vol15_issue2_apr_jun_2003

öñïíôßäáPrimary Health Care

ISSN 1105-7432

ðñùôïâÜèìéáðñùôïâÜèìéáöñïíôßäáõãåßáòõãåßáò

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Ôçò Óýíôáîçò

54 Å.Á. Èçñáßïò: 15o ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò

Âñáâåõèåßóá åñãáóßá óôï Äéáãùíéóìü "Ä. ºêêïõ"

57 Á. ÆåúìðÝêçò, ×. Ðßôóáâïò, Ä. ÐáíáãéùôÜêïò, ×. ×ñõóï÷üïõ, É. Óêïýìáò, Ì. Ôïýôïõæá,Ð. Ôïýôïõæáò, ×. ÓôåöáíÜäçò: Óôåöáíéáßá íüóïò êáé ðáñÜãïíôåò êáñäéáããåéáêïýêéíäýíïõ óå ôõ÷áßï äåßãìá ôïõ ðëçèõóìïý: ÅðéäçìéïëïãéêÞ ìåëÝôç “ÁÔÔÉÊÇ”

Åðáéíåèåßóá åñãáóßá óôï Äéáãùíéóìü "Ä. ºêêïõ"

68 Å. ÂåêñÞ, ×. Ëçîïõñéþôçò, Á. Ìáñéüëçò, Å. ÌåóóÜñçò, Í. ÐáñáñÜò, Â. Âïõãéïýêáò,Æ. ÁëìÜæ, Á. Ìïíáóôçñéþôçò, Í. Áëåîáíäñüðïõëïò, Á. ÌïõëáêÜêçò:Ìðïñåß ç C-Áíôéäñþóá ÐñùôåÀíç íá áðïôåëÝóåé ðñïãíùóôéêü äåßêôç óôá ÁããåéáêÜÅãêåöáëéêÜ Åðåéóüäéá óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò;

Âñáâåõèåßóåò åëåýèåñåò áíáêïéíþóåéò

73 Á. Ìáñéüëçò, ×. ÊáëáúôæÞ, Á. ÆåúìðÝêçò, Áéêáôåñßíç ÖïõôóéôæÞ-Äáíßêá,Í. Áëåîáíäñüðïõëïò, Ã. ÃåùñãéÜäçò: Ç ìÝôñçóç ôçò áñôçñéáêÞò ðßåóçò óôï óðßôé êáéç óõìâïëÞ ôçò óôçí êáëýôåñç èåñáðåõôéêÞ áíôéìåôþðéóç ôùí õðåñôáóéêþí áôüìùíóôçí ðåñéï÷Þ åõèýíçò KÝíôñïõ Yãåßáò Âýñùíá

79 Á. Ìðáôßêáò, Ê. Óôåöáíïðïýëïõ, É. ÄñõãéáííÜêçò, Á. ÐåôñÜêç, Í. ÐáðáäÜêçò:KáôáíÜëùóç áëêïüë áðü åöÞâïõò: Mßá åðéêßíäõíç ðñáãìáôéêüôçôá

84 Ê. Óõñéáíüò, Â. ËÝôôá, Ä. ÊáêëáìÜíïõ: Ïé ôñïðïðïéÞóéìïé ðáñÜãïíôåò ðïõ êáèïñßæïõíôçí ðéèáíüôçôá åðéâßùóçò áóèåíþí ìå åîùíïóïêïìåéáêÞ êáñäéáêÞ áíáêïðÞ

Êåßìåío ïìïöùíßáò

91 ÂÞìáôá ãéá ôçí áíÜðôõîç êáôåõèõíôÞñéùí ïäçãéþí óôç ÃåíéêÞ ÉáôñéêÞ óôçí ÅëëÜäá:Ýíá êåßìåíï ïìïöùíßáò

Áíôáðüêñéóç áðü ôçí ÊñÞôç

94 2ç Åëëçíï-ÏëëáíäéêÞ ÓõíÜíôçóç ãéá ôéò ÊáôåõèõíôÞñéåò Ïäçãßåò óôç ÃåíéêÞ ÉáôñéêÞ

Ôñéìçíéáßá ̧ êäïóç ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞòQuarterly edited by the Greek Association of General Practitioners

ÐåñéëáìâÜíåôáé óôçí çëåêôñïíéêÞ âÜóç Index Copernicus. Included in Index Copernicus electronic data baseÔüìïò 15, Ôåý÷ïò 2, Áðñßëéïò - Éïýíéïò 2003, Volume 15, Number 2, April - June 2003

ÐËÇÑÙÌÅÍÏÔÅËÏÓ

Ôá÷. ÃñáöåßïÊ. Ä. Áèçíþí

Áñéèìüò ¢äåéáò451/91

Ðáðáäéáìáíôïðïýëïõ 4, 115 28 ÁÈÇÍÁ

öñïíôßäáðñùôïâÜèìéáðñùôïâÜèìéá

õãåßáòõãåßáòISSN 1105-7432

ÅÊÄÏÔÇÓ:ÌðïäïóÜêçò-Ðñüäñïìïò ÌåñêïýñçòÌ. ×ïõñìïýæç 28 Ê. Ôïýìðá544 53 ÈåóóáëïíßêçÔçë. (2310) 910342

Primary Health Care

öñïíôßäá

ÄéåõèõíôÞò Óýíôáîçò×ñÞóôïò ËéïíÞò

AíáðëçñùôÞò ÊáèçãçôÞòÔìÞìá ÉáôñéêÞò

ÐáíåðéóôÞìéï ÊñÞôçòÔ.È. 2208, ÇñÜêëåéïÔçë. (2810) 394621Fax. (2810) 394606

E-mail: [email protected]

ÁíáðëçñùôÝò Ä/íôÝò ÓýíôáîçòÍßêïò ÁíôùíÜêçò (ÇñÜêëåéïí)ÅëåõèÝñéïò Èçñáßïò (ÁèÞíá)

Åðßêïõñïé Ä/íôÝò ÓýíôáîçòÈùìÜò Áããåëüðïõëïò (Èåóóáëïíßêç)

Ðáýëïò ÈåïäùñÜêçò (ÉùÜííéíá)Êïñíçëßá ÌáêñÞ (ÇñÜêëåéï)

ÁíÜñãõñoò Ìáñéüëçò (ÁèÞíá)

ÌÝëç ÓõíôáêôéêÞò ÅðéôñïðÞòÓôÝëéïò ÅõáããÝëïõ (ÁèÞíá)ÃéÜííçò ÌïíÝäáò (KÝñêõñá)Íßêïò ÐáðáíéêïëÜïõ (ÁèÞíá)ÐçãÞ ÐåñäéêÜêç (´Áóôñïò)ÁèçíÜ Ôáôóéþíç (ÉùÜííéíá)×ñýóá ×áôæüãëïõ (ËÜñéóá)

Áíáóôáóßá ×ñéóôïöÝëç (Áëßáñôïò)¸öç Öñáãêïýëç (ËÞìíïò)

ÁíôáðïêñéôÝò ÓýíôáîçòÊýðñïò

¸ëåíá ÅõáããåëÜêçÈåïäþñá Æá÷áñéÜäïõ

ÁëâáíßáLlukan Rrumbullaku

ÓõìâïõëåõôéêÞ ÅðéôñïðÞÐ. ÂÜñäáò,

ÊáèçãçôÞò Êáñäéïëïãßáò Ðáí/ìßïõ ÊñÞôçò

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

Ä. ÃëÜñïò,ÊáèçãçôÞò ÉáôñéêÞò ÖõóéêÞò Ðáí/ìßïõ Éùáííßíùí

Á. Êñáíßäçò �,ÊáèçãçôÞò Ïõñïëïãßáò Ðáí/ìßïõ ÊñÞôçò

É. Êõñéüðïõëïò,ÊáèçãçôÞò ÅèíéêÞò Ó÷ïëÞò Äçìüóéáò Õãåßáò

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

M. ÓãÜíôæïò,ËÝêôïñáò Áíáôïìßáò Ðáí/ìßïõ Èåó/ëßáò

Í. ÓéáöÜêáò,ÊáèçãçôÞò Ðíåõìïíïëïãßáò Ðáí/ìßïõ ÊñÞôçò

Ó. ÓìðõñÜêéò,ÊáèçãçôÞò ÐáéäéáôñéêÞò Ðáí/ìßïõ ÊñÞôçò

Ë. ÓðÜñïò,ÊáèçãçôÞò ÊïéíùíéêÞò ÉáôñéêÞò Ðáí/ìßïõ Áèçíþí

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

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

Editor-in-Chief:Christos Lionis

Ássociate ProfessorFaculty of MedicineUniversity of Crete

P.O. Box 2208, HeraklionTel: +30 2810 394621Fax: +30 2810 394606E-mail: [email protected]

Associate EditorsNick Antonakis (Heraklion)Åleftherios Thireos (Athens)

Assistant EditorsThomas Aggelopoulos (Thessaloniki)

Pavlos Theodorakis (Ioannina)Kornilia Makri (Heraklion)

Anargiros Mariolis (Athens)

Members of Editorial BoardStelios Evagelou (Athens)Ioannis Monedas (Corfu)

Nikos Papanikolau (Athens)Pigi Perdikaki (Astros)Atina Tatsioni (Ioannina)

Chrysa Chatzoglou (Larissa)Anastasia Christofeli (Aliartos)

Efi Fragouli (Limnos)

Corresponding EditorsCyprus

Elena EvaggelakiTheodora Zaxariadou

AlbaniaLlukan Rrumbullaku

Advisory BoardP. Vardas,

Professor of University of Crete

J. Vlachonikolis,Associate Professor of University of Crete

D. Glaros,Professor of University of Ioannina

A. Cranidis �,Professor of University of Crete

J. Kyriopoulos,Professor of National School of Public Health

V. Mavreas,Professor of University of Ioannina

M. Syantzos,Lector of Anatomy in University of Thessalia

N. Siafakas,Professor of University of Crete

S. Smpyrakis,Professor of University of Crete

L. Sparos,Professor of University of Athens

A. Philalithis,Associate Professor of University of Crete

G. Christodoulou,Professor of University of Athens

Äéïéêçôéêü Óõìâïýëéïôçò ÅëëçíéêÞò Åôáéñåßáò

ÃåíéêÞò ÉáôñéêÞò

ÐñüåäñïòÌðïäïóÜêçò-ÐñüäñïìïòÌåñêïýñçò

Áíôéðñüåäñïò Á×ñÞóôïò ËéoíÞò

Áíôéðñüåäñïò ÂÁíôþíçò Êáñüôóçò

Ãåíéêüò ÃñáììáôÝáò-ÔáìßáòÁèáíÜóéïò Óõìåùíßäçò

Åéäéêüò ÃñáììáôÝáòÓôÝëëá ÁñãõñéÜäïõ

ÌÝëçÁíÜñãõñïò ÌáñéüëçòÁíôþíçò Ìðáôßêáò

Executive Boardof the Greek Associationof General Practitioners

PresidentBodosakis-ProdromosMerkouris

Vice-President AChristos Lionis

Vice-President BAntonis Karotsis

General SecretaryTreasurerAthanasios Symeonidis

Special SecretaryStella Argiriadou

MembersAnargiros MargiolisAntonis Batikas

Åêôýðùóç:ÔÅ×ÍÏÃÑÁÌÌÁÌ. ÁõãÝñç 12, 15343 Áã. ÐáñáóêåõÞÔçë.: 210.60.00.643, Fax: 210.6002295E-mail: [email protected]

Ãñáììáôåßá Óýíôáîçò:Áíáóôáóßá ÑùìáíßäïõÔçë.: (2810) 394615, (28310) 25833

öñïíôßäáPrimary Health Care

ðñùôïâÜèìéáðñùôïâÜèìéáöñïíôßäáõãåßáòõãåßáò

ÐÅÑÉÅ×ÏÌÅÍÁ

Ôçò ÓýíôáîçòÅ.A. Èçñáßïò: 15o ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞò ........................................................................................................................................... 54

Âñáâåõèåßóá åñãáóßá óôï Äéáãùíéóìü "Ä. ºêêïõ"Á. ÆåúìðÝêçò, ×. Ðßôóáâïò, Ä. ÐáíáãéùôÜêïò, ×. ×ñõóï÷üïõ, É. Óêïýìáò, Ì. Ôïýôïõæá, Ð. Ôïýôïõæáò,×. ÓôåöáíÜäçò: Óôåöáíéáßá íüóïò êáé ðáñÜãïíôåò êáñäéáããåéáêïý êéíäýíïõ óå ôõ÷áßï äåßãìá ôïõ ðëçèõóìïý:ÅðéäçìéïëïãéêÞ ìåëÝôç “ÁÔÔÉÊÇ” ................................................................................................................................................................................................... 57

Åðáéíåèåßóá åñãáóßá óôï Äéáãùíéóìü "Ä. ºêêïõ"Å. ÂåêñÞ, ×. Ëçîïõñéþôçò, Á. Ìáñéüëçò, Å. ÌåóóÜñçò, Í. ÐáñáñÜò, Â. Âïõãéïýêáò, Æ. ÁëìÜæ, Á. Ìïíáóôçñéþôçò,Í. Áëåîáíäñüðïõëïò, Á. ÌïõëáêÜêçò: Ìðïñåß ç C-Áíôéäñþóá ÐñùôåÀíç íá áðïôåëÝóåé ðñïãíùóôéêü äåßêôç óôáÁããåéáêÜ ÅãêåöáëéêÜ Åðåéóüäéá óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò; .............................................................................................................. 68

Âñáâåõèåßóåò åëåýèåñåò áíáêïéíþóåéòÁ. Ìáñéüëçò, ×. ÊáëáúôæÞ, Á. ÆåúìðÝêçò, Áéêáôåñßíç ÖïõôóéôæÞ-Äáíßêá, Í. Áëåîáíäñüðïõëïò, Ã. ÃåùñãéÜäçò:Ç ìÝôñçóç ôçò áñôçñéáêÞò ðßåóçò óôï óðßôé êáé ç óõìâïëÞ ôçò óôçí êáëýôåñç èåñáðåõôéêÞ áíôéìåôþðéóçôùí õðåñôáóéêþí áôüìùí óôçí ðåñéï÷Þ åõèýíçò KÝíôñïõ Yãåßáò Âýñùíá ..................................................................................................... 73

Á. Ìðáôßêáò, Ê. Óôåöáíïðïýëïõ, É. ÄñõãéáííÜêçò, Á. ÐåôñÜêç, Í. ÐáðáäÜêçò: KáôáíÜëùóç áëêïüë áðü åöÞâïõò:Mßá åðéêßíäõíç ðñáãìáôéêüôçôá ..................................................................................................................................................................................................... 79

Ê. Óõñéáíüò, Â. ËÝôôá, Ä. ÊáêëáìÜíïõ: Ïé ôñïðïðïéÞóéìïé ðáñÜãïíôåò ðïõ êáèïñßæïõí ôçí ðéèáíüôçôá åðéâßùóçòáóèåíþí ìå åîùíïóïêïìåéáêÞ êáñäéáêÞ áíáêïðÞ .............................................................................................................................................................. 84

Êåßìåío ïìïöùíßáòÂÞìáôá ãéá ôçí áíÜðôõîç êáôåõèõíôÞñéùí ïäçãéþí óôç ÃåíéêÞ ÉáôñéêÞ óôçí ÅëëÜäá: Ýíá êåßìåíï ïìïöùíßáò ................... 91

Áíôáðüêñéóç áðü ôçí ÊñÞôç2ç Åëëçíï-ÏëëáíäéêÞ ÓõíÜíôçóç ãéá ôéò ÊáôåõèõíôÞñéåò Ïäçãßåò óôç ÃåíéêÞ ÉáôñéêÞ ........................................................................ 94

CONTENTS

EditorialE.A. Thireos: 15th National Congress of General Practice ............................................................................................................................................. 54

Awarded paper in the memory of Prof. D. IkkouA Zeibekis, C. Pitsavos, D.B. Panagiotakos, C. Chrysohoou, J. Skoumas, M. Toutouza, P. Toutouzas, C. Stefanadis:Coronary heart disease and cardiovascular risk factors, in a random sample of males and females of Atticacounty: The “ATTICA STUDY” ........................................................................................................................................................................................................... 57

The second awarded paper in the memory of Prof. D. IkkouI. Vekri, Ch. Lixuriotis, A. Mariolis, E. Mesaris, N. Pararas, V. Vougioukas, Z. Almaz, A. Monastiriotis,N. Alexandropoulos, A. Moulakakis: Can C-Reactive Protein be considered as marker in cerebral vascular strokein the primary health care setting? ............................................................................................................................................................................................... 68

Awarded Freestanding PapersA. Mariolis, C. Kalaitzi, A. Zeimbekis, A. Foutsitzi-Danika, N. Alexandropoulos, G. Georgiadis: Blood pressuremesurement in the patient’s home and it’s contribution in the better therapeutic approach of hypertensive patientsin the catchment area of the Vyronas Health Centre ....................................................................................................................................................... 73

A. Batikas, K. Stefanopoulou, I. Drygjannakis, A. Petraki, N. Papadakis: Alcohol consumption by adolescents:A dangerous reality .................................................................................................................................................................................................................................. 79

K. Syrianos, V. Letta, D. Kaklamanou: The modifiable factors that determine the survival probability of petientswith out-of-hospital cardiac arrest ................................................................................................................................................................................................. 84

Consensus ReportSteps in developing guidelines in General Practice in Greece: a consensus report ................................................................................... 91

Correspondence from Crete2nd Dutch-Greek Meeting “On Guidelines in General Practice” ................................................................................................................................ 94

Ôñéìçíéáßá ̧ êäïóç ôçò ÅëëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞòQuarterly edited by the Greek Association of General Practitioners

ÐåñéëáìâÜíåôáé óôçí çëåêôñïíéêÞ âÜóç Index Copernicus. Included in Index Copernicus electronic data baseÔüìïò 15, Ôåý÷ïò 2, Áðñßëéïò - Éïýíéïò 2003, Volume 15, Number 2, April - June 2003

ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò

54

Å.Á. Èçñáßïò

ÔÇÓ ÓÕÍÔÁÎÇÓ

EDITORIALPrimary Heatlh Care, Volume 15, Number 2, 54-56, 2003ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 15, Ôåý÷ïò 2, 54-56, 2003

15ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò ÉáôñéêÞòÓéèùíßá ×áëêéäéêÞò, 30 Áðñéëßïõ – 4 ÌáÀïõ 2003


Ôï 15ï ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞò Éáôñé-êÞò ðñáãìáôïðïéÞèçêå óôç Óéèùíßá ôçò ×áëêé-äéêÞò áðü 30 Áðñéëßïõ Ýùò 4 ÌáÀïõ 2003. Äõ-óôõ÷þò ç åðéëïãÞ ôïõ îåíïäï÷åéáêïý óõãêñïôÞ-ìáôïò Porto Carras ãéá ôç äéåîáãùãÞ ôùí åñãá-óéþí ôïõ óõíåäñßïõ äåí Þôáí ç êáëýôåñç äõíáôÞ,ìéáò êáé áíáêáôáóêåõáæüôáí ãéá ôéò áíÜãêåò ôçòÅõñùðáúêÞò Óõíüäïõ ÊïñõöÞò, ãåãïíüò ðïõ äç-ìéïýñãçóå ðïëëÜ ðñïâëÞìáôá óôçí ÏñãáíùôéêÞÅðéôñïðÞ ôïõ óõíåäñßïõ êáé óôïõò óõììåôÝ÷ï-íôåò óõíÝäñïõò. Ïé åñãáóßåò ðÜíôùò ôïõ Óõíå-äñßïõ ïëïêëçñþèçêáí ìå åðéôõ÷ßá êáé ç ëÞîç ôïõâñÞêå ôçí ÅËÅÃÅÉÁ ìå íÝï Ä.Ó., ôï ïðïßï èáåðùìéóèåß êáé ôçí åõèýíç ôçò äéïñãÜíùóçò ôïõÅõñùðáúêïý Óõíåäñßïõ ôçò WONCA óôçí ÁèÞ-íá óôéò 3-7 Óåðôåìâñßïõ 2005.

Áðü ôçí åíáñêôÞñéá óõíåäñßáóç êáé ôï óôñïã-ãõëü ôñáðÝæé ìå èÝìá “Áíáóõãêñüôçóç ôïõ ÅÓÕ:åñùôÞìáôá, ðñïâëçìáôéóìïß êáé ðñïïðôéêÞ” ìåóõíôïíéóôÞ ôïí Ðñüåäñï ôçò ÅëëçíéêÞò ÅôáéñåßáòÃåíéêÞò ÉáôñéêÞò ê. Ì.Ð. Ìåñêïýñç, óôï ïðïßïêáôÝèåóáí ôéò áðüøåéò ôïõò ïé ê. Ê. ÊáëëÝñãçòÐñüåäñïò Â´ Ðå.Ó.Õ.Ð. ÊåíôñéêÞò Ìáêåäïíßáò,Å. Êáëïêáéñéíüò Ðñüåäñïò ÐáíåëëÞíéïõ Éáôñé-êïý Óõëëüãïõ, Ê. Êéëôßäçò ÂïõëåõôÞò ÍÝáò Äç-ìïêñáôßáò êáé Ì ÓðõñéäÜêçò Íïìáñ÷éáêüò Óýì-âïõëïò Èåó/íßêçò åêðñüóùðïò ôïõ Ê.Ê.Å., íáóôáèïýìå óôçí åéóÞãçóç ôïõ ê. Ê. ÓïõëéþôçÅðéóôçìïíéêïý Óõìâïýëïõ Õðïõñãåßïõ Õãåßáò êáéÐñüíïéáò ìå ôßôëï “Ç ðïëéôéêÞ õãåßáò óôçí Åë-ëÜäá ìåôÜ ôç èåóìïèÝôçóç ôïõ ÅÓÕ: ðñïêëÞóåéòêáé ðñïâëçìáôéóìïß ãéá ôçí áíáóõãêñüôçóç ôçòÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò”. Êáßñéåò ïé

åðéóçìÜíóåéò ôïõ ãéá ôï õöéóôÜìåíï ÷ñçìáôïäï-ôéêü ðëáßóéï: ñáãäáßá áýîçóç ôùí äáðáíþí õãåßáò(êáôÜ 9.1% åðß ôïõ ÁÅÐ ôç äåêáåôßá 1991-2000, ðïóïóôü ðïõ õðåñâáßíåé ôï ìÝóï üñï ôùí÷ùñþí-ìåëþí ôïõ ÏÏÓÁ), áýîçóç ôçò éäéùôéêÞòäáðÜíçò (ïé éäéùôéêÝò äáðÜíåò áðïôåëïýí ôï 42%ôùí óõíïëéêþí äáðáíþí õãåßáò, ìå ôçí ðáñáïé-êïíïìßá íá áíÝñ÷åôáé óôï 20% ðåñßðïõ, ãåãïíüòôï ïðïßï óçìáßíåé üôé ðñáêôéêÜ ôï ÷ñçìáôïäïôé-êü âÜñïò ôùí õðçñåóéþí õãåßáò ìåôáêõëýåôå óôáíïéêïêõñéÜ áêõñþíïíôáò Ýôóé óå ìåãÜëï âáèìüôï äéêáßùìá ôçò áóöáëéóôéêÞò êÜëõøçò), ðñïóá-íáôïëéóìüò ôùí äçìïóßùí äáðáíþí óôç íïóïêï-ìåéáêÞ ðåñßèáëøç (ðïõ áðïññïöÜ ôï 55% ðåñß-ðïõ) êáé ôùí éäéùôéêþí äáðáíþí óôçí åîùíïóï-êïìåéáêÞ ðñùôïâÜèìéá ðåñßèáëøç (63% ðåñßðïõ).Ïé õöéóôÜìåíåò äïìÝò ôïõ ÉÊÁ óõíèÝôïõí ôçíðëáôöüñìá ðÜíù óôçí ïðïßá Ý÷åé ïéêïäïìçèåßôï óýóôçìá ðáñï÷Þò Ð.Ö.Õ. óôá áóôéêÜ êÝíôñá,åíþ ç ýðáñîç äýï êÝíôñùí åõèýíçò êáé ðáñï÷Þòôùí õðçñåóéþí áõôþí (ÉÊÁ/ÅÓÕ) èåùñåßôáé õðåý-èõíç ãéá ôéò äéáöïñïðïéÞóåéò óôéò ðáñå÷üìåíåòõðçñåóßåò, ôç óðáôÜëç ðüñùí êáé ôçí áóõíÝ÷åéáôçò öñïíôßäáò. Ìéá óåéñÜ åñùôçìÜôùí áðáéôïýíáðáíôÞóåéò ðñïêåéìÝíïõ íá åöáñìïóôåß ï èåóìüòôïõ “ðñïóùðéêïý” ïéêïãåíåéáêïý éáôñïý: Ðïéïòåßíáé ï áñéèìüò ôùí ãåíéêþí ãéáôñþí ï ïðïßïòáðáéôåßôáé ãéá ôç óõãêñüôçóç åíüò óõóôÞìáôïòâáóéóìÝíïõ óôï èåóìü êáé ðüóïò ÷ñüíï áðáéôåß-ôáé ãéá ôçí ðáñáãùãÞ ôïõ áñéèìïý áõôïý; Ðïéåòåßíáé ïé äéáèÝóåéò ôïõ éáôñéêïý óþìáôïò áëëÜêáé ïé äéáèÝóåéò-ðñïóäïêßåò ôùí ÷ñçóôþí; ÄýïðñïôÜóåéò Ý÷ïõí êáôáôåèåß, ìå ôá ðëåïíåêôÞìá-

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Å.Á. Èçñáßïò Ôüìïò 15, Ôåý÷ïò 2, 2003

ôá êáé ôá ìåéïíåêôÞìáôá ôïõò ç êÜèå ìéá. Çðñþôç ðñïâëÝðåé äéïéêçôéêÞ, ïñãáíùôéêÞ êáé ëåé-ôïõñãéêÞ ïìïãåíïðïéÞóåé ôçò äÝóìçò ôùí ðáñï-÷þí, õðü êñáôéêü Ýëåã÷ï êáé óõíôïíéóìü. ÁõôüðñáêôéêÜ óçìáßíåé õðáãùãÞ üëùí ôùí õöéóôÜìå-íùí äïìþí óå åíéáßï ó÷Þìá óôá ðëáßóéá ôïõ ÅÓÕ.Óôï ó÷Þìá áõôü, ç äçìéïõñãßá êïìâéêþí óçìåßùí(ð.÷. Ïéêïãåíåéáêüò Éáôñüò) êáé ç õéïèÝôçóç åíáë-ëáêôéêþí ìç÷áíéóìþí áðïæçìßùóçò åßíáé åðéâå-âëçìÝíá. Ìå ôçí õéïèÝôçóç áõôÞò ôçò ðñüôáóçòåîáóöáëßæåôáé ðëÞñçò êñáôéêüò Ýëåã÷ïò óôï óý-óôçìá êáé ìáêñïðñüèåóìá ìðïñåß íá óõìâÜëëåéóôïí Ýëåã÷ï ôùí äáðáíþí, áëëÜ ðåñéïñßæåé ôçíåëåõèåñßá åðéëïãÞò ôùí ÷ñçóôþí, ðñïûðïèÝôåéáëëáãÞ ôïõ åñãáóéáêïý êáèåóôþôïò ôùí óõìâá-óéïý÷ùí éáôñþí ôïõ ÉÊÁ êáé Ý÷åé õøçëü êüóôïòìåôÜâáóçò. Ç äåýôåñç ðñüôáóç ðñïôåßíåé ôç äéá-ôÞñçóç ôïõ õöéóôÜìåíïõ ôñüðïõ êÜëõøçò óôéòáóôéêÝò ðåñéï÷Ýò êáé åíßó÷õóç ôçò õðïäïìÞò ôïõÉÊÁ, áðü ôï ïðïßï èá ìðïñïýí íá “áãïñÜæïõí”õðçñåóßåò õãåßáò ôá Üëëá áóöáëéóôéêÜ ôáìåßá.Óôá ðëáßóéá áõôÜ, ç äçìéïõñãßá ðïëõúáôñåßùí ôáïðïßá èá óôåëå÷þíïíôáé áðü ïìÜäåò éáôñþí (gro-up practices) ìðïñåß íá óõìðëçñþóåé ôï èåóìüôïõ ïéêïãåíåéáêïý éáôñïý ìÝóá áðü äéáäéêáóßåòïñéïèÝôçóçò ôïõ ðëçèõóìïý åõèýíçò ìå ìéá óåéñÜáðü êñéôÞñéá. Ç ðñüôáóç áõôÞ ìïéÜæåé íá áðïôå-ëåß ìéá ðéï ñåáëéóôéêÞ åêäï÷Þ ìå ðéï Üìåóá áðï-ôåëÝóìáôá êáé ìå ìéêñüôåñï äéïéêçôéêü êüóôïò, ïÝëåã÷ïò üìùò ôçò êåíôñéêÞò äéïßêçóçò èåùñåßôáéðåñéïñéóìÝíïò êáé ùò åê ôïýôïõ äåí äéáóöáëßæåéôçí ôÞñçóç ôùí äåóìåýóåùí ôùí ôáìåßùí.

Ï ãüíéìïò áõôüò ðñïâëçìáôéóìüò óõíå÷ßóôç-êå êáé óå äýï Üëëá åíäéáöÝñïíôá óôñïããõëÜ ôñá-ðÝæéá:

· “ÁóôéêÜ ÊÝíôñá Õãåßáò: ÐñùôïâÜèìéá Öñï-íôßäá Õãåßáò êáé Ãåíéêüò Éáôñüò” ìå óõíôïíé-óôÞ ôïí ê. ×. ËéïíÞ ÁíáðëçñùôÞ ÊáèçãçôÞÐáí/ìßïõ ÊñÞôçò êáé ïìéëçôÝò ôïõò Á. ÌðÝíïÁíáðëçñùôÞ ÊáèçãçôÞ Ðáí/ìßïõ Èåó/íßêçò,É. ×áôæçãéÜííç Ä/íôñéá Õðçñåóéþí ÕãåßáòÉÊÁ, êáé Ì. ÊáëïåéäÜ Ãåíéêü Éáôñü.

· “Ï ñüëïò ôïõ Ãåíéêïý Éáôñïý óå Åõñþðç êáéÅëëÜäá. Ðáñüí êáé ìÝëëïí” ìå óõíôïíéóôÞôïí ê. Á. ÖéëáëÞèç ÁíáðëçñùôÞ ÊáèçãçôÞÐáí/ìßïõ ÊñÞôçò êáé ïìéëçôÝò äõï óçìáíôé-êÝò ðñïóùðéêüôçôåò ôçò ÃåíéêÞò ÉáôñéêÞò óôçíÅõñþðç ôïõò P. Evans Ðñüåäñï ôçò Åõñù-ðáúêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞò êáé I. PiscoÐñüåäñï ôçò ÐïñôïãáëéêÞò Åôáéñåßáò Ãåíé-

êÞò ÉáôñéêÞò, êáèþò êáé ôïí Ä. ÌðïýìðáÊáèçãçôÞ Ðáí/ìßïõ ÊñÞôçò.Ôï õðüëïéðï åðéóôçìïíéêü ðñüãñáììá ôïõ

óõíåäñßïõ ðåñéåëÜìâáíå 12 óôñïããõëÝò ôñÜðåæåò,10 äéáëÝîåéò, 324 åëåýèåñåò áíáêïéíþóåéò, 80áíáñôçìÝíåò áíáêïéíþóåéò (poster) êáé ôñßá êëé-íéêÜ öñïíôéóôÞñéá.

ÊëéíéêÜ ÖñïíôéóôÞñéá

· “Áíôéìåôþðéóç áóèåíþí ìå ðïëëáðëïýò êéí-äýíïõò ãéá êáñäéáããåéáêÞ íüóï óå åðßðåäïÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò”. ÏìéëçôÝò:Ì. ÅëéóÜö ÊáèçãçôÞò Ðáèïëïãßáò Ðáí/ìßïõÉùáííßíùí, Â. ÊáñáìÜíïò ÁíáðëçñùôÞò êá-èçãçôÞò Ðáí/ìßïõ Áèçíþí, Ã. Óôåñãßïõ Åðß-êïõñïò ÊáèçãçôÞò Ðáí/ìßïõ Áèçíþí

· “Ç êáôÜèëéøç óôçí ÐñùôïâÜèìéá Ðåñßèáë-øç. Ç óïâáñüôçôá ôïõ ðñïâëÞìáôïò êáé çäéÜãíùóç. Ç öáñìáêåõôéêÞ áíôéìåôþðéóç”.ÏìéëçôÞò: É. ÐáñÜó÷ïò Øõ÷ßáôñïò

· “Ç ðñáêôéêÞ êëéíéêÞ áíôéìåôþðéóç ôïõ ïóôåï-ðïñùôéêïý áóèåíïýò óå åðßðåäï ÐñùôïâÜè-ìéáò Öñïíôßäáò Õãåßáò”. ÏìéëçôÝò: Ã. Óêá-ñáíôÜâïò Ñåõìáôïëüãïò, Á. Ëïõôñéþôçò Ïñ-èïðáéäéêüò, Ã. ÓðáèáñÜêçò Ãåíéêüò Éáôñüò

ÓôñïããõëÝò ôñÜðåæåò

· Ôï ãåíéêåõìÝíï Üã÷ïò óôçí ÐñùôïâÜèìéáÖñïíôßäá Õãåßáò

· Ç ÷ñÞóç êáé áîéïëüãçóç ôùí êáôåõèõíôç-ñßùí ïäçãéþí óôçí ÃåíéêÞ ÉáôñéêÞ

· Áíôéìåôþðéóç åðåéãüíôùí ðåñéóôáôéêþí áðüôïí Ãåíéêü Éáôñü

· Óýã÷ñïíåò óôñáôçãéêÝò áíôéìåôþðéóçò áóèå-íþí ìå ìåãÜëï êáñäéáããåéáêü êßíäõíï

· Áèçñïèñüìâùóç: ìéá óõóôçìáôéêÞ íüóïò –ÄéÜãíùóç êáé èåñáðåßá

· ÊáñäéáããåéáêÞ íüóïò êáé äõóëéðéäáéìßá. Íåü-ôåñåò áðüøåéò ãéá ôçí ðñüëçøç êáé ôçí áíôé-ìåôþðéóÞ ôçò

· ÈåñáðåõôéêÞ ðñïóÝããéóç ôçò öëåãìïíÞò.Ðñïóäïêßåò êáé åðéöõëÜîåéò

· ÍÝá äåäïìÝíá óôçí ðáèïãÝíåéá êáé èåñá-ðåßá ôïõ óáê÷áñþäç äéáâÞôç

· ÊáëïÞèçò õðåñðëáóßá ôïõ ðñïóôÜôç. ÄéÜ-ãíùóç êáé öáñìáêåõôéêÞ áíôéìåôþðéóç óôçí


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ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò· ÊáôÜèëéøç êáé ÷ñüíéá íïóÞìáôá· ×ñüíéá áðïöñáêôéêÞ ðíåõìïíïðÜèåéá: ìéáðïëõðáñáãïíôéêÞ íüóïò – Óýã÷ñïíç èåñá-ðåõôéêÞ áíôéìåôþðéóç

· Ç åéóáãùãÞ ôïõ âéâëéáñßïõ åéäéêåõïìÝíïõ óôçíåêðáßäåõóç ôùí Ãåíéêþí Éáôñþí. ̧ íá ÷ñÞóé-ìï åñãáëåßï ãéá ôçí áíáâÜèìéóç ôçò åêðáß-äåõóçò – Ðñïôåéíüìåíç âéâëéïãñáößá ãéá êÜèåÃåíéêü Éáôñü

ÄéáëÝîåéò

· ÏëõìðéáêÞ óõíäñïìéêÞ åðéôÞñçóç· ÁíôéâéïôéêÜ 2003: ðüôå, ðïéá êáé ãéáôß· Óáê÷áñþäçò äéáâÞôçò: íåüôåñåò åîåëßîåéò óôçíáíôéìåôþðéóÞ ôïõ

· Óõíå÷éæüìåíç éáôñéêÞ åêðáßäåõóç ìå ÷ñÞóçðïëõìÝóùí

· Áíôéìåôþðéóç ëïéìþîåùí ôïõ áíáðíåõóôéêïý· Äõóðåøßá – Íõ÷ôåñéíÞ õðåñïîýôçôá· ×ñüíéá çðáôßôéäá Â – Áðü ôç äéÜãíùóç óôçèåñáðåßá

· Ìåôáâïëßôåò ôçò âéôáìßíçò D. Ïé ãíùóôïß-Üãíùóôïé óôçí áíôéìåôþðéóç ôçò ïóôåïðü-ñùóçò

· ¸ñåõíá óôç ÃåíéêÞ ÉáôñéêÞ: ïñãÜíùóç, äõ-óêïëßåò, äõíáôüôçôåò

· Ç óçìáóßá ôçò ëåéôïõñãéêÞò áðïêáôÜóôáóçòóôéò ÷ñüíéåò ðáèÞóåéò

Ïé åñãáóßåò ôïõ óõíåäñßïõ Ýêëåéóáí ìå ôçíáðïíïìÞ ôùí âñáâåßùí “Ä. ºêêïõ” êáé åëåõèÝ-ñùí áíáêïéíþóåùí, ôá ïðïßá Ýëáâáí:

Âñáâåßï Êáèçãçôïý “Ä. ºêêïõ”

“Óôåöáíéáßá íüóïò êáé ðáñÜãïíôåò êáñäéáã-ãåéáêïý êéíäýíïõ óå ôõ÷áßï äåßãìá ðëçèõóìïý:åðéäçìéïëïãéêÞ ìåëÝôç “ÁÔÔÉÊÇ””, ôùí óõíá-äÝëöùí Á. ÆåúìðÝêç, ×. Ðßôóáâï, Ä. Ðáíáãéù-ôÜêïõ, ×. ×ñõóï÷üïõ, É. Óêïýìá, Ì. Ôïýôïõæá,Ð. Ôïýôïõæá, ×. ÓôåöáíÜäç.

¸ðáéíïé Êáèçãçôïý “Ä. ºêêïõ”

“Ìðïñåß ç C-áíôéäñþóá ðñùôåÀíç íá áðï-

ôåëÝóåé ðñïãíùóôéêü äåßêôç óôá áããåéáêÞ åãêå-öáëéêÜ åðåéóüäéá óôçí ÐñùôïâÜèìéá ÖñïíôßäáÕãåßáò”, ôùí óõíáäÝëöùí Å. ÂåêñÞ, ×. Ëçîïõ-ñéþôç, Á. Ìáñéüëç, Å. ÌåóóÜñç, Í. ÐáñáñÜ, Â.Âïõãéïýêá, Æ. ÁëìÜæ, Á. Ìïíáóôçñéþôç, Í. Áëå-îáíäñüðïõëïõ, Á. ÌïõëáêÜêç.

“Åðßäñáóç ôùí ìç óôåñïåéäþí áíôéöëåãìï-íùäþí öáñìÜêùí óôçí áñôçñéáêÞ ðßåóç ôùí åíç-ëßêùí”, ôùí óõíáäÝëöùí Áè. ÂÞôá, Å. ÍåñáíôæÜ-êç, Áíä. ÂÞôá, ×. Óåìåñôæßäç.

Âñáâåßá åëåõèÝñùí áíáêïéíþóåùí

“Ç ìÝôñçóç ôçò áñôçñéáêÞò ðßåóçò óôï óðßôéêáé ç óõìâïëÞ ôçò óôçí êáëýôåñç èåñáðåõôéêÞáíôéìåôþðéóç ôùí õðåñôáóéêþí áôüìùí óôçíðåñéï÷Þ åõèýíçò ÊÝíôñïõ Õãåßáò Âýñùíá”, ôùíóõíáäÝëöùí Á. Ìáñéüëç, ×. ÊáëáúôæÞ, Á. Æåú-ìðÝêç. Á. ÖïõôæéôæÞ-Äáíßêá, Í. Áëåîáíäñüðïõ-ëïõ, Ã. ÃåùñãéÜäç.

“ÊáôáíÜëùóç áëêïüë áðü åöÞâïõò: ìéá åðé-êßíäõíç ðñáãìáôéêüôçôá”, ôùí óõíáäÝëöùí Á.Ìðáôßêá, Ê. Óôåöáíïðïýëïõ, É. ÄñõãéáííÜêç, Á.ÐåôñÜêç, Í. ÐáðáäÜêç.

“Ïé ôñïðïðïéÞóéìïé ðáñÜãïíôåò ðïõ êáèïñß-æïõí ôçí ðéèáíüôçôá åðéâßùóçò áóèåíþí ìå åîù-íïóïêïìåéáêÞ êáñäéáêÞ áíáêïðÞ”, ôùí óõíáäÝë-öùí Ê. Óõñéáíïý, Â. ËÝôôá, Ä. ÊáêëáìÜíïõ.

¸ðáéíïé åëåõèÝñùí áíáêïéíþóåùí

“Åêôßìçóç ôçò áíáãêáéüôçôáò æçôïõìÝíùíìéêñïâéïëïãéêþí åîåôÜóåùí óå êÝíôñï ÐñùôïâÜè-ìéáò Öñïíôßäáò Õãåßáò”, ôùí óõíáäÝëöùí Ä. Æþãá,Â. Æþãá, ×. Ôóéþëç, Ó. Ðáíáãéùôßäïõ, É. ÔóéÜ-ëéïõ, Ê. Äéáìáíôüðïõëïõ, Í. Åëåõèåñßïõ.

“ËåéôïõñãéêÞ äéáóýíäåóç êáé óõíåñãáóßá ôïõðñïóùðéêïý ôùí ÊÝíôñùí Õãåßáò ôïõ Â´ Ðå.Ó.Õ.Ð.ÁôôéêÞò”, ôùí óõíáäÝëöùí Å. Èçñáßïõ, Í. Ãéá-ìáëÜêçò, Å. Ëýêïõ, Ì. Ðýëëç, Ã. ÌðÝëïõ, ×.Ïéêïíïìïðïýëïõ, Å. ÌùñáÀôç.

“¸ðáéíïò Ã. ÐáðáäÜêç” “Äéá÷ñïíéêÞ åîÝëé-îç ôçò èíçóéìüôçôáò áðü êáêïÞèç íåïðëÜóìáôáóôçí ðåñéï÷Þ åõèýíçò åíüò Ðåñéöåñåéáêïý Éá-ôñåßïõ ôçò ÊñÞôçò”, ôïõ óõíáäÝëöïõ Ê. Êáôñé-ôæéäÜêç.

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Á. ÆåúìðÝêçò êáé óõí. Ôüìïò 15, Ôåý÷ïò 2, 2003

ÂÑÁÂÅÕÈÅÉÓÁ ÅÑÃÁÓÉÁ ÓÔÏ ÄÉÁÃÙÍÉÓÌÏ Ä. ÉÊÊÏÕ

AWARDED PAPER IN THE MEMORY OF PROF. D. IKKOYPrimary Heatlh Care, Volume 15, Number 2, 57-67, 2003ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 15, Ôåý÷ïò 2, 57-67, 2003

ÐåñßëçøçÓêïðüò: Óôçí ðáñïýóá åñãáóßá ðáñïõóéÜæïíôáé áðïôåëÝóìáôá ôçò åðéäçìéï-ëïãéêÞò ìåëÝôçò “ÁÔÔÉÊÇ” ìå óêïðü ôç ìåëÝôç ôçò ó÷Ýóçò êëáóéêþí êáéíåüôåñùí ðáñáãüíôùí êéíäýíïõ ìå ôçí êáñäéáããåéáêÞ íüóï óå äéÜóôçìá 10åôþí ðáñáêïëïýèçóçò. Õëéêü: Ç ìåëÝôç “ÁÔÔÉÊÇ” èá óõìðåñéëÜâåé (óôçí ôåëé-êÞ ôçò öÜóç) 3075 Üôïìá (48% Üíäñåò êáé 52% ãõíáßêåò) ôïõ ãåíéêïý ðëçèõ-óìïý, çëéêßáò Üíù ôùí 18 åôþí. Ôï äåßãìá ôçò ðáñïýóáò áíÜëõóçò åßíáé ôáðñþôá 1660 ôõ÷áßá åðéëåãìÝíá Üôïìá ðïõ åíôÜ÷èçêáí óôç ìåëÝôç. Ïé ðáñÜ-ìåôñïé ðïõ ðáñïõóéÜæïíôáé åßíáé ïé ôéìÝò ïëéêÞò ÷ïëçóôåñüëçò, HDL-÷ïëçóôå-ñüëçò, ôñéãëõêåñéäßùí, ãëõêüæçò ïñïý, áñôçñéáêÞò ðßåóçò, ïìïêõóôåÀíçò, éíù-äïãüíïõ, C-áíôéäñþóáò ðñùôåÀíçò, êáèþò åðßóçò êáé, áäñÝò, äéáôñïöéêÝò óõ-íÞèåéåò ôùí áôüìùí ôçò ìåëÝôçò. ÁðïôåëÝóìáôá: Ï ðñïóáñìïóìÝíïò êáôÜçëéêßá åðéðïëáóìüò ôçò óôåöáíéáßáò íüóïõ âñÝèçêå ßóïò óôïõò Üíäñåò ìå 620/ 10000 Üôïìá (6,2%) êáé óôéò ãõíáßêåò 400 / 10000 Üôïìá (4,0%), åíþ ïåðéðïëáóìüò ôùí áããåéáêþí åãêåöáëéêþí åðåéóïäßùí, ôüóï óôïõò Üíäñåò üóïêáé óôéò ãõíáßêåò âñÝèçêå ßóïò ìå 110 / 10000 Üôïìá (1,1%). Ç áíÜëõóç ôùíóôïé÷åßùí Ýäåéîå üôé: 38,5% ôùí áíäñþí êáé 24,1% ôùí ãõíáéêþí åß÷áí õðÝñ-ôáóç, 39% ôùí áíäñþí êáé 37% ôùí ãõíáéêþí åß÷áí õðåñ÷ïëçóôåñïëáéìßá, 8%ôùí áíäñþí êáé 7% ôùí ãõíáéêþí åß÷áí óáê÷áñþäç äéáâÞôç. Åðßóçò, 64,6%ôùí áíäñþí êáé 40,5% ôùí ãõíáéêþí äÞëùóáí åíåñãïß Þ ðñþçí êáðíéóôÝò,åíþ 55,3% ôùí áíäñþí êáé 62,8% ôùí ãõíáéêþí äÞëùóáí üôé äåí ãõìíÜæïíôáéïýôå ìéá öïñÜ ôçí åâäïìÜäá. ÔÝëïò, 44% ôùí áíäñþí êáé 25% ôùí ãõíáéêþíåß÷áí ôïõëÜ÷éóôïí 3 áðü ôïõò ðñïáíáöåñèÝíôåò ðáñÜãïíôåò êéíäýíïõ. Óõ-ìðåñÜóìáôá: Óå éäéáßôåñá óçìáíôéêü ðïóïóôü ôïõ ãåíéêïý ðëçèõóìïý öáßíå-ôáé íá åðéðïëÜæïõí ðåñéóóüôåñïé áðü ôñåéò ðáñÜãïíôåò êéíäýíïõ. Ç áíÜãêçëÞøçò ìÝôñùí êáôÜ ôçí ðñùôïâÜèìéá öñïíôßäá õãåßáò, êñßíåôáé åðéôáêôéêÞ,ðåñéóóüôåñï áðü ðïôÝ Üëëïôå.

Óôåöáíéáßá íüóïò êáé ðáñÜãïíôåò êáñäéáããåéáêïý êéíäýíïõ óåôõ÷áßï äåßãìá ôïõ ðëçèõóìïý: ÅðéäçìéïëïãéêÞ ìåëÝôç “ÁÔÔÉÊÇ”

Á. ÆåúìðÝêçò1, ×. Ðßôóáâïò2, Ä. ÐáíáãéùôÜêïò2, ×. ×ñõóï÷üïõ2, É. Óêïýìáò2, Ì. Ôïýôïõæá2,Ð. Ôïýôïõæáò1, ×. ÓôåöáíÜäçò2

ÅéóáãùãÞ

Ôá ìÝ÷ñé óÞìåñá óôïé÷åßá áðü ìå-ëÝôåò ðïõ íá áíáöÝñïíôáé ôüóï óôïõòêëáóéêïýò (êÜðíéóìá, óùìáôéêü âÜñïò,öõóéêÞ Üóêçóç, äéáôñïöÞ, áñôçñéáêÞðßåóç ê.ëð.)1-4 üóï êáé óôïõò íåüôåñïõòêáñäéïáããåéáêïýò ðáñÜãïíôåò êéíäýíïõ(ïìïêõóôåÀíç, éíùäïãüíï, C-áíôéäñþóáðñùôåÀíç ê.ëð.) óå ìåãÜëá äåßãìáôá ôïõãåíéêïý ðëçèõóìïý, óôç ÷þñá ìáò åß-íáé åëÜ÷éóôá. Åßíáé åðßóçò ãåãïíüò üôéôá ôåëåõôáßá ÷ñüíéá Ý÷ïõí óõíôåëåóèåßóçìáíôéêÝò áëëáãÝò óôéò äéÜöïñåò óõ-íÞèåéåò ôïõ ðëçèõóìïý ðïõ ðéèáíüí íáåðçñåÜæïõí ôéò ôéìÝò ôùí ðáñáãüíôùíêéíäýíïõ êáé íá áõîÜíïõí ôá ðïóïóôÜôùí áôüìùí ðïõ áíÞêïõí óôéò ïìÜäåòõøçëïý êéíäýíïõ óå ó÷Ýóç ìå ôï ðá-ñåëèüí.

Óôçí ðñïóðÜèåéá íá êáëõöèåß ôï

ËÝîåéò ÊëåéäéÜ: ÊáñäéáããåéáêÞ íüóïò, ÊáñäéáããåéáêïßðáñÜãïíôåò êéíäýíïõ, ÐñùôïâÜèìéá öñïíôßäá ÕãåßáòÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå óôï äéáãùíé-óìü "Ä. ºêêïõ" óôá ðëáßóéá ôïõ 15ïõ ÐáíåëëÞíéïõÓõíåäñßïõ ÃåíéêÞò ÉáôñéêÞò (×áëêéäéêÞ 30 Áðñéëßïõ- 4 ÌáÀïõ 2003) êáé âñáâåýôçêå áðü ôçí ÅðéôñïðÞÊñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò Óõíôá-êôéêÞò ÅðéôñïðÞò ôïõ ðåñéïäéêïý êáé ôçò Ïñãáíù-ôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ.Õðåýèõíïò áëëçëïãñáößáò: ÄçìïóèÝíçò Â Ðáíáãéù-ôÜêïò, ×ßïõ 48-50, ÃëõöÜäá 165 61, ÁèÞíá, Tçë.(210)9603116, Fax. (210)9600719,E-mail: [email protected]

1Ãåíéêüò Éáôñüò, 2ÉððïêñÜôåéï Íïóïêïìåßï Áèçíþí, ÊáñäéïëïãéêÞ ÊëéíéêÞ É.Ã.Í.Á., ÉáôñéêÞÓ÷ïëÞ Ðáíåðéóôçìßïõ Áèçíþí


58

Á. ÆåúìðÝêçò êáé óõí.

ôùí ôçò ìåëÝôçò “ÁÔÔÉÊÇ” ìå Üëëåòäéåèíåßò ìåëÝôåò, ãéá ôçí åîáãùãÞ óõ-íïëéêþí óõìðåñáóìÜôùí.

Óôçí ðáñïýóá åñãáóßá ðáñïõóéÜ-æåôáé ï ó÷åäéáóìüò êáé ç ìåèïäïëïãßáôçò ìåëÝôçò áõôÞò (óõíïðôéêÜ), êá-èþò åðßóçò êáé ôá ðñþôá ðåñéãñáöé-êÜ áðïôåëÝóìáôÜ ôçò ðïõ áöïñïýíäéÜöïñïõò äçìïãñáöéêïýò, âéï÷çìéêïýòêáé êëéíéêïýò äåßêôåò ðïõ ó÷åôßæïíôáéìå ôçí êáñäéáããåéáêÞ íïóçñüôçôá êáéèíçóéìüôçôá.

Ðëçèõóìüò ìåëÝôçò - ÌÝèïäïò

Óõíïðôéêüò ó÷åäéáóìüò

Ç ìåëÝôç “ÁÔÔÉÊÇ” åßíáé ìéá äéá-÷ñïíéêÞ ìåëÝôç ðáñáêïëïýèçóçò äåßã-ìáôïò ôïõ ãåíéêïý ðëçèõóìïý. ¼ðùòðñïáíáöÝñèçêå ç ìåëÝôç Ý÷åé óáí áñ-÷éêü óôü÷ï íá êáôáãñÜøåé ôéò ôéìÝòäéáöüñùí äçìïãñáöéêþí, âéï÷çìéêþí,êëéíéêþí, ãåíåôéêþí, äéáôñïöéêþí êáé

Coronary heart disease and cardiovascular risk factors,in a randomsample of males and females of Attica county: The “ATTICA STUDY”A Zeibekis, C. Pitsavos, D.B. Panagiotakos, C. Chrysohoou, J. Skoumas, M.Toutouza, P. Toutouzas, C. Stefanadis.

SummaryAim: In this work we present results from the “ATTICA” epidemiological study,in order to evaluate the association between established or emerging cardiovas-cular risk factors and the cardiovascular disease. Design and settings: Thepopulation analyzed in this work is consisted by 1660 randomly selected malesand females, from several regions of Attica province. The parameters presentedin this work are the serum values of total cholesterol, HDL-cholesterol, triglyc-erides, glucose, hs CRP, homocysteine, fibrinogen, and blood pressure levels.Additionally we evaluated the nutrition habits of the population of this study. Theage adjusted prevalence of coronary heart disease was equal to 599 / 10000persons (6%)in men and 400 / 10000 persons (4 %)in women, and the preva-lence of vascular brain episodes was 110 / 10000 persons (1.1%) both in menand women. The 38.5% of the male population and 24.1% of the females hadelevated blood pressure levels, 39% of the men’s and 37% of the women’s hadhypercholesterolaemia, while 8% of the males and 7% of the females haddiabetes mellitus. Additionally, 64.6% of the males and 40.5% of the femaleswere defined as current smokers, and 55.3% of the males and 62.8% of thefemales reported physical inactivity (less than once per week). Finally, 44% ofthe males and 25% of the females had at least three of the referred above riskfactors. Conclusions: The presented data are preliminary, but the increasedprevalence of the common cardiovascular risk factors leads to the thought thatactions for primary health care have become more essential than ever.Key words: Primary health care, Cardiovascular disease, Cardiovascular riskfactors

êåíü ó÷åôéêÜ ìå ôçí êáñäéáããåéáêÞ íüóï óôç ÷þñáìáò, ç êáñäéïëïãéêÞ êëéíéêÞ ôïõ ÐáíåðéóôçìßïõÁèçíþí äéïñãÜíùóå óôéò áñ÷Ýò ôïõ 2001 ìéáäéá÷ñïíéêÞ åðéäçìéïëïãéêÞ ìåëÝôç ìå ôçí åðùíõ-ìßá ìåëÝôç “ÁÔÔÉÊÇ”. Ç ìåëÝôç áõôÞ Ý÷åé óáíóêïðü íá êáôáãñÜøåé, íá áðïôéìÞóåé, íá ïìáäï-ðïéÞóåé, íá éåñáñ÷Þóåé êáé íá óõó÷åôßóåé ìå ôïí10åôÞ êßíäõíï åêäÞëùóçò êáñäéáããåéáêÞò íüóïõôéò ôéìÝò äéáöüñùí êëáóéêþí ðáñáãüíôùí êéíäý-íïõ, óå Ýíá áíôéðñïóùðåõôéêü, óôñùìáôïðïéçìÝ-íï êáé ôõ÷áßá åðéëåãìÝíï äåßãìá ôïõ ãåíéêïýðëçèõóìïý ôïõ íïìïý ÁôôéêÞò. ÐáñÜëëçëá, èáåêôéìçèåß ï åðéðïëáóìüò êáé ç åðßðôùóç ôçò óôå-öáíéáßáò íüóïõ, ôùí áããåéáêþí åãêåöáëéêþí êáéêáñêßíïõ êáé Üëëùí ìïñöþí áèçñïóêëçñõíôéêÞòíüóïõ (áíåõñýóìáôá áïñôÞò, áðïöñáêôéêÞ áñôç-ñéïðÜèåéá Üêñùí). Ôåëéêüò óôü÷ïò ôçò ìåëÝôçòèá åßíáé ç äçìéïõñãßá “ìïíôÝëïõ” êáñäéáããåéá-êïý êéíäýíïõ ãéá ôïí Åëëçíéêü ðëçèõóìü ìå âÜóçôï ïðïßï èá ìðïñåß íá áîéïëïãçèåß ï ó÷åôéêüòêßíäõíïò åìöÜíéóçò êáñäéáããåéáêïý åðåéóïäßïõêáôÜ ôá ðñüôõðá äçìéïõñãßáò ðáñüìïéùí ìïíôÝ-ëùí äéåèíþí ìåëåôþí (ìåëÝôç Framingham). Áðþ-ôåñïò óôü÷ïò åßíáé ç ìåôÜ-áíÜëõóç ôùí åõñçìÜ-

øõ÷ïëïãéêþí ðáñáìÝôñùí óå ôõ÷áßá åðéëåãìÝíïäåßãìá ôïõ íïìïý ÁôôéêÞò. Ï ðëçèõóìüò áõôüòðåñéëáìâÜíåé ôïõò êõñéüôåñïõò ôýðïõò ôïõ óýã-÷ñïíïõ ¸ëëçíá ìéá êáé áðïôåëåßôáé áðü Üôïìááóôéêþí, çìéáóôéêþí êáé áãñïôéêþí ðåñéï÷þí. Ðá-ñÜëëçëá áðïôåëåß ôï 40% ôïõ ãåíéêïý ðëçèõ-óìïý ôçò ÷þñáò (ÐçãÞ Å.Ó.Õ.Å. 2001). Ìå ôç10åôÞ äéá÷ñïíéêÞ ðáñáêïëïýèçóç ôùí áôüìùíèá áðïôéìçèåß ï ñüëïò ðïõ Ý÷ïõí ïé äéåñåõíïýìå-íïé ðáñÜãïíôåò óôïí êßíäõíï èáíáôçöüñáò Þ ìç,åêäÞëùóçò êáñäéáããåéáêÞò íüóïõ êáé êáñêßíïõ,óôïí ðëçèõóìü ôçò ìåëÝôçò. Ôï ôåëéêü äåßãìá èáðåñéëáìâÜíåé 3075 Üôïìá. Åî áõôþí 1476 èáåßíáé Üíäñåò (48%) êáé ïé 1599 ãõíáßêåò (52%).Ôï ôåëéêü ìÝãåèïò ôïõ äåßãìáôïò ðñïÝêõøå Ýðåé-ôá áðü áíÜëõóç óôáôéóôéêÞò éó÷ýïò ìå âÜóç ôçíáðïôßìçóç äéáöïñþí óôïí åêôéìïýìåíï ó÷åôéêüêßíäõíï (hazard ratio) ãéá ðñïïðôéêÞ ðáñáêï-ëïýèçóç 10 åôþí ìåãáëýôåñùí áðü 10%, óå åðß-ðåäï óôáôéóôéêÞò óçìáíôéêüôçôáò < 5% êáé ìåóôáôéóôéêÞ éó÷ý (1 - óöÜëìá ôýðïõ ÉÉ) > 80% ãéáäßðëåõñïõò åëÝã÷ïõò. Ç äåéãìáôïëçøßá åßíáé ôõ-÷áßá, ðïëõóôáäéáêÞ (áíÜ ðüëç), óôñùìáôïðïéç-ìÝíç (áíÜ çëéêéáêÞ êáôçãïñßá êáé öýëï), êáéáíáëïãéêÞ (ìå âÜóç ôïí ðëçèõóìü ôùí ÄÞìùí

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êáé ÊïéíïôÞôùí ôçò ÕðÝñ-íïìáñ÷ßáò ÁôôéêÞòêáèþò åðßóçò êáé ôùí íïìáñ÷éþí ÁíáôïëéêÞò êáéÄõôéêÞò ÁôôéêÞò). Ç óõíåéóöïñÜ ôùí åõñýôåñùíðåñéï÷þí ôçò ÁôôéêÞò óôï ôåëéêü äåßãìá ôçò ìå-ëÝôçò èá åßíáé ç áêüëïõèç: ÄÞìïò Áèçíáßùí (20%),ÄÞìïò Ðåéñáéþò (8%), åõñýôåñç ðåñéöÝñåéá ðñù-ôåõïýóçò (41%), “õðüëïéðï” ÁôôéêÞò (29%) êáéíÞóïé (2%). Ìå âÜóç ôï ó÷åäéáóìü åðéëÝãïíôáíôõ÷áßá åñãáóéáêïß ÷þñïé (Äçìüóéïé êáé Éäéùôé-êïß), êÝíôñá óõãêÝíôñùóçò çëéêéùìÝíùí, êáèþòåðßóçò äçìïôéêïß ÷þñïé üðïõ åöáñìüóôçêå ôõ-÷áßá åðéëïãÞ óôéò ëßóôåò ôùí áôüìùí (äõáäéêÞáêïëïõèßá ôõ÷áßùí áñéèìþí, 1 = Ýíôáîç óôç ìå-ëÝôç, 0 = ìç Ýíôáîç óôç ìåëÝôç). Ìå ôïí ôñüðïáõôü åëá÷éóôïðïéåßôáé ç óõììåôï÷Þ åèåëïíôþí óôçíìåëÝôç êáé ôïõ óõóôçìáôéêïý óöÜëìáôïò êáôÜôçí åðéëïãÞ. Ôï ðñùôüêïëëï ðñïâëÝðåé íá åðéëÝ-ãåôáé Ýíá Üôïìï áíÜ ïéêïãÝíåéá, ïéêïäïìéêü óõ-ãêñüôçìá êáé ôåôñÜãùíï. Ôá óôïé÷åßá èá óõãêå-íôñþíïíôáé óå åéäéêü åñùôçìáôïëüãéï áðü ôïõòåñåõíçôÝò ôçò ìåëÝôçò “ÁÔÔÉÊÇ” êáé Ýðåéôá èáêùäéêïðïéïýíôáé óå âÜóç äåäïìÝíùí ðïõ ó÷åäéÜ-óèçêå ãéá ôï óêïðü áõôü. Ôá åñùôçìáôïëüãéáôçò ìåëÝôçò åßíáé åìðéóôåõôéêÜ, áðëÜ êáé ãñÞãï-ñá ðñïóðåëÜóéìá. ¼ëá ôá Üôïìá åíçìåñþíïíôáéãéá ôïõò óêïðïýò ôçò ìåëÝôçò êáé óõìöùíïýíóôï íá óõììåôÜó÷ïõí.

Äéåñåõíïýìåíïé ðáñÜãïíôåò

Ïé ðáñÜãïíôåò ðïõ äéåñåõíïýíôáé åßíáé ðá-ñÜìåôñïé ðïõ åêöñÜæïõí ôïí êáèçìåñéíü ôñüðïæùÞò, üðùò ïé êáðíéóôéêÝò óõíÞèåéåò, ç óùìáôé-êÞ Üóêçóç, äéáôñïöéêÝò óõíÞèåéåò, ðáñïõóßá Üã-÷ïõò - êáôÜèëéøçò êáèþò åðßóçò êáôáãñáöÞ óù-ìáôïìåôñéêþí êáé êïéíùíéêü-ïéêïíïìéêþí ÷áñá-êôçñéóôéêþí (ïéêïãåíåéáêÞ êáôÜóôáóç, ìïñöùôé-êü åðßðåäï, ïéêïíïìéêÞ êáé åðáããåëìáôéêÞ êáôÜ-óôáóç), ïéêïãåíåéáêïý éóôïñéêïý óôåöáíéáßáò íü-óïõ êáé ðáñáãüíôùí êéíäýíïõ. Èá êáôáãñÜöå-ôáé, åðßóçò, ç ðáñïõóßá êáé ç ôõ÷üí èåñáðåßááñôçñéáêÞò õðÝñôáóçò, óáê÷áñþäç äéáâÞôç, êáéõðåñëéðéäáéìßáò. Åðßóçò åëÝã÷åôáé ç ãíþóç ôùíáíþôåñùí öõóéïëïãéêþí åðéðÝäùí ÷ïëçóôåñüëçòêáé ç óõ÷íüôçôá ðáñáêïëïýèçóçò ôïõò. ¼ëç çäéáäéêáóßá ðñáãìáôïðïéåßôáé áðü ôçí ïìÜäá ôùíåñåõíçôþí (êáñäéïëüãïé, ðáèïëüãïé,ãåíéêïß éáôñïß,øõ÷ßáôñïé, ìéêñïâéïëüãïé, êáé äéáôñïöïëüãïé) ôçòìåëÝôçò “ÁÔÔÉÊÇ”.

Áñ÷éêÜ ðñáãìáôïðïéåßôáé êáñäéïëïãéêÞ åîÝ-ôáóç ðïõ ðåñéëáìâÜíåé ëÞøç áñôçñéáêÞò ðßåóçòêáé çëåêôñïêáñäéïãñÜöçìá 12-áðáãùãþí. ÌåôÜëáìâÜíåôáé áßìá, áöïý Ý÷åé ðñïçãçèåß 12ùñçíçóôåßá ôùí åîåôáæïìÝíùí áôüìùí, ãéá: (á) ãåíé-êÞ åîÝôáóç áßìáôïò ìå ÷ñÞóç áõôüìáôïõ áéìáôï-ëïãéêïý áíáëõôÞ Ç

1 Þ Ç

2 ôçò Medicon, (â) âéï÷ç-

ìéêü Ýëåã÷ï ðïõ ðåñéëáìâÜíåé ïõñßá, ïõñéêü ïîý,ïëéêÞ ÷ïëåñõèñßíç- Üìåóç, êñåáôéíßíç (Cr), SGOT,SGPT, ãGT, áëêáëéêÞ öùóöáôÜóç, CPK, óÜê-÷áñï, ïëéêÞ ÷ïëçóôåñüëç ïñïý (TC), HDL ÷ïëç-óôåñüëç, LDL ÷ïëçóôåñüëç, ôñéãëõêåñßäéá (TG),ìå ôç ÷ñÞóç áõôüìáôïõ âéï÷çìéêïý áíáëõôÞ RA1000 ôçò Techikon (÷ñùìáôïìåôñéêÞ åíæõìáôéêÞìÝèïäïò), (ã) ðñïóäéïñéóìü áðïëéðñùôåÀíçò (Ápo)A1 êáé Â, ëéðïðñùôåÀíçò (Lp) a, õøçëÞò åõáé-óèçóßáò (hs) C – áíôéäñþóáò ðñùôåÀíçò (CRP),éíùäïãüíïõ, ìå áõôüìáôï íåöåëüìåôñï ÂÍÉÉ ôçòDade Behring, êáé (ä) ðñïóäéïñéóìü ïìïêõóôåÀ-íçò ìå áõôüìáôï áíïóïëïãéêü áíáëõôÞ Axsymôçò Abott (ôå÷íïëïãßá ôïõ ðïëùìÝíïõ áíïóïöèï-ñéóìïý, FPIA), ïîåéäùìÝíçò LDL, ïëéêïý èñïì-âùôéêïý ðáñÜãïíôá, êáé áìõëïåéäïýò Á ïñïý.ÐáñÜëëçëá ãßíåôáé öýëáîç äåßãìáôïò óôïõò -80ï C ãéá ìåëëïíôéêÞ ÷ñÞóç êáé ãåíåôéêü Ýëåã÷ï(ìåôÜ áðü áðïìüíùóç ôïõ DNA).

ÊëéíéêÝò ðáñÜìåôñïé

Ç áñôçñéáêÞ ðßåóç ìåôñÜôáé óôï áñéóôåñü÷Ýñé (ãéá ôïõò äåîéü÷åéñåò) Ý÷ïíôáò ôá Üôïìá óåêáèéóôÞ èÝóç êáé óå Þñåìç êáôÜóôáóç. Ãßíïíôáéôñåéò ìåôñÞóåéò êáé õðïëïãßæåôáé ï ìÝóïò üñïòôïõò. Áí ãéá êÜðïéï ëüãï ç ìÝôñçóç ãßíåé óôïäåîß ÷Ýñé áõôü óçìåéþíåôáé óôï åñùôçìáôïëüãéïôïõ áôüìïõ. Åðßóçò óçìåéþíåôáé áí øçëáöþíôáòêáé ôéò äýï êåñêéäéêÝò áñôçñßåò, äéáðéóôþèçêåäéáöïñÜ óôï óöõãìü óôá äõï ÷Ýñéá, ïðüôå ìå-ôñÞèçêå ç áñôçñéáêÞ ðßåóç êáé óôï äåîß ÷Ýñé. ÇôéìÞ ôçò óõóôïëéêÞò ðßåóçò áíôéóôïé÷åß óôçí ôéìÞðïõ äåß÷íåé ôï ðéåóüìåôñï üôáí áêïõóôåß ï ðñþ-ôïò Þ÷ïò. Ç ôéìÞ ôçò äéáóôïëéêÞò ðßåóçò êáèïñß-æåôáé üôáí ï Þ÷ïò óôáìáôÞóåé íá áêïýãåôáé ñõè-ìéêüò êáé áêïýãåôáé óõíå÷üìåíïò.

ÁíèñùðïìåôñéêÝò ðáñÜìåôñïé

Ôï ýøïò ôùí áôüìùí ìåôñÜôáé ìéá öïñÜ, ÷ùñßò


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ðáðïýôóéá êáé ïé ìåôñÞóåéò óôñïããõëïðïéïýíôáéóôï ðëçóéÝóôåñï 0,5 cm ôïõ ìÝôñïõ. Ôï âÜñïòôùí áôüìùí åðßóçò ìåôñÜôáé ìéá öïñÜ, ÷ùñßò ðá-ðïýôóéá êáé ìå åëáöñÜ åóùôåñéêÞ Ýíäõóç. Ïé ìå-ôñÞóåéò óôñïããõëïðïéïýíôáé óôçí ðëçóéÝóôåñç åêá-ôïíôÜäá ãñáììáñßùí. Ï äåßêôçò ìÜæáò óþìáôïò(ÄÌÓ) õðïëïãßæåôáé óáí âÜñïò (Kg) / ýøïò2 (m).

Áðïôßìçóç ôïõ ôñüðïõ æùÞò

Ôá Üôïìá ïìáäïðïéïýíôáé ìå âÜóç ôç óùìá-ôéêÞ ôïõò äñáóôçñéüôçôá óå ôñåéò êáôçãïñßåò. Óôçíêáôçãïñßá É óõìðåñéëáìâÜíïíôáé Üôïìá ðïõ äåíáóêïýíôáé êáèüëïõ (êáèéóôéêÞ æùÞ), óôçí êáôç-ãïñßá ÉÉ áõôÜ ðïõ áóêïýíôáé ëßãï êáé óôçí êá-ôçãïñßá ÉÉÉ áõôÜ ðïõ áóêïýíôáé óõóôçìáôéêÜ. ÇêáôÜôáîç ãßíåôáé ìå âÜóç ôéò áðáíôÞóåéò ôùíáôüìùí óå áíÜëïãåò åñùôÞóåéò ó÷åôéêÝò ãéá ïðïéá-äÞðïôå ìïñöÞ óùìáôéêÞò Üóêçóçò ðïõ äåí ó÷å-ôßæïíôáé ìå ôï êýñéï åðÜããåëìá. Ïé ðëçñïöïñßåòó÷åôéêÜ ìå ôéò êáðíéóôéêÝò óõíÞèåéåò óõëëÝãïíôáéìå âÜóç ôõðïðïéçìÝíï åñùôçìáôïëüãéï ðïõ ó÷å-äéÜóôçêå ãéá ôç ìåëÝôç êáé ôï ïðïßï äéåñåõíÜ ôáÝôç êáðíßóìáôïò, ôïí çìåñÞóéï áñéèìü ôóéãÜñùí,ôá áßôéá äéáêïðÞò êáèþò åðßóçò êáé ôçí Ýêèåóçóå ðáèçôéêü êÜðíéóìá.

ÄéáôñïöéêÞ áðïôßìçóç

×ñçóéìïðïéåßôáé ôï åñùôçìáôïëüãéï ôïõ Åõ-ñùðáúêïý ÐñïãñÜììáôïò Óõíåñãáóßáò ÉáôñéêÞòêáé Êïéíùíßáò (ÅÐÉÊ) áðü ôï åñãáóôÞñéï Õãéåé-íÞò êáé Åðéäçìéïëïãßáò ôçò ÉáôñéêÞò Ó÷ïëÞò ôïõÐáíåðéóôçìßïõ Áèçíþí.

ÓôáôéóôéêÞ áíÜëõóç

Óôçí ðáñïýóá åñãáóßá ïé óõíå÷åßò ìåôáâëç-ôÝò ðáñïõóéÜæïíôáé óáí ìÝóç ôéìÞ ± ôõðéêÞ áðü-êëéóç, åíþ óôá ãñáöÞìáôá ðáñïõóéÜæïíôáé óáíìÝóç ôéìÞ êáé 95% äéÜóôçìá åìðéóôïóýíçò (ÄÅ).Ïé ðïéïôéêÝò - êáôçãïñéêÝò ìåôáâëçôÝò ðáñïõóéÜ-æïíôáé óáí áðüëõôåò êáé ó÷åôéêÝò (%) óõ÷íüôçôåò.Ïé Ýëåã÷ïé ìåôáîý óõíå÷þí êáé êáôçãïñéêþí ìå-ôáâëçôþí Ýãéíáí ìå ôç ÷ñÞóç ôïõ t-êñéôçñßïõ ôïõStudent Þ ôïõ åëÝã÷ïõ áíÜëõóçò äéáóðïñÜò (AN-OVA), áöïý ðñïçãÞèçêå Ýëåã÷ïò êáíïíéêüôçôáò.

Ïé Ýëåã÷ïé ìåôáîý ôùí êáôçãïñéêþí ìåôáâëçôþíÝãéíáí ìå ôç ÷ñÞóç ôïõ êñéôçñßïõ ×2, ÷ùñßò äéüñ-èùóç óõíÝ÷åéáò. Óõó÷åôßóåéò ìåôáîý óõíå÷þí ìå-ôáâëçôþí Ýãéíáí ìå ôç ÷ñÞóç ôïõ óõíôåëåóôÞ óõ-ó÷Ýôéóçò ôïõ Pearson. ¼ëïé ïé óôáôéóôéêïß õðïëï-ãéóìïß ðñáãìáôïðïéÞèçêáí ìå ôï ðñüãñáììá SPSS10,0 (SPSS Inc., Illinois, USA).

ÁðïôåëÝóìáôá

Óôçí ðáñïýóá áíáöïñÜ ðáñïõóéÜæïíôáé ôááðïôåëÝóìáôá áðü ôá ðñþôá 1660 Üôïìá ðïõåéóÞ÷èçóáí óôç ìåëÝôç (ôï 87% åê ôùí áôüìùíðïõ ôïõò æçôÞèçêå íá óõììåôÜó÷ïõí óôç ìåëÝ-ôç). Óýìöùíá ìå ôïõò åñåõíçôÝò ôçò ìåëÝôçò“ÁÔÔÉÊÇ” äåí ðáñáôçñÞèçêå êáìéÜ äéáöïñÜ,üóïí áöïñÜ ôï êïéíùíéêü-ïéêïíïìéêü åðßðåäï,ìåôáîý ôùí óõììåôå÷üíôùí êáé áõôþí ðïõ áñíÞ-èçêáí íá óõììåôÜó÷ïõí (Ðßíáêáò 1).

Åê ôùí 1660 áôüìùí ïé 804 (48,4%) åßíáéÜíäñåò ìÝóçò çëéêßáò 49 ± 14 åôþí (áðü 18 Ýùò89 åôþí) êáé ïé 856 (51,6%) åßíáé ãõíáßêåò ìÝ-óçò çëéêßáò 48 ± 14 åôþí (áðü 18 Ýùò 90 åôþí).Ôï 73% ôùí åñùôçèÝíôùí äÞëùóáí Ýããáìïé, ôï17% Üãáìïé êáé ïé õðüëïéðïé Þôáí äéáæåõãìÝíïé(4%) Þ ÷Þñïé (6%). Ï ìÝóïò áñéèìüò ðáéäéþí Þôáíäýï áíÜ ïéêïãÝíåéá.

Ï ðñïóáñìïóìÝíïò êáôÜ çëéêßá åðéðïëáóìüòôçò óôåöáíéáßáò íüóïõ (üðùò áõôÞ ïñßæåôáé áðüðáñïõóßá äéáôáñá÷þí éó÷áéìéêïý ôýðïõ Þ ïõëÞòðáëáéïý åìöñÜãìáôïò óôï çëåêôñïêáñäéïãñÜöç-ìá, Þ / êáé áíáöïñÜ êëéíéêïý óõíäñüìïõ ïìïéÜ-æïíôá ìå óôçèÜã÷ç Þ áíÜëïãü ôçò êáôÜ ôç ëÞøçëåðôïìåñïýò éáôñéêïý éóôïñéêïý) âñÝèçêå ßóïò ìå620 áíÜ 10000 Üíäñåò (6,2%) êáé 400 / 10000ãõíáßêåò (4,0%), åíþ ï ðñïóáñìïóìÝíïò êáôÜçëéêßá åðéðïëáóìüò ôùí áããåéáêþí åãêåöáëéêþíåðåéóïäßùí âñÝèçêå ßóïò ìå 100 / 10000 Üíäñåò(1,0%) êáé 110 / 10000 ãõíáßêåò (1,1%). Ôï 31%ôùí åñùôçèÝíôùí äÞëùóå üôé Ý÷åé ïéêïãåíåéáêüéóôïñéêü ðñþéìçò åêäÞëùóçò óôåöáíéáßáò íüóïõóå óõããåíåßò ðñþôïõ Þ äåýôåñïõ âáèìïý < 55åôþí ãéá Üíäñåò êáé < 65 åôþí ãéá ãõíáßêåò. ÏéêáðíéóôéêÝò óõíÞèåéåò üðùò áðïôõðþèçêáí êáôÜäÞëùóç ôùí óõììåôå÷üíôùí óôç ìåëÝôç ðáñïõ-óéÜæïíôáé óôïí Ðßíáêá 2 êáé áöïñïýí ôçí êáôá-íÜëùóç ôïõëÜ÷éóôïí åíüò ôóéãÜñïõ çìåñçóßùò(ôþñá Þ óôï ðáñåëèüí) êáé ãéá ÷ñïíéêü äéÜóôçìáôïõëÜ÷éóôïí åíüò Ýôïõò. Ðáñáôçñïýìå üôé ôï

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Ðßíáêáò 1. Óôñùìáôïðïßçóç, óôï ìÝ÷ñé ôþñá äåßãìá ôçò ìåëÝôçò (í = 1660 Üôïìá), áíÜ öýëï, çëéêßá êáéãåùãñáöéêÞ ðåñéï÷Þ

ÄÞìïò Áèçíáßùí Õðüëïéðï ÁôôéêÞò

¢íäñåò Ãõíáßêåò Óýíïëï ¢íäñåò Ãõíáßêåò Óýíïëï20 -29 60 65 125 20 -29 42 44 8630 -39 57 62 119 30 -39 40 42 8240 -49 48 52 100 40 -49 34 36 7050 -59 52 57 109 50 -59 37 39 7660 -69 44 47 91 60 -69 31 32 6370 -79 25 28 53 70 -79 18 19 3780+ 14 15 29 80+ 9 10 19Óýíïëï 300 326 626 Óýíïëï 211 222 433

ÄÞìïò Ðåéñáéþò ÐåñéöÝñåéá Ðåéñáéþò

¢íäñåò Ãõíáßêåò Óýíïëï ¢íäñåò Ãõíáßêåò Óýíïëï20 -29 23 24 47 20 -29 36 37 7330 -39 22 23 45 30 -39 34 36 7040 -49 18 19 37 40 -49 29 30 5950 -59 20 21 41 50 -59 31 33 6460 -69 17 17 34 60 -69 26 27 5370 -79 9 10 19 70 -79 15 16 3180+ 5 6 11 80+ 8 9 17Óýíïëï 114 120 234 Óýíïëï 179 188 367

Ðßíáêáò 2. ÊáðíéóôéêÝò óõíÞèåéåò (åíåñãïß Þ ðñþçí êáðíéóôÝò) êáé êáèéóôéêÞ æùÞ óôï äåßãìá ôçò ìåëÝôçò, áíÜöýëï êáé çëéêßá

ÇëéêéáêÞ êáôçãïñßá

ÊÜðíéóìá 20 – 29 30 – 39 40 – 49 50 – 59 60 – 69 70 – 79 80 + Óýíïëï

¢íäñåò 59% 62,1% 75,2% 72,9% 64,4% 55,2% 50% 64,7%95/161 95/153 97/129 102/140 76/118 37/67 18/36 520/804

Ãõíáßêåò 46,5% 53,4% 49,6% 42,7% 34,1% 9,5% 0% 40,5%79/170 87/163 68/137 64/150 42/123 7/73 0/40 347/856

ÊáèéóôéêÞ æùÞ

¢íäñåò 49,1% 60,1% 72,1% 56,4% 51,7% 40,3% 38,9% 55,3%79/161 92/153 93/129 79/140 61/118 27/67 14/36 445/804

Ãõíáßêåò 62,4% 62,0% 70,8% 60,7% 62,6% 59,9% 57,5% 62,8%106/170 101/163 97/137 91/150 77/123 43/73 23/40 538/856

64,6% (520/804) ôùí áíäñþí êáé ôï 40,5% (347/856) ôùí ãõíáéêþí äÞëùóáí üôé åßíáé Þ õðÞñîáíêáðíéóôÝò (p < 0,01). To 55,3% (445/804) ôùíáíäñþí êáé ôï 62,8% (538/856) ôùí ãõíáéêþíäÞëùóáí üôé äåí ãõìíÜæïíôáé ïýôå ìéá öïñÜ ôçíåâäïìÜäá (p < 0,01) (Ðßíáêáò 2).

Ôï ÄéÜãñáììá 1 ðáñïõóéÜæåé ôçí êáôáíïìÞôïõ äåßêôç ìÜæáò óþìáôïò óôïõò Üíäñåò êáé óôéòãõíáßêåò ôïõ äåßãìáôïò. Óôï ãñÜöçìá áõôü öáß-íåôáé ç êáìðõëïåéäÞò ó÷Ýóç ôïõ ÄÌÓ ìå ôçíçëéêßá, ôüóï óôïõò Üíäñåò üóï êáé óôéò ãõíáßêåò.Óôéò ìéêñÝò êáé ìÝóåò çëéêéáêÝò ïìÜäåò åðéâå-âáéþíåôáé ç äéáöïñÜ ìåôáîý áíäñþí êáé ãõíáé-êþí óôçí ðñïóáñìïóìÝíç óùìáôéêÞ ìÜæá, ãåãï-

íüò ðïõ öáßíåôáé íá áíáéñåßôáé óôéò ìåãáëýôåñåòçëéêßåò. ¸íá Üëëï ìÝôñï áíèñùðïìåôñéêþí ÷á-ñáêôçñéóôéêþí åßíáé ï ëüãïò ôçò ðåñéöÝñåéáò ìÝ-óçò ðñïò ôçí ðåñéöÝñåéá ôùí ãïöþí, êáé ï ïðïßïòðåñéãñÜöåôáé óôï ÄéÜãñáììá 2.

Ï åðéðïëáóìüò ôçò áñôçñéáêÞò õðÝñôáóçò(ÓÁÐ / ÄÁÐ > 140 / 90 mm Hg Þ åéäéêÞ áíôé-õðåñôáóéêÞ áãùãÞ) Þôáí 38,5% óôïõò Üíäñåò êáé24,1% óôéò ãõíáßêåò ôçò ìåëÝôçò (p < 0,05). Åêôùí õðåñôáóéêþí ôï 38% áêïëïõèåß åéäéêÞ äéáé-ôçôéêÞ áãùãÞ êáé ôï 74% ðáßñíåé åéäéêÜ áíôé-õðåñôáóéêÜ öÜñìáêá. Óôï ÃñÜöçìá 3 ðáñïõóéÜ-æïíôáé ïé ìÝóåò ôéìÝò óõóôïëéêÞò êáé äéáóôïëéêÞòáñôçñéáêÞò ðßåóçò. Áðü ôá ãñáöÞìáôá ãßíåôáé


62


åìöáíÞò ç èåôéêÞ ó÷Ýóç ìå ôçí çëéêßá (p < 0,01),êáèþò åðßóçò êáé ç äéáöïñÜ ìåôáîý ôùí äýïöýëùí, êõñßùò, ìÝ÷ñé ôçí çëéêßá ôùí 55 åôþí(ÄéÜãñáììá 3).

Ï óáê÷áñþäçò äéáâÞôçò åðéðüëáæå óå ðïóï-óôü 8% åê ôùí áíäñþí êáé 7% åê ôùí ãõíáéêþíôçò ìåëÝôçò (p = 0,43). Åðßóçò, ôï 6% ôùí áí-äñþí êáé ôï 7% ôùí ãõíáéêþí åß÷áí äéáôáñá÷Þôçò ãëõêüæçò íçóôåßáò (ãëõêüæç ïñïý 110 – 125mg/dl). Ôá äéáâçôéêÜ Üôïìá ñýèìéæáí ôï óÜê÷á-ñï ôïõò ìå åéäéêÞ äéáôñïöÞ (70%), ëÞøç äéóêßùí(64%) Þ / êáé ÷ïñÞãçóç éíóïõëßíçò (16%). Ôï27% ôùí äéáâçôéêþí åß÷å ïéêïãåíåéáêü éóôïñéêüóáê÷áñþäïõò äéáâÞôç (p < 0,001). Ôï 39% ôùíáíäñþí êáé 37% ôùí ãõíáéêþí åß÷áí õðåñ÷ïëç-óôåñïëáéìßá (ïëéêÞ ÷ïëçóôåñüëç ïñïý > 220 mg/dl Þ åéäéêÞ õðïëéðéäáéìéêÞ áãùãÞ) (p = 0,15).ÔÝëïò, áîéïóçìåßùôï åßíáé üôé 44% ôùí áíäñþíêáé 25% ôùí ãõíáéêþí åß÷áí ôïõëÜ÷éóôïí ôñåéòáðü ôïõò êëáóóéêïýò ðáñÜãïíôåò êéíäýíïõ (õðÝñ-ôáóç, õðåñ÷ïëçóôåñïëáéìßá, óáê÷áñþäç äéáâÞ-ôç, êáðíéóôéêÝò óõíÞèåéåò êáé êáèéóôéêÞ æùÞ)).Ïé ìÝóåò ôéìÝò ôùí äéåñåõíïýìåíùí âéï÷çìéêþíäåéêôþí, üðùò áõôÝò ìåôñÞèçêáí êáôÜ ôïí åñãá-óôçñéáêü Ýëåã÷ï, ðáñïõóéÜæïíôáé óôïí Ðßíáêá 3.

Ç óôáôéóôéêÞ áíÜëõóç Ýäåéîå üôé ïé ôéìÝò ôùíôñéãëõêåñéäßùí, ôçò ãëõêüæçò ïñïý êáé ôùí áðïëé-ðïðñùôåúíþí äéÝöåñáí óçìáíôéêÜ ìåôáîý ôùíöýëùí (p < 0,01). Åðßóçò ÷áñáêôçñéóôéêü åßíáéüôé ôï 45% ôùí åñùôçèÝíôùí äåí ãíþñéæå ðïéåòðñÝðåé íá åßíáé ïé öõóéïëïãéêÝò ôéìÝò ôçò ÷ïëçóôå-ñüëçò, åíþ ôï 21% áðÜíôçóå ëáíèáóìÝíá óôçíáíôßóôïé÷ç åñþôçóç ðïõ ôïõò ôÝèçêå (>220 mg/

Çëéêßá (Ýôç)

> 7565 - 7555 - 6545 - 5535 - 45< 35

¢íäñåò

Ãõíáßêåò


> 7565 - 7555 - 6545 - 5535 - 45< 35

ÄÁ

Ð (

95

% Ä

Å)

100

90

80

70

60

¢íäñåò

Ãõíáßêåò

ÄéÜãñáììá 3. ÓõóôïëéêÞ êáé äéáóôïëéêÞ áñôçñéáêÞ ðßåóç (mm Hg) áíÜ öýëï êáé çëéêßá.


> 7565 - 7555 - 6545 - 5535 - 45< 35

ÄÌ

Ó (

Kg

/m2

) -

95

% Ä

Å

31

30

29

28

27

26

25

24

23

22

21

¢íäñåò

Ãõíáßêåò


> 7565 - 7555 - 6545 - 5535 - 45< 35

Wa

ist-

to-h

ip (

95

% Ä

Å)

1,0

,9

,8

,7

¢íäñåò

Ãõíáßêåò

ÄéÜãñáììá 2. Ëüãïò ðåñéöÝñåéáò ìÝóçò – ðåñéöÝñåéáò ãïöþí áíÜöýëï êáé çëéêßá.

ÄéÜãñáììá 1. Äåßêôçò ìÜæáò óþìáôïò (Kg / m2) áíÜ öýëï êáéçëéêßá.

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Ðßíáêáò 3. Äåßêôåò êåíôñéêÞò ôÜóçò êáé äéáóðïñÜò ôùí âáóéêþí ëéðéäßùí êáé óáê÷Üñïõ, êáèþò åðßóçò êáéäåéêôþí öëåãìïíÞò êáé èñüìâùóçò óôï äåßãìá ôçò ìåëÝôçò

ÌÝóç ÔõðéêÞ ÔåôáñôçìüñéáôéìÞ áðüêëéóç

25% ÄéÜìåóïò 75%

¢íäñåò

ÏëéêÞ ÷ïëçóôåñüëç ïñïý (mg/dl) 215,5 46,9 181,0 213,8 243,8Ôñéãëõêåñßäéá (mg/dl) 157,1** 116,8 92,0 127,0 188,0Ãëõêüæç ïñïý (mg/dl) 96,7** 38,4 82,0 91,0 101,0HDL – ÷ïëçóôåñüëç (mg/dl) 44,3** 18,0 35,0 41,0 50,0Lp (a) 18,3** 22,3 4,5 10,6 22,5APO-Á1 141,3** 26,4 128,0 140,0 154,0APO-B 118,6** 30,8 95,2 119,0 141,0Éíùäïãüíï (mg/dl) 306,4** 74,3 258,0 297,0 348,0Ïìïêõóôåßíç (ìMol/l) 14,8** 6,8 11,1 13,1 16,5hs -CRP (mg/dl) 2,3 3,5 0,6 1,2 2,5

Ãõíáßêåò

ÏëéêÞ ÷ïëçóôåñüëç ïñïý (mg/dl) 213,9 44,0 182,9 211,1 241,1Ôñéãëõêåñßäéá (mg/dl) 111,4 62,0 71,5 100,0 137,0Ãëõêüæç ïñïý (mg/dl) 90,6 21,1 79,0 86,0 96,2HDL – ÷ïëçóôåñüëç (mg/dl) 52,3 14,7 42,0 52,0 61,0Lp (a) 20,2 26,5 4,5 11,4 23,9APO-Á1 160,1 59,2 142,0 158,0 174,0APO-B 109,0 53,8 85,9 106,0 125,0Éíùäïãüíï (mg/dl) 341,2 214,3 279,0 318,0 367,0Ïìïêõóôåßíç (ìMol/l) 10,5 3,4 8,3 10,1 12,5hs - CRP (mg/dl) 2,3 3,2 0,4 1,2 2,8

äéáóìüò êáé ôá ðñþôá áðïôåëÝóìáôá ôçò åðéäç-ìéïëïãéêÞò ìåëÝôçò “ÁÔÔÉÊÇ” ó÷åôéêÜ ìå äéÜ-öïñïõò ôåêìçñéùìÝíïõò áëëÜ êáé áíáäõüìåíïõòðáñÜãïíôåò êáñäéáããåéáêïý êéíäýíïõ. Áîéïóçìåßù-ôï åßíáé üôé 44% ôùí áíäñþí êáé 25% ôùí ãõ-íáéêþí åß÷áí ôïõëÜ÷éóôïí ôñåéò áðü ôïõò êëáóé-êïýò ðáñÜãïíôåò êéíäýíïõ (õðÝñôáóç, õðåñ÷ïëç-óôåñïëáéìßá, óáê÷áñþäç äéáâÞôç, êáðíéóôéêÝòóõíÞèåéåò êáé êáèéóôéêÞ æùÞ).

Åßíáé ôåêìçñéùìÝíïò ï ñüëïò ôïõ êáðíßóìá-ôïò óôçí êáñäéáããåéáêÞ íüóï áðü ðïëëÝò ðëçèõ-óìéáêÝò ìåëÝôåò ðáñáôÞñçóçò, åíþ óõíå÷þò ðëç-èáßíïõí ïé åíäåßîåéò ãéá ôç óõììåôï÷Þ êáé ôïõðáèçôéêïý êáðíßóìáôïò óôïí êßíäõíï óôåöáíéáßáòíüóïõ êáé ãåíéêüôåñá áèçñïóêëçñõíôéêÞò íüóïõ5-7.Ç óõ÷íüôçôá ôïõ åíåñãïý êáðíßóìáôïò âñÝèçêåêáé óôç ìåëÝôç ìáò åîáéñåôéêÜ õøçëÞ åðéâåâáéþ-íïíôáò ðñüóöáôç åðéäçìéïëïãéêÞ ìåëÝôç8, áëëÜêáé óôïé÷åßá Üëëùí öïñÝùí, üðùò ôçò ÅëëçíéêÞòÁíôéêáñêéíéêÞò Åôáéñåßáò, ôá ïðïßá öÝñíïõí ôç÷þñá ìáò óôéò ðñþôåò èÝóåéò óôçí êáôáíÜëùóçôóéãÜñùí óôçí Åõñþðç. ¸ôóé ç äéáêïðÞ ôïõêáðíßóìáôïò, áëëÜ êáé ç ðñïóôáóßá áðü ôçí Ýê-

dl). Ôï 58% ôùí áôüìùí äÞëùóå üôé ðáñáêïëïõ-èåß ôéò ôéìÝò ôùí ëéðéäßùí ôïõ ìå ôáêôéêÝò åðéóêÝ-øåéò (åôÞóéåò Þ áíÜ äéåôßá) óôá ìéêñïâéïëïãéêÜéáôñåßá. Óôï ÄéÜãñáììá 4 ðáñïõóéÜæåôáé ç ó÷Ýóçôçò ïëéêÞò ÷ïëçóôåñüëçò, ôùí ôñéãëõêåñéäßùí, ôïõóáê÷Üñïõ êáé ôçò Lp(a) ìå ôçí çëéêßá ôùí áôü-ìùí ôçò ìåëÝôçò (p < 0,01) (ÄéÜãñáììá 4).

ÔÝëïò, ï Ðßíáêáò 4 ðáñïõóéÜæåé ìéá áäñÞåéêüíá ôùí äéáôñïöéêþí óõíçèåéþí ôùí áíäñþíêáé ãõíáéêþí ôçò ìåëÝôçò. Ç óõíôñéðôéêÞ ðëåéï-øçößá ôùí åñùôçèÝíôùí (95%) äÞëùóå üôé ÷ñç-óéìïðïéåß åëáéüëáäï óôçí êáèçìåñéíÞ ìáãåéñéêÞåíþ 41% ôùí áíäñþí êáé 12% ôùí ãõíáéêþíêáôáíáëþíïõí ìéêñÝò ðïóüôçôåò êñáóéïý, óõíÞ-èùò ìáæß ìå ôá ãåýìáôá. ÔÝëïò ôï 84% ôùí áí-äñþí êáé ôï 55% ôùí ãõíáéêþí ÷ñçóéìïðïéïýíÝôïéìï öáãçôü (fast food, øçôïðùëåßá ê.ë.ð) ôïõ-ëÜ÷éóôïí ìéá öïñÜ ôçí åâäïìÜäá.

ÓõæÞôçóç

Óôçí åñãáóßá áõôÞ ðáñïõóéÜóèçêáí ï ó÷å-


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400

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Lp

(a)

200

175

150

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100

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25

0

r = 0.33, p < 0.001r = 0.23, p < 0.001

r = 0.22, p < 0.001r = 0.06, p = 0.003

ÄéÜãñáììá 4. ÔéìÝò ïëéêÞò ÷ïëçóôåñüëçò (mg/dl), ôñéãëõêåñéäßùí (mg/dl), óáê÷Üñïõ (mg/dl) êáé Lp(a) (mg/dl), êáé çëéêßá ôùí áôüìùí ôçòìåëÝôçò.

êáðíßóìáôïò óôéò íåáñÝò ãõíáßêåò (Ðßíáêáò 2).Ç âëáðôéêÞ åðßäñáóç ôïõ êáðíßóìáôïò ó÷åôßæå-ôáé âÝâáéá ìå ôïí áñéèìü ôùí ôóéãÜñùí êáé ôçí÷ñïíéêÞ äéÜñêåéá ôïõ êáðíßóìáôïò, åíäå÷ïìÝíùòüìùò ðñÝðåé íá áíáìÝíåôáé áýîçóç ôçò åðßðôù-óçò ôçò óôåöáíéáßáò íüóïõ ôá åðüìåíá ÷ñüíéá,éäéáßôåñá óôéò ãõíáßêåò ìÝóçò çëéêßáò, ôüôå äçëá-äÞ ðïõ äåí èá õößóôáôáé ç ó÷åôéêÞ ðñïóôáóßáôïõ ãõíáéêåßïõ öýëïõ áðü ôç óôåöáíéáßá íüóïëüãù ôçò åììçíüðáõóçò8.

Åßíáé ãíùóôüò ï ñüëïò ôçò ðá÷õóáñêßáò –êåíôñéêïý ôýðïõ - óôïí êáñäéáããåéáêü êßíäõíï9- 11,áíåîÜñôçôá áðü Üëëïõò ðáñÜãïíôåò êéíäýíïõ. Óåíåüôåñåò çëéêßåò ç áýîçóç ôïõ âÜñïõò õðïäçëþ-íåé áíèõãéåéíÝò óõíÞèåéåò óôïí ôñüðï æùÞò ôùíáôüìùí, üðùò êÜðíéóìá êáé êáèéóôéêÞ æùÞ12–14.Ç õéïèÝôçóç áêüìá êáé Þðéáò óùìáôéêÞò äñá-

Ðßíáêáò 4. ÌÝóç åâäïìáäéáßá êáôáíÜëùóç (ãåýìáôá)äéáöüñùí ôñïöþí, áíÜ öýëï

¢íäñåò Ãõíáßêåò

Êüêêéíï êñÝáò 2,1 ± 1.4 1,7 ± 1,2Êïôüðïõëï 1,3 ± 0.8 1,3 ± 0,8ØÜñé 1,3 ± 0.9 1,4 ± 1,0¼óðñéá 1,4 ± 0.9 1,3 ± 1,0Ëá÷áíéêÜ 2,1 ± 1.6 2,3 ± 1,7ÆõìáñéêÜ 1,8 ± 1.7 1,7 ± 1,3ÓáëÜôåò 5,5 ± 2.0 5,6 ± 2,1Öñïýôá (çìåñçóßùò) 2,0 ± 1.9 2,1 ± 1,8

èåóç óå êáðíü ôïõ ðåñéâÜëëïíôïò, ðñÝðåé íá áðï-ôåëÝóåé åðéôáêôéêü óôü÷ï ðáñÝìâáóçò ôùí ãéá-ôñþí ðñïò ôïõò áóèåíåßò, åßôå óå åðßðåäï ðñùôï-ãåíïýò åßôå äåõôåñïãåíïýò ðñüëçøçò. Áîßæåé éäéáß-ôåñçò ðñïóï÷Þò ç áõîçìÝíç óõ÷íüôçôá åíåñãïý

, ,

, ,

65


óôçñéüôçôáò áðü Üôïìá ìåãÜëùí çëéêéþí öáßíå-ôáé íá Ý÷åé åõíïúêÜ áðïôåëÝóìáôá óôç ìåßùóçôïõ óùìáôéêïý âÜñïõò (åëÜôôùóç äåßêôç ìÜæáòóþìáôïò êáé åëÜôôùóç ëüãïõ ìÝóç ðñïò ðåñéöÝ-ñåéá), óôçí åëÜôôùóç ôçò ïëéêÞò ÷ïëçóôåñüëçòêáé óôçí ñýèìéóç ôçò áñôçñéáêÞò õðÝñôáóçò êáéóôá äýï öýëá12. Ôá ðáñáðÜíù áðïôõðþíïíôáéóáöÝóôåñá óôéò çëéêéáêÝò ïìÜäåò ìå õøçëü åðß-ðåäï óùìáôéêÞò äñáóôçñéüôçôáò. Äõóôõ÷þò êáéóôçí åëëçíéêÞ êïéíùíßá ðëÝïí, åëÜ÷éóôá åßíáé ôáåðáããÝëìáôá ðïõ óõíïäåýïíôáé Þ êáé áðáéôïýíóùìáôéêÞ äñáóôçñéüôçôá. ¼ðùò öáßíåôáé áðü ôïíÐßíáêá 2 óçìáíôéêüôáôï ðïóïóôü áíäñþí êáéãõíáéêþí, áêüìá êáé íÝùí, äÞëùóå áðïõóßá óù-ìáôéêÞò äñáóôçñéüôçôáò. ̧ ôóé ç ìüíç ëýóç åßíáéç áîéïðïßçóç ôïõ åëåýèåñïõ ÷ñüíïõ, ìå ðñïãñÜì-ìáôá áåñïâéêÞò Üóêçóçò ðñïóáñìïóìÝíá, öõóé-êÜ, óôçí çëéêßá, óôï öýëï êáé óôï áôïìéêü éóôï-ñéêü ôùí áôüìùí.

Ç óçìáóßá ôçò áñôçñéáêÞò õðÝñôáóçò ùòðáñÜãùí êéíäýíïõ óôåöáíéáßáò íüóïõ óå Üíäñåòêáé ãõíáßêåò åßíáé Þäç ãíùóôÞ áðü ðïëëÝò åðéäç-ìéïëïãéêÝò ìåëÝôåò15–17. ÐáñÜ ôéò ðñïüäïõò ðïõÝ÷ïõí ãßíåé ôá ôåëåõôáßá ÷ñüíéá óôç öáñìáêåõôé-êÞ áíôéìåôþðéóç ôçò õðÝñôáóçò, äéáðéóôþíåôáéäõóêïëßá óôç óùóôÞ ñýèìéóç ôùí áóèåíþí, åíþç õãéåéíï-äéáéôçôéêÞ áãùãÞ õðïëåßðåôáé óçìáíôé-êÜ17–19. Åðßóçò ðáñüëç ôçí ðñïóðÜèåéá ãéá åíç-ìÝñùóç, ðïëëïß Üíèñùðïé äåí ãíùñßæïõí üôé ðÜ-ó÷ïõí áðü õðÝñôáóç, êáé áðü áõôïýò ðïõ ôïãíùñßæïõí ðïëý ëßãïé ôç ñõèìßæïõí ôåëéêÜ17. Ðá-ñüìïéá óôïé÷åßá ðñïÝêõøáí êáé áðü ôï äåßãìáôçò ìåëÝôçò ìáò. ÕðÜñ÷ïõí ðëçèõóìéáêÝò ìåôá-áíáëýóåéò êáé åðéäçìéïëïãéêÝò ìåëÝôåò ðïõ êáèï-ñßæïõí ìå éêáíïðïéçôéêü ôñüðï ôçí õðåñ-ôñéãëõ-êåñéäáéìßá óáí ðáñÜãïíôá óôåöáíéáßïõ êéíäý-íïõ20,21 áí êáé äå ëåßðïõí êáé ìåëÝôåò êõñßùòðïëõðáñáãïíôéêÝò ðïõ äåí äåß÷íïõí óáöÞ óõó÷Ý-ôéóç22,23. Ç ìÝóç ôéìÞ ïëéêÞò ÷ïëçóôåñüëçò êáéôñéãëõêåñéäßùí ôùí áôüìùí ôçò ìåëÝôçò ìáò åß-íáé óáöÝóôáôá õøçëüôåñåò ôùí áíôßóôïé÷ùí Áìå-ñéêáíþí åíçëßêùí24, ãåãïíüò ðïõ äýóêïëá åîç-ãåßôáé áðü ôéò äéáöïñåôéêÝò äéáôñïöéêÝò óõíÞ-èåéåò ìåôáîý ôùí ðëçèõóìþí. Åðßóçò, ïé ãõíáßêåòôïõ äåßãìáôïò åìöáíßæïõí õøçëüôåñåò ôéìÝò ApoA-1 êáé ÷áìçëüôåñåò Apo-B áðü ôïõò Üíäñåò,óôïé÷åßá ðïõ óõíçãïñïýí óå ÷áìçëüôåñï êßíäõíïôùí ãõíáéêþí ãéá êáñäéáããåéáêÝò ðáèÞóåéò14.ÔÝëïò, üðùò ðáñáôçñÞèçêå êáé áðü ôçí ðáñïý-óá ìåëÝôç áëëÜ êáé ôç äéåèíÞ âéâëéïãñáößá, ðá-

ñáôçñåßôáé áýîçóç ôçò áñôçñéáêÞò õðÝñôáóçò êáéôçò ÷ïëçóôåñßíçò áðü ôçí çëéêßá ôçò åììçíüðáõ-óçò äçë. ôï 45 Ýôïò êáé Ýðåéôá. Óôéò Ç.Ð.Á Üíùôïõ 50% ôùí ãõíáéêþí ìåãáëýôåñùí ôùí 55 åôþíÝ÷ïõí åðßðåäá ÷ïëçóôåñüëçò ìåãáëýôåñá ôùí 240mg/dl30.

Ôá ôåëåõôáßá ÷ñüíéá ôåêìçñéþíåôáé óõíå÷þò,áí êáé õðÜñ÷ïõí êáé áíôßèåôåò áðüøåéò, ï ñüëïòôçò ïìïêõóôåÀíçò óáí áíåîÜñôçôïò êáé éó÷õñüòðáñÜãïíôáò êáñäéáããåéáêïý êéíäýíïõ25-30. ÕðÜñ-÷ïõí ðåéñáìáôéêÜ äåäïìÝíá ãéá ôïõò ðéèáíïýòìç÷áíéóìïýò äñÜóçò ôçò óôçí áèçñùìáôéêÞ ðëÜ-êá, åíþ ïé åñåõíçôÝò öáßíåôáé íá óõìöùíïýí óåöõóéïëïãéêÝò ôéìÝò ôçò êÜôù ôùí 10ìMol/lt25.Áðü ôá ìÝ÷ñé ôþñá äåäïìÝíá ôçò ìåëÝôçò “ÁÔ-ÔÉÊÇ”31 ðñïêýðôïõí õøçëÝò ôéìÝò ïìïêõóôåÀíçò,óôïé÷åßï ðïõ åßíáé ðåñéóóüôåñï ðéèáíü íá ïöåß-ëåôáé óå áðïõóßá âéôáìßíçò B12 êáé öõëëéêïýïîÝïò áðü ôç äéáôñïöÞ ôïõ ðëçèõóìïý ôçò ìåëÝ-ôçò, ðáñÜ óå ãåíåôéêü õðüâáèñï. Óôïõò áíáäõü-ìåíïõò ðáñÜãïíôåò áíÞêïõí êáé ïé ôéìÝò ôçò C –áíôéäñþóáò ðñùôåÀíçò êáé ôïõ éíùäïãüíïõ. Óôçíðáñïýóá åñãáóßá ðáñáôçñïýíôáé áõîçìÝíåò ôé-ìÝò CRP óå ó÷Ýóç ìå Üëëåò äéåèíåßò ìåëÝôåò. Áõôüèá ðñÝðåé íá åîåôáóèåß ðåñáéôÝñù, êáé ìå ôçíïëïêëÞñùóç ôïõ äåßãìáôïò, ãéá ðéèáíÝò ãåíåôé-êÝò, äéáôñïöéêÝò, Þ êáé Üëëåò óõó÷åôßóåéò ìå ôéòôéìÝò ôçò CRP Þ ôïõ éíùäïãüíïõ.

Ôá óôïé÷åßá ðïõ ðáñïõóéÜóèçêáí áðïôåëïýíôá ðñþôá ôçò ìåëÝôçò “ÁÔÔÉÊÇ” êáé åíäå÷ïìÝ-íùò íá ôñïðïðïéçèïýí, ìåñéêþò, ìÝ÷ñé ôçí ïëï-êëÞñùóç ôçò äåéãìáôïëçðôéêÞò äéáäéêáóßáò. Ðá-ñüëá áõôÜ, ôï ãåãïíüò üôé ôï 44% ôùí áíäñþíêáé ôï 25% ôùí ãõíáéêþí åß÷áí ôïõëÜ÷éóôïí ôñåéòáðü ôïõò êëáóéêïýò ðáñÜãïíôåò êéíäýíïõ, êáèþòåðßóçò êáé ç óçìáíôéêÞ Ýëëåéøç êáôÜëëçëçò áãù-ãÞò, ðñÝðåé íá áíçóõ÷Þóïõí éäéáßôåñá ôïõò öï-ñåßò ðïõ åìðëÝêïíôáé óôá ðñïãñÜììáôá ðñüëç-øçò ôçò äçìüóéáò õãåßáò.

Åõ÷áñéóôßåò

Ïé óõããñáöåßò åðéèõìïýí íá åõ÷áñéóôÞóïõíôá õðüëïéðá óôåëÝ÷ç ôçò ïìÜäáò “ÁÔÔÉÊÇ” (ÅöçÔóåôóÝêïõ, Óðýñï Âåëëßá, ËÜìðñï Ðáðáäçìç-ôñßïõ, Êáôåñßíá Ãéáííáêïðïýëïõ, Ãéþñãï Ìðåëå-ãñßíï, Íôßíá Ìáóïýñïõ, Áíáóôáóßá Êáôçíéþôç,ÅììáíïõÞë Ïéêïíüìïõ, ÊÜñìåí ÂáóéëåéÜäïõ, ÓßáÐïõëïðïýëïõ, ×ñõóïýëá Ôóåëßêá, Ìáíþëç ÊÜ-


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ìðáîç, Êùíóôáíôßíá ÐÜëéïõ, êáé Ìáñßá Ôïý-ôïõæá) ãéá ôçí ïõóéáóôéêÞ êáé áíåêôßìçôç óõì-âïëÞ ôïõò óôç ìÝ÷ñé ôþñá äéåîáãùãÞ ôçò ìåëÝ-ôçò.

Âéâëéïãñáößá

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2. Moulopoulos SD, Adamopoulos PN, Diamanto-poulos EI, Nanas SN, Anthopoulos LN, Iliadi-Alexandrou M. Coronary heart diseas risk fac-tors in a random sample of Athenian adults.The Athens Study. Am J Epidemiod, 126:882-892, 1987.

3. Kalandidi A, Tzonou A, Toupadaki N, Lan SJ,Koutis C, Drogari P, Notara V, Hsieh CC, Tout-ouzas P, Trichopoulos D. A case-control studyof coronary heart disease in Athens, Greece.Int J Epidemiol, 21:1074-1080, 1992.

4. Pitsavos C, Skoumas J, Dernellis J, Doulalas A,Stefanadis C, Toutouzas P. Influence of biolog-ical factors on lipid and fibrinogen measure-ments in young men. An epidemiological studyin 2009 recruits. Eur Heart J, 19:1642-1647,1998.

5. Dwyer JH :Exposure to environmental tobaccosmoke and coronary risk. Circulation, 96:1403-1407, 1997.

6. Liam TH, He Y. Passive smoking and coronaryheart disease: a brief review. Clin Exp Pharma-col Physiol, 24:993-996, 1997.

7. Panagiotakos D.B., Chrysohoou C, Pitsavos C,Papaioannou I, Skoumas J, Stefanadis C, Tout-ouzas P.K.. The association between secondhandsmoke and the risk of developing acute coro-nary syndromes, among non-smokers, under thepresence of several cardiovascular risk factors:the CARDIO2000 case-control study. BMCPublic Health, 2:9, 2002.

8. Panagiotakos DB, Pitsavos C, Chrysohoou C,Stefanadis C, Toutouzas PK. Risk Stratificationof Coronary Heart Disease through Establishedand Emerging Lifestyle Factors, In A Mediter-ranean Population: CARDIO2000 Epidemiolog-ical Study. J Cardiovasc Risk, 8:6: 329-335,2001.

9. Rimm EB, Stampfer MJ, Giovanucci E. et al.Body size and fat distribution as predictors ofcoronary heart disease among middle-aged andolder US men.Am J Epidemiol, 141:1117-1127,1995.

10. Folsom AR, Kaye SA, Sellers TA, et al. Bodyfat distribution and 5-year risk of death in old-er women. JAMA, 269:483-487 1993.

11. Larsson B. Obesity and body fat distribution aspredictors of coronary heart disease. In : Mar-mot M, Elliot P, Eds. Coronary heart diseaseepidemiology. From aetiology to public health.Oxford University Press, 1992, pp 233-241.

12. Paffenbarger Jr R, Hyde RT, Wing Al, Lee I-Mlu, Jung DL, Kampert JB: The association ofchanges in physical activity level and otherlifestyle characteristics with mortality amongmen. N Engl Med, 328:538-545, 1993.

13. Blair SN. Changes in physical fitness and allcause mortality: a prospective study of healthand unhealthy men. JAMA, 73:1093-1098, 1995.

14. Labarthe D. Epidemiology and Prevention ofCardiovascular disease. A global challenge.Maryland, An Aspen Publications, 1998, 167-367.

15. Prevention of coronary heart disease in clinicalpractice. European Heart Journal, 19, 1434-1503, 1998.

16. Joint National Committee on Detection, Evalu-ation and Treatment of High Blood Pressure.The fifth report of the joint National Commit-tee on Detection. Evaluation and Treatment ofHigh Blood Pressure (JNC-V). Arch Intern Med,153:154-183, 1993.

17. Burt VL, Culter JA, Higgins MN. Trends inprevalence, awareness, treatment and controlof hypertension in the adult US population:data from the health examination surveys, 1960to 1991. Hypertension, 26:60-69, 1995.

18. Williams GH. Assessing Patient Wellness: NewPerspectives on Quality of Life and Compli-ance. Am J Hypertens, 11:186S-191S 1998.

19. Panagiotakos DB, Chrysohoou C, Pitsavos C,Tzioumis K, Papaioannou I, Stefanadis C, Tout-ouzas PK. The Association Of MediterraneanDiet With Lower Risk Of Acute Coronary Syn-dromes, In Hypertensive Subjects. Int J Cardi-ol, 82:141-147, 2002.

20. Bainton D, Miller NE, Bolton CH, Yarnell JWG,Sweetnam PM, Baker IA, Lewis R, ElwoodPC. Plasma triglyceride and high-density lipo-protein cholesterol as predictors of ischaemicheart disease in British men. Br Heart J, 68:60-66, 1992

21. Stampfer MJ, Krauss RM, Ma J et al. A pro-spective study of triglycerides, LDL particlediameter and risk of myocardial infarction. JAm Med Assoc, 276:882-888, 1996.

22. Jeppesen J, Hein HO, Suadicani P, Gyntelberg

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F. Triglyceride concentration and ischemic heartdisease. An eight –year follow –up in the Copen-hagen Male Study. Circulation, 97:1029-1036,1998.

23. US Department of Health and Human Servic-es, Public Health Service, The lipid researchclinics population studies: the prevalence study,data book, vol.1, 1980 Bethesda. (Report NoUSDHHS/NIH/ 80-1527).

24. Austin MA. Plasma triglycerides as a risk fac-tor for coronary heart disease: the epidemiolog-ic evidence and beyond. Am J Epidemiol,129:249-259, 1989.

25. Boushey CJ, Beresford SAA, Omenn GS, et al.A quantitative assessment of plasma homocys-teine as a risk factor for vascular disease prob-able benefits of increasing folic acid intakes.JAMA, 274:1049-1057, 1995.

26. McCully KS. Vascular pathology of homocys-

teinemia: implications for the pathogenesis ofarteriosclerosis. Am J Pathol, 56:111-128, 1969.

27. Berger PB. Homocysteine and coronary arterydisease. ACC Educational Highlights, 1-5, 1998.

28. Folson AR, Nieto FJ, McGovern PG. Prospec-tive study of coronary heart disease incidencein relation to fasting total homocysteine relatedgenetic polymorphisms and vitamins D. TheAtherosclerosis Risk in Communities (ARIC)Study. Circulation, 98:204-210, 1998.

29. Wong N, Black H, Gardin J. Preventive Cardi-ology. Mc Graw-Hill Co 2000.

30. Miller NH, Hill M, Kottke T, et al. The multi-level compliance challenge: recommendationsfor a call to action. Circulation 1997: 95:1085-1090.

31. Pitsavos C.E., Toutouzas P.K. Cardiovascular RiskFactors Profile. in Greece: Results from CAR-DIO2000 and ATTICA epidemiological stud-ies. Current Med Res Opinion 2000.

ÊÁÔÁ×ÙÑÇÓÅÉÓ ÔÙÍ ÅÑÃÁÓÉÙÍ ÔÏÕ ÐÅÑÉÏÄÉÊÏÕ"ÐÑÙÔÏÂÁÈÌÉÁ ÖÑÏÍÔÉÄÁ ÕÃÅÉÁÓ"

Ôá ðåñéå÷üìåíá ôïõ Ðåñéïäéêïý "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò"Êáôá÷ùñïýíôáé óôçí çëåêôñïíéêÞ âÜóç äåäïìÝíùí Index Copernicus

http://indexcopernicus.org.

Ç "ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò" åðßóçò óõãêáôáëÝãåôáéóôá ÅëëçíéêÜ ÐåñéïäéêÜ ìå "ÅèíéêÞ Áíáãíþñéóç"

(Õð. Áðüö. ÖÅÊ áñ. öýëëïõ 972/27 Íïåìâñßïõ 1999 Ô.Â´)ðïõ ëáìâÜíïíôáé õðüøç áðü ôá ÐåñéöåñåéáêÜ Óõìâïýëéá ÅðéëïãÞò

Åðéìåëçôþí Éáôñþí êáé ÏäïíôéÜôñùí ôïõ ÅÓÕêáé ôá Óõìâïýëéá ÅðéëïãÞò Äéåõèõíôþí ÅÓÕ.


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Å. ÂåêñÞ êáé óõí.

ÅÐÁÉÍÅÈÅÉÓÁ ÅÑÃÁÓÉÁ ÓÔÏ ÄÉÁÃÙÍÉÓÌÏ "Ä. ÉÊÊÏÕ"

THE SECOND AWARDED PAPER IN THE MEMORY OF PROF. "D. IKKOY"Primary Heatlh Care, Volume 15, Number 2, 68-72, 2003ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 15, Ôåý÷ïò 2, 68-72, 2003

ÐåñßëçøçÓêïðüò ôçò ðáñïýóáò ìåëÝôçò åßíáé íá åêôéìÞóåé ôçí ðñïãíùóôéêÞ óçìáóßáôçò CRP óôá áããåéáêÜ åãêåöáëéêÜ åðåéóüäéá (ÁÅÅ) óå ðñùôïâÜèìéï åðßðåäïðåñßèáëøçò. Ðëçèõóìüò ìåëÝôçò êáé ìÝèïäïò: Ç ìåëÝôç Þôáí ðñïïðôéêÞ êáéáöïñïýóå 50 äéáäï÷éêÝò åéóáãùãÝò éó÷áéìéêþí ÁÅÅ óôï ÉððïêñÜôåéï íïóïêï-ìåßï, ìå åëåýèåñï éóôïñéêü ÷ñüíéùí ðáèÞóåùí. Åéäéêåõüìåíïò Ãåíéêüò Éáôñüòåêôåëïýóå ðëÞñç íåõñïëïãéêÞ åîÝôáóç êáé åêôßìçóç ôçò âáñýôçôáò ôçò íåõ-ñïëïãéêÞò âëÜâçò ìå ôçí Êëßìáêá Ãëáóêþâçò êáé ôçí êëßìáêá ôïõ ÅèíéêïýÉíóôéôïýôïõ Õãåßáò ôùí ÇíùìÝíùí Ðïëéôåéþí (ÍÉÇ). ÁíÜ áóèåíÞ ãéíüôáí ìÝôñç-óç ôùí åðéðÝäùí CRP óôïí ïñü ìÝóá óå 6 þñåò áðü ôçí Ýíáñîç ôïõ åðåéóï-äßïõ êáé ç ìÝôñçóç åðáíáëáìâáíüôáí óôéò 12 þñåò. ÁðïôåëÝóìáôá: Ç ìÝóçôéìÞ ôçò CRP óå ÷ñïíéêü äéÜóôçìá ìéêñüôåñï ôùí 6 ùñþí áðü ôçí Ýíáñîç ôïõÁÅÅ âñÝèçêå 2,1±0,3 mg/l, åíþ ç ìÝóç ôéìÞ ôçò CRP 12 þñåò ìåôÜ ôï ÁÅÅÞôáí 3,1±0,5 mg/l êáé âñÝèçêå óçìáíôéêÜ áõîçìÝíç óå óýãêñéóç ìå ôçí ðñþôçìÝôñçóç (p=0,012). Ç Üíïäïò ôùí ôéìþí ôçò CRP 12 þñåò ìåôÜ ôï ÁÅÅâñÝèçêå íá óõíïäåýåôáé ìå ìåßùóç ôùí ôéìþí ôçò Êëßìáêáò Ãëáóêþâçò óôéò 6(p=0,036) êáé 12 þñåò (p=0,026) áðü ôï ÁÅÅ êáèþò êáé ìå áýîçóç ôùí ôéìþíôçò ÍÉÇ óôéò 6 (p=0,006) êáé 12 þñåò (p=0,0011) áðü ôï ÁÅÅ. Ôá õøçëÜåðßðåäá CRP óõó÷åôßóôçêáí ìå åìöÜíéóç áõîçìÝíùí åðéðëïêþí êáé äõóìåíÞðñüãíùóç (p<0,05) óôïõò áóèåíåßò ìå ÁÅÅ.

Ìðïñåß ç C-Áíôéäñþóá ÐñùôåÀíç íá áðïôåëÝóåé ðñïãíùóôéêüäåßêôç óôá ÁããåéáêÜ ÅãêåöáëéêÜ Åðåéóüäéá óôçí ÐñùôïâÜèìéáÖñïíôßäá Õãåßáò;

Å. ÂåêñÞ3, ×. Ëçîïõñéþôçò3, Á. Ìáñéüëçò3, Å. ÌåóóÜñçò2, Í. ÐáñáñÜò², Â. Âïõãéïýêáò5, Æ. ÁëìÜæ5,Á. Ìïíáóôçñéþôçò³, Í. Áëåîáíäñüðïõëïò1, Á. ÌïõëáêÜêçò4

1Âéï÷çìéêü ÔìÞìá, ÉððïêñÜôåéï Íïóïêïìåßï, ÁèÞíá, 2ÅñãáóôÞñéï ×åéñïõñãéêÞò ̧ ñåõíáò, Á’ÐñïðáéäåõôéêÞ ×åéñïõñãéêÞ ÊëéíéêÞ, ÐáíåðéóôÞìéï Áèçíþí, ÉððïêñÜôåéï Íïóïêïìåßï, 3ÔìÞìáÃåíéêÞò ÉáôñéêÞò, ÉððïêñÜôåéï Íïóïêïìåßï, ÁèÞíá, 4ÁíáðëçñùôÞò Ä/íôÞò ÐáèïëïãéêÞò Êëéíé-êÞò ÉððïêñÜôåéïõ Íïóïêïìåßïõ Áèçíþí, 5Éáôñïß

ÅéóáãùãÞ

Ðåñéóóüôåñá áðü 700.000 áããåéá-êÜ åãêåöáëéêÜ åðåéóüäéá (ÁÅÅ) êá-ôáãñÜöïíôáé åôçóßùò óôéò ÇíùìÝíåòÐïëéôåßåò1.Ôï óýã÷ñïíï åñåõíçôéêüðåäßï óôïí ôïìÝá ôùí áããåéáêþí åãêå-öáëéêþí åðåéóïäßùí åíôïðßæåôáé óåèÝìáôá ðñüëçøçò, ìÝóù ôçò áíáãíþ-ñéóçò ðáñáãüíôùí êéíäýíïõ êáé ðñü-ãíùóçò. Ôá éó÷áéìéêÜ áããåéáêÜ åãêå-öáëéêÜ åðåéóüäéá áíôéóôïé÷ïýí óôçíðëåéïøçößá ôùí óõìâáìÜôùí. Áí êáéç Üìåóç áéôßá ôïõ åãêåöáëéêïý åì-öñÜêôïõ åßíáé ç äçìéïõñãßá áñôçñéá-êïý èñüìâïõ, ï âáóéêüò ðáñÜãùí ãéáôç äçìéïõñãßá áõôïý åßíáé ç áèçñï-óêëÞñõíóç. Ç áíÜðôõîç ôçò áèçñù-ìÜôùóçò óôá áããåßá ôïõ áíèñþðéíïõïñãáíéóìïý ïäçãåß óôç óôÝíùóç êáé

ËÝîåéò ÊëåéäéÜ: CRP, ÁããåéáêÜ ÅãêåöáëéêÜ Åðåéóü-äéá ÐñùôïâÜèìéá Öñïíôßäá õãåßáòÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå óôï äéáãùíé-óìü "Ä. ºêêïõ" óôá ðëáßóéá ôïõ 15ïõ ÐáíåëëÞíéïõÓõíåäñßïõ ÃåíéêÞò ÉáôñéêÞò (×áëêéäéêÞ 30 Áðñéëßïõ- 4 ÌáÀïõ 2003) êáé Ýëáâå Ýðáéíï áðü ôçí Åðéôñï-ðÞ Êñßóçò. Äçìïóéåýåôáé ìå êïéíÞ áðüöáóç ôçò Óõ-íôáêôéêÞò ÅðéôñïðÞò ôïõ ðåñéïäéêïý êáé ôçò Ïñãá-íùôéêÞò ÅðéôñïðÞò ôïõ Óõíåäñßïõ.Õðåýèõíïò áëëçëïãñáößáò: Å. ÂåêñÞ, ÉððïêñÜ-ôåéï Íïóïêïìåßï Áèçíþí, Ôçë. (6972)217396,(210)2224393

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Å. ÂåêñÞ êáé óõí. Ôüìïò 15, Ôåý÷ïò 2, 2003

Can C-Reactive Protein be considered as marker in cerebral vascularstrokes in primary health care?I. Vekri, Ch. Lixuriotis, A. Mariolis, E. Mesaris, N. Pararas, V. Vougioukas,Z. Almaz, A.Monastiriotis, N. Alexandropoulos, A. Moulakakis

SummaryAim: The aim of this study is to appreciate the prognostic role of C-ReactiveProtein in Primary Health Care level. Study population and methods: Thestudy was preoptic. The study population consisted of 50 patients, recovered inHippokrateion Hospital of Athens, with ischemic strokes. The patients haven’tother illness. Resident, General practitioner was executing a complete Neurolog-ical examination. He also was estimating the gravity of the situation with theGlasgow Scale and the NIH Stroke Scale. In each patient was estimated thelevel of CRP in the plasma 6 hour after the beginning of the event. Result: 6hour after the beginning of stroke, the media value of CRP was 2.1±0.32 mg/land 12 hour after was 3.1±0.55 mg/l. This deference is statistically important(p=0.012).The increase of CRP values 12 hour after stroke, was found to beaccompanied with a decrease of Glasgow scale, 6 hour (p=0.036) and 12 hours(p=0.026) after stroke also with an increase of value of NIH stroke scale 6 hour(p=0.006) and 12 hour (p=0.001) after stroke. The high value of CRP wasrelated with appearance complications and poor prognosis (p<0.05) in patientswith stroke. Conclusion: The first hours of stroke the increment of CRP valuerelated poor prognosis and clinical situation get worse. So CRP value can beused as a marker, in patients no other illness.Key word: CRP, cerebral ischemic stroke, Primary Health Care.

íåßò ìå éó÷áéìéêü áããåéáêü åãêåöáëé-êü åðåéóüäéï, ïé ïðïßïé áíôéìåôùðß-óôçêáí óôï ÉððïêñÜôåéï ÍïóïêïìåßïÁèçíþí. Ôá êñéôÞñéá åéóüäïõ óôç ìå-ëÝôç áðïôÝëåóáí: ç äéÜãíùóç ôïõ éó÷áé-ìéêïý ÁÅÅ ðñüôåñá ôùí 6 ùñþí áðüôçí Ýíáñîç ôïõ åðåéóïäßïõ, ç çëéêßáôïõ áóèåíïýò ìåôáîý 18 êáé 90 åôþíêáé ç ðáñïõóßá óõããåíþí ãéá ôç ëÞøçóõãêáôÜèåóçò. Ôá êñéôÞñéá áðïêëåé-óìïý áðü ôç ìåëÝôç áðïôÝëåóáí: ïèÜíáôïò åíôüò 12 ùñþí áðü ôçí åéóá-ãùãÞ, ç ðáñïõóßá êáêïÞèåéáò, ç äéÜ-ãíùóç óõíõðÜñ÷ïõóáò ëïßìùîçò, ñåõ-ìáôïëïãéêïý íïóÞìáôïò, íåöñéêÞò áíå-ðÜñêåéáò, áíïóïêáôáóôïëÞò Þ áíïóïá-íåðÜñêåéáò, ç ëÞøç ìç óôåñïåéäþíáíôéöëåãìïíùäþí öáñìÜêùí, êïñôéêï-óôåñïåéäþí, êõôôáñïóôáôéêþí ÷çìåéï-èåñáðåõôéêþí, ç ðñüóöáôç ìåôÜããé-óç, ïé ðñüóöáôåò åðåìâÜóåéò (<1 ìç-íüò), ôï ôñáýìá (<1 ìçíüò), ï ðõñåôüò

áðüöñáîç áõôþí ìå ôåëéêü áðïôÝëåóìá ôçí åê-äÞëùóç áããåéáêþí óõìâáìÜôùí, üðùò ôï Ýìöñáã-ìá ôïõ ìõïêáñäßïõ êáé ôá áããåéáêÜ åãêåöáëéêÜåðåéóüäéá2. ÐëÝïí ç áèçñùìÜôùóç èåùñåßôáé ìéáöëåãìïíþäçò íüóïò. Ç CRP áðïôåëåß ðñùôåÀíçïîåßáò öÜóçò ôçò ðñïöëåãìïíþäïõò äéåñãáóßáò3.¸÷åé ðáñáôçñçèåß ìéá éó÷õñÞ óõó÷Ýôéóç ìåôáîýôùí êëéíéêþí åêäçëþóåùí ôçò áèçñùìáôéêÞò íü-óïõ êáé ôùí åðéðÝäùí ôçò CRP óôï áßìá óåáóèåíåßò ìå ïîý Ýìöñáãìá ôïõ ìõïêáñäßïõ, óôá-èåñÞ êáé áóôáèÞ óôçèÜã÷ç êáé ïîÝá óôåöáíéáßáóýíäñïìá4,5. ÌåãÜëåò ðñïïðôéêÝò ìåëÝôåò óå õãéåßòáíèñþðïõò åðéâåâáßùóáí ôçí ðñïãíùóôéêÞ áîßáôçò CRP ãéá ôçí åêôßìçóç ôïõ êáñäéáããåéáêïýêéíäýíïõ. ¼ìùò ëßãá óôïé÷åßá õðÜñ÷ïõí ãéá ôçíðéèáíÞ ó÷Ýóç ôùí åðéðÝäùí ôçò CRP óôï áßìáêáé ôçí ðñüãíùóç ôùí éó÷áéìéêþí áããåéáêþí åãêå-öáëéêþí åðåéóïäßùí6,7.

Óêïðüò ôçò ðáñïýóáò ìåëÝôçò åßíáé ç ìÝôñç-óç ôùí åðéðÝäùí CRP óôï áßìá áóèåíþí êáôÜôçí ïîåßá öÜóç ôùí éó÷áéìéêþí åãêåöáëéêþí åðåé-óïäßùí êáé ç åêôßìçóç ôçò ðñïãíùóôéêÞò ôïõòóçìáóßáò.


Óôç ìåëÝôç åéóÞ÷èçóáí 50 äéáäï÷éêïß áóèå-

áãíþóôïõ áéôéïëïãßáò êáé ç ýðáñîç éóôïñéêïýíåõñïëïãéêïý åëëåßììáôïò. Ôñåéò áóèåíåßò áðï-êëåßóôçêáí áðü ôç ìåëÝôç ëüãù ðáñïõóßáò ñåõ-ìáôïëïãéêïý íïóÞìáôïò êáé Ýíáò áóèåíÞò äå óõ-íáßíåóå ãéá ôç óõììåôï÷Þ ôïõ óôï åñåõíçôéêüðñùôüêïëëï. Ôçí ïìÜäá ìåëÝôçò áðïôÝëåóáí ôå-ëéêÜ 46 áóèåíåßò ìÝóçò çëéêßáò 79,1±1,3 åôþí(ÄéÜìåóïò: 80 Ýôç), åê ôùí ïðïßùí 19 (41,3%)Þôáí Üíäñåò êáé 27 (58,7%) Þôáí ãõíáßêåò.

ÌåôÜ ôçí åéóáãùãÞ ôïõò óôï ÔìÞìá Åðåé-ãüíôùí Ðåñéóôáôéêþí, ïé áóèåíåßò õðïâÜëëïíôáíóå ëåðôïìåñÞ íåõñïëïãéêÞ åêôßìçóç áðü åéäé-êåõüìåíï Ãåíéêü Éáôñü êáé Ýíáí ÅéäéêåõìÝíï Ðá-èïëüãï. Ç íåõñïëïãéêÞ åêôßìçóç ðåñéåëÜìâáíåêáé ôçí áíáëõôéêÞ êáôáãñáöÞ ôùí êëéíéêþí åõ-ñçìÜôùí, ôá ïðïßá åßíáé áðáñáßôçôá ãéá ôïíõðïëïãéóìü ôçò Êëßìáêáò Ãëáóêþâçò êáé ôçòÊëßìáêáò Åãêåöáëéêþí ôïõ Åèíéêïý Éíóôéôïý-ôïõ Õãåßáò ôùí ÇíùìÝíùí Ðïëéôåéþí. Ðñïêåé-ìÝíïõ íá áðïêëåéóôåß ôï áéìïññáãéêü ÁÅÅ êÜèåáóèåíÞò õðïâáëëüôáí óå áîïíéêÞ ôïìïãñáößá.Óå êÜèå áóèåíÞ åðéðëÝïí ôïõ óõíÞèç åñãáóôç-ñéáêïý åëÝã÷ïõ (ÃåíéêÞ áßìáôïò, ÓÜê÷áñï, Ïõ-ñßá, Êñåáôéíßíç, SGOT, SGPT, ã-gt, ALP, Na,K, HDL, LDL, LDH, CPK, ÔÊÅ, Ro Èþñá-êïò) ãéíüôáí ìÝôñçóç ôùí åðéðÝäùí CRP (Âéï-÷çìéêü ÅñãáóôÞñéï, ÉððïêñÜôåéï Íïóïêïìåßï)óôï áßìá êáôÜ ôçí åéóáãùãÞ ôïõ óôá ÔÅÐ êáé


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ïðùóäÞðïôå óå ëéãüôåñï áðü 6 þñåò áðü ôçíÝíáñîç ôïõ åðåéóïäßïõ. Óôéò 12 þñåò ìåôÜ ôçíåãêáôÜóôáóç ôïõ ÁÅÅ ãéíüôáí íÝá êëéíéêÞ åîÝ-ôáóç ôïõ áóèåíïýò ìå Ýìöáóç óôç íåõñïëïãéêÞóçìåéïëïãßá êáé åê íÝïõ åñãáóôçñéáêüò Ýëåã-÷ïò, óõìðåñéëáìâáíïìÝíçò ôçò ìÝôñçóçò ôùíåðéðÝäùí ôçò CRP. Áóèåíåßò ïé ïðïßïé åìöÜíé-æáí êëéíéêÜ óçìåßá Þ åñãáóôçñéáêÜ åõñÞìáôáëïéìþîåùò ìÝóá óôéò 12 þñåò áðü ôçí åéóáãùãÞôïõò áðïêëåßïíôáí áðü ôç ìåëÝôç.

ÓôáôéóôéêÞ ÁíÜëõóç

Ãéá ôç óýãêñéóç ðïóïôéêþí ìåôáâëçôþí óåäéÜöïñåò äéáäï÷éêÝò ÷ñïíéêÝò óôéãìÝò åöáñìüóèçêåç ìç ðáñáìåôñéêÞ äïêéìáóßá Wilcoxon. Ãéá ôçóõó÷Ýôéóç ðïóïôéêþí ìåôáâëçôþí ìåôáîý ôïõòåöáñìüóèçêå ç äïêéìáóßá Spearman. Ãéá ôç ìå-ëÝôç ôçò åðßäñáóçò ôùí ôéìþí ðïóïôéêþí ìåôá-âëçôþí óôçí ðñüãíùóç ôùí áóèåíþí ÷ñçóéìï-ðïéÞèçêå ðáëßíäñïìç áíÜëõóç (regression anal-ysis). ¼ëåò ïé äïêéìáóßåò ìå ôéìÞ p<0.05 èåùñÞ-èçêáí ùò óôáôéóôéêþò óçìáíôéêÝò.


Ç ìÝóç ôéìÞ ôçò CRP óôï áßìá óå ÷ñïíéêüäéÜóôçìá ìéêñüôåñï ôùí 6 ùñþí áðü ôçí Ýíáñîçôïõ ÁÅÅ âñÝèçêå íá åßíáé 2,1±0,3 mg/l (ÄéÜìå-óïò:1,6), åíþ ç ìÝóç ôéìÞ ôçò CRP 12 þñåò ìåôÜôï ÁÅÅ Þôáí 3,1±0,55 mg/l (ÄéÜìåóïò: 1,9) êáéâñÝèçêå óçìáíôéêÜ áõîçìÝíç óå óýãêñéóç ìå ôçí

ðñþôç ìÝôñçóç (p=0,012). ÅðéðëÝïí ç ÊëßìáêáÅãêåöáëéêþí ôïõ Åèíéêïý Éíóôéôïýôïõ Õãåßáò ôùíÇíùìÝíùí Ðïëéôåéþí åìöÜíéóå óôáôéóôéêþò óç-ìáíôéêÞ ìåßùóç ôùí ôéìþí ôçò áðü 7,6±0,9 (<6þñåò) óå 7±0,9 (12 þñåò) (p=0,006). Áíôßèåôáäåí ðáñáôçñÞèçêáí óçìáíôéêÝò ìåôáâïëÝò óôçíÊëßìáêá Ãëáóêþâçò (<6 þñåò:13,5±0,2, Ýíáíôé12 þñåò: 13,6±0,3, p=0,68).

ÐáñáôçñÞèçêå ìßá óôáèåñÞ óõó÷Ýôéóç ìå-ôáîý ôçò ôéìÞò ôçò CRP 12 þñåò ìåôÜ ôçí åãêá-ôÜóôáóç ôïõ ÁÅÅ êáé ôùí êëéíéêþí âáèìßäùíáîéïëüãçóçò: Êëßìáêá Ãëáóêþâçò êáé ÊëßìáêáÅãêåöáëéêþí ôïõ Åèíéêïý Éíóôéôïýôïõ Õãåßáòôùí ÇíùìÝíùí Ðïëéôåéþí. Ç Üíïäïò ôùí ôéìþíôçò CRP 12 þñåò ìåôÜ ôï ÁÅÅ âñÝèçêå íáóõíïäåýåôáé ìå ìåßùóç ôùí ôéìþí ôçò ÊëßìáêáòÃëáóêþâçò (ÄõóìåíÞò Ðñüãíùóç) óôéò 6(p=0,036) êáé 12 þñåò (p=0,026) áðü ôï ÁÅÅêáèþò êáé ìå áýîçóç ôùí ôéìþí ôçò ÊëßìáêáòÅãêåöáëéêþí ôïõ Åèíéêïý Éíóôéôïýôïõ Õãåßáòôùí ÇíùìÝíùí Ðïëéôåéþí (ÄõóìåíÞò Ðñüãíù-óç) óôéò 6 (p=0,006) êáé 12 þñåò (p=0,0011)áðü ôï ÁÅÅ.

ÔÝóóåñéò áóèåíåßò (8,7%) êáôÝëçîáí ôïõëÜ-÷éóôïí 12 þñåò ìåôÜ ôçí åãêáôÜóôáóç ôïõ ÁÅÅ,åíþ 13 (28,3%) åìöÜíéóáí åðéðëïêÝò ìåôÜ ôçíåãêáôÜóôáóç ôïõ ÁÅÅ (åéóñüöçóç, ðíåõìïíßá).Ôá åðßðåäá CRP óôï áßìá áóèåíþí ìå ÁÅÅ âñÝ-èçêáí íá Ý÷ïõí ðñïãíùóôéêÞ óçìáóßá ôüóï ãéáôçí ôåëéêÞ Ýêâáóç ôùí áóèåíþí, üóï êáé ãéá ôçíåìöÜíéóç åðéðëïêþí. Ç ðñïãíùóôéêÞ áîßá ôçòCRP óôá ÁÅÅ ðáñïõóéÜæåôáé óôïí Ðßíáêá 1êáé ôçí ÄéÜãñáììá 1.

Ðßíáêáò 1. Ç CRP ùò ðñïãíùóôéêüò äåßêôçò óôá ÁÅÅ

ÌÝôñçóç Åðéâßùóç ÔéìÞ p ÅðéðëïêÝò ÔéìÞ p

CRP (<6 þñåò) Íåêñïß: 5,8±2,4 0,008* ¢íåõ: 1,4±0,2 0,001*Æùíôáíïß: 1,8±0,2 ÅðéðëåãìÝíïé: 3,8±0,9

CRP (12 þñåò) Íåêñïß: 11±4 0,005* ¢íåõ: 1,8±0,2 0,0001*Æùíôáíïß: 2,3±0,3 ÅðéðëåãìÝíïé: 6,1±1,5

GCS (<6 þñåò) Íåêñïß: 11±0,7 0,007* ¢íåõ: 14±0,2 0,0024*Æùíôáíïß: 13,8±0,2 ÅðéðëåãìÝíïé: 12,2±0,7

GCS (12 þñåò) Íåêñïß: 9,7±0,8 0,001* ¢íåõ: 14,2±0,2 0,007*Æùíôáíïß: 14±0,3 ÅðéðëåãìÝíïé: 11,6±0,9

ÍÉÇ (<6 þñåò) Íåêñïß: 15±3 0,56 ¢íåõ: 6.5±0.9 0,025*Æùíôáíïß: 7,4±0,9 ÅðéðëåãìÝíïé: 11,7±3

ÍÉÇ (12 þñåò) Íåêñïß: 16±2,8 0,3 ¢íåõ: 5.9±0.8 0,024*Æùíôáíïß: 6,8±0,9 ÅðéðëåãìÝíïé: 11,6±3,1

*Óôáôéóôéêþò óçìáíôéêÞ äéáöïñÜ

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Å. ÂåêñÞ êáé óõí. Ôüìïò 15, Ôåý÷ïò 2, 2003

óôïé÷åßá õðÜñ÷ïõí óôç âéâëéïãñáößá ãéá ôïí ðñï-ãíùóôéêü ñüëï ôçò CRP ìåôÜ áðü ôçí åêäÞëùóçôïõ ÁÅÅ. Áðü ôá åõñÞìáôá ôçò ðáñïýóáò ìåëÝ-ôçò ðñïêýðôåé üôé ç CRP åßíáé áíåîÜñôçôïò ðñï-ãíùóôéêüò ðáñÜãïíôáò üóïí áöïñÜ ôçí Ýêâáóçóôá éó÷áéìéêÜ ÁÅÅ êáé üôé ç Üíïäïò ôùí ôéìþíôçò óõó÷åôßæåôáé ìå äõóìåíÞ ðñüãíùóç. Ôá åðß-ðåäá CRP óôï áßìá áóèåíþí ìå ÁÅÅ âñÝèçêáííá Ý÷ïõí ðñïãíùóôéêÞ óçìáóßá ôüóï ãéá ôçí ôå-ëéêÞ Ýêâáóç ôùí áóèåíþí, üóï êáé ãéá ôçí åìöÜ-íéóç åðéðëïêþí. Ôá áðïôåëÝóìáôá áõôÜ Ýñ÷ï-íôáé óå óõìöùíßá ìå áíáöïñÝò Üëëùí åñåõíç-ôþí14-16. ÅðéðëÝïí, ïé Di Napoli êáé óõí. Ý÷ïõíóõó÷åôßóåé ôá åðßðåäá ôçò CRP óôï áßìá áóèå-íþí ìå ÁÅÅ ìå ôï ìÝãåèïò ôçò åãêåöáëéêÞò âëÜ-âçò êáé áíáöÝñïõí üôé ôá åðßðåäá áõôÞò áõîÜ-íïõí ìå ôï ÷ñüíï áðü ôçí åãêáôÜóôáóç ôïõ åì-öñÜêôïõ êáé ðáñÜëëçëá ìå ôçí áýîçóç ôïõ ìå-ãÝèïõò áõôïý. ×ñçóéìïðïéÞóáìå äýï, êïéíþò áðï-äåêôÝò, êëßìáêåò áîéïëüãçóçò ôùí áóèåíþí ìáò(Êëßìáêá Ãëáóêþâçò êáé Êëßìáêá Åãêåöáëéêþíôïõ Åèíéêïý Éíóôéôïýôïõ Õãåßáò ôùí ÇíùìÝíùíÐïëéôåéþí), þóôå íá ðñïóäéïñéóôåß êëéíéêÜ ôïìÝãåèïò ôçò åãêåöáëéêÞò âëÜâçò. ÂñÞêáìå üôéüóï áõîÜíïõí ôá åðßðåäá ôçò CRP 12 þñåò ìåôÜôçí Ýíáñîç ôïõ åãêåöáëéêïý, üðïõ ðëÝïí ôï Ýì-öñáêôï Ý÷åé “ïñãáíùèåß”, ìåéþíïíôáé ïé ôéìÝòôçò Êëßìáêáò Ãëáóêþâçò êáé ôçò Êëßìáêáò Åãêå-öáëéêþí ôïõ Åèíéêïý Éíóôéôïýôïõ Õãåßáò ôùíÇíùìÝíùí Ðïëéôåéþí (ÁëëáãÝò äõóìåíïýò ðñü-ãíùóçò). Ç Üíïäïò ôùí åðéðÝäùí ôçò CRP óôáÁÅÅ Ý÷åé âñåèåß üôé ìðïñåß íá ïöåßëåôáé åßôå óôçíÝêñùóç, åßôå óôï ìÝãåèïò ôçò öëåãìïíþäïõòáíôßäñáóçò êáé ßóùò íá áðïôåëåß ôï äåßêôç ðïõêáôáãñÜöåé ôçí áäõíáìßá åðáíáóçñáããïðïßçóçòôïõ áðïöñá÷èÝíôïò áããåßïõ Þ ôçí åììÝíïõóáéó÷áéìßá. Ç CRP óôéò 12 þñåò ìðïñåß íá ÷ñçóé-ìïðïéçèåß ùò äåßêôçò ôüóï ôçò íÝêñùóçò, üóïêáé ôçò öëåãìïíþäïõò áíôßäñáóçò êáé íá êáôåõ-èýíåé ðñïò ìßá ðéï åðéèåôéêÞ èåñáðåõôéêÞ áãùãÞêáôÜ ðåñßðôùóç17-19.

ÓõìðåñáóìáôéêÜ, ç ÷ñÞóç ôçò CRP óôçíêáèçìåñéíÞ êëéíéêÞ ðñÜîç óôï åðßðåäï ôçò Ðñù-ôïâÜèìéáò öñïíôßäáò äßíåé ôç äõíáôüôçôá óôïíêëéíéêü éáôñü íá åêôéìÞóåé ôç âáñýôçôá ôïõ éó÷áé-ìéêïý ÁÅÅ. Óå áóèåíåßò ìå ÁÅÅ ôá áõîçìÝíáåðßðåäá CRP óôï áßìá óå óõíäõáóìü ìå ôá êëé-íéêÜ åõñÞìáôá áðïôåëïýí Ýíá áóöáëÝò êñéôÞñéïåêôßìçóçò ôçò Ýêâáóçò ôïõ åðåéóïäßïõ.

0

2

4

6

8

10

12

14

16

CRP (<6 þñåò)

CRP (12 þñåò)

GCS (<6 þñåò)

GCS (12 þñåò)

ÍÉÇ (<6 þñåò)

ÍÉÇ (12 þñåò)

Íåêñïß Æùíôáíïß

ÄéÜãñáììá 1. Ôá åðßðåäá CRP <6 þñåò êáé 12 þñåò ìåôÜ ôï ÁÅÅÝ÷ïõí ðñïãíùóôéêÞ óçìáóßá.

ÓõæÞôçóç

Ôï ÁÅÅ åßíáé ôï ðéï óõ÷íÜ åìöáíéæüìåíïíåõñïëïãéêü íüóçìá óôïõò åíçëßêïõò. ¸÷åé õðï-ëïãéóôåß üôé ðáñáðÜíù áðü 700.000 áããåéáêÜåãêåöáëéêÜ åðåéóüäéá êáôáãñÜöïíôáé åôçóßùò óôéòÇíùìÝíåò Ðïëéôåßåò êáé åßíáé ç ôñßôç áéôßá èá-íÜôïõ ìåôÜ ôá êáñäéáêÜ íïóÞìáôá êáé üëïõòôïõò ôýðïõò íåïðëáóìÜôùí. Ôá éó÷áéìéêÜ áããåéáêÜåãêåöáëéêÜ åðåéóüäéá áíôéóôïé÷ïýí óôçí ðëåéï-øçößá ôùí óõìâáìÜôùí. ÊáôÜ ôç äéÜñêåéá ôçòôåëåõôáßáò äåêáåôßáò óçìáíôéêÞ ðñüïäïò Ý÷åé åðé-ôåõ÷èåß óôïí ôïìÝá ôçò èåñáðåßáò ôùí éó÷áéìé-êþí áããåéáêþí åãêåöáëéêþí åðåéóïäßùí8,9. Ðá-ñáìÝíåé üìùò ï êßíäõíïò èáíÜôïõ Þ êáéíïýñãéïõáããåéáêïý åðåéóïäßïõ. Ãéá ôï ëüãï áõôü ç áíåý-ñåóç êáéíïýñãéùí ðñïãíùóôéêþí äåéêôþí èá âïç-èïýóå óçìáíôéêÜ óôçí áíáãíþñéóç áôüìùí õøç-ëïý êéíäýíïõ êáé ôçí ðåñáéôÝñù êáôáíüçóç ôçòðáèïöõóéïëïãßáò ôçò íüóïõ. Óôçí ðáñïýóá ìåëÝ-ôç åîåôÜæåôáé ï ðñïãíùóôéêüò ñüëïò ôçò CRP óåáóèåíåßò ðïõ Ý÷ïõí õðïóôåß éó÷áéìéêü ÁÅÅ.

¸÷åé ðáñáôçñçèåß ìéá éó÷õñÞ óõó÷Ýôéóç ìå-ôáîý ôùí êëéíéêþí åêäçëþóåùí ôçò áèçñùìáôé-êÞò íüóïõ êáé ôùí åðéðÝäùí ôçò CRP óôï áßìáóå áóèåíåßò ìå ïîý Ýìöñáãìá ôïõ ìõïêáñäßïõ,óôáèåñÞ êáé áóôáèÞ óôçèÜã÷ç êáé ïîÝá óôåöá-íéáßá óýíäñïìá12,13. ¢ëëåò ìåëÝôåò êáôáãñÜöïõíôçí ðñïãíùóôéêÞ óçìáóßá ôùí åðéðÝäùí ôçò CRPóå õãéåßò ìÜñôõñåò, ïé ïðïßïé óå óõãêåêñéìÝíçóôéãìÞ ôçò æùÞò ôïõò õößóôáíôáé ÁÅÅ. Ëßãá


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2. Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, andrisk of incident cardiovascular events: an 8-year follow-up of 14,719 initially healthy Amer-ican women. Circulation, 107:391-397, 2003.

3. Iyigun I, Bakirci Y. Plasma concentrations ofC-reactive protein and fibrinogen in ischaemicstroke. J Int Med Res, 30:591-6,2003.

4. Van Der Meer IM, De Maat MP, Hak AE,Kiliaan AJ, Del Sol AI, Van Der Kuip DA,Nijhuis RL, Hofman A, Witteman JC. C-reac-tive protein predicts progression of atheroscle-rosis measured at various sites in the arterialtree: the Rotterdam Study. Stroke, 3:2750-5,2002.

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Á. Ìáñéüëçò êáé óõí Ôüìïò 15, Ôåý÷ïò 2, 2003

ÂÑÁÂÅÕÈÅÉÓÁ ÅËÅÕÈÅÑÇ ÁÍÁÊÏÉÍÙÓÇ

AWARDED FREESTANDING PAPERPrimary Heatlh Care, Volume 15, Number 2, 73-78, 2003ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 15, Ôåý÷ïò 2, 73-78, 2003

ÐåñßëçøçÓêïðüò: Íá åîåôáóèåß ç ÷ñçóéìüôçôá ôùí ìåôñÞóåùí ôçò áñôçñéáêÞò ðßåóçò(ÁÐ) óôï óðßôé óôçí åêôßìçóç ôçò ñýèìéóçò ôçò áñôçñéáêÞò õðÝñôáóçò (ÁÕ), ìåôç óõíéóôþìåíç áãùãÞ (öáñìáêåõôéêÞ Þ õãéåéíïäéáéôçôéêÞ) óå õðåñôáóéêÜ Üôïìáðåñéï÷Þò åõèýíçò ÊÝíôñïõ Õãåßáò Áóôéêïý Ôýðïõ. Ðëçèõóìüò ìåëÝôçò –ÌÝèï-äïò: Óå 80 õðåñôáóéêÜ Üôïìá ðïõ ðñïóÞëèáí óôï ÊÝíôñï Õãåßáò Âýñùíá óåäéÜóôçìá 2 ìçíþí ãéá ìÝôñçóç ôçò ÁÐ Þ ãéá óõíôáãïãñÜöçóç áíôéõðåñôáóéêþíöáñìÜêùí êáôáãñÜöçêå ç çëéêßá, ôï öýëï, ôï ýøïò êáé ôï âÜñïò. Óôïõò áóèå-íåßò áõôïýò, áöïý Ýãéíå åðáñêÞò åêðáßäåõóç óôçí ôå÷íéêÞ ìÝôñçóçò ôçò ÁÐ,óõíåóôÞèç íá ìåôñïýí ôçí ÁÐ óôï óðßôé äýï öïñÝò ôçí çìÝñá, ðñùß êáé âñÜäõìå ôï ðéåóüìåôñï ðïõ äéáèÝôïõí êáé íá êáôáãñÜöïõí ôéò ìåôñÞóåéò ôïõò ãéáäéÜóôçìá 4 åâäïìÜäùí. Áðáéôåßôï êÜèå öïñÜ Ýíá æåýãïò ìåôñÞóåùí ôçò ÁÐ ìåäéáöïñÜ 1 ëåðôïý ç ìßá áðü ôçí Üëëç ìå ôïí áóèåíÞ óå êáèåóôçêõßá èÝóç. ÏéìåôñÞóåéò ãßíïíôáí ðåñßðïõ ôçí ßäéá þñá êÜèå çìÝñá ìå ôï ßäéï ðéåóüìåôñï êáéáðü ôï ßäéï Üôïìï. Ùò ÁÐ óôï óðßôé èåùñÞèçêå ï ìÝóïò üñïò ôùí âñáäéíþí êáéðñùéíþí ìåôñÞóåùí. Ïé áóèåíåßò åðáíÝñ÷ïíôáí óôï ÊÝíôñï Õãåßáò ìåôÜ áðüÝíá ìÞíá üðïõ åëÝã÷ïíôáí ìå õäñáñãõñéêü óöõãìïìáíüìåôñï ç ÁÐ ôñåéò öï-ñÝò êáé ëáìâÜíïíôáí ï ìÝóïò üñïò áõôþí ôùí ìåôñÞóåùí. ÑõèìéóìÝíç èåùñåßôïç ÁÕ áí ç ìÝóç ôéìÞ ôùí ìåôñÞóåùí ôçò ÁÐ óôï éáôñåßï Þ óôï óðßôé Þôáí <140/90 mmHg. ÁðïôåëÝóìáôá: Áðü ôïõò 80 õðåñôáóéêïýò áóèåíåßò, óôç ìåëÝôçôåëéêÜ óõìðåñéëÞöèçóáí 75 áóèåíåßò áöïý 5 áóèåíåßò áðïññßöèçêáí ëüãùáíåðáñêïýò áñéèìïý ìåôñÞóåùí ôçò ÁÐ óôï óðßôé. Ï ìÝóïò áñéèìüò ìåôñÞóåùíôçò ÁÐ óôï óðßôé áíÜ Üôïìï Þôáí 85±12 (áðü 45-110 ìåôñÞóåéò). Ç ìÝóç çëéêßáôùí áôüìùí Þôáí 72±9 (64-87 Ýôç), ï äåßêôçò ìÜæáò óþìáôïò Þôáí 27,9±6 Kg/m2 êáé 71 Üôïìá ëÜìâáíáí áíôéõðåñôáóéêÞ áãùãÞ. Ç ÁÐ óôï éáôñåßï Þôáí óôá-ôéóôéêÜ óçìáíôéêÜ õøçëüôåñç óõãêñéôéêÜ ìå ôçí ÁÐ óôï óðßôé (15,2±17/81±10Ýíáíôé 150±14/80±11 mmHg, p<0,05). Ïé ðñùéíÝò ôéìÝò ìÝôñçóçò ôçò ÁÐ óôïóðßôé Þôáí óôáôéóôéêÜ óçìáíôéêÜ õøçëüôåñåò óõãêñéôéêÜ ìå ôéò âñáäéíÝò ôéìÝòôçò ÁÐ (155±13/81±12 Ýíáíôé 144±15/78±11 mmHg, p<0,05). ÄéáðéóôþèçêåóôáôéóôéêÜ óçìáíôéêÞ óõó÷Ýôéóç áíÜìåóá óôçí ÁÐ éáôñåßïõ êáé óôçí ÁÐ óôï óðßôé(r=0,44, p<0,005). Âáóéæüìåíïé óôçí ÁÐ éáôñåßïõ ôï 24 % ôùí õðåñôáóéêþí åß÷åñõèìéóìÝíç ôçí ÁÐ åíþ âáóéæüìåíïé óôçí ÁÐ óôï óðßôé ôï 32% åß÷å ñõèìéóìÝíçôçí ÁÐ (p<0,005). ÓõìðåñÜóìáôá: Ç ìÝôñçóç ôçò ÁÐ óôï óðßôé öáßíåôáé íááðïôåëåß ìßá êáëÞ åíáëëáêôéêÞ ðñáêôéêÞ óôçí ðñïóðÜèåéá åðßôåõîçò êáëýôåñçòñýèìéóçò ôçò ÁÐ óôá õðåñôáóéêÜ Üôïìá.

1Ãåíéêïß Éáôñïß - 2Íïóçëåýôñéá ÊÝíôñïõ Õãåßáò Âýñùíá ‘’ÉððïêñÜôåéï” Ã.Í.Á., 3Øõ÷ßáôñïòÃ.Í.Á. “Ã. ÃåííçìáôÜò”, 5ÓõíôïíéóôÞò êáé 4ÁíáðëçñùôÞò Åêðáßäåõóçò Ãåíéêþí Éáôñþí "Éððï-êñÜôåéï". Ã.Í.Á.

Ç ìÝôñçóç ôçò áñôçñéáêÞò ðßåóçò óôï óðßôé êáé ç óõìâïëÞ ôçòóôçí êáëýôåñç èåñáðåõôéêÞ áíôéìåôþðéóç ôùí õðåñôáóéêþíáôüìùí óôçí ðåñéï÷Þ åõèýíçò KÝíôñïõ Yãåßáò Âýñùíá

Á. Ìáñéüëçò1, ×. ÊáëáúôæÞ3, Á. ÆåúìðÝêçò1, Áéêáôåñßíç ÖïõôóéôæÞ-Äáíßêá2, Í. Áëåîáíäñüðïõëïò4,Ã. ÃåùñãéÜäçò5

ÅéóáãùãÞ

Ìå ôïí üñï áñôçñéáêÞ õðÝñôáóçåííïïýìå ôçí áýîçóç ôçò áñôçñéáêÞòðéÝóåùò (ÁÐ) ðÜíù áðü ôá öõóéïëï-ãéêÜ üñéá, ðïõ Ý÷åé ùò óõíÝðåéá ôïíáõîçìÝíï êßíäõíï åìöÜíéóçò íïóçñü-ôçôáò êáé èíçôüôçôáò áðü êáñäéáã-ãåéáêÜ êõñßùò íïóÞìáôá. Ïñßæåôáé ùòöõóéïëïãéêÞ ç ÁÐ, üôáí ç óõóôïëéêÞáñôçñéáêÞ ðßåóç (ÓÁÐ) åßíáé ìéêñü-ôåñç áðü 140 mmHg êáé ç äéáóôïëé-êÞ áñôçñéáêÞ ðßåóç (ÄÁÐ) ìéêñüôåñçáðü 90 mmHg. Ç åðßðôùóç ôçò áñ-ôçñéáêÞò õðåñôÜóåùò (ðáñáôçñåßôáéóôï 20 – 30 % ôïõ ãåíéêïý ðëçèõ-óìïý ôùí åíçëßêùí), êáèþò êáé ïéóçìáíôéêÝò êëéíéêÝò åðéðôþóåéò ôçò (áã-ãåéïåãêåöáëéêÝò, óôåöáíéáßåò, ðåñéöå-

ËÝîåéò ÊëåéäéÜ: ÁñôçñéáêÞ ðßåóç óôï óðßôé, áñôç-ñéáêÞ ðßåóç éáôñåßïõ, èåñáðåõôéêÞ áíôéìåôþðéóçõðÝñôáóçòÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñçáíáêïßíùóç óôï 15o ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞòÉáôñéêÞò (×áëêéäéêÞ 30 Áðñéëßïõ - 4 ÌáÀïõ 2003)êáé âñáâåýôçêå áðü ôçí åðéôñïðÞ Êñßóçò. Äçìï-óéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò Åðé-ôñïðÞò ôïõ ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò Åðé-ôñïðÞò ôïõ Óõíåäñßïõ.Õðåýèõíïò áëëçëïãñáößáò: ÁíÜñãõñïò Ä. Ìáñéü-ëçò, Ìáíïýóïõ Êïõíäïýñïõ 85, KáóôÝëëá - Ðåé-ñáéÜò 18533, Ôçë. (210)4129393, (6945)713380,e-mail: [email protected]


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Á. Ìáñéüëçò êáé óõí

Blood pressure mesurement in the patient’s home and it’s contributionin the better therapeutic approach of hypertensive patients in thecatchment area of the Vyronas Health CentreA. Mariolis, C. Kalaitzi, A. Zeimbekis, A. Foutsitzi-Danika, N. Alexandropoulos,G. Georgiadis

SummaryAim: Our purpose was to examine the usefulness of blood pressure measure-ments in the patients’ home in treating blood pressure (with medications orbehavioral changes) in hypertensive patients residing in the sector of a HealthCenter. Population- Method: We examined 80 hypertensive patients that cameto Byronas Health Center within a time period of 2 months for BP measurementor prescription of antihypertensive agents, keeping records of their age, gender,height and weight. After being sufficiently trained to self- measure their bloodpressure (BP), patients were recommended to measure their blood pressure intheir home twice daily (morning and night) and to record these measurementsfor the next 4 weeks. Patients had to be in a sitting position and measure theirblood pressure each time twice, with an one minute interval between measure-ments. Measurements were set to take place approximately the same time eachday, with the same sphygmomanometer, by the same person. We considered ashome BP, the mean of morning and night measurements. Each month patientsreturned to Health Center, where they had their BP measured three times witha mercurial sphygmomanometer, and we calculated the mean of these mea-surements. Blood pressure was considered regulated if the mean of bloodpressure measurements at home or at health center was <140/90mmHg.Results: From the initial 80 hypertesive patients, 75 were finally included in thestudy, as 5 patients were excluded for insufficient home measurements. Themean number of home blood pressure measurements was 85±12 (45-110measurements).Patients’ mean age was 72±9 years (64-87 years), mean body mass index(BMI) was 27.9±6 Kg/m2. Of these patients, 71 were receiving antihypertensivetreatment. Blood pressure measurements at Health Center were significantlyhigher than those taken at home (152±17/81±10 vs 150±14/80±11 mmHg,p<0.05). For measurements at home, morning blood pressure values were sig-nificantly higher than night ones (155±13/81±12 vs. 144±15/78±11 mmHg,p<0.05). There was a statistically significant difference between BP measuredat the Health Center and BP measured at home (r=0.44, p<0.005). Based on BPmeasurements at the Health Center, 24% of hypertensive patients had theirblood pressure satisfactorily regulated, while based on home measurements,this percentage mounted to 32 (p<0.005).Conclusions: Measuring blood pressure at home seems to be a good alterna-tive in attempting to achieve a better regulation of BP in hypertensive patients.Key words: home blood pressure, office blood pressure, hypertensive treat-ment.

Vyronas Health Centre, Athens’s Greece

ñéêÝò áããåéáêÝò, íåöñáããåéáêÝò âëÜâåò êáé áìöé-âëçóôñïåéäïðÜèåéá, õðåñôñïößá ôçò áñéóôåñÜòêïéëßáò êáé áõîçìÝíï ðïóïóôü äéáóôïëéêÞò êáéóõóôïëéêÞò äõóëåéôïõñãßáò), êáèéóôïýí áíáãêáßáôç äéÜãíùóç, äéåñåýíçóç êáé áíôéìåôþðéóç ôçòáñôçñéáêÞò õðåñôÜóåùò óôá ðëáßóéá ôçò Ðñùôï-âÜèìéáò Öñïíôßäáò Õãåßáò. Ãéá ôïí ðñïóäéïñéóìüôçò áñôçñéáêÞò ðéÝóåùò, ðëçí ôçò ðñüôõðçò ìå-èüäïõ ôïõ åíäáñôçñéáêïý êáèåôçñéáóìïý, ìåèü-äïõ öõóéêÜ ìç ðñáêôéêÞò ãéá ôéò ðåñéðôþóåéò ìçíïóçëåõïìÝíùí Þ ðåñéðáôçôéêþí áóèåíþí, ÷ñçóé-

ìïðïéåßôáé ç Ýììåóç óöõãìáíïìÝôñç-óç, ç ðáëìéêÞ ìÝèïäïò ðïõ ÷ñçóéìï-ðïéåßôáé óôï óðßôé êáé óå óõóêåõÝòðåñéðáôçôéêÞò êáôáãñáöÞò êáé õðå-ñç÷ïãñáöéêÝò ôå÷íéêÝò. Ç Ýììåóç ìÝ-ôñçóç ôçò áñôçñéáêÞò ðéÝóåùò ðïõåéóÞ÷èç ôï 1896 áðü ôïí Rocci áðï-ôåëåß ôç óõíÞèç ðñáêôéêÞ ãéá ôçí êá-ôáãñáöÞ ôçò ÁÐ ôüóï óôï éáôñåßïüóï êáé óôï óðßôé.

Ôá ôåëåõôáßá ÷ñüíéá ðáñáôçñÞèç-êå ìéá óçìáíôéêÞ áýîçóç óôç ÷ñÞóçôçò ðáñáêïëïõèÞóåùò ôçò áñôçñéáêÞòðéÝóåùò áðü ôïí áóèåíÞ óôï óðßôé ùòìéá óõìðëçñùìáôéêÞ ðçãÞ ðëçñïöïñéþíóôç êëéíéêÞ ðñáêôéêÞ1,2. ÄéÜöïñåò éá-ôñéêÝò ïñãáíþóåéò åíèáññýíïõí ôç ðñá-êôéêÞ ôçò ìÝôñçóçò ôçò áñôçñéáêÞòðéÝóåùò óôï óðßôé1,3,4. ¸ôóé, ç USA’sJoint National Committee on the De-tection, Evaluation, and Treatment ofHigh Blood Pressure3, ç World HealthOrganization/International Society ofHypertension4 êáé ç World Hyperten-sion League1 áðïäÝ÷ïíôáé ôçí êëéíéêÞóçìáóßá ôçò ìÝôñçóçò ôçò áñôçñéáêÞòðéÝóåùò óôï óðßôé óôç äéÜãíùóç ôçòáñôçñéáêÞò õðåñôÜóåùò êáé óôçí áîéï-ëüãçóç ôùí áðïôåëåóìÜôùí ôçò èåñá-ðåßáò. Ùóôüóï, êáìéÜ áðü áõôÝò ôéòáíáöïñÝò äåí äéáôýðùóå óõãêåêñéìÝ-íåò êáôåõèõíôÞñéåò ãñáììÝò ãéá ôï ðþòç ìÝôñçóç ôçò áñôçñéáêÞò ðéÝóåùò óôïóðßôé ìðïñåß íá ÷ñçóéìïðïéçèåß óôçíðñÜîç. ̧ íá áðü ôá ìåãÜëá èåùñçôéêÜðëåïíåêôÞìáôá ôçò ÷ñÞóçò ôçò ìÝôñç-óçò ôçò áñôçñéáêÞò ðéÝóåùò óôï óðßôéåßíáé ï ìåãÜëïò áñéèìüò ôùí êáôáãñá-öþí ôçò ÁÐ ðïõ ìðïñïýí íá ëçöèïýí1,2.

ÕðÜñ÷ïõí äéáöïñÝò óôéò ôéìÝò ôùí ìåôñÞóåùí ôçòÁÐ óôï óðßôé óå ó÷Ýóç ìå ôéò ôéìÝò ôçò ÁÐ ðïõêáôáãñÜöïíôáé óôï éáôñåßï. Áðü ôçí åðï÷Þ ðïõäéáôõðþèçêå ç Üðïøç üôé ïé ôéìÝò ôçò ÁÐ óôïóðßôé åßíáé ìéêñüôåñåò ôùí ôéìþí ðïõ êáôáãñÜöï-íôáé óôï éáôñåßï (Ayman and Goldshine)5, ðïëëÝòìåëÝôåò áíáöÝñïõí üôé ç åðßóêåøç óôï éáôñåßïåðéöÝñåé ìéá áýîçóç ôçò ÁÐ ôïõ áóèåíïýò óåó÷Ýóç ìå ôéò ôéìÝò ðïõ êáôáãñÜöïíôáé óôï óðßôé Þìå ôçí 24ùñç ðåñéðáôçôéêÞ êáôáãñáöÞ-Holter24ùñçò êáôáãñáöÞò ÁÐ (õðÝñôáóç ôçò ëåõêÞò

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ìðëïýæáò)6-12. Ç ìÝôñçóç ôçò ÁÐ óôï óðßôé ìðïñåßíá Ý÷åé èåôéêÞ åðßäñáóç óôçí êáôáíüçóç ôùí õðåñ-ôáóéêþí “ðñïâëçìÜôùí” êáé óôç óõììüñöùóç ôïõáóèåíïýò óôçí áíôéõðåñôáóéêÞ áãùãÞ, åíþ ç 24ùñçêáôáãñáöÞ ìðïñåß íá áðïôåëåß ôçí ðëÝïí áîéüðé-óôç, áëëÜ ôáõôü÷ñïíá êáé ôçí ðåñéóóüôåñï äáðá-íçñÞ êáé óðáíéüôåñá ÷ñçóéìïðïéïýìåíç ìÝèïäï13.

Ç ðáñïýóá åñãáóßá áðïóêïðåß óôçí áîéïëü-ãçóç ôùí ìåôñÞóåùí ôçò áñôçñéáêÞò ðéÝóåùò óôïóðßôé ìå ôç ÷ñÞóç äéáöüñùí ôýðùí ðéåóüìåôñùí,ùò ðñïò ôçí åêôßìçóç ôçò ñýèìéóçò ôçò áñôçñéá-êÞò ðéÝóåùò (ÁÕ) ìå ôç óõíéóôþìåíç öáñìáêåõ-ôéêÞ Þ õãéåéíïäéáéôçôéêÞ áãùãÞ óå õðåñôáóéêÜÜôïìá ôçò ðåñéï÷Þò åõèýíçò ÊÝíôñïõ Õãåßáò Áóôé-êïý Ôýðïõ.


Ðëçèõóìüò ôçò ìåëÝôçò

Ðñüêåéôáé ãéá ìéá ìåëÝôç ðïõ ðñáãìáôïðïéÞ-èçêå óôï ÊÝíôñï Õãåßáò Áóôéêïý ôýðïõ ôïõ Âý-ñùíá. Ôïí ðëçèõóìü ôçò ìåëÝôçò áðïôåëïýóáíÜôïìá ôçò ðåñéï÷Þò åõèýíçò ôïõ Ê. Õ. Âýñùíáìå éäéïðáèÞ áñôçñéáêÞ õðÝñôáóç õðü öáñìáêåõ-ôéêÞ Þ õãéåéíïäéáéôçôéêÞ áãùãÞ, ðïõ ðñïóÞëèáíóå äéÜóôçìá äýï ìçíþí (Áðñßëéïò-ÌÜéïò 2002)ãéá ìÝôñçóç ôçò áñôçñéáêÞò ôïõò ðéÝóåùò Þ ãéáóõíôáãïãñáößá áíôéõðåñôáóéêþí öáñìÜêùí.

Óôïõò áóèåíåßò áõôïýò êáôáãñÜöçêå ç çëé-êßá, ôï ýøïò, ôï âÜñïò êáé ïé êáðíéóôéêÝò ôïõòóõíÞèåéåò. Ôá äçìïãñáöéêÜ êáé êëéíéêÜ ÷áñáêôç-ñéóôéêÜ ôùí áóèåíþí êáôáãñÜöïíôáé óôïí ðßíá-êá 1. Ç áíôéõðåñôáóéêÞ áãùãÞ, áí õðÞñ÷å, óõíå-÷éæüôáí áìåôÜâëçôç êáôÜ ôçí ðåñßïäï ôçò ìåëÝ-

ôçò. ÊñéôÞñéï áðïêëåéóìïý áðü ôç ìåëÝôç áðïôå-ëïýóå ïðïéáäÞðïôå áëëáãÞ ôçò öáñìáêåõôéêÞòáãùãÞò, ç ïðïßá èá åðçñÝáæå ôéò ôéìÝò ôçò Á.Ð.,ôÝóóåñéò åâäïìÜäåò ðñéí êáé êáôÜ ôç äéÜñêåéáôçò ìåëÝôçò. ¼ëïé ïé áóèåíåßò Ýäùóáí ôç óõãêá-ôÜèåóÞ ôïõò ãéá ôç óõììåôï÷Þ ôïõò óôç ìåëÝôç.Óôïõò áóèåíåßò áõôïýò (ðëçèõóìüò 80 áôüìùí),Ýãéíå åðáñêÞò åêðáßäåõóç óôçí ôå÷íéêÞ ìÝôñçóçòôçò ÁÐ.

ÌÝôñçóç ôçò áñôçñéáêÞò ðéÝóåùò

Óôïõò áóèåíåßò óõíåóôÞèç íá ìåôñïýí ôçíáñôçñéáêÞ ôïõò ðßåóç (ÁÐ) óôï óðßôé äýï öïñÝòôçí çìÝñá, ðñùß êáé âñÜäõ, ìå ôï ðéåóüìåôñï ðïõäéáèÝôïõí êáé íá êáôáãñÜöïõí ôéò ìåôñÞóåéò ôïõòãéá ÷ñïíéêü äéÜóôçìá ôåóóÜñùí åâäïìÜäùí. Áðáé-ôåßôï êÜèå öïñÜ Ýíá æåýãïò ìåôñÞóåùí, ìåôÜ áðüäéÜóôçìá áíÜðáõóçò 5´ ëåðôþí, ìå äéáöïñÜ 1´ëåðôïý ç ìßá áðü ôçí Üëëç êáé ìå ôïí áóèåíÞ óåêáèåóôçêõßá èÝóç. Ïé ìåôñÞóåéò ãßíïíôáí ôçí ßäéáðåñßðïõ þñá êÜèå çìÝñá, ìå ôï ßäéï ðéåóüìåôñïêáé áðü ôï ßäéï Üôïìï. Ôï ðéåóüìåôñï ðïõ èá÷ñçóéìïðïéïýóå êÜèå áóèåíÞò åëÝã÷èçêå þóôå íáåðéâåâáéùèåß üôé ç ÁÐ ðïõ êáôÝãñáöå, äåí äéÝöå-ñå ðåñéóóüôåñï áðü 5 mmHg áðü ôçí ÁÐ ðïõêáôÝãñáöå Ýíá õäñáñãõñéêü óöõãìïìáíüìåôñï ôïõéáôñåßïõ. Ùò ÁÐ óôï óðßôé èåùñÞèçêå ï ìÝóïòüñïò ôùí ðñùéíþí êáé âñáäéíþí ìåôñÞóåùí.

Ïé áóèåíåßò åðáíÝñ÷ïíôáí óôï éáôñåßï ìåôÜáðü ôÝóóåñéò åâäïìÜäåò, üðïõ åëÝã÷ïíôáí ìåõäñáñãõñéêü óöõãìïìáíüìåôñï ôïõ éáôñåßïõ çáñôçñéáêÞ ôïõò ðßåóç. Ðñáãìáôïðïéïýíôáí ôñåéòìåôñÞóåéò ôçò áñôçñéáêÞò ôïõò ðßåóçò ìå äéáöï-ñÜ 1´ ëåðôïý ç ìéá áðü ôçí Üëëç, óå êáèåóôç-êõßá èÝóç êáé ìåôÜ áðü ðåñßïäï áíÜðáõóçò 5´ëåðôþí êáé ëáìâÜíïíôáí ï ìÝóïò üñïò ôùí ìå-ôñÞóåùí áõôþí. Ôï õäñáñãõñéêü óöõãìïìáíüìå-ôñï Þôáí êïéíü ãéá üëïõò ôïõò áóèåíåßò ìå ìÝãå-èïò ðåñé÷åéñßäïò 15 cm x 35 cm, åíþ ãéá ôçíêáôáãñáöÞ ôçò äéáóôïëéêÞò áñôçñéáêÞò ðéÝóåùò(ÄÁÐ) ãßíïíôáí ÷ñÞóç ôùí Þ÷ùí Korotkoff V.ÑõèìéóìÝíç èåùñåßôï ç áñôçñéáêÞ õðÝñôáóç (ÁÕ)áí ç ìÝóç ôéìÞ ôùí ìåôñÞóåùí ôçò ÁÐ óôï éá-ôñåßï Þ óôï óðßôé Þôáí ìéêñüôåñç áðü 140 mmHgç óõóôïëéêÞ êáé ìéêñüôåñç áðü 90 mmHg çäéáóôïëéêÞ áñôçñéáêÞ ðßåóç.

Ôá áðïôåëÝóìáôá ôçò ìåëÝôçò åêöñÜóôçêáíùò ìÝóïò üñïò ôùí ìåôñÞóåùí ± ôç óôáèåñÜ

Ðßíáêáò 1. ÄçìïãñáöéêÜ êáé êëéíéêÜ ÷áñáêôçñéóôéêÜôùí áóèåíþí

ÐáñÜìåôñïé Óõíïëéêüò Ðëçèõóìüò(n =75)

Çëéêßá (Ýôç) 72±9Öýëï (Üíäñåò / ãõíáßêåò) 46/29Äåßêôçò ìÜæáò óþìáôïò (Kgr/m²) 27,9±6ÊáðíéóôÝò 24 (32%)ÄéÜñêåéá õðÝñôáóçò (Ýôç) 15±3ÁÐ (Baseline – mmHg) 158±19 / 83±13Êáñäéáêüò ñõèìüò 77±5(Baseline-ðáëìïß/ ëåðôü)Áóèåíåßò õðü áãùãÞ 71 (95%)


76


áðüêëéóç (SD). Ñ < 0,05 èåùñÞèçêå óôáôéóôéêÜóçìáíôéêü.


Áðü ôïõò 80 õðåñôáóéêïýò áóèåíåßò, óôçìåëÝôç ôåëéêÜ óõìðåñéëÞöèçóáí 75 áóèåíåßò (46Üíäñåò êáé 29 ãõíáßêåò, ìå ìÝóç äéÜñêåéá ÁÕ15±3 Ýôç), áöïý 5 áóèåíåßò áðïññßöèçêáí ëüãùáíåðáñêïýò áñéèìïý ìåôñÞóåùí ôçò ÁÐ óôï óðß-ôé. Ï ìÝóïò áñéèìüò ìåôñÞóåùí ôçò ÁÐ óôï óðßôéáíÜ Üôïìï Þôáí 85±12 (áðü 45-110 ìåôñÞóåéò).ÇëåêôñïíéêÜ ðéåóüìåôñá ÷ñçóéìïðïßçóáí 30 áóèå-íåßò, áíåñïåéäÞ ðéåóüìåôñá 39 áóèåíåßò êáé õäñáñ-ãõñéêÜ ðéåóüìåôñá 6 áóèåíåßò. Ç ìÝóç çëéêßá ôùíáôüìùí Þôáí 72±9 (64-87 Ýôç), ï äåßêôçò ìÜæáòóþìáôïò Þôáí 27,9±6 Kg/m2, ïé 24 (32%) ÞôáíêáðíéóôÝò êáé 71 áóèåíåßò (95%) ëÜìâáíáí áíôéõ-ðåñôáóéêÞ áãùãÞ. Ç ÁÐ óôï éáôñåßï Þôáí óôáôé-óôéêÜ óçìáíôéêÜ õøçëüôåñç óõãêñéôéêÜ ìå ôçíÁÐ óôï óðßôé (152±17/81±10 Ýíáíôé 150±14/80±11 mmHg, p<0,05). Ïé ðñùéíÝò ôéìÝò ìÝôñç-óçò ôçò ÁÐ óôï óðßôé Þôáí óôáôéóôéêÜ óçìáíôé-êÜ õøçëüôåñåò óõãêñéôéêÜ ìå ôéò âñáäéíÝò ôéìÝòôçò ÁÐ (155±13/81±12 Ýíáíôé 144±15/78±11mmHg, p<0,05). Äéáðéóôþèçêå óôáôéóôéêÜ óç-ìáíôéêÞ óõó÷Ýôéóç áíÜìåóá óôçí ÁÐ éáôñåßïõêáé óôçí ÁÐ óôï óðßôé (r=0,44, p<0,005). Âáóé-

æüìåíïé óôçí ÁÐ éáôñåßïõ ôï 24 % ôùí õðåñôá-óéêþí åß÷å ñõèìéóìÝíç ôçí ÁÐ åíþ âáóéæüìåíïéóôçí ÁÐ óôï óðßôé ôï 32% åß÷å ñõèìéóìÝíç ôçíÁÐ (p<0,005). Ïé ôéìÝò ôçò ÁÐ óôï éáôñåßï êáéóôï óðßôé öáßíïíôáé óôïí ðßíáêá 2, åíþ ôï ðïóï-óôü ôùí áóèåíþí ìå ñõèìéóìÝíç ôçí áñôçñéáêÞôïõò ðßåóç óôïí ðßíáêá 3.

ÓõæÞôçóç

Óôç ìåëÝôç áõôÞ åðé÷åéñÞèçêå ç äéåñåýíçóçôçò óõìâïëÞò ôçò ìÝôñçóçò ôçò áñôçñéáêÞò ðßå-óçò óôï óðßôé óôçí êáëýôåñç èåñáðåõôéêÞ áíôé-ìåôþðéóç ôùí õðåñôáóéêþí áôüìùí. Âáóéæüìåíïéóôç äéáðßóôùóç ôçò óôáôéóôéêÜ óçìáíôéêÞò óõ-ó÷åôßóåùò áíÜìåóá óôçí ÁÐ ôïõ éáôñåßïõ êáéóôçí ÁÐ óôï óðßôé öáßíåôáé íá áðïôåëåß ìéáêáëÞ åíáëëáêôéêÞ ðñáêôéêÞ óôçí ðñïóðÜèåéáåðßôåõîçò êáëýôåñçò ñýèìéóçò ôçò ÁÐ óôá õðåñ-ôáóéêÜ Üôïìá.

Ç ìÝôñçóç ôçò ÁÐ óôï óðßôé áðü ôï ßäéïôï Üôïìï Ý÷åé åíèáññõíèåß áðü äéåèíåßò ïñãáíé-óìïýò êáé åöáñìüæåôáé üëï êáé ðåñéóóüôåñï óôçíêëéíéêÞ ðñÜîç1-4. ÁðïôÝëåóìá ìåëÝôçò ðïõ äéå-ñåõíïýóå ôïí áñéèìü ôùí ìåôñÞóåùí ðïõ áðáé-ôïýíôáé óôï óðßôé, þóôå íá åîáóöáëéóèåß ï áêñé-âÞò ðñïóäéïñéóìüò ôùí åðéðÝäùí ôçò ÁÐ, Ýäåé-îáí üôé ï ìÝóïò üñïò ôçò ÁÐ äýï çìåñþí ìå äýï

Ðßíáêáò 3. Ðïóïóôü õðåñôáóéêþí áóèåíþí ìå ñõèìéóìÝíç ôçí ÁÐ

ÂÜóåé ôùí ìåôñÞóåùí ôçò ÁÐ óôï éáôñåßï 24%ÂÜóåé ôùí ðñùéíþí êáé âñáäõíþí ìåôñÞóåùí ôçò ÁÐ óôï óðßôé 32%*ÂÜóåé ôùí ðñùéíþí ìåôñÞóåùí ôçò ÁÐ óôï óðßôé 22%ÂÜóåé ôùí âñáäõíþí ìåôñÞóåùí ôçò ÁÐ óôï óðßôé 38%*

*p<0,05 Ýíáíôé ôùí ìåôñÞóåùí ôçò ÁÐ óôï éáôñåßï

Ðßíáêáò 2. ÔéìÝò ÁÐ óôï éáôñåßï êáé óôï óðßôé

ÓõóôïëéêÞ ÁÐ (mmHg) ÄéáóôïëéêÞ ÁÐ (mmHg)

ÁÐ Éáôñåßïõ

1ç ìÝôñçóç 156±18 82±122ç ìÝôñçóç 151±15 80±113ç ìÝôñçóç 150±16 80±11ÌÝóïò üñïò 152±17 81±10

ÁÐ óôï óðßôé

ÌÝóïò üñïò ðñùéíþí ìåôñÞóåùí 155±13 81±12ÌÝóïò üñïò âñáäõíþí ìåôñÞóåùí 144±15 78±11ÌÝóïò üñïò 150±14* 80±11*

*p<0,05 Ýíáíôé ôïõ ìÝóïõ üñïõ ôùí ìåôñÞóåùí ôçò ÁÐ óôï éáôñåßï

77


ðñùéíÝò êáé äýï áðïãåõìáôéíÝò ìåôñÞóåéò ôçò ÁÐ,ìå äéáöïñÜ 1´ ëåðôïý ìåôáîý ôùí ìåôñÞóåùí,öáßíåôáé üôé ìðïñåß íá õéïèåôçèåß, ìå ôçí ðñïû-ðüèåóç üôé åîáéñïýíôáé ïé ôéìÝò ôùí ìåôñÞóåùíôçò áñ÷éêÞò “áóôáèïýò” ùò ðñïò ôçí ÁÐ çìÝ-ñáò14. ÅðéðëÝïí, ï ìÝóïò üñïò ôùí ôéìþí ôùíðñùéíþí ìåôñÞóåùí ôçò ÁÐ óôï óðßôé öáßíåôáéíá åßíáé óôáèåñÜ õøçëüôåñïò áðü üôé ï áíôßóôïé-÷ïò ìÝóïò üñïò ôùí ôéìþí ôùí âñáäéíþí ìåôñÞ-óåùí ôçò ÁÐ. ÁõôÞ ç äéáöïñÜ ðïõ åðéôõã÷ÜíåéóôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ, äåí ìðïñåß íááðïäïèåß óôçí áíôéõðåñôáóéêÞ áãùãÞ, ìéá êáéÞôáí åìöáíÞò óôï ßäéï ìÝãåèïò ôüóï óå áóèåíåßòõðü èåñáðåõôéêÞ áãùãÞ üóï êáé óå áõôïýò ÷ùñßòáãùãÞ14. Óå êëéíéêÝò ìåëÝôåò üðùò ç ìåëÝôç PAM-ELA15 êáé ç ìåëÝôç SAMPLE16, óôéò ïðïßåò åëÞ-öèçóáí äýï ìüíï ìåôñÞóåéò ôçò ÁÐ óôï óðßôé óåìßá ìüíï ìÝñá (ìßá ðñùéíÞ êáé ìßá âñáäéíÞ ìÝ-ôñçóç ôçò ÁÐ), ôá áðïôåëÝóìáôá êáé ôá óõìðå-ñÜóìáôá öáßíåôáé íá åßíáé äéáöïñåôéêÜ áðü ôááíôßóôïé÷á ðïõ ðñïêýðôïõí áðü ðåñéóóüôåñåòìåôñÞóåéò ôçò ÁÐ óôï óðßôé, óå ðåñéóóüôåñåò áðüìßá ìÝñåò.

ÐáñÜëëçëá ï Ohkubo et al. ðáñáôÞñçóáíüôé ç ìÝôñçóç ôçò áñôçñéáêÞò ðéÝóåùò óôï óðßôéåßíáé ðåñéóóüôåñï ðñïãíùóôéêÞ ôçò ìåëëïíôéêÞòíïóçñüôçôáò ëüãù áñôçñéáêÞò õðåñôÜóåùò áðüüôé ç ìÝôñçóç ôçò ÁÐ óôï éáôñåßï17. Ðáñüôé çìéêñïý ìåãÝèïõò ìåëÝôç ôïõ Ohkubo (ðëçèõóìüò1789 Éáðþíùí), åßíáé ç ìïíáäéêÞ ðïõ åîåôÜæåéôç ó÷Ýóç ìåôáîý ôùí ôéìþí ôçò ÁÐ óôï óðßôéêáé ôçí ðñüãíùóç ôçò íïóçñüôçôáò áðü ôçíáñôçñéáêÞ õðÝñôáóç, öáßíåôáé üôé ïé ôéìÝò ôçòÁÐ óôï óðßôé áðïôåëïýí óçìáíôéêü ðñïãíùóôéêüðáñÜãïíôá.

Áðü ôçí Üëëç ðëåõñÜ, ìéá óåéñÜ ìåëåôþíäåß÷íïõí üôé ï ìÝóïò üñïò ôùí ôéìþí ôùí ìåôñÞ-óåùí ôçò ÁÐ óôï óðßôé, ó÷åôßæåôáé Üìåóá ìå ôïìÝóï üñï ôùí çìåñÞóéùí ôéìþí ôçò 24ùñçò ðåñé-ðáôçôéêÞò êáôáãñáöÞò ìå ìéá äéáöïñÜ ôéìþíðïõ ðñïóäéïñßæïíôáé ìüëéò -1,7/+1,2 mmHg18,19,15.Ï ìÝóïò üñïò ôùí ìåôñÞóåùí ôçò 24ùñçò ðåñé-ðáôçôéêÞò êáôáãñáöÞò, öáßíåôáé íá åßíáé ìéêñü-ôåñïò ôüóï ôïõ ìÝóïõ üñïõ ôùí ôéìþí ôçò ðåñé-ðáôçôéêÞò êáôáãñáöÞò êáôÜ ôç äéÜñêåéá ôçòçìÝñáò (äéáöïñÜ -5/-4 mmHg), üóï êáé ôïõ ìÝ-óïõ üñïõ ôùí ìåôñÞóåùí ôçò ÁÐ óôï óðßôé15.

Ç óõììüñöùóç ôùí áóèåíþí óôçí áíôéõðåñ-ôáóéêÞ èåñáðåßá âåëôéþíåôáé ìå ôçí åöáñìïãÞôçò êáôáãñáöÞò ôçò ÁÐ óôï óðßôé. ÌåëÝôç áðü

ôïí Ashida et al. äåß÷íåé õøçëüôåñç óõììüñöùóçóôïõò áóèåíåßò ðïõ ðáñáêïëïõèïýóáí ôçí ÁÐóôï óðßôé óå ó÷Ýóç ìå áõôïýò ðïõ äåí áêïëïõ-èïýóáí áõôÞ ôçí ðñáêôéêÞ21.

ÕðÜñ÷ïõí Üñáãå “áíôåíäåßîåéò” ôçò ìÝôñç-óçò ôçò ÁÐ óôï óðßôé; Ï Nordman äéáôýðùóåüôé ïé êáôáãñáöÝò ôçò ÁÐ áóèåíþí ìå ÷áìçëüåðßðåäï åêðáßäåõóçò, åßíáé áíáêñéâåßò22. Ïé äéá-ôáñá÷Ýò ôïõ êáñäéáêïý ñõèìïý êáèéóôïýí ôéòìåôñÞóåéò óôï óðßôé ìç áêñéâåßò19,23, Ýôóé þóôå çêïëðéêÞ ìáñìáñõãÞ íá áðïôåëåß ßóùò “áíôÝíäåé-îç” ôçò ðñáêôéêÞò áõôÞò.

Äåí õðÜñ÷ïõí äåäïìÝíá ãéá ôïí ôñüðï ðïõìðïñåß ç ÷ñÞóç ôçò ìÝôñçóçò ôçò ÁÐ óôï óðßôéíá ïäçãÞóåé óå áëëáãÝò ôçò öáñìáêåõôéêÞò áãù-ãÞò. Åðßóçò, äåí åßíáé ãíùóôü áí ïé áóèåíåßòðñïôéìïýí ôçí ðñáêôéêÞ ôçò ìÝôñçóçò ôçò ÁÐóôï óðßôé Þ ôéò ìåôñÞóåéò ôçò ÁÐ ôïõ éáôñåßïõ,üðùò êáé áí ïé áóèåíåßò ðïõ áêïëïõèïýí ôçíðñáêôéêÞ ôçò êáôáãñáöÞò ôçò ÁÐ óôï óðßôé ,åðéôõã÷Üíïõí êáëýôåñï Ýëåã÷ï ôçò áñôçñéáêÞòôïõò ðßåóçò. ÐåñáéôÝñù Ýñåõíá áðáéôåßôáé ìå óôü÷ïôçí áðÜíôçóç ôùí ðáñáðÜíù åñùôçìÜôùí.


1. World Hypertension League. Self measurementof blood pressure: a statement by the WorldHypertension League. J Hypertens, 6:257-261,1998.

2. Pickering T, for an American Society of Hy-pertension ad hoc panel. Recommendations forthe use of home (self) and ambulatory bloodpressure monitoring. Am J Hypertens, 9:1-11,1995.

3. Joint National Committee on Detection, Evalu-ation and Treatment of High Blood Pressure.The fifth report of the Joint National Commit-tee on Detection, Evaluation and Treatment ofHigh Blood Pressure (JNC V). Arch Intern Med,153:154-183, 1993.

4. WHO/ISH. Guidelines for the management ofmild hypertension: memorandum from a WorldHealth Organization/International Society of Hy-pertension meeting. J Hypertens, 11:905-918,1993.

5. Ayman D, Goldshine A. The differences be-tween clinic and home readings before treat-ment. Am J Med Sci, 200:465-474, 1940.

6. Mancia G, Bertinieri G, Grassi G, Parati G,Pomidossi G, Ferrari A, et al. Effects of blood


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pressure measurement by the doctor on pa-tient’s blood pressure and hear rate. Lancet,24;2:695-698, 1983.

7. Pickering TG, James GD, Boddie C, HarshfieldGA, Blank S, Laragh JH. How common is whitecoat hypertension. JAMA, 259:225-228, 1988.

8. Mengden T, Battig B, Edmonds D, Jeck T,Huss R, Sachindis A, et al. Self measured bloodpressures at home and during consulting hours:are there any differences. J Hypertens, 8:S15-19, 1990.

9. Verdecchia P, Schillaci G, Borgioni C, CiucciA, Zampi I, Gattobigio R, et al. White coathypertension and white coat effect similaritiesand differences. Am J Hypertens, 8:790-798,1995.

10. Khattar RS, Senior R, Lahiri A. Cardiovascularoutcome in white-coat versus sustained mildhypertension: a 10-year follow-up study. Circu-lation, 98:1892-1897, 1998.

11. Verdecchia P, Schillaci G, Borgioni C, CiucciA, Porcellati C. Prognostic significance of thewhite-coat effect. Hyprtension, 29:1218-1224,1997.

12. Julius S, Mejia A, Jones K, Krause L, SchorkN, Van de Ven C, et al. White coat versussustained borderline hypertension in Tecum-seh, Michigan. Hypertension, 16:617-623, 1990.

13. Chalmers J and WHO_ISH Guidelines Com-mittee. Committee, World Health Organisation-International Society of Hypertension Guide-lines for the management of hypertension. JHypertens, 17:151-185, 1999.

14. Stergiou GS, Skeva II, Zourbaki AS, Moun-tokalakis TD. Self-monitoring of blood pres-sure at home: how many measurements are

needed. J Hypertens, 16:725-731, 1998.15. Mancia G, Sega R, Bravi C, De Vito G, Vala-

gussa F, Cesana G, et al. Ambulatory bloodpressure normality: results from the PAMELAstudy. J Hypertens, 13:1377-1390, 1995.

16. Mancia G, Zanchetti A, Agebiti-Rosei E, Ben-emio G, De Cesaris R, Fogari R, et al. Ambu-latory blood pressure is superior to clinic bloodpressure in predicting treatment-induced regres-sion of left ventricular hypertrophy. Circula-tion, 95:1464-1470, 1997.

17. Ohkubo T, Imai Y, Tsuji I, Nagai K, KikuchiN, Nishiyama A, et al. Home blood pressuremeasurement has a stronger predictive powerfor mortality than does screening blood pres-sure measurement: a population-based observa-tion in Ohasama, Japan. J Hypertens, 16: 971-975, 1998.

18. Stergiou GS, Zourbaki AS, Skeva II, Moun-tokalakis TD. White coat effect detected usingself-monitoring of blood pressure at home: com-parison with ambulatory blood pressure. Am JHypertens, 11:820-827, 1998.

19. Yarows SA, Julius S, Pickering TG. Home bloodpressure monitoring. Arch Intern Med, 160:1251-1257, 2000.

20. Ashida T, Sugiyama T, Okuno S, Ebihara A,Fujii J. Relationship between home blood pres-sure measurement and medication complianceand name recognition of antihypertensive drugs.Hypertens Res Clin Exper, 23:21-24, 2000.

21. Nordmann A, Frach B, Walker T, Martina B,Battegay E. Reliability of patients measuringblood pressure at home: prospective observa-tional study. BMJ, 319:1172, 1999.

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ÐåñßëçøçÓêïðüò: Ç áíß÷íåõóç åöÞâùí ÷ñçóôþí áëêïüë áíÜìåóá óôï ìáèçôéêü ðëçèõ-óìü ëõêåßïõ çìéáóôéêÞò ðåñéï÷Þò ôçò âüñåéáò ÊñÞôçò, áöïý åßíáé ðñïöáíÝòüôé ôá ðñïãñÜììáôá ðñüëçøçò ðñÝðåé íá îåêéíïýí Ýãêáéñá êáé íá åðéêåíôñþ-íïíôáß ü÷é ìüíï óôï Üôïìï áëëÜ êáé óôçí ïéêïãÝíåéá êáé ôï ó÷ïëåßï. Ðëçèõ-óìüò – ìÝèïäïò: Ôá óôïé÷åßá óõãêåíôñþèçêáí óôç äéÜñêåéá ôïõ ôåëåõôáßïõôñéìÞíïõ ôïõ 2002. Ïé óõììåôÝ÷ïíôåò Þôáí ï óõíïëéêüò áñéèìüò ôùí ìáèçôþí(Í=133) ôïõ ìïíáäéêïý ëõêåßïõ ôïõ ÄÞìïõ ÃåñïðïôÜìïõ. Ôá áãüñéá Þôáí 58/133 (43,6%) êáé ôá êïñßôóéá 75/133 (56,4%). Ç ìÝóç çëéêßá ôùí óõììåôå÷ü-íôùí Þôáí ôá 16,9 ÷ñüíéá. ×ñçóéìïðïéÞèçêáí ùò åñãáëåßá áíß÷íåõóçò ôáåñùôçìáôïëüãéá CRAFFT (Car Relax Alone Forget Family-Friends Trouble) ãéáåöÞâïõò êáé AUDIT (Alcohol Use Disorder Identification Test). Äüèçêå Ýìöáóçóôïí åèåëïíôéêü ÷áñáêôÞñá ôçò óõììåôï÷Þò óôçí áíùíõìßá êáé ôç äéáóöÜëéóçôïõ áðïññÞôïõ. ÁðïôåëÝóìáôá: Áðü ôç âáèìïëüãçóç ôïõ CRAFFT test çåêôßìçóç Þôáí èåôéêÞ (score ≥ 2) ãéá 28/58 áãüñéá (48,3%) êáé ãéá 14/75êïñßôóéá (18,7%). Ôá áíôßóôïé÷á ðïóïóôÜ èåôéêþí áðïôåëåóìÜôùí áðü ôï AU-DIT test (score > 8) Þôáí 17/58 (29,3%) ãéá ôá áãüñéá êáé 3/75 (0,04%) ãéá ôáêïñßôóéá. Ðáñáôçñåßôáé óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ óôçí êáôáíÜëùóç áë-êïüë ìåôáîý ôùí äõï öýëùí óôçí ßäéá çëéêßá (Person’s x2: p<0,001) ¢îéïðñïóï÷Þò êáé ðñïâëçìáôéóìïý åßíáé üôé 80/133 (60,2%) ðáéäßá áðÜíôçóáíèåôéêÜ óôï ðñþôï åñþôçìá ôïõ CRAFFT, ðïõ áöïñÜ óôçí ðáñïõóßá ôïõò óåáõôïêßíçôï ðïõ ïäçãïýóå êÜðïéïò ï ïðïßïò åß÷å êÜíåé êáôáíÜëùóç áëêïüë.ÓõìðåñÜóìáôá: Ôï ðñüâëçìá ôçò ÷ñÞóçò áëêïüë áíÜìåóá óå íåáñïýò åöÞ-âïõò ðáßñíåé åðéêßíäõíåò äéáóôÜóåéò. Ç ëåéôïõñãßá ðñïãñáììÜôùí ÝãêáéñçòðáñÝìâáóçò ìðïñåß íá áíáêüøåé ôçí ðïñåßá ðñïò ôçí ðñïâëçìáôéêÞ ÷ñÞóçêáé ôçí åîÜñôçóç áðü ôï áëêïüë.

KáôáíÜëùóç áëêïüë áðü åöÞâïõò:Mßá åðéêßíäõíç ðñáãìáôéêüôçôá

Á. Ìðáôßêáò, Ê. Óôåöáíïðïýëïõ, É. ÄñõãéáííÜêçò, Á. ÐåôñÜêç, Í. ÐáðáäÜêçò

ÅéóáãùãÞ

Ç ÷ñÞóç “ïõóéþí” åßíáé ðéá áñ-êåôÜ äéáäåäïìÝíç áíÜìåóá óôïõò åöÞ-âïõò êáé ç êáôÜ÷ñçóÞ ôïõò áðïôåëåßÝíá óõíå÷þò ïîõíüìåíï ðñüâëçìá.

Ï üñïò “ïõóßåò” ìðïñåß íá ÷ñçóé-ìïðïéçèåß ãéá ðïëëÝò øõ÷ïôñüðåò ïõ-óßåò, áðü ôïí êáðíü êáé ôï áëêïüëÝùò ôçí êÜííáâç êáé ôçí çñùßíç, ôùíïðïßùí ç ÷ñÞóç êáé ç êáôÜ÷ñçóçìðïñåß íá åðçñåÜóåé óå ìåãÜëï âáèìüáñíçôéêÜ ôçí ðïéüôçôá æùÞò ôùí ÷ñç-óôþí1.

ÐñÜãìáôé, ç êáôáíÜëùóç ïéíï-ðíåõìáôùäþí ðïôþí áõîÜíåôáé êáôá-êüñõöá óôçí åöçâåßá. Ç óõ÷íüôçôáôçò ìÝèçò áõîÜíåôáé, åðßóçò, äñáìáôé-êÜ.

Óôç ÌåãÜëç Âñåôáíßá ç êáôÜ-÷ñçóç áëêïüë áíÜìåóá óôïõò íÝïõò

ËÝîåéò ÊëåéäéÜ: áëêïüë, Ýöçâïò, åîÜñôçóç, ðñüëç-øç, ðñùôïâÜèìéá öñïíôßäá õãåßáòÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñçáíáêïßíùóç óôï 15o ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞòÉáôñéêÞò (×áëêéäéêÞ 30 Áðñéëßïõ - 4 ÌáÀïõ 2003)êáé âñáâåýôçêå áðü ôçí åðéôñïðÞ Êñßóçò. Äçìï-óéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò Åðé-ôñïðÞò ôïõ ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò Åðé-ôñïðÞò ôïõ Óõíåäñßïõ.Õðåýèõíïò áëëçëïãñáößáò: Áíôþíçò Ìðáôßêáò, ÊÝ-íôñï Õãåßáò ÐåñÜìáôïò Ñåèýìíïõ, Ôçë. (2834)023074,(6944)504898, Fax: (28340)23191,E-Mail: [email protected]

KÝíôñï Õãåßáò ÐåñÜìáôïò Ñåèýìíïõ


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Á. Ìðáôßêáò êáé óõí.

Ðëçèõóìüò ìåëÝôçò - ÌÝèïäïò:

Tá óôïé÷åßá óõãêåíôñþèçêáí óôçäéÜñêåéá ôïõ ôåëåõôáßïõ ôñéìÞíïõ ôïõ2002. Ç ìåëÝôç åãêñßèçêå áðü ôç Äéåý-èõíóç ÄåõôåñïâÜèìéáò Åêðáßäåõóçò Ñå-èýìíïõ, äåäïìÝíïõ üôé ïé óõììåôÝ÷ï-íôåò Þôáí ï óõíïëéêüò áñéèìüò ôùíìáèçôþí (Í=133) ôïõ ìïíáäéêïý ëõ-êåßïõ ôïõ ÄÞìïõ ÃåñïðïôÜìïõ Ñåèý-ìíïõ.

Ôá áãüñéá Þôáí 58/133 (43,6%)êáé ôá êïñßôóéá 75/133 (56,4%). HìÝóç çëéêßá ôùí ðáéäéþí ðïõ ðÞñáíìÝñïò óôçí Ýñåõíá Þôáí ôá 16,9 ÷ñü-íéá.

×ñçóéìïðïéÞèçêáí ùò åñãáëåßááíß÷íåõóçò ôá åñùôçìáôïëüãéá CRA-FFT (Car Relax Alone Forget Fami-ly-Friends Trouble) ãéá åöÞâïõò4 êáéAUDIÔ (Alcohol Use Disorder Iden-tification Test)5, üðùò áõôÜ Ý÷ïõíáðïäïèåß óôá åëëçíéêÜ áðü ôï ÊÝíôñïÅîÜñôçóçò êáé Èåñáðåßáò ÅîáñôçìÝ-

Alcohol consumption by adolescents: A dangerous realityA. Batikas, K. Stefanopoulou, I. Drygjannakis, A. Petraki, N. Papadakis

SummaryAim: The detection of adolescent alcohol consumers among the higher gradesstudent population of a semi-urban region in nothern Crete, since it is evidentthat prevention programmes should start in time and focus not only on theindividual but also on family and school. Population-methods: The data weregathered during the last trimester of 2002. The participants were the totalnumber of students (N=133) of the only lyceum (three last grades of secondaryeducation) of the municipality of Geropotamos.There were 58/133 boys (43.6%)and 75/133 girls (56.4%). The participants’ mean age were 16.9 years.As tools of detection, the CRAFFT (Car Relax Alone Forget Family-FriendsTrouble) for teenagers and AUDIT (Alcohol Use Disorder Identification Test)inquiry tests were used. Voluntary participation as well as anonymity wereemphasized. Results: Judging by CRAFFT test, the score was positive (score =2) for 28/58 boys (48.3%) and for 14/75 girls (18.7%). Respective positivescores from AUDIT test (score > 8) were 17/58 (29.3%) for boys and 3/75(0.04%) for girls. A statistically significant difference in alcohol consumptionbetween the two sexes is noted (Person’s x2: p<0.001). It is worth noting that80/133 (60.2%) children answered positively to the first CRAFFT question reg-arding their presence in a car driven by someone having previously consumedalcohol. Conclusions: the alcohol consumption problem among young teenage-rs is taking dangerous dimensions. Early intervention programs may inhibit thecourse towards alcohol dependence.Key Words: alcohol, adolescent, dependence, prevention, primary health care

Health Centre of Perama

íùí Áôüìùí (Ê.Å.È.Å.Á), ôï ïðïßï óå óõíåñãá-óßá ìå ôï ôìÞìá øõ÷éáôñéêÞò ôïõ Ðáí/ìßïõ ÓáíÍôéÝãêï ôçò Êáëéöüñíéá, õðü ôçí áéãßäá ôïõÐ.å.Ó.Õ.Ð. ÊñÞôçò, áíÝëáâå ôçí åêðáßäåõóç ëåé-ôïõñãþí ôçò ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáòóôçí áíß÷íåõóç, áëëÜ êáé áñ÷éêÞ áíôéìåôþðéóçåîáñôçìÝíùí áôüìùí.

Ôï CRAFFT test ðåñéëáìâÜíåé Ýîé åñùôÞ-óåéò (íáé/ü÷é), åßíáé êáôÜëëçëï ùò åñãáëåßï áíß-÷íåõóçò êáôáíÜëùóçò áëêïüë óôïõò åöÞâïõò êáéÝ÷åé õøçëÞ åõáéóèçóßá êáé åéäéêüôçôá óå ðïóï-óôü 92% êáé 82% áíôßóôïé÷á.

Ôï AUDIT åßíáé Ýíá åñãáëåßï äéáëïãÞò ìåäÝêá åñùôÞóåéò ðïëëáðëÞò åðéëïãÞò, êáôÜëëçëïãéá üëåò ôéò çëéêßåò. Ç åõáéóèçóßá (51-79%) êáéç åéäéêüôçôá (78-96%) ôïõ äéáöÝñåé áíÜëïãá ìåôçí êïõëôïýñá êáé ôçí åèíéêüôçôá.

Äüèçêå éäéáßôåñç Ýìöáóç óôïí åèåëïíôéêü÷áñáêôÞñá ôçò óõììåôï÷Þò, óôçí áíùíõìßá êáéôç äéáóöÜëéóç ôïõ áðïññÞôïõ, áöïý ïé ìáèçôÝòäåí Ýðñåðå íá ãñÜøïõí ôï üíïìÜ ôïõò óôï Ýíôõ-ðï, áëëÜ, ìüíï ôï öýëï êáé ôç ÷ñïíïëïãßá ãÝí-íçóÞò ôïõò, ïé äå êáèçãçôÝò äåí Þôáí ðáñüíôåòêáôÜ ôç äéÜñêåéá ôçò óõìðëÞñùóçò ôùí åñùôç-ìáôïëïãßùí. Ôá ìÝëç ôçò ïìÜäáò õãåßáò, ðïõóõììåôåß÷áí óôçí Ýñåõíá, Ýäéíáí ãåíéêÝò ïäçãßåò

áðïôåëåß ðïëý ìåãáëýôåñï ðñüâëçìá áð’áõôü ôçòêáôÜ÷ñçóçò íáñêùôéêþí.

Ïé ðáìð êáé ôá ìðáñ åëêýïõí ôïõò íÝïõòüëï êáé ðåñéóóüôåñï, åíþ ôï ðïôü óÞìåñá Ý÷åéãßíåé óðïõäáßï êïììÜôé ôçò æùÞò ôïõò1.

Åßíáé åíäéáöÝñïí, åðßóçò, üôé ç ÷ñÞóç áë-êïüë óôçí åöçâåßá áðïôåëåß óçìáíôéêü ðáñÜãï-íôá êéíäýíïõ ãéá ôçí Ýíáñîç ôçò ÷ñÞóçò ðáñÜíï-ìùí ïõóéþí2, åíþ ôá óùìáôéêÜ ôñáýìáôá êáé çåðéêßíäõíç óåîïõáëéêÞ óõìðåñéöïñÜ, üôáí ôïÜôïìï âñßóêåôáé õðü ôçí åðÞñåéá áëêïüë åßíáéóõ÷íü öáéíüìåíï óôïõò åöÞâïõò.

ÔÝëïò, ôï ìåãáëýôåñï ðïóïóôü ôùí åíçëßêùíáëêïïëéêþí îåêßíçóå áðü õðåñâïëéêÞ êáôáíÜëù-óç áëêïüë óôçí åöçâåßá3.

Óêïðüò ôçò ìåëÝôçò ìáò åßíáé ç áíß÷íåõóçåöÞâùí ÷ñçóôþí áëêïüë áíÜìåóá óôïí ìáèçôéêüðëçèõóìü Ëõêåßïõ áãñïôéêÞò-çìéáóôéêÞò ðåñéï-÷Þò ôçò Âüñåéáò ÊñÞôçò, áöïý åßíáé ðñïöáíÝòüôé ôá ðñïãñÜììáôá ðñüëçøçò ðñÝðåé íá îåêé-íïýí ðñéí áðü ôçí çëéêßá áõôÞ êáé íá åðéêå-íôñþíïíôáé ü÷é ìüíï óôï Üôïìï, áëëÜ êáé óôçíïéêïãÝíåéá êáé ôï ó÷ïëåßï.

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óôïõò ìáèçôÝò ðïõ Ýêáíáí åñùôÞóåéò, áëëÜ äåíôïõò âïçèïýóáí óôç óõìðëÞñùóç ôùí åñùôçìá-ôïëïãßùí. Óôï ôÝëïò êÜèå óõíåäñßáò, ãéíüôáí ìéááíáóêüðçóç áðü ôïõò ëåéôïõñãïýò ôçò Ðñùôï-âÜèìéáò Öñïíôßäáò Õãåßáò ìå óôü÷ï íá ìåôáöåñ-èåß ôï êáôÜëëçëï ãé’áõôÞ ôçí çëéêéáêÞ ïìÜäáìÞíõìá åíÜíôéá óôç ÷ñÞóç ïõóéþí.

Áêïëïýèçóå ç âáèìïëüãçóç ôùí åñùôçìá-ôïëïãßùí (âáèìïëüãçóç êÜèå åñþôçóçò ÷ùñéóôÜêáé õðïëïãéóìüò ôïõ ôåëéêïý score) óýìöùíá ìåôéò õðïäåéêíõüìåíåò áðü ôï åñùôçìáôïëüãéï-åñ-ãáëåßï áíß÷íåõóçò ïäçãßåò.

Ôï èåôéêü CRAFFT TEST ãéá åöÞâïõò (äýïÞ ðåñéóóüôåñåò èåôéêÝò áðáíôÞóåéò) öáíåñþíåéìåãÜëç ðéèáíüôçôá Ýíáñîçò åðéêßíäõíçò êáé åðé-âëáâïýò êáôáíÜëùóçò áëêïüë êáé õðïäåéêíýåéôçí áíÜãêç ãéá ðåñáéôÝñù åêôßìçóç, åíçìÝñùóç,åõáéóèçôïðïßçóç êáé ðáñáêïëïýèçóç4.

¼óïí áöïñÜ óôï AUDIT test ôï åëÜ÷éóôïóêïñ ðïõ ìðïñåß íá åðéôåõ÷èåß (áðü Üôïìá ðïõäåí êÜíïõí êáôáíÜëùóç áëêïüë) åßíáé 0 êáé ôïìåãáëýôåñï äõíáôü ôï 40. Óêïñ õøçëüôåñï ôïõ 8õðïäåéêíýåé ìåãÜëç ðéèáíüôçôá åðéêßíäõíçò Þåðéâëáâïýò êáôáíÜëùóçò áëêïüë5.

Ôá áðïôåëÝóìáôá êáôá÷ùñÞèçêáí óå âÜóçäåäïìÝíùí Excel êáé áíáëýèçêáí óôáôéóôéêÜ ìÝóùSPSS, Ver. 8.


Áðü ôç âáèìïëüãçóç ôïõ CRAFFT ôåóô(ÄéÜãñáììá 1) ç åêôßìçóç Þôáí èåôéêÞ (score ≥

2) ãéá 28/58 áãüñéá (48,3%)êáé ãéá 14/75 êïñß-ôóéá (18,7%).

Ôá áíôßóôïé÷á ðïóïóôÜ èåôéêþí áðïôåëåóìÜ-ôùí áðü ôï AUDIT test (score>8) Þôáí17/58äçë. ( 29,3%) ãéá ôá áãüñéá êáé 3/75 ( 0,04%)ãéá ôá êïñßôóéá (ÄéÜãñáììá 2).

Ðáñáôçñåßôáé êáé ìå ôá äýï åñùôçìáôïëü-ãéá óôáôéóôéêÜ óçìáíôéêÞ äéáöïñÜ óôçí êáôáíÜ-ëùóç áëêïüë ìåôáîý ôùí äýï öýëùí óôçí ßäéáçëéêßá (Pearson’s ÷2 : p<0,001).

¢îéï ðñïóï÷Þò áëëÜ êáé ðñïâëçìáôéóìïý åßíáéüôé 80 óôá 133 ðáéäéÜ (60,2%) áðÜíôçóáí èåôé-êÜ óôï ðñþôï åñþôçìá ôïõ CRAFFT test:

“¸÷åéò âñåèåß ðïôÝ óå áõôïêßíçôï (CAR) ôïïðïßï ïäçãïýóå êÜðïéïò (óõìðåñéëáìâáíïìÝíïõôïõ åáõôïý óïõ) ï ïðïßïò Þôáí ¨öôéáãìÝíïò¨ Þåß÷å êÜíåé êáôáíÜëùóç áëêïüë Þ ïõóéþí ”, äåäï-ìÝíïõ üôé ôá ôñï÷áßá áôõ÷Þìáôá áðïôåëïýí ôçíðñþôç áéôßá èáíÜôïõ êáé áíáðçñßáò óôçí çëé-êéáêÞ ïìÜäá 15-44 óôéò áíåðôõãìÝíåò ÷þñåò5.

ÓõìðåñÜóìáôá

• ¼ðùò ðñïêýðôåé áðü ôá áðïôåëÝóìáôá ôçòÝñåõíÜò ìáò ôï ðñüâëçìá ôçò ÷ñÞóçò áë-êïüë áíÜìåóá óå íåáñïýò åöÞâïõò ðáßñíåéåðéêßíäõíåò äéáóôÜóåéò êáé óýìöùíá ìå áñ-êåôïýò ìåëåôçôÝò ìðïñåß íá ëåéôïõñãÞóåé ùò“ðýëç åéóüäïõ” óôá ðáñÜíïìá íáñêùôéêÜ7.Åéäéêüôåñá, ç óõììåôï÷Þ óå êáôáóôÜóåéò÷ñÞóçò áëêïüë áðü áíçëßêïõò ìðïñåß íáïäçãåß ôïõò åöÞâïõò ó’Ýíá ðåñéâÜëëïí ÷ñÞ-

ÄéÜãñáììá 1. ÁðïôåëÝóìáôá CRAFFT áíÜ öýëï.

48,28%51,72%

0,00%

10,00%

20,00%

30,00%

40,00%

50,00%

60,00%

70,00%

80,00%

90,00%

èåôéêÞ åêôßìçóç áñíçôéêÞ

ÁðÜíôçóç

% ¢ññåíÈÞëõ


82

Á. Ìðáôßêáò êáé óõí.

29,31%

70,69%

0,03%

99,97%

0,00%

20,00%

40,00%

60,00%

80,00%

100,00%

120,00%

èåôéêÞ åêôßìçóç áñíçôéêÞ åêôßìçóç

ÁðÜíôçóç

%

¢ññåí

ÈÞëõ

ÄéÜãñáììá 2. ÁðïôåëÝóìáôá AUDIT áíÜ öýëï.

óçò óôï ïðïßï åßíáé ðéï ðéèáíü íá ôïõò ðñï-óöÝñïõí íáñêùôéêÜ Þ óôï ïðïßï åêôßèåíôáéðåñéóóüôåñï óå óôÜóåéò êáé áðüøåéò öéëéêÝòðñïò ôç ÷ñÞóç8.

• Ç ëåéôïõñãßá ðñïãñáììÜôùí Ýãêáéñçò ðá-ñÝìâáóçò ìðïñåß íá áíáêüøåé ôçí ðïñåßáôùí ÷ñçóôþí, ðïõ âñßóêïíôáé óå öÜóç ðåé-ñáìáôéóìïý Þ óå ðñþéìá óôÜäéá êáôÜ÷ñçóçòáëêïüë Þ Üëëùí ïõóéþí ðñïò ôçí ðñïâëçìá-ôéêÞ ÷ñÞóç êáé ôçí åîÜñôçóç.

ÓõæÞôçóç

Ïé Ýöçâïé ìåãáëþíïõí óå ìéá êïéíùíßá, üðïõï êáðíüò êáé ôï áëêïüë, Þ ôï ÷áóßò êáé ïé áìöå-ôáìßíåò âñßóêïíôáé ðáíôïý êáé äå èá ðñÝðåé íáìáò åêðëÞóóåé ôï ãåãïíüò üôé äåëåÜæïíôáé êáéèÝëïõí íá ðåéñáìáôéóèïýí ì’ áõôÜ.

Ôá íáñêùôéêÜ ðáñïõóéÜæïíôáé ùò ïé èáõìá-ôïõñãÝò ïõóßåò ðïõ õðïôßèåôáé üôé ëýíïõí üëá ôáðñïâëÞìáôá ôçò áíÜðôõîçò êáé ôçò æùÞò ó’ Ýíáíêüóìï ãåìÜôï Ýíôáóç1.

Áðü Ýíá óçìåßï üìùò êé Ýðåéôá, ðáýïõí íáåßíáé ìéá óõíáñðáóôéêÞ åìðåéñßá êáé ãßíïíôáé Ýíáäåêáíßêé ÷ùñßò ôï ïðïßï äåí ìðïñåß íá êÜíåéâÞìá óôç æùÞ. Ìå ôïí ßäéï, áêñéâþò, ôñüðï ëåé-ôïõñãåß ôï ïéíüðíåõìá óôïõò áëêïïëéêïýò.

Ôï áëêïüë ðñïóöÝñåé ìéá áðüäñáóç áðü ôçäõóÜñåóôç ðñáãìáôéêüôçôá, äçìéïõñãåß êÝöé, ìåéþ-íåé ôéò áíáóôïëÝò, åîáëåßöåé ôçí Ýíôáóç êáé äéåõ-

êïëýíåé ôéò êïéíùíéêÝò ó÷Ýóåéò. ÐñïóöÝñåé äçë.óôéãìÝò áíáêïýöéóçò áðü ôç óôåíï÷þñéá êáé ôçäõóôõ÷ßá1,9.

Ç êáôÜ÷ñçóÞ ôïõ üìùò, ïäçãåß óõ÷íÜ óôéòãíùóôÝò åíï÷ëçôéêÝò óêçíÝò ôùí ìåèõóìÝíùí, óåóåîïõáëéêÝò áðñÝðåéåò, óå êáâãÜäåò, áêüìá êáéóôï èÜíáôï óôç ìÝóç ôïõ äñüìïõ, åíþ äå èáðñÝðåé íá ðáñáãíùñßóïõìå êáé ôï ìåãÜëï ðïóï-óôü ôùí ôñï÷áßùí áôõ÷çìÜôùí ðïõ óõìâáßíïõíõðü ôçí åðÞñåéá ôïõ áëêïüë.

Åðßóçò, åßíáé åíäéáöÝñïí ôï ãåãïíüò üôé çêáôáíÜëùóç áëêïüë óå ìéêñÝò çëéêßåò óõíäÝåôáéìå ôç ÷ñÞóç íüìéìùí êáé ðáñÜíïìùí ïõóéþí10.

¸÷åé áðïäåé÷èåß üôé äåí õðÜñ÷åé ó÷åäüí êá-íÝíáò Ýöçâïò, ðïõ íá êÜíåé ôþñá ÷ñÞóç óêëç-ñþí íáñêùôéêþí êáé ðïõ íá ìçí Ý÷åé êÜíåé óôïðáñåëèüí êáôÜ÷ñçóç áëêïüë, êáðíïý êáé ÷áóßò11.Áõôü äå óçìáßíåé, âÝâáéá, üôé ïé Ýöçâïé ðïõ ðñþ-ôá êáðíßæïõí êáé ìåôÜ ðßíïõí, èá óõíå÷ßóïõíáíáãêáóôéêÜ ìå ìáñé÷ïõÜíá Þ “óêëçñÜ” íáñêù-ôéêÜ.

Ï íÝïò ðïõ ðßíåé õðåñâïëéêÜ, öáßíåôáé ðùòÝ÷åé ìéá éäéáßôåñç áíÜãêç íá áéóèáíèåß äõíáôüò.Ôï ðïôü, ëïéðüí, áõîÜíåé ôï áßóèçìá ôçò äýíá-ìçò, ðïõ íéþèåé êáíåßò12.

ÖõóéêÜ, õðÜñ÷ïõí êáé ôá áñíçôéêÜ ïéêïãå-íåéáêÜ ðñüôõðá ðïõ ðñïäéáèÝôïõí êáôÜ êÜðïéïíôñüðï ôïí Ýöçâï ãéá õðÝñìåôñç êáôáíÜëùóçáëêïüë.

Óôçí ïéêïãÝíåéá åíüò åöÞâïõ ðïõ ðßíåé õðÜñ-÷åé óõíÞèùò Ýíá “ãåñü ðïôÞñé” êé áõôüò ôéò ðå-

83


ñéóóüôåñåò öïñÝò åßíáé ï ðáôÝñáò13.Ï ðéï áðïôåëåóìáôéêüò ôñüðïò óõìðáñÜóôá-

óçò åßíáé íá âïçèÞóïõìå ôïõò åöÞâïõò íá áíôé-ìåôùðßóïõí ôá ðñïâëÞìáôá ðïõ ðëáéóéþíïõí ôçíêáôáíÜëùóç áëêïüë.

Ï øõ÷ïëüãïò J.Ôravers õðïóôçñßæåé üôé ç ðéïäýóêïëç áðüöáóç ãéá Ýíáí Ýöçâï äåí åßíáé ôïíá äéáëÝîåé áí èá ðßíåé Þ ü÷é. Ï ðñáãìáôéêüòãñßöïò åßíáé áí èá ìðïñÝóåé íá æÞóåé ìå ôçíáðüöáóÞ ôïõ üðïéá êé áí åßíáé áõôÞ14.

Áò Ý÷ïõìå óôï íïõ ìáò üôé ðñÝðåé íá ðñïóÝ-÷ïõìå ðïëý üôáí ìéëÜìå óôá ðáéäéÜ ãéá ôï áë-êïüë Þ Üëëá íáñêùôéêÜ.

Ìéá ëÜèïò êïõâÝíôá óå ìéá áêáôÜëëçëç óôéã-ìÞ ìðïñåß íá ôá êÜíåé íá åðáíáóôáôÞóïõí êéÝôóé íá öÝñïõìå áíôßèåôá áðïôåëÝóìáôá.

Ìéá óùóôÞ êïõâÝíôá êáôáíüçóçò, ðÜëé,ìðïñåß íá åíéó÷ýóåé ôçí êñõöÞ ôïõò áðüöáóç íáìçí ðéïõí Þ íá ìç äïêéìÜóïõí ôá íáñêùôéêÜ.

Ç ðñüëçøç êáé ç áíôéìåôþðéóç ôùí åîáñôÞ-óåùí ðñïûðïèÝôåé ôïí ãüíéìï äéÜëïãï êáé ôçóõíåñãáóßá áíÜìåóá óôïõò åðáããåëìáôßåò õãåßáò,ôçí áêáäçìáúêÞ êïéíüôçôá êáé ôïõò ðïëéôéêÜõðåýèõíïõò ãéá ôá èÝìáôá áõôÜ.


1. Herbert Ì., Øõ÷ïëïãéêÜ ðñïâëÞìáôá åöçâéêÞòçëéêßáò, êåö.7, óåë.171-198, åêäüóåéò ÅëëçíéêÜÃñÜììáôá, 1994.

2. Wilner P. A view through the gateway: expect-ancies as a possible pathway from alcohol tocannabis, Adiction, 96:5, 2001.

3. Bonomo Y, Colfey C, Wolfie R, Lynskey M,Bowes G, Patton G. Ïé áñíçôéêÝò óõíÝðåéåò ôçò÷ñÞóçò áëêïüë áðü åöÞâïõò. Addiction, 96:10,2001.

4. Knight JR, Shrier LA, Bravender TD, FarrellM, Vander Bilt J, Shaffer HJ. A new brief

screen for adolescent substance abuse. ArchPediatr Adolesc Med, 153:591-596, 1999.

5. Babor TF, de la Fuente JR, Saunders J, GrantM.AUDIT: The Alcohol use disorders identifi-cation Tests: Guidelines for use in Primary healthcare. Geneva, Switzerland: World Health Orga-nization, 1992.

6. Murray CJL, Lopez AD. Evidence Based HealthPolicy-Lessons from the Global Burden of Dis-ease Study. Science, 274:740, 2002.

7. Kandel D.B, Yamaguchi K. Stages of progres-sion in drug involvement from adolescence toadult hood: further evidence for the gatewaytheory. Journal of Studies on Alcohol, 53:447-457, 1992.

8. Welte JW Barnes G.M Alcohol: the gateway toother drug use among secondary school stu-dents. Journal of Youth and Adolescence, 14:487-498 1981.

9. Stefanis N.C, Kokkevi A.: “Depression and druguse“ Psychopathology, 19:S2:124-134, 1986.

10. Kokkevi A. Stefanis N.C “Alcohol consumptionamong Creek Adolescents” Paper presented atthe world Psychiatric association, Warsow, Po-land 22-25-November, 11-16, 1987.

11. Kandel D.B, Yamaguchi K. Stages of progres-sion in drug involvement from adolescence toadult hood: further evidence for the gatewaytheory. Journal of Studies on Alcohol, 53:447-457, 1992.

12. Marlatt G.A., Baer, J.S. Quigley L.A. Self-effi-cacy and addictive behavior. In Bandura, A.(ed) Self-efficacy in changing societies. Cam-bridge University Press, Cambridge, 289-315,1995.

13. O”Malley S.S. Maisto, S.A. Effect off familydrinking history and expectancies on responsesto alcohol in men. Journal of Studies on Alco-hol, 46:289-297, 1985.

14. Travers J.F. The Growing child, New York,Wiley, 1977.


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Ê. Óõñéáíüò êáé óõí.



ÐåñßëçøçÓêïðüò ôçò ìåëÝôçò åßíáé ç áíáæÞôçóç ôùí ôñïðïðïéÞóéìùí ðáñáãüíôùí,ðïõ êáèïñßæïõí ôçí ðéèáíüôçôá åðéâßùóçò ôùí áóèåíþí, ðïõ Ý÷ïõí õðïóôåßêáñäéáêÞ áíáêïðÞ Ýîù áðü ôï íïóïêïìåßï êáé áíôéìåôùðßóèçêáí áðü ôéò õðç-ñåóßåò ðáñï÷Þò åðåßãïõóáò ðñïíïóïêïìåéáêÞò éáôñéêÞò. Õëéêü êáé ìÝèïäïò:ìåëåôÞèçêå ç Ýêâáóç ôùí ðåñéóôáôéêþí êáñäéáêÞò áíáêïðÞò, ðïõ áíôéìåôùðß-óèçêáí áðü ôï ÅÊÁÂ ÊïæÜíçò, óå äéÜóôçìá 13 ìçíþí, áðü 1 Éáíïõáñßïõ 2002Ýùò 28 Öåâñïõáñßïõ 2003. ¸ãéíå ôáîéíüìçóç, óýìöùíá ìå ôçí Ýêâáóç, óåôñåéò êáôçãïñßåò, óå ðåñéóôáôéêÜ ìå áðïôõ÷çìÝíç ðñïóðÜèåéá áíÜôáîçò, óåðåñéóôáôéêÜ ìå áñ÷éêÞ áíÜôáîç êáé áðïêáôÜóôáóç ôçò áõôüíïìçò êõêëïöïñßáòêáé óå ðåñéóôáôéêÜ ìå ôåëéêÞ åðéâßùóç, ðïõ ôáõôßæåôáé ìå ôçí Ýêäïóç åîéôçñßïõáðü ôï íïóïêïìåßï. Õðïëïãßóáìå ôçí ðéèáíüôçôá åðéâßùóçò ôùí ðåñéóôáôéêþí,ìå âÜóç ôïí åìðåéñéêü ìáèçìáôéêü ôýðï ACLS (Score for Predicting SurvivalAfter Out-of-Hospital Cardiac Arrest) êáé êÜíáìå óýãêñéóç ìå ôéò ðñáãìáôéêÝòåêâÜóåéò. ÁðïôåëÝóìáôá: óôá ðåñéóôáôéêÜ ìå áðïôõ÷çìÝíç ðñïóðÜèåéá áíÜ-ôáîçò (26 áðü 37) ç ìÝóç ôéìÞ ôçò ðéèáíüôçôáò åðéâßùóçò Þôáí 6,3%, óôáðåñéóôáôéêÜ ìå áñ÷éêÞ áíÜôáîç (11 áðü 37) Þôáí 39,5% êáé óôá ðåñéóôáôéêÜìå ôåëéêÞ åðéâßùóç (5 áðü 37) Þôáí 49%. Ç õðïëïãéóìÝíç ðéèáíüôçôá äåß÷íåéóõó÷Ýôéóç ìå ôçí ðñáãìáôéêÞ Ýêâáóç ôùí ðåñéóôáôéêþí. Áðü ôçí áíÜëõóçðñïêýðôåé üôé, ïé âáóéêïß ðáñÜãïíôåò, ðïõ êáèïñßæïõí ôçí ðéèáíüôçôá åðéâßù-óçò, åßíáé ç ðñüùñç Ýíáñîç áíáæùïãüíçóçò êáé ï ÷ñüíïò Üöéîçò ôïõ áóèåíï-öüñïõ. ÓõìðåñÜóìáôá: ïé äõï âáóéêïß ôñïðïðïéÞóéìïé ðáñÜãïíôåò, ðïõ êáèï-ñßæïõí ôçí ðéèáíüôçôá åðéâßùóçò áôüìùí ìå åîùíïóïêïìåéáêÞ êáñäéáêÞ áíá-êïðÞ, åßíáé ç Ýíáñîç ôçò õðïóôÞñéîçò ôçò æùÞò áðü ôïõò ìÜñôõñåò ôçòáíáêïðÞò êáé ç ôá÷åßá áíôáðüêñéóç ôïõ áóèåíïöüñïõ. Ç ôñïðïðïßçóç ìðïñåßíá ãßíåé ìå ôçí áðïêÝíôñùóç ôùí õðçñåóéþí åðåßãïõóáò éáôñéêÞò êáé ìå ôçíåêðáßäåõóç êáé åíçìÝñùóç ôùí ðïëéôþí óôá èÝìáôá õðïóôÞñéîçò ôçò æùÞò êáé÷ñÞóçò ôïõ áõôüìáôïõ áðéíéäùôÞ.

Ïé ôñïðïðïéÞóéìïé ðáñÜãïíôåò ðïõ êáèïñßæïõí ôçí ðéèáíüôçôáåðéâßùóçò áóèåíþí ìå åîùíïóïêïìåéáêÞ êáñäéáêÞ áíáêïðÞ

Ê. Óõñéáíüò1, Â. ËÝôôá1, Ä. ÊáêëáìÜíïõ2

ÅéóáãùãÞ

Ç åîùíïóïêïìåéáêÞ êáñäéáêÞáíáêïðÞ åßíáé óõ÷íÜ ç ðñþôç åêäÞ-ëùóç ôçò éó÷áéìéêÞò íüóïõ ôçò êáñ-äéÜò. Óôéò ÇíùìÝíåò Ðïëéôåßåò ç åðß-ðôùóç ôçò êáñäéáêÞò áíáêïðÞò õðï-ëïãßæåôáé ðåñßðïõ óôï 1/1000 ôïõðëçèõóìïý áíÜ Ýôïò (15%-20% üëùíôùí èáíÜôùí)1,2.

Ïé ìç áíáóôñÝøéìåò åãêåöáëéêÝòâëÜâåò åìöáíßæïíôáé ìÝóá óå äéÜóôç-ìá 4 ëåðôþí áðü ôçí Ýíáñîç ôçò êáñ-äéáêÞò áíáêïðÞò êáé ï åãêåöáëéêüòèÜíáôïò åìöáíßæåôáé óå 12 ëåðôÜ, åÜíï áóèåíÞò ðáñáìÝíåé ÷ùñßò êáìéÜ õðï-óôÞñéîç3,4.

Ç ðéèáíüôçôá åðéâßùóçò ìåôÜ áðüêáñäéáêÞ áíáêïðÞ êõìáßíåôáé áðü30% Ýùò 70%, êáé åîáñôÜôáé áðü ôçíåîáóöÜëéóç óôïí ðÜó÷ïíôá ôçò áëõ-

ËÝîåéò ÊëåéäéÜ: Áóõóôïëßá, ÂáóéêÞ õðïóôÞñéîç ôçòæùÞò, Åðåßãïõóá éáôñéêÞ, ÊáñäéáêÞ áíáêïðÞ, Êïé-ëéáêÞ ìáñìáñõãÞ, ÊïéëéáêÞ ôá÷õêáñäßáÕðïâëÞèçêå: Ç åñãáóßá õðïâëÞèçêå ùò åëåýèåñçáíáêïßíùóç óôï 15o ÐáíåëëÞíéï ÓõíÝäñéï ÃåíéêÞòÉáôñéêÞò (×áëêéäéêÞ 30 Áðñéëßïõ - 4 ÌáÀïõ 2003)êáé âñáâåýôçêå áðü ôçí åðéôñïðÞ Êñßóçò. Äçìï-óéåýåôáé ìå êïéíÞ áðüöáóç ôçò ÓõíôáêôéêÞò Åðé-ôñïðÞò ôïõ ðåñéïäéêïý êáé ôçò ÏñãáíùôéêÞò Åðé-ôñïðÞò ôïõ Óõíåäñßïõ.Õðåýèõíïò áëëçëïãñáößáò: Êá÷ëÜí Óõñéáíüò, ÁãßáòÐáñáóêåõÞò 23, ÊïæÜíç, 50100 Ôçë. (24610)21065,(24610)32988, (6972)307740.

1ÊÝíôñï Õãåßáò ÓéÜôéóôáò, 2ÐáñÜñôçìá ÊïæÜíçò ôïõ ÅÊÁÂ

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Ê. Óõñéáíüò êáé óõí. Ôüìïò 15, Ôåý÷ïò 2, 2003

íáé 60-70% óå üëïõò ôïõò áóèåíåßò ìåêáñäéáêÞ áíáêïðÞ16,17 êáé ç âáóéêÞõðïóôÞñéîç ôçò æùÞò ìðïñåß íá åðé-âñáäýíåé óçìáíôéêÜ ôç ãñÞãïñç ìåôÜ-ðôùóÞ ôçò óå áóõóôïëßá15.

Ïé õðçñåóßåò ðáñï÷Þò åðåßãïõóáòðñïíïóïêïìåéáêÞò éáôñéêÞò êáëïýíôáéóõ÷íÜ ãéá áíôéìåôþðéóç ðåñéóôáôéêþíåîùíïóïêïìåéáêÞò êáñäéáêÞò áíáêï-ðÞò. Ó’ áõôÝò ôéò ðåñéðôþóåéò åßíáéëßãá ôá áêáôáìÜ÷çôá êñéôÞñéá, ðïõìðïñïýí íá âïçèÞóïõí, áðü ôçí ðñþ-ôç åðáöÞ ìå ôïí áóèåíÞ, óôçí ðñü-âëåøç ôçò ìáôáéüôçôáò ôçò ðñïóðÜ-èåéáò áíáæùïãüíçóçò Þ ôçò ðéèáíüôç-ôáò åðéâßùóçò ðïõ Ý÷åé ï áóèåíÞò êáéç ãåíéêÞ ôÜóç åßíáé ç ðñïóðÜèåéá áíá-æùïãüíçóçò üëùí ôùí áóèåíþí, åíáðïõóßá ôçò ðôùìáôéêÞò áêáìøßáò êáéôçò íåêñéêÞò ðåëéäíüôçôáò18. ÙóôüóïÝ÷ïõí ãßíåé ðïëëÝò ìåëÝôåò ìå óêïðüôïí êáèïñéóìü ôùí êñéôçñßùí ãéá ôçíÝíáñîç Þ ìç ôùí ðñïóðáèåéþí áíá-æùïãüíçóçò êáé ãéá ôç ìåôáöïñÜ ôïõðÜó÷ïíôïò êáé ôç óõíÝ÷éóç ôùí ðñï-óðáèåéþí åíôüò ôïõ íïóïêïìåßïõ19-23.

Óôçí ðáñïýóá ìåëÝôç ãßíåôáé áíá-æÞôçóç ôùí ôñïðïðïéÞóéìùí ðáñáãü-

The modifiable factors that determine the survival probability ofpetients with out-of-hospital cardiac arrestK. Syrianos, V. Letta, D. Kaklamanou

SummaryAim: study of modifiable factors that determine the chance of survival from out-of-hospital cardiac arrest that treated by emergency medical services.Methods: retrospective study on the outcomes of out-of-hospital cardiac arrestsbetween January 1, 2002, and February 28, 2003, who were treated by emer-gency medical services in the city of Kozani. The outcomes of the incidentshave been classified in three categories, in incidents with unsuccessful resus-citation, incidents with successful initial resuscitation, defined as return of spon-taneous circulation and incidents with survival to hospital discharge. The surviv-al rate of every category has been compared with the ACLS score (Score forPredicting Survival After Out-of-Hospital Cardiac Arrest). Results: in the inci-dents with failed resuscitation (26 from 37) the ACLS was 6,3%, in the incidentswith successful initial resuscitation (11 from 37) the ACLS was 39,5% and inthe incidents with survival to hospital discharge (5 from 37) the ACLS was 49%.The calculated probability shows cross-correlation with the outcomes of theincidents. The analysis of results shows that the basic factors that determinethe chance of survival from out-of-hospital cardiac arrest is the early initiationof CPR and the interval between collapse and arrival of the ambulance. Con-clusions: the two basic modifiable factors that determine the chance of survivalfrom out-of-hospital cardiac arrest are the beginning of support of life from thewitnesses and the rapid response of ambulance. The modification can becomewith the decentralisation of emergency medical services, with an aggressivecitizen CPR training program and with the public education on the use ofautomated external defibrillators (AEDs).Key Words: Asystole, Basic Life Support, Cardiac Arrest, Emergency MedicalServices, ventricular fibrillation, ventricular tachycardia

Health Centre of Siatista, Kozani

íôùí, ðïõ êáèïñßæïõí ôçí ðéèáíüôçôá åðéâßùóçòôùí áóèåíþí ìå åîùíïóïêïìåéáêÞ êáñäéáêÞ áíá-êïðÞ, ìå óêïðü ôïí êáëýôåñï ó÷åäéáóìü ôçò áíôé-ìåôþðéóçò áõôþí ôùí ðåñéóôáôéêþí.

Ðëõèõóìüò ìåëÝôçò - ÌÝèïäïò

ÌåëåôÞèçêáí ôá ðåñéóôáôéêÜ åîùíïóïêïìåéá-êÞò áíáêïðÞò ðïõ áíôéìåôùðßóèçêáí áðü ôïðáñÜñôçìá ÊïæÜíçò ôïõ ÅÊÁÂ, óå äéÜóôçìá 13ìçíþí áðü ÉáíïõÜñéï 2002 Ýùò ôï ÖåâñïõÜñéï2003. Óôç ìåëÝôç óõìðåñéëÞöèçóáí ôá ðåñéóôá-ôéêÜ ðïõ áíôéìåôùðßóèçêáí áðü ôçí êéíçôÞ ìï-íÜäá ôïõ ÅÊÁÂ, ìå ðáñïõóßá éáôñéêïý ðñïóù-ðéêïý êáé äõíáôüôçôá åðéôüðéáò äéáóùëÞíùóçò,áðéíßäùóçò êáé ÷ïñÞãçóçò öáñìÜêùí. Áðïêëåß-óôçêáí ôá ðåñéóôáôéêÜ ðïõ åß÷áí åìöáíßóåé óç-ìåßá áìåôÜêëçôïõ èáíÜôïõ (ð.÷. íåêñéêÞ áêáì-øßá), ôá ðåñéóôáôéêÜ ìå áíáêïðÞ ôñáõìáôïëïãé-êÞò áéôéïëïãßáò êáé ôá ðåñéóôáôéêÜ óôá ïðïßáäåí Þôáí äõíáôÞ ç ðñüóâáóç óå ëéãüôåñá áðü 20

óßäáò åðéâßùóçò3, ç ïðïßá ðåñéëáìâÜíåé ôçí Üìå-óç ðñüóâáóç êáé êéíçôïðïßçóç ôùí õðçñåóéþíåðåßãïõóáò éáôñéêÞò, ôçí ðñþéìç âáóéêÞ õðïóôÞ-ñéîç ôçò æùÞò, ôçí ðñþéìç áðéíßäùóç êáé ôçíðñþéìç åîåéäéêåõìÝíç õðïóôÞñéîç ôçò æùÞò2,5-11.Ç ðñüãíùóç åßíáé åîáéñåôéêÜ öôù÷Þ üôáí ç êáñ-äéáêÞ áíáêïðÞ åìöáíßæåôáé ÷ùñßò ðáñïõóßá ìÜñ-ôõñá Þ üôáí êáèõóôåñåß ç Ýíáñîç ôçò âáóéêÞòõðïóôÞñéîçò ôçò æùÞò (ÊÁÑÐÁ) ðÝñá áðü 6 ëåðôÜêáé ç áðéíßäùóç ðÝñá áðü 8 ëåðôÜ12.

Ç ðéï óõ÷íÞ áññõèìßá ðïõ ðñïêáëåß ôçíêáñäéáêÞ áíáêïðÞ åßíáé ç êïéëéáêÞ ìáñìáñõãÞ(ÊÌ), ðïõ Ý÷åé êáé êáëýôåñç ðñüãíùóç áðü ôéòÜëëåò áññõèìßåò (áóõóôïëßá, Üóöõãìç çëåêôñéêÞäñáóôçñéüôçôá ê.ëð.)13,14. Ç ðéèáíüôçôá åðéâßù-óçò óôçí êïéëéáêÞ ìáñìáñõãÞ åßíáé ìÝ÷ñé äÝêáöïñÝò õøçëüôåñç áðü åêåßíç, ðïõ áíáìÝíåôáé óôéòÜëëåò áññõèìßåò ôçò áíáêïðÞò. ÁõôÞ ç ðéèáíüôç-ôá ìåéþíåôáé ìå ôçí ðôþóç ôùí çëåêôñéêþí äõ-íáìéêþí ôçò êïéëéáêÞò ìáñìáñõãÞò ìå ôçí ðÜñï-äï ôïõ ÷ñüíïõ ìÝ÷ñé ôçí åðéêñÜôçóç ôçò áóõóôï-ëßáò15. Ç åðßðôùóç ôçò ÊÌ õðïëïãßæåôáé üôé åß-


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ëåðôÜ, åöüóïí äåí õðÞñ÷å êáìéÜ õðïóôÞñéîç óôïíðÜó÷ïíôá ó’ áõôü ôï äéÜóôçìá.

¸ãéíå êáôáãñáöÞ ôçò ðñþôçò áññõèìßáò ðïõåíôïðßóèçêå ìå ôï ìüíéôïñ, ôéò óõíèÞêåò ôçò áíá-êïðÞò, áí Ýãéíå ðáñïõóßá ìÜñôõñá êáé áí ÝãéíåðñïóðÜèåéá âáóéêÞò ÊÁÑÐÁ áðü ôïõò ðáñåõñé-óêïìÝíïõò óôï óçìåßï ôïõ óõìâÜíôïò. Óå üëá ôáðåñéóôáôéêÜ õðÞñîå ïñéóôéêÞ åîáóöÜëéóç ôïõáåñáãùãïý, ÷ïñçãÞèçêáí öÜñìáêá êáé Ýãéíáíáðéíéäþóåéò üðïõ õðÞñ÷áí åíäåßîåéò.

Ôá ðåñéóôáôéêÜ ôáîéíïìÞèçêáí óå ôñåéò êá-ôçãïñßåò, óýìöùíá ìå ôçí Ýêâáóç, óå ðåñéóôáôé-êÜ ìå áñ÷éêÞ áíÜôáîç êáé áðïêáôÜóôáóç ôçòáõôüíïìçò êõêëïöïñßáò ãéá ôïõëÜ÷éóôïí 20 ëå-ðôÜ, óå ðåñéóôáôéêÜ ìå ôåëéêÞ åðéâßùóç, ðïõôáõôßæåôáé ìå ôçí Ýêäïóç åîéôçñßïõ áðü ôï íïóï-êïìåßï êáé óå ðåñéóôáôéêÜ ìå áðïôõ÷çìÝíç ðñï-óðÜèåéá áíÜôáîçò.

¸ãéíå õðïëïãéóìüò ôçò áíáìåíüìåíçò ðéèá-íüôçôáò åðéâßùóçò, ìå âÜóç ôïí åìðåéñéêü ìáèç-ìáôéêü ôýðï (ACLS Score for Predicting Surviv-al After Out-of-Hospital Cardiac Arrest), ðïõåß÷å ðñïôáèåß áðü ôïí Eisenberg êáé óõí. ôï198124:Ðéèáíüôçôá åðéâßùóçò = ACLS score = 80-A-C-L-S

¼ðïõ A = ðáñïõóßá ìÜñôõñá (Arrest wit-nessed) êáé ðáßñíåé ôéìÞ (ìçäÝí) ãéá ôçí ðåñß-ðôùóç ýðáñîçò ìÜñôõñá ôçò áíáêïðÞò êáé ôéìÞ(40) ãéá ôçí ðåñßðôùóç áíáêïðÞò ÷ùñßò ôçí ðá-ñïõóßá ìÜñôõñá, C = êáñäéáêüò ñõèìüò ôçò áíá-êïðÞò (Cardiac rhythm) êáé ðáßñíåé ôéìÞ (ìçäÝí)ãéá ôçí êïéëéáêÞ ìáñìáñõãÞ Þ Üóöõãìç êïéëéá-êÞ ôá÷õêáñäßá êáé ôéìÞ (40) ãéá ïðïéïíäÞðïôåÜëëï êáñäéáêü ñõèìü, L = ç ðáñï÷Þ Þ ìç ÊÁÑ-ÐÁ áðü ôïõò ðáñåõñéóêüìåíïõò (Lay bystanderinitiates) êáé ðáßñíåé ôéìÞ (ìçäÝí) ãéá ôçí ðáñï-÷Þ ÊÁÑÐÁ áðü ôïõò ðáñåõñéóêüìåíïõò êáé (20)ãéá ôçí ðåñßðôùóç Ýíáñîçò ÊÁÑÐÁ áðü ôï ðëÞ-

ñùìá áóèåíïöüñïõ, S = ôá÷ýôçôá áíôáðüêñéóçòáóèåíïöüñïõ (Speed of response by paramedicsquad) êáé õðïëïãßæåôáé áðü ôïí ðïëëáðëáóéá-óìü ôï ÷ñüíï óå ëåðôÜ ìå ôïí áñéèìü 5, üðùòöáßíåôáé êáé óôïí ðßíáêá 1. Ç ìéêñüôåñç ðéèá-íüôçôá éóïýôáé ìå ìçäÝí (H ôéìÞ äåí ìðïñåß íáåßíáé áñíçôéêÞ) êáé ç ìåãáëýôåñç ðéèáíüôçôáéóïýôáé ìå 80.

ÌåôÜ ôïí õðïëïãéóìü ôçò ðéèáíüôçôáò åðé-âßùóçò, êÜíáìå óýãêñéóç ìå ôéò ðñáãìáôéêÝò åê-âÜóåéò ôùí ðåñéóôáôéêþí áíáêïðÞò ðïõ áíôéìå-ôùðßóáìå, ðñïêåéìÝíïõ íá åîåôÜóïõìå ôçí áîéï-ðéóôßá ôùí ðáñáìÝôñùí, ðïõ åíóùìáôþíïíôáéóôïí ôñüðï õðïëïãéóìïý êáé íá áðïìïíþóïõìååêåßíïõò ôïõò ðáñÜãïíôåò, ðïõ åßíáé ôñïðïðïéÞ-óéìïé.


Óôï äéÜóôçìá ôùí 13 ìçíþí ôï ðáñÜñôçìáÊïæÜíçò ôïõ ÅÊÁÂ êëÞèçêå ãéá ôçí áíôéìåôþ-ðéóç 48 ðåñéóôáôéêþí åîùíïóïêïìåéáêÞò áíáêï-ðÞò, áðü ôá ïðïßá ôá 37 ðëçñïýí ôá êñéôÞñéáôçò ìåëÝôçò. Ïé 27 ðáèüíôåò Þôáí Üíäñåò (73%)êáé ïé 10 Þôáí ãõíáßêåò (23%). Ç ìÝóç çëéêßáôùí ðáèüíôùí Þôáí 62,8 åôþí. Ï ìÝóïò ÷ñüíïòáíôáðüêñéóçò ôïõ áóèåíïöüñïõ Þôáí 6,4 ëåðôÜ.Ï áñ÷éêüò êáôáãñáììÝíïò ñõèìüò Þôáí áðéíéäþ-óéìïò (êïéëéáêÞ ìáñìáñõãÞ Þ Üóöõãìç êïéëéáêÞôá÷õêáñäßá) óå 12 ðåñéóôáôéêÜ (32%) êáé óôáõðüëïéðá 25 ðåñéóôáôéêÜ (68%) Þôáí ìç áðéíé-äþóéìïò (áóõóôïëßá). Ìüíï óå 4 ðåñéóôáôéêÜ (11%)õðÞñ÷å Üìåóç õðïóôÞñéîç ôçò æùÞò, áðü êÜðïéïíðáñåõñéóêüìåíï óôï óçìåßï ôïõ óõìâÜíôïò. Óå25 ðåñéóôáôéêÜ (68%) ç áíáêïðÞ åß÷å óõìâåßðáñïõóßá ìÜñôõñá. Ç ðñïóðÜèåéá áíÜôáîçò Þôáí÷ùñßò åðéôõ÷ßá óå 26 ðåñéóôáôéêÜ (70%) êáé ç

Ðßíáêáò 1. ÔéìÝò ôùí ðáñáìÝôñùí ãéá ôïí õðïëïãéóìü ôçò ðéèáíüôçôáò åðéâßùóçò

ÐáñÜìåôñïò ÐáñáëëáãÝò ÔéìÞ

A = ÊáñäéáêÞ áíáêïðÞ Ðáñïõóßá ìÜñôõñá 0×ùñßò ìÜñôõñá 40

C = Êáñäéáêüò ñõèìüò ÊïéëéáêÞ ìáñìáñõãÞ 0¢óöõãìç êïéëéáêÞ ôá÷õêáñäßá 0¢ëëïò ñõèìüò 40

L = ÊÁÑÐÁ ¸íáñîç áðü ôïõò ðáñåõñéóêüìåíïõò 0¸íáñîç áðü ôï ðëÞñùìá ôïõ 20áóèåíïöüñïõ

S = Áíôáðüêñéóç ôïõ áóèåíïöüñïõ (÷ñüíïò óå ëåðôÜ) × 5

87


ìÝóç õðïëïãéóìÝíç ðéèáíüôçôáò åðéâßùóçò áõ-ôþí ôùí ðåñéóôáôéêþí Þôáí 6,3%. Áñ÷éêÞ áíÜ-ôáîç, ìå åðéóôñïöÞ ôçò áõôüíïìçò êõêëïöïñßáòõðÞñ÷å óå 11 ðåñéóôáôéêÜ (30%). Ç ìÝóç õðïëï-ãéóìÝíç ðéèáíüôçôá åðéâßùóçò ãé’ áõôÜ ôá ðåñé-óôáôéêÜ Þôáí 39,5%. Ôá ðåñéóôáôéêÜ ìå ôåëéêÞåðéâßùóç (åîéôÞñéï áðü ôï íïóïêïìåßï) Þôáí 5(13,5%) êáé ç ìÝóç õðïëïãéóìÝíç ðéèáíüôçôáåðéâßùóçò áõôþí ôùí ðåñéóôáôéêþí Þôáí 49%.ÁíáëõôéêÜ ôá áðïôåëÝóìáôá öáßíïíôáé óôïí ðß-íáêá 2.

Ãéá ôçí åîÝôáóç ôçò ìåôáâïëÞò ôïõ ñõèìïýôçò êáñäéáêÞò áíáêïðÞò, óå ó÷Ýóç ìå ôï ÷ñüíï,

áðïìïíþóáìå ôá 25 ðåñéóôáôéêÜ, üðïõ ç áíáêï-ðÞ åß÷å ãßíåé ðáñïõóßá ìÜñôõñá, åðåéäÞ ó’ áõôÜôá ðåñéóôáôéêÜ Þôáí åöéêôü íá êáôáãñáöåß, ìåìåãáëýôåñç áêñßâåéá, ï ÷ñüíïò ðïõ ðÝñáóå áðüôç óôéãìÞ ôçò Ýíáñîçò ôçò áíáêïðÞò. Äéáðéóôþ-óáìå ìåãáëýôåñç óõ÷íüôçôá åìöÜíéóçò ôçò êïé-ëéáêÞò ìáñìáñõãÞò, óôá ðñþôá ëåðôÜ ôçò áíá-êïðÞò. ÁõôÞ ç óõ÷íüôçôá ìåéþíåôáé ãñÞãïñá ìåôçí ðÜñïäï ôïõ ÷ñüíïõ, åíþ ôáõôü÷ñïíá áõîÜíå-ôáé ç óõ÷íüôçôá åìöÜíéóçò ôçò áóõóôïëßáò, üðùòöáßíåôáé óôïí ðßíáêá 3 êáé óôï ãñÜöçìá1.

Óå ü,ôé áöïñÜ ôçí åðßäñáóç ôçò âáóéêÞò õðï-óôÞñéîçò ôçò æùÞò, üôáí ðáñÝ÷åôáé Üìåóá áðü

Ðßíáêáò 2. ÁíáëõôéêÜ óôïé÷åßá ðåñéóôáôéêþí êáñäéáêÞò áíáêïðÞò

Á/á Öýëï Çëéêßá ÁíáêïðÞ Áññõèìßá ¢ìåóç ×ñüíïò ÅðéóôñïöÞ Åðéâßùóç Ðéèáíüôçôáðáñïõóßá ðïõ ÊÁÑÐÁ áíôáðüêñéóçò áõôüíïìçò åðéâßùóçòìÜñôõñá êáôáãñÜöçêå áóèåíïöüñïõ êõêëïöïñßáò ACLS score

1 Á 62 Íáé KM 2 Íáé Íáé 502 È 87 Íáé KM 2 503 Á 72 Íáé Áóõóôïëßá 2 Íáé Íáé 304 Á 48 Íáé ÊÌ Íáé 3 Íáé Íáé 655 Á 57 Íáé ÊÌ 3 Íáé 456 Á 68 Íáé ÊÌ 3 Íáé Íáé 457 È 78 Íáé Áóõóôïëßá 3 58 Á 57 Íáé Áóõóôïëßá 3 59 Á 48 Áóõóôïëßá 3 510 È 39 Áóõóôïëßá 3 511 Á 62 Áóõóôïëßá 3 512 Á 54 Íáé ÊÌ 4 Íáé 4013 Á 67 Íáé Áóõóôïëßá 4 014 È 76 Íáé Áóõóôïëßá 4 015 Á 47 Íáé ÊÌ 4 4016 È 57 Áóõóôïëßá 4 017 Á 61 Áóõóôïëßá 4 018 È 24 Íáé ÊÌ Íáé 5 Íáé Íáé 5519 È 74 Íáé ÊÌ 5 Íáé 3520 È 85 Íáé Áóõóôïëßá 5 021 Á 49 Íáé Áóõóôïëßá Íáé 5 1522 È 69 Íáé Áóõóôïëßá 5 023 Á 53 Áóõóôïëßá 5 024 Á 67 Íáé ÊÌ 6 Íáé 3025 Á 62 Íáé ÊÌ 6 Íáé 3026 Á 58 Íáé Áóõóôïëßá Íáé 6 Íáé 1027 È 59 Íáé Áóõóôïëßá 6 028 Á 49 Íáé Áóõóôïëßá 6 029 È 62 Íáé Áóõóôïëßá 8 030 Á 74 Íáé ÊÌ 9 1531 Á 59 Íáé Áóõóôïëßá 10 032 Á 77 Áóõóôïëßá 13 033 Á 70 Áóõóôïëßá 13 034 Á 60 Áóõóôïëßá 16 035 Á 62 Áóõóôïëßá 17 036 È 76 Áóõóôïëßá 18 037 Á 76 Áóõóôïëßá 19 0


88


Ðßíáêáò 3. Ï êáñäéáêüò ñõèìüò ðïõ åíôïðßóèçêå óå ó÷Ýóç ìå ôï ÷ñüíï

×ñüíïò áðü ôçí Ýíáñîç Óýíïëï ÊÌ % Áóõóôïëßá %ôçò áíáêïðÞò óå ëåðôÜ ðåñéóôáôéêþí

2 3 2 0,7 1 0,33 5 3 0,6 2 0,44 4 2 0,5 2 0,55 5 2 0,4 3 0,66 5 2 0,4 3 0,6

> 7 3 1 0,3 2 0,7

0,00

0,10

0,20

0,30

0,40

0,50

0,60

0,70

1 2 3 4 5 6

ËåðôÜ

Ðïóïóôü

Áóõóôïëßá

ÊÌ

ÃñÜöçìá 1. Ï êáñäéáêüò ñõèìüò óå ó÷Ýóç ìå ôï ÷ñüíï áðü ôçí Ýíáñîç ôçò áíáêïðÞò.

ôïõò ðáñåõñéóêüìåíïõò óôï óçìåßï ôïõ óõìâÜ-íôïò, ï áñéèìüò ôùí ðåñéðôþóåùí Þôáí åîáéñåôé-êÜ ìéêñüò (ìüíï 4 áðü 37). Ðáñüëï ðïõ õðÞñ÷ååðéóôñïöÞ ôçò áõôüíïìçò êõêëïöïñßáò óå 3 áðüôá ôÝóóåñá ðåñéóôáôéêÜ, üðïõ åß÷å ãßíåé ÜìåóçâáóéêÞ õðïóôÞñéîç ôïõ ðÜó÷ïíôïò êáé ïñéóôéêÞáíÜôáîç óå äõï áð’ áõôÜ, ï ìéêñüò áñéèìüò äåíìáò åðéôñÝðåé íá âãÜëïõìå óôáôéóôéêÜ óõìðåñÜ-óìáôá.

ÓõæÞôçóç

Áðü ìéá áñ÷éêÞ åêôßìçóç ôùí áðïôåëåóìÜ-ôùí ôçò ìåëÝôçò öáßíåôáé üôé ï õðïëïãéóìüò ôçòðéèáíüôçôáò åðéâßùóçò, ìå âÜóç ôïí åìðåéñéêüìáèçìáôéêü ôýðï ôïõ Eisenberg êáé óõí. ìðïñåßíá ðñïóåããßóåé ôçí ðñáãìáôéêüôçôá ìå ó÷åôéêÞáêñßâåéá. Óôá ðåñéóôáôéêÜ ìå ïñéóôéêÞ áíÜôáîçðïõ ðÞñáí åîéôÞñéï áðü ôï íïóïêïìåßï) õðÞñ÷åó÷åôéêÜ õøçëÞ ðéèáíüôçôá åðéâßùóçò (49%), åíþóôá ðåñéóôáôéêÜ ìå áðïôõ÷çìÝíç ðñïóðÜèåéááíÜôáîçò ç ðéèáíüôçôá Þôáí åîáéñåôéêÜ ìéêñÞ(6,3%) êáé åíäéÜìåóç ðéèáíüôçôá åß÷áí ôá ðåñé-óôáôéêÜ ìå áñ÷éêÞ áíÜôáîç êáé åðéóôñïöÞ ôçòáõôüíïìçò êõêëïöïñßáò (39,5).

Áðü ôïõò ðáñÜãïíôåò, ðïõ åíóùìáôþíïíôáé

óôïí õðïëïãéóìü ôçò ðéèáíüôçôáò åðéâßùóçò, ïéôñåéò åßíáé ôñïðïðïéÞóéìïé. Áõôïß åßíáé ï êáñäéá-êüò ñõèìüò, ç Üìåóç âáóéêÞ õðïóôÞñéîç ôçò æùÞòáðü ôïõò ðáñåõñéóêüìåíïõò óôï óçìåßï ôïõ óõì-âÜíôïò êáé ï ÷ñüíïò áíôáðüêñéóçò ôçò åðåßãïõ-óáò ðñïíïóïêïìåéáêÞò éáôñéêÞò.

Ï êáñäéáêüò ñõèìüò ôçò áíáêïðÞò ìåôáâÜë-ëåôáé ãñÞãïñá ìå ôçí ðÜñïäï ôïõ ÷ñüíïõ, áðüáðéíéäþóéìï ñõèìü (êïéëéáêÞ ìáñìáñõãÞ Þ Üóöõã-ìç êïéëéáêÞ ôá÷õêáñäßá) óå ìç áðéíéäþóéìï (áóõ-óôïëßá). ÁõôÞ ç åîÝëéîç åðéâñáäýíåôáé ìå ôçíÜìåóç âáóéêÞ õðïóôÞñéîç ôçò æùÞò. Ç ôá÷åßááíôáðüêñéóç ôçò åðåßãïõóáò ðñïíïóïêïìåéáêÞòéáôñéêÞò (áðéíßäùóç) ìðïñåß íá ðñïëÜâåé áõôÞôç ìåôáâïëÞ ôïõ êáñäéáêïý ñõèìïý.

Ìüíï óå 4 ðåñéóôáôéêÜ áðü ôï äåßãìá ðïõåîåôÜóáìå õðÞñ÷å Üìåóç ðáñï÷Þ âáóéêÞò ÊÁÑ-ÐÁ (ðïóïóôü 11%). Áõôü ôï ðïóïóôü äéáöÝñåéáðü ÷þñá óå ÷þñá, áíÜëïãá ìå ôï åðßðåäï åíç-ìÝñùóçò êáé åêðáßäåõóçò ôùí ðïëéôþí. Óôç Óïõç-äßá, ëüãïõ ÷Üñéí, ïé ìåëÝôåò áíáöÝñïõí Üìåóçðáñï÷Þ âáóéêÞò ÊÁÑÐÁ áðü ôïõò ðáñåõñéóêü-ìåíïõò óå ðïóïóôü 36%25. Ç Üìåóç õðïóôÞñéîçôçò æùÞò ìðïñåß íá åðéâñáäýíåé ôç ìåôÜðôùóçôïõ áðéíéäþóéìïõ êáñäéáêïý ñõèìïý óå ìç áðéíé-äþóéìï. Ôáõôü÷ñïíá êáèõóôåñåß ôçí åãêáôÜóôá-óç ìç áíáóôñÝøéìùí âëáâþí ôïõ åãêåöÜëïõ, âåë-

89


ôéþíïíôáò Ýôóé óçìáíôéêÜ ôçí åðéâßùóç ôïõ ðÜ-ó÷ïíôïò.

Ï ÷ñüíïò áíôáðüêñéóçò áóèåíïöüñïõ åîáñ-ôÜôáé áðü ôïí ôñüðï ïñãÜíùóçò êáé áíÜðôõîçòôùí õðçñåóéþí ðáñï÷Þò åðåßãïõóáò ðñïíïóïêï-ìåéáêÞò éáôñéêÞò. Ç åõåñãåôéêÞ åðßäñáóç ôçòÜìåóçò áíôáðüêñéóçò ôçò åðåßãïõóáò ðñïíïóï-êïìåéáêÞò éáôñéêÞò óôçí ðéèáíüôçôá åðéâßùóçòìåôÜ áðü êáñäéáêÞ áíáêïðÞ, óõíßóôáôáé êõñßùòóôçí ðñþéìç åöáñìïãÞ ôçò áðéíßäùóçò, ðñéí ìå-ôáâëçèåß ï êáñäéáêüò ñõèìüò. Ç äéÜäïóç ôçòåõñåßáò ÷ñÞóçò ôïõ áõôüìáôïõ åîùôåñéêïý áðéíé-äùôÞ áðü ôïõò ìç åðáããåëìáôßåò õãåßáò ìðïñåßíá äþóåé ôç ëýóç óôçí áäõíáìßá ôçò åðåßãïõóáòéáôñéêÞò íá áíôáðïêñéèåß ðÜíôá óå ôüóï óýíôï-ìï ÷ñüíï.

ÓõìðåñÜóìáôá

Ç ðéèáíüôçôá åðéâßùóçò ìåôÜ áðü åîùíïóï-êïìåéáêÞ êáñäéáêÞ áíáêïðÞ åîáñôÜôáé áðü ôçíÜìåóç ðáñï÷Þ âáóéêÞò õðïóôÞñéîçò ôçò æùÞò óôïíðáèüíôá êáé áðü ôçí ðñþéìç áðéíßäùóç. Ãéá ôçíáýîçóç áõôÞò ôçò ðéèáíüôçôáò áðáéôåßôáé:1. Ýíá åðéèåôéêü ðñüãñáììá åêðáßäåõóçò ôùí

ðïëéôþí óôçí ðáñï÷Þ âáóéêÞò õðïóôÞñéîçòôçò æùÞò,

2. ìéá êáëýôåñç ïñéæüíôéá ïñãÜíùóç ôùí õðç-ñåóéþí åðåßãïõóáò ðñïíïóïêïìåéáêÞò éáôñé-êÞò (ÅÊÁÂ), âáóéóìÝíç óôéò ÷ñüíï-áðïóôÜ-óåéò,

3. ç Ýíôáîç ôùí êÝíôñùí õãåßáò óôéò õðçñåóßåòåðåßãïõóáò ðñïíïóïêïìåéáêÞò éáôñéêÞò ãéáôçí åîáóöÜëéóç êáëýôåñçò ãåùãñáöéêÞò êÜ-ëõøçò êáé

4. ç áíÜðôõîç ðñïãñáììÜôùí åéóáãùãÞò ôçòåõñåßáò ÷ñÞóçò ôùí åîùôåñéêþí áõôüìáôùíáðéíéäùôþí áðü ôïõò ìç åðáããåëìáôßåò õãåßáò(áðü ôçí áóôõíïìßá, ôçí ðõñïóâåóôéêÞ êáéôïõò áðëïýò ðïëßôåò)


1. Becker LB, Smith DW, Rhodes KV. Incidenceof cardiac arrest: a neglected factor in evaluat-ing survival rates. Ann Emerg Med, 22:86-91,1993.

2. Lindholm DJ, Campbell JP: Predicting survival

from out-of-hospital cardiac arrest. Prehospitaland Disaster Medicine, 13:126-129.

3. Larson MP, Eisenberg MS, Cummins RO, et al.Predicting survival from out-of-hospital cardiacarrest. Ann Emerg Med, 22:1652-1658, 1993.

4. American Heart Association. Emergency Car-diac Care Committee and Subcommittees. Guide-lines for cardiopulmonary resuscitation andemergency care. JAMA, 268:2171, 1992.

5. Aghababian RV, Mears G, Ornato JP, Kuden-chuk PJ, Overton J. Cardiac arrest manage-ment. Prehosp Emerg Care, 5:237-46, 2001.

6. Cummins RO, Ornato JP, Theis W, et al. Im-proving survival from cardiac arrest: the chainof survival concept. Circulation, 83:1832-1847,1991.

7. Maguire JE. Advances in cardiac life support:sorting the science from the dogma. Emerg Med,9 Suppl:1-8, 1997.

8. Callahan M, Madsen CD. Relationship of time-liness of paramedic Advanced Life Support in-terventions to outcome in out-of hospital cardi-ac arrest treated by first responders with defibril-lators. Ann Emerg Med, 27:638-648, 1996.

9. Weaver WD, Cobb LA, Hallstrom AP, et al.Considerations for improving survival from out-of-hospital cardiac arrest. Ann Emerg Med, 10:1181-1186, 1986.

10. Eisenberg, M.S., Predicting Survival From Outof Hospital Cardiac Arrest ANN EmergencyMed, 1652-1658, 1993.

11. Kudenchuk, P J. Prehospital Treatment of Pro-tracted Ventricular Tachycardia and VentricularFibrillation, Continuing Education Home,www.aacn.org

12. Bailey ED, Wydro GC, Cone DC. Terminationof resuscitation in the prehospital setting foradult patients suffering nontraumatic cardiacarrest. National Association of EMS PhysiciansStandards and Clinical Practice Committee. Pre-hosp Emerg Care, 4:190-5, 2000.

13. Eisenberg MS, Horwood BT, Cummins RO, etal. Cardiac arrest and resuscitation: a tale of 29cities. Ann Emerg Med, 19:179-186, 1990.

14. Engdahl J, Holmberg M, Karlson BW, LuepkerR, Herlitz J. The epidemiology of out-of-hospi-tal ‘sudden’ cardiac arrest, Resuscitation, 52:235-45, 2002.

15. Waalewijn RA, Nijpels MA, Tijssen JG, KosterRW. Prevention of deterioration of ventricularfibrillation by basic life support during out-of-hospital cardiac arrest, Resuscitation, 54:31-6,2002.

16. Holmberg M, Holmberg S, Herlitz J. Incidence,


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duration and survival of ventricular fibrillationin out-of-hospital cardiac arrest patients inSweden, Resuscitation, 44:7-17, 2000.

17. Kuisma M, Maatta T. Out-of-hospital cardiacarrests in Helsinki: Utstein style, Heart, 76:18-23, 1996.

18. Pepe PE, Swor RA, Ornato JP, Racht EM, Blan-ton DM, Griswell JK, Blackwell T, Dunford J;Turtle Creek Conference II. Resuscitation inthe out-of-hospital setting: medical futility cri-teria for on-scene pronouncement of death,Prehosp Emerg Care, 5:79-87, 2001.

19. Hick JL, Mahoney BD, Lappe M. Factors in-fluencing hospital transport of patients in con-tinuing cardiac arrest. Ann Emerg Med, 32:19-25, 1998.

20. Kellermann AL, Staves DR, Hackman BB. In-hospital resuscitation following unsuccessfulprehospital advanced cardiac life support: ‘he-roic efforts’ or an exercise in futility? AnnEmerg Med, 17:589-94, 1988.

21. Van der Hoeven JG, Waanders H, Compier EA,van der Weyden PK, Meinders AE. Prolongedresuscitation efforts for cardiac arrest patientswho cannot be resuscitated at the scene: who islikely to benefit? Ann Emerg Med, 22:1659-63, 1993.

22. Faine PG, Willoughby PJ, Koenigsberg M, Manc-zko TJ, Ward S. Implementation of an out-of-hospital termination of resuscitation policy.Prehosp Emerg Care, 1:246-52, 1997.

23. Smith JP, Bodai BI. Guidelines for discontinu-ing prehospital CPR in the emergency depart-ment—a review. Ann Emerg Med, 14:1093-98,1985.

24. Eisenberg M, Hallstrom A, Bergner L. TheACLS score. Predicting survival from out-of-hospital cardiac arrest. JAMA, 246-50, 1981.

25. Holmberg M, Holmberg S, Herlitz J. Factorsmodifying the effect of bystander cardiopulmo-nary resuscitation on survival in out-of-hospitalcardiac arrest patients in Sweden, Eur Heart J,22:511-19, 2001.

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CONSENSUS REPORTPrimary Heatlh Care, Volume 15, Number 2, 91-93, 2003ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 15, Ôåý÷ïò 2, 91-93, 2003

ÂÞìáôá ãéá ôçí áíÜðôõîç êáôåõèõíôÞñéùí ïäçãéþí óôç ÃåíéêÞÉáôñéêÞ óôçí ÅëëÜäá: ¸íá êåßìåíï ïìïöùíßáò×. ËéïíÞò, Í. ÁíôùíÜêçò, Ì. Áíôùíïðïýëïõ, Ó. ÁñãõñéÜäïõ, E. Ãåùñãáêßëá, Í. ÃåùñãéÜííïò,N. ÄñáêùíÜêçò, Å. Èçñáßïò, Ä. ÊïõíáëÜêçò, Ê. ÌáêñÞ, Ã. Ìáíôæáâßíçò, Á. Ìáñéüëçò, Ì. ÌáñêÜêçò,Ì. ÌðáèéáíÜêç, Á Ìðáôßêáò, Ð. ÍéêçôÜêçò, Í. ÐáðáíéêïëÜïõ, Ì. Ñïâßèçò, Á. Ôáôóéþíç, Ì. Ôñiãþíç,É. ÔóéëéãéÜííç, Ì. ×áôæçáñóÝíçò, Á. ×ñéóôïöÝëç

Ïé êáôåõèõíôÞñéåò ïäçãßåò áðïôåëïýí åñãá-ëåßá ãéá ôç ëÞøç áðïöÜóåùí, ôüóï áðü ôïõòãéáôñïýò ãéá ôïõò áóèåíåßò ôïõò ùò Üôïìá, üóïêáé áðü Oñãáíéóìïýò êáé ÅðéóôçìïíéêÝò Åôáé-ñåßåò. ÓçìáíôéêÝò óõæçôÞóåéò ó÷åôéêÜ ìå ôçí áðï-ôåëåóìáôéêüôçôÜ ôïõò êáé ôç ÷ñçóôéêÞ ôïõò áîßáðáñïõóéÜæïíôáé óôç äéåèíÞ âéâëéïãñáößá Ïé ïäç-ãßåò áõôÝò áðáéôïýí óçìáíôéêÞ ðñïóðÜèåéá êáééó÷õñÝò óõìöùíßåò ãéá íá áíáðôõ÷èïýí êáé íáåöáñìïóôïýí, üðùò õðïóôçñßæåôáé áðü åèíéêÝòêáé ôïðéêÝò ïìÜäåò áíÜðôõîçò êáôåõèõíôÞñéùíïäçãéþí1-6. Ãéá ôçí áíÜðôõîÞ ôïõò Ý÷ïõí õéïèåôç-èåß äýï ðñïóåããßóåéò, ç äçìéïõñãßá åîáñ÷Þò áõ-ôïôåëþí ïäçãéþí Þ ç ÷ñçóéìïðïßçóç ôçò åìðåé-ñßáò Ïñãáíéóìþí Þ Åôáéñåéþí êáé ôçò ðñïóáñìï-ãÞ ôïõò óôéò ôïðéêÝò óõíÞèåéåò. Ç ôåëåõôáßá ðñï-óÝããéóç öáßíåôáé íá Ý÷åé ìåéùìÝíï êüóôïò óåðüñïõò êáé ÷ñüíï êáé ðëåïíåêôÞìáôá êáé ìåéïíå-êôÞìáôá õðÜñ÷ïõí êáé ãéá ôéò äýï áõôÝò ðñïóåã-ãßóåéò.

Ç áíáãêáéüôçôá äçìéïõñãßáò êáôåõèõíôÞñéùíïäçãéþí êáé óôçí ÅëëÜäá Ý÷åé áíáãíùñéóôåß ôáôåëåõôáßá ÷ñüíéá êáèþò ç áðÞ÷çóç ôçò åéäéêüôç-ôáò ôçò ÃåíéêÞò ÉáôñéêÞò äéåõñýíåôáé ôá ôåëåõôáßá÷ñüíéá. ̧ ôóé, îåêßíçóå ìßá óõíåñãáóßá ìåôáîý ôïõÏëëáíäéêïý Êïëåãßïõ Ãåíéêþí Ãéáôñþí êáé ìéáòÏìÜäáò Ðñùôïâïõëßáò ôçò ÊëéíéêÞò ÊïéíùíéêÞòêáé ÏéêïãåíåéáêÞò ÉáôñéêÞò ôïõ ÐáíåðéóôçìßïõÊñÞôçò ãéá ôçí ÁíÜðôõîç ÊáôåõèõíôÞñéùí Ïäç-ãéþí óôçí ÅëëÜäá. Óêïðüò ôçò óõíåñãáóßáò áõôÞòåßíáé ç ÷ñçóéìïðïßçóç ôçò ÏëëáíäéêÞò åìðåéñßáòãéá ôçí êáèéÝñùóç êáôåõèõíôçñßùí ïäçãéþí ãéá

ôç ÃåíéêÞ ÉáôñéêÞ óôçí ÅëëÜäá. ÌåôÜ ôçí ðñþôçóõíÜíôçóç óôçí ÁèÞíá ôï ÌÜñôéï ôïõ 20017

áêïëïýèçóå ìßá äåýôåñç óõíÜíôçóç óôá ×áíéÜ ôïÌÜéï ôïõ 2003. Óôç äåýôåñç áõôÞ óõíÜíôçóç, ïé¸ëëçíåò óõììåôÝ÷ïíôåò óõìöþíçóáí ïìüöùíá ãéáôç äçìéïõñãßá åíüò ðñùôïêüëëïõ ãéá ôçí áíÜðôõ-îç êáôåõèõíôÞñéùí ïäçãéþí óôçí ÅëëÜäá. Ôï ðñù-ôüêïëëï âáóßæåôáé óôçí ÏëëáíäéêÞ åìðåéñßá êáéóõíßóôáôáé áðü 8 âÞìáôá ôá ïðïßá ðåñéãñÜöï-íôáé óôï Üñèñï áõôü.

Óêïðüò ôïõ êåéìÝíïõ ïìïöùíßáò áõôïý åßíáéíá ðáñïõóéÜóåé ôéò èÝóåéò êáé ôá âÞìáôá Þ äéá-äéêáóßåò ðïõ óõæçôÞèçêáí óôçí Åëëçíï-Ïëëáíäé-êÞ ÓõíÜíôçóç ôïõ Ìáúïõ 2003, ôá ïðïßá áðïôå-ëïýí óõã÷ñüíùò êáé ìéá ðñüôáóç óôçí ÅëëçíéêÞÅôáéñåßá ÃåíéêÞò ÉáôñéêÞò.

ÂÞìáôá/Äéáäéêáóßåò ãéá ôçí áíÜðôõîç êáôåõèõíôÞ-ñéùí ïäçãéþí óôçí ÃåíéêÞ ÉáôñéêÞ óôçí ÅëëÜäá

ÂÞìá 1: ÅðéëïãÞ ôïõ êëéíéêïý èÝìáôïò êáé êáèïñéóìüòôçò óðïõäáéüôçôÜò ôïõ óôç ÃåíéêÞ ÉáôñéêÞ

Ç åðéëïãÞ ôïõ èÝìáôïò èá ðñÝðåé íá ãßíåé ìåâÜóç ïñéóìÝíá êñéôÞñéá, ðïõ óõìðåñéëáìâÜíïõí:

- ôç âáñýôçôá ôïõ ðñïâëÞìáôïò ìå âÜóç ôïõòåðéäçìéïëïãéêïýò äåßêôåò,

- ôç óõ÷íüôçôá ðáñïõóßáò ôïõ ðñïâëÞìáôïòóôï éáôñåßï ôùí ãåíéêþí ãéáôñþí. Ôï ó÷Ýäéï áõôüèá ìðïñïýóå íá áðïôåëÝóåé Ýíá ìÝôñï ãéá ôçíåíßó÷õóç ôçò ðïéüôçôáò êáé ôçí åëÜôôùóç ôùíäéáêõìÜíóåùí óôéò õðçñåóßåò õãåßáò. ºóùò áõôü


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×. ËéïíÞò êáé óõí.

íá åßíáé Ýíá ó÷Ýäéï ãéá ôï ìÝëëïí.- ôçí åðßäñáóÞ ôïõ óôçí ðïéüôçôá æùÞò ôùí áíèñþðùí ðïõ ðÜó÷ïõí áðü áõôü- ôçí åðßäñáóÞ ôïõ óôï êüóôïò ðïõ äáðáíÜ-ôáé áðü ôéò äïìÝò ãéá ôçí ðñùôïâÜèìéá öñï-íôßäá õãåßáò êáé ôá íïóïêïìåßáÇ åðéëïãÞ ôïõ èÝìáôïò èá ðñÝðåé íá ãßíåé

áðü ìßá ïñéóìÝíç ïìÜäá ãéá ôï óêïðü áõôü. ÇïìÜäá áõôÞ ìðïñåß íá áðïôåëåßôáé áðü 2-3 ãåíé-êïýò ãéáôñïýò, êáé ç ïðïßá èá Ý÷åé ðñïêýøåé áðüìßá åõñýôåñç ïìÜäá 20-25 ãåíéêþí ãéáôñþí. Çåõñýôåñç áõôÞ ïìÜäá èá áðïôåëåßôáé áðü ãåíé-êïýò ãéáôñïýò ìå éäéáßôåñï åíäéáöÝñïí óôçí áíÜ-ðôõîç ôùí êáôåõèõíôÞñéùí ïäçãéþí êáèþò åðß-óçò êáé áðü ãåíéêïýò ãéáôñïýò – ìÝëç ôïõ äéïé-êçôéêïý óõìâïõëßïõ êáé ôùí Åðéôñïðþí ôçò Åë-ëçíéêÞò Åôáéñåßáò ÃåíéêÞò ÉáôñéêÞò (ÅËÅÃÅÉÁ).

ÂÞìá 2: ÅöáñìïãÞ ìéáò óõóôçìáôéêÞò áíáóêüðçóçò ôçòâéâëéïãñáößáò êáé áíáæÞôçóç ôùí äçìïóéåõìÝíùí êáôåõ-èõíôÞñéùí ïäçãéþí

Ç äéáäéêáóßá ãéá ôçí åíôüðéóç ôùí äçìï-óéåõìÝíùí êáôåõèõíôÞñéùí ïäçãéþí èá ðñÝðåé íáãßíåé áðü 10-15 ãåíéêïýò ãéáôñïýò ïé ïðïßïé èáåßíáé åîïéêåéùìÝíïé ìå ôéò ìåèüäïõò áíáæÞôçóçòóôç âéâëéïãñáößá, ïé ïðïßïé èá ðñï÷ùñÞóïõí óåìßá óõóôçìáôéêÞ áíáóêüðçóç âáóéóìÝíç ôüóï óåäåäïìÝíá çëåêôñïíéêÞò ìïñöÞò üóï êáé óå äåäï-ìÝíá ðïõ áíáóýñèçêáí ÷ùñßò çëåêôñïíéêÞ áíá-æÞôçóç êáé ìå êáèïñéóìÝíá êñéôÞñéá ãéá ôçí áíá-óêüðçóç.

Ï óêïðüò áõôïý ôïõ âÞìáôïò èá åßíáé íáåíôïðéóôåß ç äçìïóéåõìÝíç âéâëéïãñáößá, ç ó÷åôé-êÞ ìå ôéò êáôåõèõíôÞñéåò ïäçãßåò ðïõ åíäéáöÝ-ñïõí ôç ãåíéêÞ éáôñéêÞ.

ÂÞìá 3: Áîéïëüãçóç ôçò ðïéüôçôáò ôùí êáôåõèõíôçñßùíïäçãéþí ðïõ èá åíôïðéóôïýí

Ç áîéïëüãçóç ôçò ðïéüôçôáò ôùí êáôåõèõ-íôÞñéùí ïäçãéþí èá ðñÝðåé íá ãßíåé áðü 3-4 ãå-íéêïýò ãéáôñïýò, ðïõ Ý÷ïõí åêðáéäåõôåß óôç ÷ñÞ-óç åñãáëåßùí ãéá ôçí áîéïëüãçóç ôçò ðïéüôçôáòêáôåõèõíôÞñéùí ïäçãéþí, ìå ôç ÷ñçóéìïðïßçóçåíüò êáôÜëëçëïõ êáé Ýãêõñïõ åñãáëåßïõ, ôï ïðïßïèá áîéïëïãåß ôçí ðïéüôçôá ôùí êáôåõèõíôçñßùíïäçãéþí8-12.

Ôçí áîéïëüãçóç ôçò ðïéüôçôáò ìéáò êáôåõ-èõíôÞñéáò ïäçãßáò èá ðñÝðåé íá áêïëïõèÞóåé çåêôßìçóç ãéá ôï áí áõôÞ ç ïäçãßá åßíáé åöéêôüíá åöáñìïóôåß óôç ãåíéêÞ éáôñéêÞ (feasibility)

Ãéá ôï ôåëåõôáßï áõôü óôÜäéï, èá Þôáí óêü-ðéìç ç áíÜðôõîç åíüò åñãáëåßïõ, ðïõ èá åêôéìÜáí ìßá êáôåõèõíôÞñéá ïäçãßá åßíáé êáôÜëëçëçãéá ôç ãåíéêÞ éáôñéêÞ.

ÂÞìá 4: ÔïðïèÝôçóç ôùí åðéëåãìÝíùí êáôåõèõíôÞñéùíïäçãéþí óôá åëëçíéêÜ äåäïìÝíá

Åäþ ðåñéëáìâÜíåôáé óõæÞôçóç ðÜíù óôéòåðéëåãìÝíåò êáôåõèõíôÞñéåò ïäçãßåò, ëáìâÜíïíôáòõðüøç ôéò åëëçíéêÝò ôïðéêÝò óõíèÞêåò êáé ôçíêáèçìåñéíÞ ðñáêôéêÞ ãéá ôçí åöáñìïãÞ ôçò êá-ôåõèõíôÞñéáò ïäçãßáò. Ôï âÞìá áõôü ìðïñåß íáõëïðïéçèåß áðü ôçí ïìÜäá ôçí õðåýèõíç ãéá ôçíõëïðïßçóç ôïõ âÞìáôïò 3.

ÂÞìá 5: ÓõæÞôçóç êáé áíÜðôõîç ìéáò åõñýôåñçò óõìöù-íßáò ãéá ôç äéÜäïóç ðñáêôéêþí ïäçãéþí ãéá ôçí ÅëëÜäá.

Ôï âÞìá áõôü ðåñéëáìâÜíåé ìéá äéáäéêáóßáïìïöùíßáò ðïõ èá ðñÝðåé íá óõììåôÝ÷ïõí

- 2-3 åéäéêåõìÝíïé áðü åéäéêüôçôåò ðïõ áöï-ñïýí ôï êëéíéêü ðåäßï ôçò êáôåõèõíôÞñéáòïäçãßáò ðïõ áíáðôýóóåôáé

- 3-4 ãåíéêïß ãéáôñïß – ìÝëç ôçò óõíôïíéóôéêÞòïìÜäáò ãéá ôçí áíÜðôõîç ôçò êáôåõèõíôÞ-ñéáò ïäçãßáò

- 2-3 åêðñüóùðïé ôùí éáôñéêþí ïñãáíþóåùí- 2-3 åêðñüóùðïé Üëëùí éáôñéêþí åðáããåëìÜ-ôùí

- 2-3 åêðñüóùðïé áðü ôéò ïñãáíþóåéò ôùíáóèåíþí

ÂÞìá 6: ¸ãêñéóç ôùí êáôåõèõíôÞñéùí ïäçãéþí

Ç Ýãêñéóç ôïõ ôåëéêïý êåéìÝíïõ èá ãßíåôáéáðü ôï Äéïéêçôéêü Óõìâïýëéï ôçò ÅËÅÃÅÉÁ

ÂÞìá 7: Äçìïóßåõóç ôùí êáôåõèõíôÞñéùí ïäçãéþí

Ïé åãêåêñéìÝíåò êáôåõèõíôÞñéåò ïäçãßåò èáäçìïóéåýïíôáé óôï åëëçíéêü ðåñéïäéêü “Ðñùôï-âÜèìéá Öñïíôßäá Õãåßáò”, ôï ïðïßï åêäßäåôáé áðüôçí ÅëëçíéêÞ Åôáéñåßá ÃåíéêÞò ÉáôñéêÞò.

ÂÞìá 8: ÄéÜäïóç ôùí êáôåõèõíôÞñéùí ïäçãéþí

Ç äéÜäïóç ôùí äçìïóéåõìÝíùí êáôåõèõíôÞ-ñéùí ïäçãéþí, èá ãßíåé áðü ôçí ÅëëçíéêÞ Åôáé-ñåßá ÃåíéêÞò ÉáôñéêÞò (ÅËÅÃÅÉÁ) ìÝóù ôùí ôï-ðéêþí ôçò ôìçìÜôùí óå óõíåñãáóßá ìå ôçí ÏìÜ-äá ôçò ÊñÞôçò ãéá ôçí Áíáóêüðçóç ôùí Êáôåõ-èõíôÞñéùí Ïäçãéþí (Cretan Guidelines ReviewGroup), ðïõ èá ðñÝðåé íá ìåôïíïìáóèåß óå Åëëç-íéêÞ ÏìÜäá Áíáóêüðçóçò ôùí ÊáôåõèõíôÞñéùíÏäçãéþí (Greek Guidelines Review Group).

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- èá åäñáéþíåé ôñüðïõò ãéá íá äéáóöáëßóïõíôçí ðñüïäï ìÝóá óå ðñïêáèïñéóìÝíá ÷ñïíé-êÜ üñéá


1. National Guideline Clearinghouse, United States:-http//www.guideline.gov./index.asp.

2. National Health and Medical Research Council(NHMRC), Australia: http://www.health.gov.au/hfs/nhmrc

3. Dutch College of General Practitioners, TheNetherlands: http://www.artsen.net.

4. New Zealand Guidelines Group (NZGG),NewZealand: http://www.nzgg.org.nz.

5. Scottish Intercollegiate Network (SIGN), Scot-land: http://www.show.scot .nhs.uk/sign/index.html:

6. Guidelines Advisory Committee, Canada: http://www.gacguidelines.ca.

7. ËéïíÞò ×, Ôáôóéþíç Á, Heurberger P., Muijden-Karssen E van, H van der Schaaf, ÐáðáæÞóçòÇ., ÄÜóêïò Ã, ÌïíÝäáò É, ÊïõíáëÜêçò Ä,ÔæáãêáñÜêçò Ä, ÔóéëéãéÜííç É, Ôóéôßíç Å.ÊáôåõèõíôÞñéåò ïäçãßåò óôçí ðñùôïâÜèìéáöñïíôßäá õãåßáò: Ýíá êåßìåíï âáóéóìÝíï óôçóõíÜíôçóç åñãáóßáò ÅëëÞíùí êáé Ïëëáíäþíåñåõíçôþí êáé ãåíéêþí ãéáôñþí. ÐñùôïâÜèìéáÖñïíôßäá Õãåßáò, 13:214-21, 2001.

8. Lohr KN, Field MJ. A provisional instrumentfor assessing clinical practice guidelines. In:Field MJ, Lohr KN (eds). Guidelines for clini-cal practice. From development to use. Wash-ington D.C. National Academy Press, 1992.

9. Cluzeau F, Littlejohns P, Grimshaw J, Feder G,Moran S. Development and application of ageneric methodology to assess the quality ofclinical guidelines. International Journal forQuality in Health Care, 11:21-28, 1999.

10. Grol R, Dalhuijzen J, Mokkink H, Thomas S,Veld C, Rutten G. Attributes of clinical guide-lines that influence use of guidelines in gener-al practice: observational study BMJ, 317:858-861, 1998.

11. Lohr KN. The quality of practice guidelinesand the quality of health care. In: Guidelines inhealth care. Report of a WHO Conference. Jan-uary 1997, Baden-Baden: Nomos Verlagsgesell-schaft 1998.

12. Appraisal of Guidelines Research and Evalua-tion (AGREE), http://www.agreecollaboration.org

Åðßëïãïò

Ç êáèéÝñùóç ìéáò äéáäéêáóßáò ãéá ôçí áíÜ-ðôõîç êáôåõèõíôÞñéùí ïäçãéþí áðïôåëåß âáóéêÞðñïûðüèåóç ãéá ôç äçìéïõñãßá óõóôÜóåùí ðïõèá óõìâÜëëïõí óôçí âåëôßùóç ôçò ðïéüôçôáò ôùíõðçñåóéþí óôçí ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò.Ôï êåßìåíï ãéá ôá âÞìáôá áíÜðôõîçò êáôåõèõ-íôÞñéùí ïäçãéþí óôçí ÅëëÜäá, áíáìÝíåôáé íáðáñÝîåé ôï ðëáßóéï ãéá ôçí ðëÞñç óõëëïãÞ áíôé-êåéìåíéêþí äåäïìÝíùí, ìå óêïðü ôç äçìéïõñãßáêëéíéêþí ðñáêôéêþí ïäçãéþí óôç ãåíéêÞ éáôñéêÞêáé ôçí ðåñáéôÝñù äéÜäïóç ôïõò. Ôï ðñùôüêïëëïáõôü èá êáôáôåèåß ãéá Ýãêñéóç óôï äéïéêçôéêüóõìâïýëéï ôçò ÅËÅÃÅÉÁ êáé åíôÜóóåôáé óôáðëáßóéá ôçò óõæÞôçóçò ãéá ôçí äçìéïõñãßá ìéáòÏìÜäáò Åñãáóßáò (Task Force) ãéá ôç äéá÷åßñéóçôçò öñïíôßäáò óôçí êáèçìåñéíÞ ðñÜîç.

ÌåôÜ ôç ëåéôïõñãßá ôïõ ðñùôïêüëëïõ, ôçäçìéïõñãßá êáé äéÜäïóç ôùí êáôåõèõíôÞñéùí ïäç-ãéþí, êáèßóôáôáé áíáãêáßá ç áíÜðôõîç åíüò ðëáé-óßïõ ãéá ôçí åöáñìïãÞ êáé ôç ÷ñÞóç ôùí ïäç-ãéþí áõôþí. Óôï ÷þñï ôçò õãåßáò åìöáíßæïíôáéäõóêïëßåò, ðïõ åìðïäßæïõí ðïëëÝò öïñÝò ôéò óõ-óôÜóåéò êáé ôéò ðñáêôéêÝò ïäçãßåò íá ãßíïõí ðñÜ-îç13. ̧ ôóé öáßíåôáé íá åßíáé áðáñáßôçôï Ýíá ó÷Ý-äéï ðïõ:

- èá êáèïñßæåé åèíéêïýò óôü÷ïõò êáé èá åíôï-ðßæåé êïìâéêÝò ðáñåìâÜóåéò ãéá ìßá óõãêå-êñéìÝíç õðçñåóßá Þ ïìÜäá öñïíôßäáò

- èá áíáðôýóóåé óôñáôçãéêÝò ãéá ôçí õðïóôÞ-ñéîç åöáñìïãÞò ôùí êáôåõèõíôçñßùí ïäçãéþíóõóôÜóåùí, êáé

Ðßíáêáò. ÂÞìáôá ãéá ôçí áíÜðôõîç êáôåõèõíôÞñéùíïäçãéþí

ÂÞìá 1: ÅðéëïãÞ ôïõ êëéíéêïý èÝìáôïò êáé êáèïñé-óìüò ôçò óðïõäáéüôçôÜò ôïõ óôç ÃåíéêÞ Éá-ôñéêÞ

ÂÞìá 2: ÅöáñìïãÞ ìéáò óõóôçìáôéêÞò áíáóêüðçóçòôçò âéâëéïãñáößáò êáé áíáæÞôçóç ôùí äçìï-óéåõìÝíùí êáôåõèõíôÞñéùí ïäçãéþí

ÂÞìá 3: Áîéïëüãçóç ôçò ðïéüôçôáò ôùí êáôåõèõíôç-ñßùí ïäçãéþí ðïõ èá åíôïðéóôïýí

ÂÞìá 4: ÔïðïèÝôçóç ôùí åðéëåãìÝíùí êáôåõèõíôÞ-ñéùí ïäçãéþí óôá åëëçíéêÜ äåäïìÝíá

ÂÞìá 5: ÓõæÞôçóç êáé áíÜðôõîç ìéáò åõñýôåñçò óõì-öùíßáò ãéá ôçí äéÜäïóç ôùí ðñáêôéêþí ïäç-ãéþí ãéá ôçí ÅëëÜäá

ÂÞìá 6: ¸ãêñéóç ôùí êáôåõèõíôÞñéùí ïäçãéþíÂÞìá 7: Äçìïóßåõóç ôùí êáôåõèõíôÞñéùí ïäçãéþíÂÞìá 8: ÄéÜäïóç ôùí êáôåõèõíôÞñéùí ïäçãéþí


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ÁÍÔÁÐÏÊÑÉÓÇ ÁÐÏ ÔÇÍ ÊÑÇÔÇ

CORRESPONDENCE FROM CRETEPrimary Heatlh Care, Volume 15, Number 2, 94-95, 2003ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò, Ôüìïò 15, Ôåý÷ïò 2, 94-95, 2003

2ç Åëëçíï-ÏëëáíäéêÞ ÓõíÜíôçóç ãéá ôéò ÊáôåõèõíôÞñéåò Ïäçãßåòóôç ÃåíéêÞ ÉáôñéêÞ

ï ÄéïéêçôÞò ôïõ Ãåíéêïý Íïóïêïìåßïõ ×áíßùí ê.×. ÄïõëãåñÜêçò.

Ç ÓõíÜíôçóç Åñãáóßáò ðåñéåëÜìâáíå ðá-ñÜëëçëåò óõíåäñéÜóåéò ôùí äýï åñåõíçôéêþí ïìÜ-äùí (Workshops) ðïõ åðåîåñãÜóôçêáí ôá èÝìá-ôá ôçò êáñäéáêÞò áíåðÜñêåéáò êáé ôïõ óáê÷á-ñþäïõò äéáâÞôç, êïéíÝò óõíåäñéÜóåéò üðïõ ðá-ñïõóéÜóôçêáí ôá óõìðåñÜóìáôá ôçò åñãáóßáòôùí ïìÜäùí êáé åíôïðßóôçêáí ïé äéáöïñÝò êáéïé ïìïéüôçôåò óôç äéá÷åßñéóç áõôþí ôùí íïóç-ìÜôùí êáé äéáëÝîåéò áðü óõììåôÝ÷ïíôåò åñåõíç-ôÝò. Ïé äéáëÝîåéò ôùí ÅëëÞíùí ïìéëçôþí áöï-ñïýóáí ôç äéá÷åßñéóç ôçò êáôÜèëéøçò (ïìéëÞ-ôñéá ç êá ÓôÝëëá ÁñãõñéÜäïõ), ôç äéá÷åßñéóçáóèåíþí ìå áõîçìÝíï êßíäõíï óôåöáíéáßáò íü-óïõ (ïìéëçôÞò ï ê. ÅëåõèÝñéïò Èçñáßïò), ôçíðáñïõóßáóç åíüò åñåõíçôéêïý ðñùôïêüëëïõ ãéáôçí êáñäéáêÞ áíåðÜñêåéá áðü ôïí ê. ÌÜñéï×áôæçáñóÝíç, ôç óõíôáãïãñáößá öáñìÜêùí (ïìé-ëçôÞò ï ê. Íßêïò ÁíôùíÜêçò), åíþ éäéáßôåñïåíäéáöÝñïí åß÷å ç åéóÞãçóç ôùí ×. ËéïíÞ êáéÁèçíÜò Ôáôóéþíç ìå èÝìá ôçí åêôßìçóç ôçòðïéüôçôáò ôùí êáôåõèõíôçñßùí ïäçãéþí. Ïé äéá-ëÝîåéò ôùí Ïëëáíäþí åñåõíçôþí áöïñïýóáí ôïðñüâëçìá ôçò åîÜñôçóçò áðü ïõóßåò êáé éäéáßôå-ñá ôï áëêïüë (åéóçãÞôñéá ç êá Marijke Niels-en) êáé ôçí åðßäñáóç ôçò äéáöïñåôéêüôçôáò ôçòêïõëôïýñáò óôçí áíÜðôõîç ôùí êáôåõèõíôçñßùíïäçãéþí (åéóçãçôÞò ï ê. Hans van der Schaaf).Ôï ðñüãñáììá ôçò ÓõíÜíôçóçò Åñãáóßáò ïëï-êëçñþèçêå ìå ôçí åðßóêåøç ôùí Ïëëáíäþí åñåõ-íçôþí óôï ÊÝíôñï Õãåßáò ÊáíäÜíïõ ×áíßùí.

Ãéá ôçí áíÜðôõîç ôùí êáôåõèõíôçñßùí ïäç-ãéþí Ý÷ïõí õéïèåôçèåß äýï óôñáôçãéêÝò, ç äç-ìéïõñãßá åîáñ÷Þò áõôïôåëþí ïäçãéþí Þ ç ÷ñçóé-ìïðïßçóç ôçò åìðåéñßáò Ïñãáíéóìþí Þ Åôáéñåéþí

Ôïí ÌÜéï ôïõ 2001 ðñáãìáôïðïéÞèçêå óôçíÁèÞíá ç ðñþôç óõíÜíôçóç óõíåñãáóßáò ìåôáîýÅëëÞíùí êáé Ïëëáíäþí åñåõíçôþí êáé ãåíéêþíéáôñþí, ç ïðïßá åß÷å ùò óêïðü ôç óõæÞôçóç êáéáíôáëëáãÞ ãíþóåùí êáé åìðåéñéþí üóïí áöïñÜóôçí áíÜðôõîç, åöáñìïãÞ êáé áîéïëüãçóç ôùíêáôåõèõíôçñßùí ãñáììþí (Guidelines) óôç Ãåíé-êÞ ÉáôñéêÞ. Ôá óõìðåñÜóìáôá áõôÞò ôçò óõíÜ-íôçóçò ðáñïõóéÜóôçêáí óå ó÷åôéêÞ äçìïóßåõóçóôï ðåñéïäéêü “ÐñùôïâÜèìéá Öñïíôßäá Õãåßáò”1.

Ç äåýôåñç Åëëçíï-ÏëëáíäéêÞ óõíÜíôçóç åñ-ãáóßáò ðñáãìáôïðïéÞèçêå óôçí ÊñÞôç áðü 24Ýùò 28 ÌáÀïõ óôï îåíïäï÷åßï Santa Marina óôá×áíéÜ. Ïñãáíþèçêå áðü ôçí ÊëéíéêÞ ÊïéíùíéêÞòêáé ÏéêïãåíåéáêÞò ÉáôñéêÞò ôïõ ÐáíåðéóôçìßïõÊñÞôçò, óå óõíåñãáóßá ìå ôçí ÅëëçíéêÞ Åôáé-ñåßá ÃåíéêÞò ÉáôñéêÞò êáé ôï Ïëëáíäéêü ÊïëÝãéïÃåíéêþí Éáôñþí, åíþ ç üëç åêäÞëùóç ôåëïýóåõðü ôçí áéãßäá ôïõ ÐåÓÕÐ ÊñÞôçò. Óõììåôåß-÷áí óõíïëéêÜ 17 Ïëëáíäïß êáé 20 ̧ ëëçíåò ãåíé-êïß éáôñïß êáé åñåõíçôÝò.

Ôçí ðñþôç çìÝñá ôçò óõíÜíôçóçò Ýãéíáí ïéåíáñêôÞñéåò ïìéëßåò. Ï ê. ×. ËéïíÞò, Áíáðëçñù-ôÞò ÊáèçãçôÞò ôïõ Ðáíåðéóôçìßïõ ÊñÞôçò êáéÁíáðëçñùôÞò Ãåíéêüò ÄéåõèõíôÞò ôïõ Ðå.Ó.Õ.Ð.ÊñÞôçò óôçí äéêÞ ôïõ åéóÞãçóç áíáöÝñèçêå óôéòóôñáôçãéêÝò áíÜðôõîçò ôùí êáôåõèõíôçñßùí ïäç-ãéþí êáé ðáñïõóßáóå ôçí åëëçíéêÞ åìðåéñßá. Ï ê.Á. ÖéëáëÞèçò, ÁíáðëçñùôÞò ÊáèçãçôÞò ôïõÐáíåðéóôçìßïõ ÊñÞôçò êáé Ä/íôÞò ôçò ÊëéíéêÞòÊïéíùíéêÞò êáé ÏéêïãåíåéáêÞò ÉáôñéêÞò Ýêáíå ìéáðáñïõóßáóç ôïõ ÓõóôÞìáôïò ÐñùôïâÜèìéáò Öñï-íôßäáò Õãåßáò óôçí ÅëëÜäá, åíþ ï ê. Paul Heub-erger Ýêáíå ìéá áíáöïñÜ óôçí ÏëëáíäéêÞ åìðåé-ñßá ó÷åôéêÜ ìå ôç äéáìüñöùóç êáôåõèõíôçñßùíïäçãéþí êáé standards. Ôçí åêäÞëùóç ÷áéñÝôéóå

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êáé ç ðñïóáñìïãÞ ôïõò óôéò ôïðéêÝò óõíÞèåéåò.Óôá ðëáßóéá ôçò ôåëåõôáßáò óôñáôçãéêÞò åíôÜó-óåôáé êáé áõôÞ ç Åëëçíï-ÏëëáíäéêÞ ÓõíÜíôçóçÅñãáóßáò. Óôá èåôéêÜ áðïôåëÝóìáôá áõôÞò íáóôáèïýìå éäéáßôåñá óôçí óõìöùíßá ôùí ÅëëÞíùíóõììåôå÷üíôùí ãéá ôç äçìéïõñãßá åíüò ðñùôï-êüëëïõ ãéá ôçí áíÜðôõîç êáôåõèõíôÞñéùí ïäç-ãéþí óôçí ÅëëÜäá, óôï ïðïßï èá ðáñïõóéÜæïíôáéïé èÝóåéò êáé ôá âÞìáôá Þ äéáäéêáóßåò ðïõ óõæç-ôÞèçêáí óôç óõíÜíôçóç, ôá ïðïßá áðïôåëïýíóõã÷ñüíùò êáé ðñüôáóç óôçí ÅëëçíéêÞ ÅôáéñåßáÃåíéêÞò ÉáôñéêÞò.

ÅëåõèÝñéïò ÈçñáßïòÃåíéêüò Éáôñüò


1. ËéïíÞò ×., Ôáôóéþíç Á., Heuberger P., VanMuijden-Karssen E., Van der Schaaf H.,ÐáðáæÞóçò Ç., ÄÜóêïò Ã., ÌïíÝäáò É., ÊïõíáëÜêçòÄ., ÔæáãêáñÜêçò Å., ÔóéëéãéÜííç É., Ôóéôßíç Å.ÊáôåõèõíôÞñéåò ïäçãßåò óôçí ðñùôïâÜèìéáöñïíôßäá õãåßáò: Ýíá êåßìåíï âáóéóìÝíï óôçóõíÜíôçóç åñãáóßáò ÅëëÞíùí êáé Ïëëáíäþíåñåõíçôþí êáé ãåíéêþí éáôñþí. ÐñùôïâÜèìéáÖñïíôßäá Õãåßáò, 13:214-221, 2001

Â´ ÐåÓÕÐ ÁÔÔÉÊÇÓÃÅÍÉÊÏ ÍÏÓÏÊÏÌÅÉÏ ÁÈÇÍÙÍ "Ã. ÃÅÍÍÇÌÁÔÁÓ"

ÊÅÍÔÑÏ ÅÐÁÃÃÅËÌÁÔÉÊÇÓ ÊÁÔÁÑÔÉÓÇÓÐÑÏÓÊËÇÓÇ ÅÊÄÇËÙÓÇÓ ÅÍÄÉÁÖÅÑÏÍÔÏÓ

Ãíùóôïðïéåßôáé üôé óôï ÊÝíôñï ÅðáããåëìáôéêÞò ÊáôÜñôéóçò ôïõ Ã.Í. Áèçíþí "Ã. ÃÅÍÍÇÌÁÔÁÓ"áðü 8.9.2003 ìÝ÷ñé 20.10.2003 èá õëïðïéçèåß åðéäïôïýìåíï ðñüãñáììá åðáããåëìáôéêÞò êáôÜñôéóçò200 ùñþí, ãéá 25 åñãáæüìåíïõò, Éáôñéêü Ðñïóùðéêü ÐñùôïâÜèìéáò Öñïíôßäáò Õãåßáò, ôùíÍïóïêïìåßùí, Ê.Õ., Ðåñ. Éáôñåßùí, ôïõ ÅÓÕ, ÅÊÁÂ, ÐåÓÕÐ êáé Õ.Õ.Ð. ìå ôßôëï "ÅêðáßäåõóçÊëéíéêþí Åêðáéäåõôþí" êáé Êùä. ÅíÝñãåéáò Õ.02 - Õ.04 - ÕÅ/Å 302.

Ôï ðñüãñáììá èá õëïðïéçèåß óôï ðëáßóéï ôïõ Å.Ð. "ÕÃÅÉÁ - ÐÑÏÍÏÉÁ" 2000-2006 ôïõ Ã' ÊÐÓ,ìå óõã÷ñçìáôïäïôÞóåé êáôÜ 75% ôïõ Åõñùðáúêïý Êïéíïôéêïý Ôáìåßïõ êáé 25% ôïõ ÅëëçíéêïýÄçìïóßïõ.

Êáëïýíôáé ïé åíäéáöåñüìåíïé íá õðïâÜëïõí ìÝ÷ñé êáé ôçí 25.8.2003 áßôçóç óõììåôï÷Þò ãéá ôïðñüãñáììá óôï ÊÝíôñï ÅðáããåëìáôéêÞò ÊáôÜñôéóçò ôïõ Ã.Í. Áèçíþí "Ã. ÃÅÍÍÇÌÁÔÁÓ", Ôá÷.Ä/íóç Ìåóïãåßùí 154 Ô.Ê. 115 27.

Ï ÄéïéêçôÞòÁËÅÎÁÍÄÑÏÓ ×ÏËÅÂÁÓ

ÏÄÇÃÉÅÓ ÃÉÁ ÔÏÕÓ ÓÕÃÃÑÁÖÅÉÓ

INSTRUCTIONS FOR THE AUTHORS

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

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

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

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

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

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

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

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

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

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

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

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