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Christos Lionis

Publications and source records attributed to Christos Lionis.

At least 19 recordsLinked to original sources
PubMed2006

Association of allergic rhinitis with pesticide use among grape farmers in Crete, Greece.

OBJECTIVE: To explore the association of allergic rhinitis with the use of pesticides among grape farmers in Crete. METHODS: A cross-sectional study of 120 grape farmers and 100 controls at the Malevisi region in Northern Crete was conducted. The protocol consisted of a questionnaire, skin prick tests for 16 common allergens, measurement of specific IgE antibodies against 8 allergens, and spirometry before and after bronchodilatation. RESULTS: Grape farmers who used pesticides had higher prevalence rates of allergic rhinitis symptoms (OR, 3.0; 95% CI, 1.4 to 6.2) compared with grape farmers who reported no current use of pesticides, and control subjects. Logistic regression models controlling for age, sex and smoking status showed that 6 of the 12 predefined groups of major pesticides were significantly related to allergic rhinitis symptoms. The highest risks were observed for paraquat and other bipyridyl herbicides (OR, 2.2; 95% CI, 1.0 to 4.8), dithiocarbamate fungicides (OR, 2.5; 95% CI, 1.1 to 5.3) and carbamate insecticides (OR, 3.0; 95% CI, 1.4 to 6.5). A factor analysis of pesticides used identified 3 distinct factors. The most common factor was that of multiple pesticide use that included 9 pesticides and was significantly associated with allergic rhinitis (OR, 1.5; 95% CI, 1.0 to 2.3). ORs were higher when allergic rhinitis was defined using both questionnaire data on symptoms and atopy. CONCLUSIONS: Occupational exposure to multiple agricultural chemicals could be related to allergic rhinitis in grape farmers.

Adult↗
PubMed2006

Health-related quality of life of irritable bowel syndrome patients in different cultural settings.

BACKGROUND: Persons with Irritable bowel syndrome (IBS) are seriously affected in their everyday life. The effect across different cultural settings of IBS on their quality of life has been little studied. The aim was to compare health-related quality of life (HRQOL) of individuals suffering from IBS in two different cultural settings; Crete, Greece and Linköping, Sweden. METHODS: This study is a sex and age-matched case-control study, with n = 30 Cretan IBS cases and n = 90 Swedish IBS cases and a Swedish control group (n = 300) randomly selected from the general population. Health-related quality of life, measured by SF-36 and demographics, life style indicators and co-morbidity, was measured. RESULTS: Cretan IBS cases reported lower HRQOL on most dimensions of SF-36 in comparison to the Swedish IBS cases. Significant differences were found for the dimensions mental health (p < 0.0001) and general health (p = 0.05) even after adjustments for educational level and co-morbidity. Women from Crete with IBS scored especially low on the dimensions general health (p = 0.009) and mental health (p < 0.0001) in comparison with Swedish women with IBS. The IBS cases, from both sites, reported significantly lower scores on all HRQOL dimensions in comparison with the Swedish control group. CONCLUSION: The results from this study tentatively support that the claim that similar individuals having the same disease, e.g. IBS, but living in different cultural environments could perceive their disease differently and that the disease might affect their everyday life and quality of life in a different way. The Cretan population, and especially women, are more seriously affected mentally by their disease than Swedish IBS cases. Coping with IBS in everyday life might be more problematic in the Cretan environment than in the Swedish setting.

Adolescent↗
PubMed2006

Identifying dyspepsia in the Greek population: translation and validation of a questionnaire.

BACKGROUND: Studies on clinical issues, including diagnostic strategies, are considered to be the core content of general practice research. The use of standardised instruments is regarded as an important component for the development of Primary Health Care research capacity. Demand for epidemiological cross-cultural comparisons in the international setting and the use of common instruments and definitions valid to each culture is bigger than ever. Dyspepsia is a common complaint in primary practice but little is known with respect to its incidence in Greece. There are some references about the Helicobacter Pylori infection in patients with functional dyspepsia or gastric ulcer in Greece but there is no specific instrument for the identification of dyspepsia. This paper reports on the validation and translation into Greek, of an English questionnaire for the identification of dyspepsia in the general population and discusses several possibilities of its use in the Greek primary care. METHODS: The selected English postal questionnaire for the identification of people with dyspepsia in the general population consists of 30 items and was developed in 1995. The translation and cultural adaptation of the questionnaire has been performed according to international standards. For the validation of the instrument the internal consistency of the items was established using the alpha coefficient of Chronbach, the reproducibility (test - retest reliability) was measured by kappa correlation coefficient and the criterion validity was calculated against the diagnosis of the patients' records using also kappa correlation coefficient. RESULTS: The final Greek version of the postal questionnaire for the identification of dyspepsia in the general population was reliably translated. The internal consistency of the questionnaire was good, Chronbach's alpha was found to be 0.88 (95% CI: 0.81-0.93), suggesting that all items were appropriate to measure. Kappa coefficient for reproducibility (test - retest reliability) was found 0.66 (95% CI: 0.62-0.71), whereas the kappa analysis for criterion validity was 0.63 (95% CI: 0.36-0.89). CONCLUSION: This study indicates that the Greek translation is comparable with the English-language version in terms of validity and reliability, and is suitable for epidemiological research within the Greek primary health care setting.

Dyspepsia↗
PubMed2006

Measuring health inequalities in Albania: a focus on the distribution of general practitioners.

BACKGROUND: The health workforce has a dynamically changing nature and the regular documentation of the distribution of health professionals is a persistent policy concern. The aim of the present study was to examine available human medical resources in primary care and identify possible inequalities regarding the distribution of general practitioners in Albania between 2000 and 2004. METHODS: With census data, we investigated the degree of inequality by calculating relative inequality indices. We plotted the Lorenz curves and calculated the Gini, Atkinson and Robin Hood indices and decile ratios, both before and after adjusting for mortality and consultation rates. RESULTS: The Gini index for the distribution of general practitioners in 2000 was 0.154. After adjusting for mortality it was 0.126, while after adjusting for consultation rates it was 0.288. The Robin Hood index for 2000 was 11.2%, which corresponds to 173 general practitioners who should be relocated in order to achieve equality. The corresponding figure after adjusting for mortality was 9.2% (142 general practitioners), while after adjusting for consultation rates the number was 20.6% (315). These figures changed to 6.3% (100), 6.3% (115) and 19.8% (315) in 2004. CONCLUSION: There was a declining trend in the inequality of distribution of general practitioners in Albania between 2000 and 2004. The trend in inequality was apparent irrespective of the relative inequality indicator used. The level of inequality varied depending on the adjustment method used. Reallocation strategies for general practitioners in Albania could be the key in alleviating the inequalities in primary care workforce distribution.

Journal Article↗
PubMed2006

Seeking prescribing patterns in rural Crete: a pharmacoepidemiological study from a primary care area.

INTRODUCTION: Deliberation of drug prescribing patterns is essential in an effort to improve prescribing standards and quality of care. It is vital for pharmaco-epidemiological research. In this study, data from GPs' practices was used to explore variation in the prescribing patterns in a rural area of Crete. This article reports the findings with respect to the patients' age, sex and diagnoses, and discusses them with the broad aim of identifying areas for practice improvement. METHODS: One thousand prescriptions, issued during a one-year period, were pre-selected from the area of Anogia Health Centre in Crete, Greece. A copy of each pre-selected prescription was made, and a short pre-tested questionnaire with supplementary information about the prescription was filled. Age, gender, prescription through a third person's intervention, and renewal of an old prescription, were registered on this questionnaire. Drugs were classified according to the International Classification of Primary Care--Drugs, and diagnoses according to the International Classification of Primary Care. RESULTS: The vast majority of prescriptions, namely n = 285 (74.2%) for male and n = 481 (78.1%) for female patients, were prescribed for individuals between the ages of 50 and 89 years. The 10 most commonly recorded diagnoses were found in 54.2% of the studied prescriptions for the male population, although only 47% for the female. Hypertension, respiratory infections, and ischaemic heart disease were, over all, the most commonly recorded diseases. The drugs commonly recorded for both sexes were paracetamol and furosemide, as well as some antibiotics. Analysis of the prescribing data revealed that more than one in every three prescriptions was prescribed through a third-person contact and 69.8% (n = 698) of the prescriptions were renewal of an older one. For more than 51% of the cases, the patients asked only for a prescription. The diagnosis 'oral contraceptive' was absent in the study, while there was a large consumption of antibiotics. CONCLUSION: The prescribing patterns illustrated in this study present both similarities with and differences from the registered patterns in other studies. The recognition of these patterns is an essential tool for the GPs who are serving rural areas of Crete, and formulation of practical guidelines on the drugs most often prescribed is anticipated to improve the primary care physicians' performance.

Acetaminophen↗
PubMed2006

Skin symptoms and work-related skin symptoms among grape farmers in Crete, Greece.

BACKGROUND: Grape farmers are exposed to a variety of agents capable of inducing occupational skin disease. We conducted a study to measure the prevalence of skin symptoms and work-related skin symptoms among grape farmers in the Malevisi region of Crete and to provide data on associated risk factors. METHODS: One hundred twenty grape farmers and 100 controls participated in the study. The protocol consisted of a questionnaire, skin prick tests for 16 common allergens, and measurement of specific IgE antibodies against 8 allergens. RESULTS: Self-reported itchy rash (OR, 2.31; 95%CI, 1.10-4.84, P<0.05) within the last 12 months, and work-related itchy rash (OR, 4.08; 95%CI, 1.01-20.33, P<0.05) were significantly higher in grape farmers than in controls, after adjusting for age and sex. Sensitization to pollens (OR, 4.20; 95% CI, 1.41-12.82, P<0.01) and allergic rhinitis (OR, 3.06; 95% CI, 1.21-8.28, P<0.05) were found to be significantly associated with self-reported itchy rash in the grape farmers group. CONCLUSIONS: Grape farmers reported skin symptoms more frequently than non-exposed controls, and IgE-mediated sensitization to pollens was found to be significantly associated with the reported symptoms. Further studies are needed to evaluate the impact of specific occupational agents on skin diseases among grape farmers.

Adult↗
PubMed2005

Measuring the frequency of functional gastrointestinal disorders in rural Crete: a need for improving primary care physicians' diagnostic skills.

INTRODUCTION: Studies of the frequency and aetiology of functional gastrointestinal disorders in the general population have received increasing interest over the past few years; the field seems to be neglected in Southern Europe. The aim of this study was to report on the frequency of functional dyspepsia (FD), irritable bowel syndrome (IBS) and gastroenteritis within the primary care setting, to provide some information on the extent to which the recorded diagnoses in the physicians' notes fulfil existing diagnostic criteria. METHOD: A retrospective study was used, where all new cases of these diseases at five primary health care centres in three rural and two semi-rural areas of Crete were identified by scrutinizing medical records from 280,000 consecutive visits during a 4 year period. The occurrence rate per 1000 person-years were calculated for the three conditions. We also checked the extent to which the Talley's criteria for FD and Rome II diagnostic criteria for IBS were followed. RESULTS: Gastroenteritis was revealed to be a quite frequent health problem among the rural population on Crete, while the occurrence rates for other problems, such as dyspepsia and IBS, were found to be lower than expected. IBS was over-represented among women compared with men, OR 2.04 (CI 1.39-3.00). In many cases a diagnosis of FD, IBS or gastroenteritis was evident to the research team on the basis of findings recorded in the notes, but the diagnosis was not recorded by the clinician at the time of consultation. CONCLUSIONS: This study yielded two key messages: the first that gastroenteritis is still a frequent health problem, and the second that primary care physicians in rural Crete seem to fail in adequately diagnosing FD and IBS and need further training.

Adolescent↗
PubMed2005

Are health education meetings effective in recruiting women in cervical screening programmes? An innovative and inexpensive intervention from the island of Crete.

INTRODUCTION: 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. OBJECTIVE: 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. METHODS: 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 intervention was based on the 'social learning theory'. Emphasis was placed up individual and social responsibility regarding cervical cancer. RESULTS: A total number of 48 women (average age 62 years) including all those who participated in the educational discussion meeting, visited the Spili Health Center, Crete, 15 days after the discussion meeting. The main finding was the high compliance rate of the women who participated in the educational discussion meeting, resulting in recruiting all the initial participants. Moreover, the lay women who participated in the small group discussion meeting, in the capacity of key messengers convinced an additional 32 women to participate in a screening program for cervical cancer as members of a team, rather than individually. The majority (52.1%, n = 25 out of 48) of the women had not been previously screened for cervical cancer. CONCLUSIONS: Health education is an important factor in the process of health promotion, and health professionals should consider the dynamics of a specific group in order to carry out their work effectively. Awareness of the special characteristics of an individual as a member of a defined group can contribute to increasing the motivation for participation in health programs as a member of that group. It is suggested that more educational programs take place in rural Crete in order to augment the compliance rate of women in cervical screening programs.

Aged↗
PubMed2005

Clinical undergraduate training and assessment in primary health care: experiences gained from Crete, Greece.

BACKGROUND: Primary health care (PHC) is increasingly being introduced into undergraduate medical education. In Greece, the Faculty of Medicine of the University of Crete was the first to introduce a 4-week long training in primary health care. This paper presents the experiences gained from the initial implementation of the teaching of practice-based primary care in rural Crete and reports on the assessment scale that was developed. METHODS: 284 students' case write-ups from the 6 primary care units (PCUs) where they were allocated for the period 1990 to 1994 were analysed. The demographic data of the students and patients and the number of home visits were studied. Content analysis of the students' write-ups was carried out, using an assessment scale consisting of 10 dichotomous variables, in order to quantify eight (8) primary qualitative criteria. RESULTS: Internal reliability was estimated by the index KR20 = 0.67. Face and content validity was found to conform to the standards set for the course, while logistic linear regression analysis showed that the quality criteria could be used as an assessment scale. The number of home visits carried out varied between the various different PCUs (p < 0.001) and more were reported in the write-ups that fulfilled criteria related to the biopsychosocial approach (p < 0.05). Nine quantitative criteria were fulfilled in more than 90% of case reports, but laboratory investigations were reported only in 69.0% of case reports. Statistically significant differences between the PCUs were observed in the fulfilment of criteria related to the community approach, patient assessment and information related to the patient's perception of the illness, but not to those related to aspects of clinical patient management. Differences in reporting laboratory investigations (p < 0.001) are explained by the lack of such facilities in some PCUs. Demographic characteristics of the patients or the students' do not affect the criteria. CONCLUSION: The primary health care course achieved the objectives of introducing students to comprehensive, community oriented care, although there was variation between the PCUs. The assessment scale that was developed to analyse the case-write ups of the students provided data that can be used to evaluate the course.

Clinical Laboratory Techniques↗
PubMed2005

Quality of life of women with urinary incontinence: cross-cultural performance of 15 language versions of the I-QOL.

Urinary incontinence (UI) has substantial and important impacts on health-related quality of life. The purpose of this research is to report the psychometric performance of 15 different language versions of the Incontinence-specific Quality of Life (I-QOL)measure, a patient-reported outcome measure specific to stress, urge and mixed urinary incontinence. The multi-national dataset consisted of data from four clinical trials for stress incontinent females and from two additional population studies, enrolling women with stress, urge and mixed UI. All enrolled patients completed the I-QOL and comparative measures at baseline. The clinical trial populations had multiple administrations up to 12 weeks, and the two population studies included a shorter retest. Country-specific psychometric testing for validity, reliability, and responsiveness followed standardized procedures. Confirmatory factor analyses were performed to assess the I-QOL subscales. The I-QOL measurement model was confirmed as three subscales. Summary and subscale scores for the 15 versions were internally consistent (alpha values = 0.91-0.96) and reproducible (ICC = 0.72-0.97). Using changes in the independent measures of incontinence episode frequency standardized response means were predominantly strong (ranged 0.71-1.05) across 13 versions (out of 15) in association with these measures and effect sizes. These additional language versions of the I-QOL instrument demonstrate psychometric properties similar to the original version. The I-QOL has shown good results in both community studies and clinical trials with varying types and severity of urinary incontinence. It is a reliable and valid measure of HRQOL, suitable for use in a variety of international settings.

Adult↗
PubMed2005

Prevention and health promotion in clinical practice: the views of general practitioners in Europe.

BACKGROUND: Disease prevention and health promotion are important tasks in the daily practice of all general practitioners (GPs). The objective of this study was to explore the knowledge and attitudes of European GPs in implementing evidence-based health promotion and disease prevention recommendations in primary care, to describe GPs' perceived barriers to implementing these recommendations and to assess how GPs' own health behaviors affect their work with their patients. METHODS: A postal multinational survey was carried out from June to December 2000 in a random sample of GPs listed from national colleges of each country. RESULTS: Eleven European countries participated in the study, giving a total of 2082 GPs. Although GPs believe they should advise preventive and health promotion activities, in practice, they are less likely to do so. About 56.02% of the GPs answered that carrying-out prevention and health promotion activities are difficult. The two most important barriers reported were heavy workload/lack of time and no reimbursement. Associations between personal health behaviour and attitudes to health promotion or activities in prevention were found. GPs who smoked felt less effective in helping patients to reduce tobacco consumption than non-smoking GPs (39.34% versus 48.18%, P < 0.01). GPs who exercised felt that they were more effective in helping patients to practice regular physical exercise than sedentary GPs (59.14% versus 49.70%, P < 0.01). CONCLUSIONS: Significant gaps between GP's knowledge and practices persist in the use of evidence-based recommendations for health promotion and disease prevention in primary care.

Alcohol Drinking↗
PubMed2005

Allergic rhinitis, asthma, and atopy among grape farmers in a rural population in Crete, Greece.

STUDY OBJECTIVE: To measure the prevalence of allergic rhinitis, atopy, and asthma among grape farmers, and to compare the respiratory and atopic status in grape farmers with those of nonexposed control subjects. DESIGN: Cross-sectional study. SETTING: Malevisi region in northern Crete, Greece. SUBJECTS AND METHODS: One hundred twenty grape farmers and 100 control subjects living in the Malevisi region were examined. The protocol comprised a questionnaire, skin prick tests for 16 common allergens, measurement of specific IgE antibodies against 8 allergens, and spirometry before and after bronchodilation. RESULTS: Grape farmers were found to have an excess of respiratory symptoms. The comparison with the control group, after adjusting for age, sex, and smoking status, showed that the differences were statistically significant for rhinorrhea (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.5 to 5.1; p < 0.001), sneezing (OR, 2.2; 95% CI, 1.2 to 4.0; p < 0.01), and nasal itching (OR, 1.9; 95% CI, 1.0 to 3.6; p < 0.05), but were nonsignificant for asthma-related symptoms. In the multiple logistic regression model, grape farmers were found to have increased work-related symptoms, such as sneezing (OR, 2.9; 95% CI, 1.3 to 6.6; p < 01), rhinorrhea (OR, 2.9; 95% CI, 1.3 to 6.6; p < 0.01), cough (OR, 3.7; 95% CI, 1.2 to 11.4; p < 0.05), and dyspnea (OR, 3.8; 95% CI, 1.1 to 1.3; p < 0.05). The prevalence of allergic rhinitis was 40.8% in grape farmers and 26% in control subjects (OR, 2.0; 95% CI, 1.1 to 3.5; p < 0.02). Increased but statistically nonsignificant values of asthma prevalence were found in grape farmers (6.7%) compared with the control group (2.0%). The prevalence of atopy was 64.2% in grape farmers and 38.0% in the control group (OR, 2.2; 95% CI, 1.2 to 3.5; p < 0.01). Mean FEV1 was significantly lower in grape farmers than in control subjects (p < 0.05), after adjusting for age, sex, and smoking status. Bronchial obstruction was reversible in 23 grape farmers (19.2%) and in 6 control subjects (6%; p < 0.01). CONCLUSIONS: The study mainly demonstrated the high prevalence of allergic rhinitis and work-related respiratory symptoms in grape farmers compared to control subjects. It also suggested that grape farming is possibly associated with increased allergic sensitization to specific pollens, low baseline FEV1, and increased bronchial hyper-responsiveness. Further studies are needed to determine the potential risk factors for these disorders among the farming population.

Adult↗
PubMed2004

General practice in Greece: a student's and supervisor's perspective.

OBJECTIVE: The present study reports the observations of an Australian medical student, his reflections on these observations and commentary from the Greek supervisor. SETTING: One urban General Practice at the University Hospital in Heraklion, Crete and three community health centres in rural Crete. MAIN OUTCOME MEASURES: Points of comparison were formed during the patient's consultations and clinical investigations. RESULTS: Although the level of knowledge and GP's competence in Crete and New South Wales appear to be similar and there is an impression that the patient satisfaction in Greece is comparable to that in Australia, a striking feature in Greek primary care is the communication between practitioner and patient, as well as the poor level of note keeping. In contrast, Primary Care in Greece seems to be far more involved in research. CONCLUSION: To attain a higher quality in primary care, leading to a better outcome for the people of Greece, the primary care physicians need more effective vocational training and the appropriate support from health authorities.

Australia↗