Reporting new cases of anaemia in primary care settings in Crete, Greece: a rural practice study

<p>Abstract</p> <p>Background</p> <p>Early diagnosis of anaemia represents an important task within primary care settings. This study reports on the frequency of new cases of anaemia among patients attending rural primary care settings in Crete (Greece) and to offer an estimate of iron deficiency anaemia (IDA) frequency in this study group.</p> <p>Methods</p> <p>All patients attending the rural primary health care units of twelve general practitioners (GPs) on the island of Crete for ten consecutive working days were eligible to participate in this study. Hemoglobin (Hb) levels were measured by portable analyzers. Laboratory tests to confirm new cases of anaemia were performed at the University General Hospital of Heraklion.</p> <p>Results</p> <p>One hundred and thirteen out of 541 recruited patients had a low value of Hb according to the initial measurement obtained by the use of the portable analyzer. Forty five (45.5%) of the 99 subjects who underwent laboratory testing had confirmed anaemia. The mean value of the Hb levels in the group with confirmed anaemia, as detected by the portable analyzer was 11.1 g/dl (95% Confidence Interval (CI) from 10.9 to 11.4) and the respective mean value of the Hb levels obtained from the full blood count was 11.4 g/dl (95% CI from 11.2 to 11.7) (<it>P </it>= 0.01). Sixteen out of those 45 patients with anaemia (35.6%) had IDA, with ferritin levels lower than 30 ng/ml.</p> <p>Conclusion</p> <p>Keeping in mind that this paper does not deal with specificity or sensitivity figures, it is suggested that in rural and remote settings anaemia is still invisible and point of care testing may have a place to identify it.</p

Vaccination coverage of patients with HIV on Crete

Εισαγωγή: Η εισαγωγή της αντιρετροϊκής αγωγής (ART) έχει συμβάλει σημαντικά στη βελτίωση της ποιότητας ζωής και στο προσδόκιμο ζωής των ατόμων με HIV (αΗΐν). Τα αΗΐν εξακολουθούν όμως να διατρέχουν μεγαλύτερο κίνδυνο από λοιμώξεις σε σύγκριση με τον υγιή πληθυσμό, που θα μπορούσαν να προληφθούν με τον εμβολιασμό. Στόχος της μελέτης είναι να εξεταστεί σε τι βαθμό έχει επιτευχθεί η εμβολιαστική κάλυψη των αΗΐν, οι οποίοι παρακολουθούνται στα ειδικά ιατρεία λοιμώξεων της 7ης Υγειονομικής Περιφέρειας Κρήτης. Μεθοδολογία: Έγινε συλλογή δεδομένων από τους ιατρικούς φακέλους των αΗΐν που επισκέπτονται τα ειδικά ιατρεία λοιμώξεων. Συλλέχθηκαν δεδομένα που αφορούσαν τα κοινωνικο-δημογραφικά χαρακτηριστικά, τη συννοσηρότητα των ασθενών, την ανοσοποιητική κατάσταση τους (CD4+, CD4+/CD8+, ιικό φορτίο), καθώς και τα εμβόλια που είχαν λάβει. Αποτελέσματα: Συλλέχθηκαν δεδομένα από 382 ασθενείς εκ των οποίων 304 ήταν άνδρες (79.1%), με μέση ηλικία τα 47.6 έτη και η πλειοψηφία τους έκανε λήψη ART (368 άτομα, 96.3%). Ο μέσος αριθμός των CD4+ κυττάρων και της αναλογίας των κυττάρων CD4+/CD8+ βρέθηκε να είναι αντίστοιχα 319.3 και 0.40 όταν είχε γίνει η αρχική διάγνωση της λοίμωξης HIV και σύμφωνα με το τελευταίο καταγεγραμμένο έλεγχο ο μέσος αριθμός των CD4+ ήταν αυξημένος στο 618.3 και η αναλογία των κυττάρων CD4+/CD8+ στο 0.91. Το εμβόλιο έναντι της γρίπης είχε διενεργηθεί σε 108 άτομα (28.3%), 136 (35.6%), 192 (50.3%) για τα αντίστοιχα έτη 2018, 2019 και 2020. Για το εμβολιασμό έναντι του πνευμονιοκόκκου, 235 άτομα (61.5%) είχαν εμβολιαστεί με το συζευγμένο εμβόλιο και 196 άτομα (51.3%) με το πολυσακχαριδικό εμβόλιο, ενώ 149 άτομα (39%) είχαν εμβολιαστεί και με τα δύο εμβόλια έναντι της πνευμονιοκοκκικής νόσου. Ο εμβολιασμός έναντι της ηπατίτιδας Α και Β είχε γίνει αντίστοιχα σε 16 (4.2%) και 187 (49%) άτομα. Εμβολιασμό με μια αναμνηστική δόση έναντι τετάνου - διφθερίτιδας είχαν λάβει 17 άτομα (4.5%). Από την ηλικιακή ομάδα ασθενών ηλικίας 60 ετών και άνω, είχαν εμβολιαστεί για τον έρπητα ζωστήρα 5 ασθενείς από τους 52 (9.6%). Οι Έλληνες ασθενείς και όσοι διαθέτουν ασφαλιστική ικανότητα είχαν συσχετιστεί θετικά με τη διενέργεια των εμβολίων έναντι της γρίπης, του πνευμονιόκοκκου (PCV-13) και της ηπατίτιδας Β (p<0.001). Το εμβόλιο έναντι της ηπατίτιδας Β συσχετιζόταν θετικά με τα νεαρά αΗΐν ηλικίας 20 - 39 ετών (p=0.005), ενώ της γρίπης και του πνευμονιόκοκκου (PCV-13) με τα άτομα ηλικίας 60 ετών και άνω (p<0.001). H πολυνοσηρότητα όπως είχε οριστεί με τη παρουσία τουλάχιστον τριών χρονίων νοσημάτων, βρέθηκε να συσχετίζεται θετικά με τη διενέργεια του αντιγριπικού εμβολιασμού (p=0.009). Επίσης θετική συσχέτιση βρέθηκε και με το μορφωτικό επίπεδο για τη διενέργεια προληπτικού εμβολιασμού (p=0.001). Δεκαέξι άτομα (4.2%) είχαν εισαχθεί σε νοσοκομείο για αντιμετώπιση λοίμωξης αναπνευστικού όπου δεν αναδείχθηκε καμία συσχέτιση νοσηλείας με τη διενέργεια αντιγριπικού και αντιπνευμονιοκοκκικού εμβολιασμού. Συμπέρασμα: Αν και υπάρχει σημαντική βελτίωση και αποκατάσταση του ανοσοποιητικού συστήματος στα αHIV, τα ποσοστά εμβολιαστικής κάλυψης βρέθηκαν να είναι σχετικά ανεπαρκή και να υπάρχει ακόμα χώρος για βελτίωση τους. Οι αλλοδαποί ασθενείς και αυτοί που δεν έχουν ασφαλιστική ικανότητα φαίνεται να έχουν πιο χαμηλή συμμόρφωση με τη διενέργεια προληπτικού εμβολιασμού.Introduction: Although the introduction of antiretroviral therapy (ART) has significantly contributed to improving the quality of life and life expectancy of people living with HIV (PLWHIV), they are at a greater risk of infections compared to the healthy population, which could be prevented with vaccination. The aim of the study is to examine the extent to which the vaccination coverage has been achieved for adults who are monitored at the special infection clinics of the 7th Health District of Crete. Methodology: Data were collected from the medical records of the patients with HIV who visit the special infection clinics. Data were collected on socio-demographic data, patients' co-morbidity, their immune status (CD4 +, CD4 + / CD8 +, viral load), as well as the vaccines they had received. Results: Data were collected from 382 patients of which 304 were men (79.1%), the mean age was 47.6 years and the majority did receive ART (368 persons, 96.3%). The mean CD4 + cell count and the CD4 + / CD8 + ratio were respectively 319.3 and 0.40, when they had been diagnosed initially with HIV infection and it was found to be elevated at the last recorded screening with the mean CD4 + count being 618.3 and the CD4 + / ratio CD8 + at 0.91. The flu vaccine was given to 108 (28.3%), 136 (35.6%), 192 (50.3%) patients with HIV for the respective years 2018, 2019 and 2020. For pneumococcal vaccination, 235 people (61.5%) were vaccinated with the conjugated vaccine and 196 patients (51.3%) with the polysaccharide vaccine. Hepatitis A and B vaccination was given to 16 (4.2%) and 187 (49%) individuals, respectively. A booster dose of tetanus - diphtheria was given to 17 people (4.5%) and the shingles vaccine was given to 5 patients out of 52 people in the study population who were at least 60 years old (9.6%). Greek patients and those with insurance capacity were associated with vaccinations against influenza, Streptococcus Pneumoniae (PCV-13) and hepatitis B (p <0.001). The hepatitis Β vaccine was associated with young PLWHIV aged 20 - 39 years (p = 0.005), while the vaccines against influenza and Streptococcus Pneumoniae. (PCV-13) were associated with individuals who were at least 60 years old (p&le;0.001). Also a positive correlation was found with the educational level for the conduction of preventive vaccination (p= 0.001). Conclusion: Although there is a significant improvement and restoration of the immune system of PLWHIV, the vaccination coverage rates for preventable diseases were found to be relatively insufficient and there is still room for improvement. Foreign patients and those without insurance coverage appear to have lower compliance with vaccination

Cognitive screening tools for primary care settings: examining the ‘Test Your Memory’ and ‘General Practitioner assessment of Cognition’ tools in a rural aging population in Greece

Background: Under conditions of high demand for primary care services in a setting of low financial resources, there is need for brief, easily administered cognitive screening tools for use in the primary care setting, especially in rural areas. However, interpretation of these cognitive tests’ results requires knowledge on their susceptibility to cultural, educational and demographic patient characteristics. Objectives: To assess the clinical validity of the ‘Test Your Memory’ (TYM) and ‘General Practitioner assessment of Cognition’ (GPCog) which was specifically designed for primary care practice, in a rural primary care setting in Greece, utilizing the ‘Mini Mental State Examination’ (MMSE) as a reference standard. Methods: The MMSE, TYM, and GPCog were administered to a random sample of 319 community dwelling Greek adults aged 60 to 89 years in 11 rural Primary Healthcare Centres of the Prefecture of Heraklion on the island of Crete, Greece. Analyses examined (a) The association of each instrument with demographic factors and MMSE and (b) optimal cut-off scores, sensitivity and specificity against MMSE-based cognitive impairment risk using ROC analyses with the MMSE 23/24 point cut-off as a reference standard. Results: We found a sensitivity of 80% and a specificity of 77% for TYM (35/36 or 38/39 cut-off, depending on education). Corresponding values were 89% and 61% for GPCog (7/8 cut-off), respectively. Conclusion: The TYM and GPCog instruments appear to be suitable for routine use in the primary care setting as tools for cognitive impairment risk detection in elderly rural populations

Cognitive impairment in a primary healthcare population: a cross-sectional study on the island of Crete, Greece

Objectives Cognitive impairment is known to have a significant impact on the quality of life of individuals and their caregivers, yet it is often underdiagnosed. The objective of this study is to assess the extent of cognitive impairment among elders visiting primary healthcare (PHC) practice settings, to explore associated risk factors and discuss current care challenges for PHC providers. Design A cross-sectional study was conducted between March 2013 and May 2014. Setting Fourteen PHC units located in rural and urban areas of the Heraklion district in Crete, Greece. Participants Consecutive visitors aged at least 60 years attending selected PHC practices. Primary and secondary outcome measures The Mini-Mental State Examination (MMSE) was used to indicate cognitive status. Associations of low MMSE scores (&lt;= 23/24, adjusted for education level) with 12 socio-demographic factors, comorbidities and lifestyle factors were assessed. Results A total of 3140 PHC patients met inclusion criteria (43.2% male; mean age 73.7 +/- 7.8 years). The average MMSE score was 26.0 +/- 3.8; 26.7 +/- 3.5 in male and 25.4 +/- 3.9 in female participants (p&lt;0.0001). Low MMSE scores were detected in 20.2% of participants; 25.9% for females vs 12.8% for males; p&lt;0.0001. Female gender (adjusted OR (AOR)=2.72; 95% CI 2.31 to 3.47), age (AOR=1.11; 95% CI 1.10 to 1.13), having received only primary or no formal education (AOR=2.87; 95% CI 2.26 to 3.65), alcohol intake (AOR=1.19; 95% CI 1.03 to 1.37), reporting one or more sleep complaints (AOR 1.63; 95% CI 1.14 to 2.32), dyslipidaemia (AOR=0.80; 95% CI 0.65 to 0.98) and history of depression (AOR=1.90; 95% CI 1.43 to 2.52) were associated with low MMSE scores. Conclusions This study identified a relatively high prevalence of low MMSE scores among persons attending PHC practices in a southern European community setting and associations with several known risk factors