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As Greece moves during the last two decades toward a national health care system, which gives emphasis to the development of a primary care system, many worry how to ensure that the quality of care is assessed. This is more apparent in the rural populations, in which health care is served to a large extent by physicians without formal training in general practice. This article explores the level of knowledge of primary care physicians in relation to Alzheimer's disease in geographically defined areas of Crete, Greece, in comparison with that of general practitioners in Ostergötland, Sweden, and in Iceland. It emphasizes the need for better education and training for primary care physicians in Crete in both the early diagnosis and management of Alzheimer's disease.

Background: Dementia and depression are very common disorders among elderly people and their presence decreases the well-being of the aged., Objectives: The purpose of this study was to assess the magnitude of dementia and depression among elderly people living in different settings in the catchment area of the Chrisoupolis health centre (HCCh) in northern Greece., Methods: A total of 536 patients aged 65 years and over, including 48 subjects living in an old people's home, 75 subjects who were taking part in the activities of the open centre for the elderly and 413 subjects randomly selected from those visiting the HCCh, were interviewed by the primary health care team of the HCCh. Medical and family history data were recorded, while cognitive and mood disorders were assessed by using the Mini Mental State Examination and Geriatric Depression Screening Scale., Results: At the time of the examination, 37.6% of the men and 41.6% of the women showed various degrees of cognitive impairment, while 29.9% of the women and 19.6% of the men showed mild to moderate depression. Diabetes mellitus and hypertension frequently were found to co-exist with depression and dementia., Conclusion: The results reaffirm that there is a high prevalence of the studied mental disorders in older patients in the out-patient setting in Greece. A set of recommendations to Greek GPs has now been formulated, with specific emphasis on the use of different screening tools and the appropriate treatment of the most frequently co-existing chronic diseases.

Background: Hepatitis C is a serious problem on the Greek island of Crete, where a high prevalence of antibodies against hepatitis C (anti-HCV) has recently been reported. This article reports the findings of a study carried out in Crete, which investigated the prevalence of serum autoantibodies in patients with chronic hepatitis C., Patients and Methods: One hundred and forty two patients (59 men and 83 women), who were found anti-HCV seropositive in two hospitals and two Primary Health Care Centres in Crete, were eligible. Sixty healthy blood donors (46 men, 14 women), which were negative to anti-HCV, were used as the control group. They were randomly selected from those attending Rethymnon Hospital. Autoantibodies were identified using the indirect immunofluorescence (IFL) technique on human epithelial cells from larynx cancer (HEp-2 cells), rat liver-kidney-stomach substrate (CT3) and Chrithidia Luciliae (CL)., Results: Serum autoantibodies were detected in 104 HCV patients, yielding an overall prevalence of 73.2%. The most frequent autoantibodies were antinuclear antibodies (ANA), positive in 72 patients (50.7%). Anti-smooth muscle antibodies (ASMA) were detected in 33 patients (23.2%). Only one patient was positive for LKM1 autoantibodies. No autoantibodies were found in 38 patients (26.7%). Autoantibodies were also found in 5 out of the 60 examined healthy blood donors (8.3%)., Conclusions: Autoantibodies, mainly ANA and ASMA are very common in HCV seropositive patients from Crete. By contrast LKM1 autoantibodies are exceptionally rare in these patients.

Aim: To assess the level of knowledge for bronchial asthma of the primary healthcare physicians serving a rural population on the island of Crete, both before and immediately after a one-day educational course., Methods: Twenty-one primary health care physicians, randomly selected from a list of 14 Health Care Centres on the island of Crete were invited to participate in the study and attended an educational course. Nine of the 21 physicians were fully qualified general practitioners, while the remainder were non-specialized (NSs) physicians who had recently graduated from the University of Crete, Medical School. A questionnaire of 20 items based on current bronchial asthma clinical guidelines was used. Three scores, the mean total, knowledge subscore and attitudes subscore, were calculated for each group of physicians, both before and after the course., Results: At baseline mean total score and knowledge and attitudes subscores were higher for non-specialized physicians than for the general practitioners, but the differences were not statistically significant (p > 0.05). The knowledge subscore was improved in both groups, however the difference was statistically significant only for the non-specialized physicians (t = 2.628, d.f. = 11, p < 0.05). The mean total score after the course was significantly higher for the non-specialized physicians in comparison to that of the general practitioners (t=-2.688, d.f. = 19, p < 0.05)., Conclusions: This study adds to the information about the success of continuing medical education, and also demonstrates that the recent graduates in the studied population, could be educated with more positive results than the fully qualified practitioners

Background: A project aimed at studying the frequency of dementia and depression in the catchment area of the Health Centre of Chrissoupolis (HCCh), Northern Greece, was carried out. This paper reports the association between AD and anemia among the elderly participants in this Greek study., Methods: Eligible participants were people 65 years or over who were (a) living in the Elderly People's Home (all 48 subjects included); (b) visiting the Open Center for Elderly People during a 20 workday period (75 subjects) and (c) visiting the HCCh for routine medical care. The Mini Mental State Examination (MMSE) was used in assessing the cognitive capacity of the participants. Blood was drawn for serum hematocrit, vitamin B12 and folate determination., Results: The prevalence proportions of possible cognitive impairment among anemic and non-anemic males were 55.6% and 34.4%, respectively (X2 = 5.8, d.f. = 1, p = 0.016). The corresponding proportions in females were 47.5% and 40.1 % (X2 = 1.1, d.f. = 1, p = 0.305). Using logistic regression analysis, age-group (>or= 80 yrs), type of Institute, vitamin B12 and anemia had significant independent associations with possible cognitive impairment., Conclusions: Anemia is a frequent finding in elderly and it may be a risk factor for dementia, but the extent of the associated deterioration of cognitive impairment or the relation with AD is not known. GPs should be aware of this coexistence and recommend for screening, assaying and treating elderly people.

A seroepidemiological study was carried out in 15 primary health care (PHC) centres in rural Greece to determine the prevalence of hepatitis C virus (HCV) in the surgeries of Greek General Practitioners (GPs) and to further clarify the transmission of hepatitis C in Greece. Serum samples were obtained from 1961 subjects (1259 females) aged >/= 15 years, who visited GP surgeries between July 1996 and February 1997 in 15 PHC centres located in three large Greek regions (Macedonia, Attika and Crete). Subjects who participated in the study fulfilled the following criteria: history of blood transfusion; hospital admission of > 7 days' duration without surgical or other intervention; use of intravenous drugs (current or previous); or women with a history of medical or paramedical abortion. Nearly 65% (1263 subjects) of the participants in this study reported hospital admission with a length of stay > 7 days. Antibodies to HCV (anti-HCV) were found in 67 participants (3. 5%), 41 of whom were females and 44 of whom were aged >/= 61 years. The highest prevalence (4.8%) of anti-HCV was found in Crete, and differences among the Greek regions were statistically significant (P < 0.05). Multivariate statistical analysis showed that in addition to regional differences, the following variables had a statistically significant effect on the prevalence of anti-HCV: history of dental surgery; use of intravenous drugs; hospital admission for > 7 days; and the high consumption of alcoholic drinks. Hence there is a significant variability in the prevalence of hepatitis C in well-defined PHC areas of Greece. Several risk factors for acquiring HCV infection have been identified. Screening for HCV risk factors may enable Greek GPs to identify HCV-infected patients.

The possible role of environmental aluminium exposure in the pathogenesis of various diseases has highlighted the need for methods by which the long-term exposure to aluminium can be assessed. Therefore, we have further developed a method to determine aluminium in human deciduous teeth and applied this method for studying populations in Sweden, Crete and Iceland.

Objective: The prevalence of urine leakage and care-seeking rates of women 35-75 years of age who visited GPs in two rural areas of Crete were investigated., Participants: All the women who visited their family physician in two primary care units during the period of August to November 1997 (N = 251) were asked if they had experienced symptoms of involuntary urine leakage. A set of questions was addressed to the women who replied positively., Results: Sixty-nine of the 251 women (27.5%) reported symptoms of involuntary urine leakage, and among the incontinent women 11 (15.9%) had previously contacted the health services about their problem. Only six out of thirty (20%) of the incontinent women who report effects on household activities, social and sexual life had contacted a physician about urinary incontinence (UI). The most common reason reported for not consulting the physicians was that the symptoms were not considered serious (35 women out of 58, 60.3%)., Conclusion: This study points out the need for further awareness programs for both women and healthcare professionals to be set up in countries like Greece, in which a low care-seeking rate of incontinent women has been reported.

A seroepidemiological study was conducted to assess the seroprevalence of hepatitis A, B and C markers in 285 males (mean age: 24.4+/-4.4 years) aboard a Greek warship. Two hundred and sixty three serum samples were tested. None was found to be positive for HAV antibodies, three persons (1.1%) were positive for HBsAg, four persons (1.5%) were positive for anti-HBc and one person (0.4%) was positive for anti-HCV. Forty-five persons (17.1%) had developed titles anti-HBs > 10 IU/L. The establishment of a vaccination policy against hepatitis A among warship personnel is strongly recommended.

Our recent descriptive report in this journal of "Healthometer", an interactive instrument for self-mediated health counseling, was well received in the medical systems research and development community. Suitable for paper as well as electronic mediation and covering both screening, processing/storage, and advisory tasks in a positively reinforcing and confidential way, it has on the whole been considered to be an interesting model in the advancing "information society technologies" perspective; however, a closer scientific and operative evaluation is warranted. Because the power of the instrument in addition to the hardware is critically dependent upon the wet- and software quality, the present study aims at examining in the same forefront forum some basic aspects of all these modalities, with emphasis on face and content validity, feasibility, and users' attitudes and opinions. It can be summarized, quite briefly, that all of them were satisfactory.

Objective: The purpose of this study was to determine the prevalence of hepatitis markers in inmates and staff of the Penitentiary of Neapolis on Crete and discuss the role of GPs in identifying and vaccinating susceptible subjects., Method: Forty-five prisoners and 20 house workers were invited to participate in the study. Hepatitis B (HBV) markers (HBsAg and anti-HBc) and hepatitis C antibodies (anti-HCV) were tested. Vaccination against hepatitis B was administered to all susceptible subjects., Results: Hepatitis B carriage was found in 10 people, six of whom were prisoners. Fifteen of the subjects tested were found to be positive for anti-HBc, six of whom were house workers. Anti-HCV were found to be positive in seven prisoners and one worker. A vaccination programme against hepatitis B was introduced in 27 susceptible subjects (58.7% of unexposed subjects) and was completed in 22., Conclusion: Prisoners and staff at Neapolis Prison constitute a high-risk group for hepatitis B and C. Compliance rate in screening was high and GPs were successful in having a desirable response rate in the administration of vaccines.

In a small Cretan township hospital combining secondary and primary care, a questionnaire was distributed to a consecutive visitor sample. The questionnaire requested information on the participants' personal smoking and other life habits, perceptions and expectations of the delivery of the health care services, and attitudes toward their own doctors and others who provide various health services. Three hundred and one individuals of both sexes who were 15 years and older participated in the study (participation rate, more than 97%). An interesting and varied response was recorded, covering a wide range of perceptions, opinions, and attitudes not only toward the services, but also toward the staff. Although a high confidence in and appreciation of both the primary care and hospital sections appeared in the study results, these attitudes should not be allowed to deteriorate. Therefore, specific actions should be undertaken: constant upgrading of the existing organizational context, implementation of promotional and educational programs, and use of the questionnaire as an effective tool for periodically assessing the population's attitudes, experiences, and expectations.

Hospital utilisation rates comprise the main available source of information on morbidity patterns and the need for health care in a number of developing countries. On the basis of the findings of a Greek-Swedish comparison of somatic hospital admission (presented per the 18 principal head groups of the International Classification of Diseases) between two regional University hospitals, a number of important findings and methodological questions are considered. Factors that can explain the large variations of hospital admission found are examined; in particular those related to disease definition, classification and coding, hospital services supply, professional behavior and practices, illness behavior of patients, and demographic and socio-economic characteristics but especially a true difference in morbidity. An additional statistical elaboration of the hospitalization data in the form of a logistic regression analysis is suggested, in particular at the district or regional level. However, after rigorous scrutiny, our data point to persistent remarkable differences at the respective sites in the major "welfare-related" population diseases, notably, cancer and cardiovascular diseases.

Objective: A school-based immunization survey was used to assess vaccination coverage of a population of children in the region of three Primary Health Care Centres in rural Crete., Methods: The medical charts of 771 (92.6% of the total) students attending primary schools at the municipalities of Archanes and Hersonissos in the district of Heraklion, and Neapolis in the district of Lasithi, as well as the charts of 438 (68.9% of the total) students attending the secondary school at Neapolis, Lasithi, were obtained. The immunization records from these charts were then compiled and analysed. All information was based on the standardized procedures of the Spili Health Centre, Crete. The age-specific vaccination rate was calculated for children of both primary and secondary school age., Results: The vaccination coverage against diphtheria and tetanus was high (82%, 1035 pupils had received the fifth dose) for both groups of students, while the coverage for pertussis was incomplete, especially the fifth dose, which had been received by only 17% (n = 131) of the children of primary school age and 4.3% (n = 19) of the children of secondary school age. In total, 638 of the children of primary school age (82.7%) and 257 (58.7%) of the children of secondary school age were immunized against measles. The corresponding numbers and the percentages of children of primary and secondary school age immunized against mumps and rubella were: 75.6% (n = 583) and 36.3% (n = 159) for mumps, and 74.7% (n = 576) and 32% (n = 140) for rubella., Conclusion: Immunization coverage of schoolchildren in the studied areas is inadequate in a number of instances. This appears to be most pronounced in children of secondary school age. The school-based immunization survey, which is an accurate and inexpensive tool for assessing vaccination coverage, is suggested as an appropriate means for primary health care workers in Greece to develop further and increase the immunization rate.

Modern health systems research and development emphasize the transition from hospital to primary health care. Importantly, this transition is projected to be coordinated and interactive, as facilitated, e.g., by improved information systems and collaboration between the involved parties, including Universities and health authorities. An ideal combination of this might accordingly be offered by a synthesis of a basic hospital and primary health care center in an area of suitable site, size, and structure. We believe that our institution, Nosokomion Neapolis, in; the moderate-size Cretan township of Neapolis (New-city) offers an interesting model example of this, because of its affiliation with the University of Heraklion and its international and EU-supported project status. In the present report we want to emphasize the elements that are particularly well suited and manageable and in many ways both opportunistic and conscientious "back to the future" instances of a successful Hospital/Primary Health Care integration. Specifically, we think that the advantages in local area epidemiology, prevention, and quality assurance are apparent, and nurture a--rather renewed that new-role of the general practitioner as both a holistic population doctor and a health systems researcher for the year 2,000 and beyond.

The conception of new, 'avoidable' life style diseases in affluent Western societies is largely based upon observations in groups of middle-aged urban males with mortality as the major end-point. This applies to cancer, too, and studies of morbidity, where cancer is put within the overall disease spectrum, are called for as a necessary intermediary stage for hypothesis generation and initiation of evaluative and interventive epidemiological projects in the community. Here also the conditions and circumstances that determine health and well being, that is, salutogenetic factors, come increasingly into focus. We made a comparative analysis of the total hospitalization for somatic diseases during 1986-1987 at the Linköping University Hospital in the county of Ostergötland, Sweden and the both complementary and commensurable Heraklion University Hospital on Crete. They are representative of their respective European situations, and are the only somatic hospitals in their regions. Large differences were found with lower morbidity in the more 'Arcadian', rural settings. The results provide valuable data on traits and patterns between earlier surveys such as the Seven Countries study and today. We have earlier reported on the findings from the female group of the two populations, and here wish to concentrate on the males. In particular, cancer is compared with the both prominent and 'archetypical' forms of male ill-health that are comprised by cardiovascular diseases and accidents. We discuss some of the salutogenetic as well as pathogenetic factors that call for closer study in the next stage of our project, whose emblem of Ariadne's thread we feel also has a strong bearing on the masculine gender.

Objective: To determine the prevalence of hepatitis A, B, and C markers in children who were attending junior and senior high schools in a high risk area in rural Crete, Greece., Methods: Three-hundred and thirty-four children who attended the three junior schools and one senior high school in the Agios Vassilios province of Southern Crete were invited to participate in the study. Three hundred and four of them were tested for hepatitis A, B, and C markers. Hepatitis B (HBV) markers (HBsAg and anti-HBc) as well as hepatitis A (anti-HAV) and hepatitis (anti-HCV) antibodies were tested with commercial enzyme-linked immunosorbent assay kits., Results: Six of the 304 children (1.97%) were found to be positive for anti-HAV, 1 (0.33%) to HBsAg, 7 (2.30%) to anti-HBc and none were found positive for anti-HCV. No significant differences were seen between the prevalence of anti-HAV antibodies in males (2%) and females (1.95%), and of anti-HBc antibodies in males (3.33%) and females (1.30%)., Conclusions: The very low prevalence of anti-HAV is obviously due to the improved conditions of hygiene and it raises the question of the possible emergence of this disease at an older age and therefore appropriate preventative strategies should be considered. The low endemicity of hepatitis B in Crete in contrast to other areas of Greece also calls for a vaccination policy probably during adolescence. The absence of hepatitis C markers in the children in contrast to the observed higher prevalence of HCV-infected people in the adult population in the same rural area raises questions regarding possible sources of transmission of hepatitis C during the preceding years.

Modern health system research emphasises the transition from mortality statistics via morbidity and risk factors observations to comparative site explorations in defined areas. The health of women from the perspective of their gender has become a priority in medical research over the last decade. Studies of morbidity have been called for as necessary intermediary stage for hypothesis generation, and the formulation and inception of epidemiological projects which are recognized as essential for attaining knowledge on the factors and circumstances that determine diseases and wellbeing in the general population. This applies especially to cancer, where the importance of seeing disease, from a ecological, cultural as well as gender context is evident. We made a comparative analysis of the hospitalization for somatic diseases during 1986-1987 at the Heraklion University Hospital on Crete, and the commensurable Linköping University Hospital in the country of Ostergötland, Sweden. They are representative of their complementary Europian situations and comprise the total hospital admissions in their regions. Large differences were found, notably regarding both cardiovascular diseases and cancer, with lower morbidity in the more 'arcadian', rural circumstances. The results provide unique data on traits and patterns intermediate to the pioneering observations of the Seven Countries survey on the rapidly changing European scene. In the field of cancer the data are effectively unmatched both as raw data and as a platform for further investigation, which we are presently pursuing under the emblem of 'Ariadne's thread'. From a salutogenetic point of view the elderly rural women on Crete, and from a pathogenetic point of view the elderly urban women in Linköping warrant particular attention.

A seroepidemiological study was carried out in a geographically well-defined area in rural Crete in order to determine the prevalence of A, B and C hepatitis markers in the local population. Serum samples were obtained from 257 subjects (94 males, 163 females), aged 15 years and over, who visited the primary health care services of the Spili Health Centre between July 1993 and March 1994, and from 164 subjects (83 males, 81 females) randomly selected from households in three neighbouring villages of the study area. In samples obtained from the Spili Health Centre, antibodies to hepatitis A virus (anti-HAV) were detected in 234/244 (95.9%) subjects, antibodies to hepatitis B virus core antigen (HBcAb) were detected in 63/257 (24.5%) subjects and antibodies to hepatitis C virus (anti-HCV) were detected in 28/257 (10.9%) subjects. The corresponding figures for those randomly selected from the villages were 135/154 (87.7%), 16/164 (9.8%) and 5/164 (3%) respectively. Hepatitis B surface antigen (HBsAg) was positive in three (1.2%) subjects from the first group, while none of those recruited from the villages were positive for HBsAg. Interestingly, hepatitis markers were closely associated with age. No subjects under the age of 15 years showed evidence of prior hepatitis A infection and approximately 20% of those between 15 and 44 years of age were also negative. By contrast, practically all subjects older than 44 years were anti-HAV positive. Similarly, the majority of all those who were anti-HCV positive were older subjects. Seroepidemiology of hepatitis in this well-defined population seems to be different from other parts of Greece, at least for hepatitis B and C viruses. There is a very low prevalence of HBsAg and a very high incidence of anti-HCV. Low exposure to HAV, as found in other parts of the country, was also found in the younger generation in this rural area of Crete.

In Greece, Fasciola hepatica, the sheep liver fluke, is common in sheep but only three human cases of fascioliasis have been reported. An epidemiological study was conducted in central Crete which proved to be a focus of F. hepatica. Sheep and snails were found positive for this parasite, but none of the 205 persons tested serologically.

The health of women has risen to a priority position in medical research. Comparative studies of female morbidity are called for as an intermediary stage for generation of hypotheses and design of deeper studies of determinants, such as social, ecological, and individual factors. In previous studies, we have noted differences in female hospitalization between Heraklion in Greece and Linköping in Sweden. They were related to age and to urban versus rural dwelling, and fit projections for a more archaic and a more technocratic society, respectively. This paper aims at showing how the study of women's health may proceed from relevant hospitalization observations to the next level, of exploring already available indicators of self-perceived health in elderly females.

Background: Diabetes mellitus is a common disease in developed countries, but in Greece national figures on its prevalence are lacking., Objectives: The aim of this study was to identify the burden of known diabetes mellitus through its estimation in the area of responsibility of the Spili Health Centre, based on the health information system that had been established in Primary Health Care in rural Crete., Method: The diagnosis of diabetes was retrospectively documented by reviewing all medical records (n = 47151) at the Spili Health Centre and its five regional outposts during the period 1/6/1988-1/7/1993. The diagnostic criteria of WHO were used to establish the diagnosis., Results: After excluding the patients who had died, we found 210 patients with diabetes mellitus. Thirty cases were evaluated with OGTT because of mild but not diagnostic elevations of fasting plasma glucose, on more than one occasion. The prevalence of diabetes after age and sex standardization of that for the European population was estimated at 1.52% (1.31% in males and 1.68 in females)., Conclusions: Our study shows that: 1) the role of the GPs and one appropriate information system in measuring the prevalence of known diabetes mellitus are now considered important within the Greek context; 2) diabetes mellitus seems not to be a rare disease in rural Crete. The estimated prevalence appears to be similar to the prevalence rates reported in other areas of rural Greece.

Cancer frequency has been studied in a Department of Crete and a Department of Sweden, using in-patient data collected in the Departmental Hospitals, for a two-year period. The results of the study suggest that similar trends exist in the prevalence of different forms of cancer between the two areas studied, as well as some significant differences. The differences observed concern mainly the frequency of cancers of the lung, prostate, bladder and large bowel among men and breast and large bowel among women. These findings could to a great extent be explained by life-style and environmental differences between the two areas and are consistent with data concerning the cancer mortality in the two countries.

A research project in primary health care has been in progress since 1988 in an agricultural area of Crete, with the aim of surveying the cardiovascular risk profile and following the incidence of cardiovascular disease in the population over time. In the present paper we have investigated the mortality rates and the causes of death in 1989 and 1990 of the population of the Agios Vassilios county (n = 7758). Furthermore, whenever possible, we have checked the accuracy of the certified causes of death against the case record system introduced in 1988 in the health centre. During 1989 and 1990, 267 subjects died in the research area, 234 of whom were > 65 years old. Diseases of the circulatory system (mostly congestive heart failure) accounted for 46% of all deaths. The corresponding figure for neoplasms was 18%. The standardized mortality from ischaemic heart disease was found to be very low in both men and women, 37.9 and 41.9 per 100,000 per year, respectively, in comparison with that of Greece as a whole in 1989, 140.0 and 59.5, respectively. These figures were considerably lower than those reported in 1988 from for example Sweden, 303.6 and 153.3, respectively. The standardized mortality from cerebrovascular disease in Agios Vassilios county was found to be somewhat lower than the national figures in 1989, 118.1 and 107.0 in males and females versus 135.7 and 142.1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: Ischemic heart disease (IHD) has been shown to be very uncommon in the population of Crete. Therefore, we established a research project in a rural part of Crete to survey the cardiovascular risk profile and follow the incidence of cardiovascular disease over time. This study investigated the prevalence of ECG abnormalities in the population of five villages and compared the prevalence of hypertension, obesity, diabetes, and hypercholesterolemia in those with and without ECG signs of IHD., Methods: A cross-sectional study was conducted in a group from 15 to 79 years of age (n = 1218); overall attendance was 926 (76%). Studies included case history, clinical status, laboratory variables, and 12-lead ECG. Technically acceptable ECGs were read and coded blindly for 895 subjects (97%)., Results: Minnesota codes suggesting "Probable IHD" were recorded in 3.3% of the women and 3.5% of the men from 45 to 79 years of age. Hypertension was more common in subjects with than in those without "Probable IHD." This also tended to be the case for diabetes. Cholesterol and body mass index were relatively high in both groups., Conclusions: The present prevalence of "Probable IHD" in Cretans appears to be very similar to that observed in other population surveys. Also, the contemporary cardiovascular risk factor profile in the population was quite unfavorable, with a relatively high prevalence of smoking, dyslipidemia, hypertension, and diabetes. The prevalence of "Probable IHD" was lowest in the village where the health center was situated (1% vs 4.5%), and this difference was also reflected in differences among the villages of some important risk factors for IHD as well as in the way patients with hypertension and other diseases were cared for. Thus, it seems IHD is becoming more prevalent in the "low risk" population of Crete. This may very well be a result of a more unfavorable lifestyle and a higher rate of risk factors than before.

We have compared the use of primary health care and the diagnoses at visits to doctors in the Spili Health Centre (SHC) in Crete and the Dalby Health Centre (DHC) in Sweden. In DHC more patients per 1000 population visited the doctors than in SHC. This was so regardless of age-group and sex, in fact more or less regardless of diagnosis. Other differences between the populations were: The diagnosis acute otitis media was more frequent in the Dalby children than in the Spili ones. The opposite was true of "head injuries" which were more frequent in the Spili boys. Visits to doctors for bronchitis was more frequent in the Spili men, maybe because of the extensive smoking habits of Cretan men. Visits for diseases of the musculoskeletal system were more frequent in DHC than in SHC. A hypothesis worth testing is that this was influenced by differences in the health insurance and sick benefit systems. Angina pectoris was fairly frequent in both areas but cardiosclerosis (including healed myocardial infarction) was more common in DHC than in SHC. Use of primary health care may be influenced by the need for health care in the population, the accessibility of the health care facilities, the costs for the patients, the quality of care as perceived by the patients and by other sociocultural factors. Comparative studies, even though fairly uncommon today, may be of use in generating hypotheses about the impact of different factors on the use of health care.

We have studied hypertension, obesity, diabetes and hypercholesterolaemia in those aged 45-79 years in the Cretan low risk population of Spili (n = 249; attendance 82%) to see if these conditions interacted in the same way as previously described for high risk populations. Hypertension, diabetes, obesity, and hypercholesterolaemia were found to be at least as prevalent in Spili as in Sweden. Furthermore, the previously described 'Metabolic Syndrome X', with insulin resistance and hyperinsulinaemia as a common denominator also seemed to exist in the Spili population where patients with these conditions had higher insulin and C-peptide levels than normals. Our finding should be viewed against the low prevalence of past myocardial infarction in Cretan men from Spili reported by us and confirming the results of the Seven Countries Study.

We have established a research project in primary health care in Crete with the aim of surveying the cardiovascular risk profile of a defined 'low-risk' population. The study population comprised all men and women aged 15-79 years in the village of Spili (n = 445); the overall attendance rate was 77% (greater than or equal to 82% in those aged 45 years and above). In this cross-sectional study we found a high (44%) prevalence of smoking in men aged 45-64 years as well as a high alcohol intake (48% drank greater than or equal to 210 g of pure alcohol every week). Furthermore, there was a high cholesterol level (6.2 mmol.l-1), and a high prevalence of hypertension and diabetes. Against this background it is somewhat surprising that we did not find any signs of post-myocardial infarction in Spili men aged 63 and under. It is possible that positive factors, i.e. the closely knit social networks, the low unemployment rate, the hard water, and some of the dietary habits, e.g. the high consumption of olive oil, may counter-balance the negative factors mentioned above. It is also possible that the low risk factors in the past explain the low incidence of myocardial infarction today, and that this will change in the years to come.

Primary Health Care (PHC) in Crete is in a state of rapid development. The strategy for introducing PHC involves an orientation towards the population and the creation of possibilities for evaluation. A case records system, "Egino", was installed in the University of Heraklion and at the Health Centre in Spili in 1988, and was further developed according to local needs during 1989, when also a Greek version of the statistical system, "DoIt", was installed. The main reasons for establishing a computerized medical information system were (i) to assess the health needs in Crete, (ii) to monitor activities of the primary health care organizations, and (iii) to introduce epidemiological research into primary health care in Greece. The information system was based on specially assigned patient numbers containing several pieces of information about the individual; the system was developed at the Dalby Health Sciences Centre in Sweden. Each month, data were extracted in Spili Health Centre, and these data were regularly used to present incidence and prevalence indices. Some of the data extracted were reported to the health authorities in Greece. "EginO" and "DoIt" gave possibilities to evaluate health services by following the morbidity, while also making it possible to describe and analyse health needs in the population of Spili and other primary health care catchment areas in Greece.

A computerized medical record system was introduced in Greek primary health care (PHC) in the village of Spili in Crete. The present study was carried out to study similarities and differences in the pattern of PHC use in Dalby Health Centre, Sweden (DHC), and Spili Health Centre, Greece (SHC). In both Dalby and Spili more than half the population contacted their respective health centre during 1989. Patients contacted DHC more often than SHC, 3.33 vs 2.30 times. Relatively more females than males used the health services in Dalby (64% vs 50%) but not in Spili (57% vs 55%). More visits were made by appointment at DHC than SHC (36.0% vs 12.6%). There were great similarities in the two areas in the ten most common diagnoses, analysed in four age-groups. In both areas, acute upper respiratory infections dominated in the youngest age-groups, and hypertension and diabetes in those aged 45 years and above.

Background: An educational intervention program for the prevention of cardiovascular disease among 171 Cretan school students (13- and 14-year-olds) is assessed. Three schools from the province of Agios Vassilios acted as the intervention group while two schools from a neighboring province (Amari) formed the control group., Methods: Variables measured included: systolic and diastolic blood pressures, body mass index, triceps skinfold thickness, serum total and high-density lipoprotein cholesterol, triglycerides, and smoking habits. The intervention, based upon social learning theory, consisted of 10 sessions of theoretical and practical instruction on health issues in the classroom, supplemented with discussion, in the classroom, of the issues raised by different sessions., Results: At the end of 1 academic year of intervention the results showed, after adjusting for age, sex, baseline value, height, and weight, an increase in total serum cholesterol of 0.70 mg/dl in the intervention group and 17.91 mg/dl in the control group (P less than 0.0001). Diastolic blood pressure (fourth phase) decreased by 2.95 mm Hg in the intervention group and by 0.48 mm Hg in the control group (P less than 0.05). Similar changes were observed in the body mass index (P less than 0.05). The proportion of school children starting smoking was significantly lower in the intervention group (6%) than in the control (20%) (P less than 0.01). The results indicate that this health education program in schools is effective in decreasing some of the major CVD risk factors. The long-term effect remains to be evaluated.