Social medicine

BACKGROUND:
Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece.

METHODS:
The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating. In total 19 GPs from 14 health care units in rural Crete were invited to participate, covering a total turnover patient population of approximately 25,000 subjects. For the purpose of this study an electronic record database was constructed and used as the main tool for monitoring HZ and PHN incidence. Stress related data was also collected with the use of the Short Anxiety Screening Test (SAST).

RESULTS:
The crude incidence rate of HZ was 1.4/1000 patients/year throughout the entire network of health centers and satellite practices, while among satellite practices alone it was calculated at 1.3/1000 patients/year. Additionally, the standardised incidence density within satellite practices was calculated at 1.6/1000 patients/year. In regards to the stress associated with HZ and PHN, the latter were found to have lower levels of anxiety, as assessed through the SAST score (17.4 +/- 3.9 vs. 21.1 +/- 5.7; p=0.029).

CONCLUSIONS:
The implementation of an electronic surveillance system was feasible so as to measure the burden of HZ and PHN within the rural general practice setting in Crete.

Research has highlighted the wide impact of intimate partner violence (IPV) and the public health role of community health professionals in detection of victimized women. The purpose of this study was to identify postpartum emotional and physical abuse and to validate the Greek version of the Women Abuse Screening Tool (WAST) along with its sensitivity and specificity. Five hundred seventy-nine mothers within 12 weeks postpartum were recruited from the perinatal care registers of the Maternity Departments of two public hospitals in Athens, Greece. Participants were randomly selected by clinic or shift. The WAST and the Partner Violence Screen (PVS) surveys were administered in random order to the mothers from September 2007 to January 2008. The WAST was compared with the PVS as a criterion standard. Agreement between the screening instruments was examined. The psychometric measurements that were performed included: two independent sample t tests, reliability coefficients, explanatory factor analysis using a Varimax rotation, and Principal Components Method. Confirmatory analysis—also called structural equation modeling—of principal components was conducted by Linear Structural Relations. A receiver operating characteristic (ROC) analysis was carried out to evaluate the global functioning of the scale. Two hundred four (35.6%) of the mothers screened were identified as experiencing IPV. Scores on the WAST correlated well with those on the PVS; the internal consistency of the WAST Greek version—tested using Cronbach’s alpha coefficient—was found to be 0.926 and that of Guttman’s split-half coefficient was 0.924. Our findings confirm the multidimensionality of the WAST, demonstrating a two-factor structure. The area under ROC curve (AUC) was found to be 0.824, and the logistic estimate for the threshold score of 0/1 fitted the model sensitivity at 99.7% and model specificity at 64.4%. Our data confirm the validity of the Greek version of the WAST in identifying IPV. The validated Greek WAST scale could be used for screening purposes in both clinical practice and research.

The study explored the perceptions and practices of general practitioners (GPs) regarding the identification and management of victimized patients in primary care settings. A qualitative study was conducted employing three focus groups and a total of 18 GPs drawn from Greek General Practice Networks. Participants discussed issues of identification, assessment, recording, and referral of victimized patients at their clinical setting. Important points raised were the role ambiguity in the management of the victimized patients, the lack of confidence in diagnosing the problem, the discomfort in discussing Intimate Partner Violence (IPV) with their patients, the mistrust in the referral services, and the confidentiality issues affecting their recording practices. This preliminary information is expected to guide large-scale surveys and future interventions.

The aim of the present study was to examine the psychometric properties of the Greek version of Family Adaptability and Cohesion Evaluation Scales IV (FACES IV) Package. The original FACES IV displays a six-factor structure with two balanced scales—Balanced Cohesion and Balanced Flexibility—and four unbalanced scales—Disengaged, Enmeshed, Rigid, and Chaotic—and has been shown to have satisfactory internal and test–retest reliability. A total of 584 family members agreed to participate in the study. The findings indicated that the Greek version displays similar factor structure to the original version.
Cronbach’s α coefficients for the six scales ranged from .59 to .79. The test–retest correlation coefficients ranged between .94 and .97. The Family Communication Scale and the Family Satisfaction Scale demonstrated highinternal consistency and test–retest reliability. Thus, the Greek version of the
FACES IV Package appears to be a valid and reliable instrument to be used in both research and clinical assessment of family functioning.

Expressed emotion (EE) has proved to be an established factor in short-term relapse in schizophrenia. The aim of the present study was to examine the psychometric properties of the Greek version of the Family Questionnaire (FQ), a brief self-report questionnaire measuring the EE status of relatives of patients with schizophrenia in terms of criticism (CC) and emotional overinvolvement (EOI). The translated and adapted 20-item FQ was administered to 176 family caregivers of patients with schizophrenia and bipolar disorder. Caregivers' burden
(Family Burden Scale) and psychological distress (General Health Questionnaire-28) were also evaluated. The findings indicated that the Greek version displays a two-factor structure with two subscales of EE—CC and EOI—with 10 items each, similarly to the original version. The convergent validity of the subscales was highly supported by correlations with caregivers' burden and psychological distress. The Cronbach's α coefficient measuring internal consistency for the two scales were 0.90 for CC and 0.82 for EOI. The test–retest correlation coefficients measuring reproducibility were 0.99 and 0.98 for CC and EOI, respectively. The Greek version of the FQ appears to be a valid
and reliable instrument to be used in both research and clinical assessment of family EE.

Background: Studies on determinants affecting family functioning of patients with psychosis are still limited in Greece.
Aim: The aim of this study was to describe the socio-demographic and clinical characteristics associated with family
functioning in patients with schizophrenia and bipolar disorder in Crete, Greece.
Methods: A total of 100 patients and their caregivers agreed to participate in the study. Family functioning was assessed in
terms of cohesion, adaptability, communication and satisfaction dimensions (Family Adaptability and Cohesion Evaluation
Scale IV Package), expressed emotion (Family Questionnaire), family burden (Family Burden Scale) and caregivers’
psychological distress (General Health Questionnaire-28). Multivariate linear regression models were implemented to
examine the associations between each one of the family measures and different social and clinical characteristics.
Results: With regard to the caregivers’ characteristics, gender, employment status, origin, residence, financial status,
relation to the patient, contact with the patient and family structure were among the most significant determinants
of family functioning. Also, patients’ socio-demographic characteristics, including age, education, origin, residence and
employment status, as well as illness-related factors, such as onset of mental illness, number of hospitalisations, last
hospitalisation, longer hospitalisation and clinical diagnosis impacted intrafamilial relationships.
Conclusion: The results of this study suggest that a number of social and clinical factors contributed to the family
environment of patients with psychosis. Identifying the determinants of family functioning in psychosis is instrumental in developing understandings regarding the factors which may contribute to the rehabilitation or relapse of the patient and
the support required to strengthen positive family interactions.

The present study aimed to investigate possible differences in family environmen tamong patientsexperiencing their First Episode of Psychosis (FEP) ,chronic patients and controls. Family cohesion and flexibility (FACES-IV) and psychological distress (GHQ-28) were evaluated in families of 50FEP and 50 chronic patients, as well as 50 controls, where as expressed emotion (FQ) and family burden (FBS) we reassessed in families of FEP and chronic patients. Multivariable linear regression analysis, adjusted for confounders, indicated impaired cohesion and flexibility for families of FEP patients compared to controls, and lower scores for families of chronic patients compared to those of FEP patients.Caregivers of chronic patients scored significantly higher in criticism, and reported higher burden and psychological distress than those of FEP patients. Our findings suggest that unbalanced levels of cohesion and flexibility,high criticism and burden appeared to be the out come of psychosis and not risk factors triggering the onset of the illness. Furthermore, emotional over-involvement both in terms of positive (i.e. concern) and negative behaviors (i.e.overprotection) is prevalent in Greek families. Psychoeduca-
tional interventions from the early stages of the illness should be considered to promote caregivers'awarenes sregarding the patients'illness, which in turn, may ameliorate dysfunctional family interactions.

Το βιβλίο αυτό αποσκοπεί στην ανάδειξη τόσο των προβλημάτων όσων και των
πολιτικών που συνδέονται με τη δημόσια υγεία, αναδεικνύοντας ταυτόχρονα τον
(δυνητικό) ρόλο του «τοπικού», στο σχεδιασμό και την υλοποίηση των αντίστοιχων δράσεων. Η δομή του περιλαμβάνει κατ’ αρχάς την παρουσίαση της ιστορικής εξέλιξης των πολιτικών δημόσιας υγείας στο διεθνή χώρο και την ανάδειξη των «καλών πρακτικών», καθώς και την ανάλυση της πορείας του ελληνικού υγειονομικού συστήματος με έμφαση στις πολιτικές και τα μέτρα δημόσιας υγείας. Ειδικότερα, στο πρώτο κεφάλαιο προσεγγίζεται εννοιολογικά η δημόσια υγεία και παρουσιάζεται η εξέλιξή της στο πέρασμα του χρόνου φτάνοντας να αντιπροσωπεύει αυτό που 7 γνωρίζουμε σήμερα. Στο δεύτερο κεφάλαιο παρουσιάζονται οι τάσεις στο επίπεδο υγείας του ελληνικού πληθυσμού και αναδεικνύονται οι μείζονες παράγοντες κινδύνου. Στο τρίτο κεφάλαιο πραγματοποιείται μια ιστορική ανασκόπηση της οργάνωσης και ανάπτυξης της δημόσιας υγείας στο διεθνή χώρο και στην Ελλάδα από το 1800 έως τις μέρες μας. Στο τέταρτο κεφάλαιο αναδεικνύονται οι διεθνείς τάσεις στη δημόσια υγεία με έμφαση στη δράση της Ευρωπαϊκής Ένωσης και του Παγκόσμιου Οργανισμού Υγείας.
Το πέμπτο και το έκτο κεφάλαιο είναι αφιερωμένα στην οργάνωση της δημόσιας υγείας στην Ελλάδα. Περιγράφεται αναλυτικά το ισχύον θεσμικό πλαίσιο και ο τρόπος λειτουργίας των υπηρεσιών, δομών, φορέων και οργανισμών δημόσιας υγείας σε εθνικό, περιφερειακό και τοπικό επίπεδο. Το έβδομο κεφάλαιο υπεισέρχεται στην ανάλυση των πολιτικών δημόσιας υγείας σε επίπεδο τοπικής αυτοδιοίκησης. Παρουσιάζονται οι θεσμικά προβλεπόμενες δράσεις καθώς και τα αποτελέσματα της πρωτογενούς έρευνας η οποία πραγματοποιήθηκε στους οργανισμούς τοπικής αυτοδιοίκησης Α' και Β' βαθμού με σκοπό την καταγραφή των υπηρεσιών δημόσιας υγείας που παρέχονται, το υπάρχον προσωπικό και τις ανάγκες τους. Στο όγδοο κεφάλαιο και στη βάση της αξιολόγησης των αποτελεσμάτων της πρωτογενούς έρευνας, αναπτύσσονται σκέψεις και προτάσεις με σκοπό την ανάδειξη της τοπικής αυτοδιοίκησης στο πεδίο της παροχής υπηρεσιών δημόσιας υγείας. Εν όψει και της «Νέας Αρχιτεκτονικής της Αυτοδιοίκησης και της Αποκεντρωμένης (ιοίκησης» που προωθείται στη χώρα μας, στόχος των συγγραφέων είναι η αξιοποίηση των αποτελεσμάτων της έρευνας στην κατανόηση της σημασίας που έχει για τη δημόσια υγεία η ενεργοποίηση μηχανισμών και δομών που δρουν σε τοπικό επίπεδο, προς την κατεύθυνση της βελτίωσης του επιπέδου υγείας του πληθυσμού.

The definition and determinants of successful aging is still controversial. Although dietary habits have long been associated with aging, eating habits and behaviors have rarely been included in various proposed indices of successful aging. The aim of this work was to evaluate determinants of successful aging together with assessment of dietary habits in relation to healthcare facility use among elders living in the Mediterranean basin. During 2005-2011, 2663 elderly (aged 65-100 years) individuals from 21 Mediterranean islands and rural Mani region (Peloponnesus) were voluntarily enrolled in the study. A successful aging index ranging from a score of 0 to a score of 10 was constructed using 10 attributes, i.e., education, financial status, physical activity, body mass index, depression, participation in social activities with friends and family, number of yearly excursions, number of cardiovascular disease risk factors and adherence to the Mediterranean diet. The applied factor analysis on the components of the index extracted three main components for successful aging: psychosocial-economic, bioclinical and lifestyle; confirming the multiple dimensions of aging. After adjusting for confounders, a 1/10-unit increase in the successful aging index was associated with 0.8 less annual visits to healthcare centers (95% CI -1.3 to-0.2). Stratified analysis by gender revealed heterogeneity of factors predicting successful aging. These findings suggest that successful aging is a multidimensional and complex concept that exhibits gender heterogeneity. Annual use of health care services by the elders was found to be related to level of successful aging.

The determinants that promote living beyond life expectancy and successful aging still remain unknown. The aim of the present work was to evaluate the role of energy balance in successful aging, in a random sample of older adults living in the Mediterranean basin. During 2005 to 2011, 2,663 older (aged 65-100 years) adults from 21 Mediterranean islands and the rural Mani region (Peloponnesus) of Greece were voluntarily enrolled in the study. Dietary habits, energy intake, expenditure, and energy balance were derived throughout standard procedures. A successful aging index (range = 0-10) was used. After adjusting for several confounders, high energy intake (i.e., >1,700 kcal/day), b-coefficient [95% CI] = -0.21[-0.37, -0.05], as well as positive energy balance, b-coefficient [95% CI] = -0.21 [-0.37, -0.05], were inversely associated with successful aging. A diet with excessive energy intake and a positive energy balance seems to be associated with lower quality of life, as measure...