Self-medication with antibiotics in rural population in Greece: a cross-sectional multicenter study

<p>Abstract</p> <p>Background</p> <p>Self-medication is an important driver of antimicrobial overuse as well as a worldwide problem. The aim of the present study was to estimate the use of antibiotics, without medical prescription, in a sample of rural population presenting in primary care in southern Greece.</p> <p>Methods</p> <p>The study included data from 1,139 randomly selected adults (545 men/594 women, mean age ± SD: 56.2 ± 19.8 years), who visited the 6 rural Health Centres of southern Greece, between November 2009 and January 2010. The eligible participants were sought out on a one-to-one basis and asked to answer an anonymous questionnaire.</p> <p>Results</p> <p>Use of antibiotics within the past 12 months was reported by 888 participants (77.9%). 508 individuals (44.6%) reported that they had received antibiotics without medical prescription at least one time. The major source of self-medication was the pharmacy without prescription (76.2%). The antibiotics most frequently used for self-medication were amoxicillin (18.3%), amoxicillin/clavulanic acid (15.4%), cefaclor (9.7%), cefuroxim (7.9%), cefprozil (4.7%) and ciprofloxacin (2.3%). Fever (41.2%), common cold (32.0%) and sore throat (20.6%) were the most frequent indications for the use of self-medicated antibiotics.</p> <p>Conclusion</p> <p>In Greece, despite the open and rapid access to primary care services, it appears that a high proportion of rural adult population use antibiotics without medical prescription preferably for fever and common cold.</p

Prevalence of asymptomatic bacteriuria in type 2 diabetic subjects with and without microalbuminuria

<p>Abstract</p> <p>Background</p> <p>Diabetic subjects, especially women, show high prevalence of asymptomatic bacteriuria (ASB). The aim of the present study was to evaluate the prevalence of ASB in subjects with type 2 diabetes mellitus (T2D) with and without microalbuminuria (MA).</p> <p>Findings</p> <p>A hundred diabetic subjects with MA (53 males/47 females, mean age ± standard deviation: 65.5 ± 11.1 years) and 100 diabetic subjects without MA (52 males/48 females, mean age ± standard deviation: 65.4 ± 11.3 years), consecutively attending the outpatient diabetes clinic of our hospital were recruited in the study. Subjects with overt diabetic nephropathy or nephropathy from other causes were excluded. In addition, subjects with symptoms of urinary track infection or use of antimicrobial drugs in the last 14 days were excluded by the study.</p> <p>Diabetic subjects with MA showed increased prevalence of ASB compared to diabetic subjects without MA (21% versus 8%, P < 0.001, respectively). <it>Escherichia coli </it>was the most prevalent pathogen isolated in diabetic subjects with and without MA (12% versus 3.0%, P = 0.01, respectively) followed by <it>Proteus mirabilis </it>(6% versus 5%, P = 0.75, respectively) and <it>Klebsiella </it>spp (5% versus 1%, P = 0.09, respectively). Univariate logistic analysis showed that ASB was associated with the presence of coronary artery disease [odds ratio (OR): 0.29, 95% Confidence Intervals (95% CI): 0.09-0.95, P = 0.04] and gender (OR: 0.09, 95% CI: 0.02-0.35, P < 0.001) in the diabetic study group with MA.</p> <p>Conclusions</p> <p>ASB is more prevalent among T2D subjects with MA. Screening for ASB is warranted in diabetic patients especially if pyuria is detected in urine analysis since ASB has been found to be a risk factor for developing symptomatic urinary tract infection.</p

Familial history of diabetes and clinical characteristics in Greek subjects with type 2 diabetes

<p>Abstract</p> <p>Background</p> <p>A lot of studies have showed an excess maternal transmission of type 2 diabetes (T2D). The aim, therefore, of the present study was to estimate the prevalence of familial history of T2D in Greek patients, and to evaluate its potential effect on the patient's metabolic control and the presence of diabetic complications.</p> <p>Methods</p> <p>A total of 1,473 T2D patients were recruited. Those with diabetic mothers, diabetic fathers, diabetic relatives other than parents and no known diabetic relatives, were considered separately.</p> <p>Results</p> <p>The prevalence of diabetes in the mother, the father and relatives other than parents, was 27.7, 11.0 and 10.7%, respectively. Patients with paternal diabetes had a higher prevalence of hypertension (64.8 vs. 57.1%, P = 0.05) and lower LDL-cholesterol levels (115.12 ± 39.76 vs. 127.13 ± 46.53 mg/dl, P = 0.006) than patients with diabetes in the mother. Patients with familial diabetes were significantly younger (P < 0.001), with lower age at diabetes diagnosis (P < 0.001) than those without diabetic relatives. Patients with a diabetic parent had higher body mass index (BMI) (31.22 ± 5.87 vs. 30.67 ± 5.35 Kg/m², P = 0.08), higher prevalence of dyslipidemia (49.8 vs. 44.6%, P = 0.06) and retinopathy (17.9 vs. 14.5%, P = 0.08) compared with patients with no diabetic relatives. No difference in the degree of metabolic control and the prevalence of chronic complications were observed.</p> <p>Conclusion</p> <p>The present study showed an excess maternal transmission of T2D in a sample of Greek diabetic patients. However, no different influence was found between maternal and paternal diabetes on the clinical characteristics of diabetic patients except for LDL-cholesterol levels and presence of hypertension. The presence of a family history of diabetes resulted to an early onset of the disease to the offspring.</p

Prevalence, and associated risk factors, of self-reported diabetes mellitus in a sample of adult urban population in Greece: MEDICAL Exit Poll Research in Salamis (MEDICAL EXPRESS 2002)

BACKGROUND: The continuous monitoring and future prediction of the growing epidemic of diabetes mellitus worldwide presuppose consistent information about the extent of the problem. The aim of this study was to determine the prevalence of diagnosed diabetes and to identify associated risk factors in a sample of adult urban Greek population. METHODS: A cross-sectional population-based survey was conducted in municipality of Salamis, Greece, during an election day (2002). The study sample consisted of 2805 participants, aged 20–94 years. Data were collected using a standardized short questionnaire that was completed by a face-to-face interview. Multiple regression analyses were performed to evaluate the association of diabetes with potential risk factors. RESULTS: The overall prevalence of diagnosed diabetes was 8.7% (95% CI 7.7–9.8%). After age adjustment for the current adult population (2001 census) of Greece, the projection prevalence was calculated to 8.2%. Multivariate logistic regression analysis identified as independent risk factors: increasing age (odds ratio, OR = 1.07, 95% CI 1.06–1.08), male sex (OR = 1.43, 95% CI 1.04–1.95), overweight and obesity (OR = 1.97, 95% CI 1.29–3.01 and OR = 3.76, 95% CI 2.41–5.86, respectively), family history of diabetes (OR = 6.91, 95% CI 5.11–9.34), hypertension (OR = 2.19, 95% CI 1.60–2.99) and, among women, lower educational level (OR = 2.62, 95% CI 1.22–5.63). The prevalence of overweight and obesity, based on self-reported BMI, were 44.2% and 18.4%, respectively. Moreover, the odds for diabetes in obese subjects with family history were 25-fold higher than those with normal weight and without family history of diabetes, while the odds in overweight subjects with family history of diabetes were 15-fold higher. CONCLUSIONS: Our findings indicated that the prevalence of diabetes is high in Greek population. It is suggested that the main modifiable contributing factor is obesity, whose effect is extremely increased upon positive heredity presence

General practitioner's contribution in early diagnosis and treatment of hepatitis C in a geographically well defined area

Hepatitis C is a serious matter of public health worldwide because of its chronicity that leads to cirrhosis and hepatic cancer. Thirteen years after the cloning of the HCV’s genome, the necessity of the doctor’s participation in coping with Hepatitis C in Primary Health Care has just been understood. The main purpose of this PhD is to study Hepatitis C in a district region and define the General Practitioner’s role in the epidemiological analysis and treatment. In this direction, four individual studies were conducted to determine: a. The prevalence of Hepatitis C among patients of regional Health Centres or other Primary Health Care physicians. b. Possible ways of transmission and high risk factors in Greece. c. The ability of General Practitioners to cope with Hepatitis C in rural regions. Results show that Hepatitis C is an existing problem in Primary Health Care in Greece. In our study, the prevalence of anti-HCV is 3.5% varying between 0 and 12.7%. Hepatitis C is related to hospital admission for more than four days, dentical acts, blood transfusion, intravenous drug use and more than 5 deliveries. The prevalence of anti-HCV between individuals with high blood ALT levels is 6.5% (7/107) and therefore, the use of blood transaminase levels as a method to diagnose patients is limited. Furthermore, the study in Kurdish population does not reveal any anti-HCV positive individual, which makes the construction of conclusions very difficult. The results of our study demonstrate that Primary Care physicians deal with and treat Hepatitis C patients. In addition to that, they are capable of coping with Hepatitis C in rural regions. Finally, multidisciplinary working between General Practitioners and Gastrenterologists appears to be extremely necessary and at the same time very successful when patients have already been treated in their region. In conclusion, taking and evaluating a complete history during the physical examination is essential to determine all the possible risk factors. The diagnosis in Primary Health Care is based on revealing these factors. Finally, a second important conclusion is that primary health care physicians can participate in treating Hepatitis C in collaboration with secondary health care practitioners or units.Η ηπατίτιδα C αποτελεί ένα σημαντικό πρόβλημα δημόσιας υγείας διεθνώς, λόγω του υψηλού ποσοστού της μετάπτωσης σε χρονιότητα, που οδηγεί σε κίρρωση και ηπατοκυτταρικό καρκίνο. Μετά από 13 χρόνια από την κλωνοποίηση του γονιδιώµατος του HCV και παρά την πρόοδο που έχει επιτευχθεί τα τελευταία χρόνια, έγινε πλέον αντιληπτή η αναγκαιότητα συμμετοχής των ιατρών της Π.Φ.Υ. στην αντιμετώπιση του προβλήματος. Βασικός σκοπός της παρούσας διδακτορικής διατριβής ήταν η μελέτη της ηπατίτιδας C σε μια γεωγραφικά προσδιορισμένη περιοχή και ο προσδιορισμός του ρόλου του Γενικού Ιατρού στην επιδημιολογική διερεύνηση και στην θεραπευτική της διαχείριση. Για την πραγματοποίηση του σκοπού της διατριβής σχεδιάστηκαν και ολοκληρώθηκαν 4 επιμέρους μελέτες που καθόρισαν: α) τον επιπολασµό της ηπατίτιδας C σε πληθυσμούς ευθύνης των Κέντρων Υγείας, καθώς και σε άτομα που επισκέπτονταν ιατρεία γενικής ιατρικής ή άλλων ιατρών της πρωτοβάθµιας φροντίδας υγείας στην Ελλάδα, β) τους τρόπους μετάδοσης και τους παράγοντες υψηλού κινδύνου για την ηπατίτιδα C στην Ελλάδα. και γ) την ύπαρξη δυνατότητας και ικανότητας των γενικών ιατρών να διαχειρίζονται και να αντιμετωπίζουν ασθενείς µε ηπατίτιδα C σε αγροτικές περιοχές. Τα αποτελέσματα µας δείχνουν ότι η ηπατίτιδα C αποτελεί έναν υπαρκτό και αναγνωρίσιμο πρόβλημα υγείας σε ιατρεία γενικής ιατρικής στην Ελλάδα. Ο επιπολασµός των anti-HCV στη μελέτη µας ήταν 3,5% και κυμαινόταν από 0-12,7%. Παράγοντες που ανευρέθηκαν να σχετίζονται µε την ηπατίτιδα C ήταν η νοσηλεία ≥ 4 ημερών, οι οδοντιατρικές πράξεις, η μετάγγιση αίματος, η χρήση ενδοφλέβιων τοξικών ουσιών και ο αριθμός τοκετών ≥ 5. Στη μελέτη στα άτομα µε αυξημένη τιμή της ALT ο επιπολασµός των anti-HCV ήταν 6,5% (7/107) γεγονός που περιορίζει τη χρησιμοποίηση των τιμών των τρανσαµινασών ως «εργαλείο» διαλογής – ανίχνευσης ασθενών µε ηπατίτιδα C. Επίσης στην μελέτη µας σε Κούρδους πρόσφυγες δεν ανευρέθηκε κανένα άτομο anti - HCV οροθετικό και η διεξαγωγή συμπερασμάτων για την διασπορά του HCV σε τέτοιους πληθυσμούς είναι δύσκολη. Τέλος οι ιατροί πρωτοβάθµιας φροντίδας (Π.Φ.Υ.) ήταν αυτοί που διαχειρίστηκαν και παρακολούθησαν την θεραπεία των ασθενών µε ηπατίτιδα C. Τα αποτελέσματα της μελέτης µας δείχνουν ότι ιατροί Π.Φ.Υ. σε αγροτικές περιοχές είναι ικανοί να αναλάβουν έναν τέτοιο ρόλο. Το επίπεδο συνεργασίας των γενικών ιατρών µε τους γαστρεντερολόγους εκτιμάται αναγκαίο και κρίνεται αποδοτικό και επιτυχημένο αφού οι ασθενείς ολοκλήρωσαν την θεραπεία τους σε τοπικό επίπεδο. Μέσα από το σύνολο των μελετών της διδακτορικής διατριβής αναδεικνύεται η σημασία της σωστής λήψης και αξιολόγησης του ατομικού ιστορικού, για την ανίχνευση παραγόντων κινδύνου για ηπατίτιδα C. Η διάγνωση της ηπατίτιδας C στην Π.Φ.Υ. πρέπει να στηριχτεί στην ανίχνευση αυτών των παραγόντων. Ένα δεύτερο σημαντικό συμπέρασμα της διατριβής είναι ότι σε ένα πλαίσιο συνεργασίας πρωτοβάθµιας και δευτεροβάθµιας φροντίδας, οι ιατροί Π.Φ.Υ. μπορούν να συμμετέχουν στην παρακολούθηση της θεραπείας των ασθενών µε ηπατίτιδα C