüìåíç ìåëÝôç óôçí ïðïßá èá ÷ñçóéìïðïéçèïýí åñãáëåßá ðïõ óôáèìßæïíôáé áõôÞ ôç óôéãìÞ óôçí ÊëéíéêÞ ÊïéíùíéêÞò êáé ÏéêïãåíåéáêÞò ÉáôñéêÞò ôïõ Ðáíåðéóôçìßïõ ÊñÞôçò üðùò ôï DISQ (Doctors Interpersonal Skills Questionnaire) ãéá ôç ìÝôñçóç ôùí äéáðñïóùðéêþí äåîéïôÞôùí ôùí éáôñþí, ôï QWB (Quality Well-Being) ãéá ôç ìÝôñçóç ôçò ðïéüôçôáò æùÞò áëëÜ êáé ôùí Ýëåã÷ï ôçò ñýèìéóçò ôùí ÷ñïíéþí íïóçìÜôùí (ìåôáâïëéêïß êáé Üëëïé äåßêôåò), èá ìðïñïýóå íá äéåõñýíåé ôç ãíþóç ó÷åôéêÜ ìå ôçí áðïôåëåóìáôéêüôçôá êáé ôçí ðïéüôçôá ôïõ É.Ó. óôç ÷þñá ìáò.

â) ÐáñÝìâáóç Ç ëåéôïõñãßá ôïõ É.Ó. óôï ÊÝíôñï Õãåßáò ÐåñÜìáôïò åß÷å ùò ìïíáäéêü óêïðü ôç óõíôáãïãñÜöçóç ÷ùñßò êáíÝíá Ýëåã÷ï ôçò êáôÜóôáóçò õãåßáò ôïõ áóèåíÞ ðïõ ðñïóåñ÷üôáí óå áõôü. Ìå âÜóç ôá áðïôåëÝóìáôá ôçò ðéëïôéêÞò áõôÞò ìåëÝôçò êáé ìå ôç ãíþóç üôé ïé ìçíéáßåò áõôÝò åðéóêÝøåéò Ýäéíáí óôïí áóèåíÞ ôçí åóöáëìÝíç 125

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

åíôýðùóç üôé «ðÞãå óôïí éáôñü», ëÞöèçêå ç áðüöáóç êáôÜñãçóçò ôïõ É.Ó. Óôç èÝóç ôçò õðçñåóßáò áõôÞò äçìéïõñãÞèçêáí äõï êáéíïýñãéá éáôñåßá óôá ïðïßá óå êÜèå áóèåíÞ ðïõ ðñïóÝñ÷ïíôáí ãéá óõíôáãïãñÜöçóç èá ëáìâáíüôáí áðáñáéôÞôùò Ýíá âáóéêü éáôñéêü éóôïñéêü êáé èá õðïâÜëëïíôáí óå Ýíá áäñü êáôÜ óõóôÞìáôá êëéíéêü Ýëåã÷ï ìå ðáñÜëëçëç ìÝôñçóç ôçò áñôçñéáêÞò ðßåóçò êáé ôùí óùìáôïìåôñéêþí äåäïìÝíùí ôïõ, åíþ ôáõôü÷ñïíá èá ôïõ äßíïíôáí óõóôÜóåéò ãéá ôç äéá÷åßñéóç ôùí ìåéæüíùí ðáñáãüíôùí êéíäýíïõ, åêåß ðïõ Þôáí ðáñüíôåò. ÅÜí ç óõíôáãïãñÜöçóç ãéíüôáí äéá áíôéðñïóþðïõ, óõóôçíüôáí Þ ðñïóÝëåõóç ôïõ ßäéïõ ôïõ áóèåíÞ Þ óå ðåñßðôùóç ðïõ Þôáí áäýíáôç ç ðñïóÝëåõóç ôïõ ðñáãìáôïðïéïýíôáí åðßóêåøç óôï óðßôé áðü åéäéêåõìÝíï éáôñü ôïõ ÊÝíôñïõ Õãåßáò. Ôéò ðñþôåò ìÝñåò ôçò ëåéôïõñãßáò ôùí íÝùí éáôñåßùí ãéíüôáí åíçìÝñùóç óôïõò åðéóêÝðôåò áðü ìüíéìï éáôñü ãéá ôçí áëëáãÞ ôïõ ôñüðïõ ëåéôïõñãßáò ôùí éáôñåßùí ìå óêïðü ôç âåëôßùóç ôçò ðïéüôçôáò ôùí ðáñå÷ïìÝíùí õðçñåóéþí. ÌåôÜ ôéò ðñþôåò çìÝñåò ëåéôïõñãßáò åíôïðßóôçêáí äõï êõñßùò ðñïâëÞìáôá. Ôï ðñþôï áöïñïýóå ôï äéïéêçôéêü ðñïóùðéêü ôïõ ÷þñïõ õðïäï÷Þò ðïõ äåí Þèåëå íá áíáëÜâåé ôçí åõèýíç ôïõ ðåñéïñéóìïý óå áñéèìü ôùí áôüìùí ðïõ ðñïóåñ÷üôáí ãéá óõíôáãïãñáößá êáé ôï äåýôåñï ôï éáôñéêü ðñïóùðéêü ðïõ äå÷üôáí ðéÝóåéò áðü ïñéóìÝíïõò åðéóêÝðôåò ðïõ åß÷áí óõíçèßóåé óå ðéï ãñÞãïñïõò ñõèìïýò åîõðçñÝôçóçò. Ãéá íá áíôéìåôùðéóèïýí ôá ðáñáðÜíù ðñïâëÞìáôá äéáíåìÞèçêå Ýíôõðï õëéêü óôïõò åðéóêÝðôåò ðïõ ôïõò åíçìÝñùíáí ãéá ôéò åí ëüãù áëëáãÝò êáé ãéá ôç óçìáóßá ôïõò, êáèþò êáé üôé óå êÜèå åðßóêåøÞ ôïõò èá ìðïñïýóáí íá åîõðçñåôçèïýí ðëÞñùò áðü Ýíá ìüíï éáôñåßï. Åðßóçò ó÷åäéÜóèçêáí íÝá ðáñáðåìðôéêÜ ãéá ôá äõï íåïóýóôáôá éáôñåßá ðïõ Þôáí åê ôùí ðñïôÝñùí áñéèìçìÝíá êáé ìå áíáãñáöÞ þñáò åîõðçñÝôçóçò ãéá êÜèå áñéèìü, ìå ÷ñïíéêü ðåñéèþñéï 15 ëåðôþí áíÜ åðßóêåøç. ÌåôÜ êáé áðü áõôÞ ôçí ðáñÝìâáóç êáé ôéò êáèçìåñéíÝò åðåìâÜóåéò ôùí ìïíßìùí éáôñþí óå áõôÜ ôá éáôñåßá, ï óçìåñéíüò ôñüðïò ëåéôïõñãßáò Ýäåé÷íå íá âåëôéþíåôáé êáèçìåñéíÜ.

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Á. Ìðáôßêáò êáé óõí.

ÓõìðåñÜóìáôá Ç åðáíáëáìâáíüìåíç óõíôáãïãñáößá ðïõ ðñáãìáôïðïéåßôáé óÞìåñá óôá Ê.Õ., óõíäÝåôáé ìå áíåðáñêÞ êáé ÷áìçëÞò ðïéüôçôáò öñïíôßäá õãåßáò óôç ÃåíéêÞ ÉáôñéêÞ. Ç ðáñÝìâáóç ãéá ôç âåëôßùóç ôçò ðáñïýóáò êáôÜóôáóçò öáßíåôáé íá åßíáé áðïôåëåóìáôéêÞ. ×ñåéÜæïíôáé üìùò ðåñáéôÝñù ìåëÝôåò ìå ôï ó÷åäéáóìü ðïõ ðñïáíáöÝñáìå ãéá íá óôçñßîïõí ôç ãåíßêåõóç ôùí áðïôåëåóìÜôùí áõôÞò ôçò ðéëïôéêÞò ìåëÝôçò. Âéâëéïãñáößá 1. ×. ËéïíÞò, Ì.Ð. Ìåñêïýñçò. Áðüøåéò ãéá ôç óçìåñéíÞ êáôÜóôáóç óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò êáé ðñïôÜóåéò ãéá ôç âåëôßùóÞ ôçò. ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò 12, 2000. (Áñèñï Óýíôáîçò) 2. ×. ËéïíÞò. ÃåíéêÞ/ÏéêïãåíåéáêÞ ÉáôñéêÞ. Ìéá áíáôÝëëïõóá êáé ðïëëÜ õðïó÷üìåíç éáôñéêÞ åéäéêüôçôá. ÉáôñéêÞ 77: 324-327, 2000. (¢ñèñï Óýíôáîçò). 3. C. M. Harris, R. Dajda. The scale of repeat prescribing. Br. J. Gen. Pract. 46:649-653, 1996. 4. ×. ËéïíÞò êáé Ì. ÐáñáóêÜêçò. Ðåñéöåñåéáêü Éáôñåßï: Ïäçãßåò ãéá ôï ãéáôñü ÃåíéêÞò/ÏéêïãåíåéáêÞò ÉáôñéêÞò êáé ôï ãéáôñü Õðü÷ñåï Õðçñåóßáò Õðáßèñïõ. Åôáéñåßá ÅØÉËÏÍ êáé ×. ËéïíÞò åêäüôåò, ÁèÞíá 1997. 5. Ðáãêüóìéïò Ïñãáíéóìüò Õãåßáò. Åã÷åéñßäéï ÄéåèíÞò ÔáîéíïìÞóåùò ôùí íüóùí, êáêþóåùí êáé áéôéþí èáíÜôïõ, ¸íáôç áíáèåþñçóç, ÉáôñéêÝò Åêäüóåéò ÁèÞíá 1980. 6. Ì.Ð. Ìåñêïýñçò. ÅëëçíéêÞ Ýêäïóç ôïõ ICPC. ÉáôñéêÝò Åêäüóåéò, Éëßóéá 1992. 7. N. ÁíôùíÜêçò, N. ÐëïõìÞò, M. ÓáñéäÜêçò, K. ÌáêñÞ, M. ÖéëéððÜêç, X. ËéïíÞò. Ç óõíôáãïãñáößá óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò(ÉÉÉ). (¸÷åé ãßíåé äåêôÞ ãéá äçìïóßåõóç) 8. N. Britten, S. Brant, A. Cairns, et al. Continued Prescribing of inappropriate drugs in general practice. J. Clin. Pharm. Ther. 20:199-205, 1995. 9. J. Straand, K.S. Rokstad. Elderly patient in general practice: diagnoses, drugs and inappropriate prescriptions: A report from the More and Romsdal Prescription Study. Fam Pract 16:380388, 1999.

Ôüìïò 13, Ôåý÷ïò 3, 2001

Ó. ÁñãõñéÜäïõ êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅÑÃÁÓÉÁ ÓÔÏ ÄÉÁÃÙÍÉÓÌÏ "Ä. ÉÊÊÏÕ" THE SECOND AWARDED PAPER IN THE MEMORY OF PROF. D. IKKOS Primary Heatlh Care, Volume 13, Number 3, 127-135, 2001 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 13, Ôåý÷ïò 3, 127-135, 2001

¸íá ìïíôÝëï ïëéóôéêÞò ðñïóÝããéóçò ôïõ Ãåíéêïý Éáôñïý óôïõò áóèåíåßò ìå áããåéáêü åãêåöáëéêü åðåéóüäéï ÁñãõñéÜäïõ ÓôÝëëá, Ìåëéóóïðïýëïõ ×áñéôßíç, ×áñßóç ÁñåôÞ, ËõãéäÜêçò ×., ÊáöåôæÞò Ä., Êïæáäßíïò Áíô., ÁíôùíéÜäçò Áíô., ÑÜëëç Óïößá, ×ïõ÷ïýëç ÊùóôáíôéíéÜ, ÖùôéÜäïõ ËéÜíá, Ãåùñãïýóç Ãåùñãßá, Ìïó÷ïêÜñöç ÂáñâÜñá

Ðåñßëçøç ÅéóáãùãÞ: Ôá ÁããåéáêÜ ÅãêåöáëéêÜ Åðåéóüäéá (ÁÅÅ) áðïôåëïýí ôçí ôñßôç óõ÷íüôåñç áéôßá èáíÜôïõ Þ êáé áíáðçñßáò ãéá üëåò ôéò çëéêßåò, óôéò áíáðôõãìÝíåò ÷þñåò, ìå óõíÝðåéá ôï áíõðïëüãéóôï áíèñþðéíï êáé ïéêïíïìéêü êüóôïò. Óêïðüò ôçò åñãáóßáò Þôáí ç ìÝôñçóç ôçò óõ÷íüôçôáò ôùí ÁÅÅ óôçí åðáñ÷ßá ÍÝóôïõ, ç êáôáãñáöÞ ôùí ðáñáãüíôùí êéíäýíïõ, ç åêôßìçóç ôùí ðñïóöåñüìåíùí õðçñåóéþí õãåßáò áðü ôïí Ãåíéêü/Ïéêïãåíåéáêü (Ã/Ï) ãéáôñü êáôÜ ôçí ðñïíïóïêïìåéáêÞ êáé ìåôáíïóïêïìåéáêÞ öñïíôßäá óå áóèåíåßò ìå ÁÅÅ êáé ç áîéïëüãçóç ôçò ëåéôïõñãéêüôçôáò ôùí áóèåíþí áõôþí. ¢íèñùðïé êáé ìåèïäïëïãßá: 372 áóèåíåßò ìå ÁÅÅ áðü 45 åôþí êáé Üíù äéáêïìßóôçêáí ãéá ôéò ðñþôåò âïÞèåéåò óôï ÊÕ× êáé áðïôÝëåóáí ôï õëéêü ôçò ìåëÝôçò. Ôáõôü÷ñïíá ìå ôçí êëéíéêÞ åîÝôáóç êáé ôçí ðáñï÷Þ ðñþôùí âïçèåéþí, óõìðëçñùíüôáí áðü ìÝëïò ôçò ïìÜäáò åñùôçìáôïëüãéï ìå ôá äçìïãñáöéêÜ ôïõò óôïé÷åßá, ôéò óõíÞèåéåò, ôï áôïìéêü êáé ïéêïãåíåéáêü ôïõò éóôïñéêü ãéá ðáèÞóåéò ðïõ áðïôåëïýí ðáñÜãïíôåò êéíäýíïõ óôçí åìöÜíéóç ôùí ÁÅÅ. ÌåôÜ ôçí Ýîïäï ôïõ áóèåíïýò áðü ôï Íïìáñ÷éáêü íïóïêïìåßï ïé ãéáôñïß êáé ïé íïóçëåýôñéåò áíáëÜìâáíáí ôç ìåôáíïóïêïìåéáêÞ öñïíôßäá ôïõ áóèåíïýò (áíôéìåôþðéóç ïîÝùí êáôáóôÜóåùí, ñýèìéóç öáñìáêåõôéêÞò áãùãÞò, øõ÷éêÞ õðïóôÞñéîç ê.ëð.) êáé ôÝëïò ôçí åêôßìçóç ôçò ëåéôïõñãéêüôçôáò êáé ôçò øõ÷éêÞò ôïõ õãåßáò ìå ôç ÷ñÞóç ôùí åñùôçìáôïëïãßùí ADL êáé Zung. ÁðïôåëÝóìáôá: Aðü ôïõò áóèåíåßò êáôÝëçîå ôï 13,17%. Ïé ðáñÜãïíôåò êéíäýíïõ ðïõ öÜíçêáí íá óõíäÝïíôáé ìå ôá ÁÅÅ Þôáí ïé ðáèÞóåéò ôçò êáñäéÜò, ôï öýëï, ôï êÜðíéóìá êáé ôï áëêïüë (p <0.001). Ôï áðïôÝëåóìá ôïõ ADL ó÷åôßæåôáé åêôüò ôçò áíáðçñßáò, ìå ôçí çëéêßá, ôï êÜðíéóìá, ôï öýëï, ôçí ïéêïãåíåéáêÞ êáôÜóôáóç (p <0.001). Ï ÂÌÉ Þôáí ïñéáêüò óôï 45,87% êáé áõîçìÝíïò óôï 47,25% ôùí áóèåíþí. ÓõìðåñÜóìáôá: Ç åñãáóßá ðåñéãñÜöåé Ýíá ìïíôÝëï ôçò ïëéóôéêÞò ðñïóÝããéóçò ôçò ÐÖÕ, óôçí öñïíôßäá ôùí áíèñþðùí ìå ÁÅÅ óôçí êïéíüôçôá.

ÊÝíôñï Õãåßáò ×ñõóïýðïëçò

ÅéóáãùãÞ Ôá áããåéáêÜ åãêåöáëéêÜ åðåéóüäéá (ÁÅÅ) áðïôåëïýí óÞìåñá óõ÷íÞ áéôßá èáíÜôïõ ìå äéáñêþò áõîáíüìåíï åðéðïëáóìü. Óôéò áíáðôõãìÝíåò ÷þñåò áðïôåëïýí ôçí ôñßôç óõ÷íüôåñç áéôßá èáíÜôïõ êáé èåùñïýíôáé áðü ôïõò óçìáíôéêüôåñïõò ëüãïõò áíéêáíüôçôáò êáé áíáðçñßáò. Ôï 1991 óôéò ÇÐÁ õðÞñîáí 500.000 íÝïé áóèåíåßò áðü ôïõò ïðïßïõò ïé 143.000 ðÝèáíáí áöÞíïíôáò Üëëïõò ôüóïõò âáñéÜ Þ åëáöñÜ áíßêáíïõò1. Ãéá ôçí ÅëëÜäá õðïëïãßæåôáé üôé åôÞóéá ÷Üíïíôáé 25.000-30.000 Üíèñùðïé. Ï Í. ÊáâÜëáò óýìöùíá ìå óôïé÷åßá ôçò ÅÓÕÅ èåùñåßôáé íïìüò õøçëïý êéíäýíïõ. Áðü ìåôñÞóåéò ðïõ Ýãéíáí óôçí 20åôßá 1972-92 óýìöùíá ðÜíôá ìå ôçí ßäéá ðçãÞ, åíþ ïé èÜíáôïé áðü êáñäéáããåéáêÜ íïóÞìáôá (ÊÁÍ) Þôáí 906 áíÜ Ýôïò êáé áíÜ ËÝîåéò êëåéäéÜ: Áããåéáêü Åãêåöáëéêü Åðåéóüäéï, Ãåíéêü Éáôñüò, ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò Åëåýèåñç Áíáêïßíùóç óôï 13ï ÐáíåëëÞíéïõ ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (Ñüäïò, 8-22 Áðñéëßïõ 2001) êáé âñáâåýèçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Ó. ÁñãõñéÜäïõ, ÊÝíôñï Õãåßáò ×ñõóïýðïëçò, ÊáâÜëá, Ôçë.: (05910) 22222 127

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ó. ÁñãõñéÜäïõ êáé óõí.

óå ôñåéò Üîïíåò. Ï ðñþôïò áöïñÜ ôç ìåßùóç ôùí ðáñáãüíôùí êéíäýíïõ ãéá ôá êáñäéáããåéáêÜ åðåéóüäéá óå åðßðåäï ìáèçôþí, ï äåýôåñïò óôçí êáôáãñáöÞ, êáé ïñèÞ ðñïíïóïêïìåéáêÞ Summary öñïíôßäá ôùí áóèåíþí êáé ï ôñßôïò Introduction: Strokes represent the third largest cause of death and/or impairôç ìåôáíïóïêïìåéáêÞ öñïíôßäá – áðïment for all ages in developed countries and results unestimated human and êáôÜóôáóç. Ãéá ôçí åðßôåõîç ôïõ óôüeconomic value. ÷ïõ ëåéôïýñãçóáí ïìáäéêÜ Ã/Ï ãéáThe aim of the study was to estimate the frequency of strokes and risk factors ôñïß, ãéáôñïß õðü÷ñåïé õðçñåóßáò õðáßin the catchment area of the Chrissupoulis Health Center (HCCh) and to evaluate the Health Services that General Practitioners (GPs) offer to people through èñïõ, íïóçëåýôñéåò êáé öõóéïèåñáðåõtheir visit to the HCCh short time after the stroke onset as well as after their ôÝò. hospital discharge and the functionality of those patients. Ãéá ôçí õëïðïßçóç ôïõ äåýôåñïõ Subjects and Methods: 372 patients with stroke aged over 45 years, who êáé ôñßôïõ Üîïíá ôïõ ðñïãñÜììáôïò, were admitted for first aid to the HCCh made up the study group. During clinical óõãêåíôñþèçêå äåßãìá áðïôåëïýìåíï examination and first aid, a member of the Primary Health Care (PHC) team completed a questionnaire about demographics, habits, past medical and family áðü 372 áóèåíåßò ìå ÁÅÅ çëéêßáò, 45 history as well as history for stroke risk factors. After a patient's discharge from åôþí êáé Üíù, ïé ïðïßïé äéåêïìßóèçhospital the doctors and nurses from the HCCh were taking care of them in êáí óôï ÊÕ×. Ïé ïìÜäá ìáò ðáñáêïtheir own homes. They were dealing with acute disorders, with their medicaëïýèçóå óôåíÜ ôçí ðïñåßá êÜèå áóèåtions' set up and their psychological support. For the measurement of their íÞ, êáëýðôïíôáò êõñßùò ôï ðåäßï åífunctionality and mental health the ADL (Activities of Daily Living) and Zung questionnaire were used. äéáöÝñïíôïò êáé äñáóôçñéüôçôáò ôïõ Results: 13.17% of the study group was diseased. Risk factors associated with Ã/Ï ãéáôñïý. Áõôü îåêéíïýóå áðü ôçí strokes were cardiovascular diseases, gender, smoking and alcohol consumpåðåßãïõóá ðñïóÝëåõóÞ ôïõ óôï ÊÝíôñï tion (p <0.001). ADL results are associated except from disability, with age, Õãåßáò êáé ôçí ðñïíïóïêïìåéáêÞ ôïõ smoking, gender and family status (p <0.001). BMI (body mass index) was ðåñßèáëøç, êáé óõìðëçñùíüôáí êáôÜ borderline at 45.87% and 47.25% of the patients were obese. Conclusions: The study results recommend a holistic approach in PHC be ôç ìåôáíïóïêïìåéáêÞ ôïõ öñïíôßäá êáé adopted for the care of people with stroke in the community. áðïêáôÜóôáóç. Key words: Strokes, General Practitioner, Primary Health Care ÊáôÜ ôçí ðñïíïóïêïìåéáêÞ öÜóç, Health Centre of Chrisoupolis åöáñìüóôçêå ï ðáñáêÜôù áëãüñéèìïò äéÜñêåéáò äÝêá ëåðôþí. 100.000 êáôïßêïõò, óôï Í. ÊáâÜëáò õðïëïãßóôç1. ÁðÜíôçóç óôï åñþôçìá “Ðñüêåéôáé ðñÜãìáêáí óå 10532. ôé ãéá åãêåöáëéêü;”. Óôá ðëáßóéá ôùí ðñþôùí åíåñãåéþí ç ïìÜäá ðñïÝâáéíå óå: Ìå ôïí üñï “åãêåöáëéêü” åííïïýìå ü,ôé áöïñÜ • ÅíÝñãåéåò ãéá ôçí åîáóöÜëéóç ôùí åëåýèåôçí áéöíßäéáò Ýíáñîçò åëÜôôùóç ôçò åãêåöáëéñùí áåñáãùãþí. êÞò ñïÞò. Óêïðüò ôçò åñãáóßáò ìáò Þôáí ç ìÝ• ¸ëåã÷ï ôùí æùôéêþí óçìåßùí. ôñçóç ôçò óõ÷íüôçôáò ôùí ÁÅÅ óôçí åðáñ÷ßá • ÃåíéêÞ åêôßìçóç/äéáöïñïäéÜãíùóç óôçí ðåÍÝóôïõ, ç êáôáãñáöÞ ôùí ðáñáãüíôùí êéíäýñßðôùóç ðïõ ï áóèåíÞò âñéóêüôáí óå êùìáíïõ, ç åêôßìçóç ôùí ðñïóöåñüìåíùí õðçñåóéþí ôþäç êáôÜóôáóç áðü ôçí õðïãëõêáéìßá, ôçí õãåßáò áðü ôïí Ã/Ï ãéáôñü êáôÜ ôçí ðñïíïóïêïôïîßêùóç áðü öÜñìáêá, ôéò åðéëçðôéêÝò êñßìåéáêÞ êáé ìåôáíïóïêïìåéáêÞ öñïíôßäá óå áóèåóåéò, ôçí êñáíéïåãêåöáëéêÞ êÜêùóç. íåßò ìå ÁÅÅ, ç áîéïëüãçóç ôçò ëåéôïõñãéêüôçôáò • ¸ëåã÷ï ôïõ áõ÷Ýíá êáé ôçò êåöáëÞò ãéá ôùí áóèåíþí áõôþí. ðéèáíÜ ôñáýìáôá êáé åîÝôáóç ôçò êáñäéÜò êáé ôïõ ðíåýìïíá. • ÁäñÞ íåõñïëïãéêÞ åêôßìçóç êáé óå Ýëåã÷ï Ðëçèõóìüò ÌåëÝôçò êáé ÌÝèïäïé ôçò óõíåßäçóçò êáé ôçò ðéèáíÞò ýðáñîçò åðéëçðôéêÞò äñáóôçñéüôçôáò. Óôçí ðåñéï÷Þ åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò • ÅöáñìïãÞ ôçò êëßìáêáò ôçò Ãëáóêüâçò. ×ñõóïýðïëçò óôçí åðáñ÷ßá ÍÝóôïõ, ç ïðïßá • ¸ëåã÷ï ôùí êüñùí (ìÝãåèïò, óõììåôñßá, áíôßêáëýðôåé 22.000 êáôïßêïõò, êáôÜ ôçí ôåëåõôáßá äñáóç óôï öùò). ðåíôáåôßá îåêßíçóå Ýíá ðñüãñáììá âáóéæüìåíï A model for a holistic approach from general practitioners to patients suffering from stroke S. Argriadou, H. Melissopoulou, A. Charisi, H. Lygidakis, D. Kafetzis, A. Kozadinos, A. Antoniadis, S. Ralli, K. Houhouli, L. Fotiadou, G. Giorgousi, V. Moshokarfi

128

Ôüìïò 13, Ôåý÷ïò 3, 2001

Ó. ÁñãõñéÜäïõ êáé óõí.

2. ÓõìðëÞñùóç åñùôçìáôïëïãßïõ áðü ìÝëïò ôçò ïìÜäáò áðåõèõíüìåíï óôïõò óõíïäïýò, ôï ïðïßï áöïñïýóå ôç ëÞøç äçìïãñáöéêþí óôïé÷åßùí, ôéò óõíÞèåéåò, ôï ïéêïãåíåéáêü êáé áôïìéêü éóôïñéêü. 3. ÁðÜíôçóç óôï åñþôçìá “Óå ðïéï óçìåßï ôïõ åãêåöÜëïõ õðÞñ÷å ç âëÜâç;”, ÷ñçóéìïðïéþíôáò ùò âïÞèçìá ôïí åìöáíéæüìåíï ðßíáêá 1. Ôï ðñüãñáììá óõíå÷éæüôáí ìå ôçí åðéóôñïöÞ ôïõ áóèåíÞ áðü ôï íïóïêïìåßï. ÊáôÜ ôçí ðåñßïäï áíÜññùóçò - áðïèåñáðåßáò ï Ã/Ï ãéáôñüò Þ ï Áãñïôéêüò ãéáôñüò óõíïäåõüìåíïò áðü íïóçëåýôñéá, ðáñáêïëïõèïýóå ôçí ðïñåßá ôçò íüóïõ, ðáñÝ÷ïíôáò: • ëýóåéò óôçí áíôéìåôþðéóç ïîÝùí êáôáóôÜóåùí ðïõ ôõ÷üí ðáñïõóéáæüôáí. • ñýèìéóç ôçò öáñìáêåõôéêÞò áãùãÞò ôùí ðñïçãïýìåíùí íïóçìÜôùí áðü ôá ïðïßá Ýðáó÷å. • óõíôïíéóìü êáé óõíåñãáóßá ìå åéäéêïýò ðïõ åìðëÝêïíôáé óôï óôÜäéï áõôü ôçò áóèÝíåéáò (öõóéïèåñáðåõôÝò, øõ÷ïëüãïõò ê.ëð.) ãéá ôçí åðßôåõîç ôçò øõ÷éêÞò õðïóôÞñéîçò êáé ôçò

êïéíùíéêÞò åðáíÝíôáîÞò ôïõ. • öñïíôßäá êáé åíçìÝñùóç ôçò ïéêïãÝíåéÜò ôïõ ó÷åôéêÜ ìå ôïí ôñüðï ðïõ èá Ýðñåðå íá ÷åéñßæïíôáé ôïí áóèåíÞ (äéáôñïöÞ, êéíçóéïèåñáðåßá, õãéåéíÞ, êëð), êáèþò êáé çèéêÞ êáé øõ÷ïëïãéêÞ õðïóôÞñéîç ôçò, äéáóöáëßæïíôáò ìå ôïí ôñüðï áõôü Ýíá ðåñéâÜëëïí êáôÜëëçëï ãéá áíÜññùóç. • åîÝôáóç ôçò ïéêïãÝíåéáò êáé ôùí óõããåíþí ãéá áíß÷íåõóç ìåéæüíùí ðáñáãüíôùí êéíäýíïõ ãéá ÊÁÍ. Åðéðñüóèåôá, åöáñìüóôçêå ôï åñùôçìáôïëüãéï Activities of Daily Live (ADL) ãéá ôçí åêôßìçóç ôçò éêáíüôçôáò åêôÝëåóçò êáèçìåñéíþí ëåéôïõñãéþí ôïõ áóèåíÞ3. Áõôü áðïôåëåß ìßá áðü ôéò ãíùóôüôåñåò êáé ðïéïôéêÝò ìåèüäïõò óôç Ã/Ï éáôñéêÞ ãéá ôç óõ÷íÞ ìÝôñçóç ôçò ëåéôïõñãéêÞò êáôÜóôáóçò, ðïõ âïçèÜ óôçí êáôÜóôñùóç ó÷åäßïõ áíôéìåôþðéóçò, èåñáðåõôéêþí ÷åéñéóìþí êáé ðñïóÝããéóçò ôùí ìáêñü÷ñïíùí áðáéôÞóåùí öñïíôßäáò ôùí áóèåíþí. Óôçí ðáñïýóá ìåëÝôç ÷ñçóéìïðïéÞèçêå êõñßùò ãéá ôï follow up ôùí áóèå-

Ðßíáêáò 1. ÊáôÜëïãïò ðïõ ÷ñçóéìïðïéïýóå ç ïìÜäá Óõìðôïìáôïëïãßá

Éóôïñéêü

Åìâïëéêüò ìç÷áíéóìüò Ìåßùóç ôïõ åðéðÝäïõ óõíåßäçóçò, Ýëëåéììá ïðôéêþí ðåäßùí, ÷ùñéêÞ áãíùóßá, áöáóßá, áðïõóßá ðáñïäéêïý ÁÅÅ

Öýóçìá óôéò êáñùôßäåò, óôåöáíéáßá íüóïò, ðåñéöåñéêÞ áããåéïðÜèåéá

×áìçëÞò ñïÞò ìç÷áíéóìüò Ðáñïõóßá ðñïçãïýìåíùí ÁÅÅ, ç êáôÜ âÞìáôá åðÝêôáóç ôïõ åëëåßììáôïò, ç åðéäåéíïýìåíç éó÷áéìßá ôïõ åãêåöáëéêïý óôåëÝ÷ïõò

Óôåöáíéáßá íüóïò, ðåñéöåñéêÞ áããåéïðÜèåéá

Íüóïò ìéêñþí áããåßùí ÇìéðÜñåóç, áôáîéêÞ çìéðÜñåóç, çìéáíáéóèçóßá, áðïõóßá ìåßùóçò ôçò óõíåßäçóçò, áöáóéêþí äéáôáñá÷þí, ðïíïêåöÜëïõ, åìÝôùí Êáñäéïåìâïëéêü Ýìöñáêôï Áéöíßäéá Ýíáñîç, ìåßùóç ôïõ åðéðÝäïõ óõíåßäçóçò, Ýëëåéììá ïðôéêþí ðåäßùí, ÷ùñéêÞ áãíùóßá, áöáóßá

ÊïëðéêÞ ìáñìáñõãÞ, ðôåñõãéóìüò, íüóïò ôïõ öëåâïêüìâïõ, âáëâéäéêÝò íüóïé, åíäïêáñäßôéäá, êáñäéáêÞ áíåðÜñêåéá, ðñüóöáôï Ýìöñáãìá

Óõóôçìáôéêïß áéìïäõíáìéêïß ëüãïé ÅìöÜíéóç íåõñïëïãéêïý óõìâÜìáôïò ìå óõóôçìáôéêÞ äéáôáñá÷Þ (õðüôáóç, ù÷ñüôçôá, éäñþôåò, áöáóßá, êþìá) Ðáñåã÷õìáôþäçò áéìïññáãßá Óçìåßá áýîçóçò åíäïêñÜíéáò ðßåóçò (Ýìåôïò, åëÜôôùóç åðéðÝäïõ óõíåßäçóçò)

ÕðÝñôáóç, áéìïññáãéêÞ äéÜèåóç, áðïõóßá ðáñïäéêþí ÁÅÅ, ðåñéöåñéöåñéêÞò áðïöñáêôéêÞò áããåéïðÜèåéáò

Õðáñá÷íïåéäÞò áéìïññáãßá Áéöíßäéá åìöÜíéóç éó÷õñïý ðïíïêåöÜëïõ, Ýìåôïé, áðþëåéá óõíåßäçóçò ðïõ áñãüôåñá ï áóèåíÞò ìðïñåß íá åðáíÝëèåé 129

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ó. ÁñãõñéÜäïõ êáé óõí.

íþí, äçëáäÞ ãéá ôçí ðïéïôéêÞ áîéïëüãçóç ôçò ðïñåßáò ôçò áðïêáôÜóôáóÞ ôïõò, êáé ü÷é óáí ìÝóï ðïóïôéêÞò åêôßìçóçò ôùí áíáãêþí ôïõò. Ôï åñùôçìáôïëüãéï áðïôåëåßôáé áðü 10 åñùôÞóåéò - äåîéüôçôåò, 7 êýñéåò êáé 3 äåõôåñåýïõóåò. Ç áíåîáñôçóßá óå êÜðïéá äåîéüôçôá âáèìïëïãÞèçêå ìå 0, ç áíÜãêç ãéá âïÞèåéá ìå 1 êáé ç áíéêáíüôçôá ìå 2. Âáèìïëïãßá ðÜíù áðü 12 âáèìïýò óçìáßíåé üôé ï åîåôáæüìåíïò äåí Þôáí áíåîÜñôçôïò. ÔÝëïò óõìðëçñùíüôáí åñùôçìáôïëüãéï ãéá ôçí áõôïåêôßìçóç ôùí äéáôáñá÷þí ôçò äéÜèåóçò ôïõ Zung5,6, ãéá ôçí áíß÷íåõóç øõ÷éêþí íïóçìÜôùí, ðïõ üðùò åßíáé ãíùóôü åßíáé óõ÷íüôáôá óôç óõãêåêñéìÝíç êáôçãïñßá áóèåíþí. Ç êëßìáêá áõôÞ ðïõ ç ÷ñÞóç ôçò áíÜãåôáé óôç äåêáåôßá ôïõ ’60 áðïäåß÷ôçêå åîáéñåôéêÜ ÷ñÞóéìç, ôüóï óôçí êëéíéêÞ ðáñáêïëïýèçóç üóï êáé óôçí áíôéìåôþðéóç áóèåíþí ìå øõ÷éêÝò äéáôáñá÷Ýò óôçí ÐÖÕ. Áðïôåëåßôáé áðü 20 åñùôÞìáôá ðïõ óôï óýíïëü ôïõò ìáò åðéôñÝðïõí íá ïñßóïõìå ðïóïôéêÜ ôçí ïíôüôçôá ôçò êáôáèëéðôéêÞò äéáôáñá÷Þò. Ï õðïëïãéóìüò ôçò ôåëéêÞò âáèìïëïãßáò ãßíåôáé áðü ôï ãéáôñü êáé ôï Üèñïéóìá ìåôáôñÝðåôáé óå äåßêôç SDS (self-rating depression scale) óýìöùíá ìå ôïí áêüëïõèï ôýðï: äåßêôçò SDS= óõíïëéêÞ âáèìïëïãßá 20 åñùôçìÜôùí/ ìÝãéóôç âáèìïëïãßá ôçò

êëßìáêáò (80 âáèìïß)= × 100. ¸ôóé üôáí ï äåßêôçò SDS åßíáé <50 ï åîåôáæüìåíïò äåí ðáñïõóéÜæåé óôïé÷åßá êáôÜèëéøçò. ¼ôáí ï SDS åßíáé áðü 50-59 óõíåðÜãåôáé ìå åëáöñÜ êáôÜèëéøç, áðü 60-69 õðÜñ÷åé êáôÜèëéøç ìåôñßïõ âáèìïý åíþ ðÜíù áðü 70 äçëþíåé âáñéÜ êáôÜèëéøç. Ïé áóèåíåßò ÷ùñßóôçêáí óå ðÝíôå çëéêéáêÝò ïìÜäåò (45-54, 55-64, 65-74, 75-84 êáé ôÝëïò áðü 85 êáé Üíù) ãéá ôçí åõêïëßá ôçò åðåîåñãáóßáò ôùí áðïôåëåóìÜôùí, áëëÜ êáé ãéá ôçí éäéáéôåñüôçôá ôùí ÷áñáêôçñéóôéêþí ôïõò.

ÁðïôåëÝóìáôá Ôá äçìïãñáöéêÜ ÷áñáêôçñéóôéêÜ ôùí áóèåíþí öáßíïíôáé óôïí ðßíáêá 2. Áðü ôïõò áóèåíåßò ìå ÁÅÅ êáôÝëçîáí 29 ãõíáßêåò êáé 20 Üíäñåò. ÅîåôÜæïíôáò ôéò óõíÞèåéåò ôïõò âñÝèçêáí íá êáðíßæïõí ïé 135 (36,3%) íá êÜíïõí ÷ñÞóç áëêïüëçò ïé 61 (16,4%) êáé íá Ý÷ïõí èåôéêü ïéêïãåíåéáêü éóôïñéêü ãéá ÊÁÍ ïé 96 (25,8%). Åéäéêüôåñá ï óõó÷åôéóìüò äçìïãñáöéêþí êáé óõíÞèåéþí öáßíåôáé óôïí ðßíáêá 3. Áîéïóçìåßùôç åßíáé ç ó÷Ýóç ôùí ðáñáãüíôùí êÜðíéóìá, öýëï, çëéêßá, áëêïüë êáé ÂÌÉ.

Ðßíáêáò 2. ÄçìïãñáöéêÜ ÷áñáêôçñéóôéêÜ ôùí áóèåíþí ÌåôáâëçôÝò ÇëéêéáêÝò ïìÜäåò 45-54 55-64 65-74 75-84 85 êáé Üíù

¢íäñåò (%)

Ãõíáßêåò (%)

Óýíïëï (%)

21 44 49 30 10

(13,6) (28,6) (31,8) (19,5) (6,5)

17 42 66 62 31

(7,8) (19,3) (30,3) (28,4) (14,2)

38 86 115 92 41

126 28

(81,8) (18,2)

150 68

(68,8) (31,2)

276 96

(10,2) (23,1) (30,9) (24,7) (11,0)

ÏéêïãåíåéáêÞ êáôÜóôáóç ÐáíôñåìÝíïé ×Þñïé Áðåâßùóáí

(13,2)

Ðßíáêáò 3. Ó÷Ýóç äçìïãñáöéêþí óôïé÷åßùí êáé óõíçèåéþí óýìöùíá ìå ôç äéìåôáâëçôÞ óõó÷Ýôéóç ôïõ Pearson Sig. (2-tailed)

Öýëï

Çëéêßá

ÏéêïãåíåéáêÞ ÊáôÜóôáóç

ÊÜðíéóìá

Áëêïüë

BMI

Öýëï Çëéêßá ÏéêïãåíåéáêÞ ÊáôÜóôáóç ÊÜðíéóìá Áëêïüë BMI

.000 .005 .000 .000 .000

.000 .000 .000 .000 .347

.005 .000 .002 .031 .589

.000 .000 .002 .000 .000

.000 .000 .031 .000 .019

.000 .347 .589 .000 .019 -

130

Ôüìïò 13, Ôåý÷ïò 3, 2001

Ó. ÁñãõñéÜäïõ êáé óõí.

ÅðéðëÝïí âñÝèçêå ó÷Ýóç óôáôéóôéêÜ óçìáíôéêÞ (p <0.001) ìåôáîý ôùí êáñäéáêþí íïóçìÜôùí, ôçò äõóëéðéäáéìßáò êáé ôïõ ïéêïãåíåéáêïý éóôïñéêïý. Óõãêñßíïíôáò ôá äçìïãñáöéêÜ, ôéò óõíÞèåéåò êáé ôç “ìåôáíïóïêïìåéáêÞ” æùÞ ôùí áóèåíþí öÜíçêáí ôá ðáñáêÜôù (Ðßíáêáò 4). Óôïí ðßíáêá 4 áíáäåéêíýåôáé ç óôáôéóôéêÞ óçìáíôéêüôçôá ôçò ó÷Ýóçò ôïõ ADL ìå ôçí çëé-

êßá, êÜðíéóìá, öýëï, êáé ïéêïãåíåéáêÞ êáôÜóôáóç, êáèþò åðßóçò êáé ï óõó÷åôéóìüò çëéêßáò ìå ôçí áíáðçñßá (çìéðëçãßá êáé êëéíïóôáôéóìüò). ¼ðùò Þôáí áíáìåíüìåíï ïé åðéóêÝøåéò êáô´ ïßêïí ó÷åôßæïíôáé ìå ôï ðáèïëïãéêü ADL, ìå ôçí çìéðëçãßá, åíþ ç êáôÜèëéøç ìå ôïí êëéíïóôáôéóìü (Ðßíáêåò 5 êáé 6). Áðü ôç óôáôéóôéêÞ åðåîåñãáóßá âñÝèçêå íá

Ðßíáêáò 4. ÄçìïãñáöéêÜ – ÓõíÞèåéåò – “ìåôáíïóïêïìåéáêÞ öñïíôßäá” Sig. (2-tailed)

ADL

ZUNG

ÅðéóêÝøåéò êáô´ Ïßêïí

Çìéðëçãéêïß

ÊáôáêåêëéìÝíïé

Öýëï Çëéêßá ÏéêïãåíåéáêÞ ÊáôÜóôáóç ÊÜðíéóìá Áëêïüë BMI

.005 .000 .005 .000 .707 .223

.329 .000 .001 .000 .019 .957

.068 .027 .868 .004 .199 .918

.231 .000 .120 .033 .405 .594

.255 .000 .003 .021 .885 .146

Ðßíáêáò 5. Óõó÷åôéóìüò “ìåôáíïóïêïìåéáêÞò” öñïíôßäáò ìå ôç äéìåôáâëçôÞ óõó÷Ýôéóç ôïõ Pearson Sig. (2-tailed)

ADL

ZUNG

ÅðéóêÝøåéò êáô´ Ïßêïí

Çìéðëçãéêïß

ÊáôáêåêëéìÝíïé

ADL Zung ÅðéóêÝøåéò êáô´ Ïßêïí Çìéðëçãéêïß ÊáôáêåêëçìÝíïé

.046 .001 .002 .019

.046 .694 .017 .002

.001 .694 .002 .060

.002 .017 .002 .060

.019 .002 .060 .060 -

Ðßíáêáò 6. ÁðïôåëÝóìáôá óõíÜñôçóçò ADL, êáô’ ïßêïí åðéóêÝøåéò êáé áíáðçñßá

ADL ðáèïëïãéêü

×ùñßò ÅðéóêÝøåéò

Çìéðëçãéêïß ÊáôáêåêëéìÝíïé Öõóéïëïãéêïß Óýíïëï

21 14 172 207

Ìå ÅðéóêÝøåéò

(10,14%) (6,76%) (83,09%) (100,0%)

21 12 71 104

ADL ðáèïëïãéêü Çëéêßá

45-54 55-64 65-74 75-84 85

9 27 43 30 10

(42,9) (61,4) (87,8) (100,0) (100,0)

Óýíïëï

(20,19%) (11,54%) (68,27%) (100,0%)

42 26 243 311

Çìéðëçãéêïß %

11 (64,7) 33 (78,6) 56 (84,9) 61 (98,4) 31 (100,0)

1 (4,8) 1 (2,3) 7 (14,3) 9 (30,0) 3 (30,0)

(13,50%) (8,36%) (78,14%) (100,0%)

ÊáôáêåêëéìÝíïé %

1 (4,8) 1 (2,3) 7 (14,3) 9 (30,0) 3 (30,0)

0 (0,0) 1 (2,3) 3 (6,1) 4 (13,3) 0 (0,0)

0 (0,0) 0 (0,0) 4 (6,1) 6 (9,7) 8 (25,8) 131

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ó. ÁñãõñéÜäïõ êáé óõí.

ó÷åôßæïíôáé óçìáíôéêÜ ïé ðáèÞóåéò ôçò êáñäéÜò ìå ôï öýëï, ìå ôï êÜðíéóìá êáé ôï áëêïüë (p<0.001). Áêüìç óõíäÝïíôáé ç çëéêßá ìå ôçí õðÝñôáóç (p <0.001) êáé ç ðá÷õóáñêßá ìå ôç äõóëéðéäáéìßá êáé ôïí äéáâÞôç (p <0.005). Óõó÷åôßæïíôáò ôá äçìïãñáöéêÜ êáé ôéò óõíÞèåéåò ìå ôïõò ðáñÜãïíôåò êéíäýíïõ ÁÅÅ öÜíçêå íá Ý÷ïõí óôáôéóôéêÞ óçìáíôéêüôçôá ôï öýëï ìå ôéò êáñäéáêÝò ðáèÞóåéò (p <0.001), ç çëéêßá ìå ôçí õðÝñôáóç (p <0.001), ôï êÜðíéóìá ìå ôçí õðÝñôáóç êáé ôéò êáñäéáêÝò ðáèÞóåéò (p <0.001), ç êáôáíÜëùóç áëêïüë ìå ôéò äõóëéðéäáéìßåò (p <0.005) êáé ôÝëïò ôï BMI ìå ôéò äõóëéðéäáéìßåò (p <0.001).Ôï ôåëåõôáßï ìÜëéóôá Ý÷åé êÜðïéá ó÷Ýóç ü÷é üìùò óôáôéóôéêÜ óçìáíôéêÞ êáé ìå ôïí äéáâÞôç (p=0.007). Ïé óõ÷íüôåñïé ðáñÜãïíôåò êéíäýíïõ, äçëáäÞ ï óáê÷áñþäçò äéáâÞôçò, ç õðÝñôáóç, ôï èåôéêü ïéêïãåíåéáêü éóôïñéêü êáé ç ðá÷õóáñêßá êáôáãñÜöçêáí êáé áíáëýèçêáí áðü ôçí ïìÜäá, ôá äå ìåãÝèç ôïõò áêïëïõèïýí (Ðßíáêåò 7 êáé 8). Ç åêôßìçóç ôùí øõ÷éêþí äéáôáñá÷þí ôùí áóèåíþí ìå ÁÅÅ êáé ç ó÷Ýóçò ôïõò ìå ôçí çëéêßá êáé ôï öýëï ôùí áóèåíþí öáßíåôáé óôïí

ðßíáêá 9.

ÓõæÞôçóç - ÓõìðåñÜóìáôá Ç ðñáãìáôïðïßçóç áõôÞò ôçò ìåëÝôçò ðáñïõóßáóå ðïëëÝò äõóêïëßåò, üðùò ç Ýëëåéøç åéäéêïôÞôùí ìÝóá óôéò äïìÝò ôïõ ÊÕ (öõóéïèåñáðåõôÝò, ëïãïèåñáðåõôÝò, øõ÷ïëüãïé ê.ëð.). Ç óçìáíôéêüôåñç üìùò áäõíáìßá ôçò åßíáé ç Ýëëåéøç ìáñôýñùí, ç ýðáñîç ôùí ïðïßùí üìùò áíôéâáßíåé óôç äåïíôïëïãßá ôïõ Ã/Ï ãéáôñïý. ¸ôóé ç áðïôåëåóìáôéêüôçôá ôçò öñïíôßäáò ìðïñåß íá «ìåôñçèåß» ìüíï áðü ôç âåëôßùóç äåéêôþí, üðùò ç óýãêñéóç ôùí äéáãñáììÜôùí ADL, ç âåëôßùóç ôçò êáôÜèëéøçò êáé ãåíéêüôåñá ôùí õðïëïßðùí äåéêôþí õãåßáò. Ôá ÁÅÅ áðáó÷ïëïýí ôç âéâëéïãñáößá, óáí óõ÷íÞ áéôßá áíáðçñßáò êáé èáíÜôïõ. ¸ôóé ïé Abadal LT et al óå ìéá ìåãÜëç ìåëÝôç4 ðáñáôÞñçóáí üôé ç çëéêßá ôïõ 64% ôùí áíèñþðùí ìå ÁÅÅ Þôáí ìåôÜ ôá 60 ÷ñüíéá êáé áõôü óõìâáäßæåé ìå ôá äåäïìÝíá ìáò êáôÜ ôá ïðïßá ôï 33,3% ôùí áóèåíþí áíÞêïõí óôçí ðñþôç êáé äåýôåñç

Ðßíáêáò 7.Óõó÷Ýôéóç ôùí ÁÅÅ ìå ôïí óáê÷áñþäç äéáâÞôç, ôçí õðÝñôáóç êáé ôï èåôéêü ïéêïãåíåéáêü éóôïñéêü

Öýëï Çëéêßåò

Ïéêïãåíåéáêü éóôïñéêü ¢íäñåò Ãõíáßêåò ¢íäñåò (%)

Ãõíáßêåò (%)

45-54 55-64 65-74 75-84 85+

21% 44% 49% 30% 10%

17% 42% 66% 62% 31%

6 13 21 12 5

(28,6) (29,6) (42,9) (40,0) (50,0)

2 12 15 21 9

(11,8) (28,6) (22,7) (33,9) (29,0)

Óýíïëï

154%

218%

(37,0)

(27,0)

132

Óáê÷áñþäçò äéáâÞôçò ¢íäñåò (%) Ãõíáßêåò (%) 3 4 6 3 1

(14,3) (9,0) (12,2) (10,0) (10,0)

3 2 1 5 3

(17,6) (4,8) (1,5) (8,0) (9,7)

17 (11,0)

(6,4)

ÕðÝñôáóç ¢íäñåò (%) Ãõíáßêåò (%) 4 7 12 14 4

(19,0) (15,9) (24,5) (46,7) (40,0)

41 (26,6)

3 9 10 21 14

(17,6) (21,4) (15,1) (33,9) (45,2)

57 (26,1)

Ôüìïò 13, Ôåý÷ïò 3, 2001

Ó. ÁñãõñéÜäïõ êáé óõí. Ðßíáêáò 8. Äåßêôçò ìÜæáò óþìáôïò êáé áããåéáêü åãêåöáëéêü åðåéóüäéï

¢íäñåò

Ãõíáßêåò

Çëéêßåò

Ïñéáêïß

(%)

ÏñéáêÝò

(%)

45-54 55-64 65-74 75-84 85+

3 12 18 13 6

(14,3) (27,3) (38,7) (43,3) (60,0)

ÕðÝñâáñïé (%) 10 8 14 11 2

(47,6) (18,2) (28,6) (36,7) (20,0)

3 17 38 30 12

(17,6) (40,5) (57,6) (48,4) (38,7)

ÕðÝñâáñåò (%) 12 23 26 28 14

(70,6) (54,8) (39,4) (45,2) (45,2)

Óýíïëï

(33,8)

(29,2)

100

(45,9)

103

(47,2)

Ðßíáêáò 9. ÁðïôåëÝóìáôá åñùôçìáôïëïãßïõ Zung óå óõíÜñôçóç ìå ôçí çëéêßá êáé ôï öýëï

Zung (SDS) SDS 45-54 55-64 65-74 75-84 85+

¢íäñåò(%) 50-59 8 (38,1) 21 (47,7) 2 (4,1) 0 (0,0) 0 (0,0)

60-69 0 (0,0) 6 (13,6) 1 (2,0) 0 (0,0) 0 (0,0)

Ãõíáßêåò (%) >70 3 (14,3) 4 (9,1) 0 (0,0) 0 (0,0) 0 (0,0)

50-59 5 (29,4) 19 (45,2) 8 (12,1) 1 (1,6) 0 (0,0)

60-69 7 14 3 2 0

(41,2) (33,3) (4,6) (3,2) (0,0)

>70 2 (11,8) 7 (16,7) 0 (0,0) 0 (0,0) 0 (0,0) 133

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

çëéêéáêÞ ïìÜäá äçëáäÞ áðü 45-64 Ýôç. Áðü ìåëÝôåò áðïäåéêíýåôáé óáí éó÷õñüôåñïò ðáñÜãïíôáò êéíäýíïõ ç õðÝñôáóç5-7 (55% ðåñßðïõ). Áõôü Ýñ÷åôáé óå áíôßèåóç ìå ôá äåäïìÝíá ìáò óýìöùíá ìå ôá ïðïßá ïé õðåñôáóéêïß áðïôåëïýóáí ôï 26,3%, üìùò Þôáí éó÷õñüôåñïò ðáñÜãïíôáò áðü ôéò äõóëéðéäáéìßåò êáé ôï óáê÷áñþäç äéáâÞôç, ãåãïíüò ðïõ óõìöùíåß êáé ìå ôéò ðáñáðÜíù ìåëÝôåò. Óýìöùíá ìå ôá äåäïìÝíá ìáò, éó÷õñüôáôïò ðáñÜãïíôáò êéíäýíïõ áðïôÝëåóå ï áõîçìÝíïò BMI êáé ôï êÜðíéóìá. Ïé áóèåíåßò ìáò ÷ùñßóôçêáí óå ôñåéò êáôçãïñßåò ãéá ôçí åõêïëßá ôçò åðåîåñãáóßáò ôùí óôáôéóôéêþí óôïé÷åßùí óôïõò öõóéïëïãéêïýò, ôïõò õðÝñâáñïõò êáé ôïõò ðá÷ýóáñêïõò (BMI 20-25, 26-30, 31 êáé Üíù). Ç êáôçãïñßá ôùí õðÝñâáñùí áðïôåëïýóå ôï 40,9%, ðïóïóôü ðïõ èá ðñÝðåé íá ãßíåé áíôéêåßìåíï ðåñáéôÝñù ìåëÝôçò ãéá ôçí åîáêñßâùóç ôùí áéôßùí, êáé ôï ßäéï éó÷ýåé ãéá ôï ðïóïóôü êáðíéóôþí (36,3%). Áðü ôç “ÌåëÝôç ôçò ÊáâÜëáò”8 Ý÷åé åðéóçìáíèåß üôé ôï ðïóïóôü ôùí êáðíéóôþí, éäßùò ôùí íÝùí åßíáé õøçëü óôçí ðåñéï÷Þ, üðùò êáé ôï ðïóïóôü ôïõ èåôéêïý ïéêïãåíåéáêïý éóôïñéêïý ÊÁÍ (31,2%). Äåí èá ðñÝðåé íá ðáñáëçöèåß, üôé óôï ôñßôï åñþôçìá ôïõ áëãïñßèìïõ, “óå ðïéï óçìåßï ôïõ åãêåöÜëïõ õðÞñ÷å âëÜâç”, áêïëïõèþíôáò ôï âïçèçôéêü ó÷Þìá, ôï ðïóïóôü åðéôõ÷ßáò ôçò ïìÜäáò Üããéæå ôï 81% ðåñßðïõ óôïí åíôïðéóìü ôçò, üðùò äéáðéóôùíüôáí êáôüðéí ìå ôçí CT êáé/Þ ôç MRI ðïõ ðñáãìáôïðïéïýóå ôï Íïìáñ÷éáêü Íïóïêïìåßï. Ôï ãåãïíüò áõôü ôïíßæåé îáíÜ ôçí áîßá ôçò óùóôÞò êëéíéêÞò åîÝôáóçò êáé óõìöùíåß ìå ôá ðïóïóôÜ ðñüóöáôçò ÅëëçíéêÞò ìåëÝôçò ðïõ äçìïóéåýôçêå áðü ïìÜäá ãéáôñþí ôïõ «ÁëåîÜíäñá»9 ó÷åôéêÞ ìå ôá åßäç ôùí ÁÅÅ. Áíáöåñüìåíïé óôéò êáô´ ïßêïí åðéóêÝøåéò, ðñáãìáôïðïéÞèçêáí óôï 29.8% ôùí áóèåíþí ìå ÁÅÅ êáé ü÷é áðïêëåéóôéêÜ óôïõò âáñéÜ áíÜðçñïõò. Áõôü åðáëçèåýåôáé Üëëùóôå áðü ôï Üèñïéóìá ôùí ðïóïóôþí ôùí çìßðëçêôùí êáé êáôáêåêëéìÝíùí áóèåíþí ðïõ Þôáí óõíïëéêÜ 18,3%. Ïé åðéóêÝøåéò, åêôüò ôùí éáôñéêþí ðñÜîåùí ðïõ áöïñïýí áõôÞ ôçí ïìÜäá ôùí áóèåíþí (üðùò áëëáãÞ êáèåôÞñùí ïõñïäü÷ïõ êýóôåùò, ðåñéðïßçóç êáôáêëßóåùí, åíõäÜôùóç ê.ëð.), ðñáãìáôïðïéÞèçêáí Ý÷ïíôáò ôïí óêïðü ôçò áíôéìåôþðéóçò ïîÝùí êáôáóôÜóåùí, ôçò øõ÷éêÞò õðïóôÞñéîçò óôïõò êáôáèëéðôéêïýò áóèåíåßò, ôçò åíèÜññõíóçò ãéá ðñïëçðôéêü Ýëåã÷ï ôùí óõããåíþí ê.ëð. Èá ðñÝðåé åðßóçò íá äéåõêñéíéóèåß üôé óôï 16,9% ôùí 134

Ó. ÁñãõñéÜäïõ êáé óõí.

áíáðÞñùí äåí ðñáãìáôïðïéÞèçêáí åðéóêÝøåéò äéüôé áíÞêáí óå ðåñéöåñåéáêÜ éáôñåßá êáé ôç öñïíôßäá ôïõò åß÷å áíáëÜâåé ï áãñïôéêüò ãéáôñüò. Óôéò åðéóêÝøåéò áõôÝò ðáñáôçñÞèçêå ìéá áíáëïãßá, óôç ó÷Ýóç ëåéôïõñãéêÞ éêáíüôçôá êáé ðïéüôçôá æùÞò, ç ïðïßá Þôáí áíôéóôñüöùò áíÜëïãç ìå ôçí êáôÜèëéøç êáôÜ ôï ðñþôï åîÜìçíï. Êáôüðéí, ç ó÷Ýóç áöïñïýóå ìüíï ôçí ðïéüôçôá æùÞò êáé ôçí êáôÜèëéøç. Ï óõó÷åôéóìüò ôçò ëåéôïõñãéêüôçôáò ôùí áíèñþðùí ìå ôçí ðïéüôçôá æùÞò êáé ôçí êáôÜèëéøç10 åßíáé ôåêìçñéùìÝíïò, êáèþò åðßóçò êáé ôçò óõíýðáñîçò ôçò êáôÜèëéøçò óôïõò áíèñþðïõò ìå ÁÅÅ êáé õðÜñ÷ïõí Üöèïíåò âéâëéïãñáöéêÝò áíáöïñÝò11-14. Óå ðïëëÝò áðü áõôÝò ìÜëéóôá ôï ADL èåùñåßôáé Ýíá Üñéóôï åñãáëåßï ãéá ôçí ðáñáêïëïýèçóç áõôþí ôùí áóèåíþí êáé ïé åñåõíçôÝò õðïóôçñßæïõí ôçí åöáñìïãÞ ôïõ óôç ìåôáíïóïêïìåéáêÞ ðåñßïäï, êáèþò êáé ôçí ðåñßïäï ôçò áðïêáôÜóôáóçò15-17. Óôç ìåëÝôç áõôÞ ãßíåôáé ç ðåñéãñáöÞ åíüò óõóôÞìáôïò áíôéìåôþðéóçò ôùí ÁÅÅ, ìå ôéò üðïéåò äõóêïëßåò ôïõ, óôï ðåñéâÜëëïí ôçò ÐÖÕ, ôï ïðïßï óßãïõñá åðéäÝ÷åôáé âåëôéþóåéò, Ý÷åé üìùò ôá ÷áñáêôçñéóôéêÜ ëåéôïõñãßáò ôïõ óõóôÞìáôïò ôçò éáôñéêÞò óôçí êïéíüôçôá. Ï Ã/Ï ãéáôñüò ìå ôç íïóçëåýôñéá åêôüò áðü ôçí áñ÷éêÞ áíôéìåôþðéóç – ðñïíïóïêïìåéáêÞ öñïíôßäá ìå ôç óõ÷íÞ åðáöÞ, ôéò åðéóêÝøåéò óôï óðßôé, ôçí ðñïëçðôéêÞ åîÝôáóç ôùí ìåëþí ôçò ïéêïãÝíåéáò, ôçí êáôáãñáöÞ êáé áíÜëõóç ðáñáãüíôùí êéíäýíïõ, áíáëáìâÜíåé êáé ôç ìåôáíïóïêïìåéáêÞ öñïíôßäá. Åßíáé, ëïéðüí, ôï ìïíôÝëï ôçò ïëéóôéêÞò éáôñéêÞò, ðïõ ðáñÜ ôçí ðñüïäï ôçò ôå÷íïëïãßáò áíèßóôáôáé óôï ÷ñüíï. Âéâëéïãñáößá: 1. Heart and Stroke Facts. 1994 Statistical Supplement. Dallas, Tex: American Heart Association; 1993. 2. Áñ÷åßá ÅÓÕÅ ãéá ôá Ýôç 1979-1993. 3. K. Holmen, K. Ericsson, L. Anderson, B. Winbland. ADL capacity and loneliness among elderly persons with cognitive impairment. Scand. J. Prim. Health Care 1993, 11:56-60. 4. L.T. Abadal, T. Puig, I. Balaguer Vintro. Incidence, mortality and risk factors for stroke in the Manresa Study: 28 years of follow-up. Rev.

Ôüìïò 13, Ôåý÷ïò 3, 2001

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Esp. Cardiol. 2000, 53:15-20. 5. T. Moulin, L. Tatu, F. Vuillier, E. Berger, D. Chavot, L. Rumbach. Role of a stroke data bank in evaluating cerebral infarction subtypes patterns end outcome of 1,776 consecutive patients from Besancon stroke registry. Cerebrovasc. Dis. 2000, 10:261-71. 6. R.L. Sacco, P.A. Wolf, P.B. Gorelick. Risk factors and their management for stroke prevention: outlook for 1999 and beyond. Neurology 1999, 53:S15-24. 7. J. Moncayo, G. Devuyst, G. Van Melle, J. Bogousslavsky. Coexisting causes of ischemic stroke. Arch. Neurol. 2000, 57:1139-44. 8. Á. Ôõñïëüãïò, Ð. Äïõëãåñßäçò, ×. Êåöáëßäïõ, Ä. Óõìåùíßäçò: “ÖõóéêÞ åîÝëéîç ôùí èáíÜôùí áðü Éó÷áéìéêÞ êáñäéïðÜèåéá êáé ÁããåéáêÜ åãêåöáëéêÜ óôç 14åôßá 1979-92.” ÅëëçíéêÞ ÉáôñéêÞ 165, 1995. 9. K.N. Vemos, C.E. Takis, K. Georgilis, N.A. Zakopoulos, J.P. Lekakis, C.M. Papamichael, et al. The Athens stroke registry: results of a five– year hospital–based study. Cerebrovasc. Dis. 2000, 10:133-41 10. G. Robinson-Smith, M.V. Johnson, J. Allen. Self-

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care self-efficacy, quality of life, and depression after stroke. Arch. Phys. Med. Rehabil. 2000, 81:460-64 C. Lionis and S. Argyriadou. Working for the elderly and disabled people within the General Practice in Greece. Abstract in the proceedings of the European General Practice Workshop, Malta, 3-6 October 1996, presentation 6. S. Éliffe, S. See Tai, A. Haines, A. Boorof, E. Goldenberg, et al. Assessment of elderly people in general practice. Depression, functional ability and contact with services. British J. of General Practice, September 1993, 371-73. É. ÐáñÜó÷ïò: ç êáôÜèëéøç óôçí Ôñßôç çëéêßá. DepRelief on Lundberk Hellas ed. 1996. J.A. Secrest, S.P. Thomaw. Continuity and discontinuity: the quality of life following stroke. Rehabil. Nurs. 1999, 24:240:46. M.S. Clark, D.S. Smith. Changes in family functioning for stroke rehabilitation patiens and their families. Int. J. Res. 1999, 22:171-79. F.J. Carod–Artal. Measurment of the quality of life in sroke survivors. Rev. Neurol. 1999, 29:447-56.

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Áãáðçôïß óõíÜäåëöïé, Óôï âáèìü ðïõ êÜðïéïé áðü åóÜò Ý÷ïõí áëëÜîåé äéåõèýíóåéò äéáìïíÞò Þ åñãáóßáò, ôçëÝöùíá êáé e-mail, ðáñáêáëïýìå íá åðéêïéíùíåßôå ìå ôá ãñáöåßá ôçò ÅËÅÃÅÉÁ êáé íá äçëþíåôå ôá êáéíïýñéá óáò óôïé÷åßá, Ýôóé þóôå íá åßíáé óùóôÜ åíçìåñùìÝíï ôï áñ÷åßï ìåëþí ôçò åôáéñåßáò ìáò êáé íá ãßíïíôáé óùóôÜ ïé áðïóôïëÝò ôùí åíôýðùí. Ðáñáêáëïýìå áõôü íá éó÷ýåé äéá÷ñïíéêÜ ãéá ïðïéáäÞðïôå áëëáãÞ. Ìðïñåßôå íá åðéêïéíùíåßôå óôá ôçëÝöùíá ôçò åôáéñåßáò: (0310) 55 00 48 êáé (0310) 53 99 95 (Êá ÌÞíïõ Áèáíáóßá). Ãéá ôï Ä.Ó. Ï Áíôéðñüåäñïò Á´ ÌùñáÀôçò Êùíóôáíôßíïò

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ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ã. ÌáíôæïõñÜíçò êáé óõí.

ÂÑÁÂÅÕÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ AWARDED FREESTANDING PAPER Primary Heatlh Care, Volume 13, Number 3, 136-139, 2001 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 13, Ôåý÷ïò 3, 136-139, 2001

ÅíçìÝñùóç êáé ðñüëçøç ôïõ íïóçëåõôéêïý - ðáñáúáôñéêïý ðñïóùðéêïý ãéá ôá ëïéìþäç íïóÞìáôá óôïí åñãáóéáêü ÷þñï Ã. ÌáíôæïõñÜíçò1, Ð. Êïóêåñßäïõ1, ×. Öëïýäá1, Ì. Ìáñáãêüò2

Ðåñßëçøç Óêïðüò: Ç áîéïëüãçóç ôçò óõìðåñéöïñÜò, ôùí ãíþóåùí, êáé ôçò åíçìÝñùóçò ôïõ íïóçëåõôéêïý-ðáñáúáôñéêïý ðñïóùðéêïý óå èÝìáôá ðïõ áöïñïýí á) óôçí áíïóïëïãéêÞ ôïõò êáôÜóôáóç, â) óôïõò ôñüðïõò ìåôÜäïóçò êáé ìÝôñá ðñïöýëáîçò áðü ëïéìþäç íïóÞìáôá óôï ÷þñï ôïõ íïóïêïìåßïõ. Õëéêü-ìÝèïäïò: Óõììåôåß÷áí 194 åñãáæüìåíïé óå äýï íïóïêïìåßá ôçò ðñùôåýïõóáò êáé Ýíá ðåñéöåñåéáêü ðáíåðéóôçìéáêü íïóïêïìåßï. Áðü áõôïýò 26 Þôáí Üíôñåò êáé 168 ãõíáßêåò, çëéêßáò áðü 20 Ýùò 56 åôþí, ìå ìÝóç ÷ñïíéêÞ äéÜñêåéá åñãáóßáò 6,1±4,5 Ýôç. ÁðïôåëÝóìáôá: Ðïóïóôü 10,8%-22,1% áðü ôïõò åñùôçèÝíôåò äåí ãíþñéæå áí åß÷å íïóÞóåé áðü çðáôßôéäá Á, çðáôßôéäá C, áíåìïâëïãéÜ, éëáñÜ, ðáñùôßôéäá Þ êïêêýôç. 38,1% äåí åß÷å åìâïëéáóèåß Þ äåí ãíþñéæå åÜí åß÷å áíôéóþìáôá Ýíáíôé ôïõ éïý ôçò çðáôßôéäáò Â, åíþ ôï áíôßóôïé÷ï ðïóïóôü ãéá ôïí ôÝôáíï Þôáí 56,1%. Ìüíï ôï 54,6% ÷ñçóéìïðïéåß ðÜíôá ãÜíôéá óôéò åðåìâáôéêÝò ðñÜîåéò, åíþ äåí ÷ñçóéìïðïéïýíôáé ãõáëéÜ óôçí áíôéìåôþðéóç ðïëõôñáõìáôßá. 27,8% ôùí åñãáæïìÝíùí äåí åß÷å åëåã÷èåß ìå öõìáôéíïáíôßäñáóç Mantoux. Ôï 49,5% ôùí åñùôçèÝíôùí äåí åß÷å åëåã÷èåß ãéá AIDS. Ôï 47,9% áíÝöåñå ôñýðçìá áðü âåëüíá, êáèåôÞñá Þ Üëëï áé÷ìçñü áíôéêåßìåíï ðïõ åß÷å ÷ñçóéìïðïéçèåß óå áóèåíÞ êáé ôï 60,3% åß÷å Ýñèåé óå åðáöÞ ìå ìïëõóìÝíá õãñÜ áóèåíïýò. Ôï 43,8% äåí ðñïÝâç óå êáìéÜ åíÝñãåéá ìåôÜ ôï ôñýðçìá Þ ôçí åðáöÞ ìå ìïëõóìÝíá õãñÜ áóèåíïýò. Ôï 58,2% äåí åß÷å åíçìåñùèåß ãéá ôïõò ðéèáíïýò ôñüðïõò ìåôÜäïóçò ëïéìùäþí íïóçìÜôùí óôï ÷þñï ôçò åñãáóßáò. ÓõìðåñÜóìáôá: Áðü ôá áíùôÝñù êáèßóôáôáé åìöáíÞò ç áíÜãêç ãéá 1) Ýëåã÷ï áíïóßáò êáé äéåíÝñãåéá ôùí áðáñáßôçôùí åìâïëéáóìþí 2) êáôÜñôéóç áîéüðéóôïõ áôïìéêïý éóôïñéêïý óå êÜèå åñãáæüìåíï íïóçëåõôéêïý éäñýìáôïò 3) âáóéêü êáé ôïõëÜ÷éóôïí åôÞóéï åðáíÝëåã÷ï ìå öõìáôéíïáíôßäñáóç Mantoux ôùí PPD (-) åñãáæüìåíùí 4) óõíå÷Þ åêðáßäåõóç ôïõ õãåéïíïìéêïý ðñïóùðéêïý ó÷åôéêÜ ìå ôïõò ôñüðïõò ìåôÜäïóçò êáé ðñüëçøç áðü ëïéìþäç íïóÞìáôá 5) ýðáñîç ðñùôïêüëëïõ ãéá ôçí áíôéìåôþðéóç ðåñéóôáôéêþí åðáããåëìáôéêÞò Ýêèåóçò óå ëïéìþäåéò ðáñÜãïíôåò.

Åéäéêåõüìåíïé Ãåíéêïß Éáôñïß, 2ÅðéìåëçôÞò Á´ ÐáèïëïãéêÞò ÊëéíéêÞò, 1Ðåñéöåñåéáêü Ðáíåðéóôçìéáêü Ãåíéêü Íïóïêïìåßï Ðáôñþí, 2ÈñéÜóéï Ãåíéêü Íïóïêïìåßï

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ÅéóáãùãÞ Ïé åñãáæüìåíïé óôï ÷þñï ôçò õãåßáò (éáôñïß, íïóçëåõôÝò, ðáñáúáôñéêü êáé âïçèçôéêü ðñïóùðéêü) äéáôñÝ÷ïõí êßíäõíï íïóÞóåùò áðü ëïéìþäç íïóÞìáôá åßôå óôï ÷þñï åñãáóßáò åßôå óôçí êïéíüôçôá. ÅÜí íïóÞóïõí ìðïñåß íá èÝóïõí óå êßíäõíï Ýêèåóçò ôïõò áóèåíåßò, Üëëïõò åñãáæüìåíïõò Þ ìÝëç ôïõ ïéêïãåíåéáêïý ôïõò ðåñéâÜëëïíôïò. Åñãáæüìåíïé åðßóçò ðïõ Ý÷ïõí óõ÷íÞ êáé ðáñáôåôáìÝíç Üìåóç åðáöÞ ìå áóèåíåßò Ý÷ïõí ìåãáëýôåñï êßíäõíï Ýêèåóçò óå ëïéìþäåéò ðáñÜãïíôåò1-4. Óôï ÷þñï åñãáóßáò, ï óõ÷íüôåñïò ôñüðïò Ýêèåóçò óå ëïéìþäåéò ðáñÜãïíôåò åßíáé, åßôå ç êáôÜ ëÜèïò åðáöÞ (contact) ìå ìïëõóìÝíá õãñÜ áóèåíþí ìå ôï äÝñìá Þ ôïõò âëåííïãüíïõò åßôå ìå ëýóç ôçò óõíÝ÷åéáò ôïõ äÝñìáôïò ìåôÜ áðü ôñýðçìá ìå áé÷ìçñü áíôéêåßìåíï ôï ïðïßï åß÷å ÷ñçóéìïðïéçèåß óå áóèåíåßò (Ýêèåóç óôïí éü ôçò çðáËÝîåéò êëåéäéÜ: ëïéìþäç íïóÞìáôá, ðñüëçøç, åñãáóéáêüò ÷þñïò ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò Åëåýèåñç Áíáêïßíùóç óôï 13ï ÐáíåëëÞíéïõ ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (Ñüäïò, 8-22 Áðñéëßïõ 2001) êáé âñáâåýèçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò Áëëçëïãñáößáò: Ã. ÌáíôæïõñÜíçò, Áêñùôçñßïõ 9, 26334 ÐÜôñá, Ôçë.: (0610) 321-611

Ôüìïò 13, Ôåý÷ïò 3, 2001

Ã. ÌáíôæïõñÜíçò êáé óõí.

Education regarding infection risks and preventive measures of Health Care Workers in the workplace G. Mantzouranis, P. Koskeridou, C. Flouda, M. Marangos Summary Objective: To assess the behavior and knowledge of Health Care Workers (HCWs) regarding 1) their immune status and 2) the ways of transmission and preventive measures against infectious diseases in the hospital. Materials and Methods: 194 HCWs (from two hospitals in the capital and one peripheral University Hospital) participated in the study. 26 were men and 168 were women. The age range was 20-56 years and the mean duration of their occupation 6.1±4.5 years. Results: 10.8%-22.1% of the HCWs were not aware of past medical history of hepatitis A, hepatitis C, varicella, measles, mumps and pertussis. 38.1% and 56.1% of the HCWs had not been immunized or didn't know their serology status for hepatitis B and tetanus, respectively. Just 54.6% of HCWs use gloves during operative procedures while protective eyeglasses are not utilized during the management of trauma patients. 27.8% of HCWs did not receive a Mantoux tuberculin skin test. 49.5% had not been tested for HIV. 47.9% reported percutaneous exposure to blood by needle stick or other previously used sharp object and 60.3% experienced contact with potentially infectious patient body fluids. 43.8% did not take any action after such a hazardous exposure. 58.2% was not informed regarding the possible ways of transmission of infectious diseases in the workplace. Conclusions: The above results outline the necessity for 1) testing of the immunity status and performing the necessary immunizations, 2) maintaining health records on all HCWs, 3) baseline and ,at least, annual retesting of PPDnegative HCWs, 4) continuous education of the HCWs regarding the ways of transmission and prevention of infectious diseases and 5) guidelines for management of occupational exposure to infectious agents. Key words: Infectious diseases, prevention, health care workers

ôßôéäáò Â, çðáôßôéäáò C, HIV ê.ëð.) 5-6. ¢ëëïò ôñüðïò åßíáé ç áåñïãåíÞò ìåôÜäïóç (airborne) üðùò óõìâáßíåé ìå ôï ìõêïâáêôçñßäéï ôçò öõìáôéþóåùò êáé ôçí áíåìïâëïãéÜ7. Óôá ðëáßóéá áõôÞò ôçò ìåëÝôçò, ðñïóðáèÞóáìå íá áîéïëïãÞóïõìå ôçí åíçìÝñùóç, ôç óõìðåñéöïñÜ êáé ôç ãíþóç ôïõ íïóçëåõôéêïý êáé ðáñáúáôñéêïý ðñïóùðéêïý óå ü,ôé áöïñÜ óôïõò ôñüðïõò ìåôÜäïóçò êáé ôá ìÝôñá ðñïöýëáîçò áðü ôá ëïéìþäç íïóÞìáôá óôïõò ÷þñïõò åñãáóßáò. ÐñïóðáèÞóáìå åðßóçò íá êáôáäåßîïõìå ôçí áíáãêáéüôçôá ýðáñîçò ðñùôïêüëëïõ ãéá ôçí áíôéìåôþðéóç ôùí ðåñéóôáôéêþí åðáããåëìáôéêÞò Ýêèåóçò óå ëïéìþäåéò ðáñÜãïíôåò êáèþò êáé ôç óçìáóßá ãéá óõíå÷Þ åêðáßäåõóç ôïõ õãåéïíïìéêïý ðñïóùðéêïý ó÷åôéêÜ ìå ôïõò ôñüðïõò ìåôÜäïóçò êáé ðñüëçøçò ôùí ëïéìùäþí íïóçìÜôùí.

Ðëçèõóìüò ìåëÝôçò êáé ÌÝèïäïò Óôçí ðáñïýóá åñãáóßá óõììåôåß÷áí 194 åñãáæüìåíïé (íïóçëåõôÝò êáé ðáñáúáôñéêü ðñïóù-

ðéêü) ïé ïðïßïé åñãÜæïíôáé óå äõï íïóïêïìåßá ôçò ðñùôåýïõóáò êáé Ýíá ðåñéöåñåéáêü ðáíåðéóôçìéáêü íïóïêïìåßï. Ãéá ôç óõëëïãÞ ôùí äåäïìÝíùí ôçò åñãáóßáò ïé åñãáæüìåíïé óõìðëÞñùóáí áíþíõìï åñùôçìáôïëüãéï. Ç äïìÞ ôïõ åñùôçìáôïëüãéïõ äéáìïñöþèçêå Ýôóé þóôå íá ðåñéëáìâÜíåé åñùôÞóåéò ðïõ áöïñïýóáí óôá óôïé÷åßá ôùí åñãáæüìåíùí, óôï éáôñéêü éóôïñéêü, óôïõò åìâïëéáóìïýò áõôþí, êáèþò êáé óôç óõìðåñéöïñÜ êáé óôÜóç ôïõò, ôéò ãíþóåéò êáé ôçí åíçìÝñùóÞ ôïõò ùò ðñïò ôïõò ôñüðïõò ìåôÜäïóçò, ôá ìÝôñá ðñïöýëáîçò êáé ðñüëçøçò áðü ôá ëïéìþäç íïóÞìáôá óôïí åñãáóéáêü ôïõò ÷þñï.

ÁðïôåëÝóìáôá

Óôá ðëáßóéá áõôÞò ôçò åñãáóßáò êáé ìå âÜóç ôá óôïé÷åßá ðïõ ðñïÞëèáí áðü ôçí åðåîåñãáóßá ôïõ åñùôçìáôïëüãéïõ ðïõ óõìðëçñþèçêå, ðñïêýðôåé üôé óõììåôåß÷áí óå áõôÞ 194 åñãáæüìåíïé, áðü ôïõò ïðïßïõò 135 (70%) íïóçëåõôÝò åíþ 54 (30%) áíÞêáí óôï ðáñáúáôñéêü ðñïóùðéêü. Áðü áõôïýò 26 (13%) Þôáí Üíäñåò êáé 168 (87%) ãõíáßêåò, çëéêßáò áðü 20 Ýùò 56 åôþí, ìå ìÝóç ÷ñïíéêÞ äéÜñêåéá åñãáóßáò 6.1±4.5 Ýôç. ÐåíÞíôá åííÝá (30%) åî áõôþí åñãÜæïíôáé óå ðáèïëïãéêÝò êëéíéêÝò, 64 (34%) óå ÷åéñïõñãéêÝò êëéíéêÝò, 24 (12%) óå åîùôåñéêÜ éáôñåßá, 31 (16%) óôá åñãáóôÞñéá êáé 16(8%) åñãÜæïíôáé óå Üëëåò õðçñåóßåò ôïõ íïóïêïìåßïõ (Ó÷Þìá 1). Áðü ôï éáôñéêü éóôïñéêü ôùí åñãáæüìåíùí ðñéí ôçí Ýíáñîç ôçò åñãáóßáò âëÝðïõìå üôé Ýíá ðïóïóôü 11%-22% äåí ãíþñéæå åÜí åß÷å íïóÞóåé áðü ôá ëïéìþäç íïóÞìáôá ðïõ áíáãñÜöïíôáé óôïí ðßíáêá 1. Ôï ßäéï ðáñáôçñïýìå êáé óôï éáôñéêü éóôïñéêü ìåôÜ ôçí Ýíáñîç ôçò åñãáóßáò (Ðßíáêáò 2). Ôï óõ÷íüôåñï ëïéìþäåò íüóçìá ìåôÜ ôçí Ýíáñîç ôçò åñãáóßáò áðü áõôÜ ðïõ áíáöÝñïíôáé óôïí ðßíáêá 2 åßíáé ç áíåìåõëïãéÜ ìå ðïóïóôü 4,64%. Åßêïóé ðÝíôå Üôïìá (38,14%) äåí åß÷áí åìâïëéáóèåß Þ äåí ãíþñéæáí åÜí åß÷áí áíôéóþìáôá Ýíáíôé ôïõ éïý ôçò çðáôßôéäáò Â. Ïé áíôßóôïé÷ïé áñéèìïß ãéá ôïí ôÝôáíï Þôáí 63 (56,1%), ôçí 137

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ã. ÌáíôæïõñÜíçò êáé óõí. Ðßíáêáò 3. Åìâïëéáóìüò ôïõ õãåéïíïìéêïý ðñïóùðéêïý ðñï ôçò Ýíáñîçò ôçò åñãáóßáò

Ó÷Þìá 1. ÊáôáíïìÞ åñãáæïìÝíùí óôï ÷þñï åñãáóßáò. Ðßíáêáò 1. Éáôñéêü éóôïñéêü ðñï ôçò Ýíáñîçò ôçò åñãáóßáò Íüóïò Öõìáôßùóç Çðáôßôéäá Á Çðáôßôéäá Â Çðáôßôéäá C ÁíåìåõëïãéÜ Êïêêýôçò ÉëáñÜ Ðáñùôßôéäá

¸÷ïõí íïóÞóåé

Äåí Ý÷ïõí íïóÞóåé

Äå ãíùñßæïõí

3 3 3 1 89 53 113 55

164 169 166 128 68 98 49 100

27 22 25 25 35 43 32 39

Ðßíáêáò 2. Éáôñéêü éóôïñéêü ìåôÜ ôçò Ýíáñîç ôçò åñãáóßáò Íüóïò Öõìáôßùóç Çðáôßôéäá Á Çðáôßôéäá Â Çðáôßôéäá C ÁíåìåõëïãéÜ Êïêêýôçò ÉëáñÜ Ðáñùôßôéäá

¸÷ïõí íïóÞóåé 2 1 3 1 9 2 4 3

Äåí Ý÷ïõí íïóÞóåé

Äå ãíùñßæïõí

165 168 164 165 164 170 169 168

27 25 27 28 21 22 21 23

åñõèñÜ 74 (68,5%), ôç öõìáôßùóç 73 (64,94%), ôç äéöèåñßôéäá 83 (64,94%). Äå ãíþñéæáí åÜí Ý÷ïõí åìâïëéáóèåß ìå ôï ôñéðëü åìâüëéï MMR 84 (73,19%) (Ðßíáêáò 3). ÌåôÜ ôçí ðñüóëçøç áðü ôï íïóïêïìåßï åìâïëéÜóèçêáí Ýíáíôé ôçò çðáôßôéäáò Â 62 áðü ôïõò 120 ðïõ åß÷áí óõíïëéêÜ åìâïëéáóèåß, Ýíáíôé ôïõ ôåôÜíïõ ïé 12 áðü ôïõò 65, ãéá åñõèñÜ ïé 2 138

Íüóïò

Íáé

¼÷é

Äå ãíùñßæïõí

Çðáôßôéäá Â ÔÝôáíïò ÅñõèñÜ Öõìáôßùóç Äéöèåñßôéäá Ðïëéïìõåëßôéäá MMR

120 65 61 68 68 75 52

49 46 59 53 43 35 56

25 63 74 73 83 84 86

áðü ôïõò 61, ãéá öõìáôßùóç ïé 3 áðü ôïõò 68, åíþ ãéá äéöèåñßôéäá 1 áðü 68 (Ó÷Þìá 2). Áðü ôïõò 194 åñãáæüìåíïõò, ïé 140 (72%) åß÷áí åëåã÷èåß ìå öõìáôéíï-áíôßäñáóç Mantoux. ¼ðùò öáßíåôáé êáé óôï ó÷Þìá 3, 119 åñãáæüìåíïé (67%) äåí ãíþñéæå åÜí ðñéí áðü ôïí ôåëåõôáßï Ýëåã÷ï åß÷å èåôéêÞ öõìáôéíïáíôßäñáóç Mantoux, åíþ 21 (28%) åß÷áí áñíçôéêÞ êáé 13 (5%) åß÷áí èåôéêÞ. Ðáñáôçñïýìå åðßóçò üôé 99 (51%) ôùí åñãáæüìåíùí Ý÷åé åëåã÷èåß ãéá AIDS. Áîéïóçìåßùôï åßíáé üôé 103 (53%) áíÝöåñáí üôé èá ôïõò ðñïâëçìÜôéæå ç óõììåôï÷Þ ôïõò óå íïóçëåßá áóèåíþí ðïõ Ý÷ïõí ðñïóâëçèåß áðü ôïí HIV. ¼ðùò öáßíåôáé êáé áðü ôï ó÷Þìá IV, áðü ôïõò åñùôçèÝíôåò óõììåôåß÷áí óå íïóçëåßá áóèåíþí ðïõ Ýðáó÷áí áðü çðáôßôéäá Â 136 (42%), áðü öõìáôßùóç 112 (34%) êáé áðü AIDS 79 (24%). Åêáôüí äåêáåðôÜ Üôïìá (60,3%) áðü ôï íïóçëåõôéêü êáé ðáñáúáôñéêü ðñïóùðéêü ôùí

Ó÷Þìá 2. Åìâïëéáóìüò åñãáæïìÝíùí ìåôÜ áðü ôçí ðñüóëçøÞ ôïõò.

Ôüìïò 13, Ôåý÷ïò 3, 2001

Ã. ÌáíôæïõñÜíçò êáé óõí.

ÓõìðåñÜóìáôá

Ó÷Þìá 3. Öõìáôéíïáíôßäñáóç Mantoux, èåôéêÞ Þ áñíçôéêÞ ðñéí áðü ôïí ôåëåõôáßï Ýëåã÷ï.

112

ÖÕÌÁÔÉÙÓÇ

HIV ÁÓÈÅÍÅÉÓ

136

ÇÐÁÔÉÔÉÄÁ

100

120

140

160

Ó÷Þìá 4. Óõììåôï÷Þ åñãáæïìÝíùí óå íïóçëåßá áóèåíþí ìå çðáôßôéäá Â, öõìáôßùóç êáé HIV ëïßìùîç.

íïóïêïìåßùí ðïõ åñùôÞèçêáí, åß÷áí Ýñèåé óå åðáöÞ ìå ìïëõóìÝíá õãñÜ áóèåíþí êáèþò åðßóçò êáé 93 (48%) ôùí åñùôçèÝíôùí áíÜöåñáí ôñýðçìá áðü âåëüíá, êáèåôÞñá Þ Üëëï áé÷ìçñü áíôéêåßìåíï ðïõ åß÷å ÷ñçóéìïðïéçèåß óå Üññùóôï. Áðü áõôïýò 85 (44%) äåí ðñïÝâç óå êáìéÜ åíÝñãåéá ìåôÜ ôï ôñýðçìá Þ ôçí åðáöÞ ìå ìïëõóìÝíá õãñÜ áóèåíïýò, åíþ ïé 47 (24,2%) Ýêáíáí åîÝôáóç áßìáôïò ôïõ áóèåíïýò êáé ìüíï 5 Üôïìá (2,6%) åîåôÜóèçêáí ïñïëïãéêÜ. Óå 6 (31,57%) ÷ïñçãÞèçêå áíïóïóöáéñßíç åíþ 6 (31,57%) åìâïëéÜóèçêáí. ÅâäïìÞíôá åðôÜ åñãáæüìåíïé (40%) áíáöÝñïõí üôé äå ãíþñéæáí ôçí õðçñåóßá ðïõ Ýðñåðå íá áðåõèõíèïýí ìåôÜ áðü Ýíá áíÜëïãï óõìâÜí. Ìüíï 106 (54,6%) ÷ñçóéìïðïéïýí ðÜíôá ãÜíôéá óôéò åðåìâáôéêÝò ðñÜîåéò, 72 (39,69%) óõíÞèùò êáé 11 (5,67%) óðÜíéá, åíþ äå ÷ñçóéìïðïéïýíôáé åéäéêÜ ðñïóôáôåõôéêÜ ãõáëéÜ êáôÜ ôçí áíôéìåôþðéóç ðïëõôñáõìáôßá. Ãéá ôïõò ðéèáíïýò ôñüðïõò ìåôÜäïóçò ôùí ëïéìùäþí íïóçìÜôùí óôï ÷þñï ôçò åñãáóßáò äåí åß÷áí åíçìåñùèåß 113 (58,2%) ôùí åñãáæüìåíùí.

Óå Ýíá ðñüãñáììá õãåßáò åßíáé áðáñáßôçôç áöåíüò ç ðñïóôáóßá ôùí áóèåíþí áðü ìåôáäïôéêÜ íïóÞìáôá ôïõ õãåéïíïìéêïý ðñïóùðéêïý áöåôÝñïõ äå ôùí åñãáæïìÝíùí áðü íïóÞìáôá ðïõ ìðïñïýí íá ìåôáäïèïýí áðü ôïõò áóèåíåßò. Áðü ôçí áíÜëõóç ôùí áíùôÝñù áðïôåëåóìÜôùí êáèßóôáôáé åìöáíÞò ç áíÜãêç ãéá 1. êáôÜñôéóç áîéüðéóôïõ áôïìéêïý éóôïñéêïý óå êÜèå åñãáæüìåíï íïóçëåõôéêïý éäñýìáôïò, 2. Ýëåã÷ï áíoóßáò êáé äéåíÝñãåéá ôùí áðáñáßôçôùí åìâïëéáóìþí, 3. âáóéêü êáé ôïõëÜ÷éóôïí åôÞóéï åðáíÝëåã÷ï ìå öõìáôéíïáíôßäñáóç Mantoux óå Üôïìá ìå áñíçôéêÞ PPD, 4. óõíå÷Þ åêðáßäåõóç ôïõ õãåéïíïìéêïý ðñïóùðéêïý ó÷åôéêÜ ìå ôïõò ôñüðïõò ìåôÜäïóçò êáé ðñüëçøçò áðü ôá ëïéìþäç íïóÞìáôá, 5. ýðáñîç ðñùôïêüëëïõ ãéá ôçí áíôéìåôþðéóç ðåñéóôáôéêþí åðáããåëìáôéêÞò Ýêèåóçò óå ëïéìþäåéò ðáñÜãïíôåò, 6. åêôßìçóç ðåñéðôþóåùò ïîåßáò íïóÞóåùò êáé áðïìÜêñõíóç áðü ôçí åñãáóßá áôüìùí ìå ïîÝá ìåôáäïôéêÜ íïóÞìáôá, 7. ýðáñîç ðñïãñÜììáôïò ðáñï÷Þò óõìâïõëåõôéêÞò âïÞèåéáò.

Âéâëéïãñáößá 1. Marian Swinker. Occupational infections in health care workers: Prevention and intervetion. American Family Physician 1998. 2. F. Regis. Occupational safety and health administration. Occupational exposure to bloodborne pathogens-final rule 1991, 56:64004-182 3. K.A. Sepkowitz. Occupationally acquired infections in health care workers. Part 1 Ann. Intern. Med. 1996, 125:826-34. 4. K.A. Sepkowitz. Occupationally acquired infections in health care workers. Part 11 Ann. Intern. Med. 1996, 125:917-28. 5. J.L. Gerberding. Management of occupational exposure to blood-borne viruses. N. Engl. J. Med. 1955, 332:444-51. 6. D.M. Bell. Occupational risk of HIV infection in healthcare workers: an overview. Am. J. Med. 1997, 102(suppl 5B):9-15. 7. K. Bowden, M. Mc Diarmid. Occupationally acquired tuberculosis: what's known. J. Occup. Med. 1994, 36:320-5. 139

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ó. ÁñãõñéÜäïõ êáé óõí.

ÂÑÁÂÅÕÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÍÙÓÇ AWARDED FREESTANDING PAPER Primary Heatlh Care, Volume 13, Number 3, 140-146, 2001 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 13, Ôåý÷ïò 3, 140-146, 2001

ÐáñçãïñçôéêÞ öñïíôßäá êáñêéíïðáèþí: ¸íáò óçìáíôéêüò êáé óõ÷íüò ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Ãéáôñïý Ó. ÁñãõñéÜäïõ, Ì. ÐåñåíôæÞ, Ä. Óááôæüãëïõ, ×. Ìåëéóóïðïýëïõ, Á. Ïñöáíßäçò, ×. ËõãéäÜêçò, Ã. Íáëìðáíôßäçò, Ê. Êùíóôáíôéíßäïõ, ×. ËõãéäÜêç, Â. Ìïó÷ïêÜñöç, É. ÊÜëöá, Ã. Ãåùñãïýóç

Ðåñßëçøç ÅéóáãùãÞ: Ç íåïðëáóßá äéáöüñùí ïñãÜíùí, ðáñÜ ôçí ðñüïäï ôçò éáôñéêÞò ðáñáìÝíåé ó÷åäüí ðÜíôá áíßáôï íüóçìá êáé óôïí åðüìåíï áéþíá áíáìÝíåôáé íá áðïôåëåß ôçí êõñéüôåñç áéôßá èáíÜôïõ. Ç åìðëïêÞ ôçò ðñùôïâÜèìéáò öñïíôßäáò õãåßáò (ÐÖÕ) óôçí ïìÜäá áõôÞ ôùí áóèåíþí åßíáé óçìáíôéêÞ êáé ï ñüëïò ôçò ðáñçãïñçôéêÞò öñïíôßäáò áðïêëåéóôéêÜ äéêüò ôçò. Óêïðüò ôçò åñãáóßáò Þôáí ç êáôáãñáöÞ ôùí áíèñþðùí ìå êáñêßíï ôåëéêïý óôáäßïõ, ç åêôßìçóç ôçò áðïôåëåóìáôéêüôçôáò ôçò èåñáðåßáò ôïõ ðüíïõ ôïõò, ïé ðéèáíÝò äéáôáñá÷Ýò ôçò äéÜèåóçò, êáé ç ìÝôñçóç ôçò óôáäéáêÞò áðþëåéáò ôçò ëåéôïõñãéêüôçôáò ôïõò. ¢íèñùðïé êáé ìåèïäïëïãßá: Áðü ôï 1996 ìÝ÷ñé óÞìåñá êáôáãñÜöçêáí 132 ðåñéðôþóåéò áíèñþðùí ìå êáñêßíï óå ôåëéêü óôÜäéï óôçí ðåñéï÷Þ åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò ×ñõóïýðïëçò (ÊÕ×). Åêôüò ôçò óõãêÝíôñùóçò ôùí äçìïãñáöéêþí ôïõò óôïé÷åßùí (ìå Ýìöáóç óôï åðÜããåëìá êáé ôéò óõíÞèåéåò), ôïõ áôïìéêïý êáé ïéêïãåíåéáêïý ôïõò éóôïñéêïý, óõìðëçñùíüôáí ãéá ôïí Ýëåã÷ï ôïõ ðüíïõ ç êëßìáêá ïðôéêÞò áíáëïãßáò. Ãéá ôçí ðéèáíüôçôá åìöÜíéóçò, óôïõò ßäéïõò êáé óôïõò öñïíôéóôÝò ôïõò äéáôáñá÷þí ôçò äéÜèåóçò, óõìðëçñùíüôáí ç êëßìáêá áõôïáîéïëüãçóçò ôïõ Zung, êáé ãéá ôçí åêôßìçóç ôçò ðñïïäåõôéêÞò áðþëåéáò ôçò êáèçìåñéíÞò ëåéôïõñãéêüôçôáò ç êëßìáêá ADL (Áctivities of Daily Live). ÁðïôåëÝóìáôá: Ôï 42,4% ôùí áóèåíþí êáé ôï 31.6% ôùí öñïíôéóôþí ôïõò ðáñïõóßáóáí óõìðôùìáôïëïãßá äéáôáñá÷þí ôçò äéÜèåóçò. Ïé åðéóêÝøåéò óôï óðßôé ðïõ ðñáãìáôïðïéÞèçêáí ãéá ðáñçãïñçôéêÞ èåñáðåßá áöïñïýóáí óôéò ÷áìçëüôåñåò ïéêïíïìéêÜ ôÜîåéò (78.8%) êáé Þôáí êõñßùò ãéá Ýëåã÷ï ðüíïõ (72.7%), êáèåôçñéáóìü ïõñïäü÷ïõ êýóôåùò (35.6%), åíõäÜôùóç (17.4%) ê.ëð. Áðü ôéò óõ÷íüôåñåò íåïðëáóßåò ìå ôç ãñçãïñüôåñç Ýêðôùóç óôç âáèìïëïãßá ôïõ ADL Þôáí ï êáñêßíïò ôïõ ðíåýìïíá åíþ ìå ôç âñáäýôåñç ï êáñêßíïò ôïõ ðñïóôÜôç. ÓõìðåñÜóìáôá: Ç ðáñçãïñçôéêÞ öñïíôßäá åìðßðôåé óôá êáèÞêïíôá ôïõ ãéáôñïý ôçò ÐÖÕ, ï ïðïßïò ìå Üñôéá ðëçñïöüñçóç ó÷åôéêÜ ìå ôçí áíáêïýöéóç ôïõ ðüíïõ, êáôÜëëçëç óõìðåñéöïñÜ óôïí áóèåíÞ êáé ôï ðåñéâÜëëïí ôïõ, íá âïçèÜ óôçí åðßëõóç ôùí êëéíéêþí, øõ÷éêþí êáé êïéíùíéêþí ðñïâëçìÜôùí ðïõ áíáêýðôïõí.

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ÅéóáãùãÞ Ïé íåïðëáóßåò ôùí äéáöüñùí ïñãÜíùí, ðáñÜ ôçí ðñüïäï ôçò éáôñéêÞò åðéóôÞìçò ðáñáìÝíïõí ó÷åäüí ðÜíôá áíßáôá íïóÞìáôá êáé óôïí åðüìåíï áéþíá áíáìÝíåôáé íá áðïôåëïýí ôçí êõñéüôåñç áéôßá èáíÜôïõ1,2. Ï êáñêéíïðáèÞò áíôáíáêëÜ üëç ôçí øõ÷ïâéïëïãéêÞ ðáèïëïãßá ðïõ ìðïñåß íá âéþóåé ï Üíèñùðïò êáé ìÜëéóôá óå ìéêñü ÷ñïíéêü äéÜóôçìá. ÐáñÜëëçëá –üðùò åßíáé ãíùóôü- óôçí éáôñéêÞ êåñäßæåé Ýäáöïò ç áíôßëçøç üôé ï Üíèñùðïò ðÜó÷åé áðü ôçí “ðñïóùðéêÜ äéêÞ ôïõ áóèÝíåéá” õðü ôçí Ýííïéá üôé áíÜëïãá ìå ôçí ðñïóùðéêüôçôá, ôá âéþìáôá ôïõ êëð ðáñïõóéÜæåé äéáöïñåôéêÞ óõìðåñéöïñÜ áðÝíáíôé óôç íüóï3. Ç åìðëïêÞ ôçò ðñùôïâÜèìéáò öñïíôßäáò õãåßáò (ÐÖÕ) óôçí ïìÜäá áõôÞ ôùí áóèåíþí åßíáé óçìáíôéêÞ ËÝîåéò êëåéäéÜ: ÍåïðëáóìáôéêÝò íüóïé, ðáñçãïñçôéêÞ öñïíôßäá, Ãåíéêüò Éáôñüò ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 13ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (Ñüäïò, 8-22 Áðñéëßïõ 2001) êáé âñáâåýèçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êá ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Ó. ÁñãõñéÜäïõ, ÊÝíôñï Õãåßáò ×ñõóïýðïëçò, ÊáâÜëá, Ôçë.: (05910) 22222

Ó. ÁñãõñéÜäïõ êáé óõí.

Ôüìïò 13, Ôåý÷ïò 3, 2001

÷Þ ìå 22.000 êáôïßêïõò ðåñßðïõ, ðïõ ôïõò ðáñáó÷Ýèçêå ïëïêëçñùìÝíá ôåëéêÞ öñïíôßäá. Ï ìÝóïò üñïò çëéêßáò ôùí áôüìùí áõôþí Þôáí 52 Ýôç (19 Ýôç ï ìéêñüôåñïò êáé 91 ï ìåãáëýôåSummary ñïò). Ôçí åñåõíçôéêÞ ïìÜäá áðïôÝëåIntroduction: Although medicine is making daily progress, organic neoplasia óáí ãéáôñïß Ã/Ï ÉáôñéêÞò, ãéáôñïß remains mostly incurable and according to statistics, it is expected to be the õðï÷ñåùôéêÞò õðçñåóßáò õðáßèñïõ, most common cause of death in the next century. Implication of primary health íïóçëåýôñéåò, öõóéïèåñáðåýôñéá. care (PHC) with those patients is important and comforting care exclusively Óõãêåíôñþèçêáí ôá äçìïãñáöébelongs to her. The aim of this study was to estimate the prevalence of cancer patientsêÜ ôïõò óôïé÷åßá äßíïíôáò Ýìöáóç óôï terminal phase, the effectiveness of pain relief therapy, the possible mood disoråðÜããåëìá, ôéò óõíÞèåéåò, ôï áôïìéêü ders, and the progressive loss of their functionality. êáé ïéêïãåíåéáêü ôïõò éóôïñéêü, ôçí Study population and methods: 132 cases of cancer patients in terminal åììçíáñ÷Þ, ôçí åììçíüðáõóç ê.ëð. phase have been recorded since 1996 in the district area of the Chrisoupolis Óõìðëçñþèçêå åðßóçò ãéá ôïí Health Centre (HCCh). Except for their demographics (emphasis on occupation and habits), their personal and family medical history, the optical analogical Ýëåã÷ï ôïõ ðüíïõ, ç êëßìáêá ïðôéêÞò scale was completed for the control of pain. For the possible appearance of áíáëïãßáò4. Ç ôõðéêÞ êëßìáêá åßíáé mood disorders for either themselves and/or their caregivers, the Zung quesìéá åõèåßá 10 åêáôïóôþí óôçò ïðïßáò tionnaire for self-evaluation was used as well as the ADL (Activities of Daily ôá Üêñá áíáãñÜöïíôáé óôï Ýíá “êáLiving) questionnaire for the possible progressive loss of functional activities. èüëïõ ðüíïò” êáé óôï Üëëï “õðåñâïResults: 42.4% of the cancer patients and 31.6% of their caregivers appeared with symptoms of mood disorders. Home visits were performed for comforting ëéêüò ðüíïò”. Óôçí åñãáóßá ìáò ÷ñçtreatment to the economical low classes (78.8%) and mostly were due to pain óéìïðïéÞèçêå ç ôåëåéïðïéçìÝíç ôïõ relief (72.7%), input of urethral catheter (35.6%), hydration (17.4%) etc. The ìïñöÞ ìå êáíüíá êáé êÝíóïñá. Ðñügreater loss in functional activity (ADL questionnaire) showed that most people êåéôáé ãéá áðëü êáé åý÷ñçóôï åñãáwere suffering from lung cancer and the least, from prostate cancer. ëåßï ìå Üñéóôç åðáíáëçøéìüôçôá. Conclusions: Comforting care for cancer patients is one of the important roles of the general practitioner who has to use his knowledgeable background about Åöáñìïæüôáí óå êÜèå åðáöÞ ìå ôïí pain relief and about conducting the patient and his relatives, in order to help áóèåíÞ, äéáìÝóïõ ôçò ïðïßáò ëáìâÜand solve the clinical, psychological, and social problems that often occur. íïíôáí ðëçñïöïñßåò ó÷åôéêÜ ìå ôçí Key words: Neoplasmatic diseases, Comforting care, General Practitioner ðñïóùðéêÞ áðü ôïí áóèåíÞ áíôßëçøç 1 Chrisoupolis Health Centre, 2Old People's Home ôïõ ðüíïõ, ôçí áíáêïýöéóç ôïõ áð´ áõôüí êáé êáôÜ óõíÝðåéá ðëçñïöïëüãù ôçò ðñïóâáóéìüôçôáò áëëÜ êáé ôçò óõíå÷é- ñßåò ãéá ôçí ðñïóùðéêÞ áíôßëçøç ôçò õãåßáò ôïõ. æüìåíçò öñïíôßäáò ðïõ ìðïñåß íá ðáñÝ÷åé óôá Ôá ïõóéþäç ðëåïíåêôÞìáôá ôçò ïðôéêÞò êëßìáäéÜöïñá óôÜäéá ôçò íüóïõ ãåãïíüò ðïõ êáèéóôÜ êáò óå ó÷Ýóç ìå Üëëåò, åßíáé ç áõîçìÝíç åõáéóèçôï ñüëï ôçò óçìáíôéêü êáé áðïêëåéóôéêÜ äéêü óßá êáé ï áðÝñáíôïò áñéèìüò ôùí óçìåßùí ìåôáîý ôùí Üêñùí ôçò êëßìáêáò. ôçò. Ãéá ôçí ðéèáíüôçôá åìöÜíéóçò, óôïõò ßäéïõò Óêïðüò ôçò åñãáóßáò Þôáí ç êáôáãñáöÞ ôùí óõìðôùìÜôùí ôùí áíèñþðùí ìå êáñêßíï ôåëéêïý êáé óôïõò öñïíôéóôÝò ôïõò äéáôáñá÷þí ôçò äéÜóôáäßïõ, ç åêôßìçóç ôçò áðïôåëåóìáôéêüôçôáò ôçò èåóçò, óõìðëçñùíüôáí ç êëßìáêá áõôïáîéïëüãçèåñáðåßáò ôïõ ðüíïõ ôïõò, ïé ðéèáíÝò äéáôáñá÷Ýò óçò ôïõ Zung, åñùôçìáôïëüãéï ãéá ôçí áõôïåôéò äéÜèåóçò, êáé ç ìÝôñçóç ôçò óôáäéáêÞò áðþ- êôßìçóç ôùí äéáôáñá÷þí ôçò äéÜèåóçò5,6, ãéá ôçí áíß÷íåõóç øõ÷éêþí íïóçìÜôùí, ðïõ üðùò åßíáé ëåéáò ôçò ëåéôïõñãéêüôçôáò ôïõò. ãíùóôü åßíáé óõ÷íüôáôá óôçí óõãêåêñéìÝíç êáôçãïñßá áóèåíþí7. Ç êëßìáêá ÷ñçóéìïðïéåßôáé áðü ôç äåêáåôßá ôïõ ’60 óôçí ÐÖÕ, ãéá ôçí êëéíéêÞ Ðëçèõóìüò ìåëÝôçò êáé ÌÝèïäïò ðáñáêïëïýèçóç êáé áíôéìåôþðéóç áóèåíþí ìå Áðü ôï 1996 ìÝ÷ñé ôï ÄåêÝìâñéï ôïõ 2000 øõ÷éêÝò äéáôáñá÷Ýò. Áðïôåëåßôáé áðü 20 åñùôÞêáôáãñÜöçêáí 132 ðåñéðôþóåéò áíèñþðùí ìå ìáôá ðïõ ìáò åðéôñÝðïõí íá ïñßóïõìå ðïóïôéêÜ êáñêßíï óå ôåëéêü óôÜäéï óôçí ðåñéï÷Þ åõèýíçò ôçí ïíôüôçôá ôçò êáôáèëéðôéêÞò äéáôáñá÷Þò. Ï ôïõ ÊÝíôñïõ Õãåßáò ×ñõóïýðïëçò (ÊÕ×), ðåñéï- õðïëïãéóìüò ôçò ôåëéêÞò âáèìïëïãßáò ãßíåôáé áðü Palliative care for Cancer patients. An important and frequent role of the general practitioner S. Argyriadou1, M. Perentzi1, D. Saatzoglou1, H. Melissopoulou1, A. Orfanidis1, H. Lygidakis1, G. Nalbandidis1, K. Konstantinidou1, H. Lygidaki1, V. Moshokarfi2, P. Kalfa2, G. Georgousi1

141

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

ôï ãéáôñü êáé ôï Üèñïéóìá ìåôáôñÝðåôáé óå äåßêôç SDS (self-rating depression scale) óýìöùíá ìå ôïí áêüëïõèï ôýðï: äåßêôçò SDS= óõíïëéêÞ âáèìïëïãßá 20 åñùôçìÜôùí/ìÝãéóôç âáèìïëïãßá ôçò êëßìáêáò (80 âáèìïß)= × 100. ¸ôóé üôáí ï äåßêôçò SDS åßíáé <50 ï åîåôáæüìåíïò äåí ðáñïõóéÜæåé óôïé÷åßá êáôÜèëéøçò. ¼ôáí ï SDS åßíáé áðü 50-59 óõíåðÜãåôáé ìå åëáöñÜ êáôÜèëéøç, áðü 60-69 õðÜñ÷åé êáôÜèëéøç ìåôñßïõ âáèìïý åíþ ðÜíù áðü 70 äçëþíåé âáñéÜ êáôÜèëéøç. Ç åêôßìçóç ôçò ðñïïäåõôéêÞò áðþëåéáò ôçò êáèçìåñéíÞò ëåéôïõñãéêüôçôáò ãéíüôáí ìå ôçí êëßìáêá ADL (Áctivities of Daily Live)8. Ôï åñùôçìáôïëüãéï ADL ãéá ôçí åêôßìçóç ôçò éêáíüôçôáò åêôÝëåóçò êáèçìåñéíþí ëåéôïõñãéþí ôïõ áóèåíÞ, áðïôåëåß ìßá ãíùóôÞ ðïéïôéêÞ ìÝèïäï óôç Ã/Ï éáôñéêÞ ãéá ôçí óõ÷íÞ ìÝôñçóç ôçò ëåéôïõñãéêÞò êáôÜóôáóçò ðïõ âïçèÜ óôçí êáôÜóôñùóç ó÷åäßïõ áíôéìåôþðéóçò, èåñáðåõôéêþí ÷åéñéóìþí êáé ðñïóÝããéóçò ôùí ìáêñü÷ñïíùí áðáéôÞóåùí öñïíôßäáò ôùí áóèåíþí. Óôç ìåëÝôç ìáò ÷ñçóéìïðïéÞèçêå ãéá ôçí ðïéïôéêÞ áîéïëüãçóç ôçò ðïñåßáò ôïõò, êáé ü÷é óáí ìÝóï ðïóïôéêÞò åêôßìçóçò ôùí áíáãêþí ôïõò. Ôï åñùôçìáôïëüãéï áðïôåëåßôáé áðü 10 åñùôÞóåéò - äåîéüôçôåò, 7 êýñéåò êáé 3 äåõôåñåýïõóåò. Ç áíåîáñôçóßá óå êÜðïéá äåîéüôçôá âáèìïëïãÞèçêå ìå 1, ç áíÜãêç ãéá âïÞèåéá ìå 2 êáé ç áíéêáíüôçôá ìå 3. Âáèìïëïãßá ðÜíù áðü 18 âáèìïýò óçìáßíåé üôé ï åîåôáæüìåíïò äåí Þôáí áíåîÜñôçôïò. Ôá óôïé÷åßá óõãêåíôñþèçêáí äéáìÝóïõ åðéóêÝøåùí ðïõ ðñáãìáôïðïéÞèçêáí óôá óðßôéá ôùí áóèåíþí, ðÜíôá áðü ãéáôñü êáé íïóçëåýôñéá êáé ç óõìðëÞñùóç ôùí åñùôçìáôïëïãßùí ãéíüôáí ìå ðëçñïöïñßåò ðïõ ëáìâÜíïíôáí êáé äéáóôáõñþíïíôáí áðü ôïõò ßäéïõò êáé ôïõò öñïíôéóôÝò ôïõò. Ïé áóèåíåßò ðïõ áðïôÝëåóáí ôï äåßãìá ìáò åß÷áí ôá ðáñáêÜôù ÷áñáêôçñéóôéêÜ: Óõììåôåß÷áí 81 Üíäñåò êáé 52 ãõíáßêåò êáé ôï ìïñöùôéêü ôïõò åðßðåäï Þôáí: 67,4% óôïé÷åéþäïõò åêðáßäåõóçò, ôï 20,7% ìÝóçò, ôï 7,4% áíþôåñçò êáé ôï 2,2% áíþôáôçò.

ÁðïôåëÝóìáôá Ï ÌÏ ôùí åðéóêÝøåùí ðïõ ðñáãìáôïðïéÞèçêáí óôïõò áíèñþðïõò ìå íåïðëáóßåò óå ôåëéêü óôÜäéï óôï ôåëåõôáßï 4ìçíï ôçò æùÞò ôïõò Þôáí 142

Ó. ÁñãõñéÜäïõ êáé óõí.

5,4 ãéá ôïõò Üíäñåò êáé 5,8 ãéá ôéò ãõíáßêåò. Ïé åðéóêÝøåéò óôï óðßôé ðïõ ðñáãìáôïðïéÞèçêáí ãéá ðáñçãïñçôéêÞ èåñáðåßá áöïñïýóáí ôéò ÷áìçëüôåñåò ïéêïíïìéêÜ ôÜîåéò (78,8%). ÁõôÝò áöïñïýóáí êõñßùò ãéá Ýëåã÷ï ðüíïõ (72,7%), êáèåôçñéáóìü ïõñïäü÷ïõ êýóôåùò (35,6%), áíôéìåôþðéóç ïîÝùí êáôáóôÜóåùí 31,2%, åíõäÜôùóç (17,4%) ê.ëð. Ç óõ÷íüôçôá ôùí óõìðôùìÜôùí ôéò ôåëåõôáßåò åâäïìÜäåò öáßíåôáé óôï äéÜãñáììá 1. Ìåôñþíôáò ôçí áðïôåëåóìáôéêüôçôá ôçò ðáõóßðïíçò áãùãÞò ôïõò ìå ôçí êëßìáêá ïðôéêÞò áíáëïãßáò ï ÌÏ ðïõ ðÞñáìå Þôáí 67,9 (S.E. 23,03). Ç áíáëïãßá ôùí áðáíôÞóåùí ôùí áóèåíþí öáßíåôáé óôï äéÜãñáììá 2. Ôï 42,4% áðü ôï óýíïëï ôùí áóèåíþí ðáñïõóßáóáí óõìðôùìáôïëïãßá äéáôáñá÷þí ôçò äéÜèåóçò. Óýìöùíá ìå ôï åñùôçìáôïëüãéï Zung ï äåßêôçò SDS óôï óýíïëï ôùí áíèñþðùí ìå íåïðëáóßá óå ôåëéêü óôÜäéï åìöÜíéóå ôéìÝò áðü 28,75 Ýùò 50,73 (SD 10,85). Óôï äéÜãñáììá 3 öáßíïíôáé êáé ôá ðïóïóôÜ ôùí áðáíôÞóåùí ôùí áóèåíþí ìå êáôÜèëéøç. Ïé öñïíôéóôÝò ôïõò ïé ïðïßïé Þôáí êáé ðñüóùðá ôïõ Üìåóïõ óõããåíéêïý ðåñéâÜëëïíôïò âñÝèçêáí íá ðáñïõóéÜæïõí ðáñüìïéåò äéáôáñá÷Ýò óôï 31,6%. ¼óïí áöïñÜ ôçí êáèçìåñéíÞ ëåéôïõñãéêüôçôá ìå ôïí Ýëåã÷ï ìå ADL ç óõ÷íüôçôá ôùí áðáíôÞóåùí öáßíåôáé óôï äéÜãñáììá 4. ÔÝëïò óôïí ðßíáêá 1 öáßíåôáé ç ó÷Ýóç ôùí ðáñáãüíôùí ADL, Êëßìáêá ÏðôéêÞò Áíáëïãßáò êáé Äåßêôç SDS ìåôáîý ôïõò. ¼ðùò öáßíåôáé üëïé ïé ðáñÜãïíôåò ó÷åôßæïíôáé ìåôáîý ôïõò ãåãïíüò áíáìåíüìåíï. Ï ÌÏ ôùí áðïôåëåóìÜôùí ôïõ ADL Þôáí 25,65 (SD 7,13), ôçò Êëßìáêáò ÏðôéêÞò Áíáëïãßáò 57,80 (SD 24,21) êáé ôïõ Äåßêôç SDS 50,73 (SD 10,85).

ÓõæÞôçóç Ôá ôåëåõôáßá ÷ñüíéá Üñ÷éóå íá ÷ñçóéìïðïéåßôáé óôçí éáôñéêÞ ï üñïò “palliative care” ðáñçãïñçôéêÞ öñïíôßäá, ðïõ óõìðåñéëáìâÜíåé åêôüò ôçò óùìáôéêÞò êáé ôçí øõ÷ïêïéíùíéêÞ õðïóôÞñéîç ôùí áíèñþðùí ìå íåïðëáóßåò óå ôåëéêü óôÜäéï. ÐáñÜëëçëá áðü ôç äåêáåôßá ôïõ 1990 êáé ç øõ÷éáôñéêÞ óôñÝöåé ôï åíäéáöÝñïí ôçò áðü ôçí

Ôüìïò 13, Ôåý÷ïò 3, 2001

Ó. ÁñãõñéÜäïõ êáé óõí.

ÄéÜãñáììá 1. Óõìðôþìáôá ôùí ôåëåõôáßùí åâäïìÜäùí.

ÄéÜãñáììá 2. ÐïóïóôÜ óõ÷íüôçôáò áðáíôÞóåùí óôçí ïðôéêÞ áíáëïãéêÞ êëßìáêá

áéôéïðáèïãÝíåéá óôçí áíôéìåôþðéóç ôçò íüóïõ, åîåéäéêåýïíôáò ìÜëéóôá óôçí Øõ÷ïïãêïëïãßá9. ¸ôóé äßäåôáé Ýìöáóç óôçí ðïéüôçôá æùÞò áõôþí ôùí áóèåíþí10-11, óõæçôåßôáé ãéá ôçí ðñïóùðéêüôçôá ôýðïõ C ôùí áíèñþðùí êáé ôç óõìâïëÞ ôçò óôçí êáñêéíïãÝíåóç12, óôçí åðßäñáóç ôïõ stress óôçí åìöÜíéóç ôùí ìåôáóôÜóåùí ê.ëð.13

ÁíÜìåóá óôéò áðïäåêôÝò èåñáðåõôéêÝò ðáñåìâÜóåéò åîáêïëïõèåß íá åßíáé, üóï åñáóéôå÷íéêÞ êé áí öáßíåôáé, êáé áõôÞ ðïõ åöáñìüæåôáé áðü ôçí ÐÖÕ ç ïðïßá äéáóöáëßæåé óõ÷íÞ åðáöÞ ìå éáôñéêü êáé íïóçëåõôéêü ðñïóùðéêü êïéíùíéêïýò ëåéôïõñãïýò ê.ëð., áíèñþðéíç åðéêïéíùíßá ìå ôïõò áóèåíåßò êáé ôéò ïéêïãÝíåéåò ôïõò, èåñáðåõôéêÝò 143

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ó. ÁñãõñéÜäïõ êáé óõí.

ÄéÜãñáììá 3. Óõ÷íüôçôá áðáíôÞóåùí áóèåíþí ìå êáôÜèëéøç óôïí äåßêôç SDS.

ÄéÜãñáììá 4. ÌÏ óõ÷íüôçôáò áðáíôÞóåùí óôï ADL.

ðáñåìâÜóåéò óôçí áíáêïýöéóç ôùí óõìðôùìÜôùí ôïõ êáñêßíïõ áëëÜ êáé ôùí åðéðôþóåùí ôçò áíôéêáñêéíéêÞò èåñáðåßáò óôçí ïðïßá Ý÷ïõí õðïâëçèåß14-18. ÕðÜñ÷ïõí äéÜöïñá ðéï åîåéäéêåõìÝíá åñùôç144

ìáôïëüãéá ãéá ôç ìÝôñçóç ôçò ðïéüôçôáò æùÞò êáé ôçí «øõ÷ïìÝôñçóç» áóèåíþí ìå íåïðëáóßåò, üðùò ôï FLIC (functional Living Index) ðïõ ÷ñçóéìïðïéåßôáé åõñÝùò óôçí ÁìåñéêÞ19 êáé ôï EORTC-QLQ (Quality of Live Questionnaire)

Ôüìïò 13, Ôåý÷ïò 3, 2001

Ó. ÁñãõñéÜäïõ êáé óõí.

Ðßíáêáò 1. Ó÷Ýóç ðáñáãüíôùí ADL, Êëßìáêá ÏðôéêÞò Áíáëïãßáò, êáé Äåßêôç SDS ìåôáîý ôïõò ADL Pearson Correlation ADL ÏðôéêÞ Êëßìáêá Äåßêôçò SDS

1,000 ,316** -,060

ÏðôéêÞ Êëßìáêá p value

Äåßêôçò SDS

Pearson Correlation

p value

Pearson Correlation

p value

,316** 1,000 -,177*

,000

-,060 -,177* 1,000

,492 ,042

,000 ,492

,042

** Correlation is significant at the 0.01 level (2-tailed). * Correlation is significant at the 0.05 level (2-tailed).

ðïõ åßíáé ðåñéóóüôåñï áðïäåêôü óôçí Åõñþðç20. Ôï êáèÝíá áðü áõôÜ üìùò åêôüò ôïõ üôé äåí óôáèìßóôçêå ìÝ÷ñé ôþñá óôçí ÅëëÜäá, åðéðëÝïí ðáñïõóéÜæåé óýìöùíá ìå äçìïóéåýìáôá êáôÜ ðåñßðôùóç ìåèïäïëïãéêÜ, áëëÜ êáé ðñáêôéêÜ ðñïâëÞìáôá21. Áõôüò Þôáí ï ëüãïò ðïõ ðñïôéìÞèçêå óôçí åñãáóßá áõôÞ íá ÷ñçóéìïðïéçèïýí ãéá ôéò ìåôñÞóåéò ìáò ç êëßìáêá ïðôéêÞò áíáëïãßáò, ãéá ôïí ðüíï, ôï åñùôçìáôïëüãéï ôïõ Zung ãéá ôç ìÝôñçóç ôçò øõ÷éêÞò êáôÜóôáóçò êáé ôï ADL ãéá ôç ëåéôïõñãéêÞ ôïõò êáôÜóôáóç, ðéóôåýïíôáò üôé óôï óýíïëï ôïõò ìáò ðëçñïöïñïýí ãéá ôçí ðïéüôçôá æùÞò. Óôçí åöáñìïãÞ ôïõò äéáðéóôþèçêáí âÝâáéá áäõíáìßåò üðùò ð÷ üôé ç ïðôéêÞ êëßìáêá äåí åßíáé áêñéâÞò óôéò åíäéÜìåóåò ôéìÝò êáé äåß÷íåé íá åðçñåÜæåôáé áðü åîùãåíåßò ðáñÜãïíôåò üðùò ç ðáñïõóßá ôñßôùí. Åðßóçò üôé ôï ADL åíþ åßíáé åñãáëåßï èáõìÜóéï óôï “follow up” ðñïóùðéêÜ ôïõ êÜèå áóèåíÞ, ðáñïõóéÜæåé áäõíáìßá óôïí ðïóïôéêü ðñïóäéïñéóìü ôùí êáèçìåñéíþí ëåéôïõñãéþí êáé óôç ãåíßêåõóç áõôþí ôùí áðïôåëåóìÜôùí. ÔÝëïò ôï åñùôçìáôïëüãéï ôïõ Zung äåí ðåñéëáìâÜíåé ôï ïñãáíéêü øõ÷ïóýíäñïìï ðïõ ðáñïõóéÜæåôáé óôï 8%, ôéò äéáôáñá÷Ýò ôçò ðñïóùðéêüôçôáò ðïõ áíôéóôïé÷ïýí óôï 7% ôùí áóèåíþí áõôþí êáé åðïìÝíùò äåí åßíáé ïëïêëçñùìÝíç ç åéêüíá ôçò øõ÷éêÞò ôïõò êáôÜóôáóçò. Ôá ðñïáíáöåñüìåíá áðïôåëïýí óßãïõñá ìåéïíåêôÞìáôá ôçò ìåëÝôçò, üðùò åðßóçò ðéèáíüôáôá íá õðÜñ÷ïõí ëÜèç óôáôéóôéêÜ, ìåèïäïëïãéêÜ ê.ëð. Ðáñüëá áõôÜ óå ìéá åðï÷Þ ðïõ óõæçôïýíôáé ôüóï Ýíôïíá “ôá ïéêïíïìéêÜ ôçò õãåßáò” ç óõììåôï÷Þ ôçò ÐÖÕ óôçí “ðáñçãïñçôéêÞ öñïíôßäá” ôùí êáñêéíïðáèþí óå ôåëéêü óôÜäéï åßíáé ßóùò ï ðéï áíÝîïäïò ôñüðïò äéáóöÜëéóçò ïõóéáóôéêÞò êáé ðïéïôéêÞò öñïíôßäáò ôùí áóèåíþí áõôþí.

Âéâëéïãñáößá 1. K. Faber-Langendoen. Death by request. Assisted suicide and the oncologist. Cancer 1998; 82:35-41. 2. S.R. Gambert. Prostate cancer. When to offer screening in the primary care. Geriatrics 2001; 56:29-31. 3. Ã. ÑçãÜôïò. Ï ðüíïò óôïí êáñêéíïðáèÞ. Óôï Ðüíïò: êëéíéêÝò åéêüíåò êáé áíôéìåôþðéóç. ÊëéíéêÜ ÖñïíôéóôÞñéá. ÉáôñéêÞ Åôáéñåßá Áèçíþí, 1991 ôüìïò 3, ôåý÷ïò 2, óåë. 67-80. 4. Ã. Âáúüðïõëïò. Ï ðüíïò ôùí ñåõìáôïðáèþí. Óôï Ðüíïò: ÊëéíéêÝò Åéêüíåò êáé Áíôéìåôþðéóç. ÊëéíéêÜ ÖñïíôéóôÞñéá. ÉáôñéêÞ Åôáéñåßá Áèçíþí, 1991 ôüìïò 3, ôåý÷ïò 2, óåë. 37-66. 5. W.W.K. Zung. A cross- cultural survey of symptoms in depression. Am. J. Phychiatry 1969; 126: 116-21. 6. W.W.K. Zung. Treatment prediction in depression using a self-rating scale. Biol. Phychiatry 1970; 2:321-29. 7. ×.Ó. Éåñïäéáêüíïõ. Ï Üññùóôïò ìå êáñêßíï. Óôï “Øõ÷éáôñéêÝò ãíþóåéò ãéá åöáñìïãÞ áðü êÜèå ãéáôñü, ðñáêôéêüò ïäçãüò øõ÷ïóùìáôéêÞò èåñáðåõôéêÞò” Åêä. Ìáóôïñßäç, Èåóóáëïíßêç 2000. óåë. 133-45. 8. K. Holmen, K. Ericson, L. Andersson, B. Winbland. ADL capacity and loneliness among older people persons with cognitive impairment” Scand. J. Prim. Health Care, 1993; 11: 56-60. 9. G.A. Rigatos. Psychosomatic aspects in cancer. From Antiquity to the 20th century. Pub.Hellenic Society of Psychosocial Oncology, Athens/ Beaune 1992. 10. M. Aapro. Pain under treated, depression under recognized in cancer patients. In: New clinical strategies for Symptom Management and Quality of Life Enhancement in Cancer patients. Faculty International Abstracts, Paris, 1995, pp 2-3. 11. R. Payne, S.D. Mathias, D.J. Pasta. Quality of Life and cancer pain: satisfaction and side ef145

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Ôüìïò 13, Ôåý÷ïò 3, 2001

È. Ðáõëïðïýëïõ êáé óõí.

ÂÑÁÂÅÕÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ AWARDED FREESTANDING PAPER Primary Heatlh Care, Volume 13, Number 3, 147-152, 2001 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 13, Ôåý÷ïò 3, 147-152, 2001

Äéá÷åßñéóç êõíÜã÷çò óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò È. Ðáõëïðïýëïõ1, É. ÐáðáúùÜííïõ1, Ç. ÌáñãÝëïò2, È. Ãïõëéþôç2, ×. ÐÝæïõ1, Ó. ×áëêéÜ1, Å.Á. Óêëçñüò1

Ðåñßëçøç Óêïðü ôçò ìåëÝôçò ìáò áðïôåëåß ç áîéïëüãçóç á) ôçò äéá÷åßñéóçò ôùí áóèåíþí ìå ïîåßá öáñõããßôéäá êáé â) ôçò äõíáôüôçôáò äéÜãíùóçò ôçò óôñåðôïêïêêéêÞò öáñõããßôéäáò ìå âÜóç ôá êëéíéêÜ êáé åðéäçìéïëïãéêÜ óôïé÷åßá þóôå íá ìðïñïýí íá åöáñìïóèïýí óôçí ðñùôïâÜèìéá öñïíôßäá õãåßáò. Áóèåíåßò êáé ìÝèïäïò: ÅðéëÝ÷èçêáí ïé çëéêßåò 3 Ýùò 15 åôþí áöïý ç óôñåðôïêïêêéêÞ öáñõããßôéäá åßíáé óðÜíéá êÜôù ôçò çëéêßáò ôùí 5 åôþí êáé áðïôåëåß íüóï êõñßùò ôçò ðáéäéêÞò çëéêßáò. Áðü óýíïëï 600 ðåñßðïõ áôüìùí çëéêßáò 5-15 åôþí ðïõ äéáìÝíïõí óôï Ä. ÍåìÝáò ôï Ê.Õ. ÍåìÝáò äÝ÷èçêå 345 åðéóêÝøåéò ôï ðáñáðÜíù ïñéóìÝíï ÷ñïíéêü äéÜóôçìá ãéá ïîåßá öáñõããßôéäá. ÔåëéêÜ 100 ðåñéóôáôéêÜ ðåñéåëÞöèçóáí óôç ìåëÝôç. Áðü ôï óýíïëï ôùí ðáéäéþí ðïõ ðåñéåëÞöèçóáí óôç ìåëÝôç åëÞöèçóáí êáëëéÝñãåéåò öÜñõããá. ÁðïôåëÝóìáôá: Èåôéêü éóôïñéêü õðïôñïðéÜæïõóùí ëïéìþîåùí åß÷å ôï 41% ôïõ äåßãìáôïò åíþ Ýíôïíç êëéíéêÞ åéêüíá ôï 56%. ÁíÜðôõîç ðáèïãüíùí ìéêñïïñãáíéóìþí ðáñïõóßáóáí 33 äåßãìáôá (33%). Ç çëéêßá óõó÷åôßóèçêå áñíçôéêÜ ìå ôçí êëéíéêÞ åéêüíá (r= -0,256, p= 0,01). Äåí áíåâñÝèçêå óõó÷Ýôéóç ìåôáîý çëéêßáò - èåôéêÞò êáëëéÝñãåéáò (p= 0,645) êáé èåñáðåßáò (p= 0,325). Äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ ó÷Ýóç ìåôáîý êëéíéêÞò åéêüíáò êáé öýëïõ (p= 0,074), éóôïñéêïý ëïéìþîåùí (p= 0,884), ó÷ïëåßïõ (p= 0,138) êáé èåôéêÞò êáëëéÝñãåéáò (p= 0,524). ÁíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ ó÷Ýóç ìåôáîý êëéíéêÞò åéêüíáò êáé èåñáðåßáò (r= 0,659, p= 0,001) Äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ ó÷Ýóç ìåôáîý êáëëéÝñãåéáò êáé çëéêßáò (p= 0,645), öýëïõ (p= 0,400), ðáñáêïëïýèçóç ó÷ïëåßïõ (p= 0,742), êëéíéêÞò åéêüíáò (p= 0,524) êáé èåñáðåßáò (p=0,631). ÓõìðåñÜóìáôá: Óôç ìåëÝôç ìáò áëëÜ êáé óå Üëëåò ìåëÝôåò, Ý÷åé äåé÷èåß üôé ôá êëéíéêÜ åõñÞìáôá êáé ôá åðéäçìéïëïãéêÜ äåäïìÝíá äå ìðïñïýí íá ÷ñçóéìïðïéçèïýí ìå õøçëÞ áîéïðéóôßá ãéá ôç äéÜãíùóç ôçò óôñåðôïêïêêéêÞò öáñõããßôéäáò

ÊÕ ÍåìÝáò, http://www.http.gr/kynemeas, kyn@nethouse.gr., 2Ìéêñïâéïëïãéêü ôìÞìá Ã.Í.Í. Êïñßíèïõ.

ÅéóáãùãÞ Ç ïîåßá öáñõããßôéäá áðïôåëåß ìéá áðü ôéò óõ÷íüôåñåò ðáèÞóåéò ãéá ôçí ïðïßá ïé áóèåíåßò åðéóêÝðôïíôáé ôïí ðáéäßáôñï Þ ôïí ïéêïãåíåéáêü ôïõò ãéáôñü. Åßíáé êõñßùs éïãåíïýs áéôéïëïãßáò, áëëÜ êáé âáêôÞñéá åìðëÝêïíôáé óôçí ðáèïãÝíåóÞ ôçò. Éïß ïé ïðïßïé ðñïêáëïýí ïîåßá öáñõããßôéäá åßíáé êõñßùs áäåíïúïß, ñéíïïúïß, ï éüò ôçò ãñßðçò, ï RSV, ïé HSV 1 êáé 2, ï Epstein Barr, ïé Cïxachie A, CMV êáé ï HIV1. ÂáêôçñéäéáêÞò áéôéïëïãßáò öáñõããßôéäá ðñïêáëïýí ïé â- áéìïëõôéêïß óôñåðôüêïêêïé ïìÜäáò Á, C êáé G, ç Neisseria gonorrea, ôï Corynobacterium difteriae, ç Yersinia pestis, ôï Mycoplasma pneumoniae, äéÜöïñá áíáåñüâéá (êõíÜã÷ç Vincent) êáé äéÜöïñá åßäç ÷ëáìõäßùí2. Ôï óõ÷íüôåñï âáêôçñéáêü áßôéï ôçò ïîåßáò öáñõããßôéäáò åßíáé ï â- áéìïëõôéêüò óôñåðôüêïêêïò ËÝîåéò êëåéäéÜ: ÊõíÜã÷ç, ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 13ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (Ñüäïò, 8-22 Áðñéëßïõ 2001) êáé âñáâåýèçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Å. Óêëçñüò, Äçìïêñáôßáò êáé ÍÝóôïñïò 32, ÁéãÜëåù Ô.Ê. 122 44, Ôçë.: (010) 5693387, Fax: (07460) 22227 147

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

È. Ðáõëïðïýëïõ êáé óõí.

The management of acute pharyngitis in primary health care Th. Paulopoulou, I. Papaioannou, H. Margelos, Th. Goulioti, Ch. Pezou, E. Skliros Summary The Aim: The aim of this study is the evaluation of: a) The care of patients suffering from acute pharyngitis and b) The possibility to diagnose streptococic pharyngitis based on clinical and epidemiological data so that the conclusions may be used in primary health care. Patients and Methods: 100 persons between the age of 3 to 14 years of age, with acute pharyngitis, and specific criteria were studied. More specifically excluded patients were those: 1) with disease onset <12 hours and duration >5 days, 2) having already taken antibiotics, 3) suffering from diabetes mellitus type I, 4) who appeared to have serious symptoms (cyanosis, crepitus, and other). From all the patients of this study cultures of pharyngeal swabs in blood agar and Mc Conkey Petri disher were taken from all the participants of this study. The clinical symptoms, signs and epidemiologic characteristics were registered. The statistical analysis was based on Fischer's exact test, Pearson's x2, Logistic Regression Analysis. The therapeutic scheme was given according to the clinical picture, without the knowledge of the results of the culture. Results: The age was negatively related to the clinical picture (r= 0,256, p= 0,01), while the risks of a heavy clinical picture concerning patients at the age of < 5 years old, was OR=2,469 (1,163-5,245). No relation between the clinical picture and the results of the culture was substantiated. 33 children were positive (16 due to â hemolytic streptococcus of group A). Antibiotics were prescribed for 65 persons. An important statistical relation between the clinical picture and therapy (p=0,0010 was discovered. In logistic regression analysis with dependent variable the culture of the pharyngeal swab, no serious statistical relation with the clinical or the epidemiologic factor was substantiated. Conclusion: Although the acute pharyngitis is a disease which does not reveal any pathogenic microbe in cultures, it creates the need for the prescribing of antibiotics. The diseased individuals are ascertained characteristically by the clinical picture, a fact which leads to the over consumption of antibiotics, caused by the over prescribing of antibiotics, and for this reason should be taken into consideration by GP's and primary health care workers when dealing with pharyngitis. Key words: Pharyngitis, General Practice, Primary Health Care

ïìÜäáò Á áí êáé ìéêñüò áñéèìüò áóèåíþí ðñïóâÜëëåôáé. Åíôïýôïéò üìùò, ç öáñõããßôéäá áðü â- áéìïëõôéêü óôñåðôüêïêêï Á áðáéôåß ïðùóäÞðïôå ôç ÷ïñÞãçóç áíôéìéêñïâéáêÞò3 èåñáðåßáò, áöåíüò ãéá ôçí ðñüëçøç ôïõ ñåõìáôéêïý ðõñåôïý, áöåôÝñïõ ãéá ôçí ðñüëçøç ôùí åðéðëïêþí (ð.÷. ìáóôïåéäßôéäá) êáé ôïí ðåñéïñéóìü ôçò äåõôåñïãåíïýò äéáóðïñÜò óôï åíäïïéêïãåíåéáêü ðåñéâÜëëïí êáé óôéò õðüëïéðåò êïéíùíéêÝò åðáöÝò. ¼ìùò, ôá óõìðôþìáôá êáé ôá óçìåßá ôçò óôñåðôïêïêêéêÞò óå ó÷Ýóç ìå ôç ìç óôñåðôïêïêêéêÞ öáñõããßôéäá åðéêáëýðôïíôáé, ìå áðïôÝëåóìá íá åßíáé äýóêïëç Þ åðéóöáëÞò ç äéÜãíùóç óå êëéíéêÞ âÜóç4. Åßíáé óçìáíôéêü ïé éáôñïß íá åßíáé éêáíïß íá ìðïñïýí íá áðïññßøïõí ôç äéÜãíùóç ôçò óôñåðôïêïêêéêÞò öáñõããßôéäáò óå êëéíéêÞ Þ åðéäçìéïëïãéêÞ âÜóç, þóôå íá áðïöåõ÷èïýí Þ ðåñéôôÞ 148

÷ñÞóç áíôéìéêñïâéáêþí óå Ýíá óçìáíôéêü áñéèìü áóèåíþí ìå ïîåßá öáñõããßôéäá. Ï ðåñéïñéóìüò ôçò ÷ñÞóçò ôùí áíôéìéêñïâéáêþí ðñïöáíþò åðéäñÜ óôï êüóôïò, áëëÜ ôáõôü÷ñïíá ìåéþíåé ôéò ðéèáíÝò ðáñåíÝñãåéåò áðü ôç ÷ñÞóç ôïõò êáé óõíåéóöÝñåé óôï ðñüâëçìá ôçò áíôßóôáóçò ôùí ìéêñïâßùí óôá áíôéâéïôéêÜ. Óêïðü ôçò ìåëÝôçò ìáò áðïôåëåß ç áîéïëüãçóç á) ôçò äéá÷åßñéóçò ôùí áóèåíþí ìå ïîåßá öáñõããßôéäá êáé â) ôçò äõíáôüôçôáò äéÜãíùóçò ôçò óôñåðôïêïêêéêÞò öáñõããßôéäáò ìå âÜóç ôá êëéíéêÜ êáé åðéäçìéïëïãéêÜ óôïé÷åßá þóôå íá ìðïñïýí íá åöáñìïóèïýí óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò.

Ðëçèõóìüò êáé ìåëÝôçò êáé ÌÝèïäïò Ó÷åäéáóìüò ìåëÝôçò

Ðñüêåéôáé ãéá ðñïïðôéêÞ åðéäçìéïëïãéêÞ ìåëÝôç (cross sectional) ìå óêïðü ôçí áîéïëüãçóç êëéíéêþí óçìåßùí, óõìðôùìÜôùí êáé åðéäçìéïëïãéêþí ÷áñáêôçñéóôéêþí ðïõ èá ìðïñïýóáí íá ÷ñçóéìïðïéçèïýí ãéá ôç ëÞøç áðüöáóçò ÷ïñÞãçóçò áíôéìéêñïâéáêÞò èåñáðåßáò óå ðåñéóôáôéêÜ ïîåßáò óôñåðôïêïêêéêÞò öáñõããßôéäáò. ÌåëåôÞèçêáí 100 ðåñéóôáôéêÜ êõíÜã÷çò ðïõ ðñïóÞëèáí óôï Ê.Õ. ÍåìÝáò êáé ðëçñïýóáí óõãêåêñéìÝíá êñéôÞñéá.

ÄéÜñêåéá ìåëÝôçò Ï ÷ñüíïò ìåëÝôçò êáèïñßóôçêå íá åßíáé Ýíá åîÜìçíï, áðü 1 Äåêåìâñßïõ 1999 ìÝ÷ñé 31 ÌáÀïõ 2000, áöïý ïé ëïéìþîåéò áðü â- áéìïëõôéêü óôñåðôüêïêêï ðáñïõóéÜæïíôáé êõñßùò ôï ÷åéìþíá êáé óôéò áñ÷Ýò ôçò Üíïéîçò.

Ðëçèõóìüò ìåëÝôçò Á) Çëéêéáêü öÜóìá: ÅðéëÝ÷èçêáí ïé çëéêßåò 3 Ýùò 15 åôþí áöïý ç óôñåðôïêïêêéêÞ öáñõããß-

Ôüìïò 13, Ôåý÷ïò 3, 2001

È. Ðáõëïðïýëïõ êáé óõí.

ôéäá åßíáé óðÜíéá êÜôù ôçò çëéêßáò ôùí 5 åôþí êáé áðïôåëåß íüóï êõñßùò ôçò ðáéäéêÞò çëéêßáò. Â) Áñéèìüò ðåñéóôáôéêþí: áðü óýíïëï 600 ðåñßðïõ áôüìùí çëéêßáò 5-15 åôþí ðïõ äéáìÝíïõí óôï Ä. ÍåìÝáò ôï Ê.Õ. ÍåìÝáò äÝ÷èçêå 345 åðéóêÝøåéò ôï ðáñáðÜíù ïñéóìÝíï ÷ñïíéêü äéÜóôçìá ãéá ïîåßá öáñõããßôéäá. ÅîáéñÝèçêáí üëá ôá ðåñéóôáôéêÜ ðïõ ôçñïýóáí ôéò ðáñáêÜôù ðñïûðïèÝóåéò: á) Ýíáñîç óõìðôùìÜôùí <12 ùñþí êáé äéÜñêåéáò >5 çìåñþí, â) åðáíåîåôÜóåéò áóèåíþí, ã) óõìðôþìáôá ðñïåîÜñ÷ïíôá éïãåíïýò ëïßìùîçò (åîÜíèçìá, óôïìáôßôéäá, åîåëêþóåéò, äéÜññïéá), ä) Ýíáñîç áíôéâéþóåùò ðñéí ôç äéÜãíùóç, å) íåáíéêüò óáê÷áñþäçò äéáâÞôçò êáé óô) óïâáñÜ óõìðôþìáôá áðüöñáîçò áåñáãùãþí (êõÜíùóç, ôñéóìüò). ÔåëéêÜ 100 ðåñéóôáôéêÜ ðåñéåëÞöèçóáí óôç ìåëÝôç.

ÐáñÜìåôñïé áîéïëüãçóçò Çëéêßá

ÊñéôÞñéá ÷ïñÞãçóçò áíôéìéêñïâéáêÞò áãùãÞò ÐñïêáèïñéóìÝíï êñéôÞñéï ãéá ôç ÷ïñÞãçóç áðïôÝëåóå ç Ýíôïíç êëéíéêÞ åéêüíá üðùò åêôéìÞèçêå êáôüðéí ëåðôïìåñïýò êëéíéêÞò åîÝôáóçò.

Åñãáóôçñéáêüò Ýëåã÷ïò Áðü ôï óýíïëï ôùí ðáéäéþí ðïõ ðåñéåëÞöèçóáí óôç ìåëÝôç åëÞöèçóáí êáëëéÝñãåéåò öÜñõããá. Ç êáëëéÝñãåéá öáñõããéêïý åðé÷ñßóìáôïò ðñáãìáôïðïéÞèçêå ìå ôç ÷ñÞóç óôõëåïý êáé åðßóôñùóç óå ôñõâëßá áéìáôïý÷ïõ Üãáñ êáé McConkey ðïõ åðùÜóèçêáí óôïõò 37° C ãéá Ýíá 24ùñï. Ç äéáöïñïðïßçóç êáé ôáõôïðïßçóç ôçò ïìÜäáò Á áðü ôéò Üëëåò ïìÜäåò óôñåðôïêüêêùí ðñáãìáôïðïéÞèçêå ìå ôï test äßóêïõ âáêéôñáêßíçò (0,04 ìïíÜäåò). Ôï test áõôü óôçñßæåôáé óôï ãåãïíüò üôé >95% ôùí óôñåðôïêüêêùí ôçò ïìÜäáò Á äßíïõí æþíç áíáóôïëÞò ãýñù áðü ôï äßóêï âáêéôñáêßíçò.

Ôï äåßãìá êáôçãïñéïðïéÞèçêå óôéò çëéêßåò <5 åôþí êáé >5 åôþí. ÓôáôéóôéêÞ áíÜëõóç ÊëéíéêÞ åéêüíá Ç êëéíéêÞ åéêüíá ôçò ïîåßáò óôñåðôïêïêêéêÞò öáñõããßôéäáò ÷áñáêôçñßæåôáé áðü ðïíüëáéìï, ðõñåôü, êåöáëáëãßá, íáõôßá, åñýèçìá öÜñõããá, áìõãäáëþí ìå/Þ ÷ùñßò åðß÷ñéóìá êáé ëåìöáäåíßôéäá. Ïé áóèåíåßò êáôçãïñéïðïéÞèçêáí óå äýï êáôçãïñßåò âÜóåé ôùí êëéíéêþí åõñçìÜôùí êáé ôùí óõìðôùìÜôùí óå Þðéá êáé Ýíôïíç êëéíéêÞ åéêüíá. Ùò Ýíôïíç êëéíéêÞ åéêüíá ÷áñáêôçñßóôçêå ç ýðáñîç á) ðõñåôïý >38° C, â) ñõðáñïý åðé÷ñßóìáôïò áìõãäáëþí êáé ã) ëåìöáäåíßôéäá.

Ç óôáôéóôéêÞ áíÜëõóç ôùí äåäïìÝíùí Ýãéíå ìå ôç äïêéìáóßá ×2 êáé Fischer's exact test óå ðßíáêåò 2×2 ãéá ðïéïôéêÜ äåäïìÝíá ôïõ äåßãìáôïò. ¸ãéíå ðñïóäéïñéóìüò ôïõ ó÷åôéêïý êéíäýíïõ ìå ôï ODDS RATIO êáé 95% CI. Óõó÷Ýôéóç ôùí ìåôáâëçôþí ðñáãìáôïðïéÞèçêå ìå Pearson's correlation analysis åíþ ëïãéóôéêÜ ìïíôÝëá (Logistic regression analysis) ðñáãìáôïðïéÞèçêáí ìå åîáñôçìÝíç ìåôáâëçôÞ ôç èåôéêÞ êáëëéÝñãåéá êáé ôçí êëéíéêÞ åéêüíá êáé áíåîÜñôçôåò ìåôáâëçôÝò ìåôÜ áðü êáôÜëëçëï ìåôáó÷çìáôéóìü ôïõò äéÜöïñïõò ðáñÜãïíôåò áîéïëüãçóçò.

ÁðïôåëÝóìáôá Éóôïñéêü õðïôñïðéáæïõóþí ëïéìþîåùí Ôï éóôïñéêü õðïôñïðéáæïõóþí ëïéìþîåùí êáôþôåñïõ áíáðíåõóôéêïý æçôÞèçêå áðü ôïõò ãïíåßò êáé åðéâåâáéþèçêå áðü ôá âéâëéÜñéá õãåßáò ôùí ðáéäéþí.

ÌåëåôÞèçêáí 100 Üôïìá çëéêßáò 3-14 åôþí, 49 (49%) áãüñéá êáé 51 (51%) êïñßôóéá. Ôá äçìïãñáöéêÜ ÷áñáêôçñéóôéêÜ ôïõ äåßãìáôïò ðáñïõóéÜæïíôáé óôïí ðßíáêá 1. Èåôéêü éóôïñéêü õðïôñïðéáæïõóþí ëïéìþîåùí åß÷å ôï 41% ôïõ äåßãìáôïò åíþ Ýíôïíç êëéíéêÞ åéêüíá ôï 56%. ÁíÜ-

149

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

È. Ðáõëïðïýëïõ êáé óõí.

Ðßíáêáò 1. ÄçìïãñáöéêÜ ÷áñáêôçñéóôéêÜ

ÊëéíéêÞ åéêüíá %

Í Çëéêßá (3-14 åôþí) £5 åôþí >5 åôþí

29 71

Öýëï ¢ññåí ÈÞëõ

49 51

Ó÷ïëåßï/Ðáéäéêüò óôáèìüò Íáé ¼÷é

87 13

Èåôéêü éóôïñéêü ëïéìþîåùí Íáé ¼÷é

44 56

ÊëéíéêÞ åéêüíá ÂáñéÜ ¹ðéá

56 44

Ê/á öáñõããéêïý åðé÷ñßóìáôïò ÈåôéêÞ ÁñíçôéêÞ

33 67

ËÞøç áíôéâßùóçò Íáé ¼÷é

65 35

Äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ ó÷Ýóç ìåôáîý êëéíéêÞò åéêüíáò êáé öýëïõ (p= 0,074), éóôïñéêïý ëïéìþîåùí (p= 0,884), ó÷ïëåßïõ (p= 0,138) êáé èåôéêÞò êáëëéÝñãåéáò (p= 0,524). ÁíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ ó÷Ýóç ìåôáîý êëéíéêÞò åéêüíáò êáé èåñáðåßáò (r= 0,659, p= 0,001) ãåãïíüò óçìáíôéêü, áöïý ç êëéíéêÞ åéêüíá áðïôÝëåóå êñéôÞñéï ãéá ôç èåñáðåßá.

ÈåôéêÞ êáëëéÝñãåéá Äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ ó÷Ýóç ìåôáîý êáëëéÝñãåéáò êáé çëéêßáò (p= 0,645), öýëïõ (p= 0,400), ðáñáêïëïýèçóç ó÷ïëåßïõ (p= 0,742), êëéíéêÞò åéêüíáò (p= 0,524) êáé èåñáðåßáò (p=0,631).

Áíôéâßùóç Ðßíáêáò 2. ÁðïôåëÝóìáôá êáëëéåñãåéþí Åßäïò

Â- áéìïëõôéêüò Streptococcus S. aureus S. pneumoniae Clebsiella

14 14 4 1

42,42% 42,42% 12,12% 3%

ðôõîç ðáèïãüíùí ìéêñïïñãáíéóìþí ðáñïõóßáóáí 33 äåßãìáôá (33%). Óôïí ðßíáêá 2 ðáñïõóéÜæïíôáé ôá åßäç ôùí ìéêñïïñãáíéóìþí óôéò êáëëéÝñãåéåò. ÔåëéêÜ áíôéìéêñïâéáêÞ èåñáðåßá ÷ïñçãÞèçêå óå 65 (65%) Üôïìá.

×ïñçãÞèçêå áíôéâßùóç óå 65 Üôïìá. Ôá 20 Üôïìá åß÷áí èåôéêÞ êáëëéÝñãåéá åíþ ôá õðüëïéðá áñíçôéêÞ. Óå áóèåíåßò ìå Þðéá êëéíéêÞ åéêüíá ðáñáôçñÞèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ óôç ÷ïñÞãçóç áíôéâßùóçò óå áóèåíåßò ìå èåôéêÞ êáëëéÝñãåéá óå ó÷Ýóç ìå áõôïýò ìå áñíçôéêÞ êáëëéÝñãåéá. ¸ëáâáí áíôéâßùóç 13/31 ìå áñíçôéêÞ êáëëéÝñãåéá vs 0/13 ìå èåôéêÞ (Fischer's p= 0,004). Ìå ôç ÷ñÞóç ëïãéóôéêïý ìïíôÝëïõ (Logistic regression analysis) ìå åîáñôçìÝíç ìåôáâëçôÞ ôçí êáëëéÝñãåéá êáé áíåîÜñôçôç ôï öýëï, ôçí çëéêßá êáé ôçí êëéíéêÞ åéêüíá äåí áíåâñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ ó÷Ýóç.

ÐáñÜãïíôåò áîéïëüãçóçò ÓõæÞôçóç Çëéêßá Ç çëéêßá óõó÷åôßóèçêå áñíçôéêÜ ìå ôçí êëéíéêÞ åéêüíá (r= -0,256, p= 0,01), åíþ ï ó÷åôéêüò êßíäõíïò áíÜðôõîçò Ýíôïíçò êëéíéêÞò åéêüíáò óôéò çëéêßåò <5 åôþí (22/29 vs 34/71, p= 0,01) óå ó÷Ýóç ìå ôçí çëéêßá >5 åôþí Þôáí OR= 2,469 (95% CI: 1,163- 5,245). Äåí áíåâñÝèçêå óõó÷Ýôéóç ìåôáîý çëéêßáò- èåôéêÞò êáëëéÝñãåéáò (p= 0,645) êáé èåñáðåßáò (p= 0,325). 150

Ç ïîåßá öáñõããßôéäá åßíáé êõñßùò éïãåíïýò áéôéïëïãßáò1. Ôï óçìáíôéêüôåñï üìùò áßôéï áðïôåëåß ï â- áéìïëõôéêüò óôñåðôüêïêêïò ôçò ïìÜäáò Á, ãéá ôïí ïðïßï ÷ñåéÜæåôáé ïðùóäÞðïôå áíôéìéêñïâéáêÞ èåñáðåßá5. Óôç ìåëÝôç ìáò ìüíï ôï 14% ôùí ðåñéóôáôéêþí ïîåßáò öáñõããßôéäáò ïöåéëüôáí óå â- áéìïëõôéêü óôñåðôüêïêêï ïìÜäáò Á. Ç èåñáðåßá ôçò öáñõããßôéäáò åßíáé ïõóéáóôé-

Ôüìïò 13, Ôåý÷ïò 3, 2001

È. Ðáõëïðïýëïõ êáé óõí.

êÜ ïñèÞ üôáí âáóßæåôáé óôï Strep Test (RST) Þ óå êáëëéÝñãåéåò. Ôï RST Ý÷åé ó÷åäüí 100% åéäéêüôçôá, åðéôñÝðåé ôçí Üìåóç ÷ïñÞãçóç áíôéâßùóçò, ìåéþíåé ôéò åðéóêÝøåéò óôïí éáôñü êáé Ý÷åé êáëÞ áðïäï÷Þ áðü ôïõò áóèåíåßò6. Ôá ìåéïíåêôÞìáôÜ ôïõ üìùò åßíáé üôé Ý÷åé õøçëü êüóôïò, óå Ðßíáêáò 3. ÁíáëõôéêÞ ðáñÜóôáóç ôùí ìåôáâëçôþí óå ó÷Ýóç ìå ôçí êëéíéêÞ åéêüíá ¸íôïíç

¹ðéá

34 22

37 7

p= 0,01

Ó÷ïëåßï Íáé ¼÷é

46 10

41 3

p= 0,138

Éóôïñéêü Íáé ¼÷é

25 31

19 25

p= 0,884

ÊáëëéÝñãåéá ÈåôéêÞ ÁñíçôéêÞ

21 35

13 31

p 0,524

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Ðßíáêáò 4. ÁíáëõôéêÞ ðáñïõóßáóç ôùí ìåôáâëçôþí óå ó÷Ýóç ìå ôçí êáëëéÝñãåéá Ê/á +

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ðåñßðôùóç áñíçôéêïý áðïôåëÝóìáôïò ÷ñåéÜæåôáé êáëëéÝñãåéá êáé äåí äéáöïñïðïéåß ôçí öïñåßá áðü ôçí áóèÝíåéá. Áðü ôçí Üëëç ìåñéÜ ç êáëëéÝñãåéá áðïôåëåß ôïí áêñïãùíéáßï ëßèï óôç äéÜãíùóç7 ôçò óôñåðôïêïêêéêÞò öáñõããßôéäáò êáé åßíáé êáé öôçíÞ êáé åýêïëç óôç ëÞøç ôçò. Ç áîéïðéóôßá üìùò ôçò êáëëéÝñãåéáò åîáñôÜôáé áðü ðïëëïýò ðáñÜãïíôåò8. ÐñÝðåé íá ëáìâÜíåôáé êáé áðü ôéò äýï áìõãäáëÝò êáé ôï ïðßóèéï ôïß÷ùìá ôïõ öÜñõããá ÷ùñßò ï óôõëåüò íá Ýñ÷åôáé óå åðáöÞ ìå Üëëïõò éóôïýò, åíþ ç ðñïçãïýìåíç ëÞøç áíôéâéïôéêþí ìðïñåß íá áëëïéþóåé ôï áðïôÝëåóìá. Ï ÷ñüíïò åðþáóçò èá ðñÝðåé íá åßíáé ôïõëÜ÷éóôïí 24 þñåò þóôå íá áíáðôõ÷èïýí ïé áðïéêßåò ôïõ óôñåðôüêïêêïõ, ìå áðïôÝëåóìá íá êáèõóôåñåß ç Ýíáñîç áãùãÞò. Ôï åñþôçìá üìùò ðïõ ðáñáìÝíåé ãéá ôïí êëéíéêü éáôñü áêüìá êáé áí Ý÷åé ëçöèåß êáëëéÝñãåéá åßíáé áí èá ðñÝðåé íá äþóåé èåñáðåßá þóðïõ íá âãåé ôï áðïôÝëåóìá. Óáöþò ç Üìåóç ÷ïñÞãçóç ìåéþíåé ôçí Üìåóç íïóçñüôçôá, áëëÜ ðéèáíüí áöåíüò áõîÜíåé ôï êüóôïò, ïäçãåß óå áíáßôéá ÷ñÞóç áíôéâéïôéêþí êáé ìðïñåß íá ïäçãÞóåé óå éáôñïãåíÞ íïóçñüôçôá åîáéôßáò ðáñåíåñãåéþí. Óå áäõíáìßá áðü ôçí Üëëç ìåñéÜ ëÞøçò Strep Test Þ êáëëéåñãåéþí åíäåßêíõôáé ç åìðåéñéêÞ èåñáðåßá9. Ç åìðåéñéêÞ èåñáðåßá åîïéêïíïìåß ÷ñüíï ìå ôç ìç ÷ñÞóç äéáãíùóôéêþí ìåèüäùí êáé ðñïóöÝñåé ôåëéêÜ éêáíïðïßçóç óôïí áóèåíÞ åðéëýïíôáò ôï ðñüâëçìÜ ôïõ1. ÏõóéáóôéêÜ üìùò ôéò ðåñéóóüôåñåò öïñÝò ïäçãåß óå õðåñèåñáðåßá êáé óå ìç óôïé÷åéïèåôçìÝíç èåñáðåõôéêÞ ðñïóÝããéóç, óå éáôñïãåíÞ íïóçñüôçôá10 êáé óôç äéáìüñöùóç ëáíèáóìÝíùí áíôéëÞøåùí óôïõò áóèåíåßò ãéá ôç íüóï11. Óôç ìåëÝôç ìáò, áëëÜ êáé óå Üëëåò ìåëÝôåò üìùò, Ý÷åé äåé÷èåß üôé ôá êëéíéêÜ åõñÞìáôá êáé ôá åðéäçìéïëïãéêÜ äåäïìÝíá äåí ìðïñïýí íá ÷ñçóéìïðïéçèïýí ìå õøçëÞ áîéïðéóôßá ãéá ôç äéÜãíùóç ôçò óôñåðôïêïêêéêÞò öáñõããßôéäáò12. Ç äéáãíùóôéêÞ ôïõò áîßá åßíáé óôçí êáëýôåñç ðåñßðôùóç 50-75% áí êáé áðü ôç ìåëÝôç ìáò âñÝèçêå ëßãï ÷áìçëüôåñá. Óýìöùíá ìå ôá áðïôåëÝóìáôá ôçò ìåëÝôçò ìáò, áóèåíåßò ðïõ Ýðñåðå íá ëÜâïõí áíôéâßùóç äåí Ýëáâáí åíþ áóèåíåßò ïé ïðïßïé Ýðñåðå íá áíôéìåôùðéóèïýí óõíôçñçôéêÜ Ýëáâáí èåñáðåßá. ¢ëëùóôå êáìéÜ óôáôéóôéêÜ óçìáíôéêÞ óõó÷Ýôéóç êëéíéêÞò åéêüíáò êáé êáëëéÝñãåéáò äåí áíåâñÝèçêå. Ç äéáöïñéêÞ äéÜãíùóç ôçò óôñåðôïêïêêéêÞò öáñõããßôéäáò åßíáé äýóêïëç áöïý äåí õðÜñ÷ïõí 151

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

÷áñáêôçñéóôéêÜ êëéíéêÜ óçìåßá êáé óõìðôþìáôá (Ðéí. 5). ¸ôóé óôçí áíôéìåôþðéóç êáé äéá÷åßñéóç ôùí áóèåíþí ìå öáñõããßôéäá èá ðñÝðåé íá ëçöèïýí õðüøç üôé ç óôñåðôïêïêêéêÞ öáñõããßôéäá óõíÞèùò åìöáíßæåôáé óå ðáéäéÜ 5-15 åôþí, ÷åéìþíá-Üíïéîç êáé üôé õðÜñ÷ïõí ðáñÜãïíôåò ðïõ ðñÝðåé íá ëçöèïýí õðüøç üðùò êáé óïâáñÜ óõìðôþìáôá ðïõ ðñÝðåé íá áîéïëïãçèïýí îå÷ùñéóôÜ (Ðßíáêáò 6, 7). ÏõóéáóôéêÜ üìùò áõôü ðïõ ðñÝðåé íá ãíùñßæåé ï êëéíéêüò éáôñüò åßíáé üôé ç áíôéìéêñïâéáêÞ èåñáðåßá Ý÷åé üöåëïò ìüíï óôç öáñõããßôéäá áðü óôñåðôüêïêêï ïìÜäáò Á êáé èá ðñÝðåé íá åßíáé éêáíüò íá áðïêëåßåé ôç äéÜãíùóÞ ôçò ãéá ôçí áðïöõãÞ ÷ïñÞãçóçò áíôéâéïôéêþí óå ìåãÜëç ìÜæá áóèåíþí ðïõ äåí ôç ÷ñåéÜæïíôáé. ÓõìðåñáóìáôéêÜ, åðåéäÞ äåí õðÜñ÷ïõí êëéíéêÜ êáé åðéäçìéïëïãéêÜ óôïé÷åßá ðïõ ó÷åôßæïíôáé ìå ôç äéÜãíùóÞ ôçò óôñåðôïêïêêéêÞò öáñõããßôéäáò, óçìáóßá ôåëéêÜ Ý÷åé ï áðïêëåéóìüò ôçò äéÜãíùóçò.

Ðßíáêáò 5. Óõìðôþìáôá ëïßìùîçò áðü â- áéìïë. Óôñåðôüêïêêï ïì. Á 1. 2. 3. 4. 5.

ÎáöíéêÞ Ýíáñîç Áìõãäáëßôéäá ËåìöáäåíïðÜèåéá Ðõñåôüò ¸ëëåéøç âÞ÷á, ñéíüññïéáò, äéÜññïéáò

Ðßíáêáò 6. Óôïé÷åßá áîéïëüãçóçò áðü ôï éóôïñéêü 1. 2. 3. 4. 5. 6. 7.

Éóôïñéêü ñåõìáôéêïý ðõñåôïý HIV ×çìåéïèåñáðåßá ÁíïóïêáôáóôïëÞ Êýçóç ÄéÜñêåéá > 5 çìåñþí Áðïôõ÷ßá ðñïçãïýìåíçò áãùãÞò

Ðßíáêáò 7. ÓïâáñÜ óõìðôþìáôá 1. 2. 3. 4.

Ôñéóìüò Äýóðíïéá Áäõíáìßá êáôÜðïóçò õãñþí Óõñéãìüò

152

È. Ðáõëïðïýëïõ êáé óõí.

Åõ÷áñéóôÞñéï Åõ÷áñéóôïýìå ôïí êï Äåëüôç Áíôþíéï ãéá ôç óõìâïëÞ ôïõ óôç óôáôéóôéêÞ áíÜëõóç ôçò ìåëÝôçò.

Âéâëéïãñáößá 1. A.L. Bisno. Acute pharyngitis: etiology and diagnosis. Pediatrics 1996, 97:949-954. 2. Paradise SL: Etiology and management of pharyngitis and pharyngotonosillitis in children. A current review. 3. A.L. Bisno, M.A. Gerber, S.M. Gwaltney et al. Diagnosis and management of group A streptococcal pharyngitis: a practice guidline. Clin. Infect. Dis. 1997, 25:574-583. 4. L.W. Wannameker. Perplexity and precision in the diagnosis of streptococcal pharyngitis. Am. J. Dis. Child. 1972, 124:352-358. 5. A. Dajani, K. Taubert, P. Ferrier et al. Treatment of acute streptococcal pharyngitis and prevention of rheumatic fever: a statement for health professionals. Pediatrics 1995, 96:758764. 6. M.A. Gerber, R.R. Tanz, W. Kabat et al. Optical immunoassay test for group A b- hemolytic streptococcal pharyngitis. JAMA 1997, 277:899903. 7. M.A. Gerber. Comparison of throat cultures and rapid strep tests for diagnosis of streptococcal pharyngitis. Pediatr. Infect. Dis. J. 1989, 8:820824. 8. O.F. Roddey, H.W. Clegg, E.S. Martin et al. Comparison of throat culture methods for the recovery of group A streptococci in a pediatric office setting. JAMA 1995, 274:1863-1865. 9. S. Berman. Pediatric decision making. 2nd ed Philadelphia. B.C. Decker 1991. 10. Center for Disease Control and Prevention: Careful antibiotic use. CDC Academic Detailing Sheet 1999. 11. R.L. Watson, S. Dawell, J. Jayaraman et al. Antimicrobial use for pediatric upper respiratory infections reported practice. Actual practice and parent beliefs. Pediatrics 1999, 104:1251-1257. 12. Committee on Infectious Diseases of the American Academy of Pediatrics 1997 Red Book: report of the Committee on Infectious 24th Ed. ELK Grove Village, Illinois: American Academy of Pediatrics, 1997.

Ôüìïò 13, Ôåý÷ïò 3, 2001

Â. Ðáðáãåùñãßïõ êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ THE SECOND AWARDED FREESTANDING PAPER Primary Heatlh Care, Volume 13, Number 3, 153-160, 2001 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 13, Ôåý÷ïò 3, 153-160, 2001

Åðéðïëáóìüò õðåñâÜëëïíôïò âÜñïõò (Þ êáé ðá÷õóáñêßáò), äéáôñïöéêÝò óõíÞèåéåò êáé äéáôñïöéêÞ áãùãÞ óå ìáèçôéêïýò ðëçèõóìïýò ôïõ íïìïý ×áëêéäéêÞò Â. Ðáðáãåùñãßïõ, Âáñ. Ðáðáãåùñãßïõ, Áñ. Ôóá÷ïõñßäçò, Ê. Ãñßâïõ

Ðåñßëçøç Óêïðüò ôçò ðáñïýóáò åñãáóßáò åßíáé ç åêôßìçóç ôïõ åðéðïëáóìïý ôïõ õðåñâÜëëïíôïò âÜñïõò (Þ êáé ðá÷õóáñêßáò) êáé ôùí äéáôñïöéêþí óõíçèåéþí, êáèþò êáé ç áîéïëüãçóç ôçò äéáöïñÜò ôïõ åðéðÝäïõ äéáôñïöéêþí ãíþóåùí óå ìáèçôéêïýò ðëçèõóìïýò ìå Þ ÷ùñßò åöáñìïãÞ ðñïãñÜììáôïò äéáôñïöéêÞò áãùãÞò. Õëéêü êáé ìÝèïäïò. Ç Ýñåõíá äéåíåñãÞèçêå óå ôñßá ó÷ïëåßá (ãõìíÜóéá-ëýêåéá) ôïõ Íïìïý ×áëêéäéêÞò (Ôñßãëéáò, Ìïõäáíéþí, ÊáóóÜíäñáò) ôá ó÷ïëéêÜ Ýôç 19992001. ÓõíïëéêÜ åñåõíÞèçêáí 1.036 Üôïìá (481 áñ.-555 èçë.). Áðü ðëåõñÜò ìåèïäïëïãßáò ÷ñçóéìïðïéÞèçêáí ï BMI (Body Mass Index, Äåßêôçò ÌÜæáò Óþìáôïò) êáé åí ìÝñåé ç Ðåñßìåôñïò ÌÝóçò êáé ï ëüãïò WHR (Waist to Hip Ratio, Ðåñßìåôñïò ÌÝóçò ðñïò Ðåñßìåôñï Ãëïõôþí), êáèþò êáé ï Äåßêôçò ÏñèÞò Ãíþóçò (ÄÏÃ) êáé åéäéêÜ åñùôçìáôïëüãéá áîéïëüãçóçò ôùí äéáôñïöéêþí óõíçèåéþí êáé ôïõ åðéðÝäïõ äéáôñïöéêþí ãíþóåùí. ÁðïôåëÝóìáôá. Áðü ôéò ãåíüìåíåò ìåôñÞóåéò êáé ôïí õðïëïãéóìü ôùí ó÷åôéêþí äåéêôþí ðñïÝêõøáí ôá åîÞò: Ôá ðïóïóôÜ õðåñâÜëëïíôïò âÜñïõò (Þ êáé ðá÷õóáñêßáò) èåùñïýíôáé õøçëÜ ãéá ôïõò ìáèçôÝò êáé ôùí ôñéþí ó÷ïëåßùí (20.90%, 18.34% êáé 17.77% áíôßóôïé÷á), ï äå BMI ðáñïõóéÜæåé êáé ãéá ôá äýï öýëá ìéá áõîçôéêÞ ðïñåßá ðñïúïýóçò ôçò çëéêßáò. Ï ÄÏÃ åðçñåÜóôçêå èåôéêÜ áðü ôçí åöáñìïãÞ ìáèçìÜôùí äéáôñïöéêÞò áãùãÞò (Ôñßãëéá: 0.64 áñ., 0.78 èçë.). Áðü ðëåõñÜò öýëïõ ç ìÝóç ôéìÞ ôïõ ÄÏÃ êáé ãéá ôá 3 ó÷ïëåßá Þôáí óõãêñéôéêÜ õøçëüôåñç óôá èÞëåá óå ó÷Ýóç ìå ôá Üññåíá Üôïìá. ÁíáöïñéêÜ ìå ôéò äéáôñïöéêÝò óõíÞèåéåò ôùí ìáèçôþí, öáßíåôáé üôé áõôÝò áðïêëßíïõí áðü ôá ðñüôõðá õãéåéíÞò äéáôñïöÞò, ç äéáðßóôùóç äå áõôÞ óõíåéäçôïðïéåßôáé åíôïíüôåñá áðü ôïõò ìáèçôÝò ðïõ ðáñáêïëïõèïýí ìáèÞìáôá äéáôñïöéêÞò áãùãÞò. ÔÝëïò åíäéáöÝñïõóá ðáñïõóéÜæåôáé êáé ç Üðïøç üôé ïé ìáèçôÝò êáé ôùí 3 ó÷ïëåßùí, ðáñÜ ôéò õðÜñ÷ïõóåò äéáöïñÝò åíçìÝñùóçò, åðéèõìïýí ìåãáëýôåñç ðëçñïöüñçóç óå èÝìáôá äéáôñïöéêÞò áãùãÞò. ÓõìðåñÜóìáôá: Áðü ôçí áíÜëõóç ôùí äåäïìÝíùí ôçò Ýñåõíáò ðñïêýðôåé óáöþò üôé õößóôáôáé ðñüâëçìá õðåñâÜëëïíôïò âÜñïõò Þ êáé ðá÷õóáñêßáò óôéò åñåõíçèåßóåò ìáèçôéêÝò êïéíüôçôåò. Åðßóçò ç åöáñìïãÞ ðñïãñáììÜôùí äéáôñïöéêÞò áãùãÞò, åíôáãìÝíùí óå ó÷ïëéêÜ ðñïãñÜììáôá, ìðïñåß íá ðñïÜãåé óçìáíôéêÜ ôéò äéáôñïöéêÝò ãíþóåéò ôùí ìáèçôþí êáé íá ôïõò ùèÞóåé óôçí õéïèÝôçóç õãéåéíüôåñùí äéáôñïöéêþí ðñïôýðùí. Ôá áíùôÝñù êáèéóôïýí ðñüäçëç ôçí áíÜãêç ãéá ïõóéáóôéêüôåñç åíçìÝñùóç êáé åêðáßäåõóç ôùí ìáèçôþí óå èÝìáôá äéáôñïöÞò, áöïý óÞìåñá åßíáé áðïäåêôü üôé ç ðá÷õóáñêßá áðïôåëåß íüóï êáé óçìáíôéêü ðñüâëçìá äçìüóéáò õãåßáò, ç äå õéïèÝôçóç õãéåéíÞò äéáôñïöÞò äñá ðñïóôáôåõôéêÜ óôçí åìöÜíéóç ðïëëþí ÷ñüíéùí íïóçìÜôùí. ÔïìÝáò ÃåíéêÞò ÉáôñéêÞò Ê.Õ. Êáóóáíäñåßáò, ÊáóóÜíäñåéá

ÅéóáãùãÞ ÓÞìåñá ç ðá÷õóáñêßá, Þ Üëëùò ç ðáèïëïãéêÞ áýîçóç ôïõ ëßðïõò óôï óþìá, áðïôåëåß óçìáíôéêü ðñüâëçìá õãåßáò ãéá ìåãÜëï ìÝñïò ôïõ ðëçèõóìïý1,24,25. Óõãêëßíïõóåò åíäåßîåéò áðü åðéäçìéïëïãéêÝò, êëéíéêÝò êáé ðåéñáìáôéêÝò Ýñåõíåò, åíï÷ïðïéïýí ôç äéáôñïöÞ ãéá ìåãÜëï ìÝñïò ôïõ óýã÷ñïíïõ íïóïëïãéêïý öÜóìáôïò2, ðïõ êáëýðôåé ôá ðåñéóóüôåñá íïóÞìáôá ôïõ êõêëïöïñéêïý êáé áñêåôÝò êáêïÞèåéò íåïðëáóßåò. Ïé äéáôñïöéêÝò åêôñïðÝò áöïñïýí ôüóï óôçí õðÝñâáóç ôçò ðñïóëáìâáíüìåíçò ìå ôçí ôñïöÞ ðïóüôçôáò åíÝñãåéáò, üóï êáé óôçí Ýëëåéøç éóïññïðßáò áíÜìåóá óôéò âáóéêÝò ïìÜäåò ôñïößìùí, ìå Ýìöáóç ôçí õðåñâïëéêÞ êáôáíÜëùóç ëßðïõò, æÜ÷áñçò, æùéêþí ËÝîåéò êëåéäéÜ: Ð÷õóáñêßá, äéáôñïöéêÝò óõíÞèåéåò, áãùãÞ õãåßáò, ìáèçôÝò ÕðïâïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 13ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (Ñüäïò, 8-22 Áðñéëßïõ 2001) êáé âñáâåýèçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Â. Ðáðáãåùñãßïõ, ÊÝíôñï Õãåßáò Êáóóáíäñåßáò, ×áëêéäéêÞ, Ôçë. (03740) 22222 153

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Â. Ðáðáãåùñãßïõ êáé óõí.

The prevalence of excess weight and obecity, dietary habits and dietary education in school populations from Chalkidiki County V. Papageorgiou, Var. Papageorgiou, Ar. Tsachouridis, E. Grivou Summary The aim of this study was to calculate the prevalence of excess weight and obesity in school populations from N.Triglia, N.Moudania and Kassandra. We also tried to investigate if a form of educational lessons would be able to influence the students' dietary habits. It was found that the rate of excess weight and obesity was higher than expected, being proportional to the age of individuals. It was also indicated that the educational lessons made a major contribution in changing the students' wrongly adapted dietary habits into a healthier standard of nourishment. Key words: Excess weight, obecity, dietary habits, students

ðñùôåúíþí êáé ôç ìåéùìÝíç êáôáíÜëùóç öñïýôùí, äçìçôñéáêþí êáé ïóðñßùí. Ïé äéáôñïöéêÝò áõôÝò åêôñïðÝò áðïôåëïýí óõíÝðåéá ôçò äõíáìéêÞò ôçò áãïñÜò, ôùí äéáöçìéóôéêþí ðéÝóåùí êáé ôïõ ãåãïíüôïò üôé ôï Üôïìï áíáæçôåß óôï öáãçôü, ðÝñáí ôçò éêáíïðïßçóçò ôïõ âáóéêïý åíóôßêôïõ ôçò ðåßíáò, êáé íÝá ðåäßá ôÝñøåùò. Ïé äéáôñïöéêÝò åîåëßîåéò óôïí åëëçíéêü ðëçèõóìü Þôáí ó÷åôéêÜ éäéüìïñöåò êáé áíôßóôïé÷åò Þôáí êáé ïé íïóïëïãéêÝò óõíÝðåéåò ôùí éäéïìïñöéþí áõôþí. Ãéá ðïëëÜ ÷ñüíéá ôï äéáôñïöéêü ðñüâëçìá ôùí ÅëëÞíùí Þôáí ç ðïóïôéêÞ åðÜñêåéá, åíþ áðü ðïéïôéêÞò áðüøåùò ç äéáôñïöÞ ôïõò Þôáí âáóéêÜ óùóôÞ, õðÞñ÷å äçë. ìéá óùóôÞ Ýìöáóç óôï øùìß, óôá üóðñéá, óôá öñïýôá, óôá ëá÷áíéêÜ êáé óôï ëÜäé, áíôßèåôá ç êáôáíÜëùóç ôùí ãáëáêôïêïìéêþí ðñïúüíôùí Þôáí ìÝôñéá êáé ôïõ êñÝáôïò ÷áìçëÞ. ¹ôáí ç ëåãüìåíç ðáñáäïóéáêÞ åëëçíéêÞ äéáôñïöÞ, áíÜëïãç ôçò ìåóïãåéáêÞò, üðùò áõôÞ êáôáãñÜöçêå óôç 10åôßá ôïõ 1960. Ç åãêáôÜëåéøç áõôÞò ôçò ðáñáäïóéáêÞò äéáôñïöÞò6,7 ôéò ôåëåõôáßåò 10åôßåò, êáé ç óôñïöÞ óå äõôéêïý ôýðïõ äéáôñïöéêÜ ðñüôõðá8-10, óå óõíäõáóìü êáé ìå Üëëïõò ðáñÜãïíôåò, êõñßùò ãåíåôéêïýò, åßíáé ïé êýñéåò áéôßåò ðïõ ïäçãïýí óôçí áíÜðôõîç ôçò ðá÷õóáñêßáò, áëëÜ êáé óå ìåôáâïëÝò Üëëùí äåéêôþí êáé ðáñáìÝôñùí, üðùò ç áýîçóç ôçò ÷ïëçóôåñüëçò êáé ôïõ óáê÷Üñïõ ôïõ áßìáôïò, ôçò áñôçñéáêÞò ðßåóçò ê.ëð.11-13. Ïé ìåôáâïëÝò áõôÝò óôç óõíÝ÷åéá óõíåðÜãïíôáé áýîçóç ôïõ êéíäýíïõ åìöÜíéóçò êáñäéáããåéáêþí íïóçìÜôùí3-5, ãåãïíüò ðïõ åðéâåâáéþíåôáé áðü ôç äéá÷ñïíéêÞ åîÝëéîç ôçò èíçóéìüôçôáò óôçí ÅëëÜäá áðü ôá íïóÞìáôá áõôÜ óå óýãêñéóç ìå Üëëåò ÷þñåò ôçò Åõñþðçò14-16. 154

Ç õéïèÝôçóç äéáôñïöéêþí ðñïôýðùí ôùí äõôéêþí êïéíùíéþí ïöåßëåôáé åí ðïëëïßò óôï ÷áìçëü åðßðåäï ôùí äéáôñïöéêþí ãíþóåùí ôïõ ðëçèõóìïý êáé óôçí áíåðáñêÞ ðëçñïöüñçóç ó÷åôéêÜ ìå ôï ôé åßíáé õãéåéíÞ äéáôñïöÞ. Ç áíÜëçøç ïñãáíùìÝíùí êáé óõíôïíéóìÝíùí ðñïóðáèåéþí äéáôñïöéêÞò ðïëéôéêÞò èá óõìâÜëåé óôç âåëôßùóç ôïõ åðéðÝäïõ ôùí äéáôñïöéêþí ãíþóåùí êáé èá ïäçãÞóåé óôçí áëëáãÞ ôùí äéáôñïöéêþí åðéëïãþí ôïõ ðëç-

èõóìïý17. ÄåäïìÝíïõ üôé ïé ðáñÜãïíôåò êéíäýíïõ ãéá ðïëëÜ íïóÞìáôá öèïñÜò Ý÷ïõí ôéò åããñáöÝò ôïõò óôéò äéáôñïöéêÝò åêôñïðÝò êáé óõíÞèåéåò ôçò ðáéäéêÞò êáé åöçâéêÞò çëéêßáò18-21, ïé ïðïßåò ðáãéþíïíôáé Þ êáé åðéäåéíþíïíôáé óôá ìåôÝðåéôá ÷ñüíéá, èåùñåßôáé üôé ìéá äéáôñïöéêÞ áãùãÞ, ç ïðïßá åöáñìüæåôáé óôçí çëéêßá áõôÞ, èá åßíáé êáé ðéï áðïôåëåóìáôéêÞ20-23. ÊáôÜ óõíÝðåéá ó÷ïëéêÜ ðñïãñÜììáôá óõóôçìáôéêÞò ðëçñïöüñçóçò ôùí ìáèçôéêþí ðëçèõóìþí ãéá ôïõò êáíüíåò ôçò óùóôÞò äéáôñïöÞò, ìå ôçí åíåñãü óõììåôï÷Þ êáé óýìðñáîç äáóêÜëùí, ãïíÝùí, ëåéôïõñãþí õãåßáò êáé ü÷é ìüíï, ìðïñïýí íá ðñïÜãïõí óçìáíôéêÜ ôéò äéáôñïöéêÝò ãíþóåéò ôùí ìáèçôþí êáé íá ôïõò ïäçãÞóïõí óå ìéá ðéï óôáèåñÞ êáé ìáêñïðñüèåóìç õéïèÝôçóç õãéåéíþí äéáôñïöéêþí ðñïôýðùí, óôÜóåùí êáé óõìðåñéöïñþí22. ÌéêñÞ óõìâïëÞ óôçí êáôåýèõíóç áõôÞ ìðïñåß íá ðñïóöÝñåé êáé ç äéêÞ ìáò ðñïóðÜèåéá, ç ïðïßá óôï÷åýåé óôçí åêôßìçóç ôïõ åðéðïëáóìïý ôïõ õðåñâÜëëïíôïò âÜñïõò (Þ êáé ðá÷õóáñêßáò) êáé ôùí äéáôñïöéêþí óõíçèåéþí, êáèþò êáé óôçí áîéïëüãçóç ôçò äéáöïñÜò ôïõ åðéðÝäïõ ôùí äéáôñïöéêþí ãíþóåùí óå ìáèçôéêÝò êïéíüôçôåò ìåôÜ áðü åöáñìïãÞ êáé ÷ùñßò åöáñìïãÞ ðñïãñáììÜôùí äéáôñïöéêÞò áãùãÞò.

Ðëçèõóìüò ìåëÝôçò êáé ÌÝèïäïé Ç Ýñåõíá ðñáãìáôïðïéÞèçêå óå ó÷ïëåßá (ãõìíÜóéá-ëýêåéá) ôñéþí äÞìùí ôïõ Í. ×áëêéäéêÞò, çìéáóôéêïý ÷áñáêôÞñá, Þôïé ôùí äÞìùí Ôñßãëéáò, Ìïõäáíéþí êáé ÊáóóÜíäñáò, êáôÜ ôá ó÷ïëéêÜ Ýôç 1999-2001.

Ôüìïò 13, Ôåý÷ïò 3, 2001

Â. Ðáðáãåùñãßïõ êáé óõí.

Óôï ó÷ïëåßï (ãõìíÜóéï-ëýêåéï) ôïõ äÞìïõ Ôñßãëéáò åöáñìüóôçêå ðñüãñáììá äéáôñïöéêÞò áãùãÞò ìå 5 åðéóôçìïíéêÝò ïìéëßåò äéáôñïöéêïý ðåäßïõ (Ðßíáêáò 1), áðü ôçí ïìÜäá åñãáóßáò, åíþ ïé ìáèçôÝò ôùí ó÷ïëåßùí ôùí äýï Üëëùí äÞìùí äåí Ýëáâáí åðéðñüóèåôåò ãíþóåéò äéáôñïöÞò, åêôüò åêåßíùí ðïõ ðñïâëÝðïíôáé áðü ôï ó÷ïëéêü ðñüãñáììá (ó÷ïëåßá åëÝã÷ïõ). ÓõíïëéêÜ åñåõíÞèçêáí 1.036 ìáèçôÝò (Ôñßãëéá 149 áãüñéá - 181 êïñßôóéá, ÌïõäáíéÜ 204 áãüñéá - 232 êïñßôóéá, ÊáóóÜíäñá 128 áãüñéá 142 êïñßôóéá). Áðü ðëåõñÜò ìåèïäïëïãßáò ÷ñçóéìïðïéÞèçêáí ï Äåßêôçò ìÜæáò óþìáôïò êáé (BMI) åí ìÝñåé ç Ðåñßìåôñïò ÌÝóçò (ÐÌ) êáé ï ëüãïò Ðåñßìåôñïò ÌÝóçò ðñïò Ðåñßìåôñï Éó÷ýïõ (Þ WHR, Waist to Hip Ratio), êáèþò êáé ï Äåßêôçò ÏñèÞò Ãíþóçò (ÄÏÃ) êáé åéäéêÜ äïìçìÝíá åñùôçìáôïëüãéá ãéá ôçí áîéïëüãçóç ôïõ åðéðÝäïõ äéáôñïöéêþí ãíþóåùí (ìÝóù ôïõ ÄÏÃ) êáé ôùí äéáôñïöéêþí óõíçèåéþí. Ï BMI, ï ïðïßïò óõíäõÜæåé ôï âÜñïò åíüò áôüìïõ óå êéëÜ (Kg) ðñïò ôï ôåôñÜãùíï ôïõ ýøïõò óå ìÝôñá (m), åßíáé Ýíáò áäñüò êáé áðëüò äåßêôçò ðïõ ÷ñçóéìïðïéåßôáé åõñÝùò óôçí êáèçìåñéíÞ ðñÜîç êáé åßíáé ðáãêüóìéá áðïäåêôüò ëüãù ôçò åýêïëçò êáôáíüçóçò êáé ôïõ åõ÷åñïýò õðïëïãéóìïý ôïõ. ¢ôïìá ìå BMI ìåôáîý 25-30 èåùñïýíôáé õðÝñâáñá êáé Üíù ôïõ 30 ðá÷ýóáñêá (Ðßíáêáò 2). Ç ÐÌ êáé ï WHR áðïôåëïýí äõï ÷ñÞóéÐßíáêáò 1. Ðñüãñáììá äéáôñïöéêÞò áãùãÞò. ÄéáôñïöÞ êáé Õãåßá 1. ÄéáôñïöÞ êáé èñåðôéêÜ óõóôáôéêÜ (Ãåíéêüôçôåò, èñåðôéêÜ óõóôáôéêÜ. ÄïìÞ õäáôáíèñÜêùí -ðñùôåúíþí - ëéðéäßùí. ÏìÜäåò ôñïößìùí, ÊáôÜóôáóç óôçí ÅëëÜäá, äéáôñïöéêÞ ðõñáìßäá) 2. ÄéáôñïöÞ êáé íïóïëïãßá (Ãåíéêüôçôåò, äéáôñïöÞ êáé Óôåöáíéáßá Íüóïò, äéáôñïöÞ êáé Êáñêßíïé) 3. ÄéáôñïöÞ êáé äéÜöïñåò çëéêéáêÝò ïìÜäåò (Ãåíéêüôçôåò, ÅíåñãåéáêÝò áíÜãêåò êÜèå çëéêßáò, ÁíÜãêåò óå áíüñãáíá Üëáôá êáé âéôáìßíåò. Óýíèåóç äéáéôïëïãßïõ óôéò äéÜöïñåò çëéêßåò) 4. ÄéáôñïöÞ êáé öõóéêÝò ôñïöÝò (Ãåíéêüôçôåò, Ðüóï õãéåéíÜ åßíáé ôá "öõóéêÜ" ôñüöéìá, Ðüóï öõóéêÜ åßíáé ôá "öõóéêÜ " ôñüöéìá) 5. ÄéáôñïöéêÞ ðïëéôéêÞ êáé óôü÷ïé óôçí ÅëëÜäá (Ãåíéêüôçôåò, ÌÝôñá êáé óôü÷ïé äéáôñïöéêÞò ðïëéôéêÞò, Õëïðïßçóç äéáôñïöéêþí óôü÷ùí)

Ðßíáêáò 2. Äåßêôçò ìÜæáò óþìáôïò (BMI) BMI=

ÂÜñïò (óåKg) ¾øïò2 (óå m)

<18,5: 18,5-24,9: 25 - 29,9: >30:

÷áìçëü âÜñïò, öõóéïëïãéêü âÜñïò õðåñâÜëëïí âÜñïò ðá÷õóáñêßá

Áíáëïãßá ìÝóçò-éó÷ßùí (WHR) WHR=

Ðåñßìåôñïò ÌÝóçò Ðåñßìåôñïò Ãïöþí

ÖõóéïëïãéêÝò ÔéìÝò: <1,0 ãéá ôá Üññåíá Üôïìá <0,85 ãéá ôá èÞëåá Üôïìá

ìïõò óõìðëçñùìáôéêïýò äåßêôåò ìåëÝôçò ôçò ðá÷õóáñêßáò êáé ç åîåýñåóç ôéìþí ãéá ôïõò äåßêôåò áõôïýò ðÜíù áðü ïñéóìÝíá åðßðåäá (ÐÌ >94 åê. áãüñéá - >80 åê. êïñßôóéá, WHR >1 áãüñéá >0,85 êïñßôóéá) ó÷åôßæåôáé ìå êéíäýíïõò åìöÜíéóçò íüóùí êáé ìåôáâïëéêþí äéáôáñá÷þí ëüãù ðá÷õóáñêßáò (Ðßíáêáò 2). Ï ÄÏÃ, ï ïðïßïò ìáò äßíåé ìéá åéêüíá ôïõ åðéðÝäïõ ôùí äéáôñïöéêþí ãíþóåùí, õðïëïãßóôçêå îå÷ùñéóôÜ ãéá êÜèå ìáèçôÞ óáí ôï ðçëßêï ôïõ áñéèìïý ôùí ïñèþí áðáíôÞóåùí ðïõ Ýäùóå ðñïò ôï óõíïëéêü áñéèìü åñùôÞóåùí ðïõ êëÞèçêå íá áðáíôÞóåé. Ôï åñùôçìáôïëüãéï ðåñéåëÜìâáíå 20 åñùôÞóåéò åëÝã÷ïõ ôùí ãíþóåùí ôùí ìáèçôþí óå èÝìáôá õãéåéíÞò äéáôñïöÞò (Ðßíáêáò 3).

ÁðïôåëÝóìáôá Áðü ôéò ãåíüìåíåò ìåôñÞóåéò êáé ôïí õðïëïãéóìü ôùí ó÷åôéêþí äåéêôþí êáé ëüãùí ðñïÝêõøáí ôá êáôùôÝñù áðïôåëÝóìáôá. Óôïí ðßíáêá 4 êáé óôéò åéêüíåò Éá, 1â êáé 1ã öáßíïíôáé ç ôáîéíüìçóç ôùí ìáèçôþí ìå âÜóç ôï BMI êáé ôá ðïóïóôÜ õðåñâÜëëïíôïò âÜñïõò êáé ðá÷õóáñêßáò áíôßóôïé÷á. ÐïóïóôÜ õðåñâÜëëïíôïò âÜñïõò êáé ðá÷õóáñêßáò: • Ôñßãëéá: 20,90 % • ÌïõäáíéÜ: 18,34 % • ÊáóóÜíäñá: 17,77% Óôïí ðßíáêá 5 êáé óôéò åéêüíåò 2á, 2â, 2ã êáé 2ä öáßíïíôáé ïé ìÝóïé üñïé ôçò ÐÌ êáé ôïõ ëüãïõ WHR ôùí ìáèçôþí êáôÜ ó÷ïëåßï êáé öýëï. Êáé ïé äõï äåßêôåò ðñïò ôï ðáñüí áðÝ÷ïõí óçìá155

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Â. Ðáðáãåùñãßïõ êáé óõí.

Ðßíáêáò 3. Åñùôçìáôïëüãéï åêôßìçóçò Äåßêôç ÏñèÞò Ãíþóçò

ü Ðüóï óõ÷íÜ ðñÝðåé íá êáôáíáëþíåôáé ôï êñÝáò óôç äéáôñïöÞ ìáò ü Ðüóï óõ÷íÜ ðñÝðåé íá êáôáíáëþíïíôáé ôá äçìçôñéáêÜ óôç äéáôñïöÞ ìáò ü Ðüóï óõ÷íÜ ðñÝðåé íá êáôáíáëþíïíôáé ôá ãáëáêôïêïìéêÜ óôç äéáôñïöÞ ìáò ü Ðüóï óõ÷íÜ ðñÝðåé íá êáôáíáëþíïíôáé ôá üóðñéá óôç äéáôñïöÞ ìáò ü Ðüóï óõ÷íÜ ðñÝðåé íá êáôáíáëþíïíôáé ôá ëá÷áíéêÜ óôç äéáôñïöÞ ìáò ü Ðüóï óõ÷íÜ ðñÝðåé íá êáôáíáëþíïíôáé ôá öñÝóêá öñïýôá óôç äéáôñïöÞ ìáò ü Ðüóï óõ÷íÜ ðñÝðåé íá êáôáíáëþíïíôáé ôá óïêïëáôïý÷á ðñïúüíôá óôç äéáôñïöÞ ìáò ü Ôï êñÝáò åßíáé ç ìïíáäéêÞ ðçãÞ ðñùôåúíþí óôïí ïñãáíéóìü ìáò ü Ôï åëáéüëáäï åßíáé êáëýôåñï áðü ôï âïýôõñï óôçí ðáñáóêåõÞ ôùí öáãçôþí ü Ôï åëáéüëáäï åßíáé õãéåéíüôåñï áðü ôá óðïñÝëáéá ü Ôá üóðñéá åßíáé ðçãÞ ðñùôåúíþí ãéá ôïí ïñãáíéóìü ü Ôï ìáýñï øùìß ðåñéÝ÷åé ðåñéóóüôåñåò öõôéêÝò ßíåò áðü ôï Üóðñï ü Ôï øùìß áðïäßäåé ðåñéóóüôåñåò èåñìßäåò áðü ôç öñõãáíéÜ ü Ôá êïíóåñâïðïéçìÝíá ôñüöéìá åßíáé åîßóïõ èñåðôéêÜ ìå ôá íùðÜ ü Ôá êáôåøõãìÝíá ôñüöéìá åßíáé åîßóïõ èñåðôéêÜ ìå ôá íùðÜ ü Ç óõ÷íÞ óßôéóç óå Fast Food åßíáé óõìâáôÞ ìå ìéá óùóôÞ ÄéáôñïöÞ ü Ç óõ÷íÞ êáôáíÜëùóç ãëõêþí êáé óáê÷áñùäþí ðñïúüíôùí åßíáé ÂëáðôéêÞ ü Ç óõ÷íÞ êáôáíÜëùóç áíáøõêôéêþí åßíáé óõìâáôÞ ìå ìßá óùóôÞ äéáôñïöÞ ü Ç ÷ñÞóç áëêïïëïý÷ùí ðïôþí åßíáé ùöÝëéìç ãéá ôïí ïñãáíéóìü ü Ç ðëÞñçò áðïöõãÞ ôïõ êñÝáôïò èåùñåßôáé óùóôÞ

Åéêüíá 1á.

Åéêüíá 1â.

Åéêüíá 1ã.

Ðßíáêáò 4. Êáôçãïñéïðïßçóç áóèåíþí ìå âÜóç ôï BMI BMI

<24,9 25-29,9 >30 Óýíïëï

Ôñßãëéá 112 30 7 49

ÌïõäáíéÜ 149 25 7 181

161 35 8 204

ÊáóóÜíäñá 195 31 6 232

101 25 2 128

121 18 3 142

Ðßíáêáò 5. Åêôßìçóç ÐåñéìÝôñïõ ÌÝóçò (ÐÌ) êáé WHR ìáèçôþí Tñßãëéá ÐÌ (åê.) WHR

156

74,27 0,76

68,15 0,73

72,10 0,74

ÌïõäáíéÜ 66,30 0,72

71,90 0,73

ÊáóóÜíäñá 65,90 0,70

Ôüìïò 13, Ôåý÷ïò 3, 2001

Â. Ðáðáãåùñãßïõ êáé óõí.

áðïôõðþíïíôáé ïé ìÝóïé üñïé ôïõ ÄÏÃ ôùí ìáèçôþí êáôÜ ó÷ïëåßï êáé öýëï. Åßíáé óáöÞò ç äéáöïñïðïßçóç ôïõ ÄÏÃ ôùí ìáèçôþí ôçò Ôñßãëéáò óå ó÷Ýóç ìå ôïí ÄÏÃ ôùí ìáèçôþí ôùí äõï Üëëùí ó÷ïëåßùí. • ÄÏÃ áññÝíùí áôüìùí êáé ôùí ôñéþí ó÷ïëåßùí: 0.58 • ÄÏÃ èçëÝùí áôüìùí êáé ôùí ôñéþí ó÷ïëåßùí: 0.67. Óôïí Ðßíáêá 7 åìöáíßæïíôáé ïé äéáôñïöéêÝò óõíÞèåéåò ôùí ìáèçôþí ôùí ôñéþí ó÷ïëåßùí. Êé åäþ åßíáé åìöáíÞò ç åðßäñáóç ôùí ìáèçìÜôùí äéáôñïöéêïý ðåäßïõ ãéá ôïõò ìáèçôÝò ôçò Ôñßãëéáò üóïí áöïñÜ ôç óõ÷íüôçôá ãåõìÜôùí åêôüò óðéôéïý êáé óå åóôéáôüñéá ôá÷åßáò åîõðçñÝôçóçò (Fast Food). Óôïí Ðßíáêá 8 öáßíïíôáé ï âáèìüò åíçìÝñùóçò ôùí ìáèçôþí êáé ç áõôïáîéïëüãçóç ôùí äéáôñïöéêþí ôïõò óõíçèåéþí. Åßíáé êé åäþ åìöáíÞò ç èåôéêÞ åðéññïÞ ôùí ìáèçìÜôùí äéáôñïöéêÞò áãùãÞò, ãéá ôïõò ìáèçôÝò ôçò Ôñßãëéáò, óôéò áíùôÝñù ðáñáìÝôñïõò. ÔÝëïò, óôïí Ðßíáêá 9 åìöáíßæïíôáé ïé ðçãÝò åíçìÝñùóçò ôùí ìáèçôþí óå èÝìáôá äéáôñïöÞò. Ïé ìáèçôÝò ôçò Ôñßãëéáò ðñïôÜóóïõí óôç óõíôñéðôéêÞ ôïõò ðëåéïøçößá ôï Ó÷ïëåßï ùò ðñþôç ðçãÞ ðëçñïöüñçóçò.

Åéêüíá 2á. Åêôßìçóç ÐåñéìÝôñïõ ÌÝóçò ÁññÝíùí (óå åê.)

Åéêüíá 2â. Åêôßìçóç ÐåñéìÝôñïõ ÌÝóçò ÈçëÝùí (óå åê.)

Åéêüíá 2ã. Åêôßìçóç WHR ÁññÝíùí

ÓõæÞôçóç - ÓõìðåñÜóìáôá Åéêüíá 2ä. Åêôßìçóç WHR ÈçëÝùí

íôéêÜ áðü ôéò êñßóéìåò ôéìÝò áõîçìÝíïõ êéíäýíïõ áíÜðôõîçò íüóùí ëüãù ðá÷õóáñêßáò. Ó÷Ýóç ÐÌ ìå êßíäõíï åìöÜíéóçò ìåôáâïëéêþí äéáôáñá÷þí ëüãù ðá÷õóáñêßáò: • ¢íäñåò >94 åê. • Ãõíáßêåò >80 åê. Êßíäõíïò áíÜðôõîçò íüóùí êáé WHR: • ¢íäñåò >1,0 • Ãõíáßêåò >0,85 Óôïí Ðßíáêá 6 êáé óôéò åéêüíåò 3á êáé 3â

Áðü ôçí áíÜëõóç ôùí áðïôåëåóìÜôùí ôçò Ýñåõíáò êáôáëÞãåé êáíåßò óôá áêüëïõèá óõìðåñÜóìáôá. 1. Ãéá Ýíá áñêïýíôùò ìåãÜëï ìÝñïò ôùí ìáèçôþí êáé ôùí ôñéþí ó÷ïëåßùí õðÜñ÷åé, ìå âÜóç ôï BMI, ðñüâëçìá õðåñâÜëëïíôïò âÜñïõò Þ êáé ðá÷õóáñêßáò. 2. Ç Ðåñßìåôñïò ÌÝóçò ôùí èçëÝùí õðïëåßðåôáé êáôÜ ì.ï. ôçò áíôéóôïß÷ïõ ðåñéìÝôñïõ ôùí áññÝíùí, áëëÜ áìöüôåñåò áðÝ÷ïõí óçìáíôéêÜ áêüìç áðü ôá üñéá ôïõ áõîçìÝíïõ êéíäýíïõ (>94 åê. ãéá Üññåíá êáé >80 åê. ãéá èÞëåá). 3. Ï ëüãïò WHR ôùí áññÝíùí åìöáíßæåôáé

Ðßíáêáò 6. Äåßêôçò ÏñèÞò Ãíþóçò (ÄÏÃ) ìáèçôþí Tñßãëéá ÄÏÃ (ì.ï.)

0,64

ÌïõäáíéÜ 0,78

0,54

0,62

0,56

ÊáóóÜíäñá 0,63 157

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Â. Ðáðáãåùñãßïõ êáé óõí.

Ðßíáêáò 7. ÄéáôñïöéêÝò óõíÞèåéåò ìáèçôþí Tñßãëéá

ÌïõäáíéÜ

ÊáóóÜíäñá

Ìáãåéñåýïõí ïé ãïíåßò êáèçìåñéíÜ Íáé ¼÷é Äå ãíùñßæù

96,5% 2,5% 1,0%

97,1% 2,7% 0,2%

97,3% 1,8% 0,9%

Ðñïôéìïýí ôï öáãçôü óôï óðßôé Íáé ¼÷é Äå ãíùñßæù

72,4% 14,6% 13,0%

71,9% 16,2% 11,9%

73,2% 15,6% 11,2%

Óõ÷íüôçôá ãåõìÜôùí åêôüò óðéôéïý ¸ùò êáé ìéá öïñÜ åâäïìáäéáßùò Þ êáé ëéãüôåñï ÐÜíù áðü äýï öïñÝò åâäïìáäéáßùò

68,5% 31,5%

55,7% 44,3%

56,6% 43,4%

Óõ÷íüôçôá ãåõìÜôùí óå Fast Food ¸ùò êáé ìéá öïñÜ åâäïìáäéáßùò Þ êáé ëéãüôåñï ÐÜíù áðü äýï öïñÝò åâäïìáäéáßùò

67,3% 32,7%

58,2% 41,8%

57,4% 42,6%

ÊáôáíÜëùóç óïêïëáôïý÷ùí ðñïúüíôùí ¸ùò êáé ìéá öïñÜ åâäïìáäéáßùò Þ êáé ëéãüôåñï ÐÜíù áðü äýï öïñÝò åâäïìáäéáßùò

30,5% 69,5%

28,6% 71,4%

27,9% 72,1%

Ðßíáêáò 8. Áîéïëüãçóç åíçìÝñùóçò êáé äéáôñïöéêþí óõíçèåéþí ìáèçôþí Tñßãëéá

ÌïõäáíéÜ

ÊáóóÜíäñá

¸÷ïõí åíçìåñùèåß óå èÝìáôá äéáôñïöÞò Íáé ¼÷é Äå ãíùñßæù

98,4% 5,2% -

74,2% 21,9% 3,9%

73,1% 22,4% 4,5%

Åðéèõìïýí ðåñéóóüôåñç åíçìÝñùóç Íáé ¼÷é Äå ãíùñßæù

84,2% 12,1% 3,7%

82,3% 12,5% 5,2%

81,9% 12,2% 5,9%

Åßíáé ï ôñüðïò äéáôñïöÞò ôïõò õãéåéíüò Íáé ¼÷é Äå ãíùñßæù

42,4% 44,8% 12,8%

46,7% 29,5% 24,8%

47,2% 27,6% 25,2%

ÐñÝðåé íá áëëÜîåé ï ôñüðïò äéáôñïöÞò ôïõò Íáé ¼÷é Äå ãíùñßæù

59,2% 30,4% 10,4%

39,1% 44,8% 16,1%

35,7% 45,1% 19,2%

ìåãáëýôåñïò ôïõ ëüãïõ WHR ôùí èçëÝùí, áëëÜ êé åäþ ïé äýï ëüãïé áðÝ÷ïõí ðñïò ôï ðáñüí áðü ôá üñéá ôïõ áõîçìÝíïõ êéíäýíïõ (>1,0 ãéá Üññåíá, >0,85 ãéá èÞëåá) ãéá áíÜðôõîç ó÷åôéæüìåíçò ìå ôçí ðá÷õóáñêßá íüóïõ. 4. Ï Äåßêôçò ÏñèÞò Ãíþóçò (ÄÏÃ), ï ïðïßïò áðåéêïíßæåé ôï åðßðåäï äéáôñïöéêþí ãíþóåùí ôùí ìáèçôþí, åìöáíßæåôáé ìåãáëýôåñïò óôïõò ìáèçôÝò ôïõ ó÷ïëåßïõ ôçò Ôñßãëéáò (0,64 ãéá Üññåíá, 0,78 ãéá èÞëåá), óå ó÷Ýóç ìå ôïõò 158

ìáèçôÝò ôùí äýï Üëëùí ó÷ïëåßùí, ïé ïðïßïé áñêÝóôçêáí óôéò ðñïâëåðüìåíåò áðü ôï ó÷ïëéêü ðñüãñáììá ãíþóåéò äéáôñïöÞò. Åðßóçò ï äåßêôçò áõôüò åßíáé ìåãáëýôåñïò ãéá ôá èÞëåá Üôïìá Ýíáíôé ôùí áññÝíùí (0,67 êïñßôóéá - 0,58 áãüñéá) êáé ãéá ôá ôñßá ó÷ïëåßá. Ç äéáðßóôùóç áõôÞ ðéèáíüí íá áíôáíáêëÜ ôï ìåãáëýôåñï åíäéáöÝñïí ôùí ìáèçôñéþí ãéá õãéåéíüôåñç äéáôñïöÞ ãéá ëüãïõò áéóèçôéêïýò. 5. ¼óïí áöïñÜ óôéò äéáôñïöéêÝò óõíÞèåéåò ôùí

Ôüìïò 13, Ôåý÷ïò 3, 2001

Â. Ðáðáãåùñãßïõ êáé óõí. Ðßíáêáò 9. ÐçãÝò åíçìÝñùóçò ìáèçôþí

ÌÌÅ Ãïíåßò Ó÷ïëåßï Éáôñüò ¸íôõðá Üëëåò ðçãÝò

Tñßãëéá

ÌïõäáíéÜ

ÊáóóÜíäñá

29% 70% 92% 45% 52%

35% 68% 46% 40% 43%

32% 72% 45% 42% 44%

ìáèçôþí, Ýíá ìåãÜëï ðïóïóôü (72% ðåñßðïõ) ðñïôéìÜ ôï óðéôéêü ãåýìá, åíþ ìåãÜëï ðïóïóôü ìáèçôþí (97% ðåñßðïõ) áíáöÝñåé üôé ïé ãïíåßò ôïõò ìáãåéñåýïõí êáèçìåñéíÜ. ¼ìùò ïé ìáèçôÝò ôïõ ó÷ïëåßïõ ôçò Ôñßãëéáò, ïé ïðïßïé ðáñáêïëïýèçóáí ìáèÞìáôá äéáôñïöéêÞò áãùãÞò, ðÝñáí ôùí ðñïâëåðïìÝíùí áðü ôï ó÷ïëéêü ðñüãñáììá, åìöáíßæïíôáé äéáöïñïðïéçìÝíïé óå ó÷Ýóç ìå ôïõò ìáèçôÝò ôùí äýï Üëëùí ó÷ïëåßùí, üóïí áöïñÜ óôç óõ÷íüôçôá óßôéóçò åêôüò óðéôéïý êáé óå åóôéáôüñéá ôá÷åßáò åîõðçñÝôçóçò (Fast Food). Ïé ìáèçôÝò áõôïß åêäçëþíïõí óå ìåãáëýôåñï âáèìü (68,5%-67,3%) ôçí áðáîßá ôïõò óå ãåýìáôá åêôüò óðéôéïý êáé óå Fast Food. ÁíáöïñéêÜ ìå ôç óõ÷íüôçôá êáôáíÜëùóçò óïêïëáôïý÷ùí ðñïúüíôùí, äåí öáßíåôáé íá õðÜñ÷åé ïõóéáóôéêÞ äéáöïñÜ áíÜìåóá óôïõò ìáèçôÝò ôùí ôñéþí ó÷ïëåßùí. 6. Ó÷åôéêÜ ìå ôçí åíçìÝñùóç ôùí ìáèçôþí óå èÝìáôá äéáôñïöÞò êáé ôçí áõôïáîéïëüãçóç ôùí äéáôñïöéêþí ôïõò ãíþóåùí, ðáñÜ ôéò õöéóôÜìåíåò äéáöïñÝò åíçìÝñùóçò (94,8% ìáèçôÝò Ôñßãëéáò, 73,5% ðåñßðïõ ìáèçôÝò ôùí äõï Üëëùí ó÷ïëåßùí), ïé ìáèçôÝò êáé ôùí ôñéþí ó÷ïëåßùí åðéèõìïýí óå Ýíá ðïóïóôü 83% ðåñßðïõ ðåñéóóüôåñç ðëçñïöüñçóç óå èÝìáôá äéáôñïöÞò. ÅðéðëÝïí ïé ìáèçôÝò ôïõ ó÷ïëåßïõ ôçò Ôñßãëéáò áíáãíùñßæïõí óå ìåãáëýôåñï âáèìü (44,8%) üôé ï ôñüðïò äéáôñïöÞò ôïõò äåí åßíáé õãéåéíüò êáé äçëþíïõí åðßóçò óå ðïóïóôü 59% üôé ðñÝðåé íá áëëÜîåé (Ýíáíôé 39,1% êáé 35,7% ôùí Üëëùí äýï ó÷ïëåßùí)7. ÔÝëïò, áíáöïñéêÜ ìå ôéò ðçãÝò åíçìÝñùóçò óå èÝìáôá äéáôñïöÞò, öáßíåôáé ç óáöÞò åðéññïÞ ôïõ ðñïãñÜììáôïò äéáôñïöéêÞò áãùãÞò óôïõò ìáèçôÝò ôïõ ó÷ïëåßïõ ôçò Ôñßãëéáò. Ïé ìáèçôÝò áõôïß áíáöÝñïõí óáí ðñþôç ðçãÞ ðëçñïöüñçóçò (92%) ôï ó÷ïëåßï, åíþ ïé ìáèçôÝò ôùí ó÷ïëåßùí åëÝã-

÷ïõ äçëþíïõí óáí ðñþôç ðçãÞ åíçìÝñùóçò ôïõò ãïíåßò ôïõò (68% êáé 72% áíôßóôïé÷á). Ïëïêëçñþíïíôáò êáíåßò ôç óõæÞôçóç ãýñù áðü ôá óõìðåñÜóìáôá ôçò ðáñïýóçò Ýñåõíáò êáôáëÞãåé óôá åîÞò. Ãéá ôéò åñåõíçèåßóåò ìáèçôéêÝò êïéíüôçôåò ôùí ôñéþí áíùôÝñù ó÷ïëåßùí õößóôáôáé óáöþò ðñüâëçìá õðåñâÜëëïíôïò âÜñïõò Þ êáé ðá÷õóáñêßáò. Ç åöáñìïãÞ ðñïãñÜììáôïò äéáôñïöéêÞò áãùãÞò óôï ó÷ïëåßï ôçò Ôñßãëéáò êáôÝäåéîå ôïí èåôéêü ñüëï ôïõ óôï åðßðåäï äéáôñïöéêþí ãíþóåùí ôùí ìáèçôþí êáé óôçí åíôïíüôåñç óõíåéäçôïðïßçóç üôé ïé äéáôñïöéêÝò ôïõò óõíÞèåéåò äåí áíôáðïêñßíïíôáé óôá ðñüôõðá õãéåéíÞò äéáôñïöÞò. Ôï ãåãïíüò åðßóçò üôé ïé ìáèçôÝò êáé ôùí ôñéþí ó÷ïëåßùí åðéèõìïýí ðåñéóóüôåñç ðëçñïöüñçóç óå èÝìáôá äéáôñïöÞò, êáèéóôÜ ðñüäçëç êáé åðéôáêôéêÞ ôçí áíÜãêç ãéá ïõóéáóôéêüôåñç åíçìÝñùóç óå ôÝôïéáò öýóåùò èÝìáôá. Ç åöáñìïãÞ ðñïãñáììÜôùí äéáôñïöéêÞò áãùãÞò åíôáãìÝíùí óôá ó÷ïëéêÜ ðñïãñÜììáôá ìðïñåß íá ðñïÜãåé óçìáíôéêÜ ôéò äéáôñïöéêÝò ãíþóåéò ôùí ìáèçôþí êáé íá ôïõò ïäçãÞóåé óå ìéá ðéï óôáèåñÞ êáé ìüíéìç õéïèÝôçóç õãéåéíüôåñùí äéáôñïöéêþí ðñïôýðùí, óôÜóåùí êáé óõìðåñéöïñþí. Ç óõìâïëÞ ôçò åöáñìïãÞò ôÝôïéùí ðñïãñáììÜôùí èá êáôáóôåß ïõóéáóôéêüôåñç áí ãßíåé ìå ôçí åíåñãü êáé áãáóôÞ óýìðñáîç äáóêÜëùí, ãïíÝùí, ëåéôïõñãþí õãåßáò êáé ü÷é ìüíï, áöïý óÞìåñá åßíáé áðüëõôá ôåêìçñéùìÝíï üôé ç ðá÷õóáñêßá áðïôåëåß íüóï êáé óçìáíôéêü ðñüâëçìá äçìüóéáò õãåßáò, ç äå õéïèÝôçóç õãéåéíÞò äéáôñïöÞò óõíéóôÜ ðñïóôáôåõôéêü ðáñÜãïíôá óôçí åìöÜíéóç ðïëëþí ÷ñüíéùí íïóçìÜôùí.

Âéâëéïãñáößá 1. J.C. Seidell, K.M. Flegal. Assessing obesity: classification and epidemiology. Br. Med. Bull. 1997, 53:238-252. 2. Á. Ôñé÷ïðïýëïõ êáé Ä. Ôñé÷üðïõëïò. ÐñïëçðôéêÞ ÉáôñéêÞ, Åêäüóåéò Ãñ. ÐáñéóéÜíïò, ÁèÞíá 1986, 159-191. 3. A. Keys. Seven countries. A multivariate analysis of death and coronaiy heart diseases. Cambridge, Harvard University Press, 1980. 4. A. Keys, A. Menotti, C. Aravanis, et al. The seven countries study: 2289 deaths in 15 years. Prev. Med. 1984, 13:141-154. 159

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5. W.C. Willert, F. Sacks, A. Trichopoulou, G. Drescher, A. Ferro-Luzzi, E. Helsing et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am. J. Clin. Nutr. 1995, 61:14021406. 6. D. Kromhourt, A. Keys, C. Aravanis, R. Buzina, F. Filanza, A. Jansen et al. Food composition patterns in the nineteen sixties in seven countries. Am. J. Clin. Nutr. 1989, 49:889-894. 7. A. Trichopoulou, K. Katsoujanni, C. Gnardellis. The traditional Greek diet. Eur. J. Clin. Nutr. 1993, 47 (Suppl l):76-81. 8. A. Trichopoulou, P. Efstathiadis. Changes in nutrition patterns and health indicators at the population level in Greece. Am. J. Clin. Nutr. 1989, 49:1042-1047. 9. A. Trichopoulou, N. Toupadaki, A. Tzonou, K. Katsoujanni, O. Manousos, E. Kada et al. The macronutrient composition of the Greek diet; estimates deriving from six case-control studies. Fur. J. Clin. Nutr. 1993, 47:549-558. 10. Á. ÑåóâÜíç, Ë. ÔæÜëá, Ã. Ôïõëïýìç, Á. Ôñé÷ïðïýëïõ, Á. ×áôæÜêçò, Ê. ÊáôóïõãéÜííç. Áíáëïãßá èåñìßäùí áðü èñåðôéêÝò ïõóßåò óå ïìÜäåò ðáéäéþí ôïõ åëëçíéêïý ðëçèõóìïý. ÉáôñéêÞ 1997, 71:270-273. 11. Á. ÊáöÜôïò, Ã. Ðáíáãéùôáêüðïõëïò, Í. ÔñÜêá, E. Wynder, Ó. ÐáíôåëÜêçò, Ó. ÄïîéÜäçò. Ðñïäéáèåóéêïß ðáñÜãïíôåò êáñäéáããåéáêþí íïóçìÜôùí óå ðáéäéÜ çëéêßáò 13 ÷ñüíùí. ÉáôñéêÞ 1981, 40:113-121. 12. C. Aravanis, R.P. Melsing, N. Karalias, B. Christopoulou, A. Kafatos, M.B. Katan Serum lipids, apoproteins and nutrient intakes in rural Cretan boys consuming high -olive oil- diet. J. Clin. Epidemiol. 1988, 41:1117-1123. 13. Å. ËõäÜêç, Á. ÊáöÜôïò, Ä. ÊïõíÜëç, É. ÁðïóôïëÜêç. ÄéáéôçôéêÝò óõíÞèåéåò, öõóéêÞ äñáóôçñéüôçôá êáé ëéðßäéá ïñïý ðá÷ýóáñêùí ðáéäéþí çëéêßáò 12-14 ÷ñüíùí. ÐáéäéáôñéêÞ 1994, 57:330343. 14. G. Papaevangelou, C. Tsibos. Cardiovascular diseases mortality in Greece. Trends and international comparisons. Mat. Med. Greca 1982, 239250. 15. Ä. Ôñé÷üðïõëïò, I. Óêáëêßäçò, Á. Ôñé÷ïðïýëïõ,

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Ôüìïò 13, Ôåý÷ïò 3, 2001

Áéêáôåñßíç È. Ãáôïðïýëïõ êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ THE SECOND AWARDED FREESTANDING PAPER Primary Heatlh Care, Volume 13, Number 3, 161-165, 2001 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 13, Ôåý÷ïò 3, 161-165, 2001

ÌÝôñçóç äåéêôþí çðáôßôéäïò Â óå ôñåéò ïìÜäåò: ðïëõìåôáããéæüìåíïõò - åñãáæüìåíïõò óå äçìüóéï íïóïêïìåßï êñáôïýìåíïõò êëåéóôÞò öõëáêÞò Áéê.È. Ãáôïðïýëïõ1,3, Ã.É. Ôóßñïò2, Ðáí.Å. Âïúëá1, ×.Á. Âüóóïõ1, Ã.×. ÊáñäÜôïò1, Ð.Ê. Áèáíáóüðïõëïò3, Ä.Í. Áäáìüðïõëïò4

Ðåñßëçøç Óêïðüò: ï ïñïëïãéêüò Ýëåã÷ïò ôçò çðáôßôéäáò Â óôéò ôñåéò áíùôÝñù ïìÜäåò èåùñïýìåíåò õøçëïý êéíäýíïõ êáé ç äéáìüñöùóç óõìðåñáóìÜôùí ãéá ôç äçìüóéá õãåßá, ìåôÜ óýãêñéóç áðïôåëåóìÜôùí. Õëéêü: éóÜñéèìïé ïñïß áßìáôïò áðü: á) 60 ðïëõìåôáããéæüìåíïõò ëüãù â-ÌåóïãåéáêÞò Áíáéìßáò óôï ÊáñáìáíäÜíåéï Íïóïêïìåßï Ðáßäùí Ðáôñþí â) 219 åñãáæïìÝíïõò óôï Ðåñéöåñåéáêü Íïóïêïìåßï "¢ãéïò ÁíäñÝáò" Ðáôñþí ã) 477 êñáôïõìÝíïõò ôçò ÖõëáêÞò "Áãßïõ ÓôåöÜíïõ" Ðáôñþí, ïé ïðïßïé åëÝã÷èçóáí ãéá ôïõò äåßêôåò ôçò çðáôßôéäïò Â: HbsAg, Anti-S êáé Anti-Core. ÁðïôåëÝóìáôá: öïñåßò ôïõ HbsAg åõñÝèçóáí 0%, 5,48% êáé 9,43% áíôßóôïé÷á óôïõò ðïëõìåôáããéæïìÝíïõò, óôïõò åñãáæïìÝíïõò óå Íïóïêïìåßï êáé óôïõò êñáôïõìÝíïõò. Ôá anti-S êáé anti-Core äéáìïñöþèçóáí ùò êÜôùèé: Äåßêôåò Çð. Â

HbsAg (+) Anti-S (+) Anti-Core (+)

Ðïëõìåôáã. ÌåóïãåéáêÞò Áíáéìßáò 60 0% 100% 30,5%

Åñãáæüìåíïé Äçì. Íïóïêïìåßïõ 219 5,48% 16,89% 16,44%

Êñáôïýìåíïé KëåéóôÞò ÖõëáêÞò 477 9,43% 34,17% 43,61%

ÓõìðåñÜóìáôá: ôï åõ÷Üñéóôï 0% HbsAg êáé ôï 100% ôùí ðñïóôáôåõôéêþí áíôéóùìÜôùí Anti-S (+) óôïõò ðïëõìåôáããéæïìÝíïõò (ÌåóïãåéáêÞ Áíáéìßá) ïöåßëåôáé óôïõò õãéåßò ÅèåëïíôÝò Áéìïäüôåò, óôïí Ýëåã÷ï ôùí öéáëþí áßìáôïò êáé óôï ðéóôü ðñüãñáììá åìâïëéáóìïý ìå åðáíáëçðôéêÝò (áíáëüãùò ôßôëïõ) äüóåéò. Ôï 5,48% HbsAg (+) åñãáæïìÝíùí Äçìïóßïõ Íïóïêïìåßïõ êáé ôï 9,43% êñáôïõìÝíùí óõìâáäßæïõí ìå áíÜëïãá åõñÞìáôá ôïõ åëëáäéêïý ÷þñïõ. Ó÷åôßæïíôáé ìå åðáããåëìáôéêÞ åíáó÷üëçóç ôùí ðñþôùí - óõã÷ñùôéóìü êáé ÷ñÞóç åíäïöëåâßùí ôùí äåõôÝñùí. Ôá õøçëÜ (+) Anti-Core õðïäçëïýí êñõøéìüëõíóç êõñßùò óôïõò êñáôïõìÝíïõò, äåýôåñïí óôïõò ðïëõìåôáããéæïìÝíïõò êáé ëéãüôåñï óôïõò åðáããåëìáôßåò Äçìïóßïõ Íïóïêïìåßïõ. Ôá (+) Anti-S 16,89% êáé 34,17% óôïõò åñãáæïìÝíïõò Äçìïóßïõ Íïóïêïìåßïõ êáé óôïõò êñáôïõìÝíïõò áíôßóôïé÷á ðñïÝñ÷ïíôáé ðëåéïøçöéêÜ áðü êñõøéìüëõíóç. Ùò åê ôïýôïõ êáé ïé äýï áõôÝò ïìÜäåò åôÝèçóáí óå óõíå÷Ýò ðñüãñáììá åìâïëéáóìïý ãéá ôç ìç ðåñáéôÝñù äéáóðïñÜ ôïõ HBV (ìåôÜ åìâïëéáóìüí Anti-S åñãáæïìÝíùí Äçì. Íïóïêïìåßïõ: 47,94%). 1

Áéìïäïóßá Êáñáìáíäáíåßïõ Íïó. Ðáßäùí Ðáôñþí, 2ÃåíéêÞ ÉáôñéêÞ Ð.Ð.Ã.Í. Ðáôñþí, 3Ìéêñïâéïëïãéêüí Åñã. Ðåñ. Íïó. Ðáôñþí "¢ãéïò ÁíäñÝáò", 4Éáôñåßï ÊëåéóôÞò ÖõëáêÞò "Áãßïõ ÓôåöÜíïõ" Ðáôñþí

ÅéóáãùãÞ Ç çðáôßôéäá Â ïöåßëåôáé óôïí éü ôçò çðáôßôéäïò Â (HBV-Hepatitis B Virus), ï ïðïßïò åßíáé Ýíáò ìéêñüò DNA-éüò ôçò ïéêïãÝíåéáò ôùí Hepadnavividae êáëõðôüìåíïò áðü ðñùôåúíéêü êÜëõìá (coat)1. ÐïëëáðëáóéÜæåôáé óôïí ðõñÞíá ôùí çðáôïêõôôÜñùí ôïõ îåíéóôÞ ìå ìç÷áíéóìü áñêåôÜ ðáñåìöåñÞ ðñïò áõôü ôùí ñåôñïúþí2,3. Ç çðáôßôéäá Â áðïôåëåß óïâáñü ðñüâëçìá äçìïóßáò õãåßáò ó' üëï ôïí êüóìï4. Ôá ÊÝíôñá ÅëÝã÷ïõ Íüóùí (Centers Desease Control CDC) õðïëïãßæïõí üôé êáôÜ ðñïóÝããéóç 200-300 åêáôïììýñéá Üíèñùðïé áíÜ ôïí êüóìï åßíáé åðéìÝíïíôåò öïñåßò (persistËÝîåéò êëåéäéÜ: Ïñïëïãéêïß äåßêôåò, Çðáôßôéäá Â, Êñõøéìüëõíóç, Åìâïëéáóìüò ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 13ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (Ñüäïò, 8-22 Áðñéëßïõ 2001) êáé Ýëáâå Ýðáéíï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíç áëëçëïãñáößáò: Áéêáôåñßíç Ãáôïðïýëïõ, Äéåõèýíôñéá Áéìïäïóßáò Êáñáìáíäáíåßïõ Íïó. Ðáßäùí Ðáôñþí, Ðïõêåâßë 9 & Ìáéæþíïò, 262 23 ÐÜôñá, Ô.È. 1182, Ôçë. (061) 624 269, 635 106 161

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Áéêáôåñßíç È. Ãáôïðïýëïõ êáé óõí.

Measuring of Hepatitis B indexes in three groups: multitransfusioners, public hospital employees, and prisoners in closed prison E. Gatopoulou, G. Tsiros, P. Voila, Ch. Vossou, G. Kardatos, P. Athanasopoulos, D. Adamopoulos Summary Aim: The serological examination of Hep.B in the above three groups which are considered as "high risk groups" and formation of the results. Material: An equal in number of blood serum samples: from 60 multitransfusioners- carriers of a-Thalasaemia Major from the "Karamandanion" Hospital in Patras- from 219 emplo ees from the "Saint Andreas" Hospital in Patras-and from 477 prisoners of the "Saint Stefanos" Closed Prison in Patras, who had been examinnated for HbsAg, Anti-S and Anti-Core of Hep.B. Method: Anosoenzymic (ELISA- IMX) for examination of the surface antigen Hbs Ag and surface antibodies Anti-S and nuclear antibodies Anti-Core. Results: Carriers of Hb s Ag were founded to be 0%, 5,48% and 9,43% respectively for the multitransfusioners, the Public Hospital employees and the Prisoners. Conclusions: The pleasing 0% of Hbs Ag (+) and the 100% of protecting antibodies Anti-S (+) in the multitransfusioners' group (a-Thalasaemia Major) is due to the Healthy Volunteer Blood Donors, the examination of the blood bottles and the exact programme of vaccination with repeated (depending on the title) doses. The 5,48% Hbs Ag (+) of the Public Hospital employees and 9,43% of the Prisoners goes hand to hand with other proportional findings in Greece- they have relation with professional activity of the first and assosiation and use of intravenous by the seconds. The high (+) Anti-Core shows hidden infection mainly for the prisoners, secondly for the multitransfusioners and less for the Public Hospital employees. The (+) Anti-S 16,89% and 34,15% of the Public Hospital employees and prisoners, correspondingly, in the majority, comes from the hidden infection. Both of the groups were set in continuing programmes of vaccination for no- further propagation of HBV (After vaccination the Anti-S of employed in Public Hospital were 47,94). Key words: Serum indexes, Hepatitis B, hidden infection, vaccination.

ent carriers) ôïõ éïý ôçò çðáôßôéäïò Â, áðïôåëþíôáò Ýôóé æùíôáíÞ äåîáìåíÞ ìåôÜäïóçò ôïõ éïý óå Üëëá Üôïìá. Åðßóçò óôá ÊÝíôñá ÅëÝã÷ïõ Íüóùí (CDC) õðïëïãßæïõí, üôé êÜèå ÷ñüíï óôéò Ç.Ð.Á. óõìâáßíïõí 4.000 èÜíáôïé ëüãù êßññùóçò ôïõ Þðáôïò êáé 1.000 èÜíáôïé ëüãù çðáôïêõôôáñéêïý êáñêßíïõ ìåôáîý áôüìùí ìå ÷ñüíéá HBV-ëïßìùîç. Óå ÷þñåò ìÜëéóôá üðïõ åíäçìåß ï HBV, ç óõ÷íüôçôá èáíÜôùí ëüãù áõôþí ôùí åðéðëïêþí åßíáé êáôÜ ðïëý õøçëüôåñç5. Ç çðáôßôéäá Â èåùñåßôáé åðßóçò ùò ôï ðëÝïí óïâáñü åðáããåëìáôéêü íüóçìá: óôçí Åõñþðç, åíþ êÜèå ÷ñüíï 1.000.000 Üíèñùðïé ìïëýíïíôáé áðü ôïí éü ôçò çðáôßôéäïò Â, ïé 18.000 åßíáé åñãáæüìåíïé óå ÷þñïõò õãåßáò, áðü ôïõò ïðïßïõò ÷Üíïíôáé åôçóßùò 234.180 çìÝñåò åñãáóßáò. Åðßóçò, ìåëÝôç ç ïðïßá ðñáãìáôïðïéÞèçêå óôï ÂÝëãéï ãéá ôçí Ðáãêüóìéá ÏñãÜíùóç Õãåßáò (Ð.Ï.Õ.), Ýäåéîå üôé êÜèå ÷ñüíï ðåèáßíïõí 300 åñãáæüìåíïé óå åðáããÝëìáôá õãåßáò ùò áðïôÝëåóìá ìüëõíóçò áðü ôïí HBV. Ïé èÜíáôïé áõôïß 162

èá åß÷áí áðïöåõ÷èåß ìå ôïí åìâïëéáóìü áõôþí ôùí áôüìùí Ýíáíôé ôïõ éïý ôçò çðáôßôéäïò Â. Óêïðüò ôçò ðáñïýóçò åñãáóßáò Þôáí íá äéåêðåñáéùèåß ï ïñïëïãéêüò Ýëåã÷ïò ôçò çðáôßôéäïò Â óå ôñåéò ïìÜäåò èåùñïýìåíåò õøçëïý êéíäýíïõ: á) óå ðïëõìåôáããéæüìåíïõò, ëüãù âÌåóïãåéáêÞò Áíáéìßáò â) óå åñãáæïìÝíïõò Äçìïóßïõ Íïóïêïìåßïõ (Ðåñéöåñåéáêïý) ã) óå êñáôïõìÝíïõò êëåéóôÞò öõëáêÞò, êáèþò êáé ç äéáìüñöùóç óõìðåñáóìÜôùí ãéá ôç äçìüóéá õãåßá, ìåôÜ óýãêñéóç ôùí áðïôåëåóìÜôùí.

Ðëçèõóìüò ìåëÝôçò êáé ÌÝèïäïé

Ùò õëéêü å÷ñçóéìïðïéÞèçóáí éóÜñéèìïé ïñïß áßìáôïò áðü: á) 60 ðïëõìåôáããéæüìåíïõò ëüãù â-ÌåóïãåéáêÞò Áíáéìßáò óôï ÊáñáìáíäÜíåéï Íïóïêïìåßï Ðáßäùí Ðáôñþí â) 219 åñãáæïìÝíïõò óôï Ðåñéöåñåéáêü Íïóïêïìåßï "¢ãéïò ÁíäñÝáò" Ðáôñþí ã) 477 êñáôïõìÝíïõò ôçò ÖõëáêÞò "Áãßïõ ÓôåöÜíïõ" Ðáôñþí, ïé ïðïßïé åëÝã÷èçóáí ãéá ôïõò äåßêôåò ôçò çðáôßôéäïò Â: HbsAg, Anti-S êáé Anti-Core. Ç ìÝèïäïò ðïõ ÷ñçóéìïðïéÞèçêå ãéá ôéò ìåôñÞóåéò Þôáí áíïóïåíæõìéêÞ (ELISA-IMX), ìå åéäéêüôçôá ãéá ôïí Ýëåã÷ï ôïõ áíôéãüíïõ åðéöÜíåéáò HbsAg 99,65% êáé åõáéóèçóßá 0,43, ãéá ôïí Ýëåã÷ï ôùí áíôéóùìÜôùí åðéöáíåßáò Anti-S ç åéäéêüôçôá Þôáí 99,4% êáé ç åõáéóèçóßá 1u/l êáé ôÝëïò ãéá ôïí Ýëåã÷ï ôùí áíôéóùìÜôùí ôïõ ðõñÞíïò Anti-Core IgG ç åéäéêüôçôá Þôáí 99,26% êáé ç åõáéóèçóßá 1u/l.

ÁðïôåëÝóìáôá Ç åñãáóßá ìáò áõôÞ åß÷å ùò áðïôÝëåóìá íá åõñåèïýí öïñåßò ôïõ HbsAg 0%, 5,48% êáé 9,43% áíôßóôïé÷á óôïõò ðïëõìåôáããéæïìÝíïõò, óôïõò åñãáæïìÝíïõò óå Íïóïêïìåßï êáé óôïõò êñáôïõìÝíïõò. Ôá anti-S êáé anti-Core äéáìïñöþèçóáí üðùò öáßíïíôáé óôïí Ðßíáêá 1. ÄåäïìÝíïõ üôé óôçí ÅëëÜäá ç çðáôßôéäá Â

Ôüìïò 13, Ôåý÷ïò 3, 2001

Áéêáôåñßíç È. Ãáôïðïýëïõ êáé óõí. Ðßíáêáò 1. Äéáìüñöùóç áðïôåëåóìÜôùí Äåßêôåò Çð. Â

HbsAg (+) Anti-S (+) Anti-Core (+)

Ðïëõìåôáã. ÌåóïãåéáêÞò Áíáéìßáò

Åñãáæüìåíïé Äçì. Íïóïêïìåßïõ

Êñáôïýìåíïé KëåéóôÞò ÖõëáêÞò

60 0% 100% 30,5%

219 5,48% 16,89% 16,44%

477 9,43% 34,17% 43,61%

åßíáé óõ÷íüôåñç áðü üôé óôéò Üëëåò åõñùðáúêÝò ÷þñåò êáé ï åðéðïëáóìüò ôùí öïñÝùí ôïõ HbsAg óôçí ðáôñßäá ìáò ðñïóåããßæåé ôï 5% (ìå åõñýôåñá üñéá ôï 2-6%), åßíáé ïñáôüò ï êßíäõíïò íá Ý÷ïõí ìåãáëýôåñç ðéèáíüôçôá ìüëõíóçò áðü ôïí HBV ïé åñãáæüìåíïé óå åðáããÝëìáôá õãåßáò óôç ÷þñá ìáò, áð' üôé ïé áíôßóôïé÷ïé åðáããåëìáôßåò óôçí Åõñþðç. Åßíáé óçìáíôéêÜ ôá åõñåèÝíôá ðïóïóôÜ: 5,48% ôùí åñãáæïìÝíùí óôï Ðåñéöåñåéáêü Íïóïêïìåßï êáé 9,43% ôùí êñáôïõìÝíùí óôç ÖõëáêÞ, ðïóïóôÜ ðïõ õðïäçëþíïõí ôïõò öïñåßò ôïõ åðéöáíåéáêïý áíôéãüíïõ HbsAg(+). Ôï 5,48% ìåí åßíáé óôï áíþôåñï üñéï ôïõ ðïóïóôïý öïñÝùí ôïõ éïý çð. Â HbsAg(+) óôï ãåíéêü ðëçèõóìü ôïõ óõãêåêñéìÝíïõ Íïìïý (2-6%), ôï 9,43% äå õðåñâáßíåé áñêåôÜ ôï áíþôåñï üñéï áõôïý. Ðñï åìâïëéáóìïý ðïóïóôü ìüíï 16,89% áðü ôïõò åñãáæïìÝíïõò óå Íïóïêïìåßï åß÷áí èåôéêü ôï Anti-S (êõñßùò áðü êñõøéìüëõíóç). Êáôüðéí åìâïëéáóìïý áõôü áíÞëèå óôï 47,94% êáé ìáæß ìå ôï êáôüðéí åìâïëéáóìïý 100% ôùí èåôéêþí Anti-S óôá ðïëõìåôáããéæüìåíá Üôïìá (Â-ÌåóïãåéáêÞ Áíáéìßá), áðïäåéêíýåé ðùò ôï åìâüëéï êáôÜ ôïõ HBV äéáèÝôåé êáé áíôéãïíéêüôçôá êáé áðïôåëåóìáôéêüôçôá. Ôá áðïôåëÝóìáôá áõôÞò ôçò åñãáóßáò, ùò ðñïò ôçí éêáíïðïéçôéêÞ, áíôéóùìáôéêÞ áðüêñéóç, óõìðëçñþíïíôáé ìå ôéò äéáðéóôþóåéò ôïõ â' åðáíåëÝã÷ïõ ìåôÜ ôïí åìâïëéáóìü (12 ìÞíåò ìåôÜ ôçí 3ç äüóç ôïõ åìâïëßïõ) êáé ïé ïðïßåò óõíßóôáíôáé óôï üôé: á) Ïé ìÝãéóôïé ôßôëïé Anti-S > 1000 Iu/l êáé ïé ðñïóôáôåõôéêïß ôßôëïé Anti-S > 250 Iu/l, åëÜ÷éóôá ìåéþíïíôáé ìåôÜ ðÜñïäï åíüò Ýôïõò áðü ðëÞñç åìâïëéáóìü. â) Õøçëüôåñïé ôßôëïé áíôéóùìÜôùí ðáñÝ÷ïõí ðñïóôáóßá ãéá ìåãáëýôåñï ÷ñïíéêü äéÜóôçìá.

ÓõæÞôçóç - ÓõìðåñÜóìáôá ÓõíïðôéêÜ áíáöÝñïõìå üôé ôá áíôéãüíá ôïõ HBV ôá áíé÷íåõüìåíá óôï áßìá åßíáé: ôï áíôéãüíï åðéöáíåßáò ôïõ éïý ôçò çðáôßôéäïò Â HbsAg (Hepatitis B surface antigen), ôï ðáëáéüôåñá êáëïýìåíï "Áõóôñáëéáíü áíôéãüíï", ç áíß÷íåõóç ôïõ ïðïßïõ ÷áñáêôçñßæåé ôïõò öïñåßò ôïõ HBV êáé ôï HbeAg (áíôéãüíï e ôïõ HBV), ôï ïðïßï áðïôåëåß äåßêôç åíåñãïý ðïëëáðëáóéáóìïý ôïõ éïý êáé õøçëÞò ìïëõóìáôéêüôçôïò ôïõ ðñïóâëçèÝíôïò áôüìïõ8. Ç ðáñáìïíÞ ôïõ HbsAg (üóï êáé ôïõ HbeAg) Üíù ôùí 6 ìçíþí óôï áßìá åßíáé äåßãìá ÷ñüíéáò ëïßìùîçò áðü HBV9. Ôá áíôéóþìáôá ðïõ áíé÷íåýïíôáé óôï áßìá åßíáé ôá Anti-S (Ýíáíôé ôïõ HbsAg), ôï AntiCore (Ýíáíôé ôïõ HbcAg) êáé ôï Anti-e (Ýíáíôé ôïõ HbeAg)10. Ôï áíôßóùìá Hbc (Anti-Hbc) ìðïñåß íá åßíáé: • Ôýðïõ IgM-äåßêôçò ðñüóöáôçò ëïßìùîçò11 Äõíáôüí íá åßíáé ï ìüíïò èåôéêüò äåßêôçò ëïßìùîçò áðü çðáôßôéäá-Â êáôÜ ôçí ðåñßïäï ôçò öÜóçò "ðáñáèýñïõ", êáôÜ ôçí ïðïßá äåí áíé÷íåýåôáé ìåí ôï HbsAg, áëëÜ êáé äåí Ý÷ïõí åìöáíéóèåß äå áêüìá ôá áíôéóþìáôá Anti-Hbs. • Ôýðïõ IgG- äåßêôçò ðáëáéÜò Þ ÷ñüíéáò ëïßìùîçò Ï êáèïñéóìüò ôïõ ôýðïõ ôïõ Anti-Core (IgM Þ IgG) ìáò åðéôñÝðåé ôï ÷ñïíéêü ðñïóäéïñéóìü ôçò åðáöÞò ìå ôïí HBV (ìüëõíóç) êáé ôçò ðéèáíÞò íüóïõ. Ôá áíôßóùìá Hbe (Anti Hbe) åßíáé ôï äåýôåñï ÷ñïíéêÜ áíé÷íåõüìåíï áíôßóùìá, ç åìöÜíéóç ôïõ ïðïßïõ äçëïß åîáöÜíéóç ôïõ Hbe Ag áðü ôïí ïñü (ùò êáé ôïõ HBV DNA) êáé åëÜôôùóç Þ äéáêïðÞ ôïõ ðïëëáðëáóéáóìïý ôïõ HBV12,13. ÔÝëïò, ôï áíôßóùìá Hbs (Anti-S) åßíáé ôï ôåëåõôáßï áíôßóùìá, ôï ïðïßï äçìéïõñãåßôáé, åìöáíéæüìåíï óôç öÜóç ôçò áíÜññùóçò, ãé' áõôü 163

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

êáé ç ðáñïõóßá ôïõ åßíáé óõíþíõìç ôçò áíïóßáò. Ôá êõêëïöïñïýíôá ó÷Þìáôá åìâïëéáóìïý, åßíáé: á) Áõôü ôçò óõíÞèïõò áíïóïðïßçóçò (0, 1, 6 ìÞíåò), ìå ôï ïðïßï åìâïëéÜóèçêáí ïé ôñåéò ïìÜäåò ôçò ðáñïýóçò åñãáóßáò êáé â) Ôï ôá÷åßáò áíïóïðïßçóçò (0,1, 2+12 ìÞíåò)14. Ôï ÷ñçóéìïðïéïýìåíï åìâüëéï åßíáé áóöáëÝò, áðü áíáóõíäõáóìÝíï DNA (ðáñÜãåôáé áðü ôçí êáëëéÝñãåéá ãåíåôéêÜ ðáñá÷èÝíôùí êõôôÜñùí æýìçò, üðïõ Ý÷åé åíóùìáôùèåß ôï ó÷åôéêü ãïíßäéï ôïõ áíôéãüíïõ åðéöáíåßáò ôïõ éïý ôçò çðáôßôéäïò Â, ðáñÝ÷åé êåêáèáñìÝíï áíôéãüíï åðéöáíåßáò ôïõ éïý êáé åßíáé êáëÜ áíåêôü). EêÜóôç äüóç åìâïëßïõ ðåñéåß÷å 20 mgr áíôéãïíéêÞò ðñùôåÀíçò óå üãêï 1ml åíáéùñÞìáôïò, ðïóüôçò åðáñêÞò ãéá åíçëßêïõò êáé ç ÷ïñÞãçóç åãÝíåôï åíäïìõúêþò, êáôÜ ðñïôßìçóç óôçí ðåñéï÷Þ ôïõ äåëôïåéäïýò ìõüò. Ùò óõìðÝñáóìá ëïéðüí ðñÝðåé ðñùôáñ÷éêÜ íá ôïíßóïõìå ôï åõ÷Üñéóôï 0% HbsAg êáé ôï 100% ôçò ýðáñîçò ôùí èåôéêþí ðñïóôáôåõôéêþí áíôéóùìÜôùí Anti-S óôïõò ðïëõìåôáããéæïìÝíïõò ôçò Â-ÌåóïãåéáêÞò Áíáéìßáò, ðïõ ïöåßëïíôáé ôï ìåí ìçäåíéêü ðïóïóôü öïñÝùí HbsAg: á) óôïõò óõóôçìáôéêïýò õãéåßò ÅèåëïíôÝò Áéìïäüôåò, ãéá ôïõò ïðïßïõò êñáôåßôáé åéäéêü ðñùôüêïëëï, â) óôïí óõóôçìáôéêü Ýëåã÷ï ôùí öéáëþí áßìáôïò ãéá HbsAg êáé Anti-Core ôï äå 100% (+) AntiS: óôï ðéóôü ðñüãñáììá åìâïëéáóìïý ìå åðáíáëçðôéêÝò Þ áíáìíçóôéêÝò (áíáëüãùò ôïõ ôßôëïõ) äüóåéò, ðïõ äéåíåñãåßôáé áðü ôïõò éáôñïýò ôçò ÌïíÜäáò Íïóçëåßáò ÌåóïãåéáêÞò Áíáéìßáò ôïõ Êáñáìáíäáíåßïõ óå óõíåñãáóßá ìå ôï ÅñãáóôÞñéïí Áéìïäïóßáò Êáñáìáíäáíåßïõ. Ôï 5,48% ôùí èåôéêþí ùò ðñïò ôï HbsAg åñãáæïìÝíùí Äçìïóßïõ Íïóïêïìåßïõ êáé ôï 9,43% èåôéêþí åðßóçò ãéá ôï HbsAg êñáôïõìÝíùí óõìâáäßæïõí ìå áíÜëïãá åõñÞìáôá Üëëùí Íïóïêïìåßùí êáé Üëëùí Óùöñïíéóôéêþí ÊáôáóôçìÜôùí ôïõ Åëëáäéêïý ÷þñïõ. ó÷åôßæïíôáé ìå åðáããåëìáôéêÞ åíáó÷üëçóç ôùí ðñþôùí êáé óõã÷ñùôéóìü êáé ÷ñÞóç åíäïöëåâßùí ôùí äåõôÝñùí. Ôá õøçëÜ èåôéêÜ Anti-Core õðïäçëïýí êñõøéìüëõíóç êõñßùò óôïõò êñáôïõìÝíïõò, äåýôåñïí óôïõò ðïëõìåôáããéæïìÝíïõò êáé ëéãüôåñï óôïõò åðáããåëìáôßåò Äçìïóßïõ Íïóïêïìåßïõ. Ôá èåôéêÜ Anti-S 16,89% êáé 34,17% óôïõò åñãáæïìÝíïõò Äçìïóßïõ Íïóïêïìåßïõ êáé óôïõò êñáôïõìÝíïõò áíôßóôïé÷á - ôá åõñåèÝíôá ðñï åöáñìïãÞò ðñïãñÜììáôïò åìâïëéáóìïý - ðñïÝñ164

Áéêáôåñßíç È. Ãáôïðïýëïõ êáé óõí.

÷ïíôáé ðëåéïøçöéêÜ áðü êñõøéìüëõíóç. Ùò åê ôïýôïõ êáé ïé äõï áõôÝò ïìÜäåò åôÝèçóáí óå óõíå÷Ýò ðñüãñáììá åìâïëéáóìïý ãéá ôç ìç ðåñáéôÝñù äéáóðïñÜ ôïõ HBV. ÅðåéäÞ ï ðëçèõóìüò ôùí êñáôïõìÝíùí ôçò ÊëåéóôÞò ÖõëáêÞò "Áãßïõ ÓôåöÜíïõ" Ðáôñþí (üðùò óõìâáßíåé óå üëåò ôéò öõëáêÝò) äåí åßíáé óôáèåñüò ùò ðñïò ôçí áñéèìçôéêÞ ðïóüôçôá áëëÜ êáé ôç óýíèåóç áõôïý, ðÝñáí åíüò ìéêñïý ÷ñïíéêïý äéáóôÞìáôïò, ëüãù óõíå÷þí ìåôáãùãþí äåí Þôáí áðüëõôá åöéêôüò ï óõóôçìáôéêüò åðáíÝëåã÷ïò åðß ôçò éäßáò áñ÷éêÞò ðëçèõóìéáêÞò ïìÜäïò ôùí êñáôïõìÝíùí ìåôÜ êáé êáôÜ ôçí åöáñìïãÞ ôïõ ðñïãñÜììáôïò åìâïëéáóìïý. ÏðùóäÞðïôå Ýóôù êáé óå áõôüí ôï ñåõóôü ðëçèõóìü êáé ôùí åîåñ÷ïìÝíùí ðñïò Üëëåò öõëáêÝò êáé ôùí åéóåñ÷ïìÝíùí åß÷áìå óáöÞ Üíïäï ôùí èåôéêþí Anti-S ìåôÜ ôïõò åìâïëéáóìïýò. ÁíôéèÝôùò, ôï óôáèåñü ôçò ðëçèõóìéáêÞò ïìÜäïò ôùí åñãáæïìÝíùí óôï Äçìüóéï Íïóïêïìåßï (Ðåñéöåñåéáêü Ãåíéêü Íïó/ìåßï Ðáôñþí "¢ãéïò ÁíäñÝáò") ìáò åðéôñÝðåé íá äþóïõìå óôç äçìïóéüôçôá ôï áêñéâÝò ðïóïóôü èåôéêþí Anti-S ìåôÜ åìâïëéáóìïý, ôï ïðïßïí áíÞëèå óôï 47,94%. Åäþ ðñÝðåé íá óçìåéùèåß üìùò üôé ìüíï 75 åäÝ÷èçóáí ôïí ðëÞñç åìâïëéáóìü áðü ôïõò 219 áñ÷éêþò åîåôáóèÝíôåò ôïõ Äçìüóéïõ Íïó/ìåßïõ. Áõôü áðïäåéêíýåé ôçí áíÜãêç óõíå÷ïýò åíçìÝñùóçò ãéá ôç óïâáñüôçôá ôçò íüóïõ êáé ôùí äõíçôéêÜ âáñÝùí, áêüìá êáé èáíáôçöüñùí, åðéðëïêþí ôçò. ¼ëá ôá áíùôÝñù óõãêëßíïõí óôï óõìðÝñáóìá üôé ç ìüíç óôñáôçãéêÞ ðåñéïñéóìïý, áëëÜ êáé åêñßæùóçò ôçò íüóïõ áðü HBV, åßíáé ï ãåíéêüò åìâïëéáóìüò, ï ïðïßïò åßíáé Üêñùò áðáñáßôçôïò éäßùò ãéá ôéò ïìÜäåò õøçëïý êéíäýíïõ.

Âéâëéïãñáößá 1. L.I. Lutwig. Hepatitis B virus. In: Belshe R. B., eds.: Textbook of human Virology. Littleton, Mass, 1984. 2. C. Brechot. Polymerace chain reaction, a new tool for the study of viral infections in hepatology. J Hepatol. 1991, 11:124-129. 3. R.H. Miller, S. Kaneko, C.T. Chung. Compact organization of the hepatitis B virus genome. Hepatology 1989, 9:322-328. 4. L.B. Seeff, R.S. Koff. Evolving concepts of hepatitis B virus infection. Semin Liver Dis. 1986,

Áéêáôåñßíç È. Ãáôïðïýëïõ êáé óõí.

6:11. 5. D. Zakim, T.D. Boyer, eds. Hepatology-A Textbook of Liver Diseases, 1996. 6. J.Ç. Hoofnagle. Type A and type B hepatitis. Lab. Med. 1983, 14:705. 7. R.J. Gerety. Hepatitis B. Academic press N.Y. 1985. 8. W. Robinson, et al. eds. Hepadna virus. Alan Riss, N.Y., 1987. 9. N. McÉntyre, J.P. Benhamou, J. Bircher, M. Rizzeto, J. Rodes, eds. Oxford Textbook of Clinical Hepatology, 1991. 10. F. Hollinger. Clinical features. In: Hollinger F., Melnick J., Robinson W., eds. Viral Hepatitis. Raven Press, N.Y., 1985. 11. S.J. Hadziyannis, A.S. Hadziyannis, S. Dourakis,

Ôüìïò 13, Ôåý÷ïò 3, 2001

et. al. Clinical significance of quantitative antiHBc IgM assay in acute and chronic HBV infection. Hepato-Gastroenterology 1993, 40:592. 12. M.F. Yuen, C.L. Lai. Debates in hepatitis: how to asses HBV-DNA reductions in association with therapy. Viral Hepatitis Reviews 1999, 5:159-175. 13. F. Bonino, B. Hoyer, J. Nelson, et. al. Hepatitis B virus DNA in the sera of HBsAg negative carriers: a marker of active hepatitis B virus replication in the liver. Hepatology 1981, 386391. 14. Immunization Practices Advisory Committee. Update on hepatitis B prevention. MMWR 1987, 36:353-366.

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ÏÄÇÃÉÅÓ ÃÉÁ ÔÏÕÓ ÓÕÃÃÑÁÖÅÉÓ INSTRUCTIONS FOR THE AUTHORS Ç "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äÝ÷åôáé ãéá äçìïóßåõóç êåßìåíá Åðéóôçìüíùí Õãåßáò, ôá ïðïßá êáôáôÜóóïíôáé óôéò åîÞò êáôçãïñßåò: 1) ÅñåõíçôéêÝò åñãáóßåò Þ áíáóêïðÞóåéò (óýíôïìåò äçìïóéåýóåéò) Ýêôáóçò ìÝ÷ñé 7 óåëßäåò ìå ðñüóöáôåò ü÷é Üíù áðü 5 âéâëéïãñáöéêÝò ðçãÝò, 2) ÅíçìåñùôéêÜ Üñèñá, 3) Óýíôïìá Üñèñá, 4) ÁíáöïñÝò ðåñéðôþóåùí, 5) ÐáñïõóéÜóåéò ÊÝíôñùí Õãåßáò. ¸íá óýíïëï êåéìÝíùí, ðïõ áöïñïýí Ýíá óõãêåêñéìÝíï ãíùóôéêü ôïìÝá ôçò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò, ìðïñåß íá óõãêñïôåß ÁöéÝñùìá. Åêôüò ôùí êåéìÝíùí ðïõ áíáöÝñïíôáé óôéò ðáñáðÜíù êáôçãïñßåò óôçí "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äçìïóéåýïíôáé êáé Üñèñá ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò, êáèþò êáé êåßìåíá ðïõ áðïóêïðïýí óôçí ðáñïõóßáóç, ó÷ïëéáóìü êáé êñéôéêÞ áîéïëüãçóç óõãêåêñéìÝíùí ãåãïíüôùí, Üñèñùí êáé åêäüóåùí ó÷åôéêþí ìå ôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, óôçí ÅëëÜäá êáé óôï åîùôåñéêü. Ôçí åõèýíç ôçò óõããñáöÞò ôùí Üñèñùí áõôþí Þ êåéìÝíùí Ý÷ïõí ìüíï ôá ìÝëç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò Þ åðéóôÞìïíåò ìåôÜ áðü åéäéêÞ ðñüóêëçóç. Åðßóçò óôçí "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äçìïóéåýïíôáé êáé ãñÜììáôá ðïõ áðåõèýíïíôáé óôçí ÓõíôáêôéêÞ ÅðéôñïðÞ, ôá ïðïßá áíáöÝñïíôáé óå ðáñáôçñÞóåéò, êëéíéêÝò êáé åñåõíçôéêÝò åìðåéñßåò Þ ó÷ïëéÜæïõí ôç äéåèíÞ êáé åëëçíéêÞ âéâëéïãñáößá. Ôçí åõèýíç ãéá ôç äçìïóßåõóç ôùí êåéìÝíùí áõôþí Ý÷åé ï ÄéåõèõíôÞò Óýíôáîçò êáé ç ÓõíôáêôéêÞ ÅðéôñïðÞ. Ïé åñåõíçôéêÝò åñãáóßåò, ôá åíçìåñùôéêÜ Üñèñá, ïé óýíôïìåò äçìïóéåýóåéò êáé ïé áíáöïñÝò ðåñéóôáôéêþí ãßíïíôáé äåêôÜ ãéá äçìïóßåõóç ìüíï ìåôÜ áðü èåôéêÞ êñßóç ôïõò áðü åðéóôÞìïíåò-êñéôÝò ìå ôïõò ïðïßïõò óõíåñãÜæåôáé ôï ðåñéïäéêü. ÊÜèå êåßìåíï ðïõ áðïóôÝëëåôáé óôçí "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äéáâéâÜæåôáé óôïõò êñéôÝò, ÷ùñßò íá ãíùóôïðïéïýíôáé ôá ïíüìáôá ôùí óõããñáöÝùí. Ôá ó÷üëéá êáé ïé ðáñáôçñÞóåéò ôùí êñéôþí óôç óõíÝ÷åéá, ìå ôçí åõèýíç ôçò Ãñáììáôåßáò Óýíôáîçò ôïõ ðåñéïäéêïý, åðéóôñÝöïíôáé óôïõò óõããñáöåßò, ðñïêåéìÝíïõ áõôïß íá ðñïóáñìüóïõí áíÜëïãá ôï êåßìåíü ôïõò ðñéí ôç äçìïóßåõóç. Óå ðåñßðôùóç áóõìöùíßáò ôùí êñéôþí, ôï êåßìåíï èá áîéïëïãåßôáé áðü ôçí ßäéá ôç ÓõíôáêôéêÞ ÅðéôñïðÞ. Ôá ïíüìáôá üëùí ôùí åðéóôçìüíùí ðïõ äéåôÝëåóáí êñéôÝò èá äçìïóéåýïíôáé óå åéäéêÞ óåëßäá óôï ôåëåõôáßï ôåý÷ïò êÜèå ÷ñüíïõ. Ôá êåßìåíá, ôá ïðïßá äÝ÷åôáé ç "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò", èá ðñÝðåé íá áêïëïõèïýí ôéò ðáñáêÜôù ðñïäéáãñáöÝò. • Íá åßíáé ãñáììÝíá óôçí åðßóçìç äçìïôéêÞ ãëþóóá êáé ìå ôï ìïíïôïíéêü óýóôçìá, äáêôõëïãñáöçìÝíá óôç ìßá üøç ôçò óåëßäáò, óå äéðëü äéÜóôçìá êáé ìå ëåõêü ðåñéèþñéï 3 åêáôïóôþí óå üëåò ôéò ðëåõñÝò ôïõò. • Ç ðñþôç óåëßäá ôïõ êåéìÝíïõ ðñÝðåé íá ðåñéëáìâÜíåé: á) ôïí ôßôëï (ìå ðåæÜ ãñÜììáôá), â) ôá ïíüìáôá ôùí óõããñáöÝùí (ìå êåöáëáßá ãñÜììáôá åíþ áíáãñÜöïíôáé ôá áñ÷éêÜ ôùí ïíïìÜôùí êáé ôá ðëÞñç åðþíõìá ìå áñéèìçôéêïýò åêèÝôåò ïé ïðïßïé óå õðïóçìåßùóç ðáñïõóéÜæïõí ôçí éäéüôçôá ôïõ êÜèå óõããñáöÝá), ã) ôï åðéóôçìïíéêü êÝíôñï óôï ïðïßï Ýãéíå ç åñãáóßá, ä) 3-5 ðñüóèåôïõò üñïõò ó÷åôéêÜ ìå ôï èÝìá êáé ïé ïðïßïé åßíáé õéïèåôçìÝíïé áðü ôï Medical Subject Headings (Bethesda Md, 1966), å) ôç äéåýèõíóç êáé ôï ôçëÝöùíï åíüò áðü ôïõò óõããñáöåßò, ï ïðïßïò èá åßíáé õðåýèõíïò ãéá ôçí áëëçëïãñáößá ìå ôï ðåñéïäéêü. • Óå îå÷ùñéóôÞ äåýôåñç óåëßäá ðñÝðåé íá ãñÜöåôáé ç åëëçíéêÞ ðåñßëçøç ôïõ êåéìÝíïõ (ðñïçãåßôáé ç Ýíäåéîç ÐÅÑÉËÇØÇ), ç ïðïßá äå èá ðñÝðåé íá Ý÷åé Ýêôáóç ìåãáëýôåñç ôùí 300 ëÝîåùí. • ÌåôÜ ôï êåßìåíï óå îå÷ùñéóôÞ óåëßäá èá ðñÝðåé íá ãñÜöåôáé ç áããëéêÞ ðåñßëçøç ôïõ êåéìÝíïõ, ç ïðïßá äå èá ðñÝðåé íá Ý÷åé Ýêôáóç ìåãáëýôåñç ôùí 300 ëÝîåùí. Ðñïçãïýíôáé ç ëÝîç SUMMARY, ç áããëéêÞ ìåôÜöñáóç ôïõ ôßôëïõ, ïé ëÝîåéò PRIMARY HEALTH CARE... êáé ôá ïíüìáôá ôùí óõããñáöÝùí ÷ùñßò ôßôëï Þ éäéüôçôá. • Ïé âéâëéïãñáöéêÝò ðáñáðïìðÝò, åëëçíéêÝò êáé îÝíåò, óôï êåßìåíï èá ðñÝðåé íá åßíáé ðñüóöáôåò, áðü áíáãíùñéóìÝíá ðåñéïäéêÜ Þ óõããñÜììáôá, íá åßíáé áñéèìçìÝíåò êáé í’ áíôáðïêñßíïíôáé óôï âéâëéïãñáöéêü êáôÜëïãï, ï ïðïßïò èá ðñÝðåé íá ãñÜöåôáé óå îå÷ùñéóôÞ óåëßäá ìåôÜ ôï ãñÜøéìï ôçò áããëéêÞò ðåñßëçøçò. Óôï âéâëéïãñáöéêü êáôÜëïãï ïé ðáñáðïìðÝò èá ðñÝðåé í’ áêïëïõèïýí ôç óåéñÜ ìå ôçí ïðïßá ðáñïõóéÜóôçêáí óôï êåßìåíï. ÊáèåìéÜ áðü áõôÝò èá ðñÝðåé íá ðåñéÝ÷åé óôç óåéñÜ ôá áñ÷éêÜ ôùí ïíïìÜôùí êáé ôá åðþíõìá ôùí óõããñáöÝùí, ôïí ôßôëï ôçò åñãáóßáò, ôï üíïìá ôïõ ðåñéïäéêïý óýìöùíá ìå ôï óýóôçìá ôçò WHOCISO/R4), ôïí ôüìï, ôçí ðñþôç êáé ôçí ôåëåõôáßá óåëßäá ôïõ Üñèñïõ, êáèþò êáé ôï Ýôïò äçìïóßåõóçò. ¼ôáí ðñüêåéôáé ãéá óõããñÜììáôá Þ ìïíïãñáößåò, åêôüò áðü ôïõò óõããñáöåßò, ôï Ýôïò Ýêäïóçò êáé ôïí ôßôëï, ðñÝðåé íá ãñÜöïíôáé êáé ï áñéèìüò êáé ôá óôïé÷åßá Ýêäïóçò (åêäïôéêüò ïßêïò, ðüëç). • Ïé ðßíáêåò êáé ôá ó÷Þìáôá áêïëïõèïýí ôï âéâëéïãñáöéêü êáôÜëïãï êáé èá ðñÝðåé íá ðáñïõóéÜæïíôáé óå ÷ùñéóôÝò óåëßäåò, íá öÝñïõí ëáôéíéêÞ áñßèìçóç, ç ïðïßá èá ðñÝðåé í’ áíôáðïêñßíåôáé óôéò ðáñáðïìðÝò ôïõ êåéìÝíïõ, êáèþò êáé ôéò áðáñáßôçôåò åðåîçãÞóåéò. • 'Ïëá ôá êåßìåíá èá ðñÝðåé íá õðïâÜëëïíôáé êáôÜ ðñïôßìçóç ìå êåéìåíïãñÜöï word óå äýï áíôßôõðá êáèþò êáé óå çëåêôñïíéêÞ ìïñöÞ áðïóôÝëëïíôáé óôç äéåýèõíóç ôïõ ÄéåõèõíôÞ Óýíôáîçò: - ÐáíåðéóôÞìéï ÊñÞôçò (õðüøéí Åðßêïõñïõ ÊáèçãçôÞ ×. ËéïíÞ), ÔïìÝáò ÊïéíùíéêÞò ÉáôñéêÞò, Ô.È. 1393, ÇñÜêëåéï ÊñÞôçò. Ïé óõããñáöåßò èá ðñÝðåé íá äåóìåýïíôáé óôçí åðéóôïëÞ ôïõò üôé ç åñãáóßá äåí Ý÷åé õðïâëçèåß Þ äåí Ý÷åé äçìïóéåõèåß åí üëù Þ åí ìÝñåé óå Üëëï ðåñéïäéêü, üôé üëïé ïé óõããñáöåßò åéíáé óýìöùíïé ìå ôçí áðïóôïëÞ ôçò êáé óå ðåñßðôùóç áðïäï÷Þò ôçò ãéá äçìïóßåõóç, ôá óõããñáöéêÜ äéêáéþìáôá åê÷ùñïýíôáé óôï ðåñéïäéêü. Ç ÓõíôáêôéêÞ ÅðéôñïðÞ äéáôçñåß ôï äéêáßùìá áðïóýñóåùò ìéáò åñãáóßáò åöüóïí áõôÞ Ý÷åé óôáëåß êáé ó' Üëëï ðåñéïäéêü. 166

Ôüìïò 12, Ôåý÷ïò 1, 2000

Ðáñáããåëßá áíáôýðùí

Ïé áíáãíþóôåò ôçò "ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò", Ãåíéêïß Ãéáôñïß, ïé ïðïßïé åðéèõìïýí íá Ý÷ïõí óå áíÜôõðá êÜðïéï Þ êÜðïéá áðü ôá äçìïóéåõüìåíá óôï ôåý÷ïò Üñèñá, ìðïñïýí íá ðáñáãÝëëïõí ôïí áñéèìü ôùí áíôéôýðùí óôï "Ôå÷íüãñáììá" (ç äéåýèõíóç êáé ôá ôçëÝöùíá äçìïóéåýïíôáé óôï êÜôù ìÝñïò äåîéÜ ôïõ ðßíáêá). Ïé ôéìÝò ãéá êÜèå áñéèìü áíôéôýðùí ðáñáôßèåíôáé óôïí êáôùôÝñù ðßíáêá.

ÁíÜôõðá

Óåëßäåò/Êüóôïò

50 áíÜôõðá

4/15.000

8/25.000

16/40.000

100 áíÜôõðá

4/17.000

8/30.000

16/50.000

200 áíÜôõðá

4/20.000

8/40.000

16/60.000

500 áíÜôõðá

4/30.000

8/50.000

16/80.000

"Ôå÷íüãñáììá" ÌÜñêïõ ÁõãÝñç 12 - Áã. ÐáñáóêåõÞ Ôçë.: 60.00.643, Fax.: 60.02.295

167

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

GANA

168

Ôüìïò 12, Ôåý÷ïò 1, 2000

ABBOTT

169

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

BRISTOL

170

Ôüìïò 12, Ôåý÷ïò 1, 2000

PHARMANEL

171

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

LUNDBECK

172

Ôüìïò 12, Ôåý÷ïò 1, 2000

MENARINI

173

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

SERVIE

174

Ôüìïò 12, Ôåý÷ïò 1, 2000

ROCHE

175