Rostrum of Asclepius Vol 1, No. 1 (2002): January- March 2002

The current paper focused on the effects of providing care to a family member with Alzheimer's disease (AD). Caregivers are at risk for poorer physical and mental health than their noncaring peers. Research on the direct, mediated and moderated effects of the psychosocial resource variables revealed association with positive or negative caregiver health outcomes over time. In particular, benign appraisals of stressors, perceived competence and control, enhancing routine activities, mastery in women's roles, life satisfaction, greater level of social support, and a communal relationship -between caregivers and care recipients before the onset of the disease- compensated for the effects of the stressors in the course of caring for a relative with AD.

Keywords: Coping, appraisal of stressors, perceived competence, social support

A wealth of evidence suggests that allergic diseases such as rhinitis, bronchial asthma and atopic dermatitis have become more common worldwide in recent years and a great deal of etiological and pathogenic research has been carried out to evaluate the possible causes of this increasing trend. There is also some evidence that increased atmospheric concentrations of pollutants such as nitric oxides (NOx), ozone (03), and respirale particulate (PMI0), may be linked to the increased prevalence of allergic diseases. Experimental studies have shown that diesel exhaust particulate causes respiratory symptoms and is able also to modulate the immune response by increasing IgE synthesis in predisposed animals and humans. There is also some evidence that air pollutants can interact with aeroallergens in the atmosphere and/or on human airways, potentiating their effects. In fact, by inducing airway inflammation which increases epithelial permeability, some pollutants overcome the mucosal barrier and lead to allergen-induced responses. However, air pollution and climatic changes should also have an indirect effect on allergic response by influencing quantitatively and qualitatively the pollen production by allergenic plants. Despite all these evidences, there is still much to be learned about the causal relationship between allergic diseases and air pollution. The future challenge is to tackle the complex interplay between environmental factors and genetic determinants that will eventually contribute to a better understanding and to better prevention strategies for such multifactorial conditions as asthma and allergies.

Keywords: Allergy, asthma, pollution, environmental factors

The need for continuous improvement of the citizens’ offered health services’ quality is essential since citizens’ low satisfaction is ascertained. The prevailing international predispositions are the continuous development and improvement of the health systems. The instructions of the World Health Organization for the state members is to have established successful mechanisms securing the quality of the provided health care within the scope of their systems as well as systems of methodical evaluation of the offered services. With the new law regarding the improvement and updating of the National Health System according to Law 2889/01 published in the Greek Government Gazette 37/A, provisions are foreseen giving special weight to the subject of quality improvement with reorganization and creation of structures securing the surveillance of health condition, the betterment of health, evaluation of quality and accrediting in the health services. Naturally, problems will exist in practice, as deservedness and suspiciousness. With the present study all these elements are set forth, analysis is made and proposals as well as approach efforts of probable problems during their practice are paralleled.

Keywords: Public health, health services’ quality, health system, services, model of health services

The management of acute postoperative pain after thoracotomy -one of the most painful procedures- is considered one of the major problems pain specialists are facing today. Many clinicians and researchers are working copiously towards its solution. The present review refers to the methods of preemptive analgesia during thoracotomies and analyzes the latest research efforts on the specific subject, initially, the theoretical model of preemptive analgesia, according to the evolution in pain pathophysiology, is presented. In addition, the different methods of preemptive analgesia in thoracotomies are analyzed. These methods consist of epidural analgesia, intercostals blocks, intrapleural blocks, paravertebral blocks and preoperative systemic administration of opioids and nonsteroidal antiinflammatory drugs. In conclusion, the solution to the problem of acute postoperative post-thoracotomy pain most likely lies to the multi-modal approach to the preemptive analgesia.

Keywords: Preemptive analgesia, thoracotomy, acute postoperative pain, multi-modal analgesia

Objective Many studies have shown that patients with coronary artery disease have an exaggerated rise and a delayed fail of plasma triglyceride (TG) concentration postprandialiy but the plasma TG response to a fatty meal in patients with essential hypertension. Material-Method A fatty meal (83.5% fat, 1604 kcal per 2 m2 body surface) was given to 25 patients with essential hypertension (H), and 25 normotensives (N). The two groups were matched for age, body mass index, lipid profile, basal glucose and insulin concentrations, and an index of homeostasis model of insulin resistance (HOMA-IR). Blood samples were taken 0, 4, 6, and 8 hours after the fatty meal. Lipid variables were measured in all samples. Blood glucose and insulin levels were measured in the fasting state. Results Total and high density lipoprotein cholesterol, apolipoprotein A and B and HOMA-IR did not differ significantly over time between the groups. The plasma TG concentration (mg/dL) increased significantly after fat loading in H (from 118±31 to 284±137 at 4 hours, 327±93 at 6 hours and 285±71 at 8 hours) compared to N group (from 105±29 to I50±38 at 4 hours, 146±42 at 6 hours and 115±38 at 8 hours), P=0.001, <0.001, and <0.001, respectively. Conclusions This study suggests that patients with hypertension have an exaggerated response and delayed clearance of plasma TG concentration after fat loading.

Keywords: Hypertension, hypertriglyceridemia, postprandial lipemia

The aim of this study was to identify nursing staff’s perceptions regarding the importance of parental participation in their hospitalized child’s therapeutic-nursing and training needs of care. Material- Method The study was conducted in the inpatient pediatric medical and surgical wards of the two Children’s Hospital of Athens, where one hundred and sixty members of the nursing staff were eligible for the study. For this purpose a special questionnaire was designed which the sample answered anonymously by being interviewed by the researchers. Nursing staff rated the importance of each activity from parental participation, ranging "extremely important", "very important", "fairly important", "little important", and "not important". The statistical analysis was performed by the SPSS package. Results The 79.2% of the participants perceived parental participation regarding child’s therapeutic-nursing needs as very important. A high percentage of nurses, 94.3%, perceived extremely important and very important parental participation in the training care of the child, particularly parents doctors and parents nurses communication for the caring needs of the child when the child leave the hospital and to the house. More men perceived parental participation regarding child's therapeutic- nursing needs as not important (P=0.024). The older the nurses were the more important they thought the parental participation in training and education in child's care (P=0.043) and the oldest nurses perceived that the parents should stay next to the hospitalized child (P=O.OOI). Conclusions Although a fairly high number of nurses expressed explicit support for the parental participation in their hospitalized child’s therapeutic-nursing and training care, still continue to exist a number of them who expressed different perceptions.

Keywords: Parents, hospitalized child, nurse, perceptions, therapeutic, educational activities