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What is known and objective Polypharmacy has a significant impact on patients' health with overall expenditure on over-the-counter (OTC) medicines representing a substantial burden in terms of cost of treatment. The aim of this study, which was conducted within the framework of a European Project funded by the European Union under the Seventh Framework Programme and was entitled OTC-SOCIOMED, was to report on possible determinants of patient behaviour regarding the consumption of medicines, and particularly OTCs, in the context of primary care. Methods A multicentre, cross-sectional study was designed and implemented in well-defined primary healthcare settings in Cyprus, the Czech Republic, France, Greece, Malta and Turkey. Patients completed a questionnaire constructed on the basis of the theory of planned behaviour (TPB), which was administered via face-to-face interviews. Results and discussion The percentage of patients who had consumed prescribed medicines over a 6-month period was consistently high, ranging from 79% in the Czech Republic and 82% in Turkey to 97% in Malta and 100% in Cyprus. Reported non-prescribed medicine consumption ranged from 33% in Turkey to 92% in the Czech Republic and 97% in Cyprus. TPB behavioural antecedents explained 43% of the variability of patients' intention to consume medicines in Malta and 24% in Greece, but only 3% in Turkey. Subjective norm was a significant predictor of the intention to consume medicines in all three countries (Greece, Malta and Turkey), whereas attitude towards consumption was a significant predictor of the expectation to consume medicines, if needed. What is new and conclusion This study shows that parameters such as patients' beliefs and influence from family and friends could be determining factors in explaining the high rates of medicine consumption. Factors that affect patients' behavioural intention towards medicine consumption may assist in the formulation of evidence-based policy proposals and inform initiatives and interventions aimed at increasing the appropriate use of medicines. [ABSTRACT FROM AUTHOR]

What is known and Objective Prescribing represents an important medical action especially in primary care. However, irrational prescribing is common and has an impact on clinical and economic outcomes. Therefore, there is a growing need to rationalize prescribing. Knowledge of influential factors is crucial for achieving this. The aim of the present study was to identify the behavioural, normative and control beliefs of GPs regarding prescribing in Greece. Methods Focus group sessions were conducted in three geographically defined areas in Greece. GPs working in the private and public sector in primary care settings were invited to participate. Transcripts from focus groups were content analysed using the Theory of Planned Behaviour ( TPB) as the theoretical framework. Results and Discussion GPs acknowledged prescribing as the most important method for treating diseases in primary health care, with significant impact on patient's health and quality of life. The expectations of patients and their families were extremely influential during prescribing. Pharmaceutical sales representatives, other GPs and specialists, as well as public health authorities influenced prescribing. GPs admitted that factors such as the income of the patient, the limited time available and special situations such as prescribing through a third person or prescribing following patients' prescription requests for medicines that they have previously purchased over the counter through pharmacies may facilitate or hinder their prescribing decision. What is new and Conclusion This elicitation study shed light into GPs' beliefs regarding prescribing. Factors that are not common in the usual European setting were revealed, such as the influence of the patients' family and special situations during prescribing. Thus, various issues were highlighted that should inform the development of items for inclusion in a forthcoming TPB-based questionnaire. The results of this study revealed also certain issues that can affect the design of policies aiming at the rationalization of prescribing. [ABSTRACT FROM AUTHOR]

Long-term dietary exposures to lead in young children were calculated by combining food consumption data of 11 European countries categorised using harmonised broad food categories with occurrence data on lead from different Member States (pan-European approach). The results of the assessment in children living in the Netherlands were compared with a long-term lead intake assessment in the same group using Dutch lead concentration data and linking the consumption and concentration data at the highest possible level of detail. Exposures obtained with the pan-European approach were higher than the national exposure calculations. For both assessments cereals contributed most to the exposure. The lower dietary exposure in the national study was due to the use of lower lead concentrations and a more optimal linkage of food consumption and concentration data. When a pan-European approach, using a harmonised food categorisation system and “European” concentration data, results in a possible health risk related to the intake of an environmental chemical for a certain country, it is advisable to refine this assessment, as part of a tiered approach, using national occurrence data, including an optimised linkage between foods analysed and consumed for that country. In the case of lack of occurrence data, these data can be supplemented with data from the “European” concentration database or by generating additional concentration data at country level. [ABSTRACT FROM AUTHOR]

Within the European project called EXPOCHI (Individual Food Consumption Data and Exposure Assessment Studies for Children), 14 different European individual food consumption databases of children were used to conduct harmonised dietary exposure assessments for lead, chromium, selenium and food colours. For this, two food categorisation systems were developed to classify the food consumption data in such a way that these could be linked to occurrence data of the considered compounds. One system served for the exposure calculations of lead, chromium and selenium. The second system was developed for the exposure assessment of food colours. The food categories defined for the lead, chromium and selenium exposure calculations were used as a basis for the food colour categorisation, with adaptations to optimise the linkage with the food colour occurrence data. With this work, an initial impetus was given to make user-friendly food categorisation systems for contaminants and food colours applicable on a pan-European level. However, a set of difficulties were encountered in creating a common food categorisation system for 14 individual food consumption databases that differ in the type and number of foods coded and in level of detail provided about the consumed foods. The work done and the problems encountered in this project can be of interest for future projects in which food consumption data will be collected on a pan-European level and used for common exposure assessments. [ABSTRACT FROM AUTHOR]

Objective:To examine the long-term effects of the ‘Cretan Health and Nutrition Education Program’ on blood pressure.Subjects:A representative population of 176 pupils (85 from the intervention schools and 91 from the control schools).Design:Blood pressure, dietary, anthropometrical and physical activity data were obtained at baseline (academic year 1992–1993) and at follow-up examination (academic year 2001–2002).Results:The findings of the current study revealed that the increase over the 10-year period in systolic (SBP) and diastolic blood pressure (DBP) was higher in the control group (CG) than in the intervention group (IG) (P=0.003 and P<0.001 respectively). Regarding dietary indices, the IG were found to have a significantly higher intake of potassium (P=0.018) and magnesium (P=0.011) compared to the CG. Furthermore, the decrease in body mass index (BMI) z-score observed in the IG was found to differentiate significantly from the increase observed in the CG (P=0.042). On the contrary, the increase in leisure time, moderate to vigorous physical activities (MVPA) observed in the IG, was found to differentiate significantly from the decrease observed in the CG (P=0.032). Intervention's effect on SBP was mediated by changes in MVPA (β=−0.20, P=0.030) and BMI (β=0.19, P=0.048). Similarly, intervention's effect on DBP was mediated by changes in MVPA (β=−0.18, P=0.048), BMI (β=0.26, P=0.007) and magnesium intake (β=−0.20, P=0.048).Conclusion:The findings of the current study are encouraging, indicating favorable changes in blood pressure, micronutrients intake, BMI and physical activity over the 10 years of follow-up and 4 years after program's cessation, thus providing some support for the effectiveness of school-based health education programs in successfully tackling certain chronic disease risk factors early in life.European Journal of Clinical Nutrition (2007) 61, 837–845; doi:10.1038/sj.ejcn.1602584; published online 10 January 2007 [ABSTRACT FROM AUTHOR]

The authors aimed to quantify the effects of current systolic blood pressure (SBP) and serum total cholesterol on the risk of mortality in comparison with SBP or serum cholesterol 25 years previously, taking measurement error into account. The authors reanalyzed 35-year follow-up data on mortality due to coronary heart disease and stroke among subjects aged 65 years or more from nine cohorts of the Seven Countries Study. The two-step method of Tsiatis et al. (J Am Stat Assoc 1995;90:27-37) was used to adjust for regression dilution bias, and results were compared with those obtained using more commonly applied methods of adjustment for regression dilution bias. It was found that the commonly used univariate adjustment for regression dilution bias overestimates the effects of both SBP and cholesterol compared with multivariate methods. Also, the two-step method makes better use of the information available, resulting in smaller confidence intervals. Results comparing recent and past exposure indicated that past SBP is more important than recent SBP in terms of its effect on coronary heart disease mortality, while both recent and past values seem to be important for effects of cholesterol on coronary heart disease mortality and effects of SBP on stroke mortality. Associations between serum cholesterol concentration and risk of stroke mortality are weak. [ABSTRACT FROM AUTHOR]

Background:Only one study has investigated the relationship of essential fatty acids in the adipose tissue with depression in adults and suggested an inverse relationship between docosahexaenoic acid (22:6 n-3) (DHA) and depression.Objective:To examine the relation between adipose tissue polyunsaturated fatty acids especially n-3 and n-6 fatty acids, an index of long-term or habitual fatty acid intake, and depression in adults.Design:Cross-sectional study of healthy adults from the island of Crete.Setting:The Preventive Medicine and Nutrition Clinic, University of Crete, Greece.Subjects:A total of 130 healthy adults (59 males, 71 females) aged 22—58 years. The sample was a sub-sample of the Greek ApoEurope study group.Methods:Fatty acids were determined by gas chromatography in adipose tissue. Information about depression was obtained through the Zung Self-rating Depression Scale.Results:Adipose tissue DHA was inversely related with depression. Multiple linear regression analysis taking into account the possible confounding effect of age, gender, body mass index, smoking and educational level confirmed this association.Conclusions:The inverse relationship between adipose DHA and depression in adults, replicates findings of a previous study. This relationship indicates that a low long-term dietary intake of DHA is associated with an increased risk for depression in adults.Funding:The International Olive Oil Council and the DG XII of the European Union.European Journal of Clinical Nutrition (2006) 60, 882–888. doi:10.1038/sj.ejcn.1602394; published online 8 February 2006 [ABSTRACT FROM AUTHOR]

Objective: To assess the intake of trans fatty acids (TFA) and other fatty acids in 14 Western European countries.Design and Subjects: A maximum of 100 foods per country were sampled and centrally analysed. Each country calculated the intake of individual trans and other fatty acids, clusters of fatty acids and total fat in adults and/or the total population using the best available national food consumption data set.Results: A wide variation was observed in the intake of total fat and (clusters) of fatty acids in absolute amounts. The variation in proportion of energy derived from total fat and from clusters of fatty acids was less. Only in Finland, Italy, Norway and Portugal total fat did provide on average less than 35% of energy intake. Saturated fatty acids (SFA) provided on average between 10% and 19% of total energy intake, with the lowest contribution in most Mediterranean countries. TFA intake ranged from 0.5% (Greece, Italy) to 2.1% (Iceland) of energy intake among men and from 0.8% (Greece) to 1.9% among women (Iceland) (1.2-6.7 g/d and 1.7-4.1 g/d, respectively). The TFA intake was lowest in Mediterranean countries (0.5-0.8 en%) but was also below 1% of energy in Finland and Germany. Moderate intakes were seen in Belgium, The Netherlands, Norway and UK and highest intake in Iceland. Trans isomers of C18:1 were the most TFA in the diet. Monounsaturated fatty acids contributed 9-12% of mean daily energy intake (except for Greece, nearly 18%) and polyunsaturated fatty acids 3-7%.Conclusion: The current intake of TFA in most Western European countries does not appear to be a reason for major concern. In several countries a considerable proportion of energy was derived from SFA. It would therefore be prudent to reduce intake of all cholesterol-raising fatty acids, TFA included. [ABSTRACT FROM AUTHOR]

The current study examines the long-term effects of a school-based ‘Health and Nutrition Education programme’ on body mass index (BMI) changes and the prevalence of overweight. The intervention group consisted of all pupils registered in the first grade of two counties of the island of Crete in 1992, while all pupils registered in a third county formed the control group. For evaluation purposes, a representative sample was examined at baseline (1992) following the 6-y intervention (1998) and 4 y after the programme's cessation (2002). The data presented here are based on pupils with full anthropometrical data in all three examination periods (284 intervention group pupils and 257 control group pupils). Former intervention group pupils had lower average BMI (by 0.7 kg/m2, s.e. 0.28, P=0.019) at the 10-y follow-up compared to the control group subjects, while no differences were detected in the prevalence of obesity between the two groups. The findings of the current study indicate that the beneficial effects of the programme on pupils’ BMI continue, to an extent, 4 years after its cessation. However, the lack of significant differences in the prevalence of overweight between the two groups indicates that the effects of the intervention may not be equally distributed in the population, with greater effects in certain subgroups and less or none in others.European Journal of Clinical Nutrition (2005) 59, 1090–1092. doi:10.1038/sj.ejcn.1602216; published online 6 July 2005 [ABSTRACT FROM AUTHOR]

Background: Although early detection and systematic prevention of cancer improves outcomes and reduces mortality, General Practitioners' (GP) effectiveness remains an issue that merits further investigation.Methods: To explore cancer control practices of Greek GPs, a version of the Cancer Control Practices questionnaire, originally developed in Western New York in 2001, was translated and culturally adapted.Results: Its reliability was found satisfactory in most the items.Conclusions: The instrument can be useful in determining Greek GPs' knowledge and application of internationally established cancer-related guidelines, barriers they face in daily practice, and educational or training needs. [ABSTRACT FROM AUTHOR]