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Primary Health Care Ôñéìçíéáßá ¸êäïóç ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞò Quarterly edited by the Greek Association of General Practitioners Ôüìïò 12, Ôåý÷ïò 3, Éïýëéïò - ÓåðôÝìâñéïò 2000, Volume 12, Number 3, July - September 2000

Ôçò Óýíôáîçò

Å. Èçñáßïò: 12Ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò .................................................................... 113

Âñáâåõèåßóá Åñãáóßá óôï Äéáãùíéóìü “Ä. ºêêïõ”

Â. ÓéäåñÞò, ËáìðñéíÞ ÓïõìÜêç, Í. ÑáæÞò: ÁíÜëõóç êáé áîéïëüãçóç ÷áñáêôçñéóôéêþí ôùí ðåñéëÞøåùí óôá ÐáíåëëÞíéá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò (1989-99) ................................ 115

Åðáéíåèåßóåò Åñãáóßåò óôï Äéáãùíéóìü “Ä. ºêêïõ”

Å. Ìé÷áçëßäçò, È. ÐÝððáò, Á. Óùôçñüðïõëïò, Áë. ÐëáôáíÜ, Á. Áóðñïðïôáìßôç, Â. Âëá÷üðïõëïò, É. ÐáñáóêåõáÀäçò, ×. ÊáììéëÜôïò, Ó. ÐáððÜò: ÉáôñïãåíÞò íïóçñüôçôá öáñìáêåõôéêÞò áéôéïëïãßáò ùò áßôéï åéóáãùãÞò óå ðáèïëïãéêü ôìÞìá ôñéôïèÜèìéïõ íïóïêïìåßïõ ...................................................................................................................... 125 Å.Á. Óêëçñüò, ÅéñÞíç Êôþñïõ, Á. Óùôçñüðïõëïò, Ìáñßá ÌÜãêïõ, Ã. Óåâáóôüò, Ïõñáíßá Áðïóôüëïõ, ÅéñÞíç Ðáðáäçìçôñßïõ, ×. ÊáììéëÜôïò, Áëßêç ÆåñâÜêç: ÌåëÝôç ôçò áñôçñéáêÞò ðßåóçò óå áãñïôéêü ðëçèõóìü. Åðéðïëáóìüò êáé ñýèìéóç õðÝñôáóçò ......................................................................................................................................................................... 132

Âñáâåõèåßóåò Åëåýèåñåò Áíáêïéíþóåéò

Óô. Öùôïðïýëïõ, Ã.×ñ. ÓðáèáñÜêçò, Ê. Ðïíôßêçò: ×ñÞóç ôçò äïêéìáóßáò êáôÜ ÐáðáíéêïëÜïõ óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. Ç åìðåéñßá ôïõ Ê.Õ. Áñéäáßáò ........ 138 Ê.Ê. ÊõñéáæÜôçò, Ö. Êïõëïýñá, Ï. Ñùìáíïý, ×ñ. ÊïõíôïõñÜêç, Ì. ÄåëçãéÜííç: ¢óèìá óå ðáéäéÜ ôï 1999 óôï Å.É. ÐáéäéáôñéêÞò Ã.Í.Í. ×áëêßäáò. Ñüëïò ôïõ Ãåíéêïý Éáôñïý ....................................................................................................................................... 145 Ó. ÁñãõñéÜäïõ, ×. Ìåëéóóïðïýëïõ, ×. ËõãéäÜêçò, Ë. ×Ýëçò, Ì. Ãáôïýëá, Ä. ÊáìéíÜñç: Ç ìÝèïäïò ÷ñÞóçò çìåñïëïãßïõ óáí áñ÷Þ èåñáðåõôéêÞò ðñïóÝããéóçò áóèåíþí ìå øõ÷éêÝò äéáôáñá÷Ýò óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò ......................................................... 151

ÃñÜììáôá óôïí Åêäüôç

Ðçíåëüðç Ìáíïýóïõ, Êùíóôáíôßíá ÌùñáÀôç: Ç Üðïøç ôùí öïéôçôþí ÉáôñéêÞò ôïõ Ðáíåðéóôçìßïõ Éùáííßíùí ãéá ôç ÃåíéêÞ ÉáôñéêÞ ............................................................................. 159

ÅÍÔÕÐÏ ÊËÅÉÓÔÏ ÁÑÉÈ. ÁÄÅÉÁÓ 451/91 ÊÄÁ ÅËËÇÍÉÊÇ ÅÔÁÉÑÅÉÁ ÃÅÍÉÊÇÓ ÉÁÔÑÉÊÇÓ ÐïôáìéÜíïõ 20, 115 28 ÁÈÇÍÁ

ISSN 1105-7432


ÐÅÑÉÅ×ÏÌÅÍÁ

ÐÅÑÉÏÄÉÊÏ

ÐÑÙÔÏÂÁÈÌÉÁ ÖÑÏÍÔÉÄÁ Ôñéìçíéáßá ¸êäïóç ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞò Ôüìïò 12, Ôåý÷ïò 3, Éïýëéïò - ÓåðôÝìâñéïò 2000 PRIMARY HEALTH CARE Quarterly edited by the Greek Association of General Practitioners

Ôçò Óýíôáîçò Å. Èçñáßïò: 12Ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò .............................................................................................. 113 Âñáâåõèåßóá Åñãáóßá óôï Äéáãùíéóìü “Ä. ºêêïõ” Â. ÓéäåñÞò, ËáìðñéíÞ ÓïõìÜêç, Í. ÑáæÞò: ÁíÜëõóç êáé áîéïëüãçóç ÷áñáêôçñéóôéêþí ôùí ðåñéëÞøåùí óôá ÐáíåëëÞíéá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò (1989-99) ............................................................ 115 Åðáéíåèåßóåò Åñãáóßåò óôï Äéáãùíéóìü “Ä. ºêêïõ” Å. Ìé÷áçëßäçò, È. ÐÝððáò, Á. Óùôçñüðïõëïò, Áë. ÐëáôáíÜ, Á. Áóðñïðïôáìßôç, Â. Âëá÷üðïõëïò, É. ÐáñáóêåõáÀäçò, ×. ÊáììéëÜôïò, Ó. ÐáððÜò: ÉáôñïãåíÞò íïóçñüôçôá öáñìáêåõôéêÞò áéôéïëïãßáò ùò áßôéï åéóáãùãÞò óå ðáèïëïãéêü ôìÞìá ôñéôïèÜèìéïõ íïóïêïìåßïõ ................................................................ 125 Å.Á. Óêëçñüò, ÅéñÞíç Êôþñïõ, Á. Óùôçñüðïõëïò, Ìáñßá ÌÜãêïõ, Ã. Óåâáóôüò, Ïõñáíßá Áðïóôüëïõ, ÅéñÞíç Ðáðáäçìçôñßïõ, ×. ÊáììéëÜôïò, Áëßêç ÆåñâÜêç: ÌåëÝôç ôçò áñôçñéáêÞò ðßåóçò óå áãñïôéêü ðëçèõóìü. Åðéðïëáóìüò êáé ñýèìéóç õðÝñôáóçò ............................. 132 Âñáâåõèåßóåò Åëåýèåñåò Áíáêïéíþóåéò Óô. Öùôïðïýëïõ, Ã.×ñ. ÓðáèáñÜêçò, Ê. Ðïíôßêçò: ×ñÞóç ôçò äïêéìáóßáò êáôÜ ÐáðáíéêïëÜïõ óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. Ç åìðåéñßá ôïõ Ê.Õ. Áñéäáßáò ..................................................................... 138 Ê.Ê. ÊõñéáæÜôçò, Ö. Êïõëïýñá, Ï. Ñùìáíïý, ×ñ. ÊïõíôïõñÜêç, Ì. ÄåëçãéÜííç: ¢óèìá óå ðáéäéÜ ôï 1999 óôï Å.É. ÐáéäéáôñéêÞò Ã.Í.Í. ×áëêßäáò. Ñüëïò ôïõ Ãåíéêïý Éáôñïý ...................................................... 145 Ó. ÁñãõñéÜäïõ, ×. Ìåëéóóïðïýëïõ, ×. ËõãéäÜêçò, Ë. ×Ýëçò, Ì. Ãáôïýëá, Ä. ÊáìéíÜñç: Ç ìÝèïäïò ÷ñÞóçò çìåñïëïãßïõ óáí áñ÷Þ èåñáðåõôéêÞò ðñïóÝããéóçò áóèåíþí ìå øõ÷éêÝò äéáôáñá÷Ýò óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò .................................................................................... 151 ÃñÜììáôá óôïí Åêäüôç Ð. Ìáíïýóïõ, Ê. ÌùñáÀôç: Ç Üðïøç ôùí öïéôçôþí ÉáôñéêÞò ôïõ Ðáíåðéóôçìßïõ Éùáííßíùí ãéá ôç ÃåíéêÞ ÉáôñéêÞ ......................................................................................................................................................................... 159

Volume 12, Number 3, July - September 2000 ISSN 1105-7432 ÅÊÄÏÔÇÓ:

ÌðïäïóÜêçò-Ðñüäñïìïò Ìåñêïýñçò

ÄÉÏÉÊÇÔÉÊÏ ÓÕÌÂÏÕËÉÏ Ðñüåäñïò ÌðïäïóÜêçò-Ðñüäñïìïò Ìåñêïýñçò Áíôéðñüåäñïò Á Êþóôáò ÌùñáÀôçò Áíôéðñüåäñïò  Áíôþíçò Êáñüôóçò Ãåíéêüò ÃñáììáôÝáò-Ôáìßáò ÁèáíÜóéïò Óõìåùíßäçò ÌÝëç ÐçãÞ ÐåñäéêÜêç ÓôÜèçò Óêëçñüò ÌÜñéïò ×áôæçáñóÝíçò

CONTENTS Editorial Å. Ôhireos: 12th National Congress on General Practice ............................................................................................... 113 Awarded Paper in the Memory of Prof. D. Ikkos V. Sideris, L. Soumaki, N. Razis: Analysis and evaluation of major features of presentations given at Hellenic General Practitioners Congresses (1989-99) ................................................................................. 115 The Second Awarded Papers in the Memory of Prof. D. Ikkos E. Michailidis, Th. Peppas, A. Sotiropoulos, Al. Platana, A. Aspropotamiti, V. Vlachopoulos, I. Paraskevaidis, Ch. Kammilatos, S. Pappas: Drug induced illness leading to hospitalization .................. 125 E.A. Skliros, Irine Ktorou, A. Sotiropoulos, Marie Magkou, G. Sevastos, Ourania Apostolou, Irine Papadimitriou, C. Kamilatos, Aliki Zervaki: Study of hypertension in a rural population. Prevalence and control of hypertension .................................................................................................................................. 132 Awarded Freestanding Papers St. Photopoulou, G.C. Spatharakis, C. Pontikis: Use of the PAP smear test in the primary health care setting - The Experience of the Health Center of Aridaia, Greece ............................................... 138 K.K. Kiriazatis, F. Kouloura, O. Romanou, Ch. Kountouraki, M. Deliyianni: Asthma among children who visited outpatient's department of the General Hospital of Chalkis in 1999 Role of General Practitioner ........................................................................................................................................................... 145 St. Argyriadou, H. Melissopoulou, H. Lygidakis, L. Chelis, M. Gatoula, D. Kaminari: Using diary as approaching therapeutic tool in patients with mood disorders in Primary Health Care ........................ 151 Letters to the Editor P. Manoussou, K. Moraiti: Views of medical students of the University of Ioannina on General Practice ............................................................................................................................................................................ 159

Executive Board of the Greek Association of General Practitioner President Bodosakis-Prodromos Merkouris Vice-President A Kostas Moraitis Vice-President B Antonis Karotsis General Secretary Treasurer Athanasios Symeonidis Members Marios Chatziarsenis Pigi Perdikaki Stathis Skliros

ÄéåõèõíôÞò Óýíôáîçò ×ñÞóôïò ËéïíÞò ÔìÞìá ÉáôñéêÞò ÐáíåðéóôÞìéï ÊñÞôçò Ô.È. 1393, ÇñÜêëåéï Ôçë: +30 81 39 46 21 Fax: +30 81 39 46 06 E-mail: lionis@med.uoc.gr Âïçèïß Óýíôáîçò ÅëåõèÝñéïò Èçñáßïò Êïñíçëßá ÌáêñÞ ÓõíôáêôéêÞ ÅðéôñïðÞ ÓôÝëëá ÁñãõñéÜäïõ ÂáããÝëçò Äñüóïò ÄçìÞôñçò ¸ëëçíáò ÐçãÞ ÐåñäéêÜêç ÁèáíÜóéïò Óõìåùíßäçò

Chief Editor Christos Lionis Faculty of Medicine University of Crete P.O. Box 1393, Heraklion Tel: +30 81 39 46 21 Fax: +30 81 39 46 06 E-mail: lionis@med.uoc.gr Assistants to the Editor Åleftherios Thireos Kornilia Makri Editorial Board Stella Argyriadou Vaggelis Drossos Dimitris Hellinas Pigi Perdikaki Athanasios Symeonidis


Ôüìïò 12, Ôåý÷ïò 3, 2000

Å. Èçñáßïò

ÔÇÓ ÓÕÍÔÁÎÇÓ EDITORIAL Primary Heatlh Care, Volume 12, Number 3, 113-114, 2000 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 12, Ôåý÷ïò 3, 113-114, 2000

12ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò* Å.Á. Èçñáßïò

Ôï 12ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò, ìå êáèõóôÝñçóç 5 ìçíþí, ðñáãìáôïðïéÞèçêå óôï îåíïäï÷åéáêü óõãêñüôçìá ¢èùò-ÐáëëÞíç, óôç ×áëêéäéêÞ, áðü 15-19 Ïêôùâñßïõ 2000. Ç áíáâïëÞ ôïõ óõíåäñßïõ êáé ç ìåôÜèåóç ôïõ áðü ôçí äåýôåñç åâäïìÜäá ôïõ ÐÜó÷á, åß÷å óáí óõíÝðåéá áñêåôïß óõíÜäåëöïé íá ìçí ìðïñÝóïõí íá Ý÷ïõí óõíå÷Þ ðáñïõóßá óôéò åñãáóßåò ôïõ, åíþ ç óõììåôï÷Þ éáôñþí Üëëùí åéäéêïôÞôùí äåí Þôáí áõôÞ ðïõ ãíùñßóáìå óå ðñïçãïýìåíá óõíÝäñéá. Áîéïóçìåßùôç Þôáí êáé åöÝôïò ç óõììåôï÷Þ ôùí åéäéêåõïìÝíùí ÃåíéêÞò ÉáôñéêÞò êáé ãüíéìïò ï ðñïâëçìáôéóìüò ðïõ êáôÝèåóáí ôüóï ãéá èÝìáôá åêðáßäåõóçò üóï êáé ãåíéêüôåñá ãéá ôçí ðïñåßá êáé ôçò ðñïïðôéêÝò ôçò ÃåíéêÞò ÉáôñéêÞò óôçí ÅëëÜäá. ÌåôÜ ôïõò ÷áéñåôéóìïýò êáé ôéò ðñïóöùíÞóåéò êáôÜ ôçí åíáñêôÞñéá ôåëåôÞ, áêïëïýèçóå ç åíáñêôÞñéá äéÜëåîç ðïõ, üðùò åßèéóôáé, Þôáí ïé âñáâåõèåßóåò åñãáóßåò ìå ôï âñáâåßï "Ä. ºêêïõ" óôï 11ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò. Ðñþôç ïìéëÞôñéá Þôáí ç êá. ÓôÝëëá ÁñãõñéÜäïõ, ìå èÝìá: "Äéáôáñá÷Ýò âÜäéóçò êáé çëéêéùìÝíïé: Ýãêáéñç äéÜãíùóç, êëåéäß óôçí ðñüëçøç ôçò áíáðçñßáò" êáé áêïëïýèçóå ç ïìéëßá ôïõ ê. Áíôþíç Ìðáôßêá ìå èÝìá: "Áíß÷íåõóç áõôïáíôéóùìÜôùí óå áóèåíåßò ìå ÷ñüíéá çðáôßôéäá C". Ïé åñãáóßåò ôçò ðñþôçò çìÝñáò Ýêëåéóáí ìå ôç óôñïããõëÞ ôñÜðåæá ìå èÝìá: "Ç ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò ùò èåìÝëéï ôçò õãåéïíïìéêÞò ìåôáññýèìéóçò", ìå óõíôïíéóôÞ ôïí Ðñüåäñï ôçò ÅËÅÃÅÉÁ ê. Ì. Ìåñêïýñç êáé åéóçãçôÝò ôïí ÊáèçãçôÞ óôïí ÔïìÝá Ïéêïíïìéêþí ôçò Õãåßáò ôçò ÅèíéêÞò Ó÷ïëÞò Äçìüóéáò Õãåßáò ê. É. Êõñéüðïõëï, ôïí ÁíáðëçñùôÞ ÊáèçãçôÞ ê. Á. ÖéëáëÞèç êáé ôïí Åðß* 15-19 Ïêôùâñßïõ 2000, Îåíïäï÷åßï ¢èùò-ÐáëëÞíç, ×áëêéäéêÞ

êïõñï ÊáèçãçôÞ ê. ×. ËéïíÞ áðü ôïí ÔïìÝá ÊïéíùíéêÞò ÉáôñéêÞò ôïõ Ðáíåðéóôçìßïõ ÊñÞôçò êáé ôïí åêðñüóùðï ôçò ÁÄÅÄÕ ê. Ó. Ðáðáóðýñï. Ç óõãêõñßá ôçò äçìïóéïðïßçóçò ôïõ ó÷åäßïõ ãéá ôéò ìåôáññõèìßóåéò óôçí Õãåßá áðü ôïí áñìüäéï Õðïõñãü êáé ï ðñïâëçìáôéóìüò ðïõ õðÜñ÷åé äéåèíþò ãéá ôïí åðáíáðñïóäéïñéóìü ôçò ÃåíéêÞò ÉáôñéêÞò êáé ôïõ ñüëïõ ôçò óôá ðëáßóéá ôçò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò, Ýäùóå áöïñìÞ ãéá éäéáßôåñá óçìáíôéêÝò ôïðïèåôÞóåéò áðü ôïõò åéóçãçôÝò êáé åíäéáöÝñïõóåò åðéóçìÜíóåéò áðü ôï áêñïáôÞñéï. ¼óïí áöïñÜ óôï õðüëïéðï åðéóôçìïíéêü ðñüãñáììá ôïõ óõíåäñßïõ, áõôü ðåñéåëÜìâáíå: 11 óôñïããõëÝò ôñÜðåæåò, 3 äéáëÝîåéò, 236 åëåýèåñåò áíáêïéíþóåéò êáé 124 áíáñôçìÝíåò áíáêïéíþóåéò (poster). Èá ðñÝðåé íá óçìåéþóïõìå üôé õðïâëÞèçêáí óõíïëéêÜ 445 åëåýèåñåò áíáêïéíþóåéò, áñéèìüò åîáéñåôéêÜ ìåãÜëïò ãéá ôá äåäïìÝíá ôïõ óõíåäñßïõ. ÊáôÜ ôç äéáäéêáóßá êñßóåùò ôùí õðïâëçèåéóþí åñãáóéþí, ðïõ Ýãéíå áðü ìÝë�� ôçò ÅðéôñïðÞò ¸ñåõíáò ôçò ÅËÅÃÅÉÁ, êáôáâëÞèçêå ðñïóðÜèåéá êáèïñéóìïý ôïõ ðëáéóßïõ äéåíÝñãåéáò ôùí êñßóåùí êáé êáèïñßóôçêáí êñéôÞñéá áîéïëüãçóçò ôùí åñãáóéþí ðïõ åêôéìïýóáí ôüóï ôçí ðïéüôçôá ðáñïõóßáóçò ôïõ èÝìáôïò ôçò åñãáóßáò êáé ôçí óõììüñöùóç ôïõ óõããñáöÝá ðñïò ôéò ïäçãßåò óõããñáöÞò, üóï êáé ôçí óõíÜöåéá ôïõ èÝìáôïò ìå ôçí åéäéêüôçôá ôçò ÃåíéêÞò ÉáôñéêÞò êáé ôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. Ìå ôçí åìðåéñßá áõôÞ ôùí êñßóåùí, ç ÅðéôñïðÞ ¸ñåõíáò äéáôýðùóå óõãêåêñéìÝíåò ðñïôÜóåéò ðñïò ôçò ÅðéôñïðÞ Óõíåäñßùí ôçò ÅËÅÃÅÉÁ ðïõ áöïñïýóáí óôçí åðáíáäéáôýðùóç ôùí ïäçãéþí ðñïò ôïõò óõããñáöåßò ôùí åñãáóéþí êáé óôç äéáäéêáóßá êñßóçò ôùí åñãáóéþí. 113


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Å. Èçñáßïò

¸ðáéíïò Êáèçãçôïý "Ä. ºêêïõ" Ôá èÝìáôá ôùí óôñïããõëþí ôñáðåæþí êáé ôùí äéáëÝîåùí Þôáí: ÓôñïããõëÝò ôñÜðåæåò · ÍÝïò ôñüðïò ðñïóÝããéóçò óôçí áíôéìåôþðéóç ôçò áõðíßáò. · Õðåñëéðéäáéìßá êáé êáñäéáããåéáêÝò ðáèÞóåéò, óýã÷ñïíç èåþñçóç êáé áíôéìåôþðéóç. · ÖáñìáêåõôéêÞ ðñüëçøç êáñäéáããåéáêþí íïóçìÜôùí: Óýã÷ñïíåò áíôéëÞøåéò êáé åëëçíéêÞ ðñáãìáôéêüôçôá. · ÐñáêôéêÞ áíôéìåôþðéóç ôùí äéáôáñá÷þí ôïõ ìåôáâïëéóìïý ôùí ëéðéäßùí óôï êáôþöëé ôçò íÝáò ÷éëéåôßáò. · ×åéñéóìüò äõóðåðôéêïý áóèåíïýò. ÓõæÞôçóç áíôéðñïóùðåõôéêþí ðåñéóôáôéêþí. · Ç áíôéìåôþðéóç ÷ñüíéùí áíáðíåõóôéêþí íïóçìÜôùí óôçí ðñùôïâÜèìéá ðåñßèáëøç. · Øõ÷ïóùìáôéêÜ íïóÞìáôá: Ìéá ðñüêëçóç ãéá ôïí Ãåíéêü Éáôñü. · Íåüôåñåò áðüøåéò óôç öáñìáêåõôéêÞ áíôéìåôþðéóç ôïõ ÷ñüíéïõ ðüíïõ. · Çðáôßôéäá Â: Ìéá õðïäéáãíùóìÝíç íüóïò. · Óõ÷íÜ ãáóôñåíôåñïëïãéêÜ ðñïâëÞìáôá óôçí êëéíéêÞ ðñÜîç - ÈåñáðåõôéêÝò óôñáôçãéêÝò. · Ç êëéíéêÞ Üðïøç ãéá ôï ñüëï ôùí ÁÔ1-õðïäï÷Ýùí óôïí õãéÞ êáé ôïí áóèåíÞ.

· ÉáôñïãåíÞò íïóçñüôçôá öáñìáêåõôéêÞò áéôéïëïãßáò ùò áßôéï åéóáãùãÞò óå ðáèïëïãéêü ôìÞìá ôñéôïâÜèìéïõ íïóïêïìåßïõ. Å. Ìé÷áçëßäçò, È. ÐÝððáò, Á. Óùôçñüðïõëïò, Áë. ÐëáôáíÜ, Á. Áóðñïðïôáìßôç, Â. Âëá÷üðïõëïò, É. ÐáñáóêåõáÀäçò, ×. ÊáììéëÜôïò, Ó. ÐáððÜò. · ÌåëÝôç ôçò áñôçñéáêÞò ðßåóçò óå áãñïôéêü ðëçèõóìü. Åðéðïëáóìüò êáé ñýèìéóç õðÝñôáóçò. Å. Óêëçñüò, ÅéñÞíç Êôþñïõ, Á. Óùôçñüðïõëïò, Ìáñßá ÌÜãêïõ, Ã. Óåâáóôüò, Ïõñáíßá Áðïóôüëïõ, ÅéñÞíç Ðáðáäçìçôñßïõ, ×. ÊáììéëÜôïò, Áëßêç ÆåñâÜêç áðü ôï ÊÝíôñï Õãåßáò ÍåìÝáò. Âñáâåßá åëåõèÝñùí áíáêïéíþóåùí · ×ñÞóç ôçò äïêéìáóßáò êáôÜ ÐáðáíéêïëÜïõ óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. Ç åìðåéñßá ôïõ Ê.Õ. Áñéäáßáò. ÓôÝëëá Öùôïðïýëïõ, Ã. ÓðáèáñÜêçò, Ê. Ðïíôßêçò áðü ôï ÊÝíôñï Õãåßáò Áñéäáßáò ÐÝëëáò. · ¢óèìá óå ðáéäéÜ ôï 1999 óôï Å.É. ÐáéäéáôñéêÞò Ã.Í.Í. ×áëêßäáò. Ñüëïò ôïõ Ãåíéêïý Éáôñïý. Ê. ÊõñéáæÜôçò, Ö. Êïõëïýñá, Ï. Ñùìáíïý, ×ñ. ÊïõíôïõñÜêç, Ì. ÄåëçãéÜííç. · Ç ìÝèïäïò ÷ñÞóçò çìåñïëïãßïõ óáí áñ÷Þ èåñáðåõôéêÞò ðñïóÝããéóçò áóèåíþí ìå øõ÷éêÝò äéáôáñá÷Ýò óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. ÓôÝëëá ÁñãõñéÜäïõ, ×. Ìåëéóóïðïýëïõ, ×. ËõãéäÜêçò, Ë. ×Ýëçò, Ì. Ãáôïýëá, Ä. ÊáìéíÜñç áðü ôï ÊÝíôñï Õãåßáò ×ñõóïýðïëçò.

ÄéáëÝîåéò · Ç ÷ñçóéìüôçôá ôçò øõ÷ïóùìáôéêÞò ðñïóÝããéóçò óôçí êáèçìåñéíÞ ðñÜîç ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Ãéáôñïý. · ×ñïíïâéïëïãßá ôçí áíôéìåôþðéóç ôçò áñôçñéáêÞò õðÝñôáóçò. · Ç óýã÷ñïíç áíôéìåôþðéóç ôçò ãñßððçò. Ïé åñãáóßåò ôïõ óõíåäñßïõ Ýêëåéóáí ìå ôçí áðïíïìÞ ôùí âñáâåßùí, ôá ïðïßá Ýëáâáí: Âñáâåßï Êáèçãçôïý "Ä. ºêêïõ" · ÁíÜëõóç êáé áîéïëüãçóç ÷áñáêôçñéóôéêþí ôùí ðåñéëÞøåùí óôá ÐáíåëëÞíéá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò (1989-99). Â. ÓéäåñÞò, ËáìðñéíÞ ÓïõìÜêç, Í. ÑáæÞò. 114

¸ðáéíïé åëåõèÝñùí áíáêïéíþóåùí · ÌåëÝôç ðåñéóôáôéêþí åöçìåñßáò ÊÝíôñïõ Õãåßáò Ëåõêßììçò ÊÝñêõñáò. Í. ÃåùñãéÜííïò, Å. Óðáíïý, Ó. Óïõðéþíçò, Ï. Êáóôñéíïý, Á. ÌÜéíáò, Á. Êáââáäßá, É. ÌïíÝäáò. · Ðáèçôéêü êÜðíéóìá. ÓôÜóç êáé óõìðåñéöïñÜ ôïõ éáôñéêïý êáé ðáñáúáôñéêïý ðñïóùðéêïý óå ó÷Ýóç ìå Üëëåò êáôçãïñßåò åñãáæïìÝíùí. Ä. Ãéáííüðïõëïò, Óôåöáíßá Âïõëéþôç, Â. ÊïõìáñÝëáò, Ä. Ìé÷Üëçò, Ì. ÊáëïåéäÜò. ÐïëõêåíôñéêÞ ìåëÝôç ôïõ ÔìÞìáôïò Â. Áéãáßïõ ôçò ÅËÅÃÅÉÁ. · Óõó÷Ýôéóç ðáñïõóßáò áñôçñéáêÞò õðÝñôáóçò Þ/êáé óáê÷áñþäïõò äéáâÞôç ìå ôïí äåßêôç ìÜæáò óþìáôïò (ÂÌÉ). Áéêáôåñßíç Êïñáêßäïõ, Áíáóôáóßá ×ñéóôïöÝëç, ÄÞìçôñá Ìé÷áëéïý, ÌåëðïìÝíç ÐáðáìåëÝôç, Ô. Óáêåëëáñßïõ.


Ôüìïò 12, Ôåý÷ïò 3, 2000

Â. ÓéäåñÞò êáé óõí.

ÂÑÁÂÅÕÈÅÉÓÁ ÅÑÃÁÓÉÁ ÓÔÏ ÄÉÁÃÙÍÉÓÌÏ “Ä. ÉÊÊÏÕ” AWARDED PAPER IN THE MEMORY OF PROF. D. IKKOS Primary Heatlh Care, Volume 12, Number 3, 171-180, 2000 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 12, Ôåý÷ïò 3, 171-180, 2000

ÁíÜëõóç êáé áîéïëüãçóç ÷áñáêôçñéóôéêþí ôùí ðåñéëÞøåùí óôá ÐáíåëëÞíéá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò (1989-99) Â. ÓéäåñÞò1, ËáìðñéíÞ ÓïõìÜêç2, Í. ÑáæÞò2

Ðåñßëçøç Óêïðüò ôçò ðáñïýóáò ìåëÝôçò åßíáé ç ðáñïõóßáóç, áíÜëõóç êáé áîéïëüãçóç ôùí êõñéïôÝñùí ÷áñáêôçñéóôéêþí ôùí ðåñéëÞøåùí ðïõ Ý÷ïõí áíáêïéíùèåß óôá óõíÝäñéá ôçò ÃåíéêÞò ÉáôñéêÞò. Ùò õëéêü ÷ñçóéìïðïéÞóáìå ôïõò ôüìïõò ôùí ðåñéëÞøåùí ôùí óõíåäñßùí ôçò ÃåíéêÞò ÉáôñéêÞò ðïõ ðñáãìáôïðïéÞèçêáí áðü ôï 1989 Ýùò ôï 1999 (2ï Ýùò 11ï óõíÝäñéï). Ãéá êÜèå ðåñßëçøç Ýãéíå êáôáãñáöÞ ùò ðñïò ôç èåìáôïëïãßá ôçò (Ðáèïëïãßá, Ãõíáéêïëïãßá, ÐáéäéáôñéêÞ, Åðéäçìéïëïãßá ê.Ü.), ôïí ôüðï ðñïÝëåõóçò, ôïí áñéèìü êáé ôï öýëï ôùí óõããñáöÝùí, ôï åßäïò ôïõ íïóçëåõôéêïý éäñýìáôïò (Íïóïêïìåßï, ÊÝíôñï Õãåßáò (ÊÕ), Ðåñéöåñåéáêü Éáôñåßï (ÐÉ), Áíþôáôá ÅêðáéäåõôéêÜ Éäñýìáôá (ÁÅÉ) ê.Ü.) êáèþò êáé ôéò óõíåñãáóßåò ìåôáîý áõôþí. Ôï óýíïëï ôùí áíáêïéíþóåùí óôá 10 ôåëåõôáßá óõíÝäñéá Þôáí 1112, îåêéíþíôáò áðü 41 áíáêïéíþóåéò ôï 1989 êáé öôÜíïíôáò ôéò 213 ôï 1999, ìéá áýîçóç ôçò ôÜîçò ôïõ 419,5%. Óôï ßäéï ÷ñïíéêü äéÜóôçìá Ýãéíáí óõíïëéêÜ 134 óôñïããõëÝò ôñÜðåæåò êáé äéáëÝîåéò, îåêéíþíôáò ìå 8 ôï 1989 êáé äéÜñêåéá óõíåäñßïõ 3 çìÝñåò êáé öôÜíïíôáò ôéò 15 ôï 1999 ìå äéÜñêåéá óõíåäñßïõ 5 çìÝñåò. Ôï 48,1% ôùí áíáêïéíþóåùí ðñïåñ÷üôáí áðü Íïóïêïìåßá, ôï 31,5% áðü ÊÕ, ìüëéò ôï 1,8% áðü ÐÉ êáé ôï õðüëïéðï 18,6% áðü ÁÅÉ, Ôå÷íïëïãéêÜ ÅêðáéäåõôéêÜ Éäñýìáôá (ÔÅÉ) ê.ëð., åíþ ôï 22% ôïõ óõíüëïõ ôùí áíáêïéíþóåùí Þôáí ðñïúüí óõíåñãáóßáò ìåôáîý äõï Þ ðåñéóóïôÝñùí éäñõìÜôùí. Óôéò åñãáóßåò óõììåôåß÷áí éäñýìáôá áðü 35 äéáöïñåôéêïýò íïìïýò, ìå ôéò ðåñéóóüôåñåò åî áõôþí íá ðñïÝñ÷ïíôáé áðü ôïõò íïìïýò ÁôôéêÞò (31,3%), ¸âñïõ (11,8%) êáé Èåóóáëïíßêçò (9,9%). Ï áñéèìüò ôùí óõããñáöÝùí áíÜ åñãáóßá, áõîÞèçêå áðü 4,58 ôï 1989 óå 5,92 ôï 1999, ìå ôáõôü÷ñïíç ìåßùóç ôçò áíáëïãßáò áíäñþí:ãõíáéêþí áðü 2,29:1 óå 1,89:1. ¼óïí áöïñÜ óôïí ôýðï ôùí áíáêïéíþóåùí, ïé ðåñéóóüôåñåò åß÷áí Åðéäçìéïëïãéêü ðñïóáíáôïëéóìü (15,7%), áêïëïõèïýìåíåò áðü ôéò áíáöåñüìåíåò óôçí Ðáèïëïãßá (9,1%), Éóôïñßá ÉáôñéêÞò (7,5%), Êáñäéïëïãßá (7,4%) êáé ÄéáôñïöÞ (6,9%) åíþ ïé áíáêïéíþóåéò ÉáôñéêÞò ÐëçñïöïñéêÞò ìüëéò ôï 1,3%. ÓõìðåñÜóìáôá: Ç ìåãÜëç áýîçóç ôùí ðáñïõóéáæüìåíùí áíáêïéíþóåùí ðéèáíüí êÜíåé áíáãêáßá ôçí ïñãáíùôéêÞ áíáäéÜôáîç ôùí óõíåäñßùí ìå ÷ñÞóç èåìáôéêþí åíïôÞôùí êáé ëÝîåùí êëåéäéþí áðü ôïõò óõããñáöåßò ãéá ôçí êáëýôåñç ôåêìçñßùóç ôùí åñãáóéþí, åíþ ç ìç åíåñãüò óõììåôï÷Þ ïñéóìÝíùí ðåñéï÷þí êáé ç ìéêñÞ óõììåôï÷Þ ôùí éáôñþí Ðåñéöåñåéáêþí Éáôñåßùí äçìéïõñãåß ðñïâëçìáôéóìïýò üóïí áöïñÜ áöåíüò óôçí åðéèõìßá êáé áöåôÝñïõ óôç äõíáôüôçôá ðïõ ôïõò ðáñÝ÷åôáé ãéá åðéóôçìïíéêÞ åíçìÝñùóç êõñßùò ôùí íÝùí óõíáäÝëöùí. 1

Ð.É. ÊåñðéíÞò, 2Ã.Í.-Ê.Õ. Êáëáâñýôùí, ÊáëÜâñõôá, Á÷áÀá

ÅéóáãùãÞ Ç ðëçñïöüñçóç êáé ç êïéíïðïßçóç ôùí éäåþí åßíáé Ýíáò âáóéêüò ðáñÜãïíôáò ãéá ôçí áíÜðôõîç ôçò ÉáôñéêÞò åðéóôÞìçò. Ç äçìéïõñãßá ìéáò ðåñßëçøçò åßíáé ïõóéáóôéêü ìÝñïò áõôÞò ôçò äéáäéêáóßáò êáé áðáéôåß ðñïóåêôéêü ó÷åäéáóìü êáé ðñáãìÜôùóç, þóôå íá åêðëçñþíåé óùóôÜ ôï óêïðü ãéá ôïí ïðïßï äçìéïõñãÞèçêå. Ç ëåéôïõñãßá ìéáò ðåñßëçøçò åßíáé äéôôÞ. Áðü ôç ìéá óõíïøßæåé ôï ðåñéå÷üìåíï ìéáò åñåõíçôéêÞò åñãáóßáò, åíþ ôáõôü÷ñïíá, ëåéôïõñãåß óáí äéáöÞìéóç ãéá ôçí ßäéá ôçí åñãáóßá. Ç ðåñßëçøç óõ÷íÜ åßíáé ôï ìüíï ìüíéìá êáé äçìüóéá êáôá÷ùñçìÝíï áðïäåéêôéêü ìéáò Ýñåõíáò êáé ôï ãåãïíüò áõôü êÜíåé áíáãêáßá ôç äõíáôüôçôá ðïõ ðñÝðåé íá Ý÷åé þóôå íá ìðïñåß íá óôáèåß áðü ìüíç ôçò, ÷ùñßò äçëáäÞ ôçí áíÜãêç ËÝîåéò êëåéäéÜ: ÐåñéëÞøåéò óõíåäñßùí, ÃåíéêÞ ÉáôñéêÞ ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå óôï äéáãùíéóìü "Ä. ºêêïõ" óôá ðëáßóéá ôïõ 12ïõ Ðáíåëëçíßïõ Óõíåäñßïõ ÃåíéêÞò ÉáôñéêÞò (×áëêéäéêÞ, 15-19 Ïêôùâñßïõ 2000) êáé Ýëáâå ôï ðñùôü âñáâåßï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ Õðåýèõíïò áëëçëïãñáößáò: N. ÑáæÞò, Êçðïõñãïý 5, ÊáëÜâñõôá Á÷áÀáò, 250 01, Ôçë.: (0692) 23817, Fax: (0692) 24084 171


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Â. ÓéäåñÞò êáé óõí.

ñùí áíáêïéíþóåùí, üðùò åßíáé ç åðÜñêåéá êáé ç ïñèÞ ÷ñÞóç ôïõ ÷ñüíïõ ðáñïõóßáóçò êáèþò êáé ç ðïéüôçôá ôùí äéáöáíåéþí (Takahashi et al., SUMMARY 1999). The purpose of the present study is the presentation, analysis and evaluation of major features of abstracts announced at Hellenic General Practitioners ¼óïí áöïñÜ óôá ÓõíÝäñéá ÃåíéCongresses over the last decade (1989-1999). êÞò ÉáôñéêÞò äåí Ý÷åé ãßíåé, áð' üóï Each abstract was recorded as for its thematic area (Internal Medicine, Gyneãíùñßæïõìå, êÜðïéá ðñïóðÜèåéá, åßôå cology, Epidemiology etc.), authors' number and sex, affiliation, and institution ðïéïôéêÞò áîéïëüãçóÞò ôïõò ìå ôç äéáwas recorded. äéêáóßá ðïõ ðñïáíáöÝñèçêå, åßôå âéThe total number of announcements during the 10 last congresses was 1112, starting with 41 abstracts in 1989 and reaching 213 in 1999, a 419.5% inâëéïìåôñéêÞò ôïõò áíÜëõóçò. Ïé Èçcrease. During the same period, a number of 134 round tables and lectures was ñáßïò êáé óõí. (1999á, 1999â) áíáæÞconducted, starting with 8 in 3 days time of congress in 1989, reaching 15 in ôçóáí åëëçíéêÝò äçìïóéåýóåéò ó÷åôéêÜ 5 days of congress in 1999. The 48.1% of abstracts derived from Hospitals, ìå ôç ÃåíéêÞ/ÏéêïãåíåéáêÞ ÉáôñéêÞ 31.5% from Primary Health Care Centers, just 1.8% from Peripheral Medical óôçí åëëçíéêÞ (ÉððïêñÜôçò) êáé äéåOffices and 18.6% from Universities, Technological Institutes etc. The 22.0% of announcements originated from the collaboration between two or more instituèíÞ (MEDLINE) âÜóç éáôñéêÞò âétions. During the studied period, recorded affiliation of first authors came from âëéïãñáößáò êáé ãéá äéÜóôçìá 18 êáé 35 different counties. Most of them were from Attica county (31.3%), followed 32 åôþí, áíôßóôïé÷á. Ôá áðïôåëÝóìáby Evros (11.8%) and Thessaloniki (9.9%). Number of authors per abstract ôá ôçò Ýñåõíáò Ýäåéîáí 40 êáé 30 increased from 4.6 in 1989 to 5.9 in 1999. The ratio male:female authors per êáôá÷ùñßóåéò áíôßóôïé÷á, êáé êñßèçabstract at the same time, diminished from 2.3:1 to 1.9:1. The main thematic areas treated in the announcements were Epidemiology (15.7%), Cardiology êáí áðü ôïõò óõããñáöåßò ðïóïôéêþò (7.4%) and Nutrition (6.9%), while Medical Informatics was only 1.3%. ìç éêáíïðïéçôéêÜ. Conclusions: A substantial increase in announcements presented at Hellenic Óêïðüò ôçò ðáñïýóçò ìåëÝôçò åßGeneral Practitioners Congresses was identified. Non effective participation of íáé ü÷é ôüóï ç ðïéïôéêÞ áíÜëõóç ôùí Peripheral Medical Office physicians and of some counties, raises questions ÷áñáêôçñéóôéêþí ôùí áíáêïéíùèåéóþí about their willingness and their capability for scientific information. Key words: Abstracts, Congresses, General Practice ðåñéëÞøåùí êáé åñåõíçôéêþí åñãáóéþí, áëëÜ ç ðáñïõóßáóç, áíÜëõóç êáé áîéïëüãçóç ôùí ëïéðþí "ðïóïôéêþí" âéýðáñîçò áíáëõôéêþí ðéíÜêùí, ó÷åäßùí, óõæçôÞ- âëéïìåôñéêþí óôïé÷åßùí, Ýíá åßäïò áðïëïãéóìïý óåùí êáé ëïéðþí ëåðôïìåñåéþí íá ôç óõíïäåýïõí ôùí áíáêïéíþóåùí ôùí ôåëåõôáßùí 10 Óõíåäñßùí (Brazier, 1997; Beyea and Nicoll, 1998). ôçò ÃåíéêÞò ÉáôñéêÞò. Åßíáé ãíùóôÞ ç ôáêôéêÞ ôùí åðéóôçìïíéêþí ðåñéïäéêþí óôç ÷ñÞóç äéáöüñùí óõíôåëåóôþí ãéá ôçí áîéïëüãçóç ôùí éäßùí áëëÜ êáé êáôá÷ñçóôé- Õëéêü êáé ÌÝèïäïò êÜ ìÜëëïí, ôùí ìåìïíùìÝíùí åñãáóéþí, óõããñáöÝùí êáé åðéóôçìïíéêþí - íïóçëåõôéêþí éäñõìÜÙò õëéêü ÷ñçóéìïðïéÞèçêå ôï óýíïëï ôùí ôùí (Garfield, 1996; Opthof, 1997). ÊÜôé áíôß- áíáêïéíþóåùí ðïõ ðåñéÝ÷ïíôáé óôïõò ôüìïõò ôùí óôïé÷ï êáé êïéíÜ áðïäåêôü ãéá ôçí áîéïëüãçóç ðåñéëÞøåùí ôùí Óõíåäñßùí ôçò ÃåíéêÞò ÉáôñéêÞò, ôùí åðéóôçìïíéêþí óõíåäñßùí, äåí õðÜñ÷åé óôç ðïõ ðñáãìáôïðïéÞèçêáí áðü ôï 1989 Ýùò êáé äéåèíÞ âéâëéïãñáößá. ¸÷ïõí ãßíåé üìùò êÜðïéåò ôï 1999 (2ï Ýùò êáé 11ï ÓõíÝäñéï). ðñïóðÜèåéåò ðïõ óáí óêïðü Ý÷ïõí ôçí ðïéïôéêÞ Óå ðñþôï óôÜäéï êáé ãéá êáèåìéÜ ðåñßëçøç êõñßùò áðïôßìçóç ôùí óõíåäñßùí ìÝóá áðü ôç ÷ùñéóôÜ Ýãéíå êáôáãñáöÞ óôïé÷åßùí êáé ÷áñáäéáäéêáóßá åýñåóçò óå åðéóôçìïíéêÜ ðåñéïäéêÜ êáé êôçñéóôéêþí, üðùò åßíáé ï áñéèìüò êáé ôï öýëï çëåêôñïíéêÝò âÜóåéò äåäïìÝíùí, äçìïóéåõìÝíùí ôùí óõããñáöÝùí (ìå ôçí åðéöýëáîç ôùí ïíïìÜðëÞñùí Üñèñùí ôá ïðïßá åß÷áí êáôáôåèåß ìå ôç ôùí ðïõ Þôáí ãñáììÝíá óôçí ÁããëéêÞ), ï ãåùìïñöÞ áíáêïßíùóçò óå êÜðïéï óõíÝäñéï (Gor- ãñáöéêüò ôüðïò ðñïÝëåõóçò (íïìüò, äéáìÝñéóìá, man and Oderda, 1990; Weber et al., 1998; ÷þñåò åîùôåñéêïý) êáé ôï åßäïò ôïõ Éäñýìáôïò Bowery et al., 1999; Wang et al., 1999). Ãéá ôïí (Íïóïêïìåßï, Ê.Õ., Ð.É., Á.Å.É., Ô.Å.É., éäéùôéêÜ ßäéï ëüãï Ý÷åé ÷ñçóéìïðïéçèåß åðßóçò, ç áíÜëõóç éáôñéêÜ êÝíôñá ê.ëð.) êáèþò êáé ïé óõíåñãáóßåò ÷áñáêôçñéóôéêþí ôçò ðáñïõóßáóçò ôùí åëåýèå- ìåôáîý áõôþí. Èá ðñÝðåé íá áíáöåñèåß üôé ïé Analysis and enaluation of major features of presentations given at Hellenic General Practitiners Congresses (1989-99) V. Sideris, L. Soumaki, N. Razis

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Ôüìïò 12, Ôåý÷ïò 3, 2000

Â. ÓéäåñÞò êáé óõí.

ðåñéëÞøåéò, ïé óõããñáöåßò ôùí ïðïßùí ðñïÝñ÷ïíôáé áðü Ãåíéêü Íïóïêïìåßï - ÊÝíôñï Õãåßáò (Ã.Í.-Ê.Õ.), ðåñéåëÞöèçóáí óôá íïóïêïìåßá, åíþ üóïí áöïñÜ óôéò óõíåñãáóßåò ìåôáîý äéáöïñåôéêþí ÉäñõìÜôùí êáé ôüðùí ðñïÝëåõóçò, êáôÜ ôçí ïìáäïðïßçóç, ÷ñçóéìïðïéÞèçêáí ùò ºäñõìá êáé ôüðïò ðñïÝëåõóçò, áõôÜ ôïõ ðñþôïõ óõããñáöÝá. ¸ãéíå åðßóçò êáôáãñáöÞ ùò ðñïò ôç èåìáôïëïãßá ôçò êÜèå ðåñßëçøçò. Ãéá ôï óêïðü áõôü, ÷ñçóéìïðïéÞèçêáí óáí âÜóç ïé èåìáôéêÝò åíüôçôåò ôïõ 22ïõ åôÞóéïõ ÐáíåëëÞíéïõ Éáôñéêïý Óõíåäñßïõ (ÐÉÓ), üðùò öáßíåôáé óôïí ðßíáêá 1. Èá ðñÝðåé íá áíáöåñèåß üôé óå ìåôáãåíÝóôåñá ÐÉÓ Ý÷ïõí ðñïóôåèåß êáé Üëëåò åíüôçôåò, êÜðïéåò áðü ôéò ïðïßåò áíáãñÜöïíôáé óôïí ðßíáêá 1. ÊáôáãñáöÞ Ýãéíå åðßóçò, ùò ðñïò ôéò óôñïããõëÝò ôñÜðåæåò êáé äéáëÝîåéò ðïõ áíáãñÜöïíôáé óôïõò ôüìïõò ôùí ðåñéëÞøåùí. Áêïëïýèçóå åðåîåñãáóßá êáé áíÜëõóç ôùí óõãêåêñéìÝíùí óôïé÷åßùí êáé ÷áñáêôçñéóôéêþí êáé ðáñÜèåóÞ ôïõò óå áíáëõôéêïýò ðßíáêåò êáé äéáãñÜììáôá. Ãéá ëüãïõò óýãêñéóçò, ÷ñçóéìïðïéÞèçêáí ôá áíÜëïãá óôïé÷åßá áðü ôéò ðåñéëÞøåéò ôïõ 22ïõ ÐÉÓ (ðçãÞ äåäïìÝíùí: www.mednet.gr) êáèþò êáé 9 ôåý÷ç áðü ôïõò ôüìïõò 8-10 ôïõ ðåñéïäéêïý ðïõ åêäßäåé ç ÅëëçíéêÞ Åôáéñåßá ÃåíéêÞò ÉáôñéêÞò, "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" (ÐÖÕ). Ãéá ôç óôáôéóôéêÞ åðåîåñãáóßá ôùí áðïôåëåóìÜôùí ÷ñçóéìïðïéÞèçêáí ôï ÷2 test êáé ôï Student t test, åíþ ãéá ôçí åýñåóç ðéèáíþí óõó÷åôßóåùí, ÷ñçóéìïðïéÞèçêå ï óõíôåëåóôÞò óõó÷Ýôéóçò ôïõ Spearman (ps). ¼ëåò ïé äéáöïñÝò èåùñÞèçêáí óôáôéóôéêþò óçìáíôéêÝò ãéá p<0.05 (Êïýíéáò êáé óõí., 1985; Glanz, 1992).

ÁðïôåëÝóìáôá Ôï óýíïëï ôùí áíáêïéíþóåùí óôá 10 ôåëåõôáßá óõíÝäñéá ÃåíéêÞò ÉáôñéêÞò Þôáí 1112, îåêéíþíôáò áðü 41 ðåñéëÞøåéò óôï 2ï óõíÝäñéï ôï 1989 êáé öôÜíïíôáò ôéò 213 óôï ôåëåõôáßï óõíÝäñéï ôï 1999, ìéá áýîçóç ôçò ôÜîçò ôïõ 419.5%. Óôï ó÷Þìá 1 öáßíïíôáé áíáëõôéêÜ ï áñéèìüò ôùí áíáêïéíùèåéóþí ðåñéëÞøåùí ãéá êÜèå Ýôïò, åíþ óôï ó÷Þìá 2 ï áñéèìüò ôùí óôñïããõëþí ôñáðåæþí êáé äéáëÝîåùí áíÜ Ýôïò, êáèþò êáé ç ÷ñïíéêÞ äéÜñêåéá ôïõ êÜèå óõíåäñßïõ. ÓôáôéóôéêÞ áíÜëõóç ôùí áðïôåëåóìÜôùí Ýäåéîå üôé õðÜñ÷åé, ôüóï

Ðßíáêáò 1. ÈåìáôéêÝò åíüôçôåò ôùí Óõíåäñßùí ÃåíéêÞò ÉáôñéêÞò êáé óõó÷Ýôéóç áõôþí ìå ôéò èåìáôéêÝò åíüôçôåò ôïõ 22ïõ åôÞóéïõ ÐÉÓ (1996). Ìå õðïãñÜììéóç óçìåéþíïíôáé åíüôçôåò ðïõ äåí õðÞñ÷áí óôï 22ï ÐÉÓ, áëëÜ èåùñÞèçêáí áðáñáßôçôåò ãéá ôçí ôáîéíüìçóç ôùí áíáêïéíþóåùí Åíüôçôåò ÃåíéêÞò ÉáôñéêÞò

Åíüôçôåò 22ïõ ÐÉÓ

ÁéóèçôÞñéá

Ïöèáëìïëïãßá ÙÑË Ãáóôñåíôåñïëïãßá Ãåñïíôïëïãßá Ãõíáéêïëïãßá - ÌáéåõôéêÞ Äåñìáôïëïãßá Áëëåñãéïëïãßá Áíïóïëïãßá ÄéáâÞôçò - Ìåôáâïëéóìüò ÄéáôñïöÞ Åíäïêñéíïëïãßá Ëéðéäïëïãßá Äçìüóéá Õãåßá Åðéäçìéïëïãßá ÉáôñéêÞ Åñãáóßáò ÊïéíùíéêÞ ÉáôñéêÞ ÐñïëçðôéêÞ ÉáôñéêÞ ÉáôñéêÞ Áðåéêüíéóç ÉáôñéêÞ Åêðáßäåõóç ÉáôñéêÞ ÐëçñïöïñéêÞ Éóôïñßá ÉáôñéêÞò Êáñäéïëïãßá Ëïéìþîåéò Áéìáôïëïãßá Áéìïäïóßá Âéï÷çìåßá Êõôôáñïëïãßá Ìéêñïâéïëïãßá ÏäïíôéáôñéêÞ Óôïìáôïëïãßá ÏñèïðåäéêÞ ÁðïêáôÜóôáóç ÅíôáôéêÞ Èåñáðåßá Íåöñïëïãßá Ïãêïëïãßá Ñåõìáôïëïãßá ÕðÝñôáóç ÃåíåôéêÞ ÐáéäéáôñéêÞ Ðíåõìïíïëïãßá Áããåéïëïãßá Áíáéóèçóéïëïãßá Íåõñï÷åéñïõñãéêÞ Ïõñïëïãßá ×åéñïõñãéêÞ Íåõñïëïãßá Øõ÷éáôñéêÞ Øõ÷ïóùìáôéêÞ ÉáôñïäéêáóôéêÞ ÐáèïëïãéêÞ ÁíáôïìéêÞ Ðáñïõóßáóç ÊÕ Áäõíáìßá Ôáîéíüìçóçò

Ãáóôñåíôåñïëïãßá Ãåñïíôïëïãßá Ãõíáéêïëïãßá - ÌáéåõôéêÞ Äåñìáôïëïãßá

ÄéáôñïöÞ

Åðéäçìéïëïãßá

ÉáôñéêÞ Áðåéêüíéóç ÉáôñéêÞ Åêðáßäåõóç ÉáôñéêÞ ÐëçñïöïñéêÞ Éóôïñßá ÉáôñéêÞò Êáñäéïëïãßá Ëïéìþîåéò Ìéêñïâéïëïãßá

ÏäïíôéáôñéêÞ ÏñèïðåäéêÞ Ðáèïëïãßá

ÐáéäéáôñéêÞ Ðíåõìïíïëïãßá ×åéñïõñãéêÞ

Øõ÷éáôñéêÞ

ËïéðÝò

173


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Â. ÓéäåñÞò êáé óõí.

Ó÷Þìá 3. Ðïóïóôéáßá êáôáíïìÞ ôùí ðåñéëÞøåùí, áíÜëïãá ôï ºäñõìá ðñïÝëåõóçò ôïõ ðñþôïõ óõããñáöÝá. Ãéá ëüãïõò åõ÷ñçóôßáò ôá ðïóïóôÜ óôñïããõëïðïéÞèçêáí óå áêÝñáéåò ìïíÜäåò.

Ó÷Þìá 1. Áñéèìüò áíáêïéíþóåùí, üðùò ðñïêýðôåé áðü ôïõò ôüìïõò ôùí ðåñéëÞøåùí, óôá 10 ôåëåõôáßá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò (2ï Ýùò 11ï). ÕðÜñ÷åé ìéá áõîçôéêÞ ôÜóç óôïí áñéèìü ôùí áíáêïéíþóåùí (äéáêåêïììÝíç ãñáììÞ) êáôÜ ôç äéÜñêåéá ôïõ ÷ñüíïõ (ps=0.855, p<0.01). Óôïí ïñéæüíôéï Üîïíá öáßíåôáé åðßóçò ôï Ýôïò äéåíÝñãåéáò ôïõ êÜèå óõíåäñßïõ.

Ó÷Þìá 2. Áñéèìüò óôñïããõëþí ôñáðåæþí êáé äéáëÝîåùí, üðùò ðñïêýðôåé áðü ôïõò ôüìïõò ôùí ðåñéëÞøåùí, óôá 10 ôåëåõôáßá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò (2ï Ýùò 11ï). ÕðÜñ÷åé ìéá áõîçôéêÞ ôÜóç óôïí áñéèìü áõôþí ôùí åêäçëþóåùí (äéáêåêïììÝíç ãñáììÞ) êáôÜ ôç äéÜñêåéá ôïõ ÷ñüíïõ (ps=0.814, p<0.01). Óôïí ïñéæüíôéï Üîïíá öáßíåôáé åðßóçò ç äéÜñêåéá ôïõ êÜèå óõíåäñßïõ óå çìÝñåò.

ãéá ôïí áñéèìü ôùí ðåñéëÞøåùí üóï êáé ãéá ôïí áñéèìü ôùí äéáëÝîåùí, áýîçóç óå ó÷Ýóç ìå ôïí ÷ñüíï (ps=0.855, p<0.01 êáé ps=0.814, p<0.01, áíôßóôïé÷á). Óôï ó÷Þìá 3 áðåéêïíßæåôáé ç ðïóïóôéáßá êáôáíïìÞ ôùí ðåñéëÞøåùí, áíÜëïãá ìå ôï ºäñõìá ðñïÝëåõóçò ôïõ ðñþôïõ óõããñáöÝá. ÁíáëõôéêÜ, ïé 535 (48.1%) åñãáóßåò ðñïÝñ÷ïíôáé áðü 61 äéáöïñåôéêÜ íïóïêïìåßá (óõìðåñéëáìâáíïìÝíùí ôùí ÃÍ-ÊÕ), ìå ôéò ðåñéóóüôåñåò (139) íá ðñïÝñ÷ïíôáé áðü ôï Íïóïêïìåßï Íßêáéáò, áðü 61 äéáöïñåôéêÜ ÊÕ ïé 350 (31.5%) ìå ôéò ðåñéóóüôåñåò 174

(63) íá ðñïÝñ÷ïíôáé áðü ôï ÊÕ Ðñßíïõ, áðü 11 äéáöïñåôéêÜ ÐÉ ïé 20 (1.8%), áðü ÁÅÉ ïé 85 (7.6%), áðü ÔÅÉ ïé 13 (1.2%), áðü ÷þñåò ôïõ åîùôåñéêïý ïé 40 (3.6%) ìå ôéò ìéóÝò ðåñßðïõ (21 ðåñéëÞøåéò) íá ðñïÝñ÷ïíôáé áðü ôç Ãáëëßá, ïé 26 (2.3%) ðñïÝñ÷ïíôáé áðü éäéþôåò, éäéùôéêÜ éáôñéêÜ êÝíôñá êáé éáôñéêÝò åôáéñåßåò, åíþ 43 (3.9%) äåí áíÝãñáöáí áðü ðïéá íïóçëåõôéêÞ ìïíÜäá ðñïÝñ÷ïíôáí ïé óõããñáöåßò. Ïé 245 (22%) ôïõ óõíüëïõ ôùí áíáêïéíþóåùí Þôáí ðñïúüí óõíåñãáóßáò ìåôáîý äýï Þ ðåñéóóïôÝñùí ÉäñõìÜôùí. Ðñïò óýãêñéóç, áíáöÝñåôáé üôé óôï 26ï ÐÉÓ óå 463 áíáêïéíùèåßóåò ðåñéëÞøåéò, áðü íïóïêïìåßá (óõìðåñéëáìâáíïìÝíùí ôùí ðáíåðéóôçìéáêþí êëéíéêþí) ðñïÝñ÷ïíôáí ïé 347 (74.9%), áðü ÁÅÉ (åñãáóôçñéáêÜ ôìÞìáôá) êáé ÔÅÉ ïé 50 (10.8%), áðü ÊÕ ìüíï 1, åíþ áðü éäéþôåò, ÉÊÁ êáé ëïéðÜ Éäñýìáôá ïé 65 (14%). Ï áñéèìüò ôùí óõíåñãáóéþí ìåôáîý ÉäñõìÜôùí ãéá ôçí ðñáãìÜôùóç ìéáò åñãáóßáò Þôáí 93 (20.1%). Ãéá ôïí ßäéï ëüãï áíáöÝñåôáé üôé áðü 26 äçìïóéåõìÝíåò åñåõíçôéêÝò åñãáóßåò êáé áíáóêïðÞóåéò óôï ðåñéïäéêü ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò (ÐÖÕ), ïé 13 (50%) ðñïÝñ÷ïíôáé áðü Íïóïêïìåßá, ïé 8 (30.8%) áðü ÊÕ êáé ÐÉ êáé ïé 5 (19.2%) áðü ÁÅÉ, ÔÅÉ êáé ëïéðÜ Éäñýìáôá, åíþ óõíåñãáóßåò ðáñïõóéÜæïíôáé óôéò 15 (57.7%) åñãáóßåò. Ï ìÝóïò üñïò (ÌÏ) ± ôï ôõðéêü óöÜëìá (SE) ôïõ áñéèìïý ôùí óõããñáöÝùí áíÜ åñãáóßá ãéá êÜèå Ýôïò, êáèþò êáé ï ÌÏ ôïõ áñéèìïý ôùí áíäñþí êáé ãõíáéêþí óõããñáöÝùí ÷ùñéóôÜ öáßíïíôáé óôï ó÷Þìá 4. Ï óõíïëéêüò ÌϱSE ãéá üëá ôá Ýôç åßíáé 5.37±0.08 óõããñáöåßò áíÜ åñãáóßá ìå 3.75±0.07 Üíäñåò êáé 1.62±0.05 ãõíáßêåò óõããñáöåßò. ÁíÜëõóç ôùí áðïôåëåóìÜôùí Ýäåéîå üôé ï áñéèìüò ôùí óõããñáöÝùí áíÜ åñãáóßá ðáñïõóéÜæåé áýîçóç ôïõ ìåãÝèïõò ôïõ ãéá êÜèå Ýôïò, óôáôéóôéêþò óçìáíôéêÞ (ps=0.816,


Ôüìïò 12, Ôåý÷ïò 3, 2000

Â. ÓéäåñÞò êáé óõí.

p<0.01). Ç áíáëïãßá áíäñþí:ãõíáéêþí óõããñáöÝùí áíÜ åñãáóßá ãéá êÜèå Ýôïò ðáñïõóéÜæåôáé óôï ó÷Þìá 5, êáé öáßíåôáé íá êõìáßíåôáé áðü 2 Ýùò 3 Üíäñåò ãéá êáèåìéÜ ãõíáßêá óõããñáöÝá. ÓôáôéóôéêÞ áíÜëõóç ôùí áðïôåëåóìÜôùí Ýäåéîå üôé ç áíáëïãßá áíäñþí:ãõíáéêþí óõããñáöÝùí áíÜ åñãáóßá ðáñïõóéÜæåé ìåßùóç ãéá êÜèå Ýôïò (ps=0.649, p<0.05). ÅîåôÜæïíôáò ôéò 26 åñãáóßåò ôïõ ðåñéïäéêïý ÐÖÕ, âëÝðïõìå üôé ï ìÝóïò üñïò ôùí óõããñáöÝùí áíÜ åñãáóßá åßíáé 3.46±0.38, ìå 2.19±0.34 Üíäñåò êáé 1.27±0.25 ãõíáßêåò óõããñáöåßò. Ôá áíÜëïãá óôïé÷åßá áðü ôï ÐÉÓ åßíáé 5.57±0.10, 3.67±0.09 êáé 1.90±0.07. Óýãêñéóç ôùí áðïôåëåóìÜôùí (äßðëåõñï Student t-test)

Ýäåéîå üôé äåí õðÜñ÷åé óôáôéóôéêþò óçìáíôéêÞ äéáöïñÜ áíÜìåóá óôï óõíïëéêü áñéèìü óõããñáöÝùí óôéò ðåñéëÞøåéò êáé ôùí äýï óõíåäñßùí (t=3.705, p<0.001), åíþ áíôßèåôá, ç äéáöïñÜ åßíáé óôáôéóôéêþò óçìáíôéêÞ, üôáí åîåôÜæåôáé ï óõíïëéêüò áñéèìüò óõããñáöÝùí áíÜ åñãáóßá óôá óõíÝäñéá ÃåíéêÞò ÉáôñéêÞò êáé óôï ðåñéïäéêü ÐÖÕ (t= -1.509, p>0.05). Ç êáôáíïìÞ ôùí åñãáóéþí áíÜëïãá ìå ôïí ôüðï ðñïÝëåõóçò ôùí óõããñáöÝùí, ðáñïõóéÜæåôáé óôï ó÷Þìá 6. Áíôéðñïóùðåýïíôáé ìå ôïõëÜ÷éóôïí 1 ðåñßëçøç óå ïðïéïäÞðïôå áðü ôá 10 óõíÝäñéá, ïé 35 áðü ôïõò 52 íïìïýò ôçò ÷þñáò. Îå÷ùñßæåé ï íïìüò ÁôôéêÞò ìå 348 (31.3%) ðåñéëÞøåéò êáé ïé íïìïß ¸âñïõ, Èåóóáëïíßêçò êáé ÊáâÜëáò ìå 131 (11.8%), 110 (9.9%) êáé 101 (9.1%) ðåñéëÞøåéò áíôßóôïé÷á, åíþ üðùò áíáöÝñèçêå 40 (3.6%) ðñïÝñ÷ïíôáí áðü ôï åîùôåñéêü. Ïé Üãíùóôåò äéåõèýíóåéò Þôáí 13 (1.2%). Óôï 22ï ÐÉÓ, ïé 383 (82.7%) áðü ôéò 463 ðåñéëÞøåéò ðñïÝñ÷ïíôáí áðü ôçí ÁèÞíá êáé ìüëéò ïé 69 (14.9%) áðü ôçí õðüëïéðç ÅëëÜäá, åíþ 11 (2.4%) åß÷áí äéåýèõíóç ðñþôïõ óõããñáöÝá ÷þñá ôïõ åîùôåñéêïý. Åßíáé öáíåñü, áëëÜ êáé áðïäåéêíýåôáé (÷2 test) üôé ç ãåùãñáöéêÞ êáôáíïìÞ ôùí ðåñéëÞøåùí áíÜìåóá óôá äýï óõ-

Ó÷Þìá 4. Áñéèìüò óõããñáöÝùí áíÜ ðåñßëçøç óôá 10 ôåëåõôáßá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò. Áðåéêïíßæåôáé ï áñéèìüò ôùí áíäñþí ( ) êáé ãõíáéêþí óõããñáöÝùí ( ) áíÜ åñãáóßá êáèþò êáé ôï ôõðéêü óöÜëìá ôïõ óõíüëïõ ôùí óõããñáöÝùí. Ç áýîçóç ôïõ áñéèìïý ôùí óõããñáöÝùí êÜèå Ýôïò, ÷áñáêôçñßæåôáé óôáôéóôéêþò óçìáíôéêÞ (ps=0.816, p<0.01).

Ó÷Þìá 5. ÌÝóïò üñïò ôçò áíáëïãßáò áíäñþí:ãõíáéêþí óõããñáöÝùí áíÜ ðåñßëçøç óôá 10 ôåëåõôáßá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò. Ç ìåßùóç ôçò áíáëïãßáò ðñïò üöåëïò ôùí ãõíáéêþí óõããñáöÝùí, ÷áñáêôçñßæåôáé óôáôéóôéêþò óçìáíôéêÞ (ps=0.649, p<0.05).

Ó÷Þìá 6. ÃåùãñáöéêÞ êáôáíïìÞ ôïõ óõíüëïõ ôùí áíáêïéíùèåéóþí åñãáóéþí óôá 10 ôåëåõôáßá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò, áíÜëïãá ôïí ôüðï ðñïÝëåõóçò ôïõ ðñþôïõ óõããñáöÝá. Ëåõêü: ÷ùñßò óõììåôï÷Þ. : 1-10 ðåñéëÞøåéò. : 11-20 ðåñéëÞ: 21-50 ðåñéëÞøåéò. øåéò. ðåñéëÞøåéò.

: 51-100 ðåñéëÞøåéò.

: >100

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ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Â. ÓéäåñÞò êáé óõí.

íÝäñéá åßíáé óôáôéóôéêþò äéáöïñåôéêÞ (÷2=121.5, p>0.05). ¼óïí áöïñÜ óôï ðåñéïäéêü ÐÖÕ, 15 (57.7%) åñãáóßåò ðñïÝñ÷ïíôáé áðü ôçí ÁèÞíá êáé 11 (42.3%) áðü ôçí ðåñéöÝñåéá. Êáé åäþ ç ãåùãñáöéêÞ êáôáíïìÞ äéáöÝñåé áðü áõôÞ ôùí óõíåäñßùí ÃåíéêÞò ÉáôñéêÞò (÷2=6.199, p>0.05). Ìéá äéáöïñåôéêÞ ðñïóÝããéóç Ýãéíå, üðùò öáßíåôáé óôïí ðßíáêá 2, ìå ôçí áíáãùãÞ ôùí ðåñéëÞøåùí áíÜ ãåùãñáöéêü äéáìÝñéóìá, áíÜëïãá ìå ôïí áñéèìü ôùí Ãåíéêþí Éáôñþí áëëÜ êáé ôùí éáôñþí üëùí ôùí åéäéêïôÞôùí, óôï óõãêåêñéìÝíï äéáìÝñéóìá (ðçãÞ: ÓõíïðôéêÞ ÓôáôéóôéêÞ Åðåôçñßäá, 1995). Ç ìåãáëýôåñç áíáëïãßá ðåñéëÞøåùí áíÜ Ãåíéêü Éáôñü ðáñáôçñåßôáé óôçí ðåñéï÷Þ ôçò ÈñÜêçò êáé ç ìéêñüôåñç óôá íçóéÜ ôïõ Éïíßïõ. Êáé åäþ ç óôáôéóôéêÞ áíÜëõóç Ýäåéîå üôé ç áíáëïãßá ôùí ðåñéëÞøåùí áíÜ Ãåíéêü Éáôñü óôá äéÜöïñá ãåùãñáöéêÜ äéáìåñßóìáôá åßíáé äéáöïñåôéêÞ (÷2=29.589, p>0.05). Áíôßèåôá, ç áíáëïãßá ôùí ðåñéëÞøåùí áíÜ éáôñü ïðïéáóäÞðïôå åéäéêüôçôáò, ãéá üëá ôá äéáìåñßóìáôá åßíáé ßäéá (÷2=10.304, p<0.05). ÔÝëïò, óôïí ðßíáêá 3 öáßíåôáé ç êáôáíïìÞ ôùí ðåñéëÞøåùí áíÜëïãá ìå ôï åßäïò ôçò åñãáóßáò. ¼ðùò öáßíåôáé, ïé åðéäçìéïëïãéêÝò åñãáóßåò Ý÷ïõí ôï ìåãáëýôåñï ðïóïóôü (15.7%), åíþ ïé åñãáóßåò ÉáôñéêÞò ÐëçñïöïñéêÞò ìüëéò ôï 1.3%. Ç óôáôéóôéêÞ åðåîåñãáóßá êáôÝäåéîå üôé ç êáôáíïìÞ ôùí ðåñéëÞøåùí óôá óõíÝäñéá ÃåíéêÞò ÉáôñéêÞò óôéò äéÜöïñåò åíüôçôåò äåí åßíáé ïìïéüìïñöç (÷2= 61.428, p>0.05), åíþ áðü ôç óýãêñéóç ôùí ôýðùí ôùí áíáêïéíþóåùí áíÜìåóá óôá

äõï óõíÝäñéá (ÃåíéêÞò ÉáôñéêÞò êáé ÐÉÓ) äéáðéóôþèçêå üôé ç áíáëïãßá ôùí ðåñéëÞøåùí óôéò åðéìÝñïõò åíüôçôåò åßíáé äéáöïñåôéêÞ (÷2=116.561, p>0.05).

ÓõæÞôçóç Ï óêïðüò áõôÞò ôçò ìåëÝôçò, üðùò Ý÷åé Þäç åéðùèåß, äåí åßíáé ôüóï ç ðïéïôéêÞ áíÜëõóç ôùí ÷áñáêôçñéóôéêþí ôùí áíáêïéíùèåéóþí ðåñéëÞøåùí êáé åñåõíçôéêþí åñãáóéþí. Áõôü Ý÷åé Þäç ãßíåé áðü ôçí ÅðéôñïðÞ Áîéïëüãçóçò ôïõ åêÜóôïôå Óõíåäñßïõ êé Ý÷åé ÷áñáêôçñéóôåß êáé ðéèáíüôáôá âáèìïëïãçèåß óéùðçñÜ êáé áðü ôï áêñïáôÞñéï. Óêïðüò ìáò åßíáé ç ðáñïõóßáóç ôùí "ðïóïôéêþí" óôïé÷åßùí ôùí ðåñéëÞøåùí êáé ç åîáãùãÞ ÷ñÞóéìùí, êáôÜ ôç ãíþìç ìáò, óõìðåñáóìÜôùí, ðïõ Ý÷ïõí íá êÜíïõí ðåñéóóüôåñï ìå ôçí ïñãÜíùóç ôïõ Óõíåäñßïõ. Èåùñïýìå üìùò üôé èá åß÷å åíäéáöÝñïí êáé ç ðïéïôéêÞ áîéïëüãçóç ôùí ìåãÜëùí åëëçíéêþí óõíåäñßùí êáèþò êáé ç óýãêñéóÞ ôïõò ìå áíôßóôïé÷á äéåèíÞ. Åßíáé öáíåñü, üôé êÜèå ÷ñüíï óôá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò, õðÜñ÷åé ìéá óôáèåñÞ áýîçóç ôïõ áñéèìïý ôüóï ôùí áíáêïéíþóåùí üóï êáé ôùí äéáëÝîåùí êáé óôñïããõëþí ôñáðåæþí êáé ìéá ðéèáíÞ ðñüâëåøç (Ó÷Þìáôá 1 êáé 2) åßíáé üôé ç áýîçóç áõôÞ èá óõíå÷éóèåß. Ç áýîçóç áõôÞ åß÷å óáí áðïôÝëåóìá ôçí áíôßóôïé÷ç áýîçóç ôùí çìåñþí äéåíÝñãåéáò ôùí óõíåäñßùí áðü 3 ôï 1989, óå 5 ôï 1999. Ôá áðïôåëÝóìáôÜ ìáò åßíáé óå

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Ôüìïò 12, Ôåý÷ïò 3, 2000

Â. ÓéäåñÞò êáé óõí.

Ðßíáêáò 3. ÊáôáíïìÞ ôùí ðåñéëÞøåùí óôá 10 ôåëåõôáßá óõíÝäñéá ÃåíéêÞò ÉáôñéêÞò, áíÜëïãá ôï åßäïò ôçò åñãáóßáò. Ãéá ëüãïõò óýãêñéóçò, ðáñáôßèåíôáé êáé ïé ðåñéëÞøåéò ôïõ 22ïõ ÐÉÓ Ôýðïò Åñãáóßáò ÁéóèçôÞñéá Ãáóôñåíôåñïëïãßá Ãåñïíôïëïãßá Ãõíáéêïëïãßá Äåñìáôïëïãßá ÄéáôñïöÞ Åðéäçìéïëïãßá ÉáôñéêÞ Áðåéêüíéóç ÉáôñéêÞ Åêðáßäåõóç ÉáôñéêÞ ÐëçñïöïñéêÞ Éóôïñßá ÉáôñéêÞò Êáñäéïëïãßá Ëïéìþîåéò Ìéêñïâéïëïãßá ÏäïíôéáôñéêÞ ÏñèïðåäéêÞ Ðáèïëïãßá ÐáéäéáôñéêÞ Ðíåõìïíïëïãßá ×åéñïõñãéêÞ Øõ÷éáôñéêÞ ËïéðÜ Óýíïëï

ÐåñéëÞøåéò áíÜ Ýôïò (ÌÏ ± SE)

ÐåñéëÞøåéò (%)

ÐåñéëÞøåéò 22ïõ ÐÉÓ (%)

2.00 ± 0.68 1.40 ± 0.50 2.20 ± 0.73 3.90 ± 1.10 2.30 ± 0.56 7.70 ± 1.80 17.5 ± 2.57 2.10 ± 0.58 2.50 ± 0.88 1.40 ± 0.43 8.40 ± 1.70 8.20 ± 1.81 2.90 ± 0.91 4.80 ± 1.57 3.70 ± 0.63 3.80 ± 0.71 10.10 ± 1.75 5.00 ± 1.42 2.40 ± 0.83 5.40 ± 0.84 4.60 ± 0.99 8.90 ± 2.64

1.8 1.3 2.0 3.5 2.1 6.9 15.7 1.9 2.2 1.3 7.5 7.4 2.6 4.3 3.3 3.4 9.1 4.5 2.2 4.9 4.1 8.0

11 (2.4) 13 (2.8) 5 (1.1) 11 (2.4) 18 (3.9) 30 (6.5) 38 (8.2) 21 (4.5) 7 (1.5)

111.20 ± 16.57

100

óõìöùíßá ìå äõï ìåëÝôåò ðïõ Ýãéíáí ãéá ôá Ýôç 1988-1992 êáé 1990-1997 üðïõ äéáðéóôþèçêå üôé ï áñéèìüò ôùí Üñèñùí ðïõ áíáöÝñïíôáé óôçí ðñùôïâÜèìéá öñïíôßäá õãåßáò, ôüóï óå áããëüöùíá äéåèíÞ ðåñéïäéêÜ, üóï êáé óå ìç áããëüöùíá (éóðáíéêÜ) ðåñéïäéêÜ, áõîÞèçêáí ìå åêèåôéêü ó÷åäüí ôñüðï (Alvarez et al., 1996; Simo et al., 1999). Åßíáé ãåãïíüò üôé ç áíÜðôõîç ôçò éáôñéêÞò åðéóôÞìçò óõíäÝåôáé ìå ôçí áýîçóç ôçò ðáñáãüìåíçò ãíþóçò êáé ðëçñïöïñßáò ìå ìéá ó÷Ýóç áìößäñïìç. ÊÜèå 10-15 ÷ñüíéá, ï áñéèìüò ôùí éáôñéêþí ðåñéïäéêþí ðáãêïóìßùò äéðëáóéÜæåôáé, åíþ óçìáíôéêÞ áýîçóç ðáñïõóéÜæåé êáé ï áñéèìüò ôùí åëëçíéêþí éáôñéêþí ðåñéïäéêþí. ÁäéáìöéóâÞôçôïò åßíáé êáé ï ñüëïò ðïõ ðáßæåé êáé ðïõ èá ðáßîåé óôï ìÝëëïí ôï Internet óôçí áíôáëëáãÞ ôçò åðéóôçìïíéêÞò ðëçñïöïñßáò. Ï ìüíïò ôñüðïò ãéá ôçí åðéâßùóç áõôÞò ôçò ìåãÜëçò ñïÞò ðëçñïöïñéþí, åßíáé ç áýîçóç ôçò ðïéüôçôáò ôùí åðéóôçìïíéêþí äçìïóéåýóåùí (ÄáñäáâÝóçò êáé óõí., 1997; Ingram, 1992; Murphy et al., 1998; Hook, 1999). Áðü ôá áðïôåëÝóìáôÜ ìáò öáßíåôáé üôé ïé ðåñéóóüôåñåò áíáêïéíþóåéò ðñïÝñ÷ïíôáé áðü Íïóïêïìåßá, áêïëïõèïýìåíá áðü ôá ÊÝíôñá Õãåßáò

18 (3.9) 52 (11.2) 28 (6.0) 45 (9.7) 3 (0.7) 63 (13.6) 4 (0.9) 15 (3.2) 50 (10.8) 26 (5.6) 5 (1.1) 463 (100)

êáé ôá ÁÅÉ, åíþ ôá ÐÉ áíôéðñïóùðåýïíôáé ìå Ýíá ìéêñü ðïóïóôü (1.8%). Áðü ôéò ðñïåñ÷üìåíåò áðü íïóïêïìåßá åñãáóßåò, ç ðëåéïíüôçôÜ ôïõò åß÷å óáí óõããñáöåßò åéäéêåõüìåíïõò óôç ÃåíéêÞ ÉáôñéêÞ (äåí áðåéêïíßæåôáé óôá áðïôåëÝóìáôá). Ôá áðïôåëÝóìáôá áõôÜ óõìöùíïýí ìå ìéá ìåëÝôç ðïõ Ýãéíå ãéá äéÜöïñá ðåñéïäéêÜ ðñùôïâÜèìéáò öñïíôßäáò, êáé Ýäåéîå üôé ôï 72% ôùí óõããñáöÝùí ðïõ áíáãñÜöïíôáí ðñþôïé óå óåéñÜ óôç óõããñáöéêÞ ïìÜäá, ðñïåñ÷üôáí áðü êÝíôñá ðñùôïâÜèìéáò öñïíôßäáò (Simo et al., 1999). Ìéá Üëëç ìåëÝôç Ýäåéîå üôé ðåñßðïõ ôï 38% ôùí Üñèñùí ðïõ äçìïóéåýèçêáí óå éóðáíéêü åðéóôçìïíéêü ðåñéïäéêü ãéá ôçí ïéêïãåíåéáêÞ éáôñéêÞ, ðñïåñ÷üôáí áðü ìïíÜäåò (íïóïêïìåßá Þ ðáíåðéóôçìéáêÜ ôìÞìáôá), ðïõ äéäÜóêïõí ïéêïãåíåéáêïýò éáôñïýò. Áðü ôçí ßäéá ìåëÝôç ðñïêýðôåé üôé ðåñßðïõ ôï 24% ôùí Üñèñùí Þôáí ðñïúüí óõíåñãáóßáò ìåôáîý 2 Þ ðåñéóóïôÝñùí éäñõìÜôùí, ãåãïíüò ðïõ ðáñáôçñåßôáé êáé óôá äéêÜ ìáò áðïôåëÝóìáôá (22%). Áðü ôïõò óõããñáöåßò, ôï óõãêåêñéìÝíï ðïóïóôü (24%) èåùñåßôáé ìéêñü êáé ÷áñáêôçñßæïõí ôéò óõíåñãáóßåò ìåôáîý éäñõìÜôùí ùò óðÜíéåò (Alvarez et al., 1996). Ôï ìéêñü ðïóïóôü óõììåôï÷Þò ôùí éáôñþí ÐÉ óôá ÓõíÝ177


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

äñéá ÃåíéêÞò ÉáôñéêÞò, ðáñÜ ôçí ïõóéáóôéêÞ óõììåôï÷Þ ôïõò óôçí ðáñï÷Þ ðñùôïâÜèìéáò öñïíôßäáò, èá ìðïñïýóå íá áðïäïèåß óå äéÜöïñïõò ðáñÜãïíôåò, üðùò ôçí Ýëëåéøç ðåßñáò óôï ó÷åäéáóìü êáé ðñáãìÜôùóçò ìéáò åñåõíçôéêÞò åñãáóßáò, ôçí åëëéðÞ êáèïäÞãçóç áðü ôçí ðñïúóôÜìåíç éáôñéêÞ áñ÷Þ, ôçí áðïõóßá ôçò áðáñáß��çôçò õëéêïôå÷íéêÞò õðïäïìÞò áëëÜ êáé åíäéáöÝñïíôïò. H ðñïóùñéíüôçôá áõôþí ôùí éáôñþí óôá ÐÉ, ðéèáíüí íá åðçñåÜæåé ôç åíåñãÞ óõììåôï÷Þ ôïõò óôá ÓõíÝäñéá, ãåãïíüò ðïõ Ý÷åé äéáðéóôùèåß ôïõëÜ÷éóôïí ãéá ôïõò åñãáæüìåíïõò åñåõíçôÝò (Leebens et al., 1993). ¼óïí áöïñÜ óôç ãåùãñáöéêÞ êáôáíïìÞ ôùí ðåñéëÞøåùí, åßíáé öáíåñü üôé óôá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò áí êáé ðåñßðïõ ôï 1/3 ôùí åñãáóéþí ðñïÝñ÷åôáé áðü ôçí ÁèÞíá, åßíáé ðåñéóóüôåñï áðïêåíôñùìÝíá óå ó÷Ýóç ìå ôï 22ï ÐÉÓ. Ôï ãåãïíüò ôçò óõììåôï÷Þò ôçò ðåñéöÝñåéáò ãßíåôáé ðåñéóóüôåñï öáíåñü ìå ôçí áíáãùãÞ ôùí ðåñéëÞøåùí áíÜ Ãåíéêü Éáôñü, üðïõ ôá óêÞðôñá ðáßñíåé ç ÈñÜêç áêïëïõèïýìåíç áðü ôçí ÁôôéêÞ, ôçí ÊñÞôç êáé ôçí Ðåëïðüííçóï. Ôá áðïôåëÝóìáôá áõôÜ âÝâáéá, ìüíïí åíäåéêôéêÜ ìðïñïýí íá ÷áñáêôçñéóèïýí, äåäïìÝíïõ üôé, áöåíüò óôïõò ôüìïõò ôùí ðåñéëÞøåùí äåí áíáãñÜöåôáé ðÜíôïôå ç åéäéêüôçôá Þ ïé ëïéðÝò éäéüôçôåò ôùí óõããñáöÝùí êé áöåôÝñïõ ï áñéèìüò ôùí Ãåíéêþí Éáôñþí áëëÜæåé êÜèå ÷ñüíï. Ç ÷ñÞóç ðÜíôùò ôçò ÓôáôéóôéêÞò Åðåôçñßäáò ôïõ 1995 (áíáöÝñåôáé óå áñéèìïýò ôïõ 1994), ðéóôåýïõìå üôé ðñïóåããßæåé áñêåôÜ ôï ìÝóï üñï ôçò äåêáåôßáò 19891999. Ç áíïìïéïìïñößá óôç ãåùãñáöéêÞ êáôáíïìÞ ôçò åðéóôçìïíéêÞò ðáñáãùãÞò, åßíáé Ýíá ãåãïíüò ðïõ ðáñáôçñåßôáé äéåèíþò, ü÷é ìüíï ìÝóá óôá üñéá ôçò ßäéáò ôçò ÷þñáò, áëëÜ êáé ðïëý ðåñéóóüôåñï áíÜìåóá óå äéáöïñåôéêÝò ÷þñåò. Åßíáé äå áðïäåêôü üôé ç åðéóôçìïíéêÞ ðáñáãùãéêüôçôá ìéáò ÷þñáò óå Ýíá óõãêåêñéìÝíï éáôñéêü ðåäßï, áðåéêïíßæåôáé áðü ôïí áñéèìü ôùí äçìïóéåõìÝíùí åñãáóéþí. ÄéÜöïñïé ðáñÜãïíôåò, üðùò êïéíùíéêï-ïéêïíïìéêÝò óõíèÞêåò ôçò ðåñéï÷Þò, ç äéáèåóéìüôçôá êáôÜëëçëïõ áíèñþðéíïõ äõíáìéêïý êáé õëéêïôå÷íéêÞò õðïäïìÞò ðáßæïõí ðñùôåýïíôá ñüëï óôçí áíÜðôõîç ôçò Ýñåõíáò. (Alvarez et al., 1996; Boldt et al., 1999; Lopez-Cozar et al., 1999; Minana et al., 1999). Ï ìÝóïò üñïò ôïõ áñéèìïý ôùí óõããñáöÝùí áíÜ åñãáóßá Þôáí 5.37, ìå 3.75 Üíäñåò êáé 1.62 ãõíáßêåò, åíþ üðùò öáßíåôáé óôá ó÷Þìáôá 4 êáé 178

Â. ÓéäåñÞò êáé óõí.

5, ï áñéèìüò ôïõ óõíüëïõ ôùí óõããñáöÝùí áíÜ åñãáóßá áõîÜíåôáé êáôÜ ìéêñü ðïóïóôü óå êÜèå óõíÝäñéï, åíþ ç áíáëïãßá áíäñþí:ãõíáéêþí ìåéþíåôáé áðü ðåñßðïõ 3:1 óôï 3ï êáé 4ï ÓõíÝäñéï, óå 2 Üíäñåò ãéá êáèåìéÜ ãõíáßêá óõããñáöÝá óôï 11ï. Ï ìÝóïò üñïò óõããñáöÝùí áíÜ åñãáóßá ðïõ óõíáíôÜìå óôç äéåèíÞ âéâëéïãñáößá êõìáßíåôáé áíÜëïãá ìå ôï åßäïò ôçò ìåëÝôçò êáé åîáñôÜôáé êõñßùò áðü ôï åßäïò ôïõ åðéóôçìïíéêïý ðåñéïäéêïý êáé ôï Ýôïò ðïõ áíáöÝñåôáé. ¸ôóé, óå Ýñåõíá óå ðåñéïäéêü ÷åéñïõñãéêÞò, ôï 1962 ï ÌÏ óõããñáöÝùí áíÜ åñãáóßá Þôáí 1.83 êáé Ýöôáóå óå 6.41 ôï 1992. Óå Üëëåò åñãáóßåò áíÜëïãá ìå ôïí ôýðï ôïõ ðåñéïäéêïý êáé ôï Ýôïò, ï áñéèìüò ôùí óõããñáöÝùí êõìáßíåôáé áðü 3.21 Ýùò 5.73 (Pulido et al., 1994; Drenth 1998; Figueredo, 1999). Ðáñáôçñåßôáé ãåíéêÜ, ìåãÜëç áýîçóç óôïí áñéèìü ôùí óõããñáöÝùí ìå ôçí ðÜñïäï ôùí åôþí, ãåãïíüò ðïõ üðùò åðéóçìáßíåôáé, áí óõíå÷éóèåß, åíÝ÷åé ôïí êßíäõíï ôçò äéáêýâåõóçò ôçò áêåñáéüôçôáò ôùí åñãáóéþí ðïõ äçìïóéåýïíôáé (Powers, 1988). Ç óõìâïëÞ óôçí åêôÝëåóç êáé ôç óõããñáöÞ ìéáò åðéóôçìïíéêÞò åñãáóßáò óõíéóôÜ åõèýíç, êáèÞêïí áëëÜ êáé áíáãíþñéóç. Ðéèáíüí, óå êÜðïéåò åñãáóßåò íá õðÜñ÷ïõí óõããñáöåßò ôéìçôéêÜ (óõããñáöåßò äçëáäÞ ðïõ äåí Ý÷ïõí åñãáóèåß ãéá ôç óõãêåêñéìÝíç åñãáóßá) áëëÜ êáé Üôïìá ðïõ Ý÷ïõí åñãáóèåß êáé äåí áíáöÝñïíôáé óôç óõããñáöéêÞ ïìÜäá. Ìéá ðñüóöáôç ìåëÝôç Ýäåéîå üôé ôï 19% ôùí Üñèñùí óçìáíôéêþí éáôñéêþí ðåñéïäéêþí, åß÷áí óõããñáöåßò ôéìçôéêÜ, 11% äåí áíÝöåñáí Üôïìá ôá ïðïßá åñãÜóèçêáí ãéá ôçí åñãáóßá, åíþ 2% ðåñéåß÷áí êáé áðü ôá äõï åßäç (Flanagin et al., 1998). ¼óïí áöïñÜ óôï öýëï ôùí óõããñáöÝùí, ôá áðïôåëÝóìáôÜ ìáò öáßíåôáé íá óõìöùíïýí ìå ìéá ðñüóöáôç äçìïóßåõóç ðïõ Ýãéíå ãéá ôá êõñéüôåñá ðåñéïäéêÜ ùôïñéíïëáñõããïëïãßáò êáé ðïõ Ýäåé÷íå üôé óôç äåêáåôßá 19781988 ôï ðïóïóôü ôùí ãõíáéêþí óõããñáöÝùí äéðëáóéÜóèçêå, åíþ óôçí åéêïóáåôßá 1978-1998 ó÷åäüí ôåôñáðëáóéÜóèçêå (áðü 4.1% óå 12.4%). Ôçí ßäéá ðåñßðïõ áýîçóç åß÷å êáé ï áñéèìüò ôùí ãõíáéêþí ðïõ Þôáí ðñþôï üíïìá óôç óõããñáöéêÞ ïìÜäá (Bhattacharyya and Shapiro, 2000), åíþ óå Üëëç ìåëÝôç, ôï 21% ôùí Üñèñùí åß÷å ôïõëÜ÷éóôïí ìéá ãõíáßêá óõããñáöÝá (Keating et al., 1998). Ï Knoppers, 1989, Ýäåéîå üôé ïé ãõíáßêåò äçìïóéåýïõí óõ÷íüôåñá ìüíåò áðü üôé ïé Üíäñåò, ïé ïðïßïé ðñïôéìïýí íá äçìïóéåýïõí óå ïìÜäåò.


Ôüìïò 12, Ôåý÷ïò 3, 2000

Â. ÓéäåñÞò êáé óõí.

ÁíáöïñéêÜ ìå ôï åßäïò ôçò åñãáóßáò, èá ðñÝðåé íá óçìåéùèåß ôï áõèáßñåôï ôïõ äéá÷ùñéóìïý ôùí åíïôÞôùí êáèþò êáé ôçò õðáãùãÞò ôùí ðåñéëÞøåùí óå ìéá áðü áõôÝò. Ðéèáíüí, ç äçìéïõñãßá ôÝôïéùí åíïôÞôùí íá äéåõêüëõíå ôï Ýñãï, ôüóï ôçò åðéóôçìïíéêÞò, üóï êáé ôçò ïñãáíùôéêÞò åðéôñïðÞò ôùí óõíåäñßùí. Ïé óõããñáöåßò èá ìðïñïýí Ýôóé áðü ìüíïé ôïõò, óôï âáèìü ðïõ åßíáé äõíáôü, íá ôïðïèåôïýí ôéò åñãáóßåò ôïõò óå êÜðïéá åíüôçôá. Áêüìç, ç ýðáñîç ëÝîåùí êëåéäéþí, èá âïçèïýóå óôçí êáëýôåñç ôåêìçñßùóç ôïõ ðåñéå÷ïìÝíïõ ôçò åñãáóßáò. ¼ðùò áíáëõôéêÜ öáßíåôáé óôïí ðßíáêá 3, ôï ìåãáëýôåñï ðïóïóôü åß÷áí ïé åðéäçìéïëïãéêÝò åñãáóßåò (15.7%), áêïëïõèïýìåíåò áðü áõôÝò ôçò ðáèïëïãßáò (9.1%) êáé ôéò ðåñéëÞøåéò óôçí åíüôçôá ôùí ëïéðþí (8%). Óôçí ôåëåõôáßá êáôçãïñßá õðÜãïíôáé ïé ðåñéëÞøåéò ðïõ ðáñïõóéÜæïõí äñáóôçñéüôçôåò ôùí ÊÕ êáé ãåíéêüôåñá ôç ÷ñÞóç ôùí õðçñåóéþí ðñùôïâÜèìéáò öñïíôßäáò õãåßáò. Óå ìéá áíÜëõóç ðïõ Ý÷åé ãßíåé ãéá 5 óçìáíôéêÜ ðåñéïäéêÜ ðñùôïâÜèìéáò öñïíôßäáò, âñÝèçêå üôé ôï 42% ôùí Üñèñùí áöïñïýóå óôçí ïñãÜíùóç êáé ôçí ðáñï÷Þ õðçñåóéþí õãåßáò, ôï 18% Üñèñá åðéäçìéïëïãéêïý ðñïóáíáôïëéóìïý, åíþ ôï 8% áöïñïýóå ìåëÝôåò ó÷åôéêÝò ìå ôçí åêðáßäåõóç ôùí íÝùí éáôñþí (Lopez-Miras et al., 1993). Óôç äéêÞ ìáò ìåëÝôç, ôï ðïóïóôü ôùí ðåñéëÞøåùí ìå èÝìá ôçí éáôñéêÞ åêðáßäåõóç Þôáí ìüíï 2.2% êáé ðåñßðïõ ßäéï ìå ôï áíôßóôïé÷ï ðïóïóôü ôïõ 22ïõ ÐÉÓ (1.5%). Óå Üëëç åñãáóßá ðïõ áöïñïýóå ðåñéïäéêü ðñïëçðôéêÞò êáé êïéíùíéêÞò éáôñéêÞò, ðáñáôçñÞèçêå ìåôáóôñïöÞ ôïõ åßäïõò ôùí äçìïóéåýóåùí ôç äåêáåôßá ôïõ ’80, áðü åñãáóßåò áíáöåñüìåíåò óôéò õðçñåóßåò õãåßáò êáé ãåñïíôïëïãßáò ôï ðñþôï ìéóü ôçò äåêáåôßáò, óå áõôÝò ðïõ áöïñïýóáí óôá êáñäéáêÜ íïóÞìáôá, ôçí åðéäçìéïëïãßá ôïõ êáñêßíïõ êáé ôïõ AIDS, óôï äåýôåñï ìéóü (Schubert-Subbarathnam and Rougemont, 1992). Ìéêñü ìÜëëïí ÷áñáêôçñßæåôáé ôï ðïóïóôü (1.4%) ôùí åñãáóéþí ÉáôñéêÞò ÐëçñïöïñéêÞò. Ôï ãåãïíüò áõôü ìðïñåß íá åîçãçèåß áöåíüò áðü ôç ó÷åôéêÜ ðåñéïñéóìÝíç åîÜðëùóç ôçò ôçëåúáôñéêÞò (Mavrogeni et al., 1996) êáé ôïõ Internet óôçí ÅëëÜäá êé áöåôÝñïõ áðü ôçí Ýëëåéøç åêðáßäåõóçò ôùí ìåãáëýôåñùí óå çëéêßá éáôñþí. Ìå ôç óõíå÷éæüìåíç ðñüïäï ôçò ðëçñïöïñéêÞò, ïé åöáñìïãÝò ôùí õðïëïãéóôþí óôçí éáôñéêÞ áõîÜíïíôáé ãñÞãïñá. Ôï Internet Ý÷åé ÷ñÞóéìåò åöáñìïãÝò ãéá ôïõò ïéêïãåíåéáêïýò éáôñïýò, ðïõ ðåñéëáìâÜíïõí ôçí Üìåóç åðéêïéíùíßá ìåôáîý éáôñþí,

ðñüóâáóç óôçí åðéóôçìïíéêÞ âéâëéïãñáößá, óõíå÷Þ åêðáéäåõôéêÜ ðñïãñÜììáôá êáèþò êáé ðëçñïöïñßåò ãéá ôçí õðïóôÞñéîç áóèåíþí êáé ïìÜäùí óõæÞôçóçò (Anthes et al., 1997). ÓõìðåñáóìáôéêÜ, ôá ÓõíÝäñéá ÃåíéêÞò ÉáôñéêÞò, ìðïñïýí íá ÷áñáêôçñéóèïýí ùò ðïëõèåìáôéêÜ, ìå ôçí Ýííïéá ôçò ýðáñîçò åñãáóéþí áðü üëåò ôéò éáôñéêÝò åéäéêüôçôåò ðïõ Üðôïíôáé ôùí åíäéáöåñüíôùí ôïõ Ãåíéêïý Éáôñïý. Ç äçìéïõñãßá åðéóôçìïíéêþí åíïôÞôùí êáé ç ÷ñÞóç ëÝîåùí êëåéäéþí áðü ôïõò óõããñáöåßò, èá ìðïñïýóå íá áíôéìåôùðßóåé êáëýôåñá ôüóï åðéóôçìïíéêÜ üóï êáé ïñãáíùôéêÜ, ôç ìåãÜëç áýîçóç ôïõ áñéèìïý ôùí åñãáóéþí. Ç óõììåôï÷Þ éáôñþí áðü ïëüêëçñï ó÷åäüí ôïí åëëáäéêü ÷þñï êáèþò êáé áðü ìéêñÝò íïóçëåõôéêÝò ìïíÜäåò, üðùò åßíáé ôá ÊÝíôñá Õãåßáò, åßíáé óçìáíôéêü ãåãïíüò óôçí áíÜðôõîç ôçò Ýñåõíáò êáé ôçò ðñïüäïõ ôçò éáôñéêÞò åðéóôÞìçò óôçí ÅëëÜäá, äçìéïõñãåß üìùò ðñïâëçìáôéóìïýò ç ìéêñÞ Þ êáé áíýðáñêôç óõììåôï÷Þ êÜðïéùí ðåñéï÷þí êáé ìéêñüôåñùí íïóçëåõôéêþí ìïíÜäùí, üðùò åßíáé ôá ÐåñéöåñåéáêÜ Éáôñåßá. ºóùò, ç äçìéïõñãßá óùóôÞò õëéêïôå÷íéêÞò õðïäïìÞò êáé ç êáôÜëëçëç åðéóôçìïíéêÞ åêðáßäåõóç ôùí íÝùí éáôñþí, íá áíÝóôñåöå áõôü ôï öáéíüìåíï.

Âéâëéïãñáößá 1. H Brazier. Writing a research abstract: structure, style and content. Nursing Standard, 11:346, 1997. 2. S.C. Beyea, L.H. Nicoll. Writing and submitting an abstract. AORN Journal, 67:273-4, 1998. 3. E. Garfield. Fortnightly review: How can impact factors be improved? BMJ 313:411-3, 1996. 4. T. Opthof. Sense and nonsense about the impact factor. Cardiovasc. Res., 33:1-7, 1997. 5. R.L. Gorman, G.M. Oderda. Publication of presented abstracts at annual scientific meetings: a measure of quality? Vet. Hum. Toxicol., 32:4702, 1990. 6. E.J. Weber, M.L. Callaham, R.L. Wears, C. Barton, G. Young. Unpublished research from a medical specialty meeting: why investigators fail to publish. JAMA, 280:257-9, 1998. 7. D.J. Bowrey, G.J. Morris-Stiff, G.W. Clark, P.D. Carey, R.E. Mansel. Peer-reviewed publication following presentation at a regional surgical meeting. Med. Educ., 33:212-4, 1999. 8. J.C. Wang, S. Yoo, R.B. Delamarter. The publication rates of presentations at major Spine 179


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Ôüìïò 12, Ôåý÷ïò 3, 2000

Å. Ìé÷áçëßäçò êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅÑÃÁÓÉÁ ÓÔÏ ÄÉÁÃÙÍÉÓÌÏ “Ä. ÉÊÊÏÕ” THE SECOND AWARDED PAPER IN THE MEMORY OF PROF. D. IKKOS Primary Heatlh Care, Volume 12, Number 3, 125-131, 2000 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 12, Ôåý÷ïò 3, 125-131, 2000

ÉáôñïãåíÞò íïóçñüôçôá öáñìáêåõôéêÞò áéôéïëïãßáò ùò áßôéï åéóáãùãÞò óå ðáèïëïãéêü ôìÞìá ôñéôïâÜèìéïõ íïóïêïìåßïõ Å. Ìé÷áçëßäçò1, È. ÐÝððáò3, Á. Óùôçñüðïõëïò2, Áë. ÐëáôáíÜ1, Á. Áóðñïðïôáìßôç1, Â. Âëá÷üðïõëïò1, I. ÐáñáóêåõáÀäçò1, ×. ÊáììéëÜôïò4, Ó. ÐáððÜò5

Ðåñßëçøç Óêïðüò: Ç êáôáãñáöÞ êáé ç áíÜëõóç ôùí ðåñéðôþóåùí Éáôñïãåíïýò Íïóçñüôçôáò ðïõ ÷ñåéÜóèçêå íá åéóá÷èïýí åðåéãüíôùò óôï ô Ðáèïëïãéêü ÔìÞìá óôá ðëáßóéá ÃåíéêÞò Åöçìåñßáò óôç äéÜñêåéá ôùí åôþí 1996-1998. Õëéêü êáé ìÝèïäïò: ÊáôåãñÜöçóáí ðñïïðôéêÜ üëåò ïé åéóáãùãÝò áðüôïêïé Éáôñïãåíïýò Íïóçñüôçôáò (ïñéæüìåíåò óáí åìöÜíéóç áíåðéèýìçôçò åíåñãåßáò öáñìÜêùí ÷ïñçãçèÝíôùí Þ ëçöèÝíôùí ãéá èåñáðåõôéêïýò óêïðïýò) êáôÜ ôï ÷ñïíéêü äéÜóôçìá äýï åôþí (ÍïÝìâñéïò 1996 - ÍïÝìâñéïò 1998). ÌåëåôÞèçêáí ôá äçìïãñáöéêÜ êáé åðéäçìéïëïãéêÜ ÷áñáêôçñéóôéêÜ ôùí áóèåíþí, ôï åßäïò ôùí ëçöèÝíôùí öáñìÜêùí, ç Ýêâáóç, ç äéÜñêåéá ðáñáìïíÞò óôï ÔìÞìá êáé ç èíçôüôçôá. Ç êáôá÷þñéóç êáé áíÜëõóç ôùí ðåñéóôáôéêþí Ýãéíå óå Çëåêôñïíéêü ÕðïëïãéóôÞ ìå ôï ðñüãñáììá ÅÑÉ5-Info (1991). ÁðïôåëÝóìáôá: Óôï áíùôÝñù äéÜóôçìá (1996-1998) 262 áðü ôéò 2710 åéóáãùãÝò (ðïóïóôü 9,7%) áöïñïýóáí ðåñéðôþóåéò Éáôñïãåíïýò Íïóçñüôçôáò. Óõ÷íüôåñåò äéáãíþóåéò óôïõò 262 áõôïýò áóèåíåßò (151 Üíäñåò, 111 ãõíáßêåò, ìÝóçò çëéêßáò 63,5±15,1 Ýôç) Þôáí: áéìïññáãßá áíùôÝñïõ ðåðôéêïý 157 (59,9%), áëëåñãßá 39 (14,9%), õðïãëõêáéìßá 23 (8,8%) êáé áéìïññáãéêÞ äéÜèåóç áðü áíôéðçêôéêÜ 12 (4,6%). ËçöèÝíôá öÜñìáêá óõ÷íüôåñá Þôáí áóðéñßíç Þ/ Ìç óôåñéíïåéäÞ áíôéöëåãìïíþäç (66,2%), áíôéìéêñïâéáêÜ (12,6%) êáé áíôéäéáâçôéêÜ (7,8%). ÌÝóç äéÜñêåéá íïóçëåßáò Þôáí 5,5±2,9 çìÝñåò êáé ç Ýêâáóç Þôáí ßáóç Þ/ âåëôßùóç óôï 94,6% ôùí áóèåíþí, êáé 5 èÜíáôïé (1,9%). ÌåôÜ ôçí áíÜëõóç ôùí ðåñéóôáôéêþí ôï óýìâáìá ôçò Éáôñïãåíïýò Íïóçñüôçôáò áíåõñÝèç áðïôñÝøéìï ðåñßðïõ óôï Þìéóõ (1/2) ôùí åéóá÷èÝíôùí. ÓõìðÝñáóìá: Ç ÉáôñïãåíÞò Íïóçñüôçôá åßíáé éäéáßôåñá óõ÷íÞ áéôßá íïóïêïìåéáêÞò íïóçëåßáò (9,7% åéóáãùãþí ðáèïëïãéêïý ôìÞìáôïò) ìå óïâáñÝò, åíßïôå, óõíÝðåéåò (èíçôüôçò 1,9%). Óå óçìáíôéêü ðïóïóôü åßíáé áðïôñÝøéìç ìå êáëýôåñç ðáñáêïëïýèçóç óõãêåêñéìÝíùí ïìÜäùí áóèåíþí (åðß çëéêéùìÝíùí ìå éóôïñéêü åê ôïõ ðåðôéêïý, äéáâçôéêþí, óå ëÞøç áíôéðçêôéêþí ê.Ü). ÅðïìÝíùò åßíáé Üìåóç ç åõáéóèçôïðïßçóç êáé åíçìÝñùóç ôùí Ãåíéêþí/Ïéêïãåíåéáêþí Éáôñþí äéüôé ç óçìáóßá ôçò ðñüëçøçò ôÝôïéùí óõìâáìÜôùí åßíáé ôåñÜóôéá.

Ã' Ðáèïëïãéêü ÔìÞìá êáé Ãåíéêïß Éáôñïß, Ðåñ. Ãåí. Íïóïêïìåßï Íßêáéáò - ÐåéñáéÜ, 1Åéäéêåõüìåíïò ô Ðáèïëïãéêïý ÔìÞìáôïò, 2ÅðéìåëçôÞò ´, ô Ðáèïëïãéêïý ÔìÞìáôïò, 3ÅðéìåëçôÞò Á´, ô Ðáèïëïãéêïý ÔìÞìáôïò, 4Åéäéêåõüìåíïò ÃåíéêÞò ÉáôñéêÞò, 5ÄéåõèõíôÞò ô Ðáèïëïãéêïý ÔìÞìáôïò, ÓõíôïíéóôÞò åêðáßäåõóçò åéäéêåõïìÝíùí ÃåíéêÞò ÉáôñéêÞò

ÅéóáãùãÞ Ç éáôñïãåíÞò íïóçñüôçôá Ý÷åé áíáãíùñéóèåß óôçí éáôñéêÞ ðñÜîç êáé áíáöÝñåôáé óôçí éáôñéêÞ âéâëéïãñáößá åäþ êáé áñêåôÜ ÷ñüíéá. Óáí éáôñïãåíÞò íïóçñüôçôá ïñßæåôáé êÜèå áíåðéèýìçôç åíÝñãåéá, ãíùóôÞ Þ Üãíùóôç, ðñïâëåðüìåíç Þ ìç, ðïõ ðñïêýðôåé áðü öáñìáêåõôéêÞ áãùãÞ, ðáñüôé ôï ëáìâáíüìåíï öÜñìáêï, äßíåôáé óôçí åíäåéêíõüìåíç äüóç, óýìöùíá ìå ôïõò êáíüíåò ôçò éáôñéêÞò ôÝ÷íçò ãéá äéáãíùóôéêïýò, ðñïëçðôéêïýò Þ èåñáðåõôéêïýò ëüãïõò. ÁñêåôÝò ðåñéðôþóåéò éáôñïãåíïýò íïóçñüôçôáò, åðáêüëïõèï âëáðôéêþí åðéäñÜóåùí áðü öÜñìáêá, áðáíôïýí óôç íïóïêïìåéáêÞ ðåñßèáëøç. Äçìéïõñãïýí ùò åê ôïýôïõ éäéáßôåñá Ýíôïíï ðñüâëçìá, óôá ôìÞìáôá åðåéãüíôùí ðåñéóôáôéêþí ôùí íïóïêïìåßùí, áöïý ËÝîåéò êëåéäéÜ: ÉáôñïãåíÞò íïóçñüôçôá, öáñìáêåõôéêÞ áãùãÞ, áíåðéèýìçôåò åíÝñãåéåò. ÕðïâëÞèçêå: Ç åñãáóßá áõôÞ õðïâëÞèçêå óôï äéáãùíéóìü "Ä. ºêêïõ" óôá ðëáßóéá ôïõ 12ïõ Ðáíåëëçíßïõ Óõíåäñßïõ ÃåíéêÞò ÉáôñéêÞò (×áëêéäéêÞ, 15-19 Ïêôùâñßïõ 2000) êáé Ýëáâå Ýðáéíï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Å. Ìé÷áçëßäçò, Ðëáôáéþí 20, Íßêáéá, 184 54, ôçë.: (01) 4936341, fax: (01) 4916484. 125


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Å. Ìé÷áçëßäçò êáé óõí.

Drug induced illness leading to hospitalization E. Michailidis, Th. Peppas, A. Sotiropoulos, Al. Platana, A. Aspropotamiti, V. Vlachopoulos, I. Paraskevaidis, Ch. Kammilatos, S. Pappas Summary Background: A 650 bed tertiary hospital in Greece assessed all medical admissions due to iatrogenic morbidity (IM) from the emergency ward to a medical department over a two year period (1997-8). Methods: All patient details were taken on admission, drug regimen and prescription or self-prescription details were recorded. Every probable IM case was discussed at the Department daily staff meeting and was confirmed, if every one, unanimously, agreed that the case was definitely IM. A detailed analysis of whether the event might have been prevented was performed, discussing each individual case and if, by proper history and monitonng, this could have been prevented. Results: There were 262 (9.8%) out of 2,710 admissions evaluated as IM associated. Fifty-five (20.9%) had taken the drug on self-decision. Principal conditions of IM were gastric bleeding: 157 (59.9%), allergy: 39 (14.9%) and hypoglycemia: 23 (8.8%). Associated drugs were mostly aspirin and non-steroid anti-inflammatory 181 (66.2%), antibiotics (12.6%) and antidiabetics (7.8%). The outcome was favorable overall with improvement in 95% of cases but there were five deaths. 50% of the IM cases were assessed as possibly preventable. Conclusions: A considerable percentage of admissions (9.7%) was a result of IM. One in five had taken the associated drug without prescription. Gastric bleeding and allergy were the most common IM conditions, aspirin and NSAIDs were the drugs most frequently taken. Proper history, monitoring and vigilance could prevent half these cases. Key words: Iatrogenic morbidity, drug therapy, side-effect

ðåñßðïõ ôï 6-10% ôùí åéóáãïìÝíùí êáé íïóçëåõïìÝíùí åßíáé Üññùóôïé ëüãù öáñìáêåõôéêþí áíåðéèýìçôùí åíåñãåéþí1,2. Ðñïêáëïýìåíçò âëáðôéêÞò åðßäñáóçò óôçí õãåßá ôùí áíèñþðùí ç éáôñïãåíÞò íïóçñüôçôá áðü öÜñìáêá äçìéïõñãåß ìåãÜëï ïéêïíïìéêü êüóôïò óôçí ðïëéôåßá. ÓÞìåñá ôá ðáñáðÜíù ðñïâëÞìáôá åßíáé ìåãáëýôåñá ãéá äýï åðéðñüóèåôïõò ëüãïõò: 1. Õößóôáôáé áýîçóç ôïõ ðñïóäüêéìïõ åðéâßùóçò êáé ôïõ áñéèìïý ôùí õðåñÞëéêùí áôüìùí. 2. Ç ðñüïäïò ôçò ôå÷íïëïãßáò Ý÷åé áõîÞóåé óçìáíôéêÜ ôïí áñéèìü ôùí äéáãíùóôéêþí ìåèüäùí. ÓõíÝðåéá ôùí áíùôÝñù åßíáé ç ðïëõöáñìáêßá, ç ÷ñÞóç äçëáäÞ ìåãáëõôÝñïõ áñéèìïý öáñìÜêùí, ç ïðïßá Ý÷åé óáí áðïôÝëåóìá ìåãáëýôåñç óõ÷íüôçôá ôçò éáôñïãåíïýò íïóçñüôçôáò. Ç ìåëÝôç ìáò ëïéðüí ó÷åäéÜóôçêå ìå óêïðü íá åêôéìÞóïõìå ôç óõ÷íüôçôá ôçò ðñïêáëïýìåíçò áðü ôá öÜñìáêá éáôñïãåíïýò íïóçñüôçôáò, üðùò åêöñÜóôçêå áðü ôçí êáôáãñáöÞ ôùí ðåñéðôþóåùí ðïõ ÷ñåéÜóôçêå íá åéóá÷èïýí êáé íá íïóçëåõèóýí óôçí ðáèïëïãéêÞ êëéíéêÞ ìáò óôá ðëáßóéá ãåíéêÞò åöçìåñßáò åíüò ôñéôïâÜèìéïõ 126

íïóïêïìåßïõ.

Õëéêü êáé MÝèïäïò

Ç ðñïêáëïýìåíç áðü öÜñìáêá éáôñïãåíÞò íïóçñüôçôá ðïõ Ý÷åé óáí áðïôÝëåóìá ôçí åéóáãùãÞ êáé íïóçëåßá ôïõ áóèåíïýò, ïñßæåôáé áõôÞ ðïõ ðñïêýðôåé ùò áíåðéèýìçôç åíÝñãåéá, óáí áðïôÝëåóìá ôçò èåñáðåõôéêÞò áãùãÞò. Áíåðéèýìçôç åíÝñãåéá áðü öÜñìáêá ïñßæåôáé ç áíáöåñüìåíç ùò áèÝëçôç áíôáðüêñéóç óôï öÜñìáêï, ç ïðïßá åìöáíßæåôáé ðáñÜ ôçí êáôÜëëçëç äüóç, ãéá ðñüëçøç, äéÜãíùóç Þ èåñáðåßá. Ùò ðñïêáëïýìåíç áðü öÜñìáêï áíåðéèýìçôç åíÝñãåéá ïñßóôçêå, ç ðñïêáëïýìåíç áðü ãíùóôÞ áíáìåíüìåíç áíôßäñáóç öáñìÜêïõ, óå áíáìåíüìåíï ÷ñüíï, áìÝóùò ìåôÜ ôç ëÞøç ôïõ öáñìÜêïõ. Áðïêëåßóáìå ðåñéðôþóåéò, óôéò ïðïßåò ôá óõìðôþìáôá äåí ðñïêëÞèçêáí áðü ôï ëáìâáíüìåíï öÜñìáêï, áëëÜ áðü ãíùóôÞ õðïêåßìåíç íüóï. Óôçí ðåñßðôùóç áõôÞ ç äéáêïðÞ ôïõ öáñìÜêïõ åß÷å óáí åðáêüëïõèï ôç âåëôßùóç ôïõ áññþóôïõ. Ç ìåëÝôç ó÷åäéÜóôçêå ðñïïðôéêÜ, êáôåãñÜöçóáí üëåò ïé åéóáãùãÝò ðïõ Þôáí áðïôÝëåóìá éáôñïãåíïýò íïóçñüôçôáò êáôÜ ôï ÷ñïíéêü äéÜóôçìá åíüò Ýôïõò (ÍïÝìâñéïò 1996-ÍïÝìâñéïò 1998). Ôï ðñùôüêïëëï ìåëÝôçò ðåñéåëÜìâáíå ôá äçìïãñáöéêÜ óôïé÷åßá ôïõ áóèåíïýò, ôï éóôïñéêü ôïõ, ôçí êëéíéêÞ öõóéêÞ åîÝôáóç, ôçí áéôßá åéóüäïõ êáèþò êáé ôï åíï÷ïðïéïýìåíï õðåýèõíï öÜñìáêï ãéá ôçí éáôñïãåíÞ íïóçñüôçôá. ÓõãêåêñéìÝíá áñ÷ßæïíôáò áðü ôï ïíïìáôåðþíõìï, ôçí çëéêßá êáé ôï öýëï ãéíüôáí êáôáãñáöÞ ôçò áéôßáò åéóüäïõ óôï éáôñéêü ôìÞìá óå åéäéêü Ýíôõðï áðü ôïí èåñÜðïíôá éáôñü ôïõ áóèåíïýò. Áíáöåñüôáí ç öáñìáêåõôéêÞ ïõóßá ðïõ åëÜìâáíå ï Üññùóôïò, ç äüóç êáé ç ÷ñïíéêÞ äéÜñêåéá ðïõ ãéíüôáí ç ÷ñÞóç áõôÞ. Óôç óõíÝ÷åéá óçìåéùíüôáí ç ÷ñïíéêÞ óôéãìÞ ðïõ Ýëáâå ôï öÜñìáêï ãéá ôåëåõôáßá öïñÜ êáèþò êáé ôï ÷ñïíéêü äéÜóôçìá ðïõ ìåóïëÜâçóå ìÝ÷ñé ôçí ðñïóêïìéäÞ ôïõ áóèåíïýò óôá åîùôåñéêÜ éáôñåßá ôïõ íïóïêïìåßïõ. Ó' Üëëï óçìåßï ãéíüôáí áíáöïñÜ óôçí åéäéêüôçôá ôïõ éáôñïý ðïõ ÷ïñÞãçóå ôï å-


Ôüìïò 12, Ôåý÷ïò 3, 2000

Å. Ìé÷áçëßäçò êáé óõí.

íï÷ïðïéïýìåíï öÜñìáêï êáèþò êáé áí ñùôÞèçêå ï Üññùóôïò áðü ôïí éáôñü ãéá ðñïçãïýìåíá óõìâÜìáôá Þ óôïé÷åßá ôïõ éóôïñéêïý ôïõ (ðñïçãïýìåíåò ðáèÞóåéò, ãíùóôïß éäéïóõãêñáóéáêïß ðáñÜãïíôåò Þ ëÞøç Üëëùí öáñìáêåõôéêþí ïõóéþí ðïõ äýíáíôáé íá áóêçèåß óõíÝñãåéá). Óôç óõíÝ÷åéá ç ßäéá åñþôçóç áðåõèõíüôáí êáé óôïí Üññùóôï, áí äçëáäÞ ñþôçóå ôïí éáôñü ãéá ôïõò êéíäýíïõò áðü ôç ëÞøç ôïõ öáñìÜêïõ Þ áí åðéóÞìáíå óôïí éáôñü ôï ðñïçãïýìåíï éáôñéêü éóôïñéêü ôïõ êáé ôá öÜñìáêá ðïõ Þäç ëÜìâáíå. Óôç ìåëÝôç êáôáãñáöüôáí êáé ç ðåñßðôùóç ôï öÜñìáêï íá åß÷å ÷ïñçãçèåß ìå óýóôáóç Üëëïõ áôüìïõ, ìç éáôñïý, Þ ëçöèåß åî éäßáò ðñùôïâïõëßáò ôïõ áóèåíÞ êáèþò êáé ç ðéèáíüôçôá íá åß÷å ëçöèåß ìåôÜ áðü ðñïôñïðÞ ôùí ìÝóùí ìáæéêÞò åíçìÝñùóçò. ¸íá ôìÞìá ôçò ìåëÝôçò áó÷ïëïýíôáí ìå ôï åßäïò ôçò íïóçëåßáò ôùí áóèåíþí áð' ôç óôéãìÞ ðïõ ðñïóêïìßóèçêáí óôï ôìÞìá ôùí åðåéãüíôùí, ôçí Ýêâáóç ôçò íïóçëåßáò, ôç äéÜñêåéá ðáñáìïíÞò ôïõò óôï ðáèïëïãéêü ôìÞìá êáèþò êáé áí ôï óýìâáìá Þôáí áðïôñÝøéìï. ÐñÝðåé íá ôïíéóèåß üôé ç áñ÷éêÞ óõó÷Ýôéóç êëéíéêÞò åêäÞëùóçò êáé öáñìÜêïõ ðïõ Ýëáâå ï áóèåíÞò Ýãéíå áðü ôï èåñÜðïíôá éáôñü ôïõ ôìÞìáôïò åðåéãüíôùí êáé áíáãñÜöçêå óôï öýëëï åéóüäïõ. Áêïëïýèçóáí åðáíåéëçììÝíåò ëÞøåéò éóôïñéêïý áðü éáôñïýò ôçò êëéíéêÞò êáé êáôáãñáöÞ üëùí ôùí öáñìáêåõôéêþí óêåõáóìÜôùí ðïõ ëÜìâáíå ï áóèåíÞò áðü ôï âéâëéÜñéï õãåßáò. ÆçôÞèçêå åðßóçò áðü ôïõò óõããåíåßò íá ðñïóêïìßóïõí üëá ôá óêåõÜóìáôá ðïõ ëÜìâáíå ï áóèåíÞò êáé åíäå÷ïìÝíùò äåí áíáãñáöüíôïõóáí. ¸ëåã÷ïò Ýãéíå åðßóçò óå ïôéäÞðïôå ðáñåß÷å ðëçñïöïñßåò ãéá ôï éóôïñéêü, üðùò óå åíçìåñùôéêÜ óçìåéþìáôá ðñïçãïýìåíçò íïóçëåßáò, âéâëéÜñéï õãåßáò êáé éáôñéêÝò óõíôáãÝò, ðñïêåéìÝíïõ íá åëåã÷èåß áí ôï åíï÷ïðïéïýìåíï öÜñìáêï åß÷å ÷ïñçãçèåß ìå óõíôáãÞ éáôñïý áðü ðüôå êáé ãéá ðüóï äéÜóôçìá. Ôá óôïé÷åßá áõôÜ åëÝã÷ïíôáí óå êÜèå åéóáãùãÞ, åßôå áõôÞ áöïñïýóå éáôñïãåíÞ íïóçñüôçôá åßôå ü÷é. Äýï áðü ôïõò éáôñïýò ôçò êëéíéêÞò åß÷áí ïñéóôåß íá åëÝã÷ïõí êÜèå åéóáãùãÞ áóèåíïýò óôï ôìÞìá êáé áí áõôÞ áðïôåëïýóå ðåñßðôùóç éáôñïãåíïýò íïóçñüôçôáò, íá êáôáãñáöåß, áí áõôü äåí åß÷å Þäç ãßíåé (ïé åêäçëþóåéò áíáöåñüíôïõóáí óå üëåò ôéò ðåñéðôþóåéò óôéò áíåðéèýìçôåò åíÝñãåéåò ôùí åíï÷ïðïéïýìåíùí öáñìÜêùí ãéá ðáñÜäåéãìá áóðéñßíç- áéìïññáãßá ãáóôñïäùäåêáäáêôõëéêÞ). ÓõæÞôçóç ãéá ôçí ôå-

ëéêÞ åêôßìçóç ôùí ðåñéðôþóåùí éáôñïãåíïýò íïóçñüôçôáò êáé ôç óõó÷Ýôéóç ìå ôç ÷ñïíéêÞ äéÜñêåéá áðü ôç ëÞøç ôïõ åíï÷ïðïéïýìåíïõ öáñìÜêïõ ãéíüôáí óôçí ðñùéíÞ êáèçìåñéíÞ óõãêÝíôñùóç ôùí éáôñþí ôçò êëéíéêÞò. ÕðÞñîå Ýíáò óõíå÷Þò Ýëåã÷ïò êëéíéêÞò åêäÞëùóçò êáé ëçöèÝíôïò öáñìÜêïõ þóôå íá áðïöåõ÷èïýí øåõäåßò ðåñéðôþóåéò éáôñïãåíïýò íïóçñüôçôáò. Áêüìá óôç ìåëÝôç äåí ðåñéëÞöèçêáí ïé åêïýóéåò öáñìáêåõôéêÝò äçëçôçñéÜóåéò, ï ôïîéêüò äáêôõëéäéóìüò, êáèþò íïóçëåýïíôáé óå êáñäéïëïãéêü ôìÞìá, êáèþò êáé ïé ÷ñÞóôåò íáñêùôéêþí ïõóéþí. Ç êáôá÷þñéóç üëùí ôùí óôïé÷åßùí êáé ç áíÜëõóç Ýãéíå óå Çëåêôñïíéêü ÕðïëïãéóôÞ óõìâáôü ìå I.Â.Ì ìå ôç ÷ñÞóç ôóõ óôáôéóôéêïý åðéäçìéïëïãéêïý ðñïãñÜììáôïò ÅÑÉ-INFO Version 5.01b (Éïýëéïò 1991. CDC Atlanta & WHO, Geneva. Switzerland).

ÁðïôåëÝóìáôá Ôï óýíïëï ôùí åéóá÷èÝíôùí êáé íïóçëåõèÝíôùí óôçí êëéíéêÞ ìáò ãéá ïðïéáäÞðïôå áéôßá ãéá ôï ÷ñïíéêü äéÜóôçìá áðü ôï ÍïÝìâñéï ôïõ 1996 Ýùò ôï ÍïÝìâñéï ôïõ 1998 (11/96-11/98) Þôáí 2710 Üôïìá. Ïé 262 áð' áõôïýò, ðïóïóôü äçëáäÞ 9,7%, äéåðéóôþèçóáí êáé êáôåãñÜöçóáí ùò ðåñéðôþóåéò éáôñïãåíïýò íïóçñüôçôáò. Ôá äçìïãñáöéêÜ óôïé÷åßá ôùí áóèåíþí öáßíïíôáé óôïí ðßíáêá 1. Áðü ôïõò åéóá÷èÝíôåò ïé 151 Þôáí Üíäñåò, 111 ãõíáßêåò êáé åß÷áí ìÝóï üñï çëéêßáò 63,4 Ýôç. Ïé êëéíéêÝò åêäçëþóåéò ôùí áóèåíþí êáôÜ ôçí åßóïäï áíáöÝñïíôáé óôïí ðßíáêá 2. Ç ðëåéïøçößá ôùí ðåñéðôþóåùí (157/ Ðßíáêáò 1. ÄçìïãñáöéêÜ óôïé÷åßá áóèåíþí åéóá÷èÝíôùí ëüãù ÉÍ Áñéèìüò: Öýëï: ¢íäñåò (Í - [%]): Ãõíáßêåò: (Í - [%]): Çëéêßá ± 1sd (Ýôç): Åýñïò çëéêßáò (Ýôç): ÇìÝñåò íïóçëåßáò ± 1sd: ÌÝóïò Áñéèìüò ëçöèÝíôùí öáñìÜêùí (±1sd): ËÞøç öáñìÜêïõ ìå ÉáôñéêÞ Ïäçãßá (Í - [%]): ËÞøç öáñìÜêïõ ×ùñßò ÉáôñéêÞ Ïäçãßá (Í - [%]):

262 151 [57.6] 111 [42,4] 63.5 ± 15.1 23-93 5.5 ± 2.9 2.19 ± 1.1 207 (79.1) 55 (20.9) 127


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Å. Ìé÷áçëßäçò êáé óõí.

Ðßíáêáò 2. ÊëéíéêÝò åêäçëþóåéò éáôñïãåíïýò íïóçñüôçôáò Áéìïññáãßá áíþôåñïõ ðåðôéêïý Áëëåñãßá Áëëåñãéêü shock Õðïãëõêáéìßá ËïéðÝò áðü ôï ãáóôñåíôåñéêü ÁéìïññáãéêÞ äéÜèåóç ÇëåêôñïëõôéêÝò äéáôáñá÷Ýò áðü äéïõñçôéêÜ Õðüôáóç Áðïññýèìéóç óáê÷áñþäç äéáâÞôç ÁöõäÜôùóç áðü äéïõñçôéêÜ ÏéäÞìáôá ÉáôñïãåíÝò Cushing Áããåéßôéäá Áéìïññáãéêü åîÜíèçìá

157 32 7 23 15

59,9% 12,2% 2,6% 8,8% 5,7%

12 6

4,6% 2,2%

3 2 1 1 1 1 1

1,1% 0,7% 0,3% 0,3% 0,3% 0,3% 0,3%

262) Þ 59,9% áöïñÜ óôçí áéìïññáãßá áíùôÝñïõ ðåðôéêïý, åíþ áêïëïõèïýí ç áëëåñãßá (39/262) Þ 14,9% êáé ç õðïãëõêáéìßá (23/262) Þ ðïóïóôü 8,8%. Åíþ ôá õðåýèõíá öÜñìáêá ãéá ôéò ðåñéðôþóåéò éáôñïãåíïýò íïóçñüôçôáò áíáöÝñïíôáé óôïí ðßíáêá 3, ìå ôçí áóðéñßíç êáé ôá ìç óôåñïåéäÞ áíôéöëåãìïíþäç ìüíá Þ óå óõíäõáóìü íá áðïôåëïýí ôï ìåãáëýôåñï áñéèìü ëçöèÝíôùí öáñìÜêùí 118 (66,2%) êáé íá åõèýíïíôáé ãéá ôéò

157 ðåñéðôþóåéò áéìïññáãßáò áíþôåñïõ ðåðôéêïý ðïõ íïóçëåýôçêáí, åíþ ôá áíôéìéêñïâéáêÜ, ôá áíôéäéáâçôéêÜ êáé ôá áíôéðçêôéêÜ íá áêïëïõèïýí êáôÜ óåéñÜ óõ÷íüôçôáò. Ç ìÝóç äéÜñêåéá íïóçëåßáò Þôáí 5,5 çìÝñåò. Ç Ýêâáóç, áíáöÝñåôáé óôïí ðßíáêá 4, Þôáí ßáóç Þ âåëôßùóç óôá 247 Üôïìá (94%), åíþ åîÞëèáí ïéêåßá âïõëÞóåé 2 Üôïìá, äéáêïìßóôçêáí óå ÷åéñïõñãéêü ôìÞìá 7 áóèåíåßò ìå áéìïññáãßá ðåðôéêïý ëüãù áéìïäõíáìéêÞò áóôÜèåéáò êáé áäõíáìßáò óõíôçñçôéêÞò áíôéìåôþðéóçò, åíþ áðåâßùóáí 5 Üññùóôïé, Ýíáò ìå ãáëáêôéêÞ ïîÝùóç, Ýíáò ìå âáñåßåò çëåêôñïëõôéêÝò äéáôáñá÷Ýò êáé ôñåéò ìå áéìïññáãßá áíþôåñïõ ðåðôéêïý. ÐñÝðåé íá ôïíéóôåß üôé ìåñéêÜ Üôïìá ìå áéìïññáãßá áíþôåñïõ ðåðôéêïý åß÷áí ëÜâåé ðåñéóóüôåñá áðü Ýíá öÜñìáêá, åíþ äçëáäÞ áóðéñßíç åß÷áí ëÜâåé 126 Üôïìá êáé ìç óôåñéíïåéäÞ áíôéöëåãìïíþäç (Ì.Ó.ÁÖ). 55, õðÞñîáí 11 áóèåíåßò ðïõ åß÷áí ëÜâåé áóðéñßíç êáé Ì.Ó.ÁÖ. ôáõôü÷ñïíá.

ÓõæÞôçóç Ìéá éáôñïãåíÞò íïóçñüôçôá ðñïêýðôåé üôáí ôï íïóçñü áðïôÝëåóìá ôçò èåñáðåõôéêÞò Þ äéáãíùóôéêÞò êáôÜóôáóçò ðáñÜãåé ìßá ðáèïëïãéêÞ ïíôüôçôá áíåîÜñôçôç áðü ôï ëüãï ãéá ôïí ïðïßï

Ðßíáêáò 3. ÖÜñìáêá ðïõ åíï÷ïðïéÞèçêáí ãéá éáôñïãåíÞ íïóçñüôçôá Áóðéñßíç/Ì.Ó.ÁÖ. ÁíôéìéêñïâéáêÜ ÁíôéäéáâçôéêÜ ÁíôéðçêôéêÜ ÄéïõñçôéêÜ ÊïñôéêïåéäÞ ËïéðÜ Óýíïëï

181 35 23 18 8 3 14 282*

66,2% 12,6% 7,8% 6,1% 3% 1,1% 3,8% 100

*Ìåñéêïß áóèåíåßò åß÷áí ëÜâåé äýï öÜñìáêá åíï÷ïðïéçèÝíôá ãéá éáôñïãåíÞ íïóçñüôçôá.

128

Ðßíáêáò 4. ¸êâáóç íïóçëåõïìÝíùí áóèåíþí ìå éáôñïãåíÞ íïóçñüôçôá ¸êâáóç Âåëôßùóç-ºáóç ×åéñïõñãéêÞ áíôéìåôþðéóç ÈÜíáôïò ¸îïäïò ïéêåßá âïõëÞóåé Óýíïëï

Áñéèìüò áóèåíþí

Ðïóïóôü (%)

248 7

94,6% 2,8%

5 2 262

1,9% 0,7% 100


Å. Ìé÷áçëßäçò êáé óõí.

åöáñìüóôçêå. ¸ãêåéôáé óôïí éáôñü áí èá ÷ñçóéìïðïéÞóåé éó÷õñÜ èåñáðåõôéêÜ ìÝóá, ìå âÜóç ôç äñÜóç ôïõò êáé ôç âëÜâç ðïõ ðéèáíþò íá ðñïêáëÝóïõí. ÊÜèå éáôñéêÞ äéáäéêáóßá, äéáãíùóôéêÞ Þ èåñáðåõôéêÞ, Ý÷åé ôçí ðéèáíüôçôá íá ðñïêáëÝóåé âëÜâç, üìùò èá Þôáí áäýíáôïí íá áíáêáëýøïõìå ôá èåôéêÜ áðïôåëÝóìáôá ôçò ìïíôÝñíáò éáôñéêÞò åðéóôÞìçò áí ëáìâÜíïíôáò õðüøç ôïõò ðéèáíïýò êéíäýíïõò áðïöåýãáìå ôç äéÜãíùóç êáé ôç èåñáðåßá. Ç éáôñïãåíÞò íïóçñüôçôá ðïõ óõíäÝåôáé ìå ôç ëÞøç öáñìáêåõôéêþí ïõóéþí áðïôåëåß êïéíÞ áéôßá åéóüäïõ óôï íïóïêïìåßï, ìå óïâáñÝò óõíÝðåéåò ãéá ôïí áóèåíÞ. Óôçí ðáñïýóá ìåëÝôç ç åðßðôùóç éáôñïãåíïýò íïóçñüôçôáò ìÝóá óå ìßá äéåôßá Þôáí 9,7%, ðåñéëáìâÜíïíôáò 262 áóèåíåßò óôï óýíïëï ôùí 2710 åéóá÷èÝíôùí áóèåíþí. ¸íá ðáñüìïéï ðïóïóôü åõñÝèç êáé óå Üëëåò ìåëÝôåò, üðùò ôï 11,2% óôç Äáíßá8, ôï 9,4% óôï Ðßôóìðïõñãê óôéò Ç.Ð.Á.10 êáé ôï 11,5% óôï ÇíùìÝíï Âáóßëåéï12. Óå ðáëáéüôåñåò ìåëÝôåò ç éáôñïãåíÞò íïóçñüôçôá êõìáéíüôáí áðü 2,9-5,8%12-14. Ôï ãåãïíüò üôé ç óõ÷íüôçôá ôçò éáôñïãåíïýò íïóçñüôçôáò ôåßíåé íá áõîçèåß ìðïñåß íá åîçãçèåß áðü ôçí Üíïäï ôïõ ðñïóäüêéìïõ åðéâßùóçò, âåëôßùóç ôùí êÝíôñùí õãåßáò, êáèþò êáé ç äéáèåóéìüôçôá ìåãáëýôåñïõ áñéèìïý áôüìùí êáé ç óõíå÷Þò ðñïóðÜèåéá âåëôßùóçò ôùí äéáãíùóôéêþí ìÝóùí êáé ôùí öáñìáêåõôéêþí õðçñåóéþí. Óáí áðïôÝëåóìá Ý÷ïõìå ôçí áýîçóç ôïõ áñéèìïý ôùí áôüìùí êõñßùò çëéêéùìÝíùí ðïõ êÜíïõí ÷ñÞóç ìåãÜëïõ áñéèìïý öáñìÜêùí. Åßíáé åõñÝùò äéáðéóôùìÝíï óôç âéâëéïãñáößá ôï ãåãïíüò üôé ïé çëéêéùìÝíïé áóèåíåßò åßíáé åðéññåðåßò óôçí áíÜðôõîç óõìâÜíôùí óõíäåäåìÝíùí ìå éáôñïãåíÞ íïóçñüôçôá3,7,8,10,12,1517 . Ãéá äéÜöïñïõò ëüãïõò áõôïß ïé áóèåíåßò åêäçëþíïõí ôéò áíåðéèýìçôåò åíÝñãåéåò ôùí öáñìÜêùí. Óõ÷íÜ ìåéþíåôáé ç áðÝêêñéóç ôùí öáñìÜêùí åîáéôßáò ôçò ìåßùóçò ôçò íåöñéêÞò áéìÜôùóçò êáé ôçò óðåéñáìáôéêÞò äéÞèçóçò êáèþò êáé ôçò ìåßùóçò ôçò çðáôéêÞò êÜèáñóçò. Ï üãêïò êáôáíïìÞò ôùí öáñìÜêùí åðçñåÜæåôáé, ìéá êáé ôá çëéêéùìÝíá Üôïìá ðáñïõóéÜæïõí ìéá ìåßùóç ôùí ïëéêþí óùìáôéêþí õãñþí êáé ìéá áýîçóç ôïõ óùìáôéêïý ëßðïõò. ÅðéðëÝïí, ôá åðßðåäá ôçò áëâïõìßíçò ìåéþíïíôáé, éäßá óôïõò áóèåíåßò çëéêéùìÝíïõò ìå óõíÝðåéá ôç ìåßùóç ôùí ðñùôåúíþí ðïõ äåóìåýïõí ìåñéêÜ öÜñìáêá, üðùò ç âáñöáñßíç, áöÞíïíôáò Ýôóé ðåñéóóüôåñï äéáèÝóéìï åíåñãü öÜñìáêï. ÅðéðëÝïí ïé çëéêéùìÝíïé áóèå-

Ôüìïò 12, Ôåý÷ïò 3, 2000

íåßò ðáñïõóéÜæïõí ìåôáâïëÞ óôç öáñìáêïäõíáìéêÞ. ÔÝëïò, çëéêéùìÝíïé áóèåíåßò ìå ðïëëáðëÝò ÷ñüíéåò íüóïõò ëáìâÜíïõí ðïëëÜ öÜñìáêá, ßóùò ðåñéóóüôåñá áðü ôá áíáãêáßá. ¸ôóé åßíáé ðïëý ðéèáíü íá óõìâïýí áíåðéèýìçôåò åíÝñãåéåò êáé ëÜèç óôç äïóïëïãßá, éäßá üôáí ïé áóèåíåßò áõôïß ðáñïõóéÜæïõí ðñïâëÞìáôá üñáóçò, áêïÞò Þ äéáôáñá÷Ýò ìíÞìçò. Óôçí ðáñïýóá ìåëÝôç åõñÝèç üôé ïé çëéêéùìÝíïé áóèåíåßò åëÜìâáíáí ðåñéóóüôåñá öÜñìáêá áð’ üôé ïé íÝïé. Óå áõôü óõìöùíïýí êáé Üëëåò ìåëÝôåò üðùò áõôÞ óôçí Åëâåôßá5 êáé óôïí ÊáíáäÜ18. Ç Ýêâáóç äåí äéÝöåñå êëéíéêÜ óçìáíôéêÜ óôïõò çëéêéùìÝíïõò, üìùò óçìåéþèçêáí ðåñéóóüôåñïé èÜíáôïé óôçí ïìÜäá ôùí çëéêéùìÝíùí áóèåíþí. Áðü ôá öÜñìáêá ðïõ ðñïêÜëåóáí áéìïññáãßåò áíùôÝñïõ ðåðôéêïý (ÁÁÐ) ôá ðéï óõ÷íÜ Þôáí ç áóðéñßíç êáé ôá ÌÓÁÖ. 'Ïìùò ðáñüìïéá áðïôåëÝóìáôá Ýäùóáí êáé Üëëåò ìåëÝôåò ó÷åôéêÜ ìå ôá öÜñìáêá áõôÜ3,4,10,11,19. Ôá ðáñáðÜíù öÜñìáêá óõíôáãïãñáöïýíôáé ðéï óõ÷íÜ ìå åõñåßá Ýíäåéîç íïóçìÜôùí áñêåôþí åéäéêïôÞôùí, üðùò ãéá ðáñÜäåéãìá ç ðñüëçøç êáñäéáããåéáêþí íïóçìÜôùí. Åðßóçò ðïëëïß áóèåíåßò óôçí êïéíüôçôá ëáìâÜíïõí áõôÜ ôá öÜñìáêá ãéá ôçí åîÜëåéøç êáôþôåñçò Þ ìÝóçò âáñýôçôáò óõìðôùìÜôùí, üðùò äéÜöïñá åßäç ðüíïõ êáé ùò áíôéðõñåôéêÜ. Óôçí ðáñïýóá ìåëÝôç åõñÝèç Ýíáò áñêåôÜ ìåãÜëïò áñéèìüò õðïãëõêáéìßáò, ðåñéóóüôåñï óôïõò çëéêéùìÝíïõò áóèåíåßò, åíþ ïé íåüôåñïé áóèåíåßò ðáñïõóßáæáí óõ÷íüôåñá öáéíüìåíá áëëåñãßáò ùò óõ÷íüôåñç áéôßá åéóáãùãÞò óôï íïóïêïìåßï áðü éáôñïãåíÞ íïóçñüôçôá. ÅõñÝèç Ýíá ìåãÜëï ðïóïóôü áóèåíþí ìå éáôñïãåíÞ íïóçñüôçôá áðü ëÞøç öáñìÜêùí Üíåõ óõíôáãïãñáößáò éáôñïý. Ìßá óôéò 5 åéóáãùãÝò ðáñïõóßáæå áõôü ôï éóôïñéêü êáé õðÞñ÷áí ðáñüìïéá ðåñéóôáôéêÜ óå áíáöïñÝò áðü ôï Ëßâáíï êáé ôç Äáíßá20,21. Áõôü ôï éóôïñéêü áíáöåñüôáí óå ëÞøç áóðéñßíçò Þ/êáé ÌÓÁÖ ëüãù ïäïíôáëãßáò, áñèñáëãéþí, ðõñåôïý Þ äõóìçíüññïéáò, üìùò õðÞñ÷áí êáé 2 ðåñéóôáôéêÜ áóèåíþí ìå ëÞøç áíôéìéêñïâéáêþí ãéá óõìðôþìáôá ãñéðþäïõò óõíäñïìÞò. Áîßæåé íá óçìåéùèåß ç ýðáñîç 2 ðåñéóôáôéêþí õðïãëõêáéìßáò ëüãù ëÞøçò õðïãëõêáéìéêþí ðáñáãüíôùí áðü çëéêéùìÝíá Üôïìá, ôá ïðïßá Ýíéùèáí îçñïóôïìßá êáé ôçí áðÝäéäáí óå óáê÷áñþäç äéáâÞôç ÷ùñßò êáí íá Ý÷ïõí ðñïóâëçèåß áðü áõôü. ¸íáò Üëëïò áóèåíÞò ëÜìâáíå ãéá ìáêñý ÷ñïíéêü äéÜóôçìá áóðéñßíç åðåéäÞ åß÷å áêïýóåé áðü ôá ìÝóá 129


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

ìáæéêÞò åíçìÝñùóçò üôé ç ëÞøç ÷áìçëÞò äïóïëïãßáò áóðéñßíçò óõìâÜëëåé óôçí ðñüëçøç áíÜðôõîçò êáñäéáããåéáêþí íïóçìÜôùí, áëëÜ ðïôÝ äåí óêÝöôçêå íá ñùôÞóåé ôïí ïéêïãåíåéáêü ôïõ éáôñü áí êáé ï ßäéïò åß÷å ðåðôéêü Ýëêïò êáé åß÷å íïóçëåõèåß äýï öïñÝò áðü ÁÁÐ. ÅðïìÝíùò, ïöåßëåé ç ðïëéôåßá íá ìåñéìíÞóåé ãéá ôçí ôñïðïðïßçóç ôçò åõñýôåñçò äçìüóéáò óõìðåñéöïñÜò êáé óõíÞèåéáò ó÷åôéêÜ ìå ôá èÝìáôá õãåßáò êáé èåñáðåßáò êáèþò êáé ãéá ôç óõíå÷Þ åêðáßäåõóç êáé åíçìÝñùóç ôùí Ãåíéêþí/Ïéêïãåíåéáêþí Éáôñþí êáé üëùí ôùí åéäéêïôÞôùí. Äéåðéóôþèç üôé ôï 51,8% ôùí åéóá÷èÝíôùí ëüãù éáôñïãåíïýò íïóçñüôçôáò èá ìðïñïýóå íá åß÷å ðñïâëåöèåß. Ç áíáëïãßá ôùí ðñïóâåâëçèÝíôùí ðåñéóôáôéêþí óôç âéâëéïãñáößá áíôéóôïé÷åß óôï 45-60%7,9,18,19,22-24. Óôá ðåñéóôáôéêÜ ðïõ èá ìðïñïýóáí íá áðïöåõ÷èïýí ïé ÁÁÐ, ç áóðéñßíç óõíôáãïãñáöüôáí áðü ôïõò êáñäéïëüãïõò êáé ôá ÌÓÁÖ áðü ïñèïðåäéêïýò Þ ãåíéêïýò éáôñïýò ïé ïðïßïé äåí ðÞñáí ôï éóôïñéêü ôïõ áóèåíïýò ðïõ åß÷å åêäçëþóåé ðåðôéêü Ýëêïò. ¼óïí áöïñÜ óôçí õðïãëõêáéìßá óáí áíåðéèýìçôç åíÝñãåéá ôùí öáñìÜêùí áîßæåé íá óõæçôçèåß åöüóïí õðåéóÝñ÷ïíôáé êáé Üëëïé ðáñÜãïíôåò, üðùò ç Ýëëåéøç ëÞøçò ôñïöÞò, áäýíáôç óõììüñöùóç ôùí áóèåíþí Þ áêáôÜëëçëïò õðïãëõêáéìéêüò ðáñÜãïíôáò, éäßá ç éíóïõëßíç, üóïí áöïñÜ óôç äüóç25. Óôçí ðáñïýóá ìåëÝôç èåùñÞóáìå üôé èá ìðïñïýóáí íá ðñïâëåöèïýí ôá ðåñéóôáôéêÜ üðïõ äåí åëÝã÷èç ç íåöñéêÞ ëåéôïõñãßá ãéá áñêåôü ÷ñïíéêü äéÜóôçìá áðü ôïí ïéêïãåíåéáêü éáôñü êáé Þôáí áêñéâþò áõôÞ ç Ýëëåéøç åëÝã÷ïõ ðïõ ïäÞãçóå ôïí áóèåíÞ óå õðïãëõêáéìßá26 Þ ëüãù áëëçëåðßäñáóçò ìå Üëëá öÜñìáêá üðùò ôá á-ÌÅÁ27. Ôá ðåñéóôáôéêÜ ðïõ óçìåßùóáí áëëåñãßá ìåôÜ ôç ëÞøç öáñìÜêïõ èá ìðïñïýóáí íá åß÷áí ðñïâëåöèåß áí åß÷å ðáñèåß Ýíá êáëü éóôïñéêü êáé åß÷å äéåíåñãçèåß ìßá êáëÞ áíôéêåéìåíéêÞ åîÝôáóç áðü ôçí ïðïßá èá ðñïÝêõðôå ìéá éïãåíÞò íüóïò, ç ïðïßá öõóéêÜ äåí èá Ýðñåðå íá áíôéìåôùðßæåôáé ìå áíôéìéêñïâéáêÞ áãùãÞ. ÅðïìÝíùò ðáñáôçñïýìå üôé åõèýíåôáé ãéá ôéò åéóáãùãÝò óôï íïóïêïìåßï áðü éáôñïãåíÞ íïóçñüôçôá êáé ï Ãåíéêüò/Ïéêïãåíåéáêüò Éáôñüò ðïõ äåí åöáñìüæåé óùóôÜ ôéò ðñïûðïèÝóåéò ãéá ôç ëÞøç ôçò êáôÜëëçëçò áãùãÞò óå êÜèå îå÷ùñéóôÞ éáôñéêÞ íüóï. Ôñåéò áðü ôïõò áóèåíåßò ìå éáôñïãåíÞ íïóçñüôçôá Ýëáâáí áíôéìéêñïâéáêÞ áãùãÞ ìå ìáêñïëßäåò åíþ ðáñÜëëçëá åõñßóêïíôáí õðü 130

Å. Ìé÷áçëßäçò êáé óõí.

áíôéðçêôéêÞ áãùãÞ28. Ç áëëçëåðßäñáóç ôùí äéáöüñùí öáñìÜêùí áðïôåëåß óçìáíôéêü êåöÜëáéï êáé èá Ýðñåðå íá åßíáé êôÞìá êÜèå éáôñïý ðïõ óõíôáãïãñáöåß. ¸ôóé, ëïéðüí, ïöåßëåé ï Ãåíéêüò/Ïéêïãåíåéáêüò Éáôñüò ôçò ðñùôïâÜèìéáò ðåñßèáëøçò ðñéí óõíôáãïãñáöÞóåé Ýíá óõãêåêñéìÝíï öÜñìáêï íá åñùôÞóåé ôïí áóèåíÞ ó÷åôéêÜ ìå Üëëá óõìðáñáìáñôïýíôá íïóÞìáôá, ìå ôç ëÞøç Üëëùí öáñìáêåõôéêþí ïõóéþí, ôçí ôõ÷üí äõóëåéôïõñãßá ïñãÜíùí õðåýèõíùí ãéá ôç öáñìáêïäõíáìéêÞ, ôçí áíáöåñüìåíç áëëåñãßá óå öÜñìáêá. Ìßá óçìáíôéêÞ ðñïóðÜèåéá ãéá ôçí áíÜðôõîç óôñáôçãéêþí ãéá ôçí ðñüëçøç éáôñïãåíïýò íïóçñüôçôáò, êõñßùò ãéá ôá ÌÓÁÖ, óôç Óêùôßá áðÝöåñå åõåñãåôéêÜ áðïôåëÝóìáôá19. Åðßóçò åßíáé óçìáíôéêü íá áíáöÝñåé êáíåßò ôá ïéêïíïìéêÜ ïöÝëç áðü ôçí ðñüëçøç ôçò éáôñïãåíïýò íïóçñüôçôáò ëüãù ôïõ õøçëïý íïóïêïìåéáêïý êüóôïõò. ÅêôéìÞèçêå üôé ç íïóçëåßá áðü éáôñïãåíÞ íïóçñüôçôá ðñïóåããßæåé åôçóßùò ðåñß ôá 70-100.000.000 åëâåôéêÜ öñÜãêá5 Þ 3.496.000 äïëÜñéá9. Ôï ðéï óçìáíôéêü ãåãïíüò ðïõ èá Ýðñåðå íá óêÝöôåôáé ï Ãåíéêüò/Ïéêïãåíåéáêüò Éáôñüò åßíáé áõôü ðïõ åßðå ï ÉððïêñÜôçò, 2.500 ÷ñüíéá ðñéí: "ÙöåëÝåéí, ìç âëÜðôåéí".

Âéâëéïãñáößá 1. R.H. Moser. Diseases of medical progress. N. Engl. J. Med., 255:606-14, 1956. 2. N. Hutwitz. Admissions to hospital due to drugs. Br. Med. J., 1:539-40, 1969. 3. R.R. Miller. HospitaI admissions due to adverse drug reactions. Arch. Intern. Med., 34:219, 1974. 4. A.T. Black, K. Somers. Drug related illness resulting in hospital admission. J.R. Coll. Phys. Lond., 18:40, 1984. 5. V. Lepori, A. Perren, C. Marone. Adverse internal medicine drug effects at hospital admission. Schweiz. Med. Wochenschr., 129:915-22, 1999. 6. U. Bergman, B.E. Wiholm Drug-related problems causing admission to a medical clinic. Eur. J. Clin. Pharmacol., 20:193-200, 1981. 7. K.M. Nelson, R.L. Talbert. Drug-related hospital admissions. Pharmacotherapy, 16:701-7, 1996. 8. J. Hallas, J. Worm, J. Beck-Nielsen, et al. Drug related events and drug utilization in patients admitted to a geriatric hospitaI department. Dan. Med. Bull., 38:417-20, 1991.


Å. Ìé÷áçëßäçò êáé óõí.

9. J.G.Dartnell, R.P. Anderson, V. Chohan, et al. Hospitalisation for adverse events related to drug therapy: incidence, avoidability and costs. Med. J. Aust., 164:659-62, 1996. 10. H.G. Colt, A.P. Shapiro Drug-induced illness as a cause for admission to a community hospital. J. Am. Geriatr. Soc., 37:323-6, 1989. 11. S.H. Lin, M.S. Lin A survey on drug-related hospitalization in a community teaching hospital. J. Clin. Pharmacol. Ther. Toxicol., 31:66-9, 1993. 12. C.M. Lindley, M.P. Tully, V. Paramsothy, R.C. Tallis. Inappropriate medication is a major cause of adverse dtug reactions in elderly patients. Age Ageing, 21:294-300, 1992. 13. G.J. Caranasos, R.B. Stewart, L.E. Chiff. Drug induced illness leading to hospitalization. JAMA, 228:713-7, 1974. 14. P. Trunet, J.R. Legall, F. Lhoste, et al. The role of iatrogenic disease in admissions to intensive care. JAMA, 244:2617-20, 1980. 15. F. Lefevre, J. Feinglass, C. Potts, et al. Iatrogenic complications in high-risk, elderly patients. Arch. Intern. Med., 152:2074-80, 1992. 16. M. Staubli. Iatrogenic falls. Schweiz Med. Wochenschr., 126:576-583, 1996. 17. W.D. Smucker, J.R. Kontak. Adverse drug reactions causing hospital admission in an elderly population: experience with a decision algorithm. J. Am. Board Fam. Pract., 3:105-9, 1990. 18. B.J. Courtman, S.B. Stallings Characterization of drug-related problems in elderly patients on admission to a medical ward. Can. J. Hosp. Pharm., 48:161-6, 1995. 19. G. Cunningham, T.R. Dodd, D.J. Grant, M.E. McMurdo, R.M. Richards Drug-related problems in elderly patients admitted to Tayside hospitals, methods for prevention and subsequent re-

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assessment. Age Ageing, 26:375-82, 1997. 20. S. Major, S. Badr, L. Bahlawan, et al. Drugrelated hospitalization at a tertiary teaching center in Lebanon: incidence, associations, and relation to self-medicating behavior. Clin. Pharmacol. Ther., 64:450-61, 1998. 21. J. Hallas, K.B. Jensen, E. Grodum, N. Damsbo, L.F. Gram. Drug-related admissions to a department of medical gastroenterology. The role of self-medicated and prescribed drugs. Scand. J. Gastroenterol., 26:174-80, 1991. 22. J. Bigby, J. Dunn, L. Goldman, et al. Assessing the preventability of emergency hospital admissions. A method for evaluating the quality of medicaI care in a primary care facility. Am. J. Med., 83:1031-6, 1987. 23. B. Darchy, E. Le Miere, B. Figueredo, E. Bavoux, Y. Domart. Iatrogenic diseases as a reason for admission to the intensive care unit: incidence, causes, and consequences. Arch. Intern. Med., 159:71-8, 1999. 24. E.E. Roughead, A.L. Gilbert, J.G. Primrose, L.N. Sansom Drug-related hospital admissions: a review of Australian studies published 1988-1996. Med. J. Aust., 168:405-8, 1998. 25. K.F. Fischer, J.A. Lees, J.H. Newman. Hypoglycemia in hospitalized patients: causes and outcomes. New Engl. J. Med. 315:1245-50, 1986. 26. R. Arem. Hypoglycernia associated with renal failure. Endoclinology and Metabolism Clinics of North America, 18:103-21, 1989. 27. A.D. Morris, D.I. Boyle, A.D. McMahon, et al. ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes. Diabetes Care, 20:1363-7, 1997. 28. M.W. Recker, K.L. Kier Potential interaction between clarithromycin and warfarin. Ann. Pharmacother., 31:996-8, 1997.

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Å.Á. Óêëçñüò êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅÑÃÁÓÉÁ ÓÔÏ ÄÉÁÃÙÍÉÓÌÏ “Ä. ÉÊÊÏÕ” AWARDED PAPER IN THE MEMORY OF PROF. D. IKKOS Primary Heatlh Care, Volume 12, Number 3, 132-137, 2000 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 12, Ôåý÷ïò 3, 132-137, 2000

ÌåëÝôç ôçò áñôçñéáêÞò ðßåóçò óå áãñïôéêü ðëçèõóìü Åðéðïëáóìüò êáé ñýèìéóç õðÝñôáóçò Å.Á. Óêëçñüò, ÅéñÞíç Êôþñïõ, Á. Óùôçñüðïõëïò, Ìáñßá ÌÜãêïõ, Ã. Óåâáóôüò, Ïõñáíßá Áðïóôüëïõ, ÅéñÞíç Ðáðáäçìçôñßïõ, ×. ÊáììéëÜôïò

Ðåñßëçøç Óêïðüò: Ç õðÝñôáóç åßíáé Ýíá áðü ôá óçìáíôéêüôåñá ðñïâëÞìáôá äçìüóéáò õãåßáò áöïý áðïôåëåß Ýíáí êõñßáñ÷ï ðáñÜãïíôá êéíäýíïõ ãéá áããåéáêü åãêåöáëéêü êáé óôåöáíéáßá íüóï. Óêïðüò ôçò ìåëÝôçò ìáò åßíáé ï êáèïñéóìüò ôïõ åðéðïëáóìïý êáé ôïõ ðïóïóôïý ñýèìéóçò ôçò õðÝñôáóçò óå äåßãìá áãñïôéêïý ðëçèõóìïý. Õëéêü êáé ìÝèïäïò: ÌåëåôÞèçêáí 347 äéáäï÷éêïß áóèåíåßò 211 (63,6%) Üíäñåò, 136 (36,4%) ãõíáßêåò ìÝóçò çëéêßáò 61,6±14,5 (18-88) Ýôç. Ó’ üëïõò Ýãéíå ìÝôñçóç ôçò ÁÐ óå 3 äéáäï÷éêÝò áíÜ 2 ëåðôÜ ìåôñÞóåéò ìå ôç ÷ñÞóç õäñáñãõñéêïý óöõãìïìáíüìåôñïõ, åíþ åéäéêü åðéäçìéïëïãéêü äåëôßï óõìðëçñþèçêå óå üëïõò. Ç óôáôéóôéêÞ áíÜëõóç Ýãéíå ìå Fisher’s exact test, t-test êáé Logistic Regression analysis. ÁðïôåëÝóìáôá: Ç ìÝóç ÓõóôïëéêÞ ÁÐ (Ó.Á.Ð.) Þôáí 133,8±21,4 mmHg êáé ç ìÝóç Ä.Á.Ð. 79,8±9,5 mmHg. ÄéåãíùóìÝíç õðÝñôáóç åß÷áí 151/347 (43,5%). Áðü áõôïýò 149/151 åëÜìâáíáí áíôéõðåñôáóéêÞ áãùãÞ. Åëåã÷üìåíç õðÝñôáóç õðü öáñìáêåõôéêÞ áãùãÞ åß÷áí 77/151 (50,9%) åíþ ðñùôïäéÜãíùóç õðÝñôáóçò Ýãéíå óå 23/196 (11,7%) Üôïìá. Êëçñïíïìéêü éóôïñéêü åß÷áí 192/347 (56,2%). Ï ó÷åôéêüò êßíäõíïò áíÜðôõîçò õðÝñôáóçò ìå èåôéêü éóôïñéêü Þôáí OR= 1,478 (95%: 0,960-2,275). ÁíåõñÝèçêå óôáôéóôéêÜ óçìáôíéêÞ ó÷Ýóç ìåôáîý öýëïõ êáé Ó.Á.Ð. (p=0.003). Ç Ó.Á.Ð. ó÷åôßæåôáé èåôéêÜ ìå ôçí çëéêßá (p=0.0001) åíþ ç Ä.Á.Ð. ü÷é (p=0.718). Ìå ôçí ðïëõðáñáãïíôéêÞ áíÜëõóç áíåîÜñôçôïé ðáñÜãïíôåò êéíäýíïõ ãéá õðÝôáóç âñÝèçêáí íá åßíáé ç çëéêßá (p=0.00001) êáé ôï êëçñïíïìéêü éóôïñéêü (p=0.0125). ÓõìðÝñáóìá: Ç õðÝñôáóç áðïôåëåß ßóùò ôï óõ÷íüôåñï ðñüâëçìá óôçí Ð.Ö.Õ. åíþ ôï åðßðåäï ñýèìéóÞò ôçò åßíáé ÷áìçëü. Ï ãåíéêüò éáôñüò ðñÝðåé íá óõììåôÝ÷åé óôçí áíôéìåôþðéóç ôïõ ðñïâëÞìáôïò ôçò õðÝñôáóçò êáé íá ìçí õðïåêôéìÜ ôï ðñüâëçìá.

Ä/íôÞò Å.Á. Óêëçñüò, Ê.Õ. ÍåìÝáò, Í. Êïñéíèßáò

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ÅéóáãùãÞ Ç õðÝñôáóç åßíáé Ýíá áðü ôá óçìáíôéêüôåñá ðñïâëÞìáôá äçìüóéáò õãåßáò, áöïý áðïôåëåß äéåèíþò Ýíáí êõñßáñ÷ï ðáñÜãïíôá êéíäýíïõ ãéá áããåéáêÜ åãêåöáëéêÜ åðåéóüäéá êáé óôåöáíéáßá íüóï. Ôõ÷áéïðïéçìÝíåò ìåëÝôåò ðáñÝìâáóçò Ýäåéîáí üôé ç áíôéõðåñôáóéêÞ áãùãÞ ó÷åôßæåôáé ìå ôç ìåßùóç ôçò íïóçñüôçôáò êáé èíçôüôçôáò áðü ôçí õðÝñôáóç1. Ç óõ÷íüôçôÜ ôçò óôï ãåíéêü ðëçèõóìü åßíáé 15-20%. ¼ìùò óýìöùíá ìå äéåèíÞ äåäïìÝíá 15% ôùí õðåñôáóéêþí äåí ãíùñßæïõí üôé Ý÷ïõí áñôçñéáêÞ õðÝñôáóç, 27% äåí ëáìâÜíïõí èåñáðåßá êáé 45% ðáñáìÝíïõí áññýèìéóôïé ìïëïíüôé ëáìâÜíïõí èåñáðåõôéêÞ áãùãÞ2. ¸ôóé ðáñÜ ôçí åõñåßá ÷ñÞóç ôùí íåüôåñùí áíôéõðåñôáóéêþí öáñìÜêùí ôï ðñüâëçìá ôçò áõîçìÝíçò áñôçñéáËÝîåéò êëåéäéÜ: AñôçñéáêÞ õðÝñôáóç, åðéðïëáóìüò, áãñïôéêüò ðëçèõóìüò ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå óôï äéáãïíéóìü “Ä. ºêêïõ” óôá ðëáßóéá ôïõ 12ïõ Ðáíåëëçíßïõ Óõíåäñßïõ ÃåíéêÞò ÉáôñéêÞò (×áëêéäéêÞ, 15-19 Ïêôùâñßïõ 2000) êáé Ýëáâå Ýðáéíï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Å. Óêëçñüò, Äçìïêñáôßáò êáé ÍÝóôïñïò 32, ÁéãÜëåù Ô.Ê. 122 44, ôçë.: (01) 5693387, fax: (0746) 22227


Å.Á. Óêëçñüò êáé óõí.

Ôüìïò 12, Ôåý÷ïò 3, 2000

èÝóç, ìåôÜ áðü ðÝíôå ëåðôÜ áíÜðáõóç êáé ìåôÜ áðü ôñéÜíôá áðü ôç ëÞøç êáöåúíïý÷ïõ ñïöÞìáôïò Þ/êáé êáðíßóìáôïò, ìå õðïâáóôáæüìåíï ôï ðñïò ìÝôñçóç Üíù Üêñï êáé ìå ôçí ðåñé÷åéSUMMARY To asses the prevalence and the levels of awareness, treatment and control of ñßäá óôï ýøïò ôçò êáñäéÜò. hypertension in a rural population. Ácross-sectional survey was conducted at Ç ýðáñîç ÁñôçñéáêÞò ÕðÝñôáóçò the Health Centre (H.C.) of Nemea. Hypertension was defined as systolic when (Á.Õ.) êáèïñßóôçêå á) áðü ôï éóôïñéBP> 140 mmHg and diastolic when BP >90 mmHg or when current being êü ëÞøçò áíôéõðåñôáóéêþí öáñìÜêùí treated with drugs. A total of 347 persons who visited H.C. participated in this êáé â) áðü ôçí ôéìÞ ôçò ÓõóôïëéêÞò study. The prevalence of 43.5% had hypertension and of those 58.6% were age 65yrs and over. There were 23 (11.7%) participants who were aware but were ÁñôçñéáêÞò Ðßåóçò (Ó.Á.Ð.) > 140 not receiving treatment. Finally 77 (50.9%) of the participants were already mmHg êáé/Þ áðü ôçí ôéìÞ ôçò Äéáreceiving controll treatment. These results suggest that hypertension is a comóôïëéêÞò ÁñôçñéáêÞò Ðßåóçò (Ä.Á.Ð.) mon risk factor in primary health care. > 90 mmHg óýìöùíá ìå ôéò ðñïôÜKey words: Hypertension, prevalence, rural area óåéò ôçò J.N.C. VI5. ÑõèìéóìÝíç Á.Ð. èåùñÞèçêå ç ôéìÞ êÞò ðßåóçò ðáñáìÝíåé, ìå áðïôÝëåóìá íá õðÜñ- ôçò Ó.Á.Ð. £ 140mmHg êáé ç ôéìÞ ôçò Ä.Á.Ð. £ ÷ïõí óïâáñÝò åðéðëïêÝò, ðïõ ÷áñáêôçñßæïíôáé áðü 90 mmHg óå áóèåíåßò ðïõ ëÜìâáíáí áíôéõðåñõøçëÞ åéäéêÞ íïóçñüôçôá êáé õøçëÞ èíçôüôçôá3. ôáóéêÞ áãùãÞ. Óêïðüò ôçò ìåëÝôçò ìáò åßíáé ï êáèïñéóìüò Óå áóèåíåßò ìå ðñùôïäéÜãíùóç ôçò Á.Õ. ôïõ åðéðïëáóìïý êáé ôïõ ðïóïóôïý ñýèìéóçò ôçò áêïëïõèïýóå äåýôåñç ôñéðëÞ ìÝôñçóç ìåôÜ áðü õðÝñôáóçò óå äåßãìá áãñïôéêïý ðëçèõóìïý, ðïõ äåêáÞìåñï. åðéóêÝðôåôáé ôï Ê.Õ. ÍåìÝáò. ÓôáôéóôéêÞ ÁíÜëõóç. Ç óôáôéóôéêÞ áíÜëõóç ôùí äåäïìÝíùí Ýãéíå ìå ôéò äïêéìáóßåò Fisher's exact test êáé Pearson's chi square óå ðßíáêåò ôùí 2x2. ÐïóïôéêÜ ÷áñáêôçñéóôéêÜ ôïõ äåßãìáÁóèåíåßò êáé ÌÝèïäïé ôïò áíáëýèçêáí ìå ôç äïêéìáóßá t-test. ¸ãéíå Ðñüêåéôáé ãéá ðñïïðôéêÞ ðåñéãñáöéêÞ åðé- ðñïóäéïñéóìüò ôùí ODDS Ratio ìå ôá äéáóôÞìáäçìéïëïãéêÞ Ýñåõíá (population based survey, ôá åìðéóôïóýíçò (95% CI), åíþ ðïëõðáñáãïíôécross sectional), ìå óôü÷ï ôïí êáèïñéóìü ôùí êÞ áíÜëõóç Ýãéíå ìå ôç ÷ñÞóç ëïãéóôéêïý ìïíôÝåðéäçìéïëïãéêþí ÷áñáêôçñéóôéêþí ôçò õðÝñôáóçò, ëïõ (Logistic regression analysis). ÔÝëïò Ýãéíå óå Üôïìá ðïõ åðéóêÝðôïíôáé Ýíá ÊÝíôñï Õãåßáò ðñïóäéïñéóìüò ôïõ óõíôåëåóôÞ óõó÷Ýôéóçò ôïõ Spearman. áãñïôéêïý ôýðïõ. ÌåëåôÞèçêáí 347 äéáäï÷éêïß, äéáöïñåôéêïß áóèåíåßò, ðïõ åðéóêÝöèçêáí äýï Éáôñåßá ÃåíéêÞò ÉáôñéêÞò óå äéÜóôçìá äýï ìçíþí óôï Ê.Õ. Íå- ÁðïôåëÝóìáôá ìÝáò. Óôç ìåëÝôç ðåñéåëÞöèçóáí 347 Üôïìá (ðëçÊñéôÞñéï åéóüäïõ óôç ìåëÝôç Þôáí ìüíï ç èõóìüò ÍåìÝáò 4.100 Üôïìá, äåéãìáôïëçðôéêü çëéêßá > 18 åôþí. ÌÝôñçóç ÁñôçñéáêÞò Ðßåóçò (Á.Ð.). Ç ìÝ- êëÜóìá 84/1.000), 221 Üíäñåò (63,6%) êáé 136 ôñçóç ôçò Á.Ð. Ýãéíå ìå õäñáñãõñéêü óöõãìïìá- ãõíáßêåò (36.4%). Ç ìÝóç çëéêßá ôïõ äåßãìáôïò Þôáí 61.6 ± íüìåôñï óå ôñåéò äéáäï÷éêÝò, áíÜ äýï ëåðôÜ, ìåôñÞóåéò. Ï ìÝóïò üñïò ôùí ôñéþí ìåôñÞóåùí èåù- 14,49 (åýñïò 18 - 88) Ýôç (Ó÷Þìá 1). Ç ìÝóç Ó.Á.Ð. ôïõ äåßãìáôïò Þôáí 133,8 ± 21,36 mmHg ñÞèçêå ç Á.Ð. ôïõ êÜèå áóèåíÞ. Ïé ìåôñÞóåéò ôïõ õäñáñãõñéêïý óöõãìïìáíï- êáé ç ìÝóç Ä.Á.Ð. Þôáí 79,8 ± 9,53 mmHg ìÝôñïõ Þôáí óõãêñßóéìåò ìå ôéò ìåôñÞóåéò ôïõ (Ó÷Þìá 2 êáé 3). ÄéáãíùóìÝíç õðÝñôáóç åß÷áí 151/347 Üôïçëåêôñïíéêïý ðéåóüìåôñïõ OMRON, ðïõ Ý÷åé åãêñéèåß áðü ôçí B.H.S. (British Hypertension ìá (43.5%). Áðü áõôïýò 149/151 Üôïìá åëÜìâáíáí áíôéõðåñôáóéêÞ áãùãÞ (98,6%). Ç ìÝóç Ó.Á.Ð. Society) ãéá ôç ìÝôñçóç ôçò Á.Ð.4. Ïé ìåôñÞóåéò ôçò Á.Ð. ãßíïíôáí óå êáèéóôÞ ± SD ôùí ãíùóôþí õðåñôáóéêþí Þôáí 144.65 ± Study of hypertension in a rural population. Revalence and control of hypertension E.A. Skliros, Irine Ktorou, A. Sotiropoulos, Marie Magkou, G. Sevastos, Ourania Apostolou, Irine Papadimitriou, C. Kamilatos, Aliki Zervaki

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18,61 mmHg, óå áíôßèåóç ìå ôïõò ìç õðåñôáóéêïýò ðïõ Þôáí 125,50 ± 16,21 mmHg (t= 103,

Å.Á. Óêëçñüò êáé óõí.

DF: 150, p= 0.0001). Ç ìÝóç Ä.Á.Ð. ± SD ôùí ãíùóôþí õðåñôáóéêþí Þôáí 81.89 ± 9.70 mmHg, êáé äéÝöåñå óôáôéóôéêþò óçìáíôéêÜ áðü ôùí ìç õðåñôáóéêþí (78,27 ± 9,11 mmHg) (t= 95,4, DF: 150, p= 0.0001). Åëåã÷üìåíç õðÝñôáóç õðü öáñìáêåõôéêÞ áãùãÞ ìå Ó.Á.Ð. £ 140 mmHg êáé Ä.Á.Ð £ 90 mmHg åß÷áí 77/151 (50,9%) Üôïìá, åíþ ðñùôïäéÜãíùóç õðÝñôáóçò Ýãéíå ôåëéêÜ óå 23/196 (11,7%) Üôïìá.

ÐáñÜãïíôåò Êéíäýíïõ ÕðÝñôáóçò á) Êëçñïíïìéêü Éóôïñéêü Ó÷Þìá 1. ÊáôáíïìÞ çëéêßáò óôï äåßãìá

Êëçñïíïìéêü éóôïñéêü õðÝñôáóçò áíÝöåñáí 195/347 (56,2%) Üôïìá. Ôá 93 Üôïìá ìå èåôéêü ïéêïãåíåéáêü éóôïñéêü åß÷áí áíáðôýîåé õðÝñôáóç (93/151 vs 102/196, Fisher's exact test 1-sided p= 0,047). Ï ó÷åôéêüò êßíäõíïò áíÜðôõîçò õðÝñôáóçò ìå èåôéêü ïéêïãåíåéáêü éóôïñéêü Þôáí OR= 1,478 (95% CI: 0,960 - 2,275).

â) Öýëï

Ó÷Þìá 2. ÊáôáíïìÞ óõóôïëéêÞò Á.Ð. óôï äåßãìá

Ó÷Þìá 3. ÊáôáíïìÞ äéáóôïëéêÞò Á.Ð. óôï äåßãìá 134

Ç ìÝóç Ó.Á.Ð. óôïí áíäñéêü ðëçèõóìü Þôáí 136,26 ± 19,29 mmHg, åíþ óôï ãõíáéêåßï Þôáí 130,07 ± 23,81 mmHg (t= 2,65, DF: 345, p= 0,008). Áíôßóôïé÷á ç ìÝóç Ä.Á.Ð. Þôáí 80,39 ± 9,19 mmHg vs 78,99 ± 10,05 mmHg (t = 1,346, DF: 345, p= 0,179) (Ó÷Þìá 4). ÁíåõñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ óõó÷Ýôéóç ìåôáîý öýëïõ êáé Ó.Á.Ð. (Spearman's R= 0.265,

Ó÷Þìá 4. ÄéáöïñÜ ìÝóçò óõóôïëéêÞò êáé ìÝóçò äéáóôïëéêÞò Á.Ð. óå Üíäñåò êáé ãõíáßêåò


Ôüìïò 12, Ôåý÷ïò 3, 2000

Å.Á. Óêëçñüò êáé óõí.

p= 0,003).

ã) Çëéêßá Óôïí ðßíáêá 1 ðáñïõóéÜæåôáé ï åðéðïëáóìüò ôçò õðÝñôáóçò óôéò çëéêéáêÝò ïìÜäåò á) 18 - 25, â) 26 - 35, ã) 36 - 45, ä) 46 - 55, å) 56 - 65 êáé óô) > 65 åôþí. Óå üëï ôï äåßãìá ç Ó.Á.Ð. áíåõñÝèçêå íá ó÷åôßæåôáé èåôéêÜ ìå ôçí çëéêßá (Spearman's R= 0,391, p= 0,0001), åíþ ç Ä.Á.Ð. ü÷é (Spearman's R= -0,019, p= 0,718) (Ó÷Þìá 5 êáé 6).

Ðßíáêáò 1. Åðéðïëáóìüò õðÝñôáóçò áíÜ çëéêéáêÞ ïìÜäá ÇëéêéáêÞ ÏìÜäá 18 - 25 26 - 35 36 - 45 46 - 55 56 - 65 > 65

Í

ÕðÝñôáóç

%

6 32 38 45 47 179

1 8 20 17 105

3,1 21 44,4 36,2 58,6

Ðßíáêáò 2. ÐïëõðáñáãïíôéêÞ ÁíÜëõóç ÌåôáâëçôÞ Çëéêßá Öýëï Êëçñïíïìéêü

 - 0.0714 0.1405 - 0.6140

SE

WALD

0.0106 0.2447 0.2459

45.25 0.39 6.23

p 0.00001 0.5658 0.0125

Ó÷Þìá 6. Ó÷Ýóç äéáóôïëéêÞò Á.Ð. ìå çëéêéáêÝò ïìÜäåò

Óôïõò õðåñôáóéêïýò áóèåíåßò âñÝèçêå áñíçôéêÞ óõó÷Ýôéóç ìåôáîý çëéêßáò êáé Ä.Á.Ð. (Spearman's R= -0,227, p= 0,05), åíþ ç çëéêßá ôùí õðåñôáóéêþí áóèåíþí äéÝöåñå óçìáíôéêÜ áðü áõôÞ ôùí ìç õðåñôáóéêþí (68,01 ± 9,76 vs 56,65 ± 15,59 Ýôç, t= 85,645, p= 0,001). ÔÝëïò ìå ôçí åöáñìïãÞ ôïõ ëïãáñéèìéêïý ìïíôÝëïõ, áíåîÜñôçôïé ðáñÜãïíôåò êéíäýíïõ ãéá õðÝñôáóç âñÝèçêáí íá åßíáé ç çëéêßá (p= 0.00001) êáé ôï êëçñïíïìéêü éóôïñéêü (p= 0.0125).

ÓõæÞôçóç

Ó÷Þìá 5. Ó÷Ýóç óõóôïëéêÞò Á.Ð. ìå çëéêéáêÝò ïìÜäåò

Ç áõîçìÝíç áñôçñéáêÞ ðßåóç áðïôåëåß Ýíáí áðü ôïõò éó÷õñüôåñïõò áíåîÜñôçôïõò ðáñÜãïíôåò êéíäýíïõ áíÜðôõîçò êáñäéáããåéáêÞò íüóïõ3. Ôï ãåãïíüò áõôü Ý÷åé éäéáßôåñç óçìáóßá, áöïý ç óõ÷íüôçôÜ ôçò åßíáé õøçëÞ. ÅðéäçìéïëïãéêÝò ìåëÝôåò óôéò Ç.Ð.Á.6 Ýäåéîáí üôé ôï 32% ôïõ ðëçèõóìïý ëåõêÞò öõëÞò åìöáíßæåé êÜðïéïõ âáèìïý õðÝñôáóç. Óôç ìáýñç öõëÞ ï åðéðïëáóìüò ôçò õðÝñôáóçò åßíáé õøçëüôåñïò (  40%), åíþ óå õøçëüôåñï ðïóïóôü åìöáíßæåôáé êáé ç êáêïÞèçò õðÝñôáóç. Óôçí ÅëëÜäá ôá óôïé÷åßá ãéá ôïí åðéðïëáóìü ôçò õðÝñôáóçò óôï ãåíéêü ðëçèõóìü (áóôéêü êáé áãñïôéêü) åßíáé ðåñéïñéóìÝíá. Óôïé÷åßá áðü ôéò õðÜñ÷ïõóåò ìåëÝôåò åêôéìïýí ôï ðñüâëçìá ôçò õðÝñôáóçò üôé õðÜñ÷åé óôï 18-28% ôïõ ðëç135


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

èõóìïý7,8. Ç óõ÷íüôçôá ôçò õðÝñôáóçò óôïõò åðéóêÝðôåò ôïõ Ê.Õ. ÍåìÝáò åßíáé ðåñßðïõ 50%, ãåãïíüò ðïõ ôïíßæåé ôï üôé ç õðÝñôáóç áðïôåëåß ßóùò ôï óõíçèÝóôåñï ðñüâëçìá óôçí ðñùôïâÜèìéá öñïíôßäá õãåßáò. ÐáñÜ ôçí õøçëÞ óõ÷íüôçôá áíåýñåóçò õðÝñôáóçò óôç ìåëÝôç ìáò, ðñüóöáôç Ýñåõíá óôéò Ç.Ð.Á.9 ìå ôç ÷ñÞóç ôùí êñéôçñßùí ôçò J.N.C. VI äéáðßóôùóå åðéðïëáóìü õðÝñôáóçò ôçò ôÜîçò ôïõ 43% óôï ãåíéêü ðëçèõóìü. Ïé ðáñÜãïíôåò êéíäýíïõ ðïõ ó÷åôßæïíôáé ìå ôçí áõîçìÝíç óõ÷íüôçôá õðÝñôáóçò åßíáé ðïëëïß10 êáé ÷ùñßæïíôáé óå ôñïðïðïéÞóéìïõò êáé ìç. Ìç ôñïðïðïéÞóéìïé ðáñÜãïíôåò êéíäýíïõ åßíáé ç çëéêßá, ôï öýëï, ôï èåôéêü êëçñïíïìéêü éóôïñéêü êáé ç öõëÞ (ìáýñç öõëÞ). Ç çëéêßá ó÷åôßæåôáé ìå ôï ìÝãåèïò ôçò Á.Ð. êáé ç õðÝñôáóç åßíáé óõ÷íüôåñç óå Üôïìá ôçò ôñßôçò çëéêßáò11, áöïý õðïëïãßæåôáé10 üôé ôï 50% ôïõëÜ÷éóôïí Ý÷ïõí áõîçìÝíç Á.Ð. Óôç ìåëÝôç ìáò ôï 58% ôùí áôüìùí > 65 åôþí åß÷áí õðÝñôáóç, ðïóïóôü ðïõ óõìöùíåß êáé ìå ôá åõñÞìáôá Üëëùí åëëçíéêþí ìåëåôþí8. Åéäéêüôåñá, óôïõò çëéêéùìÝíïõò ç Ó.Á.Ð. åßíáé áõîçìÝíç - ãåãïíüò ðïõ öáßíåôáé áðü ôç óõó÷Ýôéóç çëéêßáò - Ó.Á.Ð. óôï äåßãìá ìáò - êáé ç áìéãþò óõóôïëéêÞ õðÝñôáóç óõíïäåýåôáé áðü áõîçìÝíï êßíäõíï6 êáñäéáêÞò áíåðÜñêåéáò, éó÷áéìéêÞò íüóïõ êáé õðåñôñïößáò áñéóôåñÞò êïéëßáò. Ç çëéêßá óôç ìåëÝôç ìáò öÜíçêå íá áðïôåëåß áíåîÜñôçôï ðáñÜãïíôá êéíäýíïõ ãéá áíÜðôõîç õðÝñôáóçò. Ï ðáñÜãïíôáò öýëï (Üíäñáò - ãõíáßêá) áðü ôçí Üëëç ìåñéÜ óôç ìåëÝôç ìáò äåí öÜíçêå íá áðïôåëåß ðáñÜãïíôá êéíäýíïõ ãéá áíÜðôõîç õðÝñôáóçò. Ç õðÝñôáóç åßíáé ëéãüôåñï óõ÷íÞ óôéò ãõíáßêåò óå ó÷Ýóç ìå ôïõò Üíäñåò5, áëëÜ ôï ãåãïíüò áõôü äéáöïñïðïéåßôáé ìåôÜ ôçí åììçíüðáõóç. Ç ìåëÝôç ìáò, ðáñÜ ôï üôé ðåñéÝëáâå õøçëü ðïóïóôü ìåôåììçíïðáõóéáêþí ãõíáéêþí, Ýäåéîå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ óôç Ó.Á.Ð. ìåôáîý áíäñþí êáé ãõíáéêþí. ÔÝëïò ôï êëçñïíïìéêü éóôïñéêü áðïäåß÷èçêå íá áðïôåëåß óçìáíôéêü ðáñÜãïíôá êéíäýíïõ ãéá åêäÞëùóç õðÝñôáóçò áíåîÜñôçôá ôïõ öýëïõ êáé ôçò çëéêßáò. Ôï èåôéêü êëçñïíïìéêü éóôïñéêü áõîÜíåé êáôÜ 48% ôçí ðéèáíüôçôá åìöÜíéóçò õðÝñôáóçò. ÐñùôïäéÜãíùóç ôçò õðÝñôáóçò ðñáãìáôïðïéÞèçêå óå 23/196 Üôïìá (11,7%). Óå Ýñåõíá8 ôçò ô ÐáèïëïãéêÞò ÊëéíéêÞò ôïõ Ðáíåðéóôçìßïõ 136

Å.Á. Óêëçñüò êáé óõí.

Áèçíþí, ôï ðïóïóôü ðñùôïäéáãíùóìÝíçò õðÝñôáóçò Þôáí 39,2%. Ôï ðïóïóôü ìáò åßíáé óçìáíôéêÜ ÷áìçëüôåñï êáé ðéèáíþò ïöåßëåôáé óôçí éäéáéôåñüôçôá ôïõ äåßãìáôüò ìáò (åðéóêÝðôåò Ê.Õ.). Ôï åýñçìÜ ìáò üìùò åßíáé óõãêñßóéìï ìå ôï ðïóïóôü ðñùôïäéÜãíùóçò ôçò õðÝñôáóçò óå áóèåíåßò ðïõ åðéóêÝðôïíôáé Ýíá Ê.Õ. ìå ïîåßá áðïññýèìéóç ôçò Á.Ð.12. Ôï ãåãïíüò áõôü äçìéïõñãåß ôçí áíáãêáéüôçôá ôçò õðï÷ñåùôéêÞò ìÝôñçóçò ôçò Á.Ð. óå üëïõò ôïõò åðéóêÝðôåò åíüò Ê.Õ., êáèþò êáé ôçí ïñãÜíùóç ðñïãñáììÜôùí áíáãíþñéóçò êáé åëÝã÷ïõ ôçò õðÝñôáóçò. Óôç ìåëÝôç ìáò ôï 98.4% ôùí áóèåíþí ìå éóôïñéêü õðÝñôáóçò åëÜìâáíå öáñìáêåõôéêÞ áãùãÞ. ¼ðùò åßíáé ãíùóôü óôü÷ï ôçò áíôéõðåñôáóéêÞò áãùãÞò áðïôåëåß ç ìåßùóç ôùí âëáâþí óôá üñãáíá óôü÷ïõò, êáèþò êáé ç ãåíéêüôåñç ìåßùóç ôçò èíçôüôçôáò áðü ôçí áõîçìÝíç Á.Ð. Áí êáé ôï üöåëïò ôçò áíôéõðåñôáóéêÞò áãùãÞò åßíáé áíáìöéóâÞôçôï, êëéíéêÝò ìåëÝôåò Ýäåéîáí üôé ç ñýèìéóç ôçò Á.Ð. ìå ôç ëÞøç ôçò, åðéôõã÷Üíåôáé ìüíï óå Ýíá ðïóïóôü ôùí áóèåíþí13. Óôç ìåëÝôç ìáò åðéôõ÷Þ ñýèìéóç ôçò Á.Ð. åðéôåý÷èçêå óôï 50% ôùí áóèåíþí ðïõ ëÜìâáíáí áíôéõðåñôáóéêÞ áãùãÞ. Ãé’ áõôü ôï ëüãï ðáñáôçñÞèçêå Üëëùóôå êáé óçìáíôéêÞ äéáöïñÜ ôüóï óôç Ó.Á.Ð. üóï êáé óôç Ä.Á.Ð. ìåôáîý õðåñôáóéêþí õðü èåñáðåßá êáé ìç õðåñôáóéêþí. ¸ñåõíåò ðïõ ðñáãìáôïðïéÞèçêáí ôéò ðñïçãïýìåíåò äåêáåôßåò13, Ýäåéîáí üôé óôçí áíôéìåôþðéóç ôçò õðÝñôáóçò éó÷ýåé ï êáíüíáò ôùí ìéóþí, äçëáäÞ 50% áðü áõôïýò ðïõ åß÷áí õðÝñôáóç ôï ãíùñßæïõí, ôï 50% áðü áõôïýò ðïõ ôï ãíùñßæïõí ëáìâÜíïõí èåñáðåßá êáé ôÝëïò ôï 50% áõôþí ðïõ ëáìâÜíïõí èåñáðåßá Ý÷ïõí ñõèìéóèåß. Ôéò ôåëåõôáßåò äýï üìùò äåêáåôßåò ôüóï óôéò Ç.Ð.Á. üóï êáé óôçí Åõñþðç åðéôåý÷èçêå óçìáíôéêÞ âåëôßùóç ôüóï ôçò åðßãíùóçò üóï êáé ôçò êáëÞò ñýèìéóçò ôçò õðÝñôáóçò, ãåãïíüò ðïõ öáßíåôáé áðü ôç ìåßùóç ôùí áããåéáêþí åãêåöáëéêþí êáé ôùí óôåöáíéáßùí åðåéóïäßùí óôéò ÷þñåò áõôÝò. Óôç ìåëÝôç ôùí Äéäýìùí8 ôï ðïóïóôü ñýèìéóçò ôùí õðåñôáóéêþí áóèåíþí ðïõ ëÜìâáíáí èåñáðåßá Þôáí 49%, ðïóïóôü ðïõ áíôéóôïé÷åß óôï 27% ôïõ óõíüëïõ ôïõ õðåñôáóéêïý ðëçèõóìïý. Óå ìßá äéá÷ñïíéêÞ üìùò ìåëÝôç ðïõ ðñáãìáôïðïéÞèçêå óôï Ä. ×áóóßùí14, ôï ðïóïóôü ñýèìéóçò ôùí õðåñôáóéêþí áóèåíþí áðü 28,04% äéáìïñöþèçêå óôï 60,85% óôç äéÜñêåéá ìéáò ðåíôáåôßáò, ãåãïíüò ðïõ ïäÞãçóå óå óôáôéóôéêÜ


Å.Á. Óêëçñüò êáé óõí.

óçìáíôéêÞ ìåßùóç ôùí èáíÜôùí áðü áããåéáêü åãêåöáëéêü åðåéóüäéï êáé ïîý Ýìöñáãìá ìõïêáñäßïõ. Ôá áßôéá ôçò êáêÞò ñýèìéóçò ôçò Á.Ð. ðñÝðåé íá áíáæçôçèïýí áöåíüò ìåí óå ðáñÜãïíôåò15 ðïõ áöïñïýí óôïí áóèåíÞ (ð.÷. óõììüñöùóç óôï èåñáðåõôéêü ó÷Þìá) êáé áöåôÝñïõ óôçí õðïåêôßìçóç ôïõ ðñïâëÞìáôïò áðü ìÝñïõò ôïõ éáôñïý. ¸ôóé ôá áðïôåëÝóìáôá ôçò ìåëÝôçò ìáò, äåß÷íïõí ôï Þäç õðÜñ÷ïí ðñüâëçìá ôçò õðÝñôáóçò êáé ôïíßæïõí ôçí áíáãêáéüôçôá ôçò óõììåôï÷Þò ôïõ Ãåíéêïý Éáôñïý óôçí åðßëõóÞ ôïõ. Ï Ãåíéêüò Éáôñüò ìðïñåß íá óõìâÜëëåé óôçí åëá÷éóôïðïßçóÞ ôïõ ìå: á) ÏñãÜíùóç ðñïãñáììÜôùí áíß÷íåõóçò õðÝñôáóçò óôïí ðëçèõóìü åõèýíçò ôïõ, â) ÏñãÜíùóç ðñïãñáììÜôùí áãùãÞò õãåßáò ãéá ôç äéüñèùóç åóöáëìÝíùí áíôéëÞøåùí ãéá ôçí ðÜèçóç15, ã) Óõíå÷Þ åðéêïéíùíßá êáé áîéïëüãçóç ôïõ áóèåíïýò êáé ä) Äçìéïõñãßá ïñãáíùìÝíïõ éáôñåßïõ ðáñáêïëïýèçóçò ôçò Á.Ð. Âéâëéïãñáößá 1. R.Collins, R. Peto, S. MacMahon, et al. Blood pressure, stroke and coronary heart disease. Part2, short term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet, 335:827-838, 1990. 2. M. Rowland, J. Roberts. Blood pressure and hypertension in persons ages 6-74 years. United States 1976-1980. Vital. Health Stat., 84:821250, 1982. 3. M. Bodac, M.G. Marmot. East-West mortality divide and its potential explanations: proposed research agenda. BMJ, 312:421-425, 1996. 4. Å. Ï’Ârien, J. ertie, W. Littler, er al. An outline of the revised British Hypertension Society protocol for the evaluation of blood pressure measuring devices. J. Hypertens., 11:677-679, 1993.

Ôüìïò 12, Ôåý÷ïò 3, 2000

5. Joint National Committee Detection, Evaluation and Treatment of High Blood Pressure: The sixth report of the J.N.C. on the detection, evaluation and treatment of high blood pressure (J.N.C. VI) Arch. Inter. Med., 24:2413-2446, 1997. 6. A.V. Chobanian. Hypertension. In: Wilkins RW, Levinsky NG (eds). Medicine Essentials of Clinical Practice 3rd ed. Boston Little Brown 1982. 7. Á. ÍÜôóçò, É. Ðáðáíßêïò, Ê. Óéáìüðïõëïò. Ç óõ÷íüôçôá ôçò õðÝñôáóçò êáé ç áðïôåëåóìáôéêüôçôá ôçò áíôéõðåñôáóéêÞò áãùãÞò óôçí ðåñéöÝñåéá ôïõ Ð.É. Áãéïöýëëïõ. Ðñùô. Öñïí. Õãåßáò, 8:87-96, 1996. 8. G.S. Stergiou, G.C. Thomopoulou, J.I. Skeva, T.D. Mountokalakis. Prevalence, awareness, treatment and control of hypertension in Greece: the Didima Study. Am. J. Hypertens., 12:959-965, 1999. 9. D.M. Loyd-Jones, J.C. Evans, M.G. Larson, et al. Cross-classification of J.N.C. VI blood pressure stages and risks groups in the Framingham Heart Study. Arch. Intern. Med., 11:2206-2212, 1999. 10. N. Kaplan. Clinical Hypertension. Seventh Edition Williams and Wilkins. Baltimore 1998. 11. A. Koutis, A. Isacsson, C. Lionis, et al. Differences in the diagnose panorama in primary health care in Dalby Sweden and Spili Crete. Scand. J. Soc. Med., 21:51-58, 1993. 12. Å. Óêëçñüò, Á. Óùôçñüðïõëïò, Ê. Óðåñäïýëçò ê.Ü. Áßôéá ðñïóÝëåõóçò áóèåíþí ìå ïîåßá áðïññýèìéóç áñôçñéáêÞò ðßåóçò. Ï ñüëïò ôïõ Ãåíéêïý Éáôñïý. ÐñùôoâÜèìéá Öñïíôßäá Õãåßáò, 11:99-103, 1999. 13. M. Rowland, J. Roberts. Blood pressure and hypertension in persons ages 6-74 years. United States 1976-1980. Vital. Health Stat., 84:821250, 1982. 14. Á.Ì. ÍÜôóçò, É. Ðáðáíßêïò, ×.Ê. Óéáìüðïõëïò. Ç áðïôåëåóìáôéêÞ áíôéõðåñôáóéêÞ áãùãÞ ìåéþíåé ôïí êßíäõíï óôåöáíéáßáò íüóïõ êáé åãêåöáëéêïý. Ðñùô. Öñïíô. Õãåßáò, 11:150-159, 1999. 15. G.M. Sharkness, D.A. Snow. The patients view of hypertension and compliance. Am. J. Prev. Med., 141-146, 1992.

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ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Óô. Öùôïðïýëïõ êáé óõí.

BÑÁÂÅÕÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ AWARDED FREESTANDING PAPER Primary Heatlh Care, Volume 12, Number 3, 138-144, 2000 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 12, Ôåý÷ïò 3, 138-144, 2000

×ñÞóç ôçò äïêéìáóßáò êáôÜ ÐáðáíéêïëÜïõ óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. Ç åìðåéñßá ôïõ Ê.Õ. Áñéäáßáò ÓôÝëëá Öùôïðïýëïõ, Ã.×ñ. ÓðáèáñÜêçò, Ê. Ðïíôßêçò

Ðåñßëçøç Óêïðüò: Ôá ðñïãñÜììáôá ðñüëçøçò êáé ðñþéìçò áíß÷íåõóçò ôïõ ôñá÷Þëïõ ôçò ìÞôñáò ìå ôç ÷ñÞóç ôçò Äïêéìáóßáò êáôÜ ÐáðáíéêïëÜïõ (Pap-Test) óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò Ý÷ïõí áðü ìáêñïý áðïäåßîåé ôç ÷ñçóéìüôçôÜ ôïõò. Èåùñïýìå åíäéáöÝñïõóá ôçí ðáñïõóßáóç ôçò ôñéåôïýò äñáóôçñéüôçôáò (1997-1999) ôïõ ÊÝíôñïõ Õãåßáò (Ê.Õ.) Áñéäáßáò óôïí ôïìÝá áõôü, êáèþò ðáñüìïéåò áíáöïñÝò åßíáé ðïëý ïëéãÜñéèìåò óôçí åëëçíéêÞ âéâëéïãñáößá. Õëéêü-ÌÝèïäïò: Ôï õëéêü ôçò ìåëÝôçò áðïôÝëåóáí 1014 ãõíáßêåò, êÜôïéêïé ôçò Åðáñ÷ßáò Áëìùðßáò ôïõ Íïìïý ÐÝëëáò, çëéêßáò 17-72 åôþí (Ì. Ï. 46,44± 11,43 Ýôç). Ôï 73,4% Þôáí êÜôïéêïé ÷ùñéþí ôçò ðåñéï÷Þò åíþ ôï 25% êáôïéêïýóå óôçí çìéáóôéêÞ æþíç ôçò ðüëçò ôçò Áñéäáßáò. Ç çëéêéáêÞ äéáóôñùìÜôùóç ôïõ äåßãìáôïò áíÝäåéîå ðñþôç ôçí ïìÜäá ôùí 50-65 åôþí (38%), äåýôåñç åêåßíç ôùí 40-50 åôþí (27,2%) êáé ôñßôç áõôÞ ôùí 30-40 åôþí (24,3%), åíþ ìéêñÞ åêðñïóþðçóç åìöÜíéæáí ïé íåáñÝò ãõíáßêåò êÜôù ôùí 30 åôþí (8,5%) êáé ï ãçñéáôñéêüò ðëçèõóìüò (2,1%). ÁðïôåëÝóìáôá: Ôá åõñÞìáôá ôïõ 66,5% ôùí äåéãìÜôùí âñÝèçêáí ìÝóá óôá öõóéïëïãéêÜ üñéá, åíþ Ýíá óçìáíôéêü ðïóïóôü (24,3%) åìöÜíéæå óôïé÷åßá öëåãìïíÞò. Ìéêñüôåñç Þôáí ç áíáëïãßá óçìåßùí áôñïöéêÞò êïëðßôéäáò (8,7%). Ìéêñü ðïóïóôü ãõíáéêþí åìöÜíéæå ùñßìáíóç ôïõ åðéèçëßïõ ìç óõìâáôÞ ìå ôçí Ô.Å.Ñ. (0,4%) Þ óôïé÷åßá áôõðßáò (0,2%). ÅðáíÜëçøç ôïõ Pap-test óõóôÞèçêå óôï 4,8% ôùí ãõíáéêþí. Áðü ôç ìáêñïóêïðéêÞ åîÝôáóç ôïõ êüëðïõ áðü ôç ÃåíéêÞ Éáôñü ôá åõñÞìáôá Þôáí öõóéïëïãéêÜ óå 73,8% ôùí ãõíáéêþí, óôï 23,6% áíåõñÝèçêå áôñïöéêüò êüëðïò-ôñÜ÷çëïò, óå 2,4% êïëðßôéäá, 0,2% êõóôåïêÞëç êáé 1,5% ðïëýðïäåò ôñá÷Þëïõ (áðü ôéò ôåëåõôáßåò ìßá åìöÜíéæå C.I.Í. ìåôÜ áðü âéïøßá ôïõ ðïëýðïäá). ÓõìðåñÜóìáôá: 1) Ìüíï ôï 10% ôïõ óõíüëïõ ôùí ãõíáéêþí ôçò ðåñéï÷Þò åõèýíçò ôïõ Ê.Õ. Áñéäáßáò åß÷å åðáöÞ ìå ôï ðñïëçðôéêü ðñüãñáììá. ÅðïìÝíùò, ÷ñåéÜæåôáé ðåñéóóüôåñç åíçìÝñùóç ôïõ ðëçèõóìïý. 2) Óçìáíôéêü ðïóïóôü ãõíáéêþí åìöáíßæåé óôïé÷åßá öëåãìïíÞò,üðùò åðéóçìÜíèçêå êáé óå ðñïçãïýìåíåò áíáöïñÝò áðü ôçí ðåñéï÷Þ ÊñÞôçò. 3) Éêáíü ðïóïóôü åìöáíßæåé áôñïößá êáé ðéèáíþò åßíáé õðïøÞöéï ãéá èåñáðåßá õðïêáôÜóôáóçò. 4) Ôá ðïóïóôÜ áôõðßáò ôïõ Pap test åßíáé ÷áìçëüôáôá. 5) Õøçëü åßíáé ôï ðïóïóôü áìâëþóåùí, Üñá åßíáé Üãíùóôåò óôïí ðëçèõóìü ïé óýã÷ñïíåò ìÝèïäïé áíôéóýëëçøçò. 6) ÓçìáíôéêÞ åßíáé Þ ìðïñåß íá åßíáé ç óõìâïëÞ ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý óôçí ðñáãìáôïðïßçóç ôïõ Pap Test, ôï ïðïßï, åêôüò áðü ôçí ðñüëçøç, åêðëçñþíåé êáé Üëëåò ëåéôïõñãßåò. Aðü ôï ÊÝíôñï Õãåßáò Áñéäáßáò ÐÝëëáò

138

ÅéóáãùãÞ Ç ÐñùôïâÜèìéá Öñïíôßäá Ý÷åé ùò áí��éêåßìåíï ôçí ðáñï÷Þ õðçñåóéþí áíïéêôÞò öñïíôßäáò êáé áðïóêïðåß ôüóï óôïí Ýãêáéñï åíôïðéóìü ðñïâëçìÜôùí õãåßáò üóï êáé óôçí áíß÷íåõóç ôùí áíáãêþí êáé ôçí ðñüëçøç ôùí íüóùí1,2. Óôçí ÅëëÜäá ìåãÜëï âÜñïò ôçò ðñüëçøçò êáé ôçò áãùãÞò õãåßáò åðùìßæïíôáé ôá ÊÝíôñá Õãåßáò3,4. Óôç äéåèíÞ âéâëéïãñáößá êáôáãñÜöåôáé üôé ïé Ãåíéêïß Ãéáôñïß êáôáíáëþíïõí ôï 11% ôïõ ÷ñüíïõ ôïõò óôçí ðñüëçøç. ÌÜëéóôá, ôï ìéóü ôïõ ÷ñüíïõ ðïõ áíáëïãïýóå óôéò äñáóôçñéüôçôåò ðñüëçøçò Þôáí áöéåñùìÝíïò óôçí áíß÷íåõóç ôïõ êáñêßíïõ ôïõ ìáóôïý êáé ôïõ ôñá÷Þëïõ ôçò ìÞôñáò5. ÅðïìÝíùò, ï ñüëïò ôùí õðçñåóéþí ËÝîåéò êëåéäéÜ: Êáñêßíïò Ôñá÷Þëïõ ÌÞôñáò, Áíß÷íåõóç, Ðñüëçøç, ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, ÊÝíôñï Õãåßáò, Ãåíéêüò Éáôñüò, Äïêéìáóßá-Test ÐáðáíéêïëÜïõ, Pap Test, Áôñïößá Ãåííçôéêþí ÏñãÜíùí, ×ñüíéåò ÃõíáéêïëïãéêÝò öëåãìïíÝò. ÕðïâëÞèçêå: Ç åñãáóßá áõôÞ õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 12Ï Ðáíåëëçíßïõ Óõíåäñßïõ ÃåíéêÞò ÉáôñéêÞò (×áëêéäéêÞ, 15-19 Ïêôùâñßïõ 2000) êáé âñáâåýôçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: ÓôÝëëá Öùôïðïýëïõ, ÊÝíôñï Õãåßáò Áñéäáßáò ÐÝëëáò, Ô.Ê. 58400 Áñéäáßá.


Ôüìïò 12, Ôåý÷ïò 3, 2000

Óô. Öùôïðïýëïõ êáé óõí.

Use of the PAP smear test in the primary health care setting. The Experience of the Health Center of Aridaia-Greece Photopoulou St., Spatharakis G.C., Pontikis C. Summary Aim: Prevention and early screening programs for cervicaI cancer by using the Pap Smear Test Technique have already proven their usefulness in Primary Health Care Settings. As reports concerning this domain of workare very few in the Greek bibliography, the presentation of the three year activity (1997-1999) of the Health Center of Aridaia is of interest. Patients-Methods: The materiaI of the studyconducted in the district of Almopia (regional capital Aridaia) of Macedonia-Greece consisted of 1014 women, aged 17-72 (M. 46,44 ± 11,43 years of age). 73,4% were inhabitants of nearby villages while 25% resided in the semiurban zone of Aridaia. The largest age group was the 50-65 years (38%), the second 40-50 years (27.2%) and third 30-40 years (24.3%); the representation of women below 30 was 8,5% and the elderly 2.1%. Results: The findings of 66.5% of the Pap Smears were within the normal range while a significant percentage (24.3%) presented signs of innammation. Genital atrophy was present in 8.7%. 0.4% of the women presented epithelial maturation which was not in accordance with the last Date of Menstrual Flow and 0.2% showed signs of atypicity/dysplasia. Direct inspection revealed normal findings in 73.8% of women, atrophic vaginacervix in 23.6% of cases,vaginitis in 2.4%, cystocelein 0.2% and cervicaI polyps in 1.5% (one patient among the Iatter presented a C.l.N. proved by biopsy). Conclusions: 1) Only approximately 10% of the total population of the district took part in this programme of prevention and screening. 2) Our findings are in accordance with previous reports from Crete. 3) A significant number of individuals showed genital atrophy and are probable candidate for substitution therapy. 4) The percentage of atypical Pap smears were very Iow. 5) Modern methods of contraception are rather unknown to the population as confirmed by the high number of abortions. 6) The role of the General Practitioner/Family Doctor is of high importance for the realization of the Pap Smear Test which, besides prevention, can fulfill other functions as welI. Key words: Primary (Health) Care, Primary Setting, Cervical Cancer, Uterine Cancer, Pap Smear, Pap Test, Screening, Prevention, Genital Atrophy, Chronic Genital Infection.

ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò óôçí ðñþéìç äéÜãíùóç ôïõ êáñêßíïõ ôïõ ôñá÷Þëïõ ôçò ìÞôñáò åßíáé êáèïñéóôéêüò5,6. Óýìöùíá ìå ôïí Ch. Cameron (1991) “...Ç äõíáôüôçôá ôçò ðñþéìçò êõôôáñïëïãéêÞò äéÜãíùóçò ôïõ ôñá÷Þëïõ ôçò ìÞôñáò õðÞñîå Ýíá áðü ôá ðéï åíèáññõíôéêÜ åðéôåýãìáôá ôçò óýã÷ñïíçò ïãêïëïãßáò, ìå áðïôÝëåóìá ç óõóôçìáôéêÞ åöáñìïãÞ ôçò äïêéìáóßáò êáôÜ ÐáðáíéêïëÜïõ (Pap Test) íá ìåéþóåé åíôõðùóéáêÜ ôï ðïóïóôü ôïõ èáíÜôïõ áðü êáñêßíï ôçò ìÞôñáò óå ëéãüôåñï áðü ôï ìéóü åêåßíïõ ðïõ Þôáí ðñéí áðü 30 ðåñßðïõ ÷ñüíéá...” (áðüóðáóìá áðü ïìéëßá ôïõ óôçí Áêáäçìßá Áèçíþí)7. Åðßóçò, ç ôå÷íéêÞ áõôÞ áðïôåëåß áíåêôßìçôï êáé áíáíôéêáôÜóôáôï åñãáëåßï ãéá ôç ìåßùóç ôçò åðßðôùóçò ôïõ êáñêßíïõ ôïõ ôñá÷Þëïõ ôçò ìÞôñáò8. Óôïí åëëáäéêü ÷þñï äéáèÝôïõìå ïëéãÜñéèìåò

êáôáãñáöÝò ó÷åôéêÝò ìå ôï èÝìá. Ïé óçìáíôéêüôåñåò åìðåéñßåò áðü ïñãáíùìÝíåò ðñïóðÜèåéåò óôïí ôïìÝá áõôü ðñïÝñ÷ïíôáé áðü ôá Ê.Õ. Óðçëßïõ êáé Êáóôåëëßïõ óôçí ÊñÞôç, óôá ïðïßá Ý÷ïõí áíáðôõ÷èåß ðñïãñÜììáôá ðñïóõìðôùìáôéêïý åëÝã÷ïõ ôùí ãõíáéêþí áðü ôï 1990 êáé ìåôÜ9,10. Óêïðïß ôçò ðáñïýóáò ìåëÝôçò Þôáí: 1) ç ðáñïõóßáóç ôçò åìðåéñßáò áðü ôçí ôñéåôÞ äñáóôçñéüôçôá (19971999) óå Ê.Õ. ôçò çðåéñùôéêÞò ÷þñáò (Ê.Õ. Áñéäáßáò) ç ïðïßá áöïñÜ óôçí ðñïëçðôéêÞ êëéíéêÞ ãõíáéêïëïãéêÞ åîÝôáóç êáé óôç ëÞøç äåéãìÜôùí êáôÜ ôç ìÝèïäï ÐáðáíéêïëÜïõ, 2) ç åðéâåâáßùóç ôçò áîßáò ôçò ïñãáíùìÝíçò åîÝôáóçò ôïõ ðëçèõóìïý êáé ôçò äïêéìáóßáò ÐáðáíéêïëÜïõ, 3) ç åêôßìçóç ôùí áðïôåëåóìÜôùí ôçò ðñïóðÜèåéáò ìå óôü÷ï ôçí áãùãÞ êáé ôçí ðñïáãùãÞ ôçò õãåßáò, ìå óêïðü, åêôüò áðü ôçí ðñüëçøç ôïõ êáñêßíïõ ôïõ ôñá÷Þëïõ ôçò ìÞôñáò, íá äåé÷èåß ç ðïëëáðëÞ ôçò ÷ñçóéìüôçôá êáèþò êáé ç óçìáíôéêÞ èÝóç ôùí Ê.Õ. êáé ç óõìâïëÞ ôùí Ãåíéêþí Éáôñþí óôçí êáôåýèõíóç áõôÞ.

Ðëçèõóìüò ìåëÝôçò êáé ÌÝèïäïé

Óôï ðñüãñáììá áõôü Ýëáâáí ìÝñïò 1014 ãõíáßêåò çëéêßáò 17-72 åôþí, ìå ìÝóï üñï (Ì.Ï.) 46,44 ±11,43 Ýôç, ðïõ äéÝìåíáí óôçí Åðáñ÷ßá Áëìùðßáò ôïõ Íïìïý ÐÝëëáò. Ç åðáñ÷ßá Áëìùðßáò ìå 40 Êïéíüôçôåò (ðëçèõóìüò ~30.000 êÜôïéêïé) õðÜãåôáé óôçí ðåñéï÷Þ åõèýíçò ôïõ Ê.Õ. Áñéäáßáò. Ôï ðñüãñáììá Üñ÷éóå íá åöáñìüæåôáé ôï 1997 êáé óõíå÷ßæåôáé ìÝ÷ñé êáé óÞìåñá. Ç çëéêéáêÞ äéáóôñùìÜôùóç ôïõ äåßãìáôïò áíÝäåéîå ðñþôç ôçí ïìÜäá ôùí 50-65 åôþí (38%), äåýôåñç åêåßíç ôùí 40-50 åôþí (27,2%) êáé ôñßôç áõôÞ ôùí 30-40 åôþí (24,3%), åíþ ìéêñÞ åêðñïóþðçóç åìöÜíéæáí ïé íåáñÝò ãõíáßêåò êÜôù ôùí 30 åôþí (8,5%) êáé ï ãçñéáôñéêüò ðëçèõóìüò (2,1%). Ç ðëåéïíüôçôá ôùí ãõíáéêþí (73,4%) Þôáí êÜôïéêïé ÷ùñéþí ôçò ðåñéï÷Þò åíþ ôï 1/4 ôïõ ðëçèõóìïý (25%) êáôïéêïýóå óôçí çìéáóôéêÞ æþíç 139


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Óô. Öùôïðïýëïõ êáé óõí.

ôçò ðüëçò ôçò Áñéäáßáò. Áîßæåé íá óçìåéùèåß, ðÜíôùò, üôé ôï 82,6% (838) ôùí ãõíáéêþí ðïõ åîåôÜóèçêáí êáôïéêïýóáí óå áêôßíá 10 ÷éëéïìÝôñùí áðü ôï Ê.Õ. åíþ óå áðüóôáóç Üíù ôùí 15 Km äéÝìåíå, ìüíï ôï 5,3%. Ç ðëåéïíüôçôá ôïõ ìåëåôçèÝíôïò ãõíáéêåßïõ ðëçèõóìïý åß÷å áóöáëéóôéêÞ êÜëõøç áðü ôïí Ï.Ã.Á. (67,8%), ìå äåýôåñï óå óõ÷íüôçôá áóöáëéóôéêü öïñÝá ôï I.Ê.Á. (19%), ôñßôï ôï Äçìüóéï (6,7%) åíþ ôï Ô.Å.Â.Å. êÜëõðôå ôï 4,3% ôïõ ðëçèõóìïý (Ðßíáêáò 1).

Ðñïåôïéìáóßá êáé oñãÜíùóç ôïõ ðñïãñÜììáôïò 1) Ôçí ïìÜäá åñãáóßáò ôçò ìåëÝôçò áðïôÝëåóáí: ç Äéåõèýíôñéá óôï ÊÝíôñïõ Õãåßáò (ÃåíéêÞ Éáôñüò) êáé üëåò ïé íïóçëåýôñéÝò ôïõ 11,12 åñãáæüìåíåò åê ðåñéôñïðÞò, êáèþò êáé ï ÅðéóêÝðôçò Ãõíáéêïëüãïò áðü ôï Íïóïêïìåßï ¸äåóóáò (ñõèìüò åðéóêÝøåùí: Ýíá ðñùéíü åâäïìáäéáßùò). 2) Ç åíçìÝñùóç êáé åõáéóèçôïðïßçóç ôùí ãõíáéêþí ðñáãìáôïðïéÞèçêå ìå åðåîçãçìáôéêÜ Üñèñá äçìïóéåõìÝíá óôïí ôïðéêü ôýðï êáé ìå åíçìåñùôéêÝò åêðïìðÝò óôï ôïðéêü ñáäéüöùíï13. Óôéò åíçìåñþóåéò áõôÝò áíáëõüôáí ç óçìáóßá ôçò ðñüëçøçò ôïõ êáñêßíïõ ôïõ ôñá÷Þëïõ ôçò ìÞôñáò, éäéáßôåñá ìå ôç ÷ñÞóç ôçò äïêéìáóßáò êáôÜ ÐáðáíéêïëÜïõ. Ç çìåñïìçíßá ôçò åîÝôáóçò êáèïñéæüôáí ìåôÜ áðü ôçëåöùíéêÞ åðéêïéíùíßá ôùí åíäéáöåñïìÝíùí ìå ôç ãñáììáôåßá ôïõ ÊÝíôñïõ Õãåßáò 3) ×þñïò ÅîÝôáóçò-ËÞøç Åðé÷ñßóìáôïò: Ï

Ðßíáêáò 1. Áóöáëéóôéêüò öïñÝáò N ÁÍÁÓÖÁËÉÓÔÇ Ä.Õ. TÕÄÊÕ ÔÓÁÕ ÏÃÁ ÉÊÁ TÕÄÅ ÄÅÇ ÔÅÂÅ ÔÁÅ TÁÐ-ÏÔÅ ÅÈNIÊÇ TÑÁÐÅÆÁ ÏÃÁ Óýíïëï 140

2 6 68 2 1 687 193 1 6 44 1 1 0,1 1 1014

% 0,2 0,6 6,7 0,2 0,1 67,8 19,0 0,1 0,6 4,3 1 0,1 0,1 0,1 100,0

÷þñïò ðïõ ÷ñçóéìïðïéÞèçêå ãéá ôçí åîÝôáóç ôùí ãõíáéêþí ôïõ ðñïãñÜììáôïò Þôáí ôï åîïðëéóìÝíï éáôñåßï ðïõ ðñïâëåðüôáí ãéá ÷ñÞóç áðü ôïí åðéóêÝðôç ãõíáéêïëüãï áðü ôïí ïñãáíéóìü ëåéôïõñãßáò ôïõ Ê.Õ. Ôï éáôñåßï áõôü Þôáí åîïðëéóìÝíï ìå ôá áêüëïõèá õëéêÜ êáé üñãáíá: - Ãõíáéêïëïãéêü Åîåôáóôéêü ÔñáðÝæé - Ëõ÷íßá ÐëÜãéïõ Öùôéóìïý - Êïëðïäéáóôïëåßò ìéáò ÷ñÞóçò - ØÞêôñåò (ÂïõñôóÜêéá) - Âáìâáêïöüñïé Óôõëåïß - Áíôéêåéìåíïöüñá Ðëáêßäéá - ÌïíéìïðïéçôÞò - ÈÞêåò ÔïðïèÝôçóçò ôùí Ðëáêéäßùí - ÖÜêåëïé ÁðïóôïëÞò ôùí Åðé÷ñéóìÜôùí Ç äéáäéêáóßá ëÞøçò ôùí åðé÷ñéóìÜôùí Þôáí ç áêüëïõèç: ìåôÜ ôçí áñ÷éêÞ ôïðïèÝôçóç êïëðïäéáóôïëÝá ìéáò ÷ñÞóçò åðé÷åéñïýíôáí, ìå ôç âïÞèåéá âáìâáêïöüñïõ óôõëåïý, ç áðïöïëßäùóç êõôôÜñùí áðü ôïí êüëðï (áðü ôïí ïðßóèéï êïëðéêü èüëï êáé ôá ðëÜãéá êïëðéêÜ ôïé÷þìáôá), ôïí ôñÜ÷çëï êáé ìå åéäéêÞ øÞêôñá (âïõñôóÜêé) áðü ôïí åíäïôñÜ÷çëï. Óôç óõíÝ÷åéá ôá êýôôáñá åðéóôñþíïíôáí óå ðëáêßäéá êáé ãéíüôáí ç ìïíéìïðïßçóÞ ôïõò14. Êáôüðéí ôá äåßãìáôá ôïðïèåôïýíôáí óå åéäéêÝò èÞêåò êáé áðïóôÝëëïíôáí ôá÷õäñïìéêÜ, óõíïäåõüìåíá áðü ôï ðáñáðåìðôéêü êáôÜëëçëá óõìðëçñùìÝíï ìå ôï ãõíáéêïëïãéêü éóôïñéêü, óôï Êõôôáñïëïãéêü ÅñãáóôÞñéï ôïõ Ãåíéêïý Ðåñéöåñåéáêïý Íïóïêïìåßïõ Èåóóáëïíßêçò “Ãåþñãéïò ÐáðáíéêïëÜïõ”, ìåôÜ áðü óõíåííüçóç ðïõ ðñïçãÞèçêå ôïõ ðñïãñÜììáôïò. Óõã÷ñüíùò ìå ôç ëÞøç ôïõ åðé÷ñßóìáôïò ãéíüôáí áðü ôç ÃåíéêÞ Ãéáôñü ìáêñïóêïðéêÞ åîÝôáóç (ôñá÷Þëïõ, êüëðïõ, Ýîù ãåííçôéêþí ïñãÜíùí), áìöß÷åéñç ãõíáéêïëïãéêÞ åîÝôáóç êáé åîÝôáóç-øçëÜöçóç ìáóôþí. Ôá áðïôåëÝóìáôá ôùí åîåôÜóåùí áõôþí åðßóçò êáôáãñÜöçêáí êáé ðáñïõóéÜæïíôáé óôçí ðáñïýóá åñãáóßá. 4) Ç ðëçñïöüñçóç ãéá ôá áðïôåëÝóìáôá ôùí åîåôáóèåéóþí ãõíáéêþí ãéíüôáí óôï Ê.Õ. áðü ôç ÃåíéêÞ Ãéáôñü. - Óå ðåñßðôùóç ðáèïëïãéêþí åõñçìÜôùí ìå óôïé÷åßá äõóðëáóßáò ôïõ åðéèçëßïõ Þ äéçèçôéêïý êáñêßíïõ ãéíüôáí Üìåóç ðáñáðïìðÞ óôï Íïóïêïìåßï ¸äåóóáò. - Óå ðåñßðôùóç öëåãìïíÞò, ôï ðñüâëçìá áíôéìåôþðéæáí ìå êáôÜëëçëç èåñáðåõôéêÞ áãùãÞ áðü ôïí Ãõíáéêïëüãï ÅðéóêÝðôç ôïõ Íï-


Ôüìïò 12, Ôåý÷ïò 3, 2000

Óô. Öùôïðïýëïõ êáé óõí.

óïêïìåßïõ ¸äåóóáò. Ç åðáíåîÝôáóç ãéíüôáí êáé ðÜëé óôï Ê.Õ. Áñéäáßáò. - Óå ðåñéðôþóåéò öõóéïëïãéêþí åõñçìÜôùí ãéíüôáí óýóôáóç ãéá åðáíÝëåã÷ï ìåôÜ áðü Ýíá Þ äýï ÷ñüíéá óôï Ê.Õ. Ôï õëéêü ôçò ìåëÝôçò áðïôÝëåóáí: Ôá ðïñßóìáôá ôùí äïêéìáóéþí êáôÜ ÐáðáíéêïëÜïõ ôùí åôþí 1997-1999, ïé ðëçñïöïñßåò áðü ôï ãõíáéêïëïãéêü éóôïñéêü, ôï áðïôÝëåóìá áðü ôç ìáêñïóêïðéêÞ åîÝôáóç êüëðïõ-ôñá÷Þëïõ êáé ôçí áìöß÷åéñç ãõíáéêïëïãéêÞ åîÝôáóç, üðùò áõôÜ åìöáíßæïíôáí óõìðëçñùìÝíá óôéò ó÷åôéêÝò êáñôÝëåò-öáêÝëïõò. Ç åðåîåñãáóßá ôùí äåäïìÝíùí ôçò ìåëÝôçò, êáèþò êáé ç ðáñïõóßáóÞ ôïõò, Ýãéíå ÷ñçóéìïðïéþíôáò ôï óôáôéóôéêü ðñüãñáììá ðëçñïöïñéêÞò SPSS 8.0.

ÁðïôåëÝóìáô�� ÊáôÜ ôá Ýôç 1997-1999 åîåôÜóèçêáí 1014 ãõíáßêåò. Áðü áõôÝò ïé 176 (18,4%) Þôáí ãõíáßêåò ðïõ ðñïóÞëèáí ãéá ðñþôç öïñÜ ãéá åîÝôáóç. Ôï 78,2% åß÷å Þäç õðïâëçèåß ðáëáéüôåñá óôç äïêéìáóßá êáôÜ ÐáðáíéêïëÜïõ. Ôï ÷ñïíéêü äéÜóôçìá áðü ôçí ðñþôç åîÝôáóç ðáñïõóßáæå óçìáíôéêÞ äéáêýìáíóç: óõãêåêñéìÝíá ç äéáöïñïðïßçóç áöïñïýóå ÷ñïíéêÜ äéáóôÞìáôá áðü 3 ìÞíåò Ýùò êáé 22 ÷ñüíéá (Ì.Ï. 3,23 ± 2,56 Ýôç). Ôï 66,5% ôùí äïêéìáóéþí êñßèçêáí öõóéïëïãéêÝò (áñíçôéêÝò), ôï 24,3% åìöÜíéæå öëåãìïíÞ êáé ôï 8,7% áôñïöéêÞ êïëðßôéäá åíþ ìüíï ôï 0,4% ðáñïõóßáæå ùñßìáíóç ôïõ åðéèçëßïõ ìç óõìâáôÞ ìå ôçí Ôåëåõôáßá ¸ììçíç Ñýóç (Ô.Å.Ñ.) êáé ôï 0,2% áôõðßá/êáêïÞèåéá. Ôï ðïóïóôü ôùí ãõíáéêþí óôéò ïðïßåò óõóôÞèçêå åðáíÝëåã÷ïò Ýöôáóå ôï 4,8% êáé áîßæåé íá óçìåéùèåß üôé üëåò ïé áóèåíåßò óõììïñöþèçêáí óôéò ó÷åôéêÝò óõóôÜóåéò ìáò. Ôï 28,8% ôùí ãõíáéêþí åß÷å ðáëáéüôåñá (Minimum 1 ìÞíáò êáé Maximum 38 Ýôç, Ì.Ï. 7,98 ± 0,47) õðïâëçèåß óå êáõôçñßáóç. Ç ìáêñïóêïðéêÞ åîÝôáóç êüëðïõ Ýäåéîå üôé ôï 73,8% ôùí ãõíáéêþí ðáñïõóßáóå öõóéïëïãéêü êüëðï, ôï 2,4% êïëðßôéäá, ôï 23,6% áôñïöéêÞ êïëðßôéäá, åíþ êõóôåïêÞëç åìöÜíéæå ôï 0,2% (Ðßíáêáò 2). Óôçí áíôßóôïé÷ç ìáêñïóêïðéêÞ åîÝôáóç ôïõ ôñá÷Þëïõ ôá åõñÞìáôá Þôáí öõóéïëïãéêÜ óôï

Ðßíáêáò 2. ÌáêñïóêïðéêÞ åîÝôáóç êüëðïõ ÖõóéïëïãéêÞ Áôñïöéêüò Êïëðßôçò ÊõóôåïêÞëç Óýíïëï Äåí Ý÷åé êáôáãñáöåß Óýíïëï

Í

(%)

748 239 24 2 1013

(73,8) (23,6) (2,4) (0,2) (99,9)

1 1014

(0,1) (100,0)

68,8% ôùí ãõíáéêþí, áôñïößá åìöÜíéæå ôï 19,5%, ôñá÷çëßôéäá ôï 9,9%, äéáâñùôéêÞ ôñá÷çëßôéäá ôï 0,2% êáé ðïëýðïäåò ôñá÷Þëïõ ôï 1,5% ôùí ãõíáéêþí. Ïé ðïëýðïäåò ôñá÷Þëïõ ðáñáðÝìöèçêáí ãéá Üìåóç ãõíáéêïëïãéêÞ åêôßìçóç: ìÜëéóôá óôç ìßá áðü ôéò áóèåíåßò ìå åéêüíá ðïëýðïäá, ï éóôïëïãéêüò Ýëåã÷ïò äéáðßóôùóå äõóðëáóßá (C.I.Í.), åýñçìá ðïõ ïäÞãçóå óôç äéåíÝñãåéá ïëéêÞò õóôåñåêôïìÞò ìå ïìáëÞ ìåôåã÷åéñçôéêÞ ðïñåßá. Óôçí áìöß÷åéñç åîÝôáóç ôçò ìÞôñáò äéáðéóôþèçêå üôé ôï 96,7% ôïõ ãõíáéêåßïõ ðëçèõóìïý ðáñïõóßáæå öõóéïëïãéêÞ Þ áôñïöéêÞ ìÞôñá, åíþ ôï 0,7% åß÷å õðïâëçèåß óå õóôåñåêôïìÞ, ôï 1,3% åìöÜíéæå éíïìõùìáôþäç ìÞôñá êáé ôï 1,1% Ýðáó÷å áðü ðñüðôùóç ìÞôñáò. Ïé ãõíáßêåò ìå éíïìõùìáôþäç ìÞôñá êáé ðñüðôùóç ìÞôñáò ðáñáðÝìöèçêáí óôïí åéäéêü ãõíáéêïëüãï ãéá áîéïëüãçóç êáé áíôéìåôþðéóç. Áîßæåé íá óçìåéùèåß üôé ìüíï ôï 0,8% ôùí ãõíáéêþí ðïõ åîåôÜóèçêáí åß÷å êÜðïôå ÷ñçóéìïðïéÞóåé áíôéóýëëçøç åíþ áíôßèåôá óçìáíôéêü ðïóïóôü ôçò ôÜîçò ôïõ 29,7% ôïõ óõíüëïõ åß÷å õðïâëçèåß óå ìßá ôïõëÜ÷éóôïí ðñïêëçôÞ áðïâïëÞ åìâñýïõ (ìå äéáêýìáíóç Minimum-Maximum: 111 áìâëþóåéò ìå ÌÝóï ¼ñï 1,51 ± 0,84 Ýêôñùóç áíÜ ãõíáßêá). ¼ìùò, êáé áõôüìáôåò áðïâïëÝò åß÷áí ðáëáéüôåñá åðéóõìâåß óôï 17% ôùí ãõíáéêþí (Ì.Ï. 1,42 ± 0,66 áðïâïëÝò/ãõíáßêá ìå äéáêýìáíóç Ìin. 1-Max. 12).

ÓõæÞôçóç Âáóéêüò óêïðüò ôçò ìåëÝôçò Þôáí íá áíáäåé÷èåß ç äõíáôüôçôá ôçò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò íá õëïðïéÞóåé ðñïãñÜììáôá ðñüëçøçò ìå ôç óõíåñãáóßá Ãåíéêþí Éáôñþí, Íïóçëåõôñéþí êáé åéäéêþí Ãõíáéêïëüãùí. Ç óõíåñãáóßá 141


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

áõôÞ êñßíåôáé áðïäïôéêÞ êáé óôç äéåèíÞ âéâëéïãñáößá5,11,12,15,16. ¸íá áðü ôá ðñïâëÞìáôá ðïõ óõíÞèùò áðïôåëïýí ôñï÷ïðÝäç óôçí áíÜðôõîç ðñïãñáììÜôùí ðñüëçøçò ôùí ãõíáéêïëïãéêþí êáñêßíùí åßíáé ç Üñíçóç êáé ç óõóôïëÞ ðïõ ðåñéâÜëëïõí ôç ãõíáéêïëïãéêÞ åîÝôáóç17. Ôï ðñüâëçìá öÜíçêå íá Ý÷åé îåðåñáóôåß óôçí ðáñïýóá ìåëÝôç. Ôï ãåãïíüò áõôü áðïäüèçêå óôï öýëï ôïõ Ãåíéêïý Éáôñïý ðïõ äéåêðåñáßùíå ôçí åîÝôáóç (Þôáí ãõíáßêá). Ç óõãêõñßá áõôÞ áðïôåëåß óáöÝò ðëåïíÝêôçìá ãéá ìßá èåôéêüôåñç áíôáðüêñéóç ôùí ãõíáéêþí óå ðñïãñÜììáôá ðñüëçøçò. Åßíáé öõóéêüôåñï êáé ðéèáíüôåñï ãéá ôéò ãõíáßêåò éáôñïýò íá óõæçôÞóïõí ìå áóèåíåßò èçëõêïý öýëïõ ó÷åôéêÜ ìå ôç óçìáóßá ôçò ðñüëçøçò, ôéò äõíáôüôçôåò ôçò äïêéìáóßáò êáôÜ ÐáðáíéêïëÜïõ êáé íá Ý÷ïõí ðåñéóóüôåñç Üíåóç óôçí åöáñìïãÞ ôçò äïêéìáóßáò êáôÜ ÐáðáíéêïëÜïõ18. Ïé äéáöïñÝò áíÜìåóá óôéò áíôéëÞøåéò êáé ôéò óõìðåñéöïñÝò áíäñþí êáé ãõíáéêþí éáôñþí êáé ç ðñïôßìçóç ôùí ãõíáéêþí áóèåíþí ãéá ãõíáßêá éáôñü óõíåéóöÝñïõí áíåîÜñôçôá ôï Ýíá áðü ôï Üëëï óôá õøçëüôåñá ðïóïóôÜ äïêéìáóéþí áíß÷íåõóçò ôïõ êáñêßíïõ ôïõ ôñá÷Þëïõ19. Óôï õðü ìåëÝôç ðñüãñáììá óõìðåñéëÞöèçêáí ãõíáßêåò çëéêßáò 17 Ýùò 72 åôþí. Óõããñáöåßò ðñïôåßíïõí êõñßùò çëéêßåò ìåôáîý 35 êáé 60 åôþí, äéüôé óå áõôÝò êõñßùò ôéò ïìÜäåò çëéêéþí åìöáíßæåôáé áõîçìÝíïò ï êßíäõíïò áíÜðôõîçò êáñêßíïõ ôïõ ôñá÷Þëïõ ôçò ìÞôñáò20. ÐáñÜ ôç ãíþóç áõôÞ, ç åðéëïãÞ ìáò Þôáí íá ìçí åìðïäéóôåß ç áõèüñìçôç ðñïóÝëåõóç ãõíáéêþí êÜèå çëéêßáò. Ìßá ðáñüìïéá óôñáôçãéêÞ èá ìðïñïýóå íá ïäçãÞóåé óå áðïãïÞôåõóç (áêýñùóç) ôùí ðñïóäïêéþí êáé áñíçôéêïðïßçóç ìÝñïõò ôïõ ðëçèõóìïý, ìå áðïôÝëåóìá óáöåßò áñíçôéêÝò ìáêñï÷ñüíéåò, ôåëéêÝò åðéðôþóåéò óôçí ðñïóÝëåõóç21. Ç áõîçìÝíç óõììåôï÷Þ ãõíáéêþí ìåãáëýôåñçò çëéêßáò óôï ðñüãñáììá ôïõ Ê.Õ. Áñéäáßáò äåí óõìâáäßæåé ìå ôá áðïôåëÝóìáôá ôçò ìåëÝôçò ôïõ Ê.Õ. Êáóôåëëßïõ óôçí ÊñÞôç9. Ç äéáöïñÜ ðéèáíüí íá ïöåßëåôáé óå äéáöïñåôéêÞ ïñãÜíùóç ôçò åêóôñáôåßáò åíçìÝñùóçò, óå äéáöïñÝò óôïí ôñüðï êëÞóçò-õðïäï÷Þò ôùí ãõíáéêþí, óôçí Ýëëåéøç ÷ñüíïõ ôùí íÝùí êáé åñãáæïìÝíùí ãõíáéêþí óôçí ðåñéï÷Þ ìáò, óå ðïëéôéóôéêÝò äéáöïñÝò, áëëÜ êáé óå Üëëïõò ëüãïõò áäéåõêñßíéóôïõò ìÝ÷ñé óÞìåñá. ÐÜíôùò, öáßíåôáé üôé ïé êéíçôÝò ìïíÜäåò ðñüëçøçò êáé ïé ðáñï÷Ýò õðçñåóéþí ðñüëçøçò 142

Óô. Öùôïðïýëïõ êáé óõí.

óå ÊÝíôñá ÐñùôïâÜèìéáò Öñïíôßäáò áðïôåëïýí éêáíïðïéçôéêÝò óôñáôçãéêÝò ãéá ðñïãñÜììáôá ðñüëçøçò óå ãõíáßêåò ìåãáëýôåñçò çëéêßáò13. Óôç ìåëÝôç ìáò ôï 0,2% ôùí äïêéìáóéþí êáôÜ ÐáðáíéêïëÜïõ êñßèçêå ùò áôõðßá /äõóðëáóßá. Ðáñüìïéï Þôáí ôï áðïôÝëåóìá ôçò Ýñåõíáò óôï Ê.Õ. Êáóôåëëßïõ, üðïõ ôï ðïóïóôü Ýöôáóå ôï 0,8%. Åðßóçò, âñÝèçêå ìåãáëýôåñï ðïóïóôü öõóéïëïãéêþí äïêéìáóéþí óôç ìåëÝôç ìáò (66,5% Ýíáíôé 42,9% ôïõ Ê.Õ. Êáóôåëëßïõ). ¼ìïéï, åðßóçò, ðïóïóôü áôõðßáò/äõóðëáóßáò áíáöÝñåôáé êáé óå ìåëÝôç 2.056 ãõíáéêþí óôç Salamanca ôçò Éóðáíßáò (0,24%)22 åíþ êáé ðÜëé ôï ðïóïóôü ôùí öõóéïëïãéêþí åõñçìÜôùí õðïëåßðåôáé áõôïý ôçò ìåëÝôçò ôçò åðáñ÷ßáò Áëìùðßáò (43,1%). Áíôßèåôá, óå Ýñåõíåò ðïõ ðñáãìáôïðïéÞèçêáí óôç ÆéìðÜìðïõå ôá ðïóïóôÜ áôõðßáò/äõóðëáóßáò ðñïóÝããéóáí ôï 3,8% ôïõ ìåëåôçèÝíôïò ðëçèõóìïý23 ôï 8,4% óôï ÉìðáíôÜí ôçò Íéãçñßáò24 êáé ôï 8,6% óôçí Patna (Éíäßá)25. Ôï åêáôïóôéáßï ðïóïóôü êõôôáñéêÞò áôõðßáò ôçò ìåëÝôçò ìáò ôåëéêÜ áíôéóôïé÷åß óå 3 óõíïëéêÜ êëéíéêÝò ðåñéðôþóåéò. Ç ðñþôç ðåñßðôùóç, ç ïðïßá åìöÜíéæå Üôõðá áäåíéêÜ êýôôáñá, ðáñáêïëïõèåßôáé êáôÜ ôáêôÜ ÷ñïíéêÜ äéáóôÞìáôá ìÝ÷ñé óÞìåñá. Ìßá äåýôåñç áóèåíÞò âñÝèçêå íá Ý÷åé äõóðëáóßá ôïõ ôñá÷çëéêïý åðéèçëßïõ ãéá ôçí ïðïßá õðïâëÞèçêå óå èåñáðåßá ìå laser ìå ðïëý êáëÞ åîåëéêôéêÞ ðïñåßá. Ç ôñßôç ðåñßðôùóç, ðÜëé ìå äõóðëáóßá ôñá÷çëéêïý åðéèçëßïõ, ç ïðïßá áíé÷íåýèçêå êáôÜ ôç ìáêñïóêïðéêÞ åîÝôáóç ôïõ ôñá÷Þëïõ, ðáñáðÝìöèçêå óôï Ãõíáéêïëïãéêü Éáôñåßï ôïõ Íïóïêïìåßïõ ¸äåóóáò: åêåß, ìåôÜ áðü Üìåóï éóôïëïãéêü Ýëåã÷ï ðïõ åðéâåâáßùóå ôç äõóðëáóßá, ç áóèåíÞò õðïâëÞèçêå óå ïëéêÞ õóôåñåêôïìÞ ìå ïìáëÞ -ìÝ÷ñé óÞìåñá- ìåôåã÷åéñçôéêÞ ðïñåßá. Áîßæåé íá óçìåéùèåß üôé êáé ïé ôñåéò ðåñéðôþóåéò ðïõ åìöÜíéæáí áôõðßá /äõóðëáóßá áíÞêáí çëéêéáêÜ óôçí ïìÜäá ôùí 30-40 åôþí. Ôï ðïóïóôü ôùí öëåãìïíþí óôï äåßãìá ðëçèõóìïý ôçò ðåñéï÷Þò Áëìùðßáò âñÝèçêå, åðßóçò, óçìáíôéêÜ ÷áìçëüôåñï (24,3%) áðü åêåßíï ôïõ Ê.Õ. Óðçëßïõ ÊñÞôçò (53,1%)10 áëëÜ êáé ôïõ Íéãçñéáíïý äåßãìáôïò Þôáí ðåñßðïõ åöÜìéëëï ìå áõôü ôçò ìåëÝôçò ôçò Salamanca (27,3%)22. Ãéá ôéò áíáâñåèåßóåò öëåãìïíÝò ðñïãñáììáôßóèçêå èåñáðåßá áðü ôïõò ÅðéóêÝðôåò Ãõíáéêïëüãïõò ôïõ Ê.Õ. êáèþò êáé ç åðáíåîÝôáóÞ ôïõò. Êáô’ áõôü ôïí ôñüðï, ôï ðñüãñáììá óõíÝâáëå èåôéêÜ, ü÷é ìüíï óôçí ðñüëçøç-áíß÷íåõóç, áëëÜ êáé óôç èå-


Ôüìïò 12, Ôåý÷ïò 3, 2000

Óô. Öùôïðïýëïõ êáé óõí.

ñáðåßá ôùí ôñá÷çëßôéäùí êáé êïëðßôéäùí ìåãÜëïõ áñéèìïý ãõíáéêþí, öëåãìïíþí ðïõ äéáöïñåôéêÜ èá ðáñÝìåíáí ÷ùñßò äéÜãíùóç êáé èåñáðåßá. Ç óôñáôçãéêÞ áõôÞ óáöþò óõìâÜëëåé óôçí ðñïáãùãÞ ôçò ãõíáéêåßáò õãåßáò êáé âïçèÜ óôçí êáëýôåñç áðïäï÷Þ ôïõ ðñïãñÜììáôïò áðü ôïí ðëçèõóìü êáé ôç ìåãáëýôåñç äéåßóäõóÞ ôïõ óå áõôüí21. Áîéïóçìåßùôïò áñéèìüò áôüìùí ôçò ìåëÝôçò (8,7%) åìöÜíéæå áôñïößá ôùí ãåííçôéêþí ïñãÜíùí. Óçìáíôéêü ìÝñïò ôïõò ðáñáðÝìöèçêå óôï Ãõíáéêïëüãï ìå ôçí Ýíäåéîç ðéèáíÞò Ýíáñîçò èåñáðåßáò ïñìïíéêÞò õðïêáôÜóôáóçò, áëëÜ ç óõììüñöùóç óôéò ïäçãßåò äåí Þôáí éêáíïðïéçôéêÞ. Ðéèáíþò íá áðáéôåßôáé êáëýôåñç åíçìÝñùóç-åðéìüñöùóç ôùí ãõíáéêþí ðïõ âñßóêïíôáé óôçí êëéìáêôÞñéï Þ ìåôá-êëéìáêôÞñéï ðåñßïäï ãéá ôï èÝìá áõôü êáé ôç óçìáóßá ôïõ (ð.÷. ðñüëçøç ïóôåïðüñùóçò, êáñäéïðáèåéþí, ê.ëð.)26,27. Áêüìá, åëÜ÷éóôï ðïóïóôü ôùí ãõíáéêþí ôïõ ðñïãñÜììáôïò åß÷å ÷ñçóéìïðïéÞóåé êÜðïôå óôçí åíåñãÞ áíáðáñáãùãéêÞ æùÞ ôïõ êÜðïéá áíôéóõëëçðôéêÞ ìÝèïäï êáôÜ ôñüðï óõóôçìáôéêü (0,8%). Áíôßèåôá, åíôõðùóéáêü Þôáí ôï ðïóïóôü ãõíáéêþí ðïõ åß÷áí õðïâëçèåß óå Üìâëùóç (29,7%) êáèþò êáé ç áíáëïãßá áìâëþóåùí áíÜ ãõíáßêá (Ì.Ï. 1,5 ± 0,84 ìå áðüêëéóç Minimum-Maximum 1-11 áìâëþóåéò áíÜ Üôïìï). Ôá ðïóïóôÜ áõôÜ áíôáíáêëïýí ôç ó÷åäüí ïëïêëçñùôéêÞ Ýëëåéøç ïéêïãåíåéáêïý ðñïãñáììáôéóìïý ðïõ ïöåßëåôáé êáé óôç ó÷åäüí áíýðáñêôç åíçìÝñùóç ôïõ ãõíáéêåßïõ ðëçèõóìïý áðü ôïõò Öïñåßò Õãåßáò28. Åðßóçò, èá ðñÝðåé íá ôïíéóèåß ç äéáöïñÜ áíáëïãßáò óõììåôï÷Þò ôùí ãõíáéêþí ìåôáîý áóôéêïý/çìéáóôéêïý êáé áãñïôéêïý ðëçèõóìïý (ìå áðüóôáóç êáôïéêßáò ìåãáëýôåñç ôùí 10-15 Km áðü ôï Ê.Õ.) ç ïðïßá óáöþò åßíáé åéò âÜñïò ôïõ äåýôåñïõ. Ç äéáöïñÜ áõôÞ áíôáíáêëÜ ôüóï ôéò äõóêïëßåò ìåôáêßíçóçò üóï ðéèáíüí êáé ôç äéáöïñÜ åêðáßäåõóçò-íïïôñïðßáò ôùí äýï ðëçèõóìþí. Ðáñüìïéåò äéáöïñÝò, ïé ïðïßåò ìðïñïýí áêüìá êáé íá åðçñåÜóïõí ôçí ðïéüôçôá ôùí Pap Ôåóô, Ý÷ïõí êáé óå Üëëåò ÷þñåò (Ìåîéêü)29. Ôï ôñéåôÝò åã÷åßñçìá ðïõ ðáñïõóéÜæåôáé êáé áíáëýåôáé óôçí åñãáóßá áõôÞ ôåëéêÜ êÜëõøå ðåñßðïõ ôï 12%-15% ôïõ ãõíáéêåßïõ ðëçèõóìïý ôçò Åðáñ÷ßáò Áëìùðßáò ôïõ Íïìïý ÐÝëëáò (ðñïóåããéóôéêïß õðïëïãéóìïß). ÕðÝ÷åé, åðïìÝíùò, ôç èÝóç åíüò áíôéðñïóùðåõôéêïý äåßãìáôïò ôïõ óõíüëïõ ôïõ ðëçèõóìïý, áëëÜ ôáõôü÷ñïíá áðïôåëåß áêü-

ìá ìüíï ôçí áñ÷Þ ôçò ðñïóðÜèåéáò ãéá ôç óõãêåêñéìÝíç ðåñéï÷Þ. ÐÜíôùò, ç åîÝôáóç ôùí äåäïìÝíùí áðïäåéêíýåé ìå êáèáñüôçôá êáé óáöÞíåéá ôç óðïõäáéüôçôá ôçò óõìâïëÞò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý ôüóï óôçí ðñáãìáôïðïßçóç ôïõ ðñïëçðôéêïý screening ãéá ôïí êáñêßíï ôïõ ôñá÷Þëïõ ôçò ìÞôñáò30, áëëÜ êáé üôé ðáñüìïéá ðñïãñÜììáôá åêðëçñþíïõí ðïëëáðëÝò, óõìðëçñùìáôéêÝò ëåéôïõñãßåò28, üðùò: 1) Ç áíß÷íåõóç êáé ç áíôéìåôþðéóç ðáñÜðëåõñùí ðñïâëçìÜôùí. 2) Ç åíçìÝñùóç, åðéìüñöùóç êáé åêðáßäåõóç ôùí ãõíáéêþí. 3) Ç ãåíéêüôåñç åõáéóèçôïðïßçóç ôïõ ðëçèõóìïý óå èÝìáôá õãåßáò. 4) Ç äçìéïõñãßá ó÷Ýóåùí åìðéóôïóýíçò ìå ôïõò öïñåßò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò ôçò ðåñéï÷Þò31. 5) Ç êáôáãñáöÞ ôïõ äõíáìéêïý Õãåßáò/Áóèåíåéþí ôïõ ðëçèõóìïý ôçò ðåñéï÷Þò.

Âéâëéïãñáößá 1. ÄéáêÞñõîç ôçò ÁËÌÁ-ÁÔÁ. ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò. 1:2-3, 1986. 2. Á. Free, Á. Baumann, Á. Cripes Health Promotion in General Practice. Aust. Health Rev. 12:338, 1989. 3. Íüìïò 1397. Åèíéêü Óýóôçìá Õãåßáò. Åöçìåñßäá ôçò ÊõâÝñíçóçò. Áñéèìüò 143, Ôüìïò Á´, ÁèÞíá, 1983. 4. Íüìïò 2646. ÁíÜðôõîç ôïõ Åèíéêïý ÓõóôÞìáôïò ÊïéíùíéêÞò Öñïíôßäáò. Åöçìåñßäá ôçò ÊõâÝñíçóçò. Áñéèìüò 236, Ôåý÷ïò Ðñþôï, ÁèÞíá, 1998. 5. Ì. Rafferty. Prevention Services in Primary Care: Taking Time, Setting Priorities. West. J. Ìed. 169:269-75, 1998. 6. Å.Á. Warner, Á.Ê. Parsons Screening and Early Diagnosis of Gynecologic Cancers. Med. Clin. North Á.Ì., 80:45-61, 1996. 7. ÈÝêëá Êßæç. Ç ÊïéíùíéêÞ Óçìáóßá ôïõ Êáñêßíïõ ôïõ Ôñá÷Þëïõ ôçò ÌÞôñáò (ÑÁÑ-TEST). ÅëëçíéêÞ ÁíôéêáñêéíéêÞ Åôáéñåßá, ÌÜ÷ç êáé Åëðßäá, Ôåý÷ïò 34:10-11, 1991. 8. Ñ.S. Stack. Pap Smears. Still a Reliable Screening Tool for Cervical Cancer. Postgrad. Ìed., 101:207-8, 211-4, 1997. 9. ×. Æçëßäçò, I. ÄáôóÝñçò. ÏñãÜíùóç ÐñïãñÜììáôïò Ðñüëçøçò ôïõ Êáñêßíïõ ôïõ Ôñá÷Þëïõ 143


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Ôüìïò 12, Ôåý÷ïò 3, 2000

K. ÊõñéáæÜôçò êáé óõí.

BÑÁÂÅÕÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ AWARDED FREESTANDING PAPER Primary Heatlh Care, Volume 12, Number 3, 145-150, 2000 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 12, Ôåý÷ïò 3, 145-150, 2000

¢óèìá óå ðáéäéÜ ôï 1999 óôï Å.I. ÐáéäéáôñéêÞò Ã.Í.Í. ×áëêßäáò. Ñüëïò ôïõ Ãåíéêïý Éáôñïý Ê. Ê. ÊõñéáæÜôçò1, Ö. Êïõëïýñá2, Ï. Ñùìáíïý3, ×ñ. ÊïõíôïõñÜêç4, Ì. ÄåëçãéÜííç2

Ðåñßëçøç Óêïðüò ôçò åñãáóßáò Þôáí ç ìåëÝôç ôçò åðï÷éêÞò êáôáíïìÞò, ôïõ öýëïõ êáé ôçò âáñýôçôáò ôïõ Üóèìáôïò êáôÜ ôï Ýôïò 1999 êáé ï ñüëïò ôïõ Ãåíéêïý Éáôñïý. Õëéêü-ÌÝèïäïò: ÅîåôÜóôçêáí ôáêôéêÜ êáé Ýêôáêôá ðåñéóôáôéêÜ ðïõ ðñïóÞëèáí óôï Å.I ôïõ ðáéäéáôñéêïý ôïõ Ã.Í.Í. ×áëêßäáò êáôÜ ôï Ýôïò 1999. ÁðïôåëÝóìáôá: ÂñÝèçêå üôé áðü 9688 ðáéäéÜ ðïõ åîåôÜóôçêáí êáôÜ ôï Ýôïò 1999, åß÷áí Üóèìá 555 ðåñéóôáôéêÜ (5,73% ôùí åðéóêÝøåùí). 1) Áðü 555 ðåñéóôáôéêÜ Üóèìáôïò óôï Ýôïò áõôü, ôá áãüñéá 337 (60,72%) õðåñôåñïýí ôùí êïñéôóéþí 218 (39,28%) óå áíáëïãßá ðåñßðïõ 3:2. 2) Ôá ðåñéóóüôåñá ðåñéóôáôéêÜ ìáò Þôáí çëéêßáò 5-14 åôþí, üðùò ðáñïõóéÜæïíôáé ðáñáêÜôù: 0-1 åôþí 83 (14,95%), 1-3 åôþí 144 (25,95%), 3-5 åôþí 130 (23,42%) êáé 5-14 åôþí 198 (35,68%). 3) Ðåñéóóüôåñá êáé âáñýôåñá ðåñéóôáôéêÜ ðáñïõóéÜóôçêáí ôïõò ÷åéìåñéíïýò ìÞíåò, ôo 4ï ôñßìçíï êáé ôï 1ï ôñßìçíï. ÐåñéóôáôéêÜ 1999 I-3ìí. ÉÉ-3ìí. ÉÉÉ-3ìí. ÉV-4ìí.

Á 337 63 44 53 177

È 218 47 27 30 114

Óõí 555 110 71 83 291

% Âáñýôçôá óå áãüñéá 100 ÂáñéÜ ÌÝôñéá ¹ðéá 19,82 9 14 40 12,80 9 7 28 14,95 8 11 34 52,43 26 48 103

Âáñýôçôá óå êïñßôóéá ÂáñéÜ ÌÝôñéá ¹ðéá 4 10 33 2 6 19 4 4 22 9 18 87

4) Óôá âáñéÜ ðåñéóôáôéêÜ ôá ðåñéóóüôåñá Þôáí çëéêßáò 1-3 åôþí, 28 (39,44%). Áðü áõôÜ áãüñéá Þôáí 21 (75%). Óôç ìÝôñéá âáñýôçôá ôá ðåñéóóüôåñá Þôáí çëéêßáò 5-14 åôþí, 41 óå ðïóïóôü 35,04%, áãüñéá 30 (73,17%) ôùí ðåñéóôáôéêþí áõôþí. ÓõìðåñÜóìáôá: I) Ôá ðåñéóóüôåñá êáé âáñýôåñá ðåñéóôáôéêÜ Üóèìáôïò ðáñïõóéÜæïíôáé ôïõò ÷åéìåñéíïýò ìÞíåò. ÉÉ) Óôá ðëáßóéá ôùí êáèçêüíôùí ï Ãåíéêüò Éáôñüò ôçò êïéíüôçôáò èá ðñÝðåé: 1) Íá Ý÷åé êáëÞ ãíþóç ôçò íüóïõ êáé ôçò öáñìáêåõôéêÞò áãùãÞò óôá ðáéäéÜ. 2) Íá áó÷ïëçèåß ìå ôçí ðñïáãùãÞ õãåßáò ôùí ðáéäéþí åêðáéäåýïíôáò ôïõò ãïíåßò þóôå: á) íá ìçí õðÜñ÷ïõí óôï ðåñéâÜëëïí ôïõ ðáéäéïý åêëõôéêïß ðáñÜãïíôåò. â) íá ãíùñßæïõí ôç ÷ñÞóç ôùí öáñìÜêùí êáé ôùí óõóêåõþí ÷ïñÞãçóÞò ôïõò. ã) êáé üôáí, ðáñÜ ôç èåñáðåßá óôï óðßôé, âëÝðïõí íá ìç âåëôéþíåôáé ç êáôÜóôáóç, íá ðñïóÝñ÷ïíôáé Ýãêáéñá óôï Ãåíéêü Éáôñü ãéá ðåñáéôÝñù áíôéìåôþðéóç. 1 Ãåíéêüò Éáôñüò. 2Ðáéäßáôñïò. 3Åéäéêåõüìåíïò ÃåíéêÞò ÉáôñéêÞò, 4Íïóçëåýôñéá, Å. I. ÐáéäéáôñéêÞò Ã.Í.Í. ×áëêßäáò.

ÅéóáãùãÞ Ôï Üóèìá - áíåîáñôÞôùò âáñýôçôáò - åßíáé ìßá ÷ñüíéá öëåãìïíþäçò ðÜèçóç ôùí áåñáãùãþí. Ç öëåãìïíÞ ðñïêáëåß õðåñáíôéäñáóôéêüôçôá ôùí áåñáãùãþí, ðåñéïñéóìü ôçò ñïÞò ôïõ áÝñá êáé áíáðíåõóôéêÜ óõìðôþìáôá üðùò: áíáðíåõóôéêü óõñéãìü, äýóðíïéá, óõóöéãêôéêü èùñáêéêü áßóèçìá êáé âÞ÷á éäéáßôåñá êáôÜ ôéò íõêôåñéíÝò êáé ðñþôåò ðñùéíÝò þñåò. Ôï Üóèìá åßíáé ìéá áðü ôéò óõ÷íüôåñåò ðáèÞóåéò ôçò ðáéäéêÞò çëéêßáò, ìå åðéðïëáóìü ðïõ õðïëïãßæåôáé óå 5-15% óôéò ðåñéóóüôåñåò äõôéêÝò êïéíùíßåò, åíþ óå Üëëåò ìåëÝôåò ï åðéðïëáóìüò ôïõ Üóèìáôïò óôá ðáéäéÜ êõìáßíåôáé áðü 0% Ýùò 30% óå äéÜöïñïõò ðëçèõóìïýò. Óêïðüò ôçò åñãáóßáò áõôÞò Þôáí ç ìåëÝôç ôçò åðï÷éêÞò êáôáíïìÞò, ôïõ ËÝîåéò êëåéäéÜ: Âñïã÷éêü Üóèìá, ðáéäéÜ, ãåíéêüò éáôñüò ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 12ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (×áëêéäéêÞ, 15-19 Ïêôùâñßïõ 2000) êáé âñáâåýèçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Ê. ÊõñéáæÜêçò, Ðåñéöåñéêü Éáôñåßï Êáôùêåñßïõ, ÌåãáíÞóé, ËåõêÜäá Ô.Ê. 31083, Ôçë.: (0645) 51304, Fax: (0645) 51196 145


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ê. ÊõñéáæÜôçò êáé óõí.

Ùò óõíÝðåéá, ï ðåñéïñéóìüò ôçò ñïÞò ìåôÜ áðü äéÜöïñåò åðéäñÜóåéò åßíáé ìåãáëýôåñïò óôá áãüñéá. ÕðÝñ ôçò Üðïøçò áõôÞò åßíáé ç ðáñáôçñïýìåíç åîéóïññüðçóç ôçò óõ÷íüôçôáò Summary The aim of this project was to study the seasonal variation sex and gravity of ìåôÜ ôçí çëéêßá 10 åôþí, ïðüôå ï ëüãïò asthma during 1999 and discuss the role of general practitioner in the manageäéáìÝôñïõ ðñïò ìÞêïò ôùí áåñáãùment of this disease. ãþí åîéóþíåôáé ìåôáîý ôùí äýï öýSubject material - Methods: Ordinary visits of patients as well as emergenëùí, ëüãù ôùí ìåôáâïëþí ôïõ ìåãÝcies to the outpatient's department of the General Hosptital of Chalkis were èïõò ôïõ èþñáêá ðïõ áöïñïýí ìüíï examined in 1999. Results: It was found that out of 9688 children who were examined in 1999, óôá áãüñéá êáôÜ ôçí åöçâåßá êáé ü÷é 555 suffered from asthma (5.7% of the visits) óôá êïñßôóéá. 1) Out of 555 asthma patients within this year, males 337 (60.7%) outnumber Ôá äéêÜ ìáò áðïôåëÝóìáôá üðùò females 218 (39,3%) at a ratio about 3:2. öáßíïíôáé óôï ó÷Þìá 1 êáé óôïí ðß2) Most of our patients were between 5-14 years old, as presented: 0-1 years íáêá 2 óõìðßðôïõí ìå ôá äåäïìÝíá old 83 (14,9%), 1-3 years old 144 (25,9%), 3-5 years old 130 (23,4%) and 5-14 years old 198 (35,7%). óôç âéâëéïãñáößá. 3) Most and more grave cases appeared during winter months, 4th and 1st Óôçí ðáéäéêÞ çëéêßá ôá áóèìáôétrimester. êÜ áãüñéá õðåñÝ÷ïõí áñéèìçôéêÜ 1, 4) Most grave cases were children 1-3 years old 28 (39.4%). 21 (75%) of them 5-3 öïñÝò óå óýãêñéóç ìå ôá êïñßwere males. Less grave cases were 5-14 years old, 41 (35,0%). 30 (73,7%) of ôóéá. Åíþ óôçí åöçâåßá ç óõíáíôþìåthem were males. Conclusions: íç óõ÷íüôçôá ôïõ Üóèìáôïò åßíáé ðåI) The most cases of asthma were registered during winter months. ñßðïõ ç ßäéá ãéá ô�� äýï öýëá. Ç ìåôáII) In the framework of his duty the general practitioners at the community âïëÞ áõôÞ ìðïñåß íá óõó÷åôéóèåß ìå setting must. Be aware about the asthma management, especealy in childhood äýï ðáñÜãïíôåò: and ask the parents being involved and participate in their education. á) ôçí ôÜóç ôùí áãïñéþí óôçí çëéKey words: Asthma, children, general practitioner êßá áõôÞ íá âåëôéùèïýí êáé öýëïõ êáé ôçò âáñýôçôáò ôïõ Üóèìáôïò êáôÜ ôï â) óå íÝåò ðåñéðôþóåéò Üóèìáôïò óå êïñßôóéá. Ýôïò 1999 êáé ï ñüëïò ôïõ Ãåíéêïý Éáôñïý. ÅðïìÝíùò ôá êïñßôóéá åöçâéêÞò çëéêßáò ìå Üóèìá, ÷ñåéÜæïíôáé éäéáßôåñá ðñïóåêôéêÞ ðáñáêïëïýèçóç êáé ìÜëéóôá óå óõíäõáóìü ìå Ðëçèõóìüò ìåëÝôçò êáé ÌÝèïäïò ôç äéáðßóôùóç üôé ìåôÜ ôçí åöçâåßá ôï Üóèìá åìöáíßæåôáé óõ÷íüôåñá óôá èÞëåá. ÅîåôÜóôçêáí ôáêôéêÜ êáé Ýêôáêôá ðåñéóôáôéêÜ ðïõ ðñïóÞëèáí óôï Å.I ôïõ ðáéäéáôñéêïý Ðßíáêáò 1. ÊáôáíïìÞ ðåñéóôáôéêþí âÜóåé öýëïõ ôïõ Ã.Í.Í. ×áëêßäáò êáôÜ ôï Ýôïò 1999. Ásthma among children who visited outpatient's department of the General Hospital of Chalkis in 1999 - The role of general practitioner K.K. Kiriazati1, Fotini Kouloura2, Olimbia Romanou3, Chrisula Kounturaki4, Mary Delijiani2

Óýíïëï

ÁðïôåëÝóìáôá ÂñÝèçêå üôé áðü 9688 ðáéäéÜ ðïõ åîåôÜóôçêáí êáôÜ ôï Ýôïò 1999, åß÷áí Üóèìá 555 ðåñéóôáôéêÜ (5,73% ôùí åðéóêÝøåùí). 1) ÊáôáíïìÞ ðåñéóôáôéêþí êáôÜ öýëï. Áðü 555 ðåñéóôáôéêÜ Üóèìáôïò óôï Ýôïò áõôü, ôá áãüñéá 337 (60,72%) õðåñôåñïýí ôùí êïñéôóéþí 218 (39,28%) óå áíáëïãßá ðåñßðïõ 3:2. Ôï Üóèìá ôçò ðáéäéêÞò çëéêßáò åßíáé óõ÷íüôåñï óôá áãüñéá ðñÜãìá ðïõ áðïäßäåôáé üìùò, ü÷é Üìåóá óôï öýëï, áëëÜ óôç ìéêñüôåñç äéÜìåôñï êáé óôïí áõîçìÝíï ôüíï ôùí áåñáãùãþí. 146

555 (100%)

Áãüñéá

Êïñßôóéá

337 (60,72%)

218 (39,3%)

Ó÷Þìá 1. ÐåñéóôáôéêÜ áíÜ çëéêßá


Ôüìïò 12, Ôåý÷ïò 3, 2000

K. ÊõñéáæÜôçò êáé óõí. Ðßíáêáò 2. ÐåñéóôáôéêÜ áíÜ çëéêßá Çëéêßá

Ðßíáêáò 4. ÐåñéóôáôéêÜ áíÜ ìÞíá

Áãüñéá

Êïñßôóéá

Óýíïëï

49 51 34 48 34 24 33 16 20 14 6 3 3 2

31 25 39 29 17 11 24 15 4 11 7 5 0 0

80 76 73 77 51 35 57 31 24 25 13 8 3 2

1 2 3 4 5 6 7 8 9 10 11 12 13 14

2) Ôá ðåñéóóüôåñá ðåñéóôáôéêÜ ìáò Þôáí çëéêßáò 5-14 åôþí, üðùò ðáñïõóéÜæïíôáé ðáñáêÜôù: 0-1 åôþí 83 (14,95%), 1-3 åôþí 144 (25,95%), 3-5 åôþí 130 (23,42%) êáé 5-14 åôþí 198 (35,68%). 3) Åðï÷éêÞ êáôáíïìÞ ðåñéóôáôéêþí. Óôoí ðßíáêá 4 êáé óôá ó÷Þìáôá 3, 4 âëÝðïõìå üôé ôá ðåñéóóüôåñá êáé âáñýôåñá ðåñéóôáôéêÜ ðáñïõóéÜóôçêáí ôïõò ÷åéìåñéíïýò ìÞíåò, ôï 4o ôñßìçíï êáé ôï 1o ôñßìçíï.

ÌÞíáò É ÉÉ ÉÉÉ IV V VÉ VII VIII É× × ×É ×ÉÉ

Áãüñéá

Êïñßôóéá

Óýíïëï

19 31 13 14 18 12 5 16 32 52 62 63

12 21 14 13 9 5 5 9 16 38 38 38

31 52 27 27 27 17 10 25 48 90 100 101

Ó÷Þìá 3.

Ðßíáêáò 3. ÐåñéóôáôéêÜ áíÜ ïìÜäåò çëéêßáò Çëéêßá Áãüñéá Êïñßôóéá Óýíïëï %

Ó

0-1.

1-3.

3-5.

5-14.

337 218 555 100

51 32 83 14,9

84 60 144 25,9

83 47 130 23,4

119 79 198 35,7

Ó÷Þìá 4.

Ó÷Þìá 2. ÐåñéóôáôéêÜ áíÜ ïìÜäåò çëéêßáò

4) Óôá ðåñéóóüôåñá áóèìáôéêÜ ðáéäéÜ, ç áíÜðôõîç ôùí ðíåõìüíùí åßíáé êáíïíéêÞ, áëëÜ óôéò âáñýôåñåò ðåñéðôþóåéò ï ñõèìüò åðéâñáäýíåôáé êáôÜ ôçí ðáéäéêÞ êáé åöçâéêÞ çëéêßá. ÐáñÜ ôéò ìåèïäïëïãéêÝò äõó÷Ýñåéåò ôùí ìáêñï÷ñüíéùí ìåëåôþí, öáßíåôáé üôé ôï ðáéäéêü Üóèìá óå ðïóïóôü 30 Ýùò 50% üíôùò åîáöáíßæåôáé êáôÜ ôçí 147


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ê. ÊõñéáæÜôçò êáé óõí.

ôùí ðåñéóôáôéêþí ôïõò ìÞíåò ðïõ ïé Üëëåò äýï ðáèÞóåéò ðáñïõóéÜæïõí ýöåóç. Åíþ êáé ïé ôñåéò ðáèÞóåéò ìðïñåß íá Ý÷ïõí êïéíïýò áéôéïëïãéêïýò êáé åêëõôéêïýò ðáñÜãïíôåò ðñÝðåé íá ìáò ðñïâëçìáôßóåé ôï ãåãïíüò üôé ðáñïõóéÜæïõí áíôéóôñüöùò áíÜëïãç åðï÷éêÞ êáôáíïìÞ.

Þâç, áëëÜ åðáíåìöáíßæåôáé óõ÷íÜ ìå ôçí åíçëéêßùóç. Óõíåðþò, ôï ðáéäéêü Üóèìá äåí ðñÝðåé ðïôÝ íá õðïôéìÜôáé ìå ôçí åëðßäá üôé ôï ðáéäß "èá ìåãáëþóåé êáé èá áðáëëáãåß". Óôç ìåëÝôç ìáò üðùò öáßíåôáé óôïí ðßíáêá 5, 6 êáé óôï ó÷Þìá 5, áðü ôá âáñéÜ ðåñéóôáôéêÜ ôá ðåñéóóüôåñá Þôáí çëéêßáò 1-3 åôþí, 28 (39,44%). Áðü áõôÜ áãüñéá Þôáí 21 (75%). ÌÝôñéáò âáñýôçôáò Þôáí çëéêßáò 5-14 åôþí, 41 óå ðïóïóôü 35,04%, áãüñéá 30 (73,17%)ôùí ðåñéóôáôéêþí áõôþí. Ãéá ôçí ôáîéíüìçóç ôçò âáñýôçôáò ôïõ Üóèìáôïò âáóéóôÞêáìå óôçí êëéíéêÞ êáôÜóôáóç ôïõ ðáéäéïý. Áðü ðñïçãïýìåíåò ìåëÝôåò ìáò ëáñõããßôéäåò êáé Üóèìá ðáñïõóéÜæïõí ó÷åäüí ßäéá åðï÷éêÞ êáôáíïìÞ. ÂëÝðïìå üôé ïé êáìðýëåò ôùí ðåñéóôáôéêþí åßíáé ó÷åäüí ðáñÜëëçëåò. ¼óïí áöïñÜ óôçí êíßäùóç âëÝðïõìå Ýîáñóç

ÓõìðåñÜóìáôá É) Ôá ðåñéóóüôåñá êáé âáñýôåñá ðåñéóôáôéêÜ Üóèìáôïò ðáñïõóéÜæïíôáé ôïõò ÷åéìåñéíïýò ìÞíåò. ÉÉ) Óôá ðëáßóéá ôùí êáèçêüíôùí ï Ãåíéêüò Éáôñüò ôçò êïéíüôçôáò èá ðñÝðåé: 1) Íá Ý÷åé êáëÞ ãíþóç ôçò íüóïõ êáé ôçò öáñìáêåõôéêÞò áãùãÞò óôá ðáéäéÜ.

Ðßíáêáò 5. ÐåñéóôáôéêÜ Ôñßìçíá-1999

Á 337

È 218

Óýíïëï 555

% 100

É ÉÉ ÉÉÉ IV

63 44 53 177

471 27 30 114

10 71 83 291

19,8 12,8 14,9 52,4

Âáñýôçôá óå áãüñéá ÂáñéÜ ÌÝôñéá ¹ðéá 9 9 8 26

14 7 11 48

Âáñýôçôá óå êïñßôóéá ÂáñéÜ ÌÝôñéá ¹ðéá

40 28 34 103

4 2 4 9

10 6 4 18

33 19 22 87

Ðßíáêáò 6.

ÂáñéÜ ÌÝôñéá ¹ðéá 33

0-1

áãüñéá 1-3 3-5

5 13 44

21 19 54

11 18 74

5-14

0-1

êïñßôóéá 1-3 3-5

15 30 25

4 3 36

7 17 39

Ó÷Þìá 5. 148

2 6 62

5-14 6 11 58

áãüñéá êáé êïñßôóéá 0-1 1-3 3-5 5-14 Óýíïëï 9 16 80

28 36 93

13 24 136

21 41 367

71 117


Ôüìïò 12, Ôåý÷ïò 3, 2000

K. ÊõñéáæÜôçò êáé óõí. Ðßíáêáò 7. Åêôßìçóç âáñýôçôáò ðáñïîõóìïý Üóèìáôïò óôá ðáéäéÜ ÊëéíéêïåñãáóôçñéáêÞ ðáñÜìåôñïò

¹ðéïò

ÌÝôñéïò

Óïâáñüò

ÁíáðíåõóôéêÞ óõ÷íüôçôá

ÖõóéïëïãéêÞ Ýùò 30% Üíù ôçò ìÝóçò

30-50% Üíù ôçò ìÝóçò

>50% Üíù ôçò ìÝóçò

ÅãñÞãïñóç

ÖõóéïëïãéêÞ

ÖéóéïëïãéêÞ

Ðéèáíüí åëáôôùìÝíç

Äýóðíïéá

Áðïõóßá Þ Þðéá: ïìéëåß ìå ðëÞñåéò ðñïôÜóåéò

ÌÝôñéá: ïìéëåß ìå öñÜóåéò Þ äéáêåêïììÝíåò ðñïôÜóåéò

Ðéèáíüí åëáôôùìÝíç. ÓïâáñÞ: ïìéëåß ìüíï ëåêôéêÜ Þ ìå ìéêñÝò öñÜóåéò

×ñÞóç åðéêïõñéêþí ìõþí

×ùñßò åéóïëêÝò Ýùò Þðéåò ìåóïðëåýñéåò

ÌÝôñéåò ìåóïðëåýñéåò êáèþò êáé åéóïëêÝò óöáãÞò, ÷ñÞóç óôåñíïêëåéäïìáóôïåéäþí, äéÜôáóç èþñáêá

¼ðùò óôï ìÝôñéï ðáñïîõóìü ìå ôçí ðñïóèÞêç ñéíéêÞò áíáðÝôáóçò êáôÜ ôçí åéóðíïÞ

×ñþìá

Öõóéïëïãéêü

Ù÷ñü

Ðéèáíüí êõáíùôéêü

ÁêñïáóôéêÜ ÅõñÞìáôá

Ôåëïåêðíåóôéêüò óõñéãìüò

Åéóðíåõóôéêüò êáé åêóðíåõóôéêüò óõñéãìüò

"Óéùðçëüò" Èþñáêïò

Ðßíáêáò 7. Óýãêñéóç, Ëáñõããßôéäá (Ë) 1996-1998, Üóèìá (Á)1999 êáé êíßäùóç (Ê)1999 ìí Ê-1999 Á-1999 Ë-1996-98

I

ÉÉ

ÉÉÉ

IV

V

2,27 5,59 9,70

3,97 9,37 12,24

3,59 4,87 10,14

4,72 4,87 12,24

5,67 4,87 5,06

VI

VII

14,75 17,77 3,06 1,8 2,95 2,53

VIII

É×

×

×É

17,77 11,53 7,56 4,35 4,5 8,65 16,2 18,02 0,84 7,59 11,81 12,24

XII

Ó

6,05 100% 18,2 100% 12,66 100%

Ó÷Þìá 6.

2) Íá áó÷ïëçèåß ìå ôçí ðñïáãùãÞ õãåßáò ôùí ðáéäéþí åêðáéäåýïíôáò ôïõò ãïíåßò þóôå: á) íá ìçí õðÜñ÷ïõí óôï ðåñéâÜëëïí ôïõ ðáéäéïý åêëõôéêïß ðáñÜãïíôåò. â) íá ãíùñßæïõí ôç ÷ñÞóç ôùí öáñìÜêùí

êáé ôùí óõóêåõþí ÷ïñÞãçóÞò ôïõò. ã) üôáí, ðáñÜ ôç èåñáðåßá óôï óðßôé âëÝðïõí íá ìçí âåëôéþíåôáé ç êáôÜóôáóç, íá ðñïóÝñ÷ïíôáé Ýãêáéñá óôïí Ãåíéêü Éáôñü ãéá ðåñáéôÝñù áíôéìåôþðéóç. 149


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ê. ÊõñéáæÜôçò êáé óõí.

ÂéâëéïãñáöéêÝò áíáöïñÝò 1. Provisional Committee on Quality Improvement. Practice Parameter. The office management of acute exacerbations of asthma in children. Pediatrics, 93:119-126, 1994. 2. Global lnitiative for Asthma. Global strategy for asthma management and prevention. NHLBI/WHO Workshop Report. National Heart, Lung, and Blood institute, NIH, 1995. 3. R.M. Sly. Allergic disorders. Asthma in Behrman Kliegman, Arvin eds. Nelson Textbook of Pediatrics, 15th ed. WB Saunders 628-641, 1996. 4. P.N. Lesoeuf. Expression of predisposing factors in early life, in Holgate ST, et (eds), Asthrna: Physiology, immunopharmacology, and Treatment. London, Academic Press, ch 4, pp41-60, 1993. 5. L. Landau, et al. Gender related differences in airway tone in children Pediatr Pulmonol, 16:3135, 1993. 6. J.M. Smith, L.K. Harding, G. Cumming. The changing prevalence of asthrna in school children. Clin. Allergy, 1:57-61, 1971. 7. M. Rosenthal, et al. Lung Function in white children aged 4 to 19 years I-Spirometry. Thorax, 48:794-802, 1993. 8. M. Rosenthal, et al. Lung Function in white children aged 4 to 19 years. II-single breath analysis and plethysmography. Thorax, 48: 803808, 1993. 9. W. Bierman, D. Pearlman. Asthma. In: Kending

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10.

11 12.

13.

14.

15

E, Chemick V, eds. Disorders of the respiratory tract in children 5th ed. Philadelphia: W B Saunders Co, 557-601, 1990. F. Benedictis, J. Canny, H. Levison The progressive nature of childhood asthma. Lung, 168:S278-285, 1990. X.B. ÊáôóáñÞäçò. ÐáéäéáôñéêÞ, ÅëëçíéêÞ ÐáéäéáôñéêÞ Åôáéñåßá, 233-239, 1993. Ê. Ðñßöôçò, Ê. Öñßìáò, Ó. Ìõóßñçò, È. ÑÜìïò, Á. Öéëïîåíßäç, É. ÁíáãíùóôÜêçò. Ç åîÝëéîç ôïõ ðáéäéêïý Üóèìáôïò óôçí ðñþôç äåêáåôßá ôçò æùÞò. Óýã÷ñïíç åðéäçìéïëïãéêÞ ìåëÝôç. ÐáéäéáôñéêÞ, 56:146-251, 1993. Ö. Æáñêßíïò, É. ÔóáíÜêáò, È. ÐáðáóôáýñïõÌáõñïýäç, Ê. ØáñÜêïò, É. Êáñðïýæïò. ÐáíåëëÞíéá ìåëÝôç ôçò óõ÷íüôçôáò ôïõ ðáéäéêïý âñïã÷éêïý Üóèìáôïò. ÐáéäéáôñéêÞ Âïñåßïõ ÅëëÜäïò, 7:123-130, 1995. ÄéåèíÞò ÓôñáôçãéêÞ ãéá ôçí áíôéìåôþðéóç êáé ðñüëçøç ôïõ Üóèìáôïò. Áíáêïßíùóç ôùí NHLBI/WHO âáóéóìÝíç óå Ýíá óõìðüóéï ôïõ Ìáñôßïõ 1993. ÉáíïõÜñéïò 1995, 4-8, 12-24. Ê. ÊõñéáæÜôçò, ÖùôåéíÞ Êïõëïýñá, Ìáßñç ÄåëçãéÜííç, Ïëõìðßá Ñùìáíïý, ×ñõóïýëá ÊïõíôïõñÜêç Å.É. ÐáéäéáôñéêÞò Ã.Í. Í. ×áëêßäáò "Ëáñõããßôéäåò êáôÜ ôçí ôñéåôßá (1996-97-98) óôçí ðåñéï÷Þ ôçò ×áëêßäáò-Ñüëïò ôïõ ãåíéêïý éáôñïý" (Ç åñãáóßá áõôÞ õðïâëÞèçêå ùò Åëåýèåñç Áíáêïßíùóç óôï 11ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò -ÊÝñêõñá 14-18 Áðñéëßïõ 1999- êáé Ýëáâå Ýðáéíï áðü ôçí ÅðéôñïðÞ Êñßóçò).


Ôüìïò 12, Ôåý÷ïò 3, 2000

Ó. ÁñãõñéÜäïõ êáé óõí.

BÑÁÂÅÕÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ AWARDED FREESTANDING PAPER Primary Heatlh Care, Volume 12, Number 3, 151-158, 2000 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 12, Ôåý÷ïò 3, 151-158, 2000

H ìÝèïäïò ÷ñÞóçò çìåñïëïãßïõ óáí áñ÷Þ èåñáðåõôéêÞò ðñïóÝããéóçò áóèåíþí ìå øõ÷éêÝò äéáôáñá÷Ýò óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò Ó. ÁñãõñéÜäïõ, ×. Ìåëéóóïðïýëïõ, ×. ËõãéäÜêçò, Ë. ×Ýëçò, Ì. Ãáôïýëá, Ä. ÊáìéíÜñç

Ðåñßëçøç ÅéóáãùãÞ: Ç êáôÜèëéøç êáé ôï Üã÷ïò åßíáé áðü ôá óõ÷íüôåñá øõ÷éêÜ íïóÞìáôá óôçí ÐÖÕ. Ï Ãåíéêüò Ãéáôñüò êáëåßôáé íá ôá áíé÷íåýåé, íá ôá äéáãéãíþóêåé êáé íá âñßóêåé ôñüðïõò äéá÷åßñéóçò ôùí áóèåíþí áõôþí. Óêïðüò ôçò åñãáóßáò Þôáí ç åöáñìïãÞ ôçò ìåèüäïõ ÷ñÞóçò çìåñïëïãßïõ óå áóèåíåßò ìå ôéò ðáñáðÜíù äéáôáñá÷Ýò êáé ç áîéïëüãçóç ôùí áðïôåëåóìÜôùí, óå óýãêñéóç ìå áóèåíåßò ðïõ áíôéìåôùðßóèçêáí ôáõôü÷ñïíá, ìüíï ìå öáñìáêåõôéêÞ áãùãÞ. ¢íèñùðïé êáé ìÝèïäïé: 128 áóèåíåßò, áðü 21 - 80 åôþí, áðü ôï 1995 ìÝ÷ñé óÞìåñá áðïôÝëåóå ôï äåßãìá, ðïõ ÷ùñßóôçêå êáôÜ öýëï, çëéêßá, ìïñöùôéêü åðßðåäï êáé äéáôáñá÷Þ. ÓõóôÞèçêå ç ôÞñçóç çìåñïëïãßïõ ãéá Ýîé ìÞíåò, üðïõ áíáãñáöüôáí ôï åêëõôéêü áßôéï, ç ðåñéãñáöÞ ôùí áéóèçìÜôùí êáé ôùí óêÝøåùí. Ôçí åðïìÝíç áêïëïõèïýóå ç áíÜãíùóç êáé óõæÞôçóç ôùí áíáãñáöïìÝíùí. Óôï ôÝëïò ôïõ åîáìÞíïõ, ôï äåßãìá óõãêñßèçêå ìå 120 áóèåíåßò (ÖÌ), ïé ïðïßïé Ýëáâáí ìüíï öáñìáêåõôéêÞ áãùãÞ. Ãéá ôç óýãêñéóç, ÷ñçóéìïðïéÞèçêå ç êëßìáêá áõ��ïáîéïëüãçóçò W.K. ZUNG. ÁðïôåëÝóìáôá: Ïé áóèåíåßò ìå âáóéêÞ åêðáßäåõóç ðáñïõóßáóáí ôçí êáëýôåñç óõììüñöùóç óôçí ôÞñçóç ôïõ çìåñïëïãßïõ 61,6%, êáèþò åðßóçò ç ïìÜäá 2140 åôþí 71,1%. Ç ïìÜäá 61-80 åôþí óõììïñöþèçêå óôï 33,3%. Ç ïìÜäá ìå öáñìáêåõôéêÞ áãùãÞ êáé çìåñïëüãéï ðáñïõóßáóå óçìáíôéêÞ áñ÷éêÞ âåëôßùóç, óôéò 11,6 çìÝñåò, óå óýãêñéóç ìå ôïõò ÖÌ, Ì.Ï. 21,3 çìÝñåò. Ï Ì.Ï. ôùí öáñìÜêùí ðïõ ÷ïñçãÞèçêáí Þôáí 1,2, óå ó÷Ýóç ìå ôïõò ÖÌ 1,8. Ç äéÜñêåéá ôçò íüóïõ äåí äéÝöåñå ôåëéêÜ óôéò äõï ïìÜäåò. ÓõìðÝñáóìá: Ç ÷ñÞóç ôïõ çìåñïëïãßïõ óå áóèåíåßò ìå êáôÜèëéøç Þ Üã÷ïò åßíáé ìéá ìÝèïäïò ç ïðïßá âïçèÜåé ãéá óõ÷íüôåñç êáé ðïéïôéêÞ åðáöÞ, âåëôéþíåé ôç ó÷Ýóç ãéáôñïý - áóèåíÞ, êáèþò êáé ôçí ðïéüôçôá ôçò æùÞò ôïõò óå óýíôïìï ÷ñïíéêü äéÜóôçìá. ÅðïìÝíùò ç åìðåéñßá áõôÞ ßóùò èá ðñÝðåé íá áðïôåëÝóåé Ýíáõóìá ãéá ôïõò Ã/à ãéá ôçí ðåñáéôÝñù Ýñåõíá êáé åöáñìïãÞ ôïõ.

ÊÝíôñï Õãåßáò ×ñõóïýðïëçò

ÅéóáãùãÞ Ç øõ÷éáôñéêÞ íïóçñüôçôá åßíáé óõ÷íüôáôç óôï ðåñéâÜëëïí ôçò ÐÖÕ, Ýñåõíåò äå õðïëïãßæïõí üôé áðïôåëåß ôï 25-40% ôùí áíåðßëåêôùí ðåñéóôáôéêþí ôùí åîùôåñéêþí éáôñåßùí ôçò1. Óõ÷íüôåñá áðáíôþìåíåò øõ÷éáôñéêÝò ïíôüôçôåò ç êáôÜèëéøç êáé ôï Üã÷ïò2, ðïëëÝò öïñÝò áëëçëïäéáðëÝêïíôáé êáé ç óõíýðáñîÞ ôïõò3-5, ðïõ õðïëïãßæåôáé áðü 25-43%, áðïôåëåß áðü ôá ðëÝïí äõóåðßëõôá ðñïâëÞìáôá óôçí ðñÜîç6. Óôï ICD107 ðåñéÝ÷ïíôáé ìå ôïõò êùäéêïýò: ˜ F30-39: "Äéáôáñá÷Ýò ôçò äéÜèåóçò" ˜ F40-F48: "ÍåõñùóéêÝò óõíäåüìåíåò ìå ôï stress êáé óùìáôüìïñöåò äéáôáñá÷Ýò" êáé áíáöÝñåôáé ìå ôïí êùäéêü ˜ F41.2: "... ç ìåßîç ôùí óõìðôùìÜËÝîåéò êëåéäéÜ: Çìåñïëüãéï, øõ÷éêÝò äéáôáñá÷Ýò, ðñùôïâÜèìéá öñïíôßäá õãåßáò ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 12ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (×áëêéäéêÞ, 15-19 Ïêôùâñßïõ 2000) êáé âñáâåýèçêå áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ Ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: É. ÁñãõñéÜäïõ, ÊÝíôñï Õãåßáò ×ñõóïýðïëçò, ÊáâÜëáò, Ôçë.: (0591) 22222 151


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ó. ÁñãõñéÜäïõ êáé óõí.

Using diary as approaching therapeutic tool in patients with mood disorders in Primary Health Care St. Argyriadou, H. Melissopoulou, H. Lygidakis, L. Chelis, M. Gatoula, D. Kaminari Summary Aim of this study was to apply a method of keeping/using a diary with one group of patients (128 participants) and then further evaluating the results by comparing them to a second group of patients who were being treated, at the same time, although only with medications (120 participants). Subjects and Methods: The first group, whose ages ranged from 21-80 years old, were (then) divided by gender, age, educational level and disorder. They were asked to keep a diary for a six month period, where the cause, description, feelings and thoughts of each episode were recorded and later discussed with their GPs’. On completion of the six month period the two groups were compared using the Zungs’ scale of self-estimate. Results: The age group of 21-40 years mainly respected the diary method with 71.1% completion, also those with a basic level of education achieved 61.6%. However, only 33.3% of the 61-80 year age group applied the method throughout the period. The first group initially improved at 11.6 days compared to the second group who needed 2.3 days on average. The average for the prescribed medications were 1.2 drugs for the first group and 1.8 for the second. However both groups were alike at the duration of the disease. Conclusions: Using the diary method for patients with depression or stress is a method that not only helps maintain a more frequent and qualitative contact between GPs’ and their patients, but also improves their relationship as well as the quality of their lives in the short term. Therefore this experience should encourage GPs to investigate and apply it more in the future. Key words: Diary, mood disorders, primary health care

ôùí åßíáé óõíÞèçò (ç óõíýðáñîç êáôÜèëéøçò êáé Üã÷ïõò áðïôåëåß ôçí ðéï óõ÷íÞ ðåñßðôùóç, éäéáßôåñá óôéò ëéãüôåñï óïâáñÝò ðáñáëëáãÝò ôùí äéáôáñá÷þí åêåßíùí ïé ïðïßåò ðáñáôçñïýíôáé óôéò õðçñåóßåò ôçò ÐÖÕ. Ãé’ áõôü õðÜñ÷åé êïéíÞ äéáãíùóôéêÞ êáôçãïñßá ç [ÌåéêôÞ áã÷þäçò êáôáèëéðôéêÞ äéáôáñá÷Þ] F41.2 ãéá üëåò åêåßíåò ôéò ìåéêôÝò ðåñéðôþóåéò êáôÜèëéøçò êáé Üã÷ïõò óôéò ïðïßåò èá áðÝâáéíå ôå÷íçôÞ ç õðï÷ñÝùóç ãéá ìïíïóÞìáíôç äéáãíùóôéêÞ áðüöáóç." Ïé óõíÝðåéåò ôçò ìç áíáãíþñéóçò Þ ôçò êáêÞò áíôéìåôþðéóçò ôùí íïóçìÜôùí áõôþí Ý÷åé óáí áðïôÝëåóìá ôçí áðþëåéá ðáñáãùãéêüôçôáò, ôçí áýîçóç ôïõ êüóôïõò ôùí õðçñåóéþí õãåßáò, ôçí ïõóéïåîÜñôçóç, ôçí êáêÞ ðïéüôçôá æùÞò, áêüìç êáé ôçí áõôïêôïíßá. Ëüãù ôçò ìåãÜëçò óõ÷íüôçôáò áõôþí ôùí íïóçìÜôùí óôçí ÐÖÕ êáé ôùí óïâáñþí óõíåðåéþí ôïõò ï Ã/à -óáí ï éáôñüò ðñþôçò åðáöÞòåßíáé áõôüò ðïõ êáëåßôáé íá ôá áíé÷íåýóåé, íá ôá äéáãíþóåé êáé íá âñåé ôñüðïõò äéá÷åßñéóÞò ôïõò. Ç ÷ñÞóç ôïõ çìåñïëïãßïõ óôçí êëéíéêÞ ðñÜîç Ý÷åé åðé÷åéñçèåß óôï ðáñåëèüí, áëëÜ êáé ðñü152

óöáôá ìå óçìáíôéêÜ áðïôåëÝóìáôá éäéáßôåñá óå áóèåíåßò ìå ÷ñüíéá íïóÞìáôá üðùò ï óáê÷áñþäçò äéáâÞôçò8, ç ðïëëáðëÞ óêëÞñõíóç9, ôá ìåôáôñáõìáôéêÜ ðñïâëÞìáôá ìíÞìçò10, ôá êáñäéáããåéáêÜ ðñïâëÞìáôá óå óõíäõáóìü ìå áã÷þäåéò äéáôáñá÷Ýò11, ê.ëð. Äåí õðÜñ÷ïõí üìùò âéâëéïãñáöéêÝò áíáöïñÝò åöáñìïãÞò ôïõ óôá øõ÷éêÜ íïóÞìáôá óôç ÃåíéêÞ ÉáôñéêÞ óôçí ÅëëÜäá. ¸íáõóìá ãéá ôçí åöáñìïãÞ ôïõ Þôáí ôï óêåðôéêü üôé êáé ôá øõ÷éêÜ íïóÞìáôá ðáñïõóéÜæïõí ôá ÷áñáêôçñéóôéêÜ ôùí ÷ñüíéùí, üðùò ç ìåãÜëç äéÜñêåéá, ïé áóèåíåßò ìå åëáôôùìÝíåò øõ÷éêÝò áíôï÷Ýò ê.ëð. Óêïðüò ôçò åñãáóßáò Þôáí ç åöáñìïãÞ ôçò ìåèüäïõ ÷ñÞóçò çìåñïëïãßïõ óå áóèåíåßò ìå åëáöñÜò Þ ìÝôñéáò âáñýôçôáò óõìðôþìáôá áðü ôéò ðñïáíáöåñüìåíåò äéáôáñá÷Ýò êáé ç áîéïëüãçóç ôùí áðïôåëåóìÜôùí ôçò ìåèüäïõ, óå óýãêñéóç ìå áóèåíåßò ðïõ áíôéìåôùðßóèçêáí ôáõôü÷ñïíá, áëëÜ ìüíï ìå öáñìáêåõôéêÞ áãùãÞ.

Ðëçèõóìüò ìåëÝôçò êáé ÌÝèïäïé Ôï äåßãìá ìáò áðïôåëïýíôáí áðü 128 áóèåíåßò çëéêßáò áðü 21 Ýùò êáé 80 åôþí. Ç åðéëïãÞ ôïõò Ýãéíå áíÜìåóá óôïõò ðÜó÷ïíôåò áðü ôéò ðáñáðÜíù äéáôáñá÷Ýò óôçí ðåñéï÷Þ åõèýíçò ôïõ ÊÕ× óôï äéÜóôçìá 1997-1999. Ãéá ëüãïõò êáëýôåñçò åðåîåñãáóßáò ôùí áðïôåëåóìÜôùí áêïëïýèçóå ï äéá÷ùñéóìüò ôïõò êáôÜ öýëï êáé çëéêßá (çëéêéáêÝò ïìÜäåò áðü 21-40, 41-60, 61-80). Åðßóçò, êáôÜ ìïñöùôéêü åðßðåäï (âáóéêÞ, áíþôåñç êáé áíþôáôç åêðáßäåõóç) êáé äéáôáñá÷Þ (äéáôáñá÷Ýò ôçò äéÜèåóçò F30-F39 êáé íåõñùóéêÝò, óõíäåüìåíåò ìå ôï stress êáé óùìáôüìïñöåò äéáôáñá÷Ýò F40-F48 êáôÜ ôï ICD-10 ôïõ ÐÏÕ7). ÅîçãÞèçêå óôïõò áóèåíåßò ç ðÜèçóÞ ôïõò, ôá ÷áñáêôçñéóôéêÜ, ïé ðéèáíüôçôåò èåñáðåßáò êáé õðïôñïðÞò êáé äéáâåâáéþèçêå áðü ôï ãéáôñü Ã/Ï éáôñéêÞò üôé ç åðáöÞ ìáæß ôïõ èá åßíáé äõíáôÞ êáè' üëç ôç äéÜñêåéá ôçò çìÝñáò. Óôïõò êïéíïýò óôü÷ïõò ðïõ óõæçôÞèçêáí ìå ôïí áóèåíÞ ôÝèçêå ï óôü÷ïò ôçò üóï ôï äõíáôüí ãñçãïñüôåñçò áíáêïýöéóÞò ôïõ áðü ôá óõìðôþìáôá, ôçò ôá÷ýôå-


Ó. ÁñãõñéÜäïõ êáé óõí.

ñçò èåñáðåßáò, ìå ôçí ðñïûðüèåóç ôÞñçóçò çìåñïëüãéïõ ãéá ôç äéÜñêåéá 6 ìçíþí. Ó’ áõôü, èá ãéíüôáí ç ðåñéãñáöÞ ïðïéïõäÞðïôå åðåéóïäßïõ öïâßáò, Üã÷ïõò, ðáíéêïý Þ êáôÜèëéøçò ðáñïõóéáæüôáí, åîçãþíôáò üôé áðïôåëïýóå Ýíá ìÝóïí ðïõ äéåõêüëõíå ôï ãéáôñü ãéá ôçí ðëçñÝóôåñç ðáñáêïëïýèçóç ôçò ðÜèçóçò êáé ôçí êáëýôåñç áíôéìåôþðéóÞ ôçò. Ôçí åðïìÝíç èá áêïëïõèïýóå ç áíÜãíùóÞ ôïõ, êáèþò êáé ç óõæÞôçóç ìå ôïí áóèåíÞ. Ìå ôïí ôñüðï áõôü õðÞñ÷å ç äõíáôüôçôá ðñïóäéïñéóìïý ôùí ÷áñáêôçñéóôéêþí ôçò áóèÝíåéáò (óõ÷íüôçôá êñßóåùí, äéÜñêåéá, óïâáñü-

Ôüìïò 12, Ôåý÷ïò 3, 2000

ôçôá, åêëõôéêïß ðáñÜãïíôåò) êáé ç äõíáôüôçôá óôïí ßäéï ôïí áóèåíÞ íá ðáñáôçñÞóåé ôá óõìðôþìáôá êáé ôç óõìðåñéöïñÜ ôïõ. Ãéá ôçí åêôßìçóç ôçò ðñïüäïõ ôçò èåñáðåßáò êÜèå ìÞíá óõìðëçñùíüôáí åñùôçìáôïëüãéï áõôïåêôßìçóçò ôùí äéáôáñá÷þí ôçò äéÜèåóçò ôïõ Zung12. Ç êëßìáêá áõôÞ ðïõ ç ÷ñÞóç ôçò áíÜãåôáé óôç äåêáåôßá ôïõ ’60 áðïäåß÷ôçêå ÷ñÞóéìç ôüóï óôçí êëéíéêÞ ðáñáêïëïýèçóç üóï êáé óôçí áíôéìåôþðéóç áóèåíþí ìå øõ÷éêÝò äéáôáñá÷Ýò óôçí ÐÖÕ. Áðïôåëåßôáé áðü 20 åñùôÞìáôá ðïõ óôï óýíïëü ôïõò ìáò åðéôñÝðïõí íá ïñßóïõìå ðïóïôé-

153


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ó. ÁñãõñéÜäïõ êáé óõí.

êÜ ôçí ïíôüôçôá ôçò êáôáèëéðôéêÞò äéáôáñá÷Þò. Ï õðïëïãéóìüò ôçò ôåëéêÞò âáèìïëïãßáò ãßíåôáé áðü ôï ãéáôñü êáé ôï Üèñïéóìá ìåôáôñÝðåôáé óå äåßêôç SDS (Self-rating Depression Scale) óýìöùíá ìå ôïí áêüëïõèï ôýðï: äåßêôçò SDS = [óõíïëéêÞ âáèìïëïãßá 20 åñùôçìÜôùí/ìÝãéóôç âáèìïëïãßá ôçò êëßìáêáò (80 âáèìïß)] x 100. ¸ôóé üôáí ï äåßêôçò SDS åßíáé <50 ï åîåôáæüìåíïò äåí ðáñïõóéÜæåé óôïé÷åßá êáôÜèëéøçò. ¼ôáí ï SDS åßíáé áðü 50-59 óõíåðÜãåôáé åëáöñÜ êáôÜèëéøç, áðü 60-69 õðÜñ÷åé êáôÜèëéøç ìåôñßïõ âáèìïý åíþ ðÜíù áðü 70 äçëþíåé âáñéÜ êáôÜèëéøç. ÔåëéêÜ, ôï äåßãìá óõãêñßèçêå ìå 120 áóèåíåßò ìå øõ÷éáôñéêÝò äéáôáñá÷Ýò (Öõóéïëïãéêïß ÌÜñôõñåò), ôùí ïðïßùí ç èåñáðåßá ðåñéïñßóôçêå ìüíï óôç öáñìáêåõôéêÞ áíôéìåôþðéóç ôïõ ðñïâëÞìáôüò ôïõò. Ãéá ôç óýãêñéóç ÷ñçóéìïðïéÞèçêå ç êëßìáêá ôïõ Zung áíÜ ìÞíá.

ìáôïò ðáñïõóéÜæåôáé óôï áêüëïõèï ó÷Þìá 1, ðßíáêá 2. Ç óõììüñöùóç ôùí áóèåíþí êáôÜ öýëï óå ó÷Ýóç ìå ôçí åêðáßäåõóç êáé ôçí çëéêßá Þôáí ç áêüëïõèç (Ó÷Þìáôá 2á, 2â, Ðßíáêáò 3). Ðßíáêáò 1. Ìïñöùôéêü åðßðåäï áíÜ ÇëéêéáêÝò ÏìÜäåò Åêðáßäåõóç

ÇëéêéáêÝò ÏìÜäåò 21-40

41-60

61-80

Óýíïëï

ÂáóéêÞ Áíþôåñç Áíþôáôç

29 31 16

24 5 2

20 1 0

73 37 18

Óýíïëï

76

31

21

128

ÁðïôåëÝóìáôá Ôá ÷áñáêôçñéóôéêÜ ôïõ äåßãìáôïò óýìöùíá ìå ôï ìïñöùôéêü åðßðåäï êáé ôéò çëéêéáêÝò ïìÜäåò öáßíïíôáé ðáñáêÜôù (Ðßíáêáò 1). Áíáëõôéêüôåñá, ï óõó÷åôéóìüò ôïõ öýëïõ, ôçò åêðáßäåõóçò êáé ôùí çëéêéáêþí ïìÜäùí ôïõ äåßã-

Ó÷Þìá 1. ÄçìïãñáöéêÜ óôïé÷åßá

Ðßíáêáò 2. Ìïñöùôéêü åðßðåäï áíÜ ÇëéêéáêÝò ÏìÜäåò êáé Öýëï Åêðáßäåõóç

¢íäñåò

Ãõíáßêåò

21-40

41-60

61-80

Óýíïëï

21-40

41-60

61-80

Óýíïëï

ÂáóéêÞ Áíþôåñç Áíþôáôç

12 13 5

9 1 0

4 1 0

25 15 5

17 18 11

15 4 2

16 0 0

48 22 13

Óýíïëï

30

10

5

45

46

21

16

83

Ó÷Þìá 2á. Óõììüñöùóç óýìöùíá ìå ôçí çëéêßá 154

Ó÷Þìá 2â. Óõììüñöùóç óýìöùíá ìå ôçí åêðáßäåõóç


Ôüìïò 12, Ôåý÷ïò 3, 2000

Ó. ÁñãõñéÜäïõ êáé óõí.

Ðßíáêáò 3. Óõììüñöùóç óýìöùíá ìå ôéò ÇëéêéáêÝò ÏìÜäåò êáé ôï Ìïñöùôéêü Åðßðåäï Óõììüñöùóç

¢íäñåò

Ãõíáßêåò

Óýíïëï

Íáé

¼÷é

Óýíïëï

Íáé

¼÷é

Óýíïëï

Íáé

¼÷é

Óýíïëï

Çëéêßåò 21-40 41-60 61-80 Óýíïëï

17 4 3 24

13 6 2 21

30 10 5 45

37 10 4 51

9 11 12 32

46 21 16 83

54 14 7 75

22 17 14 53

76 31 21 128

Åêðáßäåõóç ÂáóéêÞ Áíþôåñç Áíþôáôç Óýíïëï

14 8 2 24

11 7 3 21

25 15 5 45

31 16 4 51

17 6 9 32

48 22 13 83

45 24 6 75

28 13 12 53

73 37 18 128

Óõììüñöùóç (%)

¢íäñåò

Ãõíáßêåò

Óýíïëï

Íáé

¼÷é

Íáé

¼÷é

Íáé

¼÷��

Çëéêßåò 21-40 41-60 61-80

56,7% 40,0% 60,0%

43,3% 60,0% 40,0%

80,4% 47,6% 25,0%

19,6% 52,4% 75,0%

71,1% 45,2% 33,3%

28,9% 54,8% 66,7%

Åêðáßäåõóç ÂáóéêÞ Áíþôåñç Áíþôáôç

56,0% 53,3% 40,0%

44,0% 46,7% 60,0%

64,6% 72,7% 30,8%

35,4% 27,3% 69,2%

61,6% 64,9% 33,3%

38,4% 35,1% 66,7%

¼ðùò öÜíçêå, ç êáëýôåñç óõììüñöùóç óôçí ôÞñçóç ôïõ çìåñïëïãßïõ ðáñïõóéÜóôçêå óôï áíäñéêü öýëï ôçò ðñþôçò çëéêéáêÞò ïìÜäáò êáé âáóéêÞò åêðáßäåõóçò (56,6% êáé 56,0% áíôßóôïé÷á) åíþ óôéò ãõíáßêåò ôçò ðñþôçò çëéêéáêÞò ïìÜäáò êáé áíþôåñçò åêðáßäåõóçò (80,4% êáé 72,7%). Áðü ôçí åêôßìçóç ôùí áóèåíþí öÜíçêáí íá ðáñïõóéÜæïõí äéáôáñá÷Ýò ìå åðéêñáôÝóôåñá ôá áã÷þäç óôïé÷åßá ôï 63,3% êáé ôï õðüëïéðï 36,7% áðü äéáôáñá÷Ýò ìå åðéêñáôÝóôåñá ôá êáôáèëéðôéêÜ óôïé÷åßá (Ó÷Þìá 3, Ðßíáêáò 4). Ï óõó÷åôéóìüò ôçò óõììüñöùóçò êáé ôùí äéáôáñá÷þí öáßíåôáé óôïí ðßíáêá 5 (Ó÷Þìá 4). Ç óõ÷íüôçôá ôùí åðéóêÝøåùí óå óýãêñéóç ìå ôïõò öõóéïëïãéêïýò ìÜñôõñåò öáßíåôáé óôï ó÷Þìá 5. ÓõãêñéôéêÜ, ç õðïêåéìåíéêÞ âåëôßùóç ôùí äýï ïìÜäùí óå ó÷Ýóç ìå ôï ÷ñüíï ìåôÜ áðü ôçí åöáñìïãÞ ôïõ åñùôçìáôïëïãßïõ ãéá ôçí áõôïåê-

Ó÷Þìá 3. Äéáôáñá÷Ýò

ôßìçóç ôùí äéáôáñá÷þí ôçò äéÜèåóçò ôïõ Zung, öáßíåôáé óôï ó÷Þìá 6 (Ðßíáêáò 5). Ç ïìÜäá ðáñáêïëïýèçóçò óå ó÷Ýóç ìå ôïõò öõóéïëïãéêïýò ìÜñôõñåò ðáñïõóßáóå âåëôßùóç ôçò óõìðôùìáôïëïãßáò êáôÜ Ì.Ï. óôéò 11,6 çìÝñåò óå áíôßèåóç ìå ôïõò öõóéïëïãéêïýò ìÜñôõñåò ðïõ ðáñïõóßáóáí êáôÜ ôçí åêôßìçóÞ ôïõò âåëôßùóç

Ðßíáêáò 4. Äéáôáñá÷Ýò Äéáôáñá÷Ýò Áã÷þäç Óôïé÷åßá ÊáôáèëéðôéêÜ Óôïé÷åßá Óýíïëï

¢íäñåò

Ãõíáßêåò

Óýíïëï

37 (82,2%) 8 (17,8%) 45

44 (53,0%) 39 (47,0%) 83

81 (63,3%) 47 (36,7%) 128 155


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ó. ÁñãõñéÜäïõ êáé óõí.

Ðßíáêáò 5. Óõììüñöùóç óýìöùíá ìå ôéò Äéáôáñá÷Ýò Óõììüñöùóç Äéáôáñá÷Ýò Áã÷þäç óôïé÷åßá ÊáôáèëéðôéêÜ Óôïé÷åßá Óýíïëï

¢íäñåò

Óýíïëï

Íáé

¼÷é

Óýíïëï

Íáé

¼÷é

Óýíïëï

Íáé

¼÷é

Óýíïëï

20

17

37

26

18

44

46

35

81

4 24

4 21

8 45

25 51

14 32

39 83

29 75

18 53

47 128

Óõììüñöùóç (%) Äéáôáñá÷Ýò Áã÷þäç óôïé÷åßá ÊáôáèëéðôéêÜ Óôïé÷åßá

Ãõíáßêåò

¢íäñåò

Ãõíáßêåò

Óýíïëï

Íáé

¼÷é

Íáé

¼÷é

Íáé

¼÷é

54,1%

45,9%

59,1%

40,9%

56,8%

43,2%

50,0%

50,0%

64,1%

35,9%

61,7%

38,3%

Ó÷Þìá 4. Óõììüñöùóç óýìöùíá ìå ôéò äéáôáñá÷Ýò Ó÷Þìá 5. Óõ÷íüôçôá åðéóêÝøåùí áíÜ ìÞíá

êáôÜ Ì.Ï. áðü ôçí 21,3 çìÝñåò (Ó÷Þìá 7). ÔÝëïò, ï Ì.Ï. ôùí öáñìÜêùí ðïõ ÷ïñçãÞèçêáí Þôáí 1,2, óå ó÷Ýóç ìå ôïõò ÖÌ 1.8 (Ó÷Þìá 8).

ÓõæÞôçóç Óýìöùíá ìå ôïí Gilbert13 ç äéá÷åßñéóç ôùí áóèåíþí ìå ÷ñüíéá íïóÞìáôá óôçí ÐÖÕ ðñÝðåé íá êáèïñßæåôáé áðü óôü÷ïõò ñåáëéóôéêïýò, åðéôåýîéìïõò, åýêïëá õðïëïãéæüìåíïõò êáé ðñïðáíôüò âñá÷õðñüèåóìïõò. ¸ôóé åðéôõã÷Üíåôáé ç êáëýôåñç äõíáôÞ óõììüñöùóÞ, ç âåëôßùóç ôçò øõ÷ïëïãßáò, ç áîéïëüãçóç ôçò áãùãÞò ê.ëð. ËáìâÜíïíôáò õðüøç ôá ðáñáðÜíù áðü ôçí ðñþôç êéüëáò åðáöÞ ìå ôïõò áóèåíåßò ìáò, åîçãÞèçêáí: ˜ Ïé äõóêïëßåò ôçò èåñáðåßáò, ïé êßíäõíïé ôùí õðïôñïðþí, ïé ðéèáíüôçôåò áðïôõ÷ßáò óôç èåñáðåßá (åîáóöáëéæüôáí äçëáäÞ ç óõììåôï÷Þ ôïõ áóèåíïýò óôç èåñáðåßá), óå áíôßèåóç ìå ðñïçãïýìåíåò ôáêôéêÝò ðïõ Þèåëáí ôï ãéáôñü áéóéüäïîï êáé ìïíáäéêü õðåýèõíï ôçò 156

Ó÷Þìá 6. ÓõãêñéôéêÜ áðïôåëÝóìáôá ôçò âåëôßùóçò ôùí äýï ïìÜäùí

èåñáðåõôéêÞò ôïõ ðáñÝìâáóçò. ˜ Ç ðñüïäïò óôç èåñáðåßá14 ìå íåüôåñá óêåõÜóìáôá ðïõ åëá÷éóôïðïßçóå ôéò ðáñåíÝñãåéåò, âåëôßùóå ôéò ðéèáíüôçôåò ôçò èåñáðåõôéêÞò åðéôõ÷ßáò êáé ôÝëïò êáôÝóôçóå äõíáôÞ ôç


Ôüìïò 12, Ôåý÷ïò 3, 2000

Ó. ÁñãõñéÜäïõ êáé óõí.

Ó÷Þìá 7. Áñ÷éêÞ âåëôßùóç

Ó÷Þìá 8. Ì.Ï. öáñìÜêùí ðïõ ÷ïñçãÞèçêáí

èåñáðåßá êáé ôùí óïâáñïôÝñùí áêüìç ìïñöþí ôùí øõ÷éêþí íïóçìÜôùí óôï óðßôé (êáèçóõ÷áóìüò äçëáäÞ ôïõ áóèåíïýò ëüãù äõíáôÞò åðßôåõîçò ôïõ èåñáðåõôéêïý óôü÷ïõ). ˜ Ìå ôç ÷ñÞóç ôïõ çìåñïëïãßïõ áíáìåíüôáí ç ãñçãïñüôåñç âåëôßùóç ôçò óõìðôùìáôïëïãßáò (åðïìÝíùò åíèÜññõíóç ôçò õðåõèõíüôçôáò ôïõ áóèåíÞ), ç áîéïëüãçóç ôçò áãùãÞò, ç áíÜëõóç ôùí áíôéäñÜóåùí ðïõ ðñïêáëïýí ôçí óõìðôùìáôïëïãßá, ç êáôáãñáöÞ ôçò åîÝëéîçò êáé ãåíéêüôåñá ðåñéóóüôåñá óôïé÷åßá ãéá ôï íüóçìá. Óôçí ðïñåßá üìùò ôçò åöáñìïãÞò ôçò ôÞñçóçò ôïõ çìåñïëïãßïõ ðáñïõóéÜóôçêáí äéÜöïñá

ðñïâëÞìáôá, üðùò óôç äéÜãíùóç, ðïõ Þôáí óõíÞèùò áðüññïéá ôçò óõíýðáñîçò Üã÷ïõò - êáôÜèëéøçò êáé ðïëëÝò öïñÝò ÷ñåéÜóôçêå ç ãíþìç ôïõ åéäéêïý. Äéáãíùóôéêü ðñüâëçìá åðßóçò ðáñïõóéÜóôçêå óôïõò çëéêéùìÝíïõò ìå êáôáèëéðôéêÝò áíôéäñÜóåéò ùò áðïôÝëåóìá ïñãáíéêþí íïóçìÜôùí (íïóÞìáôá ôïõ ÊÍÓ, ÁÅÅ, íåïðëáóßåò, öÜñìáêá ê.ëð.), ïé ïðïßïé åêäÞëùíáí ðåñéóóüôåñá óôïé÷åßá Üã÷ïõò. Áêüìç, óôçí ßäéá çëéêéáêÞ ïìÜäá áóèåíþí, áðáíôÞèçêå óõ÷íüôáôá ôï öáéíüìåíï ôçò óùìáôïðïßçóçò (êüðùóç, äéÜ÷õôá Üëãç, ãáóôñåíôåñéêÜ åíï÷ëÞìáôá êëð) ãåãïíüò ôï ïðïßï õðÞñîå áßôéï åñãáóôçñéáêþí åîåôÜóåùí ðñïò áðïêëåéóìü óùìáôéêþí íïóçìÜôùí. ÅðéðëÝïí, óôçí ðïñåßá ôçò ìåëÝôçò, ðáñïõóéÜóôçêáí äõóêïëßåò ùò áðïôÝëåóìá Ýëëåéøçò åíüò åñãáëåßïõ - "ìÝôñïõ" ìå ôï ïðïßï áíôéêåéìåíéêÜ èá ìðïñïýóå íá ìåôñçèåß ç ðïñåßá êáé ç âåëôßùóç ôùí áóèåíþí. ÔÝëïò, åðéóçìÜíèçêå ç áäõíáìßá ôïõ ãñáðôïý ëüãïõ óå êÜðïéïõò áóèåíåßò åîáéôßáò ôçò ðåñéïñéóìÝíçò åêðáßäåõóçò ôïõò (ðñïâëÞìáôá ãëþóóáò, êõñéïëåîßáò, Üðïøçò) ê.ëð. ÓõíïðôéêÜ ôá ðñïâëÞìáôá ðïõ áíôéìåôùðßóôçêáí åìöáíßæïíôáé óôïí ðßíáêá 6. Óçìáíôéêü åßíáé ðùò ç ÷ñÞóç ôçò ìåèüäïõ áõôÞò, üðùò Ýäåéîáí ôá áðïôåëÝóìáôá, åéäéêÜ ãéá ôéò íåüôåñåò çëéêßåò êáé ôéò áã÷þäåéò äéáôáñá÷Ýò, öÜíçêå íá åßíáé éäéáßôåñá áðïôåëåóìáôéêÞ êáé ìÜëéóôá êáôÜ ôçí Ýíáñîç ôçò èåñáðåßáò (ðñþôï åéêïóáÞìåñï) óå óýãêñéóç ìå ôçí ïìÜäá ôùí öõóéïëïãéêþí ìáñôýñùí. Áíôßèåôá, óôïõò áóèåíåßò ìå åíôïíüôåñá êáôáèëéðôéêÜ óôïé÷åßá ðáñáôçñÞèçêå üôé áñ÷éêÜ îåêßíçóáí áðñüèõìá ôçí óõììåôï÷Þ ôïõò óôç ìåëÝôç, üðùò Þôáí Üëëùóôå áíáìåíüìåíï, êáé åß÷áí ôç ÷åéñüôåñç óõììüñöùóç. Ðáñüëá áõôÜ, óõãêñßíïíôáò ôïõò ìå ôïõò öõóéïëïãéêïýò ìÜñôõñåò, ðáñïõóéÜóôçêå ç ìéêñüôåñç áíÜãêç óõíäõáóìÝíçò èåñáðåßáò, áëëÜ êáé üôáí ç áðïöõãÞ ôçò Þôáí áíÝöéêôç, ãéá ìéêñü ÷ñïíéêü äéÜóôçìá. ¼óïí áöïñÜ ôçí áðïôåëåóìáôéêüôçôá, áõôÞ Þôáí éäéáßôåñá óçìáíôéêÞ êáôÜ ôéò ðñþôåò çìÝ-

Ðßíáêáò 6. Áðü ôçí ðëåõñÜ ôïõ áóèåíÞ

Áðü ôçí ðëåõñÜ ôïõ ãéáôñïý

˜ Óùìáôüìïñöåò äéáôáñá÷Ýò (ÄéáöïñïäéÜãíùóç) ˜ Ç êáôÜèëéøç óáí íüóçìá (ÄéáöïñïäéÜãíùóç) ˜ Ç áîéïðéóôßá ôïõ çìåñïëïãßïõ

˜ ¢ôáêôá ùñÜñéá ˜ Ç óõ÷íüôçôá ôùí åðéóêÝøåùí ˜ Ç äéÜñêåéá ôùí åðéóêÝøåùí 157


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

ñåò, äåí õðÞñîå üìùò áîéïóçìåßùôç äéáöïñïðïßçóç óôéò äõï ïìÜäåò ùò ðñïò ôç óõíïëéêÞ äéÜñêåéá ôçò íüóïõ. ÓõìðåñáóìáôéêÜ, ç ÷ñÞóç ôïõ çìåñïëïãßïõ óå áóèåíåßò ìå êáôÜèëéøç Þ Üã÷ïò åßíáé ìéá ìÝèïäïò ç ïðïßá âïçèÜåé óôçí ðïéïôéêÞ åðáöÞ ãéáôñïý - áóèåíÞ, äéåõêïëýíïíôáò ôç äçìéïõñãßá ìéáò ó÷Ýóçò óôÞñéîçò êáé åìðéóôïóýíçò. Âåëôéþíåé ôç óõìðôùìáôïëïãßá óå óýíôïìï ÷ñïíéêü äéÜóôçìá, ðñïÜãïíôáò Ýôóé ôçí ðïéüôçôá ôçò æùÞò. ÅðïìÝíùò, ç åìðåéñßá ìáò èá ìðïñïýóå íá áðïôåëÝóåé Ýíáõóìá óôç Ã/Ï éáôñéêÞ ãéá ôçí ðåñáéôÝñù Ýñåõíá êáé åöáñìïãÞ.

Ó. ÁñãõñéÜäïõ êáé óõí.

6.

7.

8.

Âéâëéïãñáößá: 9. 1. Ê. ÓïëäÜôïò. ¢ã÷ïò êáé êáôÜèëéøç óå áóèåíåßò ìå óùìáôéêÜ íïóÞìáôá Óôï: Ê. ÓïëäÜôïò "¢ã÷ïò êáé êáôÜèëéøç: åêäçëþóåéò êáé áíôéìåôþðéóç óôç ÃåíéêÞ ÉáôñéêÞ". ÉáôñéêÞ Åôáéñåßá Áèçíþí, ÁèÞíá 1999, óåë. 103-8. 2. Â. ÌáõñÝáò. Åðéäçìéïëïãßá ôùí áã÷ùäþí äéáôáñá÷þí. Óôï: Â. Áëåâßæïõ "¢ã÷ïò êáé áã÷þäåéò äéáôáñá÷Ýò". ÉáôñéêÞ Åôáéñåßá Áèçíþí, ÁèÞíá, 1997, óåë. 32-39. 3. D.A. Regier, J.D. Burke, K.C. Burke. Comorbidity of affective and anxiety disorders in NIMH Epidemiologic Catchment Area Program. In: JD Maser, CR Cloninger (eds) "Comorbidity of mood and anxiety disorders." Washinghton DC, American Psychiatric Press, 113-122, 1990. 4. D.G. Blazer, R.C. Kessler, K.A. McGonagle, M.S. Swarz. The prevalence and distribution of major depression in a national community sample: The National Comorbidity Survey. Am. J. Psychiatry, 151:979-86, 1994. 5. J. Angst, M. Vollrath, K.R. Merikangas, C. Ernst

158

10.

11.

12. 13.

14.

Comorbidity of anxiety and depression in the Zurich cohort study of young adults. In: JD Maser, CR Cloninger (eds) "Comorbidity of mood and anxiety disorders." Washinghton DC, American Psychiatric Press, 123-37, 1990. Á.Ä. Ñáìðáâßëáò. óõííïóçñüôçôá ôçò êáôÜèëéøçò ìå ôéò áã÷þäåéò äéáôáñá÷Ýò. Óôï: ÃÍ ×ñéóôïäïýëïõ "ÊáôÜèëéøç" ÉáôñéêÞ Åôáéñåßá Áèçíþí, ÁèÞíá, 1996, óåë. 102-9. ICD10 êëéíéêÝò ðåñéãñáöÝò êáé ïäçãßåò ãéá ôç äéÜãíùóç. Åêä. ÂÇÔÁ 1993. ÐÏÕ Ãåíåýç. Áðüäïóç óôá åëëçíéêÜ Ê ÓôåöáíÞò, Ê ÓïëäÜôïò,  ÌáõñÝáò. óåë150. J.P. Roossens, L. Poulalion, I. Beigbeder, E. Fesquet, B. Becel. Identification of factors hindering better management of patients with type 2 diabetes. Diabetes Metab. 6:77-85, 2000. G.M. Timmerman, A.K. Stuifbergin. Eating patterns in women with multiple sclerosis. J. Neurosci. Nurs., 31:152-8, 1999. T.L. Ownsworth, K. Mcfarland. Memory rementation in long-term aquired brain injury: two approaches in diary training. Brain Inj., 13:60526, 1999. J.C. Beckham, M.E. Feldman, J.C. Barefoot, J.A. Fairbank, M.J. Helms et al. Ambulatory cardiovascular activity in Vietnam combat veteran with and without posttraumatic stress disorder. J. Consult. Psychol., 68:269-76, 2000. W.W.K. Zung. A self-rating depression scale. Arc. Gen. Psychiatry, 12:63-70, 1965. J.J. Gilbert. Guide pedagogique pour les personnels de sante. Geneva, Swizerlands WHO. Publication offset no 35. 1982. É. ÆÝñâáò ÖáñìáêåõôéêÞ áíôéìåôþðéóç ôïõ Üã÷ïõò. Óôï: Ê. ÓïëäÜôïò "¢ã÷ïò êáé êáôÜèëéøç: åêäçëþóåéò êáé áíôéìåôþðéóç óôç ÃåíéêÞ ÉáôñéêÞ". ÉáôñéêÞ Åôáéñåßá Áèçíþí, ÁèÞíá 1999, óåë. 26-32.


Ôüìïò 12, Ôåý÷ïò 3, 2000

Ð. Ìáíïýóïõ êáé óõí.

ÃÑÁÌÌÁÔÁ ÓÔÏÍ ÅÊÄÏÔÇ LETTERS TO THE EDITOR Primary Heatlh Care, Volume 12, Number 3, 159-160, 2000 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 12, Ôåý÷ïò 3, 159-160, 2000

Ç Üðïøç ôùí öïéôçôþí ÉáôñéêÞò ôïõ Ðáíåðéóôçìßïõ Éùáííßíùí ãéá ôç ÃåíéêÞ ÉáôñéêÞ Ð. Ìáíïýóïõ*, Ê. ÌùñáÀôç*

Ç ðáñÜèåóç ôùí áðüøåùí ôùí öïéôçôþí éáôñéêÞò ôïõ Ðáíåðéóôçìßïõ Éùáííßíùí ãéá ôçí åéäéêüôçôá ôçò ÃåíéêÞò ÉáôñéêÞò èá ìðïñïýóå íá óõìâÜëëåé óôçí áíÜðôõîç ôçò ÃåíéêÞò ÉáôñéêÞò, ðïõ ôþñá êÜíåé ôá ðñþôá âÞìáôÜ ôçò óôç ÷þñá ìáò. Èá èÝëáìå áñ÷éêÜ íá åðéóçìÜíïõìå üôé ïé ãíþóåéò ðïõ Ý÷ïõìå ãéá ôç ÃåíéêÞ ÉáôñéêÞ åßíáé áðïôÝëåóìá ðñïóùðéêïý åíäéáöÝñïíôïò ôïõ êáèåíüò êáé ü÷é êÜðïéáò åðßóçìçò åíçìÝñùóçò êáèþò üðùò ãíùñßæåôå äåí õðÜñ÷åé Ýäñá ÃåíéêÞò ÉáôñéêÞò óôï ÐáíåðéóôÞìéï Éùáííßíùí. Ãíùñßæïõìå üôé ðñüêåéôáé ãéá ìéá êáéíïýñãéá åéäéêüôçôá, ôïõëÜ÷éóôïí óå üôé áöïñÜ óôç ÷þñá ìáò, ôåôáñïåôïýò äéÜñêåéáò åêðáßäåõóçò, óôá ðëáßóéá ôçò ïðïßá ïé Ãåíéêïß Ãéáôñïß áóêïýíôáé óå üëåò ôéò åéäéêüôçôåò ãéá äéáöïñåôéêü ÷ñïíéêü äéÜóôçìá óôçí êÜèå ìßá. Åðßóçò ðáñáôçñÞóáìå, üôé ôïõëÜ÷éóôïí ôá ôåëåõôáßá ÷ñüíéá áõîÞèçêå óçìáíôéêÜ ï áñéèìüò ôùí íÝùí óõíáäÝëöùí ðïõ åðéëÝãïõí ôç ÃåíéêÞ ÉáôñéêÞ. ¼ìùò, áí êáé ç åéäéêüôçôá áõôÞ Ýôõ÷å åõñåßáò áðïäï÷Þò áð' ôïí éáôñéêü êüóìï, äéáðéóôþóáìå üôé äåí åßíáé áíÜëïãá åðáñêÞò êáé ç åêðáßäåõóç ðïõ èá ðåñßìåíå Ýíáò íÝïò åéäéêåõüìåíïò Ãåíéêüò Ãéáôñüò. Èá áíáñùôçèåßôå ðïý ôï óôçñßæïõìå áõôü. ÊáôÜ ôçí êëéíéêÞ ìáò Üóêçóç åßäáìå üôé óôçí ðëåéïøçößá ôïõò ïé Ãåíéêïß Ãéáôñïß äåí áíáëáìâÜíïõí ôéò õðï÷ñåþóåéò ðïõ áñìüæïõí óå Ýíáí åéäéêåõüìåíï ãéáôñü, äßíïíôÜò ìáò ðåñéóóüôåñï ôçí åíôýðùóç åíüò “âïçèïý ãéáôñïý”. ÂÝâáéá åìåßò ùò öïéôçôÝò äåí åßìáóôå óå èÝóç íá ãíùñßæïõìå *ÖïéôÞôñéåò ÉáôñéêÞò Ó÷ïëÞò Ðáíåðéóôçìßïõ Éùáííßíùí

áí áõôü ïöåßëåôáé óôïí ðåñéïñéóìÝíï ÷ñüíï ôçò ÜóêçóÞò ôïõò óå êÜèå êëéíéêÞ Þ áí ïé ðñùôïâïõëßåò áõôÝò åßíáé óôá ðëáßóéá ôçò åéäéêüôçôÜò ôïõò êáé åðáñêïýí ðëÞñùò ãé’ áõôÞí. ¼ìùò áêüìç êé áí äå÷ôïýìå üôé üíôùò éó÷ýåé áõôü, ðéóôåýïõìå üôé õðÜñ÷åé Üíéóïò êáôáìåñéóìüò ôïõ ÷ñüíïõ åîÜóêçóçò ôùí Ãåíéêþí Ãéáôñþí óôéò åðéìÝñïõò åéäéêüôçôåò. ÓõãêåêñéìÝíá, äåí ôï âñßóêïõìå óùóôü Ýíáò Ãåíéêüò Ãéáôñüò, ðïõ óôï ìÝëëïí èá êëçèåß íá óôçñßîåé ôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, íá åêðáéäåýåôáé ó÷åäüí ãéá ôçí ßäéá ÷ñïíéêÞ äéÜñêåéá óôéò åéäéêüôçôåò ðñþôçò ãñáììÞò êáé óå ïñéóìÝíåò åñãáóôçñéáêÝò áð' ôéò ïðïßåò ðñáêôéêÜ èá ôïõ ÷ñåéáóôïýí åëÜ÷éóôåò ãíþóåéò. Ïé öïéôçôÝò ëïéðüí, Ý÷ïíôáò äéáìïñöþóåé áõôÞí ôçí åéêüíá ãéá ôïõò ãåíéêïýò ãéáôñïýò, ü÷é ìüíï äåí Ý÷ïõí óôéò ðñþôåò åðéëïãÝò ôïõò ôçí åéäéêüôçôá ôçò ÃåíéêÞò ÉáôñéêÞò, áëëÜ ôïðïèåôïýíôáé ó÷åäüí áäéÜöïñá ùò ðñïò áõôÞí. Åßíáé Üëëùóôå åíäåéêôéêÝò ïé áðáíôÞóåéò äéáöüñùí óõìöïéôçôþí ìáò óôï åñþôçìá: “Ðþò óáò öáßíåôáé ç åðéëïãÞ ôçò ÃåíéêÞò ÉáôñéêÞò ùò åéäéêüôçôá;” Ïé áðáíôÞóåéò ôïõò åðß ëÝîåé Þôáí: “Ðïëý ùñáßá åéäéêüôçôá! ÁëëÜ ôÝóóåñá ÷ñüíéá èá åßìáé “öïéôçôÞò” êáé èá ðëçñþíïìáé ãé’ áõôü!” “Èá ìå êáëýøïõí ìüíï Ýîé ìÞíåò åîÜóêçóç óôçí ðáèïëïãßá;” “ÊáëÞ åéäéêüôçôá ìïõ öáßíåôáé, áëëÜ ãéáôß ôçí åðéëÝãïõí åëÜ÷éóôïé öïéôçôÝò áðü ôá åëëçíéêÜ ðáíåðéóôÞìéá;” Óôç äéáìüñöùóç áõôÞò ôçò áñíçôéêÞò óôÜóçò óõìâÜëëåé âÝâáéá êáé ôï ãåãïíüò üôé ï öïé159


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

ôçôÞò äå óõíåéäçôïðïéåß ôï ðüóï ïõóéáóôéêü Ýñãï ìðïñåß íá ðñïóöÝñåé Ýíáò Ãåíéêüò Ãéáôñüò óôçí ðñÜîç, êáèþò ôï óýóôçìá õãåßáò ôçò ÷þñáò ìáò äåí Ý÷åé áêüìç ôçí êáôÜëëçëç õðïäïìÞ êáé ïñãÜíùóç ðïõ èá áíáäåßîïõí ôïí óçìáíôéêüôåñï ñüëï ôïõ Ãåíéêïý Ãéáôñïý óôá ðëáßóéá ôçò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò. Óáöþò üìùò õðÜñ÷ïõí êáé åêåßíïé ïé óõìöïéôçôÝò ìáò ðïõ äéáêñßíïõí êáé áíáãíùñßæïõí ôïí êáßñéï ñüëï ðïõ èá Ý÷åé Ýíáò Ãåíéêüò Ãéáôñüò óôï Üìåóï ìÝëëïí. Ãíùñßæïõí äçëáäÞ üôé ï Ãåíéêüò Ãéáôñüò ðñïïñßæåôáé íá èåñáðåýåé, íá ðáñáðÝìðåé ôïõò áóèåíåßò óôéò êáôÜëëçëåò åéäéêüôçôåò - üðïõ åßíáé áðáñáßôçôï -, áëëÜ êáé íá óõìâÜëëåé óôçí ðñüëçøç. ¢ëëùóôå óôá êñÜôç üðïõ ç ïñãÜíùóç ôïõ óõóôÞìáôïò õãåßáò áðïôåëåß ðñüôõðï, üðùò ç Óïõçäßá, áõôü åßíáé ôï ôñßðôõ÷ï ôùí äñáóôçñéïôÞôùí ôùí Ãåíéêþí Ãéáôñþí. ÌÝóá óå Ýíá ôÝôïéï óýóôçìá, ï áóèåíÞò äåí ôáëáéðùñåßôáé áíáæçôþíôáò ôïí ãéáôñü ôçò êáôÜëëçëçò åéäéêüôçôáò ãéá ôçí ðÜèçóÞ ôïõ. ¸ôóé ï Ãåíéêüò Ãéáôñüò åîáóöáëßæåé ôçí Ýíáñîç ôçò èåñáðåõôéêÞò áãùãÞò ôïõ áóèåíïýò ìå ôïí ôá÷ýôåñï êáé ïñèüôåñï ôñüðï áëëÜ êáé ìå óáöþò ìéêñüôåñï ïéêïíïìéêü êüóôïò. ¼ìùò åîßóïõ óçìáíôéêüò åßíáé êáé ï ñüëïò ôïõ Ãåíéêïý Ãéáôñïý óå üôé áöïñÜ óôçí ðñüëçøç êáèþò ç õðåñï÷Þ ôçò ðñüëçøçò óå ó÷Ýóç ìå ôç èåñáðåßá èåùñåßôáé äåäïìÝíç. Êáé áõôü ãéáôß ç ðñïëçðôéêÞ éáôñéêÞ åðçñåÜæåé ðåñéóóüôåñï ôïõò äåßêôåò èíçóéìüôçôáò áð’ üôé ç èåñáðåõôéêÞ éáôñéêÞ êáé åßíáé ç ìüíç ðïõ ìðïñåß íá åðçñåÜóåé ôïõ äåßêôåò íïóçñüôçôáò. ÅðéðëÝïí ôá ìÝôñá ðñüëçøçò åßíáé óáöþò áðïäïôéêüôåñá áðü ïéêïíïìéêÞ Üðïøç êáé ðñïóöÝñïõí êáëýôåñç ðïéüôçôá æùÞò. ÂÝâáéá ãéá íá ìðïñÝóåé íá ëåéôïõñãÞóåé Ýíáò Ãåíéêüò Ãéáôñüò óôç ÷þñá ìáò óýìöùíá ìå ôï ðëáßóéï ðïõ ðåñéãñÜøáìå, èá ðñÝðåé íá õðÜñ÷åé êáé ç êáôÜëëçëç ïñãÜíùóç ôïõ óõóôÞìáôïò õãåßáò. Ðñïò áõôÞ ôçí êáôåýèõíóç öáßíåôáé íá êéíåßôáé ôï Õðïõñãåßï Õãåßáò ìå ôçí åðéêåßìåíç èÝóðéóç ôïõ ïéêïãåíåéáêïý - Þ ðñïóùðéêïý, üðùò áíáöÝñåôáé óôï íïìïó÷Ýäéï - ãéáôñïý. ÏõóéáôéêÜ, ï Ãåíéêüò Ãéáôñüò èá åßíáé ï èåìÝëéïò ëßèïò ôïõ

160

Ð. Ìáíïýóïõ êáé óõí.

íÝïõ óõóôÞìáôïò õãåßáò. Êáé âÝâáéá, áõôïß ðïõ êáôÜ âÜóç èá ðëçñïýí ôéò èÝóåéò ôùí ïéêïãåíåéáêþí ãéáôñþí èá åßíáé ïé Ãåíéêïß Ãéáôñïß. Êáôáíïåßôå äçëáäÞ üôé ç ÃåíéêÞ ÉáôñéêÞ, åêôüò ôùí Üëëùí, åßíáé ìéá åéäéêüôçôá ç ïðïßá åîáóöáëßæåé óå áõôüí ðïõ ôçí åðéëÝãåé Üìåóç åðáããåëìáôéêÞ áðïêáôÜóôáóç. Ãéá åìÜò ôïõò öïéôçôÝò, ôï ãåãïíüò áõôü åßíáé Ýíá åðéðëÝïí åðé÷åßñçìá ãéá ôçí åðéëïãÞ ôçò ÃåíéêÞò ÉáôñéêÞò ùò åéäéêüôçôáò, äåäïìÝíïõ üôé ó’ üëåò ó÷åäüí ôéò Üëëåò õðÜñ÷åé êïñåóìüò ü÷é ìüíï óôï äçìüóéï áëëÜ êáé óôïí éäéùôéêü ôïìÝá. Åßíáé öáíåñü ëïéðüí üôé êáèßóôáôáé åðéôáêôéêÞ áíÜãêç ü÷é ìüíï íá áíáôñáðåß ç áäéÜöïñç óôÜóç ôçò ðëåéïøçößáò ôùí óõìöïéôçôþí ìáò áðÝíáíôé óôç ÃåíéêÞ ÉáôñéêÞ, áëëÜ êáé íá áðïêôÞóåé ç ÃåíéêÞ ÉáôñéêÞ ìéá áðü ôéò ðñþôåò èÝóåéò óôéò åðéëïãÝò ôïõò ãéá åéäéêüôçôá. ¢ëëùóôå, êáé áí ôåëéêÜ äåí åðéëÝîïõí íá ãßíïõí Ãåíéêïß Ãéáôñïß, üðïéá åéäéêüôçôá êé áí áóêïýí óôï ìÝëëïí, èá óõíåñãÜæïíôáé Üìåóá Þ Ýììåóá ìå ïéêïãåíåéáêïýò ãéáôñïýò. ÊáôÜ ôç ãíþìç ìáò ï êáôáëëçëüôåñïò ôñüðïò íá åðéôåõ÷èïýí áõôïß ïé óôü÷ïé åßíáé ç åíçìÝñùóç ôùí öïéôçôþí ãéá ôç ÃåíéêÞ ÉáôñéêÞ. ÕðÜñ÷ïõí êáßñéá åñùôÞìáôá ðïõ ðñÝðåé íá áðáíôçèïýí þóôå íá áðïêôÞóïõí ìéá ïëïêëçñùìÝíç Üðïøç ãéá ôçí åéäéêüôçôá áõôÞ. ÓõãêåêñéìÝíá: Ðïéïò áêñéâþò åßíáé ï ñüëïò ôïõ Ãåíéêïý Ãéáôñïý; Ðïý èá áðáó÷ïëçèåß óôï ìÝëëïí; Ðïéåò åßíáé ïé åðáããåëìáôéêÝò ðñïïðôéêÝò; ÐñïâëÝðïíôáé áëëáãÝò óôçí åêðáßäåõóç ôïõ Ãåíéêïý Ãéáôñïý; Ç åíçìÝñùóç ôùí öïéôçôþí èá ìðïñïýóå íá ãßíåé ìÝóá áðü ïìéëßåò, óåìéíÜñéá, Þ êáé áðü åíçìåñùôéêÜ öõëëÜäéá. ¢ëëùóôå, ï ðëçñïöïñçìÝíïò öïéôçôÞò åßíáé åêåßíïò ðïõ èá óôçñßîåé Þ êáé èá åðéëÝîåé ôç ÃåíéêÞ ÉáôñéêÞ êáèïñßæïíôáò ôï ìÝëëïí ôçò. ¸íá ìÝëëïí üìùò ðïõ äéáãñÜöåôáé ëáìðñü ãéá ôç ÃåíéêÞ ÉáôñéêÞ ìüíï áí õðÜñîåé êáé Ýíá ðñüôõðï óýóôçìá õãåßáò ìÝóá óôï ïðïßï èá áíáäåé÷ôåß ï ñüëïò ôçò.


Ôüìïò 12, Ôåý÷ïò 1, 2000

ÏÄÇÃÉÅÓ ÃÉÁ ÔÏÕÓ ÓÕÃÃÑÁÖÅÉÓ INSTRUCTIONS FOR THE AUTHORS Ç "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äÝ÷åôáé ãéá äçìïóßåõóç êåßìåíá Åðéóôçìüíùí Õãåßáò, ôá ïðïßá êáôáôÜóóïíôáé óôéò åîÞò êáôçãïñßåò: 1) ÅñåõíçôéêÝò åñãáóßåò Þ áíáóêïðÞóåéò (óýíôïìåò äçìïóéåýóåéò) Ýêôáóçò ìÝ÷ñé 7 óåëßäåò 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 óõãêåêñéìÝíï ãíùóôéêü ôïìÝá ôçò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò, ìðïñåß íá óõãêñïôåß ÁöéÝñùìá. Åêôüò ôùí êåéìÝíùí ðïõ áíáöÝñïíôáé óôéò ðáñáðÜíù êáôçãïñßåò óôçí "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äçìïóéåýïíôáé êáé Üñèñá ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò, êáèþò êáé êåßìåíá ðïõ áðïóêïðïýí óôçí ðáñïõóßáóç, ó÷ïëéáóìü êáé êñéôéêÞ áîéïëüãçóç óõãêåêñéìÝíùí ãåãïíüôùí, Üñèñùí êáé åêäüóåùí ó÷åôéêþí ìå ôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, óôçí ÅëëÜäá êáé óôï åîùôåñéêü. Ôçí åõèýíç ôçò óõããñáöÞò ôùí Üñèñùí áõôþí Þ êåéìÝíùí Ý÷ïõí ìüíï ôá ìÝëç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò Þ åðéóôÞìïíåò ìåôÜ áðü åéäéêÞ ðñüóêëçóç. Åðßóçò óôçí "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äçìïóéåýïíôáé êáé ãñÜììáôá ðïõ áðåõèýíïíôáé óôçí ÓõíôáêôéêÞ ÅðéôñïðÞ, ôá ïðïßá áíáöÝñïíôáé óå ðáñáôçñÞóåéò, êëéíéêÝò êáé åñåõíçôéêÝò åìðåéñßåò Þ ó÷ïëéÜæïõí ôç äéåèíÞ êáé åëëçíéêÞ âéâëéïãñáößá. Ôçí åõèýíç ãéá ôç äçìïóßåõóç ôùí êåéìÝíùí áõôþí Ý÷åé ï ÄéåõèõíôÞò Óýíôáîçò êáé ç ÓõíôáêôéêÞ ÅðéôñïðÞ. Ïé åñåõíçôéêÝò åñãáóßåò, ôá åíçìåñùôéêÜ Üñèñá, ïé óýíôïìåò äçìïóéåýóåéò êáé ïé áíáöïñÝò ðåñéóôáôéêþí ãßíïíôáé äåêôÜ ãéá äçìïóßåõóç ìüíï ìåôÜ áðü èåôéêÞ êñßóç ôïõò áðü åðéóôÞìïíåò-êñéôÝò ìå ôïõò ïðïßïõò óõíåñãÜæåôáé ôï ðåñéïäéêü. ÊÜèå êåßìåíï ðïõ áðïóôÝëëåôáé óôçí "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äéáâéâÜæåôáé óôïõò êñéôÝò, ÷ùñßò íá ãíùóôïðïéïýíôáé ôá ïíüìáôá ôùí óõããñáöÝùí. Ôá ó÷üëéá êáé ïé ðáñáôçñÞóåéò ôùí êñéôþí óôç óõíÝ÷åéá, ìå ôçí åõèýíç ôçò Ãñáììáôåßáò Óýíôáîçò ôïõ ðåñéïäéêïý, åðéóôñÝöïíôáé óôïõò óõããñáöåßò, ðñïêåéìÝíïõ áõôïß íá ðñïóáñìüóïõí áíÜëïãá ôï êåßìåíü ôïõò ðñéí ôç äçìïóßåõóç. Óå ðåñßðôùóç áóõìöùíßáò ôùí êñéôþí, ôï êåßìåíï èá áîéïëïãåßôáé áðü ôçí ßäéá ôç ÓõíôáêôéêÞ ÅðéôñïðÞ. Ôá ïíüìáôá üëùí ôùí åðéóôçìüíùí ðïõ 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 ðáñáêÜôù ðñïäéáãñáöÝò. • Íá åßíáé ãñáììÝíá óôçí åðßóçìç äçìïôéêÞ ãëþóóá êáé ìå ôï ìïíïôïíéêü óýóôçìá, äáêôõëïãñáöçìÝíá óôç ìßá 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 ôùí óõããñáöÝùí (ìå êåöáëáßá ãñÜììáôá åíþ áíáãñÜöïíôáé ôá áñ÷éêÜ ôùí ïíïìÜôùí êáé ôá ðëÞñç åðþíõìá ìå áñéèìçôéêïýò åêèÝôåò ïé ïðïßïé óå õðïóçìåßùóç ðáñïõóéÜæïõí ôçí éäéüôçôá ôïõ êÜèå óõããñáöÝá), ã) ôï åðéóôçìïíéêü êÝíôñï óôï ïðïßï Ýãéíå ç åñãáóßá, ä) 3-5 ðñüóèåôïõò üñïõò ó÷åôéêÜ ìå ôï èÝìá êáé ïé ïðïßïé åßíáé õéïèåôçìÝíïé áðü ôï Medical Subject Headings (Bethesda Md, 1966), å) ôç äéåýèõíóç êáé ôï ôçëÝöùíï åíüò 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 Ýíäåéîç ÐÅÑÉËÇØÇ), 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 äå èá ðñÝðåé íá Ý÷åé Ýêôáóç ìåãáëýôåñç ôùí 300 ëÝîåùí. Ðñïçãïýíôáé ç ëÝîç SUMMARY, ç áããëéêÞ ìåôÜöñáóç ôïõ ôßôëïõ, ïé ëÝîåéò PRIMARY HEALTH CARE... êáé ôá ïíüìáôá ôùí óõããñáöÝùí ÷ùñßò ôßôëï Þ éäéüôçôá. • Ïé âéâëéïãñáöéêÝò ðáñáðïìðÝò, åëëçíéêÝò êáé îÝíåò, óôï êåßìåíï èá ðñÝðåé íá åßíáé ðñüóöáôåò, áðü áíáãíùñéóìÝíá ðåñéïäéêÜ Þ óõããñÜììáôá, íá åßíáé áñéèìçìÝíåò êáé í’ áíôáðïêñßíïíôáé óôï âéâëéïãñáöéêü êáôÜëïãï, 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 ðáñïõóéÜóôçêáí óôï êåßìåíï. ÊáèåìéÜ áðü áõôÝò èá ðñÝðåé íá ðåñéÝ÷åé óôç óåéñÜ ôá áñ÷éêÜ ôùí ïíïìÜôùí êáé ôá åðþíõìá ôùí óõããñáöÝùí, ôïí ôßôëï ôçò åñãáóßáò, ôï üíïìá ôïõ ðåñéïäéêïý óýìöùíá ìå ôï óýóôçìá ôçò WHOCISO/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 ôïí ôßôëï, ðñÝðåé íá ãñÜöïíôáé êáé ï áñéèìüò êáé ôá óôïé÷åßá Ýêäïóçò (åêäïôéêüò ïßêïò, ðüëç). • 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 ôïõ êåéìÝíïõ, êáèþò êáé ôéò áðáñáßôçôåò åðåîçãÞóåéò. • 'Ïëá ôá êåßìåíá èá ðñÝðåé íá õðïâÜëëïíôáé óå äýï áíôßôõðá êáèþò êáé óå çëåêôñïíéêÞ ìïñöÞ (êáôÜ ðñïôßìçóç ìå êåéìåíïãñÜöï word, ÉÂÌ óõìâáôü) êáé íá áðïóôÝëëïíôáé óôç äéåýèõíóç ôïõ ÄéåõèõíôÞ Óýíôáîçò: - ÐáíåðéóôÞìéï ÊñÞôçò (õðüøéí Åðßêïõñïõ ÊáèçãçôÞ ×. ËéïíÞ), ÔïìÝáò ÊïéíùíéêÞò ÉáôñéêÞò, Ô.È. 1393, ÇñÜêëåéï ÊñÞôçò. 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 êáé óå ðåñßðôùóç áðïäï÷Þò ôçò ãéá äçìïóßåõóç, ôá óõããñáöéêÜ äéêáéþìáôá åê÷ùñïýíôáé óôï ðåñéïäéêü. Ç ÓõíôáêôéêÞ ÅðéôñïðÞ äéáôçñåß ôï äéêáßùìá áðïóýñóåùò ìéáò åñãáóßáò åöüóïí áõôÞ Ý÷åé óôáëåß êáé ó' Üëëï ðåñéïäéêü. 161


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