TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
TEYXOS 172 3/17/09 11:13 AM Page 3 - μ. πιτσιλιδης α.ε.
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<strong>TEYXOS</strong> <strong><strong>17</strong>2</strong> 3/<strong>17</strong>/<strong>09</strong> <strong>11</strong>:14 <strong>AM</strong> <strong>Page</strong> 68<br />
Σ Υ Ν Τ Ο Μ Η Ε Ν Η Μ Ε Ρ Ω Σ Η<br />
Η ΡΗΕ <strong>ε</strong>ίχ<strong>ε</strong> <strong>ε</strong>υ<strong>ε</strong>ργ<strong>ε</strong>τικά<br />
<strong>α</strong>ποτ<strong>ε</strong>λέσ<strong>μ</strong><strong>α</strong>τ<strong>α</strong><br />
ως προς τον κ<strong>α</strong>τ<strong>ε</strong>υν<strong>α</strong>σ<strong>μ</strong>ό<br />
της <strong>α</strong>νησυχί<strong>α</strong>ς<br />
των <strong>α</strong>σθ<strong>ε</strong>νών,<br />
<strong>α</strong>λλά <strong>α</strong>νά<strong>μ</strong><strong>ε</strong>ικτη <strong>ε</strong>πίδρ<strong>α</strong>ση<br />
<strong>α</strong>ν<strong>α</strong>φορικά<br />
<strong>μ</strong><strong>ε</strong> άλλ<strong>α</strong> κλινικά<br />
<strong>α</strong>ποτ<strong>ε</strong>λέσ<strong>μ</strong><strong>α</strong>τ<strong>α</strong>.<br />
68 / MEDICAL EXPRESS / TEYXOΣ <strong><strong>17</strong>2</strong> / ΜΑΡΤΙΟΣ 20<strong>09</strong><br />
to physicians. Early experience with<br />
disclosure laws in Vermont and Minnesota.<br />
J<strong>AM</strong>A 2007 Mar 21; 297: 1216-23.<br />
Νέ<strong>ε</strong>ς κ<strong>α</strong>τ<strong>ε</strong>υθυντήρι<strong>ε</strong>ς<br />
οδηγί<strong>ε</strong>ς <strong>α</strong>πό το USPSTF<br />
Το USPSTF προέβη σ<strong>ε</strong> <strong>α</strong>ν<strong>α</strong>σκόπηση<br />
των στοιχ<strong>ε</strong>ίων γι<strong>α</strong> τη χρήση <strong>α</strong>σπιρίνης,<br />
<strong>μ</strong>η κορτικοστ<strong>ε</strong>ρο<strong>ε</strong>ιδών <strong>α</strong>ντιφλ<strong>ε</strong>γ<strong>μ</strong>ονωδών<br />
φ<strong>α</strong>ρ<strong>μ</strong>άκων (NSAIDs) κ<strong>α</strong>ι <strong>α</strong>ν<strong>α</strong>στολέων<br />
της κυκλοοξυγ<strong>ε</strong>νάσης τύπου 2<br />
(COX-2), γι<strong>α</strong> την πρωτογ<strong>ε</strong>νή πρόληψη<br />
των <strong>α</strong>δ<strong>ε</strong>νω<strong>μ</strong>άτων κ<strong>α</strong>ι του κ<strong>α</strong>ρκίνου του<br />
π<strong>α</strong>χέος <strong>ε</strong>ντέρου κ<strong>α</strong>ι του ορθού. Επ<strong>ε</strong>ιδή<br />
οι βλάβ<strong>ε</strong>ς που <strong>α</strong>υτά τ<strong>α</strong> φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong><br />
προκ<strong>α</strong>λούν <strong>ε</strong>ίν<strong>α</strong>ι π<strong>ε</strong>ρισσότ<strong>ε</strong>ρ<strong>ε</strong>ς των οφ<strong>ε</strong>λών,<br />
το USPSTF δ<strong>ε</strong> συνιστά τη χρήση<br />
ρουτίν<strong>α</strong>ς της <strong>α</strong>σπιρίνης ή των NSAID<br />
γι<strong>α</strong> την πρόληψη του κ<strong>α</strong>ρκίνου του π<strong>α</strong>χέος<br />
<strong>ε</strong>ντέρου κ<strong>α</strong>ι του ορθού στ<strong>α</strong> άτο<strong>μ</strong><strong>α</strong><br />
που δι<strong>α</strong>τρέχουν <strong>μ</strong><strong>ε</strong>σ<strong>α</strong>ίο κίνδυνο.<br />
To USPSTF <strong>ε</strong>ντόπισ<strong>ε</strong> <strong>ε</strong>π<strong>α</strong>ρκή έως ικ<strong>α</strong>νοποιητικά<br />
στοιχ<strong>ε</strong>ί<strong>α</strong> που δ<strong>ε</strong>ίχνουν ότι<br />
η λήψη <strong>α</strong>σπιρίνης κ<strong>α</strong>ι NSAID σ<strong>ε</strong> υψηλή<br />
δοσολογί<strong>α</strong> <strong>μ</strong><strong>ε</strong>ιών<strong>ε</strong>ι τ<strong>α</strong> συ<strong>μ</strong>βά<strong>μ</strong><strong>α</strong>τ<strong>α</strong><br />
<strong>α</strong>δ<strong>ε</strong>νω<strong>μ</strong><strong>α</strong>τωδών πολυπόδων, <strong>ε</strong>π<strong>α</strong>ρκή<br />
στοιχ<strong>ε</strong>ί<strong>α</strong> που <strong>α</strong>ποδ<strong>ε</strong>ικνύουν ότι η <strong>α</strong>σπιρίνη<br />
<strong>μ</strong><strong>ε</strong>ιών<strong>ε</strong>ι τ<strong>α</strong> συ<strong>μ</strong>βά<strong>μ</strong><strong>α</strong>τ<strong>α</strong> κ<strong>α</strong>ρκίνου<br />
του π<strong>α</strong>χέος <strong>ε</strong>ντέρου κ<strong>α</strong>ι του ορθού κ<strong>α</strong>ι<br />
ικ<strong>α</strong>νοποιητικά στοιχ<strong>ε</strong>ί<strong>α</strong> που δηλώνουν<br />
ότι η <strong>α</strong>σπιρίνη σ<strong>ε</strong> χ<strong>α</strong><strong>μ</strong>ηλή δοσολογί<strong>α</strong><br />
δ<strong>ε</strong> <strong>μ</strong><strong>ε</strong>ιών<strong>ε</strong>ι τ<strong>α</strong> συ<strong>μ</strong>βά<strong>μ</strong><strong>α</strong>τ<strong>α</strong> κ<strong>α</strong>ρκίνου του<br />
π<strong>α</strong>χέος <strong>ε</strong>ντέρου κ<strong>α</strong>ι του ορθού. Συγκ<strong>ε</strong>ντρώθηκ<strong>α</strong>ν<br />
<strong>ε</strong>πίσης ικ<strong>α</strong>νοποιητικά στοιχ<strong>ε</strong>ί<strong>α</strong><br />
που υποδηλώνουν ότι η λήψη<br />
<strong>α</strong>υτών των φ<strong>α</strong>ρ<strong>μ</strong>άκων συσχ<strong>ε</strong>τίζ<strong>ε</strong>τ<strong>α</strong>ι <strong>μ</strong><strong>ε</strong><br />
την πρόκληση τουλάχιστον <strong>μ</strong>έτρι<strong>α</strong>ς<br />
β<strong>α</strong>ρύτητ<strong>α</strong>ς βλ<strong>α</strong>βών (γ<strong>α</strong>στρ<strong>ε</strong>ντ<strong>ε</strong>ρική<br />
<strong>α</strong>ι<strong>μ</strong>ορρ<strong>α</strong>γί<strong>α</strong> κ<strong>α</strong>ι ν<strong>ε</strong>φρικές βλάβ<strong>ε</strong>ς <strong>μ</strong><strong>ε</strong> τη<br />
λήψη NSAID, <strong>α</strong>ι<strong>μ</strong>ορρ<strong>α</strong>γικό <strong>α</strong>γγ<strong>ε</strong>ι<strong>α</strong>κό<br />
<strong>ε</strong>γκ<strong>ε</strong>φ<strong>α</strong>λικό <strong>ε</strong>π<strong>ε</strong>ισόδιο <strong>μ</strong><strong>ε</strong> την <strong>α</strong>σπιρίνη<br />
κ<strong>α</strong>ι κ<strong>α</strong>ρδι<strong>α</strong>γγ<strong>ε</strong>ι<strong>α</strong>κά συ<strong>μ</strong>βά<strong>μ</strong><strong>α</strong>τ<strong>α</strong> <strong>μ</strong><strong>ε</strong> τους<br />
<strong>α</strong>ν<strong>α</strong>στολ<strong>ε</strong>ίς της COX-2). Κ<strong>α</strong><strong>μ</strong>ί<strong>α</strong> ο<strong>μ</strong>άδ<strong>α</strong><br />
<strong>ε</strong>ιδικών δ<strong>ε</strong> συνιστά τ<strong>α</strong> συγκ<strong>ε</strong>κρι<strong>μ</strong>έν<strong>α</strong><br />
φάρ<strong>μ</strong><strong>α</strong>κ<strong>α</strong> γι<strong>α</strong> την πρόληψη του κ<strong>α</strong>ρκίνου<br />
του π<strong>α</strong>χέος <strong>ε</strong>ντέρου κ<strong>α</strong>ι του ορθού.<br />
Σχόλιο: Αν κ<strong>α</strong>ι η χη<strong>μ</strong><strong>ε</strong>ιοπροφύλ<strong>α</strong>ξη<br />
έν<strong>α</strong>ντι του κ<strong>α</strong>ρκίνου του π<strong>α</strong>χέος <strong>ε</strong>ντέρου<br />
κ<strong>α</strong>ι του ορθού <strong>α</strong>ποτ<strong>ε</strong>λ<strong>ε</strong>ί <strong>μ</strong>ι<strong>α</strong> πολλά<br />
υποσχό<strong>μ</strong><strong>ε</strong>νη στρ<strong>α</strong>τηγική, τ<strong>α</strong> στοιχ<strong>ε</strong>ί<strong>α</strong><br />
δ<strong>ε</strong>ν <strong>ε</strong>υνοούν τη χρήση των υπ<strong>α</strong>ρχουσών<br />
<strong>ε</strong>πιλογών ή τουλάχιστον όχι <strong>α</strong>πό<br />
άτο<strong>μ</strong><strong>α</strong> που δ<strong>ε</strong>ν δι<strong>α</strong>τρέχουν <strong>α</strong>υξη<strong>μ</strong>ένο<br />
κίνδυνο <strong>ε</strong><strong>μ</strong>φάνισης της συγκ<strong>ε</strong>κρι<strong>μ</strong>ένης<br />
<strong>μ</strong>ορφής κ<strong>α</strong>ρκίνου. Αυτό που πρέπ<strong>ε</strong>ι ν<strong>α</strong><br />
ση<strong>μ</strong><strong>ε</strong>ιωθ<strong>ε</strong>ί <strong>ε</strong>ίν<strong>α</strong>ι ότι η <strong>α</strong>σπιρίνη σ<strong>ε</strong> χ<strong>α</strong><strong>μ</strong>ηλή<br />
δοσολογί<strong>α</strong>, η οποί<strong>α</strong> χρησι<strong>μ</strong>οποι<strong>ε</strong>ίτ<strong>α</strong>ι<br />
<strong>ε</strong>υρέως γι<strong>α</strong> την πρόληψη της στ<strong>ε</strong>φ<strong>α</strong>νι<strong>α</strong>ί<strong>α</strong>ς<br />
νόσου, δ<strong>ε</strong>ν προλ<strong>α</strong><strong>μ</strong>βάν<strong>ε</strong>ι<br />
τ<strong>α</strong>υτόχρον<strong>α</strong> κ<strong>α</strong>ι τον κ<strong>α</strong>ρκίνο του π<strong>α</strong>χέος<br />
<strong>ε</strong>ντέρου κ<strong>α</strong>ι του ορθού.<br />
Βιβλιογρ<strong>α</strong>φί<strong>α</strong>:<br />
1. U.S. Preventive Services Task Force.<br />
Routine aspirin of non-steroidal antiinflammatory<br />
drugs for the primary<br />
prevention of colorectal cancer U.S.<br />
Preventive Services Task Force<br />
recommendation statement. Ann Intern<br />
Med 2007 Mar 6; 146: 361-4.<br />
2. Dube C et al. The use of aspirin for<br />
primary prevention of colorectal cancer.<br />
A systematic review prepared for the<br />
U.S. Preventive Services Task Force. Ann<br />
Intern Med 2007 Mar 6; 146: 365-75.<br />
3. Rostom A et al. Non steroidal antiinflammatory<br />
drugs and cyclo-oxygenase<br />
-2 inhibitors for primary prevention of<br />
colorectal cancer A systematic review<br />
prepared for the U.S. Preventive Services<br />
Task Force. Ann Intern Med 2007 Mar<br />
6; 146: 376-89.<br />
Πόσο ωφέλι<strong>μ</strong>ο <strong>ε</strong>ίν<strong>α</strong>ι<br />
το «check up ρουτίν<strong>α</strong>ς»;<br />
Τ<strong>α</strong> οφέλη <strong>α</strong>ν<strong>α</strong>φορικά <strong>μ</strong><strong>ε</strong> την υγ<strong>ε</strong>ί<strong>α</strong> που<br />
προσφέρ<strong>ε</strong>ι η π<strong>ε</strong>ριοδική <strong>ε</strong>ξέτ<strong>α</strong>ση ή <strong>α</strong>ξιολόγηση<br />
της υγ<strong>ε</strong>ί<strong>α</strong>ς (ΡΗΕ) έχουν κ<strong>α</strong>τά<br />
κ<strong>α</strong>ιρούς <strong>α</strong><strong>μ</strong>φισβητηθ<strong>ε</strong>ί. Ορισ<strong>μ</strong>ένοι θ<strong>ε</strong>ωρούν<br />
ότι <strong>α</strong>υτού του <strong>ε</strong>ίδους οι <strong>ε</strong>ξ<strong>ε</strong>τάσ<strong>ε</strong>ις<br />
θ<strong>α</strong> <strong>μ</strong>πορούσ<strong>α</strong>ν κ<strong>α</strong>ι ν<strong>α</strong> προκ<strong>α</strong>λέσουν<br />
ζη<strong>μ</strong>ί<strong>α</strong>, οδηγώντ<strong>α</strong>ς στην <strong>α</strong>ν<strong>α</strong>ζήτηση υπηρ<strong>ε</strong>σιών<br />
<strong>α</strong>πό τις οποί<strong>ε</strong>ς δ<strong>ε</strong>ν <strong>α</strong>ποκο<strong>μ</strong>ίζ<strong>ε</strong>ι<br />
κ<strong>α</strong>ν<strong>ε</strong>ίς κάποιο <strong>α</strong>ποδ<strong>ε</strong>δ<strong>ε</strong>ιγ<strong>μ</strong>ένο όφ<strong>ε</strong>λος.<br />
Ερ<strong>ε</strong>υνητές προέβησ<strong>α</strong>ν σ<strong>ε</strong> συστη<strong>μ</strong><strong>α</strong>τική<br />
<strong>α</strong>ν<strong>α</strong>σκόπηση ώστ<strong>ε</strong> ν<strong>α</strong> συνδυάσουν<br />
τ<strong>α</strong> δι<strong>α</strong>θέσι<strong>μ</strong><strong>α</strong> στοιχ<strong>ε</strong>ί<strong>α</strong> κ<strong>α</strong>ι ν<strong>α</strong> δι<strong>α</strong>πιστώσουν<br />
τ<strong>α</strong> πιθ<strong>α</strong>νά οφέλη κ<strong>α</strong>ι τις ζη<strong>μ</strong>ί<strong>ε</strong>ς.<br />
Εντόπισ<strong>α</strong>ν 10 τυχ<strong>α</strong>ιοποιη<strong>μ</strong>έν<strong>ε</strong>ς <strong>ε</strong>λ<strong>ε</strong>γχό<strong>μ</strong><strong>ε</strong>ν<strong>ε</strong>ς<br />
<strong>μ</strong><strong>ε</strong>λέτ<strong>ε</strong>ς κ<strong>α</strong>ι 23 <strong>μ</strong><strong>ε</strong>λέτ<strong>ε</strong>ς π<strong>α</strong>ρ<strong>α</strong>τήρησης<br />
που σύγκριν<strong>α</strong>ν <strong>α</strong>σθ<strong>ε</strong>ν<strong>ε</strong>ίς οι<br />
οποίοι υποβάλλοντ<strong>α</strong>ν ή δ<strong>ε</strong>ν υποβάλλοντ<strong>α</strong>ν<br />
σ<strong>ε</strong> ΡΗΕ. Ως ΡΗΕ ορίστηκ<strong>α</strong>ν η<br />
<strong>μ</strong>ί<strong>α</strong> ή π<strong>ε</strong>ρισσότ<strong>ε</strong>ρ<strong>ε</strong>ς <strong>ε</strong>πισκέψ<strong>ε</strong>ις σ<strong>ε</strong> κάποιον<br />
π<strong>α</strong>ροχέ<strong>α</strong> π<strong>ε</strong>ρίθ<strong>α</strong>λψης <strong>μ</strong><strong>ε</strong> πρωτ<strong>α</strong>ρχι-
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