Burnout and training satisfaction of medical residents in Greece: will the European Work Time Directive make a difference?

<p>Abstract</p> <p>Background</p> <p>The aim of this study is to determine the prevalence of burnout in Greek medical residents, investigate its relationship with training satisfaction during residency and survey Greek medical residents' opinion towards the European Work Time Directive (EWTD).</p> <p>Methods</p> <p>A Multi-centre, cross-sectional survey of Greek residents was performed. The Maslach Burnout Inventory (MBI) was used to measure burnout, which was defined as high emotional exhaustion, combined with high depersonalization or low personal accomplishment. In addition, seven questions were designed for this study to evaluate self-reported resident training satisfaction and three questions queried residents' opinion on the EWTD and its effects on their personal and social life as well as their medical training. Univariate, bivariate and multivariate statistical models were used for the evaluation of data.</p> <p>Results</p> <p>Out of 311 respondents (77.8% response rate), 154 (49.5%) met burnout criteria and 99 (31.8%) indicated burnout on all three subscale scores. The number of residents that were dissatisfied with the overall quality of their residency training were 113 individuals (36.3%). Only 32 residents (10.3%) believed that the EWTD implementation will not have any beneficial effects for them.</p> <p>Conclusions</p> <p>Both burnout and training dissatisfaction were common among Greek residents. Systemic interventions are thus required within the Greek health system, aimed at reducing resident impairment due to burnout and at improving their educational and professional perspectives. Although residents' opinion on the EWTD was not associated with burnout levels, the EWTD was found to be predominantly supported and anticipated by Greek residents and should be implemented to alleviate their workload and stress.</p

How telemedicine can improve the quality of care for patients with alzheimer’s disease and related dementias? A narrative review

Background and Objectives: Dementia affects more than 55 million patients worldwide, with a significant societal, economic, and psychological impact. However, many patients with Alzheimer’s disease (AD) and other related dementias have limited access to effective and individualized treatment. Care provision for dementia is often unequal, fragmented, and inefficient. The COVID-19 pandemic accelerated telemedicine use, which holds promising potential for addressing this important gap. In this narrative review, we aim to analyze and discuss how telemedicine can improve the quality of healthcare for AD and related dementias in a structured manner, based on the seven dimensions of healthcare quality defined by the World Health Organization (WHO), 2018: effectiveness, safety, people-centeredness, timeliness, equitability, integrated care, and efficiency. Materials and Methods: MEDLINE and Scopus databases were searched for peer-reviewed articles investigating the role of telemedicine in the quality of care for patients with dementia. A narrative synthesis was based on the seven WHO dimensions. Results: Most studies indicate that telemedicine is a valuable tool for AD and related dementias: it can improve effectiveness (better access to specialized care, accurate diagnosis, evidence-based treatment, avoidance of preventable hospitalizations), timeliness (reduction of waiting times and unnecessary transportation), patient-centeredness (personalized care for needs and values), safety (appropriate treatment, reduction of infection risk),integrated care (interdisciplinary approach through several dementia-related services), efficiency (mainly cost-effectiveness) and equitability (overcoming geographical barriers, cultural diversities). However, digital illiteracy, legal and organizational issues, as well as limited awareness, are significant potential barriers. Conclusions: Telemedicine may significantly improve all aspects of the quality of care for patients with dementia. However, future longitudinal studies with control groups including participants of a wide educational level spectrum will aid in our deeper understanding of the real impact of telemedicine in quality care for this population

Attitudes toward preventive services and lifestyle : the views of primary care patients in Europe. The EUROPREVIEW patient study

Background: For preventive interventions in general practice to succeed, patients' points of view must be taken into account in addition to those of GPs. Objective: To explore patients' views and beliefs about the importance of lifestyle and preventive interventions, to assess their readiness to make changes to their lifestyle and their willingness to receive support from GPs. Methods: Cross-sectional survey conducted by EUROPREV in primary care practices in 22 European countries. Patients were consecutively selected and interviewed from September 2008 to September 2009. Results: Seven thousand nine hundred and forty-seven participants, 52.2% females. Only 30.5% of risky drinkers think they need to change, as opposed to 64% of smokers, 73.5% of patients with unhealthy eating habits and 73% with lack of physical activity. Risky drinkers reported that GPs initiated a discussion on alcohol consumption less often (42%) than on smoking (63%), eating habits (59%) or physical activity (55%). Seventy-five per cent, 66% and 63% of patients without hypertension, diabetes or hypercholesterolaemia, respectively, think blood pressure, blood sugar and serum cholesterol should be checked yearly. Women (80%) think they should be screened with the cervical smear test and 72.8% of women aged 30-49 years with mammography, yearly or every 2 years. Conclusions: A high proportion of patients attending primary care with unhealthy lifestyles (especially risky drinkers) do not perceive the need to change their habits, and about half the patients reported not having had any discussion on healthy lifestyles with their GPs. Patients overestimate their need to be screened for cardiovascular risk factors and for cancer.peer-reviewe

Primary health care services to students of the University of Crete: analysis of their type, use and quality in the academic years 1999-2000 and 2000-2001

Introduction: The issue of taking care of the personal health of students had not been given much importance in the context of education until today and it was only in the mid-90s that its importance and complexity was recognized. The systematic examination of newly entering university students, on the occasion of the mandatory medical examination required for their enrolment, is an ideal opportunity to assess their health status, identify risk factors and record their attitudes and perceptions in health matters. At the same time, it offers the opportunity to highlight the importance of disease prevention, as well as health promotion programs. Aim: The planning, organization, and development of Primary Health Care services for the students at the Schools of Rethymno and Heraklion of the University of Crete, as well as a first evaluation of their operation and effectiveness. The research questions were: •What are the most frequent problems/diseases for which students will turn to these services? •Are the tools used in these services appropriate for determining students' health problems? •Is it possible to plan PPH services for students within the current framework of the University of Crete? •What health care services should be included in such a plan?•Is it finally possible to formulate a proposal for the development of such structures at the Greek University? The sub-objectives were: •The assessment of students' needs for health services. •Highlighting the appropriate tools for assessing these needs. •Highlighting the most frequent problems for which students apply to these services and the most common illnesses that appear during their studies at the University. •The formulation of proposals for the implementation of a health program focused on students. Study population and methods: The study was applied at the Primary Health Care Setting of the University of Crete operating at the Gallos University facilities in Rethymno and at the Regional University General Hospital of Heraklion. The studied population were first-year students enrolled in the Schools of Rethymno and the Medical School of Heraklion in the academic years 1999-2000 and 2000-2001. The study was cross-sectional, with information from the application of the questionnaires (the self-assessment of the health status of the students was done by completing the "Healthometer" while the assessment of mental disorders was done by completing the "General Health Questionnaire"-GHQ-28) in health issues and health behaviors (dependent variables or outcomes), it was collected simultaneously with the information about the health status of students, as well as with the demographic, educational and other characteristics of students (independent variables or determinants) with the formulation of a Health Card. The completion of the Health Card and questionnaires had the status of consent for participation in the study. Results: The use of the "Student Health Card" in combination with the questionnaires used proved to be easy-to-use and comprehensive tools for recording and assessing both students' health status and risk factors. First-year students reported a family history of thyroid disorders (25.2%), neoplastic diseases (20.5%), lipid disorders (19.8%), cardiovascular disease (16.2%) and hypertension (14.7%). The six most reported self-reported health problems were: allergies (23.6%), anemia (21.2%), mental health problems (6.3%), thyroid disorders (6.2%) and asthma (5.8%). The female students reported some menstrual problems (11.8%), while only 9.2% had received previous cervical smears (PAP test). On average, 5% of students examined were referred to a specialist, such as a dermatologist, endocrinologist, cardiologist, psychiatrist, or psychologist. Sporadic cases of abnormal heart murmurs, severe anxiety disorder, panic attacks, anorexia nervosa, or severe sleep disturbances required follow-up by a specialist. In a focused screening program for first-year students with a family history of coronary heart disease, out of the 1,828 tested, 44 students were found to have a corresponding family history, while 26 of them responded to the invitation from the Clinic for examination. Six students were found obese (BMI>25), 11 smokers, one with diastolic hypertension and four with hypercholesterolemia. One student was found to have a very high risk (>20%) in the next decade, two students were at average risk (10-20%), while many students were not aware of the potential risk to their health due to family history. In a comparison between students of the medical school (73 people) and the schools of Rethymno (50 people), 10.9% in medicine versus 29.8% in the schools of Rethymno had GHQ-28>5 and 34.2% versus 44.7% who completed the completion of the "Hygeiometer" self-assessed their health status as poor or bad (Healthometer25), 11 καπνιστές, ένας με διαστολική υπέρταση και τέσσερις με υπερχοληστεριναιμία. Ένας φοιτητής βρέθηκε να έχει πολύ υψηλό κίνδυνο (>20%) εμφάνισης στεφανιαίου επεισοδίου την επόμενη δεκαετία, δύο φοιτητές μέσο κίνδυνο (10-20%), ενώ η πλειοψηφία των φοιτητών δεν γνώριζαν τον πιθανό κίνδυνο για την υγεία τους λόγω του οικογενειακού ιστορικού.Οι ψυχικές διαταραχές όπως εκτιμήθηκαν με το GHQ-28 δεν ήταν σπάνιες (20,7%) (GHQ-28>5) και αφορούσαν κυρίως «σωματικά συμπτώματα ψυχολογικής αρχής» και «άγχος με διαταραχές ύπνου», ενώ το 41.8% των φοιτητών που ολοκλήρωσαν την συμπλήρωση του «Υγειόμετρου» αυτοεκτίμησαν την κατάσταση της υγείας τους ως πτωχή ή κακή (Healthometer<105). Αξιοσημείωτη ήταν και η ευρεθείσα σημαντική στατιστική συσχέτιση ανάμεσα στο ερωτηματολόγιο GHQ-28 και στο κεφάλαιο ΙΙ (ψυχική υγεία) του «Healthometer» (r=0.63, R2=0.40, p<0.001). Συζήτηση-Συμπεράσματα: Με βάση την εμπειρία του Ιατρείου, ένα πρόγραμμα υγείας για τους φοιτητές θα μπορεί να εστιάσει σε μια εκτίμηση της κατάστασης υγείας των φοιτητών, των αναγκών υγείας τους, την ανάπτυξη υπηρεσιών πρόληψης και προαγωγής υγείας στα πλαίσια διεπιστημονικής συνεργασίας μιας ομάδας υγείας και την συστηματική παρακολούθηση των καταστάσεων υγείας τους. Ιδιαίτερα για τους φοιτητές της ιατρικής, με την αδυναμία των ιατρών να ασκήσουν βασικές προληπτικές πολιτικές και συμβουλευτική στην επαφή τους με τον ασθενή στην κλινική τους πρακτική, η συμμετοχή τους στη λειτουργία ενός τέτοιου ιατρείου, μπορεί να συμβάλλει στην απόκτηση μιας πιο ολοκληρωμένης και συστηματικής προσέγγισης της σωματικής και ψυχικής φροντίδας υγείας, αλλά και η ευαισθητοποίηση στην αξία της πρωτογενούς και δευτερογενούς πρόληψης. Το «Υγειόμετρο» φάνηκε να είναι ένα χρήσιμο εργαλείο με την θετική προσέγγιση της υγείας που αναδεικνύεται, με τη διαμόρφωση ενός «προφίλ υγείας» αντί για ένα «προφίλ κινδύνου». Στο πλαίσιο μάλιστα της μελέτης κρίθηκε σκόπιμο να διαμορφωθεί μια ηλεκτρονική έκθεση του ερωτηματολογίου αυτού, προκειμένου να αποτελέσει για μεν τον χρήστη των υπηρεσιών υγείας ένα εύχρηστο εργαλείο εκτίμησης της κατάστασης της υγείας του και αναγνώρισης των προβλημάτων υγείας του, για δε τον επαγγελματία υγείας στην ΠΦΥ, μια ολοκληρωμένη βάση πληροφοριών σχετικών με την υγεία των επισκεπτών τους, προκειμένου αυτή αν χρησιμοποιηθεί για τον σχεδιασμό αντιστοίχων με τις ανάγκες υγείας τους υπηρεσιών. Προκειμένου να ξεπεραστούν τα εμπόδια, οι προληπτικές προσεγγίσεις, καθώς και τα συστήματα υποστήριξης για την ευαισθητοποίηση και τη συμμετοχή των φοιτητών στην αντιμετώπιση ζητημάτων εμπιστοσύνης και ιδιωτικότητας, θα πρέπει να τύχουν κορυφαίας προτεραιότητας. Σε αυτό το πλαίσιο, οι ψηφιακές εφαρμογές για νέους που είναι πιο δεκτικοί στη χρήση της τεχνολογίας ως σημείο επαφής φροντίδας, είναι πολλά υποσχόμενες. Η απουσία μιας συναίνεσης για το πλαίσιο παροχής υπηρεσιών υγείας στους φοιτητές, η έλλειψη θεσμικού πλαισίου, οικονομικής και τεχνικής υποστήριξης, αλλά και η περιορισμένη έρευνα για την μακροπρόθεσμη επίδραση των υπηρεσιών υγείας για τους φοιτητές στην προαγωγή της υγείας τους, συνιστούν τους περιορισμούς και τους κινδύνους για την υλοποίηση τέτοιων πρωτοβουλιών. Θέτοντας την υγεία των φοιτητών σαν προτεραιότητα της ακαδημαϊκής κοινότητας, μέσα από μια «προσέγγιση πορείας ζωής» (‘’life-course approach’’) ως βάση για μελλοντική υγεία, οι κοινωνικοί προσδιοριστές υγείας και κινδύνου, καθώς και οι προστατευτικοί παράγοντες, που μεταφράζονται σε συμπεριφορές που σχετίζονται με την υγεία, μπορούν να αποτελέσουν βασικό στοιχείο στη διαμόρφωση των υπηρεσιών υγείας των φοιτητών

Going up in ashes? Smoking-attributable morbidity, hospital admissions and expenditure in Greece

Our aim was to calculate the morbidity, hospitalizations and subsequent hospital costs for the treatment of the smoking-attributable fraction of diseases in Greece using a prevalence-based annual cost approach. In 2011, smoking accounted for 199,028 hospital admissions (8.9% of the national total), with attributable hospital treatment costs calculated at more than (sic)554 million, which represents 10.7% of the national hospital budget. These results pose a compelling reason for the European Union to champion tobacco control as a means of reducing the financial and social burden of disease in Greece and other countries currently facing a financial maelstrom

Fatty liver index and hypertension-mediated organ damage in never-treated hypertensive patients without diabetes mellitus

Background: We investigated whether fatty liver index (FLI), a surrogate marker of nonalcoholic fatty liver disease (NAFLD), is associated with hypertension-mediated organ damage (HMOD) in never-treated hypertensive patients without diabetes mellitus. Methods: We performed both clinic and ambulatory blood pressure (BP) measurements, and calculated the FLI for all participants. A FLI of no less than 60 indicates a high-risk of underlying NAFLD, whereas a FLI of less than 60 indicates lower risk. We evaluated left ventricular mass (LVM) by echocardiography, arterial stiffness by carotid–femoral pulse wave velocity (PWV), capillary rarefaction by nailfold capillaroscopy, as well as urinary albumin-to-creatinine ratio (ACR). HMOD was defined according to the categorical thresholds for each domain, except for capillary rarefaction in which case the categorization of patients was made by the median. Results: We included 146 hypertensive patients (men, 43.8%; mean age, 56.6 +/- 10.8 years; BMI, 30.3 +/- 4.9 kg/m(2); FLI, 57.2 +/- 27.7; office, systolic/diastolic, and 24-h BP, 153.5 +/- 15.8/94.7 +/- 9.8 mmHg, and 140.5 +/- 9.9/83.8 +/- 9 mmHg, respectively). Patients with FLI at least 60 (n = 76) were younger, with higher BMI and 24-h SBP, compared with patients with FLI less than 60 (n = 70). FLI was associated with HMOD after adjustment (LVM indexed to height, P = 0.004; PWV, P = 0.047; reduced capillary density, P = 0.001; and logACR, P = 0.003). High-risk FLI phenotype and FLI z scores increased the likelihood of any HMOD by 3.8 (95% confidence interval, 1.6-7.1) and 5.4 (95% confidence interval, 2.3-15.0) times, respectively. However, the increased number of HMOD domains has progressively stopped being determined by the FLI z scores (P = 0.65). Conclusion: High-risk FLI pattern was associated with various HMOD, and may re-classify never-treated hypertensive patients without diabetes mellitus into a higher cardiovascular risk level

Pertussis Prevalence in Adult Population in Greece: A Seroprevalence Nationwide Study

The reported cases of pertussis vary considerably globally. In the present nationwide study, we aimed to record the Bordetella pertussis prevalence in Greece by measuring serum IgG specific antibody levels to pertussis toxin (anti-PT IgG). General practitioners and laboratories participated in this study from 12 regions of Greece. A geographically stratified sampling plan based on regional units (NUTS level 2) was applied in order to produce a representative sample, taking into consideration age group (30&ndash;39, 40&ndash;49, 50&ndash;59, 60&ndash;69, 70&ndash;79 and 80+) and sex. In total, 1169 subjects participated in the study. The percentage of participants with anti-PT IgG antibodies higher than 50 IU/mL was 3.7%. The levels of anti-PT IgG antibodies of total sample ranged between 1.46 IU/mL to 126.60 IU/mL, with mean 17.74 IU/mL and standard deviation 14.03 U/mL (p-value &lt; 0.001). The total seroprevalence of Greek regions for pertussis disease varied significantly among prefectures. The region with the highest seroprevalence was Peloponnese 21.3%, followed by the region of Central Greece 15.3%. The proportion of adults who have pertussis specific antibodies &lt;50 IU/mL has been &gt;90%, suggesting that a large number of adults may be vulnerable to infection of pertussis despite well-established vaccination programs in Greece. Despite the fact that vaccination reduced the number of reported pertussis cases in the last decades in Greece, our seroprevalence study may indicate that the herd immunity level among Greek adults is suboptimal

How Well Did the Healthcare System Respond to the Healthcare Needs of Older People with and without Dementia during the COVID-19 Pandemic? The Perception of Healthcare Providers and Older People from the SI4CARE Project in the ADRION Region

One major challenge during the COVID-19 pandemic was the limited accessibility to healthcare facilities, especially for the older population. The aim of the current study was the exploration of the extent to which the healthcare systems responded to the healthcare needs of the older people with or without cognitive impairment and their caregivers in the Adrion/Ionian region. Data were collected through e-questionnaires regarding the adequacy of the healthcare system and were anonymously administered to older individuals and stakeholder providers in the following countries: Slovenia, Italy (Calabria), Croatia, Bosnia and Herzegovina, Greece, Montenegro, and Serbia. Overall, 722 older people and 267 healthcare stakeholders participated in the study. During the COVID-19 pandemic, both healthcare stakeholders and the older population claimed that the healthcare needs of the older people and their caregivers increased dramatically in all countries, especially in Italy (Calabria), Croatia and BiH. According to our results, countries from the Adrion/Ionian regions faced significant challenges to adjust to the special needs of the older people during the COVID-19 pandemic, which was possibly due to limited accessibility opportunities to healthcare facilities. These results highlight the need for the development of alternative ways of providing medical assistance and supervision when in-person care is not possible