Πρωτοβάθμια Φροντίδα Υγείας

öñïíôßäáPrimary Health Care

ISSN 1105-7432

Ôñéìçíéáßá ̧ êäïóç ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞòQuarterly edited by the Greek Association of General PractitionersÔüìïò 14, Ôåý÷ïò 3, Éïýëéïò - ÓåðôÝìâñéïò 2002, Volume 14, Number 3, July - September 2002

ðñùôïâÜèìéáðñùôïâÜèìéáöñïíôßäáõãåßáòõãåßáò

ÅËËÇÍÉÊÇ ÅÔÁÉÑÅÉÁ ÃÅÍÉÊÇÓ ÉÁÔÑÉÊÇÓÐáðáäéáìáíôïðïýëïõ 4, 115 28 ÁÈÇÍÁ

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ÅñåõíçôéêÝò Åñãáóßåò

109 Ã. Ðáðáäüðïõëïò, Ä. Ìðñßìçò, Í. ÄñáêùíÜêçò, Ñ. ÁëåîáíäñÜêç, Ê. Óåñáöåéìßäïõ,Å. ÓôáõñáêÜêç, Ã. ÐáôåñÜêçò, Ç. Êõñéáêïý: Äåßêôåò èíçóéìüôçôáò óôïí ðëçèõóìüôçò ðåñéï÷Þò åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò ×Üñáêá ôïõ Íïìïý Çñáêëåßïõ

114 Ê. Óïõëéþôçò, A. Äüëãåñáò, Ä. Êüíôïò, ×. Ïéêïíüìïõ: Ç Éêáíïðïßçóç ôùí áóèåíþíáðü ôç íïóïêïìåéáêÞ öñïíôßäá óôçí ÅëëÜäá: ÁðïôåëÝóìáôá Ýñåõíáò ãíþìçòóôçí åõñýôåñçò ðåñéï÷Þò Áèçíþí

Aíáóêüðçóç

119 Ê. Ðáðáäçìçôñßïõ, Á. Ãêßêáò, Ã. ÌðÝëïò: ÊëéíéêÞ ðñïóÝããéóç ôçò HIV ëïßìùîçò.Ï ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý óôçí ðáñáêáëïýèçóç êáé öñïíôßäáôùí áóèåíþí ìå HIV/AIDS

Åðáéíåèåßóåò Åëåýèåñåò Áíáêïéíþóåéò - 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò

126 É. ÌïíÝäáò, Á. Èáíïðïýëïõ, Í. ÄçìçóéÜíïò, È. ÄÜóéïò, Ô. ÍôÜöçò, Â. Óôáóéíüò,Â. ÌÞëéá, Í. Ðáôïýíçò, E. ÑÝããéïõ: Óõó÷åôéóìüò óùìáôïìåôñéêþí äåéêôþíêáé áñôçñéáêÞò ðßåóçò óå ìáèçôÝò áãñïôéêÞò ðåñéï÷Þò Íüôéáò ÊÝñêõñáò

130 Ã. Ôóßñïò, Ä. Êáëïãåñüðïõëïò, Ð. ÂïÀëá, ×. Âüóóïõ, Ã. ÊáñäÜôïò, Ã. ÌïõæÜêçò,Í. ÌáãêëÜñáò, Ð. Áèáíáóüðïõëïò, Áéê. Ãáôïðïýëïõ: Ðñüëçøç, áíôéìåôþðéóçêáé óõìðåñéöïñÜ ôùí éáôñþí óå èÝìáôá õãåßáò ôïõò

139 Ê. Óôåöáíïðïýëïõ, Ó. Ãêïíôüëéáò, ×. ÓðõñÜêç, Á. Ðáñáóýñç, Á. ÐåôñÜêç,Í. ÐáðáäÜêçò, Á. Ìðáôßêáò: Aîéïëüãçóç ôùí áðïôåëåóìÜôùí ôçò ðáñÝìâáóçòôïõ éáôñïý ðåñéöåñåéáêïý éáôñåßïõ óå ãíùóôü ðëçèõóìü óáê÷áñïäéáâçôéêþíôçò ðåñéï÷Þò åõèýíçò ôïõ ìåôÜ ôçí ðáñÝëåõóç åíüò Ýôïõò

AíáöïñÜ Ðåñßðôùóçò

147 Ð. Âïõäïýñç, Á. ÂÞôáò, ×. ×áôæçåëåõèåñßïõ: ÏóôéêÞ ðñïóâïëÞ óå ðåñéóôáôéêüóõããåíïýò óýöéëçò êáé äéáöïñïäéÜãíùóç ìå ôï óýíäñïìï ôïõ êáêïðïéçìÝíïõ ðáéäéïý

150 ÍÝá

öñïíôßäáðñùôïâÜèìéáðñùôïâÜèìéá

õãåßáòõãåßáòISSN 1105-7432

ÅÊÄÏÔÇÓ:ÌðïäïóÜêçò-Ðñüäñïìïò ÌåñêïýñçòÌ. ×ïõñìïýæç 28 Ê. Ôïýìðá544 53 ÈåóóáëïíßêçÔçë. (0310) 910342

Äéïéêçôéêü Óõìâïýëéïôçò ÅëëçíéêÞò Åôáéñåßáò

ÃåíéêÞò ÉáôñéêÞò

ÐñüåäñïòÌðïäïóÜêçò-ÐñüäñïìïòÌåñêïýñçò

Áíôéðñüåäñïò ÁÊþóôáò ÌùñáÀôçò

Áíôéðñüåäñïò ÂÁíôþíçò Êáñüôóçò

Ãåíéêüò ÃñáììáôÝáò-ÔáìßáòÁèáíÜóéïò Óõìåùíßäçò

ÌÝëçÐçãÞ ÐåñäéêÜêçÓôÜèçò ÓêëçñüòÌÜñéïò ×áôæçáñóÝíçò

Executive Boardof the Greek Associationof General Practitioners

PresidentBodosakis-ProdromosMerkouris

Vice-President AKostas Moraitis

Vice-President BAntonis Karotsis

General SecretaryTreasurerAthanasios Symeonidis

MembersMarios ChatziarsenisPigi PerdikakiStathis Skliros

Primary Health Care

öñïíôßäá

ÄéåõèõíôÞò Óýíôáîçò×ñÞóôïò ËéïíÞò

Åðßêïõñïò ÊáèçãçôÞòÔìÞìá ÉáôñéêÞò

ÐáíåðéóôÞìéï ÊñÞôçòÔ.È. 1393, ÇñÜêëåéï

Ôçë. +30 810 39 46 21Fax. +30 810 39 46 06E-mail: [email protected]

ÁíáðëçñùôÝò Ä/íôÝò ÓýíôáîçòÍßêïò ÁíôùíÜêçò

E-mail: [email protected]

ÓôÜèçò ÓêëçñüòE-mail: [email protected]

Åðßêïõñïé Ä/íôÝò ÓýíôáîçòÈùìÜò Áããåëüðïõëïò (Èåóóáëïíßêç)

Ðáýëïò ÈåïäùñÜêçò (ÉùÜííéíá)ÅëåõèÝñéïò Èçñáßïò (ÁèÞíá)Êïñíçëßá ÌáêñÞ (ÇñÜêëåéï)

ÌÝëç ÓõíôáêôéêÞò ÅðéôñïðÞòÓôÝëéïò ÅõáããÝëïõÃéÜííçò ÌïíÝäáòÐçãÞ ÐåñäéêÜêç¸öç Öñáãêïýëç

ÁíôáðïêñéôÝò ÓýíôáîçòÊýðñïò

¸ëåíá ÅõáããåëÜêçÈåïäþñá Æá÷áñéÜäïõ

ÁëâáíßáLlukan Rrumbullaku

ÓõìâïõëåõôéêÞ ÅðéôñïðÞÐ. ÂÜñäáò,

ÊáèçãçôÞò Êáñäéïëïãßáò Ðáí/ìßïõ ÊñÞôçò

É. Âëá÷ïíéêïëÞò,Áíáðë. ÊáèçãçôÞò ÂéïóôáôéóôéêÞò Ðáí/ìßïõ ÊñÞôçò

Ä. ÃëÜñïò,ÊáèçãçôÞò ÉáôñéêÞò ÖõóéêÞò Ðáí/ìßïõ Éùáííßíùí

Á. Êñáíßäçò �,ÊáèçãçôÞò Ïõñïëïãßáò Ðáí/ìßïõ ÊñÞôçò

É. Êõñéüðïõëïò,ÊáèçãçôÞò ÅèíéêÞò Ó÷ïëÞò Äçìüóéáò Õãåßáò

Â. ÌáõñÝáò,ÊáèçãçôÞò Øõ÷éáôñéêÞò Ðáí/ìßïõ Éùáííßíùí

Í. ÓéáöÜêáò,ÊáèçãçôÞò Ðíåõìïíïëïãßáò Ðáí/ìßïõ ÊñÞôçò

Ó. ÓìðõñÜêéò,ÊáèçãçôÞò ÐáéäéáôñéêÞò Ðáí/ìßïõ ÊñÞôçò

Ë. ÓðÜñïò,ÊáèçãçôÞò ÊïéíùíéêÞò ÉáôñéêÞò Ðáí/ìßïõ Áèçíþí

Á. ÖéëáëÞèçò,Áíáðë. ÊáèçãçôÞò ÊïéíùíéêÞò ÉáôñéêÞò Ðáí/ìßïõ ÊñÞôçò

Ã. ×ñéóôïäïýëïõ,ÊáèçãçôÞò Øõ÷éáôñéêÞò Ðáí/ìßïõ Áèçíþí

Editor-in-Chief:Christos Lionis

Ássistant ProfessorFaculty of MedicineUniversity of Crete

P.O. Box 1393, HeraklionTel: +30 810 39 46 21Fax: +30 810 39 46 06E-mail: [email protected]

Associate EditorsNick Antonakis

E-mail: [email protected]

Stathis SklirosE-mail: [email protected]

Assistant EditorsThomas Aggelopoulos (Thessaloniki)

Pavlos Theodorakis (Ioannina)Åleftherios Thireos (Athens)Kornilia Makri (Heraklion)

Members of Editorial BoardStelios EuaggelouIoannis MonedasPigi PerdikakiEfi Fragouli

Corresponding EditorsCyprus

Elena EuaggelakiTheodora Zaxariadou

AlbaniaLlukan Rrumbullaku

Advisory BoardP. Vardas,

Professor of University of Crete

J. Vlachonikolis,Associate Professor of University of Crete

D. Glaros,Professor of University of Ioannina

A. Cranidis �,Professor of University of Crete

J. Kyriopoulos,Professor of National School of Public Health

V. Mavreas,Professor of University of Ioannina

N. Siafakas,Professor of University of Crete

S. Smpyrakis,Professor of University of Crete

L. Sparos,Professor of University of Athens

A. Philalithis,Associate Professor of University of Crete

G. Christodoulou,Professor of University of Athens

Ãñáììáôåßá Óýíôáîçò:Áíáóôáóßá ÑùìáíßäïõÔçë.: (08310) 394615, (08310) 25833e-mail: [email protected]

Åêôýðùóç:ÔÅ×ÍÏÃÑÁÌÌÁÌ. ÁõãÝñç 12, 15343 Áã. ÐáñáóêåõÞÔçë.: 010.60.00.643, Fax: 010.6002295E-mail: [email protected]

öñïíôßäáPrimary Health Care

Ôñéìçíéáßá ̧ êäïóç ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞòQuarterly edited by the Greek Association of General PractitionersÔüìïò 14, Ôåý÷ïò 3, Ioýëéïò - ÓåðôÝìâñéïò 2002, Volume 14, Number 3, July - September 2002

ðñùôïâÜèìéáðñùôïâÜèìéáöñïíôßäáõãåßáòõãåßáò

ÐÅÑÉÅ×ÏÌÅÍÁ

ÅñåõíçôéêÝò ÅñãáóßåòÃ. Ðáðáäüðïõëïò, Ä. Ìðñßìçò, Í. ÄñáêùíÜêçò, Ñ. ÁëåîáíäñÜêç, Ê. Óåñáöåéìßäïõ, Å. ÓôáõñáêÜêç, Ã. ÐáôåñÜêçò,Ç. Êõñéáêïý: Äåßêôåò èíçóéìüôçôáò óôïí ðëçèõóìü ôçò ðåñéï÷Þò åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò ×Üñáêáôïõ Íïìïý Çñáêëåßïõ ................................................................................................................................................................................................................. 109

Ê. Óïõëéþôçò, A. Äüëãåñáò, Ä. Êüíôïò, ×. Ïéêïíüìïõ: Ç Éêáíïðïßçóç ôùí áóèåíþí áðü ôç íïóïêïìåéáêÞöñïíôßäá óôçí ÅëëÜäá: ÁðïôåëÝóìáôá Ýñåõíáò ãíþìçò óôçí åõñýôåñçò ðåñéï÷Þò Áèçíþí .................................................. 114

ÁíáóêüðçóçÊ. Ðáðáäçìçôñßïõ, Á. Ãêßêáò, Ã. ÌðÝëïò: ÊëéíéêÞ ðñïóÝããéóç ôçò HIV ëïßìùîçò. Ï ñüëïòôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý óôçí ðáñáêáëïýèçóç êáé öñïíôßäá ôùí áóèåíþí ìå HIV/AIDS ..................................... 119

Åðáéíåèåßóá Åëåýèåñç Áíáêïßíùóç - 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞòÉ. ÌïíÝäáò, Á. Èáíïðïýëïõ, Í. ÄçìçóéÜíïò, È. ÄÜóéïò, Ô. ÍôÜöçò, Â. Óôáóéíüò, Â. ÌÞëéá, Í. Ðáôïýíçò, E. ÑÝããéïõ:Óõó÷åôéóìüò óùìáôïìåôñéêþí äåéêôþí êáé áñôçñéáêÞò ðßåóçò óå ìáèçôÝò áãñïôéêÞò ðåñéï÷Þò Íüôéáò ÊÝñêõñáò . 126

Ã. Ôóßñïò, Ä. Êáëïãåñüðïõëïò, Ðáí. ÂïÀëá, ×ñ. Âüóóïõ, Ã. ÊáñäÜôïò, Ã. ÌïõæÜêçò, Í. ÌáãêëÜñáò,Ð. Áèáíáóüðïõëïò, Áéê. Ãáôïðïýëïõ: Ðñüëçøç, áíôéìåôþðéóç êáé óõìðåñéöïñÜ ôùí éáôñþíóå èÝìáôá õãåßáò ôïõò .............................................................................................................................................................................................................. 130

Ê. Óôåöáíïðïýëïõ, Ó. Ãêïíôüëéáò, ×. ÓðõñÜêç, Á. Ðáñáóýñç, Á. ÐåôñÜêç, Í. ÐáðáäÜêçò, Á. Ìðáôßêáò:Aîéïëüãçóç ôùí áðïôåëåóìÜôùí ôçò ðáñÝìâáóçò ôïõ éáôñïý ðåñéöåñåéáêïý éáôñåßïõ óå ãíùóôü ðëçèõóìüóáê÷áñïäéáâçôéêþí ôçò ðåñéï÷Þò åõèýíçò ôïõ ìåôÜ ôçí ðáñÝëåõóç åíüò Ýôïõò ........................................................................... 139

ÁíáöïñÜ ÐåñßðôùóçòÐ. Âïõäïýñç, Á. ÂÞôáò, ×. ×áôæçåëåõèåñßïõ: ÏóôéêÞ ðñïóâïëÞ óå ðåñéóôáôéêü óõããåíïýò óýöéëçòêáé äéáöïñïäéÜãíùóç ìå ôï óýíäñïìï ôïõ êáêïðïéçìÝíïõ ðáéäéïý ........................................................................................................... 147

ÍÝá ....................................................................................................................................................................................................................................... 150

CONTENTS

Original PapersG. Papadopoulos, D. Brimis, N. Drakonakis, R. Alexandraki, K. Serafimidou, E. Stavrakaki, G. Paterakis,H. Kiriakou: Mortality rates for the population of the Harakas Primary Health Care Centre ............................................................ 109

K. Souliotis, A. Dolgeras, D. Kontos, C. Economou: Patient Satisfaction with Hospital Care in Greece:Results from a telephone study in the Greater Athens area ............................................................................................................................... 114

ReviewÊ. Papadimitriou, A. Gikas, G. Belos: A clinical approach to HIV infection. The role of the GeneralPractitioner in HIV care ............................................................................................................................................................................................................. 119

Awarded Freestanding Papers - 14th Hellenic Congress in General PracticeI. Monedas, A. Thanopoulou, N. Dimisianos, T. Dasios, T. Ntafis, V. Stasinos, B. Milia, N. Patounis, E. Reggiou:Correlation of body mass index (BMI) and blood pressure in students of a rural area of Corfu ............................................. 126

G. Tsiros, D. Kalogeropoulos, P. Voila, Ch. Vossou, G. Kardatos, G. Mouzakis, N. Maglaras, P. Athanasopoulos,E. Gatopoulou: Doctors' attitudes and behaviour in themes of their own health ..................................................................................... 130

K. Stefanopoulou, S. Gantolias, X. Spiraki, A. Parasiri, A. Petraki, N. Papadakis, A. Batikas:Evaluation of an intervention programme by the peripheral medical station physician (PMSP)in a known population of NIDDM patients in their area of responsibility after one year of its application .............................. 139

Case ReportP. Vuduri, Ath. Vitas, Ch. Hatzieleftheriu: Bone assault in cases of congenital syphilis and differentiationwith that of child abuse syndrome ..................................................................................................................................................................................... 147

Íews ................................................................................................................................................................................................................................... 150

109

Ã. Ðáðáäüðïõëïò êáé óõí. Ôüìïò 14, Ôåý÷ïò 3, 2002

Äåßêôåò èíçóéìüôçôáò óôïí ðëçèõóìü ôçò ðåñéï÷Þò åõèýíçòôïõ ÊÝíôñïõ Õãåßáò ×Üñáêá ôïõ Íïìïý Çñáêëåßïõ

Ã. Ðáðáäüðïõëïò1, Ä. Ìðñßìçò1, Í. ÄñáêùíÜêçò2, Ñ. ÁëåîáíäñÜêç2, Ê. Óåñáöåéìßäïõ3,Å. ÓôáõñáêÜêç3, Ã. ÐáôåñÜêçò3, Ç. Êõñéáêïý3

ÅÑÅÕÍÇÔÉÊÇ ÅÑÃÁÓÉÁ

ORIGINAL PAPERPrimary Heatlh Care, Volume 14, Number 3, 109-113, 2002ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 109-113, 2002

ÅéóáãùãÞ

Ï ðëçèõóìüò ôçò ÊñÞôçò ðáñïõ-óéÜæåé ìåãÜëï åíäéáöÝñïí áðü Üðïøçäéåñåýíçóçò ôùí áéôéþí èáíÜôïõ ìéáêáé ç èíçóéìüôçôá áðü éó÷áéìéêÞ êáñ-äéáêÞ íüóï öÜíçêå áðü ìéá ìåëÝôçíá åßíáé ÷áìçëÞ1.

Åäþ êáé ÷ñüíéá, áñêåôÝò ìåëÝôåòÝãéíáí ó÷åôéêÜ ìå ôï èÝìá ôçò èíçóé-ìüôçôáò óôïí Êñçôéêü ðëçèõóìü êáéôá áðïôåëÝóìáôá ðïéêßëëïõí. Ç êá-ôáãñáöÞ ôùí èáíÜôùí óôçí ÅëëÜäáèåùñåßôáé ðëÞñçò. Ðáñüëï ðïõ ïé äåß-êôåò áäñÞò êáé åéäéêÞò èíçóéìüôçôáòùò ðñïò ôï öýëï êáé ôçí áéôßá ìðï-ñïýí íá õðïëïãéóôïýí ìå áêñßâåéá, ïéäåßêôåò åéäéêÞò èíçóéìüôçôáò ùò ðñïòôçí áéôßá èáíÜôïõ äåí åßíáé áêñéâåßò1,2.

Óôçí ðåñéï÷Þ ôïõ ÊÝíôñïõ Õãåßáò×Üñáêá åßíáé ç ðñþôç öïñÜ ðïõ åðé-÷åéñåßôáé ìéá ôÝôïéá ìåëÝôç êáé ôááðïôåëÝóìáôá áíáìÝíïíôáé ìå åíäéá-öÝñïí äåäïìÝíïõ üôé ç ðåñéï÷Þ åõèý-íçò ôïõ åßíáé ìåãÜëç (11 êïéíüôçôåòìå ðåñßðïõ 18000 êáôïßêïõò éäßùò ôïõò

ÐåñßëçøçÓêïðüò ôçò ìåëÝôçò áõôÞò Þôáí íá åíôïðéóôïýí ïé êõñéüôåñåò áéôßåò èáíÜôïõôïõ ðëçèõóìïý åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò ×Üñáêá, íá âñåèåß ç åéäéêÞ èíç-óéìüôçôá ùò ðñïò ôï öýëï, çëéêßá êáé áéôßá êáé íá ãßíåé ðñïôõðïðïßçóç êáéóýãêñéóç ôùí êõñéïôÝñùí áéôéþí èáíÜôïõ ìå áõôÝò ôçò ÅëëçíéêÞò åðéêñÜôåéáò.Åðßóçò íá óõãêñéèïýí ôá áðïôåëÝóìáôá ìå áõôÜ Üëëùí ðåñéï÷þí ôçò ÊñÞôçò.ÅñåõíÞèçêáí 925 èÜíáôïé áðü ôï 1985 ùò ôï 1997. Ïé áéôßåò èáíÜôïõ êáôá-ãñÜöçêáí áðü ôá ðéóôïðïéçôéêÜ èáíÜôïõ áêïëïõèþíôáò ôéò ïäçãßåò êáé ôïõòêáíüíåò ôïõ ÐÏÕ ãéá ôç óùóôÞ åêôßìçóç ôùí áéôéþí èáíÜôïõ. Õðïëïãßóôçêå çáäñÞ êáé åéäéêÞ èíçóéìüôçôá ùò ðñïò ôï öýëï, ôçí çëéêßá êáé ôçí áéôßá èáíÜ-ôïõ ãéá ôéò ôñåéò çëéêéáêÝò ïìÜäåò (0-14, 15-64, 65+) êáé õðïëïãßóôçêå çðñïôõðïðïéçìÝíç èíçóéìüôçôá ãéá ôéò êýñéåò áéôßåò èáíÜôïõ. Ôá íïóÞìáôá ôïõêõêëïöïñéêïý óõóôÞìáôïò áðü ôïõò ïëéêïýò èáíÜôïõò Þôáí 30,5%, ôá íåïðëÜ-óìáôá 16,9% êáé ôá íïóÞìáôá ôïõ áíáðíåõóôéêïý óõóôÞìáôïò 8,2%. Ç ðñïôõ-ðïðïéçìÝíç èíçóéìüôçôá áðü íïóÞìáôá ôïõ êõêëïöïñéêïý Þôáí 300/100000êáé ÷áìçëüôåñç áðü áõôÞ ôçò ÅëëçíéêÞò åðéêñÜôåéáò (477/100000) êáé áðüíåïðëïóìáôéêÝò íüóïõò 160/100000 Ýíáíôé 190,5/100000 ôçò åðéêñÜôåéáò.Åðßóçò ç ðåñéï÷Þ ôïõ Ê.Õ. ×Üñáêá ðáñïõóéÜæåé ìéêñüôåñïõò äåßêôåò èíçóéìü-ôçôáò áðü üëá ôá íïóÞìáôá, áðü Üëëåò ðåñéï÷Ýò ôçò ÊñÞôçò ðïõ Ý÷ïõíåñåõíçèåß, üðùò ï Áã, Âáóßëåéïò êáé ï äÞìïò Áíùãåßùí. Ç äéá÷ñïíéêÞ ðáñáêï-ëïýèçóç ôùí äåéêôþí ôçò ðåñéï÷Þò ôïõ ×Üñáêá áëëÜ êáé Üëëùí ðåñéï÷þíèåùñåßôáé áíáãêáßá, ëüãù ôïõ üôé ç óùóôÞ áíÜëõóÞ ôïõò ìðïñåß íá óõìâÜëåéóôïí ðñïóäéïñéóìü ôùí ðñïâëçìÜôùí õãåßáò ôçò ðåñéï÷Þò êáèþò êáé óôçó÷åäßáóç êáé åöáñìïãÞ ðñïãñáììÜôùí áãùãÞò õãåßáò ôïõ ðëçèõóìïý.

1Åéäéêåõüìåíïé ÃåíéêÞò ÉáôñéêÞò, 2Ãåíéêïß ãéáôñïß, 3Aãpoôéêoß ãéáôñïß. ÊÝíôñï Õãåßáò×Üñáêá

ËÝîåéò êëåéäéÜ: äåßêôåò èíçóéìüôçôáò, ðñùôïâÜè-ìéá öñïíôßäá õãåßáòÕðïâëÞèçêå: 8 Éïõíßïõ 1999ÅðáíõðïâëÞèçêå: 27 Öåâñïõáñßïõ 2001¸ãéíå äåêôÞ ãéá äçìïóßåõóç: 30 ÌáÀïõ 2001Õðåýèõíïò áëëçëïãñáößáò: Ã. Ðáðáäüðïõëïò, Ðáñ-íáóóïý 7, 71303 ÇñÜêëåéï ÊñÞôçò, Ôçë.: (2810)310450

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

110

Ã. Ðáðáäüðïõëïò êáé óõí.

êáé öýëï ôïõ Ýôïõò 1991, åëÞöèçóáíáðü ôçí ÅëëçíéêÞ ÓôáôéóôéêÞ Õðçñå-óßá.4

Ïé õðü ìåëÝôç êïéíüôçôåò ðáñïõ-óéÜæïõí äéáôñïöéêÝò êáé êëéìáôïëïãé-êÝò äéáöïñÝò. Ïé ðåñéóóüôåñåò êïéíü-ôçôåò âñßóêïíôáé óå ðåäéíü ìÝñïò êáéïé êÜôïéêïé åßíáé áãñüôåò ðïõ áó÷ï-ëïýíôáé ìå êáëëéÝñãåéá åëáéüäåíôñùíêáé áìðåëéþí. ¼ìùò êÜðïéåò êïéíüôç-ôåò âñßóêïíôáé óå ìåãÜëï õøüìåôñï,óå ïñåéíÞ æþíç êáé ç áó÷ïëßá ôïõòåßíáé áðïêëåéóôéêÜ ìå êôçíïôñïößá.

Ç óõëëïãÞ ôùí óôïé÷åßùí Ýãéíåáðü ôá ðéóôïðïéçôéêÜ èáíÜôïõ. Äõíá-ôüôçôá ãéá íá áíôëçèïýí ðëçñïöï-ñßåò áðü ôïí éáôñéêü öÜêåëï üðùò Ý÷åéåðé÷åéñçèåß áðü Üëëåò ó÷åôéêÝò ìåëÝ-ôåò5 äåí õðÞñ÷å, áöïý äåí ëåéôïõñãïý-óå áñ÷åßï êáôáãñáöÞò éáôñéêþí éóôï-ñéêþí ôçí ðåñßïäï ôçò ðáñïýóáò ìå-ëÝôçò. Ç äéáäéêáóßá ðïõ áêïëïõèÞèç-

êå Þôáí ç åîÞò:• óõëëïãÞ áíôéãñÜöùí ôùí ðéóôïðïéçôéêþíèáíÜôïõ

• êáèïñéóìüò ôùí õðïêåßìåíùí áéôéþí èáíÜ-ôïõ

• êáôáñôéóìüò âÜóçò äåäïìÝíùí êáé áíÜëõóÞôïõòÅêôéìÞèçêå ç õðïêåßìåíç áéôßá 925 èáíÜ-

ôùí ìïíßìùí êáôïßêùí ôùí ðåñéï÷þí ìåëÝôçò ôç÷ñïíéêÞ ðåñßïäï 1985-1997, êáé åöáñìüóôçêáíïé ïäçãßåò ôïõ Ðáãêüóìéïõ Ïñãáíéóìïý Õãåßá(ÐÏÕ) ãéá ôç óùóôÞ åêôßìçóç ôçò õðïêåßìåíçòáéôßáò èáíÜôïõ áðü ôï ðéóôïðïéçôéêü. Åðßóçò çêùäéêïðïßçóç ôùí áéôéþí èáíÜôïõ Ýãéíå ìå âÜóçôç äéåèíÞ óôáôéóôéêÞ ôáîéíüìçóç ôùí íüóùí, êá-êþóåùí, êáé áéôéþí èáíÜôïõ ôïõ ÐÏÕ6.

Óå Ýíá ðïóïóôü ðéóôïðïéçôéêþí äåí ÞôáíêáôáãñáììÝíá óùóôÜ áðü ôï ãéáôñü ôá óôïé÷åßáôáõôüôçôáò ôïõ èáíüíôïò (çëéêßá). Ôá ðéóôïðïéç-ôéêÜ áõôÜ Þôáí ÷åéñüãñáöá êáé áöïñïýóáí êõ-ñßùò áðïìáêñõóìÝíåò ðåñéï÷Ýò. Ç êáôáíïìÞ ôïõòóå çëéêéáêÞ ïìÜäá Ýãéíå ìå âÜóç ðëçñïöïñßåòáðü ôïõò ïéêåßïõò ôïõò. Åðßóçò äåí èåùñÞóáìåóêüðéìç ôçí áíáèåþñçóç ôùí õðïêåßìåíùí áé-ôéþí èáíÜôïõ üðùò Ýãéíå óå Üëëåò ðáñüìïéåòìåëÝôåò1,6 óôéò ðåñéðôþóåéò üðïõ áíáãñáöüôáíáóáöþò ëüãù ôïõ üôé äåí õðÞñ÷å áñ÷åßï êáôá-ãñáöÞò áóèåíþí, ïýôå êáôïñèþóáìå íá Ý÷ïõìå

êáëïêáéñéíïýò ìÞíåò).Óêïðüò ôçò ìåëÝôçò áõôÞò åßíáé íá åíôïðé-

óôïýí ïé êõñéüôåñåò áéôßåò èáíÜôïõ ôïõ ðëçèõ-óìïý åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò ×Üñáêá, íáâñåèåß ç åéäéêÞ ùò ðñïò ôï öýëï, çëéêßá êáé áéôßáèíçóéìüôçôá ôïõ ðëçèõóìïý êáé íá ãßíåé óýãêñé-óç-ðñïôõðïðïßçóç ôùí êõñéïôÝñùí áéôéþí èáíÜ-ôïõ ìå áõôÞ ôçò ÅëëçíéêÞò åðéêñÜôåéáò. Åðßóçòíá óõãêñéèïýí ôá áðïôåëÝóìáôá ìå áõôÜ Üëëùíðåñéï÷þí ôçò ÊñÞôçò.

Ðëçèõóìüò ìåëÝôçò êáé ìÝèïäïò

Ôïí ðëçèõóìü ìåëÝôçò áðïôÝëåóáí ïé ìüíé-ìïé êÜôïéêïé ôùí ðáñáðÜíù ðåñéï÷þí êáôÜ ôç÷ñïíéêÞ ðåñßïäï áðü ôï 1985 Ýùò êáé ôï 1997.Ï ðëçèõóìüò ÷ùñßóôçêå óå ôñåéò çëéêéáêÝò ïìÜ-äåò.

Ïé êïéíüôçôåò ðïõ ðåñéåëÞöèçóáí óôç ìåëÝ-ôç åßíáé:

Êïéí. Áóçìéïý: 1104 êáô., êïéí. Á÷åíôñéÜ:367 êáô., êïéí. ÅèéÜò: 479 êáô., êïéí. Ìåóï÷ù-ñßïõ: 809 êáô., êïéí. Ðýñãïõ: 1080 êáô., êïéí.ÓïêáñÜ: 994 êáô. êïéí. Óôïëþí: 588 êáô., êïéí.Ôåöåëßïõ; 1006 êáô., êïéí. ×Üñáêá: 923 êáô.,êïéí. Ìåôáîï÷ùñßïõ: 718 êáô. Ôá óôïé÷åßá ãéáôïí ðëçèõóìü êáé ôçí êáôáíïìÞ ôïõ êáôÜ çëéêßá

Mortality rates for the population of the Harakas Primary Health CareCentreG. Papadopoulos, D. Brimis, N. Drakonakis, R. Alexandraki, K. Serafimidou,E. Stavrakaki, G. Paterakis, H Kiriakou

SummaryThis study investigates the mortality rates and causes of death from 1985 to1997, in the area of the Harakas Health Centre, with the aim of establishing themain causes of death of the population, and to compare the results with thoseof the Greek national average rate and other similar studies made throughoutCrete. From 1985 until 1997, 925 subjects died in the research area, 471 maleand 454 female. To determine the causes of death the guidelines and instruc-tions of the World Health Organization (WHO) were followed. The mortality fromcirculatory diseases was found to be 30,5%, neoplasmatic diseases 16,9% andrespiratory diseases 8,2%. The Harakas mortality rate from circulatory diseaseswas found to be lower than that of the Greek national average rate (300/100000 against 477/100000). It was also found to be lower than that of boththe Agios Vasilios and Anogia study results. The standardized mortality frommalignant neoplasms was also found to be lower than that of the Greek nationalrate (160/100000 against 190/100000). It was also shown to be lower than thestudy of Ag. Vassilios (187,8/100000) and significantly lower than that of theAnogia study (264,9/100000). In conclusion, from the results of this study thecorrect analysis could help in the recognition of the health problems of thepeople in the area, enabling the appropriate health programmes to be initiated.Key words: mortality rates, primary health care

Harakas Health Centre, Crete

111


êáé çëéêßá èíçóéìüôçôá áíÜ Ýôïò. ÓõíïëéêÜ óôïäéÜóôçìá 1985-1997 óçìåéþèçêáí 925 èÜíáôïéáðü ôïõò ïðïßïõò ïé 805 áöïñïýóáí Üôïìá çëé-êßáò Üíù ôùí 65 åôþí, ïé 115 Üôïìá çëéêßáò 15-64 êáé ïé 5 Üôïìá áðü 0-14 Ýôç. Ç åéäéêÞ ùòðñïò ôï öýëï èíçóéìüôçôá Þôáí ìåãáëýôåñç óôïõòÜíäñåò êõñßùò óôéò çëéêßåò ôùí 15-64. Óôïí ðß-íáêá 2 ðáñïõóéÜæåôáé ç åéäéêÞ êáé áíáëïãéêÞèíçóéìüôçôá áíÜ 100000 êáé áíÜ Ýôïò, áðü äéÜ-öïñåò áéôßåò èáíÜôïõ, ôáîéíïìçìÝíåò êáôÜ êáôç-ãïñßåò êáé óõ÷íüôçôá ìå ôçí ïðïßá óõíáíôþíôáé.Ôá íïóÞìáôá ôïõ êõêëïöïñéêïý óõóôÞìáôïò âñÝ-èçêáí íá åßíáé óôçí ðñþôç èÝóç ìå 30,5% ôïõóõíüëïõ ôùí èáíÜôùí, ïé áóáöþò êáèïñéæüìåíåòêáôáóôÜóåéò óôç äåýôåñç èÝóç ìå 18,8%, ïé íåï-ðëáóìáôéêÝò íüóïé áêïëïõèïýí ìå 16,9%, êáé ôáíïóÞìáôá ôïõ áíáðíåõóôéêïý óõóôÞìáôïò ìå 8,2%.Óôïí ðßíáêá 3 ðáñïõóéÜæåôáé ç åéäéêÞ èíçóéìü-ôçôá áíÜ çëéêßá êáé öýëï ãéá ôá íïóÞìáôá ôïõêõêëïöïñéêïý, ôá íåïðëÜóìáôá, ôá íïóÞìáôá ôïõðåðôéêïý, ôïõ áíáðíåõóôéêïý êáé ôùí êáêþóåùí-äçëçôçñéÜóåùí, êáèþò êáé ç ðñïôõðïðïéçìÝíçèíçóéìüôçôá ùò ðñïò ôçí çëéêßá êáé öýëï, ãéáôéò óõ÷íüôåñåò áéôßåò èáíÜôïõ ôïõ õðü ìåëÝôçðëçèõóìïý.

éáôñéêü éóôïñéêü áõôþí ôùí ðåñéðôþóåùí. ÓôçóõíÝ÷åéá Ýãéíå åðåîåñãáóßá ôùí óôïé÷åßùí áõôþíêáé õðïëïãßóôçêáí ïé äåßêôåò áäñÞò êáé åéäéêÞòèíçóéìüôçôáò ùò ðñïò ôï öýëï, çëéêßá êáé áéôßáèáíÜôïõ, ãéá ôéò ôñåéò çëéêéáêÝò ïìÜäåò (0-14/15-64/65+) êáé õðïëïãßóôçêå ç ðñïôõðïðïéçìÝ-íç èíçóéìüôçôá ãéá ôéò êýñéåò áéôßåò èáíÜôïõ ìåôç ÷ñÞóç ôïõ ôýðïõ ôçò Üìåóçò ðñïôõðïðïßçóçò:

Dj =ÓÌijÓj

KÓsi

¼ðïõ Dj = ðñïôõðïðïéçìÝíï ðïóïóôü èíçóéìü-ôçôáò áðü ôçí áéôßáMij = åéäéêÞ êáôÜ çëéêßá êáé áéôßá èíçóéìüôçôáSi = ðñüôõðïò ðëçèõóìüò çëéêßáòÊ = 100000

Ùò ðñüôõðïò ðëçèõóìüò ÷ñçóéìïðïéÞèçêå ïóõíïëéêüò ðëçèõóìüò ôçò ÅëëÜäáò óýìöùíá ìåôçí áðïãñáöÞ ôïõ 19914.

ÁðïôåëÝóìáôá

Óôïí ðßíáêá 1 ðáñïõóéÜæåôáé ï ðëçèõóìüòìåëÝôçò êáôá÷ùñçìÝíïò êáôÜ çëéêßá êáé öýëï, ïáñéèìüò èáíÜôùí êáé ç åéäéêÞ ùò ðñïò ôï öýëï

Ðßíáêáò 2. ÅéäéêÞ êáé áíáëïãéêÞ èíçóéìüôçôá áíÜ áéôßá èáíÜôïõ ôçí ðåñßïäï 1985-1997

ÈÜíáôïé ÅéäéêÞ èíçó./ ÁíáëïãéêÞ èíçóéìüôçôá (%)100.000/Ýôïò

ÍïóÞìáôá êõêëïöïñéêïý 320 305 34,5Áóáöþò êáèïñéæüìåíåò êáôáóôÜóåéò 198 188,7 21,4ÍåïðëÜóìáôá 178 169,7 18,2ÍïóÞìáôá áíáðíåõóôéêïý 86 82 9,2ÍïóÞìáôá ðåðôéêïý 30 28,6 3,2ÍïóÞìáôá ïõñïðïéïãåííçôéêïý 27 25,7 2,9Êáêþóåéò-äçëçôçñéÜóåéò 23 22 2,4ÅíäïêñéíéêÜ êáé ìåôáâïëéêÜ íïóÞìáôá 19 18 2Ëïéìþäç êáé ðáñáóéôéêÜ íïóÞìáôá 15 14,3 1,6ÍïóÞìáôá áßìáôïò êáé áéìïðïéçôéêþí ïñãÜíùí 14 13,3 1,5ÍïóÞìáôá íåõñéêïý 10 9,5 1ÍïóÞìáôá ïóôþí êáé áñèñþóåùí 3 2,8 0,3Øõ÷éáôñéêÜ íïóÞìáôá 2 1,9 0,2Óýíïëï 925 882 100

Ðßíáêáò 1. Áñéèìüò èáíÜôùí êáé åéäéêÞ èíçóéìüôçôá ùò ðñïò çëéêßá êáé öýëï ôïõ ðëçèõóìïý áðü 1985-1997

Áñéèìüò èáíÜôùí Ðëçèõóìüò ÅéäéêÞ èíçóéìüôçôá/1000/Ýôïò

Çëéêßåò ¢ññåíåò ÈÞëåéò Óýíïëï ¢ññåíåò ÈÞëåéò Óýíïëï ¢ññåíåò ÈÞëåéò Óýíïëï

0-14 2 3 5 875 823 1695 0,1 0,2 0,215-64 79 36 115 2640 2416 5056 2,3 1,1 1,765+ 390 415 805 607 707 1314 49,4 45,1 47,1Óýíïëï 471 454 925 4122 3946 8068 8,7 8,8 8,8


112

Ã. Ðáðáäüðïõëïò êáé óõí.

Ðßíáêáò 3. ÅéäéêÞ êáé ðñïôõðïðïéçìÝíç èíçóéìüôçôá ãéï ôéò óõ÷íüôåñåò áéôßåò èáíÜôïõ áðü ôï 1985-1997

ÅéäéêÞ èíçóéìüôçôá/100.000/Ýôïò ÐñïôõðïðïéçìÝíç

0-14 15-64 65+ Óýíïëï èíçóéìüôçôá/100.000/Ýôïò

ÍïóÞìáôá êõêëïöïñéêïý(óõíïëéêÜ)¢ññåíåò 0 64,1 1748,8 296,7 290ÈÞëåéò 0 54,1 1555,8 313,8 310Óýíïëï 0 59,3 1645 305 300ÍåïðëÜóìáôá¢ññåíåò 351 87,4 709,6 167,9 169,9ÈÞëåéò 186 130,5 489,6 171,5 159,9Óýíïëï 272 108 591,2 169,7 160ÍïóÞìáôá áíáðíåõóôéêïý¢ññåíåò 0 5,8 671,6 102,6 86ÈÞëåéò 0 0 337,2 60,4 51Óýíïëï 0 5,8 491,7 81,9 68,2ÍïóÞìáôá ðåðôéêïý¢ññåíåò 0 11,6 139,3 27,9 23,8ÈÞëåéò 0 22,2 87 29,2 27,9Óýíïëï 0 16,7 111,2 28,6 25,9Êáêþóåéò-äçëçôçñéÜóåéò¢ññåíåò 0 23,3 114 31,7 29,7ÈÞëåéò 0 6,3 43,5 11,6 10,8Óýíïëï 0 15,2 76,1 21,9 20,1

ÓõæÞôçóç

Ïé ìåëÝôåò óôáôéóôéêÞò èíçóéìüôçôáò óõíá-íôïýí êõñßùò ðñïâëÞìáôá åðáíáëçðôüôçôáò (re-liability) êáé åãêõñüôçôáò (validity). Ôüóï ç åðá-íáëçðôüôçôá üóï êáé ç åãêõñüôçôá ôùí óôáôé-óôéêþí áõôþí, åîáñôþíôáé áðü ôéò äéáäéêáóßåòðïõ áêïëïõèÞèçêáí3,7,8.

Óôç ìåëÝôç ìáò áêïëïõèÞèçêáí ïé êáíüíåòôïõ ÐÏÕ ãéá ôçí êáôáãñáöÞ ôçò õðïêåßìåíçòáéôßáò èáíÜôïõ. Äåí ìðïñÝóáìå üìùò íá óõãêå-íôñþóïõìå óõìðëçñùìáôéêÝò ðëçñïöïñßåò áðüÜëëåò ðçãÝò ó÷åôéêÜ ìå ôéò ðåñéðôþóåéò ðïõ äåíêáèïñßæïíôáí ìå áêñßâåéá ïé õðïêåßìåíåò áéôßåòèáíÜôïõ. Ôá ðéóôïðïéçôéêÜ èáíÜôïõ ìå áóáöÞäéÜãíùóç Þôáí ðåñßðïõ 60 êáé ðñïóôÝèçêáí óôéòáóáöþò êáèïñéæüìåíåò êáôáóôÜóåéò. Áöïñïýóáíðåñéï÷Ýò áðïìáêñõóìÝíåò êáé êõñßùò ìüíá êáéçëéêéùìÝíá Üôïìá ðïõ äåí åß÷áí ôç äõíáôüôçôáóõ÷íÞò åðáöÞò ìå ôï ãéáôñü. Ãåãïíüò åßíáé ðÜ-íôùò üôé êáé óôç ìåëÝôç ìáò ôï ðïóïóôü ôùíáóáöþò êáèïñéæüìåíùí êáôáóôÜóåùí êáôáëáì-âÜíåé õøçëÝò èÝóåéò óôçí êáôáãñáöÞ áéôéþí èá-íÜôïõ, üðùò áêñéâþò óõìâáßíåé óå üëåò ôéò ìåëÝ-ôåò ôïõ åßäïõò. Áõôü öáíåñþíåé ôçí áäõíáìßáôïõ ãéáôñïý ðïõ óõìðëçñþíåé ôï ðéóôïðïéçôéêüèáíÜôïõ íá ãíùñßæåé ôçí áêñéâÞ áéôßá èáíÜôïõ,

ãåãïíüò ðïõ åßíáé óõ÷íü óôç ÷þñá ìáò1,2,5.Ç ðñïôõðïðïßçóç ôùí äåéêôþí èíçóéìüôç-

ôáò, ìáò åðéôñÝðåé ôç óýãêñéóç ôçò èíçóéìüôçôáòêáôÜ áéôßá èáíÜôïõ ôùí ðåñéï÷þí ðïõ õðÜãï-íôáé óôï Ê.Õ. ×Üñáêá ìå áõôÞ ôçò ÅëëçíéêÞòåðéêñÜôåéáò áëëÜ êáé ìå ôç èíçóéìüôçôá ïðïéáó-äÞðïôå Üëëçò ðåñéï÷Þò Þ ÷þñáò5,3.

Ï áäñüò äåßêôçò èíçóéìüôçôáò óôéò ðåñéï÷ÝòìåëÝôçò áíÜ 1000 êáôïßêïõò âñÝèçêå 8,8 åíþ ïáíôßóôïé÷ïò ôçò ÅëëçíéêÞò åðéêñÜôåéáò åßíáé 9,39.ÌåôÜ ôçí ðñïôõðïðïßçóÞ ôïõ ï áäñüò äåßêôçòäåí Üëëáîå áöïý õðïëïãßóôçêå óôï 8,7. Èåùñïý-ìå Ýôóé üôé ï ðëçèõóìüò ìåëÝôçò ìáò ìïéÜæåé üóïíáöïñÜ ôç óýíèåóÞ ôïõ ìå áõôüí ôçò ÅëëçíéêÞòåðéêñÜôåéáò. Óå ðáñüìïéåò ìåëÝôåò üðùò óôïí ¢ãéïÂáóßëåéï êáé óôï äÞìï Áíùãåßùí ï áäñüò äåß-êôçò õðïëïãßóôçêå óôï 17,2 êáé 13,5 áíôßóôïé-÷á1,3. Ï áðïêëßóåéò áõôÝò ìåôáîý ôùí áäñþí äåé-êôþí èíçóéìüôçôáò èåùñïýìå üôé ïöåßëåôáé óåãÞñáíóç ôïõ ðëçèõóìïý ðïõ åßíáé ìåãáëýôåñçóôçí ðåñéï÷Þ ôïõ Áãßïõ Âáóéëåßïõ1.

Ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá áðü íïóÞ-ìáôá ôïõ êõêëïöïñéêïý óôç ìåëÝôç ìáò âñÝèçêåðïëý ÷áìçëÞ óå ó÷Ýóç ìå áõôÞ ôçò åðéêñÜôåéáò(300/100.000 Ýíáíôé 477/100.000)9 ãåãïíüò ðïõåðéâåâáéþíåé ôç ÷áìçëÞ èíçóéìüôçôá áðü íïóÞ-ìáôá ôïõ êõêëïöïñéêïý óôçí ÊñÞôç, üðùò Ý÷åé

113


äéáðéóôùèåß êáé áðü Üëëïõò åñåõíçôÝò1,3,5,10. Ôïðïóïóôü áõôü åßíáé ìéêñüôåñï áðü áõôü ôïõ ÁãßïõÂáóéëåßïõ12 êáé áðü áõôü ôïõ äÞìïõ Áíùãåßùí2.Ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá áðü íåïðëÜóìá-ôá âñÝèçêå ìéêñüôåñç áðü áõôÞ ôçò åðéêñÜôåéáò(160/100.000 Ýíáíôé 190/100.000)9. Åðßóçò åß-íáé ÷áìçëüôåñç áðü áõôÞ ôùí äýï Üëëùí ìåëå-ôþí1,3. Ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá ôùí íü-óùí ôïõ áíáðíåõóôéêïý âñÝèçêå 68,2/100.000êáé áõôÞ ôùí íïóçìÜôùí ôïõ ðåðôéêïý 25,9/100.000, ÷áìçëüôåñåò êáé áõôÝò áðü ôéò ìåëÝôåòôùí Üëëùí ðåñéï÷þí1,3.

Ðáñüëï ðïõ ï äåßêôçò èíçóéìüôçôáò áðüíïóÞìáôá ôïõ êõêëïöïñéêïý öáßíåôáé íá åßíáé÷áìçëüò óôçí ðåñéï÷Þ ìáò áëëÜ êáé óôéò Üëëåòðåñéï÷Ýò ðïõ Ý÷ïõí ìåëåôçèåß, êáé äåäïìÝíïõ üôéáðü Üëëåò ìåëÝôåò1,13,16 áíáìÝíåôáé áýîçóç ôçòèíçóéìüôçôáò áðü êáñäéáããåéáêÞ íüóï ëüãù ôçòáëëáãÞò äéáôñïöéêþí óõíçèåéþí ôïõ Êñçôéêïýðëçèõóìïý, åßíáé áíáãêáßá ç ðáñáêïëïýèçóç ôùíäåéêôþí èíçóéìüôçôáò.

Åðßóçò üðùò ðñïáíáöÝñèçêå ç êáôáãñáöÞôùí äåéêôþí èíçóéìüôçôáò óôçí ðåñéï÷Þ ôïõ Ê.Õ.×Üñáêá åðé÷åéñåßôáé ãéá ðñþôç öïñÜ êáé äåäï-ìÝíïõ ôïõ ìåãÜëïõ áñéèìïý ôïõ ðëçèõóìïý åõèý-íçò ôïõ, ìðïñïýìå íá ðïýìå üôé ç äéá÷ñïíéêÞðáñáêïëïýèçóç ôùí äåéêôþí èíçóéìüôçôáò ôçòðåñéï÷Þò, ìðïñåß íá ìáò öáíåß ðïëý ÷ñÞóéìç üóïíáöïñÜ ôï ó÷åäéáóìü ôçò ÐñùôïâÜèìéáò Öñïíôß-äáò Õãåßáò áëëÜ êáé ôçí åöáñìïãÞ ðñïãñáììÜ-ôùí áãùãÞò õãåßáò ôïõ ðëçèõóìïý.

Âéâëéïãñáößá

1. Lionis C, Koutis A, Antonakis N, Isacsson A,Lindholm L, Fioretos M. Mortality rates in acardiovascular “low risk” population in ruralCrete. Family Practice, 10:300-304, 1993.

2. Ôñé÷üðïõëïò Ä. Åðéäçìéïëïãßá: áñ÷Ýò, ìÝèïäïé,åöáñìïãÝò. Åêäüóåéò ÐáñéæéÜíïõ, ÁèÞíá 1982.

3. ÁíôùíÜêçò Í, ÌÜêñç Ê, ÊáëðáäÜêç ×, ËéïíÞò×. Äåßêôåò èíçóéìüôçôáò óôïí ðëçèõóìü åíüò

ïñåéíïý äÞìïõ ôçò ÊñÞôçò. Áñ÷åßá ÅëëçíéêÞòÉáôñéêÞò 14:294/299, 1997.

4. ÅèíéêÞ ÓôáôéóôéêÞ Õðçñåóßá. Óôïé÷åßá áðü ôçíáðïãñáöÞ ôïõ 1991.

5. ËéïíÞò ×, ÔóáêáëÜêç Ì, ÊïõôÞò Á, Ôóáìáí-äïõñÜêç Ê, Áëáìáíüò Ã, ÖéïñÝôïò Ì. Äåßêôåòèíçóéìüôçôáò åðáñ÷ßáò Áãßïõ Âáóéëåßïõ. Ç¸êäïóç ÊëéíéêÞò êáé ÏéêïãåíåéáêÞò ÉáôñéêÞòÐáíåðéóôçìßïõ ÊñÞôçò, 1991.

6. World Health Organization. Global strategy forhealth for all by the year 2000: “Health forall”, series No 3, W.H.O. (eds). Geneva 1981.

7. Glasser HJ. The quality and utility of deathcertificate data. Am J Public Health 71:231-233, 1981.

8. Schado B. Reliability and validity of the classi-fication of death in General Practice. Scan. JPrim Health Care 5:109-112, 1987.

9. ÅèíéêÞ ÓôáôéóôéêÞ Õðçñåóßá ÅëëÜäïò. ÓôáôéóôéêÞôçò öõóéêÞò êßíçóçò ôïõ ðëçèõóìïý ôçò ÅëëÜäáò,Ýôïõò 1988. ¸êäïóç ôçò ÅèíéêÞò ÓôáôéóôéêÞòÕðçñåóßáò ÅëëÜäïò. ÁèÞíá, 1995.

10. Keys A. Seven countries. A multivariate analy-sis of death and coronary heart disease. Har-vard University Press, Cambridge, MA, 1990.

11. Ðáãêüóìéïò Ïñãáíéóìüò Õãåßáò. Åã÷åéñßäéï äéå-èíïýò óôáôéóôéêÞò ôáîéíüìçóçò ôùí íüóùí êá-êþóåùí êáé áéôéþí èáíÜôïõ. ¸êäïóç Õðïõñ-ãåßïõ óõíôïíéóìïý êáé Õðïõñãåßï êïéíùíéêþíõðçñåóéþí. ÁèÞíá 1980.

12. ËéïíÞò ×, ÁíôùíÜêçò Í, Êïýôçò Á, Ôóáìáíäïõ-ñÜêç Ê, Áëáìáíüò Ã, ÖéïñÝôïò Ì. äåßêôåò èíç-óéìüôçôáò óôçí åðáñ÷ßá Áãßïõ ÂáóéëåßïõÍïìïý Ñåèýìíçò. ÉáôñéêÞ, 63:158-162, 1993.

13. ÐáðáåõáããÝëïõ Ã, Ôóßìðïò Ã. ÓçìáíôéêÞ áýîç-óç ôçò èíçóéìüôçôáò áðü êáñäéáããåéáêÝò ðáèÞ-óåéò óôçí ÅëëÜäá êáôÜ ôá ôåëåõôáßá ÷ñüíéá.Mat Med Greca 10:239-250, 1982

14. World Health Organization. 1991 World healthstatistics annual. WHO (eds). Geneva, 1992.

15. Lionis C, Ôrell E. Health needs assessment ingeneral practice: the Cretan approach. Eur JGeneral Practice, 5, 1999.

16. Authors. Mortality from ishaemic heart diseasein industrialized countries. Ann Statist SanitMond, p. 25-29, 1987.


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Ê. Óïõëéþôçò êáé óõí.

Ç Éêáíïðïßçóç ôùí áóèåíþí áðü ôç íïóïêïìåéáêÞ öñïíôßäáóôçí ÅëëÜäá: ÁðïôåëÝóìáôá Ýñåõíáò ãíþìçò óôçí åõñýôåñçòðåñéï÷Þò Áèçíþí

Ê. Óïõëéþôçò, A. Äüëãåñáò, Ä. Êüíôïò, ×. Ïéêïíüìïõ

ÅÑÅÕÍÇÔÉÊÇ ÅÑÃÁÓÉÁ

ORIGINAL PAPERPrimary Heatlh Care, Volume 14, Number 3, 114-118, 2002ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 114-118, 2002

ÅéóáãùãÞ

Óôï êåßìåíï áõôü, ðáñïõóéÜæïíôáéôá áðïôåëÝóìáôá ðñüóöáôçò Ýñåõíáòó÷åôéêÜ ìå ôçí éêáíïðïßçóç ôùí áóèå-íþí áðü ôç íïóïêïìåéáêÞ öñïíôßäáóôç ÷þñá ìáò. Óçìåéþíåôáé üôé ç Ýñåõ-íá áõôÞ, åîÝôáóå åðéðëÝïí ôï æÞôçìáôçò éêáíïðïßçóçò áðü ôçí áóöáëéóôé-êÞ êÜëõøç, óå óõíäõáóìü ìå ôçí ðñü-èåóç êáé ôçí ðñáêôéêÞ ôùí ÷ñçóôþííá êáôáâÜëëïõí åðéðëÝïí ÷ñÞìáôá,þóôå íá êáôáíáëþóïõí õðçñåóßåòêáëýôåñçò - üðùò ïé ßäéïé áíôéëáìâÜ-íïíôáé -ðïéüôçôáò. Óêïðüò ôïõ Üñèñïõáõôïý åßíáé: (á) ç áðïôýðùóç ôùí ÷á-ñáêôçñéóôéêþí ôùí ÷ñçóôþí ôùí íï-óçëåõôéêþí õðçñåóéþí óôçí ðåñéï÷Þôùí Áèçíþí êáé (â) ç ìÝôñçóç ôçòéêáíïðïßçóçò áðü ôç ÷ñçóéìïðïßçóçíïóïêïìåéáêþí õðçñåóéþí.


Ç Ýñåõíá óôçñß÷èçêå óå ôçëåöù-

ÐåñßëçøçÓôï êåßìåíï áõôü, ðáñïõóéÜæïíôáé ôá áðïôåëÝóìáôá ðñüóöáôçò Ýñåõíáò ó÷å-ôéêÜ ìå ôçí éêáíïðïßçóç ôùí áóèåíþí áðü ôç íïóïêïìåéáêÞ öñïíôßäá óôçíÅëëÜäá. Ç Ýñåõíá óôçñß÷èçêå óå ôçëåöùíéêÝò óõíåíôåýîåéò ðïõ äéåîÞ÷èç-óáí óå äåßãìá ðëçèõóìïý 350 áôüìùí (175 Üíäñåò êáé 175 ãõíáßêåò)çëéêßáò 15-65 åôþí, óôçí ðåñéï÷Þ ôçò ÁèÞíáò. Ïé óõëëå÷èåßóåò ðëçñï-öïñßåò áöïñïýóáí óôá êïéíùíéêïïéêïíïìéêÜ ÷áñáêôçñéóôéêÜ ôùí áóèåíþí êáéóôç ìÝôñçóç ôïõ âáèìïý éêáíïðïßçóÞò ôïõò áðü ôéò õðçñåóßåò ôùí äçìüóéùíêáé éäéùôéêþí íïóïêïìåßùí. Ç Ýñåõíá êáôáëÞãåé óôç äéáðßóôùóç üôé ç äõóáñÝ-óêåéá áðü ôá íïóïêïìåßá ôïõ ÅÓÕ ó÷åôßæåôáé ìå ôïõò ðáñÜãïíôåò ôçò îåíïäï-÷åéáêÞò õðïäïìÞò, ôçò Ýëëåéøçò ðñïóùðéêïý, ôçò êáèáñéüôçôáò ôùí ÷þñùíêáé ôçò óõìðåñéöïñÜò ôùí åðáããåëìáôéþí õãåßáò. Áðü ôçí Üëëç, ïé õðçñåóßåòôùí éäéùôéêþí íïóçëåõôéêþí äïìþí äçìéïõñãïýí ìåãáëýôåñï áßóèçìá éêáíï-ðïßçóçò óôïõò ðïëßôåò, êõñßùò óå ü,ôé áöïñÜ óôéò ãåíéêüôåñåò óõíèÞêåò íïóç-ëåßáò. ÔÝëïò, ç Ýñåõíá åðéâåâáéþíåé ôçí õðüèåóç üôé ïé áðáéôÞóåéò êáé ïéðñïóäïêßåò ôùí ðïëéôþí, áõîÜíïíôáé üóï êéíïýìáóôå ðñïò ôá õøçëüôåñá êïé-íùíéêÜ óôñþìáôá êáé ùò åê ôïýôïõ, áõôÜ áîéïëïãïýí ìå áõóôçñüôåñá êñéôÞñéáôéò ðáñå÷üìåíåò öñïíôßäåò.

ÔïìÝáò Ïéêïíïìéêþí ôçò Õãåßáò, ÅèíéêÞ Ó÷ïëÞ Äçìüóéáò Õãåßáò, ÁèÞíá

ËÝîåéò êëåéäéÜ: éêáíïðïßçóç, áóèåíÞò, íïóïêïìåßá,öñïíôßäá, ÅëëÜäáÕðïâëÞèçêå: 18 Óåðôåìâñßïõ 2001ÅðáíõðïâëÞèçêå: 3 Äåêåìâñßïõ 2001¸ãéíå äåêôÞ ãéá äçìïóßåõóç: 4 Áðñéëßïõ 2002Õðåýèõíïò áëëçëïãñáößáò: ÊõñéÜêïò Óïõëéþôçò,ÅÓÄÕ, Ë. ÁëåîÜíäñáò 196, 11521, ÁèÞíá Ôçë.(210)6435328, Fax. (210)5816615, e-mail: [email protected]

Patient Satisfaction with Hospital Care in Greece: Results from atelephone study in the Greater Athens areaK. Souliotis, A. Dolgeras, D. Kontos, C. Economou

SummaryThis paper presents the results of recent research into patients' satisfactionwith hospital care in Greece. This research was carried out through the mediaof telephone interviews, with a sample of 350 people (175 male and 175female), between the ages of 15-65 years, in the Greater Athens area. Theinformation concentrated on two main aspects, firstly those of the patients'socioeconomic status and secondly on the measurement of the standard ofsatisfaction with both the public and private hospital services. Through thisresearch some very important conclusions arouse. Firstly, patients' disappoint-ment to public hospitals was related, not only to the "hotel services", but also tothe lack of staff, general cleanliness and the behaviour of the staff. Conversely,the private sector's services were found to be more satisfactory, mainly for thegeneral hospital conditions. The final analysis of this research, confirmed theinitial assumption that the claims and expectations of people are related to theirsocioeconomic status.Key words: patient satisfaction, hospital care, Greece

Department of Health Economics, National School of Public Health

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Ê. Óïõëéþôçò êáé óõí. Ôüìïò 14, Ôåý÷ïò 3, 2002

Ðßíáêáò 1. ÅðÜããåëìá, åéóüäçìá êáé ìüñöùóç ôïõ õðåõèýíïõ ôïõ íïéêïêõñéïý

ÅðÜããåëìá õðåõèýíïõ Ìçíéáßï åéóüäçìá Ìüñöùóç õðåõèýíïõôïõ íïéêïêõñéïý ôïõ íïéêïêõñéïý ôïõ íïéêïêõñéïý

ÅðáããåëìáôéêÞ ÏìÜäá Áíáëïãßá Êáôçãïñßá Áíáëïãßá Êáôçãïñßá Áíáëïãßá% (åéóïäçìáôéêÜ êëéìÜêéá óå äñ÷.) % %

Áãñüôåò 0,6 ÊÜôù áðü 200.000 10,3 Êáôþôåñç 14,1

Åëåýèåñïé Åðáããåëìáôßåò 23,9 201.000 - 300.000 16,9 ÃõìíÜóéo/Ëýêåéï 42.9Ýùò 10 õðáëëÞëïõò

Åëåýèåñïé Åðáããåëìáôßåò 3,1 301.000 - 400.000 15,7 ÁíþôåñçÝùò 10 õðáëëÞëïõò

Åëåýèåñïé Åðáããåëìáôßåò- 7,4 401.000 - 500.000 17,4 Áíþôáôç 28,2Ýùò 10 õðáëëÞëïõò

ÕðÜëëçëïé - ÅðéóôÞìïíåò 8,6 501.000 - 600.000 7,7 Äåí áðÜíôçóáí 2,5Åéäéêïß

Ãåíéêïß ÄéåõèõíôÝò - 5,5 601.000 - 800.000 4,0ÐñïúóôÜìåíïé

ÕðÜëëçëïé ãñáöåßïõ 21,5 801.000 - 1.000.000

ÕðÜëëçëïé åêôüò ãñáöåßïõ 4,9 ÐÜíù áðü 1.000.000 8,3

ÅéäéêåõìÝíïé ÕðÜëëçëïé - 12,3 ÄÃ/ÄÁ 16,9×åéñùíáêôéêÞ åñãáóßá

ÍïéêïêõñÝò - Åéóïäçìáôßåò 2,5

ÓðïõäáóôÝò 1,2

¢ñíçóç - Äåí áðÜíôçóáí 6,1

íéêÝò óõíåíôåýîåéò ðïõ äéåîÞ÷èçóáí ôï ÖåâñïõÜ-ñéï ôïõ 2000 ìå ôç âïÞèåéá ôçò åôáéñåßáò Opin-ion, óå äåßãìá ðëçèõóìïý 350 áôüìùí (175 Üí-äñåò êáé 175 ãõíáßêåò) çëéêßáò 15-65 åôþí, óôçíðåñéï÷Þ ôçò ÁèÞíáò. Ïé óõëëå÷èåßóåò ðëçñïöï-ñßåò áöïñïýí áöåíüò óôç óêéáãñÜöçóç ôùí ÷á-ñáêôçñéóôéêþí ôùí áóèåíþí êáé óôçí êáôÜôáîÞôïõò áíÜ êïéíùíéêÞ ôÜîç êáé áöåôÝñïõ óôç ìÝ-ôñçóç ôïõ âáèìïý éêáíïðïßçóÞò ôïõò áðü ôéòõðçñåóßåò õãåßáò, ôùí äçìïóßùí êáé éäéùôéêþííïóïêïìåßùí.

Êáô' áñ÷Üò, üóïí áöïñÜ óôçí çëéêßá ôïõäåßãìáôïò, ôï ìåãáëýôåñï ðïóïóôü óõìðåñéëáì-âÜíåôáé óôçí çëéêéáêÞ ïìÜäá 35-44 åôþí (23,4%),åíþ áêïëïõèïýí ïé çëéêéáêÝò ïìÜäåò 25-34(20,6%), 45-54 (19,4%), 15-24 (18,6%) êáé 55+(18%). Ó÷åôéêÜ ìå ôá êïéíùíéêïïéêïíïìéêÜ ÷áñá-êôçñéóôéêÜ (ìüñöùóç, åðÜããåëìá êáé åéóüäçìá),ôá ïðïßá óýìöùíá êáé ìå ôç äéåèíÞ âéâëéïãñá-ößá1-3 åðçñåÜæïõí óçìáíôéêÜ ôá áðïôåëÝóìáôáôÝôïéùí åñåõíþí áöïý äéáìïñöþíïõí ôüóï ôéòåðéëïãÝò ìåôáîý äçìüóéïõ êáé éäéùôéêïý ôïìÝá,üóï êáé ôéò ðñïóäïêßåò áðü ôçí ðáñå÷üìåíç öñï-íôßäá, áõôÜ áðïôõðþíïíôáé óôïí Ðßíáêá 1.

¼ðùò ðñïáíáöÝñèçêå, óôçí ðáñïýóá Ýñåõ-íá åðé÷åéñÞèçêå ç êáôçãïñéïðïßçóç ôùí íïéêï-

êõñéþí óå ìéá ôñéôïâÜèìéá êëßìáêá êïéíùíéêÞòäéáóôñùìÜôùóçò, ÷ñçóéìïðïéþíôáò ùò êñéôÞñéáéåñÜñ÷çóçò ôï åðÜããåëìá ôïõ õðåýèõíïõ ôçò ïé-êïãÝíåéáò óå óõíäõáóìü ìå ôï ìïñöùôéêü ôïõåðßðåäï. Ç ìåãáëýôåñç óõãêÝíôñùóç, (74,3%)åìöáíßæåôáé óôç ìåóáßá ôÜîç ôçò êëßìáêáò. Óç-ìåéþíåôáé üôé ãéá ôçí êáôÜôáîç ôùí íïéêïêõñéþíóôéò ôñåéò ôÜîåéò, õéïèåôåßôáé ç êáôçãïñéïðïßçóçðïõ ðåñéãñÜöåôáé óôïí Ðßíáêá 2:

Ìå âÜóç ôá ðáñáðÜíù äåäïìÝíá, åðé÷åéñÞ-èçêå ç ìÝôñçóç ôçò éêáíïðïßçóçò ôùí áóèåíþí,ç ïðïßá óôçñß÷èçêå óå êëßìáêá ðÝíôå ðéèáíþíáðáíôÞóåùí (1: êáèüëïõ, 2: ëßãï, 3: ìÝôñéá, 4:áñêåôÜ êáé 5: ðÜñá ðïëý) êáé óõó÷åôßóôçêå ìåôá ÷áñáêôçñéóôéêÜ ôùí åñùôþìåíùí. Ãéá ôçíåîáãùãÞ óõìðåñáóìÜôùí, ïé ðëçñïöïñßåò êùäé-êïðïéÞèçêáí êáé ôáîéíïìÞèçêáí ìå âÜóç ôï ðï-óïóôü áíÜ êëßìáêá áðáíôÞóåùí. Óôïõò ðßíáêåòêáé óôá äéáãñÜììáôá ðïõ áêïëïõèïýí, ðáñïõ-óéÜæåôáé ç ðïóïóôéáßá áíáëïãßá ôùí áðáíôÞóåùíôïõ äåßãìáôïò áíÜ êáôçãïñßá áðÜíôçóçò. Óç-ìåéþíåôáé üôé ãéá ôçí áîéüðéóôç áðïôýðùóç ôçòéêáíïðïßçóçò ôùí áóèåíþí, ÷ñçóéìïðïéïýíôáé ôááðïôåëÝóìáôá ðïõ áöïñïýí óôï ðïóïóôü ôïõäåßãìáôïò ðïõ áíôáðïêñßèçêå óôçí Ýñåõíá (validpercent) êáé ü÷é óôï ðïóïóôü ðïõ áöïñÜ óôï


116


Ðßíáêáò 2. ÊïéíùíéêÝò ÔÜîåéò óå Óõíäõáóìü ìå ôï ÅðÜããåëìá êáé ôç Ìüñöùóç ôïõ Õðåõèýíïõ ôçò ÏéêïãÝíåéáò

Á-Â C D-ÅÓõãêÝíôñùóç 10,3% ÓõãêÝíôñùóç 74,3% ÓõãêÝíôñùóç 15,4%

ÅðÜããåëìá Ìüñöùóç ÅðÜããåëìá Ìüñöùóç ÅðÜããåëìá Ìüñöùóç

Åëåýèåñïé Ðôõ÷éïý÷ïé åëåýèåñïé åðáããåëìáôßåò Ðôõ÷éïý÷ïé õðÜëëçëïé Áðüöïéôïéåðáããåëìáôßåò Áíþôáôùí ðïõ áðáó÷ïëïýí ÁíùôÝñùí ÷åéñþíáêôåò, ÄçìïôéêïýåðéóôÞìïíåò, Ó÷ïëþí ìÝ÷ñé 10 õðáëëÞëïõò, Ó÷ïëþí, áíåéäßêåõôïé êÜðïéùíåëåýèåñïé åëåýèåñïé åðáããåëìáôßåò Áðüöïéôïé õðÜëëçëïé ôÜîåùí ôïõåðáããåëìáôßåò ðïõ áðáó÷ïëïýí Ëõêåßïõ êáé ÷åéñþíáêôåò, Äçìïôéêïýðïõ áðáó÷ïëïýí ðÜíù áðü 10 Ãõìíáóßïõ óõíôáîéïý÷ïé ÁíáëöÜâçôïéìÝ÷ñé 10 õðáëëÞëïõò, äéåõèõíôÝò, áãñüôåò,õðáëëÞëïõò, ðñïúóôÜìåíïé, íïéêïêõñÝò,åëåýèåñïé õðÜëëçëïé ãñáöåßïõ, åéóïäçìáôßåòåðáããåëìáôßåò åéäéêåõìÝíïé õðÜëëçëïéðïõ áðáó÷ïëïýí ÷åéñþíáêôåò,ðÜíù áðü 10 áíåéäßêåõôïé õðÜëëçëïéõðáëëÞëïõò, ÷åéñþíáêôåò,äéåõèõíôÝò, óõíôáîéïý÷ïé áãñüôåò,ðñïúóôÜìåíïé, åéóïäçìáôßåòõðÜëëçëïé óðïõäáóôÝòãñáöåßïõ,óõíôáîéïý÷ïéåéóïäçìáôßåò

óýíïëï ôïõ äåßãìáôïò.


Ôá áðïôåëÝóìáôá ôçò Ýñåõíáò, áðïêáëýðôïõíåîáéñåôéêÜ åíäéáöÝñïíôá óôïé÷åßá ãéá ôç äéáäé-êáóßá êáé ôéò óõíèÞêåò ÷ñçóéìïðïßçóçò ôùí íï-óçëåõôéêþí õðçñåóéþí óôá äçìüóéá êáé éäéùôéêÜíïóïêïìåßá ôçò ÷þñáò ìáò, ðáñÜãïíôåò ïé ïðïßïéäéáìïñöþíïõí êáé ôçí éêáíïðïßçóç ôùí ÷ñçóôþíáðü áõôÝò.

Ï âáèìüò óôïí ïðïßï ç êïéíùíéêÞ ôÜîç åðç-ñåÜæåé ôüóï ôçí åðéëïãÞ ôïõ öïñÝá õãåßáò, üóïêáé ôçí éêáíïðïßçóç áðü ðáñå÷üìåíåò õðçñåóßåò,åßíáé åìöáíÞò óôïõò ðáñáêÜôù ðßíáêåò. ¼ðùòëïéðüí ðñïêýðôåé áðü ôïí Ðßíáêá 3, ôï ìåãáëý-ôåñï ðïóïóôü ôïõ äåßãìáôïò ðïõ ÷ñçóéìïðïßçóå

Ðßíáêáò 3. Ðïéá Õðçñåóßá Õãåßáò ÷ñçóéìïðïéÞóáôå åóåßò Þ Üëëï ìÝëïò ôçò ïéêïãÝíåéÜò óáò ôåëåõôáßá öïñÜ;

ÊïéíùíéêÞ ÔÜîç

A-B C D-E ÓýíïëïÖïñÝáò Ðåñéðôþóåéò % Ðåñéðôþóåéò % Ðåñéðôþóåéò % Ðåñéðôþóåéò %

Íïóïêïìåßï ÅÓÕ 10 27,8 72 27,7 16 29,6 98 28,0ÉäéùôéêÞ ÊëéíéêÞ 12 33,3 20,8 5 9,3 71 20,3¢ëëåò õðçñåóßåò 21 58,3 172 66,2 38 70,4 231 66,0ÄÃ/ÄÁ 1 2,8 11 4,2 3 5,6 15 4,3Åñùôþìåíïé 36 100 260 100 54 100 350 100

õðçñåóßåò ôùí íïóïêïìåßùí ôïõ ÅÓÕ (29,6%)ðñïÝñ÷åôáé áðü ôéò ÷áìçëÝò ôÜîåéò óôç ó÷åôéêÞêëßìáêá (÷ùñßò üìùò ìåãÜëåò áðïêëßóåéò), óåáíôßèåóç ìå ôéò éäéùôéêÝò êëéíéêÝò, üðïõ ç ðåëá-ôåßá ôïõò ðñïÝñ÷åôáé êõñßùò áðü ôá õøçëÜ(33,3%) êáé ìåóáßá (20,8%) êïéíùíéêÜ óôñþìá-ôá.

Áðü ôá óôïé÷åßá áõôÜ äéáðéóôþíåôáé üôé:(á) Ïé õðçñåóßåò ôùí íïóïêïìåßùí ôïõ ÅÓÕ

(Ðßíáêáò 4), éêáíïðïéïýí ðåñéóóüôåñï ôïõò áóèå-íåßò ôùí ÷áìçëüôåñùí êïéíùíéêþí ôÜîåùí åíþ ïéáóèåíåßò ôùí õøçëþí êïéíùíéêþí ôÜîåùí åêöñÜ-æïõí ìåãáëýôåñç äõóáñÝóêåéá. ÐÜíôùò, ôï ìåãá-ëýôåñï ðïóïóôü ôïõ äåßãìáôïò, (59,2%) äçëþíåééêáíïðïéçìÝíï áðü ôéò õðçñåóßåò, åíþ áðü ôçíÜëëç õøçëü èåùñåßôáé êáé ôï ðïóïóôü (10,2%)ôùí åñùôçèÝíôùí ðïõ äÞëùóå êáèüëïõ éêáíï-ðïéçìÝíï áðü ôçí ðáñå÷üìåíç ðåñßèáëøç.

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Ê. Óïõëéþôçò êáé óõí. Ôüìïò 14, Ôåý÷ïò 3, 2002

Ðßíáêáò 4. Éêáíïðïßçóç áðü Íïóïêïìåßï ôïõ ÅÓÕ


A-B C D-E ÓýíïëïÉêáíïðïßçóç Ðåñéðôþóåéò % Ðåñéðôþóåéò % Ðåñéðôþóåéò % Ðåñéðôþóåéò %

ÐÜñá ðïëý 220,0 14 19,4 7 43,8 23 23,5ÁñêåôÜ 2 20,0 30 41,7 3 18,8 35 35,7ÌÝôñéá 4 40,0 19 26,4 5 31,3 28 28,6Ëßãï 1 1,4 1 1,0Êáèüëïõ 2 20,0 7 9,7 1 6,3 10 10,2ÄÃ/ÄÁ 1 1,4 1 1,0Åñùôþìåíïé 10 100 72 100 16 100 98 100

Ðßíáêáò 5. Éêáíïðïßçóç áðü ÉäéùôéêÞ ÊëéíéêÞ


A-B C D-E ÓýíïëïÉêáíïðïßçóç Ðåñéðôþóåéò % Ðåñéðôþóåéò % Ðåñéðôþóåéò % Ðåñéðôþóåéò %

ÐÜñá ðïëý 6 50,0 28 51,9 2 40,0 36 50,7ÁñêåôÜ 4 33,3 19 35,2 2 40,0 25 35,2ÌÝôñéá 1 8,3 5 9,3 1 20,0 7 9,9Ëßãï 1 1,9 1 1,4Êáèüëïõ 1 1,9 1 1,4ÄÃ/ÄÁ 1 8,3 1 1,4Åñùôþìåíïé 12 54 5 71

(â) Ïé éäéùôéêÝò êëéíéêÝò ðáñïõóéÜæïõí Ýíáðïëý õøçëü ðïóïóôü éêáíïðïßçóçò óå üëåò ôéòêïéíùíéêÝò ôÜîåéò (Ðßíáêáò 5) êáé âÝâáéá óôïóýíïëï ôïõ äåßãìáôïò, ôï 85,9% äçëþíåé éêáíï-ðïéçìÝíï åßôå ðÜñá ðïëý (50,7%), åßôå áñêåôÜ(35,2%), áðü ôéò ðáñå÷üìåíåò öñïíôßäåò. Óçìåéþ-íåôáé üôé ïé êáôçãïñßåò áðü ìÝôñéá Ýùò êáèüëïõéêáíïðïßçóç, áðïôåëïýí ìüëéò ôï 12,7% ôïõ äåßã-ìáôïò.

ÓõæÞôçóç êáé óõìðåñÜóìáôá

Óõíïøßæïíôáò ôá áðïôåëÝóìáôá ôçò ðáñá-ðÜíù áíÜëõóçò, äéáðéóôþíïõìå üôé áí êáé ç ãå-íéêüôåñç åíôýðùóç ðïõ åðéêñáôåß åßíáé üôé ïéäçìüóéåò õðçñåóßåò õóôåñïýí óçìáíôéêÜ êáé äåíáíôáðïêñßíïíôáé óôéò áðáéôÞóåéò ðïõ åðéâÜëëïõíôá äéåèíÞ ðñüôõðá êáé ïé ðñïóäïêßåò ôùí ÷ñç-óôþí, ç ìÝôñçóç ôçò éêáíïðïßçóçò áðü ôéò öñï-íôßäåò ðïõ ðáñÝ÷ïõí, ïäçãåß óå áíôßèåôá óõìðå-ñÜóìáôá. ¸ôóé, ç éêáíïðïßçóç áðü ôá íïóïêï-ìåßá ôïõ ÅÓÕ êõìáßíåôáé óå ó÷åôéêÜ õøçëÜ åðß-ðåäá, ðáñÜ ôá äåäïìÝíá ðñïâëÞìáôá ðïõ ó÷åôß-æïíôáé ìå ôçí îåíïäï÷åéáêÞ õðïäïìÞ, ôçí Ýëëåé-øç ðñïóùðéêïý, ôçí êáèáñéüôçôá ôùí ÷þñùí

êáé ôç óõìðåñéöïñÜ ôùí åðáããåëìáôéþí õãåßáò.ÅðéðëÝïí áîßæåé íá áíáöåñèåß üôé ç ðïéüôç-

ôá ôçò ðåñßèáëøçò ðïõ ðáñÝ÷åôáé áðü ôá äçìü-óéá íïóïêïìåßá õößóôáôáé óçìáíôéêÞ åðéâÜñõí-óç, áðü ôçí áðïññüöçóç åíüò ìåãÜëïõ ìÝñïõòôùí õëéêþí êáé áíèñþðéíùí ðüñùí óôá åîùôåñé-êÜ éáôñåßá - ôá ïðïßá åðéóêÝðôåôáé ðåñßðïõ ôï30% ôïõ ðëçèõóìïý - ãéá ôçí ðáñï÷Þ ðñùôïâÜè-ìéáò ðåñßèáëøçò.

Áðü ôçí Üëëç, ïé õðçñåóßåò ôùí éäéùôéêþíêëéíéêþí äçìéïõñãïýí ìåãáëýôåñï áßóèçìá éêá-íïðïßçóçò óôïõò ðïëßôåò, áí êáé üðùò ðñïêýðôåéáðü ó÷åôéêÝò ìåëÝôåò ôá âáñýôåñá ðåñéóôáôéêÜáíôéìåôùðßæïíôáé êõñßùò óå äçìüóéá íïóïêïìåßá4.Áõôü ïõóéáóôéêÜ óçìáßíåé üôé ç éêáíïðïßçóç áðüôçí ðëåõñÜ ôùí ÷ñçóôþí áöïñÜ êõñßùò óôéò ãå-íéêüôåñåò óõíèÞêåò íïóçëåßáò êáé ëéãüôåñï óå áõôÞêáè' áõôÞ ôçí ðáñå÷üìåíç öñïíôßäá õãåßáò êáéôï éáôñéêü Ýñãï.

ÁíåîÜñôçôá ðÜíôùò áðü ôïõò åðéìÝñïõòðáñÜãïíôåò éêáíïðïßçóçò, ç óõíå÷Þò áíÜðôõîçéäéùôéêþí íïóçëåõôéêþí ìïíÜäùí ôá ôåëåõôáßá÷ñüíéá óôç ÷þñá ìáò, öáßíåôáé ðùò áíôáíáêëÜôçí áõîçìÝíç æÞôçóç ãéá éäéùôéêÝò õðçñåóßåò, ùòáðüññïéá ôçò ãåíéêüôåñçò áßóèçóçò ôùí ðïëéôþíüôé óôïí éäéùôéêü ôïìÝá èá êáôáíáëþóïõí õðç-


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ñåóßåò õøçëüôåñçò ðïéüôçôáò9.Ìéá Üëëç äéÜóôáóç ôçò Ýñåõíáò ðïõ ðáñïõ-

óéÜæåé éäéáßôåñï åíäéáöÝñïí, åßíáé ç äéáöáéíüìå-íç óõó÷Ýôéóç ôçò êïéíùíéêÞò ôÜîçò êáé ôçò åê-öñáóìÝíçò éêáíïðïßçóçò áðü ôéò íïóçëåõôéêÝòõðçñåóßåò. ÓõãêåêñéìÝíá, áðü ôçí Ýñåõíá åðéâå-âáéþíåôáé ç õðüèåóç üôé ïé áðáéôÞóåéò êáé ïéðñïóäïêßåò ôùí ðïëéôþí áõîÜíïíôáé üóï êéíïý-ìáóôå ðñïò ôá õøçëüôåñá êïéíùíéêÜ óôñþìáôáêáé ùò åê ôïýôïõ, áõôÜ áîéïëïãïýí ìå áõóôçñü-ôåñá êñéôÞñéá ôéò ðáñå÷üìåíåò öñïíôßäåò.

Ç äéÜóôáóç áõôÞ ôùí åñåõíþí éêáíïðïßçóçòÝ÷åé åðéâåâáéùèåß êáé áðü áíôßóôïé÷åò åõñùðáú-êÝò Ýñåõíåò3,10, áð’ üðïõ ðñïêýðôåé üôé ïé ðñïó-äïêßåò ôùí áóèåíþí ãéá ôéò ðáñå÷üìåíåò öñïíôß-äåò õãåßáò, óõíéóôïýí ôïí óçìáíôéêüôåñï ðáñÜ-ãïíôá ôçò åêöñáóìÝíçò éêáíïðïßçóçò áðü áõôÝò.

¸íá Üëëï ôÝëïò æÞôçìá ðïõ áîßæåé íá ôïíé-óôåß, áöïñÜ óôç äéáöïñÜ ôùí áðïôåëåóìÜôùíôçò ðáñïýóáò Ýñåõíáò áðü áíôßóôïé÷åò Ýñåõíåò5-8,ïé ïðïßåò áêïëïýèçóáí äéáöïñåôéêÞ ìåèïäïëïãßáùò ðñïò ôçí åðéëïãÞ ôïõ äåßãìáôïò, ôéò åñùôÞ-óåéò êáé ôéò êëßìáêåò áðáíôÞóåùí. Ôï åýñïò áõ-ôþí ôùí äéáöïñþí áðïäåéêíýåé üôé ïé Ýñåõíåòéêáíïðïßçóçò åßíáé éäéáßôåñá "åõáßóèçôåò" óå ó÷Ý-óç ìå ôç ìåèïäïëïãßá ðïõ áêïëïõèïýí, êáèþò ôïõðïêåéìåíéêü óôïé÷åßï ôï ïðïßï áðïôõðþíïõí åß-íáé åõìåôÜâëçôï.

Óå êÜèå ðÜíôùò ðåñßðôùóç, ç áíáãêáéüôç-ôÜ ôïõò åßíáé äåäïìÝíç, áöïý óõíéóôïýí ôñüðïÝêöñáóçò êáé áðïôýðùóçò ôçò áíôáðüêñéóçò ôïõóõóôÞìáôïò õãåßáò óôéò ðñïóäïêßåò êáé ôéò áðáé-ôÞóåéò ôùí ðïëéôþí êáé ìðïñïýí íá âïçèÞóïõíóçìáíôéêÜ óôç ÷Üñáîç ôçò ðïëéôéêÞò õãåßáò, äéüôé:

(á) óõíéóôïýí äåîáìåíÝò Üíôëçóçò ðëçñïöï-ñéþí, (â) ëåéôïõñãïýí ùò åñãáëåßï âåëôßùóçò ôçòäéá÷åßñéóçò ôùí íïóïêïìåßùí êáé (ã) äçìéïõñ-ãïýí ôéò ðñïûðïèÝóåéò ãéá åðéëïãÝò óôü÷ùí äéá-

÷åßñéóçò ìå âÜóç ôéò ðñïôéìÞóåéò ôùí êáôáíáëù-ôþí.


1. Froehlich GW, Welch HG. Meeting walk-in pa-tients' expectation for testing. Effects on satis-faction. Gen Intern Med 8:470-474, 1996.

2. Tamblyn R, Benaroya S, Snell L, McLeod P,Schnarch B, Abrahamowicz M. The feasibilityand value of using patient satisfaction ratingsto evaluate medicine residents. Gen Intern Med,3:146-152, 1994.

3. Gavin TK, Turner MJ. Methods of surveyingpatients' satisfaction. BMJ, 314-327, 1997.

4. Éíóôéôïýôï Ðïëéôéêþí Ïéêïíïìéêþí êáé Êïéíùíé-êþí Åñåõíþí: ¸ñåõíá Éêáíïðïßçóçò áðü Õðç-ñåóßåò Õãåßáò, ÁèÞíá 2000.

5. Êõñéüðïõëïò Ã, Ãåùñãïýóç Å, ÃåííçìáôÜ Á. Éêá-íïðïßçóç ôùí ×ñçóôþí áðü ôéò Õðçñåóßåò Õãåßáòóôá Äçìüóéá ÍïóçëåõôÞñéá, óôï: Áóèåíåßò êáéÅðáããÝëìáôá Õãåßáò óôçí ÅëëÜäá, Êõñéüðïõ-ëïò Ã., Ãåùñãïýóç Å. (åðéì.) Áêáäçìßá Åðáã-ãåëìÜôùí Õãåßáò, ÁèÞíá, 11-24, 1994.

6. Êõñéüðïõëïò Ã, ÄñÜêïõ É, ÊôÝíáò Å, ÃåùñãïýóçÅ. ÓôÜóåéò êáé ÁíôéëÞøåéò ôùí ×ñçóôþí ùò ðñïòôçí ÍïóïêïìåéáêÞ Öñïíôßäá, óôï: Áóèåíåßò êáéÅðáããÝëìáôá Õãåßáò óôçí ÅëëÜäá, Êõñéüðïõ-ëïò Ã, Ãåùñãïýóç Å. (åðéì.), Áêáäçìßá Åðáã-ãåëìÜôùí Õãåßáò, ÁèÞíá, 1994.

7. Eurostat: Eurobarometer, Luxemburg, 1997.8. ÍéÜêáò Ä, ÃíáñäÝëëçò ×. Éêáíïðïßçóç Íïóç-

ëåõèÝíôùí Áóèåíþí óå Ýíá Ðåñéöåñåéáêü ÃåíéêüÍïóïêïìåßï. ÉáôñéêÞ, ÁèÞíá, 77:464-470, 2000.

9. Óïõëéþôçò Ê. Ï Ñüëïò ôïõ Éäéùôéêïý ÔïìÝá óôïÅëëçíéêü Óýóôçìá Õãåßáò. Åêäüóåéò ÐáðáæÞ-óçò, ÁèÞíá 2000.

10. Salisbury C. Postal survey of patients' satisfac-tion with a general practice out of hours coop-erative, BMJ, 574-594, 1997.

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Ê. Ðáðáäçìçôñßïõ êáé óõí. Ôüìïò 14, Ôåý÷ïò 3, 2002

ÊëéíéêÞ ðñïóÝããéóç ôçò HIV ëïßìùîçò - Ï ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý óôçí ðáñáêïëïýèçóç êáé öñïíôßäáôùí áóèåíþí ìå HIV/AIDS

Ê. Ðáðáäçìçôñßïõ1, Á. Ãêßêáò2, Ã. ÌðÝëïò3

ÁÍÁÓÊÏÐÇÓÇ

REVIEWPrimary Heatlh Care, Volume 14, Number 3, 119-125, 2002ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 119-125, 2002

ÅéóáãùãÞ

Ç ëïßìùîç áðü ôïí éü ôçò áíèñþ-ðéíçò áíïóïáíåðÜñêåéáò (ÇÉV) êáé ôïóýíäñïìï åðßêôçôçò áíïóïáíåðÜñêåéáò(ÁÉDS) Ý÷ïõí ðÜñåé äéáóôÜóåéò ðáí-äçìßáò êáé áðïôåëïýí ôçí ìåãáëýôåñçðñüêëçóç ôçò äçìüóéáò õãåßáò óå ðá-ãêüóìéï åðßðåäï1. Ç äéáóðïñÜ ôçòëïßìùîçò ðáñïõóéÜæåé äéÜöïñåò ðáñáë-ëáãÝò óôïí ôñüðï ìåôÜäïóçò êáé ôçãåùãñáöéêÞ êáôáíïìÞ, ðñïóâÜëëïíôáòêõñßùò ôéò ìåéïíïôéêÝò êáé ðåñéèùñéá-êÝò ïìÜäåò üðùò åñãáæüìåíïõò óôçâéïìç÷áíßá ôïõ óåî, ÷ñÞóôåò íáñêùôé-êþí ïõóéþí, ïìïöõëüöéëïõò Üíäñåò êáéÜôïìá ðïõ æïõí ìÝóá óôç öôþ÷åéá. ÇÇÉV ëïßìùîç ðëÞôôåé êõñßùò ôéò õðá-íÜðôõêôåò êáé áíáðôõóóüìåíåò ÷þñåòôçò ÁöñéêÞò (íüôéá ôçò Óá÷Üñáò), ôçòÁóßáò êáé ËáôéíéêÞò ÁìåñéêÞò (éäéáß-ôåñá ôçí ÊáñáúâéêÞ). Ôá ôåëåõôáßá÷ñüíéá ôá÷åßá åîÜðëùóç ôçò ëïßìù-îçò ðáñáôçñåßôáé êáé óôéò ÷þñåò ôçòÁíáôïëéêÞò Åõñþðçò.

Óôçí ÅëëÜäá ï óõíïëéêüò áñéè-

ÐåñßëçøçÇ ëïßìùîç áðü ôïí éü ôçò áíèñþðéíçò áíïóïáíåðÜñêåéáò (ÇÉV) êáé ôï óýíäñï-ìï åðßêôçôçò áíïóïáíåðÜñêåéáò (ÁÉDS) Ý÷ïõí ðÜñåé äéáóôÜóåéò ðáíäçìßáò êáéáðïôåëïýí ôçí ìåãáëýôåñç ðñüêëçóç ôçò äçìüóéáò õãåßáò óå ðáãêüóìéï åðß-ðåäï. Êáé óôçí ÅëëÜäá, ôçí ôåëåõôáßá äåêáåôßá, ç äéá÷ñïíéêÞ ôÜóç ôçò åðéäç-ìßáò åßíáé áõîçôéêÞ. Ãéá ôçí êáëýôåñç ðïñåßá ôçò íüóïõ áðáéôåßôáé ç ÝãêáéñçäéÜãíùóç ôçò ëïßìùîçò êáé ôùí åðéðëïêþí ôçò (åðïìÝíùò êáé ç Ýãêáéñç èåñá-ðåßá), ðáñüôé ç ìç ôõðéêÞ êëéíéêÞ åéêüíá äõóêïëåýåé ôç äéÜãíùóç. Ç óõíå÷Þòðñüïäïò, åéäéêüôåñá óôç èåñáðåßá åðÝöåñå óáí áðïôÝëåóìá ôç ìåôáâïëÞ ôçòöõóéêÞò ðïñåßáò ôçò íüóïõ, áðü ôåëåßùò áíßáôç óå êáëþò åëåã÷üìåíç ÷ñüíéáíüóïò, ðñïóöÝñïíôáò óôïõò áóèåíåßò ìáêñïâéüôçôá êáé êáëýôåñç ðïéüôçôáæùÞò. ÁõôÜ óå óõíäõáóìü ìå ôïí áõîáíüìåíï áñéèìü ôùí ðáó÷üíôùí áðáéôïýíÝíáí ðéï åíåñãü ñüëï ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý óôçí ðáñáêïëïýèçóçêáé öñïíôßäá ôùí áóèåíþí ìå HIV/AIDS. Áõôüò ï ñüëïò, o ïðïßïò äåí äéáöÝñåéáð'áõôüí óå Üëëåò ÷ñüíéåò ðáèÞóåéò, ðñïõðïèÝôåé êáôÜëëçëç åêðáßäåõóç åêìÝñïõò ôùí Ãåíéêþí Éáôñþí.

1ÄéåõèõíôÞò, Ðïëõäýíáìï Ðåñéöåñåéáêü Éáôñåßï Ìåãßóôçò, 2ÅðéìåëçôÞò Â, ÊÝíôñï ÕãåßáòÓáëáìßíáò, 3ÄéåõèõíôÞò, ÊÝíôñï Õãåßáò Êïñùðßïõ

A clinical approach to HIV infection. The role of the GeneralPractitioner in HIV careK. Papadhimitriou, A. Gikas, G. Belos

SummaryHIV infection and AIDS are pandemic and pose one of the greatest challengesto global public health. During the last decade the secular trend of the HIVinfection in Greece has increased. For a more favorable course to the outcomeof the disease an early diagnosis of the infection and its related conditions isnecessary, although the untypical clinical manifestation of the infection makesdiagnosis difficult. However the continuous progress, especially in treatment,has changed the natural of the disease, from being one of completely incurableto that of a manageable chronic condition, offering a prolonged life span and abetter quality of life. For this reason, together with the continuous increase ofthe prevalence of the infection demand a more active role of the GeneralPractitioner (GPs) in the care of HIV sufferers/patients. This role, which is nodifferent from that of any other chronic disease, presupposes appropriate train-ing for GPs.Key words: HIV/AIDS, clinical approach, General Practitioner, medical care

Çealth Centre of Salamina

ËÝîåéò êëåéäéÜ: HIV/AIDS, êëéíéêÞ ðñïóÝããéóç, Ãåíé-êüò/Ïéêïãåíåéáêüò Éáôñüò, éáôñéêÞ öñïíôßäáÕðïâëÞèçêå: 24 Oêôùâñßïõ 2002ÅðáíõðïâëÞèçêå: 29 Éïõëßïõ 2002¸ãéíå äåêôÞ ãéá äçìïóßåõóç: 10 Óåðôåìâñßïõ 2002Õðåýèõíïò áëëçëïãñáößáò: ÁñéóôïöÜíçò Ãêßêáò,Ãáâñéçëßäïõ 6, Áíù ÐáôÞóéá 11141, ÁèÞíá


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ìüò ôùí HIV ïñïèåôéêþí ðïõ äçëþèçêáí ìÝ÷ñéôéò 31 Äåêåììâñßïõ 2000 áíÝñ÷åôáé óå 5446 Üôïìáåê ôùí ïðïßùí ïé 1254 (23%) Ý÷ïõí ðåèÜíåé2.Óôçí ðëåéïøçößá ôïõò (54%) åßíáé Üôïìá çëéêßáò25-39 åôùí êáé ç ó÷Ýóç áíäñþí/ãõíáéêþí åßíáéðåñßðïõ 4.6/1. Ï êõñéüôåñïò ôñüðïò ìåôÜäïóçòåßíáé ìÝóù ôçò óåîïõáëéêÞò åðáöÞò. Ôá óôïé÷åßá,áðü ôï 1990 êáé ìåôÜ, åßíáé åíäåéêôéêÜ ôçò áõ-îçôéêÞò ôÜóçò ôçò åðéäçìßáò ðáñüëï ðïõ ãéáðñþôç öïñÜ ôï 2000 ç åðßðôùóç ôïõ HIV öáß-íåôáé íá ìåéþíåôáé.

ÊëéíéêÝò åêäçëþóåéò êáé óôáäéïðïßçóç ôçò ÇÉV ëïß-ìùîçò

Ïîåßá (ðñùôïðáèÞò) HIV ëïßìùîç

ÌåôÜ ôçí áñ÷éêÞ Ýêèåóç êáé ôçí ìüëõíóçáðü ôïí ÇÉV áêïëïõèåß ìßá Ýêñçîç óôïí ðïëëá-ðëáóéáóìü ôïõ éïý ç ïðïßá Ý÷åé óáí áðïôÝëåóìáôçí äéáóðïñÜ óôï ëåìöéêü éóôü êáé ôç ìáæéêÞéáéìßá. ÊáôÜ ôç äéÜñêåéá ôçò áé÷ìÞò ôçò éáéìßáò(2-6 åâäïìÜäåò ìåôÜ ôç ìüëõíóç) ôï ìïëõíèÝíÜôïìï ìðïñåß íá åìöáíßóåé óõìðôþìáôá êáé óç-ìåßá åíäåéêôéêÜ åíüò êëéíéêïý óõíäñüìïõ, ãíù-óôïý ùò ïîý ñåôñïúêü óýíäñïìï3. Ôá êëéíéêÜ ÷á-ñáêôçñéóôéêÜ áõôïý ôïõ óõíäñüìïõ ìïéÜæïõí ìåôç ëïéìþäç ìïíïðõñÞíùóç. Ï ðÜó÷ùí ìðïñåß íáåìöáíßóåé åìðýñåôï, áäåíïðÜèåéá, çðáôïóðëçíï-ìåãáëßá, êõíÜã÷ç, ìõáëãßåò, éëáñïåéäÝò åîÜíèç-ìá, âëåííïäåñìáôéêÝò åîåëêþóåéò, äéÜññïéá êáéíåõñïëïãéêÜ óõìðôþìáôá (ðßíáêáò 1).

Óå ìßá ðñüóöáôç ìåëÝôç, áðåäåß÷èåé üôé ìå-ôáîý ôùí ðáñáðÜíù óõìðôùìÜôùí áõôÜ ôá ïðïßá

ó÷åôßæïíôáé éó÷õñüôåñá ìå ôçí ïîåßá HIV ëïßìù-îç Þôáí ï ðõñåôüò êáé ôï åîÜíèçìá5. ÐáñüëááõôÜ êáíÝíá óýìðôùìá ç óçìåßï äåí ìáò ïäçãåßìå áóöÜëåéá óôçí Ýãêáéñç äéÜãíùóç ôçò ëïßìù-îçò6. Óõíåðþò, áõôÝò ïé êëéíéêÝò åêäçëþóåéò óåóõíäõáóìü ìå êáôáóôÜóåéò õøçëïý êéíäýíïõ èáðñÝðåé íá åêôéìþíôáé ìå õøçëü äåßêôç õðïøßáòãéá ôçí ðáñïõóßá ôçò ÇÉV ëïßìùîçò, éäßùò áðüôïí éáôñü ôçò ðñùôïâÜèìéáò ðåñßèáëøçò. Ôï ðï-óïóôü ìïëõíèÝíôùí áôüìùí ðïõ åìöáíßæïõí óõ-ìðôþìáôá óôçí ïîåßá öÜóç êõìáßíåôáé áðü 50-89%7. Ôá óõìðôþìáôá õðï÷ùñïýí áðü ìüíá ôïõòìåôÜ áðü 1-3 åâäïìÜäåò. Ï åñãáóôçñéáêüò Ýëåã-÷ïò, êáôÜ ôç öÜóç ôçò ïîåßáò ëïßìùîçò, äåß÷íåéìåãÜëç áýîçóç ôïõ ééêïý öïñôßïõ RNA óôï ðëÜ-óìá ôï ïðïßï óõíïäåýåôáé áðü áñíçôéêü ïñïëïãé-êü Ýëåã÷ï ãéá áíôé-HIV áíôéóþìáôá. Ó’ áõôü ôïóôÜäéï ôçò ëïßìùîçò ï êßíäõíïò ìåôÜäïóçò ôïõHIV óôïõò Üëëïõò åßíáé ðïëý õøçëüò ãé'áõôü êáéç Ýãêáéñç äéáãíùóÞ ôçò Ý÷åé ìåãÜëç óçìáóßá ü÷éìüíï ãéá ôïí áóèåíÞ áëëÜ êáé ôçí äçìüóéá õãåßá.

ÁóõìðôùìáôéêÞ ëïßìùîç

ÌåôÜ ôçí áíÜññùóç áðü ôçí ðñùôïëïßìùîçáêïëïõèåß ç êëéíéêÜ áóõìðôùìáôéêÞ ëïßìùîç çïðïßá ìðïñåß íá äéáñêÝóåé 5-10 ÷ñüíéá. ÊáôÜôçí ðåñßïäï áõôÞ ï áóèåíÞò åßíáé áóõìðôùìáôé-êüò ç ìðïñåß íá ðáñïõóéÜæåé åðéìÝíïõóá ãåíéêåõ-ìÝíç ëåìöáäåíïðÜèåéá. Ç ëåìöáäåíïðÜèåéá ìðï-ñåß íá ãßíåé áíôéëçðôÞ áðü ôïí ßäéï ôïí áóèåíÞ çíá äéáðéóôùèåß óå áíôéêåéìåíéêÞ åîÝôáóç ñïõôß-íáò. ºóùò íá óõíïäåýåôáé áðü áäõíáìßá, êáôá-âïëÞ, ÷áìçëÞ ðõñåôéêÞ êßíçóç êáé íõêôåñéíÞ åöß-äñùóç. Ïé ëåìöáäÝíåò Ý÷ïõí ìÝãåèïò 1-5 cm,óõíÞèùò åßíáé óêëçñïß, áíþäõíïé, åõêßíçôïé êáéåíôïðßæïíôáé óôïí ôñÜ÷çëï, õðåñêëåßäéïò ÷þñá,ïðéóèïùôéáßùò, ìáó÷Üëåò êáé åðéôñï÷éëéáêÜ8.

ÓõìðôùìáôéêÞ HIV ëïßìùîç

Ðñþéìç óõìðôùìáôéêÞ ëïßìùîç

Óôï óôÜäéï áõôü ïé áóèåíåßò Ý÷ïõí óõìðôþ-ìáôá áëëÜ äåí ðëçñïýí ôá êñéôÞñéá ôïõ AIDS.ÔÝôïéåò åêäçëþóåéò åßíáé: êáíôéíôßáóç óôüìáôïò,ôñé÷ùôÞ ëåõêïðëáêßá, ðõñåôüò (Ýùò 38,5 °C), äéÜñ-ñïéá, Ýñðçôáò æùóôÞñáò, áéäïéïêïëðéêÞ êáíôé-

ÐéíáêÜò 1. Óõìðôþìáôá êáé óçìåßá óôçí ïîåßá HIVëïßìùîç4

Åìðýñåôï 96% ÄéÜññïéá 32%ÁäåíïðÜèåéá 74% Íáõôßá Þ Ýìåôïé 27%Öáñõããßôéäá 70% Çðáôïóðëçíïìåãáëßá 14%ÅîÜíèçìá? 70% Áöèþäçò Ýëêç 12%Ìõáëãßåò 54% ÍåõñïëïãéêÜ óõìðôþìáôá² 12%Êåöáëáëãßá 32%1Êçëéäïâëáôéäþäåò åîÜíèçìá ôï ïðïßï åíôïðßæåôáé óôïðñüóùðï, êïñìü êáé Üêñá ± ðÝëìáôá êáé ðáëÜìåò. Ìðïñåßíá õðÜñ÷ïõí åîåëêþóåéò óôçí óôïìáôéêÞ êïéëüôçôá, ïéóï-öÜãï ç óôá ãåííçôéêÜ üñãáíá.2ÐåñéëáìâÜíïíôáé ç Üóçðôç ìçíéããßôéäá, ìçíéããïåãêåöáëß-ôéäá, ðåñéöåñéêÞ íåõñïðÜèåéá, óýíäñïìï Guillain-Barre,ãíùóéáêÝò äéáôáñá÷Ýò ç øý÷ùóç.

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íôßáóç, ôñá÷çëéêÞ äõóðëáóßá, öëåãìïíþäçò íü-óïò ôçò ðõÝëïõ, ëéóôåñßùóç, ðåñéöåñéêÞ íåõñïðÜ-èåéá. ÁõôÝò ïé íïóïëïãéêÝò ïíôüôçôåò áíÞêïõíóôçí êáôçãïñßá Â óýìöùíá ìå ôç óôáäéïðïßçóçôùí ÊÝíôñùí ÅëÝã÷ïõ Ëïéìþîåùí (CDC) ôùíÇÐÁ (ðßíáêáò 2).

¼øéìç óõìðôùìáôéêÞ HIV íüóïò (ðëÞñåò AIDS)

Åäþ ðåñéëáìâÜíïíôáé üëåò ïé êëéíéêÝò êáôá-óôÜóåéò ïé ïðïßåò åßíáé åðáêüëïõèåò ôçò ìáæéêÞòêáôáóôñïöÞò ôïõ áìõíôéêïý óõóôÞìáôïò êáé ôçòåëÜôôùóçò ôùí CD4-êõôôÜñùí. Ïé êáôáóôÜóåéòáõôÝò, áðïêáëïýìåíåò åõêáéñéáêÝò ðáèÞóåéò, ðñïó-äéïñßæïõí ôï AIDS(êáôçãïñßåò Á3, Â3 êáé C)êáé óôéò ïðïßåò ðåñéëáìâÜíïíôáé ôá åîÞò:

• ÅõêáéñéáêÝò ëïéìþîåéò: áðü éïýò (CMV); áðüâáêôçñßäéá (Mycobacterium avium, ìõêïâá-êôÞñéï ôçò öõìáôßùóçò, óáëìïíÝëëá, ðíåõ-ìïíéüêïêêï); áðü ìýêçôåò (Candida albicans,Cryptococcus neoformans, Histoplasma ca-psulatum, Aspergillus spp.); áðü ðñùôüæùá(Pneumocystis carinii, Cryptosporidia, Mi-crosporidia, Toxoplasma gondii).

• ÍåïðëÜóìáôá üðùò: óÜñêùìá Kaposi, ëÝì-öùìá áðü ìç Ô-êýôôáñá, äéçèçôéêü êáñêß-íùìá ôñá÷Þëïõ.

• ÍåõñïëïãéêÝò åêäçëþóåéò: Üíïéá, êåíïôïðéþ-äç ìõåëïðÜèåéá, ðñïúïýóá ðïëõåóôéáêÞ ëåõ-êïåãêåöáëïðÜèåéá.

ÊëéíéêÞ åêôßìçóç ôïõ áóèåíïýò

¼ôáí óå Ýíá Üôïìï Ý÷åé ôåèåß ç äéÜãíùóçôçò HIV ëïßìùîçò èá ðñÝðåé íá ãßíåôáé êëéíéêÞåêôßìçóç ôïõ áóèåíïýò üóï ôï äõíáôüí ãñçãïñü-ôåñá ç ïðïßá èá óõìâÜëëåé óôçí áêñéâÞ óôáäéï-

Ðßíáêáò 2. Óôáäéïðïßçóç ôçò HIV ëïßìùîçò êáôÜ CDC, 19939

ÊëéíéêÝò êáôçãïñßåò

Á Â C

Êáôçãïñßåò âÜóåé ôïõ Áóõìðôùìáôéêïß, ÅÃË, Óõìðôùìáôéêïß Åêäçëþóåéò ðïõáñéèìïý CD4-êõôôÜñùí ç óõíäñ. ðñùôïëïßìùîçò (¼÷é Á ç C) óõíéóôïýí AIDS1. >500/mm³ (>29%) A1 B1 C12. 200-499/mm³ (14-28%) A2 B2 C23. <200/mm³ (<14%) A3 B3 C3

ÅÃË: ÅðéìÝíïõóá ÃåíéêåõìÝíç ËåìöáäåíïðÜèåéá

ðïßçóç ôçò íüóïõ êáé ôçí Üìåóç èåñáðåõôéêÞðáñÝìâáóç. ÁõôÞ ðåñéëáìâÜíåé4,8:

Éóôïñéêü

Áðáñáßôçôç åßíáé ç ëÞøç ðëÞñïõò éóôïñéêïýìå ìåãáëýôåñç Ýìöáóç óôïí ðñïóäéïñéóìïý ôïõ÷ñüíïõ êáé ôñüðïõ ìåôÜäïóçò ôçò ëïßìùîçò, óôçíðñïçãïýìåíç éáôñéêÞ öñïíôßäá (åîåôÜóåéò, åìâï-ëéáóìïß) êáé óôçí êáôáãñáöÞ ôùí óõìðôùìÜôùí.Åðßóçò áðáñáßôçôç åßíáé ëÞøç éóôïñéêïý ãéá ôçíðáñïõóßá íïóçìÜôùí ðáèÞóåùí Þ êáôáóôÜóåùíðïõ ó÷åôßæïíôáé ìå ôçí HIV üðùò: öõìáôßùóç,Ýñðçò æùóôÞñáò, óåîïõáëéêþò ìåôáäéäüìåíá íï-óÞìáôá, çðáôßôéäåò, áëêïïëéóìüò, ÷ñÞóç ïõóéþíê.á..

ÁíôéêåéìåíéêÞ åîÝôáóç

Ãßíåôáé ëåðôïìåñÞò áíôéêåéìåíéêÞ åîÝôáóç ìååóôßáóç óôá åîÞò: óôïìáôéêÞ êïéëüôçôá êáé öÜ-ñõããáò, ëåìöáäÝíåò, äÝñìá, êáñäéÜ êáé ðíåýìï-íåò, êïéëéÜ, ãåííçôéêÜ üñãáíá/ðõÝëïò, íåõñïëïãé-êü óýóôçìá.

Åñãáóôçñéáêüò Ýëåã÷ïò

• ÏñïëïãéêÝò äïêéìáóßåòÐñïóäéïñßæïíôáé áíôéóþìáôá êáôÜ ôïõ HIV(-

ôá ïðïßá åìöáíßæïíôáé óõíÞèùò åíôüò 3 ìçíþíáðü ôçí ìüëõíóç) ìå ELISA, ç ïðïßá Ý÷åé åéäéêü-ôçôá êáé åõáéóèçóßá >99% Øåõäþò èåôéêÞ åîÝôá-óç ðáñáôçñåßôáé óå ðïëýôïêÝò ãõíáßêåò, ðñüóöáôïåìâïëéáóìü ãéá ãñßððç Þ HÂV, ðïëëáðëÝò ìå-ôáããßóåéò óå áéìáôïëïãéêÝò êáêïÞèåéåò, áõôïÜíï-óá íïóÞìáôá, ðïëëáðëü ìõÝëùìá, ðñùôïðáèÞò


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÷ïëéêÞ êßññùóç Þ áëêïïëéêÞ çðáôßôéäá. ØåõäþòáñíçôéêÞ åîÝôáóç ðáñáôçñåßôáé óå ðïëý ðñþúìáÞ üøéìá óôçí ðïñåßá ôçò HIV ëïßìùîçò üôáí çðáñáãùãÞ áíôéóùìÜôùí åßíáé ìéêñÞ. Ç ðñáêôéêÞãéá ôç äéÜãíùóç ôçò HIV ëïßìùîçò åßíáé: 2 EL-ISA äïêéìáóßåò êáé áí åßíáé èåôéêÝò ãßíåôáé åðé-âåâáßùóç ìå Western Blot.

• Áñéèìüò ôùí CD4 ëåìöïêõôôÜñùí (Ö.Ô »800/mm³)×ñçóéìåýåé óôçí óôáäéïðïßçóç êáé åêôßìçóç

ôçò áíïóïëïãéêÞò ëåéôïõñãßáò. Oé áóèåíåßò ìå ôé-ìÝò <500/mm³ åìöáíßæïõí õðïôñïðéÜæïõóåò âá-êôçñéäéáêÝò ëïéìþîåéò, <200/mm³ áíáðôýóïõíåõêáéñéáêÝò ëïéìþîåéò.

• ÌÝôñçóç ôïõ ééêïý öïñôßïõ HIV RNA óôïðëÜóìá ìå PCR.Åßíáé ÷ñÞóéìç óôçí äéÜãíùóç ôçò ðñùôïðá-

èïýò ëïßìùîçò, ãéá ôçí ðñüâëåøç ôçò åîÝëéîçòôçò íüóïõ êáé ôçí ðáñáêïëïýèçóç ôçò áíôáðü-êñéóçò óôç èåñáðåßá.

• Áéìáôïëïãéêüò êáé âéï÷çìéêüò Ýëåã÷ïòÇ ãåíéêÞ áßìáôïò ìðïñåß íá äåßîåé èñïìâï-

ðåíßá, ëåõêïðåíßá ç áíáéìßá. Ï âéï÷çìéêüò ðåñé-ëáìâÜíåé Ýëåã÷ï çðáôéêÞò êáé íåöñéêÞò ëåéôïõñ-ãßáò óÜê÷áñï êáé ëéðéäáéìéêü ðñïößë.

• Áêôéíïãñáößá èþñáêïò êáé Ìantoux• Toxo-test, VDRL, äåßêôåò çðáôßôéäáò Â (ãéáôï åíäå÷üìåíï åìâïëéáóìïý), áíôé-HCV (óåáíåîÞãçôç ýðåñôñáíóáìéíáóáéìßá)

• Test Pap ç êáé êáëëéÝñãåéá êïëðéêïý õãñïý.• Áíôé-CMV, áíôé-HAV (ãéá áðïöõãÞ åìâï-ëéáóìïý), G6PD (ãéá ðéèáíÞ Ýëëåéøç ç ïðïßáåðçñåÜæåé ôç ÷ñÞóç TMP-SMX ç äáøüíçò).ÅîåôÜóåéò üðùò ç ìÝôñçóç ôïõ ééêïý öïñ-

ôßïõ RNA, ï áñéèìüò CD4 ëåìöïêõôôÜñùí, çVDRL, ôï test Pap êáé ï âéï÷çìéêüò Ýëåã÷ïòåðáíáëáìâÜíïíôáé áíÜ ôáêôéêÜ ÷ñïíéêÜ äéáóôÞ-ìáôá ãéá ôçí ðáñáêïëïýèçóç ôçò ðïñåßáò ôçòíüóïõ êáé ôçò áíôáðüêñéóçò óôç èåñáðåßá.

ÈåñáðåõôéêÞ áíôéìåôþðéóç ôçò HIV ëïßìùîçò

Óôï÷ïß ôçò èåñáðåßáò åßíáé: Ç êáôáóôïëÞôïõ éïý, ðñüëçøç åîáóèÝíçóçò ôïõ áíïóïðïéçôé-êïý óõóôÞìáôïò, åðéìÞêõíóç ôçò æùÞò êáé ç äéá-öýëáîç ðïéüôçôáò æùÞò. Áõôïß ïé óôü÷ïé åðéôõã-÷Üíïíôáé óå óçìáíôéêü âáèìü ìå ôç ÷ñÞóç, ôáôåëåõôáßá 6-7 ÷ñüíéá, ôùí íÝùí áíôéúêþí öáñ-ìÜêùí. ×Üñç ó'áõôÜ ç èåñáðåßá ôçò HIV ëïßìù-

îçò Ý÷åé ãßíåé ïõóéáóôéêÞ, ðëçóéÜæïíôáò ôçí ßáóç,áðü êõñßùò áíáêïõöéóôéêÞ ðïõ Þôáí.

ÁíôéúêÞ èåñáðåßá (HAART)

Ôá íåüôåñá áíôéñåôñïúêÜ öÜñìáêá êáôáóôÝë-ëïõí ôïí ðïëëáðëáóéáóìü ôïõ éïý óå åðßðåäáðïõ äåí ìðïñïýí íá áíé÷íåõèïýí ìå ôç ìÝèïäïìÝôñçóçò HIV RNA. Ïé äéáèÝóéìåò ìÝ÷ñé ôþñáïìÜäåò áíôéñåôñïúêþí åßíáé:

Á. ÍïõêëåïóéäéêÜ áíÜëïãá, áíáóôïëåßò ôçòáíÜóôñïöçò ìåôáãñáöÜóçò (NRTIs) ôá ïðïßááíáóôÝëëïõí ôç äüìçóç ééêïý DNA, ìå óõíÝðåéááíåðÜñêåéá ðáñáãùãÞò íÝùí áíôéãñÜöùí ôïõ éïý.Â. Ìç íïõêëåïóéäéêïß áíáóôïëåßò ôçò áíÜóôñï-öçò ìåôáãñáöÜóçò (ÍÍRTIs), ôá ïðïßá ðáñåì-âáßíïõí óôç äñÜóç ôçò áíÜóôñïöçò ìåôáãñáöÜ-óçò ìå äéáöïñåôéêü ìç÷áíéóìü áðü ôá NRTIs.ÕðÜñ÷åé óçìáíôéêïý âáèìïý äéáóôáõñïýìåíç áíôï-÷Þ ìåôáîý ôïõò, þóôå íá åßíáé áíÝöéêôç ç äéáäï-÷éêÞ ÷ïñÞãçóÞ ôïõò. Ã. Ïé áíáóôïëåßò ôçò ðñù-ôåÜóçò (PIs) äñïõí óôçí ôåëéêÞ öÜóç ôïõ êýêëïõáíáðáñáãùãÞò ôïõ éïý áíáóôÝëëïíôáò ôç äñÜóçôçò ðñùôåÜóçò, ðïõ ðáßæåé êáèïñéóôéêü ñüëï óôïíéúêü ðïëëáðëáóéáóìü. ×áñáêôçñéóôéêÞ åßíáé çìåãÜëç áíÜðôõîç äéáóôáõñïýìåíçò áíôï÷Þò ìå-ôáîý ôùí öáñìÜêùí áõôÞò ôçò ïìÜäáò, ìå ôçíýðáñîç ðïëëáðëþí ìåôáëëÜîåùí.

Êáëýôåñï áðïôÝëåóìá óôçí êáôáóôïëÞ ôïõéúêïý ðïëëáðëáóéáóìïý åðéôõã÷Üíåôáé ìå ôáõôü-÷ñïíç Ýíáñîç óõíäõáóìïý öáñìÜêùí. Ïé óõí-äõáóìïß ðïõ ðñïôåßíïíôáé åßíáé ïé åîÞò: 2 NRTIs+ 1 PI, 2 NRTIs + 1 NNRTI, 2 NRTIs + 2 PIs.Ç Ýíáñîç ôçò áíôéñåôñoúêÞò èåñáðåßáò óõíéóôÜ-ôáé íá ãßíåôáé óå üëïõò ôïõò óõìðôùìáôéêïýòáóèåíåßò êáé óôïõò áóõìðôùìáôéêïýò ìåCD4<500/mm³ Þ HIV RNA>10000 áíôßãñáöá/Ml4,10.

Ôá áíôéñåôñïúêÜ öÜñìáêá ðáñïõóéÜæïõíóõ÷íÜ áíåðéèýìçôåò åíÝñãåéåò üðùò ìõåëïôïîéêü-ôçôá, ìõïðÜèåéá, ðáãêñåáôßôéäá, íåöñïëéèßáóç ê.á.ïé ïðïßåò åßíáé åéäéêÝò ôïõ åßäïõò ôïõ öáñìÜêïõ.Åðßóçò ó÷åôßæïíôáé ìå ìéá óåéñÜ åðéðëïêþí üðùòäéáôáñá÷Ýò ôïõ ìåôáâïëéóìïý ôùí ëéðéäßùí êáéóáê÷Üñïõ, ëéðïäõóôñïößá, êáñäéïìõïðÜèåéá, ãá-ëáêôéêÞ ïîÝùóç, ïóôåïðüñùóç êáé Üóçðôç íÝ-êñùóç ôùí ïóôþí. Óõíåðþò áíáãêáßá åßíáé çåîáôïìßêåõóç ôçò áãùãÞò üðïõ ôá ïöÝëç èá ðñÝ-ðåé íá óôáèìßæïíôáé ôïí êßíäõíï ôïîéêüôçôáò êáé

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ôïí ðåñéïñéóìü ãéá ìåëëïíôéêÝò åíáëëáêôéêÝò ëý-óåéò, éäßùò ëüãù ôçò áíÜðôõîçò áíèåêôéêþí óôå-ëå÷þí ôïõ éïý.

AíôéìéêñïâéáêÞ ðñïöýëáîç êáé åìâïëéáóìïß

Áðüëõôç Ýíäåéîç ãéá áíôéìéêñïâéáêÞ ðñïöý-ëáîç áðïôåëåß ç öõìáôßùóç (äåßêôçò Ìantoux³5mm ç Ýêèåóç õøçëïý êéíäýíïõ). ×ñçóéìïðïéåß-ôáé Éóïíéáæßäç + Ðõñéäïîßíç ãéá 9 ìÞíåò. Ãéá ôçíðñüëçøç ôçò ðíåõìïíßáò áðü P. Carinii üðùò êáéãéá ôçí ôïîïðëÜóìùóç ÷ïñçãåßôáé ÔÌP-SMX,üôáí ôá CD4 <200/mm³. Ïôáí ôá CD4 <50/mm³ ÷ïñçãåßôáé êëáñõèñïìõêßíç ç áæéèñïìõêßíçãéá ôçí ðñüëçøç ôçò ëïßìùîçò áðü M. avium11.

Áðáñáßôçôï èåùñåßôáé, ãéá üëïõò ôïõò áóèå-íåßò, ï åìâïëéáóìüò êáôÜ ôçò ãñßððçò, çðáôßôé-äáò Â êáé ðíåõìïíéüêïêêïõ.

ÁíáêïõöéóôéêÞ êáé õðïóôçñéêôéêÞ èåñáðåßá

Ç áíôéìåôþðéóç ôçò äéÜññïéáò, ç ïðïßá åì-öáíßæåôáé óôï 60-80% ôùí áóèåíþí, óõíßóôáôáéóôçí åéäéêÞ èåñáðåßá (áíÜëïãá ôï ðáèïãüíï áß-ôéï) êáé ôçí óõìðôùìáôéêÞ. Ç ôåëåõôáßá ðåñé-ëáìâÜíåé ãåíéêÜ ìÝôñá üðùò êáëÞ åíõäÜôùóç,êáôÜëëçëç äßáéôá êáé ÷ñÞóç áíôéäéáññïúêþíöáñìÜêùí12. ¢ëëåò äéáôáñá÷Ýò áðü ôï ðåðôéêüüðùò íáõôßá, Ýìåôïé êáé äõóêïéëéüôçôá óõíÞèùòïöåßëïíôáé óôéò åõêáéñéáêÝò ðáèÞóåéò(êáíôéíôßá-óç, êáêïÞèåéåò) Þ óôá öÜñìáêá ïðüôå ç èåñá-ðåßá åêôüò áðü óõìðôùìáôéêÞ óôï÷åýåé êáé óôçíáíôéìåôþðéóç ôçò áéôßáò.

Ïé áóèåíåßò ìå HIV ëïßìùîç ç AIDS óõ÷íÜðáñïõóéÜæïõí ðüíï, ðïõ ó÷åôßæåôáé ìå ôçí ðåñé-öåñéêÞ íåõñïðÜèåéá, Ýñðçôá æùóôÞñá, ôï óÜñêù-ìá Êaposi ê.á., üðïõ ïé áñ÷Ýò áíôéìåôþðéóÞò ôïõåßíáé ðáñüìïéåò ìå áõôÝò ôïõ êáñêéíéêïý ðüíïõ.Ôá áíáëãçôéêÜ ðïõ ÷ñçóéìïðïéïýíôáé åßíáé çáêåôáìéíïöáßíç, ôá ÌÓÁÖ êáé ôá ïðéïåéäÞ, áíÜ-ëïãá ôçò Ýíôáóçò ôïõ ðüíïõ13.

Óôïõò áóèåíåßò ìå HIV ëïßìùîç áñêåôÜ óõ-÷íÞ åßíáé ç êáôÜèëéøç êáé ôá ðéï êáôÜëëçëááíôéêáôáèëéðôéêÜ ðïõ óõíéóôþíôáé åßíáé ç ðáñï-îåôßíç êáé ç öëïõïîåôßíç. Óå ìåñéêïýò áóèåíåßòìå Þðéá áëëÜ åðéìÝíïõóá êáôÜèëéøç ç øõ÷ïèå-ñáðåßá ìðïñåß íá áíôéêáôáóôÞóåé ôá öÜñìáêá14.

Ï ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý óôçíðáñáêïëïýèçóç êáé öñïíôßäá ôùí áóèåíþí ìå HIV/AIDS

ÓÞìåñá óôçí ÅëëÜäá êáé ãåíéêüôåñá óôéòáíåðôõãìÝíåò ÷þñåò, ôç âáóéêÞ åõèýíç ãéá ôçíðáñáêïëïýèçóç êáé íïóçëåßá ôùí áóèåíþí áõ-ôþí ôçí Ý÷ïõí ïé ÅéäéêÝò ÌïíÜäåò AIDS, ïé ïðïßåòõðÜñ÷ïõí óå äéÜöïñá Íïóïêïìåßá. ¸íá ôÝôïéïóýóôçìá óçìáßíåé üôé ïé áóèåíåßò áõôïß Ý÷ïõíÜìåóç ðñüóâáóç óå Ýíá äåõôåñïâÜèìéï íïóçëåõ-ôéêü ßäñõìá, ìå ôéò üðïéåò äõó÷Ýñåéåò óõíåðÜãå-ôáé áõôü.

Ç HIV ëïßìùîç ùò ÷ñüíéá íüóïò áðáéôåßìáêñï÷ñüíéá êáé óõíå÷Þ ðáñáêïëïýèçóç. Ìå ôçíáýîçóç ôïõ áñéèìïý ôùí ðáó÷üíôùí, ôçí ðñüïäïóôç èåñáðåßá êáé ôçí ðáñÜôáóç ôçò åðéâßùóçòôá äåäïìÝíá ðïõ Üðôïíôáé ôçò ðáñáêïëïýèçóçòáõôþí ôùí áóèåíþí Ý÷ïõí áëëÜîåé. Åêôüò áõôïýç HIV ëïßìùîç óõíïäåýåôáé óõ÷íÜ ìå øõ÷ïëïãé-êÞ êáé êïéíùíéêÞ íïóçñüôçôá ç ïðïßá áðáéôåßðïëýðëåõñç ðñïóÝããéóç. Áõôïß ïé ðáñÜãïíôåòáíáäåéêíýïõí ôïí åíåñãü ñüëï ðïõ ðñÝðåé íáäéáäñáìáôßóåé ï Ãåíéêüò/Ïéêïãåíåéáêüò Éáôñüò (Ã/ÏÉ) óôçí áíôéìåôþðéóç áõôþí ôùí áóèåíþí. Óôçíðñáãìáôéêüôçôá áõôüò ï ñüëïò äåí åßíáé äéáöï-ñåôéêüò áðü ôïí ñüëï ðïõ Ý÷åé óôá Üëëá ÷ñüíéáíïóÞìáôá: Ýãêáéñç äéÜãíùóç, óõíôïíéóìÝíç öñï-íôßäá åðß óõíõðáñ÷üíôùí íïóçìÜôùí, ðáñáðï-ìðÞ üôáí ÷ñåéÜæåôáé, êáô' ïßêïí íïóçëåßá êáéáíáêïõöéóôéêÞ èåñáðåßá15. Ç ìéêñÞ äéáöïñÜ óõ-íßóôáôáé óôï üôé ï ñüëïò ôïõ Ã/ÏÉ óôçí ðåñß-ðôùóç áõôÞ åßíáé ðåñéóóüôåñï óõíõöáóìÝíïò ìåôïí ñüëï ôçò ïìÜäáò ðñùôïâÜèìéáò öñïíôßäáòõãåßáò, ãéá ôçí ïðïßá Ý÷åé ôçí åõèýíç ôïõ óõíôï-íéóìïý. Ôá âáóéêÜ ìÝëç áõôÞò ôçò ïìÜäáò åßíáéíïóçëåýôñéá/ôçò, åðéóêÝðôñéá/ôçò õãåßáò, êïéíù-íéêÞ/üò ëåéôïõñãüò, ç ìáßá/åõôÞò êáé øõ÷ïëü-ãïò16. ÅðéðëÝïí, ïé áóèåíåßò ìå HIV ëïßìùîç Ý÷ïõíðïëëÝò äõóêïëßåò ëüãù ôçò êïéíùíéêÞò áðïìüíù-óçò êáé ç õðïóôÞñéîç ó'áõôüí ôïí ôïìÝá áðáéôåßóõíåñãáóßá ìå Üëëåò äçìüóéåò êáé êïéíùíéêÝò õðç-ñåóßåò üðùò ï äÞìïò, ç åêêëçóßá, ïé åèåëïíôéêÝòïñãáíþóåéò ê.á.

Ï óçìáíôéêüôåñïò ôïìÝáò óôïí ïðïßï ç ðñï-óöïñÜ ôïõ Ã/ÏÉ èåùñåßôáé áðáñáßôçôç åßíáé çáíáêïýöéóç ôùí áóèåíþí áðü ôá óõìðôùìÜôáêáé ç êáô' ïßêïí öñïíôßäá éäßùò áõôþí ðïõ âñß-óêïíôáé óôá ôåëéêÜ óôÜäéá ôçò íüóïõ. Ç óõìðôù-ìáôéêÞ èåñáðåßá ìå ôçí ïðïßá ó÷åôßæåôáé Üìåóá


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ç ðïéüôçôá æùÞò ôïõ áññþóôïõ èá ðñÝðåé íá÷ïñçãåßôáé ÷ùñßò êáèõóôÝñçóç åíþ ðáñÜëëçëáèá ðñÝðåé íá õðïâÜëëåôáé óôïí áðáñáßôçôï åñ-ãáóôçñéáêü Ýëåã÷ï ãáé ôçí áíåýñåóç ôõ÷üí õðï-êåßìåíçò áéôßáò óôçí ïðïßá ïöåßëïíôáé ôá óõ-ìðôþìáôá. Ïé áóèåíåßò ìå AIDS ìðïñïýí, óåïñéóìÝíá óôÜäéá ôçò íüóïõ, íá íïóçëåõôïýí ìåáóöÜëåéá êáé åêôüò íïóïêïìåßïõ, äçëáäÞ óôï óðßôéôïõò, óôï ïðïßï áéóèÜíïíôáé áóöáëÞò êáé åíé-ó÷ýïíôáé øõ÷ïëïãéêÜ. ÅðéðëÝïí ç êáô'ïßêïí áíôé-ìåôþðéóç ôùí áóèåíþí ðñïëáìâÜíåé ôçò Üóêï-ðåò åðéóêÝøåéò êáé åéóáãùãÝò óôï íïóïêïìåßï.Ðïëëïß áóèåíåßò êáôÜ ôç äéÜñêåéá ôïõ ôåëéêïýóôáäßïõ ôçò íüóïõ ðñïôéìïýí íá íïóçëåýïíôáéóôï óðßôé, ìÝ÷ñé êáé ôçí êáôáëçîÞ ôïõò, áöïýôïõò Ý÷åé åîáóöáëéóôåß Ýíáò áíþäõíïò èÜíáôïò.ÁõôÜ ðñïûðïèÝôïõí ìßá ïñãáíùìÝíç õðçñåóßáãéá íïóçëåßá óôï óðßôé üðïõ ôçí êýñéá åõèýíç èáÝ÷åé ï Ã/ÏÉ17.

Ìåßæïíïò óçìáóßáò óôçí ðáñáêïëïýèçóç ôùíáóèåíþí ìå HIV ëïßìùîç åßíáé ç ó÷Ýóç ôïõ ÃÏ/É ìå ôïí åéäéêü. Å÷åé áðïäåé÷èåß üôé ç áðëÞ, Üìå-

óç êáé ôáêôéêÞ åðéêïéíùíßá ìå ôïí åéäéêü åîá-óöáëßæåé êáëýôåñï åðßðåäï éáôñéêÞò öñïíôéäáòðñïò ôïõò áóèåíåßò êáé äéåõêïëýíåé ôï Ýñãï ôïõÃ/ÏÉ18.

Óçìáíôéêüò åßíáé ï ñüëïò ôïõ Ã/ÏÉ ðïõ áöïñÜôçí åêðáßäåõóç áóèåíþí êáé ïéêåßùí. Óõãêåêñé-ìÝíá áõôüò ï ôïìÝáò ðåñéëáìâÜíåé ôçí åêðáßäåõ-óç áññþóôïõ-ïéêïãÝíåéáò ãéá ôïõò ôñüðïõò ìåôÜ-äïóçò êáé ðñïöýëáîçò áðü ôç íüóï, ãéá ôç öáñ-ìáêåõôéêÞ áãùãÞ, ôç äéáôñïöÞ êáé ôçí ðñüëçøçôùí åõêáéñéáêþí ëïéìþîåùí. Åéäéêüôåñá ç ïéêï-ãÝíåéá èá ðñÝðåé íá åêðáéäåýåôáé íá áíáãíùñßæåéåãêáßñùò ôçí áëëáãÞ óõìðåñéöïñÜò ôïõ áóèå-íïýò êáé íá ôïí õðïóôçñßæåé øõ÷ïëïãéêÜ.

Ãéá íá áíôáðïêñéèåß ó'áõôü ôï ñüëï ï Ã/ÏÉèá ðñÝðåé íá ðëçñåß ïñéóìÝíåò âáóéêÝò ðñïõðï-èÝóåéò, üðùò ôßèïíôáé êáé áðü ôï European Pri-mary Care AIDS Network (EPCAN)10. Óýìöù-íá ìå ôá éó÷ýïíôá óôçí ÅõñùðáúêÞ Åíþóç, ìåñé-êÝò áðü ôéò âáóéêÝò ãíþóåéò, óôÜóåéò êáé ðñáêôé-êÝò ðïõ ðñÝðåé íá áðïêôÞóåé ï Ã/ÏÉ öáßíïíôáéóôïí ðßíáêá:

Ðßíáêáò. ÂáóéêÝò ãíþóåéò, óôÜóåéò êáé ðñáêôéêÝò ðïõ èá ðñÝðåé íá áðïêôÞóåé ï Ã/ÏÉ

• Ï Ãåíéêüò Éáôñüò ðñÝðåé íá åßíáé óå èÝóç íá ìðïñåß íá áíáêïéíþóåé Ýíá èåôéêü test óå áóèåíÞ, üðùò êáé íáÝ÷åé ôçí éêáíüôçôá íá áíáãíùñßóåé ðåñßðïõ ôï âáèìü áíïóïêáôáóôïëÞò êáé ôï óôÜäéï ôçò íüóïõ. Íá ãíùñßæåéôï áíôßóôïé÷ï ÊÅÅË ôçò ðåñéï÷Þò åõèýíçò ôïõ êáé íá ìðïñåß íá óõíôïíßæåé ôçí éáôñéêÞ öñïíôßäá.

• Íá ðáñÜó÷åé ìå óïâáñüôçôá êáé õðåõèõíüôçôá ôç âáóéêÞ øõ÷ïëïãéêÞ õðïóôÞñéîç ÷ùñßò íá åðéêñßíåé áëëÜ íáóÝâåôáé ôçí áîéïðñÝðåéá, ôéò ðñïóùðéêÝò áðüøåéò, ôéò óåîïõáëéêÝò ðñïôéìÞóåéò, ôïí ôñüðï æùÞò, ôï êïéíùíéêü-ïéêïíïìéêü åðßðåäï êáé ðáñÜëëçëá íá ðñïóôáôåýåé ôï áðüññçôï ôùí ðëçñïöïñéþí. Íá åßíáé éêáíüò íáõðïøéáóèåß ôïõò ïñïèåôéêïýò ìå õøçëü âáèìü åðéêéíäõíüôçôáò áëëÜ êáé íá õðïóôçñßîåé ôá Üôïìá áõôÜ, þóôåíá õéïèåôÞóïõí áóöáëÝóôåñç óõìðåñéöïñÜ áðÝíáíôé óôïõò óõíáíèñþðïõò ôïõò

• ¼ëïé ïé Ãåíéêïß Éáôñïß èá ðñÝðåé íá óõíçèßóïõí óáí åîÝôáóç ñïõôßíáò ôç ëåðôïìåñÞ áíôéêåéìåíéêÞ åîÝôáóç ôïíïñïèåôéêþí ðåñéëáìâÜíïíôáò ôçí åîÝôáóç ôùí ëåìöáäÝíùí, ôçò óôïìáôéêÞò êïéëüôçôáò ê.ëð.

• ÅðéðëÝïí íá åßíáé óå èÝóç íá ôïõ áíáðôýîåé ôéò åõåñãåôéêÝò áñ÷Ýò ôçò áíôéñåôñïúêÞò èåñáðåßáò, ãéá êáëýôåñçóõììüñöùóç, üðùò êáé íá ãíùñßæåé ôéò âáóéêÝò ðáñåíÝñãåéåò ôçò ÇÁART êáé ôéò áëëçëåðéäñÜóåéò ìå ÜëëáöÜñìáêá. Må ôçí êáôÜëëçëç åêðáßäåõóç, ïé Ãåíéêïß Éáôñïß ìðïñïýí íá ôá êáôáöÝñïõí åîßóïõ êáëÜ ìå ôïõòåéäéêïýò, óôïí ôïìÝá ôéò áíôééêÞò èåñáðåßáò. Áõôü áðïäåéêíýåôáé áðü ìåëÝôåò óå ÷þñåò ìå áíåðôõãìÝíç ÐÖÕ,üðïõ ïé Ã/ÏÉ óõììåôÝ÷ïõí åíåñãÜ óôéò èåñáðåõôéêÝò áðïöÜóåéò8,9.


1. Ôhe Global HIV and AIDS Epidemic 2001.MMWR 50:434-439, 2001.

2. Åîáìçíéáßá Ýêäïóç ôïõ ÊÝíôñïõ ÅëÝã÷ïõ ÅéäéêþíËïéìþîåùí (ÊÅÅË). ÅðéäçìéïëïãéêÞ ÅðéôÞñçóçôïõ HIV/AIDS óôçí ÅëëÜäá. Ôåý÷ïò 12,ÄåêÝìâñéïò 2000.

3. Óáñüãëïõ Ã, ËéïíÞ Á, Ðïôáìïýóç Ð, ÃåùñãßïõÏ. AIDS/HIV: ÊëéíéêÞ ðñïóÝããéóç êáé èåñáðåßá.Åêäüóåéò Ðáó÷áëßäç. ÁèÞíá, 77-111, 1999.

4. Bartlett JG. The Johns Hopkins Hospital 2000-2001 guide to medical care of patients withHIV infection. Lippincott Williams & Wilkins.Ninth Edition, 11-32, 66-119, 2000.

5. Çecht FM, Busche MP, Rawale B, Webb M, etal. Use of laboratory tests and clinical symp-toms for identification HIV infection. AIDS,16:1119-1129, 2002.

6. Daar ES, Little S, Pitt J, Santangelo J, et al.Diagnosis of primary HIV infection. Ann In-tern Med 134:25-9, 2001.

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7. Schacker T, Collier AC, Hughes J, Shea T, etal. Clinical and epidemiologic features of pri-mary HIV infection. Ann Intern Med, 125:257-64, 1996.

8. Muma R, Lyons BA, Borucky MJ, Pollard RB.HIV manual for health care professionals. Ap-pleton & Lange. Second Edition, 153-161 1997.

9. Centers for Disease Control(CDC). 1993 re-vised classification system for HIV infectionand expanded surveillance case definition forAIDS among adolescents and adults. MMWR,41:1-9, 1992.

10. Ðáðáäüðïõëïò Á, ÃéáìáñÝëëïõ Å. Ç áíôéñåôñïúêÞèåñáðåßá ôçò ÷ñüíéáò HIV ëïßìùîçò êáôÜ ôïÝôïò 2000. ÅëëçíéêÜ Áñ÷åßá AIDS, 8:190-200,2000.

11. 1999 USPHS/ISDA. Guidelines for the preven-tion of opportunistic infection in persons withHuman Immunodeficiency Virus. MMWR, 48:1-66, 1999.

12. Zacharof AK. AIDS-related diarrhea - patho-genesis, evaluation and teatment. Annals ofGastroenterology, 14:22-26, 2001.

13. Swica Y, Breitbart W. Treating pain in patientswith AIDS and a history of substance use. WestJ Med, 176:33-39, 2002.

14. Remien RH, Rabkin JG. Psychological aspectsof living with HIV disease. West J Med, 175:332-

335, 2001.15. Madges S, Surinders S. The GP's role in HIV

and AIDS care. The Practitioner, 244:772-777,2000.

16. Mansfield S, Singh S. Who should fill the caregap in HIV disease. Lancet, 342:726-728, 1993.

17. Wood CG, Whitter S, Bradbeer CS. ÁBC ofpalliative care. HIV infection and AIDS. BMJ,315:1433-6, 1997.

18. Smith S, Robinson J, Hollyer J, Ramesh B, etal. Combining specialist and primary health careteams for HIV positive patients: retrospectiveand prospective studies. BMJ, 312:416-20, 1999.

19. European minimum standard of primary HIVcare: Basics requirements for all GPs. Europe-an Primary Care AIDS Network (EPCAN), 1999.

20. Reedijk M, Mohrs L, Wigersma L. When doHIV-infected persons start with antiretroviraltherapy? A retrospective analysis of patientsmonitoring and treatment status in general prac-tise, a compared with the 1991 Dutch HIVtreatment guidelines. Family Practice, 15: 525-528, 1998.

21. Reedijk M, Bindels PJE, Mohrs L, WigersmaL. Changing attitude towards antiretroviral treat-ment of HIV infection. A prospective study ofDutch general practitioners. AIDS care, 11:141-145, 1999.


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Óõó÷åôéóìüò óùìáôïìåôñéêþí äåéêôþí êáé áñôçñéáêÞò ðßåóçòóå ìáèçôÝò áãñïôéêÞò ðåñéï÷Þò Íüôéáò ÊÝñêõñáò

É. ÌïíÝäáò1, Á. Èáíïðïýëïõ2, Í. ÄçìçóéÜíïò1, È. ÄÜóéïò1, Ô. ÍôÜöçò1, Â. Óôáóéíüò1, Â. ÌÞëéá1,Í. Ðáôïýíçò1, E. ÑÝããéïõ1

ÅÐÁÉÍÅÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ - 14Ï ÐÁÍÅËËÇÍÉÏ ÓÕÍÅÄÑÉÏ ÃÅÍÉÊÇÓ ÉÁÔÑÉÊÇÓ

AWARDED FREESTANDING PAPER - 14th HELLENIC CONGRESS IN GENERAL PRACTICEPrimary Heatlh Care, Volume 14, Number 3, 126-129, 2002ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 126-129, 2002

ËÝîåéò êëåéäéÜ: áñôçñéáêÞ õðÝñôáóç, ðá÷õóáñêßá,áãñïôéêÞ ðåñéï÷Þ, ìáèçôÝòÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñçáíáêïßíùóç óôï 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞòÉáôñéêÞò (ÊñÞôç, 8-12 ÌáÀïõ 2002) êáé Ýëáâå Ýðáé-íï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïé-íÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ ðåñéï-äéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíå-äñßïõ.Õðåýèõíïò áëëçëïãñáößáò: É. ÌïíÝäáò, ÊÝíôñïÕãåßáò Ëåõêßììçò ÊÝñêõñáò, Tçë.: (26610)71098, êéí.:0932781500

ÅéóáãùãÞ

Ç ðá÷õóáñêßá áðïôåëåß óÞìåñáÝíá ìåßæïí ðñüâëçìá äçìüóéáò õãåßáò,êõñßùò ãéá ôéò äõôéêïý ôýðïõ áíåðôõã-ìÝíåò êïéíùíßåò, êáé áöïñÜ óõíå÷þòìåãáëýôåñï ðïóïóôü ôïõ ðáéäéêïý êáéåöçâéêïý ðëçèõóìïý, åíþ áõîÜíåé óôá-äéáêÜ ìå ôçí ðÜñïäï ôçò çëéêßáò.

Ðñüóöáôåò ìåëÝôåò äåß÷íïõí üôéç áëëáãÞ ôïõ ôñüðïõ æùÞò ôá ôåëåõ-ôáßá ÷ñüíéá êáé óôç ÷þñá ìáò Ý÷åéðñïêáëÝóåé áýîçóç ôïõ åðéðïëáóìïýôçò ðá÷õóáñêßáò, áëëÜ êáé êáñäéáã-ãåéáêþí íïóçìÜôùí, ðïõ ôåßíïõí íáåîéóùèïýí ìå ôá åõñùðáúêÜ êáé áìå-ñéêáíéêÜ ðïóïóôÜ.

Ç áñôçñéáêÞ õðÝñôáóç áðïôåëåßÝíáí áðü ôïõò ìåßæïíåò ðáñÜãïíôåòêéíäýíïõ áíÜðôõîçò êáñäéáããåéáêÞòíüóïõ êáé ó÷åôßæåôáé óôåíÜ ìå ôçíðá÷õóáñêßá, ìå áõîáíüìåíï åðéðïëá-

ÐåñßëçøçÓêïðüò ôçò åñãáóßáò Þôáí ç êáôáãñáöÞ ôïõ åðéðïëáóìïý ðá÷õóáñêßáò êáéõðÝñôáóçò óôïõò ìáèçôÝò äåõôåñïâÜèìéáò åêðáßäåõóçò ôçò íüôéáò ÊÝñêõñáò.Ðëçèõóìüò ìåëÝôçò - ÌÝèïäïò: ÊáôáãñÜöçêáí çëéêßá, öýëï, ýøïò, âÜñïò,ðåñßìåôñïò ìÝóçò (waist), éó÷ßùí (hip), óõóôïëéêÞ êáé áñôçñéáêÞ ðßåóç êáé Üóêç-óç. Ôá äåäïìÝíá áíáëýèçêáí óôáôéóôéêÜ ìå SPSS 10. ÁðïôåëÝóìáôá: ÅîåôÜ-óôçêáí 224 ìáèçôÝò, 108 áãüñéá 15,4+0,2 åôþí êáé 116 êïñßôóéá 14,9+0,2åôþí. Óôçí ïìÜäá ôùí áãïñéþí ïé ðáñÜìåôñïé åß÷áí ùò åîÞò: ýøïò 167+0,1cm,ÂÌÉ 22,7+0,4, óõóôïëéêÞ áñôçñéáêÞ ðßåóç (sbp) 118+1,2 mmHg, äéáóôïëéêÞáñôçñéáêÞ ðßåóç (dbp) 73+0,9 mmHg, ëüãïò ðåñéìÝôñïõ ìÝóçò/éó÷ßùí (W/Hratio) 0,85. Óôçí ïìÜäá ôùí êïñéôóéþí ïé áíôßóôïé÷åò ðáñÜìåôñïé Þôáí: ýøïò159+0,0cm, ÂÌÉ 21,5+0,3, (sbp) 114+1,2 mmHg, (dbp) 73+0,8 mmHg, W/H ratio0,79. Áðü ôç óôáôéóôéêÞ áíÜëõóç êáôáäåéêíýåôáé óõó÷Ýôéóç ôïõ ÂÌÉ ìå ôçíçëéêßá r=0,196 êáé p**, ôçí sbp r=0,296 êáé p***, ôçí dbp r=0,258 êáé p*** êáéôçí W/H ratio r=0,216 êáé p**. Óôá áãüñéá ç çëéêßá óõó÷åôßæåôáé ìå ôçí sbpr=0,378 êáé p*** êáé ôçí dbp r=0,264 êáé p***. Óôá êïñßôóéá ç çëéêßá óõó÷åôßæå-ôáé ìå ôçí sbp r=0,383 êáé p***, ôçí dbp r=0,247 êáé p*** áëëÜ êáé ôï ÂÌÉ ìår=0,264 êáé p**. Ôá áãüñéá áóêïýíôáé ðåñéóóüôåñï áðü ôá êïñßôóéá, 82,4%Ýíáíôé 49,1% ìå p***. 31 ðáéäéÜ åßíáé éó÷íÜ ìå ÂÌÉ<18 êáé 45 õðÝñâáñá ìåÂÌÉ>25. 5 ðáéäéÜ Ý÷ïõí ðáèïëïãéêÞ sbp (>140mmHg) êáé 4 ðáèïëïãéêÞ dbp(>90mmHg). ÓõìðåñÜóìáôá: To 20% ôùí ìáèçôþí çëéêßáò 12-20 åôþí åßíáéõðÝñâáñï (ÂÌÉ>25) åíþ áíôßóôïé÷á ôï 13,8% åßíáé éó÷íü (ÂÌÉ<18). Ç çëéêßáóõó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ ìå ôç óõóôïëéêÞ, äéáóôïëéêÞ áñôçñéáêÞ ðßå-óç êáé ôï ÂÌÉ óôá êïñßôóéá áëëÜ ìüíï ìå ôç óõóôïëéêÞ êáé äéáóôïëéêÞ áñôçñéá-êÞ ðßåóç óôá áãüñéá. Ôá áãüñéá áóêïýíôáé óçìáíôéêÜ ðåñéóóüôåñï áðü ôáêïñßôóéá.*p<0,005, **p<0,01, ***p<0,001

1ÊÝíôñï Õãåßáò Ëåõêßììçò, 2Äéáâçôïëïãéêü ÊÝíôñï ÉððïêñÜôåéï Íïóïêïìåßï Áèçíþí

127

É. ÌïíÝäáò êáé óõí. Ôüìïò 14, Ôåý÷ïò 3, 2002

ãñáöéêþí äåäïìÝíùí, áíèñùðïìåôñé-êþí óôïé÷åßùí, óõóôïëéêÞò êáé äéá-óôïëéêÞò áñôçñéáêÞò ðßåóçò êáé Üóêç-óçò.

Ï êáèïñéóìüò ôïõ äåßêôç ìÜæáòóþìáôïò (ÂÌÉ) ðñïóäéïñßóôçêå ìå ôïíôýðï ôïõ Quetelet, áöïý êáôáãñÜöç-êå ôï âÜñïò ôùí åîåôáæüìåíùí ìå ôáåóþñïõ÷á êáé ôï ýøïò ôïõò ìå æõãüSEGA êáé áíáóôçìüìåôñï ðñïóáñìï-óìÝíï óôï æõãü. Ùò õðÝñâáñïé èåùñÞ-èçêáí ïé Ýöçâïé ìå ÂÌÉ >25kg/m2,ùò ðá÷ýóáñêïé áõôïß ìå ÂÌÉ >30kg/m2, åíþ ùò åëëéðïâáñåßò áõôïß ìå ÂÌÉ<18kg/m2. ÊáôáãñÜöçêå åðßóçò ï äåß-êôçò ðåñßìåôñïò ìÝóçò ðñïò ðåñßìå-ôñï éó÷ßùí (waist/hip ratio) ï ïðïßïòóõíäÝåôáé ìå áõîçìÝíç êáñäéáããåéáêÞíïóçñüôçôá.

Ç áñôçñéáêÞ ðßåóç ìåôñÞèçêå ìåõäñáñãõñéêü óöõãìïìáíüìåôñï óå êá-èéóôÞ èÝóç. ̧ ãéíáí ôñåéò ìåôñÞóåéò ìåìåóïäéáóôÞìáôá äýï ëåðôþí êáé áöïýðáñáëÞöèçêå ç ôéìÞ ôçò ðñþôçò ìÝ-ôñçóçò êáôåãñÜöç ï ìÝóïò üñïò ôùíäýï åðïìÝíùí.

óìü ðïõ áðïäßäåôáé óôçí áëëáãÞ ôïõ ôñüðïõæùÞò, ÷ùñþí üðùò ç ÷þñá ìáò.

Ôï ãåãïíüò üôé ï ñüëïò ôçò áñôçñéáêÞò õðÝñ-ôáóçò êáé êõñßùò ôçò åöçâéêÞò ðá÷õóáñêßáò åß-íáé åîáéñåôéêÜ óçìáíôéêüò óôçí åìöÜíéóç êáñ-äéáããåéáêþí íïóçìÜôùí, ìáò þèçóå óôï íá ìåëå-ôÞóïõìå ôïí åðéðïëáóìü ôçò ðá÷õóáñêßáò êáéôçò áñôçñéáêÞò õðÝñôáóçò óôï ìáèçôéêü ðëçèõ-óìü.

ÅîåôÜóôçêáí ìáèçôÝò äåõôåñïâÜèìéáò åêðáß-äåõóçò ìéáò áãñïôéêÞò ðåñéï÷Þò ðïõ äéáôçñåß áêü-ìç åí ìÝñåé ÷áñáêôçñéóôéêÜ áãñïôéêÞò ðåñéï÷Þò,áëëÜ Ý÷åé õðïóôåß ôçí åðéññïÞ ôïõ äõôéêïý ôñü-ðïõ æùÞò êõñßùò óôïí ðáéäéêü êáé åöçâéêü ðëç-èõóìü, êáé íá åêôéìÞóïõìå ôç ó÷Ýóç ðá÷õóáñ-êßáò êáé áñôçñéáêÞò õðÝñôáóçò.


ÌåëåôÞèçêáí 224 ìáèçôÝò ãõìíáóßùí êáéëõêåßùí ôùí ÄÞìùí Êïñéóóßùí êáé Ëåõêßììçòôçò Íüôéáò ÊÝñêõñáò êáôÜ ôï ó÷ïëéêü Ýôïò 2001-2002. Óõìðëçñþèçêå äåëôßï êáôáãñáöÞò äçìï-

Ç Üóêçóç åêôéìÞèçêå ìÝóù åñùôçìáôïëï-ãßïõ êáé êáôåãñÜöç ç ðñáãìáôïðïßçóç êÜðïéïõáèëÞìáôïò áðü ôïí åîåôáæüìåíï êáé ïé þñåò Üèëç-óçò áíÜ åâäïìÜäá.

Ç óôáôéóôéêÞ åðåîåñãáóßá Ýãéíå ìå SPSS 10êáé ç óôáôéóôéêÞ áíÜëõóç êáôÜ Pearson's x2 ìåôç ìÝèïäï bivariate correlations.


ÅîåôÜóôçêáí 224 ìáèçôÝò, 108 áãüñéá(48,2%) êáé 116 êïñßôóéá (51,8%). Ç ìÝóç çëéêßáôïõ äåßãìáôïò Þôáí 15,13+1,90 Ýôç, ÷ùñßò íáõðÜñ÷åé óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ ìåôáîýôùí äýï öýëùí ìå ôéìÝò áíôßóôïé÷á ãéá ôá áãü-ñéá êáé ôá êïñßôóéá 15,4+1,9 êáé 14,9+1,9 Ýôç.

Ç ìÝóç óõóôïëéêÞ áñôçñéáêÞ ðßåóç (ÓÁÐ)Þôáí 116+13 mmHg, ç ìÝóç äéáóôïëéêÞ áñôç-ñéáêÞ ðßåóç (ÄÁÐ) Þôáí 73+9 mmHg, ï ìÝóïòäåßêôçò ìÜæáò óþìáôïò (ÂÌÉ) Þôáí 21,5+3,8 kg/m2 êáé ç ðåñßìåôñïò ìÝóçò ðñïò ðåñßìåôñï éó÷ßùí(w/h ratio) Þôáí 0,82.

Ïé áíôßóôïé÷åò ôéìÝò ãéá ôá áãüñéá Þôáí ÓÁÐ

Correlation of body mass index (BMI) and blood pressure in studentsof a rural area of CorfuI. Monedas, A. Thanopoulou, N. Dimisianos, T. Dasios, T. Ntafis, V. Stasinos,B. Milia, N. Patounis, E. Reggiou

SummaryAim: The aim of this study was to detect the prevalence of obesity and hyper-tension among high school students living in the Southern part of Corfu. Studypopulation-Methods: The study population consisted of 224 students, 108males 15.4+0.2 and 116 females with a mean average age of 14.9+0.2 years.Results: For the males the parameters were: Body Mass Index (BMI) 22.7+0.4,SBP 118+1.2 mmHg, DBP 73+0.9 mgHg, W/H ratio 0.85. For the females thesame parameters were BMI 21.5+0.3, SBP 114+1.2 mmHg, DBP 73+0.8 mmHg,W/H ratio 0.79. the statistical analysis shows a correlation of the BMI with age(r=0.196, p**), SBP (0.296, p***), DBP (0.258, p***) and W/H ratio (0.216, p**).For the males the age is correlated with SBP (r=0.378, p***) and the DBP(0.264, p***). For the females the age is correlated with the SBP (0.383, p***)the DBP (0.247, p***) and also with the BMI (0.264, p**). There is an 82.4% ofmales participating in some form of sport, in contrast to only 49.1% of females(p***). Thirty-one students had a BMI<18 and forty-five had a BMI>25. Fivestudents were hypertensive with SBP>140 mmHg and four with DBP>90 mmHg.Conclusions: That 20% of students between the ages of 12 and 20 years areoverweight (BMI>25) and 13.8% are underweight (BMI<18). The age is correlat-ed with the SBP, DBP and the BMI in the female group but only with the SBPand DBP in the male group.*p<0.05, **p<0.01, ***p<0.001

Key words: blood pressure, body mass index, students, rural area

Health Centre of Lefkimmi-Corfu


128

É. ÌïíÝäáò êáé óõí.

ìå ôç ÓÁÐ r=0.264 êáé p<0,01 êáé ôç ÄÁÐr=0,378 êáé p<0,01.

Ãéá ôá êïñßôóéá ôï ÂÌÉ óõó÷åôßæåôáé óôáôé-óôéêÜ óçìáíôéêÜ ìå ôç ÓÁÐ r=0,286 êáé p<0,01,ôç ÄÁÐ r=0,324 êáé p<0,01 áëëÜ ü÷é ôï ëüãïwaist/hip ratio. Ç çëéêßá óôá êïñßôóéá åðßóçòäåí ó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ ìå êáíÝíáíáðü ôïõò ðáñáðÜíù ðáñÜãïíôåò.

Ç Üóêçóç óõó÷åôßæåôáé óôáôéóôéêÜ óçìáíôé-êÜ ìå ôç ÓÁÐ r=0.146 êáé p<0,05 êáé ôç ÄÁÐr=0,159 êáé p<0,05, åíþ äå óõó÷åôßæåôáé ìå ôïÂÌÉ. Ôá áãüñéá áóêïýíôáé ðåñéóóüôåñï áðü ôáêïñßôóéá óå ðïóïóôü 82,4% vs 49,1%, r=0,349êáé p<0,01.

ÓõæÞôçóç

Áðü ôá áðïôåëÝóìáôá ôçò áíÜëõóçò ôùíäåäïìÝíùí ðñïêýðôåé üôé ç ìÝóç ôéìÞ ôïõ ÂÌÉôùí åîåôáóèÝíôùí ìáèçôþí âñßóêåôáé åíôüò ôùíöõóéïëïãéêþí ïñßùí (21,5+3,8kg/m2) êáé áðÝ÷åéáñêåôÜ áðü ôéìÝò ðïõ ÷áñáêôçñßæïíôáé óáí õðåñ-âïëéêü âÜñïò.

Ôï 3,6% (8) ôùí ìáèçôþí åßíáé ðá÷ýóáñêïé(ÂÌÉ>30), êáé ôï 16,5% (37) õðÝñâáñïé (25<ÂÌÉ<30), ðïóïóôÜ ÷áìçëüôåñá áðü áõôÜ Üëëùíåðéäçìéïëïãéêþí ìåëåôþí. Ôï 13,8% (31) åßíáéåëëéðïâáñåßò (ÂÌÉ<18).

Óôçí õðïïìÜäá ôùí áãïñéþí ôï ÂÌÉ åßíáé22,7+3,8kg/m2 åíþ ó’ áõôÞ ôùí êïñéôóéþí 21,5+3,8kg/m2, óôáôéóôéêÜ ìç óçìáíôéêÞ äéáöïñÜ.

Áîéïóçìåßùôï åßíáé ôï ãåãïíüò üôé ï ëüãïòáãïñéþí/êïñéôóéþí ãéá ôéò ôñåéò êáôçãïñßåò ðá-

118+13 mmHg, ÄÁÐ 73+10 mmHg, ÂÌÉ22,7+3,8 kg/m2 êáé w/h ratio 0,85 åíþ ãéá ôáêïñßôóéá ÓÁÐ 114+13 mmHg, ÄÁÐ 73+9, ÂÌÉ21,5+3,8 kg/m2 êáé w/h ratio 0,79.

Ìå âÜóç ôï ÂÌÉ êáôáôÜ÷ôçêáí óå ôÝóóåñéòêáôçãïñßåò, üðùò öáßíåôáé óôïí ðßíáêá 1 óå åë-ëéðïâáñåßò ìå ÂÌÉ<18 31 ìáèçôÝò (9 áãüñéá êáé22 êïñßôóéá), öõóéïëïãéêïß ìå 18<ÂÌÉ<25 148,õðÝñâáñïé ìå 25<ÂÌÉ<30 37 (23 áãüñéá êáé 14êïñßôóéá) êáé ðá÷ýóáñêá ìå ÂÌÉ>30 8 (5 áãü-ñéá êáé 3 êïñßôóéá).

Ïé åîåôáæüìåíïé êáôåôÜãçóáí óå äýï êáôç-ãïñßåò áíÜëïãá ìå ôï ëüãï waist/hip ratio. Ôáìåí áãüñéá ìå w/h <1 êáé w/h>1 ôá äå êïñßôóéáìå w/h<0,85 êáé w/h>0,85 üðùò öáßíåôáé óôïíðßíáêá 2.

¼ðùò öáßíåôáé óôïí ðßíáêá 3, áðü ôï óýíï-ëï ôùí ìáèçôþí ôéìÝò áñôçñéáêÞò ðßåóçò ðïõ÷áñáêôçñßæïíôáé õøçëÝò åß÷áí: 4 ÓÁÐ >140mmHg, 3 ÄÁÐ >90 mmHg, åíþ 1 åß÷å ÓÁÐ>140 mmHg êáé ÄÁÐ >90 mmHg.

Áðü ôç óôáôéóôéêÞ áíÜëõóç äéáðéóôþèçêåüôé ãéá ôï óýíïëï ôùí åîåôáóèÝíôùí ìáèçôþíõðÜñ÷åé óôáôéóôéêÜ óçìáíôéêÞ óõó÷Ýôéóç ôïõ ÂÌÉìå ôç ÓÁÐ r=0,296 êáé p<0,01, ôç ÄÁÐ r=0,258êáé p<0,01 êáé ôï ëüãï waist/hip ratio r=0,216êáé p<0,01.

Áíáëýïíôáò ôéò ßäéåò ðáñáìÝôñïõò ãéá êÜèåöýëï îå÷ùñéóôÜ äéáðéóôþíïõìå üôé ãéá ôá áãü-ñéá ôï ÂÌÉ óõó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜìå ôç ÓÁÐ r=0,270 êáé p<0,01, ôç ÄÁÐ r=0,201êáé p<0,05 êáé ôï ëüãï waist/hip ratio r=0,258êáé p<0,01. Äåí õðÜñ÷åé óõó÷Ýôéóç ìå ôçí çëéêßáç ïðïßá üìùò ó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ

Ðßíáêáò 3. ÅõñÞìáôá óôçí ôéìÞ ôçò áñôçñéáêÞò ðßåóçò

ÓÁÐ>140 ÄÁÐ>90 ÓÁÐ>140 êáé ÄÁÐ>90 ÓÁÐ<140 êáé ÄÁÐ<90

4 3 1 216

Ðßíáêáò 2. ÅõñÞìáôá óôçí áíáëïãßá ðåñßìåôñïò ìÝóç ðåñßìåôñïò éó÷ßùí óôïõò ìáèçôÝò

Áãüñéá w/h <1 Êïñßôóéá w/h<0,85 Áãüñéá w/h >1 Êïñßôóéá w/h>0,85

105 10 3 3 13

Ðßíáêáò 1. ÅõñÞìáôá óôï äåßêôç ìÜæáò óþìáôïò óôïõò ìáèçôÝò

ÂÌÉ<18 18<ÂÌÉ<25 25< ÂÌÉ<30 ÂÌÉ>3031 (13,8%) 148 (66,0%) 37 (16,5%) 8 (3,6%)

9 áãüñ. - 22 êïñ. 71 áãïñ. - 77 êïñ. 23 áãüñ. - 14 êïñ. 5 áãïñ. - 3 êïñ.

129

É. ÌïíÝäáò êáé óõí. Ôüìïò 14, Ôåý÷ïò 3, 2002

÷ýóáñêïé, õðÝñâáñïé, åëëéðïâáñåßò åßíáé áíôßóôïé÷á1,67, 1,64 êáé 0,41, ðñÜãìá ðïõ óçìáßíåé üôé çðñïò ôá ðÜíù åêôñïðÞ ôïõ ÂÌÉ åßíáé óõ÷íüôåñçóôá áãüñéá, åíþ ç ðñïò ôá êÜôù óôá êïñßôóéá.

Ï äåßêôçò waist/hip ratio óôá áãüñéá åßíáé0,85 êáé óôá êïñßôóéá 0,79, ôéìÝò èåìéôÝò ðïõ äåèåùñïýíôáé ðáñÜãïíôåò êéíäýíïõ. Ôï 7,14% (16)ôùí ìáèçôþí ÷áñáêôçñßæåôáé áðü ôéìÝò åêôüòôùí öõóéïëïãéêþí ïñßùí, w/h ratio >1 ãéá ôááãüñéá êáé >0,85 ãéá ôá êïñßôóéá, åõñÞìáôá ðïõóõìðßðôïõí ìå áõôÜ Üëëùí ìåëåôþí.

Ïé ôéìÝò ÓÁÐ êáé ÄÁÐ âñßóêïíôáé åíôüòöõóéïëïãéêþí ïñßùí áíôßóôïé÷á 116+13 mmHgêáé 73+9 mmHg êáé áðÝ÷ïõí áñêåôÜ áðü ôááíþôåñá öõóéïëïãéêÜ üñéá. Ãéá ôéò äõï õðïïìÜ-äåò, áãïñéþí êáé êïñéôóéþí, ïé ôéìÝò ÓÁÐ êáéÄÁÐ åßíáé áíôßóôïé÷á 118+13 mmHg, 73+10mmHg êáé 114+13 mmHg, 73+9 mmHg, óôáôé-óôéêÜ ìç óçìáíôéêÞ äéáöïñÜ.

Ôï 1,8% (4) ÷áñáêôçñßæåôáé áðü õøçëÝò ôé-ìÝò ÓÁÐ>140 mmHg, ôï 1,3% (3) áðü ôéìÝòÄÁÐ>90 mmHg, åíþ Ýíáò ìüíï ìáèçôÞò áðüõøçëÝò ôéìÝò ÓÁÐ áëëÜ êáé ÄÁÐ.

Ç Üóêçóç, íïïýìåíç óáí ðñáãìáôïðïßçóçêÜðïéïõ áèëÞìáôïò ôïõëÜ÷éóôïí ìéá çìÝñá ôçíåâäïìÜäá, åßíáé ÷áñáêôçñéóôéêü ôçò õðïïìÜäáòôùí áãïñéþí óå ðïóïóôü 82,4%, åíþ ôá êïñßôóéáõðïëåßðïíôáé óôáôéóôéêÜ óçìáíôéêÜ ìå ðïóïóôü49,1% êáé p<0,01.

Áðü ôç óôáôéóôéêÞ áíÜëõóç äéáðéóôþíåôáéóôáôéóôéêÜ óçìáíôéêÞ óõó÷Ýôéóç (p<0,01) ôïõ ÂÌÉôüóï ìå ôç ÓÁÐ (r=0,296) üóï êáé ôç ÄÁÐ(r=0,258) ãéá ôï óýíïëï ôùí ìáèçôþí, áëëÜ êáéãéá êÜèå õðïïìÜäá åîåôáæüìåíç îå÷ùñéóôÜ. Ççëéêßá åðßóçò óõó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ(p<0,01) ôüóï ìå ôç ÓÁÐ (r=0,264) üóï êáé ôçÄÁÐ (r=0,378).

¸íáò Üëëïò ðáñÜãïíôáò ðïõ óõó÷åôßæåôáéåðßóçò óôáôéóôéêÜ óçìáíôéêÜ (p<0,05) ôüóï ìåôç ÓÁÐ (r=0,146) üóï êáé ôç ÄÁÐ (r=0,159)åßíáé ç Üóêçóç.

Áðü ôçí Ýñåõíá ðïõ ðñáãìáôïðïéÞóáìå óôïõòìáèçôÝò ôçò äåõôåñïâÜèìéáò åêðáßäåõóçò ôçòíüôéáò ÊÝñêõñáò äéáðéóôþóáìå ó÷åôéêÜ ÷áìçëüåðéðïëáóìü õðåñâÜëëïíôïò âÜñïõò êáé ðá÷õóáñ-êßáò, ãåãïíüò ðïõ ðéèáíþò íá ïöåßëåôáé óôç äéá-

ôÞñçóç ôñüðïõ æùÞò ìå ÷áñáêôçñéóôéêÜ áãñïôé-êÞò ðåñéï÷Þò.

Ç çëéêßá, ôï ÂÌÉ êáé ç Üóêçóç óõó÷åôßæï-íôáé óôáôéóôéêÜ óçìáíôéêÜ, óáí áíåîÜñôçôïé ðá-ñÜãïíôåò, ìå ôç óõóôïëéêÞ áëëÜ êáé ôç äéá-óôïëéêÞ áñôçñéáêÞ ðßåóç.

Ìå äåäïìÝíï üôé ïé äõï ôåëåõôáßïé åßíáé ôñï-ðïðïéÞóéìïé ðáñÜãïíôåò, åßíáé óçìáíôéêü íá ðñï-ãñáììáôéóôïýí ðñïãñÜììáôá ðáñÝìâáóçò ãéá ôçíôñïðïðïßçóÞ ôïõò, ìå óôü÷ï ôçí åðßôåõîç ôéìþíáñôçñéáêÞò ðßåóçò åíôüò ôùí åðéèõìçôþí ïñßùí.


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130

Ã. Ôóßñïò êáé óõí.

Ðñüëçøç, áíôéìåôþðéóç êáé óõìðåñéöïñÜ ôùí éáôñþí óå èÝìáôáõãåßáò ôïõò

Ã. Ôóßñïò1, Ä. Êáëïãåñüðïõëïò1, Ðáí. ÂïÀëá2, ×ñ. Âüóóïõ3, Ã. ÊáñäÜôïò4, Ã. ÌïõæÜêçò5,Í. ÌáãêëÜñáò6, Ð. Áèáíáóüðïõëïò7, Áéê. Ãáôïðïýëïõ8



ÅéóáãùãÞ

Ïé éáôñïß, ùò ëåéôïõñãïß ôçò õãåßáòðñïóöÝñïõí ôéò õðçñåóßåò ôïõò óåêáôáóôÜóåéò áóèåíåßáò óõíáíèñþðùíôïõò, êáèïäçãþíôáò ôïõò ãéá ôçí áðï-ôåëåóìáôéêüôåñç èåñáðåßá ôùí íüóùíôïõò.

¼íôùò ùò Üíèñùðïé äéáôñÝ÷ïõíðáñÜëëçëá êáé ïé ßäéïé êßíäõíï íüóç-óçò êáé ìÜëéóôá áõîçìÝíï, áöïý åñ-ãÜæïíôáé óôï ÷þñï ôçò õãåßáò-íïóï-êïìåßá êáé “åêôßèåíôáé” óå ëïéìþäåéòðáñÜãïíôåò êáé ìïëõóìÝíá âéïëïãéêÜõãñÜ (éüò çðáôßôéäáò Â êáé çðáôßôé-äáò C, HIV ê.ëð.), þóôå íá áõîÜíï-íôáé ïé ðéèáíüôçôåò ìüëõíóçò êáé íü-óçóçò1-3. Áóðßäá-ðñüëçøç ó’ áõôÞ ôçí“Ýêèåóç” áðïôåëïýí: ç óùóôÞ åíçìÝ-ñùóç, ïé áðáñáßôçôïé åìâïëéáóìïß êáéìÜëéóôá ïé åðáíáëçðôéêÝò äüóåéò (üðùòçðáô. Â), ç ÷ñÞóç ìÝóùí ðñïóôáóßáò(ãÜíôéá, ìÜóêá ê.ëð.) üôáí áðáéôåß-

ÐåñßëçøçÓêïðüò: Ç ìåëÝôç ðñüëçøçò, óõìðåñéöïñÜò êáé áíôéìåôþðéóçò ðñïâëçìÜôùíõãåßáò éáôñþí, êáèþò êáé ï âáèìüò åìðéóôïóýíçò-óõììüñöùóÞò ôïõò óôéòóõìâïõëÝò êáé ïäçãßåò, ðáñå÷üìåíåò áðü åéäéêïýò-ùò ðñïò ôçí áíôßóôïé÷çíüóï-óõíáäÝëöïõò. Õëéêü êáé ÌÝèïäïò: Óõìðëçñþèçêå áíþíõìï åñùôçìáôï-ëüãéï áðü 208 éáôñïýò äéáöüñùí åéäéêïôÞôùí, åñãáæüìåíïõò óå äýï íïóïêï-ìåßá ôçò ÁèÞíáò (Íáõôéêü Íïóïêïìåßï, Ï Åõáããåëéóìüò) êáé Ýíá ðåñéöåñåéáêüðáíåðéóôçìéáêü (Ð.Ð.Ã.Í. Ðáôñþí). ¸ãéíå áîéïëüãçóç êáé ïìáäïðïßçóç ôùíáðáíôÞóåùí ãéá óõãêñßóåéò, êáôÜ öýëï êáé ôïìÝá åéäéêüôçôáò. ÁðïôåëÝóìáôá:Áðü 208 éáôñïýò (46% ðáèïëüãïé, 28% ÷åéñïõñãïß, 26% åñãáóôçñéáêïß), ìåëå-ôÞèçêáí 108 (51%) Üíäñåò êáé 100 (49%) ãõíáßêåò ìÝóçò çëéêßáò 32,2 êáé31,3 åôþí áíôßóôïé÷á. Ðïóïóôü 64% áõôþí åìâïëéÜóèçêáí ìå ôá áðáñáßôçôáãéá ôçí çëéêßá ôïõò åìâüëéá, áíåìâïëßáóôïé-9%, 27% äçëþíïõí Üãíïéá (êõñßùò÷åéñïõñãïß-39%). 71% åðß óõíüëïõ ÷ñçóéìïðïéåß ìÝóá ðñïóôáóßáò, üôáí áðáé-ôåßôáé óôéò þñåò åñãáóßáò (÷åéñïõñãïß 77%, åñãáóôçñéáêïß 78%, ðáèïëüãïé57%), åíþ óõ÷íÜ äçëþíïõí ÷ñÞóç 26%. ¸ãêáéñá áíôéìåôùðßæïõí êáôáóôÜóåéòáóèÝíåéÜò ôïõò 50% (ãõí. 62%, Üíäñ. 39%), áíáëüãùò êñßóåùò 39%, ìç-åãêáß-ñùò 11%. Áðåõèýíïíôáé óå åéäéêü 52% (ðáèïë. 60%, ÷åéñïõñã. 54%, åñãáóô.42%), óõ÷íÜ 36% êáé ü÷é 12%. Óôéò ïäçãßåò åéäéêïý éáôñïý óõììïñöþíåôáé ôï39% ôùí óõíáäÝëöùí (åñãáóô. 46%, ðáèïë. 42%, ÷åéñïõñã. 28%), óõ÷íÜ 54%êáé êáèüëïõ 7%. ÖáñìáêåõôéêÞ áãùãÞ óùóôÜ ëáìâÜíïõí 58% (ãõí. 66%, Üíäñ.50%), åíþ ðëçììåëþò-34%. Áðïöåýãïõí ôçí ðïëõöáñìáêßá 66%, ôï 32% üìùòëáìâÜíåé öÜñìáêá üôáí áðáéôåßôáé. 38% åìðéóôåýïíôáé óõíáäÝëöïõò ôïõò (êõ-ñßùò ëüãù åìðåéñßáò), 28% ìå ìéêñÞ åðéöýëáîç, áðüëõôç åìðéóôïóýíç 20%êáé 11% óå ãíùóôïýò-óõíåñãÜôåò. ÓõìðåñÜóìáôá: Ç ðëåéïíüôçôá ôùí éáôñþíÝ÷åé åìâïëéáóèåß åðáñêþò, êñßíåôáé üìùò áðáñáßôçôï íá äåßîïõí åíäéáöÝñïíüóïé äçëþíïõí Üãíïéá. Ïé ðáèïëüãïé ÷ñçóéìïðïéïýí ëéãüôåñï ìÝóá ðñïóôá-óßáò. Ôï Þìéóõ ôùí éáôñþí áíôéìåôùðßæåé Ýãêáéñá êáôáóôÜóåéò áóèåíåßáò ôïõò(êõñßùò ãõíáßêåò, ðïõ ëáìâÜíïõí ðéï óùóôÜ ôç öáñìáêåõôéêÞ ôïõò áãùãÞ) êáéãåíéêüôåñá áðåõèýíïíôáé óå åéäéêü ãéá ôçí ðÜèçóÞ ôïõò éáôñü, óõììïñöþíï-íôáé ìå ôéò ïäçãßåò ôïõ êáé ôïí åìðéóôåýïíôáé-êõñßùò ôïõò Ýìðåéñïõò êáéóõíåñãÜôåò ôïõò.

1ÃåíéêÞ ÉáôñéêÞ Ð.Ð.Ã.Í. Ðáôñþí, 2Éáôñüò ÉáôñéêÞò Âéïðáèïëïãßáò, 3Éáôñüò Íïóïêïìåßïõ "Åõáã-ãåëéóìüò", 4Éáôñüò Íáõôéêïý Íoó. Áèçíþí, 5Éáôñüò ÃåíéêÞò ÉáôñéêÞò, 6Öõóßáôñïò Ð.Ð.Ã.Í.Ðáôñþí, 7Ìéêñïâéïëüãïò, 8Áéìïäïóßá Êáñáìáíäáíåßïõ Íïóïêïìåßïõ Ðáôñþí

ËÝîåéò êëåéäéÜ: íïóçñüôçôá, ðñüëçøç, áíôéìåôþðé-óç, óõìðåñéöïñÜ, éáôñïßÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñçáíáêïßíùóç óôï 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞòÉáôñéêÞò (ÊñÞôç, 8-12 ÌáÀïõ 2002) êáé Ýëáâå Ýðáé-íï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïé-íÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ ðåñéï-äéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíå-äñßïõ.Õðåýèõíïò áëëçëïãñáößáò: Ãåþñãéïò Ôóßñïò, Óï-öïêëÝïõò 29, Ô.Ê. 26442 ÐÜôñá, Ôçë. (2610)454667

131

Ã. Ôóßñïò êáé óõí. Ôüìïò 14, Ôåý÷ïò 3, 2002

ðñüëçøçò, óõìðåñéöïñÜò êáé áíôéìå-ôþðéóçò ðñïâëçìÜôùí õãåßáò éáôñþí,êáèþò êáé ï âáèìüò åìðéóôïóýíçò-óõì-ìüñöùóÞò ôïõò óôéò óõìâïõëÝò êáéïäçãßåò, ðáñå÷üìåíåò áðü åéäéêïýò-ùòðñïò ôçí áíôßóôïé÷ç íüóï-óõíáäÝëöïõò.


Óôçí ðáñïýóá åñãáóßá óõììåôåß-÷áí 208 éáôñïß äéáöüñùí åéäéêïôÞôùí,ïé ïðïßïé åñãÜæïíôáé óå äýï íïóïêï-ìåßá ôçò ðñùôåýïõóáò (Ð.Ã.Í. “ÏÅõáããåëéóìüò”, Íáõôéêü ÍïóïêïìåßïÁèçíþí) êáé Ýíá Ðåñéöåñåéáêü Ðáíå-ðéóôçìéáêü Íïóïêïìåßï (Ð.Ð.Ã.Í. Ðá-ôñþí).

Óõìðëçñþèçêå áíþíõìï åñùôçìá-ôïëüãéï (ÐáñÜñôçìá), åéäéêÜ äéáìïñ-öùìÝíï, ìå ôá ÷áñáêôçñéóôéêÜ óôïé-÷åßá ôïõ éáôñïý (öýëï, çëéêßá, åéäéêü-ôçôá), þóôå íá äéåñåõíçèïýí ðáñÜãï-íôåò ó÷åôéæüìåíïé ìå:

· Ôïí áðáñáßôçôï ãéá ôçí çëéêßáôïõò åìâïëéáóìü.

· Ôç ÷ñÞóç óôéò þñåò åñãáóßáò ìÝ-óùí ðñïóôáóßáò (ãÜíôéá, ìÜóêáê.ëð.) üôáí áðáéôåßôáé.

· Ôçí Ýãêáéñç áíôéìåôþðéóç êáôá-óôÜóåùí áóèÝíåéÜò ôïõò.

Doctors' attitudes and behaviour in themes of their own healthG. Tsiros, D. Kalogeropoulos, P. Voila, Ch. Vossou, G. Kardatos, G. Mouzakis,N. Maglaras, P. Athanasopoulos, E. Gatopoulou

SummaryAim: The doctor's attitudes and behaviour in themes of their own health, suchas the degree of their confidence-compliance with the advice and guidelinesgiven by specialists as concerning the corresponding disease-colleagues.Material and Method: Anonymous questionnaires were completed by 208 doc-tors of different specialties, working in two hospitals in Athens and the RegionalUniversity Hospital of Patras. The answers were grouped for comparisons, persex and sector of specialty.Results: From 208 doctors (46% pathologists, 28% surgeons, 26% laboratoryassistants), who were studied, 108 (51%) were males and 100 (49%) femaleswith an average age of 32,2 and 31,3 respectively. Of these 64% were vacci-nated with the appropriate vaccines for their age group, 9% were unvaccinated,27% declare ignorance (mainly surgeons-39%). Means of use of protectionwhen demanded 71% (surgeons -77%, laboratory assistants -78%, pathologists-57%), while 26% declared that they often used protection.Conclusions: Although the majority of doctors are sufficiently vaccinated, thereis an important room for improvement in terms of measures for protection.Key words: doctors' diseases, prevention, confrontation, behaviour

· Ôï áí áðåõèýíïíôáé óôïí “åéäéêü” ãéá íüóç-ìÜ ôïõò éáôñü êáé áí óõììïñöþíïíôáé ìåôéò ïäçãßåò – óõìâïõëÝò ôïõ.

· Ôç óùóôÞ ëÞøç ôçò öáñìáêåõôéêÞ ôïõò áãùãÞêáé áí ÷ñçóéìïðïéïýí ðïëëÜ öÜñìáêá (ðï-ëõöáñìáêßá).

· Ôçí åìðéóôïóýíç óôïõò óõíáäÝëöïõò ôïõò óåêáôáóôÜóåéò áóèÝíåéÜò ôïõò.Áêïëïýèùò Ýãéíå áîéïëüãçóç êáé ïìáäïðïßç-

óç ôùí áðáíôÞóåùí ôïõ åñùôçìáôïëïãßïõ ãéáóýãêñéóç, êáôÜ:á) öýëïâ) ôïìÝá åéäéêüôçôáò: ðáèïëïãéêüò, ÷åéñïõñãé-

êüò, åñãáóôçñéáêüò, êáé åðß óõíüëïõ.Äåí Ýãéíå äéÜêñéóç ìåôáîý åéäéêåõüìåíùí êáé

åéäéêåõìÝíùí, áöïý ïé ðñþôïé (92%) áðïôåëïýíôç óõíôñéðôéêÞ ðëåéïøçößá ôïõ äåßãìáôïò.

¼ëá ôá óôïé÷åßá êáôá÷ùñÞèçêáí óå âÜóçäåäïìÝíùí (excel for windows), üðïõ êáé Ýãéíå ç

ôáé, êáèþò ç Ýãêáéñç êáé óùóôÞ áíôéìåôþðéóçãåíéêÜ êáôáóôÜóåùí áóèÝíåéÜò ôïõò4-7.

Ïé ãíþóåéò êáé ç åìðåéñßá áíÜ åéäéêüôçôáãéá êÜèå éáôñü óå óõíÜñôçóç ìå ôçí êáôÜëëçëçðëçñïöüñçóç, áðïôåëïýí ðïëëÝò öïñÝò âáóéêÝòðáñáìÝôñïõò þóôå íá áðåõèõíèïýí óôïí “åéäéêü”ãéá ôçí ðÜèçóÞ ôïõò óõíÜäåëöï, íá áêïëïõèÞ-óïõí ôéò óõìâïõëÝò ôïõ êáé ôçí ðñïôåéíüìåíçöáñìáêåõôéêÞ áãùãÞ.

Ï åîåôÜæùí éáôñüò áðü ôç ìåñéÜ ôïõ ïöåßëåéíá ôçñåß ôï éáôñéêü áðüññçôï (éáôñéêÞ äåïíôïëï-ãßá), íá åíçìåñþíåé åðáñêþò ôïí åîåôáæüìåíïóõíÜäåëöü ôïõ ðñéí áðü êÜèå éáôñéêÞ ðñÜîç,êáèþò åðßóçò íá áêïëïõèåß ìÝèïäï óýã÷ñïíç êáéåðéóôçìïíéêÜ ôåêìçñéùìÝíç – ùò ïöåßëåé êáé ìåêÜèå áóèåíÞ – þóôå íá åðéôý÷åé ôçí êáëýôåñçäõíáôÞ åðéêïéíùíßá êáé ôç äçìéïõñãßá êëßìáôïòåìðéóôïóýíçò ìå ôïí ðÜó÷ïíôá.

Óêïðüò ôçò åñãáóßáò ìáò Þôáí ç ìåëÝôç


132


ÄÅÍ ÃÍÙÑÉÆÙ

27%

O×É

9%

ÍÁÉ

64%

ÓÕ×ÍÁ

26%

ÍÁÉ

71%

O×É

3%

ÄÅ ÃÍÙÑÉÆÙ ÓÕ×ÍÁ

íåé ôï 27% (33%, 21%) (Ðßíáêáò 1, ÄéÜãñáììá 1).

×ñÞóç ìÝóùí ðñïóôáóßáò

Áðü ôï óýíïëü ôïõò, ÷ñçóéìïðïéïýí ìÝóáðñïóôáóßáò êáôÜ ôçí åñãáóßá ôïõò üôáí áðáé-ôåßôáé ôï 71% (63% Üíäñåò, 79% ãõíáßêåò), ìç÷ñÞóç áíáöÝñåé ôï 3% (4%, 2%), åíþ óõ÷íÞ ÷ñÞ-óç äçëþíåé ôï 26% (33%, 19%) (Ðßíáêáò 2, ÄéÜ-ãñáììá 2).

¸ãêáéñç áíôéìåôþðéóç êáôáóôÜóåùí áóèÝíåéáò

Ïé áðáíôÞóåéò áíáöÝñïíôáé ùò åîÞò: Ýãêáé-ñç áíôéìåôþðéóç ôï 50% (39% Üíäñåò, 62% ãõ-íáßêåò), ìç Ýãêáéñç ôï 11% (16%, 6%) êáé ôÝëïòáíáëüãùò êñßóåùò ðáñïõóéÜæåôáé ôï 39% (45%,32%) (Ðßíáêáò 3, ÄéÜãñáììá 3).

åðåîåñãáóßá ôïõò.


Åðß óõíüëïõ 208 éáôñþí, ìåëåôÞèçêáí 108(51%) Üíäñåò êáé 100 (49%) ãõíáßêåò ìå ëüãïöýëïõ Üíäñåò/ãõíáßêåò: 1/0,93, åíþ ç ìÝóç çëé-êßá ôïõ äåßãìáôïò Þôáí 32,2 êáé 31,3 åôþí áíôß-óôïé÷á.

ÁíÜ ôïìÝá äéáêñßíïõìå ôïõò éáôñïýò: 95 (46%)óôïí ðáèïëïãéêü (Üíäñ./ãõí.: 1/0,83), 59 (28%)óôï ÷åéñïõñãéêü (Üíäñ./ãõí.: 1/0,64), 54 (26%)óôïí åñãáóôçñéáêü (Üíäñ./ãõí.: 1/1,7).

Áðáñáßôçôïò ùò ðñïò ôçí çëéêßá åìâïëéáóìüò

Åê ôùí 208 éáôñþí, áíáöÝñåôáé üôé: Ý÷ïõíåìâïëéáóèåß ôï 64% (56% Üíäñåò, 71% ãõíáßêåò),áíåìâïëßáóôïé ôï 9% (11%, 8%), åíþ Üãíïéá äçëþ-

ÄéÜãñáììá 1. Åê ôïõ óõíüëïõ éáôñþí, áðáñáßôçôïò ãéá ôçí çëéêßáôïõò åìâïëéáóìüò %.

ÄéÜãñáììá 2. Åê ôïõ óõíüëïõ éáôñþí, ÷ñÞóç ìÝóùí ðñïóôáóßáòóôéò þñåò åñãáóßáò %.

Ðßíáêáò 1. Áðáñáßôçôïò ãéá ôçí çëéêßá åìâïëéáóìüò (%)

ÔïìÝáò Ðáèïëïãßáò ×åéñïõñãéêÞò Åñãáóôçñéáêüò ÌåéêôüòÉáôñïß Óõí Áñ ÈÞë Óõí Áñ ÈÞë Óõí Áñ ÈÞë Óõí Áñ ÈÞë

ÍÁÉ 66 56 75 52 42 61 73 70 76 64 56 71Ï×É 11 13 9 9 14 4 8 5 12 9 11 8ÄÅ ÃÍÙÑÉÆÙ 23 31 16 39 44 35 19 25 12 27 33 21

Ðßíáêáò 2. ×ñÞóç ìÝóùí ðñïóôáóßáò óôéò þñåò åñãáóßáò (%)


ÍÁÉ 57 54 60 77 64 91 78 70 85 71 63 79Ï×É 8 8 7 2 3 0 0 0 0 3 4 2ÓÕ×ÍÁ 35 38 33 21 33 9 22 30 15 26 33 19

133


Áíôéìåôþðéóç ðñïâëçìÜôùí õãåßáò áðü ôïí “åéäéêü”éáôñü-óõíÜäåëöï

Óôï åñþôçìá áí áðåõèýíïíôáé óôïí “åéäéêü”ãéá ôçí ðÜèçóÞ ôïõò óõíÜäåëöï, ïé éáôñïß áðÜ-íôçóáí: èåôéêÜ ôï 52% (55% Üíäñåò, 49% ãõíáß-êåò), áñíçôéêÜ ôï 12% (13%, 11%), ìå óõ÷íÜ íááðåõèýíåôáé ôï 36% (32%, 40%) (Ðßíáêáò 4,ÄéÜãñáììá 4).

Óõììüñöùóç ìå ôéò éáôñéêÝò ïäçãßåò – óõìâïõëÝò ôïõ“åéäéêïý”

Ôéò éáôñéêÝò ïäçãßåò áêïëïõèåß ôï 39% (38%Üíäñåò, 39% ãõíáßêåò) åê ôïõ óõíüëïõ ôùí éá-ôñþí, áíáöÝñåé ðùò äåí óõììïñöþíåôáé ôï 7%(11%, 3%), åíþ ôï 54% (51%, 58%) áêïëïõèåßôéò óõìâïõëÝò ôïõ ôéò ðåñéóóüôåñåò öïñÝò (Ðßíá-êáò 5, ÄéÜãñáììá 5).

ÄéÜãñáììá 3. Åê ôïõ óõíüëïõ éáôñþí, Ýãêáéñç áíôéìåôþðéóç êá-ôáóôÜóåùí áóèÝíåéáò %

ÍÁÉ

50%

ÊÑÉÍÙ

ÁÍÁËÏÃÁ

39%

¼×É

11%

ÄéÜãñáììá 4. Åê ôïõ óõíüëïõ éáôñþí, áíôéìåôþðéóç ðñïâëçìÜôùíõãåßáò ôïõò áðü ôïí “åéäéêü” éáôñü-óõíÜäåëöï %

ÓÕ×ÍÁ

36%

ÍÁÉ

52%

¼×É

12%

ÓùóôÞ ëÞøç öáñìáêåõôéêÞò áãùãÞò

ÓùóôÜ ëáìâÜíåé ôç öáñìáêåõôéêÞ ôïõ áãù-ãÞ ôï 58% (50% Üíäñåò, 66% ãõíáßêåò) ôùí éá-ôñþí, ðëçììåëÞò ëÞøç ôï 8% (14%, 2%), åíþ ôï34% (36%, 32%) áíáöÝñåé “ôéò ðåñéóóüôåñåò öï-ñÝò” (Ðßíáêáò 6, ÄéÜãñáììá 6).

×ñÞóç ðïëëþí öáñìÜêùí (ðïëõöáñìáêßá)

Óôï óýíïëü ôïõò ïé éáôñïß äåí ÷ñçóéìïðïéïýíãåíéêþò “ðïëëÜ” öÜñìáêá óå ðïóïóôü 66% (69%Üíäñåò, 63% ãõíáßêåò), áõôïß ðïõ êÜíïõí ÷ñÞóçðïëõöáñìáêßáò áíÝñ÷ïíôáé óôï 2% (3%, 1%), åíþ÷ñÞóç üôáí áðáéôåßôáé, äçëþíåé ôï 32% (28%,36%) (Ðßíáêáò 7, ÄéÜãñáììá 7).

Ðßíáêáò 4. Áíôéìåôþðéóç ðñïâëçìÜôùí õãåßáò áðü ôïí “åéäéêü” éáôñü-óõíÜäåëöï (%)


ÍÁÉ 60 60 60 54 56 52 42 50 35 52 55 49Ï×É 7 9 5 18 19 17 10 10 9 12 13 11ÓÕ×ÍÁ 33 31 35 28 25 31 48 40 56 36 32 40

Ðßíáêáò 3. ¸ãêáéñç áíôéìåôþðéóç êáôáóôÜóåùí áóèÝíåéáò áðü ôïõò éáôñïýò (%)


ÍÁÉ 50 35 65 50 36 65 50 45 56 50 39 62Ï×É 10 17 2 16 22 9 8 10 6 11 16 6ÊÑÉÍÙ ÁÍÁËÏÃÁ 40 48 33 34 42 26 42 45 38 39 45 32


134


ÔÉÓ

ÐÅÑÉÓÓÏÔÅÑÅÓ

ÖÏÑÅÓ

54%

ÍÁÉ

39%

¼×É

7%

ÄéÜãñáììá 5. Åê ôïõ óõíüëïõ éáôñþí, óõììüñöùóç ìå ôéò éáôñéêÝòïäçãßåò – óõìâïõëÝò ôïõ “åéäéêïý” %

ÄéÜãñáììá 6. Åê ôïõ óõíüëïõ éáôñþí, óùóôÞ ëÞøç öáñìáêåõôéêÞòáãùãÞò %

ÍÁÉ

58%

¼×É

8%

ÔÉÓ


ÖÏÑÅÓ

34%

Ðßíáêáò 5. Óõììüñöùóç ìå ôéò éáôñéêÝò ïäçãßåò – óõìâïõëÝò ôïõ “åéäéêïý” (%)


ÍÁÉ 42 38 47 28 25 30 46 50 41 39 38 39Ï×É 9 10 8 7 14 0 6 10 3 7 11 3ÔÉÓ ÐÅÑIÓ. ÖÏÑÅÓ 49 52 47 65 61 70 48 40 56 54 51 58

Åìðéóôåýåóôå ôïõò óõíáäÝëöïõò óáò óå êáôáóôÜóåéòáóèÝíåéÜò óáò;

Ó’ áõôü ôï åñþôçìá ïé éáôñïß áðáíôïýí ùòåîÞò: áðüëõôá ôï 20% (20% Üíäñåò, 20% ãõíáß-êåò), ü÷é ôï 3% (2%, 3%), ìå ìéêñÞ åðéöýëáîç(ôéò ðåñéóóüôåñåò öïñÝò) ôï 28% (27%, 28%),áíáëüãùò ôçí åìðåéñßá ôïõ ôï 38% (37%, 40%),êáé üôáí åßíáé ãíùóôïß-óõíåñãÜæïíôáé ôï 11%(14%, 9%) (Ðßíáêáò 8, ÄéÜãñáììá 8).

ÓõæÞôçóç

Áí êáé ôï ìåãáëýôåñï ðïóïóôü ôùí éáôñþíÝ÷åé åìâïëéáóôåß ìå ôá áðáñáßôçôá ãéá ôçí çëé-êßá ôïõ åìâüëéá, åíôïýôïéò ôï 27% äçëþíåé Üãíïéá(ìå ôïõò ÷åéñïõñãïýò óôï 39%). ÁíÜ öýëï, óôïõòãåíüìåíïõò åìâïëéáóìïýò õðåñÝ÷ïõí ïé ãõíáßêåòó’ üëïõò ôïõò ôïìåßò åéäéêïôÞôùí, åíþ áíôßóôïé-÷á õðåñï÷Þ ôùí áíäñþí ðáñïõóéÜæåôáé óôçíÜãíïéá/áìÝëåéá. Ôá åìâüëéá åßíáé óßãïõñá ìßá áðü

ôéò óçìáíôéêüôåñåò áíáêáëýøåéò óôçí éóôïñßá ôçòéáôñéêÞò. Ìå ôá ðñïãñÜììáôá åìâïëéáóìþí ðïõÝ÷ïõí ôåèåß óå åöáñìïãÞ Ý÷åé ãßíåé åöéêôü íáóôáìáôÞóåé ç åîÝëéîç-ðáñïõóßá ðïëëþí áóèå-íåéþí8,9. Ôá ðåñéóóüôåñá åìâüëéá óõíÞèùò ðñï-ëáìâÜíïõí ôç íüóï, åíþ ìåñéêÜ áðü áõôÜ ôçíôñïðïðïéïýí, Ýôóé þóôå íá ìçí åìöáíßæåôáé óåâáñéÜ ìïñöÞ. Ãéá ôçí åðéôõ÷ßá ôùí åìâïëéáóìþíðñÝðåé íá ôçñïýíôáé ïñéóìÝíïé êáíüíåò, üðùò çóùóôÞ ìåôáöïñÜ êáé óõíôÞñçóç ôùí åìâïëßùí, ïóùóôüò ôñüðïò êáé ç çëéêßá åöáñìïãÞò ôïõò êáéôï óðïõäáéüôåñï ßóùò ïé áíáìíçóôéêïß åìâïëéá-óìïß. Ï åðáíáëçðôéêüò åìâïëéáóìüò áíáãêÜæåé ôïíïñãáíéóìü íá “èõìçèåß” êáé íá îáíáöôéÜîåé ìåãÜ-ëï áñéèìü áíôéóùìÜôùí, þóôå íá ìðïñåß íá áíôé-ìåôùðßæåé åðáñêþò ôçí åßóïäï óôï óþìá ôïõ ìé-êñïâßùí Þ éþí. Ï óêïðüò ôùí åìâïëßùí åßíáé íá“ìéìçèïýí” ôçí ðñáãìáôéêÞ íüóï, þóôå üôáí ïïñãáíéóìüò ÷ñåéáóôåß íá ôçí áíôéìåôùðßóåé íá Ý÷åéóôç äéÜèåóÞ ôïõ áñêåôÜ áíôéóþìáôá ãéá áõôü, ìåôñüðï ðïõ íá ìçí ôïí âÜæåé óå êßíäõíï10-12.

Åíèáññõíôéêü ðáñïõóéÜæåôáé ôï õøçëü ðï-

Ðßíáêáò 6. ÓùóôÞ ëÞøç öáñìáêåõôéêÞò áãùãÞò (%)


ÍÁÉ 61 54 68 60 47 74 53 50 56 58 50 66Ï×É 5 10 0 10 20 0 8 10 6 8 14 2ÔÉÓ ÐÅÑÉÓ. ÖÏÑÅÓ 34 36 32 30 33 26 39 40 38 34 36 32

135


ÄéÜãñáììá 7. Åê ôïõ óõíüëïõ éáôñþí, ÷ñçóéìïðïßçóç “áñêåôþí”öáñìÜêùí (ðïëõöáñìáêßá) %.

¼ÔÁÍ

ÁÐÁÉÔÅÉÔÁÉ

32%

ÍÁÉ

2%

¼×É

66%

ÄéÜãñáììá 8. Åê ôïõ óõíüëïõ éáôñþí, åìðéóôïóýíç óå óõíáäÝë-öïõò, óå êáôáóôÜóåéò áóèÝíåéÜò ôïõò %.

ÅÌÐÅÉÑÉÁ

38%ÔÉÓ


ÖÏÑÅÓ

28%

¼×É

3%

ÍÁÉ

20%

ÃÍÙÓÔÏÓ

11%

Ðßíáêáò 8. Åìðéóôïóýíç óå óõíáäÝëöïõò, óå êáôáóôÜóåéò áóèÝíåéÜò ôùí éáôñþí (%)


ÍÁÉ 20 18 21 30 39 22 9 0 18 20 20 20Ï×É 2 4 0 6 3 9 0 0 0 3 2 3ÃÍÙÓÔÏÓ 13 21 76 8 7 9 13 15 11 11 14 9ÅÌÐÅÉÑÉÁ 36 32 39 31 32 30 48 45 51 38 37 40ÔÉÓ ÐÅÑIÓ. ÖÏÑÅÓ 29 25 34 25 19 30 30 40 20 28 27 28

óïóôü 71% ôùí éáôñþí ðïõ ÷ñçóéìïðïéïýí ìÝóáðñïóôáóßáò üôáí áðáéôåßôáé óå þñá åñãáóßáò, ìåáõîçìÝíï éäéáßôåñá óôéò ÷åéñïõñãéêÝò (77%) êáéåñãáóôçñéáêÝò (78%) åéäéêüôçôåò åöüóïí áõôïßïé éáôñïß Ýñ÷ïíôáé óå ìåãáëýôåñç Ýêèåóç ìå ìï-ëõóìÝíá õãñÜ, áêôéíïâïëßåò ê.ëð. ÁíÜ öýëï, ðéï“ðñïóåêôéêÝò” ðáñïõóéÜæïíôáé ïé ãõíáßêåò éáôñïßó’ üëïõò ôïõò ôïìåßò åéäéêïôÞôùí, êáé éäéáßôåñáóôï ÷åéñïõñãéêü ìå ðïóïóôü 91%. ÊáèçìåñéíÜÝíáò óçìáíôéêüò áñéèìüò áôüìùí ôïõ íïóçëåõôé-êïý ðñïóùðéêïý ðïõ Ýñ÷åôáé ó´ åðáöÞ ìå âéïëï-ãéêÜ õãñÜ ìïëõóìÝíá áðü ôïõò éïýò ôçò çðáôßôé-äáò Â, C êáé ôïí éü ôïõ óõíäñüìïõ ôçò åðßêôç-ôçò áíïóïáíåðÜñêåéáò (HIV1-2), äéáôñÝ÷åé ôïíêßíäõíï íá ìïëõíèåß êáé íá íïóÞóåé13,14. Ç áíÜ-ðôõîç ëïßìùîçò åîáñôÜôáé áðü ôï åßäïò êáé ôçëïéìïãüíï éêáíüôçôá ôïõ éïý, ôçí ðõêíüôçôÜ ôïõóôï âéïëïãéêü õãñü êáé ôï åßäïò ôçò åðáöÞò15,16.Ïé ëïéìþîåéò áõôÝò ìåôáäßäïíôáé óôï õãåéïíïìéêü

ðñïóùðéêü êõñßùò áðü ìéêñïôñáõìáôéóìïýò, áõôüüìùò óõìâáßíåé óå ÷áìçëü ðïóïóôü åíþ åîáéñåôé-êÜ óðÜíéá ïöåßëïíôáé óå åðáöÞ âéïëïãéêþí õãñþíìå âëåííïãüíïõò. Ï óõíçèÝóôåñïò ôñüðïò åðáöÞòóå ÷þñïõò üðïõ ãßíïíôáé ìéêñïåðåìâÜóåéò åßíáé ïôñáõìáôéóìüò êáôÜ ôçí ðñïóðÜèåéá êÜëõøçò ôçòâåëüíçò ìå ôï êÜëõììÜ ôçò17,18. Ôá ìïëõóìÝíááé÷ìçñÜ åñãáëåßá áðïññßðôïíôáé óå óôåñåÜ äï-÷åßá åíþ ôá ìïëõóìÝíá âéïëïãéêÜ õãñÜ óå ðëá-óôéêÝò óáêïýëåò. Áðáñáßôçôç åßíáé ç ðëÞñçò óõ-íåñãáóßá ôïõ ðñïóùðéêïý êáôÜ ôçí þñá ôùíåðåìâÜóåùí ìå óáöåßò ïäçãßåò ëåéôïõñãßáò.

Ôï Þìéóõ ðåñßðïõ ôùí éáôñþí, ó’ üëïõò ôïõòôïìåßò åéäéêïôÞôùí, áíôéìåôùðßæïõí Ýãêáéñá ðñï-âëÞìáôá õãåßáò ôïõò (éäéáßôåñá ïé ãõíáßêåò) êáéáðåõèýíïíôáé óôïí “åéäéêü” ãéá ôï íüóçìÜ ôïõòóõíÜäåëöï, êõñßùò ïé ðáèïëïãéêÝò åéäéêüôçôåò óôï60%. ÃåíéêÜ ìå ôéò ïäçãßåò ôïõ “åéäéêïý” óõììïñ-öþíïíôáé: ôéò ðåñéóóüôåñåò öïñÝò ôï 54% êáé

Ðßíáêáò 7. ×ñçóéìïðïßçóç “áñêåôþí” öáñìÜêùí (ðïëõöáñìáêßá) (%)


ÍÁÉ 0 0 0 4 8 0 2 0 3 2 3 1Ï×É 68 79 56 64 67 61 65 60 71 66 69 63ÏÔÁÍ ÁÐÁÉÔÅÉÔÁÉ 32 21 44 32 25 39 33 40 26 32 28 36


136


áðüëõôá ôï 39%, ìå ôéò ÷åéñïõñãéêÝò åéäéêüôçôåòíá ìçí áêïëïõèïýí ôéò éáôñéêÝò óõìâïõëÝò áðü-ëõôá (28%) áëëÜ ôéò ðåñéóóüôåñåò öïñÝò (65%),åíþ ôï Þìéóõ ðåñßðïõ ôùí éáôñþí ôùí åñãáóôç-ñéáêþí åéäéêïôÞôùí, äåí áðåõèýíïíôáé ðÜíôïôåóôïí êáôÜëëçëï éáôñü.

Ç ðëåéïøçößá ôùí éáôñþí (58%) ëáìâÜíåéóùóôÜ ôç öáñìáêåõôéêÞ ôïõ áãùãÞ (ìå õðåñï÷Þôùí ãõíáéêþí ó’ üëïõò ôïõò ôïìåßò åéäéêïôÞôùí),åíþ ðñïóðáèåß (ôéò ðåñéóóüôåñåò öïñÝò) ôï 34%.Áêüìá ôï 66% áðïöåýãåé ôçí ðïëõöáñìáêßá ìåôï 32% íá ôç ÷ñçóéìïðïéåß üôáí áðáéôåßôáé, äåßãìáôçò åðéóôçìïíéêÞò ãíþóçò ôùí áñíçôéêþí åðé-ðôþóåùí ôüóï ôçò ìç ÷ñÞóçò üóï êáé ôçò õðåñ-âïëéêÞò êáôáíÜëùóçò ôùí öáñìáêåõôéêþí éäéï-óêåõáóìÜôùí19-23. Ôï öÜñìáêï åßíáé ðïëýôéìï ãéáôç äéáóöÜëéóç ôçò õãåßáò, ôçí ðáñÜôáóç ôçòæùÞò êáé ôç âåëôßùóç ôçò ðïéüôçôÜò ôçò, ìðïñåßüìùò óå ëáèåìÝíç ÷ñÞóç Þ õðåñâïëéêÞ äüóç, íááðïâåß åðéêßíäõíï24-27. Ï êÜèå áóèåíÞò áðïôåëåßìéá îå÷ùñéóôÞ ðåñßðôùóç. ÁíÜëïãá ìå ôï éáôñé-êü éóôïñéêü, ôçí çëéêßá, ôç óùìáôéêÞ ôïõ åðéöÜ-íåéá, ôïí øõ÷éóìü ôïõ, ôçí áíåýñåóç õðåñåõáé-óèçóßáò (áëëåñãßåò), ôéò ðéèáíÝò áíôåíäåßîåéò Þôçí ôáõôü÷ñïíç ÷ñÞóç êáé Üëëùí öáñìÜêùí èáðñÝðåé íá åöáñìïóôåß ôï êáôÜëëçëï èåñáðåõôéêüó÷Þìá, óôç óùóôÞ äïóïëïãßá êáé ãéá óõãêåêñéìÝ-íï ÷ñïíéêü äéÜóôçìá28-31. ¸ñåõíåò åðéóçìáßíïõí(áíáöïñÜ óôï 6ï ÐáíåëëÞíéï ÓõíÝäñéï Ðáèïëï-ãßáò) üôé ç ðéèáíüôçôá íá ÷Üóåé êáíåßò ôç æùÞôïõ áðü ðáñåíÝñãåéåò êÜðïéïõ óêåõÜóìáôïò ãéá÷ñüíéï íüóçìá åßíáé ìßá óôéò åêáôü, ôç óôéãìÞðïõ ï áíôßóôïé÷ïò êßíäõíïò íá óêïôùèåß êÜðïéïòóå ôñï÷áßï åßíáé ìßá óôéò ÷ßëéåò êáé óå áåñïðïñé-êü äõóôý÷çìá ìßá óôéò äÝêá ÷éëéÜäåò.

ÁíáöïñéêÜ ìå ôçí åìðéóôïóýíç, ãéá êáôá-óôÜóåéò áóèÝíåéÜò ôïõò, óå óõíáäÝëöïõò ôïõò,ðñïâÜëëïõí êõñßùò ôçí åìðåéñßá (38%), ôç óõ-íåñãáóßá (11%), ôçí áðüëõôç åìðéóôïóýíç (20%)êáé ìéêñÞ åðéöýëáîç ôï 28%. Ç êáëýôåñç åêðáß-äåõóç ôùí éáôñþí ôüóï êáôÜ ôéò ðáíåðéóôçìéá-êÝò óðïõäÝò, üóï êáé êáôÜ ôçí ðåñßïäï ôçò åéäé-êüôçôáò, ç äéÜ âßïõ åêðáßäåõóç, ç êáëýôåñç åðé-êïéíùíßá-óõíåñãáóßá ìåôáîý ôùí éáôñþí, ç áíÜ-ðôõîç éáôñéêÞò äåïíôïëïãßáò, ç åíçìÝñùóç ôùíëåéôïõñãþí ôïõ Äéêáßïõ, áëëÜ êáé ôùí áóèåíþíüôé êÜèå ðáñÝêêëéóç áðü ôçí áíáìåíüìåíç Ýêâá-óç äåí áðïôåëåß êáô’ áíÜãêçí éáôñéêÞ áìÝëåéá,áðïôåëïýí ßóùò ôìÞìá ôçò ëýóçò ôïõ “ëåðôïý”áõôïý æçôÞìáôïò32-34.

ÓõìðåñÜóìáôá êáé ðñïôÜóåéò

· Ç ðëåéïíüôçôá ôùí éáôñþí Ý÷åé åìâïëéáóèåßåðáñêþò, êñßíåôáé üìùò áðáñáßôçôï íá äåß-îïõí åíäéáöÝñïí üóïé äçëþíïõí Üãíïéá, Þäåí Ý÷ïõí åíçìåñùèåß êáôÜëëçëá.

· ×ñçóéìïðïéïýí üôáí áðáéôåßôáé ìÝóá ðñï-óôáóßáò óôéò þñåò åñãáóßáò, (êõñßùò ïé ÷åé-ñïõñãéêÝò êáé åñãáóôçñéáêÝò åéäéêüôçôåò).

· Ôï Þìéóõ ôùí éáôñþí áíôéìåôùðßæåé ÝãêáéñáêáôáóôÜóåéò áóèåíåßáò ôïõò êáé êõñßùò ïéãõíáßêåò, ðïõ ëáìâÜíïõí ðéï óùóôÜ ôç öáñ-ìáêåõôéêÞ ôïõò áãùãÞ.

· Ç ðëåéïíüôçôá ôùí éáôñþí êÜíåé ïñèïëïãé-êÞ ÷ñÞóç ôùí öáñìÜêùí, áðïöåýãïíôáò ôçíðïëõöáñìáêßá.

· ÓõãêñéôéêÜ ìå ôïõò Üíäñåò, ïé ãõíáßêåò éá-ôñïß ðáñïõóéÜæïíôáé ðéï ðñïóåêôéêÝò êáéåõáéóèçôïðïéçìÝíåò ó÷åôéêÜ ìå ôçí ðñüëçøçêáé áíôéìåôþðéóç èåìÜôùí õãåßáò ôïõò.

· ÃåíéêÜ ïé éáôñïß áðåõèýíïíôáé óå åéäéêïýòãéá ôï íüóçìÜ ôïõò óõíáäÝëöïõò êáé óõì-ìïñöþíïíôáé ìå ôéò ïäçãßåò ôïõ. Åìðéóôåýï-íôáé êõñßùò ôïõò ðéï Ýìðåéñïõò, ãíùóôïýò ÞóõíåñãÜôåò ôïõò.Ç óùóôÞ ðñüëçøç (åìâïëéáóìïß, Ýëåã÷ïò

áíïóßáò, åíçìÝñùóç ôñüðùí ìåôÜäïóçò ëïéìù-äþí íïóçìÜôùí), ç Ýãêáéñç êáé êáôÜëëçëç áíôé-ìåôþðéóç êáôáóôÜóåùí õãåßáò (óõììüñöùóç ìåôéò ïäçãßåò ôïõ èåñÜðïíôá) ôïõ éáôñéêïý ðñïóù-ðéêïý, áðïôåëåß ýøéóôç õðï÷ñÝùóç êÜèå éáôñïý.Ï ðáñáìåñéóìüò ôùí áíùôÝñù, åêôüò ôïõ üôéåêèÝôåé óå Üìåóï êßíäõíï íüóçóçò Üëëïõò áóèå-íåßò, åñãáæüìåíïõò Þ êáé ìÝëç ôçò ïéêïãÝíåéÜòôïõ, áíôéðáñáôßèåôáé ìå ôç óýã÷ñïíç êáé åðéóôç-ìïíéêÜ ôåêìçñéùìÝíç ãíþóç, ç ïðïßá ëáìâÜíå-ôáé ìå ôç óõíå÷Þ åíçìÝñùóç êáé åêðáßäåõóç.ÅðéðñïóèÝôùò, ç ðñïóðÜèåéá ãéá ôçí êáëýôåñçäõíáôÞ åðéêïéíùíßá êáé óõíåñãáóßá ôùí éáôñþí,äçìéïõñãåß êëßìá åìðéóôïóýíçò ãéá ôïí ðÜó÷ï-íôá óõíÜäåëöï, èåìåëéþíïíôáò Ýôóé óçìáíôéêÜóôïé÷åßá áíÜðôõîçò êáé ëåéôïõñãßáò åíüò õðåýèõ-íïõ ðñïãñÜììáôïò õãåßáò.


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3. Kocks DJ, Aspinall S, Seema MT. Hepatitis Bimmunisation for adults and health care work-ers in South Africa. S Afr Med J, 87:1388-9,1997.

4. Gerberding JL. Incidence and prevalence ofhuman immunodeficiency virus, hepatitis B vi-rus, hepatitis C virus, and cytomegalovirus amonghealth care personnel at risk for blood expo-sure: final report from a longitudinal study. JInfect Dis, 170:1410-1417, 1994.

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during simulated needle-stick injury. J InfectDis, 168:1589-1592, 1993.

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18. Tokars JL, Marcus R, Culver D, et al. Surveil-lance of HIV infection and Ziduvodine useamong health care workers after occupationalexposure to HIV-infected blood. Ann Inter Med,118:913-919, 1993.

19. ÔåñæÞ Ã, ÊáôóïõãéÜííç Ê. Äéåñåýíçóç ðñïóäéï-ñéóôéêþí ðáñáãüíôùí ôçò êáôáíÜëùóçò öáñìÜ-êùí êáôÜ ãåùãñáöéêÞ ðåñéöÝñåéá óôçí ÅëëÜäá.Áñ÷åßá ÅëëçíéêÞò ÉáôñéêÞò, 3:88-9, 1986.

20. ÂáëÝñç Ñ, Áëïýðç Ä, Ìðáîåâáíßäïõ Ä êáé óõí.Áõèáßñåôç ÷ñÞóç öáñìÜêùí. Óôá ÐñáêôéêÜ 7ïõÂïñåéïåëëáäéêïý Óõíåäñßïõ, Èåóóáëïíßêç, óåë.214-7, 1992.

21 ÁíåõëáâÞò Å. ÊëéíéêÞ Ëïéìùîéïëïãßá. ÉáôñéêÝòåêäüóåéò Ð.×. Ðáó÷áëßäçò, 1997.

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University Studio Press Á.Å. Èåóóáëïíßêç 1985.32. Hoyte PJ. Unsound practice, the epidemiology

of medical negligence. MA Thesis, 1993, KeeleUniversity.

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34. Smith R. What clinical information do doctorsneed, BMJ, 313:1062-8, 1996.

ÐáñÜñôçìá

ÐÑÏËÇØÇ, ÁÍÔÉÌÅÔÙÐÉÓÇ ÊÁÉ ÓÕÌÐÅÑÉÖÏÑÁ ÔÙÍ ÉÁÔÑÙÍ ÓÅ ÈÅÌÁÔÁÕÃÅÉÁÓ ÔÏÕÓ - ÅÑÙÔÇÌÁÔÏËÏÃÉÏ

Ðáñáêáëþ óçìåéþóáôå ìå ìðëå óôõëü Ýíá ×, ìåôÜ áðü ôçí áðÜíôçóç (óôá äåîéÜ) ðïõåðéëÝîáôå.

1. Öýëï: ¢íäñáò Ãõíáßêá

2. Çëéêßá:

3. Åéäéêüôçôá:

4. ¸÷åôå åìâïëéáóôåß ìå ôá áðáñáßôçôá ãéá ôçí çëéêßá óáò åìâüëéá;ÍÁÉ ÏXÉ ÄÅÍ ÃÍÙÑÉÆÙ

5. ×ñçóéìïðïéåßôå ôéò þñåò åñãáóßáò ìÝóá ðñïïôáóßáò (ãÜíôéá, ìÜóêá ê.ëð.) üôáí áðáéôåßôáé;ÍÁÉ ÏXÉ ÓÕ×ÍÁ

6. Áíôéìåôùðßæåôå Ýãêáéñá êáôáóôÜóåéò áóèÝíåéÜò óáò;ÍÁÉ ÏXÉ ÊÑÉÍÙ ÁÍÁËÏÃÁ

7. Óå ðñïâëÞìáôá õãåßáò óáò, áðåõèýíåóôå óôïí "åéäéêü" ìå ôçí ðÜèçóÞ óáò éáôñü;ÍÁÉ ÏXÉ ÓÕ×ÍÁ

8. Óõììïñöþíåóôå ìå ôéò éáôñéêÝò ïäçãßåò - óõìâïõëÝò ôïõ "åéäéêïý";ÍÁÉ ÏXÉ ÔÉÓ ÐÅÑÉÓÓÏÔÅÑÅÓ ÖÏÑÅÓ

9. ËáìâÜíåôå óùóôÜ ôç öáñìáêåõôéêÞ óáò áãùãÞ;ÍÁÉ ÏXÉ ÔÉÓ ÐÅÑÉÓÓÏÔÅÑÅÓ ÖÏÑÅÓ

10. ×ñçóéìïðïéåßôå "áñêåôÜ" öÜñìáêá (ðïëõöáñìáêßá);ÍÁÉ ÏXÉ ÏÔÁÍ ÁÐÁÉÔÅÉÔÁÉ

11. Åìðéóôåýåóôå ôïõò óõíáäÝëöïõò óáò óå êáôáóôÜóåéò áóèÝíåéá óáò;ÍÁÉ ÁÍÁËÏÃÙÓ ÔÇÍ ÅÌÐÅÉÑÉÁ ÔÏÕÏ×É ÏÔÁÍ ÅÉÍÁÉ ÃÍÙÓÔÏÓ / ÓÕÍÅÑÃÁÆÏÌÁÉÔÉÓ ÐÅÑÉÓÓÏÔÅÑÅÓ ÖÏÑÅÓ ÁËËÏ:

139

Ê. Óôåöáíïðïýëïõ êáé óõí. Ôüìïò 14, Ôåý÷ïò 3, 2002

Aîéïëüãçóç ôùí áðïôåëåóìÜôùí ôçò ðáñÝìâáóçò ôïõ éáôñïýðåñéöåñåéáêïý éáôñåßïõ óå ãíùóôü ðëçèõóìü óáê÷áñïäéáâçôéêþíôçò ðåñéï÷Þò åõèýíçò ôïõ ìåôÜ ôçí ðáñÝëåõóç åíüò Ýôïõò

Ê. Óôåöáíïðïýëïõ1, Ó. Ãêïíôüëéáò1, ×. ÓðõñÜêç1, Á. Ðáñáóýñç2, Á. ÐåôñÜêç2, Í. ÐáðáäÜêçò1,Á. Ìðáôßêáò1



ÅéóáãùãÞ

O Óáê÷áñþäçò äéáâÞôçò ôýðïõ 2áöïñÜ óôï 95% ôùí ðåñéðôþóåùíóáê÷áñþäç äéáâÞôç1 êáé áðïôåëåßóçìáíôéêü ðñüâëçìá äçìüóéáò õãåßáò,åîáéôßáò:1) Ôçò õøçëÞò óõ÷íüôçôáò áíåýñå-

óÞò ôïõ óôïí åíÞëéêï ðëçèõóìü(Ç óõ÷íüôçôá ôïõ óáê÷áñþäç äéá-âÞôç ôýðïõ 2 áõîÜíåôáé, üóï áõ-îÜíåôáé ç çëéêßá êáé ï äåßêôçòìÜæáò2 óþìáôïò.)

2) ôçò ÷ñïíéüôçôÜò ôïõ êáé3) ôçò óïâáñüôçôáò êáé ôçò óõ÷íÜ

“ýðïõëçò” êáé “óéùðçëÞò” åîÝëé-îçò ôùí åðéðëïêþí3,4 ðïõ ôïí óõ-íïäåýïõí êáé åßíáé:

• ÌáêñïáããåéïðÜèåéá, ðïõ ïäçãåßóå áããåéáêÜ åãêåöáëéêÜ åðåéóü-äéá, éó÷áéìéêÞ êáñäéïðÜèåéá êáé

ÐåñßëçøçÓêïðüò: Ç áðïôýðùóç ôùí áðïôåëåóìÜôùí ôçò ðáñÝìâáóçò ôïõ É.Ð.É. óôïõòóáê÷áñï- äéáâçôéêïýò ôçò ðåñéï÷Þò ôïõ ìåôÜ ôçí ðáñÝëåõóç åíüò Ýôïõò,üðùò áõôÞ åêäçëþíåôáé ìå ôçí åêôßìçóç ôùí ìåôáâïëþí ôçò HbA1c, ôïõëéðéäáéìéêïý ðñïößë, áëëÜ êáé ôùí ìåôáâïëþí óôéò óõíÞèåéåò êáé ôïí ôñüðïæùÞò ôùí áóèåíþí áõôþí. Ðëçèõóìüò áíáöïñÜò - ÌÝèïäïò: ÌåëåôÞèçêáí24 äéáãíùóìÝíïé óáê÷áñoäéáâçôéêïß åðß óõíüëïõ 870 êáôïßêùí óôá äçìïôéêÜäéáìåñßóìáôá ÃáñÜæïõ, Ìïõñôæáíþí, ÅðéóêïðÞò êáé Êåöáëßïõ. ¼ëïé Ýðáó÷áíáðü óáê÷áñþäç äéáâÞôç (Ó.Ä.) ôýðïõ ÉÉ. Óôá Üôïìá áõôÜ, ìåôÜ ôçí áñ÷éêÞåêôßìçóç ôïí Áýãïõóôï ôïõ 2000 ôùí ôéìþí ôçò HbA1c êáé ôïõ ëéðéäáéìéêïýðñïößë, Ýãéíáí ïé áíÜëïãåò êáôÜ ðåñßðôùóç ôñïðïðïéÞóåéò êáé ðñïóáñìïãÝòôçò öáñìáêåõôéêÞò áãùãÞò êáé óõíåóôÞèç ìåôáâïëÞ ôïõ ôñüðïõ æùÞò (åöáñ-ìïãÞ óõãêåêñéìÝíïõ äéáéôïëïãßïõ, Üóêçóç, äéáêïðÞ êáðíßóìáôïò êáé ðåñéïñé-óìüò ôïõ áëêïüë). Åðßóçò äéïñãáíþèçêáí åêðáéäåõôéêÜ ìáèÞìáôá ìå óõæçôÞ-óåéò êáé ðñïâïëÝò slides, üðïõ óõæçôÞèçêáí èÝìáôá ó÷åôéêÜ ìå ôïí ÓÄ (ðñü-ëçøç, ðáèïëïãßá, åðéðëïêÝò, áíôéìåôþðéóç). ÁðïôåëÝóìáôá: ÌåôÜ ôçí ðá-ñÝìâáóÞ ìáò äéáðéóôþèçêå üôé üëïé ó÷åäüí ïé áóèåíåßò (21/24) ìåßùóáí ôçíHbA1c Ýùò êáé 40% ôçò áñ÷éêÞò. Áðü ôïõò åîåôáóèÝíôåò áóèåíåßò 12 êáôüñ-èùóáí íá ìåéþóïõí ôï óùìáôéêü âÜñïò ôïõò Ýùò êáé 7 êéëÜ, åíþ 16/22 ðáñïõ-óßáóáí âåëôßùóç üóïí áöïñÜ óôï ëéðéäáéìéêü ðñïößë ðïõ óõíïäåýôçêå áðüáëëáãÞ óôéò óõíÞèåéåò êáé óôïí ôñüðï æùÞò (äéáêïðÞ êáðíßóìáôïò, ðåñéïñé-óìüò áëêïüë). ÓõìðÝñáóìá: Ôá áðïôåëÝóìáôá ôçò ðáñÝìâáóÞò ìáò õðÞñîáíåíôõðùóéáêÜ, ùò áðüññïéá ôçò óõíôïíéóìÝíçò ðñïóðÜèåéáò ôïõ É.Ð.É êáé ôïõÊÝíôñïõ Õãåßáò ãéá åíçìÝñùóç êáé êéíçôïðïßçóç ôùí áóèåíþí ãéá èÝìáôáó÷åôéêÜ ìå ôç íüóï ôïõ ÓÄ, äßíïíôáò éäéáßôåñç Ýìöáóç óôçí êáôáíüçóç áðüðëåõñÜò ôïõò ôçò óðïõäáéüôçôáò ôçò áëëáãÞò ôùí õãéåéíïäéáéôçôéêþí óõíç-èåéþí ôïõò.

1Éáôñïß, 2Íïóçëåõôéêü ðñïóùðéêü, ÊÝíôñï Õãåßáò ÐåñÜìáôïò Ñåèýìíïõ

ËÝîåéò êëåéäéÜ: óáê÷áñþäçò äéáâÞôçò ôýðïõ 2, ðñù-ôïâÜèìéá öñïíôßäá õãåßáò, áãñïôéêÞ ðåñéï÷Þ.ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñçáíáêïßíùóç óôï 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞòÉáôñéêÞò (ÊñÞôç, 8-12 ÌáÀïõ 2002) êáé Ýëáâå Ýðáé-íï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïé-íÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ ðåñéï-äéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ.Õðåýèõíïò áëëçëïãñáößáò: Ê. Óôåöáíïðïýëïõ,ÊÝíôñï Õãåßáò ÐåñÜìáôïò Ñåèýìíïõ, Ôçë. (28340)23074, e-mail: [email protected]


140

Ê. Óôåöáíïðïýëïõ êáé óõí.

Evaluation of an intervention programme by the peripheral medicalstation physician (PMSP) in a known population of NIDDM patientsin their area of responsibility after one year of its applicationK. Stefanopoulou, S. Gantolias, X. Spiraki, A. Parasiri, A. Petraki,N. Papadakis, A. Batikas

SummaryAim: The evaluation of the results, from the intervention programme carried outby the PMSP for the diabetic patients of their area of responsibility, after oneyear. Evaluation was based on the following parameters: HbA1c variation, lipidprofile variation, changes in the patients' habits and lifestyle. Study population-Methods: The study population consisted of 24 patients in whom the diagnosisof NIDDM type II was already established. They were inhabitants of the munic-ipal areas of Garazo, Mourtzana, Episkopi and Kephali (total population: 870inhabitants). After the initial determination, in August 2000, of HbA1c levels andlipids profile, appropriate modifications and adjustments of medication for eachpatient were suggested. Patients were also advised to change their lifestyle, tofollow a specific dietary programme, to exercise, to stop smoking and to limittheir alcohol consumption. Educational courses were organized, during whichseveral aspects of NIDDM (prevention, pathology, complications and treatment)were discussed with the assistance of the relevant audiovisual material.Results: One year after the initiation of the programme, a decrease in HbA1clevels of up to 40% of the initial concentration was observed in almost allpatients (21/24). Twelve patients managed to reduce their body weight by up to7kgr, while sixteen out of 22 patients presented an improved lipid profile ac-companied by a modification of both their lifestyles and general habits (reduc-ing alcohol intake and giving up smoking). Conclusion: It is important to thePMSP maximize its efforts in order to inform the patients about NIDDM and tohelp them realize the importance of changes in their diet and lifestyle for thecourse of the disease had really impressive results.Key words: diabetes mellitus type II, intervention, habits, lifestyle, primary healthcare

Perama Health Centre, Rethymno, Greece

ðïôå óôñáôçãéêÞò áíôéäéáâçôéêÞò èå-ñáðåßáò ðñÝðåé íá åßíáé ç ðñüëçøç Þç êáèõóôÝñçóç åìöÜíéóçò åðéðëïêþí,ç åëÜôôùóç ôçò íïóçñüôçôáò êáé èíç-óéìüôçôáò, ðïõ óõíäÝïíôáé ìå ôç íüóï,ç âåëôßùóç ôçò óõíïëéêÞò ðïéüôçôáòæùÞò ôùí äéáâçôéêþí áóèåíþí êáé çìåßùóç ôïõ êüóôïõò ðåñßèáëøçò.

ÅðïìÝíùò, åìöáíßæåôáé åðéôáêôé-êÞ ç áíÜãêç óùóôÞò áíôéìåôþðéóçòôïõ óáê÷áñïäéáâçôéêïý áóèåíïýò,ðñÜãìá ðïõ áðáéôåß, ü÷é ìüíï ôçíêáôÜëëçëç öáñìáêåõôéêÞ áãùãÞ, áëëÜêáé ôç óôåíÞ êáé äéáñêÞ åìðëïêÞ ôïõãéáôñïý ðñùôïâÜèìéáò ðåñßèáëøçò,þóôå íá ìåãéóôïðïéçèåß ç óõììüñöù-óç ôïõ áóèåíïýò, ü÷é ìüíï ìå ôç öáñ-ìáêåõôéêÞ èåñáðåßá, áëëÜ ðñþôá êáéêýñéá ìå ôï ðñïôåéíüìåíï ìïíôÝëï õãéåé-íïäéáéôçôéêÞò áãùãÞò (áëëáãÞ ôïõôñüðïõ æùÞò ìå Ýìöáóç óôçí åöáñìï-ãÞ óõãêåêñéìÝíïõ äéáéôïëïãßïõ, óôçíÜóêçóç, óôç äéáêïðÞ ôïõ êáðíßóìá-ôïò êáé ôïí ðåñéïñéóìü ôïõ áëêïüë).12,13

Óêïðüò ôçò óõãêåêñéìÝíçò ìåëÝ-ôçò åßíáé ç áîéïëüãçóç ôùí áðïôåëå-óìÜôùí ôçò ðáñÝìâáóçò ôïõ éáôñïýðåñéöåñåéáêïý éáôñåßïõ óå ãíùóôüðëçèõóìü óáê÷áñïäéáâçôéêþí ôçò ðå-

ñéï÷Þò åõèýíçò ôïõ, üðùò áõôÞ åêäçëþíåôáé ìåôçí åêôßìçóç ôùí ìåôáâïëþí ôçò Çba1C, ôïõëéðéäáéìéêïý ðñïößë, áëëÜ êáé ôéò ìåôáâïëÝò óôéòóõíÞèåéåò êáé ôïí ôñüðï æùÞò ôùí áóèåíþí áõ-ôþí.


MåëåôÞèçóáí, óõíïëéêÜ, 24 äéáãíùóìÝíïéóáê÷áñïäéáâçôéêïß ôýðïõ 2, óå óýíïëï 870 êá-ôïßêùí óôá äçìïôéêÜ äéáìåñßóìáôá ÃáñÜæïõ,Ìïõñôæáíþí, ÅðéóêïðÞò êáé Êåöáëßïõ.

Ãéá üëïõò ôïõò áóèåíåßò, ðïõ ðåñéåëÞöèçóáíóôç ìåëÝôç, óõìðëçñþèçêå, ôïí Áýãïõóôï ôïõ2000, åéäéêü äåëôßï êáôáãñáöÞò ôùí äçìïãñáöé-êþí ôïõò óôïé÷åßùí, ôùí áíèñùðïìåôñéêþí ôïõò÷áñáêôçñéóôéêþí êáé ôïõ áôïìéêïý éóôïñéêïý ôïõò.

Ï êáèïñéóìüò ôïõ Äåßêôç ÌÜæáò Óþìáôïò(ÄÌÓ) Ýãéíå ìå ôïí ðñïóäéïñéóìü ôïõ ýøïõò êáéôç ìÝôñçóç ôïõ âÜñïõò, óýìöùíá ìå ôïí ôýðï

ðåñéöåñéêÞ áããåéïðÜèåéá5

• ÌéêñïáããåéïðÜèåéá, ðïõ ðñïêáëåß áìöéâëç-óôñïåéäïðÜèåéá êáé íåöñïðÜèåéá5 êáé

• ÍåõñïðÜèåéá5,6

Áîéïóçìåßùôï åßíáé üôé ôá áããåéáêÜ åãêåöá-ëéêÜ êáé ôá óôåöáíéáßá åðåéóüäéá, áðïôåëïýí ôçíêýñéá áéôßá èáíÜôïõ ôùí áóèåíþí ìå óáê÷áñþäçäéáâÞôç ôýðïõ 2.7-9

Áí, åðéðñüóèåôá, åêôüò áðü ôïí óáê÷áñþäçäéáâÞôç ôýðïõ 2, ëÜâïõìå õðüøç ìáò êáé ôïãåãïíüò üôé, ôï 65% ôùí áóèåíþí áõôþí Ý÷åéáõîçìÝíç áñôçñéáêÞ ðßåóç (>135/85 mmHg,óýìöùíá ìå ôá êñéôÞñéá ôçò JNC VI)10, åíþ ôï55% åìöáíßæåé óçìáíôéêÜ áõîçìÝíá åðßðåäá ëé-ðéäßùí11 óôï áßìá, ãßíåôáé öáíåñü, óå ôåëéêÞ áíÜ-ëõóç, ðüóï áõîçìÝíïò êßíäõíïò õðÜñ÷åé ãéá ôçæùÞ ôùí áóèåíþí áõôþí12.

ÄåäïìÝíïõ, äå, êáé ôïõ ôåñÜóôéïõ êüóôïõòäéá÷åßñéóçò êáé íïóçëåßáò ëüãù ôùí åðéðëïêþí(ãéá íá ìçí áíáöÝñïõìå ôïí ðüíï êáé ôçí ôáëáé-ðùñßá ôùí áóèåíþí), ï êýñéïò óôü÷ïò ïðïéáóäÞ-

141


öõôéêþí éíþí êáé óôç ìåéùìÝíç ðñüóëçøç ëß-ðïõò, óôçí Üóêçóç (æùçñü ðåñðÜôçìá ãéá ôïõ-ëÜ÷éóôïí 30 ëåðôÜ, ôñåéò (3) öïñÝò ôçí åâäïìÜ-äá, óôç äéáêïðÞ ôïõ êáðíßóìáôïò êáé ôïí ðåñéï-ñéóìü ôïõ áëêïüë).23

ÐáñÜëëçëá, äéïñãáíþèçêáí åíçìåñùôéêÝòóõãêåíôñþóåéò ìå óõæçôÞóåéò êáé ðñïâïëÝò slides,ó÷åôéêÜ ìå ôïí óáê÷áñþäç äéáâÞôç ôýðïõ 2 (ðñü-ëçøç, ðáèïëïãßá, åðéðëïêÝò, áíôéìåôþðéóç).

ÓôáôéóôéêÞ áíÜëõóç

Tá äåäïìÝíá êáôá÷ùñÞèçêáí óå âÜóç Excel2000 êáé áðü åêåß áíáëýèçêáí. Ç ìÝóç ôéìÞêÜèå äåßãìáôïò ðïóïôéêþí ðáñáôçñÞóåùí (ìå-ôñÞóåùí), õðïëïãßóèçêå ùò ôï áëãåâñéêü Üèñïé-óìá üëùí ôùí ìåôñÞóåùí, äéáéñåìÝíï ìå ôï ðëÞ-èïò ôùí ìåôñÞóåùí áõôþí, åíþ, ùò ìÝôñï ôïõâáèìïý äéáóðïñÜò ôùí ðáñáôçñÞóåùí ÷ñçóéìï-ðïéÞèçêå ç óôáèåñÞ áðüêëéóç (SD).

Ãéá ôç óýãêñéóç 2 ìÝóùí ôéìþí ðïóïôéêþíðáñáôçñÞóåùí êáé ôçí áîéïëüãçóç ôçò óôáôéóôé-êÞò óçìáíôéêüôçôáò ôçò äéáöïñÜò ôïõò ÷ñçóéìï-ðïéÞèçêå ç ôéìÞ ôïõ êñéôçñßïõ t (t-value), åíþ, ïéâáèìïß åëåõèåñßáò ãéá ôçí áîéïëüãçóç ôïõ êñéôç-ñßïõ (t), õðïëïãßóèçêáí ìå âÜóç ôïí ôýðï (n1+n2-2), üðïõ n1, n2 ôï ðëÞèïò ôùí ðáñáôçñÞóåùíêÜèå ïìÜäáò åëÝã÷ïõ.27


ÌåëåôÞèçóáí, óõíïëéêÜ, 24 Üôïìá, 13 Üí-äñåò (54,2%) êáé 11 ãõíáßêåò (45,8%).

Ç ìÝóç çëéêßá ôïõ äåßãìáôïò Þôáí 69,4 Ýôç(±SD: 8,87 Ýôç). Äåí õðÞñîå óôáôéóôéêÜ óçìáíôé-êÞ äéáöïñÜ, ìåôáîý ôçò çëéêßáò ôùí áíäñþí êáéôùí ãõíáéêþí.

ÁñôçñéáêÞ õðÝñôáóç åß÷áí 17/24 Üôïìá(70,8%), 9 Üíäñåò êáé 8 ãõíáßêåò. Ç ìÝóç ôéìÞôçò Ó.Á.Ð. Þôáí 147,1 (±13,8) mmHg, ìå ìÝóçôéìÞ Ä.Á.Ð. 85,8 (±5,24) mmHg.

Äåí âñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜóôçí áñôçñéáêÞ ðßåóç üóïí áöïñÜ ôï öýëï. ÌåôÜôçí ðáñÝëåõóç åíüò Ýôïõò ïé áíôßóôïé÷åò ìÝóåòôéìÝò äéáìïñöþèçêáí ãéá ìåí ôç ÓÁÐ óôá 141,3(±3,53) mmHg, åíþ ãéá ôç ÄÁÐ óôá 82,7 (±6,6)mmHg, ÷ùñßò, üìùò, ç öáéíïìåíéêÞ åëÜôôùóç íáåßíáé óôáôéóôéêÜ óçìáíôéêÞ óôï óõìâáôéêü åðßðå-

Ä.Ì.Ó. = ÂÜñïò/(ýøïò)2.Ç ýðáñîç óáê÷áñþäç äéáâÞôç äéáðéóôþèç-

êå åßôå áðü ôï éóôïñéêü ëÞøçò áíôéäéáâçôéêÞòáãùãÞò (äéóêßá-éíóïõëßíç), åßôå áðü ôçí áíåýñå-óç äõï äéáäï÷éêþí ôéìþí ãëõêüæçò íçóôåßáò>126mg/dl.14-21

Ïé áóèåíåßò, áíÜëïãá ìå ôç ÷ñÞóç êáðíïý,êáôçãïñéïðïéÞèçêáí óå ìç êáðíéóôÝò, ðñþçíêáðíéóôÝò êáé êáðíéóôÝò, åíþ áíÜëïãá ìå ôç ÷ñÞóçáëêïüë, êáôçãïñéïðïéÞèçêáí óå ìç ðüôåò (<10ãñ. áëêïüëçò ôçí åâäïìÜäá), Þðéïõò ðüôåò (<150ãñ. áëêïüëçò ôçí åâäïìÜäá), ìÝôñéïõò ðüôåò (<300ãñ. áëêïüëçò ôçí åâäïìÜäá) êáé ðüôåò (>300 ãñ.áëêïüëçò ôçí åâäïìÜäá). Ç çìåñÞóéá êáôáíÜëù-óç áëêïüë õðïëïãßóèçêå ìå âÜóç ôéò ðëçñïöï-ñßåò ãéá ôçí çìåñÞóéá êáôáíÜëùóç ìðßñáò, êñá-óéïý, ëéêÝñ, óýìöùíá ìå ôïí ôýðï: áëêïüë=1/7*[(0,04Ì*12)+(0,15Ê*4)+(0,45Ë*1,5)+28,35)].22

ÐáñÜëëçëá, ðñáãìáôïðïéÞèçêå ìÝôñçóç ôçòáñôçñéáêÞò ðßåóçò, ìå õäñáñãõñéêü óöõãìïìáíü-ìåôñï, óå 3 äéáäï÷éêÝò, áíÜ äßëåðôï ìåôñÞóåéò.Ïé ìåôñÞóåéò Ýãéíáí óå êáèéóôÞ èÝóç, ìåôÜ áðüðåíôÜëåðôç áíÜðáõóç êáé áöïý åß÷áí ðåñÜóåé,ôïõëÜ÷éóôïí 30 ëåðôÜ áðü ôçí ðüóç êáöåúíïý-÷ïõ ñïöÞìáôïò Þ êáðíßóìáôïò. ÉêáíïðïéçôéêÞ ñýè-ìéóç ôçò áñôçñéáêÞò ðßåóçò ÷áñáêôçñßóèçêå çôéìÞ ôçò óõóôïëéêÞò áñôçñéáêÞò ðßåóçò <135mmHg êáé ôçò äéáóôïëéêÞò áñôçñéáêÞò ðßåóçò<85 mmHg.23

ÌåôÜ ôïí áñ÷éêü ðñïóäéïñéóìü, ôïí Áýãïõ-óôï ôïõ 2000, ôùí ôéìþí ôïõ óáê÷Üñïõ íçóôåßáòóôï áßìá, ôçò ãëõêïæõëéùìÝíçò áéìïóöáéñßíçò(Hba1C), ôùí ôéìþí ôçò HDL êáé LDL ÷ïëçóôå-ñüëçò, ùò êáé ôùí ôñéãëõêåñéäßùí, êáèþò êáé ôïíõðïëïãéóìü ôïõ ÂÜñïõò, ôïõ Äåßêôç ÌÜæáò Óþ-ìáôïò êáé ôçò áñôçñéáêÞò ðßåóçò, ïé ìåôñÞóåéòåðáíáëÞöèçêáí Üëëåò äõï öïñÝò, ðïõ áðåß÷áí÷ñïíéêÜ ìåôáîý ôïõò Ýîé (6) ìÞíåò (ÖåâñïõÜñéïòÝùò Áýãïõóôïò 2001).

ÁðïäåêôÞ ôéìÞ ìåôáâïëéêïý åëÝã÷ïõ24-26, óýì-öùíá ìå ôá äéåèíÞ äåäïìÝíá, üóïí áöïñÜ óôçíHba1C èåùñåßôáé ôï 7%, åíþ ç ôéìÞ ôçò LDLðñÝðåé íá äéáôçñåßôáé óå åðßðåäá £130mg/dl23.Óôá Üôïìá áõôÜ, ìåôÜ ôçí ðñþôç åêôßìçóç, Ýãé-íáí ïé áíÜëïãåò, êáôÜ ðåñßðôùóç, ôñïðïðïéÞóåéòêáé ðñïóáñìïãÝò ôçò öáñìáêåõôéêÞò áãùãÞò êáéóõíåóôÞèç ìåôáâïëÞ ôïõ ôñüðïõ æùÞò24-25 (åéäé-êüôåñá: åöáñìïãÞ óõãêåêñéìÝíïõ äéáéôïëïãßïõ13

ìå Ýìöáóç, ðÝñá áðü ôç ìåßùóç ôùí ðñïóëáìâá-íïìÝíùí èåñìßäùí, óôçí áõîçìÝíç ðñüóëçøç


142


Êáô’ åðÝêôáóç äå, üóïí áöïñÜ óôéò ôéìÝòôçò Hba1c óôï áßìá êáé óýìöùíá ìå ôéò äéåèíåßòðáñáäï÷Ýò, ôéìÝò <7% (23) èåùñÞèçêáí éêáíï-ðïéçôéêÝò êáé ðáñáôçñÞèçêáí ôïí Áýãïõóôï ôïõ2000 óå (6) Üôïìá, (25%), 3 Üíäñåò êáé 3 ãõíáß-êåò, ôéìÝò ìåôáîý 7-8,5% èåùñÞèçêáí ùò ìÝôñéáéêáíïðïéçôéêÝò êáé äéáðéóôþèçêáí óå 3 Üôïìá(12,5%) (1 Üíäñá êáé 2 ãõíáßêåò), åíþ ôéìÝò >8,5%(ìç áðïäåêôÝò) âñÝèçêáí óå 15 Üôïìá (62,5%), 9Üíäñåò êáé 6 ãõíáßêåò.

ÌåôÜ ôçí ðáñÝìâáóÞ ìáò, äéáðéóôþèçêå üôéüëïé ó÷åäüí ïé áóèåíåßò, 21/24, äçëáäÞ ðïóïóôü(87,5%), ìåßùóáí ôç ãëõêïæõëéùìÝíç áéìïóöáéñß-íç (Hba1c) ùò êáé 40% ôçò áñ÷éêÞò. ̧ ôóé, åíþ çìÝóç ôéìÞ ôçò Hba1c Þôáí 9,2%, áõôÞ ìåéþèçêåóôï 7,6%, ôïí Áýãïõóôï ôïõ 2001 (ÄéáãñÜììáôá3, 4).

Ç äéáöïñÜ ôùí 2 ìÝóùí ôéìþí äåí åßíáéóôáôéóôéêÜ óçìáíôéêÞ óôï óõìâáôéêü åðßðåäï ôïõ5% (Üñá p>0,05), åíþ, áíôßèåôá, êáëýðôåé ôïåíäåéêôéêü åðßðåäï ôïõ 10% (p<0,10).

KáôÜ óõíÝðåéá, ÷ñåéÜæåôáé ìåãáëýôåñïò áñéè-ìüò ðáñáôçñÞóåùí ãéá ôç óôáôéóôéêÞ êáôï÷ýñù-óç ôçò äéáöïñÜò.

Áíáëõôéêüôåñá, ìåôÜ ôçí áñ÷éêÞ åêôßìçóç,

äï ôïõ 5% Þ ôïõëÜ÷éóôïí åíäåéêôéêÞ óôï åðßðåäïôïõ 10%.

Ï ìÝóïò Ä.Ì.Ó. ôïõ äåßãìáôïò Þôáí 28,5(±3,2) êáé äåí ðáñáôçñÞèçêå óôáôéóôéêÜ óçìá-íôéêÞ äéáöïñÜ ìåôáîý áíäñþí êáé ãõíáéêþí.Öõóéïëïãéêü âÜñïò óå ó÷Ýóç ìå ôï ýøïò ôïõò(ÄÌÓ <25) åß÷áí ìüíï 2 Üôïìá (8,3%) (2 ãõíáß-êåò), åíþ õðÝñâáñïé (ÄÌÓ: 25-30) êáé ðá÷ýóáñ-êïé (ÄÌÓ >30) Þôáí 22 Üôïìá (91,7%), 13 Üí-äñåò êáé 9 ãõíáßêåò. Âåëôßùóç ôïõ ÄÌÓ ìåôÜôçí ðáñÝëåõóç åíüò Ýôïõò, ðáñïõóßáóáí 12 Üôï-ìá, ðïõ áðïôåëïýóáí ôï 50% ôùí áóèåíþí, Þôïé7 Üíäñåò êáé 5 ãõíáßêåò. Ôá Üôïìá áõôÜ, êáôüñ-èùóáí íá ìåéþóïõí ôï óùìáôéêü âÜñïò ôïõò ìÝ÷ñéêáé 7 êéëÜ, ðáñ’ üëá áõôÜ ï ìÝóïò ÄÌÓ ðáñÝìåé-íå, ïõóéáóôéêÜ óôáèåñüò (ÄéáãñÜììáôá 1, 2).

Áññýèìéóôá, üóïí áöïñÜ óôá åðßðåäá ôïõóáê÷Üñïõ óôï áßìá Þôáí 17 Üôïìá (70,8%), 12Üíäñåò êáé 7 ãõíáßêåò, ìå ìÝóç ôéìÞ óáê÷Üñïõíçóôåßáò ôá 192,7 mg/dl êáé áðïäåêôÞ ôéìÞ ôá140mg/dl23,28. Äåí âñÝèçêå óôáôéóôéêÜ óçìáíôéêÞäéáöïñÜ óôéò ôéìÝò ôçò ãëõêüæçò óôï áßìá ìåôáîýáíäñþí êáé ãõíáéêþí.

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11

2

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2

1

7

10

2

12

9

10

0

2

4

6

8

10

12

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25-28

28-35

35-40

>40

6

9

3

8

15

7

0

2

4

6

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10

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14

ÊÁËÇ(<7) ÌÅÔÑÉÁ(7-

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ÊÁÊÇ(>8,5)

ÁÕÃ.2000

ÁÕÃ.2001

7

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10

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4

5

9

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Ã

ÓÕÍ

10

ÄéÜãñáììá 2. ÌåôáâïëÞ % ÄÌÓ áóèåíþí ìå ÓÄ.ÄéÜãñáììá 4. Óýãêñéóç ôéìþí HbA1c áôüìùí ìå ÓÄ ìåôÜ áðüäéÜóôçìá 1 Ýôïõò èåñáðåßáò.

ÄéÜãñáììá 1. ÄÌÓ áôüìùí ìå ÓÄ.

ÄéÜãñáììá 3. ÌåôáâïëÞ % HbA1c óå Üôïìá ìå ÓÄ.

67

4 4

2 0 0 0

0

2

4

6

8

ÂÅËÔÉÙÓÇ ÅÐÉÄÅÉÍÙÓÇ

0-10%

10-20%

20-30%

30-40%

143


áëêïüë 5 Üôïìá óå óýíïëï 10 áôüìùí (50%),ðïõ ðåñéåëÜìâáíå, Þðéïõò êáé ìÝôñéïõò ðüôåò.

ÓõæÞôçóç

O ÓÄ Ý÷åé áíáãíùñéóèåß ðëÝïí ùò ðñüâëç-ìá, ðïõ áõîÜíåôáé óôéò äõôéêÝò êïéíùíßåò. Åßíáéåíäåéêôéêü üôé ôï 1985, ðåñßðïõ 30.000.000 Üí-èñùðïé ó’ üëï ôïí êüóìï Ýðáó÷áí áðü óáê÷áñþ-äç äéáâÞôç, ôï 1998 ïé áóèåíåßò õðïëïãßóèçêáíóå 143.000.000 êáé ï áñéèìüò ôïõò áíáìÝíåôáéíá áíÝëèåé ôï 2025 óå, ðåñßðïõ, 300.000.00032-34.

Óôéò ÇÐÁ ôï ðïóïóôü ôùí óáê÷áñïäéáâçôé-êþí ôýðïõ 2 åããßæåé, ðëÝïí, ôï 7%2, åíþ, ðåñß-ðïõ, 1.000.000 ̧ ëëçíåò ôáëáéðùñïýíôáé áðü óáê-÷áñþäç äéáâÞôç êáé êéíäõíåýïõí áðü ôéò åðéðëï-êÝò ôïõ.

Ç íüóïò ðáñïõóéÜæåôáé ýðïõëá óå åíçëß-êïõò35-37 (óõíÞèùò >40 åôþí, áí êáé óôç âéâëéï-ãñáößá ðåñéãñÜöïíôáé êáé ðåñéðôþóåéò ðáéäéþíÞ åöÞâùí ìå óáê÷áñþäç äéáâÞôç ôýðïõ 2)34,35

êáé åìöáíßæåôáé ðåñéóóüôåñï óõ÷íÜ óå ðá÷ýóáñ-êá Üôïìá, ðïõ êÜíïõí êáèéóôéêÞ æùÞ, ðñïóëáì-âÜíïõí ìå ôç äéáôñïöÞ ôïõò ðåñéóóüôåñá ëéðáñÜêáé Ý÷ïõí èåôéêü ïéêïãåíåéáêü éóôïñéêü.40-43

Ôï óùìáôéêü âÜñïò åßíáé ï óçìáíôéêüôåñïòðáñÜãïíôáò êéíäýíïõ ãéá ôï äéáâÞôç44-47, ï ïðïßïòìðïñåß íá ôñïðïðïéçèåß, áöïý ï ðÜó÷ùí ìðïñåß,êáé åðéâÜëëåôáé, íá åëáôôþóåé ôï óùìáôéêü ôïõâÜñïò, åöüóïí åßíáé ðá÷ýóáñêïò.

Ç âáñýôçôá ôçò íüóïõ ôïõ óáê÷áñþäç äéá-âÞôç ïöåßëåôáé óôéò äéÜöïñåò åðéðëïêÝò ôçò. Ôï75% ôùí óáê÷áñïäéáâçôéêþí áóèåíþí ðåèáßíåéùò áðïôÝëåóìá ôùí äéáöüñùí êáñäéáããåéáêþíåðéðëïêþí.23

Ôï äéáâçôéêü ðüäé êáôÝ÷åé ëüãù ôïõ óõ÷íïýóõíäõáóìïý ôïõ ìå íåõñïðÜèåéá, éó÷áéìßá êáéëïéìþîåéò ìéá åéäéêÞ èÝóç êáé áðïôåëåß ôçí êýñéááéôßá áêñùôçñéáóìïý óôéò ÇÐÁ.48-50

Ç íåöñéêÞ áíåðÜñêåéá åßíáé ç äåýôåñç óõ-÷íüôåñç áéôßá èáíÜôïõ êáé áíáðçñßáò êáé åìöá-íßæåôáé ðåñßðïõ óôï 10% ôùí äéáâçôéêþí áóèå-íþí.23

ÔÝëïò, ç äéáâçôéêÞ áìöéâëçóôñïåéäïðÜèåéáåßíáé ç ðéï óõ÷íÞ áéôßá íÝùí ðåñéðôþóåùí ôý-öëùóçò óôïõò Áìåñéêáíïýò (20-74 åôþí) êáéöèÜíåé ôéò 20.000 íÝåò ðåñéðôþóåéò ôï ÷ñüíï.23

Óôü÷ïò ôïõ êëéíéêïý ãéáôñïý åßíáé íá ìÜèåéóôïõò áóèåíåßò ôïõ íá æïõí ìå ôï óáê÷áñþäç

ôéìÞ Hba1c <7% åß÷áí 9 Üôïìá (7 Üíäñåò êáé 2ãõíáßêåò), ìåôáîý 7-8% 8 Üôïìá (2 Üíäñåò êáé 6ãõíáßêåò), åíþ ðÜíù áðü 8,5%, 7 Üôïìá (4 Üí-äñåò êáé 3 ãõíáßêåò).

ÓôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ óôéò ôéìÝò ôçòHba1c óôï áßìá ìåôáîý áíäñþí êáé ãõíáéêþíäåí âñÝèçêå.

Áîéïóçìåßùôï åßíáé üôé ç åðéäçìéïëïãéêÞ ìå-ëÝôç ôïõ Wisconsin5 Ýäùóå éó÷õñÝò áðïäåßîåéòüôé óå áóèåíåßò ìå óáê÷áñþäç äéáâÞôç ôýðïõ 2,ðïõ õðïâëÞèçêáí óå ðáñáêïëïýèçóç åðß 10 Ýôç,ï âáèìüò êáé ç äéÜñêåéá ôçò õðåñãëõêáéìßáò, ðïõáîéïëïãÞèçêáí ìå âÜóç ôç ãëõêïæõëéùìÝíç áéìï-óöáéñßíç, áðïôÝëåóáí óçìáíôéêü ðáñÜãïíôá ðñü-âëåøçò ôüóï ãéá ôéò ìéêñï- üóï êáé ôéò ìáêñï-áããåéáêÝò åðéðëïêÝò.

Ç âåëôßùóç ôïõ ãëõêáéìéêïý åëÝã÷ïõ ðñï-ëáìâÜíåé ôéò åðéðëïêÝò29-31.

Ùò ðñïò ôï óõíåêôéìçèÝí ëéðéäáéìéêü pro-file, üðùò áõôü åêöñÜæåôáé, êõñßùò, ìå ôéò ôéìÝòôçò LDL, ðïõ ðëÝïí åðéäéþêåôáé íá äéáôçñåßôáéóå åðßðåäá £130mg/dl óôï áßìá23,28, 16 áðü ôïõò22 åíáðïìåßíáíôåò óôçí ïìÜäá åëÝã÷ïõ áóèåíåßò(2 áðåâßùóáí êáôÜ ôç äéÜñêåéá ôçò ìåëÝôçò),ðáñïõóßáóáí âåëôßùóç, ìÝ÷ñé êáé ðÜíù áðü 20%(ÄéÜãñáììá 5).

¸ôóé, ç ìÝóç ôéìÞ ôçò LDL åëáôôþèçêå áðüôá 131 óå 121,5 mg/dl, óôï ÷ñïíéêü äéÜóôçìáìåôáîý ôùí ìåôñÞóåùí áõôþí, ÷ùñßò, üìùò, íáôåêìçñéùèåß ç óôáôéóôéêÞ óçìáíôéêüôçôá áõôÞòôçò äéáöïñÜò óôï óõìâáôéêü åðßðåäï ôïõ 5%.

ÐáñÜëëçëá, áîéïóçìåßùôï åßíáé üôé áíÜëïãïðïóïóôü áóèåíþí ìå óáê÷áñþäç äéáâÞôç ôýðïõ2, âåëôßùóáí ôéò óõíÞèåéåò êáé ôïí ôñüðï æùÞòôïõò. ¸ôóé, óôáìÜôçóáí íá êáðíßæïõí 6 Üôïìáóå óýíïëï 8 êáðíéóôþí (75%), åíþ áðü ôïõò ìçêáðíßæïíôåò, êáíåßò äåí Üñ÷éóå ôï êÜðíéóìá.Åðßóçò, óôáìÜôçóáí íá ðßíïõí Þ ðåñéüñéóáí ôï

ÄéÜãñáììá 5. ÌåôáâïëÞ LDL áóèåíþí ìå ÓÄ

43

10

2 21

0

2

4

6

8

10

0-10% 10-20% >20%

ÂÅËÔÉÙÓÇ

ÅÐÉÄÅÉÍÙÓÇ


144



1. National Diabetes Information clearinghouse.Diabetes Statistics. NIH publication no.96-3926.Washington, DC: US Department of Health andHuman Services, Public Health Service, NationalInstitutes of Health, 1995.

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äéáâÞôç.Ç áíôéìåôþðéóç ôçò íüóïõ åðéêåíôñþíåôáé

óôï óùóôü ìåôáâïëéêü Ýëåã÷ï, óôçí õðïóôÞñéîçôçò áõôïöñïíôßäáò ôïõ áóèåíïýò êáé óôçí ðñü-ëçøç ôùí åðéðëïêþí.

ÓõíÞèùò, ãéá ôïýôï, åßíáé æùôéêÞò óçìáóßáòìéá ïìÜäá åéäéêþí, ðïõ èá ðñïóåããßóåé êáé èáöñïíôßóåé ôï äéáâçôéêü áóèåíÞ.

¼ëïé ïé íÝïé áóèåíåßò, åöüóïí êáé ïé ßäéïé ôïåðéèõìïýí, ðñÝðåé íá Ý÷ïõí ëåðôïìåñÞ åíçìÝñù-óç êáé åêðáßäåõóç23 ó÷åôéêÜ ìå ôç íüóï ôïõò, ôéòáëëáãÝò ðïõ åðéâÜëëïíôáé óôïí ôñüðï ôçò æùÞòôïõò, êáèþò êáé ãéá ôá óõìðôþìáôá êáé óçìåßáôçò õðÝñ- Þ õðï-ãëõêáéìßáò êáé ôéò óõíÞèåéò åðé-ðëïêÝò.

Ôï ìÞíõìá, ðïõ ðñÝðåé íá ëÜâïõí åßíáé üôé:á) Ï óáê÷áñþäçò äéáâÞôçò åßíáé ìéá óïâáñÞ

áóèÝíåéá êáéâ) üôé ïé áëëáãÝò óôïí ôñüðï æùÞò (äéáéôçôéêÝò

óõíÞèåéåò, êÜðíéóìá, åðßðåäï öõóéêÞò äñá-óôçñéüôçôáò), ðáßæïõí ïõóéáóôéêü ñüëï óôçíáíôéìåôþðéóÞ ôçò.Áõôü, áêñéâþò, ðñïóðáèÞóáìå êáé ðéóôåýù

üôé ðåôý÷áìå, óå éêáíïðïéçôéêü âáèìü, íá êÜíïõ-ìå óôçí õðü Ýëåã÷ï ïìÜäá ôùí óá÷áñïäéáâçôé-êþí áóèåíþí, óôçí ðåñéï÷Þ åõèýíçò ôïõ ðåñéöå-ñåéáêïý éáôñåßïõ ÃáñÜæïõ.

ÂÝâáéá, ç áíôéìåôþðéóç åßíáé ðïëýðëïêç êáéáðáéôåß óõíÝ÷åéá óôç ó÷Ýóç ôïõ áóèåíïýò ìå ôïãéáôñü ðñùôïâÜèìéáò ðåñßèáëøçò. ÁõôÞ ç ó÷ÝóçðñÝðåé íá åßíáé öéëéêÞ, þóôå íá ìåãéóôïðïéçèåß çóõììüñöùóç ôïõ áóèåíïýò ìå ôçí ðñïôåéíüìåíçèåñáðåõôéêÞ áãùãÞ êáé óå ôåëéêÞ áíÜëõóç, ïßäéïò ï ãéáôñüò èá Ý÷åé ôçí åõ÷Üñéóôç åìðåéñßáôçò éêáíïðïßçóçò áðü ôçí ðñüëçøç ôñáãéêþíåðéðëïêþí.

Ôá áðïôåëÝóìáôá ôçò ðáñÝìâáóÞò ìáò õðÞñ-îáí, êáô’ áñ÷Þí, éêáíïðïéçôéêÜ, ùò áðüññïéá ôçòóõíôïíéóìÝíçò ðñïóðÜèåéáò ôïõ éáôñïý ðåñéöå-ñåéáêïý éáôñåßïõ êáé ÊÝíôñïõ Õãåßáò, ãéá åíçìÝ-ñùóç êáé êéíçôïðïßçóç ôùí áóèåíþí ãéá èÝìáôáó÷åôéêÜ ìå ôç íüóï ôïõ óáê÷áñþäç äéáâÞôç, äß-íïíôáò éäéáßôåñç Ýìöáóç óôçí êáôáíüçóç áðüðëåõñÜò ôïõò ôçò óðïõäáéüôçôáò ôçò áëëáãÞòôùí õãéåéíïäéáéôçôéêþí óõíçèåéþí ôïõò. ÂÝâáéá ïìéêñüò áñéèìüò ôùí ðáñáôçñÞóåùí äåí ìáò åðÝ-ôñåøå íá ôåêìçñéþóïõìå ôç óôáôéóôéêÞ óçìáíôé-êüôçôá ôùí ðáñáôçñçèåéóþí ìåôáâïëþí.

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48. Lipsky BA, Berendt AR. Principles and prac-tice of antibiotic therapy of diabetic food infec-tions. Diabetes Metab Res Rev, 16 Suppl 1:S42-6, 2000.

49. Slovenkai MP. Foot problems in diabetes. MedCin North Am, 82:949-71, 1998.

50. Franse LV, Valk GD, Dekker JH, Heine RJ, vanEijk JT. Numbnessof the feet is a poor indicatorfor polyneuropathy in Type 2 Diabetic patients.Diabet Med, 17:105-10, 2000.

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ÏóôéêÞ ðñïóâïëÞ óå ðåñéóôáôéêü óõããåíïýò óýöéëçòêáé äéáöïñïäéÜãíùóç ìå ôï óýíäñïìïôïõ êáêïðïéçìÝíïõ ðáéäéïý

Ð. Âïõäïýñç1, Á. ÂÞôáò2, ×. ×áôæçåëåõèåñßïõ3

ÁÍÁÖÏÑÁ ÐÅÑÉÐÔÙÓÇÓ

CASE REPORTPrimary Heatlh Care, Volume 14, Number 3, 147-149, 2002ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 147-149, 2002

ÅéóáãùãÞ

Ç åðßðôùóç ôçò óõããåíïýò óýöé-ëçò åßíáé óõíå÷þò áõîáíüìåíç óôçíÅëëÜäá üðùò êáé óôïí õðüëïéðï êü-óìï áöåíüò ëüãù áõîÞóåùò ôùí åíåñ-ãþí ðåñéðôþóåùí ôçò íüóïõ êáé áöå-ôÝñïõ ëüãù ôùí ðëçèõóìéáêþí ìåôá-âïëþí ðïõ óõíôåëïýíôáé óôç ÷þñá ìáò,åîáéôßáò ôçò ìåôáíáóôåýóåùò.1 ÐïëëÜêñïýóìáôá åêäçëþíïíôáé óôçí åðáñ-÷ßá êáé áðáó÷ïëïýí ôïõò Éáôñïýò ðïõðáñÝ÷ïõí ðñùôïâÜèìéá öñïíôßäáõãåßáò.

Áõôü ôï Üñèñï ðåñéãñÜöåé ìéááóõíÞèç ïóôéêÞ ðñïóâïëÞ (åôåñüðëåõ-ñïò ëýóç ôçò ïóôéêÞò óõíÝ÷åéáò ôïõáñéóôåñïý âñá÷éïíßïõ ïóôïý), óå íåï-ãíü 3 ìçíþí ðïõ ðáñïõóéÜóôçêå óôïôìÞìá åðåéãüíôùí ðåñéóôáôéêþí(ÔÅÐ), ôïõ íïóïêïìåßïõ ìáò ìå ðá-ñÜëõóç ôïõ áñéóôåñïý (áñ.) Üíù Üêñïõêáé ðïõ áñ÷éêÜ èåùñÞèçêå ùò áðïôÝ-ëåóìá êáêïðïßçóçò áõôïý.

Ðåñßëçøç¸÷åé áíáöåñèåß üôé ôá êáôÜãìáôá ðïõ åðéðëÝêïõí ôç óõããåíÞ óýöéëç ìåïóôéêÞ ðñïóâïëÞ ìðïñåß íá ðñïóïìïéÜæïõí ì’ áõôÜ ðïõ åìöáíßæïíôáé óôçíðáéäéêÞ êáêïðïßçóç. ÐáñïõóéÜæïõìå Ýíá ôÝôïéï ðåñéóôáôéêü, óå íåïãíü 3 ìç-íþí ðïõ ðñïóêïìßóèçêå óôï ôìÞìá åðåéãüíôùí ðåñéóôáôéêþí ôïõ Ã. Í. ÄñÜìáòìå ðáñÜëõóç ôïõ áñéóôåñïý Üíù Üêñïõ.

Bone assault in cases of congenital syphilis and differentiation with thatof child abuse syndrome.P. Vuduri, Ath. Vitas, H. Hatzieleftheriu.

SummaryIt has been reported that fractures complicating congenital syphilis can mimicchild abuse. We present such a finding in a 3-month-old infant who is sufferingfrom paralysis of the left arm.Key words: fracture, congenital syphilis, abuse syndrome, childhood

General Hospital of Drama, Greece

1 Åéäéêüò Áêôéíïëüãïò, 2 Åéä/íïò ÃåíéêÞò ÉáôñéêÞò, 3 Åéäéêüò Êáñäéïëüãïò, Ãåíéêü ÍïóïêïìåßïÄñÜìáò

ËÝîåéò êëåéäéÜ: ÓõããåíÞò óýöéëç, äéÜãíùóç, ïóôéêÜêáôÜãìáôáYðïâëÞèçêå: 31 Éïõëßïõ 2001¸ãéíå äåêôÞ ãéá äçìïóßåõóç: 12 Óåðôåìâñßïõ 2001Õðåýèõíïò áëëçëïãñáößáò: ÁèáíÜóéïò Ã. ÂÞôáò,Íáõáñßíïõ 7, ÄñÜìá Ô.Ê. 66100, Ôçë.: 05210-32009êáé 0974-212472, e-mail: [email protected]


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íåôáé ãñÞãïñá ëüãù ôçò äéáãíþóåùò ðïëëáðëþíïóôéêþí âëáâþí, ìåôÜ áðü ðñïóåêôéêüôåñç åêôß-ìçóç ôùí áêôéíïëïãéêþí åõñçìÜôùí.

Ç ðáñïõóßá óõììåôñéêþí öëåãìïíùäþí áë-ëïéþóåùí óôéò ìåôáöýóåéò ôùí ìáêñþí ïóôþíôùí Üíù Üêñùí êáé êíçìþí (ìåôáöõóßôéäá - óç-ìåßï Wimberger), ç óáöÞò õðïðåñéïóôéêÞ áíôß-äñáóç, êõñßùò óôéò äéáöýóåéò ôùí ìáêñþí ïóôþíêáé ç ýðáñîç ìéêñþí öëåãìïíùäþí åóôéþí óôïóþìá ôùí ìéêñþí ïóôþí (äéáöõóßôéäá), èÝôïõíôçí õðüíïéá óõóôçìáôéêÞò ðáèïëïãéêÞò ïóôéêÞòðñïóâïëÞò (Åéêüíá 2).

Ï åðåßãùí áéìáôïëïãéêüò Ýëåã÷ïò ðåñéëÜì-âáíå öõóéïëïãéêÞ ãåíéêÞ áßìáôïò êáé ìÝôñéá áý-îçóç ôçò ôá÷ýôçôáò êáèéæÞóåùò ôùí åñõèñþíáéìïóöáéñßùí (ÔÊÅ: 60mm/h).

Ëüãù ôçò ðáñïõóßáò óõóôïëéêïý öõóÞìáôïòãßíåôáé õðåñç÷ïãñÜöçìá êáñäéÜò ðïõ áðïêáëý-ðôåé ìéêñÞ ðåñéêáñäéêÞ óõëëïãÞ ìå öõóéïëïãéêÞüìùò ëåéôïõñãéêüôçôá ôçò êáñäéÜò.

¸ãéíå åêôåôáìÝíïò áðåéêïíéóôéêüò Ýëåã÷ïòìå ïëïóùìáôéêÝò áêôéíïãñáößåò. Ç áíåýñåóç ïñï-èåôéêüôçôáò ôçò ìçôÝñáò êáé ôïõ íåïãíïý (VDRLäïêéìáóßá èåôéêÞ), ïäÞãçóå ôåëéêÜ óôç äéÜãíùóçôçò óõããåíïýò óýöéëçò.

ÐåñéãñáöÞ ôçò ðåñßðôùóçò

Íåïãíü 3 ìçíþí ìåôáöÝñèçêå óôï ÔÅÐ ãéáåêôßìçóç ðáñÜëõóçò ôïõ áñ. Üíù Üêñïõ. ÃåííÞ-èçêå ìåôÜ áðü áíåðßðëåêôç êõïöïñßá, ìå öõóéï-ëïãéêü ôïêåôü. Ç ðåñéãåííçôéêÞ ðïñåßá äåí åß÷åóõìâÜìáôá êáé ôï íåïãíü åîÞëèå ôïõ íïóïêï-ìåßïõ êáôÜ ôç 2ç ìÝñá ìåôÜ ôç ãÝííçóÞ ôïõ.VDRL test äåí äéåíåñãÞèçêå óôç ìçôÝñá êáôÜôç äéÜñêåéá ôçò åãêõìïóýíçò.

Ç ìçôÝñá áíáöÝñåé, üôé áðü ìçíüò ðåñßðïõôï íåïãíü åìöáíßæåé óçìåßá ðüíïõ êáôÜ ôçí êß-íçóç ôïõ áñ. Üíù Üêñïõ ðïõ åðéäåéíþíïíôáé ðñïï-äåõôéêÜ êáé ôçí áíáãêÜæïõí íá ðñïóÝñ÷åôáé åðá-íåéëëçìÝíá óôï ÔÅÐ, üðïõ üìùò ôçò äßäïíôáéáðëÜ ïäçãßåò.

Ìéá åâäïìÜäá áñãüôåñá, ôï íåïãíü ðñïóêï-ìßæåôáé åê íÝïõ, ëüãù áäõíáìßáò ôïõ íá ÷ñçóéìï-ðïéÞóåé ôï áñ. Üíù Üêñï. Ïé áêôéíïãñáößåò ôïõÜêñïõ áðïêáëýðôïõí óõìðéåóôéêü êÜôáãìá ôçòÜíù ìåôáöýóåùò ôïõ áñ. âñá÷éïíßïõ ïóôïý ìååêóçìáóìÝíç ðåñéïóôéêÞ áíôßäñáóç (callous for-nation) (Åéêüíá 1).

Áêïëïõèåß ðëÞñçò ïëïóùìáôéêüò áêôéíïëï-ãéêüò Ýëåã÷ïò, ï ïðïßïò äåí åìöáíßæåé ðáñïõóßáÜëëùí êáôáãìÜôùí. Ôßèåôáé áñ÷éêþò ç õðüíïéáôçò êáêïðïéÞóåùò, ç ïðïßá üìùò êáé áðïìáêñý-

Åéêüíá 1.

Ç åðåßãïõóá åêôßìçóç, áðü ôï áéìáôïëïãéêüåñãáóôÞñéï ôçò ïñïèåôéêüôçôáò ôïõ ïñïý, äéÜìÝóïõ ôçò ìç ôñåðïíçìéêÞò äïêéìáóßáò VDRL,öáíåñþíåé èåôéêüôçôá ôüóï ôçò ìçôÝñáò üóï êáéôïõ íåïãíïý. ¸ôóé, ï óõíäõáóìüò ôùí áêôéíïëï-ãéêþí êáé ôùí åñãáóôçñéáêþí åõñçìÜôùí èÝôåéôç äéÜãíùóç ôçò óõããåíïýò óýöéëçò êáé êáôÜóõíÝðåéá ôï íåïãíü åéóÜãåôáé óôçí ðáéäéáôñéêÞêëéíéêÞ.

ÌçôÝñá êáé íåïãíü ôÝèçêáí óå áãùãÞ ìåðåíéêéëëßíç, åíþ ï åðáíáëçðôéêüò áêôéíïëïãéêüòÝëåã÷ïò (1 ìÞíá ìåôÜ), êáôáäåéêíýåé ó÷åäüí ðëÞ-ñç ýöåóç ôùí ïóôéêþí âëáâþí ôïõ íåïãíïý.

ÊÜôáãìá ìåôáöýóåùòáñéóôåñïý âñá÷éïíßïõ

ïóôïý

ÄéáöéóßôéäáÏóôåüëõóçáñéóôåñïýìçñéáßïõïóôïý

ÕðïðåñéïóôéêÞáíôßäñáóç

Åéêüíá 2.

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óôçí õðüíïéá ôçò ðáéäéêÞò êáêïðïßçóçò.Ôï åýñçìá ôçò ðåñéêáñäéêÞò óõëëïãÞò èåù-

ñÞèçêå ùò ìç åéäéêü, äåäïìÝíïõ üôé ç ðñïóâïëÞôïõ êáñäéáããåéáêïý óõóôÞìáôïò åìöáíßæåôáé óåìåãáëýôåñåò çëéêßåò.4

ÕðÜñ÷ïõí ðïëëÝò ðåñéðôþóåéò ïé ïðïßåò äç-ëþíïõí üôé ôá êáôÜãìáôá ðïõ åðéðëÝêïõí ôçóõããåíÞ óýöéëç ãßíåôáé íá ïìïéÜæïõí ì’ áõôÜôçò ðáéäéêÞò êáêïðïßçóçò.5-7 Ïé âëÜâåò óôç óõã-ãåíÞ óýöéëç êáèéóôïýí ôï ïóôü åýèñáõóôï, áðï-äéïñãáíùìÝíï êáé åðéññåðÝò óå ôñáõìáôéóìïýò8,9.


1. Ikela MK, Jenson HB. Evaluation and treat-ment of congenital syphilis. J Pediatr, 117:843-852, 1990.

2. Rasool MN, Govender S. The skeletal manifes-tations of congenital syphilis, a review of 197cases. J Bone Joint Surg Br 71:752-755, 1989.

3. Caffey J. Pediatric X-ray diagnosis: ihtegratedimaging approach. 9th edn. Mosby St Louis, pp.1813-1817, 1993.

4. Hurst. Cardiovascular syphilis. The Çeart.85:2284-2285, 1990.

5. Fisher RH, Kaplan J, Holder JC. Congenitalsyphilis mimicking the battered child syndrome,how does one tell them apart? Clin Pediatr,11:305-307, 1972.

6. Horodniceanu C, Grunebum M, Volovitz B,Nitzan M. Unusual bone involve- ment in con-genital syphilis mimicking the battered childsyndrome. Pediatr Radiol, 7:232-234, 1978.

7. Gurry DL, Porter PA, Evans DTP. Congenitalsyphilis: when the medium fails to transmit themessage.Med J Aust, 159:121-124, 1993.

8. Caffey J. Some traumatic lesions in growingbones other than fractures and dislocations, clin-ical and radiological features. Br J Radiol, 30:225-238, 1957.

9. Solomon A, Rosen E. The aspect of trauma inthe bone changes of congenital lunes. PediatrRadiol, 3:176-178, 1975.

ÓõæÞôçóç

Ç óõ÷íüôçôá ôçò óõããåíïýò óýöéëçò óôéòáíáðôõãìÝíåò ÷þñåò ìåéþèçêå óçìáíôéêÜ ìåôÜôç èåñáðåõôéêÞ åéóáãùãÞ ôçò ðåíéêéëßíçò. ¼ìùòç ðñüóöáôç áýîçóç ôçò åðßðôùóçò ôçò íüóïõãéá ôïõò ëüãïõò ðïõ ðñïáíáöÝñèçêáí, óôïí ðëç-èõóìü ôùí íåïãÝííçôùí, èá ðñÝðåé íá åãåßñåé ôçíõðïøßá ôçò óõããåíïýò ëïéìþîåùò ôüóï óôïí êëé-íéêü üóï êáé ôïí ïéêïãåíåéáêü Éáôñü.

Ïé êáëÜ ôåêìçñéùìÝíåò åðéðëïêÝò ôçò óõã-ãåíïýò óýöéëçò óôá ïóôÜ ðåñéëáìâÜíïõí ôç äéá-öõóßôéäá, ôç ìåôáöõóßôéäá êáé ôá ðïëëáðëÜ ðá-èïëïãéêÜ êáôÜãìáôá. ×áñáêôçñéóôéêüôáôï áêôé-íïëïãéêü åýñçìá áðïôåëåß ç áìöïôåñüðëåõñç äéÜ-÷õôç óõììåôñéêÞ óêåëåôéêÞ ðñïóâïëÞ.2 ¼ìùò, çóùóôÞ äéÜãíùóç ãßíåôáé äýóêïëç üôáí ç êëáóéêÞåìöÜíéóç ôçò óõììåôñéêÞò ïóôåïðåñéïóôßôéäáò åß-íáé áðïýóá Þ õðïåêôéìçèåß.

Ôá áêôéíïëïãéêÜ åõñÞìáôá óõã÷Ýïíôáé åýêï-ëá ìå áõôÜ ôçò ðáéäéêÞò êáêïðïßçóçò, üðïõ ïéäéáãíùóôéêÝò âëÜâåò üðùò ôï ìïíÞñåò Þ ôá ðïë-ëáðëÜ êáôÜãìáôá óå äéáöïñåôéêü óôÜäéï ðùñü-óåùò, ìå ðñïåîÝ÷ïõóá ôçí ðåñéïóôéêÞ áíôßäñáóç,ðáñïõóéÜæïõí ðñïôßìçóç óôéò ìåôáöýóåéò.3 ÔáêáôÜãìáôá ôùí äéáöýóåùí åßíáé ëéãüôåñï óõ÷íÜáðü ôá ìåôáöõóéáêÜ êáôÜãìáôá.

Óôéò ðåñéóóüôåñåò ðåñéðôþóåéò ç äéÜãíùóçôçò êáêïðïßçóçò Ýãêåéôáé óôïí õøçëü âáèìüõðüíïéáò êáôÜ ôç äéÜñêåéá ôçò åîÝôáóçò. Áêôé-íïëïãéêÝò âëÜâåò ôçò ðáéäéêÞò êáêïðïßçóçò ìðï-ñåß íá ïìïéÜæïõí ì’ áõôÝò ôçò óõããåíïýò óýöéëçòóôçí ðåñßðôùóç ôùí äéáöõóéêþí âëáâþí. ÓôçóõããåíÞ óýöéëç ôá êáôÜãìáôá ðáñïõóéÜæïíôáéóôéò ìåôáöýóåéò, óðÜíéá ç äéÜöõóç åíüò ìáêñïýïóôïý åìöáíßæåé êÜôáãìá.

Ï ìéêñüò áóèåíÞò Þôáí áóõìðôùìáôéêüò áðüôç ãÝííçóç Ýùò ôçí çëéêßá ôùí äýï ìçíþí. ÇÝëëåéøç áõîçìÝíçò õðïøßáò, ç ðáñïõóßá åôåñü-ðëåõñçò ëýóçò ôçò ïóôéêÞò óõíÝ÷åéáò óå ìáêñüïóôü, ç õðïåêôßìçóç ôçò õðïðåñéïóôéêÞò áíôé-äñÜóåùò áëëÜ êáé ôùí õðïëïßðùí öëåãìïíùäþíåõñçìÜôùí, Þôáí ïé ëüãïé ðïõ ïäÞãçóáí áñ÷éêÜ


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ÏÄÇÃÉÅÓ ÃÉÁ ÔÏÕÓ ÓÕÃÃÑÁÖÅÉÓ

INSTRUCTIONS FOR THE AUTHORS

Ç "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äÝ÷åôáé ãéá äçìïóßåõóç êåßìåíá Åðéóôçìüíùí Õãåßáò, ôá ïðïßá êáôáôÜó-óïíôáé óôéò åîÞò êáôçãïñßåò: 1) ÅñåõíçôéêÝò åñãáóßåò Þ áíáóêïðÞóåéò (óýíôïìåò äçìïóéåýóåéò) Ýêôáóçò ìÝ÷ñé 7óåëßäåò ìå ðñüóöáôåò ü÷é Üíù áðü 5 âéâëéïãñáöéêÝò ðçãÝò, 2) ÅíçìåñùôéêÜ Üñèñá, 3) Óýíôïìá Üñèñá, 4)ÁíáöïñÝò ðåñéðôþóåùí, 5) ÐáñïõóéÜóåéò ÊÝíôñùí Õãåßáò. ¸íá óýíïëï êåéìÝíùí, ðïõ áöïñïýí Ýíá óõãêåêñéìÝíïãíùóôéêü ôïìÝá ôçò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò, ìðïñåß íá óõãêñïôåß ÁöéÝñùìá. Åêôüò ôùí êåéìÝíùí ðïõáíáöÝñïíôáé óôéò ðáñáðÜíù êáôçãïñßåò óôçí "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äçìïóéåýïíôáé êáé Üñèñá ôçòÓõíôáêôéêÞò ÅðéôñïðÞò, êáèþò êáé êåßìåíá ðïõ áðïóêïðïýí óôçí ðáñïõóßáóç, ó÷ïëéáóìü êáé êñéôéêÞ áîéïëüãç-óç óõãêåêñéìÝíùí ãåãïíüôùí, Üñèñùí êáé åêäüóåùí ó÷åôéêþí ìå ôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, óôçíÅëëÜäá êáé óôï åîùôåñéêü. Ôçí åõèýíç ôçò óõããñáöÞò ôùí Üñèñùí áõôþí Þ êåéìÝíùí Ý÷ïõí ìüíï ôá ìÝëç ôçòÓõíôáêôéêÞò ÅðéôñïðÞò Þ åðéóôÞìïíåò ìåôÜ áðü åéäéêÞ ðñüóêëçóç. Åðßóçò óôçí "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò"äçìïóéåýïíôáé êáé ãñÜììáôá ðïõ áðåõèýíïíôáé óôçí ÓõíôáêôéêÞ ÅðéôñïðÞ, ôá ïðïßá áíáöÝñïíôáé óå ðáñáôçñÞ-óåéò, êëéíéêÝò êáé åñåõíçôéêÝò åìðåéñßåò Þ ó÷ïëéÜæïõí ôç äéåèíÞ êáé åëëçíéêÞ âéâëéïãñáößá. Ôçí åõèýíç ãéá ôçäçìïóßåõóç ôùí êåéìÝíùí áõôþí Ý÷åé ï ÄéåõèõíôÞò Óýíôáîçò êáé ç ÓõíôáêôéêÞ ÅðéôñïðÞ.

Ïé åñåõíçôéêÝò åñãáóßåò, ôá åíçìåñùôéêÜ Üñèñá, ïé óýíôïìåò äçìïóéåýóåéò êáé ïé áíáöïñÝò ðåñéóôáôéêþíãßíïíôáé äåêôÜ ãéá äçìïóßåõóç ìüíï ìåôÜ áðü èåôéêÞ êñßóç ôïõò áðü åðéóôÞìïíåò-êñéôÝò ìå ôïõò ïðïßïõòóõíåñãÜæåôáé ôï ðåñéïäéêü. ÊÜèå êåßìåíï ðïõ áðïóôÝëëåôáé óôçí "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äéáâéâÜæåôáéóôïõò êñéôÝò, ÷ùñßò íá ãíùóôïðïéïýíôáé ôá ïíüìáôá ôùí óõããñáöÝùí. Ôá ó÷üëéá êáé ïé ðáñáôçñÞóåéò ôùí êñéôþíóôç óõíÝ÷åéá, ìå ôçí åõèýíç ôçò Ãñáììáôåßáò Óýíôáîçò ôïõ ðåñéïäéêïý, åðéóôñÝöïíôáé óôïõò óõããñáöåßò, ðñïêåé-ìÝíïõ áõôïß íá ðñïóáñìüóïõí áíÜëïãá ôï êåßìåíü ôïõò ðñéí ôç äçìïóßåõóç. Óå ðåñßðôùóç áóõìöùíßáò ôùíêñéôþí, ôï êåßìåíï èá áîéïëïãåßôáé áðü ôçí ßäéá ôç ÓõíôáêôéêÞ ÅðéôñïðÞ. Ôá ïíüìáôá üëùí ôùí åðéóôçìüíùíðïõ äéåôÝëåóáí êñéôÝò èá äçìïóéåýïíôáé óå åéäéêÞ óåëßäá óôï ôåëåõôáßï ôåý÷ïò êÜèå ÷ñüíïõ.

Ôá êåßìåíá, ôá ïðïßá äÝ÷åôáé ç "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò", èá ðñÝðåé íá áêïëïõèïýí ôéò ðáñáêÜôùðñïäéáãñáöÝò.

• Íá åßíáé ãñáììÝíá óôçí åðßóçìç äçìïôéêÞ ãëþóóá êáé ìå ôï ìïíïôïíéêü óýóôçìá, äáêôõëïãñáöçìÝíá óôçìéá üøç ôçò óåëßäáò, óå äéðëü äéÜóôçìá êáé ìå ëåõêü ðåñéèþñéï 3 åêáôïóôþí óå üëåò ôéò ðëåõñÝò ôïõò.

• Ç ðñþôç óåëßäá ôïõ êåéìÝíïõ ðñÝðåé íá ðåñéëáìâÜíåé: á) ôïí ôßôëï (ìå ðåæÜ ãñÜììáôá), â) ôá ïíüìáôá ôùíóõããñáöÝùí (ìå êåöáëáßá ãñÜììáôá åíþ áíáãñÜöïíôáé ôá áñ÷éêÜ ôùí ïíïìÜôùí êáé ôá ðëÞñç åðþíõìá ìåáñéèìçôéêïýò åêèÝôåò ïé ïðïßïé óå õðïóçìåßùóç ðáñïõóéÜæïõí ôçí éäéüôçôá ôïõ êÜèå óõããñáöÝá), ã) ôïåðéóôçìïíéêü êÝíôñï óôï ïðïßï Ýãéíå ç åñãáóßá, ä) 3-5 ðñüóèåôïõò üñïõò ó÷åôéêÜ ìå ôï èÝìá êáé ïé ïðïßïéåßíáé õéïèåôçìÝíïé áðü ôï Medical Subject Headings (Bethesda Md, 1966), å) ôç äéåýèõíóç êáé ôï ôçëÝöùíïåíüò áðü ôïõò óõããñáöåßò, ï ïðïßïò èá åßíáé õðåýèõíïò ãéá ôçí áëëçëïãñáößá ìå ôï ðåñéïäéêü.

• Óå îå÷ùñéóôÞ äåýôåñç óåëßäá ðñÝðåé íá ãñÜöåôáé ç åëëçíéêÞ ðåñßëçøç ôïõ êåéìÝíïõ (ðñïçãåßôáé ç ÝíäåéîçÐÅÑÉËÇØÇ), ç ïðïßá äå èá ðñÝðåé íá Ý÷åé Ýêôáóç ìåãáëýôåñç ôùí 300 ëÝîåùí.

• ÌåôÜ ôï êåßìåíï óå îå÷ùñéóôÞ óåëßäá èá ðñÝðåé íá ãñÜöåôáé ç áããëéêÞ ðåñßëçøç ôïõ êåéìÝíïõ, ç ïðïßá äåèá ðñÝðåé íá Ý÷åé Ýêôáóç ìåãáëýôåñç ôùí 300 ëÝîåùí. Ðñïçãïýíôáé ç ëÝîç SUMMARY, ç áããëéêÞ ìåôÜöñá-óç ôïõ ôßôëïõ, ïé ëÝîåéò PRIMARY HEALTH CARE... êáé ôá ïíüìáôá ôùí óõããñáöÝùí ÷ùñßò ôßôëï Þéäéüôçôá.

• Ïé âéâëéïãñáöéêÝò ðáñáðïìðÝò, åëëçíéêÝò êáé îÝíåò, óôï êåßìåíï èá ðñÝðåé íá åßíáé ðñüóöáôåò, áðüáíáãíùñéóìÝíá ðåñéïäéêÜ Þ óõããñÜììáôá, íá åßíáé áñéèìçìÝíåò êáé í’ áíôáðïêñßíïíôáé óôï âéâëéïãñáöéêüêáôÜëïãï, ï ïðïßïò èá ðñÝðåé íá ãñÜöåôáé óå îå÷ùñéóôÞ óåëßäá ìåôÜ ôï ãñÜøéìï ôçò áããëéêÞò ðåñßëçøçò.Óôï âéâëéïãñáöéêü êáôÜëïãï ïé ðáñáðïìðÝò èá ðñÝðåé í’ áêïëïõèïýí ôç óåéñÜ ìå ôçí ïðïßá ðáñïõóéÜóôç-êáí óôï êåßìåíï. ÊáèåìéÜ áðü áõôÝò èá ðñÝðåé íá ðåñéÝ÷åé óôç óåéñÜ ôá áñ÷éêÜ ôùí ïíïìÜôùí êáé ôáåðþíõìá ôùí óõããñáöÝùí, ôïí ôßôëï ôçò åñãáóßáò, ôï üíïìá ôïõ ðåñéïäéêïý óýìöùíá ìå ôï óýóôçìá ôçòWHOCISO/R4), ôïí ôüìï, ôçí ðñþôç êáé ôçí ôåëåõôáßá óåëßäá ôïõ Üñèñïõ, êáèþò êáé ôï Ýôïò äçìïóßåõóçò.¼ôáí ðñüêåéôáé ãéá óõããñÜììáôá Þ ìïíïãñáößåò, åêôüò áðü ôïõò óõããñáöåßò, ôï Ýôïò Ýêäïóçò êáé ôïíôßôëï, ðñÝðåé íá ãñÜöïíôáé êáé ï áñéèìüò êáé ôá óôïé÷åßá Ýêäïóçò (åêäïôéêüò ïßêïò, ðüëç).(õðüäåéãìá âéâëéïãñáößáò: Biziagos E, Moschandrea J, Kouroumalis ÅÁ. Prevalence of hepatitis Â and Cmarkers in volunteer blood donors in Crete. A 5-year study. J Viral Hepat, 6:243-8, 1999.).

• Ïé ðßíáêåò êáé ôá ó÷Þìáôá áêïëïõèïýí ôï âéâëéïãñáöéêü êáôÜëïãï êáé èá ðñÝðåé íá ðáñïõóéÜæïíôáé óå÷ùñéóôÝò óåëßäåò, íá öÝñïõí ëáôéíéêÞ áñßèìçóç, ç ïðïßá èá ðñÝðåé í’ áíôáðïêñßíåôáé óôéò ðáñáðïìðÝò ôïõêåéìÝíïõ, êáèþò êáé ôéò áðáñáßôçôåò åðåîçãÞóåéò.

• 'Ïëá ôá êåßìåíá èá ðñÝðåé íá õðïâÜëëïíôáé êáôÜ ðñïôßìçóç ìå êåéìåíïãñÜöï word óå äýï áíôßôõðá êáé íááðïóôÝëëïíôáé óôç äéåýèõíóç ôïõ ÄéåõèõíôÞ Óýíôáîçò:- ÐáíåðéóôÞìéï ÊñÞôçò (õðüøç Åðßêïõñïõ ÊáèçãçôÞ ×. ËéïíÞ), ÔïìÝáò ÊïéíùíéêÞò ÉáôñéêÞò, Ô.È. 1393,ÇñÜêëåéï ÊñÞôçò.Ïé óõããñáöåßò ìðïñïýí íá õðïâÜëëïõí ôá êåßìåíá ôïõò êé óå çëåêôñïíéêÞ ìïñöÞ óôç äéåýèõíóç:[email protected]Ïé óõããñáöåßò èá ðñÝðåé íá äåóìåýïíôáé óôçí åðéóôïëÞ ôïõò üôé ç åñãáóßá äåí Ý÷åé õðïâëçèåß Þ äåí Ý÷åé

äçìïóéåõèåß åí üëù Þ åí ìÝñåé óå Üëëï ðåñéïäéêü, üôé üëïé ïé óõããñáöåßò åéíáé óýìöùíïé ìå ôçí áðïóôïëÞ ôçò êáéóå ðåñßðôùóç áðïäï÷Þò ôçò ãéá äçìïóßåõóç, ôá óõããñáöéêÜ äéêáéþìáôá åê÷ùñïýíôáé óôï ðåñéïäéêü. Ç Óõíôáêôé-êÞ ÅðéôñïðÞ äéáôçñåß ôï äéêáßùìá áðïóýñóåùò ìéáò åñãáóßáò åöüóïí áõôÞ Ý÷åé óôáëåß êáé ó' Üëëï ðåñéïäéêü.

Ðáñáããåëßá áíáôýðùí

Ïé áíáãíþóôåò ôçò "ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò", Ãåíéêïß Ãéáôñïß, ïé ïðïßïé åðéèõìïýí íáÝ÷ïõí óå áíÜôõðá êÜðïéï Þ êÜðïéá áðü ôá äçìïóéåõüìåíá óôï ôåý÷ïò Üñèñá, ìðïñïýí íá ðáñáãÝë-ëïõí ôïí áñéèìü ôùí áíôéôýðùí óôï "Ôå÷íüãñáììá" (ç äéåýèõíóç êáé ôá ôçëÝöùíá äçìïóéåýïíôáé óôïêÜôù ìÝñïò äåîéÜ ôïõ ðßíáêá).

Ïé ôéìÝò ãéá êÜèå áñéèìü áíôéôýðùí ðáñáôßèåíôáé óôïí êáôùôÝñù ðßíáêá.

ÁíÜôõðá Óåëßäåò/Êüóôïò Óåëßäåò/Êüóôïò Óåëßäåò/Êüóôïò

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