Economic crisis, austerity and unmet healthcare needs: the case of Greece

Background: The programme for fiscal consolidation in Greece has led to income decrease and several changes in health policy. In this context, this study aims to assess how economic crisis affected unmet healthcare needs in Greece. Methods: Time series analysis was performed for the years 2004 through 2011 using the EU-SILC database. The dependent variable was the percentage of people who had medical needs but did not use healthcare services. Median income, unemployment and time period were used as independent variables. We also compared self-reported unmet healthcare needs drawn from a national survey conducted in pre-crisis 2006 with a similar survey from 2011 (after the onset of the crisis). A common questionnaire was used in both years to assess unmet healthcare needs, including year of survey, gender, age, health status, chronic disease, educational level, income, employment, health insurance status, and prefecture. The outcome of interest was unmet healthcare needs due to financial reasons. Ordinary least squares, as well as logistic regression analysis were conducted to analyze the results. Results: Unmet healthcare needs increased after the enactment of austerity measures, while the year of participation in the survey was significantly associated with unmet healthcare needs. Income, educational level, employment status, and having insurance, private or public, were also significant determinants of unmet healthcare needs due to financial reasons. Conclusions: The adverse economic environment has significantly affected unmet health needs. Therefore health policy actions and social policy measures are essential in order to mitigate the negative impact on access to healthcare services and health status

Oral Cancer Treatment Costs in Greece and the Effect of Advanced Disease

Background: The main purpose of the study was to quantify the direct costs of oral cancer treatment to the healthcare system of Greece. Another aim was to identify factors that affect costs and potential cost reduction items. More specifically, we examined the relationship between stage of disease, modality of treatment and total direct costs. Methods: The medical records and clinic files of the Oral and Maxillofacial Clinic of the Athens General Hospital "Genimatas" were abstracted to investigate clinical treatment characteristics, including length of hospitalization, modes of treatment, stage of disease etc. Records of 95 patients with oral squamous cell carcinoma (OSSC), with at least six months of follow-up, were examined. The clinical data was then used to calculate actual direct costs, based on 2001 market values. Results: The mean total direct costs for OSSC treatment estimated at euro 8,450 or approximately US$ 7,450. Costs depended on the stage of the disease, with significant increases in stages III and IV, as compared with stages I and II (p < 0.05). Multi-modality treatment applied mainly to patients in stages III and IV was the factor that affected the cost. Disease stage was also associated with the total duration of hospitalization (p < 0.05). Conclusions: The clinical management of advanced oral cancer is strongly associated with higher costs. Although the ideal would be to prevent cancer, the combination of high-risk screening, early diagnosis and early treatment seems the most efficient way to reduce costs, and most importantly, prolong life

Primary Health Services Utilization in Greece: Studying the Past for Planning the Future

Σκοπός του συγκεκριμένου άρθρου είναι η μελέτη της χρήσης των πρωτοβάθμιων υπηρεσιών υγείας στην Ελλάδα. Για το σκοπό αυτό αναλύθηκαν, μέσω των μεθόδων Logistic και Linear Regression, δεδομένα από πανελλαδική έρευνα η οποία υλοποιήθηκε το έτος 2006. Η πιθανότητα χρήσης υπηρεσιών υγείας προσδιορίζεται από το φύλο, την ύπαρξη χρόνιας νόσου, το αυτό-αξιολογούμενο επίπεδο υγείας και την ηλικία, ενώ ο λογάριθμος του αριθμού των επισκέψεων προσδιορίζεται από το φύλο, την ύπαρξη χρόνιας νόσου, τη γεωγραφική περιφέρεια, το εισόδημα και την αντίληψη σχετικά με την απειλή από τα ιατρικά προβλήματα. Η χρήση πρωτοβάθμιων υπηρεσιών υγείας συσχετίζεται επομένως με τις αντιλήψεις των ατόμων αλλά και με παράγοντες οι οποίοι εκφράζουν τις ανάγκες υγείας ή το κοινωνικοοικονομικό επίπεδο.The objective of this paper is to study healthcare utilization in Greece. Thedata were derived from a national survey conducted in 2006, and analysed through Logistic and Linear Regression. The likelihood of primary healthcare utilization is determined by the gender, the existence of a chronic disease, the self-rated health and the age, while the logarithm of the visitsto primary health services is determined by the gender, the existence of a chronic disease, the income, the geographical region and the perceived threat from the health condition. Thus, primary healthcare utilization is determined by beliefs, health need as well as socioeconomic factors

Genetics of Tobacco Use

The worldwide prevalence of tobacco use is widespread, resulting in nearly 4.5 million deaths every year. Nicotine is addictive and has psychopharmacological effects that maintain the use of tobacco products. Several studies have documented a strong hereditary component to tobacco use. The present article reviews results from twin and adoption studies and proceeds to present association studies of specific genes that may be involved in tobacco use. Cholinergic receptor nicotinic beta polypeptide 2, serotonin receptor and transporter genes, dopamine receptor and transporter genes, and the cytochrome P450A6 gene are reviewed. Linkage studies help to identify regions of the genome that may be worth further investigation. The paper concludes with a discussion of the limitations of genetic research and the future of genetic epidemiology in this domain

Health and social care in aging population: an integrated care institution for the elderly in Greece

PURPOSE: To describe the nature of the services actually offered to the elderly in Greece by an institution of integrated care, as opposed to those that should be offered according to the relevant law, and to investigate the factors influencing the supply of those services. BACKGROUND: By the year 2020 about 20 million people will be aged 80 and over in the European Union. People of third age consist 16.9% of the total Greek population. Population aging has major implications on health services, employment and society as a whole. “Open Care Centres for the Elderly” (KAPI) is a rapidly developing and expanding institution providing integrated care for the elderly. METHODS: A questionnaire to be completed by the staff was sent to all 370 KAPI. Response rate reached 66%. For the analysis of the data multiple logistic regression analysis was performed using SPSS 10.0. RESULTS: Both medical and social care is provided by the KAPI to the elderly with different magnitude all over the country. Factors such as number of members, medical, paramedical and non-medical staff and fund availability in the KAPI mainly influence the supply of services. CONCLUSIONS: Integrated care services are offered by the KAPI. However, more steps need to be taken towards the direction of other European countries' integrated care schemes, in order to improve both quality and quantity of the services provided

Συστηματική ανασκόπηση και μετά-ανάλυση των ελάχιστα επεμβατικών τεχνικών στην αντιμετώπιση της αχαλασίας του οισοφάγου στα παιδιά

Εισαγωγή. Η αχαλασία οισοφάγου (ΑΟ) είναι μια σπάνια διαταραχή της κινητικότητας του οισοφάγου. Όπως στους ενήλικες, έτσι και στα παιδιά εκδηλώνεται με δυσφαγία, αναγωγές και πόνο στο στήθος. Η διάγνωση της ΑΟ βασίζεται στην κλινική βαθμονόμηση των συμπτωμάτων με βάση το Eckardt score (ΕS), στο βαριούχο γεύμα, την ενδοσκόπηση και τη μανομετρία του κατώτερου οισοφαγικού σφιγκτήρα (Lower Esophageal Sphincter-LES). Σήμερα, για την αντιμετώπιση της ΑΟ προτείνεται η λαπαροσκοπική μυοτομή κατά Heller (LHM-Laparoscopic Heller Myotomy) και η δια του στόματος ενδοσκοπική μυοτομή (POEM-Per Oral Endoscopic Myotomy). Η παρούσα συστηματική ανασκόπηση και μετά-ανάλυση έχει σκοπό να συγκρίνει τις δύο αυτές μεθόδους όσον αφορά την αποτελεσματικότητα και ασφάλεια τους. Υλικό-Μέθοδος. Πραγματοποιήσαμε μια συστηματική έρευνα στις ηλεκτρονικές πλατφόρμες PubMed, Google Scholar και Web of Science για κλινικές μελέτες αναφερόμενες στις δύο αυτές μεθόδους, στην αγγλική γλώσσα. Κύριες παράμετροι ενδιαφέροντος της μετά-ανάλυσης ήταν το ES και η πίεση του LES πριν και μετά την επέμβαση. Δευτερεύουσες παράμετροι ενδιαφέροντος ήταν: οι διεγχειρητικές επιπλοκές, οι μετατροπές των μεθόδων, η παρουσία γαστροοισοφαγικής παλινδρόμησης (ΓΟΠ) μετεγχειρητικά, η μέθοδος επανεπέμβασης, η επιτυχία της κάθε μεθόδου και η θνητότητα. Αποτελέσματα. Συνολικά ανευρέθηκαν 32 άρθρα που αφορούσαν 800 παιδιά (κορίτσια 345, αγόρια/κορίτσια: 1:0.73) με εύρος ηλικίας 1-17 έτη. Σε LHM υποβλήθηκαν 293 παιδιά και σε POEM 507. Λόγω έλλειψης δεδομένων όσον αφορά το ES και την πίεση του LES πριν και μετά την επέμβαση των ασθενών που υπεβλήθησαν σε LHM, η μετά-ανάλυση περιορίσθηκε στα αποτελέσματα του ES και της πίεσης του LES της POEM. Σύμφωνα με τα αποτελέσματα, στατιστικά σημαντική διαφορά παρατηρήθηκε στη μέση τιμή του ES και της πίεσης του LES πριν και μετά την επέμβαση (p&lt;0.001 και p&lt;0.001 αντίστοιχα). Όσον αφορά τις δευτερεύουσες παραμέτρους, από τα διαθέσιμα δεδομένα δεν προέκυψαν στατιστικά σημαντικές διαφορές μεταξύ LHM και POEM όσον αφορά τις διεγχειρητικές επιπλοκές, τις μετατροπές, τη μετεγχειρητική ΓΟΠ, τις επανεπεμβάσεις και τα ποσοστά επιτυχίας της κάθε μεθόδου (p=0.139, p=0.118, p=0.125, p=0.50 και p=0.53 αντίστοιχα). Δεν αναφέρεται θάνατος ασθενούς και στις δύο μεθόδους. Συμπεράσματα. Τα αποτελέσματα της μετά-ανάλυσης έδειξαν ότι η POEM επιτυγχάνει σημαντική βελτίωση του ES και της πίεσης του LES. Η σύγκριση μεταξύ των δύο μεθόδων λόγω έλλειψης δεδομένων δεν έγινε δυνατόν να ολοκληρωθεί με αποτέλεσμα να περιορισθούμε μόνο στα αποτελέσματα της POEM που έδειξαν ότι η τεχνική είναι αποτελεσματική και με μακροχρόνια θεραπευτικά αποτελέσματα. Αμφότερες οι μέθοδοι δεν είχαν στατιστικά σημαντικές διαφορές όσον αφορά τις διεγχειρητικές επιπλοκές, τις μετατροπές, την μετεγχειρητική ΓΟΠ, τις επανεπεμβάσεις και τα ποσοστά επιτυχίας. Απαιτούνται καλά σχεδιασμένες μελέτες στο μέλλον που θα αναδείξουν τις διαφορές, αν υπάρχουν, μεταξύ των δύο μεθόδων.Introduction. Achalasia of the esophagus (AO) is a rare motility disorder in children. Similarly, to the disease found in adults, children experience symptoms of dysphagia, regurgitation, and chest pain. Standard diagnostic approaches include barium meal, upper endoscopy, and esophageal manometry. Current available data suggest laparoscopic Heller myotomy (LHM) and per-oral endoscopic myotomy (POEM) as the best treatment modalities. This systematic review and meta-analysis aim to compare the safety and efficacy of LHM and POEM for AO. Methods. A systematic electronic literature search was performed in PubMed/Medline, Google Scholar and Web of Science for original articles comparing LHM and POEM limited to English texts full articles. After a detailed review, all articles collected were analyzed further in depth with respect to treatment protocols, Primary outcomes included pre- and post-Eckardt score (ES) and pre- and postoperative lower esophageal sphincter (LES) pressure. Secondary outcomes included intraoperative complications, conversions, re-interventions and type, gastroesophageal reflux (GER), success ratea, and mortality. Results. A total of 32 articles reporting on 800 patients were selected, tabulated and reviewed. There were 800 children (female: 345, M/F: 1:0.73), aging 1-17 years. LHM underwent 293 patients, and POEM 507. The meta-analysis due to missing diagnostic values of ES and LES in the LHM group was limited to the POEM results. According to the random effects model the mean ES difference pre- and pos-operatively was 4.387 (95% C.I.: 3.799-4.974), significantly different to zero (z=14.64, p&lt;0.001), while the mean LES pressure difference pre- and postoperatively was 3.63 (95% C.I.: 2247-3.879), significantly different to zero (z=7.36, p&lt;0.001). Moreover, our results showed no statistical differences regarding intraoperative complications, conversions, post-operative GER, re-interventions and success rates (p=0.139, p=0.118, p=0.125, p=0.50 and p=0.53 respectively), while no conversions with POEM were noticed. No mortality was reported either with LHM or POEM method. Conclusions. Both LHM and POEM demonstrated similar results regarding intraoperative complications, conversions, postoperative GER, re-interventions and success rates. Moreover, no conversions were identified with POEM technique. However, our study was failed to compare the two methods regarding their impact on ES and LES, due to inappropriate design of LHM procedure. Therefore, we were limited to the POEM results that showed statistically better outcomes regarding ES and LES pressure pre-and postoperatively. These results showed that POEM is effective and durable for treating AO in children. Well-designed studies are warranted in the future to further clarify differences between the two methods