Christos, L. (Lionis)
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- The EASL-Lancet Liver Commission: protecting the next generation of Europeans against liver disease complications and premature mortality(Elsevier BV, 2022) Yki-Järvinen, H. (Hannele); Christos, L. (Lionis); Verkade, H.J. (Henkjan J.); Karlsen, T.H. (Tom H.); Pryke, R. (Rachel); Flisiak, R. (Robert); Kelly, D. (Deirdre); Simonova, M. (Marieta); Serra-Burriel, M. (Miquel); Ginès, P. (Pere); Lerouge, A. (Alienor); Hutchinson, S.J. (Sharon J.); Barrett, D. (Damon); Manns, M.P. (Michael P.); Burra, P. (Patrizia); Mendive, J.M. (Juan M.); Ma, A.T. (Ann T.); Devaux, M. (Marion); Cecchini, M. (Michele); Belloni, A. (Annalisa); Sheena, B. (Brittney); Sangro, B. (Bruno); Marchesini, G. (Giulio); Ashworth-Dirac, M. (Mae); Reic, T. (Tatjana); Cortez-Pinto, H. (Helena); Zelber-Sagi, S. (Shira); Treloar, C. (Carla); Targher, G. (Giovanni); Cucchetti, A. (Alessandro); Carrieri, P. (Patrizia); Petersen, C. (Claus); Scott, N. (Nick); Byrne, C.D. (Chris D.); Buti, M. (Maria); Fabrellas, N. (Nuria); Rutter, H. (Harry); Hellard, M. (Margaret); Bugianesi, E. (Elisabetta); Schramm, C. (Christoph); Martin, N.K. (Natasha K.); Taylor, A. (Alison); Parés, A. (Albert); Lazarus, J.V. (Jeffrey V.); Sturm, E. (Ekkehard); Ponsioen, C.Y. (Cyriel Y.); Tur-Sinai, A. (Aviad); Pose, E. (Elisa); Johnson, P.J. (Philip J.); Burton, R. (Robyn); Mazzaferro, V. (Vicenzo); Newsome, P. (Philip N.); Ninburg, M. (Michael); Rhodes, T. (Tim); Sheron, N. (Nick); Dusheiko, G. (Geoffrey); Graupera, I. (Isabel)Liver diseases have become a major health threat across Europe, and the face of European hepatology is changing due to the cure of viral hepatitis C and the control of chronic viral hepatitis B, the increasingly widespread unhealthy use of alcohol, the epidemic of obesity, and undiagnosed or untreated liver disease in migrant populations. Consequently, Europe is facing a looming syndemic, in which socioeconomic and health inequities combine to adversely affect liver disease prevalence, outcomes, and opportunities to receive care. In addition, the COVID-19 pandemic has magnified pre-existing challenges to uniform implementation of policies and equity of access to care in Europe, arising from national borders and the cultural and historical heterogeneity of European societies. In following up on work from the Lancet Commission on liver disease in the UK and epidemiological studies led by the European Association for the Study of the Liver (EASL), our multidisciplinary Commission, comprising a wide range of public health, medical, and nursing specialty groups, along with patient representatives, set out to provide a snapshot of the European landscape on liver diseases and to propose a framework for the principal actions required to improve liver health in Europe. We believe that a joint European process of thinking, and construction of uniform policies and action, implementation, and evaluation can serve as a powerful mechanism to improve liver care in Europe and set the way for similar changes globally. On the basis of these data, we present ten actionable recommendations, half of which are oriented towards health-care providers and half of which focus primarily on health policy. A fundamental shift must occur, in which health promotion, prevention, proactive casefinding, early identification of progressive liver fibrosis, and early treatment of liver diseases replace the current emphasis on the management of end-stage liver disease complications. A considerable focus should be put on underserved and marginalised communities, including early diagnosis and management in children, and we provide proposals on how to better target disadvantaged communities through health promotion, prevention, and care using multilevel interventions acting on current barriers. Underlying this transformative shift is the need to enhance awareness of the preventable and treatable nature of many liver diseases. Therapeutic nihilism, which is prevalent in current clinical practice across a range of medical specialities as well as in many patients themselves, has to end. We wish to challenge medical specialty protectionism and invite a broad range of stakeholders, including primary care physicians, nurses, patients, peers, and members of relevant communities, along with medical specialists trained in obesity, diabetes, liver disease, oncology, cardiovascular disease, public health, addictions, infectious diseases, and more, to engage in integrated person-centred liver patient care across classical medical specialty boundaries. This shift includes a revision in how we converse about liver disease and speak with our patients, and a reappraisal of disease-related medical nomenclature conducted to increase awareness and reduce the social stigmatisation associated with liver disease. Reimbursement mechanisms and insurance systems must be harmonised to account for patient-centric, multimorbidity models of care across a range of medical specialties, and the World Health Assembly resolution to improve the transparency and fairness of market prices for medicines throughout Europe should be reinforced. Finally, we outline how Europe can move forward with implementation of effective policy action on taxation, food reformulation, and product labelling, advertising, and availability, similar to that implemented for tobacco, to reduce consumption of alcohol, ultraprocessed foods, and foods with added sugar, especially among young people. We should utilise the window of opportunity created by the COVID-19 pandemic to overcome fragmentation and the variability of health prevention policies and research across Europe. We argue that the liver is a window to the 21st-century health of the European population. Through our proposed syndemic approach to liver disease and social and health inequities in Europe, the liver will serve as a sentinel for improving the overall health of European populations.
- Social support and health in diabetes patients: an observational study in six european countries in an era of austerity(Public Library of Science, 2015) Vassilev, I. (Ivo); Christos, L. (Lionis); Serrano-Gil, M. (Manuel); Wensing, M. (Michel); Foss, C. (Christina); Portillo, M.C. (María Carmen); Koetsenruijter, J. (Jan); Van-Lieshout, J. (Jan); Todorova, E. (Elka); Ruud-Knutsen, I. (Ingrid); Mujika, A. (Agurtzane); Rogers, A. (Anne); Roukova, P. (Poli); Kennedy, A. (Anne); Angelaki, A. (Agapi)Introduction Support from individual social networks, community organizations and neighborhoods is associated with better self-management and health outcomes. This international study examined the relative impact of different types of support on health and health-related behaviors in patients with type 2 diabetes. Methods Observational study (using interviews and questionnaires) in a sample of 1,692 type 2 diabetes patients with 5,433 connections from Bulgaria, Greece, Netherlands, Norway, Spain, and the United Kingdom. Outcomes were patient-reported health status (SF-12), physical exercise (RAPA), diet and smoking (SDCSCA). Random coefficient regression models were used to examine linkages with individual networks, community organizations, and neighborhood type (deprived rural, deprived urban, or affluent urban). Results Patients had a median of 3 support connections and 34.6% participated in community organizations. Controlled for patients’ age, sex, education, income and comorbidities, large emotional support networks were associated with decrease of non-smoking (OR = 0.87). Large practical support networks were associated with worse physical and mental health (B = -0.46 and -0.27 respectively) and less physical activity (OR = 0.90). Participation in community organizations was associated with better physical and mental health (B = 1.39 and 1.22, respectively) and, in patients with low income, with more physical activity (OR = 1.53). Discussion Participation in community organizations was most consistently related to better health status. Many diabetes patients have individual support networks, but this study did not provide evidence to increase their size as a public health strategy. The consistent association between participation in community organizations and health status provides a clear target for interventions and policies.
- Stakeholders in support systems for self-care for chronic illness: the gap between expectations and reality regarding their identity, roles and relationships(2017) Vassilev, I. (Ivo); Serrano, M. (Manuel); Christos, L. (Lionis); Wensing, M. (Michel); Foss, C. (Christina); Portillo, M.C. (María Carmen); Todorova, E. (Elka); Ruud-Knutsen, I. (Ingrid); Mujika, A. (Agurtzane); Rogers, A. (Anne); Roukova, P. (Poli); Pumar-Mendez, M.J. (María Jesús); Regaira, E. (Elena)Background and objective: The spread of self-care holds the promise of containing chronic illness burden. Falling within the framework of a FP7 collaborative research project, this paper reports the views of key informants from six countries regarding who the main stakeholders are at different levels in the support system for self-care for patients with chronic illness (SSSC) and how they accomplish their role and collaborate. Methods: 90 Interviews with purposefully selected key informants from Bulgaria, Greece, the Netherlands, Norway, Spain and United Kingdom were conducted. Interviews involved government and local authorities, politicians, academics, health professionals and private sector representatives. Interviewers followed an expert opinion-based guide. Analysis involved a cross-country examination with thematic analysis and framework method techniques. Results Key informants described the ideal SSSC as inclusive, interdependent and patient-centred. The following main stakeholders in SSSC were identified: patients, governments, health-care professionals, associations, private companies and the media. In the current SSSCs, collaboration among stakeholders within and across different levels was said to be lacking. Patients were seen as playing a passive subordinate role based on the following: their own attitudes; the paternalistic and medicalized attitudes of the health-care professionals; their misrepresentation by patient associations; and their exposure to the damaging influences of media and industries. Conclusions Making SSSC patient-centred constitutes the greatest challenge for European authorities. Strategies must be revised for promoting patient participation. They should undergo changes so as to promote industry and media social responsibility and patient association advocacy capacity.