Christos Lionis

Cervical screening programs have been introduced in many countries and are generally regarded as the most appropriate and effective method currently available for preventing cervical cancer. Although action has been undertaken by some rural practitioners, especially by district midwives, there are still few published data on the effectiveness of community-oriented cervical screening programs in Greece. To explore an innovative approach in a primary-care setting in rural Crete. This study reports on the effectiveness of a health education meeting in recruiting women for a cervical screening program. At a centre for the elderly, 16 women participated in an educational discussion meeting organised to promote cervical screening. The women who participated in the discussion meeting were invited to organise a group visit to a rural primary healthcare centre, in order to be screened as a team during the following 15 days. The theoretical model underpinning the development of this intervent...

Objective: To investigate attitudes towards schizophrenia and people with schizophrenia presented in YouTube videos. Methods: We searched YouTube using the search terms "schizophrenia" and "psychosis" in Finnish and Greek language on April 3rd, 2013. The first 20 videos from each search (N = 80) were retrieved. Deductive content analysis was first applied for coding and data interpretation and it was followed by descriptive statistical analysis. Results: A total of 52 videos were analyzed (65%). The majority of the videos were in the "Music" category (50%, n = 26). Most of the videos (83%, n = 43) tended to present schizophrenia in a negative way, while less than a fifth (17%, n = 9) presented schizophrenia in a positive or neutral way. Specifically, the most common negative attitude towards schizophrenia was dangerousness (29%, n = 15), while the most often identified positive attitude was objective, medically appropriate beliefs (21%, n = 11). All attitudes identified were similarly present in the Finnish and Greek videos, without any statistically significant difference. Conclusions: Negative presentations of schizophrenia are most likely to be accessed when searching YouTube for schizophrenia in Finnish and Greek language. More research is needed to investigate to what extent, if any, YouTube viewers' attitudes are affected by the videos they watch.

Objectives Guidelines and training initiatives (G/TIs) are available to support communication in cross-cultural consultations but are rarely implemented in routine practice in primary care. As part of the European Union RESTORE project, our objective was to explore whether the available G/TIs make sense to migrants and other key stakeholders and whether they could collectively choose G/TIs and engage in their implementation in primary care settings.

Setting As part of a comparative analysis of 5 linked qualitative case studies, we used purposeful and snowball sampling to recruit migrants and other key stakeholders in primary care settings in Austria, England, Greece, Ireland and the Netherlands.

Participants A total of 78 stakeholders participated in the study (Austria 15, England 9, Ireland 11, Greece 16, Netherlands 27), covering a range of groups (migrants, general practitioners, nurses, administrative staff, interpreters, health service planners).

Primary and secondary outcome measures We combined Normalisation Process Theory (NPT) and Participatory Learning and Action (PLA) research to conduct a series of PLA style focus groups. Using a standardised protocol, stakeholders' discussions about a set of G/TIs were recorded on PLA commentary charts and their selection process was recorded through a PLA direct-ranking technique. We performed inductive and deductive thematic analysis to investigate sensemaking and engagement with the G/TIs.

Results The need for new ways of working was strongly endorsed by most stakeholders. Stakeholders considered that they were the right people to drive the work forward and were keen to enrol others to support the implementation work. This was evidenced by the democratic selection by stakeholders in each setting of one G/TI as a local implementation project.

Conclusions This theoretically informed participatory approach used across 5 countries with diverse healthcare systems could be used in other settings to establish positive conditions for the start of implementation journeys for G/TIs to improve healthcare for migrants.

There is a growing interest in the health of migrants worldwide. Migrants, particularly those in marginalised situations, face significant barriers and inequities in entitlement and access to high quality health care. This study aimed to explore the potential role of primary care in mitigating such barriers and identify ways in which health care policies and systems can influence the ability of primary care to meet the needs of vulnerable and marginalised migrants. The study compared routinely available country-level data on health system structure and financing, policy support for language and communication, and barriers and facilitators to health care access reported in the published literature. These were then mapped to a framework of primary care systems to identify where the key features mitigating or amplifying barriers to access lay. Reflecting on the data generated, we argue that culturally-sensitive primary care can play a key role in delivering accessible, high-quality care to migrants in vulnerable situations. Policymakers and practitioners need to appreciate that both individual patient capacity, and the way health care systems are configured and funded, can constrain access to care and have a negative impact on the quality of care that practitioners can provide to such populations. Strategies to address these issues, from the level of policy through to practice, are urgently needed.

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 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 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.

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.

Living with and self-managing a long-term condition implicates a diversity of networked relationships. This qualitative study examines the personal communities of support of people with type 2 diabetes. We conducted 170 biographical interviews in six European countries (Bulgaria, Greece, the Netherlands, Norway, Spain and UK) to explore social support and networks. Analysis was framed with reference to three predetermined social support mechanisms: the negotiation of support enabling engagement with healthy practices, navigation to sources of support and collective efficacy. Each interview was summarized to describe navigation and negotiation of participants' networks and the degree of collective efficacy. Analysis highlighted the similarities and differences between countries and provided insights into capacities of networks to support self-management. The network support mechanisms were identified in all interviews, and losses and gains in networks impacted on diabetes management. There were contextual differences between countries, most notably the impact of financial austerity on network dynamics. Four types of network are suggested: generative, diverse and beneficial to individuals; proxy, network members undertook diabetes management work; avoidant, support not engaged with; and struggling, diabetes management a struggle or not prioritized. It is possible to differentiate types of network input to living with and managing diabetes. Recognizing the nature of active, generative aspects of networks support is likely to have relevance for self-management support interventions either through encouraging continuing development and maintenance of these contacts or intervening to address struggling networks through introducing the means to connect people to additional sources of support.

The purpose of this study is to critically review the literature on the role and work of voluntary organizations and community groups and volunteers in diabetes self-management programs. It seeks to explain how these organizations are located and could be integrated further within a broader system of support. A critical interpretative synthesis of the literature was undertaken as part of the conceptual development of a European research project. Evidence (2000-November 2014) was searched in databases, with the use of key terms, and limited to the languages of the participating countries. This was supplemented by an additional hand search and snowballing technique. A total of 21 articles were included in the review. Evidence regarding the involvement of voluntary organizations in diabetes self-management programs mainly related to: the nature and remit of their work, responsibilities, and attributes; key strategies of programs accounting for success; motivations/barriers for engaging...

Research in family medicine is a well-established entity nationally and internationally, covering all aspects of primary care including remote and isolated practices. However, due to limited capacity and resources in rural family medicine, its potential is not fully exploited yet. An idea to foster European rural primary care research by establishing a practice-based research network has been recently put forward by several members of the European Rural and Isolated Practitioners Association (EURIPA) and the European General Practice Research Network (EGPRN). Two workshops on why, and how to design a practice-based research network among rural family practices in Europe were conducted at two international meetings. This paper revisits the definition of practice-based research in family medicine, reflects on the current situation in Europe regarding the research in rural family practice, and discusses a rationale for practice-based research in rural family medicine. A SWOT analysis w...

This is a short commentary to the editorial issued by Marianna Fotaki, entitled: “Why and how is compassion necessary to provide good quality healthcare.” It introduces the necessity of a more cognitive approach to explore further the determinants of behavior towards compassionate care. It raises questions about the importance of training towards a more patient-care and values driven healthcare system.

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.