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ðñùôïâÜèìéá Ôüìïò 14, Ôåý÷ïò 3, Éïýëéïò - ÓåðôÝìâñéïò 2002

öñïíôßäá õãåßáò

Primary Health Care Ôñéìçíéáßá ¸êäïóç ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞò Quarterly edited by the Greek Association of General Practitioners Ôüìïò 14, Ôåý÷ïò 3, Éïýëéïò - ÓåðôÝìâñéïò 2002, Volume 14, Number 3, July - September 2002

ÅñåõíçôéêÝò Åñãáóßåò 109

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

114

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

119

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

ÐÑÙÔÏÂÁÈÌÉÁ ÖÑÏÍÔÉÄÁ ÕÃÅÉÁÓ – Primary Health Care

Åðáéíåèåßóåò Åëåýèåñåò Áíáêïéíþóåéò - 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò 126

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

130

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

139

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

147

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

150

ÍÝá

ÅÍÔÕÐÏ ÊËÅÉÓÔÏ ÁÑÉÈ. ÁÄÅÉÁÓ 451/91 ÊÄÁ ÅËËÇÍÉÊÇ ÅÔÁÉÑÅÉÁ ÃÅÍÉÊÇÓ ÉÁÔÑÉÊÇÓ Ðáðáäéáìáíôïðïýëïõ 4, 115 28 ÁÈÇÍÁ

ISSN 1105-7432


ðñùôïâÜèìéá

öñïíôßäá õãåßáò

Primary Health Care

ÅÊÄÏÔÇÓ:

ÌðïäïóÜêçò-Ðñüäñïìïò Ìåñêïýñçò Ì. ×ïõñìïýæç 28 Ê. Ôïýìðá 544 53 Èåóóáëïíßêç Ôçë. (0310) 910342

Äéïéêçôéêü Óõìâïýëéï ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞò Ðñüåäñïò ÌðïäïóÜêçò-Ðñüäñïìïò Ìåñêïýñçò

ISSN 1105-7432

ÄéåõèõíôÞò Óýíôáîçò

Editor-in-Chief:

×ñÞóôïò ËéïíÞò Åðßêïõñïò ÊáèçãçôÞò ÔìÞìá ÉáôñéêÞò ÐáíåðéóôÞìéï ÊñÞôçò Ô.È. 1393, ÇñÜêëåéï Ôçë. +30 810 39 46 21 Fax. +30 810 39 46 06 E-mail: lionis@med.uoc.gr

Christos Lionis Ássistant Professor Faculty of Medicine University of Crete P.O. Box 1393, Heraklion Tel: +30 810 39 46 21 Fax: +30 810 39 46 06 E-mail: lionis@med.uoc.gr

ÁíáðëçñùôÝò Ä/íôÝò Óýíôáîçò

Associate Editors

Íßêïò ÁíôùíÜêçò E-mail: antonakisnikos@yahoo.gr ÓôÜèçò Óêëçñüò E-mail: eskliros@otenet.gr

Nick Antonakis E-mail: antonakisnikos@yahoo.gr Stathis Skliros E-mail: eskliros@otenet.gr

Åðßêïõñïé Ä/íôÝò Óýíôáîçò

Assistant Editors

ÈùìÜò Áããåëüðïõëïò (Èåóóáëïíßêç) Ðáýëïò ÈåïäùñÜêçò (ÉùÜííéíá) ÅëåõèÝñéïò Èçñáßïò (ÁèÞíá) Êïñíçëßá ÌáêñÞ (ÇñÜêëåéï)

Thomas Aggelopoulos (Thessaloniki) Pavlos Theodorakis (Ioannina) Åleftherios Thireos (Athens) Kornilia Makri (Heraklion)

ÌÝëç ÓõíôáêôéêÞò ÅðéôñïðÞò

Members of Editorial Board

ÓôÝëéïò ÅõáããÝëïõ ÃéÜííçò ÌïíÝäáò ÐçãÞ ÐåñäéêÜêç ¸öç Öñáãêïýëç

Stelios Euaggelou Ioannis Monedas Pigi Perdikaki Efi Fragouli

ÁíôáðïêñéôÝò Óýíôáîçò

Corresponding Editors

Êýðñïò ¸ëåíá ÅõáããåëÜêç Èåïäþñá Æá÷áñéÜäïõ

Cyprus Elena Euaggelaki Theodora Zaxariadou

Áëâáíßá Llukan Rrumbullaku

Albania Llukan Rrumbullaku

ÓõìâïõëåõôéêÞ ÅðéôñïðÞ

Advisory Board

Ð. ÂÜñäáò, ÊáèçãçôÞò Êáñäéïëïãßáò Ðáí/ìßïõ ÊñÞôçò

P. Vardas, Professor of University of Crete

Vice-President A Kostas Moraitis

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

J. Vlachonikolis, Associate Professor of University of Crete

Vice-President B Antonis Karotsis

Ä. ÃëÜñïò, ÊáèçãçôÞò ÉáôñéêÞò ÖõóéêÞò Ðáí/ìßïõ Éùáííßíùí Á. Êñáíßäçò †,

D. Glaros, Professor of University of Ioannina A. Cranidis †,

ÊáèçãçôÞò Ïõñïëïãßáò Ðáí/ìßïõ ÊñÞôçò

Professor of University of Crete

É. Êõñéüðïõëïò, ÊáèçãçôÞò ÅèíéêÞò Ó÷ïëÞò Äçìüóéáò Õãåßáò

J. Kyriopoulos, Professor of National School of Public Health

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

V. Mavreas, Professor of University of Ioannina

Í. ÓéáöÜêáò, ÊáèçãçôÞò Ðíåõìïíïëïãßáò Ðáí/ìßïõ ÊñÞôçò

N. Siafakas, Professor of University of Crete

Ó. ÓìðõñÜêéò, ÊáèçãçôÞò ÐáéäéáôñéêÞò Ðáí/ìßïõ ÊñÞôçò

S. Smpyrakis, Professor of University of Crete

Ë. ÓðÜñïò, ÊáèçãçôÞò ÊïéíùíéêÞò ÉáôñéêÞò Ðáí/ìßïõ Áèçíþí

L. Sparos, Professor of University of Athens

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

A. Philalithis, Associate Professor of University of Crete

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

G. Christodoulou, Professor of University of Athens

Áíôéðñüåäñïò Á Êþóôáò ÌùñáÀôçò Áíôéðñüåäñïò  Áíôþíçò Êáñüôóçò Ãåíéêüò ÃñáììáôÝáò-Ôáìßáò ÁèáíÜóéïò Óõìåùíßäçò ÌÝëç ÐçãÞ ÐåñäéêÜêç ÓôÜèçò Óêëçñüò ÌÜñéïò ×áôæçáñóÝíçò

Executive Board of the Greek Association of General Practitioners President Bodosakis-Prodromos Merkouris

General Secretary Treasurer Athanasios Symeonidis Members Marios Chatziarsenis Pigi Perdikaki Stathis Skliros Ãñáììáôåßá Óýíôáîçò: Áíáóôáóßá Ñùìáíßäïõ Ôçë.: (08310) 394615, (08310) 25833 e-mail: primcare@fammed.med.uoc.gr Åêôýðùóç: ÔÅ×ÍÏÃÑÁÌÌÁ Ì. ÁõãÝñç 12, 153 43 Áã. ÐáñáóêåõÞ Ôçë.: 010.60.00.643, Fax: 010.6002295 E-mail: techn@hol.gr


ðñùôïâÜèìéá

öñïíôßäá õãåßáò

Primary Health Care Ôñéìçíéáßá ¸êäïóç ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞò Quarterly edited by the Greek Association of General Practitioners Ôüìïò 14, Ôåý÷ïò 3, Ioýëéïò - ÓåðôÝìâñéïò 2002, Volume 14, Number 3, July - September 2002

ÐÅÑÉÅ×ÏÌÅÍÁ ÅñåõíçôéêÝò Åñãáóßåò Ã. Ðáðáäüðïõëïò, Ä. Ìðñßìçò, Í. ÄñáêùíÜêçò, Ñ. ÁëåîáíäñÜêç, Ê. Óåñáöåéìßäïõ, Å. ÓôáõñáêÜêç, Ã. ÐáôåñÜêçò, Ç. Êõñéáêïý: Äåßêôåò èíçóéìüôçôáò óôïí ðëçèõóìü ôçò ðåñéï÷Þò åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò ×Üñáêá ôïõ Íïìïý Çñáêëåßïõ ................................................................................................................................................................................................................. 109 Ê. Óïõëéþôçò, A. Äüëãåñáò, Ä. Êüíôïò, ×. Ïéêïíüìïõ: Ç Éêáíïðïßçóç ôùí áóèåíþí áðü ôç íïóïêïìåéáêÞ öñïíôßäá óôçí ÅëëÜäá: ÁðïôåëÝóìáôá Ýñåõíáò ãíþìçò óôçí åõñýôåñçò ðåñéï÷Þò Áèçíþí .................................................. 114 Áíáóêüðçóç Ê. Ðáðáäçìçôñßïõ, Á. Ãêßêáò, Ã. ÌðÝëïò: ÊëéíéêÞ ðñïóÝããéóç ôçò HIV ëïßìùîçò. Ï ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý óôçí ðáñáêáëïýèçóç êáé öñïíôßäá ôùí áóèåíþí ìå HIV/AIDS ..................................... 119 Åðáéíåèåßóá Åëåýèåñç Áíáêïßíùóç - 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò É. ÌïíÝäáò, Á. Èáíïðïýëïõ, Í. ÄçìçóéÜíïò, È. ÄÜóéïò, Ô. ÍôÜöçò, Â. Óôáóéíüò, Â. ÌÞëéá, Í. Ðáôïýíçò, E. ÑÝããéïõ: Óõó÷åôéóìüò óùìáôïìåôñéêþí äåéêôþí êáé áñôçñéáêÞò ðßåóçò óå ìáèçôÝò áãñïôéêÞò ðåñéï÷Þò Íüôéáò ÊÝñêõñáò . 126 Ã. Ôóßñïò, Ä. Êáëïãåñüðïõëïò, Ðáí. ÂïÀëá, ×ñ. Âüóóïõ, Ã. ÊáñäÜôïò, Ã. ÌïõæÜêçò, Í. ÌáãêëÜñáò, Ð. Áèáíáóüðïõëïò, Áéê. Ãáôïðïýëïõ: Ðñüëçøç, áíôéìåôþðéóç êáé óõìðåñéöïñÜ ôùí éáôñþí óå èÝìáôá õãåßáò ôïõò .............................................................................................................................................................................................................. 130 Ê. Óôåöáíïðïýëïõ, Ó. Ãêïíôüëéáò, ×. ÓðõñÜêç, Á. Ðáñáóýñç, Á. ÐåôñÜêç, Í. ÐáðáäÜêçò, Á. Ìðáôßêáò: Aîéïëüãçóç ôùí áðïôåëåóìÜôùí ôçò ðáñÝìâáóçò ôïõ éáôñïý ðåñéöåñåéáêïý éáôñåßïõ óå ãíùóôü ðëçèõóìü óáê÷áñïäéáâçôéêþí ôçò ðåñéï÷Þò åõèýíçò ôïõ ìåôÜ ôçí ðáñÝëåõóç åíüò Ýôïõò ........................................................................... 139 ÁíáöïñÜ Ðåñßðôùóçò Ð. Âïõäïýñç, Á. ÂÞôáò, ×. ×áôæçåëåõèåñßïõ: ÏóôéêÞ ðñïóâïëÞ óå ðåñéóôáôéêü óõããåíïýò óýöéëçò êáé äéáöïñïäéÜãíùóç ìå ôï óýíäñïìï ôïõ êáêïðïéçìÝíïõ ðáéäéïý ........................................................................................................... 147 ÍÝá ....................................................................................................................................................................................................................................... 150

CONTENTS Original Papers G. Papadopoulos, D. Brimis, N. Drakonakis, R. Alexandraki, K. Serafimidou, E. Stavrakaki, G. Paterakis, H. Kiriakou: Mortality rates for the population of the Harakas Primary Health Care Centre ............................................................ 109 K. Souliotis, A. Dolgeras, D. Kontos, C. Economou: Patient Satisfaction with Hospital Care in Greece: Results from a telephone study in the Greater Athens area ............................................................................................................................... 114 Review Ê. Papadimitriou, A. Gikas, G. Belos: A clinical approach to HIV infection. The role of the General Practitioner in HIV care ............................................................................................................................................................................................................. 119 Awarded Freestanding Papers - 14th Hellenic Congress in General Practice I. Monedas, A. Thanopoulou, N. Dimisianos, T. Dasios, T. Ntafis, V. Stasinos, B. Milia, N. Patounis, E. Reggiou: Correlation of body mass index (BMI) and blood pressure in students of a rural area of Corfu ............................................. 126 G. Tsiros, D. Kalogeropoulos, P. Voila, Ch. Vossou, G. Kardatos, G. Mouzakis, N. Maglaras, P. Athanasopoulos, E. Gatopoulou: Doctors' attitudes and behaviour in themes of their own health ..................................................................................... 130 K. Stefanopoulou, S. Gantolias, X. Spiraki, A. Parasiri, A. Petraki, N. Papadakis, A. Batikas: Evaluation of an intervention programme by the peripheral medical station physician (PMSP) in a known population of NIDDM patients in their area of responsibility after one year of its application .............................. 139 Case Report P. Vuduri, Ath. Vitas, Ch. Hatzieleftheriu: Bone assault in cases of congenital syphilis and differentiation with that of child abuse syndrome ..................................................................................................................................................................................... 147 Íews ................................................................................................................................................................................................................................... 150


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ã. Ðáðáäüðïõëïò êáé óõí.

ÅÑÅÕÍÇÔÉÊÇ ÅÑÃÁÓÉÁ ORIGINAL PAPER Primary Heatlh Care, Volume 14, Number 3, 109-113, 2002 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 109-113, 2002

Äåßêôåò èíçóéìüôçôáò óôïí ðëçèõóìü ôçò ðåñéï÷Þò åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò ×Üñáêá ôïõ Íïìïý Çñáêëåßïõ Ã. Ðáðáäüðïõëïò1, Ä. Ìðñßìçò1, Í. ÄñáêùíÜêçò2, Ñ. ÁëåîáíäñÜêç2, Ê. Óåñáöåéìßäïõ3, Å. ÓôáõñáêÜêç3, Ã. ÐáôåñÜêçò3, Ç. Êõñéáêïý3

Ðåñßëçøç Óêïðüò ôçò ìåëÝôçò áõôÞò Þôáí íá åíôïðéóôïýí ïé êõñéüôåñåò áéôßåò èáíÜôïõ ôïõ ðëçèõóìïý åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò ×Üñáêá, íá âñåèåß ç åéäéêÞ èíçóéìüôçôá ùò ðñïò ôï öýëï, çëéêßá êáé áéôßá êáé íá ãßíåé ðñïôõðïðïßçóç êáé óýãêñéóç ôùí êõñéïôÝñùí áéôéþí èáíÜôïõ ìå áõôÝò ôçò ÅëëçíéêÞò åðéêñÜôåéáò. Åðßóçò íá óõãêñéèïýí ôá áðïôåëÝóìáôá ìå áõôÜ Üëëùí ðåñéï÷þí ôçò ÊñÞôçò. ÅñåõíÞèçêáí 925 èÜíáôïé áðü ôï 1985 ùò ôï 1997. Ïé áéôßåò èáíÜôïõ êáôáãñÜöçêáí áðü ôá ðéóôïðïéçôéêÜ èáíÜôïõ áêïëïõèþíôáò ôéò ïäçãßåò êáé ôïõò êáíüíåò ôïõ ÐÏÕ ãéá ôç óùóôÞ åêôßìçóç ôùí áéôéþí èáíÜôïõ. Õðïëïãßóôçêå ç áäñÞ êáé åéäéêÞ èíçóéìüôçôá ùò ðñïò ôï öýëï, ôçí çëéêßá êáé ôçí áéôßá èáíÜôïõ ãéá ôéò ôñåéò çëéêéáêÝò ïìÜäåò (0-14, 15-64, 65+) êáé õðïëïãßóôçêå ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá ãéá ôéò êýñéåò áéôßåò èáíÜôïõ. Ôá íïóÞìáôá ôïõ êõêëïöïñéêïý óõóôÞìáôïò áðü ôïõò ïëéêïýò èáíÜôïõò Þôáí 30,5%, ôá íåïðëÜóìáôá 16,9% êáé ôá íïóÞìáôá ôïõ áíáðíåõóôéêïý óõóôÞìáôïò 8,2%. Ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá áðü íïóÞìáôá ôïõ êõêëïöïñéêïý Þôáí 300/100000 êáé ÷áìçëüôåñç áðü áõôÞ ôçò ÅëëçíéêÞò åðéêñÜôåéáò (477/100000) êáé áðü íåïðëïóìáôéêÝò íüóïõò 160/100000 Ýíáíôé 190,5/100000 ôçò åðéêñÜôåéáò. Åðßóçò ç ðåñéï÷Þ ôïõ Ê.Õ. ×Üñáêá ðáñïõóéÜæåé ìéêñüôåñïõò äåßêôåò èíçóéìüôçôáò áðü üëá ôá íïóÞìáôá, áðü Üëëåò ðåñéï÷Ýò ôçò ÊñÞôçò ðïõ Ý÷ïõí åñåõíçèåß, üðùò ï Áã, Âáóßëåéïò êáé ï äÞìïò Áíùãåßùí. Ç äéá÷ñïíéêÞ ðáñáêïëïýèçóç ôùí äåéêôþí ôçò ðåñéï÷Þò ôïõ ×Üñáêá áëëÜ êáé Üëëùí ðåñéï÷þí èåùñåßôáé áíáãêáßá, ëüãù ôïõ üôé ç óùóôÞ áíÜëõóÞ ôïõò ìðïñåß íá óõìâÜëåé óôïí ðñïóäéïñéóìü ôùí ðñïâëçìÜôùí õãåßáò ôçò ðåñéï÷Þò êáèþò êáé óôç ó÷åäßáóç êáé åöáñìïãÞ ðñïãñáììÜôùí áãùãÞò õãåßáò ôïõ ðëçèõóìïý.

1

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

ÅéóáãùãÞ Ï ðëçèõóìüò ôçò ÊñÞôçò ðáñïõóéÜæåé ìåãÜëï åíäéáöÝñïí áðü Üðïøç äéåñåýíçóçò ôùí áéôéþí èáíÜôïõ ìéá êáé ç èíçóéìüôçôá áðü éó÷áéìéêÞ êáñäéáêÞ íüóï öÜíçêå áðü ìéá ìåëÝôç íá åßíáé ÷áìçëÞ1. Åäþ êáé ÷ñüíéá, áñêåôÝò ìåëÝôåò Ýãéíáí ó÷åôéêÜ ìå ôï èÝìá ôçò èíçóéìüôçôáò óôïí Êñçôéêü ðëçèõóìü êáé ôá áðïôåëÝóìáôá ðïéêßëëïõí. Ç êáôáãñáöÞ ôùí èáíÜôùí óôçí ÅëëÜäá èåùñåßôáé ðëÞñçò. Ðáñüëï ðïõ ïé äåßêôåò áäñÞò êáé åéäéêÞò èíçóéìüôçôáò ùò ðñïò ôï öýëï êáé ôçí áéôßá ìðïñïýí íá õðïëïãéóôïýí ìå áêñßâåéá, ïé äåßêôåò åéäéêÞò èíçóéìüôçôáò ùò ðñïò ôçí áéôßá èáíÜôïõ äåí åßíáé áêñéâåßò1,2. Óôçí ðåñéï÷Þ ôïõ ÊÝíôñïõ Õãåßáò ×Üñáêá åßíáé ç ðñþôç öïñÜ ðïõ åðé÷åéñåßôáé ìéá ôÝôïéá ìåëÝôç êáé ôá áðïôåëÝóìáôá áíáìÝíïíôáé ìå åíäéáöÝñïí äåäïìÝíïõ üôé ç ðåñéï÷Þ åõèýíçò ôïõ åßíáé ìåãÜëç (11 êïéíüôçôåò ìå ðåñßðïõ 18000 êáôïßêïõò éäßùò ôïõò ËÝîåéò êëåéäéÜ: äåßêôåò èíçóéìüôçôáò, ðñùôïâÜèìéá öñïíôßäá õãåßáò ÕðïâëÞèçêå: 8 Éïõíßïõ 1999 ÅðáíõðïâëÞèçêå: 27 Öåâñïõáñßïõ 2001 ¸ãéíå äåêôÞ ãéá äçìïóßåõóç: 30 ÌáÀïõ 2001 Õðåýèõíïò áëëçëïãñáößáò: Ã. Ðáðáäüðïõëïò, Ðáñíáóóïý 7, 71303 ÇñÜêëåéï ÊñÞôçò, Ôçë.: (2810)310450 109


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ã. Ðáðáäüðïõëïò êáé óõí.

êáé öýëï ôïõ Ýôïõò 1991, åëÞöèçóáí áðü ôçí ÅëëçíéêÞ ÓôáôéóôéêÞ Õðçñåóßá.4 Ïé õðü ìåëÝôç êïéíüôçôåò ðáñïõSummary óéÜæïõí äéáôñïöéêÝò êáé êëéìáôïëïãéThis study investigates the mortality rates and causes of death from 1985 to êÝò äéáöïñÝò. Ïé ðåñéóóüôåñåò êïéíü1997, in the area of the Harakas Health Centre, with the aim of establishing the ôçôåò âñßóêïíôáé óå ðåäéíü ìÝñïò êáé main causes of death of the population, and to compare the results with those of the Greek national average rate and other similar studies made throughout ïé êÜôïéêïé åßíáé áãñüôåò ðïõ áó÷ïCrete. From 1985 until 1997, 925 subjects died in the research area, 471 male ëïýíôáé ìå êáëëéÝñãåéá åëáéüäåíôñùí and 454 female. To determine the causes of death the guidelines and instrucêáé áìðåëéþí. ¼ìùò êÜðïéåò êïéíüôçtions of the World Health Organization (WHO) were followed. The mortality from ôåò âñßóêïíôáé óå ìåãÜëï õøüìåôñï, circulatory diseases was found to be 30,5%, neoplasmatic diseases 16,9% and respiratory diseases 8,2%. The Harakas mortality rate from circulatory diseases óå ïñåéíÞ æþíç êáé ç áó÷ïëßá ôïõò was found to be lower than that of the Greek national average rate (300/ åßíáé áðïêëåéóôéêÜ ìå êôçíïôñïößá. 100000 against 477/100000). It was also found to be lower than that of both Ç óõëëïãÞ ôùí óôïé÷åßùí Ýãéíå the Agios Vasilios and Anogia study results. The standardized mortality from malignant neoplasms was also found to be lower than that of the Greek national áðü ôá ðéóôïðïéçôéêÜ èáíÜôïõ. Äõíárate (160/100000 against 190/100000). It was also shown to be lower than the ôüôçôá ãéá íá áíôëçèïýí ðëçñïöïstudy of Ag. Vassilios (187,8/100000) and significantly lower than that of the ñßåò áðü ôïí éáôñéêü öÜêåëï üðùò Ý÷åé Anogia study (264,9/100000). In conclusion, from the results of this study the åðé÷åéñçèåß áðü Üëëåò ó÷åôéêÝò ìåëÝcorrect analysis could help in the recognition of the health problems of the people in the area, enabling the appropriate health programmes to be initiated. ôåò5 äåí õðÞñ÷å, áöïý äåí ëåéôïõñãïýKey words: mortality rates, primary health care óå áñ÷åßï êáôáãñáöÞò éáôñéêþí éóôïHarakas Health Centre, Crete ñéêþí ôçí ðåñßïäï ôçò ðáñïýóáò ìåëÝôçò. Ç äéáäéêáóßá ðïõ áêïëïõèÞèçêáëïêáéñéíïýò ìÞíåò). êå Þôáí ç åîÞò: Óêïðüò ôçò ìåëÝôçò áõôÞò åßíáé íá åíôïðé• óõëëïãÞ áíôéãñÜöùí ôùí ðéóôïðïéçôéêþí óôïýí ïé êõñéüôåñåò áéôßåò èáíÜôïõ ôïõ ðëçèõèáíÜôïõ óìïý åõèýíçò ôïõ ÊÝíôñïõ Õãåßáò ×Üñáêá, íá • êáèïñéóìüò ôùí õðïêåßìåíùí áéôéþí èáíÜâñåèåß ç åéäéêÞ ùò ðñïò ôï öýëï, çëéêßá êáé áéôßá ôïõ èíçóéìüôçôá ôïõ ðëçèõóìïý êáé íá ãßíåé óýãêñé• êáôáñôéóìüò âÜóçò äåäïìÝíùí êáé áíÜëõóÞ óç-ðñïôõðïðïßçóç ôùí êõñéïôÝñùí áéôéþí èáíÜôïõò ôïõ ìå áõôÞ ôçò ÅëëçíéêÞò åðéêñÜôåéáò. Åðßóçò ÅêôéìÞèçêå ç õðïêåßìåíç áéôßá 925 èáíÜíá óõãêñéèïýí ôá áðïôåëÝóìáôá ìå áõôÜ Üëëùí ôùí ìïíßìùí êáôïßêùí ôùí ðåñéï÷þí ìåëÝôçò ôç ðåñéï÷þí ôçò ÊñÞôçò. ÷ñïíéêÞ ðåñßïäï 1985-1997, êáé åöáñìüóôçêáí ïé ïäçãßåò ôïõ Ðáãêüóìéïõ Ïñãáíéóìïý Õãåßá (ÐÏÕ) ãéá ôç óùóôÞ åêôßìçóç ôçò õðïêåßìåíçò Ðëçèõóìüò ìåëÝôçò êáé ìÝèïäïò áéôßáò èáíÜôïõ áðü ôï ðéóôïðïéçôéêü. Åðßóçò ç êùäéêïðïßçóç ôùí áéôéþí èáíÜôïõ Ýãéíå ìå âÜóç Ôïí ðëçèõóìü ìåëÝôçò áðïôÝëåóáí ïé ìüíé- ôç äéåèíÞ óôáôéóôéêÞ ôáîéíüìçóç ôùí íüóùí, êáìïé êÜôïéêïé ôùí ðáñáðÜíù ðåñéï÷þí êáôÜ ôç êþóåùí, êáé áéôéþí èáíÜôïõ ôïõ ÐÏÕ6. Óå Ýíá ðïóïóôü ðéóôïðïéçôéêþí äåí Þôáí ÷ñïíéêÞ ðåñßïäï áðü ôï 1985 Ýùò êáé ôï 1997. Ï ðëçèõóìüò ÷ùñßóôçêå óå ôñåéò çëéêéáêÝò ïìÜ- êáôáãñáììÝíá óùóôÜ áðü ôï ãéáôñü ôá óôïé÷åßá ôáõôüôçôáò ôïõ èáíüíôïò (çëéêßá). Ôá ðéóôïðïéçäåò. Ïé êïéíüôçôåò ðïõ ðåñéåëÞöèçóáí óôç ìåëÝ- ôéêÜ áõôÜ Þôáí ÷åéñüãñáöá êáé áöïñïýóáí êõñßùò áðïìáêñõóìÝíåò ðåñéï÷Ýò. Ç êáôáíïìÞ ôïõò ôç åßíáé: Êïéí. Áóçìéïý: 1104 êáô., êïéí. Á÷åíôñéÜ: óå çëéêéáêÞ ïìÜäá Ýãéíå ìå âÜóç ðëçñïöïñßåò 367 êáô., êïéí. ÅèéÜò: 479 êáô., êïéí. Ìåóï÷ù- áðü ôïõò ïéêåßïõò ôïõò. Åðßóçò äåí èåùñÞóáìå ñßïõ: 809 êáô., êïéí. Ðýñãïõ: 1080 êáô., êïéí. óêüðéìç ôçí áíáèåþñçóç ôùí õðïêåßìåíùí áéÓïêáñÜ: 994 êáô. êïéí. Óôïëþí: 588 êáô., êïéí. ôéþí èáíÜôïõ üðùò Ýãéíå óå Üëëåò ðáñüìïéåò Ôåöåëßïõ; 1006 êáô., êïéí. ×Üñáêá: 923 êáô., ìåëÝôåò1,6 óôéò ðåñéðôþóåéò üðïõ áíáãñáöüôáí êïéí. Ìåôáîï÷ùñßïõ: 718 êáô. Ôá óôïé÷åßá ãéá áóáöþò ëüãù ôïõ üôé äåí õðÞñ÷å áñ÷åßï êáôáôïí ðëçèõóìü êáé ôçí êáôáíïìÞ ôïõ êáôÜ çëéêßá ãñáöÞò áóèåíþí, ïýôå êáôïñèþóáìå íá Ý÷ïõìå Mortality rates for the population of the Harakas Primary Health Care Centre G. Papadopoulos, D. Brimis, N. Drakonakis, R. Alexandraki, K. Serafimidou, E. Stavrakaki, G. Paterakis, H Kiriakou

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Ôüìïò 14, Ôåý÷ïò 3, 2002

Ã. Ðáðáäüðïõëïò êáé óõí.

éáôñéêü éóôïñéêü áõôþí ôùí ðåñéðôþóåùí. Óôç óõíÝ÷åéá Ýãéíå åðåîåñãáóßá ôùí óôïé÷åßùí áõôþí êáé õðïëïãßóôçêáí ïé äåßêôåò áäñÞò êáé åéäéêÞò èíçóéìüôçôáò ùò ðñïò ôï öýëï, çëéêßá êáé áéôßá èáíÜôïõ, ãéá ôéò ôñåéò çëéêéáêÝò ïìÜäåò (0-14/ 15-64/65+) êáé õðïëïãßóôçêå ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá ãéá ôéò êýñéåò áéôßåò èáíÜôïõ ìå ôç ÷ñÞóç ôïõ ôýðïõ ôçò Üìåóçò ðñïôõðïðïßçóçò: ÓÌijÓj Dj = K Ósi ¼ðïõ Dj = ðñïôõðïðïéçìÝíï ðïóïóôü èíçóéìüôçôáò áðü ôçí áéôßá Mij = åéäéêÞ êáôÜ çëéêßá êáé áéôßá èíçóéìüôçôá Si = ðñüôõðïò ðëçèõóìüò çëéêßáò Ê = 100000 Ùò ðñüôõðïò ðëçèõóìüò ÷ñçóéìïðïéÞèçêå ï óõíïëéêüò ðëçèõóìüò ôçò ÅëëÜäáò óýìöùíá ìå ôçí áðïãñáöÞ ôïõ 19914. ÁðïôåëÝóìáôá Óôïí ðßíáêá 1 ðáñïõóéÜæåôáé ï ðëçèõóìüò ìåëÝôçò êáôá÷ùñçìÝíïò êáôÜ çëéêßá êáé öýëï, ï áñéèìüò èáíÜôùí êáé ç åéäéêÞ ùò ðñïò ôï öýëï

êáé çëéêßá èíçóéìüôçôá áíÜ Ýôïò. ÓõíïëéêÜ óôï äéÜóôçìá 1985-1997 óçìåéþèçêáí 925 èÜíáôïé áðü ôïõò ïðïßïõò ïé 805 áöïñïýóáí Üôïìá çëéêßáò Üíù ôùí 65 åôþí, ïé 115 Üôïìá çëéêßáò 1564 êáé ïé 5 Üôïìá áðü 0-14 Ýôç. Ç åéäéêÞ ùò ðñïò ôï öýëï èíçóéìüôçôá Þôáí ìåãáëýôåñç óôïõò Üíäñåò êõñßùò óôéò çëéêßåò ôùí 15-64. Óôïí ðßíáêá 2 ðáñïõóéÜæåôáé ç åéäéêÞ êáé áíáëïãéêÞ èíçóéìüôçôá áíÜ 100000 êáé áíÜ Ýôïò, áðü äéÜöïñåò áéôßåò èáíÜôïõ, ôáîéíïìçìÝíåò êáôÜ êáôçãïñßåò êáé óõ÷íüôçôá ìå ôçí ïðïßá óõíáíôþíôáé. Ôá íïóÞìáôá ôïõ êõêëïöïñéêïý óõóôÞìáôïò âñÝèçêáí íá åßíáé óôçí ðñþôç èÝóç ìå 30,5% ôïõ óõíüëïõ ôùí èáíÜôùí, ïé áóáöþò êáèïñéæüìåíåò êáôáóôÜóåéò óôç äåýôåñç èÝóç ìå 18,8%, ïé íåïðëáóìáôéêÝò íüóïé áêïëïõèïýí ìå 16,9%, êáé ôá íïóÞìáôá ôïõ áíáðíåõóôéêïý óõóôÞìáôïò ìå 8,2%. Óôïí ðßíáêá 3 ðáñïõóéÜæåôáé ç åéäéêÞ èíçóéìüôçôá áíÜ çëéêßá êáé öýëï ãéá ôá íïóÞìáôá ôïõ êõêëïöïñéêïý, ôá íåïðëÜóìáôá, ôá íïóÞìáôá ôïõ ðåðôéêïý, ôïõ áíáðíåõóôéêïý êáé ôùí êáêþóåùíäçëçôçñéÜóåùí, êáèþò êáé ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá ùò ðñïò ôçí çëéêßá êáé öýëï, ãéá ôéò óõ÷íüôåñåò áéôßåò èáíÜôïõ ôïõ õðü ìåëÝôç ðëçèõóìïý.

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

Ðëçèõóìüò

ÅéäéêÞ èíçóéìüôçôá/1000/Ýôïò

Çëéêßåò

¢ññåíåò

ÈÞëåéò

Óýíïëï

¢ññåíåò

ÈÞëåéò

Óýíïëï

¢ññåíåò

ÈÞëåéò

Óýíïëï

0-14 15-64 65+ Óýíïëï

2 79 390 471

3 36 415 454

5 115 805 925

875 2640 607 4122

823 2416 707 3946

1695 5056 1314 8068

0,1 2,3 49,4 8,7

0,2 1,1 45,1 8,8

0,2 1,7 47,1 8,8

Ðßíáêáò 2. ÅéäéêÞ êáé áíáëïãéêÞ èíçóéìüôçôá áíÜ áéôßá èáíÜôïõ ôçí ðåñßïäï 1985-1997 ÈÜíáôïé ÍïóÞìáôá êõêëïöïñéêïý Áóáöþò êáèïñéæüìåíåò êáôáóôÜóåéò ÍåïðëÜóìáôá ÍïóÞìáôá áíáðíåõóôéêïý ÍïóÞìáôá ðåðôéêïý ÍïóÞìáôá ïõñïðïéïãåííçôéêïý Êáêþóåéò-äçëçôçñéÜóåéò ÅíäïêñéíéêÜ êáé ìåôáâïëéêÜ íïóÞìáôá Ëïéìþäç êáé ðáñáóéôéêÜ íïóÞìáôá ÍïóÞìáôá áßìáôïò êáé áéìïðïéçôéêþí ïñãÜíùí ÍïóÞìáôá íåõñéêïý ÍïóÞìáôá ïóôþí êáé áñèñþóåùí Øõ÷éáôñéêÜ íïóÞìáôá Óýíïëï

320 198 178 86 30 27 23 19 15 14 10 3 2 925

ÅéäéêÞ èíçó./ 100.000/Ýôïò

ÁíáëïãéêÞ èíçóéìüôçôá (%)

305 188,7 169,7 82 28,6 25,7 22 18 14,3 13,3 9,5 2,8 1,9 882

34,5 21,4 18,2 9,2 3,2 2,9 2,4 2 1,6 1,5 1 0,3 0,2 100 111


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ã. Ðáðáäüðïõëïò êáé óõí.

Ðßíáêáò 3. ÅéäéêÞ êáé ðñïôõðïðïéçìÝíç èíçóéìüôçôá ãéï ôéò óõ÷íüôåñ��ò áéôßåò èáíÜôïõ áðü ôï 1985-1997 ÅéäéêÞ èíçóéìüôçôá/100.000/Ýôïò ÍïóÞìáôá êõêëïöïñéêïý (óõíïëéêÜ) ¢ññåíåò ÈÞëåéò Óýíïëï ÍåïðëÜóìáôá ¢ññåíåò ÈÞëåéò Óýíïëï ÍïóÞìáôá áíáðíåõóôéêïý ¢ññåíåò ÈÞëåéò Óýíïëï ÍïóÞìáôá ðåðôéêïý ¢ññåíåò ÈÞëåéò Óýíïëï Êáêþóåéò-äçëçôçñéÜóåéò ¢ññåíåò ÈÞëåéò Óýíïëï

15-64

65+

Óýíïëï

èíçóéìüôçôá/100.000/Ýôïò

0 0 0

64,1 54,1 59,3

1748,8 1555,8 1645

296,7 313,8 305

290 310 300

351 186 272

87,4 130,5 108

709,6 489,6 591,2

167,9 171,5 169,7

169,9 159,9 160

0 0 0

5,8 0 5,8

671,6 337,2 491,7

102,6 60,4 81,9

86 51 68,2

0 0 0

11,6 22,2 16,7

139,3 87 111,2

27,9 29,2 28,6

23,8 27,9 25,9

0 0 0

23,3 6,3 15,2

114 43,5 76,1

31,7 11,6 21,9

29,7 10,8 20,1

ÓõæÞôçóç Ïé ìåëÝôåò óôáôéóôéêÞò èíçóéìüôçôáò óõíáíôïýí êõñßùò ðñïâëÞìáôá åðáíáëçðôüôçôáò (reliability) êáé åãêõñüôçôáò (validity). Ôüóï ç åðáíáëçðôüôçôá üóï êáé ç åãêõñüôçôá ôùí óôáôéóôéêþí áõôþí, åîáñôþíôáé áðü ôéò äéáäéêáóßåò ðïõ áêïëïõèÞèçêáí3,7,8. Óôç ìåëÝôç ìáò áêïëïõèÞèçêáí ïé êáíüíåò ôïõ ÐÏÕ ãéá ôçí êáôáãñáöÞ ôçò õðïêåßìåíçò áéôßáò èáíÜôïõ. Äåí ìðïñÝóáìå üìùò íá óõãêåíôñþóïõìå óõìðëçñùìáôéêÝò ðëçñïöïñßåò áðü Üëëåò ðçãÝò ó÷åôéêÜ ìå ôéò ðåñéðôþóåéò ðïõ äåí êáèïñßæïíôáí ìå áêñßâåéá ïé õðïêåßìåíåò áéôßåò èáíÜôïõ. Ôá ðéóôïðïéçôéêÜ èáíÜôïõ ìå áóáöÞ äéÜãíùóç Þôáí ðåñßðïõ 60 êáé ðñïóôÝèçêáí óôéò áóáöþò êáèïñéæüìåíåò êáôáóôÜóåéò. Áöïñïýóáí ðåñéï÷Ýò áðïìáêñõóìÝíåò êáé êõñßùò ìüíá êáé çëéêéùìÝíá Üôïìá ðïõ äåí åß÷áí ôç äõíáôüôçôá óõ÷íÞò åðáöÞò ìå ôï ãéáôñü. Ãåãïíüò åßíáé ðÜíôùò üôé êáé óôç ìåëÝôç ìáò ôï ðïóïóôü ôùí áóáöþò êáèïñéæüìåíùí êáôáóôÜóåùí êáôáëáìâÜíåé õøçëÝò èÝóåéò óôçí êáôáãñáöÞ áéôéþí èáíÜôïõ, üðùò áêñéâþò óõìâáßíåé óå üëåò ôéò ìåëÝôåò ôïõ åßäïõò. Áõôü öáíåñþíåé ôçí áäõíáìßá ôïõ ãéáôñïý ðïõ óõìðëçñþíåé ôï ðéóôïðïéçôéêü èáíÜôïõ íá ãíùñßæåé ôçí áêñéâÞ áéôßá èáíÜôïõ, 112

ÐñïôõðïðïéçìÝíç

0-14

ãåãïíüò ðïõ åßíáé óõ÷íü óôç ÷þñá ìáò1,2,5. Ç ðñïôõðïðïßçóç ôùí äåéêôþí èíçóéìüôçôáò, ìáò åðéôñÝðåé ôç óýãêñéóç ôçò èíçóéìüôçôáò êáôÜ áéôßá èáíÜôïõ ôùí ðåñéï÷þí ðïõ õðÜãïíôáé óôï Ê.Õ. ×Üñáêá ìå áõôÞ ôçò ÅëëçíéêÞò åðéêñÜôåéáò áëëÜ êáé ìå ôç èíçóéìüôçôá ïðïéáóäÞðïôå Üëëçò ðåñéï÷Þò Þ ÷þñáò5,3. Ï áäñüò äåßêôçò èíçóéìüôçôáò óôéò ðåñéï÷Ýò ìåëÝôçò áíÜ 1000 êáôïßêïõò âñÝèçêå 8,8 åíþ ï áíôßóôïé÷ïò ôçò ÅëëçíéêÞò åðéêñÜôåéáò åßíáé 9,39. ÌåôÜ ôçí ðñïôõðïðïßçóÞ ôïõ ï áäñüò äåßêôçò äåí Üëëáîå áöïý õðïëïãßóôçêå óôï 8,7. Èåùñïýìå Ýôóé üôé ï ðëçèõóìüò ìåëÝôçò ìáò ìïéÜæåé üóïí áöïñÜ ôç óýíèåóÞ ôïõ ìå áõôüí ôçò ÅëëçíéêÞò åðéêñÜôåéáò. Óå ðáñüìïéåò ìåëÝôåò üðùò óôïí ¢ãéï Âáóßëåéï êáé óôï äÞìï Áíùãåßùí ï áäñüò äåßêôçò õðïëïãßóôçêå óôï 17,2 êáé 13,5 áíôßóôïé÷á1,3. Ï áðïêëßóåéò áõôÝò ìåôáîý ôùí áäñþí äåéêôþí èíçóéìüôçôáò èåùñïýìå üôé ïöåßëåôáé óå ãÞñáíóç ôïõ ðëçèõóìïý ðïõ åßíáé ìåãáëýôåñç óôçí ðåñéï÷Þ ôïõ Áãßïõ Âáóéëåßïõ1. Ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá áðü íïóÞìáôá ôïõ êõêëïöïñéêïý óôç ìåëÝôç ìáò âñÝèçêå ðïëý ÷áìçëÞ óå ó÷Ýóç ìå áõôÞ ôçò åðéêñÜôåéáò (300/100.000 Ýíáíôé 477/100.000)9 ãåãïíüò ðïõ åðéâåâáéþíåé ôç ÷áìçëÞ èíçóéìüôçôá áðü íïóÞìáôá ôïõ êõêëïöïñéêïý óôçí ÊñÞôç, üðùò Ý÷åé


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ã. Ðáðáäüðïõëïò êáé óõí.

äéáðéóôùèåß êáé áðü Üëëïõò åñåõíçôÝò1,3,5,10. Ôï ðïóïóôü áõôü åßíáé ìéêñüôåñï áðü áõôü ôïõ Áãßïõ Âáóéëåßïõ12 êáé áðü áõôü ôïõ äÞìïõ Áíùãåßùí2. Ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá áðü íåïðëÜóìáôá âñÝèçêå ìéêñüôåñç áðü áõôÞ ôçò åðéêñÜôåéáò (160/100.000 Ýíáíôé 190/100.000)9. Åðßóçò åßíáé ÷áìçëüôåñç áðü áõôÞ ôùí äýï Üëëùí ìåëåôþí1,3. Ç ðñïôõðïðïéçìÝíç èíçóéìüôçôá ôùí íüóùí ôïõ áíáðíåõóôéêïý âñÝèçêå 68,2/100.000 êáé áõôÞ ôùí íïóçìÜôùí ôïõ ðåðôéêïý 25,9/ 100.000, ÷áìçëüôåñåò êáé áõôÝò áðü ôéò ìåëÝôåò ôùí Üëëùí ðåñéï÷þí1,3. Ðáñüëï ðïõ ï äåßêôçò èíçóéìüôçôáò áðü íïóÞìáôá ôïõ êõêëïöïñéêïý öáßíåôáé íá åßíáé ÷áìçëüò óôçí ðåñéï÷Þ ìáò áëëÜ êáé óôéò Üëëåò ðåñéï÷Ýò ðïõ Ý÷ïõí ìåëåôçèåß, êáé äåäïìÝíïõ üôé áðü Üëëåò ìåëÝôåò1,13,16 áíáìÝíåôáé áýîçóç ôçò èíçóéìüôçôáò áðü êáñäéáããåéáêÞ íüóï ëüãù ôçò áëëáãÞò äéáôñïöéêþí óõíçèåéþí ôïõ Êñçôéêïý ðëçèõóìïý, åßíáé áíáãêáßá ç ðáñáêïëïýèçóç ôùí äåéêôþí èíçóéìüôçôáò. Åðßóçò üðùò ðñïáíáöÝñèçêå ç êáôáãñáöÞ ôùí äåéêôþí èíçóéìüôçôáò óôçí ðåñéï÷Þ ôïõ Ê.Õ. ×Üñáêá åðé÷åéñåßôáé ãéá ðñþôç öïñÜ êáé äåäïìÝíïõ ôïõ ìåãÜëïõ áñéèìïý ôïõ ðëçèõóìïý åõèýíçò ôïõ, ìðïñïýìå íá ðïýìå üôé ç äéá÷ñïíéêÞ ðáñáêïëïýèçóç ôùí äåéêôþí èíçóéìüôçôáò ôçò ðåñéï÷Þò, ìðïñåß íá ìáò öáíåß ðïëý ÷ñÞóéìç üóïí áöïñÜ ôï ó÷åäéáóìü ôçò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò áëëÜ êáé ôçí åöáñìïãÞ ðñïãñáììÜôùí áãùãÞò õãåßáò ôïõ ðëçèõóìïý.

4. 5.

6.

7.

8.

9.

10.

11.

12.

13.

Âéâëéïãñáößá 1. Lionis C, Koutis A, Antonakis N, Isacsson A, Lindholm L, Fioretos M. Mortality rates in a cardiovascular “low risk” population in rural Crete. Family Practice, 10:300-304, 1993. 2. Ôñé÷üðïõëïò Ä. Åðéäçìéïëïãßá: áñ÷Ýò, ìÝèïäïé, åöáñìïãÝò. Åêäüóåéò ÐáñéæéÜíïõ, ÁèÞíá 1982. 3. ÁíôùíÜêçò Í, ÌÜêñç Ê, ÊáëðáäÜêç ×, ËéïíÞò ×. Äåßêôåò èíçóéìüôçôáò óôïí ðëçèõóìü åíüò

14. 15.

16.

ïñåéíïý äÞìïõ ôçò ÊñÞôçò. Áñ÷åßá ÅëëçíéêÞò ÉáôñéêÞò 14:294/299, 1997. ÅèíéêÞ ÓôáôéóôéêÞ Õðçñåóßá. Óôïé÷åßá áðü ôçí áðïãñáöÞ ôïõ 1991. ËéïíÞò ×, ÔóáêáëÜêç Ì, ÊïõôÞò Á, ÔóáìáíäïõñÜêç Ê, Áëáìáíüò Ã, ÖéïñÝôïò Ì. Äåßêôåò èíçóéìüôçôáò åðáñ÷ßáò Áãßïõ Âáóéëåßïõ. Ç ¸êäïóç ÊëéíéêÞò êáé ÏéêïãåíåéáêÞò ÉáôñéêÞò Ðáíåðéóôçìßïõ ÊñÞôçò, 1991. World Health Organization. Global strategy for health for all by the year 2000: “Health for all”, series No 3, W.H.O. (eds). Geneva 1981. Glasser HJ. The quality and utility of death certificate data. Am J Public Health 71:231233, 1981. Schado B. Reliability and validity of the classification of death in General Practice. Scan. J Prim Health Care 5:109-112, 1987. ÅèíéêÞ ÓôáôéóôéêÞ Õðçñåóßá ÅëëÜäïò. ÓôáôéóôéêÞ ôçò öõóéêÞò êßíçóçò ôïõ ðëçèõóìïý ôçò ÅëëÜäáò, Ýôïõò 1988. ¸êäïóç ôçò ÅèíéêÞò ÓôáôéóôéêÞò Õðçñåóßáò ÅëëÜäïò. ÁèÞíá, 1995. Keys A. Seven countries. A multivariate analysis of death and coronary heart disease. Harvard University Press, Cambridge, MA, 1990. Ðáãêüóìéïò Ïñãáíéóìüò Õãåßáò. Åã÷åéñßäéï äéåèíïýò óôáôéóôéêÞò ôáîéíüìçóçò ôùí íüóùí êáêþóåùí êáé áéôéþí èáíÜôïõ. ¸êäïóç Õðïõñãåßïõ óõíôïíéóìïý êáé Õðïõñãåßï êïéíùíéêþí õðçñåóéþí. ÁèÞíá 1980. ËéïíÞò ×, ÁíôùíÜêçò Í, Êïýôçò Á, ÔóáìáíäïõñÜêç Ê, Áëáìáíüò Ã, ÖéïñÝôïò Ì. äåßêôåò èíçóéìüôçôáò óôçí åðáñ÷ßá Áãßïõ Âáóéëåßïõ Íïìïý Ñåèýìíçò. ÉáôñéêÞ, 63:158-162, 1993. ÐáðáåõáããÝëïõ Ã, Ôóßìðïò Ã. ÓçìáíôéêÞ áýîçóç ôçò èíçóéìüôçôáò áðü êáñäéáããåéáêÝò ðáèÞóåéò óôçí ÅëëÜäá êáôÜ ôá ôåëåõôáßá ÷ñüíéá. Mat Med Greca 10:239-250, 1982 World Health Organization. 1991 World health statistics annual. WHO (eds). Geneva, 1992. Lionis C, Ôrell E. Health needs assessment in general practice: the Cretan approach. Eur J General Practice, 5, 1999. Authors. Mortality from ishaemic heart disease in industrialized countries. Ann Statist Sanit Mond, p. 25-29, 1987.

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ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ê. Óïõëéþôçò êáé óõí.

ÅÑÅÕÍÇÔÉÊÇ ÅÑÃÁÓÉÁ ORIGINAL PAPER Primary Heatlh Care, Volume 14, Number 3, 114-118, 2002 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 114-118, 2002

Ç Éêáíïðïßçóç ôùí áóèåíþí áðü ôç íïóïêïìåéáêÞ öñïíôßäá óôçí ÅëëÜäá: ÁðïôåëÝóìáôá Ýñåõíáò ãíþìçò óôçí åõñýôåñçò ðåñéï÷Þò Áèçíþí Ê. Óïõëéþôçò, A. Äüëãåñáò, Ä. Êüíôïò, ×. Ïéêïíüìïõ Ðåñßëçøç Óôï êåßìåíï áõôü, ðáñïõóéÜæïíôáé ôá áðïôåëÝóìáôá ðñüóöáôçò Ýñåõíáò ó÷åôéêÜ ìå ôçí éêáíïðïßçóç ôùí áóèåíþí áðü ôç íïóïêïìåéáêÞ öñïíôßäá óôçí ÅëëÜäá. Ç Ýñåõíá óôçñß÷èçêå óå ôçëåöùíéêÝò óõíåíôåýîåéò ðïõ äéåîÞ÷èçóáí óå äåßãìá ðëçèõóìïý 350 áôüìùí (175 Üíäñåò êáé 175 ãõíáßêåò) çëéêßáò 15-65 åôþí, óôçí ðåñéï÷Þ ôçò ÁèÞíáò. Ïé óõëëå÷èåßóåò ðëçñïöïñßåò áöïñïýóáí óôá êïéíùíéêïïéêïíïìéêÜ ÷áñáêôçñéóôéêÜ ôùí áóèåíþí êáé óôç ìÝôñçóç ôïõ âáèìïý éêáíïðïßçóÞò ôïõò áðü ôéò õðçñåóßåò ôùí äçìüóéùí êáé éäéùôéêþí íïóïêïìåßùí. Ç Ýñåõíá êáôáëÞãåé óôç äéáðßóôùóç üôé ç äõóáñÝóêåéá áðü ôá íïóïêïìåßá ôïõ ÅÓÕ ó÷åôßæåôáé ìå ôïõò ðáñÜãïíôåò ôçò îåíïäï÷åéáêÞò õðïäïìÞò, ôçò Ýëëåéøçò ðñïóùðéêïý, ôçò êáèáñéüôçôáò ôùí ÷þñùí êáé ôçò óõìðåñéöïñÜò ôùí åðáããåëìáôéþí õãåßáò. Áðü ôçí Üëëç, ïé õðçñåóßåò ôùí éäéùôéêþí íïóçëåõôéêþí äïìþí äçìéïõñãïýí ìåãáëýôåñï áßóèçìá éêáíïðïßçóçò óôïõò ðïëßôåò, êõñßùò óå ü,ôé áöïñÜ óôéò ãåíéêüôåñåò óõíèÞêåò íïóçëåßáò. ÔÝëïò, ç Ýñåõíá åðéâåâáéþíåé ôçí õðüèåóç üôé ïé áðáéôÞóåéò êáé ïé ðñïóäïêßåò ôùí ðïëéôþí, áõîÜíïíôáé üóï êéíïýìáóôå ðñïò ôá õøçëüôåñá êïéíùíéêÜ óôñþìáôá êáé ùò åê ôïýôïõ, áõôÜ áîéïëïãïýí ìå áõóôçñüôåñá êñéôÞñéá ôéò ðáñå÷üìåíåò öñïíôßäåò. ÔïìÝáò Ïéêïíïìéêþí ôçò Õãåßáò, ÅèíéêÞ Ó÷ïëÞ Äçìüóéáò Õãåßáò, ÁèÞíá

Patient Satisfaction with Hospital Care in Greece: Results from a telephone study in the Greater Athens area K. Souliotis, A. Dolgeras, D. Kontos, C. Economou Summary This paper presents the results of recent research into patients' satisfaction with hospital care in Greece. This research was carried out through the media of telephone interviews, with a sample of 350 people (175 male and 175 female), between the ages of 15-65 years, in the Greater Athens area. The information concentrated on two main aspects, firstly those of the patients' socioeconomic status and secondly on the measurement of the standard of satisfaction with both the public and private hospital services. Through this research some very important conclusions arouse. Firstly, patients' disappointment to public hospitals was related, not only to the "hotel services", but also to the lack of staff, general cleanliness and the behaviour of the staff. Conversely, the private sector's services were found to be more satisfactory, mainly for the general hospital conditions. The final analysis of this research, confirmed the initial assumption that the claims and expectations of people are related to their socioeconomic status. Key words: patient satisfaction, hospital care, Greece Department of Health Economics, National School of Public Health

114

ÅéóáãùãÞ Óôï êåßìåíï áõôü, ðáñïõóéÜæïíôáé ôá áðïôåëÝóìáôá ðñüóöáôçò Ýñåõíáò ó÷åôéêÜ ìå ôçí éêáíïðïßçóç ôùí áóèåíþí áðü ôç íïóïêïìåéáêÞ öñïíôßäá óôç ÷þñá ìáò. Óçìåéþíåôáé üôé ç Ýñåõíá áõôÞ, åîÝôáóå åðéðëÝïí ôï æÞôçìá ôçò éêáíïðïßçóçò áðü ôçí áóöáëéóôéêÞ êÜëõøç, óå óõíäõáóìü ìå ôçí ðñüèåóç êáé ôçí ðñáêôéêÞ ôùí ÷ñçóôþí íá êáôáâÜëëïõí åðéðëÝïí ÷ñÞìáôá, þóôå íá êáôáíáëþóïõí õðçñåóßåò êáëýôåñçò - üðùò ïé ßäéïé áíôéëáìâÜíïíôáé -ðïéüôçôáò. Óêïðüò ôïõ Üñèñïõ áõôïý åßíáé: (á) ç áðïôýðùóç ôùí ÷áñáêôçñéóôéêþí ôùí ÷ñçóôþí ôùí íïóçëåõôéêþí õðçñåóéþí óôçí ðåñéï÷Þ ôùí Áèçíþí êáé (â) ç ìÝôñçóç ôçò éêáíïðïßçóçò áðü ôç ÷ñçóéìïðïßçóç íïóïêïìåéáêþí õðçñåóéþí.

Ðëçèõóìüò ìåëÝôçò êáé ìÝèïäïò Ç Ýñåõíá óôçñß÷èçêå óå ôçëåöùËÝîåéò êëåéäéÜ: éêáíïðïßçóç, áóèåíÞò, íïóïêïìåßá, öñïíôßäá, ÅëëÜä�� ÕðïâëÞèçêå: 18 Óåðôåìâñßïõ 2001 ÅðáíõðïâëÞèçêå: 3 Äåêåìâñßïõ 2001 ¸ãéíå äåêôÞ ãéá äçìïóßåõóç: 4 Áðñéëßïõ 2002 Õðåýèõíïò áëëçëïãñáößáò: ÊõñéÜêïò Óïõëéþôçò, ÅÓÄÕ, Ë. ÁëåîÜíäñáò 196, 11521, ÁèÞíá Ôçë. (210)6435328, Fax. (210)5816615, e-mail: soulioti@hol.gr


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ê. Óïõëéþôçò êáé óõí.

íéêÝò óõíåíôåýîåéò ðïõ äéåîÞ÷èçóáí ôï ÖåâñïõÜñéï ôïõ 2000 ìå ôç âïÞèåéá ôçò åôáéñåßáò Opinion, óå äåßãìá ðëçèõóìïý 350 áôüìùí (175 Üíäñåò êáé 175 ãõíáßêåò) çëéêßáò 15-65 åôþí, óôçí ðåñéï÷Þ ôçò ÁèÞíáò. Ïé óõëëå÷èåßóåò ðëçñïöïñßåò áöïñïýí áöåíüò óôç óêéáãñÜöçóç ôùí ÷áñáêôçñéóôéêþí ôùí áóèåíþí êáé óôçí êáôÜôáîÞ ôïõò áíÜ êïéíùíéêÞ ôÜîç êáé áöåôÝñïõ óôç ìÝôñçóç ôïõ âáèìïý éêáíïðïßçóÞò ôïõò áðü ôéò õðçñåóßåò õãåßáò, ôùí äçìïóßùí êáé éäéùôéêþí íïóïêïìåßùí. Êáô' áñ÷Üò, üóïí áöïñÜ óôçí çëéêßá ôïõ äåßãìáôïò, ôï ìåãáëýôåñï ðïóïóôü óõìðåñéëáìâÜíåôáé óôçí çëéêéáêÞ ïìÜäá 35-44 åôþí (23,4%), åíþ áêïëïõèïýí ïé çëéêéáêÝò ïìÜäåò 25-34 (20,6%), 45-54 (19,4%), 15-24 (18,6%) êáé 55+ (18%). Ó÷åôéêÜ ìå ôá êïéíùíéêïïéêïíïìéêÜ ÷áñáêôçñéóôéêÜ (ìüñöùóç, åðÜããåëìá êáé åéóüäçìá), ôá ïðïßá óýìöùíá êáé ìå ôç äéåèíÞ âéâëéïãñáößá1-3 åðçñåÜæïõí óçìáíôéêÜ ôá áðïôåëÝóìáôá ôÝôïéùí åñåõíþí áöïý äéáìïñöþíïõí ôüóï ôéò åðéëïãÝò ìåôáîý äçìüóéïõ êáé éäéùôéêïý ôïìÝá, üóï êáé ôéò ðñïóäïêßåò áðü ôçí ðáñå÷üìåíç öñïíôßäá, áõôÜ áðïôõðþíïíôáé óôïí Ðßíáêá 1. ¼ðùò ðñïáíáöÝñèçêå, óôçí ðáñïýóá Ýñåõíá åðé÷åéñÞèçêå ç êáôçãïñéïðïßçóç ôùí íïéêï-

êõñéþí óå ìéá ôñéôïâÜèìéá êëßìáêá êïéíùíéêÞò äéáóôñùìÜôùóçò, ÷ñçóéìïðïéþíôáò ùò êñéôÞñéá éåñÜñ÷çóçò ôï åðÜããåëìá ôïõ õðåýèõíïõ ôçò ïéêïãÝíåéáò óå óõíäõáóìü ìå ôï ìïñöùôéêü ôïõ åðßðåäï. Ç ìåãáëýôåñç óõãêÝíôñùóç, (74,3%) åìöáíßæåôáé óôç ìåóáßá ôÜîç ôçò êëßìáêáò. Óçìåéþíåôáé üôé ãéá ôçí êáôÜôáîç ôùí íïéêïêõñéþí óôéò ôñåéò ôÜîåéò, õéïèåôåßôáé ç êáôçãïñéïðïßçóç ðïõ ðåñéãñÜöåôáé óôïí Ðßíáêá 2: Ìå âÜóç ôá ðáñáðÜíù äåäïìÝíá, åðé÷åéñÞèçêå ç ìÝôñçóç ôçò éêáíïðïßçóçò ôùí áóèåíþí, ç ïðïßá óôçñß÷èçêå óå êëßìáêá ðÝíôå ðéèáíþí áðáíôÞóåùí (1: êáèüëïõ, 2: ëßãï, 3: ìÝôñéá, 4: áñêåôÜ êáé 5: ðÜñá ðïëý) êáé óõó÷åôßóôçêå ìå ôá ÷áñáêôçñéóôéêÜ ôùí åñùôþìåíùí. Ãéá ôçí åîáãùãÞ óõìðåñáóìÜôùí, ïé ðëçñïöïñßåò êùäéêïðïéÞèçêáí êáé ôáîéíïìÞèçêáí ìå âÜóç ôï ðïóïóôü áíÜ êëßìáêá áðáíôÞóåùí. Óôïõò ðßíáêåò êáé óôá äéáãñÜììáôá ðïõ áêïëïõèïýí, ðáñïõóéÜæåôáé ç ðïóïóôéáßá áíáëïãßá ôùí áðáíôÞóåùí ôïõ äåßãìáôïò áíÜ êáôçãïñßá áðÜíôçóçò. Óçìåéþíåôáé üôé ãéá ôçí áîéüðéóôç áðïôýðùóç ôçò éêáíïðïßçóçò ôùí áóèåíþí, ÷ñçóéìïðïéïýíôáé ôá áðïôåëÝóìáôá ðïõ áöïñïýí óôï ðïóïóôü ôïõ äåßãìáôïò ðïõ áíôáðïêñßèçêå óôçí Ýñåõíá (valid percent) êáé ü÷é óôï ðïóïóôü ðïõ áöïñÜ óôï

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

Ìçíéáßï åéóüäçìá ôïõ íïéêïêõñéïý

Áíáëïãßá %

Ìüñöùóç õðåõèýíïõ ôïõ íïéêïêõñéïý

Êáôçãïñßá Áíáëïãßá (åéóïäçìáôéêÜ êëéìÜêéá óå äñ÷.) %

Êáôçãïñßá

Áíáëïãßá %

Áãñüôåò

0,6

ÊÜôù áðü 200.000

10,3

Êáôþôåñç

14,1

Åëåýèåñïé Åðáããåëìáôßåò Ýùò 10 õðáëëÞëïõò

23,9

201.000 - 300.000

16,9

ÃõìíÜóéo/Ëýêåéï

42.9

Åëåýèåñïé Åðáããåëìáôßåò Ýùò 10 õðáëëÞëïõò

3,1

301.000 - 400.000

15,7

Áíþôåñç

Åëåýèåñïé ÅðáããåëìáôßåòÝùò 10 õðáëëÞëïõò

7,4

401.000 - 500.000

17,4

Áíþôáôç

28,2

ÕðÜëëçëïé - ÅðéóôÞìïíåò Åéäéêïß

8,6

501.000 - 600.000

7,7

Äåí áðÜíôçóáí

2,5

Ãåíéêïß ÄéåõèõíôÝò ÐñïúóôÜìåíïé

5,5

601.000 - 800.000

4,0

ÕðÜëëçëïé ãñáöåßïõ

21,5

ÕðÜëëçëïé åêôüò ãñáöåßïõ

4,9

ÅéäéêåõìÝíïé ÕðÜëëçëïé ×åéñùíáêôéêÞ åñãáóßá

12,3

ÍïéêïêõñÝò - Åéóïäçìáôßåò

2,5

ÓðïõäáóôÝò

1,2

¢ñíçóç - Äåí áðÜíôçóáí

6,1

801.000 - 1.000.000 ÐÜíù áðü 1.000.000

8,3

ÄÃ/ÄÁ

16,9

115


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ê. Óïõëéþôçò êáé óõí.

Ðßíáêáò 2. ÊïéíùíéêÝò ÔÜîåéò óå Óõíäõáóìü ìå ôï ÅðÜããåëìá êáé ôç Ìüñöùóç ôïõ Õðåõèýíïõ ôçò ÏéêïãÝíåéáò Á- ÓõãêÝíôñùóç 10,3%

C ÓõãêÝíôñùóç 74,3%

D-Å ÓõãêÝíôñùóç 15,4%

ÅðÜããåëìá

Ìüñöùóç

ÅðÜããåëìá

Ìüñöùóç

ÅðÜããåëìá

Ìüñöùóç

Åëåýèåñïé åðáããåëìáôßåò åðéóôÞìïíåò, åëåýèåñïé åðáããåëìáôßåò ðïõ áðáó÷ïëïýí ìÝ÷ñé 10 õðáëëÞëïõò, åëåýèåñïé åðáããåëìáôßåò ðïõ áðáó÷ïëïýí ðÜíù áðü 10 õðáëëÞëïõò, äéåõèõíôÝò, ðñïúóôÜìåíïé, õðÜëëçëïé ãñáöåßïõ, óõíôáîéïý÷ïé åéóïäçìáôßåò

Ðôõ÷éïý÷ïé Áíþôáôùí Ó÷ïëþí

åëåýèåñïé åðáããåëìáôßåò ðïõ áðáó÷ïëïýí ìÝ÷ñé 10 õðáëëÞëïõò, åëåýèåñïé åðáããåëìáôßåò ðïõ áðáó÷ïëïýí ðÜíù áðü 10 õðáëëÞëïõò, äéåõèõíôÝò, ðñïúóôÜìåíïé, õðÜëëçëïé ãñáöåßïõ, åéäéêåõìÝíïé õðÜëëçëïé ÷åéñþíáêôåò, áíåéäßêåõôïé õðÜëëçëïé ÷åéñþíáêôåò, óõíôáîéïý÷ïé áãñüôåò, åéóïäçìáôßåò óðïõäáóôÝò

Ðôõ÷éïý÷ïé ÁíùôÝñùí Ó÷ïëþí, Áðüöïéôïé Ëõêåßïõ êáé Ãõìíáóßïõ

õðÜëëçëïé ÷åéñþíáêôåò, áíåéäßêåõôïé õðÜëëçëïé ÷åéñþíáêôåò, óõíôáîéïý÷ïé áãñüôåò, íïéêïêõñÝò, åéóïäçìáôßåò

Áðüöïéôïé Äçìïôéêïý êÜðïéùí ôÜîåùí ôïõ Äçìïôéêïý ÁíáëöÜâçôïé

óýíïëï ôïõ äåßãìáôïò.

ÁðïôåëÝóìáôá Ôá áðïôåëÝóìáôá ôçò Ýñåõíáò, áðïêáëýðôïõí åîáéñåôéêÜ åíäéáöÝñïíôá óôïé÷åßá ãéá ôç äéáäéêáóßá êáé ôéò óõíèÞêåò ÷ñçóéìïðïßçóçò ôùí íïóçëåõôéêþí õðçñåóéþí óôá äçìüóéá êáé éäéùôéêÜ íïóïêïìåßá ôçò ÷þñáò ìáò, ðáñÜãïíôåò ïé ïðïßïé äéáìïñöþíïõí êáé ôçí éêáíïðïßçóç ôùí ÷ñçóôþí áðü áõôÝò. Ï âáèìüò óôïí ïðïßï ç êïéíùíéêÞ ôÜîç åðçñåÜæåé ôüóï ôçí åðéëïãÞ ôïõ öïñÝá õãåßáò, üóï êáé ôçí éêáíïðïßçóç áðü ðáñå÷üìåíåò õðçñåóßåò, åßíáé åìöáíÞò óôïõò ðáñáêÜôù ðßíáêåò. ¼ðùò ëïéðüí ðñïêýðôåé áðü ôïí Ðßíáêá 3, ôï ìåãáëýôåñï ðïóïóôü ôïõ äåßãìáôïò ðïõ ÷ñçóéìïðïßçóå

õðçñåóßåò ôùí íïóïêïìåßùí ôïõ ÅÓÕ (29,6%) ðñïÝñ÷åôáé áðü ôéò ÷áìçëÝò ôÜîåéò óôç ó÷åôéêÞ êëßìáêá (÷ùñßò üìùò ìåãÜëåò áðïêëßóåéò), óå áíôßèåóç ìå ôéò éäéùôéêÝò êëéíéêÝò, üðïõ ç ðåëáôåßá ôïõò ðñïÝñ÷åôáé êõñßùò áðü ôá õøçëÜ (33,3%) êáé ìåóáßá (20,8%) êïéíùíéêÜ óôñþìáôá. Áðü ôá óôïé÷åßá áõôÜ äéáðéóôþíåôáé üôé: (á) Ïé õðçñåóßåò ôùí íïóïêïìåßùí ôïõ ÅÓÕ (Ðßíáêáò 4), éêáíïðïéïýí ðåñéóóüôåñï ôïõò áóèåíåßò ôùí ÷áìçëüôåñùí êïéíùíéêþí ôÜîåùí åíþ ïé áóèåíåßò ôùí õøçëþí êïéíùíéêþí ôÜîåùí åêöñÜæïõí ìåãáëýôåñç äõóáñÝóêåéá. ÐÜíôùò, ôï ìåãáëýôåñï ðïóïóôü ôïõ äåßãìáôïò, (59,2%) äçëþíåé éêáíïðïéçìÝíï áðü ôéò õðçñåóßåò, åíþ áðü ôçí Üëëç õøçëü èåùñåßôáé êáé ôï ðïóïóôü (10,2%) ôùí åñùôçèÝíôùí ðïõ äÞëùóå êáèüëïõ éêáíïðïéçìÝíï áðü ôçí ðáñå÷üìåíç ðåñßèáëøç.

Ðßíáêáò 3. Ðïéá Õðçñåóßá Õãåßáò ÷ñçóéìïðïéÞóáôå åóåßò Þ Üëëï ìÝëïò ôçò ïéêïãÝíåéÜò óáò ôåëåõôáßá öïñÜ; ÊïéíùíéêÞ ÔÜîç ÖïñÝáò Íïóïêïìåßï ÅÓÕ ÉäéùôéêÞ ÊëéíéêÞ ¢ëëåò õðçñåóßåò ÄÃ/ÄÁ Åñùôþìåíïé 116

A-B Ðåñéðôþóåéò 10 12 21 1 36

%

C Ðåñéðôþóåéò

%

27,8 33,3 58,3 2,8 100

72 20,8 172 11 260

27,7 5 66,2 4,2 100

D-E Ðåñéðôþóåéò 16 9,3 38 3 54

% 29,6 71 70,4 5,6 100

Óýíïëï Ðåñéðôþóåéò 98 20,3 231 15 350

% 28,0 66,0 4,3 100


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ê. Óïõëéþôçò êáé óõí. Ðßíáêáò 4. Éêáíïðïßçóç áðü Íïóïêïìåßï ôïõ ÅÓÕ ÊïéíùíéêÞ ÔÜîç Éêáíïðïßçóç ÐÜñá ðïëý ÁñêåôÜ ÌÝôñéá Ëßãï Êáèüëïõ ÄÃ/ÄÁ Åñùôþìåíïé

A-B Ðåñéðôþóåéò

%

220,0 2 4 1 2

14 20,0 40,0 1,4 20,0

10

C Ðåñéðôþóåéò 19,4 30 19 1 7 1 72

100

% 7 41,7 26,4 1,0 9,7 1,4 100

D-E Ðåñéðôþóåéò 43,8 3 5 1 16

%

Óýíïëï Ðåñéðôþóåéò

%

23 18,8 31,3

23,5 35 28

35,7 28,6

6,3 100

10 1 98

10,2 1,0 100

Ðßíáêáò 5. Éêáíïðïßçóç áðü ÉäéùôéêÞ ÊëéíéêÞ ÊïéíùíéêÞ ÔÜîç Éêáíïðïßçóç ÐÜñá ðïëý ÁñêåôÜ ÌÝôñéá Ëßãï Êáèüëïõ ÄÃ/ÄÁ Åñùôþìåíïé

A-B Ðåñéðôþóåéò

%

6 4 1

50,0 33,3 8,3

1 12

8,3

C Ðåñéðôþóåéò

%

28 19 5 1 1

51,9 35,2 9,3 1,9 1,9

54

(â) Ïé éäéùôéêÝò êëéíéêÝò ðáñïõóéÜæïõí Ýíá ðïëý õøçëü ðïóïóôü éêáíïðïßçóçò óå üëåò ôéò êïéíùíéêÝò ôÜîåéò (Ðßíáêáò 5) êáé âÝâáéá óôï óýíïëï ôïõ äåßãìáôïò, ôï 85,9% äçëþíåé éêáíïðïéçìÝíï åßôå ðÜñá ðïëý (50,7%), åßôå áñêåôÜ (35,2%), áðü ôéò ðáñå÷üìåíåò öñïíôßäåò. Óçìåéþíåôáé üôé ïé êáôçãïñßåò áðü ìÝôñéá Ýùò êáèüëïõ éêáíïðïßçóç, áðïôåëïýí ìüëéò ôï 12,7% ôïõ äåßãìáôïò.

ÓõæÞôçóç êáé óõìðåñÜóìáôá Óõíïøßæïíôáò ôá áðïôåëÝóìáôá ôçò ðáñáðÜíù áíÜëõóçò, äéáðéóôþíïõìå üôé áí êáé ç ãåíéêüôåñç åíôýðùóç ðïõ åðéêñáôåß åßíáé üôé ïé äçìüóéåò õðçñåóßåò õóôåñïýí óçìáíôéêÜ êáé äåí áíôáðïêñßíïíôáé óôéò áðáéôÞóåéò ðïõ åðéâÜëëïõí ôá äéåèíÞ ðñüôõðá êáé ïé ðñïóäïêßåò ôùí ÷ñçóôþí, ç ìÝôñçóç ôçò éêáíïðïßçóçò áðü ôéò öñïíôßäåò ðïõ ðáñÝ÷ïõí, ïäçãåß óå áíôßèåôá óõìðåñÜóìáôá. ¸ôóé, ç éêáíïðïßçóç áðü ôá íïóïêïìåßá ôïõ ÅÓÕ êõìáßíåôáé óå ó÷åôéêÜ õøçëÜ åðßðåäá, ðáñÜ ôá äåäïìÝíá ðñïâëÞìáôá ðïõ ó÷åôßæïíôáé ìå ôçí îåíïäï÷åéáêÞ õðïäïìÞ, ôçí Ýëëåéøç ðñïóùðéêïý, ôçí êáèáñéüôçôá ôùí ÷þñùí

D-E Ðåñéðôþóåéò 2 2 1

5

% 40,0 40,0 20,0

Óýíïëï Ðåñéðôþóåéò 36 25 7 1 1 1 71

% 50,7 35,2 9,9 1,4 1,4 1,4

êáé ôç óõìðåñéöïñÜ ôùí åðáããåëìáôéþí õãåßáò. ÅðéðëÝïí áîßæåé íá áíáöåñèåß üôé ç ðïéüôçôá ôçò ðåñßèáëøçò ðïõ ðáñÝ÷åôáé áðü ôá äçìüóéá íïóïêïìåßá õößóôáôáé óçìáíôéêÞ åðéâÜñõíóç, áðü ôçí áðïññüöçóç åíüò ìåãÜëïõ ìÝñïõò ôùí õëéêþí êáé áíèñþðéíùí ðüñùí óôá åîùôåñéêÜ éáôñåßá - ôá ïðïßá åðéóêÝðôåôáé ðåñßðïõ ôï 30% ôïõ ðëçèõóìïý - ãéá ôçí ðáñï÷Þ ðñùôïâÜèìéáò ðåñßèáëøçò. Áðü ôçí Üëëç, ïé õðçñåóßåò ôùí éäéùôéêþí êëéíéêþí äçìéïõñãïýí ìåãáëýôåñï áßóèçìá éêáíïðïßçóçò óôïõò ðïëßôåò, áí êáé üðùò ðñïêýðôåé áðü ó÷åôéêÝò ìåëÝôåò ôá âáñýôåñá ðåñéóôáôéêÜ áíôéìåôùðßæïíôáé êõñßùò óå äçìüóéá íïóïêïìåßá4. Áõôü ïõóéáóôéêÜ óçìáßíåé üôé ç éêáíïðïßçóç áðü ôçí ðëåõñÜ ôùí ÷ñçóôþí áöïñÜ êõñßùò óôéò ãåíéêüôåñåò óõíèÞêåò íïóçëåßáò êáé ëéãüôåñï óå áõôÞ êáè' áõôÞ ôçí ðáñå÷üìåíç öñïíôßäá õãåßáò êáé ôï éáôñéêü Ýñãï. ÁíåîÜñôçôá ðÜíôùò áðü ôïõò åðéìÝñïõò ðáñÜãïíôåò éêáíïðïßçóçò, ç óõíå÷Þò áíÜðôõîç éäéùôéêþí íïóçëåõôéêþí ìïíÜäùí ôá ôåëåõôáßá ÷ñüíéá óôç ÷þñá ìáò, öáßíåôáé ðùò áíôáíáêëÜ ôçí áõîçìÝíç æÞôçóç ãéá éäéùôéêÝò õðçñåóßåò, ùò áðüññïéá ôçò ãåíéêüôåñçò áßóèçóçò ôùí ðïëéôþí üôé óôïí éäéùôéêü ôïìÝá èá êáôáíáëþóïõí õðç117


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

ñåóßåò õøçëüôåñçò ðïéüôçôáò9. Ìéá Üëëç äéÜóôáóç ôçò Ýñåõíáò ðïõ ðáñïõóéÜæåé éäéáßôåñï åíäéáöÝñïí, åßíáé ç äéáöáéíüìåíç óõó÷Ýôéóç ôçò êïéíùíéêÞò ôÜîçò êáé ôçò åêöñáóìÝíçò éêáíïðïßçóçò áðü ôéò íïóçëåõôéêÝò õðçñåóßåò. ÓõãêåêñéìÝíá, áðü ôçí Ýñåõíá åðéâåâáéþíåôáé ç õðüèåóç üôé ïé áðáéôÞóåéò êáé ïé ðñïóäïêßåò ôùí ðïëéôþí áõîÜíïíôáé üóï êéíïýìáóôå ðñïò ôá õøçëüôåñá êïéíùíéêÜ óôñþìáôá êáé ùò åê ôïýôïõ, áõôÜ áîéïëïãïýí ìå áõóôçñüôåñá êñéôÞñéá ôéò ðáñå÷üìåíåò öñïíôßäåò. Ç äéÜóôáóç áõôÞ ôùí åñåõíþí éêáíïðïßçóçò Ý÷åé åðéâåâáéùèåß êáé áðü áíôßóôïé÷åò åõñùðáúêÝò Ýñåõíåò3,10, áð’ üðïõ ðñïêýðôåé üôé ïé ðñïóäïêßåò ôùí áóèåíþí ãéá ôéò ðáñå÷üìåíåò öñïíôßäåò õãåßáò, óõíéóôïýí ôïí óçìáíôéêüôåñï ðáñÜãïíôá ôçò åêöñáóìÝíçò éêáíïðïßçóçò áðü áõôÝò. ¸íá Üëëï ôÝëïò æÞôçìá ðïõ áîßæåé íá ôïíéóôåß, áöïñÜ óôç äéáöïñÜ ôùí áðïôåëåóìÜôùí ôçò ðáñïýóáò Ýñåõíáò áðü áíôßóôïé÷åò Ýñåõíåò5-8, ïé ïðïßåò áêïëïýèçóáí äéáöïñåôéêÞ ìåèïäïëïãßá ùò ðñïò ôçí åðéëïãÞ ôïõ äåßãìáôïò, ôéò åñùôÞóåéò êáé ôéò êëßìáêåò áðáíôÞóåùí. Ôï åýñïò áõôþí ôùí äéáöïñþí áðïäåéêíýåé üôé ïé Ýñåõíåò éêáíïðïßçóçò åßíáé éäéáßôåñá "åõáßóèçôåò" óå ó÷Ýóç ìå ôç ìåèïäïëïãßá ðïõ áêïëïõèïýí, êáèþò ôï õðïêåéìåíéêü óôïé÷åßï ôï ïðïßï áðïôõðþíïõí åßíáé åõìåôÜâëçôï. Óå êÜèå ðÜíôùò ðåñßðôùóç, ç áíáãêáéüôçôÜ ôïõò åßíáé äåäïìÝíç, áöïý óõíéóôïýí ôñüðï Ýêöñáóçò êáé áðïôýðùóçò ôçò áíôáðüêñéóçò ôïõ óõóôÞìáôïò õãåßáò óôéò ðñïóäïêßåò êáé ôéò áðáéôÞóåéò ôùí ðïëéôþí êáé ìðïñïýí íá âïçèÞóïõí óçìáíôéêÜ óôç ÷Üñáîç ôçò ðïëéôéêÞò õãåßáò, äéüôé: (á) óõíéóôïýí äåîáìåíÝò Üíôëçóçò ðëçñïöïñéþí, (â) ëåéôïõñãïýí ùò åñãáëåßï âåëôßùóçò ôçò äéá÷åßñéóçò ôùí íïóïêïìåßùí êáé (ã) äçìéïõñãïýí ôéò ðñïûðïèÝóåéò ãéá åðéëïãÝò óôü÷ùí äéá-

118

Ê. Óïõëéþôçò êáé óõí.

÷åßñéóçò ìå âÜóç ôéò ðñïôéìÞóåéò ôùí êáôáíáëùôþí.

Âéâëéïãñáößá 1. Froehlich GW, Welch HG. Meeting walk-in patients' expectation for testing. Effects on satisfaction. Gen Intern Med 8:470-474, 1996. 2. Tamblyn R, Benaroya S, Snell L, McLeod P, Schnarch B, Abrahamowicz M. The feasibility and value of using patient satisfaction ratings to evaluate medicine residents. Gen Intern Med, 3:146-152, 1994. 3. Gavin TK, Turner MJ. Methods of surveying patients' satisfaction. BMJ, 314-327, 1997. 4. Éíóôéôïýôï Ðïëéôéêþí Ïéêïíïìéêþí êáé Êïéíùíéêþí Åñåõíþí: ¸ñåõíá Éêáíïðïßçóçò áðü Õðçñåóßåò Õãåßáò, ÁèÞíá 2000. 5. Êõñéüðïõëïò Ã, Ãåùñãïýóç Å, ÃåííçìáôÜ Á. Éêáíïðïßçóç ôùí ×ñçóôþí áðü ôéò Õðçñåóßåò Õãåßáò óôá Äçìüóéá ÍïóçëåõôÞñéá, óôï: Áóèåíåßò êáé ÅðáããÝëìáôá Õãåßáò óôçí ÅëëÜäá, Êõñéüðïõëïò Ã., Ãåùñãïýóç Å. (åðéì.) Áêáäçìßá ÅðáããåëìÜôùí Õãåßáò, ÁèÞíá, 11-24, 1994. 6. Êõñéüðïõëïò Ã, ÄñÜêïõ É, ÊôÝíáò Å, Ãåùñãïýóç Å. ÓôÜóåéò êáé ÁíôéëÞøåéò ôùí ×ñçóôþí ùò ðñïò ôçí ÍïóïêïìåéáêÞ Öñïíôßäá, óôï: Áóèåíåßò êáé ÅðáããÝëìáôá Õãåßáò óôçí ÅëëÜäá, Êõñéüðïõëïò Ã, Ãåùñãïýóç Å. (åðéì.), Áêáäçìßá ÅðáããåëìÜôùí Õãåßáò, ÁèÞíá, 1994. 7. Eurostat: Eurobarometer, Luxemburg, 1997. 8. ÍéÜêáò Ä, ÃíáñäÝëëçò ×. Éêáíïðïßçóç ÍïóçëåõèÝíôùí Áóèåíþí óå Ýíá Ðåñéöåñåéáêü Ãåíéêü Íïóïêïìåßï. ÉáôñéêÞ, ÁèÞíá, 77:464-470, 2000. 9. Óïõëéþôçò Ê. Ï Ñüëïò ôïõ Éäéùôéêïý ÔïìÝá óôï Åëëçíéêü Óýóôçìá Õãåßáò. Åêäüóåéò ÐáðáæÞóçò, ÁèÞíá 2000. 10. Salisbury C. Postal survey of patients' satisfaction with a general practice out of hours cooperative, BMJ, 574-594, 1997.


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ê. Ðáðáäçìçôñßïõ êáé óõí.

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

ÊëéíéêÞ ðñïóÝããéóç ôçò HIV ëïßìùîçò - Ï ñüëïò ôïõ Ãåíéêïý/ Ïéêïãåíåéáêïý Éáôñïý óôçí ðáñáêïëïýèçóç êáé öñïíôßäá ôùí áóèåíþí ìå HIV/AIDS Ê. Ðáðáäçìçôñßïõ1, Á. Ãêßêáò2, Ã. ÌðÝëïò3 Ðåñßëçøç Ç ëïßìùîç áðü ôïí éü ôçò áíèñþðéíçò áíïóïáíåðÜñêåéáò (ÇÉV) êáé ôï óýíäñïìï åðßêôçôçò áíïóïáíåðÜñêåéáò (ÁÉDS) Ý÷ïõí ðÜñåé äéáóôÜóåéò ðáíäçìßáò êáé áðïôåëïýí ôçí ìåãáëýôåñç ðñüêëçóç ôçò äçìüóéáò õãåßáò óå ðáãêüóìéï åðßðåäï. Êáé óôçí ÅëëÜäá, ôçí ôåëåõôáßá äåêáåôßá, ç äéá÷ñïíéêÞ ôÜóç ôçò åðéäçìßáò åßíáé áõîçôéêÞ. Ãéá ôçí êáëýôåñç ðïñåßá ôçò íüóïõ áðáéôåßôáé ç Ýãêáéñç äéÜãíùóç ôçò ëïßìùîçò êáé ôùí åðéðëïêþí ôçò (åðïìÝíùò êáé ç Ýãêáéñç èåñáðåßá), ðáñüôé ç ìç ôõðéêÞ êëéíéêÞ åéêüíá äõóêïëåýåé ôç äéÜãíùóç. Ç óõíå÷Þò ðñüïäïò, åéäéêüôåñá óôç èåñáðåßá åðÝöåñå óáí áðïôÝëåóìá ôç ìåôáâïëÞ ôçò öõóéêÞò ðïñåßáò ôçò íüóïõ, áðü ôåëåßùò áíßáôç óå êáëþò åëåã÷üìåíç ÷ñüíéá íüóïò, ðñïóöÝñïíôáò óôïõò áóèåíåßò ìáêñïâéüôçôá êáé êáëýôåñç ðïéüôçôá æùÞò. ÁõôÜ óå óõíäõáóìü ìå ôïí áõîáíüìåíï áñéèìü ôùí ðáó÷üíôùí áðáéôïýí Ýíáí ðéï åíåñãü ñüëï ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý óôçí ðáñáêïëïýèçóç êáé öñïíôßäá ôùí áóèåíþí ìå HIV/AIDS. Áõôüò ï ñüëïò, o ïðïßïò äåí äéáöÝñåé áð'áõôüí óå Üëëåò ÷ñüíéåò ðáèÞóåéò, ðñïõðïèÝôåé êáôÜëëçëç åêðáßäåõóç åê ìÝñïõò ôùí Ãåíéêþí Éáôñþí. 1

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

A clinical approach to HIV infection. The role of the General Practitioner in HIV care K. Papadhimitriou, A. Gikas, G. Belos Summary HIV infection and AIDS are pandemic and pose one of the greatest challenges to global public health. During the last decade the secular trend of the HIV infection in Greece has increased. For a more favorable course to the outcome of the disease an early diagnosis of the infection and its related conditions is necessary, although the untypical clinical manifestation of the infection makes diagnosis difficult. However the continuous progress, especially in treatment, has changed the natural of the disease, from being one of completely incurable to that of a manageable chronic condition, offering a prolonged life span and a better quality of life. For this reason, together with the continuous increase of the prevalence of the infection demand a more active role of the General Practitioner (GPs) in the care of HIV sufferers/patients. This role, which is no different from that of any other chronic disease, presupposes appropriate training for GPs. Key words: HIV/AIDS, clinical approach, General Practitioner, medical care Çealth Centre of Salamina

ÅéóáãùãÞ Ç ëïßìùîç áðü ôïí éü ôçò áíèñþðéíçò áíïóïáíåðÜñêåéáò (ÇÉV) êáé ôï óýíäñïìï åðßêôçôçò áíïóïáíåðÜñêåéáò (ÁÉDS) Ý÷ïõí ðÜñåé äéáóôÜóåéò ðáíäçìßáò êáé áðïôåëïýí ôçí ìåãáëýôåñç ðñüêëçóç ôçò äçìüóéáò õãåßáò óå ðáãêüóìéï åðßðåäï1. Ç äéáóðïñÜ ôçò ëïßìùîçò ðáñïõóéÜæåé äéÜöïñåò ðáñáëëáãÝò óôïí ôñüðï ìåôÜäïóçò êáé ôç ãåùãñáöéêÞ êáôáíïìÞ, ðñïóâÜëëïíôáò êõñßùò ôéò ìåéïíïôéêÝò êáé ðåñéèùñéáêÝò ïìÜäåò üðùò åñãáæüìåíïõò óôç âéïìç÷áíßá ôïõ óåî, ÷ñÞóôåò íáñêùôéêþí ïõóéþí, ïìïöõëüöéëïõò Üíäñåò êáé Üôïìá ðïõ æïõí ìÝóá óôç öôþ÷åéá. Ç ÇÉV ëïßìùîç ðëÞôôåé êõñßùò ôéò õðáíÜðôõêôåò êáé áíáðôõóóüìåíåò ÷þñåò ôçò ÁöñéêÞò (íüôéá ôçò Óá÷Üñáò), ôçò Áóßáò êáé ËáôéíéêÞò ÁìåñéêÞò (éäéáßôåñá ôçí ÊáñáúâéêÞ). Ôá ôåëåõôáßá ÷ñüíéá ôá÷åßá åîÜðëùóç ôçò ëïßìùîçò ðáñáôçñåßôáé êáé óôéò ÷þñåò ôçò ÁíáôïëéêÞò Åõñþðçò. Óôçí ÅëëÜäá ï óõíïëéêüò áñéèËÝîåéò êëåéäéÜ: HIV/AIDS, êëéíéêÞ ðñïóÝããéóç, Ãåíéêüò/Ïéêïãåíåéáêüò Éáôñüò, éáôñéêÞ öñïíôßäá ÕðïâëÞèçêå: 24 Oêôùâñßïõ 2002 ÅðáíõðïâëÞèçêå: 29 Éïõëßïõ 2002 ¸ãéíå äåêôÞ ãéá äçìïóßåõóç: 10 Óåðôåìâñßïõ 2002 Õðåýèõíïò áëëçëïãñáößáò: ÁñéóôïöÜíçò Ãêßêáò, Ãáâñéçëßäïõ 6, Áíù ÐáôÞóéá 11141, ÁèÞíá 119


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ê. Ðáðáäçìçôñßïõ êáé óõí.

ìüò ôùí HIV ïñïèåôéêþí ðïõ äçëþèçêáí ìÝ÷ñé ôéò 31 Äåêåììâñßïõ 2000 áíÝñ÷åôáé óå 5446 Üôïìá åê ôùí ïðïßùí ïé 1254 (23%) Ý÷ïõí ðåèÜíåé2. Óôçí ðëåéïøçößá ôïõò (54%) åßíáé Üôïìá çëéêßáò 25-39 åôùí êáé ç ó÷Ýóç áíäñþí/ãõíáéêþí åßíáé ðåñßðïõ 4.6/1. Ï êõñéüôåñïò ôñüðïò ìåôÜäïóçò åßíáé ìÝóù ôçò óåîïõáëéêÞò åðáöÞò. Ôá óôïé÷åßá, áðü ôï 1990 êáé ìåôÜ, åßíáé åíäåéêôéêÜ ôçò áõîçôéêÞò ôÜóçò ôçò åðéäçìßáò ðáñüëï ðïõ ãéá ðñþôç öïñÜ ôï 2000 ç åðßðôùóç ôïõ HIV öáßíåôáé íá ìåéþíåôáé.

ÊëéíéêÝò åêäçëþóåéò êáé óôáäéïðïßçóç ôçò ÇÉV ëïßìùîçò Ïîåßá (ðñùôïðáèÞò) HIV ëïßìùîç ÌåôÜ ôçí áñ÷éêÞ Ýêèåóç êáé ôçí ìüëõíóç áðü ôïí ÇÉV áêïëïõèåß ìßá Ýêñçîç óôïí ðïëëáðëáóéáóìü ôïõ éïý ç ïðïßá Ý÷åé óáí áðïôÝëåóìá ôçí äéáóðïñÜ óôï ëåìöéêü éóôü êáé ôç ìáæéêÞ éáéìßá. ÊáôÜ ôç äéÜñêåéá ôçò áé÷ìÞò ôçò éáéìßáò (2-6 åâäïìÜäåò ìåôÜ ôç ìüëõíóç) ôï ìïëõíèÝí Üôïìï ìðïñåß íá åìöáíßóåé óõìðôþìáôá êáé óçìåßá åíäåéêôéêÜ åíüò êëéíéêïý óõíäñüìïõ, ãíùóôïý ùò ïîý ñåôñïúêü óýíäñïìï3. Ôá êëéíéêÜ ÷áñáêôçñéóôéêÜ áõôïý ôïõ óõíäñüìïõ ìïéÜæïõí ìå ôç ëïéìþäç ìïíïðõñÞíùóç. Ï ðÜó÷ùí ìðïñåß íá åìöáíßóåé åìðýñåôï, áäåíïðÜèåéá, çðáôïóðëçíïìåãáëßá, êõíÜã÷ç, ìõáëãßåò, éëáñïåéäÝò åîÜíèçìá, âëåííïäåñìáôéêÝò åîåëêþóåéò, äéÜññïéá êáé íåõñïëïãéêÜ óõìðôþìáôá (ðßíáêáò 1). Óå ìßá ðñüóöáôç ìåëÝôç, áðåäåß÷èåé üôé ìåôáîý ôùí ðáñáðÜíù óõìðôùìÜôùí áõôÜ ôá ïðïßá

ÐéíáêÜò 1. Óõìðôþìáôá êáé óçìåßá óôçí ïîåßá HIV ëïßìùîç4 Åìðýñåôï ÁäåíïðÜèåéá Öáñõããßôéäá ÅîÜíèçìá? Ìõáëãßåò Êåöáëáëãßá

96% 74% 70% 70% 54% 32%

ÄéÜññïéá Íáõôßá Þ Ýìåôïé Çðáôïóðëçíïìåãáëßá Áöèþäçò Ýëêç ÍåõñïëïãéêÜ óõìðôþìáôá²

32% 27% 14% 12% 12%

ó÷åôßæïíôáé éó÷õñüôåñá ìå ôçí ïîåßá HIV ëïßìùîç Þôáí ï ðõñåôüò êáé ôï åîÜíèçìá5. Ðáñüëá áõôÜ êáíÝíá óýìðôùìá ç óçìåßï äåí ìáò ïäçãåß ìå áóöÜëåéá óôçí Ýãêáéñç äéÜãíùóç ôçò ëïßìùîçò6. Óõíåðþò, áõôÝò ïé êëéíéêÝò åêäçëþóåéò óå óõíäõáóìü ìå êáôáóôÜóåéò õøçëïý êéíäýíïõ èá ðñÝðåé íá åêôéìþíôáé ìå õøçëü äåßêôç õðïøßáò ãéá ôçí ðáñïõóßá ôçò ÇÉV ëïßìùîçò, éäßùò áðü ôïí éáôñü ôçò ðñùôïâÜèìéáò ðåñßèáëøçò. Ôï ðïóïóôü ìïëõíèÝíôùí áôüìùí ðïõ åìöáíßæïõí óõìðôþìáôá óôçí ïîåßá öÜóç êõìáßíåôáé áðü 5089%7. Ôá óõìðôþìáôá õðï÷ùñïýí áðü ìüíá ôïõò ìåôÜ áðü 1-3 åâäïìÜäåò. Ï åñãáóôçñéáêüò Ýëåã÷ïò, êáôÜ ôç öÜóç ôçò ïîåßáò ëïßìùîçò, äåß÷íåé ìåãÜëç áýîçóç ôïõ ééêïý öïñôßïõ RNA óôï ðëÜóìá ôï ïðïßï óõíïäåýåôáé áðü áñíçôéêü ïñïëïãéêü Ýëåã÷ï ãéá áíôé-HIV áíôéóþìáôá. Ó’ áõôü ôï óôÜäéï ôçò ëïßìùîçò ï êßíäõíïò ìåôÜäïóçò ôïõ HIV óôïõò Üëëïõò åßíáé ðïëý õøçëüò ãé'áõôü êáé ç Ýãêáéñç äéáãíùóÞ ôçò Ý÷åé ìåãÜëç óçìáóßá ü÷é ìüíï ãéá ôïí áóèåíÞ áëëÜ êáé ôçí äçìüóéá õãåßá.

ÁóõìðôùìáôéêÞ ëïßìùîç ÌåôÜ ôçí áíÜññùóç áðü ôçí ðñùôïëïßìùîç áêïëïõèåß ç êëéíéêÜ áóõìðôùìáôéêÞ ëïßìùîç ç ïðïßá ìðïñåß íá äéáñêÝóåé 5-10 ÷ñüíéá. ÊáôÜ ôçí ðåñßïäï áõôÞ ï áóèåíÞò åßíáé áóõìðôùìáôéêüò ç ìðïñåß íá ðáñïõóéÜæåé åðéìÝíïõóá ãåíéêåõìÝíç ëåìöáäåíïðÜèåéá. Ç ëåìöáäåíïðÜèåéá ìðïñåß íá ãßíåé áíôéëçðôÞ áðü ôïí ßäéï ôïí áóèåíÞ ç íá äéáðéóôùèåß óå áíôéêåéìåíéêÞ åîÝôáóç ñïõôßíáò. ºóùò íá óõíïäåýåôáé áðü áäõíáìßá, êáôáâïëÞ, ÷áìçëÞ ðõñåôéêÞ êßíçóç êáé íõêôåñéíÞ åößäñùóç. Ïé ëåìöáäÝíåò Ý÷ïõí ìÝãåèïò 1-5 cm, óõíÞèùò åßíáé óêëçñïß, áíþäõíïé, åõêßíçôïé êáé åíôïðßæïíôáé óôïí ôñÜ÷çëï, õðåñêëåßäéïò ÷þñá, ïðéóèïùôéáßùò, ìáó÷Üëåò êáé åðéôñï÷éëéáêÜ8.

ÓõìðôùìáôéêÞ HIV ëïßìùîç Ðñþéìç óõìðôùìáôéêÞ ëïßìùîç

1

Êçëéäïâëáôéäþäåò åîÜíèçìá ôï ïðïßï åíôïðßæåôáé óôï ðñüóùðï, êïñìü êáé Üêñá ± ðÝëìáôá êáé ðáëÜìåò. Ìðïñåß íá õðÜñ÷ïõí åîåëêþóåéò óôçí óôïìáôéêÞ êïéëüôçôá, ïéóïöÜãï ç óôá ãåííçôéêÜ üñãáíá. 2 ÐåñéëáìâÜíïíôáé ç Üóçðôç ìçíéããßôéäá, ìçíéããïåãêåöáëßôéäá, ðåñéöåñéêÞ íåõñïðÜèåéá, óýíäñïìï Guillain-Barre, ãíùóéáêÝò äéáôáñá÷Ýò ç øý÷ùóç.

120

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


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ê. Ðáðáäçìçôñßïõ êáé óõí.

íôßáóç, ôñá÷çëéêÞ äõóðëáóßá, öëåãìïíþäçò íüóïò ôçò ðõÝëïõ, ëéóôåñßùóç, ðåñéöåñéêÞ íåõñïðÜèåéá. ÁõôÝò ïé íïóïëïãéêÝò ïíôüôçôåò áíÞêïõí óôçí êáôçãïñßá  óýìöùíá ìå ôç óôáäéïðïßçóç ôùí ÊÝíôñùí ÅëÝã÷ïõ Ëïéìþîåùí (CDC) ôùí ÇÐÁ (ðßíáêáò 2).

¼øéìç óõìðôùìáôéêÞ HIV íüóïò (ðëÞñåò AIDS) Åäþ ðåñéëáìâÜíïíôáé üëåò ïé êëéíéêÝò êáôáóôÜóåéò ïé ïðïßåò åßíáé åðáêüëïõèåò ôçò ìáæéêÞò êáôáóôñïöÞò ôïõ áìõíôéêïý óõóôÞìáôïò êáé ôçò åëÜôôùóçò ôùí CD4-êõôôÜñùí. Ïé êáôáóôÜóåéò áõôÝò, áðïêáëïýìåíåò åõêáéñéáêÝò ðáèÞóåéò, ðñïóäéïñßæïõí ôï AIDS(êáôçãïñßåò Á3, Â3 êáé C) êáé óôéò ïðïßåò ðåñéëáìâÜíïíôáé ôá åîÞò: • ÅõêáéñéáêÝò ëïéìþîåéò: áðü éïýò (CMV); áðü âáêôçñßäéá (Mycobacterium avium, ìõêïâáêôÞñéï ôçò öõìáôßùóçò, óáëìïíÝëëá, ðíåõìïíéüêïêêï); áðü ìýêçôåò (Candida albicans, Cryptococcus neoformans, Histoplasma capsulatum, Aspergillus spp.); áðü ðñùôüæùá (Pneumocystis carinii, Cryptosporidia, Microsporidia, Toxoplasma gondii). • ÍåïðëÜóìáôá üðùò: óÜñêùìá Kaposi, ëÝìöùìá áðü ìç Ô-êýôôáñá, äéçèçôéêü êáñêßíùìá ôñá÷Þëïõ. • ÍåõñïëïãéêÝò åêäçëþóåéò: Üíïéá, êåíïôïðéþäç ìõåëïðÜèåéá, ðñïúïýóá ðïëõåóôéáêÞ ëåõêïåãêåöáëïðÜèåéá.

ÊëéíéêÞ åêôßìçóç ôïõ áóèåíïýò ¼ôáí óå Ýíá Üôïìï Ý÷åé ôåèåß ç äéÜãíùóç ôçò HIV ëïßìùîçò èá ðñÝðåé íá ãßíåôáé êëéíéêÞ åêôßìçóç ôïõ áóèåíïýò üóï ôï äõíáôüí ãñçãïñüôåñá ç ïðïßá èá óõìâÜëëåé óôçí áêñéâÞ óôáäéï-

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

Éóôïñéêü Áðáñáßôçôç åßíáé ç ëÞøç ðëÞñïõò éóôïñéêïý ìå ìåãáëýôåñç Ýìöáóç óôïí ðñïóäéïñéóìïý ôïõ ÷ñüíïõ êáé ôñüðïõ ìåôÜäïóçò ôçò ëïßìùîçò, óôçí ðñïçãïýìåíç éáôñéêÞ öñïíôßäá (åîåôÜóåéò, åìâïëéáóìïß) êáé óôçí êáôáãñáöÞ ôùí óõìðôùìÜôùí. Åðßóçò áðáñáßôçôç åßíáé ëÞøç éóôïñéêïý ãéá ôçí ðáñïõóßá íïóçìÜôùí ðáèÞóåùí Þ êáôáóôÜóåùí ðïõ ó÷åôßæïíôáé ìå ôçí HIV üðùò: öõìáôßùóç, Ýñðçò æùóôÞñáò, óåîïõáëéêþò ìåôáäéäüìåíá íïóÞìáôá, çðáôßôéäåò, áëêïïëéóìüò, ÷ñÞóç ïõóéþí ê.á..

ÁíôéêåéìåíéêÞ åîÝôáóç Ãßíåôáé ëåðôïìåñÞò áíôéêåéìåíéêÞ åîÝôáóç ìå åóôßáóç óôá åîÞò: óôïìáôéêÞ êïéëüôçôá êáé öÜñõããáò, ëåìöáäÝíåò, äÝñìá, êáñäéÜ êáé ðíåýìïíåò, êïéëéÜ, ãåííçôéêÜ üñãáíá/ðõÝëïò, íåõñïëïãéêü óýóôçìá.

Åñãáóôçñéáêüò Ýëåã÷ïò • ÏñïëïãéêÝò äïêéìáóßåò Ðñïóäéïñßæïíôáé áíôéóþìáôá êáôÜ ôïõ HIV(ôá ïðïßá åìöáíßæïíôáé óõíÞèùò åíôüò 3 ìçíþí áðü ôçí ìüëõíóç) ìå ELISA, ç ïðïßá Ý÷åé åéäéêüôçôá êáé åõáéóèçóßá >99% Øåõäþò èåôéêÞ åîÝôáóç ðáñáôçñåßôáé óå ðïëýôïêÝò ãõíáßêåò, ðñüóöáôï åìâïëéáóìü ãéá ãñßððç Þ HÂV, ðïëëáðëÝò ìåôáããßóåéò óå áéìáôïëïãéêÝò êáêïÞèåéåò, áõôïÜíïóá íïóÞìáôá, ðïëëáðëü ìõÝëùìá, ðñùôïðáèÞò

Ðßíáêáò 2. Óôáäéïðïßçóç ôçò HIV ëïßìùîçò êáôÜ CDC, 1993 9 ÊëéíéêÝò êáôçãïñßåò Êáôçãïñßåò âÜóåé ôïõ áñéèìïý CD4-êõôôÜñùí 1. >500/mm³ (>29%) 2. 200-499/mm³ (14-28%) 3. <200/mm³ (<14%)

Á

Â

C

Áóõìðôùìáôéêïß, ÅÃË, ç óõíäñ. ðñùôïëïßìùîçò A1 A2 A3

Óõìðôùìáôéêïß (¼÷é Á ç C) B1 B2 B3

Åêäçëþóåéò ðïõ óõíéóôïýí AIDS C1 C2 C3

ÅÃË: ÅðéìÝíïõóá ÃåíéêåõìÝíç ËåìöáäåíïðÜèåéá

121


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

÷ïëéêÞ êßññùóç Þ áëêïïëéêÞ çðáôßôéäá. Øåõäþò áñíçôéêÞ åîÝôáóç ðáñáôçñåßôáé óå ðïëý ðñþúìá Þ üøéìá óôçí ðïñåßá ôçò HIV ëïßìùîçò üôáí ç ðáñáãùãÞ áíôéóùìÜôùí åßíáé ìéêñÞ. Ç ðñáêôéêÞ ãéá ôç äéÜãíùóç ôçò HIV ëïßìùîçò åßíáé: 2 ELISA äïêéìáóßåò êáé áí åßíáé èåôéêÝò ãßíåôáé åðéâåâáßùóç ìå Western Blot. • Áñéèìüò ôùí CD4 ëåìöïêõôôÜñùí (Ö.Ô » 800/mm³) ×ñçóéìåýåé óôçí óôáäéïðïßçóç êáé åêôßìçóç ôçò áíïóïëïãéêÞò ëåéôïõñãßáò. Oé áóèåíåßò ìå ôéìÝò <500/mm³ åìöáíßæïõí õðïôñïðéÜæïõóåò âáêôçñéäéáêÝò ëïéìþîåéò, <200/mm³ áíáðôýóïõí åõêáéñéáêÝò ëïéìþîåéò. • ÌÝôñçóç ôïõ ééêïý öïñôßïõ HIV RNA óôï ðëÜóìá ìå PCR. Åßíáé ÷ñÞóéìç óôçí äéÜãíùóç ôçò ðñùôïðáèïýò ëïßìùîçò, ãéá ôçí ðñüâëåøç ôçò åîÝëéîçò ôçò íüóïõ êáé ôçí ðáñáêïëïýèçóç ôçò áíôáðüêñéóçò óôç èåñáðåßá. • Áéìáôïëïãéêüò êáé âéï÷çìéêüò Ýëåã÷ïò Ç ãåíéêÞ áßìáôïò ìðïñåß íá äåßîåé èñïìâïðåíßá, ëåõêïðåíßá ç áíáéìßá. Ï âéï÷çìéêüò ðåñéëáìâÜíåé Ýëåã÷ï çðáôéêÞò êáé íåöñéêÞò ëåéôïõñãßáò óÜê÷áñï êáé ëéðéäáéìéêü ðñïößë. • Áêôéíïãñáößá èþñáêïò êáé Ìantoux • Toxo-test, VDRL, äåßêôåò çðáôßôéäáò  (ãéá ôï åíäå÷üìåíï åìâïëéáóìïý), áíôé-HCV (óå áíåîÞãçôç ýðåñôñáíóáìéíáóáéìßá) • Test Pap ç êáé êáëëéÝñãåéá êïëðéêïý õãñïý. • Áíôé-CMV, áíôé-HAV (ãéá áðïöõãÞ åìâïëéáóìïý), G6PD (ãéá ðéèáíÞ Ýëëåéøç ç ïðïßá åðçñåÜæåé ôç ÷ñÞóç TMP-SMX ç äáøüíçò). ÅîåôÜóåéò üðùò ç ìÝôñçóç ôïõ ééêïý öïñôßïõ RNA, ï áñéèìüò CD4 ëåìöïêõôôÜñùí, ç VDRL, ôï test Pap êáé ï âéï÷çìéêüò Ýëåã÷ïò åðáíáëáìâÜíïíôáé áíÜ ôáêôéêÜ ÷ñïíéêÜ äéáóôÞìáôá ãéá ôçí ðáñáêïëïýèçóç ôçò ðïñåßáò ôçò íüóïõ êáé ôçò áíôáðüêñéóçò óôç èåñáðåßá.

ÈåñáðåõôéêÞ áíôéìåôþðéóç ôçò HIV ëïßìùîçò Óôï÷ïß ôçò èåñáðåßáò åßíáé: Ç êáôáóôïëÞ ôïõ éïý, ðñüëçøç åîáóèÝíçóçò ôïõ áíïóïðïéçôéêïý óõóôÞìáôïò, åðéìÞêõíóç ôçò æùÞò êáé ç äéáöýëáîç ðïéüôçôáò æùÞò. Áõôïß ïé óôü÷ïé åðéôõã÷Üíïíôáé óå óçìáíôéêü âáèìü ìå ôç ÷ñÞóç, ôá ôåëåõôáßá 6-7 ÷ñüíéá, ôùí íÝùí áíôéúêþí öáñìÜêùí. ×Üñç ó'áõôÜ ç èåñáðåßá ôçò HIV ëïßìù122

Ê. Ðáðáäçìçôñßïõ êáé óõí.

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

ÁíôéúêÞ èåñáðåßá (HAART) Ôá íåüôåñá áíôéñåôñïúêÜ öÜñìáêá êáôáóôÝëëïõí ôïí ðïëëáðëáóéáóìü ôïõ éïý óå åðßðåäá ðïõ äåí ìðïñïýí íá áíé÷íåõèïýí ìå ôç ìÝèïäï ìÝôñçóçò HIV RNA. Ïé äéáèÝóéìåò ìÝ÷ñé ôþñá ïìÜäåò áíôéñåôñïúêþí åßíáé: Á. ÍïõêëåïóéäéêÜ áíÜëïãá, áíáóôïëåßò ôçò áíÜóôñïöçò ìåôáãñáöÜóçò (NRTIs) ôá ïðïßá áíáóôÝëëïõí ôç äüìçóç ééêïý DNA, ìå óõíÝðåéá áíåðÜñêåéá ðáñáãùãÞò íÝùí áíôéãñÜöùí ôïõ éïý. Â. Ìç íïõêëåïóéäéêïß áíáóôïëåßò ôçò áíÜóôñïöçò ìåôáãñáöÜóçò (ÍÍRTIs), ôá ïðïßá ðáñåìâáßíïõí óôç äñÜóç ôçò áíÜóôñïöçò ìåôáãñáöÜóçò ìå äéáöïñåôéêü ìç÷áíéóìü áðü ôá NRTIs. ÕðÜñ÷åé óçìáíôéêïý âáèìïý äéáóôáõñïýìåíç áíôï÷Þ ìåôáîý ôïõò, þóôå íá åßíáé áíÝöéêôç ç äéáäï÷éêÞ ÷ïñÞãçóÞ ôïõò. Ã. Ïé áíáóôïëåßò ôçò ðñùôåÜóçò (PIs) äñïõí óôçí ôåëéêÞ öÜóç ôïõ êýêëïõ áíáðáñáãùãÞò ôïõ éïý áíáóôÝëëïíôáò ôç äñÜóç ôçò ðñùôåÜóçò, ðïõ ðáßæåé êáèïñéóôéêü ñüëï óôïí éúêü ðïëëáðëáóéáóìü. ×áñáêôçñéóôéêÞ åßíáé ç ìåãÜëç áíÜðôõîç äéáóôáõñïýìåíçò áíôï÷Þò ìåôáîý ôùí öáñìÜêùí áõôÞò ôçò ïìÜäáò, ìå ôçí ýðáñîç ðïëëáðëþí ìåôáëëÜîåùí. Êáëýôåñï áðïôÝëåóìá óôçí êáôáóôïëÞ ôïõ éúêïý ðïëëáðëáóéáóìïý åðéôõã÷Üíåôáé ìå ôáõôü÷ñïíç Ýíáñîç óõíäõáóìïý öáñìÜêùí. Ïé óõíäõáóìïß ðïõ ðñïôåßíïíôáé åßíáé ïé åîÞò: 2 NRTIs + 1 PI, 2 NRTIs + 1 NNRTI, 2 NRTIs + 2 PIs. Ç Ýíáñîç ôçò áíôéñåôñoúêÞò èåñáðåßáò óõíéóôÜôáé íá ãßíåôáé óå üëïõò ôïõò óõìðôùìáôéêïýò áóèåíåßò êáé óôïõò áóõìðôùìáôéêïýò ìå CD4<500/mm³ Þ HIV RNA>10000 áíôßãñáöá/ Ml4,10. Ôá áíôéñåôñïúêÜ öÜñìáêá ðáñïõóéÜæïõí óõ÷íÜ áíåðéèýìçôåò åíÝñãåéåò üðùò ìõåëïôïîéêüôçôá, ìõïðÜèåéá, ðáãêñåáôßôéäá, íåöñïëéèßáóç ê.á. ïé ïðïßåò åßíáé åéäéêÝò ôïõ åßäïõò ôïõ öáñìÜêïõ. Åðßóçò ó÷åôßæïíôáé ìå ìéá óåéñÜ åðéðëïêþí üðùò äéáôáñá÷Ýò ôïõ ìåôáâïëéóìïý ôùí ëéðéäßùí êáé óáê÷Üñïõ, ëéðïäõóôñïößá, êáñäéïìõïðÜèåéá, ãáëáêôéêÞ ïîÝùóç, ïóôåïðüñùóç êáé Üóçðôç íÝêñùóç ôùí ïóôþí. Óõíåðþò áíáãêáßá åßíáé ç åîáôïìßêåõóç ôçò áãùãÞò üðïõ ôá ïöÝëç èá ðñÝðåé íá óôáèìßæïíôáé ôïí êßíäõíï ôïîéêüôçôáò êáé


Ê. Ðáðáäçìçôñßïõ êáé óõí.

ôïí ðåñéïñéóìü ãéá ìåëëïíôéêÝò åíáëëáêôéêÝò ëýóåéò, éäßùò ëüãù ôçò áíÜðôõîçò áíèåêôéêþí óôåëå÷þí ôïõ éïý.

AíôéìéêñïâéáêÞ ðñïöýëáîç êáé åìâïëéáóìïß Áðüëõôç Ýíäåéîç ãéá áíôéìéêñïâéáêÞ ðñïöýëáîç áðïôåëåß ç öõìáôßùóç (äåßêôçò Ìantoux ³5mm ç Ýêèåóç õøçëïý êéíäýíïõ). ×ñçóéìïðïéåßôáé Éóïíéáæßäç + Ðõñéäïîßíç ãéá 9 ìÞíåò. Ãéá ôçí ðñüëçøç ôçò ðíåõìïíßáò áðü P. Carinii üðùò êáé ãéá ôçí ôïîïðëÜóìùóç ÷ïñçãåßôáé ÔÌP-SMX, üôáí ôá CD4 <200/mm³. Ïôáí ôá CD4 <50/ mm³ ÷ïñçãåßôáé êëáñõèñïìõêßíç ç áæéèñïìõêßíç ãéá ôçí ðñüëçøç ôçò ëïßìùîçò áðü M. avium11. Áðáñáßôçôï èåùñåßôáé, ãéá üëïõò ôïõò áóèåíåßò, ï åìâïëéáóìüò êáôÜ ôçò ãñßððçò, çðáôßôéäáò  êáé ðíåõìïíéüêïêêïõ.

ÁíáêïõöéóôéêÞ êáé õðïóôçñéêôéêÞ èåñáðåßá Ç áíôéìåôþðéóç ôçò äéÜññïéáò, ç ïðïßá åìöáíßæåôáé óôï 60-80% ôùí áóèåíþí, óõíßóôáôáé óôçí åéäéêÞ èåñáðåßá (áíÜëïãá ôï ðáèïãüíï áßôéï) êáé ôçí óõìðôùìáôéêÞ. Ç ôåëåõôáßá ðåñéëáìâÜíåé ãåíéêÜ ìÝôñá üðùò êáëÞ åíõäÜôùóç, êáôÜëëçëç äßáéôá êáé ÷ñÞóç áíôéäéáññïúêþí öáñìÜêùí12. ¢ëëåò äéáôáñá÷Ýò áðü ôï ðåðôéêü üðùò íáõôßá, Ýìåôïé êáé äõóêïéëéüôçôá óõíÞèùò ïöåßëïíôáé óôéò åõêáéñéáêÝò ðáèÞóåéò(êáíôéíôßáóç, êáêïÞèåéåò) Þ óôá öÜñìáêá ïðüôå ç èåñáðåßá åêôüò áðü óõìðôùìáôéêÞ óôï÷åýåé êáé óôçí áíôéìåôþðéóç ôçò áéôßáò. Ïé áóèåíåßò ìå HIV ëïßìùîç ç AIDS óõ÷íÜ ðáñïõóéÜæïõí ðüíï, ðïõ ó÷åôßæåôáé ìå ôçí ðåñéöåñéêÞ íåõñïðÜèåéá, Ýñðçôá æùóôÞñá, ôï óÜñêùìá Êaposi ê.á., üðïõ ïé áñ÷Ýò áíôéìåôþðéóÞò ôïõ åßíáé ðáñüìïéåò ìå áõôÝò ôïõ êáñêéíéêïý ðüíïõ. Ôá áíáëãçôéêÜ ðïõ ÷ñçóéìïðïéïýíôáé åßíáé ç áêåôáìéíïöáßíç, ôá ÌÓÁÖ êáé ôá ïðéïåéäÞ, áíÜëïãá ôçò Ýíôáóçò ôïõ ðüíïõ13. Óôïõò áóèåíåßò ìå HIV ëïßìùîç áñêåôÜ óõ÷íÞ åßíáé ç êáôÜèëéøç êáé ôá ðéï êáôÜëëçëá áíôéêáôáèëéðôéêÜ ðïõ óõíéóôþíôáé åßíáé ç ðáñïîåôßíç êáé ç öëïõïîåôßíç. Óå ìåñéêïýò áóèåíåßò ìå Þðéá áëëÜ åðéìÝíïõóá êáôÜèëéøç ç øõ÷ïèåñáðåßá ìðïñåß íá áíôéêáôáóôÞóåé ôá öÜñìáêá14.

Ôüìïò 14, Ôåý÷ïò 3, 2002

Ï ñüëïò ôïõ Ãåíéêïý/Ïéêïãåíåéáêïý Éáôñïý óôçí ðáñáêïëïýèçóç êáé öñïíôßäá ôùí áóèåíþí ìå HIV/ AIDS ÓÞìåñá óôçí ÅëëÜäá êáé ãåíéêüôåñá óôéò áíåðôõãìÝíåò ÷þñåò, ôç âáóéêÞ åõèýíç ãéá ôçí ðáñáêïëïýèçóç êáé íïóçëåßá ôùí áóèåíþí áõôþí ôçí Ý÷ïõí ïé ÅéäéêÝò ÌïíÜäåò AIDS, ïé ïðïßåò õðÜñ÷ïõí óå äéÜöïñá Íïóïêïìåßá. ¸íá ôÝôïéï óýóôçìá óçìáßíåé üôé ïé áóèåíåßò áõôïß Ý÷ïõí Üìåóç ðñüóâáóç óå Ýíá äåõôåñïâÜèìéï íïóçëåõôéêü ßäñõìá, ìå ôéò üðïéåò äõó÷Ýñåéåò óõíåðÜãåôáé áõôü. Ç HIV ëïßìùîç ùò ÷ñüíéá íüóïò áðáéôåß ìáêñï÷ñüíéá êáé óõíå÷Þ ðáñáêïëïýèçóç. Ìå ôçí áýîçóç ôïõ áñéèìïý ôùí ðáó÷üíôùí, ôçí ðñüïäï óôç èåñáðåßá êáé ôçí ðáñÜôáóç ôçò åðéâßùóçò ôá äåäïìÝíá ðïõ Üðôïíôáé ôçò ðáñáêïëïýèçóçò áõôþí ôùí áóèåíþí Ý÷ïõí áëëÜîåé. Åêôüò áõôïý ç HIV ëïßìùîç óõíïäåýåôáé óõ÷íÜ ìå øõ÷ïëïãéêÞ êáé êïéíùíéêÞ íïóçñüôçôá ç ïðïßá áðáéôåß ðïëýðëåõñç ðñïóÝããéóç. Áõôïß ïé ðáñÜãïíôåò áíáäåéêíýïõí ôïí åíåñãü ñüëï ðïõ ðñÝðåé íá äéáäñáìáôßóåé ï Ãåíéêüò/Ïéêïãåíåéáêüò Éáôñüò (Ã/ ÏÉ) óôçí áíôéìåôþðéóç áõôþí ôùí áóèåíþí. Óôçí ðñáãìáôéêüôçôá áõôüò ï ñüëïò äåí åßíáé äéáöïñåôéêüò áðü ôïí ñüëï ðïõ Ý÷åé óôá Üëëá ÷ñüíéá íïóÞìáôá: Ýãêáéñç äéÜãíùóç, óõíôïíéóìÝíç öñïíôßäá åðß óõíõðáñ÷üíôùí íïóçìÜôùí, ðáñáðïìðÞ üôáí ÷ñåéÜæåôáé, êáô' ïßêïí íïóçëåßá êáé áíáêïõöéóôéêÞ èåñáðåßá15. Ç ìéêñÞ äéáöïñÜ óõíßóôáôáé óôï üôé ï ñüëïò ôïõ Ã/ÏÉ óôçí ðåñßðôùóç áõôÞ åßíáé ðåñéóóüôåñï óõíõöáóìÝíïò ìå ôïí ñüëï ôçò ïìÜäáò ðñùôïâÜèìéáò öñïíôßäáò õãåßáò, ãéá ôçí ïðïßá Ý÷åé ôçí åõèýíç ôïõ óõíôïíéóìïý. Ôá âáóéêÜ ìÝëç áõôÞò ôçò ïìÜäáò åßíáé íïóçëåýôñéá/ôçò, åðéóêÝðôñéá/ôçò õãåßáò, êïéíùíéêÞ/üò ëåéôïõñãüò, ç ìáßá/åõôÞò êáé øõ÷ïëüãïò16. ÅðéðëÝïí, ïé áóèåíåßò ìå HIV ëïßìùîç Ý÷ïõí ðïëëÝò äõóêïëßåò ëüãù ôçò êïéíùíéêÞò áðïìüíùóçò êáé ç õðïóôÞñéîç ó'áõôüí ôïí ôïìÝá áðáéôåß óõíåñãáóßá ìå Üëëåò äçìüóéåò êáé êïéíùíéêÝò õðçñåóßåò üðùò ï äÞìïò, ç åêêëçóßá, ïé åèåëïíôéêÝò ïñãáíþóåéò ê.á. Ï óçìáíôéêüôåñïò ôïìÝáò óôïí ïðïßï ç ðñïóöïñÜ ôïõ Ã/ÏÉ èåùñåßôáé áðáñáßôçôç åßíáé ç áíáêïýöéóç ôùí áóèåíþí áðü ôá óõìðôùìÜôá êáé ç êáô' ïßêïí öñïíôßäá éäßùò áõôþí ðïõ âñßóêïíôáé óôá ôåëéêÜ óôÜäéá ôçò íüóïõ. Ç óõìðôùìáôéêÞ èåñáðåßá ìå ôçí ïðïßá ó÷åôßæåôáé Üìåóá 123


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

ç ðïéüôçôá æùÞò ôïõ áññþóôïõ èá ðñÝðåé íá ÷ïñçãåßôáé ÷ùñßò êáèõóôÝñçóç åíþ ðáñÜëëçëá èá ðñÝðåé íá õðïâÜëëåôáé óôïí áðáñáßôçôï åñãáóôçñéáêü Ýëåã÷ï ãáé ôçí áíåýñåóç ôõ÷üí õðïêåßìåíçò áéôßáò óôçí ïðïßá ïöåßëïíôáé ôá óõìðôþìáôá. Ïé áóèåíåßò ìå AIDS ìðïñïýí, óå ïñéóìÝíá óôÜäéá ôçò íüóïõ, íá íïóçëåõôïýí ìå áóöÜëåéá êáé åêôüò íïóïêïìåßïõ, äçëáäÞ óôï óðßôé ôïõò, óôï ïðïßï áéóèÜíïíôáé áóöáëÞò êáé åíéó÷ýïíôáé øõ÷ïëïãéêÜ. ÅðéðëÝïí ç êáô'ïßêïí áíôéìåôþðéóç ôùí áóèåíþí ðñïëáìâÜíåé ôçò Üóêïðåò åðéóêÝøåéò êáé åéóáãùãÝò óôï íïóïêïìåßï. Ðïëëïß áóèåíåßò êáôÜ ôç äéÜñêåéá ôïõ ôåëéêïý óôáäßïõ ôçò íüóïõ ðñïôéìïýí íá íïóçëåýïíôáé óôï óðßôé, ìÝ÷ñé êáé ôçí êáôáëçîÞ ôïõò, áöïý ôïõò Ý÷åé åîáóöáëéóôåß Ýíáò áíþäõíïò èÜíáôïò. ÁõôÜ ðñïûðïèÝôïõí ìßá ïñãáíùìÝíç õðçñåóßá ãéá íïóçëåßá óôï óðßôé üðïõ ôçí êýñéá åõèýíç èá Ý÷åé ï Ã/ÏÉ17. Ìåßæïíïò óçìáóßáò óôçí ðáñáêïëïýèçóç ôùí áóèåíþí ìå HIV ëïßìùîç åßíáé ç ó÷Ýóç ôïõ ÃÏ/ É ìå ôïí åéäéêü. Å÷åé áðïäåé÷èåß üôé ç áðëÞ, Üìå-

Ê. Ðáðáäçìçôñßïõ êáé óõí.

óç êáé ôáêôéêÞ åðéêïéíùíßá ìå ôïí åéäéêü åîáóöáëßæåé êáëýôåñï åðßðåäï éáôñéêÞò öñïíôéäáò ðñïò ôïõò áóèåíåßò êáé äéåõêïëýíåé ôï Ýñãï ôïõ Ã/ÏÉ18. Óçìáíôéêüò åßíáé ï ñüëïò ôïõ Ã/ÏÉ ðïõ áöïñÜ ôçí åêðáßäåõóç áóèåíþí êáé ïéêåßùí. ÓõãêåêñéìÝíá áõôüò ï ôïìÝáò ðåñéëáìâÜíåé ôçí åêðáßäåõóç áññþóôïõ-ïéêïãÝíåéáò ãéá ôïõò ôñüðïõò ìåôÜäïóçò êáé ðñïöýëáîçò áðü ôç íüóï, ãéá ôç öáñìáêåõôéêÞ áãùãÞ, ôç äéáôñïöÞ êáé ôçí ðñüëçøç ôùí åõêáéñéáêþí ëïéìþîåùí. Åéäéêüôåñá ç ïéêïãÝíåéá èá ðñÝðåé íá åêðáéäåýåôáé íá áíáãíùñßæåé åãêáßñùò ôçí áëëáãÞ óõìðåñéöïñÜò ôïõ áóèåíïýò êáé íá ôïí õðïóôçñßæåé øõ÷ïëïãéêÜ. Ãéá íá áíôáðïêñéèåß ó'áõôü ôï ñüëï ï Ã/ÏÉ èá ðñÝðåé íá ðëçñåß ïñéóìÝíåò âáóéêÝò ðñïõðïèÝóåéò, üðùò ôßèïíôáé êáé áðü ôï European Primary Care AIDS Network (EPCAN)10. Óýìöùíá ìå ôá éó÷ýïíôá óôçí ÅõñùðáúêÞ Åíþóç, ìåñéêÝò áðü ôéò âáóéêÝò ãíþóåéò, óôÜóåéò êáé ðñáêôéêÝò ðïõ ðñÝðåé íá áðïêôÞóåé ï Ã/ÏÉ öáßíïíôáé óôïí ðßíáêá:

Ðßíáêáò. ÂáóéêÝò ãíþóåéò, óôÜóåéò êáé ðñáêôéêÝò ðïõ èá ðñÝðåé íá áðïêôÞóåé ï Ã/ÏÉ • Ï Ãåíéêüò Éáôñüò ðñÝðåé íá åßíáé óå èÝóç íá ìðïñåß íá áíáêïéíþóåé Ýíá èåôéêü test óå áóèåíÞ, üðùò êáé íá Ý÷åé ôçí éêáíüôçôá íá áíáãíùñßóåé ðåñßðïõ ôï âáèìü áíïóïêáôáóôïëÞò êáé ôï óôÜäéï ôçò íüóïõ. Íá ãíùñßæåé ôï áíôßóôïé÷ï ÊÅÅË ôçò ðåñéï÷Þò åõèýíçò ôïõ êáé íá ìðïñåß íá óõíôïíßæåé ôçí éáôñéêÞ öñïíôßäá. • Íá ðáñÜó÷åé ìå óïâáñüôçôá êáé õðåõèõíüôçôá ôç âáóéêÞ øõ÷ïëïãéêÞ õðïóôÞñéîç ÷ùñßò íá åðéêñßíåé áëëÜ íá óÝâåôáé ôçí áîéïðñÝðåéá, ôéò ðñïóùðéêÝò áðüøåéò, ôéò óåîïõáëéêÝò ðñïôéìÞóåéò, ôïí ôñüðï æùÞò, ôï êïéíùíéêüïéêïíïìéêü åðßðåäï êáé ðáñÜëëçëá íá ðñïóôáôåýåé ôï áðüññçôï ôùí ðëçñïöïñéþí. Íá åßíáé éêáíüò íá õðïøéáóèåß ôïõò ïñïèåôéêïýò ìå õøçëü âáèìü åðéêéíäõíüôçôáò áëëÜ êáé íá õðïóôçñßîåé ôá Üôïìá áõôÜ, þóôå íá õéïèåôÞóïõí áóöáëÝóôåñç óõìðåñéöïñÜ áðÝíáíôé óôïõò óõíáíèñþðïõò ôïõò • ¼ëïé ïé Ãåíéêïß Éáôñïß èá ðñÝðåé íá óõíçèßóïõí óáí åîÝôáóç ñïõôßíáò ôç ëåðôïìåñÞ áíôéêåéìåíéêÞ åîÝôáóç ôïí ïñïèåôéêþí ðåñéëáìâÜíïíôáò ôçí åîÝôáóç ôùí ëåìöáäÝíùí, ôçò óôïìáôéêÞò êïéëüôçôáò ê.ëð. • ÅðéðëÝïí íá åßíáé óå èÝóç íá ôïõ áíáðôýîåé ôéò åõåñãåôéêÝò áñ÷Ýò ôçò áíôéñåôñïúêÞò èåñáðåßáò, ãéá êáëýôåñç óõììüñöùóç, üðùò êáé íá ãíùñßæåé ôéò âáóéêÝò ðáñåíÝñãåéåò ôçò ÇÁART êáé ôéò áëëçëåðéäñÜóåéò ìå Üëëá öÜñìáêá. Må ôçí êáôÜëëçëç åêðáßäåõóç, ïé Ãåíéêïß Éáôñïß ìðïñïýí íá ôá êáôáöÝñïõí åîßóïõ êáëÜ ìå ôïõò åéäéêïýò, óôïí ôïìÝá ôéò áíôééêÞò èåñáðåßáò. Áõôü áðïäåéêíýåôáé áðü ìåëÝôåò óå ÷þñåò ìå áíåðôõãìÝíç ÐÖÕ, üðïõ ïé Ã/ÏÉ óõììåôÝ÷ïõí åíåñãÜ óôéò èåñáðåõôéêÝò áðïöÜóåéò8,9.

Âéâëéïãñáößá 1. Ôhe Global HIV and AIDS Epidemic 2001. MMWR 50:434-439, 2001. 2. Åîáìçíéáßá Ýêäïóç ôïõ ÊÝíôñïõ ÅëÝã÷ïõ Åéäéêþí Ëïéìþîåùí (ÊÅÅË). ÅðéäçìéïëïãéêÞ ÅðéôÞñçóç ôïõ HIV/AIDS óôçí ÅëëÜäá. Ôåý÷ïò 12, ÄåêÝìâñéïò 2000. 3. Óáñüãëïõ Ã, ËéïíÞ Á, Ðïôáìïýóç Ð, Ãåùñãßïõ Ï. AIDS/HIV: ÊëéíéêÞ ðñïóÝããéóç êáé èåñáðåßá. Åêäüóåéò Ðáó÷áëßäç. ÁèÞíá, 77-111, 1999. 124

4. Bartlett JG. The Johns Hopkins Hospital 20002001 guide to medical care of patients with HIV infection. Lippincott Williams & Wilkins. Ninth Edition, 11-32, 66-119, 2000. 5. Çecht FM, Busche MP, Rawale B, Webb M, et al. Use of laboratory tests and clinical symptoms for identification HIV infection. AIDS, 16:1119-1129, 2002. 6. Daar ES, Little S, Pitt J, Santangelo J, et al. Diagnosis of primary HIV infection. Ann Intern Med 134:25-9, 2001.


Ê. Ðáðáäçìçôñßïõ êáé óõí.

7. Schacker T, Collier AC, Hughes J, Shea T, et al. Clinical and epidemiologic features of primary HIV infection. Ann Intern Med, 125:25764, 1996. 8. Muma R, Lyons BA, Borucky MJ, Pollard RB. HIV manual for health care professionals. Appleton & Lange. Second Edition, 153-161 1997. 9. Centers for Disease Control(CDC). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR, 41:1-9, 1992. 10. Ðáðáäüðïõëïò Á, ÃéáìáñÝëëïõ Å. Ç áíôéñåôñïúêÞ èåñáðåßá ôçò ÷ñüíéáò HIV ëïßìùîçò êáôÜ ôï Ýôïò 2000. ÅëëçíéêÜ Áñ÷åßá AIDS, 8:190-200, 2000. 11. 1999 USPHS/ISDA. Guidelines for the prevention of opportunistic infection in persons with Human Immunodeficiency Virus. MMWR, 48:166, 1999. 12. Zacharof AK. AIDS-related diarrhea - pathogenesis, evaluation and teatment. Annals of Gastroenterology, 14:22-26, 2001. 13. Swica Y, Breitbart W. Treating pain in patients with AIDS and a history of substance use. West J Med, 176:33-39, 2002. 14. Remien RH, Rabkin JG. Psychological aspects of living with HIV disease. West J Med, 175:332-

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335, 2001. 15. Madges S, Surinders S. The GP's role in HIV and AIDS care. The Practitioner, 244:772-777, 2000. 16. Mansfield S, Singh S. Who should fill the care gap in HIV disease. Lancet, 342:726-728, 1993. 17. Wood CG, Whitter S, Bradbeer CS. ÁBC of palliative care. HIV infection and AIDS. BMJ, 315:1433-6, 1997. 18. Smith S, Robinson J, Hollyer J, Ramesh B, et al. Combining specialist and primary health care teams for HIV positive patients: retrospective and prospective studies. BMJ, 312:416-20, 1999. 19. European minimum standard of primary HIV care: Basics requirements for all GPs. European Primary Care AIDS Network (EPCAN), 1999. 20. Reedijk M, Mohrs L, Wigersma L. When do HIV-infected persons start with antiretroviral therapy? A retrospective analysis of patients monitoring and treatment status in general practise, a compared with the 1991 Dutch HIV treatment guidelines. Family Practice, 15: 525528, 1998. 21. Reedijk M, Bindels PJE, Mohrs L, Wigersma L. Changing attitude towards antiretroviral treatment of HIV infection. A prospective study of Dutch general practitioners. AIDS care, 11:141145, 1999.

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ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

É. ÌïíÝäáò êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ - 14Ï ÐÁÍÅËËÇÍÉÏ ÓÕÍÅÄÑÉÏ ÃÅÍÉÊÇÓ ÉÁÔÑÉÊÇÓ AWARDED FREESTANDING PAPER - 14th HELLENIC CONGRESS IN GENERAL PRACTICE Primary Heatlh Care, Volume 14, Number 3, 126-129, 2002 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 126-129, 2002

Óõó÷åôéóìüò óùìáôïìåôñéêþí äåéêôþí êáé áñôçñéáêÞò ðßåóçò óå ìáèçôÝò áãñïôéêÞò ðåñéï÷Þò Íüôéáò ÊÝñêõñáò É. ÌïíÝäáò1, Á. Èáíïðïýëïõ2, Í. ÄçìçóéÜíïò1, È. ÄÜóéïò1, Ô. ÍôÜöçò1, Â. Óôáóéíüò1, Â. ÌÞëéá1, Í. Ðáôïýíçò1, E. ÑÝããéïõ1

Ðåñßëçøç Óêïðüò ôçò åñãáóßáò Þôáí ç êáôáãñáöÞ ôïõ åðéðïëáóìïý ðá÷õóáñêßáò êáé õðÝñôáóçò óôïõò ìáèçôÝò äåõôåñïâÜèìéáò åêðáßäåõóçò ôçò íüôéáò ÊÝñêõñáò. Ðëçèõóìüò ìåëÝôçò - ÌÝèïäïò: ÊáôáãñÜöçêáí çëéêßá, öýëï, ýøïò, âÜñïò, ðåñßìåôñïò ìÝóçò (waist), éó÷ßùí (hip), óõóôïëéêÞ êáé áñôçñéáêÞ ðßåóç êáé Üóêçóç. Ôá äåäïìÝíá áíáëýèçêáí óôáôéóôéêÜ ìå SPSS 10. ÁðïôåëÝóìáôá: ÅîåôÜóôçêáí 224 ìáèçôÝò, 108 áãüñéá 15,4+0,2 åôþí êáé 116 êïñßôóéá 14,9+0,2 åôþí. Óôçí ïìÜäá ôùí áãïñéþí ïé ðáñÜìåôñïé åß÷áí ùò åîÞò: ýøïò 167+0,1cm, ÂÌÉ 22,7+0,4, óõóôïëéêÞ áñôçñéáêÞ ðßåóç (sbp) 118+1,2 mmHg, äéáóôïëéêÞ áñôçñéáêÞ ðßåóç (dbp) 73+0,9 mmHg, ëüãïò ðåñéìÝôñïõ ìÝóçò/éó÷ßùí (W/H ratio) 0,85. Óôçí ïìÜäá ôùí êïñéôóéþí ïé áíôßóôïé÷åò ðáñÜìåôñïé Þôáí: ýøïò 159+0,0cm, ÂÌÉ 21,5+0,3, (sbp) 114+1,2 mmHg, (dbp) 73+0,8 mmHg, W/H ratio 0,79. Áðü ôç óôáôéóôéêÞ áíÜëõóç êáôáäåéêíýåôáé óõó÷Ýôéóç ôïõ ÂÌÉ ìå ôçí çëéêßá r=0,196 êáé p**, ôçí sbp r=0,296 êáé p***, ôçí dbp r=0,258 êáé p*** êáé ôçí W/H ratio r=0,216 êáé p**. Óôá áãüñéá ç çëéêßá óõó÷åôßæåôáé ìå ôçí sbp r=0,378 êáé p*** êáé ôçí dbp r=0,264 êáé p***. Óôá êïñßôóéá ç çëéêßá óõó÷åôßæåôáé ìå ôçí sbp r=0,383 êáé p***, ôçí dbp r=0,247 êáé p*** áëëÜ êáé ôï ÂÌÉ ìå r=0,264 êáé p**. Ôá áãüñéá áóêïýíôáé ðåñéóóüôåñï áðü ôá êïñßôóéá, 82,4% Ýíáíôé 49,1% ìå p***. 31 ðáéäéÜ åßíáé éó÷íÜ ìå ÂÌÉ<18 êáé 45 õðÝñâáñá ìå ÂÌÉ>25. 5 ðáéäéÜ Ý÷ïõí ðáèïëïãéêÞ sbp (>140mmHg) êáé 4 ðáèïëïãéêÞ dbp (>90mmHg). ÓõìðåñÜóìáôá: To 20% ôùí ìáèçôþí çëéêßáò 12-20 åôþí åßíáé õðÝñâáñï (ÂÌÉ>25) åíþ áíôßóôïé÷á ôï 13,8% åßíáé éó÷íü (ÂÌÉ<18). Ç çëéêßá óõó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ ìå ôç óõóôïëéêÞ, äéáóôïëéêÞ áñôçñéáêÞ ðßåóç êáé ôï ÂÌÉ óôá êïñßôóéá áëëÜ ìüíï ìå ôç óõóôïëéêÞ êáé äéáóôïëéêÞ áñôçñéáêÞ ðßåóç óôá áãüñéá. Ôá áãüñéá áóêïýíôáé óçìáíôéêÜ ðåñéóóüôåñï áðü ôá êïñßôóéá. *p<0,005, **p<0,01, ***p<0,001

1

ÊÝíôñï Õãåßáò Ëåõêßììçò, 2Äéáâçôïëïãéêü ÊÝíôñï ÉððïêñÜôåéï Íïóïêïìåßï Áèçíþí

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ÅéóáãùãÞ Ç ðá÷õóáñêßá áðïôåëåß óÞìåñá Ýíá ìåßæïí ðñüâëçìá äçìüóéáò õãåßáò, êõñßùò ãéá ôéò äõôéêïý ôýðïõ áíåðôõãìÝíåò êïéíùíßåò, êáé áöïñÜ óõíå÷þò ìåãáëýôåñï ðïóïóôü ôïõ ðáéäéêïý êáé åöçâéêïý ðëçèõóìïý, åíþ áõîÜíåé óôáäéáêÜ ìå ôçí ðÜñïäï ôçò çëéêßáò. Ðñüóöáôåò ìåëÝôåò äåß÷íïõí üôé ç áëëáãÞ ôïõ ôñüðïõ æùÞò ôá ôåëåõôáßá ÷ñüíéá êáé óôç ÷þñá ìáò Ý÷åé ðñïêáëÝóåé áýîçóç ôïõ åðéðïëáóìïý ôçò ðá÷õóáñêßáò, áëëÜ êáé êáñäéáããåéáêþí íïóçìÜôùí, ðïõ ôåßíïõí íá åîéóùèïýí ìå ôá åõñùðáúêÜ êáé áìåñéêáíéêÜ ðïóïóôÜ. Ç áñôçñéáêÞ õðÝñôáóç áðïôåëåß Ýíáí áðü ôïõò ìåßæïíåò ðáñÜãïíôåò êéíäýíïõ áíÜðôõîçò êáñäéáããåéáêÞò íüóïõ êáé ó÷åôßæåôáé óôåíÜ ìå ôçí ðá÷õóáñêßá, ìå áõîáíüìåíï åðéðïëáËÝîåéò êëåéäéÜ: áñôçñéáêÞ õðÝñôáóç, ðá÷õóáñêßá, áãñïôéêÞ ðåñéï÷Þ, ìáèçôÝò ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (ÊñÞôç, 8-12 ÌáÀïõ 2002) êáé Ýëáâå Ýðáéíï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: É. ÌïíÝäáò, ÊÝíôñï Õãåßáò Ëåõêßììçò ÊÝñêõñáò, Tçë.: (26610)71098, êéí.: 0932781500


É. ÌïíÝäáò êáé óõí.

Ôüìïò 14, Ôåý÷ïò 3, 2002

ãñáöéêþí äåäïìÝíùí, áíèñùðïìåôñéêþí óôïé÷åßùí, óõóôïëéêÞò êáé äéáóôïëéêÞò áñôçñéáêÞò ðßåóçò êáé Üóêçóçò. Ï êáèïñéóìüò ôïõ äåßêôç ìÜæáò Summary Aim: The aim of this study was to detect the prevalence of obesity and hyperóþìáôïò (ÂÌÉ) ðñïóäéïñßóôçêå ìå ôïí tension among high school students living in the Southern part of Corfu. Study ôýðï ôïõ Quetelet, áöïý êáôáãñÜöçpopulation-Methods: The study population consisted of 224 students, 108 êå ôï âÜñïò ôùí åîåôáæüìåíùí ìå ôá males 15.4+0.2 and 116 females with a mean average age of 14.9+0.2 years. åóþñïõ÷á êáé ôï ýøïò ôïõò ìå æõãü Results: For the males the parameters were: Body Mass Index (BMI) 22.7+0.4, SEGA êáé áíáóôçìüìåôñï ðñïóáñìïSBP 118+1.2 mmHg, DBP 73+0.9 mgHg, W/H ratio 0.85. For the females the same parameters were BMI 21.5+0.3, SBP 114+1.2 mmHg, DBP 73+0.8 mmHg, óìÝíï óôï æõãü. Ùò õðÝñâáñïé èåùñÞW/H ratio 0.79. the statistical analysis shows a correlation of the BMI with age èçêáí ïé Ýöçâïé ìå ÂÌÉ >25kg/m2, (r=0.196, p**), SBP (0.296, p***), DBP (0.258, p***) and W/H ratio (0.216, p**). ùò ðá÷ýóáñêïé áõôïß ìå ÂÌÉ >30kg/ For the males the age is correlated with SBP (r=0.378, p***) and the DBP m2, åíþ ùò åëëéðïâáñåßò áõôïß ìå ÂÌÉ (0.264, p***). For the females the age is correlated with the SBP (0.383, p***) <18kg/m2. ÊáôáãñÜöçêå åðßóçò ï äåßthe DBP (0.247, p***) and also with the BMI (0.264, p**). There is an 82.4% of males participating in some form of sport, in contrast to only 49.1% of females êôçò ðåñßìåôñïò ìÝóçò ðñïò ðåñßìå(p***). Thirty-one students had a BMI<18 and forty-five had a BMI>25. Five ôñï éó÷ßùí (waist/hip ratio) ï ïðïßïò students were hypertensive with SBP>140 mmHg and four with DBP>90 mmHg. óõíäÝåôáé ìå áõîçìÝíç êáñäéáããåéáêÞ Conclusions: That 20% of students between the ages of 12 and 20 years are íïóçñüôçôá. overweight (BMI>25) and 13.8% are underweight (BMI<18). The age is correlatÇ áñôçñéáêÞ ðßåóç ìåôñÞèçêå ìå ed with the SBP, DBP and the BMI in the female group but only with the SBP and DBP in the male group. õäñáñãõñéêü óöõãìïìáíüìåôñï óå êá*p<0.05, **p<0.01, ***p<0.001 èéóôÞ èÝóç. ¸ãéíáí ôñåéò ìåôñÞóåéò ìå Key words: blood pressure, body mass index, students, rural area ìåóïäéáóôÞìáôá äýï ëåðôþí êáé áöïý ðáñáëÞöèçêå ç ôéìÞ ôçò ðñþôçò ìÝHealth Centre of Lefkimmi-Corfu ôñçóçò êáôåãñÜöç ï ìÝóïò üñïò ôùí äýï åðïìÝíùí. óìü ðïõ áðïäßäåôáé óôçí áëëáãÞ ôïõ ôñüðïõ Ç Üóêçóç åêôéìÞèçêå ìÝóù åñùôçìáôïëïæùÞò, ÷ùñþí üðùò ç ÷þñá ìáò. ãßïõ êáé êáôåãñÜöç ç ðñáãìáôïðïßçóç êÜðïéïõ Ôï ãåãïíüò üôé ï ñüëïò ôçò áñôçñéáêÞò õðÝñ- áèëÞìáôïò áðü ôïí åîåôáæüìåíï êáé ïé þñåò Üèëçôáóçò êáé êõñßùò ôçò åöçâéêÞò ðá÷õóáñêßáò åß- óçò áíÜ åâäïìÜäá. íáé åîáéñåôéêÜ óçìáíôéêüò óôçí åìöÜíéóç êáñÇ óôáôéóôéêÞ åðåîåñãáóßá Ýãéíå ìå SPSS 10 äéáããåéáêþí íïóçìÜôùí, ìáò þèçóå óôï íá ìåëå- êáé ç óôáôéóôéêÞ áíÜëõóç êáôÜ Pearson's x2 ìå ôÞóïõìå ôïí åðéðïëáóìü ôçò ðá÷õóáñêßáò êáé ôç ìÝèïäï bivariate correlations. ôçò áñôçñéáêÞò õðÝñôáóçò óôï ìáèçôéêü ðëçèõóìü. ÅîåôÜóôçêáí ìáèçôÝò äåõôåñïâÜèìéáò åêðáß- ÁðïôåëÝóìáôá äåõóçò ìéáò áãñïôéêÞò ðåñéï÷Þò ðïõ äéáôçñåß áêüìç åí ìÝñåé ÷áñáêôçñéóôéêÜ áãñïôéêÞò ðåñéï÷Þò, ÅîåôÜóôçêáí 224 ìáèçôÝò, 108 áãüñéá áëëÜ Ý÷åé õðïóôåß ôçí åðéññïÞ ôïõ äõôéêïý ôñü- (48,2%) êáé 116 êïñßôóéá (51,8%). Ç ìÝóç çëéêßá ðïõ æùÞò êõñßùò óôïí ðáéäéêü êáé åöçâéêü ðëç- ôïõ äåßãìáôïò Þôáí 15,13+1,90 Ýôç, ÷ùñßò íá èõóìü, êáé íá åêôéìÞóïõìå ôç ó÷Ýóç ðá÷õóáñ- õðÜñ÷åé óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ ìåôáîý êßáò êáé áñôçñéáêÞò õðÝñôáóçò. ôùí äýï öýëùí ìå ôéìÝò áíôßóôïé÷á ãéá ôá áãüñéá êáé ôá êïñßôóéá 15,4+1,9 êáé 14,9+1,9 Ýôç. Ç ìÝóç óõóôïëéêÞ áñôçñéáêÞ ðßåóç (ÓÁÐ) Ðëçèõóìüò ìåëÝôçò êáé ìÝèïäïò Þôáí 116+13 mmHg, ç ìÝóç äéáóôïëéêÞ áñôçñéáêÞ ðßåóç (ÄÁÐ) Þôáí 73+9 mmHg, ï ìÝóïò ÌåëåôÞèçêáí 224 ìáèçôÝò ãõìíáóßùí êáé äåßêôçò ìÜæáò óþìáôïò (ÂÌÉ) Þôáí 21,5+3,8 kg/ ëõêåßùí ôùí ÄÞìùí Êïñéóóßùí êáé Ëåõêßììçò m2 êáé ç ðåñßìåôñïò ìÝóçò ðñïò ðåñßìåôñï éó÷ßùí ôçò Íüôéáò ÊÝñêõñáò êáôÜ ôï ó÷ïëéêü Ýôïò 2001- (w/h ratio) Þôáí 0,82. Ïé áíôßóôïé÷åò ôéìÝò ãéá ôá áãüñéá Þôáí ÓÁÐ 2002. Óõìðëçñþèçêå äåëôßï êáôáãñáöÞò äçìïCorrelation of body mass index (BMI) and blood pressure in students of a rural area of Corfu I. Monedas, A. Thanopoulou, N. Dimisianos, T. Dasios, T. Ntafis, V. Stasinos, B. Milia, N. Patounis, E. Reggiou

127


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

É. ÌïíÝäáò êáé óõí.

ìå ôç ÓÁÐ r=0.264 êáé p<0,01 êáé ôç ÄÁÐ r=0,378 êáé p<0,01. Ãéá ôá êïñßôóéá ôï ÂÌÉ óõó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ ìå ôç ÓÁÐ r=0,286 êáé p<0,01, ôç ÄÁÐ r=0,324 êáé p<0,01 áëëÜ ü÷é ôï ëüãï waist/hip ratio. Ç çëéêßá óôá êïñßôóéá åðßóçò äåí ó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ ìå êáíÝíáí áðü ôïõò ðáñáðÜíù ðáñÜãïíôåò. Ç Üóêçóç óõó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ ìå ôç ÓÁÐ r=0.146 êáé p<0,05 êáé ôç ÄÁÐ r=0,159 êáé p<0,05, åíþ äå óõó÷åôßæåôáé ìå ôï ÂÌÉ. Ôá áãüñéá áóêïýíôáé ðåñéóóüôåñï áðü ôá êïñßôóéá óå ðïóïóôü 82,4% vs 49,1%, r=0,349 êáé p<0,01.

118+13 mmHg, ÄÁÐ 73+10 mmHg, ÂÌÉ 22,7+3,8 kg/m2 êáé w/h ratio 0,85 åíþ ãéá ôá êïñßôóéá ÓÁÐ 114+13 mmHg, ÄÁÐ 73+9, ÂÌÉ 21,5+3,8 kg/m2 êáé w/h ratio 0,79. Ìå âÜóç ôï ÂÌÉ êáôáôÜ÷ôçêáí óå ôÝóóåñéò êáôçãïñßåò, üðùò öáßíåôáé óôïí ðßíáêá 1 óå åëëéðïâáñåßò ìå ÂÌÉ<18 31 ìáèçôÝò (9 áãüñéá êáé 22 êïñßôóéá), öõóéïëïãéêïß ìå 18<ÂÌÉ<25 148, õðÝñâáñïé ìå 25<ÂÌÉ<30 37 (23 áãüñéá êáé 14 êïñßôóéá) êáé ðá÷ýóáñêá ìå ÂÌÉ>30 8 (5 áãüñéá êáé 3 êïñßôóéá). Ïé åîåôáæüìåíïé êáôåôÜãçóáí óå äýï êáôçãïñßåò áíÜëïãá ìå ôï ëüãï waist/hip ratio. Ôá ìåí áãüñéá ìå w/h <1 êáé w/h>1 ôá äå êïñßôóéá ìå w/h<0,85 êáé w/h>0,85 üðùò öáßíåôáé óôïí ðßíáêá 2. ¼ðùò öáßíåôáé óôïí ðßíáêá 3, áðü ôï óýíïëï ôùí ìáèçôþí ôéìÝò áñôçñéáêÞò ðßåóçò ðïõ ÷áñáêôçñßæïíôáé õøçëÝò åß÷áí: 4 ÓÁÐ >140 mmHg, 3 ÄÁÐ >90 mmHg, åíþ 1 åß÷å ÓÁÐ >140 mmHg êáé ÄÁÐ >90 mmHg. Áðü ôç óôáôéóôéêÞ áíÜëõóç äéáðéóôþèçêå üôé ãéá ôï óýíïëï ôùí åîåôáóèÝíôùí ìáèçôþí õðÜñ÷åé óôáôéóôéêÜ óçìáíôéêÞ óõó÷Ýôéóç ôïõ ÂÌÉ ìå ôç ÓÁÐ r=0,296 êáé p<0,01, ôç ÄÁÐ r=0,258 êáé p<0,01 êáé ôï ëüãï waist/hip ratio r=0,216 êáé p<0,01. Áíáëýïíôáò ôéò ßäéåò ðáñáìÝôñïõò ãéá êÜèå öýëï îå÷ùñéóôÜ äéáðéóôþíïõìå üôé ãéá ôá áãüñéá ôï ÂÌÉ óõó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ ìå ôç ÓÁÐ r=0,270 êáé p<0,01, ôç ÄÁÐ r=0,201 êáé p<0,05 êáé ôï ëüãï waist/hip ratio r=0,258 êáé p<0,01. Äåí õðÜñ÷åé óõó÷Ýôéóç ìå ôçí çëéêßá ç ïðïßá üìùò ó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ

ÓõæÞôçóç Áðü ôá áðïôåëÝóìáôá ôçò áíÜëõóçò ôùí äåäïìÝíùí ðñïêýðôåé üôé ç ìÝóç ôéìÞ ôïõ ÂÌÉ ôùí åîåôáóèÝíôùí ìáèçôþí âñßóêåôáé åíôüò ôùí öõóéïëïãéêþí ïñßùí (21,5+3,8kg/m2) êáé áðÝ÷åé áñêåôÜ áðü ôéìÝò ðïõ ÷áñáêôçñßæïíôáé óáí õðåñâïëéêü âÜñïò. Ôï 3,6% (8) ôùí ìáèçôþí åßíáé ðá÷ýóáñêïé (ÂÌÉ>30), êáé ôï 16,5% (37) õðÝñâáñïé (25< ÂÌÉ<30), ðïóïóôÜ ÷áìçëüôåñá áðü áõôÜ Üëëùí åðéäçìéïëïãéêþí ìåëåôþí. Ôï 13,8% (31) åßíáé åëëéðïâáñåßò (ÂÌÉ<18). Óôçí õðïïìÜäá ôùí áãïñéþí ôï ÂÌÉ åßíáé 22,7+3,8kg/m2 åíþ ó’ áõôÞ ôùí êïñéôóéþí 21,5+ 3,8kg/m2, óôáôéóôéêÜ ìç óçìáíôéêÞ äéáöïñÜ. Áîéïóçìåßùôï åßíáé ôï ãåãïíüò üôé ï ëüãïò áãïñéþí/êïñéôóéþí ãéá ôéò ôñåéò êáôçãïñßåò ðá-

Ðßíáêáò 1. ÅõñÞìáôá óôï äåßêôç ìÜæáò óþìáôïò óôïõò ìáèçôÝò ÂÌÉ<18 31 (13,8%) 9 áãüñ. - 22 êïñ.

18<ÂÌÉ<25 148 (66,0%) 71 áãïñ. - 77 êïñ.

25< ÂÌÉ<30 37 (16,5%) 23 áãüñ. - 14 êïñ.

ÂÌÉ>30 8 (3,6%) 5 áãïñ. - 3 êïñ.

Ðßíáêáò 2. ÅõñÞìáôá óôçí áíáëïãßá ðåñßìåôñïò ìÝóç ðåñßìåôñïò éó÷ßùí óôïõò ìáèçôÝò Áãüñéá w/h <1

Êïñßôóéá w/h<0,85

Áãüñéá w/h >1

Êïñßôóéá w/h>0,85

105

10

3

3 13

Ðßíáêáò 3. ÅõñÞìáôá óôçí ôéìÞ ôçò áñôçñéáêÞò ðßåóçò ÓÁÐ>140

ÄÁÐ>90

ÓÁÐ>140 êáé ÄÁÐ>90

ÓÁÐ<140 êáé ÄÁÐ<90

4

3

1

216

128


Ôüìïò 14, Ôåý÷ïò 3, 2002

É. ÌïíÝäáò êáé óõí.

÷ýóáñêïé, õðÝñâáñïé, åëëéðïâáñåßò åßíáé áíôßóôïé÷á 1,67, 1,64 êáé 0,41, ðñÜãìá ðïõ óçìáßíåé üôé ç ðñïò ôá ðÜíù åêôñïðÞ ôïõ ÂÌÉ åßíáé óõ÷íüôåñç óôá áãüñéá, åíþ ç ðñïò ôá êÜôù óôá êïñßôóéá. Ï äåßêôçò waist/hip ratio óôá áãüñéá åßíáé 0,85 êáé óôá êïñßôóéá 0,79, ôéìÝò èåìéôÝò ðïõ äå èåùñïýíôáé ðáñÜãïíôåò êéíäýíïõ. Ôï 7,14% (16) ôùí ìáèçôþí ÷áñáêôçñßæåôáé áðü ôéìÝò åêôüò ôùí öõóéïëïãéêþí ïñßùí, w/h ratio >1 ãéá ôá áãüñéá êáé >0,85 ãéá ôá êïñßôóéá, åõñÞìáôá ðïõ óõìðßðôïõí ìå áõôÜ Üëëùí ìåëåôþí. Ïé ôéìÝò ÓÁÐ êáé ÄÁÐ âñßóêïíôáé åíôüò öõóéïëïãéêþí ïñßùí áíôßóôïé÷á 116+13 mmHg êáé 73+9 mmHg êáé áðÝ÷ïõí áñêåôÜ áðü ôá áíþôåñá öõóéïëïãéêÜ üñéá. Ãéá ôéò äõï õðïïìÜäåò, áãïñéþí êáé êïñéôóéþí, ïé ôéìÝò ÓÁÐ êáé ÄÁÐ åßíáé áíôßóôïé÷á 118+13 mmHg, 73+10 mmHg êáé 114+13 mmHg, 73+9 mmHg, óôáôéóôéêÜ ìç óçìáíôéêÞ äéáöïñÜ. Ôï 1,8% (4) ÷áñáêôçñßæåôáé áðü õøçëÝò ôéìÝò ÓÁÐ>140 mmHg, ôï 1,3% (3) áðü ôéìÝò ÄÁÐ>90 mmHg, åíþ Ýíáò ìüíï ìáèçôÞò áðü õøçëÝò ôéìÝò ÓÁÐ áëëÜ êáé ÄÁÐ. Ç Üóêçóç, íïïýìåíç óáí ðñáãìáôïðïßçóç êÜðïéïõ áèëÞìáôïò ôïõëÜ÷éóôïí ìéá çìÝñá ôçí åâäïìÜäá, åßíáé ÷áñáêôçñéóôéêü ôçò õðïïìÜäáò ôùí áãïñéþí óå ðïóïóôü 82,4%, åíþ ôá êïñßôóéá õðïëåßðïíôáé óôáôéóôéêÜ óçìáíôéêÜ ìå ðïóïóôü 49,1% êáé p<0,01. Áðü ôç óôáôéóôéêÞ áíÜëõóç äéáðéóôþíåôáé óôáôéóôéêÜ óçìáíôéêÞ óõó÷Ýôéóç (p<0,01) ôïõ ÂÌÉ ôüóï ìå ôç ÓÁÐ (r=0,296) üóï êáé ôç ÄÁÐ (r=0,258) ãéá ôï óýíïëï ôùí ìáèçôþí, áëëÜ êáé ãéá êÜèå õðïïìÜäá åîåôáæüìåíç îå÷ùñéóôÜ. Ç çëéêßá åðßóçò óõó÷åôßæåôáé óôáôéóôéêÜ óçìáíôéêÜ (p<0,01) ôüóï ìå ôç ÓÁÐ (r=0,264) üóï êáé ôç ÄÁÐ (r=0,378). ¸íáò Üëëïò ðáñÜãïíôáò ðïõ óõó÷åôßæåôáé åðßóçò óôáôéóôéêÜ óçìáíôéêÜ (p<0,05) ôüóï ìå ôç ÓÁÐ (r=0,146) üóï êáé ôç ÄÁÐ (r=0,159) åßíáé ç Üóêçóç. Áðü ôçí Ýñåõíá ðïõ ðñáãìáôïðïéÞóáìå óôïõò ìáèçôÝò ôçò äåõôåñïâÜèìéáò åêðáßäåõóçò ôçò íüôéáò ÊÝñêõñáò äéáðéóôþóáìå ó÷åôéêÜ ÷áìçëü åðéðïëáóìü õðåñâÜëëïíôïò âÜñïõò êáé ðá÷õóáñêßáò, ãåãïíüò ðïõ ðéèáíþò íá ïöåßëåôáé óôç äéá-

ôÞñçóç ôñüðïõ æùÞò ìå ÷áñáêôçñéóôéêÜ áãñïôéêÞò ðåñéï÷Þò. Ç çëéêßá, ôï ÂÌÉ êáé ç Üóêçóç óõó÷åôßæïíôáé óôáôéóôéêÜ óçìáíôéêÜ, óáí áíåîÜñôçôïé ðáñÜãïíôåò, ìå ôç óõóôïëéêÞ áëëÜ êáé ôç äéáóôïëéêÞ áñôçñéáêÞ ðßåóç. Ìå äåäïìÝíï üôé ïé äõï ôåëåõôáßïé åßíáé ôñïðïðïéÞóéìïé ðáñÜãïíôåò, åßíáé óçìáíôéêü íá ðñïãñáììáôéóôïýí ðñïãñÜììáôá ðáñÝìâáóçò ãéá ôçí ôñïðïðïßçóÞ ôïõò, ìå óôü÷ï ôçí åðßôåõîç ôéìþí áñôçñéáêÞò ðßåóçò åíôüò ôùí åðéèõìçôþí ïñßùí. Âéâëéïãñáößá 1. Trichopoulou A, Efstasiadis P. Changes in nutrition patterns and health indicators at the population level in Greece. Am J Clin Nutr, 49:1042-1047, 1989. 2. ÃåùñãéÜäçò Å, ÐáðáíäñÝïõ Ë, Ìáíôæþñïò ×, ÁëéöÝñçò Ê, Êùíóôáíôßíïõ Ê. Åðßäñáóç êïéíùíéêïïéêïíïìéêþí ðáñáãüíôùí óôï âÜñïò êáé óôçí ðá÷õóáñêßá ôùí íÝùí ÅëëÞíùí. ÉáôñéêÞ, 63:595601, 1993. 3. Mamalakis G, Kafatos A. Prevalence of obesity in Greece. Inter J Obesity, 20:480-492, 1996. 4. Seidell JC, Flegal KM. Assessing obesity: classification and epidemiology. Br Med Bull, 53:238252, 1997. 5. Obesity: Preventing and managing the global epidemic. Report of WHO Consultation on Obesity, 1997. 6. 1999 WHO-International Society of Hypertension. Guidelines for the management of hypertension, J Hypert, 17:151-183, 1999. 7. Brueren MM, Petri H, Van Weel C, Van Ree JW. how many measurements are necessary in diagnosing mild to moderate hypertension. Fam Pract, 14:130-135, 1997. 8. Ðáðáãåùñãßïõ Â, Ðáðáãåùñãßïõ Â, Ôóá÷ïõñßäçò Á, Ãñßâïõ Ê. Åðéðïëáóìüò õðåñâÜëëïíôïò âÜñïõò (Þ êáé ðá÷õóáñêßáò), äéáôñïöéêÝò óõíÞèåéåò êáé äéáôñïöéêÞ áãùãÞ óå ìáèçôéêïýò ðëçèõóìïýò ôïõ íïìïý ×áëêéäéêÞò. ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, 13:153-160, 2001. 9. ÓõóôÜóåéò ãéá ôç ÄéÜãíùóç êáé ôç Èåñáðåßá ôçò ÁñôçñéáêÞò ÕðÝñôáóçò áðü ôïí Êëéíéêü Ãéáôñü. Åíçìåñùôéêü öõëëÜäéï Õðïõñãåßïõ Õãåßáò êáé Ðñüíïéáò. ÁèÞíá ÄåêÝìâñéïò 2001.

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ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ã. Ôóßñïò êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ - 14Ï ÐÁÍÅËËÇÍÉÏ ÓÕÍÅÄÑÉÏ ÃÅÍÉÊÇÓ ÉÁÔÑÉÊÇÓ AWARDED FREESTANDING PAPER - 14th HELLENIC CONGRESS IN GENERAL PRACTICE Primary Heatlh Care, Volume 14, Number 3, 130-138, 2002 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 130-138, 2002

Ðñüëçøç, áíôéìåôþðéóç êáé óõìðåñéöïñÜ ôùí éáôñþí óå èÝìáôá õãåßáò ôïõò Ã. Ôóßñïò1, Ä. Êáëïãåñüðïõëïò1, Ðáí. ÂïÀëá2, ×ñ. Âüóóïõ3, Ã. ÊáñäÜôïò4, Ã. ÌïõæÜêçò5, Í. ÌáãêëÜñáò6, Ð. Áèáíáóüðïõëïò7, Áéê. Ãáôïðïýëïõ8

Ðåñßëçøç Óêïðüò: Ç ìåëÝôç ðñüëçøçò, óõìðåñéöïñÜò êáé áíôéìåôþðéóçò ðñïâëçìÜôùí õãåßáò éáôñþí, êáèþò êáé ï âáèìüò åìðéóôïóýíçò-óõììüñöùóÞò ôïõò óôéò óõìâïõëÝò êáé ïäçãßåò, ðáñå÷üìåíåò áðü åéäéêïýò-ùò ðñïò ôçí áíôßóôïé÷ç íüóï-óõíáäÝëöïõò. Õëéêü êáé ÌÝèïäïò: Óõìðëçñþèçêå áíþíõìï åñùôçìáôïëüãéï áðü 208 éáôñïýò äéáöüñùí åéäéêïôÞôùí, åñãáæüìåíïõò óå äýï íïóïêïìåßá ôçò ÁèÞíáò (Íáõôéêü Íïóïêïìåßï, Ï Åõáããåëéóìüò) êáé Ýíá ðåñéöåñåéáêü ðáíåðéóôçìéáêü (Ð.Ð.Ã.Í. Ðáôñþí). ¸ãéíå áîéïëüãçóç êáé ïìáäïðïßçóç ôùí áðáíôÞóåùí ãéá óõãêñßóåéò, êáôÜ öýëï êáé ôïìÝá åéäéêüôçôáò. ÁðïôåëÝóìáôá: Áðü 208 éáôñïýò (46% ðáèïëüãïé, 28% ÷åéñïõñãïß, 26% åñãáóôçñéáêïß), ìåëåôÞèçêáí 108 (51%) Üíäñåò êáé 100 (49%) ãõíáßêåò ìÝóçò çëéêßáò 32,2 êáé 31,3 åôþí áíôßóôïé÷á. Ðïóïóôü 64% áõôþí åìâïëéÜóèçêáí ìå ôá áðáñáßôçôá ãéá ôçí çëéêßá ôïõò åìâüëéá, áíåìâïëßáóôïé-9%, 27% äçëþíïõí Üãíïéá (êõñßùò ÷åéñïõñãïß-39%). 71% åðß óõíüëïõ ÷ñçóéìïðïéåß ìÝóá ðñïóôáóßáò, üôáí áðáéôåßôáé óôéò þñåò åñãáóßáò (÷åéñïõñãïß 77%, åñãáóôçñéáêïß 78%, ðáèïëüãïé 57%), åíþ óõ÷íÜ äçëþíïõí ÷ñÞóç 26%. ¸ãêáéñá áíôéìåôùðßæïõí êáôáóôÜóåéò áóèÝíåéÜò ôïõò 50% (ãõí. 62%, Üíäñ. 39%), áíáëüãùò êñßóåùò 39%, ìç-åãêáßñùò 11%. Áðåõèýíïíôáé óå åéäéêü 52% (ðáèïë. 60%, ÷åéñïõñã. 54%, åñãáóô. 42%), óõ÷íÜ 36% êáé ü÷é 12%. Óôéò ïäçãßåò åéäéêïý éáôñïý óõììïñöþíåôáé ôï 39% ôùí óõíáäÝëöùí (åñãáóô. 46%, ðáèïë. 42%, ÷åéñïõñã. 28%), óõ÷íÜ 54% êáé êáèüëïõ 7%. ÖáñìáêåõôéêÞ áãùãÞ óùóôÜ ëáìâÜíïõí 58% (ãõí. 66%, Üíäñ. 50%), åíþ ðëçììåëþò-34%. Áðïöåýãïõí ôçí ðïëõöáñìáêßá 66%, ôï 32% üìùò ëáìâÜíåé öÜñìáêá üôáí áðáéôåßôáé. 38% åìðéóôåýïíôáé óõíáäÝëöïõò ôïõò (êõñßùò ëüãù åìðåéñßáò), 28% ìå ìéêñÞ åðéöýëáîç, áðüëõôç åìðéóôïóýíç 20% êáé 11% óå ãíùóôïýò-óõíåñãÜôåò. ÓõìðåñÜóìáôá: Ç ðëåéïíüôçôá ôùí éáôñþí Ý÷åé åìâïëéáóèåß åðáñêþò, êñßíåôáé üìùò áðáñáßôçôï íá äåßîïõí åíäéáöÝñïí üóïé äçëþíïõí Üãíïéá. Ïé ðáèïëüãïé ÷ñçóéìïðïéïýí ëéãüôåñï ìÝóá ðñïóôáóßáò. Ôï Þìéóõ ôùí éáôñþí áíôéìåôùðßæåé Ýãêáéñá êáôáóôÜóåéò áóèåíåßáò ôïõò (êõñßùò ãõíáßêåò, ðïõ ëáìâÜíïõí ðéï óùóôÜ ôç öáñìáêåõôéêÞ ôïõò áãùãÞ) êáé ãåíéêüôåñá áðåõèýíïíôáé óå åéäéêü ãéá ôçí ðÜèçóÞ ôïõò éáôñü, óõììïñöþíïíôáé ìå ôéò ïäçãßåò ôïõ êáé ôïí åìðéóôåýïíôáé-êõñßùò ôïõò Ýìðåéñïõò êáé óõíåñãÜôåò ôïõò.

1

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

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ÅéóáãùãÞ Ïé éáôñïß, ùò ëåéôïõñãïß ôçò õãåßáò ðñïóöÝñïõí ôéò õðçñåóßåò ôïõò óå êáôáóôÜóåéò áóèåíåßáò óõíáíèñþðùí ôïõò, êáèïäçãþíôáò ôïõò ãéá ôçí áðïôåëåóìáôéêüôåñç èåñáðåßá ôùí íüóùí ôïõò. ¼íôùò ùò Üíèñùðïé äéáôñÝ÷ïõí ðáñÜëëçëá êáé ïé ßäéïé êßíäõíï íüóçóçò êáé ìÜëéóôá áõîçìÝíï, áöïý åñãÜæïíôáé óôï ÷þñï ôçò õãåßáò-íïóïêïìåßá êáé “åêôßèåíôáé” óå ëïéìþäåéò ðáñÜãïíôåò êáé ìïëõóìÝíá âéïëïãéêÜ õãñÜ (éüò çðáôßôéäáò  êáé çðáôßôéäáò C, HIV ê.ëð.), þóôå íá áõîÜíïíôáé ïé ðéèáíüôçôåò ìüëõíóçò êáé íüóçóçò1-3. Áóðßäá-ðñüëçøç ó’ áõôÞ ôçí “Ýêèåóç” áðïôåëïýí: ç óùóôÞ åíçìÝñùóç, ïé áðáñáßôçôïé åìâïëéáóìïß êáé ìÜëéóôá ïé åðáíáëçðôéêÝò äüóåéò (üðùò çðáô. Â), ç ÷ñÞóç ìÝóùí ðñïóôáóßáò (ãÜíôéá, ìÜóêá ê.ëð.) üôáí áðáéôåßËÝîåéò êëåéäéÜ: íïóçñüôçôá, ðñüëçøç, áíôéìåôþðéóç, óõìðåñéöïñÜ, éáôñïß ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (ÊñÞôç, 8-12 ÌáÀïõ 2002) êáé Ýëáâå Ýðáéíï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Ãåþñãéïò Ôóßñïò, ÓïöïêëÝïõò 29, Ô.Ê. 26442 ÐÜôñá, Ôçë. (2610)454667


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ã. Ôóßñïò êáé óõí.

Doctors' attitudes and behaviour in themes of their own health G. Tsiros, D. Kalogeropoulos, P. Voila, Ch. Vossou, G. Kardatos, G. Mouzakis, N. Maglaras, P. Athanasopoulos, E. Gatopoulou Summary Aim: The doctor's attitudes and behaviour in themes of their own health, such as the degree of their confidence-compliance with the advice and guidelines given by specialists as concerning the corresponding disease-colleagues. Material and Method: Anonymous questionnaires were completed by 208 doctors of different specialties, working in two hospitals in Athens and the Regional University Hospital of Patras. The answers were grouped for comparisons, per sex and sector of specialty. Results: From 208 doctors (46% pathologists, 28% surgeons, 26% laboratory assistants), who were studied, 108 (51%) were males and 100 (49%) females with an average age of 32,2 and 31,3 respectively. Of these 64% were vaccinated with the appropriate vaccines for their age group, 9% were unvaccinated, 27% declare ignorance (mainly surgeons-39%). Means of use of protection when demanded 71% (surgeons -77%, laboratory assistants -78%, pathologists -57%), while 26% declared that they often used protection. Conclusions: Although the majority of doctors are sufficiently vaccinated, there is an important room for improvement in terms of measures for protection. Key words: doctors' diseases, prevention, confrontation, behaviour

ôáé, êáèþò ç Ýãêáéñç êáé óùóôÞ áíôéìåôþðéóç ãåíéêÜ êáôáóôÜóåùí áóèÝíåéÜò ôïõò4-7. Ïé ãíþóåéò êáé ç åìðåéñßá áíÜ åéäéêüôçôá ãéá êÜèå éáôñü óå óõíÜñôçóç ìå ôçí êáôÜëëçëç ðëçñïöüñçóç, áðïôåëïýí ðïëëÝò öïñÝò âáóéêÝò ðáñáìÝôñïõò þóôå íá áðåõèõíèïýí óôïí “åéäéêü” ãéá ôçí ðÜèçóÞ ôïõò óõíÜäåëöï, íá áêïëïõèÞóïõí ôéò óõìâïõëÝò ôïõ êáé ôçí ðñïôåéíüìåíç öáñìáêåõôéêÞ áãùãÞ. Ï åîåôÜæùí éáôñüò áðü ôç ìåñéÜ ôïõ ïöåßëåé íá ôçñåß ôï éáôñéêü áðüññçôï (éáôñéêÞ äåïíôïëïãßá), íá åíçìåñþíåé åðáñêþò ôïí åîåôáæüìåíï óõíÜäåëöü ôïõ ðñéí áðü êÜèå éáôñéêÞ ðñÜîç, êáèþò åðßóçò íá áêïëïõèåß ìÝèïäï óýã÷ñïíç êáé åðéóôçìïíéêÜ ôåêìçñéùìÝíç – ùò ïöåßëåé êáé ìå êÜèå áóèåíÞ – þóôå íá åðéôý÷åé ôçí êáëýôåñç äõíáôÞ åðéêïéíùíßá êáé ôç äçìéïõñãßá êëßìáôïò åìðéóôïóýíçò ìå ôïí ðÜó÷ïíôá. Óêïðüò ôçò åñãáóßáò ìáò Þôáí ç ìåëÝôç

ðñüëçøçò, óõìðåñéöïñÜò êáé áíôéìåôþðéóçò ðñïâëçìÜôùí õãåßáò éáôñþí, êáèþò êáé ï âáèìüò åìðéóôïóýíçò-óõììüñöùóÞò ôïõò óôéò óõìâïõëÝò êáé ïäçãßåò, ðáñå÷üìåíåò áðü åéäéêïýò-ùò ðñïò ôçí áíôßóôïé÷ç íüóï-óõíáäÝëöïõò.

Ðëçèõóìüò ìåëÝôçò êáé ìÝèïäïò

Óôçí ðáñïýóá åñãáóßá óõììåôåß÷áí 208 éáôñïß äéáöüñùí åéäéêïôÞôùí, ïé ïðïßïé åñãÜæïíôáé óå äýï íïóïêïìåßá ôçò ðñùôåýïõóáò (Ð.Ã.Í. “Ï Åõáããåëéóìüò”, Íáõôéêü Íïóïêïìåßï Áèçíþí) êáé Ýíá Ðåñéöåñåéáêü Ðáíåðéóôçìéáêü Íïóïêïìåßï (Ð.Ð.Ã.Í. Ðáôñþí). Óõìðëçñþèçêå áíþíõìï åñùôçìáôïëüãéï (ÐáñÜñôçìá), åéäéêÜ äéáìïñöùìÝíï, ìå ôá ÷áñáêôçñéóôéêÜ óôïé÷åßá ôïõ éáôñïý (öýëï, çëéêßá, åéäéêüôçôá), þóôå íá äéåñåõíçèïýí ðáñÜãïíôåò ó÷åôéæüìåíïé ìå: · Ôïí áðáñáßôçôï ãéá ôçí çëéêßá ôïõò åìâïëéáóìü. · Ôç ÷ñÞóç óôéò þñåò åñãáóßáò ìÝóùí ðñïóôáóßáò (ãÜíôéá, ìÜóêá ê.ëð.) üôáí áðáéôåßôáé. · Ôçí Ýãêáéñç áíôéìåôþðéóç êáôáóôÜóåùí áóèÝíåéÜò ôïõò. · Ôï áí áðåõèýíïíôáé óôïí “åéäéêü” ãéá íüóçìÜ ôïõò éáôñü êáé áí óõììïñöþíïíôáé ìå ôéò ïäçãßåò – óõìâïõëÝò ôïõ. · Ôç óùóôÞ ëÞøç ôçò öáñìáêåõôéêÞ ôïõò áãùãÞ êáé áí ÷ñçóéìïðïéïýí ðïëëÜ öÜñìáêá (ðïëõöáñìáêßá). · Ôçí åìðéóôïóýíç óôïõò óõíáäÝëöïõò ôïõò óå êáôáóôÜóåéò áóèÝíåéÜò ôïõò. Áêïëïýèùò Ýãéíå áîéïëüãçóç êáé ïìáäïðïßçóç ôùí áðáíôÞóåùí ôïõ åñùôçìáôïëïãßïõ ãéá óýãêñéóç, êáôÜ: á) öýëï â) ôïìÝá åéäéêüôçôáò: ðáèïëïãéêüò, ÷åéñïõñãéêüò, åñãáóôçñéáêüò, êáé åðß óõíüëïõ. Äåí Ýãéíå äéÜêñéóç ìåôáîý åéäéêåõüìåíùí êáé åéäéêåõìÝíùí, áöïý ïé ðñþôïé (92%) áðïôåëïýí ôç óõíôñéðôéêÞ ðëåéïøçößá ôïõ äåßãìáôïò. ¼ëá ôá óôïé÷åßá êáôá÷ùñÞèçêáí óå âÜóç äåäïìÝíùí (excel for windows), üðïõ êáé Ýãéíå ç 131


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ã. Ôóßñïò êáé óõí.

åðåîåñãáóßá ôïõò.

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

ÁðïôåëÝóìáôá

×ñÞóç ìÝóùí ðñïóôáóßáò

Åðß óõíüëïõ 208 éáôñþí, ìåëåôÞèçêáí 108 (51%) Üíäñåò êáé 100 (49%) ãõíáßêåò ìå ëüãï öýëïõ Üíäñåò/ãõíáßêåò: 1/0,93, åíþ ç ìÝóç çëéêßá ôïõ äåßãìáôïò Þôáí 32,2 êáé 31,3 åôþí áíôßóôïé÷á. ÁíÜ ôïìÝá äéáêñßíïõìå ôïõò éáôñïýò: 95 (46%) óôïí ðáèïëïãéêü (Üíäñ./ãõí.: 1/0,83), 59 (28%) óôï ÷åéñïõñãéêü (Üíäñ./ãõí.: 1/0,64), 54 (26%) óôïí åñãáóôçñéáêü (Üíäñ./ãõí.: 1/1,7).

Áðü ôï óýíïëü ôïõò, ÷ñçóéìïðïéïýí ìÝóá ðñïóôáóßáò êáôÜ ôçí åñãáóßá ôïõò üôáí áðáéôåßôáé ôï 71% (63% Üíäñåò, 79% ãõíáßêåò), ìç ÷ñÞóç áíáöÝñåé ôï 3% (4%, 2%), åíþ óõ÷íÞ ÷ñÞóç äçëþíåé ôï 26% (33%, 19%) (Ðßíáêáò 2, ÄéÜãñáììá 2).

Áðáñáßôçôïò ùò ðñïò ôçí çëéêßá åìâïëéáóìüò Åê ôùí 208 éáôñþí, áíáöÝñåôáé üôé: Ý÷ïõí åìâïëéáóèåß ôï 64% (56% Üíäñåò, 71% ãõíáßêåò), áíåìâïëßáóôïé ôï 9% (11%, 8%), åíþ Üãíïéá äçëþ-

¸ãêáéñç áíôéìåôþðéóç êáôáóôÜóåùí áóèÝíåéáò Ïé áðáíôÞóåéò áíáöÝñïíôáé ùò åîÞò: Ýãêáéñç áíôéìåôþðéóç ôï 50% (39% Üíäñåò, 62% ãõíáßêåò), ìç Ýãêáéñç ôï 11% (16%, 6%) êáé ôÝëïò áíáëüãùò êñßóåùò ðáñïõóéÜæåôáé ôï 39% (45%, 32%) (Ðßíáêáò 3, ÄéÜãñáììá 3).

Ðßíáêáò 1. Áðáñáßôçôïò ãéá ôçí çëéêßá åìâïëéáóìüò (%) ÔïìÝáò Éáôñïß

Ðáèïëïãßáò Óõí Áñ ÈÞë

×åéñïõñãéêÞò Óõí Áñ ÈÞë

Åñãáóôçñéáêüò Óõí Áñ ÈÞë

Óõí

ÍÁÉ Ï×É ÄÅ ÃÍÙÑÉÆÙ

66 11 23

52 9 39

73 8 19

64 9 27

56 13 31

75 9 16

42 14 44

61 4 35

70 5 25

76 12 12

Ìåéêôüò Áñ ÈÞë 56 11 33

71 8 21

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

Ðáèïëïãßáò Óõí Áñ ÈÞë

×åéñïõñãéêÞò Óõí Áñ ÈÞë

Åñãáóôçñéáêüò Óõí Áñ ÈÞë

Óõí

ÍÁÉ Ï×É ÓÕ×ÍÁ

57 8 35

77 2 21

78 0 22

71 3 26

54 8 38

60 7 33

64 3 33

ÍÁÉ 64%

ÄéÜãñáììá 1. Åê ôïõ óõíüëïõ éáôñþí, áðáñáßôçôïò ãéá ôçí çëéêßá ôïõò åìâïëéáóìüò %. 132

70 0 30

85 0 15

63 4 33

79 2 19

ÓÕ×ÍÁ ÓÕ×ÍÁ 26%

ÄÅÍ ÃÍÙÑÉÆÙ ÄÅ ÃÍÙÑÉÆÙ 27%

O×É 9%

91 0 9

Ìåéêôüò Áñ ÈÞë

O×É 3%

ÍÁÉ 71%

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


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ã. Ôóßñïò êáé óõí.

Áíôéìåôþðéóç ðñïâëçìÜôùí õãåßáò áðü ôïí “åéäéêü” éáôñü-óõíÜäåëöï Óôï åñþôçìá áí áðåõèýíïíôáé óôïí “åéäéêü” ãéá ôçí ðÜèçóÞ ôïõò óõíÜäåëöï, ïé éáôñïß áðÜíôçóáí: èåôéêÜ ôï 52% (55% Üíäñåò, 49% ãõíáßêåò), áñíçôéêÜ ôï 12% (13%, 11%), ìå óõ÷íÜ íá áðåõèýíåôáé ôï 36% (32%, 40%) (Ðßíáêáò 4, ÄéÜãñáììá 4).

ÓùóôÞ ëÞøç öáñìáêåõôéêÞò áãùãÞò ÓùóôÜ ëáìâÜíåé ôç öáñìáêåõôéêÞ ôïõ áãùãÞ ôï 58% (50% Üíäñåò, 66% ãõíáßêåò) ôùí éáôñþí, ðëçììåëÞò ëÞøç ôï 8% (14%, 2%), åíþ ôï 34% (36%, 32%) áíáöÝñåé “ôéò ðåñéóóüôåñåò öïñÝò” (Ðßíáêáò 6, ÄéÜãñáììá 6).

×ñÞóç ðïëëþí öáñìÜêùí (ðïëõöáñìáêßá) Óõììüñöùóç ìå ôéò éáôñéêÝò ïäçãßåò – óõìâïõëÝò ôïõ “åéäéêïý” Ôéò éáôñéêÝò ïäçãßåò áêïëïõèåß ôï 39% (38% Üíäñåò, 39% ãõíáßêåò) åê ôïõ óõíüëïõ ôùí éáôñþí, áíáöÝñåé ðùò äåí óõììïñöþíåôáé ôï 7% (11%, 3%), åíþ ôï 54% (51%, 58%) áêïëïõèåß ôéò óõìâïõëÝò ôïõ ôéò ðåñéóóüôåñåò öïñÝò (Ðßíáêáò 5, ÄéÜãñáììá 5).

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

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

Ðáèïëïãßáò Óõí Áñ ÈÞë

ÍÁÉ 50 Ï×É 10 ÊÑÉÍÙ ÁÍÁËÏÃÁ 40

35 17 48

65 2 33

×åéñïõñãéêÞò Óõí Áñ ÈÞë

Åñãáóôçñéáêüò Óõí Áñ ÈÞë

Óõí

50 16 34

50 8 42

50 11 39

36 22 42

65 9 26

45 10 45

56 6 38

Ìåéêôüò Áñ ÈÞë 39 16 45

62 6 32

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

Ðáèïëïãßáò Óõí Áñ ÈÞë

×åéñïõñãéêÞò Óõí Áñ ÈÞë

Åñãáóôçñéáêüò Óõí Áñ ÈÞë

Óõí

ÍÁÉ Ï×É ÓÕ×ÍÁ

60 7 33

54 18 28

42 10 48

52 12 36

60 9 31

60 5 35

56 19 25

52 17 31

50 10 40

35 9 56

Ìåéêôüò Áñ ÈÞë 55 13 32

49 11 40

ÓÕ×ÍÁ 36%

ÊÑÉÍÙ ÁÍÁËÏÃÁ 39%

ÍÁÉ 50%

¼×É 11%

ÄéÜãñáììá 3. Åê ôïõ óõíüëïõ éáôñþí, Ýãêáéñç áíôéìåôþðéóç êáôáóôÜóåùí áóèÝíåéáò %

ÍÁÉ 52%

¼×É 12%

ÄéÜãñáììá 4. Åê ôïõ óõíüëïõ éáôñþí, áíôéìåôþðéóç ðñïâëçìÜôùí õãåßáò ôïõò áðü ôïí “åéäéêü” éáôñü-óõíÜäåëöï % 133


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ã. Ôóßñïò êáé óõí.

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

Ðáèïëïãßáò Óõí Áñ ÈÞë

×åéñïõñãéêÞò Óõí Áñ ÈÞë

Åñãáóôçñéáêüò Óõí Áñ ÈÞë

Óõí

ÍÁÉ Ï×É ÔÉÓ ÐÅÑIÓ. ÖÏÑÅÓ

42 9 49

28 7 65

46 6 48

39 7 54

38 10 52

47 8 47

25 14 61

30 0 70

50 10 40

41 3 56

Ìåéêôüò Áñ ÈÞë 38 11 51

39 3 58

Ðßíáêáò 6. ÓùóôÞ ëÞøç öáñìáêåõôéêÞò áãùãÞò (%) ÔïìÝáò Éáôñïß

Ðáèïëïãßáò Óõí Áñ ÈÞë

×åéñïõñãéêÞò Óõí Áñ ÈÞë

Åñãáóôçñéáêüò Óõí Áñ ÈÞë

Óõí

ÍÁÉ Ï×É ÔÉÓ ÐÅÑÉÓ. ÖÏÑÅÓ

61 5 34

60 10 30

53 8 39

58 8 34

54 10 36

68 0 32

47 20 33

ÍÁÉ 39%

ÔÉÓ ÐÅÑÉÓÓÏÔÅÑÅÓ ÖÏÑÅÓ 54%

¼×É 7%

74 0 26

50 10 40

ÔÉÓ ÐÅÑÉÓÓÏÔÅÑÅÓ ÖÏÑÅÓ 34%

56 6 38

Ìåéêôüò Áñ ÈÞë 50 14 36

66 2 32

ÍÁÉ 58%

¼×É 8%

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

ÄéÜãñáììá 6. Åê ôïõ óõíüëïõ éáôñþí, óùóôÞ ëÞøç öáñìáêåõôéêÞò áãùãÞò %

Åìðéóôåýåóôå ôïõò óõíáäÝëöïõò óáò óå êáôáóôÜóåéò áóèÝíåéÜò óáò;

ôéò óçìáíôéêüôåñåò áíáêáëýøåéò óôçí éóôïñßá ôçò éáôñéêÞò. Ìå ôá ðñïãñÜììáôá åìâïëéáóìþí ðïõ Ý÷ïõí ôåèåß óå åöáñìïãÞ Ý÷åé ãßíåé åöéêôü íá óôáìáôÞóåé ç åîÝëéîç-ðáñïõóßá ðïëëþí áóèåíåéþí8,9. Ôá ðåñéóóüôåñá åìâüëéá óõíÞèùò ðñïëáìâÜíïõí ôç íüóï, åíþ ìåñéêÜ áðü áõôÜ ôçí ôñïðïðïéïýí, Ýôóé þóôå íá ìçí åìöáíßæåôáé óå âáñéÜ ìïñöÞ. Ãéá ôçí åðéôõ÷ßá ôùí åìâïëéáóìþí ðñÝðåé íá ôçñïýíôáé ïñéóìÝíïé êáíüíåò, üðùò ç óùóôÞ ìåôáöïñÜ êáé óõíôÞñçóç ôùí åìâïëßùí, ï óùóôüò ôñüðïò êáé ç çëéêßá åöáñìïãÞò ôïõò êáé ôï óðïõäáéüôåñï ßóùò ïé áíáìíçóôéêïß åìâïëéáóìïß. Ï åðáíáëçðôéêüò åìâïëéáóìüò áíáãêÜæåé ôïí ïñãáíéóìü íá “èõìçèåß” êáé íá îáíáöôéÜîåé ìåãÜëï áñéèìü áíôéóùìÜôùí, þóôå íá ìðïñåß íá áíôéìåôùðßæåé åðáñêþò ôçí åßóïäï óôï óþìá ôïõ ìéêñïâßùí Þ éþí. Ï óêïðüò ôùí åìâïëßùí åßíáé íá “ìéìçèïýí” ôçí ðñáãìáôéêÞ íüóï, þóôå üôáí ï ïñãáíéóìüò ÷ñåéáóôåß íá ôçí áíôéìåôùðßóåé íá Ý÷åé óôç äéÜèåóÞ ôïõ áñêåôÜ áíôéóþìáôá ãéá áõôü, ìå ôñüðï ðïõ íá ìçí ôïí âÜæåé óå êßíäõíï10-12. Åíèáññõíôéêü ðáñïõóéÜæåôáé ôï õøçëü ðï-

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

ÓõæÞôçóç Áí êáé ôï ìåãáëýôåñï ðïóïóôü ôùí éáôñþí Ý÷åé åìâïëéáóôåß ìå ôá áðáñáßôçôá ãéá ôçí çëéêßá ôïõ åìâüëéá, åíôïýôïéò ôï 27% äçëþíåé Üãíïéá (ìå ôïõò ÷åéñïõñãïýò óôï 39%). ÁíÜ öýëï, óôïõò ãåíüìåíïõò åìâïëéáóìïýò õðåñÝ÷ïõí ïé ãõíáßêåò ó’ üëïõò ôïõò ôïìåßò åéäéêïôÞôùí, åíþ áíôßóôïé÷á õðåñï÷Þ ôùí áíäñþí ðáñïõóéÜæåôáé óôçí Üãíïéá/áìÝëåéá. Ôá åìâüëéá åßíáé óßãïõñá ìßá áðü 134


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ã. Ôóßñïò êáé óõí. Ðßíáêáò 7. ×ñçóéìïðïßçóç “áñêåôþí” öáñìÜêùí (ðïëõöáñìáêßá) (%) ÔïìÝáò Éáôñïß

Ðáèïëïãßáò Óõí Áñ ÈÞë

×åéñïõñãéêÞò Óõí Áñ ÈÞë

Åñãáóôçñéáêüò Óõí Áñ ÈÞë

Óõí

ÍÁÉ Ï×É ÏÔÁÍ ÁÐÁÉÔÅÉÔÁÉ

0 68 32

4 64 32

2 65 33

2 66 32

0 79 21

0 56 44

8 67 25

0 61 39

0 60 40

3 71 26

Ìåéêôüò Áñ ÈÞë 3 69 28

1 63 36

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

Ðáèïëïãßáò Óõí Áñ ÈÞë

×åéñïõñãéêÞò Óõí Áñ ÈÞë

Åñãáóôçñéáêüò Óõí Áñ ÈÞë

Óõí

ÍÁÉ Ï×É ÃÍÙÓÔÏÓ ÅÌÐÅÉÑÉÁ ÔÉÓ ÐÅÑIÓ. ÖÏÑÅÓ

20 2 13 36 29

30 6 8 31 25

9 0 13 48 30

20 3 11 38 28

18 4 21 32 25

21 0 76 39 34

39 3 7 32 19

22 9 9 30 30

ÍÁÉ 2%

0 0 15 45 40

ÃÍÙÓÔÏÓ 11%

¼ÔÁÍ ÁÐÁÉÔÅÉÔÁÉ 32% ¼×É 66%

ÅÌÐÅÉÑÉÁ 38%

18 0 11 51 20

Ìåéêôüò Áñ ÈÞë 20 2 14 37 27

20 3 9 40 28

ÍÁÉ 20% ¼×É 3% ÔÉÓ ÐÅÑÉÓÓÏÔÅÑÅÓ ÖÏÑÅÓ 28%

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

ÄéÜãñáììá 8. Åê ôïõ óõíüëïõ éáôñþí, åìðéóôïóýíç óå óõíáäÝëöïõò, óå êáôáóôÜóåéò áóèÝíåéÜò ôïõò %.

óïóôü 71% ôùí éáôñþí ðïõ ÷ñçóéìïðïéïýí ìÝóá ðñïóôáóßáò üôáí áðáéôåßôáé óå þñá åñãáóßáò, ìå áõîçìÝíï éäéáßôåñá óôéò ÷åéñïõñãéêÝò (77%) êáé åñãáóôçñéáêÝò (78%) åéäéêüôçôåò åöüóïí áõôïß ïé éáôñïß Ýñ÷ïíôáé óå ìåãáëýôåñç Ýêèåóç ìå ìïëõóìÝíá õãñÜ, áêôéíïâïëßåò ê.ëð. ÁíÜ öýëï, ðéï “ðñïóåêôéêÝò” ðáñïõóéÜæïíôáé ïé ãõíáßêåò éáôñïß ó’ üëïõò ôïõò ôïìåßò åéäéêïôÞôùí, êáé éäéáßôåñá óôï ÷åéñïõñãéêü ìå ðïóïóôü 91%. ÊáèçìåñéíÜ Ýíáò óçìáíôéêüò áñéèìüò áôüìùí ôïõ íïóçëåõôéêïý ðñïóùðéêïý ðïõ Ýñ÷åôáé ó´ åðáöÞ ìå âéïëïãéêÜ õãñÜ ìïëõóìÝíá áðü ôïõò éïýò ôçò çðáôßôéäáò Â, C êáé ôïí éü ôïõ óõíäñüìïõ ôçò åðßêôçôçò áíïóïáíåðÜñêåéáò (HIV1-2), äéáôñÝ÷åé ôïí êßíäõíï íá ìïëõíèåß êáé íá íïóÞóåé13,14. Ç áíÜðôõîç ëïßìùîçò åîáñôÜôáé áðü ôï åßäïò êáé ôç ëïéìïãüíï éêáíüôçôá ôïõ éïý, ôçí ðõêíüôçôÜ ôïõ óôï âéïëïãéêü õãñü êáé ôï åßäïò ôçò åðáöÞò15,16. Ïé ëïéìþîåéò áõôÝò ìåôáäßäïíôáé óôï õãåéïíïìéêü

ðñïóùðéêü êõñßùò áðü ìéêñïôñáõìáôéóìïýò, áõôü üìùò óõìâáßíåé óå ÷áìçëü ðïóïóôü åíþ åîáéñåôéêÜ óðÜíéá ïöåßëïíôáé óå åðáöÞ âéïëïãéêþí õãñþí ìå âëåííïãüíïõò. Ï óõíçèÝóôåñïò ôñüðïò åðáöÞò óå ÷þñïõò üðïõ ãßíïíôáé ìéêñïåðåìâÜóåéò åßíáé ï ôñáõìáôéóìüò êáôÜ ôçí ðñïóðÜèåéá êÜëõøçò ôçò âåëüíçò ìå ôï êÜëõììÜ ôçò17,18. Ôá ìïëõóìÝíá áé÷ìçñÜ åñãáëåßá áðïññßðôïíôáé óå óôåñåÜ äï÷åßá åíþ ôá ìïëõóìÝíá âéïëïãéêÜ õãñÜ óå ðëáóôéêÝò óáêïýëåò. Áðáñáßôçôç åßíáé ç ðëÞñçò óõíåñãáóßá ôïõ ðñïóùðéêïý êáôÜ ôçí þñá ôùí åðåìâÜóåùí ìå óáöåßò ïäçãßåò ëåéôïõñãßáò. Ôï Þìéóõ ðåñßðïõ ôùí éáôñþí, ó’ üëïõò ôïõò ôïìåßò åéäéêïôÞôùí, áíôéìåôùðßæïõí Ýãêáéñá ðñïâëÞìáôá õãåßáò ôïõò (éäéáßôåñá ïé ãõíáßêåò) êáé áðåõèýíïíôáé óôïí “åéäéêü” ãéá ôï íüóçìÜ ôïõò óõíÜäåëöï, êõñßùò ïé ðáèïëïãéêÝò åéäéêüôçôåò óôï 60%. ÃåíéêÜ ìå ôéò ïäçãßåò ôïõ “åéäéêïý” óõììïñöþíïíôáé: ôéò ðåñéóóüôåñåò öïñÝò ôï 54% êáé 135


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

áðüëõôá ôï 39%, ìå ôéò ÷åéñïõñãéêÝò åéäéêüôçôåò íá ìçí áêïëïõèïýí ôéò éáôñéêÝò óõìâïõëÝò áðüëõôá (28%) áëëÜ ôéò ðåñéóóüôåñåò öïñÝò (65%), åíþ ôï Þìéóõ ðåñßðïõ ôùí éáôñþí ôùí åñãáóôçñéáêþí åéäéêïôÞôùí, äåí áðåõèýíïíôáé ðÜíôïôå óôïí êáôÜëëçëï éáôñü. Ç ðëåéïøçößá ôùí éáôñþí (58%) ëáìâÜíåé óùóôÜ ôç öáñìáêåõôéêÞ ôïõ áãùãÞ (ìå õðåñï÷Þ ôùí ãõíáéêþí ó’ üëïõò ôïõò ôïìåßò åéäéêïôÞôùí), åíþ ðñïóðáèåß (ôéò ðåñéóóüôåñåò öïñÝò) ôï 34%. Áêüìá ôï 66% áðïöåýãåé ôçí ðïëõöáñìáêßá ìå ôï 32% íá ôç ÷ñçóéìïðïéåß üôáí áðáéôåßôáé, äåßãìá ôçò åðéóôçìïíéêÞò ãíþóçò ôùí áñíçôéêþí åðéðôþóåùí ôüóï ôçò ìç ÷ñÞóçò üóï êáé ôçò õðåñâïëéêÞò êáôáíÜëùóçò ôùí öáñìáêåõôéêþí éäéïóêåõáóìÜôùí19-23. Ôï öÜñìáêï åßíáé ðïëýôéìï ãéá ôç äéáóöÜëéóç ôçò õãåßáò, ôçí ðáñÜôáóç ôçò æùÞò êáé ôç âåëôßùóç ôçò ðïéüôçôÜò ôçò, ìðïñåß üìùò óå ëáèåìÝíç ÷ñÞóç Þ õðåñâïëéêÞ äüóç, íá áðïâåß åðéêßíäõíï24-27. Ï êÜèå áóèåíÞò áðïôåëåß ìéá îå÷ùñéóôÞ ðåñßðôùóç. ÁíÜëïãá ìå ôï éáôñéêü éóôïñéêü, ôçí çëéêßá, ôç óùìáôéêÞ ôïõ åðéöÜíåéá, ôïí øõ÷éóìü ôïõ, ôçí áíåýñåóç õðåñåõáéóèçóßáò (áëëåñãßåò), ôéò ðéèáíÝò áíôåíäåßîåéò Þ ôçí ôáõôü÷ñïíç ÷ñÞóç êáé Üëëùí öáñìÜêùí èá ðñÝðåé íá åöáñìïóôåß ôï êáôÜëëçëï èåñáðåõôéêü ó÷Þìá, óôç óùóôÞ äïóïëïãßá êáé ãéá óõãêåêñéìÝíï ÷ñïíéêü äéÜóôçìá28-31. ¸ñåõíåò åðéóçìáßíïõí (áíáöïñÜ óôï 6ï ÐáíåëëÞíéï ÓõíÝäñéï Ðáèïëïãßáò) üôé ç ðéèáíüôçôá íá ÷Üóåé êáíåßò ôç æùÞ ôïõ áðü ðáñåíÝñãåéåò êÜðïéïõ óêåõÜóìáôïò ãéá ÷ñüíéï íüóçìá åßíáé ìßá óôéò åêáôü, ôç óôéãìÞ ðïõ ï áíôßóôïé÷ïò êßíäõíïò íá óêïôùèåß êÜðïéïò óå ôñï÷áßï åßíáé ìßá óôéò ÷ßëéåò êáé óå áåñïðïñéêü äõóôý÷çìá ìßá óôéò äÝêá ÷éëéÜäåò. ÁíáöïñéêÜ ìå ôçí åìðéóôïóýíç, ãéá êáôáóôÜóåéò áóèÝíåéÜò ôïõò, óå óõíáäÝëöïõò ôïõò, ðñïâÜëëïõí êõñßùò ôçí åìðåéñßá (38%), ôç óõíåñãáóßá (11%), ôçí áðüëõôç åìðéóôïóýíç (20%) êáé ìéêñÞ åðéöýëáîç ôï 28%. Ç êáëýôåñç åêðáßäåõóç ôùí éáôñþí ôüóï êáôÜ ôéò ðáíåðéóôçìéáêÝò óðïõäÝò, üóï êáé êáôÜ ôçí ðåñßïäï ôçò åéäéêüôçôáò, ç äéÜ âßïõ åêðáßäåõóç, ç êáëýôåñç åðéêïéíùíßá-óõíåñãáóßá ìåôáîý ôùí éáôñþí, ç áíÜðôõîç éáôñéêÞò äåïíôïëïãßáò, ç åíçìÝñùóç ôùí ëåéôïõñãþí ôïõ Äéêáßïõ, áëëÜ êáé ôùí áóèåíþí üôé êÜèå ðáñÝêêëéóç áðü ôçí áíáìåíüìåíç Ýêâáóç äåí áðïôåëåß êáô’ áíÜãêçí éáôñéêÞ áìÝëåéá, áðïôåëïýí ßóùò ôìÞìá ôçò ëýóçò ôïõ “ëåðôïý” áõôïý æçôÞìáôïò32-34. 136

Ã. Ôóßñïò êáé óõí.

ÓõìðåñÜóìáôá êáé ðñïôÜóåéò · Ç ðëåéïíüôçôá ôùí éáôñþí Ý÷åé åìâïëéáóèåß åðáñêþò, êñßíåôáé üìùò áðáñáßôçôï íá äåßîïõí åíäéáöÝñïí üóïé äçëþíïõí Üãíïéá, Þ äåí Ý÷ïõí åíçìåñùèåß êáôÜëëçëá. · ×ñçóéìïðïéïýí üôáí áðáéôåßôáé ìÝóá ðñïóôáóßáò óôéò þñåò åñãáóßáò, (êõñßùò ïé ÷åéñïõñãéêÝò êáé åñãáóôçñéáêÝò åéäéêüôçôåò). · Ôï Þìéóõ ôùí éáôñþí áíôéìåôùðßæåé Ýãêáéñá êáôáóôÜóåéò áóèåíåßáò ôïõò êáé êõñßùò ïé ãõíáßêåò, ðïõ ëáìâÜíïõí ðéï óùóôÜ ôç öáñìáêåõôéêÞ ôïõò áãùãÞ. · Ç ðëåéïíüôçôá ôùí éáôñþí êÜíåé ïñèïëïãéêÞ ÷ñÞóç ôùí öáñìÜêùí, áðïöåýãïíôáò ôçí ðïëõöáñìáêßá. · ÓõãêñéôéêÜ ìå ôïõò Üíäñåò, ïé ãõíáßêåò éáôñïß ðáñïõóéÜæïíôáé ðéï ðñïóåêôéêÝò êáé åõáéóèçôïðïéçìÝíåò ó÷åôéêÜ ìå ôçí ðñüëçøç êáé áíôéìåôþðéóç èåìÜôùí õãåßáò ôïõò. · ÃåíéêÜ ïé éáôñïß áðåõèýíïíôáé óå åéäéêïýò ãéá ôï íüóçìÜ ôïõò óõíáäÝëöïõò êáé óõììïñöþíïíôáé ìå ôéò ïäçãßåò ôïõ. Åìðéóôåýïíôáé êõñßùò ôïõò ðéï Ýìðåéñïõò, ãíùóôïýò Þ óõíåñãÜôåò ôïõò. Ç óùóôÞ ðñüëçøç (åìâïëéáóìïß, Ýëåã÷ïò áíïóßáò, åíçìÝñùóç ôñüðùí ìåôÜäïóçò ëïéìùäþí íïóçìÜôùí), ç Ýãêáéñç êáé êáôÜëëçëç áíôéìåôþðéóç êáôáóôÜóåùí õãåßáò (óõììüñöùóç ìå ôéò ïäçãßåò ôïõ èåñÜðïíôá) ôïõ éáôñéêïý ðñïóùðéêïý, áðïôåëåß ýøéóôç õðï÷ñÝùóç êÜèå éáôñïý. Ï ðáñáìåñéóìüò ôùí áíùôÝñù, åêôüò ôïõ üôé åêèÝôåé óå Üìåóï êßíäõíï íüóçóçò Üëëïõò áóèåíåßò, åñãáæüìåíïõò Þ êáé ìÝëç ôçò ïéêïãÝíåéÜò ôïõ, áíôéðáñáôßèåôáé ìå ôç óýã÷ñïíç êáé åðéóôçìïíéêÜ ôåêìçñéùìÝíç ãíþóç, ç ïðïßá ëáìâÜíåôáé ìå ôç óõíå÷Þ åíçìÝñùóç êáé åêðáßäåõóç. ÅðéðñïóèÝôùò, ç ðñïóðÜèåéá ãéá ôçí êáëýôåñç äõíáôÞ åðéêïéíùíßá êáé óõíåñãáóßá ôùí éáôñþí, äçìéïõñãåß êëßìá åìðéóôïóýíçò ãéá ôïí ðÜó÷ïíôá óõíÜäåëöï, èåìåëéþíïíôáò Ýôóé óçìáíôéêÜ óôïé÷åßá áíÜðôõîçò êáé ëåéôïõñãßáò åíüò õðåýèõíïõ ðñïãñÜììáôïò õãåßáò.

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ÐáñÜñôçìá ÐÑÏËÇØÇ, ÁÍÔÉÌÅÔÙÐÉÓÇ ÊÁÉ ÓÕÌÐÅÑÉÖÏÑÁ ÔÙÍ ÉÁÔÑÙÍ ÓÅ ÈÅÌÁÔÁ ÕÃÅÉÁÓ ÔÏÕÓ - ÅÑÙÔÇÌÁÔÏËÏÃÉÏ Ðáñáêáëþ óçìåéþóáôå ìå ìðëå óôõëü Ýíá ×, ìåôÜ áðü ôçí áðÜíôçóç (óôá äåîéÜ) ðïõ åðéëÝîáôå. 1. Öýëï:

¢íäñáò

Ãõíáßêá

2. Çëéêßá: 3. Åéäéêüôçôá: 4. ¸÷åôå åìâïëéáóôåß ìå ôá áðáñáßôçôá ãéá ôçí çëéêßá óáò åìâüëéá; ÍÁÉ ÏXÉ ÄÅÍ ÃÍÙÑÉÆÙ 5. ×ñçóéìïðïéåßôå ôéò þñåò åñãáóßáò ìÝóá ðñïïôáóßáò (ãÜíôéá, ìÜóêá ê.ëð.) üôáí áðáéôåßôáé; ÍÁÉ ÏXÉ ÓÕ×ÍÁ 6. Áíôéìåôùðßæåôå Ýãêáéñá êáôáóôÜóåéò áóèÝíåéÜò óáò; ÍÁÉ ÏXÉ ÊÑÉÍÙ ÁÍÁËÏÃÁ 7. Óå ðñïâëÞìáôá õãåßáò óáò, áðåõèýíåóôå óôïí "åéäéêü" ìå ôçí ðÜèçóÞ óáò éáôñü; ÍÁÉ ÏXÉ ÓÕ×ÍÁ 8. Óõììïñöþíåóôå ìå ôéò éáôñéêÝò ïäçãßåò - óõìâïõëÝò ôïõ "åéäéêïý"; ÍÁÉ ÏXÉ ÔÉÓ ÐÅÑÉÓÓÏÔÅÑÅÓ ÖÏÑÅÓ 9. ËáìâÜíåôå óùóôÜ ôç öáñìáêåõôéêÞ óáò áãùãÞ; ÍÁÉ ÏXÉ ÔÉÓ ÐÅÑÉÓÓÏÔÅÑÅÓ ÖÏÑÅÓ 10. ×ñçóéìïðïéåßôå "áñêåôÜ" öÜñìáêá (ðïëõöáñìáêßá); ÍÁÉ ÏXÉ ÏÔÁÍ ÁÐÁÉÔÅÉÔÁÉ 11. Åìðéóôåýåóôå ôïõò óõíáäÝëöïõò óáò óå êáôáóôÜóåéò áóèÝíåéá óáò; ÍÁÉ ÁÍÁËÏÃÙÓ ÔÇÍ ÅÌÐÅÉÑÉÁ ÔÏÕ Ï×É ÏÔÁÍ ÅÉÍÁÉ ÃÍÙÓÔÏÓ / ÓÕÍÅÑÃÁÆÏÌÁÉ ÔÉÓ ÐÅÑÉÓÓÏÔÅÑÅÓ ÖÏÑÅÓ ÁËËÏ:

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Ôüìïò 14, Ôåý÷ïò 3, 2002

Ê. Óôåöáíïðïýëïõ êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ - 14Ï ÐÁÍÅËËÇÍÉÏ ÓÕÍÅÄÑÉÏ ÃÅÍÉÊÇÓ ÉÁÔÑÉÊÇÓ AWARDED FREESTANDING PAPER - 14th HELLENIC CONGRESS IN GENERAL PRACTICE Primary Heatlh Care, Volume 14, Number 3, 139-146, 2002 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 139-146, 2002

Aîéïëüãçóç ôùí áðïôåëåóìÜôùí ôçò ðáñÝìâáóçò ôïõ éáôñïý ðåñéöåñåéáêïý éáôñåßïõ óå ãíùóôü ðëçèõóìü óáê÷áñïäéáâçôéêþí ôçò ðåñéï÷Þò åõèýíçò ôïõ ìåôÜ ôçí ðáñÝëåõóç åíüò Ýôïõò Ê. Óôåöáíïðïýëïõ1, Ó. Ãêïíôüëéáò1, ×. ÓðõñÜêç1, Á. Ðáñáóýñç2, Á. ÐåôñÜêç2, Í. ÐáðáäÜêçò1, Á. Ìðáôßêáò1

Ðåñßëçøç Óêïðüò: Ç áðïôýðùóç ôùí áðïôåëåóìÜôùí ôçò ðáñÝìâáóçò ôïõ É.Ð.É. óôïõò óáê÷áñï- äéáâçôéêïýò ôçò ðåñéï÷Þò ôïõ ìåôÜ ôçí ðáñÝëåõóç åíüò Ýôïõò, üðùò áõôÞ åêäçëþíåôáé ìå ôçí åêôßìçóç ôùí ìåôáâïëþí ôçò HbA1c, ôïõ ëéðéäáéìéêïý ðñïößë, áëëÜ êáé ôùí ìåôáâïëþí óôéò óõíÞèåéåò êáé ôïí ôñüðï æùÞò ôùí áóèåíþí áõôþí. Ðëçèõóìüò áíáöïñÜò - ÌÝèïäïò: ÌåëåôÞèçêáí 24 äéáãíùóìÝíïé óáê÷áñoäéáâçôéêïß åðß óõíüëïõ 870 êáôïßêùí óôá äçìïôéêÜ äéáìåñßóìáôá ÃáñÜæïõ, Ìïõñôæáíþí, ÅðéóêïðÞò êáé Êåöáëßïõ. ¼ëïé Ýðáó÷áí áðü óáê÷áñþäç äéáâÞôç (Ó.Ä.) ôýðïõ ��É. Óôá Üôïìá áõôÜ, ìåôÜ ôçí áñ÷éêÞ åêôßìçóç ôïí Áýãïõóôï ôïõ 2000 ôùí ôéìþí ôçò HbA1c êáé ôïõ ëéðéäáéìéêïý ðñïößë, Ýãéíáí ïé áíÜëïãåò êáôÜ ðåñßðôùóç ôñïðïðïéÞóåéò êáé ðñïóáñìïãÝò ôçò öáñìáêåõôéêÞò áãùãÞò êáé óõíåóôÞèç ìåôáâïëÞ ôïõ ôñüðïõ æùÞò (åöáñìïãÞ óõãêåêñéìÝíïõ äéáéôïëïãßïõ, Üóêçóç, äéáêïðÞ êáðíßóìáôïò êáé ðåñéïñéóìüò ôïõ áëêïüë). Åðßóçò äéïñãáíþèçêáí åêðáéäåõôéêÜ ìáèÞìáôá ìå óõæçôÞóåéò êáé ðñïâïëÝò slides, üðïõ óõæçôÞèçêáí èÝìáôá ó÷åôéêÜ ìå ôïí ÓÄ (ðñüëçøç, ðáèïëïãßá, åðéðëïêÝò, áíôéìåôþðéóç). ÁðïôåëÝóìáôá: ÌåôÜ ôçí ðáñÝìâáóÞ ìáò äéáðéóôþèçêå üôé üëïé ó÷åäüí ïé áóèåíåßò (21/24) ìåßùóáí ôçí HbA1c Ýùò êáé 40% ôçò áñ÷éêÞò. Áðü ôïõò åîåôáóèÝíôåò áóèåíåßò 12 êáôüñèùóáí íá ìåéþóïõí ôï óùìáôéêü âÜñïò ôïõò Ýùò êáé 7 êéëÜ, åíþ 16/22 ðáñïõóßáóáí âåëôßùóç üóïí áöïñÜ óôï ëéðéäáéìéêü ðñïößë ðïõ óõíïäåýôçêå áðü áëëáãÞ óôéò óõíÞèåéåò êáé óôïí ôñüðï æùÞò (äéáêïðÞ êáðíßóìáôïò, ðåñéïñéóìüò áëêïüë). ÓõìðÝñáóìá: Ôá áðïôåëÝóìáôá ôçò ðáñÝìâáóÞò ìáò õðÞñîáí åíôõðùóéáêÜ, ùò áðüññïéá ôçò óõíôïíéóìÝíçò ðñïóðÜèåéáò ôïõ É.Ð.É êáé ôïõ ÊÝíôñïõ Õãåßáò ãéá åíçìÝñùóç êáé êéíçôïðïßçóç ôùí áóèåíþí ãéá èÝìáôá ó÷åôéêÜ ìå ôç íüóï ôïõ ÓÄ, äßíïíôáò éäéáßôåñç Ýìöáóç óôçí êáôáíüçóç áðü ðëåõñÜò ôïõò ôçò óðïõäáéüôçôáò ôçò áëëáãÞò ôùí õãéåéíïäéáéôçôéêþí óõíçèåéþí ôïõò.

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Éáôñïß, 2Íïóçëåõôéêü ðñïóùðéêü, ÊÝíôñï Õãåßáò ÐåñÜìáôïò Ñåèýìíïõ

ÅéóáãùãÞ O Óáê÷áñþäçò äéáâÞôçò ôýðïõ 2 áöïñÜ óôï 95% ôùí ðåñéðôþóåùí óáê÷áñþäç äéáâÞôç 1 êáé áðïôåëåß óçìáíôéêü ðñüâëçìá äçìüóéáò õãåßáò, åîáéôßáò: 1) Ôçò õøçëÞò óõ÷íüôçôáò áíåýñåóÞò ôïõ óôïí åíÞëéêï ðëçèõóìü (Ç óõ÷íüôçôá ôïõ óáê÷áñþäç äéáâÞôç ôýðïõ 2 áõîÜíåôáé, üóï áõîÜíåôáé ç çëéêßá êáé ï äåßêôçò ìÜæáò2 óþìáôïò.) 2) ôçò ÷ñïíéüôçôÜò ôïõ êáé 3) ôçò óïâáñüôçôáò êáé ôçò óõ÷íÜ “ýðïõëçò” êáé “óéùðçëÞò” åîÝëéîçò ôùí åðéðëïêþí3,4 ðïõ ôïí óõíïäåýïõí êáé åßíáé: • ÌáêñïáããåéïðÜèåéá, ðïõ ïäçãåß óå áããåéáêÜ åãêåöáëéêÜ åðåéóüäéá, éó÷áéìéêÞ êáñäéïðÜèåéá êáé ËÝîåéò êëåéäéÜ: óáê÷áñþäçò äéáâÞôçò ôýðïõ 2, ðñùôïâÜèìéá öñïíôßäá õãåßáò, áãñïôéêÞ ðåñéï÷Þ. ÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñç áíáêïßíùóç óôï 14ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò (ÊñÞôç, 8-12 ÌáÀïõ 2002) êáé Ýëáâå Ýðáéíï áðü ôçí ÅðéôñïðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò ÅðéôñïðÞò ôïõ ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ. Õðåýèõíïò áëëçëïãñáößáò: Ê. Óôåöáíïðïýëïõ, ÊÝíôñï Õãåßáò ÐåñÜìáôïò Ñåèýìíïõ, Ôçë. (28340) 23074, e-mail: serteda@otenet.gr 139


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ê. Óôåöáíïðïýëïõ êáé óõí.

ðïôå óôñáôçãéêÞò áíôéäéáâçôéêÞò èåñáðåßáò ðñÝðåé íá åßíáé ç ðñüëçøç Þ ç êáèõóôÝñçóç åìöÜíéóçò åðéðëïêþí, ç åëÜôôùóç ôçò íïóçñüôçôáò êáé èíçóéìüôçôáò, ðïõ óõíäÝïíôáé ìå ôç íüóï, Summary ç âåëôßùóç ôçò óõíïëéêÞò ðïéüôçôáò Aim: The evaluation of the results, from the intervention programme carried out æùÞò ôùí äéáâçôéêþí áóèåíþí êáé ç by the PMSP for the diabetic patients of their area of responsibility, after one ìåßùóç ôïõ êüóôïõò ðåñßèáëøçò. year. Evaluation was based on the following parameters: HbA1c variation, lipid ÅðïìÝíùò, åìöáíßæåôáé åðéôáêôéprofile variation, changes in the patients' habits and lifestyle. Study populationêÞ ç áíÜãêç óùóôÞò áíôéìåôþðéóçò Methods: The study population consisted of 24 patients in whom the diagnosis of NIDDM type II was already established. They were inhabitants of the municôïõ óáê÷áñïäéáâçôéêïý áóèåíïýò, ipal areas of Garazo, Mourtzana, Episkopi and Kephali (total population: 870 ðñÜãìá ðïõ áðáéôåß, ü÷é ìüíï ôçí inhabitants). After the initial determination, in August 2000, of HbA1c levels and êáôÜëëçëç öáñìáêåõôéêÞ áãùãÞ, áëëÜ lipids profile, appropriate modifications and adjustments of medication for each êáé ôç óôåíÞ êáé äéáñêÞ åìðëïêÞ ôïõ patient were suggested. Patients were also advised to change their lifestyle, to ãéáôñïý ðñùôïâÜèìéáò ðåñßèáëøçò, follow a specific dietary programme, to exercise, to stop smoking and to limit their alcohol consumption. Educational courses were organized, during which þóôå íá ìåãéóôïðïéçèåß ç óõììüñöùseveral aspects of NIDDM (prevention, pathology, complications and treatment) óç ôïõ áóèåíïýò, ü÷é ìüíï ìå ôç öáñwere discussed with the assistance of the relevant audiovisual material. ìáêåõôéêÞ èåñáðåßá, áëëÜ ðñþôá êáé Results: One year after the initiation of the programme, a decrease in HbA1c êýñéá ìå ôï ðñïôåéíüìåíï ìïíôÝëï õãéåélevels of up to 40% of the initial concentration was observed in almost all íïäéáéôçôéêÞò áãùãÞò (áëëáãÞ ôïõ patients (21/24). Twelve patients managed to reduce their body weight by up to 7kgr, while sixteen out of 22 patients presented an improved lipid profile acôñüðïõ æùÞò ìå Ýìöáóç óôçí åöáñìïcompanied by a modification of both their lifestyles and general habits (reducãÞ óõãêåêñéìÝíïõ äéáéôïëïãßïõ, óôçí ing alcohol intake and giving up smoking). Conclusion: It is important to the Üóêçóç, óôç äéáêïðÞ ôïõ êáðíßóìáPMSP maximize its efforts in order to inform the patients about NIDDM and to ôïò êáé ôïí ðåñéïñéóìü ôïõ áëêïüë).12,13 help them realize the importance of changes in their diet and lifestyle for the Óêïðüò ôçò óõãêåêñéìÝíçò ìåëÝcourse of the disease had really impressive results. Key words: diabetes mellitus type II, intervention, habits, lifestyle, primary health ôçò åßíáé ç áîéïëüãçóç ôùí áðïôåëåcare óìÜôùí ôçò ðáñÝìâáóçò ôïõ éáôñïý Perama Health Centre, Rethymno, Greece ðåñéöåñåéáêïý éáôñåßïõ óå ãíùóôü ðëçèõóìü óáê÷áñïäéáâçôéêþí ôçò ðå5 ñéï÷Þò åõèýíçò ôïõ, üðùò áõôÞ åêäçëþíåôáé ìå ðåñéöåñéêÞ áããåéïðÜèåéá • ÌéêñïáããåéïðÜèåéá, ðïõ ðñïêáëåß áìöéâëç- ôçí åêôßìçóç ôùí ìåôáâïëþí ôçò Çba1C, ôïõ óôñïåéäïðÜèåéá êáé íåöñïðÜèåéá5 êáé ëéðéäáéìéêïý ðñïößë, áëëÜ êáé ôéò ìåôáâïëÝò óôéò • ÍåõñïðÜèåéá5,6 óõíÞèåéåò êáé ôïí ôñüðï æùÞò ôùí áóèåíþí áõÁîéïóçìåßùôï åßíáé üôé ôá áããåéáêÜ åãêåöá- ôþí. ëéêÜ êáé ôá óôåöáíéáßá åðåéóüäéá, áðïôåëïýí ôçí êýñéá áéôßá èáíÜôïõ ôùí áóèåíþí ìå óáê÷áñþäç äéáâÞôç ôýðïõ 2.7-9 Ðëçèõóìüò ìåëÝôçò êáé ìÝèïäïò Áí, åðéðñüóèåôá, åêôüò áðü ôïí óáê÷áñþäç äéáâÞôç ôýðïõ 2, ëÜâïõìå õðüøç ìáò êáé ôï MåëåôÞèçóáí, óõíïëéêÜ, 24 äéáãíùóìÝíïé ãåãïíüò üôé, ôï 65% ôùí áóèåíþí áõôþí Ý÷åé óáê÷áñïäéáâçôéêïß ôýðïõ 2, óå óýíïëï 870 êááõîçìÝíç áñôçñéáêÞ ðßåóç (>135/85 mmHg, ôïßêùí óôá äçìïôéêÜ äéáìåñßóìáôá ÃáñÜæïõ, óýìöùíá ìå ôá êñéôÞñéá ôçò JNC VI)10, åíþ ôï Ìïõñôæáíþí, ÅðéóêïðÞò êáé Êåöáëßïõ. 55% åìöáíßæåé óçìáíôéêÜ áõîçìÝíá åðßðåäá ëéÃéá üëïõò ôïõò áóèåíåßò, ðïõ ðåñéåëÞöèçóáí ðéäßùí11 óôï áßìá, ãßíåôáé öáíåñü, óå ôåëéêÞ áíÜ- óôç ìåëÝôç, óõìðëçñþèçêå, ôïí Áýãïõóôï ôïõ ëõóç, ðüóï áõîçìÝíïò êßíäõíïò õðÜñ÷åé ãéá ôç 2000, åéäéêü äåëôßï êáôáãñáöÞò ôùí äçìïãñáöéæùÞ ôùí áóèåíþí áõôþí12. êþí ôïõò óôïé÷åßùí, ôùí áíèñùðïìåôñéêþí ôïõò ÄåäïìÝíïõ, äå, êáé ôïõ ôåñÜóôéïõ êüóôïõò ÷áñáêôçñéóôéêþí êáé ôïõ áôïìéêïý éóôïñéêïý ôïõò. äéá÷åßñéóçò êáé íïóçëåßáò ëüãù ôùí åðéðëïêþí Ï êáèïñéóìüò ôïõ Äåßêôç ÌÜæáò Óþìáôïò (ãéá íá ìçí áíáöÝñïõìå ôïí ðüíï êáé ôçí ôáëáé- (ÄÌÓ) Ýãéíå ìå ôïí ðñïóäéïñéóìü ôïõ ýøïõò êáé ðùñßá ôùí áóèåíþí), ï êýñéïò óôü÷ïò ïðïéáóäÞ- ôç ìÝôñçóç ôïõ âÜñïõò, óýìöùíá ìå ôïí ôýðï Evaluation of an intervention programme by the peripheral medical station physician (PMSP) in a known population of NIDDM patients in their area of responsibility after one year of its application K. Stefanopoulou, S. Gantolias, X. Spiraki, A. Parasiri, A. Petraki, N. Papadakis, A. Batikas

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Ôüìïò 14, Ôåý÷ïò 3, 2002

Ê. Óôåöáíïðïýëïõ êáé óõí.

Ä.Ì.Ó. = ÂÜñïò/(ýøïò)2. Ç ýðáñîç óáê÷áñþäç äéáâÞôç äéáðéóôþèçêå åßôå áðü ôï éóôïñéêü ëÞøçò áíôéäéáâçôéêÞò áãùãÞò (äéóêßá-éíóïõëßíç), åßôå áðü ôçí áíåýñåóç äõï äéáäï÷éêþí ôéìþí ãëõêüæçò íçóôåßáò >126mg/dl.14-21 Ïé áóèåíåßò, áíÜëïãá ìå ôç ÷ñÞóç êáðíïý, êáôçãïñéïðïéÞèçêáí óå ìç êáðíéóôÝò, ðñþçí êáðíéóôÝò êáé êáðíéóôÝò, åíþ áíÜëïãá ìå ôç ÷ñÞóç áëêïüë, êáôçãïñéïðïéÞèçêáí óå ìç ðüôåò (<10 ãñ. áëêïüëçò ôçí åâäïìÜäá), Þðéïõò ðüôåò (<150 ãñ. áëêïüëçò ôçí åâäïìÜäá), ìÝôñéïõò ðüôåò (<300 ãñ. áëêïüëçò ôçí åâäïìÜäá) êáé ðüôåò (>300 ãñ. áëêïüëçò ôçí åâäïìÜäá). Ç çìåñÞóéá êáôáíÜëùóç áëêïüë õðïëïãßóèçêå ìå âÜóç ôéò ðëçñïöïñßåò ãéá ôçí çìåñÞóéá êáôáíÜëùóç ìðßñáò, êñáóéïý, ëéêÝñ, óýìöùíá ìå ôïí ôýðï: áëêïüë=1/7* [(0,04Ì*12)+(0,15Ê*4)+(0,45Ë*1,5)+28,35)].22 ÐáñÜëëçëá, ðñáãìáôïðïéÞèçêå ìÝôñçóç ôçò áñôçñéáêÞò ðßåóçò, ìå õäñáñãõñéêü óöõãìïìáíüìåôñï, óå 3 äéáäï÷éêÝò, áíÜ äßëåðôï ìåôñÞóåéò. Ïé ìåôñÞóåéò Ýãéíáí óå êáèéóôÞ èÝóç, ìåôÜ áðü ðåíôÜëåðôç áíÜðáõóç êáé áöïý åß÷áí ðåñÜóåé, ôïõëÜ÷éóôïí 30 ëåðôÜ áðü ôçí ðüóç êáöåúíïý÷ïõ ñïöÞìáôïò Þ êáðíßóìáôïò. ÉêáíïðïéçôéêÞ ñýèìéóç ôçò áñôçñéáêÞò ðßåóçò ÷áñáêôçñßóèçêå ç ôéìÞ ôçò óõóôïëéêÞò áñôçñéáêÞò ðßåóçò <135 mmHg êáé ôçò äéáóôïëéêÞò áñôçñéáêÞò ðßåóçò <85 mmHg.23 ÌåôÜ ôïí áñ÷éêü ðñïóäéïñéóìü, ôïí Áýãïõóôï ôïõ 2000, ôùí ôéìþí ôïõ óáê÷Üñïõ íçóôåßáò óôï áßìá, ôçò ãëõêïæõëéùìÝíçò áéìïóöáéñßíçò (Hba1C), ôùí ôéìþí ôçò HDL êáé LDL ÷ïëçóôåñüëçò, ùò êáé ôùí ôñéãëõêåñéäßùí, êáèþò êáé ôïí õðïëïãéóìü ôïõ ÂÜñïõò, ôïõ Äåßêôç ÌÜæáò Óþìáôïò êáé ôçò áñôçñéáêÞò ðßåóçò, ïé ìåôñÞóåéò åðáíáëÞöèçêáí Üëëåò äõï öïñÝò, ðïõ áðåß÷áí ÷ñïíéêÜ ìåôáîý ôïõò Ýîé (6) ìÞíåò (ÖåâñïõÜñéïò Ýùò Áýãïõóôïò 2001). ÁðïäåêôÞ ôéìÞ ìåôáâïëéêïý åëÝã÷ïõ24-26, óýìöùíá ìå ôá äéåèíÞ äåäïìÝíá, üóïí áöïñÜ óôçí Hba1C èåùñåßôáé ôï 7%, åíþ ç ôéìÞ ôçò LDL ðñÝðåé íá äéáôçñåßôáé óå åðßðåäá £130mg/dl23. Óôá Üôïìá áõôÜ, ìåôÜ ôçí ðñþôç åêôßìçóç, Ýãéíáí ïé áíÜëïãåò, êáôÜ ðåñßðôùóç, ôñïðïðïéÞóåéò êáé ðñïóáñìïãÝò ôçò öáñìáêåõôéêÞò áãùãÞò êáé óõíåóôÞèç ìåôáâïëÞ ôïõ ôñüðïõ æùÞò24-25 (åéäéêüôåñá: åöáñìïãÞ óõãêåêñéìÝíïõ äéáéôïëïãßïõ13 ìå Ýìöáóç, ðÝñá áðü ôç ìåßùóç ôùí ðñïóëáìâáíïìÝíùí èåñìßäùí, óôçí áõîçìÝíç ðñüóëçøç

öõôéêþí éíþí êáé óôç ìåéùìÝíç ðñüóëçøç ëßðïõò, óôçí Üóêçóç (æùçñü ðåñðÜôçìá ãéá ôïõëÜ÷éóôïí 30 ëåðôÜ, ôñåéò (3) öïñÝò ôçí åâäïìÜäá, óôç äéáêïðÞ ôïõ êáðíßóìáôïò êáé ôïí ðåñéïñéóìü ôïõ áëêïüë).23 ÐáñÜëëçëá, äéïñãáíþèçêáí åíçìåñùôéêÝò óõãêåíôñþóåéò ìå óõæçôÞóåéò êáé ðñïâïëÝò slides, ó÷åôéêÜ ìå ôïí óáê÷áñþäç äéáâÞôç ôýðïõ 2 (ðñüëçøç, ðáèïëïãßá, åðéðëïêÝò, áíôéìåôþðéóç).

ÓôáôéóôéêÞ áíÜëõóç Tá äåäïìÝíá êáôá÷ùñÞèçêáí óå âÜóç Excel 2000 êáé áðü åêåß áíáëýèçêáí. Ç ìÝóç ôéìÞ êÜèå äåßãìáôïò ðïóïôéêþí ðáñáôçñÞóåùí (ìåôñÞóåùí), õðïëïãßóèçêå ùò ôï áëãåâñéêü Üèñïéóìá üëùí ôùí ìåôñÞóåùí, äéáéñåìÝíï ìå ôï ðëÞèïò ôùí ìåôñÞóåùí áõôþí, åíþ, ùò ìÝôñï ôïõ âáèìïý äéáóðïñÜò ôùí ðáñáôçñÞóåùí ÷ñçóéìïðïéÞèçêå ç óôáèåñÞ áðüêëéóç (SD). Ãéá ôç óýãêñéóç 2 ìÝóùí ôéìþí ðïóïôéêþí ðáñáôçñÞóåùí êáé ôçí áîéïëüãçóç ôçò óôáôéóôéêÞò óçìáíôéêüôçôáò ôçò äéáöïñÜò ôïõò ÷ñçóéìïðïéÞèçêå ç ôéìÞ ôïõ êñéôçñßïõ t (t-value), åíþ, ïé âáèìïß åëåõèåñßáò ãéá ôçí áîéïëüãçóç ôïõ êñéôçñßïõ (t), õðïëïãßóèçêáí ìå âÜóç ôïí ôýðï (n1+n22), üðïõ n1, n2 ôï ðëÞèïò ôùí ðáñáôçñÞóåùí êÜèå ïìÜäáò åëÝã÷ïõ.27

ÁðïôåëÝóìáôá ÌåëåôÞèçóáí, óõíïëéêÜ, 24 Üôïìá, 13 Üíäñåò (54,2%) êáé 11 ãõíáßêåò (45,8%). Ç ìÝóç çëéêßá ôïõ äåßãìáôïò Þôáí 69,4 Ýôç (±SD: 8,87 Ýôç). Äåí õðÞñîå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ, ìåôáîý ôçò çëéêßáò ôùí áíäñþí êáé ôùí ãõíáéêþí. ÁñôçñéáêÞ õðÝñôáóç åß÷áí 17/24 Üôïìá (70,8%), 9 Üíäñåò êáé 8 ãõíáßêåò. Ç ìÝóç ôéìÞ ôçò Ó.Á.Ð. Þôáí 147,1 (±13,8) mmHg, ìå ìÝóç ôéìÞ Ä.Á.Ð. 85,8 (±5,24) mmHg. Äåí âñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ óôçí áñôçñéáêÞ ðßåóç üóïí áöïñÜ ôï öýëï. ÌåôÜ ôçí ðáñÝëåõóç åíüò Ýôïõò ïé áíôßóôïé÷åò ìÝóåò ôéìÝò äéáìïñöþèçêáí ãéá ìåí ôç ÓÁÐ óôá 141,3 (±3,53) mmHg, åíþ ãéá ôç ÄÁÐ óôá 82,7 (±6,6) mmHg, ÷ùñßò, üìùò, ç öáéíïìåíéêÞ åëÜôôùóç íá åßíáé óôáôéóôéêÜ óçìáíôéêÞ óôï óõìâáôéêü åðßðå141


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

Ê. Óôåöáíïðïýëïõ êáé óõí.

äï ôïõ 5% Þ ôïõëÜ÷éóôïí åíäåéêôéêÞ óôï åðßðåäï ôïõ 10%. Ï ìÝóïò Ä.Ì.Ó. ôïõ äåßãìáôïò Þôáí 28,5 (±3,2) êáé äåí ðáñáôçñÞèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ ìåôáîý áíäñþí êáé ãõíáéêþí. Öõóéïëïãéêü âÜñïò óå ó÷Ýóç ìå ôï ýøïò ôïõò (ÄÌÓ <25) åß÷áí ìüíï 2 Üôïìá (8,3%) (2 ãõíáßêåò), åíþ õðÝñâáñïé (ÄÌÓ: 25-30) êáé ðá÷ýóáñêïé (ÄÌÓ >30) Þôáí 22 Üôïìá (91,7%), 13 Üíäñåò êáé 9 ãõíáßêåò. Âåëôßùóç ôïõ ÄÌÓ ìåôÜ ôçí ðáñÝëåõóç åíüò Ýôïõò, ðáñïõóßáóáí 12 Üôïìá, ðïõ áðïôåëïýóáí ôï 50% ôùí áóèåíþí, Þôïé 7 Üíäñåò êáé 5 ãõíáßêåò. Ôá Üôïìá áõôÜ, êáôüñèùóáí íá ìåéþóïõí ôï óùìáôéêü âÜñïò ôïõò ìÝ÷ñé êáé 7 êéëÜ, ðáñ’ üëá áõôÜ ï ìÝóïò ÄÌÓ ðáñÝìåéíå, ïõóéáóôéêÜ óôáèåñüò (ÄéáãñÜììáôá 1, 2). Áññýèìéóôá, üóïí áöïñÜ óôá åðßðåäá ôïõ óáê÷Üñïõ óôï áßìá Þôáí 17 Üôïìá (70,8%), 12 Üíäñåò êáé 7 ãõíáßêåò, ìå ìÝóç ôéìÞ óáê÷Üñïõ íçóôåßáò ôá 192,7 mg/dl êáé áðïäåêôÞ ôéìÞ ôá 140mg/dl23,28. Äåí âñÝèçêå óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ óôéò ôéìÝò ôçò ãëõêüæçò óôï áßìá ìåôáîý áíäñþí êáé ãõíáéêþí. 12

11

12

9

10

<25

7

8

25-28 28-35 35-40

6 4

2

2

0

0

Êáô’ åðÝêôáóç äå, üóïí áöïñÜ óôéò ôéìÝò ôçò Hba1c óôï áßìá êáé óýìöùíá ìå ôéò äéåèíåßò ðáñáäï÷Ýò, ôéìÝò <7% (23) èåùñÞèçêáí éêáíïðïéçôéêÝò êáé ðáñáôçñÞèçêáí ôïí Áýãïõóôï ôïõ 2000 óå (6) Üôïìá, (25%), 3 Üíäñåò êáé 3 ãõíáßêåò, ôéìÝò ìåôáîý 7-8,5% èåùñÞèçêáí ùò ìÝôñéá éêáíïðïéçôéêÝò êáé äéáðéóôþèçêáí óå 3 Üôïìá (12,5%) (1 Üíäñá êáé 2 ãõíáßêåò), åíþ ôéìÝò >8,5% (ìç áðïäåêôÝò) âñÝèçêáí óå 15 Üôïìá (62,5%), 9 Üíäñåò êáé 6 ãõíáßêåò. ÌåôÜ ôçí ðáñÝìâáóÞ ìáò, äéáðéóôþèçêå üôé üëïé ó÷åäüí ïé áóèåíåßò, 21/24, äçëáäÞ ðïóïóôü (87,5%), ìåßùóáí ôç ãëõêïæõëéùìÝíç áéìïóöáéñßíç (Hba1c) ùò êáé 40% ôçò áñ÷éêÞò. ¸ôóé, åíþ ç ìÝóç ôéìÞ ôçò Hba1c Þôáí 9,2%, áõôÞ ìåéþèçêå óôï 7,6%, ôïí Áýãïõóôï ôïõ 2001 (ÄéáãñÜììáôá 3, 4). Ç äéáöïñÜ ôùí 2 ìÝóùí ôéìþí äåí åßíáé óôáôéóôéêÜ óçìáíôéêÞ óôï óõìâáôéêü åðßðåäï ôïõ 5% (Üñá p>0,05), åíþ, áíôßèåôá, êáëýðôåé ôï åíäåéêôéêü åðßðåäï ôïõ 10% (p<0,10). KáôÜ óõíÝðåéá, ÷ñåéÜæåôáé ìåãáëýôåñïò áñéèìüò ðáñáôçñÞóåùí ãéá ôç óôáôéóôéêÞ êáôï÷ýñùóç ôçò äéáöïñÜò. Áíáëõôéêüôåñá, ìåôÜ ôçí áñ÷éêÞ åêôßìçóç,

2 0 0

Á

1

1

2

1

0

Ã

>40

8 6

7

6

4

0-10% 10-20% 20-30% 30-40%

4 4

2

0

ÓÕÍ

0

ÄéÜãñáììá 1. ÄÌÓ áôüìùí ìå ÓÄ.

2 ÂÅËÔÉÙÓÇ

0 0 0

ÅÐÉÄÅÉÍÙÓÇ

ÄéÜãñáììá 3. ÌåôáâïëÞ % HbA1c óå Üôïìá ìå ÓÄ. 9 8 7 6 5 4 3 2 1 0

9

10 7

3

3 1

0-5%

4

ÂÅËÔÉÙÓÇ

à 2

2

5-10%

Á

5 10

0-5%

11 5-10%

ÅÐÉÄÅÉÍÙÓÇ

ÄéÜãñáììá 2. ÌåôáâïëÞ % ÄÌÓ áóèåíþí ìå ÓÄ. 142

ÓÕÍ

14 12 10 8 6 4 2 0

15 9 6

8

7

3

ÁÕÃ.2000 ÁÕÃ.2001

ÊÁËÇ(<7) ÌÅÔÑÉÁ(7- ÊÁÊÇ(>8,5) 8,4)

ÄéÜãñáììá 4. Óýãêñéóç ôéìþí HbA1c áôüìùí ìå ÓÄ ìåôÜ áðü äéÜóôçìá 1 Ýôïõò èåñáðåßáò.


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ê. Óôåöáíïðïýëïõ êáé óõí.

ôéìÞ Hba1c <7% åß÷áí 9 Üôïìá (7 Üíäñåò êáé 2 ãõíáßêåò), ìåôáîý 7-8% 8 Üôïìá (2 Üíäñåò êáé 6 ãõíáßêåò), åíþ ðÜíù áðü 8,5%, 7 Üôïìá (4 Üíäñåò êáé 3 ãõíáßêåò). ÓôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ óôéò ôéìÝò ôçò Hba1c óôï áßìá ìåôáîý áíäñþí êáé ãõíáéêþí äåí âñÝèçêå. Áîéïóçìåßùôï åßíáé üôé ç åðéäçìéïëïãéêÞ ìåëÝôç ôïõ Wisconsin5 Ýäùóå éó÷õñÝò áðïäåßîåéò üôé óå áóèåíåßò ìå óáê÷áñþäç äéáâÞôç ôýðïõ 2, ðïõ õðïâëÞèçêáí óå ðáñáêïëïýèçóç åðß 10 Ýôç, ï âáèìüò êáé ç äéÜñêåéá ôçò õðåñãëõêáéìßáò, ðïõ áîéïëïãÞèçêáí ìå âÜóç ôç ãëõêïæõëéùìÝíç áéìïóöáéñßíç, áðïôÝëåóáí óçìáíôéêü ðáñÜãïíôá ðñüâëåøçò ôüóï ãéá ôéò ìéêñï- üóï êáé ôéò ìáêñïáããåéáêÝò åðéðëïêÝò. Ç âåëôßùóç ôïõ ãëõêáéìéêïý åëÝã÷ïõ ðñïëáìâÜíåé ôéò åðéðëïêÝò29-31. Ùò ðñïò ôï óõíåêôéìçèÝí ëéðéäáéìéêü profile, üðùò áõôü åêöñÜæåôáé, êõñßùò, ìå ôéò ôéìÝò ôçò LDL, ðïõ ðëÝïí åðéäéþêåôáé íá äéáôçñåßôáé óå åðßðåäá £130mg/dl óôï áßìá23,28, 16 áðü ôïõò 22 åíáðïìåßíáíôåò óôçí ïìÜäá åëÝã÷ïõ áóèåíåßò (2 áðåâßùóáí êáôÜ ôç äéÜñêåéá ôçò ìåëÝôçò), ðáñïõóßáóáí âåëôßùóç, ìÝ÷ñé êáé ðÜíù áðü 20% (ÄéÜãñáììá 5). ¸ôóé, ç ìÝóç ôéìÞ ôçò LDL åëáôôþèçêå áðü ôá 131 óå 121,5 mg/dl, óôï ÷ñïíéêü äéÜóôçìá ìåôáîý ôùí ìåôñÞóåùí áõôþí, ÷ùñßò, üìùò, íá ôåêìçñéùèåß ç óôáôéóôéêÞ óçìáíôéêüôçôá áõôÞò ôçò äéáöïñÜò óôï óõìâáôéêü åðßðåäï ôïõ 5%. ÐáñÜëëçëá, áîéïóçìåßùôï åßíáé üôé áíÜëïãï ðïóïóôü áóèåíþí ìå óáê÷áñþäç äéáâÞôç ôýðïõ 2, âåëôßùóáí ôéò óõíÞèåéåò êáé ôïí ôñüðï æùÞò ôïõò. ¸ôóé, óôáìÜôçóáí íá êáðíßæïõí 6 Üôïìá óå óýíïëï 8 êáðíéóôþí (75%), åíþ áðü ôïõò ìç êáðíßæïíôåò, êáíåßò äåí Üñ÷éóå ôï êÜðíéóìá. Åðßóçò, óôáìÜôçóáí íá ðßíïõí Þ ðåñéüñéóáí ôï

10

10

8 6 4 2 0

ÂÅËÔÉÙÓÇ ÅÐÉÄÅÉÍÙÓÇ 4

3

0-10%

2 10-20%

2

1

>20%

ÄéÜãñáììá 5. ÌåôáâïëÞ LDL áóèåíþí ìå ÓÄ

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

ÓõæÞôçóç O ÓÄ Ý÷åé áíáãíùñéóèåß ðëÝïí ùò ðñüâëçìá, ðïõ áõîÜíåôáé óôéò äõôéêÝò êïéíùíßåò. Åßíáé åíäåéêôéêü üôé ôï 1985, ðåñßðïõ 30.000.000 Üíèñùðïé ó’ üëï ôïí êüóìï Ýðáó÷áí áðü óáê÷áñþäç äéáâÞôç, ôï 1998 ïé áóèåíåßò õðïëïãßóèçêáí óå 143.000.000 êáé ï áñéèìüò ôïõò áíáìÝíåôáé íá áíÝëèåé ôï 2025 óå, ðåñßðïõ, 300.000.00032-34. Óôéò ÇÐÁ ôï ðïóïóôü ôùí óáê÷áñïäéáâçôéêþí ôýðïõ 2 åããßæåé, ðëÝïí, ôï 7%2, åíþ, ðåñßðïõ, 1.000.000 ¸ëëçíåò ôáëáéðùñïýíôáé áðü óáê÷áñþäç äéáâÞôç êáé êéíäõíåýïõí áðü ôéò åðéðëïêÝò ôïõ. Ç íüóïò ðáñïõóéÜæåôáé ýðïõëá óå åíçëßêïõò35-37 (óõíÞèùò >40 åôþí, áí êáé óôç âéâëéïãñáößá ðåñéãñÜöïíôáé êáé ðåñéðôþóåéò ðáéäéþí Þ åöÞâùí ìå óáê÷áñþäç äéáâÞôç ôýðïõ 2)34,35 êáé åìöáíßæåôáé ðåñéóóüôåñï óõ÷íÜ óå ðá÷ýóáñêá Üôïìá, ðïõ êÜíïõí êáèéóôéêÞ æùÞ, ðñïóëáìâÜíïõí ìå ôç äéáôñïöÞ ôïõò ðåñéóóüôåñá ëéðáñÜ êáé Ý÷ïõí èåôéêü ïéêïãåíåéáêü éóôïñéêü.40-43 Ôï óùìáôéêü âÜñïò åßíáé ï óçìáíôéêüôåñïò ðáñÜãïíôáò êéíäýíïõ ãéá ôï äéáâÞôç44-47, ï ïðïßïò ìðïñåß íá ôñïðïðïéçèåß, áöïý ï ðÜó÷ùí ìðïñåß, êáé åðéâÜëëåôáé, íá åëáôôþóåé ôï óùìáôéêü ôïõ âÜñïò, åöüóïí åßíáé ðá÷ýóáñêïò. Ç âáñýôçôá ôçò íüóïõ ôïõ óáê÷áñþäç äéáâÞôç ïöåßëåôáé óôéò äéÜöïñåò åðéðëïêÝò ôçò. Ôï 75% ôùí óáê÷áñïäéáâçôéêþí áóèåíþí ðåèáßíåé ùò áðïôÝëåóìá ôùí äéáöüñùí êáñäéáããåéáêþí åðéðëïêþí.23 Ôï äéáâçôéêü ðüäé êáôÝ÷åé ëüãù ôïõ óõ÷íïý óõíäõáóìïý ôïõ ìå íåõñïðÜèåéá, éó÷áéìßá êáé ëïéìþîåéò ìéá åéäéêÞ èÝóç êáé áðïôåëåß ôçí êýñéá áéôßá áêñùôçñéáóìïý óôéò ÇÐÁ.48-50 Ç íåöñéêÞ áíåðÜñêåéá åßíáé ç äåýôåñç óõ÷íüôåñç áéôßá èáíÜôïõ êáé áíáðçñßáò êáé åìöáíßæåôáé ðåñßðïõ óôï 10% ôùí äéáâçôéêþí áóèåíþí.23 ÔÝëïò, ç äéáâçôéêÞ áìöéâëçóôñïåéäïðÜèåéá åßíáé ç ðéï óõ÷íÞ áéôßá íÝùí ðåñéðôþóåùí ôýöëùóçò óôïõò Áìåñéêáíïýò (20-74 åôþí) êáé öèÜíåé ôéò 20.000 íÝåò ðåñéðôþóåéò ôï ÷ñüíï.23 Óôü÷ïò ôïõ êëéíéêïý ãéáôñïý åßíáé íá ìÜèåé óôïõò áóèåíåßò ôïõ íá æïõí ìå ôï óáê÷áñþäç 143


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

äéáâÞôç. Ç áíôéìåôþðéóç ôçò íüóïõ åðéêåíôñþíåôáé óôï óùóôü ìåôáâïëéêü Ýëåã÷ï, óôçí õðïóôÞñéîç ôçò áõôïöñïíôßäáò ôïõ áóèåíïýò êáé óôçí ðñüëçøç ôùí åðéðëïêþí. ÓõíÞèùò, ãéá ôïýôï, åßíáé æùôéêÞò óçìáóßáò ìéá ïìÜäá åéäéêþí, ðïõ èá ðñïóåããßóåé êáé èá öñïíôßóåé ôï äéáâçôéêü áóèåíÞ. ¼ëïé ïé íÝïé áóèåíåßò, åöüóïí êáé ïé ßäéïé ôï åðéèõìïýí, ðñÝðåé íá Ý÷ïõí ëåðôïìåñÞ åíçìÝñùóç êáé åêðáßäåõóç23 ó÷åôéêÜ ìå ôç íüóï ôïõò, ôéò áëëáãÝò ðïõ åðéâÜëëïíôáé óôïí ôñüðï ôçò æùÞò ôïõò, êáèþò êáé ãéá ôá óõìðôþìáôá êáé óçìåßá ôçò õðÝñ- Þ õðï-ãëõêáéìßáò êáé ôéò óõíÞèåéò åðéðëïêÝò. Ôï ìÞíõìá, ðïõ ðñÝðåé íá ëÜâïõí åßíáé üôé: á) Ï óáê÷áñþäçò äéáâÞôçò åßíáé ìéá óïâáñÞ áóèÝíåéá êáé â) üôé ïé áëëáãÝò óôïí ôñüðï æùÞò (äéáéôçôéêÝò óõíÞèåéåò, êÜðíéóìá, åðßðåäï öõóéêÞò äñáóôçñéüôçôáò), ðáßæïõí ïõóéáóôéêü ñüëï óôçí áíôéìåôþðéóÞ ôçò. Áõôü, áêñéâþò, ðñïóðáèÞóáìå êáé ðéóôåýù üôé ðåôý÷áìå, óå éêáíïðïéçôéêü âáèìü, íá êÜíïõìå óôçí õðü Ýëåã÷ï ïìÜäá ôùí óá÷áñïäéáâçôéêþí áóèåíþí, óôçí ðåñéï÷Þ åõèýíçò ôïõ ðåñéöåñåéáêïý éáôñåßïõ ÃáñÜæïõ. ÂÝâáéá, ç áíôéìåôþðéóç åßíáé ðïëýðëïêç êáé áðáéôåß óõíÝ÷åéá óôç ó÷Ýóç ôïõ áóèåíïýò ìå ôï ãéáôñü ðñùôïâÜèìéáò ðåñßèáëøçò. ÁõôÞ ç ó÷Ýóç ðñÝðåé íá åßíáé öéëéêÞ, þóôå íá ìåãéóôïðïéçèåß ç óõììüñöùóç ôïõ áóèåíïýò ìå ôçí ðñïôåéíüìåíç èåñáðåõôéêÞ áãùãÞ êáé óå ôåëéêÞ áíÜëõóç, ï ßäéïò ï ãéáôñüò èá Ý÷åé ôçí åõ÷Üñéóôç åìðåéñßá ôçò éêáíïðïßçóçò áðü ôçí ðñüëçøç ôñáãéêþí åðéðëïêþí. Ôá áðïôåëÝóìáôá ôçò ðáñÝìâáóÞò ìáò õðÞñîáí, êáô’ áñ÷Þí, éêáíïðïéçôéêÜ, ùò áðüññïéá ôçò óõíôïíéóìÝíçò ðñïóðÜèåéáò ôïõ éáôñïý ðåñéöåñåéáêïý éáôñåßïõ êáé ÊÝíôñïõ Õãåßáò, ãéá åíçìÝñùóç êáé êéíçôïðïßçóç ôùí áóèåíþí ãéá èÝìáôá ó÷åôéêÜ ìå ôç íüóï ôïõ óáê÷áñþäç äéáâÞôç, äßíïíôáò éäéáßôåñç Ýìöáóç óôçí êáôáíüçóç áðü ðëåõñÜò ôïõò ôçò óðïõäáéüôçôáò ôçò áëëáãÞò ôùí õãéåéíïäéáéôçôéêþí óõíçèåéþí ôïõò. ÂÝâáéá ï ìéêñüò áñéèìüò ôùí ðáñáôçñÞóåùí äåí ìáò åðÝôñåøå íá ôåêìçñéþóïõìå ôç óôáôéóôéêÞ óçìáíôéêüôçôá ôùí ðáñáôçñçèåéóþí ìåôáâïëþí.

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26. Del Prato S. Metabolic control in type 2 diabetes: The impact of prandial glucose. Curr Opin Endocrinol diabetes, 6:S1-S6, 1999. 27. Ôñé÷üðïõëïò Ä, Ôæþíïõ Á, ÊáôóïõãéÜííç Ê. ÂéïóôáôéóôéêÞ - ÅðéóôçìïíéêÝò åêäüóåéò Ì.Ã. ÐáñéóéÜíïõ, ÁÈÇÍÁ, 2000. 28. Reaven G. Measurment of plasma glucose, free fatty acid, lactate, and insulin for 24h, in patients with NIDDM. Diabetes, 37:1020-4, 1988. 29. UKPDS 33. Imtensive blood-glucose control with soulfonylourias or insulin compared with conventional treatment and risk of complications in-patients with type 2 diabetes. UK Prospective study (UKPDS) Group. Lancet, 352:837-53, 1998. 30. Yki-Jarvinen. Management of type 2 diabetes mellitus and cardiovascular risk: lessons from intervention trials. Drugs, 975-83, 2000. 31. Palumbo PJ. Glycemic control, mealtime glucose excursions and diabetic complications type 2 diabetes mellitus. Mayo Clin Proc, 24:250-6, 2001. 32. Buysschaert M, Vandenbroucke C, Barsoum SA. type 2 diabetes screening program by general practitioners in a Belgian at risk population. Diabetes Metab, 27:109-14, 2001. 33. De Vegt F, Decker JM, Jager A, Hienkens E, Kostence PJ. Relation of impaired fasting and post load glucose with incident type 2 diabetes in a Dutch population: The Hoorn Study. JAMA, 285:2109-13, 2001. 34. Gatling W, Guzder RN, Turnbull JC, Budd S, Mulle MA. The Poole Diabetes Study: how many cases of type 2 diabetes are diagnosed each year during normal health care in a defined community? Diabetes Res Clin Pract, 53:107-12, 2001. 35. Sinclair AJ, Gadsby R, Penford S, Croxson SC, Bayer AJ. Prevalence of diabetes in care home residents. Diabetes Care, 24:1066-8, 2001. 36. J. Rosenstock. management of type 2 diabetes mellitus in the elderly: special considerations drugs Aging, 18:31-44, 2001. 37. Leiter LA, Barr A, Lubin S, Ross SA. Diabetes Screening in Canada (DIASCAN) Study: Prevalence of undiagnosed diabetes and glucose intolerance in family physician offices. Diabetes Care, 24:1038-43, 2001. 38. Ehtisham K, Kirk J, McEvilly A, Shaw N, Jones S. Prevalence of type 2 diabetes in chilS.A. dren in Birmingham. BMJ, 322:1428B, 2001. 39. Fagot-Campagna A, Saaddine JB, Flegal KM, Beckles GL. Diabetes, impaired fasting glucose and elevated Hba1C in US adolescents: the Third National Health and Nutritional Examination 145


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Survey. Diabetes Care, 153:892-7, 2001. 40. Defay R, Delcourt C, Ranvier M, Lacroux A, Papoz L. Relationships between physical activity, obesity and diabetes mellitus in a French elderly population: the POLA study. Int J Obes Relat Metab Disord, 25:512-8, 2001. 41. Ford ES. Vitamin supplement use and diabetes mellitus incidence among adults in the United States. Am J Epidemiol, 153:892-7, 2001. 42. Muggeo Maccelarated complications in type 2 diabetes mellitus: the need for greater awareness and earlier detection. Diab Med, 15 Suppl 4:S60-2, 1998. 43. Santos JL, Perez-Bravo F, Carrasco E, Calvillan M, Albala C. Low prevalence of type 2 diabetes despite a high average body mass index in the aymara natives from chile. Nutrition, 17:305-9, 2001. 44. Helmrich SP, Ragland DR, Leung RW, Paffenbarger RS.r. Physical activity and reduced occurrence of non insulin dependent diabetes mellitus. N Engl J Med, 325:147-152, 1991.

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Ð. Âïõäïýñç êáé óõí.

ÁÍÁÖÏÑÁ ÐÅÑÉÐÔÙÓÇÓ CASE REPORT Primary Heatlh Care, Volume 14, Number 3, 147-149, 2002 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 147-149, 2002

ÏóôéêÞ ðñïóâïëÞ óå ðåñéóôáôéêü óõããåíïýò óýöéëçò êáé äéáöïñïäéÜãíùóç ìå ôï óýíäñïìï ôïõ êáêïðïéçìÝíïõ ðáéäéïý Ð. Âïõäïýñç1, Á. ÂÞôáò2, ×. ×áôæçåëåõèåñßïõ3

Ðåñßëçøç ¸÷åé áíáöåñèåß üôé ôá êáôÜãìáôá ðïõ åðéðëÝêïõí ôç óõããåíÞ óýöéëç ìå ïóôéêÞ ðñïóâïëÞ ìðïñåß íá ðñïóïìïéÜæïõí ì’ áõôÜ ðïõ åìöáíßæïíôáé óôçí ðáéäéêÞ êáêïðïßçóç. ÐáñïõóéÜæïõìå Ýíá ôÝôïéï ðåñéóôáôéêü, óå íåïãíü 3 ìçíþí ðïõ ðñïóêïìßóèçêå óôï ôìÞìá åðåéãüíôùí ðåñéóôáôéêþí ôïõ Ã. Í. ÄñÜìáò ìå ðáñÜëõóç ôïõ áñéóôåñïý Üíù Üêñïõ. 1

Åéäéêüò Áêôéíïëüãïò, 2 Åéä/íïò ÃåíéêÞò ÉáôñéêÞò, 3 Åéäéêüò Êáñäéïëüãïò, Ãåíéêü Íïóïêïìåßï ÄñÜìáò

Bone assault in cases of congenital syphilis and differentiation with that of child abuse syndrome. P. Vuduri, Ath. Vitas, H. Hatzieleftheriu. Summary It has been reported that fractures complicating congenital syphilis can mimic child abuse. We present such a finding in a 3-month-old infant who is suffering from paralysis of the left arm. Key words: fracture, congenital syphilis, abuse syndrome, childhood

General Hospital of Drama, Greece

ÅéóáãùãÞ Ç åðßðôùóç ôçò óõããåíïýò óýöéëçò åßíáé óõíå÷þò áõîáíüìåíç óôçí ÅëëÜäá üðùò êáé óôïí õðüëïéðï êüóìï áöåíüò ëüãù áõîÞóåùò ôùí åíåñãþí ðåñéðôþóåùí ôçò íüóïõ êáé áöåôÝñïõ ëüãù ôùí ðëçèõóìéáêþí ìåôáâïëþí ðïõ óõíôåëïýíôáé óôç ÷þñá ìáò, åîáéôßáò ôçò ìåôáíáóôåýóåùò.1 ÐïëëÜ êñïýóìáôá åêäçëþíïíôáé óôçí åðáñ÷ßá êáé áðáó÷ïëïýí ôïõò Éáôñïýò ðïõ ðáñÝ÷ïõí ðñùôïâÜèìéá öñïíôßäá õãåßáò. Áõôü ôï Üñèñï ðåñéãñÜöåé ìéá áóõíÞèç ïóôéêÞ ðñïóâïëÞ (åôåñüðëåõñïò ëýóç ôçò ïóôéêÞò óõíÝ÷åéáò ôïõ áñéóôåñïý âñá÷éïíßïõ ïóôïý), óå íåïãíü 3 ìçíþí ðïõ ðáñïõóéÜóôçêå óôï ôìÞìá åðåéãüíôùí ðåñéóôáôéêþí (ÔÅÐ), ôïõ íïóïêïìåßïõ ìáò ìå ðáñÜëõóç ôïõ áñéóôåñïý (áñ.) Üíù Üêñïõ êáé ðïõ áñ÷éêÜ èåùñÞèçêå ùò áðïôÝëåóìá êáêïðïßçóçò áõôïý. ËÝîåéò êëåéäéÜ: ÓõããåíÞò óýöéëç, äéÜãíùóç, ïóôéêÜ êáôÜãìáôá YðïâëÞèçêå: 31 Éïõëßïõ 2001 ¸ãéíå äåêôÞ ãéá äçìïóßåõóç: 12 Óåðôåìâñßïõ 2001 Õðåýèõíïò áëëçëïãñáößáò: ÁèáíÜóéïò Ã. ÂÞôáò, Íáõáñßíïõ 7, ÄñÜìá Ô.Ê. 66100, Ôçë.: 05210-32009 êáé 0974-212472, e-mail: athanasiosgvitas@yahoo.gr 147


ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

¸ãéíå åêôåôáìÝíïò áðåéêïíéóôéêüò Ýëåã÷ïò ìå ïëïóùìáôéêÝò áêôéíïãñáößåò. Ç áíåýñåóç ïñïèåôéêüôçôáò ôçò ìçôÝñáò êáé ôïõ íåïãíïý (VDRL äïêéìáóßá èåôéêÞ), ïäÞãçóå ôåëéêÜ óôç äéÜãíùóç ôçò óõããåíïýò óýöéëçò.

ÐåñéãñáöÞ ôçò ðåñßðôùóçò Íåïãíü 3 ìçíþí ìåôáöÝñèçêå óôï ÔÅÐ ãéá åêôßìçóç ðáñÜëõóçò ôïõ áñ. Üíù Üêñïõ. ÃåííÞèçêå ìåôÜ áðü áíåðßðëåêôç êõïöïñßá, ìå öõóéïëïãéêü ôïêåôü. Ç ðåñéãåííçôéêÞ ðïñåßá äåí åß÷å óõìâÜìáôá êáé ôï íåïãíü åîÞëèå ôïõ íïóïêïìåßïõ êáôÜ ôç 2ç ìÝñá ìåôÜ ôç ãÝííçóÞ ôïõ. VDRL test äåí äéåíåñãÞèçêå óôç ìçôÝñá êáôÜ ôç äéÜñêåéá ôçò åãêõìïóýíçò. Ç ìçôÝñá áíáöÝñåé, üôé áðü ìçíüò ðåñßðïõ ôï íåïãíü åìöáíßæåé óçìåßá ðüíïõ êáôÜ ôçí êßíçóç ôïõ áñ. Üíù Üêñïõ ðïõ åðéäåéíþíïíôáé ðñïïäåõôéêÜ êáé ôçí áíáãêÜæïõí íá ðñïóÝñ÷åôáé åðáíåéëëçìÝíá óôï ÔÅÐ, üðïõ üìùò ôçò äßäïíôáé áðëÜ ïäçãßåò. Ìéá åâäïìÜäá áñãüôåñá, ôï íåïãíü ðñïóêïìßæåôáé åê íÝïõ, ëüãù áäõíáìßáò ôïõ íá ÷ñçóéìïðïéÞóåé ôï áñ. Üíù Üêñï. Ïé áêôéíïãñáößåò ôïõ Üêñïõ áðïêáëýðôïõí óõìðéåóôéêü êÜôáãìá ôçò Üíù ìåôáöýóåùò ôïõ áñ. âñá÷éïíßïõ ïóôïý ìå åêóçìáóìÝíç ðåñéïóôéêÞ áíôßäñáóç (callous fornation) (Åéêüíá 1). Áêïëïõèåß ðëÞñçò ïëïóùìáôéêüò áêôéíïëïãéêüò Ýëåã÷ïò, ï ïðïßïò äåí åìöáíßæåé ðáñïõóßá Üëëùí êáôáãìÜôùí. Ôßèåôáé áñ÷éêþò ç õðüíïéá ôçò êáêïðïéÞóåùò, ç ïðïßá üìùò êáé áðïìáêñý-

Ð. Âïõäïýñç êáé óõí.

íåôáé ãñÞãïñá ëüãù ôçò äéáãíþóåùò ðïëëáðëþí ïóôéêþí âëáâþí, ìåôÜ áðü ðñïóåêôéêüôåñç åêôßìçóç ôùí áêôéíïëïãéêþí åõñçìÜôùí. Ç ðáñïõóßá óõììåôñéêþí öëåãìïíùäþí áëëïéþóåùí óôéò ìåôáöýóåéò ôùí ìáêñþí ïóôþí ôùí Üíù Üêñùí êáé êíçìþí (ìåôáöõóßôéäá - óçìåßï Wimberger), ç óáöÞò õðïðåñéïóôéêÞ áíôßäñáóç, êõñßùò óôéò äéáöýóåéò ôùí ìáêñþí ïóôþí êáé ç ýðáñîç ìéêñþí öëåãìïíùäþí åóôéþí óôï óþìá ôùí ìéêñþí ïóôþí (äéáöõóßôéäá), èÝôïõí ôçí õðüíïéá óõóôçìáôéêÞò ðáèïëïãéêÞò ïóôéêÞò ðñïóâïëÞò (Åéêüíá 2). Ï åðåßãùí áéìáôïëïãéêüò Ýëåã÷ïò ðåñéëÜìâáíå öõóéïëïãéêÞ ãåíéêÞ áßìáôïò êáé ìÝôñéá áýîçóç ôçò ôá÷ýôçôáò êáèéæÞóåùò ôùí åñõèñþí áéìïóöáéñßùí (ÔÊÅ: 60mm/h). Ëüãù ôçò ðáñïõóßáò óõóôïëéêïý öõóÞìáôïò ãßíåôáé õðåñç÷ïãñÜöçìá êáñäéÜò ðïõ áðïêáëýðôåé ìéêñÞ ðåñéêáñäéêÞ óõëëïãÞ ìå öõóéïëïãéêÞ üìùò ëåéôïõñãéêüôçôá ôçò êáñäéÜò.

Äéáöéóßôéäá Ïóôåüëõóç áñéóôåñïý ìçñéáßïõ ïóôïý

ÕðïðåñéïóôéêÞ áíôßäñáóç

Åéêüíá 2.

ÊÜôáãìá ìåôáöýóåùò áñéóôåñïý âñá÷éïíßïõ ïóôïý

Åéêüíá 1. 148

Ç åðåßãïõóá åêôßìçóç, áðü ôï áéìáôïëïãéêü åñãáóôÞñéï ôçò ïñïèåôéêüôçôáò ôïõ ïñïý, äéÜ ìÝóïõ ôçò ìç ôñåðïíçìéêÞò äïêéìáóßáò VDRL, öáíåñþíåé èåôéêüôçôá ôüóï ôçò ìçôÝñáò üóï ��áé ôïõ íåïãíïý. ¸ôóé, ï óõíäõáóìüò ôùí áêôéíïëïãéêþí êáé ôùí åñãáóôçñéáêþí åõñçìÜôùí èÝôåé ôç äéÜãíùóç ôçò óõããåíïýò óýöéëçò êáé êáôÜ óõíÝðåéá ôï íåïãíü åéóÜãåôáé óôçí ðáéäéáôñéêÞ êëéíéêÞ. ÌçôÝñá êáé íåïãíü ôÝèçêáí óå áãùãÞ ìå ðåíéêéëëßíç, åíþ ï åðáíáëçðôéêüò áêôéíïëïãéêüò Ýëåã÷ïò (1 ìÞíá ìåôÜ), êáôáäåéêíýåé ó÷åäüí ðëÞñç ýöåóç ôùí ïóôéêþí âëáâþí ôïõ íåïãíïý.


Ôüìïò 14, Ôåý÷ïò 3, 2002

Ð. Âïõäïýñç êáé óõí.

ÓõæÞôçóç Ç óõ÷íüôçôá ôçò óõããåíïýò óýöéëçò óôéò áíáðôõãìÝíåò ÷þñåò ìåéþèçêå óçìáíôéêÜ ìåôÜ ôç èåñáðåõôéêÞ åéóáãùãÞ ôçò ðåíéêéëßíçò. ¼ìùò ç ðñüóöáôç áýîçóç ôçò åðßðôùóçò ôçò íüóïõ ãéá ôïõò ëüãïõò ðïõ ðñïáíáöÝñèçêáí, óôïí ðëçèõóìü ôùí íåïãÝííçôùí, èá ðñÝðåé íá åãåßñåé ôçí õðïøßá ôçò óõããåíïýò ëïéìþîåùò ôüóï óôïí êëéíéêü üóï êáé ôïí ïéêïãåíåéáêü Éáôñü. Ïé êáëÜ ôåêìçñéùìÝíåò åðéðëïêÝò ôçò óõããåíïýò óýöéëçò óôá ïóôÜ ðåñéëáìâÜíïõí ôç äéáöõóßôéäá, ôç ìåôáöõóßôéäá êáé ôá ðïëëáðëÜ ðáèïëïãéêÜ êáôÜãìáôá. ×áñáêôçñéóôéêüôáôï áêôéíïëïãéêü åýñçìá áðïôåëåß ç áìöïôåñüðëåõñç äéÜ÷õôç óõììåôñéêÞ óêåëåôéêÞ ðñïóâïëÞ.2 ¼ìùò, ç óùóôÞ äéÜãíùóç ãßíåôáé äýóêïëç üôáí ç êëáóéêÞ åìöÜíéóç ôçò óõììåôñéêÞò ïóôåïðåñéïóôßôéäáò åßíáé áðïýóá Þ õðïåêôéìçèåß. Ôá áêôéíïëïãéêÜ åõñÞìáôá óõã÷Ýïíôáé åýêïëá ìå áõôÜ ôçò ðáéäéêÞò êáêïðïßçóçò, üðïõ ïé äéáãíùóôéêÝò âëÜâåò üðùò ôï ìïíÞñåò Þ ôá ðïëëáðëÜ êáôÜãìáôá óå äéáöïñåôéêü óôÜäéï ðùñüóåùò, ìå ðñïåîÝ÷ïõóá ôçí ðåñéïóôéêÞ áíôßäñáóç, ðáñïõóéÜæïõí ðñïôßìçóç óôéò ìåôáöýóåéò.3 Ôá êáôÜãìáôá ôùí äéáöýóåùí åßíáé ëéãüôåñï óõ÷íÜ áðü ôá ìåôáöõóéáêÜ êáôÜãìáôá. Óôéò ðåñéóóüôåñåò ðåñéðôþóåéò ç äéÜãíùóç ôçò êáêïðïßçóçò Ýãêåéôáé óôïí õøçëü âáèìü õðüíïéáò êáôÜ ôç äéÜñêåéá ôçò åîÝôáóçò. ÁêôéíïëïãéêÝò âëÜâåò ôçò ðáéäéêÞò êáêïðïßçóçò ìðïñåß íá ïìïéÜæïõí ì’ áõôÝò ôçò óõããåíïýò óýöéëçò óôçí ðåñßðôùóç ôùí äéáöõóéêþí âëáâþí. Óôç óõããåíÞ óýöéëç ôá êáôÜãìáôá ðáñïõóéÜæïíôáé óôéò ìåôáöýóåéò, óðÜíéá ç äéÜöõóç åíüò ìáêñïý ïóôïý åìöáíßæåé êÜôáãìá. Ï ìéêñüò áóèåíÞò Þôáí áóõìðôùìáôéêüò áðü ôç ãÝííçóç Ýùò ôçí çëéêßá ôùí äýï ìçíþí. Ç Ýëëåéøç áõîçìÝíçò õðïøßáò, ç ðáñïõóßá åôåñüðëåõñçò ëýóçò ôçò ïóôéêÞò óõíÝ÷åéáò óå ìáêñü ïóôü, ç õðïåêôßìçóç ôçò õðïðåñéïóôéêÞò áíôéäñÜóåùò áëëÜ êáé ôùí õðïëïßðùí öëåãìïíùäþí åõñçìÜôùí, Þôáí ïé ëüãïé ðïõ ïäÞãçóáí áñ÷éêÜ

óôçí õðüíïéá ôçò ðáéäéêÞò êáêïðïßçóçò. Ôï åýñçìá ôçò ðåñéêáñäéêÞò óõëëïãÞò èåùñÞèçêå ùò ìç åéäéêü, äåäïìÝíïõ üôé ç ðñïóâïëÞ ôïõ êáñäéáããåéáêïý óõóôÞìáôïò åìöáíßæåôáé óå ìåãáëýôåñåò çëéêßåò.4 ÕðÜñ÷ïõí ðïëëÝò ðåñéðôþóåéò ïé ïðïßåò äçëþíïõí üôé ôá êáôÜãìáôá ðïõ åðéðëÝêïõí ôç óõããåíÞ óýöéëç ãßíåôáé íá ïìïéÜæïõí ì’ áõôÜ ôçò ðáéäéêÞò êáêïðïßçóçò.5-7 Ïé âëÜâåò óôç óõããåíÞ óýöéëç êáèéóôïýí ôï ïóôü åýèñáõóôï, áðïäéïñãáíùìÝíï êáé åðéññåðÝò óå ôñáõìáôéóìïýò8,9.

Âéâëéïãñáößá 1. Ikela MK, Jenson HB. Evaluation and treatment of congenital syphilis. J Pediatr, 117:843852, 1990. 2. Rasool MN, Govender S. The skeletal manifestations of congenital syphilis, a review of 197 cases. J Bone Joint Surg Br 71:752-755, 1989. 3. Caffey J. Pediatric X-ray diagnosis: ihtegrated imaging approach. 9th edn. Mosby St Louis, pp. 1813-1817, 1993. 4. Hurst. Cardiovascular syphilis. The Çeart. 85:2284-2285, 1990. 5. Fisher RH, Kaplan J, Holder JC. Congenital syphilis mimicking the battered child syndrome, how does one tell them apart? Clin Pediatr, 11:305-307, 1972. 6. Horodniceanu C, Grunebum M, Volovitz B, Nitzan M. Unusual bone involve- ment in congenital syphilis mimicking the battered child syndrome. Pediatr Radiol, 7:232-234, 1978. 7. Gurry DL, Porter PA, Evans DTP. Congenital syphilis: when the medium fails to transmit the message.Med J Aust, 159:121-124, 1993. 8. Caffey J. Some traumatic lesions in growing bones other than fractures and dislocations, clinical and radiological features. Br J Radiol, 30:225238, 1957. 9. Solomon A, Rosen E. The aspect of trauma in the bone changes of congenital lunes. Pediatr Radiol, 3:176-178, 1975.

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ÍÝá

NEA NEWS Primary Heatlh Care, Volume 14, Number 3, 150, 2002 ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 14, Ôåý÷ïò 3, 150, 2002

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ÏÄÇÃÉÅÓ ÃÉÁ ÔÏÕÓ ÓÕÃÃÑÁÖÅÉÓ INSTRUCTIONS FOR THE AUTHORS Ç "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" äÝ÷åôáé ãéá äçìïóßåõóç êåßìåíá Åðéóôçìüíùí Õãåßáò, ôá ïðïßá 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 ìéá 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). (õðüäåéãìá âéâëéïãñáößáò: Biziagos E, Moschandrea J, Kouroumalis ÅÁ. Prevalence of hepatitis  and C markers in volunteer blood donors in Crete. A 5-year study. J Viral Hepat, 6:243-8, 1999.). • Ïé ðßíáêåò êáé ôá ó÷Þìáôá áêïëïõèïýí ôï âéâëéïãñáöéêü êáôÜëïãï êáé èá ðñÝðåé íá ðáñïõóéÜæïíôáé óå ÷ùñéóôÝò óåëßäåò, íá öÝñïõí ëáôéíéêÞ áñßèìçóç, ç ïðïßá èá ðñÝðåé í’ áíôáðïêñßíåôáé óôéò ðáñáðïìðÝò ôïõ êåéìÝíïõ, êáèþò êáé ôéò áðáñáßôçôåò åðåîçãÞóåéò. • 'Ïëá ôá êåßìåíá èá ðñÝðåé íá õðïâÜëëïíôáé êáôÜ ðñïôßìçóç ìå êåéìåíïãñÜöï word óå äýï áíôßôõðá êáé íá áðïóôÝëëïíôáé óôç äéåýèõíóç ôïõ ÄéåõèõíôÞ Óýíôáîçò: - ÐáíåðéóôÞìéï ÊñÞôçò (õðüøç Åðßêïõñïõ ÊáèçãçôÞ ×. ËéïíÞ), ÔïìÝáò ÊïéíùíéêÞò ÉáôñéêÞò, Ô.È. 1393, ÇñÜêëåéï ÊñÞôçò. Ïé óõããñáöåßò ìðïñïýí íá õðïâÜëëïõí ôá êåßìåíá ôïõò êé óå çëåêôñïíéêÞ ìïñöÞ óôç äéåýèõíóç: primcare@fammed.med.uoc.gr 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. 151


Ðáñáããåëßá áíáôýðùí

Ïé áíáãíþóôåò ôçò "ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò", Ãåíéêïß Ãéáôñïß, ïé ïðïßïé åðéèõìïýí íá Ý÷ïõí óå áíÜôõðá êÜðïéï Þ êÜðïéá áðü ôá äçìïóéåõüìåíá óôï ôåý÷ïò Üñèñá, ìðïñïýí íá ðáñáãÝëëïõí ôïí áñéèìü ôùí áíôéôýðùí óôï "Ôå÷íüãñáììá" (ç äéåýèõíóç êáé ôá ôçëÝöùíá äçìïóéåýïíôáé óôï êÜôù ìÝñïò äåîéÜ ôïõ ðßíáêá). Ïé ôéìÝò ãéá êÜèå áñéèìü áíôéôýðùí ðáñáôßèåíôáé óôïí êáôùôÝñù ðßíáêá.

ÁíÜôõðá

Óåëßäåò/Êüóôïò

Óåëßäåò/Êüóôïò

Óåëßäåò/Êüóôïò

50 áíÜôõðá

4/44,00 EÕÑÙ

8/74,00 EÕÑÙ

16/118,40 EÕÑÙ

100 áíÜôõðá

4/50,00 EÕÑÙ

8/88,00 EÕÑÙ

16/174,80 EÕÑÙ

200 áíÜôõðá

4/60,70 EÕÑÙ

8/118,40 EÕÑÙ

16/177,00 EÕÑÙ

500 áíÜôõðá

4/88,00 EÕÑÙ

8/147,80 EÕÑÙ

16/235,00 EÕÑÙ

"Ôå÷íüãñáììá" ÌÜñêïõ ÁõãÝñç 12 - Áã. ÐáñáóêåõÞ Ôçë.: 210.60.00.643, Fax.: 210.60.02.295


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