Quarterly scientific journal

Rostrum of Asclepius Vol 4, No. 2 (2005): April - June 2005

Vima AsklipiouRostrum of Asclepius Vol 4, No. 2 (2005): April - June 2005

Hot Topic

Vascular Dementia and a new Treatment Plan | 89-92

Greta Wozniak , Zoe Roupa , Evangelia Kotrotsiou

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It is estimated that, universally, the number of dementia suffering patients will increase from the current (2004) 19 million patients to 34 million patients in end of 2005, a result of the increasingly aging population. The most common type of dementia is Alzheimeraes disease accounting for about 2/3 of cases. Vascular dementia is the second in frequency cause of dementia. It represents the 15%-30% of dementias in the form of multiple cortical infarcts, subcortical arteriosclerotic encephaloparthy and lacunar infarct. Of decisive importance for the development of dementia is the presence of lesions in areas affecting the memory and the cognitive function such as the frontal white matter, the mesencephalon the thalamus, the hippocampus, the pons, the basal ganglion, the mammilary bodies and the genu of the internal capsule. The optimal treatment of hypertension (systolic, diastolic and pulse pressure) is significant for the prevention of clinical manifestation and for the progression of vascular dementia. Concerning the primary and secondary prevention of the stroke, the optimal treatment of hypertension in patients with stroke and in patients with high risk for developing a stroke or another cerebrovascular complication (such as the vascular dementia), demands the use of antihypertensive drugs. These drugs not only decrease the blood pressure but also have pleotropic effects concerning the pathogenesis, progression and prognosis of the ischemic brain lesions. According to the results of large scale randomized studies (Scandinavian Multi- Infract Dementia, Progress) the latest antihypertensive drugs such as: slow release calcium channel blockers, ACE inhibitors and angiotensin Π receptor blocking agents, seem to outclass the conventional antihypertensive treatment (beta- blockers, diuretics) concerning the prevention of brain tissue damage (probably due to additional actions), even though their antihypertensive effects remain the same. Furthermore, a number of other medications have been proposed for the treatment of cognitive decline, including NSAIDaeS, estrogen supplementation, melatonin and botanical agents, such as ginkgo biloba.
There are a number of psychoactive medications that are used for the purposes of restoring cognitive abilities, preventing further decline, and increasing functional status in patients with vascular dementia. These include cholinesterase inhibitors donepezil (ARICEPT). However, accumulated data horn clinical practice with typical Alzheimerdes disease patients, along with the outcome of additional clinical trials, will be critical in developing a more complete picture of donepezilaes efficacy. Thus, donepezil may prove preferable as a first-line treatment of vascular dementia.

Keywords: Vascular dementia, cognitive function, treatment

Review

Motivation of Nurses Skills in Critical and Intensive Care | 51-59

Thalia Bellali

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Motivating personnel skills in any health care organization is important since it is closely related to the level of efficiency, productivity and quality of services. The motivation of occupational behavior is a complex and intricate process that has been studied by researchers from various fields who formulated various theoretical approaches. Nursing science offers a challenging field for the application and testing of theories about work motivation due to the nature and distinct characteristics of nursing profession. Factors such as excessive workload, lack of appreciation towards nursing work, lack of freedom and autonomy, low wages, and lack of reliable evaluation and coordination of services have a negative impact on nurses' morale and thus generate reactions of indifference and cynicism, and lead nurses to experience a loss of motives, enthusiasm and interest. Although these adverse working conditions are associated more with the nursing profession as a whole than with specific work settings or departments, different problems may arise in relation to the nature and characteristics of nursing care in specialized departments such as Intensive Care Units (ICU) or Emergency Departments (ED).
The purpose of this article is to briefly review the key theoretical approaches of work motivation and to identify the factors that hamper nurses’ skills in critical care nursing. Although there are no all-inclusive rules in order to achieve the optimum performance by any nurse in any given time and setting, motivation theories may act as a basis for the formulation of guidelines that may be applied within or out of an existing institutional setting, thus contributing in the motivation of nurses and the full development of their skills.

Keywords: "Nurse, motivated occupational behavior, cntical and intensive care"

The Role of Nutrition to Coronary Disease | 60-69

Eleni Kyritsi , Maria Polikandrioti

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Coronary disease is one of the most widespread epidemics that the world has ever seen. The cause and the pathogenesis of the disease derive from the development of the atheromatic plaque, the creative mechanism of which is complicated. The most common risk factors for the incidence of atheromatosis are genetic and psychological, the way of living and the state of health of the individual. Among these factors, nutrition constitutes a significant risk factor for coronary disease.
The aim of this review was to study the role of nutrition to the development of coronary disease.
The method of this study included bibliography research from both the review and the research literature, mainly during the last five 5 years and was referred to the relationship of coronary disease and nutrition.
Results: Most studies focus on the role of serum cholesterol, mainly the LDL lipoprotein as the main factor for the development of atheromatic plaque in combination with other factors such as hypertension, smoking and obesity. From the foods the ones that are rich in animal saturated fats, are responsible for the increase of the serum cholesterol. However the adoption of the Mediterranean diet which contains olive-oil cereal fibbers and legumes as well as fish which is rich to n-3 fatty acids, little meat, fruits and light consumption of wine has a protective role to the development of coronary disease.
Conclusively the intake of saturated fatty acids which increase the levels of serum cholesterol and the levels of LDL cholesterol should be avoided and replaced by monosaturated, n-3 fatty acids and n-6 fatty acids. The Mediterranean diet is necessary not only to high risk individuals for coronary disease but to other populations.

Keywords: Nutrition, coronary disease, cholesterol, obesity, Mediterranean diet

Risk Factors of Alzheimer’s Disease and the Role of certain Cenes | 70-74

Konstantinos Pantazis , Nikolaos Fotos

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Alzheimer's disease is a degenerative disorder of unknown cause, leading to the gradual damage of the brain cells structure and function. The name of the disease is due to Alois Alzheimer, who presented a case of dementia at the 37th Congress of the German Psychiatrists on 1906. The disease is the most common form of dementia representing more than 50% of the cases. Gradual loss of memory, deterioration of cognitive functions, confusion, change in mood and behavior and kinetic disturbances characterize Alzheimer's disease. These findings along with the patient's history, the complete clinical and neurological examination and the laboratory tests contribute to the diagnosis of the disease. Genetics, age, sex, low education level, Down syndrome and coexisting diseases flavor the appearance of Alzheimer's disease. The genes contributing to Alzheimer's disease are those of amyloid precursor protein (APP) located on chromosome 21, presenilin 1 (PS-1) on chromosome 14, presenilin 2 (PS-2) on chromosome 1 and apolipoprotein E (ApoE) on chromosome 19. These genes are inherited by the autosomal dominant pattern.

Keywords: Ανοια, Νόσος του Alzheimer, Γονίδια

Special Article

Children’s Literature Contribution to Preschooler’s Health Education. Findings from a Creek Study | 75-78

Chrysoula Melissa-Halikiopoulou , Triantafylia Natsiopoulou

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Health behavior is considered as relative to its particular cultural context and stresses. Cross- Cultural Psychology, in an attempt to study behavioral health across cultures, has looked at the legends and folktales of different countries. On the basis of interpersonal experiences as well as exchanges with the environment, people develop their personal efficacy towards health matters. This study supports that health education for preschoolers can be introduced by parents, teachers and nurses through folktales, traditional stories and modern ones that enhance health beliefs. In our research we recorded more than 100 books on preschoolers' health education that are available on the Greek market.

Keywords: health education, preschoolers, childrens books on health

"Art Therapy" Plastic Expression - Symbolism | 79-82

Konstantinos Koukourikos , Fani Totti

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In the last few years the psychotherapeutic practices are increasing spectacularly. Each one of them claims to have the big answer to the human pain both bodily and mental.
One of them is the "Art Therapy", which has a significant place in the USA and Europe. In the center of this therapeutic approach lies the emphasis, which it attributes to the patient, as an active factor for his/her own cure. Art Therapy, requires the human being to be a "creator". The person projects a part of his/her psychism through designs, sculptures, drawings and embroidery that are created spontaneously. This manifestation bears a therapeutic value of its own, regardless of the fact that later experts in the fields realized and supported that the creations of the patients have a close relation with their inner conflicts.
We realized then the importance of the "Art Therapy" in the field of mental health mainly. People who suffer from a mental illness find the creation of some kind of work of art as a salvation, in their effort not to lose contact with reality. But even experts in the field (psychiatrists - nurses) understand and appreciate this "alternative" way of communication and the particular aesthetic power and dynamics that it develops.
In the present research there is an attempt to approach the "Art therapy", there is a particular reference to the plastic expression, as a cure and the role of symbolic expression.

Keywords: art therapy, alternative therapy, plastic expression, symbolism

The Problem of Legionnaires’ Disease in Hospitals | 83-87

Eleni Apostolopoulou

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Legionnaires' disease has been recognized as an important cause of hospital-acquired pneumonia. Inhalation of aerosols of water contaminated with Legionella from cooling towers, showers, faucets, respiratory therapy equipment, and room-air humidifiers is believed to be the primary mechanism of entry of these organisms into a patient's respiratory tract. About 30% of sporadic cases of hospital- acquired pneumonia are caused by Legionella and the mortality rate is as high as 80%, usually is immunosuppressed patients who did not receive appropriate antibiotics. A combination of culture of respiratory secretions and urinary antigen detection by immunofluorescence offer the best method for diagnosis of hospital-acquired Legionnaires' disease. Emergency measures that can be used during an outbreak include superheat and flush in combination with hyperchlorination. Continuous hyperchlorination is not favoured because of high expense, marginal efficacy, corrosion of piping, and release of carcinogenic byproducts into

Keywords: Legionnares’ disease, Risk factors, Control, Surveillance

Original Paper

Quality of Life of Cancer Patients | 93-104

Maria Polikandrioti , Eleni Evagelou , Christos Vlachos , P. Dimitrakopoulou , P. Kermeli , Dimitrios Koukoularis , Eleni Kyritsi

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Cancer-patients face with many and various physical and psychosocial problems which affect the outcome of the disease and their quality of life.
The evaluation of the quality of life of cancer- patients, offers valuable information related with the problems that affect the patient, either those that derive from the disease or those from the applied treatment. The changes that can be observed to their quality of life, during the course of the treatment, but also after treatment, give a complete image of its effectiveness.
Aim: The aim of the present study was to evaluate the quality of life of patients who suffer from cancer. Material-method: The participant sample comprised of 145 patients who suffered from various types of cancer. The data were collected by using the specific questionnaire: "Palliative Care Quality of Life Instrument" (PQLI).
Results: The results revealed that patients who suffer from cancer have a poor quality of life, whereas the hospitalized patients report that they have better global quality of life when compared to the non- hospitalized patients and to those that undergo analgesic treatment, p=0.042. According to the way of treatment, outpatients have better activity p=0.044, better self-care p= <0.001 and they perceive better health p=0.031. Patients of 50-59 years old, have better support p=0.050. Patients with metastasis report that they have reduced activity, self-care, poor health and don't wish to choose their medical treatment p=0.025, p= <0.001 p=<0.001, p=0.025, relatively. The results also showed that the patients who work to office continue their activity p=0.004.
Conclusion: Quality of life is affected by the way of nursing, the marital status, the type of cancer, the stage of the disease, the kind of treatment, the duration of the disease and the area they five.

Keywords: quality of life, cancer, daily activity, self- care, global quality

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