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TOMOS4_TEFXOS1 5/11/11 11:21 AM Page 1

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!"µ#$ 4 - !%&'#$ 1 [5]

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& K<6RCL4<B9 ;@D 7J5@D B;6 %!3 µC ET4<@ R646-E;94<B;<EJ ;95 67@DBL6 ? ;95 C88<7? CE;Lµ9B9 E6< ;957C4<@4<BµI59 R4?B9 µC=JKP5 6568>9BL6A 67@KC<-E5TC;6< 65C764E? B;95 656E@TN<B9 ;P5 6B=C5:5 (Toddet al 2002, Karwowski-Soulie F et al 2006, Todd etal 2007). $< 7C4<BBJ;C4CA I4CD5CA CB;<MQ@5;6< B;6R6µ98M 7@B@B;M 6568>9BL6A (Kozlowski et al 2002,Johnston et al 2005), ;95 D7@K@B@8@>L6 (Goldman etal 2008), E6< ;<A 6W<@B9µCLP;CA E6=DB;C4?BC<A (Grant2006). HB;JB@ ;@ N6<5JµC5@ ;9A @8<>@6568>9BL6A(Wilson and Pendleton 1989) KC5 7646;94?=9EC BC;JB@ µC>M89 IE;6B9 BC %!3 6>4@;<E?A 7C4<@R?A (Vlahakiand Milne 2008) E6< BC EI5;46 ;46Tµ6;@A (Probst etal 2005, Mader et al 2006, Chisholm et al 2008).

$< 764M>@5;CA 7@D IR@D5 C5@R@7@<9=CL ><6 ;95 C7<-E46;@TB6 E6;MB;6B9 ;9A D7@=C467CL6A ;@D 7J5@DK<6E4L5@5;6< BC Cµ7JK<6 7@D BRC;LQ@5;6< µC ;@DA C76>->C8µ6;LCA D>CL6A, µC ;@ D>C<@5@µ<EJ BTB;9µ6 E6< ;@DA6B=C5CLA (Duignan and Dunn 2008). ';@ 5@B98CD;<-EJ 74@BP7<EJ K<67<B;:5@5;6< µC>M86 >5PB;<EIA K<6RCL4<B9A ;@D 7J5@D(Tanabe and Buschmann 2000, Jastzab et al 2003,Van Hulle Vincent 2005, Tsai et al 2007) E6< D7@CE;L-µ9B9 ;@D S6=µ@T I5;6B9A ;@D 7J5@D ;@D 6B=C5?(Puntillo at al 2003, Duignan and Dunn 2008, Davoudiet al 2008).

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& 6W<@8J>9B9 ;9A I5;6B9A ;@D 7J5@D I><5C µC ;9511-S6=µ<6 64<=µ9;<E? E8Lµ6E6 (11-NRS) E6< @ S6=-µJA <E65@7@L9B9A µC ;95 5-S6=µ<6 E8Lµ6E6 Likert(E6=J8@D-8L>@-64EC;M-7@8T-7646 7@8T). & K<M>5P-B9 E6;M ;95 IW@K@ E6;9>@4<@7@<?=9EC µC SMB9 ;95K<C=5? ;6W<5Jµ9B9 ICD-10 E6< ;6 6568>9;M8CA E6;9>@4LCA (7646EC;6-µJ89-('/U-@7<@C<K?). HA C8MR<B;6 E8<5? B;95 I5;6B9 ;@D7J5@D LB9 ? µC>68T;C49 ;P5 2 µ@5MKP5 (Todd et al2007). $ R4J5@A 6568>9BL6A BD>E4L=9EC BTµNP56 µC;<A E6;CD=D5;?4<CA @K9>LCA ;@D 'D88J>@D !7CL>@DB6A,6;4<E?A ;@D !5PµI5@D 16B<8CL@D.

!D:D89D8>= 2E2F23;:94:';95 7C4<>46N<E? B;6;<B;<E? R49B<µ@7@<?=9E65 BDR5J-;9;CA ><6 ;95 67C<EJ5<B9 R646E;94<B;<E:5 E6< µIB9

;<µ?, ;D7<E? 67JE8<B9 E6< CT4@A ><6 ;95 67C<EJ5<B9;P5 C5;MBCP5. $ I8C>R@A ;9A E6;65@µ?A ;P5 BDR5@-;?;P5 K<6NJ4P5 E6;9>@4<E:5 µC;6S89;:5 65M E6;9->@4LCA M88P5 µC;6S89;:5 746>µ6;@7@<?=9EC µC I8C>-R@ 22 . $< K<6N@4IA B;95 I5;6B9 ;@D 7J5@D 65M C7L7CK6KL;@µ9A E6;9>@4<E?A µC;6S89;?A 746>µ6;@7@<?=9ECµC t-test E6< Mann-Whitney test J;65 6D;IA 6E@8@D-=@T5 ? JR< ;95 E65@5<E? E6;65@µ? 65;LB;@<R6. $ I8C>-R@A ;9A E6;65@µ?A I5;6B9A 7J5@D 65MµCB6 BC @µM-KCA 6B=C5:5 746>µ6;@7@<?=9EC µC one-way ANOVA.

!I"#$#% 2: 1+$2*%'3") 4(+*,0."-, "564%7 +#6 $+ 89: .;µ<-,+ µ" ICD-10

0-&"µ& 99 (40,1%)2&(.')7@ µ,$'6)%)/76$" ','/.µ&/$@ 41 (16,6%)2&(.')7@ #),-76$" ','/.µ&/$@ 23 (9,3%)!,µ+/*µ&/&-I,'76& '5µ)9& 22 (8,9%)2&(.')7@ +)+/76$" ','/.µ&/$@ 17 (6,9%)2&(.')7@ /$, $,-$+$7$A)##5/76$" ','/.µ&/$@ 14 (5,6%)2&(.')7@ $I(&%µ$"-F/$@ 9 (3,7%)2&(.')7@ 6,6%$I$-7&6$" ','/.µ&/$@ 6 (2,4%)C%%)@ +&(.')7@ 16 (6,5%)

0

5

10

15

20

25

30!"#$%$& '($%$& !)*+,µ-./

1 2 3 4 5 6 7 8 9 100

EIKONA 1: 1+$+,%µ= #6,%7 +,> ?+/µ6 &,$+.2)


[8] !""#$%&' ()*%+,%&' -#. /+0#")1-%&2. !3%0-2µ#.

+"+&'*(,-H +".!%/A

!7L7CK@ B;6;<B;<E?A B9µ65;<EJ;9;6A @4LB;9EC ;@ 5%.& B;6;<B;<E? 65M8DB9 746>µ6;@7@<?=9EC µC R4?B9B;6;<B;<E@T 76EI;@D SPSS v16.

%EAD25G9µ:D:';95 µC8I;9 C>>4MN;9E65 247 6B=C5CLA 7@D 65;<74@-BP7CTC< ;@ 30% ;P5 6B=C5:5 7@D ;94@TB65 ;6 E4<-;?4<6 C7<8@>?A (3L56E6A 1). & µIB9 98<EL6 ;@D KCL>-µ6;@A ?;65 38.5±15,3 I;9 E6< ;@ 54% ;P5 BDµµC;CRJ5;P5?;65 M5;4CA. & 78C<@V9NL6 ;P5 6B=C5:5 (87%) ?;65C8895<E?A E6;6>P>?A. $ 7J5@A ?;65 9 ET4<6 6L;<6 74@-BI8CDB9A ><6 ;@ 80% ;P5 6B=C5:5 E6< CLRC 74@E89-=CL CW6<;L6A ;46Dµ6;<Bµ@T ><6 ;@ 40,1% (3L56E6A 2).

& µIB9 I5;6B9 7J5@D E6;M ;95 CLB@K@ ?;65 7.2±1.9µC ;@ 50% ;P5 6B=C5:5 56 656NI4C< µI;4<@ E6< ;@ 46%<BRD4J 7J5@. ';95 IW@K@ 9 µIB9 I5;6B9 7J5@D ?;655.0±2.1 µC ;@ 60% ;P5 6B=C5:5 56 67@RP4CL µC µI;4<@E6< ;@ 14% µC <BRD4J 7J5@ (!<EJ56 1). & I5;6B9 7J5@D764IµC<5C 6µC;MS89;9 ><6 ;@ 33% ;P5 6B=C5:5 C5:6DW?=9EC ><6 ;@ 2,5% ;P5 6B=C5:5. (J5@ 33% ;P56B=C5:5 SLPBC E8<5<6 ;95 C7L;CDW9 ;@D 59±47 8C7;M. & µIB9 C7<=D-µ9;? I5;6B9 7J5@D E6;M ;95 IW@K@ KC5 K<6N@4@7@<-

@T;65 BTµNP56 µC ;@ NT8@ (p=0.098) ? ;95 ;46Dµ6;<-E? ? JR< 6<;<@8@>L6 ;@D 7J5@D (p=0.094). $< 74@BK@-ELCA ;P5 6B=C5:5 CE7894:=9E65 µC 67JE8<B9 PA 2µ@5MKCA (NRS\2) µJ8<A B;@ 10,3% 6D;:5.

"65I56A 67J ;@DA 6B=C5CLA KC5 CLRC ;CEµ94<PµI-59 CE;Lµ9B9 ;9A I5;6B9A ;@D 7J5@D µC R4?B9 E8<µM-EP5 B;@ <6;4@5@B98CD;<EJ ;@D K<M>46µµ6. (J8<A 6%CLRC E6;6>C>46µµI59 R4?B9 6568>9;<E@T (!<EJ56 2)RP4LA R4@5<EJ 74@BK<@4<BµJ R@4?>9B9A ;@D. & 7<@BDR5M R49B<µ@7@<@TµC59 E6;9>@4L6 6568>9;<E:5 ?;65;6 ('/U µC 63% C5: 9 @7<@C<K? 6568>9BL6 7C4<@4<-QJ;65 B;@ 1%. 'C J8@DA BRCKJ5 ;@DA 6B=C5CLA (99%)74@;<µ?=9EC 9 C5K@µDXE? R@4?>9B9 6568>9BL6A.

'TµNP56 µC ;95 656N@4M ;@D 6B=C5? E6;M ;95 IW@-K@ ;@ 7@B@B;J R@4?>9B9A 6568>9BL6A 65C4RJ;65 B;@25% (!<EJ56 2) µC µIB@ 65;<897;J R4J5@ 55±22 8C7;M."65I56A 67J ;@DA 6B=C5CLA µC µI;4<@ 7J5@ KC5 I86-SC 67J ;@D B;Jµ6;@A 6568>9BL6 B;95 K<68@>? E6< µJ8<A5,5% ;P5 6B=C5:5 µC <BRD4J 7J5@ I86SC 6568>9BL6(C5K@µDXEM) C5;JA 20 8C7;:5 67J ;95 MN<W9 ;@DA BTµ-NP56 µC ;<A E6;CD=D5;?4<CA @K9>LCA ;@D 'D88J>@D!7CL>@DB6A ,6;4<E?A ;9A (C>M89A 14C;M5<6A.

& 78C<@V9NL6 ;P5 6B=C5:5 BC 7@B@B;J 70% C7<-=Dµ@TBC ;95 8?V9 6568>9;<E@T ><6 ;95 656E@TN<B9;@D 7J5@D ;@D (!<EJ56 2). %@ 24% ;P5 6B=C5:5 C7<-=Dµ@TBC ;95 8?V9 6568>9;<E@T 67J ;@ 5@B98CD;<EJ74@BP7<EJ E6;M ;95 K<68@>? 74<5 ;95 <6;4<E? CWI;6-

0

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15

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25

30

!)*+,µ"0 1*2340µµ0 5,.$0607$42

4 5 6 7 8 9 103

EIKONA 2: @%'=*2.2 +,+A*2$(B0, +,> ?+/µ6 &,$+.2) #6,%7


!"µ#$ 4 - !%&'#$ 1 [9]

+"+&'*(,-H +".!%/A

B9. & C7<=DµL6 R@4?>9B9A 6568>9;<E@T C794C6QJ;6567J ;95 I5;6B9 ;@D 7J5@D E6;M ;95 CLB@K@ (p<0.001).(J5@ 32% ;P5 6B=C5:5 7@D C7<=Tµ9B65 ;95 R@4?>9-B9 6568>9;<E@T E6< 7% ;P5 6B=C5:5 7@D KC5 C7<=D-µ@TB65 ;C89;<EJ.

364M ;95 7C4<@4<BµI59 656E@TN<B9 9 @7@L6 KC565;67@E4<5J;65 B;<A 74@BK@ELCA ;P5 6B=C5:5 ;@ 63%?;65 <E65@7@<9µI5@< ? 7@8T <E65@7@<9µI5@< 67J ;95K<6RCL4<B9 ;@D 7J5@D ;@DA. !86N4:A DV98J;C46 BC7@B@B;J 69% 6W<@8J>9B65 ;95 BD5@8<E? N4@5;LK6 ;@D74@S8?µ6;@A ;@DA B;@ %!3 (!<EJ56 3).

!HI=D696';95 764@TB6 µC8I;9 656KC<E5TC;6< J;< 9 K<6RCL4<B9;@D 7J5@D B;@ %!3 CL56< 65C764E? E6=:A BDµN:56µC ;95 6D;@656N@4M ;P5 6B=C5:5 ;6 ? 67@RP4@T5 µCµI;4<@ 9 <BRD4J 7J5@. %@ LK<@ 6E4<S:A 7@B@B;J (74%)K<67<B;:=9EC BC 6B=C5CLA µC µI;4<@ IPA <BRD4J 7J5@(NRS>3), 98<EL6A 8 C;:5 E6< M5P @< @7@L@< 74@B?8-=65 BC 17 %!3 ;P5 &3/ E6< C 3 %!3 ;@D "656KM (Toddet al 2007). 'C 764Jµ@<6 I4CD56 ;@ 78% ;P5 6B=C5:5S<:5C< µI;4<6A ? <BRD4?A C5;MBCPA 7J5@ E6;M ;95 IW@-K@ 67J %!3 ;9A 0688L6A (Karwowski-Soulie et al 2006)E6< @< µ<B@L 67J ;@DA 6B=C5CLA 2 765C7<B;9µ<6E:55@B@E@µCLP5 ;P5 &3/ (Todd et al 2002).

& 64R? ;9A E6E@K<6RCL4<B9A ;@D 7J5@D B;6 %!3N6L5C;6< 56 CL56< 9 67@DBL6 ;CEµ94<PµI59A CE;Lµ9-B9A ;9A I5;6B9A ;@D 7J5@D. 34M>µ6;< BC E65I56 <6;4@-5@B98CD;<EJ K<M>46µµ6 KC5 D7?4RC CE;Lµ9B9 ;9A I5;6-B9A ;@D 7J5@D ;@D 6B=C5? @T;C E6;M ;95 K<68@>? @T;CE6;M ;95 IW@K@ 67J ;6 %!3 >C>@5JA 7@D CW9>CL;6< 67J;95 67@DBL6 C5BPµ6;PµI5P5 E8<µMEP5 CE;Lµ9B9A7J5@D. %@ 67@;I8CBµ6 6D;J CL56< BDµS6;J µC 2 74@9->@TµC5CA I4CD5CA J7@D B;95 74:;9 KC5 D7?4RC E6µ<MCE;Lµ9B9 7J5@D B;@ <6;4<EJ <B;@4<EJ E6< µJ8<A 7% B;@5@B98CD;<EJ <B;@4<EJ (Guru and Dubinsky 2000) C5:B;95 KCT;C49 ;@ 7@B@B;J CE;Lµ9B9A KC5 WC7C45@TBC;@ 23% ;P5 6B=C5:5 (Eder et al 2003). & K<67LB;PB9><6 ;95 CE;Lµ9B9 ;@D 7J5@D 67J ;@ 5@B98CD;<EJ 74@-BP7<EJ B;6 %!3 CL56< J;< ;<A 7C4<BBJ;C4CA N@4IA7C4<@4LQC;6< B;@ ME@DBµ6 ;9A 7C4<>46N?A ;@D 7J5@D67J ;@5 6B=C5? E6;M ;95 74@BI8CDB9 ;@D C5: C76EJ-8@D=CA C765CE;<µ?BC<A >L5@5;6< µJ5@ E6;J7<5 7646-7J5P5 ;@DA ><6 65C764E? 656E@TN<B9 (Blank et al2001).

%@ KCT;C4@ E@µS<EJ B9µCL@ ;9A D7@=C467CL6A ;@D7J5@D B;@ %!3 ;9A µC8I;9A CL56< 9 674@=DµL6 R@4?->9B9A 6568>9BL6A J7@D 9 BD5;6>@>4MN9B9 B;@ K<M->46µµ6 ;@D 6B=C5? CL56< 64EC;M 7C4<@4<BµI59 C5: BC65M8@>CA I4CD5CA ;6 7@B@B;M ;CEµ94<PµI59A R@4?-

1*089"4*#- ):6$,

;,6$<*=/ 74$6."%0

>0+:<$, ?"3$ @$<A54=9.2 @240 )$<A

0

5

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15

20

25

30

35

40

EIKONA 3: CB+,%#%32.2 +./",0, +#6 $2, 4(+D"3'(.2 $%7 #6,%7 B+( $2, .7,%A(B= <'%,$34+ .$% 89:


[10] !""#$%&' ()*%+,%&' -#. /+0#")1-%&2. !3%0-2µ#.

+"+&'*(,-H +".!%/A

>9B9A 6568>9BL6A BC 6B=C5CLA µC 7J5@ 7@<EL89A 6<;<@-8@>L6A EDµ6L5C;6< µC;6WT 27-60% (Todd et al 2002,Karwowski-Soulie et al 2006, Todd et al 2007). ,K<-6L;C46 9 @7<@C<K? 6568>9BL6 ?;65 BRCKJ5 65T764E;9µC 8<>J;C4@ 67J 1% ;@ @7@L@ 67IRC< 67J ;@ 7,6% ;P56B=C5:5 7@D I86S65 764C5;C4>8L6A(Forero et al 2008).

& B;6;<B;<6 ;95 8?V9 6568>9;<E@T E6;M ;95 7646µ@5? ;@D B;6%!3 KC5 SC8;LPBC ;@ N6<5JµC5@ ;9A @8<>@6568>9BL6A./D;? 9 6BDµNP5L6 CLRC K<67<B;P=CL 74@>C5IB;C46 BCµC>68T;C49 IE;6B9 µC ;@DA ><6;4@TA 56 R@49>@T56568>9BL6 B;@ 79,9% ;P5 6B=C5:5 688M 56 ;@ E6;6->4MN@D5 B;@ 31,7% ;P5 <B;@4<E:5 ;@DA >C>@5JA 7@D;@DA @K?>9BC B;@ BDµ7I46Bµ6 J;< 9 656K4@µ<E? 65M-8DB9 K<6>46µµM;P5 KC5 67@;C8CL C764E? 65;<74@B:-7CDB9 ;9A 6568>9;<E?A K<6RCL4<B9A B;6 %!3 (Chisholmet al 2008).

!7LB9A 9 7C4<@4<BµI59 R4?B9 6568>9;<E:5 KC5K<E6<@8@>CL;6< 67J ;95 674@=DµL6 ;P5 6B=C5:5 568MS@D5 6568>9;<EJ ;95 @7@L6 K<67LB;PB65 BC 3926B=C5CLA %!3 J7@D @< µ<B@L 6B=C5CLA µC µIB9 64R<-E? I5;6B9 7J5@D 7.1 (SD=2) KC5 C7<=Dµ@TB65 ;95 8?V96568>9;<E@T ><6 ;95 65;<µC;:7<B9 ;@D 7J5@D ;@DA C5:BC 6D;@TA 7@D C7<=Dµ@TB65 ;@ 81% (95% CI 75% to86%) I86SC 6568>9;<EJ. & 74@B=?E9 E6< ;9A 74@BP-7<E?A CD=T59A ;@D 6B=C5? ><6 ;@5 ;4J7@ K<6RCL4<B9A;@D 7J5@D ;@D BRC;9;<E:5 ?;659 M7@V9 7@D 74@;M=9EC 67J 6D;?5 ;95 C4CD5M (Singeret al 2008).

(<6 M889 K<MB;6B9 ;9A 6568>9;<E?A K<6RCL4<B9ACL56< 9 K<M4EC<6 656µ@5?A 67J ;95 K<68@>? µIR4< ;95R@4?>9B9 6568>9;<E:5 N64µMEP5 J7@D BDµN:56 µC;95 6D;@656N@4M ;@D 6B=C5? ?;65 7C4L7@D µ<6 :46.%@ R4@5<EJ 6D;J K<MB;9µ6 CL56< BDµS6;J µC 74@9>@T-µC5CA I4CD5CA B;<A J7@<CA EDµ6L5C;6< 67J 46-1168C7;M (Todd et al 2002, Karwowski-Soulie et al 2006,Todd et al 2007). HB;JB@ 67IRC< 67J ;<A E6;CD=D5;?-4<CA @K9>LCA ;@D 14C;65<E@T 'D5KIBµ@D !7CL>@DB6A,6;4<E?A BTµNP56 µC ;<A J7@<CA 74I7C< 56 R@49>CL-;6< E6;M88989 6568>9BL6 C5;JA 20 8C7;:5 BC 6B=C-5CLA µC <BRD4J 7J5@ E6< E6;M ;95 K<68@>? BC 6B=C5CLAµC µI;4<@ 7J5@, J7@D ;T>R6565 CN64µ@>?A µJ8<A B;@1% ;P5 6B=C5:5 ;9A µC8I;9A. 'C C4CD5M BC %!3 ;9A/>>8L6A 9 µIB9 K<M4EC<6 656µ@5?A ><6 R@4?>9B9 6568->9BL6A BC 6B=C5CLA µC µI;4<@ ? <BRD4J 7J5@ ?;65 1068C7;M E6< @< E6;CD=D5;?4<CA @K9>LCA CN64µJB;9E65µJ8<A B;@ 32% ;P5 6B=C5:5 (Grant 2006).

& C7M4EC<6 ? JR< ;9A =C467CL6A ;@D 7J5@D B;6 %!3KC5 74I7C< 56 7C4<@4LQC;6< µJ5@ BC 6886>IA B;95 I5;6-B9 ;@D 7J5@D ? B;95 R@4?>9B9 N64µMEP5 688M =674I7C< 56 CB;<MQC;6< B;95 CE78?4PB9 ;P5 656>E:5

;P5 6B=C5:5 ><6 656E@TN<B9 67J ;@5 7J5@. (<6 I5;6-B9 7J5@D 2.5 µ@5MKP5 B;95 64<=µ9;<E? E8Lµ6E6 E6;M;95 IW@K@ 67J ;6 %!3 ?;65 65CE;? ><6 ;@DA 6B=C5CLA;9A µC8I;9A 74@BNI4@5;6A C764E? 656E@TN<B9. (C;95 100mm 6568@><E? E8Lµ6E6, 9 65CE;? E6;M ;@56B=C5? I5;6B9 7J5@D CL56< 33mm (Blank et al 2001)C5: 9 µIB9 C7<=Dµ9;? 656E@TN<B9 B;95 <KL6 E8Lµ6-E6, J7@D ;@ 64<B;C4J ME4@ (0mm) 65;<B;@<RCL BC 67@D-BL6 656E@TN<B9A E6< ;@ KCWL ME4@ (100mm) BC 67J-8D;9 656E@TN<B9, CL56< 72mm (95% CI 70-74). (Fosnochtet al 2004).

';95 764@TB6 µC8I;9 @< 6B=C5CLA 67@RP4@TB65µC K<786BL6 I5;6B9 7J5@D 67J ;95 @7@L6 C7<=Dµ@T-B65 65 KC5 ?;65 CN<E;? 9 78?49 656E@TN<B9 C5: 9K<6N@4M 65MµCB6 B;95 746>µ6;<E? E6< ;95 C7<=Dµ9-;? 656E@TN<B9 ?;65 µC>68T;C49 ;P5 2 µ@5MKP5 B;9564<=µ9;<E? E8Lµ6E6 ><6 B;95 BD5;4<7;<E? 78C<@V9NL6;P5 6B=C5:5. /5;LB;@<R6 BC 6B=C5CLA µC E@<8<6EJM8>@A µJ8<A ;@ 14,6% ;P5 6B=C5:5 SLPBC ;95 656E@T-N<B9 7@D C7<=Dµ@TBC B;6 %!3 (Yee et all 2006).

364M ;95 65C764E? 656E@TN<B9 K<67<B;:=9EC J;<@< 6B=C5CLA ?;65 <E65@7@<9µI5@< µC ;95 K<6RCL4<B9;@D 7J5@D ;@DA E6< µC ;95 BD5@8<E? 65;<µC;:7<B9 ;@D74@S8?µ6;@A ><6 ;@ @7@L@ 74@B?8=65. %@ 764MK@W@6D;J N6<5JµC5@ ;@ @7@L@ IRC< K<67<B;P=CL E6< BC 74@9->@TµC5CA I4CD5CA (Todd et al 2002, Todd et al 2007)@K?>9BC B;95 6µN<BS?;9B9 ;9A 67@E8C<B;<E? BDµS@-8? ;9A 656E@TN<B9A ;@D 7J5@D B;95 <E65@7@L9B9 ;@D6B=C5? (<6 7<=65? CW?>9B9 CL56< J;< 9 656E@TN<B9;@D 7J5@D 656NI4C;6< B;95 K<6ETµ65B9 ;9A I5;6B9A;@D BDµ7;:µ6;@A C5: 9 <E65@7@L9B9 B;95 74@BP7<-E? CE;Lµ9B9 ;P5 D794CB<:5 D>CL6A E6< ;<A K<674@BP-7<EIA BRIBC<A (Dawson et al 2002).

/7J ;6 67@;C8IBµ6;6 ;9A 764@TB6A C4>6BL6A >C5-5<I;6< 9 65M>E9 ><6 ;95 8?V9 µI;4P5 7@D IR@D5 ?K974@;6=CL E6< CN64µ@B;CL BC M88CA R:4CA J7PA 9 @4>M-5PB9 CE76<KCD;<E:5 74@>46µµM;P5 (Augarten et al2006, Decosterd et al 2007), 9 C5BPµM;PB9 µ<6A E8L-µ6E6A 7J5@D KL786 67J ;6 D7J8@<76 QP;? E6;CD=D5;9-4LP5 @K9><:5 67J K<C=5CLA @4>65<Bµ@TA J7PA 9 "@<-5? !7<;4@7? 3<B;@7@L9B9A ;@D $4>65<Bµ@T *>C<@5@-µ<E?A 3C4L=68V9A (JCAHO 2001 guidelines), E6< @'T88@>@A !7CL>@DB6A ,6;4<E?A ;9A (C>M89A 14C;M-5<6A (CEM 2004 guidelines).

';95 656B;4@N? ;9A C7<E46;@TB6A E6;MB;6B9A µC;95 65C764E? 65;<µC;:7<B9 ;@D 7J5@D B9µ65;<EJ 4@8JN6L5C;6< 56 K<6K46µ6;LQC< ;@ 5@B98CD;<EJ 74@BP7<-EJ B;@ @7@L@ CERP4CL;6< 9 CD=T59 ><6 ;95 CN64µ@>?74P;@EJ88P5 65;<µC;:7<B9A ;@D 7J5@D (Fry andHoldgate 2002, Fry et al 2004, Kelly et al 2005, Tamchèset al 2007, Viallon et al 2007). Y88PB;C 9 74@ET7;@D-B6 BTB;6B9 67J ;95 E6E@K<6RCL4<B9 ;@D 7J5@D B;6%!3 CL56< J;< ;@ 5@B98CD;<EJ 74@BP7<EJ IRC< E6=?-


!"µ#$ 4 - !%&'#$ 1 [11]

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ABSTRACT

OORRIIGGIINNAALL AARRTTIICCLLEETThhee eeffffeeccttiivveenneessss ooff ppaaiinn mmaannaaggeemmeenntt iinn tthhee EEmmeerrggeennccyy DDeeppaarrttmmeenntt aanndd tthhee ddeeggrreeee ooff rreessppoonnssiivveenneessssttoo tthhee ppaattiieenntt’’ss nneeeeddss..GGeeoorrggee FFiilliippppaattooss,, RRNN,, MMSScc,, GGeenneerraall HHoossppiittaall ooff EElleeffssiinnaa ‘‘TThhrriiaassssiioo’’..

IInnttrroodduuccttiioonn:: Pain is the main reason for out patients visitation to the Emergency Department. Painmanagement however in most cases is inadequate due to underestimation and inefficient treatment. AAiimm:: Identifying pain management practices and assess their effectiveness in pain relief. We also desireto identify the best pain management care plan to effectively reduce the patient’s pain and need foranalgesic drugs.MMeetthhoodd:: A study was conducted at the General Hospital of Attica, Emergency department during Juneand July of 2009. Data was completed by the collection of questionnaires (arrival / discharge) of all patientsaged 14 and over whose illness was not life threatening and had the ability to understand and answerthe questionnaire, and also with the patients analysis charts. Pain intensity was evaluated with an 11point numerical pain scale. RReessuullttss:: 247 patients participated in the study with a mean age 38.5 ± 15.3 years. The mean pain intensity onarrival was 7.2 ± 1.9 and at discharge 5.0 ± 2. Pain intensity was unchanged for 35.5% of patients during theirvisit to the ED. Patients were expected to leave the emergency department with a mean pain intensity of 2.5± 1.3, which deviates more than 2 points for 90% of the patients concerning pain intensity on discharge. In 68%of patients who should have been administered analgesics, they were not administered. Not one of the patientshad their pain intensity documented and less than 6% were recorded to have been administered pain relief. CCoonncclluussiioonnss:: The results showed a poor response in pain relief due to prevailing practice of pain managementin the Emergency Department and a lack of assessment of the needs and expectations of the patient.

KKeeyy wwoorrddss:: Pain management, oligoanalgesia, emergency department, patient expectation, patientsatisfaction


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& K<6K<E6BL6 ;9A µC;MN46B9A B;6 C8895<-5C BTµNP56 µC ;9 K<6K<E6BL6 7@D 74@;CL5C;6< 67J ;95“Trust Scientific Advisory Committee” SAC (MedicalOutcomes Trust Bulletin 1997 E6< MAPI ResearchInstitute, 2002): 6) K<>8PBB<E? µC;MN46B9 74@A KT@ E6;CD=T5BC<A(forward translation, backward translation) S) 7@8<;<Bµ<E? 74@B64µ@>? (cultural adaptation) µC7<8@;<E? CN64µ@>? ;P5 E8<µMEP5 B;@DA C4P;:µC5@DAµC R4?B9 ;9A >5PB;<E?A 74@BI>><B9A C765674@BK<@-4<Bµ@T (cognitive debriefing process/interview). &µC;MN46B9 E6< 9 74@B64µ@>? CL56< 7<=65J 56 688M-W@D5 ;95 CBP;C4<E? K@µ?, ><’ 6D;J R4C<MQC;6< 56 K<6-BN68<B;CL 9 6W<@7<B;L6 E6< C>ED4J;9;6 ;@D 656=CP-

49µI5@D C4>68CL@D. & µC;6N46B=CLB6 CEK@R? =CP-4CL;6< <BJ;<µ9 ;@D 74P;@>C5@TA C4>68CL@D µJ5@5 J;659 6W<@7<B;L6, 9 C>ED4J;9;6 E6< @ K@µ<EJA 764M>@5;6ACL56< 764Jµ@<6 µC ;@ 74P;@>C5IA C4>68CL@.

//WW<<@@77<<BB;;LL66HA 6W<@7<B;L6 C5JA C4CD59;<E@T C4>68CL@D @4LQC;6< 9IE;6B9 B;95 @7@L6 ;@ C4>68CL@ KL5C< ;6 LK<6 67@;C8I-Bµ6;6 BC C765C<89µµI5CA µC;4?BC<A E6< 656NI4C;6<B;95 6568@>L6 6E4LSC<6A E6< 656E4LSC<6A B;9 µI;49B9.

$< ;4C<A ED4<J;C4CA <K<J;9;CA ;9A 6W<@7<B;L6A CL56<9 B;6=C4J;9;6, K986K? 9 <E65J;9;6 µ<6A E8Lµ6E6A 56KL5C< ;6 LK<6 67@;C8IBµ6;6 BC C765C<89µµI5CA µC;4?-BC<A, 9 @µ@<@>I5C<6, 7@D B9µ6L5C< J;< J86 ;6 B9µCL6BC I56 C4>68CL@ µC;4@T5 ;95 LK<6 I55@<6 ? R646E;9-4<B;<EJ, E6< ;95 <B@KD56µL6, K986K? ;95 <E65J;9;6 ;@DC4>68CL@D 56 764M>C< ;6 LK<6 67@;C8IBµ6;6 J;65 R49-B<µ@7@<@T5;6< 764M88986 C4>68CL6 ? K<6K<E6BLCA.';<A CE;<µ?BC<A CBP;C4<E?A BD5@R?A R49B<µ@7@<CL-;6< @ BD5;C8CB;?A 6 ;@D Cronbach, µC ;@5 @7@L@ D7@-8@>LQC;6< 9 CBP;C4<E? BD5I7C<6 ? 9 @µ@<@>I5C<6 C5JAC4>68CL@D. !<K<EJ;C46, @ 6 67@;C8CL ;@ R6µ98J;C4@J4<@ ><6 ;95 689=<5? 6W<@7<B;L6 @8JE8949A ;9A I4CD-56A. (6=9µ6;<EM, 9 6W<@7<B;L6 E6=@4LQC;6< PA 9 656-8@>L6 ;9A µC;6S89;J;9;6A ;P5 65;67@E4LBCP5 ;9AµC8I;9A, 7@D CL56< ;@ 67@;I8CBµ6 ;P5 K<6N@4:5 65M-µCB6 B;@DA BDµµC;IR@5;CA. 'D5C7:A, @< 65;67@E4L-BC<A BC µ<6 6W<J7<B;9 µC8I;9 =6 K<6NI4@D5 8J>P ;@DJ;< ;6 M;@µ6 7@D BDµµC;IR@D5 IR@D5 K<6N@4C;<EIA67JVC<A E6< JR< K<J;< 9 I4CD56 CL56< BD>RD;<E? ? 74@-E68CL K<MN@4CA C4µ95CLCA. (C M886 8J><6, JB@ V98J-;C4@A CL56< @ 6, K986K? JB@ 7<@ E@5;M B;@ 1, ;JB@µC>68T;C49 CL56< 9 6W<@7<B;L6.

!!>>EEDD44JJ;;99;;66& C>ED4J;9;6 656NI4C;6< B;@ E6;M 7JB@ I56 C4CD59-;<EJ C4>68CL@ µC;4M µC 6E4LSC<6 6D;J 7@D D7@;L=C;6<J;< µC;4M. (<6 E8Lµ6E6 µ7@4CL 56 CL56< 6W<J7<B;9 688M56 µ95 CL56ED49, E6< 9 V98? 6W<@7<B;L6 KC5 67@-;C8CL 67646L;9;9 I5KC<W9 ;9A C>ED4J;9;6A, C5: ;@I>ED4@ C4>68CL@ CL56< 7M5;@;C 6W<J7<B;@. ';9 S<S8<@->46NL6 7C4<>4MN@5;6< ;4L6 CLK9 C>ED4J;9;6A: 7C4<C-R@µI5@D, K986K? 9 IE;6B9 B;95 @7@L6 ;@ 7C4<CRJµC-5@ ;9A E8Lµ6E6A 65;<74@BP7CTC< BN6<4µ6-;<E? BDµ7C4<N@4M ;@D D7@EC<µI5@D, E6< K@µ<E?, 9@7@L6 S6BLQC;6< B;95 IE;6B9 B;95 @7@L6 µ<6 E8Lµ6E6µC;4M EM7@<6 =CP49;<E? K@µ? ? I56 R646E;94<B;<EJ.

//55MM88DDBB99 77664466>>JJ55;;PP55& 65M8DB9 7646>J5;P5 (factor analysis) 67@;C8CL µ<674@BI>><B9 6W<@8J>9B9A ;9A K@µ<E?A C>ED4J;9;6A,7@D KL5C< B;@5 C4CD59;? 7894@N@4LCA BRC;@5;CA E6< 9 65M8DB9 CL56< C7L-B9A C5KC<E;<E? ;@D E6;M 7JB@ ;6 B9µCL6 C5JA C4>6-8CL@D 65;656E8@T5 µL6 µ@56K<E? ? 7C4<BBJ;C4CA I55@<-CA. & K<C4CD59;<E? 65M8DB9 7646>J5;P5 «B;@RCTC<B;95 6W<@8J>9B9 ;9A C>ED4J;9;6A ;@D ;4J7@D K<6RCL-4<B9A µ<6A @µMK6A KC<E;:5, µC ;4J7@ 7@D 56 65;656-E8@T5 ;95 LK<6 I55@<6». (C M886 8J><6, 9 µI=@K@A 6D;?6568TC< ;@5 ;4J7@ µC ;@5 @7@L@ @µ6K@7@<@T5;6< @<65;67@E4LBC<A, I;B< :B;C 56 KL5@D5 5J9µ6 ><6 ;9 BRI-B9 7@D D7M4RC< 65MµCBM ;@DA. $< 6568TBC<A 6D;IACWC;MQ@D5 ;6 B9µCL6 ;P5 E8<µMEP5 WCRP4<B;M ><6 K@µ<-E? C>ED4J;9;6.

&& KK<<66KK<<EE66BBLL66 µµCC;;MMNN4466BB99AA ;;99AA EE88LLµµ66EE66AA & E8Lµ6E6 R49B<µ@7@<?=9EC µC;M 67J >467;? MKC<6;@D C5JA CE ;P5 ;P5 BD>>46NIP5 E. Reker, G.T ><6µC;MN46B? ;9A B;6 C8895<EM. & K<6K<E6BL6 ;9A µC;M-N46B9A B;6 C8895<5C BTµNP56 1C ;9 K<6K<E6-BL6 7@D 74@;CL5C;6< 67J ;95 «Trust Scientific AdvisoryCommittee» (Medical Outcomes Trust., 1997). ';J-R@A ?;65 9 µC;MN46B9 ;@D C4P;9µ6;@8@>L@D 67J ;6/>>8L@D. "6;64R?5, I><5C µC;M-N46B9 B;6 C8895>88PBB@ 5@B98CD;? 74@EC<µI5@D56 CW6BN68<B;CL 9 6E4<S?A 67JK@B9 ;P5 C4P;9µ6;@-8@>LP5 B;6 C8895<EM. %6 KT@ M;@µ6 7@D IE6565 ;9µC;MN46B9 C4>MB;9E65 65CWM4;9;6 E6< @ ET4<@A B;J-R@A ;9A 65;LB;4@N9A µC;MN46B9A ?;65 56 K<6BN68<-B;CL J;< @< C4P;?BC<A B;<A KT@ >8:BBCA =6 CLR65 ;95LK<6 I55@<6. ';9 BD5IRC<6, ;6 C4P;9µ6;@8J><6 BDQ9-;?=9E65 µC 65CWM4;9;@ 765C7<B;9µ<6EJ E6=9>9;? ;9A.@B98CD;<E?A, >5:B;9 ;@D =Iµ6;@A, ><6 ;95 6W<@8J->9B9 ;@D 8CE;<E@T, ;@D >46µµ6;<E@T E6< ;@D C55@<@-8@><E@T 7C4<CR@µI5@D ;P5 µC;6N4MBCP5. /E@8@T=9-BC BR@86B;<EJA I8C>R@A E6< BDQ?;9B9 67J ;95 C4CD59;<E?@µMK6 E6<, ;I8@A, I><565 @4<BµI5CA 6886>IA E6< C8M-R<B;CA >8PBB<EIA SC8;<:BC<A, :B;C 56 ;C8C<@7@<9=CL9 67JK@B9 B;6 C8895<EM. 0<6 56 E4<=CL 9 7@8<;<Bµ<E?E6;68898J;9;6 E6< BRC;<EJ;9;6 ;9A µC;MN46B9A ><6;@5 789=DBµJ-B;JR@, ;@ µC;6N46BµI5@ C4>68CL@ KJ=9-EC BC µ<6 @µMK6 6;JµP5 E6;M ;9 K<M4EC<6 7<8@;<E?AµC8I;9A. $ I56A 67J ;@DA E6;6BECD6B;IA ;@D C4P;9-µ6;@8@>L@D @ E. Reker, G.T., 67J ;@5 @7@L@ 8MS6µC ;95I>E4<B9 ><6 ;95 µC;MN46B9 ;@D, KC5 IE65C E6µL6 ;4@-7@7@L9B9 C7L ;@D µC;6N46BµI5@D C4P;9µ6;@8@>L@D.

33@@88<<;;<<BBµµ<<EE?? 7744@@BB6644µµ@@>>?? ;;@@DD CC44PP;;99µµ66;;@@88@@>>LL@@DD ((ccuullttuurraallaaddaappttaattiioonn)) 0<6 ;95 7@8<;<Bµ<E? 74@B64µ@>? (cultural adaptation)R49B<µ@7@<?=9EC ;@ C4P;9µ6;@8J><@ BC I56 ;DR6L@KCL>µ6 7I5;C 5@B98CD;:5, J7PA 74@;CL5C;6< B;95 K<6-K<E6BL6 >5PB;<E?A 656BEJ79B9A (cognitive debriefingprocess) (Medical Outcomes Trust., 1997). /N@T 74:-;6 C4P;?=9E65 ;6 M;@µ6 BD5@8<6 56 BDµ7894P-=CL ;@ C4P;9µ6;@8J><@, B;9 BD5IRC<6 4P;?=9E65 ><6

EM=C C4:;9B9 RP4<B;M 65 ?;65 E6;65@9;? E6< 65 R4C<-6QJ;65 56 ;95 656K<6;D7:B@D5 µC K<6 ?74@;<µ@TB65 56 6886R;CL EM7@<6 BD>ECE4<µI59 8IW9BC EM7@<6 C4:;9B9 I;B< :B;C 56 >L5C< 7<@ E6;65@9;?9 C4:;9B9 (cognitive debriefing interview). %@ C4P-;9µ6;@8J><@ E6;M ;95 K<M4EC<6 ;9A 7@8<;<Bµ<E?A 74@-B64µ@>?A (cultural adaptation), ?;65 >C5 .$%(D"3+ $-, .7µµ"$"D6,$-,

N %

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!"µ#$ 4 - !%&'#$ 1 [17]

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[18] !""#$%&' ()*%+,%&' -#. /+0#")1-%&2. !3%0-2µ#.

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!I"#$#% 5. !",*$7$-*14 -"-.1*&-54 *+, 6&0-*)-$+, *(" $%+*5µ0*(7(83(" DAP-R

death neutral approach escapeavoidance acceptance acceptance acceptance

fear of death rr 0,35 -0,43 0,23 0,20 PP <<00,,000011 <<00,,000011 00,,002211 00,,004422

death avoidance rr 0,03 0,29 0,07 PP 0,801 00,,000044 0,514

neutral acceptance rr 0,03 0,01 PP 0,768 0,959

approach acceptance rr 0,46 PP <<00,,000011

!I"#$#% 4. 9&0-*)-$&4 *(" $%+*5µ0*(7(83(" DAP-R

:7).&-*5 *&µ; <18&-*5 *&µ; <1-5 *&µ; SD Cronbach's a

fear of death 1,9 14,4 4,9 1,9 0,71death avoidance 1,2 7,0 4,9 1,5 0,85neutral acceptance 4,0 7,0 5,6 0,9 0,65approach acceptance 1,0 6,0 4,2 1,2 0,82escape acceptance 1,0 6,4 2,9 1,6 0,86

!I"#$#% 3. E#&%%(; #(" 0-=$3 *( #$%&-*0*&=/ *(" 20,)*("

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!"µ#$ 4 - !%&'#$ 1 [19]

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>7&=30fear of death r 0,11

P 0,257death avoidance r 0,27

P 0,006neutral acceptance r 0,03

P 0,760approach acceptance r 0,07

P 0,513escape acceptance r -0,02

P 0,828

!I"#$#% 7. ?,)7"-54 #0%08/,*+, µ$ *5 µ12(6( principal components<1-( ?#('"8; ?#(6(.; @/A(4 B"61*$%56&0'"8;4 20,)*(" 20,)*(" 20,)*(" 0#(6(.;

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02" 07*" *', 8"#µ' 00,,55111166 L =/,0*'% 02'*$9$4 µ;0 72"#1$#+ :;0 µ;0 809@*$(+ A53 00,,66992233 M9)25 *' =/,0*' 5% 0,08'@&;#+ 02" *0 $:8"#µ;0 -/#0,0 00,,66992299 M9)25 *' =/,0*' 5% 0,08'@&;#+ 02" *0 -/(+ 07*3% *+% A53% 00,,88223311 B,72'µ',6 :;0 *+ A53 µ$*/ *' =/,0*' 00,,770033 B2'&$@:5 *;% #8)N$;% =0,/*'7 µ$ 8/=$ 8"#*'% 00,,77111100 ?2'*$ + #8)N+ *'7 =0,/*'7 )(1$*0; #*' µ709" µ'7,

2('#20=6 ,0 *+ .;6I5 µ08(;/ 00,,77991122 !('#20=6 2/,*0 ,0 µ+, #8)&*'µ0; *' =/,0*' 00,,77771199 B2'&$@:5 ,0 #8)&*'µ0; *' =/,0*' 02" 8/=$ /2'N+ 00,,77992266 !('#20=6 ,0 µ+, )15 *42'*0 ,0 8/,5 µ$ *' =)µ0 *'7 =0,/*'7 00,,77001155 L =/,0*'% $4,0; ),5#+ µ$ *' =$" 80; 0;6,;0 $7.0;µ',40 00,,88442222 !('#-9)25 #$ µ;0 $20,),5#+ µ$ *'7% 0:02+µ),'7% µ'7

µ$*/ *' =/,0*" µ'7 00,,66332255 M9)25 *' =/,0*' 5% *' 2)(0#µ0 #$ ),0 0;6,;' 80; $79':+µ),' *"2' 00,,66222277 L =/,0*'% 2('#&)($; µ40 72)('1+ 0,08'@&;#+ *+% N713% 00,,44112288 <,0 2(/:µ0 2'7 µ'7 .4,$; /,$#+ #*' ,0 0,*;µ$*524#5

*' =/,0*' $4,0; + 24#*+ µ'7 #*+, µ$*0=/,0*' A53 00,,774411 L =/,0*'% $4,0; 15(4% 0µ&;-'940 µ40 µ08/-(;0 $µ2$;(40 00,,445522 O 2(''2*;83 *'7 .;8'@ µ'7 =0,/*'7 µ'7 .+µ;'7(:$4 /:1'% 00,,882277 E,'19'@µ0; 02" *+, '(;#*;8"*+*0 *'7 =0,/*'7 00,,88001188 <15 ),*',' &"-' :;0 *' =/,0*' 00,,77112200 J' =)µ0 *+% A53% µ$*/ *' =/,0*' µ$ 2('-9+µ0*4A$; ),*',0 00,,66552211 J' :$:',"% "*; ' =/,0*'% #+µ04,$; *' *)9'% "95, *5, 2(0:µ/*5,

"25% *0 :,5(4A5 µ$ &'-4A$; 00,,66553322 O 0-$-0;"*+*0 *'7 *; #7µ-04,$; µ$*/ *' =/,0*' µ$ 0,+#71$4 00,,443366 L =/,0*'% =0 2()2$; ,0 0,*;µ$*524A$*0; 5% 8/*; &7#;'9':;8",

0,0µ&;#-3*+*' 80; 0,02"&$78*' :$:',"% 00,,66001144 L =/,0*'% $4,0; &7#;83 .;/#*0#+ *+% A53% 00,,44661177 L@*$ &'-/µ0; '@*$ 8095#'(4A5 *' =/,0*' 00,,55442244 L =/,0*'% $4,0; 029/ ),0 *µ3µ0 *+% .;0.;80#40% *+% A53% 00,,44443300 L =/,0*'% .$, $4,0; '@*$ 809"% '@*$ 808"% 00,,4422


[20] !""#$%&' ()*%+,%&' -#. /+0#")1-%&2. !3%0-2µ#.

!"!#$%&'(H !")*+,A

1>-+7. ?,+ !0. /!3:µ,/0 !"& )-6!0µ+!"#"$%"& <,)-.)-$2:0*+. /&$*)*-,µ;.)7 @&1"µ)!-,*;7 <"*,µ+/%)7$,+ !0. )*!%µ0/0 !07 +A,"',/!%+7 (reliability) !"& )-6-!0µ+!"#"$%"&, !07 )$*&-(!0!+7 (validity), ).> '+-3#-#0#+ ;$,.) ;#)$1"7 !07 <"µ27 !"& (factor analysis).B&$*)*-,µ;.+ 0 +A,"',/!%+ )*!,µ2:0*) µ) !0 µ;!-0-/0 !07 )/6!)-,*27 /&.34),+7 (internal consistency)$,+ !". ;#)$1" !6. /!",1)%6. !"& )-6!0µ+!"#"$%"& !";.+ ).3.!,+ /!" 3##", µ;!-0/0 !"& <)%*!0 Cronbach’salpha (Cronbach, 1951). C,µ;7 µ)$+#=!)-)7 2 %/)7 !"&0,7 :)6-"=.!+, +'"<)*!;7. D, /&.!)#)/!;7 /&/1;!,-/07 !"& Pearson (r) 1-0/,µ"'",2:0*+. $,+ !0. /&/1;-!,/0 !6. <,+/!3/)6. !"& )-6!0µ+!"#"$%"& /!+ '#+%-/,+ !07 )$*&-(!0!+7 <"µ27. E +.3#&/0 '+-+$(.!6.1-0/,µ"'",2:0*) $,+ .+ <,)-)&.0:)% 0 <"µ2 !"& )-6-!0µ+!"#"$%"& DAP-R *+, $,+ .+ /&$*-,:)% µ) !0. +&:)-

.!,*2 <"µ2. E <,)-)=.0/0 !07 <"µ27 !"& )-6!0µ+!"-#"$%"& (exploratory factor analysis) ;$,.) µ) !0 1-2-/0 !07 µ):(<"& Principal Components Analysis µ)Varimax with Kaiser Normalization (rotation method),µ) !0. "'"%+ +.+80!"=.!+. ", ,<,+%!)-", '+-3$".!)7'"& /&.:;!"&. !" )-6!0µ+!"#($,". C+ )'%')<+ /0µ+-.!,*(!0!+7 )%.+, +µ4%'#)&-+ *+, 0 /!+!,/!,*2 /0µ+-.!,*(!0!+ !;:0*) /!" 0,05. ?,+ !0. +.3#&/0 1-0/,µ"-'",2:0*) !" /!+!,/!,*( '-($-+µµ+ SPSS 17.0.

!"#$%&'(µ)$)B!". ''%%..++**++ 11 <%.".!+, !+ <0µ"$-+4,*3 /!",1)%+ !6./&µµ)!)1(.!6. *+:>7 *+, /!",1)%+ '"& +4"-"=. /!0.)-$+/%+ !"&7.B!". ''%%..++**++ 22 <%.".!+, /!",1)%+ '"& +4"-"=. /!0./&µ')-,4"-3 !6. /&µµ)!)1(.!6. +';.+.!, /) +/:)-

!I"#$#% 8. O& 0#/C$&4 *+, -"µµ$*$./,*+, -.$*&=) µ$ *( 2),0*(

<1-5 *&µ; SD

L =/,0*'% $4,0; 15(4% 0µ&;-'940 µ40 µ08/-(;0 $µ2$;(40 5,5 1,9O 2(''2*;83 *'7 .;8'@ µ'7 =0,/*'7 µ'7 .+µ;'7(:$4 /:1'% 5,2 2,0B2'&$@:5 *;% #8)N$;% =0,/*'7 µ$ 8/=$ 8"#*'% 5,1 1,8!;#*$@5 "*; =0 $4µ0; #*', 20(/.$;#' µ$*/ 02" *' =/,0*" µ'7 3,8 1,7L =/,0*'% =0 $4,0; ),0 *)9'% :;0 "90 µ'7 *0 2('-93µ0*0 2,5 1,9L =/,0*'% =0 2()2$; ,0 0,*;µ$*524A$*0; 5% 8/*; &7#;'9':;8", 0,0µ&;#-3*+*' 80; 0,02"&$78*' :$:',"% 6,2 1,1E,'19'@µ0; 02" *+, '(;#*;8"*+*0 *'7 =0,/*'7 5,9 8,2L =/,0*'% $4,0; + $4#'.'% #$ ),0 16(' 02"97*+% ;80,'2'4+#+% 3,4 2,0L =/,0*'% 2('#&)($; µ40 .;0&7:3 02" *', 0204#;' 8"#µ' 2,9 1,9?2'*$ + #8)N+ *'7 =0,/*'7 )(1$*0; #*' µ709" µ'7, 2('#20=6 ,0 *+ .;6I5 µ08(;/ 5,2 1,9L =/,0*'% $4,0; 02$9$7=)(5#+ 02" *', 2",' 80; *0 -/#0,0 3,1 2,0!('#20=6 2/,*0 ,0 µ+, #8)&*'µ0; *' =/,0*' 4,5 2,1!;#*$@5 "*; ' 20(/.$;#'% =0 $4,0; ),0 809@*$(' µ)('% 02" 07*" *', 8"#µ' 4,4 2,2L =/,0*'% $4,0; &7#;83 .;/#*0#+ *+% A53% 6,2 1,0L =/,0*'% $4,0; ),5#+ µ$ *' =$" 80; 0;6,;0 $7.0;µ',40 5,1 1,8L =/,0*'% 02'*$9$4 µ;0 72"#1$#+ :;0 µ;0 809@*$(+ A53 3,4 1,8L@*$ &'-/µ0; '@*$ 8095#'(4A5 *' =/,0*' 5,1 1,7<15 ),*',' &"-' :;0 *' =/,0*' 4,0 2,1B2'&$@:5 ,0 #8)&*'µ0; *' =/,0*' 02" 8/=$ /2'N+ 4,9 1,9J' =)µ0 *+% A53% µ$*/ *' =/,0*' µ$ 2('-9+µ0*4A$; ),*',0 5,0 1,9J' :$:',"% "*; ' =/,0*'% #+µ04,$; *' *)9'% "95, *5, 2(0:µ/*5, "25% *0 :,5(4A5 µ$ &'-4A$; 4,7 1,9!('#-9)25 #$ µ;0 $20,),5#+ µ$ *'7% 0:02+µ),'7% µ'7 µ$*/ *' =/,0*" µ'7 4,9 2,1M9)25 *' =/,0*' 5% 0,08'@&;#+ 02" *0 $:8"#µ;0 -/#0,0 3,1 2,0L =/,0*'% $4,0; 029/ ),0 *µ3µ0 *+% .;0.;80#40% *+% A53% 5,7 1,3M9)25 *' =/,0*' 5% *' 2)(0#µ0 #$ ),0 0;6,;' 80; $79':+µ),' *"2' 4,5 1,8!('#20=6 ,0 µ+, )15 *42'*0 ,0 8/,5 µ$ *' =)µ0 *'7 =0,/*'7 4,7 1,8L =/,0*'% 2('#&)($; µ40 72)('1+ 0,08'@&;#+ *+% N713% 4,3 1,9<,0 2(/:µ0 2'7 µ'7 .4,$; /,$#+ #*' ,0 0,*;µ$*524#5 *' =/,0*' $4,0; + 24#*+ µ'7 #*+, µ$*0=/,0*' A53 4,8 2,0M9)25 *' =/,0*' 5% 0,08'@&;#+ 02" *0 -/(+ 07*3% *+% A53% 2,9 1,8L =/,0*'% .$, $4,0; '@*$ 809"% '@*$ 808"% 4,9 2,1B,72'µ',6 :;0 *+ A53 µ$*/ *' =/,0*' 3,0 1,9O 0-$-0;"*+*0 *'7 *; #7µ-04,$; µ$*/ *' =/,0*' µ$ 0,+#71$4 4,4 1,9


!"µ#$ 4 - !%&'#$ 1 [21]

!"!#$%&'(H !")*+,A

.)%7 '-"16-0µ;."& /!+<%"&.B!". ''%%..++**++ 33 <%.)!+, 0 )',--"2 '"& +/*)% !" ')-,-/!+!,*( !"& :+.3!"& /!"&7 /&µµ)!;1".!)7.F0µ,"&-$2:0*+. ", +-1,*;7 ';.!) <,+/!3/),7 !"& )-6-!0µ+!"#"$%"& DAP-R (as defined by Wong et al., 1994).B!". ''%%..++**++ 44 ')-,$-34".!+, +&!;7 ", <,+/!3/),7 !"&)-6!0µ+!"#"$%"& DAP-R.

G'"<)*!2 +A,"',/!%+ H3/0 !"& <)%*!0 Cronbach'sa (internal consistency Reliability of the DAP-R) ;1"&-

µ) /!,7 <,+/!3/),7 death avoidance, approach acceptance,escape acceptance. B!0 <,3/!+/0 neutral acceptance0 +A,"',/!%+ <). ;4!+/) !" +'"<)*!( (-," 0.7.B!". ''%%..++**++ 55 <%.".!+, ", /&.!)#)/!;7 /&/1;!,/07 !6.<,+/!3/)6. !"& )-6!0µ+!"#"$%"& DAP-R.

I'2-A) /0µ+.!,*2 :)!,*2 /&/1;!,/0 !07 <,3/!+-/07 «fear of death» µ) !,7 <,+/!3/),7 «death avoidance»,«approach acceptance» *+, «escape acceptance».G.!%:)!+, &'2-A) /0µ+.!,*2 +-.0!,*2 /&/1;!,/0 !07

!I"#$#% 9. @(%) *+, 0#0,*;-$+, *(" $%+*5µ0*(7(83("

9",0*14 0#0,*;-$&4

L =/,0*'% $4,0; 15(4% 0µ&;-'940 µ40 µ08/-(;0 $µ2$;(40 SD D MD U MA A SAO 2(''2*;83 *'7 .;8'@ µ'7 =0,/*'7 µ'7 .+µ;'7(:$4 /:1'% SA A MA U MD D SDB2'&$@:5 *;% #8)N$;% =0,/*'7 µ$ 8/=$ 8"#*'% SA A MA U MD D SD!;#*$@5 "*; =0 $4µ0; #*', 20(/.$;#' µ$*/ 02" *' =/,0*" µ'7 SD D MD U MA A SAL =/,0*'% =0 $4,0; ),0 *)9'% :;0 "90 µ'7 *0 2('-93µ0*0 SD D MD U MA A SAL =/,0*'% =0 2()2$; ,0 0,*;µ$*524A$*0; #0 8/*; &7#;'9':;8", 0,0µ&;#-3*+*' 80; 0,02"&$78*' :$:',"% SA A MA U MD D SDE,'19'@µ0; 02" *+, '(;#*;8"*+*0 *'7 =0,/*'7 SA A MA U MD D SDL =/,0*'% $4,0; + $4#'.'% #$ ),0 µ)('% 02"97*+% ;80,'2'4+#+% SD D MD U MA A SAL =/,0*'% 2('#&)($; µ40 .;0&7:3 02" *', 0204#;' 8"#µ' SA A MA U MD D SD?2'*$ + #8)N+ *'7 =0,/*'7 )(1$*0; #*' µ709" µ'7, 2('#20=6 ,0 *+ .;6I5 µ08(;/ SD D MD U MA A SAL =/,0*'% $4,0; 02$9$7=)(5#+ 02" *' 2",' 80; *0 -/#0,0 SD D MD U MA A SA!('#20=6 2/,*0 ,0 µ+, #8)&*'µ0; *' =/,0*' SA A MA U MD D SD!;#*$@5 "*; ' 20(/.$;#'% =0 $4,0; ),0 809@*$(' µ)('% 02" 07*" *', 8"#µ' SA A MA U MD D SDL =/,0*'% $4,0; &7#;83 .;/#*0#+ *+% A53% SA A MA U MD D SDL =/,0*'% $4,0; ),5#+ µ$ *' =$" 80; 0;6,;0 $7.0;µ',40 SD D MD U MA A SAL =/,0*'% 02'*$9$4 µ;0 72"#1$#+ :;0 µ;0 809@*$(+ A53 SA A MA U MD D SDL@*$ &'-/µ0; '@*$ 8095#'(4A5 *' =/,0*' SA A MA U MD D SD<15 ),*',' &"-' :;0 *' =/,0*' SD D MD U MA A SAB2'&$@:5 ,0 #8)&*'µ0; *' =/,0*' 02" 8/=$ /2'N+ SD D MD U MA A SAJ' =)µ0 *+% A53% µ$*/ *' =/,0*' µ$ 2('-9+µ0*4A$; ),*',0 SA A MA U MD D SDJ' :$:',"% "*; ' =/,0*'% #+µ04,$; *' *)9'% "95, *5, 2(0:µ/*5, "25% *0 :,5(4A5 µ$ &'-4A$; SA A MA U MD D SD!('#-9)25 #$ µ;0 $20,),5#+ µ$ *'7% 0:02+µ),'7% µ'7 µ$*/ *' =/,0*" µ'7 SD D MD U MA A SAM9)25 *' =/,0*' 5% 0,08'@&;#+ 02" *0 $:8"#µ;0 -/#0,0 SA A MA U MD D SDL =/,0*'% $4,0; 029/ ),0 *µ3µ0 *+% .;0.;80#40% *+% A53% SA A MA U MD D SDM9)25 *' =/,0*' 5% *' 2)(0#µ0 #$ ),0 0;6,;' 80; $79':+µ),' *"2' SA A MA U MD D SD!('#20=6 ,0 µ+, )15 *42'*0 ,0 8/,5 µ$ *' =)µ0 *'7 =0,/*'7 SD D MD U MA A SAL =/,0*'% 2('#&)($; µ40 72)('1+ 0,08'@&;#+ *+% N713% SD D MD U MA A SA<,0 2(/:µ0 2'7 µ'7 .4,$; /,$#+ #*' ,0 0,*;µ$*524#5 *' =/,0*' $4,0; + 24#*+ µ'7 #*+, µ$*0=/,0*' A53 SD D MD U MA A SAM9)25 *' =/,0*' 5% 0,08'@&;#+ 02" *0 -/(+ 07*3% *+% A53% SD D MD U MA A SAL =/,0*'% .$, $4,0; '@*$ 809"% '@*$ 808"% SA A MA U MD D SDB,72'µ',6 :;0 *+ A53 µ$*/ *' =/,0*' SA A MA U MD D SDO 0-$-0;"*+*0 *'7 *; #7µ-04,$; µ$*/ *' =/,0*' µ$ 0,+#71$4 SD D MD U MA A SA

SD=strongly disagree .;0&5,6 02"97*0, D=disagree .;0&5,6, MD= moderately disagree .;0&5,6 µ)*(;0, U= undecided0,02'&/#;#*'%/+, MA= moderately agree #7µ&5,6 µ)*(;0, A=agree #7µ&5,6, SA=strongly agree #7µ&5,6 02"97*0


<,3/!+/07 «fear of death» µ) !0 <,3/!+/0 «neutralacceptance». G*(µ+, &'2-A) /0µ+.!,*2 :)!,*2 /&/1;-!,/0 !07 <,3/!+/07 «death avoidance» µ) !0 <,3/!+-/0 «approach acceptance». C;#"7, &'2-A) /0µ+.!,-*2 :)!,*2 /&/1;!,/0 !07 <,3/!+/07 «escape acceptance»µ) !0 <,3/!+/0 «approach acceptance».B!". ''%%..++**++ 66 <%.".!+, ", /&.!)#)/!;7 /&/1;!,/07 !6.<,+/!3/)6. !"& )-6!0µ+!"#"$%"& DAP-R µ) !0. 0#,-*%+ !6. /&µµ)!)1(.!6..

I'2-A) /0µ+.!,*3 1+µ0#2 :)!,*2 /&/1;!,/0 !07<,3/!+/07 «death avoidance» µ) !0. 0#,*%+ !6. /&µ-µ)!)1(.!6.. D'(!) (/" +&A3.)!+, 0 0#,*%+ !6. /&µ-µ)!)1(.!6. !(/" +&A3.)!+, *+, 0 +'"4&$2 !"& :+.3-!"&. F). H-;:0*) /0µ+.!,*2 /&/1;!,/0 !07 0#,*%+7µ) !"&7 &'(#",'"&7 '+-3$".!)7.B!". ''%%..++**++ 77 <%.".!+, !+ +'"!)#;/µ+!+ !07 +.3#&-/07 '+-+$(.!6. (factor analysis) µ) !0 µ;:"<" principalcomponents.

E /&."#,*2 µ)!+H#0!(!0!+ '"& )')A0$)%!) +'(!"&7 +.6!;-6 5 '+-3$".!)7 )%.+, 58%. D '+-3$".!+7«G'"4&$2 :+.3!"&» /&µ'%'!), µ) !0 <,3/!+/0 «Deathavoidance». 5'%/07, " '+-3$".!+7 «J(H"7 :+.3!"&»+'"!)#)%!+, +*-,H>7 +'( !,7 %<,)7 )-6!2/),7 µ) !0<,3/!+/0 «Fear of death». D '+-3$".!+7 «D&<;!)-0+'"<"12» /&µ'%'!), µ) !0 <,3/!+/0 «Neutral acceptance».D, )-6!2/),7 4,8,13,16 *+, 31 µ) !0. '+-+'3.6 +.3-#&/0 ')-,;1".!+, /!". '+-3$".!+ «K;/" <,+4&$27»+.!% .+ ')-,;1".!+, /!0 <,3/!+/0 «Approach acceptance».

L!/, *+!+#2$"&µ) /!" (!, !" )-6!0µ+!"#($," )%.+,;$*&-" )-$+#)%" $,+ !0. )*!%µ0/0 !07 /!3/07 !6.."/0#)&!>. +';.+.!, /!" :3.+!" +##3 &'3-1), µ,+<,+4"-"'"%0/0 /!" '",)7 )-6!2/),7 /&µ')-,#+µH3-

.), " *3:) '+-3$".!+7 /!0. )##0.,*2 )*<"12 !"& DAP-R.B!!". ''%%..++**++ 88 ')-,$-34".!+, ", +'(@),7 !6. /&µµ)-!)1(.!6. /1)!,*3 µ) !" :3.+!", ('67 +&!;7 H+:µ"-#"$2:0*+. *+!3 µ;/" (-" +'( !"&7 )-$+8(µ)."&7.B!". ''%%..++**++ 99 ')-,$-34)!+, 0 4"-3 !6. +'+.!2/)6.!"& )-6!0µ+!"#"$%"&.B!". ''%%..++**++ 1100 '"& +*"#"&:)% ')-,$-34".!+, ", .;)7<,+/!3/),7 !"& )-6!0µ+!"#"$%"& DAP-R.

G'"<)*!2 +A,"',/!%+ H3/0 !"& <)%*!0 Cronbach'sa (internal consistency Reliability of the DAP-R) ;1"&-µ) /!,7 ')-,//(!)-)7 <,+/!3/),7. B!0 <,3/!+/0 D&<;-!)-0 +'"<"12 0 +A,"',/!%+ <). ;4!+/) !" +'"<)*!((-," 0.7.B!". ''%%..++**++ 1111 <%.".!+, ", /&.!)#)/!;7 /&/1;!,/07!6. .;6. <,+/!3/)6. !"& )-6!0µ+!"#"$%"& DAP-R.

I'2-A) /0µ+.!,*2 µ;!-,+ :)!,*2 /&/1;!,/0 !07<,3/!+/07 «K;/" <,+4&$27» µ) !0 <,3/!+/0 «G'"-<"12 :+.3!"&». 5'%/07, &'2-A) /0µ+.!,*2 1+µ0#2:)!,*2 /&/1;!,/0 !07 <,3/!+/07 «K;/" <,+4&$27»µ) !0 <,3/!+/0 «J(H"7 :+.3!"&». 5'%/07, &'2-A)/0µ+.!,*2 µ;!-,+ :)!,*2 /&/1;!,/0 !07 <,3/!+/07«G'"4&$2 :+.3!"&» µ) !,7 <,+/!3/),7 «G'"<"12 :+.3-!"&» *+, «J(H"7 :+.3!"&». I'2-A) /0µ+.!,*2 1+µ0-#2 :)!,*2 /&/1;!,/0 !07 <,3/!+/07 «G'"<"12 :+.3-!"&» µ) !0 <,3/!+/0 «J(H"7 :+.3!"&» *+, D&<;!)-0+'"<"12. C;#"7, &'2-A) /0µ+.!,*2 µ;!-,+ +-.0!,*2/&/1;!,/0 !07 <,3/!+/07 «D&<;!)-0 +'"<"12» µ) !0<,3/!+/0 «J(H"7 :+.3!"&».B!". ''%%..++**++ 1122 <%.".!+, ", /&.!)#)/!;7 /&/1;!,/07!6. .;6. <,+/!3/)6. !"& )-6!0µ+!"#"$%"& DAP-R µ)!0. 0#,*%+ !6. /&µµ)!)1(.!6..

[22] !""#$%&' ()*%+,%&' -#. /+0#")1-%&2. !3%0-2µ#.

!"!#$%&'(H !")*+,A

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ABSTRACT

OORRIIGGIINNAALL AARRTTIICCLLEEDDEEAATTHH AATTTTIITTUUDDEE PPRROOFFIILLEE--RREEVVIISSEEDD ((DDAAPP--RR))--VVAALLIIDDAATTIIOONN OOFF GGRREEEEKK VVEERRSSIIOONN MM.. KKaalllliiaarroouu11,, PP.. SSaarraaffiiss22,, KK.. KKaarraatthhaannaassii33,, TT.. SSeerraaffiimm44,, KK.. SSoottiirriiaaddoouu55,, EE.. TThheeooddoossooppoouulloouu66

[[11.. CCaappttaaiinn RRNN,, MMSScc oonn HHeeaalltthh IInnffoorrmmaattiiccss,, GGrraadduuaattee SSttuuddeenntt ooff HHeeaalltthh CCaarree MMaannaaggeemmeenntt,, OOppeenn UUnniivveerrssiittyy ooff CCyypprruuss,,PPhhDDcc NNuurrssiinngg FFaaccuullttyy,, NNaattiioonnaall CCaappooddiissttrriiaann UUnniivveerrssiittyy ooff AAtthheennss,, 440044 GGeenneerraall MMiilliittaarryy HHoossppiittaall,, SScciieennttiiffiicc ccoollllaabboorraattoorrTTeecchhnnoollooggiiccaall IInnssttiittuuttiioonn ooff LLaarriissaa//NNuurrssiinngg DDeeppaarrttmmeenntt,, 22.. LLiieeuutteennaanntt RRNN,, HHeell.. NNaavvyy,, AAtthheennss NNaavvaall && VVeetteerraannssHHoossppiittaall,, PPhhDD,, SScciieennttiiffiicc ccoollllaabboorraattoorr NNCCUUAA,, TTrraavveell MMeeddiicciinnee ooff EEvvggeenniiddeeiioonn HHoossppiittaall,, 33.. MMaajjoorr RRNN,, SSppeecciiaalliizzeedd oonnSSuurrggeerryy NNuurrssiinngg AAMMEEDDDD,, TTeexxaass UUSSAA,, GGrraadduuaattee SSttuuddeenntt ooff HHeeaalltthh CCaarree MMaannaaggeemmeenntt,, OOppeenn UUnniivveerrssiittyy ooff CCyypprruuss,,HHeeaadd NNuurrssee,, 440044 GGeenneerraall MMiilliittaarryy HHoossppiittaall,, 44.. MMaajjoorr,, MMeennttaall HHeeaalltthh RRNN,, 442244 GGeenneerraall MMiilliittaarryy HHoossppiittaall,, 55.. MMaajjoorr RRNN,,HHeelllleenniicc AArrmmyy GGeenneerraall SSttaaffff,, 66.. AAssssoocciiaattee PPrrooffeessssoorr,, NNuurrssiinngg FFaaccuullttyy,, NNaattiioonnaall CCaappooddiissttrriiaann UUnniivveerrssiittyy ooff AAtthheennss]]

AAiimm:: To translate a questionnaire that evaluates and validates the attitude of nurses’ attitudes towards death.MMeetthhoodd:: 150 nurses completed this questionnaire. The initial DAP-R was constructed by Wong, P.T.P., Reker, G.T.,and Gesser, G in 1994. It contains 32 questions and is separated in 5 sub levels where the participants are asked toanswer a seven-level Likert scale (I absolutely agree to I absolutely disagree).The DAP-R was translated in Greek and a psychometric evaluation of the tool was made. Prior translating and usingthe tools/questionnaires, permission was guaranteed by the authors. Translation was based on “Trust ScientificAdvisory Committee” SAC: (double reversed translation) cultural adjustment, validation of the questionnaire. In orderto validate the questionnaire certain psychometric tests were conducted to estimate the reliability and validity of thequestionnaire, in addition control of factor analysis was also made. RReessuullttss:: The factor «apofigi thanatou (G'"4&$2 :+.3!"&)» overlaps with the aspect «Death avoidance». Moreover,the factor «fovos thanatou (J(H"7 :+.3!"&)» consists of the same questions as the aspect «Fear of death». The factor«oudeteri apodoxi (D&<;!)-0 +'"<"12)» overlaps with the aspect «Neutral acceptance». Questions 4, 8, 13, 16 and31 based on the above analysis are included in factor «meso diafigis (K;/" <,+4&$27)» instead of aspect «Approachacceptance».CCoonncclluussiioonn:: The Greek version of DAP-R is a reliable and valid tool to estimate nurses' attitude towards death.

KKeeyy wwoorrddss:: death, nurse, validation.


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678&7#9/):;)1. Cronbach. 1951. http://www.joe.org/joe/1999april/tt3.php2. Clements R, Rooda LA. Factor structure, reliability, and validity of

the death attitude profile-revised. Omega 1999-2000; 40(3): 453-463.3. Kubler-Ross E. Death and Dying Macmillan. New York. 1969.4. Medical Outcomes Trust Bulletin 1997 http://www.outcomes-

trust.org/bulletin/0797blltn.htm5. Trust Scientific Advisory Committee” SAC http://www.outcomes-

trust.org/monitor/nov98/8.html6. Wong TP, Gesser G, Reker GT. Death attitudes across the life-

span: The development and validation of the Death Attitude Profile(DAP). Omega 1987; 18: 104-124.


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ABSTRACT

OORRIIGGIINNAALL AARRTTIICCLLEETTHHEE VVAACCCCIINNEE CCOOVVEERRAAGGEE OOFF SSCCHHOOOOLLCCHHIILLDDRREENN ((66--1166 YYEEAARRSS OOLLDD)) IINN AA GGRREEEEKK PPRROOVVIINNCCEEEE.. KKaassttrraappaa11,, AA.. IIffaannttiiss22,, DD.. HHaanniioottii33,, EE.. SSiiaammaannggaa44,, II.. PPrreessssaass55,, GGeeoorrggiiaa RRaappttii33,, SS.. TTssiirriinnggaa11

[[11.. MM..SScc..,, HHeeaalltthh VViissiittoorr ooff HHeeaalltthh CCeenntteerr aatt SSttyylliiddaa,, 22.. RRNN,, MM..SScc..,, GGeenneerraall HHoossppiittaall ooff LLaammiiaa,, 33..RRNN,, 44.. AAssssiissttaannttPPrrooffeessssoorr ooff TTEEII LLaammiiaa,, 55.. NNuurrssiinngg ssttuuddeenntt ooff TTEEII LLaammiiaa]]

AAiimm:: To assess the vaccine coverage of schoolchildren in the responsibility area of a Health Center, as recordedduring Personal Health Card ( PHC) fill-in procedure.MMaatteerriiaall aanndd mmeetthhooddss:: The sample consisted of 611 pupils( boys: 319), aged 6-16 years old of the 1st, 3rd and 5thgrade of Elementary School as well of 1st Junior High School class and 1st High School class, in the responsibilityarea of Stylida Health Center. Their PHC records were evaluated. X2 was used for comparison and statistical significancewas set at p=0,05.RReessuullttss:: 319 children ( 51.20%) were boys and 292(47.80%) were girls. Fully vaccinated for all the recommendedvaccines were 139 boys and 132 girls, 43.57% and 44.1% respectively. No statistical differences were observed betweenboys and girls. Most low vaccination coverage refers to meningococcus vaccine ( 45,51%) followed by MMR andvaricella –zoster vaccine (14.42%. CCoonncclluussiioonnss:: A considerable percentage of school children of both sexes s presented with vaccination coveragedeficits. Most deficits occur in vaccines lately introduced in The National Vaccination Program.

KKeeyy wwoorrddss:: Personal Health Card (PHC), vaccine, Health Promotion.


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0%. E.H.C.S., 296-7, 359-360, 362-4.4. G'7()0-G($µ0#*;,'@ JA., JA0,08/8+ J., (2004). E=,;8" G),*(' B,0-&'(/% D+,;::4*;.0%, :15.

5. G5,#*0,*"2'79'% K.B., (2005). EI$94I$;% #*+, !0;.;0*(;83, C;0-:,5#*;83 80; T$(02$7*;83. D$*$820;.$7*;8" H$µ;,/(;' !0;.;0-*(;83%. M’ !0;.;0*(;83 G9;,;83 !0,$2;#*+µ4'7 B=+,6,.

6. D0#*(02/ E., M)99;'% C., Q0*A"2'79'% >., 80; #7,. (1996). >'#+-("*+*0 20;.;6, +9;840% 5-15 $*6, #*+, 2$(;'13 H*794.0% F0µ40%.!(08*;8/ 8'7 !0,$99+,4'7 H7,$.(4'7 K$,;83% U0*(;83%, Q098;.;83.

7. >'@90 D., K8$#'@9+ E., D0#*(':;/,,+% C., 80; #7,. (2008).Vaccination coverage in primary school children of urban andsuburban population in central Greece. U0*(;8/ Q(',;8/. GBV (10):486-90.

8. !0,0:;5*"2'79'% J., M09/##+–B./µ E (1998). !0,$990.;83 µ$9)-*+ 80*/#*0#+% $µ-'9;0#µ'@. U,#*;*'@*' 7:$40% *'7 20;.;'@, C;$@-=7,#+ G';,5,;83% !0;.;0*(;83%, B=3,0

9. !0,0:;5*"2'79'% J., M09/##+–B./µ E., H0(0&4.'7 E. 80; #7,.(2002). E=,;83 µ$9)*+ Eµ-'9;0#µ6, 2001: G/97N+ µ$ $µ-"9;' :;0

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10. !0,0:;5*"2'79'% J., M09/##+–B./µ E., H0(0&4.'7 E. 80; #7,.(2002). E=,;83 µ$9)*+ Eµ-'9;0#µ6, 2001: G/97N+ µ$ DTP 80;MMR, 4o !0,$993,;' H7,).(;' C+µ"#;0% 7:$40% 80; S2+($#;6,7:$40% , B=3,0 ( 2$(49+N+).

11. !0,0:;5*"2'79'% J. 80; 'µ/.0 µ$9)*+%, E=,;83 H1'93 C+µ"#;0%S:$40% *'7 20;.;'@, U,#*;*'@*' S:$40% *'7 20;.;'@, G),*(' E9):-1'7 80; !("9+N+% >'#+µ/*5, (*µ3µ0 E2;.+µ;'9':;83% $2;*3-(+#+%), B(;#*'*)9$;' !0,$2;#*3µ;' T$##09',48+% (U0*(;8" *µ3-µ0), !0,$2;#*3µ;' G(3*+% (*'µ)0% 8';,5,;83% U0*(;83%), S2'7(:$4'S:$40% 80; G';,5,;83% B99+9$::@+, (2006). E=,;83 µ$9)*+ 80*/-#*0#+% $µ-'9;0#µ'@ 80; #71,"*+*0% &7µ0*;83% 9'4µ5I+% #*020;.;/, #$9. 6, 8, 15-23, 32-35.

12. Philalithis AE (1995). Health Service Reforms in Bulgaria:Constraints and Opportunities, #*': Oealth Challenges forCountries of Central and Eastern Europe and the Newly IndependentStates, Harrington P., Ritsatakis A. ( Eds), Copenhagen, Denmark.


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ABSTRACT

OORRIIGGIINNAALL AARRTTIICCLLEEHHUUMMAANN RREESSOOUURRCCEESS FFOORR HHEEAALLTTHH NNEEEEDDSS AASSSSEESSSSMMEENNTT OOFF LLIIFFEE--LLOONNGG LLEEAARRNNIINNGG IINN TTHHEE FFRRAAMMEEWWOORRKK OOFF TTHHEESSTTRRAATTEEGGIICC NNAATTIIOONNAALL DDEEVVEELLOOPPMMEENNTT PPLLAANN 22000077--22001133DD.. AAnnddrriioottii11,, DD.. KKoommmmaattaass22,, AA.. SSkkiittssoouu33,, GG.. CChhaarraallaammbboouuss44,, CC.. BBaarroo55

[[11.. BBAA,, MMSScc,, PPhhDD,, HHeeaalltthh EEccoonnoommiisstt,, SScciieennttiiffiicc CCoollllaabboorraattee ooff TTEEII ooff AAtthheennss,, 22.. BBAA,, MMSScc,, PPoolliittiiccaall SScciieennttiisstt,, CChhiieeff ooffEEdduuccaattiioonnaall DDiirreeccttoorraattee ooff MMiinniissttrryy ooff HHeeaalltthh aanndd SSoocciiaall SSoolliiddaarriittyy,, 33.. BBAA,, MMSScc,, PPhhDD,, LLaawwyyeerr,, PPrrooffeessssoorr ooff FFrreeddeerriiccUUnniivveerrssiittyy,, CCyypprruuss,, 44.. CChhiieeff ooff EEmmeerrggeennccyy DDeeppaarrttmmeenntt,, IIppppookkrraatteeiioonn GGeenneerraall HHoossppiittaall ooff AAtthheennss,, 55.. RRNN,, MMiinniissttrryy ooffHHeeaalltthh aanndd SSoocciiaall SSoolliiddaarriittyy]]

BBaacckkggrroouunndd:: Education and training contribute to better responsiveness and performance. Relevant policies shouldbe based on the population health needs assessment. The National Strategic Development Plan (NSDP) 2007-2013is a unique opportunity for planning modern education and training so that human resources for health meet currentand future needs of the population AAiimm:: The aim of this study was to assess health professionals’ training needs and life-long learning in our country,based on population profiles, and was one of the consultation documents under the National Strategic DevelopmentPlan (NSDP) 2007-2013MMeetthhoodd:: Demographic and epidemiological data of the Greek population were combined with relevant human resourcespolicies described by international organizations CCoonncclluussiioonn:: Leadership is crucial in shaping the appropriate policy and establishing goals and strategies to achievehuman resource development. Key issues to be addressed to this direction is detailed inventory of existing capacity(numbers and characteristics), the provision for future services, improving the quality and skills, through investmentin education and training, including lifelong learning and education in new technologies.

KKeeyy wwoorrddss:: Life long learning, health professional, skills, competencies.


whr06_consultation/en/index.html *+,-*."#-/'0. 10/4/103. 1*,2+(.3, 1(.3%4 0%5 6,578750)4 9""'".((:'4 (2005). ;."</' -/,

*"%3-5, /,2 !=750,: >/+%/'(50,: >?.$3,2 97#*/2@'4-1(.3% 0%5 6,5-78750) 9""'".((:' !>&9 2007-2013. 1169, 9=)7%

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9. !>1! (2009). D+.27% !0*%3$.2-'4 !7'"3087. B."/3, C:*,2, ;#+-/5,4 http://www.statistics.gr/portal/page/portal/ESYE/BUCKET/A0102/PressReleases/A0102_SJO18_DT_AH_00_2007_01_F_GR.pdf*+,-*."#-/'0. 5/ 4/10

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11. >%++)4 ;. &5.++#0,4 E. 9µ3/-'4 E. 62+5F*,2",4 E. >,:"'4 >(2006). 9@5,"F('-' $,µA7 -27.?5GFµ.7'4 0%/#+/5-'4 -/54 2*'-+.-3.4 2(.3%4. H,-'".2/50) 45(1):118-128

12. OECD (2010). Highlights from education at a glance OECD 201013. EUROSTAT (2009). Lifelong learning statistics http://epp.eurostat.ec.

europa.eu/statistics_explained/index.php/Lifelong_learning_statistics*+,-*."#-/'0. 5/ 4/10

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of the European Societies. Population and social conditions.Statistic in focus. 72

15. 97$+5A/' 0%5 I,2µ."5A/' (2007). B'µ,(+%J3%, B'µF-5% 1(.3% 0%5&,"5/50) 1(.3%4. !0$F-.54 &%*%G)-', 9=)7%

16. European centre for the development of VET, (Cedefop) (2008).Future Skill Needs in Europe. Medium-term forecast: synthesisreport. Luxembourg: Publications Office, *+,-*."#-/'0. 10/4/10http://www.cedefop.europa.eu/EN/Files/4078_en.pdf

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18. 1*,2+(.3, 97#*/2@'4 (2005). C.?7,",(50) &+,,*/50) B5.+.:7'--' -/'7 !""#$% >27=./50) D0=.-'. B5.:=27-' >?.$5%-µ,: 0%5&+,(+%µµ%/5-µ,:, 9=)7%

19. Kachur E., Krajic K (2006). Structures and Trends in healthprofession Education in Europe. In: Dubois C-A., McKee M.,Nolte E (eds) Human Resources for Health 5n Europe. EuropeanObservatory on Health Systems and Policies. Open UniversityPress pp 79-97

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21. 62+5F*,2",4 E. >,:"'4 >. 97$+5A/' B. K+2-#0'4 ; (1996). ;."<-/' 6%=,+5-µ,: /87 97%(0A7 !*%((."µ%/50)4 6%/#+/5-'4 (!+(%-G,µ<787 0%5 97<+(87) %7# &.+5J<+.5% 0%5 !5$50F/'/% -/,7 C,µ<%/'4 1(.3%4. C,µ<%4 L50,7,µ3%4 /'4 1(.3%4 !>B1, 0%5 Cµ)µ% B5,3-0'-'4 ;,7#$87 1(.3%4, >?,") !*%((."µ#/87 1(.3%4 0%5 &+F7,5-%4, C!M 9=)7%4. 1169, 9=)7%

22. &5.++#0,4 E. >%++)4 ; 9µ3/-'4 E. 62+5F*,2",4 E. >,:"'4 >.(2006) !0*%5$.2/50<4 %7#(0.4 0%5 -27.?5GFµ.7' 0%/#+/5-' %7=+A-*57,2 $27%µ50,: /,µ<% 2(.3%4. H,-'".2/50), 45(4):543-551

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ABSTRACT

OORRIIGGIINNAALL AARRTTIICCLLEETTRREEAATTMMEENNTT OOFF CCHHRROONNIICC KKIIDDNNEEYY DDIISSEEAASSEE:: CCOOSSTT AANNAALLYYSSIISS OOFF BBIICCAARRBBOONNAATTEE DDIIAALLYYSSIISS AANNDDHHAAEEMMOODDIIAAFFIILLTTRRAATTIIOONNPPaarraasskkeevvii TThheeooffiilloouu,, PPhhDD PPssyycchhoollooggiisstt,, NNaattiioonnaall SScchhooooll ooff PPuubblliicc AAddmmiinniissttrraattiioonn,, DDeeppaarrttmmeenntt ooff MMaannaaggeemmeenntt ooffHHeeaalltthh SSeerrvviicceess,, AAtthheennss

AAiimm:: The economic assessment of haemodialysis (HD) in a Unit of Artificial Kidney of a private clinic. More specifically,cost analysis of bicarbonate dialysis and haemodiafiltration is used.

PPooppuullaattiioonn SSttuuddyy:: 120 patients with end - stage renal disease, undergoing HD in the Unit of Artificial Kidney of theclinic in 2006.

MMaatteerriiaall aanndd MMeetthhoodd:: The demographic, clinical and economic characteristics were recorded from the files ofpatients. Data were collected by the finance management of the clinic with regards to the payroll of personnel,the capital and technological equipment, dampings, fixed costs and other consumables. Prices of 2006 were usedand one HD session was considered as the unit of cost.

RReessuullttss:: The total cost of an HD session with haemodiafiltration surpasses by 30% of the method of bicarbonatedialysis. This important increase of cost is due to the additional sanitary material that is required in the particularmethod (bags and lines of haemodiafiltration).

CCoonncclluussiioonnss:: HD is an especially expensive method regarding the treatment of end - stage renal diseasepatients, based on the use of innovative technologies. Similar analyses of economic evaluation are not fullydocumented, if they do not take into account of the clinical superiority and they do not attribute in terms ofcost -effectiveness.

KKeeyy wwoorrddss:: Economic Assessment, chronic Kidney disease, bicarbonate dialysis, haemodiafiltration


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2. E.3/,7%, ;., (1996). «&,"5/50) 0%5 L50,7,µ50# /'4 1(.3%4». 9=)7%:!@#7/%4.

3. Drummond, M., O’ Brien, B., Stoddart, G., Torrance, G., (1997).«;<=,$,5 ,50,7,µ50)4 %@5,"F('-'4 /87 *+,(+%µµ#/87 2(.3%4».;/J+. I,:--,4, H., 9=)7%: 6+5/50).

4. Goeree, R., Manalich, J., Grootendorst, P., Beecroft, M. L., Churchill,D. N., (1995). «Cost analysis of dialysis treatments for end-stagerenal disease». In: Clin Invest Med, 18: 455-464.

5. Kontodimopoulos, N., Niakas, D., Mylonakis, J., (2005). «A socio-economic comparison of haemodialysis and peritoneal dialysisin Greece». In: Int J Health Care Tech Manag, 6: 296-306.

6. 62+5F*,2",4, E., H5#0%4, B., (1994). «Q<µ%/% L50,7,µ50A7 0%5 &,"5-/50)4 1(.3%4». 9=)7%: 6<7/+, 6,578750A7 !*5-/'µA7 /'4 1(.3%4.

7. P5%+F*,2",4, P., (1996%). «N%+µ%0,,50,7,µ50<4 µ."</.4 0%5 µ.=,-

$,",(50# =<µ%/% 0,-/,"F('-'4». >/,: N%+µ%0.2/50), 9 (MMM): 97-105.

8. Piccoli, G., Formica, M., Mangiarotti, G., Pacitti, A., Piccoli, GB.,Bajardi, P., Cavagnino, A., Ghezzi, P., Rangi, R., Ramello, A.,Verzetti, G., Cesano, G., Quarello, F., Vercellone, A., (1997). «Thecost of dialysis in Italy». In: Nephrol Dial Transplant, 12 (Suppl.1): 33-44.

9. Rodriguez-Carmona, A., Perez Fontan, M., Bouza, P., GarciaFalcon, T., Valdes, F., (1996). «The economic cost of dialysis: acomparison between peritoneal dialysis and in-center haemodialysisin a Spanish unit». In: Adv Perit Dial, 12: 93-96.

10. Rozenbaum, A. E., Pliskin, J. S., Barnoon, S., Chaimovitz, C.,(1985). «Comparative study of costs and quality of life of chronicambulatory peritoneal dialysis and haemodialysis patients inIsrael». In: Israel Journal of Medical Sciences, 21: 335-339.

11. Tediosi, F., Bertolini, G., Parazzini, F., Mecca, G., Garattini, L.,(2001). «Cost analysis of dialysis modalities in Italy». In: HealthServ Manag Res, 14: 9-17.


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[50] !""#$%&' ()*%+,%&' -#. /+0#")1-%&2. !3%0-2µ#.

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ABSTRACT

RREEVVIIEEWWEEMMOOTTIIOONNAALL IINNTTEELLLLIIGGEENNCCEE:: TTHHEEOORRYY AANNDD TTHHEE IIMMPPLLIICCAATTIIOONNSS IINN TTHHEE NNUURRSSIINNGG LLEEAADDEERRSSHHIIPPZZooii VVoorrrrii RRNN,, BBSScc,, MMSScc MMeennttaall HHeeaalltthh

BBaacckkggrroouunndd:: Emotional intelligence is popular in literature as an important characteristic for successful leaders.Health care is changing rapidly and leaders should use modern models of leadership focused on creating relationshipsbased on trust. Nurse leaders who exhibit characteristics of emotional intelligence enhance staff organizationalskills and effectiveness of their work.AAiimm:: This paper aims to present an analysis of the literature on Emotional Intelligence and explore the implicationsof it for the nursing leadership.MMeetthhoodd:: A literature search was undertaken using international databases (MEDLINE, PUBMED) covering the period1998 to 2008. A hand-search of relevant journals added to the data.CCoonncclluussiioonnss:: Emotionally intelligent nurse leaders who are self-aware, supervisory skillful, capable of address theemotional side of their staff can develop strong synergized teams, necessary for the survival during this changinghealthcare landscape.

KKeeyy wwoorrddss:: Emotional intelligence, nursing administration, competence, leadership


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ABSTRACT

RREEVVIIEEWWTTHHEE RROOLLEE OOFF HHEEAALLTTHHCCAARREE PPRROOFFEESSSSIIOONNAALLSS AANNDD TTHHEE IIMMPPRROOVVEEMMEENNTT OOFF SSEERRVVIICCEE QQUUAALLIITTYY IINN HHOOSSPPIITTAALLSSDDrr.. YYaannnniiss MMaarrkkoovviittss11,, SSooffiiaa MMoonnaassttiirriiddoouu22

[[11.. PPhhDD..,, AAssttoonn BBuussiinneessss SScchhooooll,, AAssttoonn UUnniivveerrssiittyy,, BBiirrmmiinngghhaamm,, UUKK –– NNaattiioonnaall CCeennttrree ooff PPuubblliicc AAddmmiinniissttrraattiioonn aannddLLooccaall GGoovveerrnnmmeenntt,, TThheessssaalloonniikkii,, 22.. NNuurrssee,, AAggiiooss DDiimmiittrriiooss PPuubblliicc HHoossppiittaall,, TThheessssaalloonniikkii]]

The quality in the healthcare services is important for the provision of healthcare treatment for the patients. Its maindimensions relate to human resources, organization and procedures, and the outcomes from the services offeredto patients. The methods available for the improvement of quality levels have to do with Total Quality Management,systems for quality assurance and quantitative methods relevant to quality and the relationship between cost andbenefit. The role of the human factor for the improvement of quality through Donabedian’s conceptual framework issubstantial, since it is related to all three dimensions comprising healthcare services. Finally, as far as the implementationof quality improvement programmes in hospitals, in Greece and abroad, it has been found that Greece lacks behindother developed EU and OECD countries, due to the absence of organized and systematic activity on quality assuranceand development of relative quality programmes. KKeeyywwoorrddss:: service quality, health professionals, Donabedian, Total Quality Management, quality assurance


[56] !""#$%&' ()*%+,%&' -#. /+0#")1-%&2. !3%0-2µ#.

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6/72/%*(+8,+1. /234%56(7, /.8., !%952$7, :. 1999. ;<(13&=37 "93=$7/,-&-*--

µ3=-: :6%-)"<=37 *$% <1-*2+&3%7, >?µ-7 8’: 8%-=*(&( "<(13&%@#"93=$7-#-&-*-µ3=A#, 3µ<3%1=37, )5&3%7 *$% <1--<)%*B7. C/D,D5)1$.

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19. >-.#)$7, N. 2003. L B##-%$ )(7 <-%?)()$7 &)(# :$)1%*+ *$% )%7 "<(-13&=37 "93=$7. /1K3=$ C22(#%*+7 :$)1%*+7 20(5), 532-546.

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[58] !""#$%&' ()*%+,%&' -#. /+0#")1-%&2. !3%0-2µ#.

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N'=$3Cµ' )"( 3 $):34 "3- ,3!#:'-"/ !-,87'"+(1µ'!+ 0+( 3-!(+!"(01 µ' "3, $):3 "3- «!-µ>3C:3-»(Maslow, 1970 & 1973, Rogers, 1969) 0+( -23!"#$%-&3-µ' "#, +,+*0+()"#"+ 2$3D?#!#4 "#4 !-µ>3-:'--"(0/4 !"3 <D$3 "3- 63!303µ'%3-, µ' "$)23 D!"' ,+8('-03:-,?'% # '.7:(.# "#4 +2:/4 !<7!#4 ,3!#:'--"/ – +!?',/ !' '-$C"'$# !-µ>3-:'-"(0/ !<7!#. (M3!µ%-83--Hardy 1993, M3!µ)23-:34 1996).

O::=!"', 3 %8(34 3 !")<34 +-"/4 "#4 2$3!21?'(-+4 !"3 63!303µ'%3 8', '%,+( 1::34 +2) "3 ,+ 8('-03-:C,'( "3, +!?',/ 2$34 µ(+ 3:)2:'-$# 0+( -*(/ +,1-2"-.#, '2("-</ +.(323%#!# "3- '+-"3C "3-, '2("-</+,"(µ'"D2(!# 2$3>:#µ1"=, 23- !-,+,"1, !"#, 2+$3C-!+ 8C!03:# ;1!# "#4 &=/4 "3-, 0+( :/9# 0+:D, +23-;1!'=,. (M+:3C$#, 1992).

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"#!#4, +::1 0+( ,+ '%,+( !' ?7!# ,+ "+ <$#!(µ323(-'%. Sµ=4, +4 µ# .'<,1µ' )"( 7$'-,'4 7<3-, 0+"+8'%-.'( )"( :)*= "=, 8(+;)$=, 2$3>:#µ1"=, 23- +,"(-µ'"=2%&'( 3 ,3!#:'-"/4 23::74 ;3$74 )<( µ3,)+8-,+"'% ,+ <$#!(µ323(/!'( "'<,(074 +23"':'!µ+-"(0/4 '2(03(,=,%+4, +::1 +,+&#"1 3 %8(34 !-µ>3--:'-"(0/ 0+( 9-<3:3*(0/ -23!"/$(.# (M+:3C$#, B?+-,+!3C:+, 2002).

B, 0+:)4 ,3!#:'-"/4 '%,+( +-")4 23- 7<'( 0+:)*,=!(3:3*(0) '2%2'83 *(+ "#, '2(!"/µ# "3-, '2%!#40+:)4 ,3!#:'-"/4 '%,+( +-")4 23- <'($%&'"+( +23-"':'!µ+"(01 "(4 '2(03(,=,(+074 "'<,(074 0+( 8'.()-"#"'4. A%,+( +-")4 23- =4 23µ2)4 '027µ2'( µ' "$)-23 23- 3 870"#4 – +!?',/4 ,+ 0+"+,3'% +-"1 23-'027µ23,"+(. A%,+( +-")4 23- 7<'( "# 8-,+")"#"+ ,+8(+;3$3¬23('% "#, !-µ2'$(;3$1 "3- 2$34 );':34µ(+4 ':'C?'$#4 '2(03(,=,(+0/4/!-µ>3-:'-"(0/4!<7!#4. 5"#, 2'$%2"=!# 8', "#4 !-µ>3-:'-"(0/4 '2(-03(,=,(+0/4 !<7!#4 "3- ,3!#:'-"/ '%,+( !+;74 )"(+,+;'$)µ+!"':BB)) 5"#, +µ;%8$3µ#, -(3?'"D,"+4 8(+8$+!"(01 µ3,"7-:+ '2(03(,=,%+4 (H+0 M3-7#: 1993, M+&1&# 1995),0+( )<( "#, µ3,)8$3µ# '2(03(,=,%+, )23- 3 23µ2)4)<( µ),3, ',8(+;7$'"+( *(+ "#, 3$?/ :/9# 0+( +23-0=8(0323%#!# "3- µ#,Cµ+"34, +::1 +,+"$3;383"'%-"+( +2) "#, +,"%8$+!# "3- :/2"# 0+( # '2(03(,=,%+0+?%!"+"+( 2'$(!!)"'$3 +23"':'!µ+"(0/ (M+:3C-$#,2002)UU)) 5"#, 0-0:(0/ 0+( )<( '-?C*$+µµ# '2(03(,=,%+,)23- ',(!<C'"+( # +µ3(>+()"#"+ "#4 '2(03(,=,(+0/48(+8(0+!%+4 µ7!+ +2) "#, '2(:'0"(0/ :/9# 0+( 0+"’'270"+!# +230=8(0323%#!# "=, µ#,-µ1"=, "3-23µ23C +2) "3, +23870"# (M+:3C$#, 2002).LL)) 5"#, +::30',"$(0/ / 0+( +::#:30',"$(0/ '2(03(-,=,(+0/ 2$3!7**(!#, # 323%+ +;3$1 "#, %8(+ "# !<7-!# µ'"+.C "=, 2$3!D2=, 23- '2(03(,=,3C,, "# !-,1-,"#!#, "#, '2(03(,=,%+ 0+( )<( "#, '*=0',"$(0/'2(03(,=,%+ )23- "3 1"3µ3 '2(03(,=,'% *(+ "(4 8(074"3- µ),3, +,1*0'4 (H2+0($"&/4, 2002).JJ)) 5"#, ;-!(0/, '0 "3- !C,'**-4 0+( )<( '. +23!"1-!'=4 '2(03(,=,%+, # 323%+ 2$+*µ+"323('%"+( µ' "#;-!(0/ 2+$3-!%+ "3- 23µ23C 0+( "3- 870"#AA)) P)!3 !"#, :'0"(0/ )!3 0+( !"# µ# :'0"(0/ '2(03(-,=,%+ (Pease 1991, M3µ,#,10#4 1998, Verderber,1997). A.1::3- 8', '%,+( :%*3( '0'%,3( 23- 7<3-,0+"+:/.'( !"3 !-µ27$+!µ+ )"( "3 65% "#4 '2(03(-,=,%+4 '%,+( +23"7:'!µ+ "#4 µ# :'0"(0/4 !-µ2'$(-;3$14 0+( µ),3 "3 35% +23"7:'!µ+ "#4 :'0"(0/4(Burgoon, etal. 1989)

N'=$'%"+( +2+$+%"#"3 # '2(03(,=,%+ ,+ 2$+*µ+-"323('%"+( ':'-?7$+, ,+ -21$<'( +"µ)!;+($+ +23-83</4, ,+ -21$<3-, ',8'%.'(4 )"( 3( (87'4 "3- +!?'-,/ :+µ>1,3,"+( 2$1*µ+"( -2)9#. M1?' 1239#, !<):(3/ (87+ ,+ +,"(µ'"=2%&'"+( ?'"(01, ):+ "+ !-µµ'"7-<3,"+ µ7:# ,+ 8%,3-, 2$3!3</ !"+ 8$Dµ',+, ,+ µ#µ3,32=:'%"+( # '2(03(,=,%+ µ),3 +2) 0123(+ 1"3µ+

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A,D :3(2), # !#µ+!%+ "#4 0+:/4 '2(03(,=,(+-0/4 !<7!#4 '%,+( 2$3;+,/4, 8', '%,+( :%*'4 3( ;3$7423- 8#¬µ(3-$*3C,"+( *(+ 0123(3-4 :)*3-4 2$3>:/-µ+"+ !"#, '2(03(,=,%+, 2$3>:/µ+"+ "+ 323%+ µ23-$'% ,+ !<'"%&3,"+( µ' "3, 23µ2), "3, 870"#, "3 µ7!3-8%+-:3 '2(03(,=,%+4 / 0+( +-") +0)µ# "3 2'$('<)µ',3"3- µ#,Cµ+"34 (J#µ#"$)23-:34 & M+:3C$#, 2002).

P+ 0%,#"$+ 0+( 3( 'µ2'($%'4 "3- 23µ23C 0+( "3-870"#, "3- ,3!#:'-"/ 8#:+8/ 0+( "3- +!?',/, "+2$3!830Dµ',+, 3( 03(,=,(074 µ+4 +,"(:/9'(4, #!-,+(!?#µ+"(0/ µ+4 0+"1!"+!#, 3 0D8(0+4 23- <$#-!(µ323(3Cµ', "$32323(3C, !-,'(8#"1 / +!-,'%8#"+"#, '023µ2/ 0+( +,"%!"3(<+ "# :/9# "3- µ#,Cµ+"34.Q+$=?#"(01 '$'?%!µ+"+ !-,"':3C, !"# 8#µ(3-$*%+0+:/4 '2(03(,=,(+0/4 – 0=8(0323(#"(0/4 0+( +23-0=8(0323(#"(0/4 – !<7!#4 0+( 8(+!;+:%&3-, 0+:C-"'$'4 8(+2$3!=2(074 !<7!'(4 (J#µ#"$)23-:34 &M+:3C$#, 2002).

B0)µ#, !#µ+,"(0) $):3 !"#, 0+:/ '2(03(,=,%+0+( "(4 +23"':'!µ+"(074 8(+2$3!=2(074 !<7!'(42+%&'( "3 2D4 3( 8C3 !-,3µ(:#"74 +,"(:+µ>1,3,"+("3, '+-") "3-4. O"3µ+ µ' ?'"(0/ +-"3'(0),+ 0+( ?'"(-0) +-"3!-,+%!?#µ+, !' +,"%?'!# µ' "+ 1"3µ+ µ'<+µ#:/ +-"3'(0),+, 7<3-, "#, "1!# ,+ +2387<3,"+(0+( "3-4 1::3-4 0+( ,+ +230=8(0323(3C, "+ '2(03(-,=,(+01 µ#,Cµ+"+ µ' "3, "$)23 23- ?'=$3C, )"( ?+'2(?-µ3C!' 3 !-,3µ(:#"/4 "3-4 (Verderber, 2000.Remy, 1988) 0+?(!"D,"+4 +23"':'!µ+¬"(0)"'$# "#,'2(03(,=,%+.

I+(+.$1(/#$/.G J@%$)2)#µ+$/.4- :@/.%/0?0,+-Q)"' )µ=4 ?+ µ23$3C!+µ' ,+ <+$+0"#$%!3-µ' +23-"':'!µ+"(0/ "#, '2(03(,=,%+; N+ :7*+µ' )"+, «-:3-23(3C,"+( 3( !0323% *(+ "3-4 323%3-4 *%,'"+(», )"+,«3( 8(+2$3!=2(074 !<7!'(4 8('-03:C,3,"+( !"3,µ7*(!"3 >+?µ)», )"+, 3( !-µµ'"7<3,"'4 7<3-, 03(-,3C4 0D8(0'4, )"+, -21$<'( '2+$0/4 '2(03(,=,(+-0/ (0+,)"#"+, )"+, # '2(03(,=,(+0/ !-µ2'$(;3$1'%,+( 0+"1::#:# 0+( +23"':'!µ+"(0/ (M+:3C$#,2002). A%,+( 8' 0+"1::#:# 0+( +23"':'!µ+"(0/, )"+,'0;$1&'( "3, !-*0'0$(µ7,3 !032) 0+( "3 0%,#"$3"3- 23µ23C, )"+, '2("-*<1,'( "3-4 !")<3-4 "#4, )"+,!-µµ3$;D,'"+( µ' )!+ +,+µ7,3,"+( !"#, '2(03(-,=,(+0/ +-"/ !<7!# (Spitzberg, 1997) 0+( )"+, "':(-0D4 "3 '02'µ2)µ',3 µ/,-µ+ *%,'"+( +238'0") +2)"3, :/2"# +0$(>D4 )2=4 ?+ "3 /?':' 0+( "3 ',,3-3C!' 3 23µ2)4.

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[60] !""#$%&' ()*%+,%&' -#. /+0#")1-%&2. !3%0-2µ#.

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42, 355-363.3. Douglas, T. (1997). L C<%O=A&( &)%7 Fµ5637. G$&%*B7 /1KB7 )(7!"µµ3)-K+7 &3 Fµ5637. /'+#$: C22(#%*5 N15µµ$)$.

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&3%7 P22(#. 12. Verderber, R. (2000). Inter-act Using interpersonal communication

skills, (8ed), Wadsworth.13. 8(µ()1?<-"2-7, C. & 0$2-.1(-/#)A#-<-.2-", F. (2003). D$%-

6$9A9%*+ Q"K-2-9=$. /<? )( R3A1=$ H5'(&(7 &)(# C*<$=63"-&( ,BA# *$% C#(2=*A#, /'+#$, 3*6. CEEL,

14. R3-I%2=6(7, S. (1997). 834%?)()37 8%6$&*$2=$7: 2. C<%*-%#A#=$./'+#$: C*6. N1(9?1(7.

15. 0$M5M(, H. (1995). /#'1@<%#37 !KB&3%7 *$% C<%*-%#A#=$. /'+#$:C*6. CEEL,.

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17. 0-&µ?<-"2-7, /. (1996). !.µO-"2-7 *$% 65&*$2-7. 8"- ?T3%7)-" %6=-" #-µ=&µ$)-7; C<%'3@1(&( !"µO-"23")%*+7 *$% D1-&$-#$)-2%&µ-., ). 38-39, 1996, 102-109.

18. Mialaret, G. (1991). Pedagogic Generate. Paris; P.U.F.19. H$* 0-"B(2, ,. & G%#)52, !. (1993). H-#)B2$ C<%*-%#A#=$7, (µ)I1.).

/'+#$: C*6. 0$¬&)$#%@)(7.20. H<$*%1)M+7 0. (1996). L 6"#$µ%*+ )(7 $22(23<=61$&(7 &)(# 3<%-

*-%#A#=$, /'+#$, Gutenberg.21. H<$*%1)M+7, 0. (2002). C<%*-%#A#=$ *$% /9A9+. /'+#$: C*6.

Gutenberg.

ABSTRACT

RREEVVIIEEWWTTHHEE DDIISSCCUUSSSSIIOONN AASS AANN EEFFFFEECCTTIIVVEE WWAAYY OOFF CCOOMMMMUUNNIICCAATTIIOONN IINN DDAAIILLYY NNUURRSSIINNGG PPRRAACCTTIICCEE MMaarrnneerraass CChhrriissttooss11,, AArrvvaanniittiiss GGeeoorrggiiooss22

[[11.. NNuurrssee TT..EE..,, MMSScc --PPHHDDcc,, UUnniivveerrssiittyy HHoossppiittaall ooff RRiioo,, 22.. NNuurrssee TT..EE..,, HHoossppiittaall ooff RRiioo]]

The communication is an interaction process aiming at the exchange of messages. It is innate in each person, butsome techniques and skills are teachable. The nurses are considered "professionals" in communication, sincenursing is based upon the competence to create good interpersonal relations with the patients.

WWoorrddss KKeeyyss:: discussion, communication, consultation, nursing practice, transmitter, receptor, message, patient.


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ABSTRACT

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In an international level, the effort of reducing the mean time of hospitalization in secondary and tertiary health careinstitutions constitutes a common practice. Modern technologies provide the possibility of reliable and empoweredhealth care, out of hospitals. This fact becomes very important given that in contemporary societies the populationolder than 65 years old constantly increases. “Smart Wearable Biomedical Systems” could play a key-role in thepreventive health care. The present article constitutes a thorough study, based on the review of relevant printed andon-line Greek and International literature. The purpose of the study is to present current situation about “Smart WearableBiomedical Systems”, focusing on the monitoring of cardiovascular and respiratory disorders. Topics like telemedicine,telecare, informatics’ and communications’ technologies are presented as well. Additionally, concepts relatively biologicalsigns and the operation of biosensors regarding measuring vital parameters of human body are described.

KKeeyywwoorrddss:: Telemedicine, wearable systems, biosensors, life signs, health services, telecommunications, telecare,smart clothes.


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[2005] «>#"2?-=,*4@ (=#$ 1,<A#», !43%(2*7 !$ 9"', BC@$- 2. D;E<,# F. (2005), “1,+7 =+ -5,*+”, >+ )@µ-, 20-08-20053. http://mpl.med.uoa.gr/ekpaideytiko-yliko/i-y-stin-iatrik/tileiatrik.pdf4. http://www.msobiz.com/site/SleepApnea/Vivo/5. http://www.pdacortex.com/VivoMetrics.htm6. http://www.vitatherapy.gr/DCA0AFF6.el.aspx7. http://www.vivometrics.com/8. http://www.wealthy.gr9. http://el.wikipedia.org/wiki/Bluetooth/GSM

GG22$$%%&&""''((((## ))**))""**++&&,,--..//--10. A.C.Norris [2002] Essentials of Telemedicine and Telecare,

WILEY11. Axisa F., Schmitt P. M., Gehin C., Delhomme G., McAdams E.,

Dittmar A., [2005], Flexible technologies and smart clothingfor Citizen Medicine, Home Healthcare, and Disease Prevention,H!!! Transactions on Information Technology in Biomedicine

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International Solid-State Circuits Conference14. Ikeda K., Watanabe A. and Saito M. [1991], “A Vital Sign Sensor

for Elderly .People at Home”, Biotelemetry, Vol. 1115. John Mantas, Arie Hasman. [2007] 1"#,+.+,*4@ =#7 I&2/-7

J+(#"2;=*4@ 1,+(K&&*(#. H-=,*4K7 !43%(2*7 1.F. 1-(E-"/3#7 16. Mann S., [1997], Smart Clothing: The Wearable Computer

and WearCam, Personal and Ubiquitous Computing17. Fabrice Axisa, Pierre Michael Schmitt, Claudine Gehin, Georges

Delhomme, Eric McAdams, and André Dittmar [SEPTEMBER2005] Flexible Technologies and Smart Clothing for Citizen,Medicine, Home Healthcare, and Disease Prevention. IEEETRANSACTIONS ON INFORMATION TECHNOLOGY INBIOMEDICINE, VOL. 9, NO. 3

18. Field M.J. [1996] “Telemedicine: A guide to assessingtelecommunications in health care”, Washington, DC: NationalAcademy Press

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21. Van Langenhove L., Hertleer C., [2004], Smart clothing: a newlife, International Journal of Clothing Science and Technology

22. Wollina U., Heide M., Müller-Litz W., Obenauf D., Ash J., [2003],Functional Textiles in Prevention of Chronic Wounds, WoundHealing and Tissue Engineering, Textiles and the Skin

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4. 6*- K$- =;9'µK$+ <,C,+ (2 92,*+3*4%: Padda, J. (2003) “CreativeWriting in Coventry”. Journal of Writing Studies 3 (2) 44-59

5. 6*- µ*- *(=+(2"/3-: Centre of Academic Writing The List of ReferencesIllustrated [online] available from http://home.ched.coventry.ac.uk/caw/harvard/index.htm [Sept 2009]

6. 6*- K$- <,C,+ (2 #"24=,+$*4% 92,*+3*4%: Dhillon, B. (2004) “ShouldDoctors Wear Ties?” Medical Monthly [online] 3 (1) 55-88. availablefrom http://hospitals/infections/latest-advice [20 April 2005]

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Ελληνικό περιοδικό της Νοσηλευτικής Επιστήjournal-ene.gr/wp-content/uploads/2011/05/TOMOS4_TEFXOS1.pdf1, Ι Α Ν Ο Υ Α Ρ Ι Ο Σ-Φ Ε Β