Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease.

Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference.

Assessing patient-reported outcomes in asthma and COPD patients: which can be recommended in clinical practice?

Purpose Of Review: There is a clear need for simple and reliable patient-reported outcome measures for chronic obstructive pulmonary disease (COPD) and asthma in daily practice. The purpose of this review is to facilitate the choice for clinicians of patient-reported outcomes which they can use in their daily practice.

Recent Findings: More than 50 patient-reported outcome measures for asthma and COPD exist and clinicians are often left confused on which to use.

Investigating sensitivity, specificity, and area under the curve of the Clinical COPD Questionnaire, COPD Assessment Test, and Modified Medical Research Council scale according to GOLD using St George's Respiratory Questionnaire cutoff 25 (and 20) as reference.

Background: In the GOLD (Global initiative for chronic Obstructive Lung Disease) strategy document, the Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), or modified Medical Research Council (mMRC) scale are recommended for the assessment of symptoms using the cutoff points of CCQ ≥1, CAT ≥10, and mMRC scale ≥2 to indicate symptomatic patients. The current study investigates the criterion validity of the CCQ, CAT and mMRC scale based on a reference cutoff point of St George's Respiratory Questionnaire (SGRQ) ≥25, as suggested by GOLD, following sensitivity and specificity analysis. In addition, areas under the curve (AUCs) of the CCQ, CAT, and mMRC scale were compared using two SGRQ cutoff points (≥25 and ≥20).

Impact of the financial crisis on adherence to treatment of a rural population in Crete, Greece.

Background: The global economic crisis has affected Greece. Data on patients' adherence to medications for chronic diseases are missing. The objective of this study was to identify to what extent the financial crisis and the repeated pharmacists strike have influenced patients adherence to therapy.

The minimal clinically important difference of the Control of Allergic Rhinitis and Asthma Test (CARAT): cross-cultural validation and relation with pollen counts.

Background: The Control of Allergic Rhinitis and Asthma Test (CARAT) monitors control of asthma and allergic rhinitis.

Aims: To determine the CARAT's minimal clinically important difference (MCID) and to evaluate the psychometric properties of the Dutch CARAT.

Methods: CARAT was applied in three measurements at 1-month intervals.

Studying the burden of community-acquired pneumonia in adults aged ≥50 years in primary health care: an observational study in rural Crete, Greece.

Background: Community-acquired pneumonia (CAP) is a potentially life-threatening condition that often requires hospitalisation particularly in the elderly population or in patients with comorbidities.

Aims: The aims of this study were to estimate the CAP frequency and severity in a well-defined primary healthcare setting in rural Crete, to record patient characteristics, their immunisation status and to estimate hospitalisation frequency and determinants.

Methods: An observational study was designed and implemented in a rural setting within the prefecture of Heraklion in the island of Crete, Greece.

The use of health status questionnaires in the management of chronic obstructive pulmonary disease patients in clinical practice.

Current guidelines recommend chronic obstructive pulmonary disease (COPD) management based on symptoms or health status assessment and lung function parameters. However, COPD is a complex and heterogeneous disease that needs an individualized approach for proper disease management. A structured consultation including health status assessment tools, such as the Clinical COPD Questionnaire and the COPD Assessment Test should improve the quality of the consultation, providing more information than symptoms alone.

Depressive symptoms in postmenopausal women: results from the MEDIS Study.

Data regarding the factors associated with depressive symptoms are limited, especially in postmenopausal women. The aim of this study was to investigate to what extent depressive symptoms were present in postmenopausal women, to explore characteristics associated with depressive symptoms and to determine if time since menopause was independently associated with depressive symptoms. Data collected within the Mediterranean Islands (MEDIS) Study, a health and nutrition survey of elderly people living on Mediterranean islands was used.

Trends in metabolic syndrome risk factors among adolescents in rural Crete between 1989 and 2011.

Objective: To investigate all the important factors contributing to the development of metabolic syndrome (MetS) as well as to explore the changes of these factors, over time, by comparing adolescent populations of rural areas of Heraklion, Crete, for the years 2011 and 1989.

Design: This study was carried out within two rural areas of the Heraklion region in Crete, Greece. The 1989 study was conducted in the village of Agia Varvara and the respective 2011 study within the municipality of Minoa Pediados.

Primary care COPD patients compared with large pharmaceutically-sponsored COPD studies: an UNLOCK validation study.

Background: Guideline recommendations for chronic obstructive pulmonary disease (COPD) are based on the results of large pharmaceutically-sponsored COPD studies (LPCS). There is a paucity of data on disease characteristics at the primary care level, while the majority of COPD patients are treated in primary care.

Objective: We aimed to evaluate the external validity of six LPCS (ISOLDE, TRISTAN, TORCH, UPLIFT, ECLIPSE, POET-COPD) on which current guidelines are based, in relation to primary care COPD patients, in order to inform future clinical practice guidelines and trials.

Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries.

Background: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the "OTC SOCIOMED", conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region.

Day-to-day measurement of patient-reported outcomes in exacerbations of chronic obstructive pulmonary disease.

Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are a major burden to patients and to society. Little is known about the possible role of day-to-day patient-reported outcomes during an exacerbation. This study aims to describe the day-to-day course of patient-reported health status during exacerbations of COPD and to assess its value in predicting clinical outcomes.

Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care.

Asthma frequently occurs in association with allergic rhinitis and a combined management approach has been suggested. The Control of Allergic Rhinitis and Asthma Test (CARAT) is the first questionnaire to assess control of both diseases concurrently. However, to have an impact on healthcare it needs to be disseminated and adopted.

Managing comorbidity in COPD: a difficult task.

Chronic obstructive pulmonary disease is a public health problem that results in high morbidity, disability and mortality. Comorbidities are highly prevalent in COPD patients because of aging, common risk factors and pathways, rising mortality, and disability. In this review article we present the most prevalent co-morbidities in COPD patients, we face the issue of multimorbidity and discuss the practical management approach relevant to chest physicians and general practitioners.

The association between alcohol and tobacco use among elementary and high school students in Crete, Greece.

Background: Tobacco and alcohol use during adolescence have potential long term health consequences and a possibility of future addiction.

Methods: This cross sectional study took place in 2007 among a convenience sample of 981 adolescents from public elementary and high schools in Eastern Crete, Greece. Following parental consent, an anonymous structured questionnaire including information on personal and family use of alcohol and tobacco was distributed.

Assessment of COPD wellness tools for use in primary care: an IPCRG initiative.

COPD is considered a complex disease and global problem that is predicted to be the third most common cause of death by 2030. While managing this chronic condition, primary health care practitioners are faced with the ongoing challenge of achieving good quality of life and overall "wellness" for those affected. As such, a practical tool for monitoring quality of life in a clinical setting is required.

Assessing health status in COPD. A head-to-head comparison between the COPD assessment test (CAT) and the clinical COPD questionnaire (CCQ).

Background: Health status provides valuable information, complementary to spirometry and improvement of health status has become an important treatment goal in COPD management. We compared the usefulness and validity of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ), two simple questionnaires, in comparison with the St. George Respiratory Questionnaire (SGRQ).

Measuring the burden of herpes zoster and post herpetic neuralgia within primary care in rural Crete, Greece.

Background: Research has indicated that general practitioners (GPs) have good clinical judgment in regards to diagnosing and managing herpes zoster (HZ) within clinical practice in a country with limited resources for primary care and general practice. The objective of the current study was to assess the burden of HZ and post herpetic neuralgia (PHN) within rural general practices in Crete, Greece.

Methods: The current study took place within a rural setting in Crete, Greece during the period of November 2007 to November 2009 within the catchment area in which the Cretan Rural Practice-based Research Network is operating.

A household survey on the extent of home medication storage. A cross-sectional study from rural Crete, Greece.

Background: Patients often have multiple chronic diseases, use multiple prescriptions and over the counter medications resulting in polypharmacy. Many of them store these medications for future use in their homes, rather than take them as directed by their physician, resulting in a waste of health care resources, and potentially dangerous misuse.

Objectives: This study aimed to investigate the magnitude of medication home hoarding, the exchange of medication with family/friends, families' beliefs about the medication use, source of medication, pharmaceutical class, cost of stored medicine and conditions of storage.