Nikolaos Tzanakis

University of Crete, Retimo, Crete, Greece

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Publications (80)203.16 Total impact

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    ABSTRACT: Lung cancer is a stressful condition for both patient and family. The anxiety and pain accompanying cancer and its treatment have a significant negative influence on the patient's quality of life. The aim of this study was to investigate the correlation between anxiety, pain, and perceived family support in a sample of lung cancer patients. The sample consisted of a total of 101 lung cancer outpatients receiving treatment at the oncology department of a general hospital. Anxiety, pain (severity and impact on everyday life), and perceived family support were assessed using Spielberger's State-Trait Anxiety Inventory, the Brief Pain Inventory, and the Family Support Scale, respectively. Statistical analyses revealed correlations between anxiety, pain, and family support as perceived by the patients. The intensity of pain had a positive correlation with both state and trait anxiety and a negative correlation with family support. Anxiety (state and trait) had a significant negative correlation with family support. In conclusion, high prevalence rates of anxiety disorders were observed in lung cancer patients. Females appeared more susceptible to anxiety symptoms with a less sense of family support. A negative correlation was evidenced between family support and anxiety and a positive one between anxiety and pain.
    Pain Research and Treatment. 07/2014; 2014.
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    ABSTRACT: We aimed to compare the effect of intensive versus standard interventions on continuous positive airway pressure (CPAP) adherence 2 years after CPAP initiation, as well as on sleepiness, quality of life, depression, hospitalisation and death rate due to cardiovascular disease (CVD). 3100 patients with newly diagnosed sleep apnoea were randomised into the standard group, with usual follow-up care, or the intensive group, with additional visits, telephone calls and education. Subjective daytime sleepiness (Epworth Sleepiness Scale; ESS), quality of life (36-item Short Form Health Survey; SF-36) and the patient's level of depression (Beck Depression Inventory; BDI) were recorded before and 2 years after CPAP initiation, together with CVD hospitalisations and death rate. 2 years after CPAP initiation, the intensive group used CPAP significantly more than the standard group (6.9 versus 5.2 h per night; p<0.001). ESS, SF-36 and BDI scores were also significantly better in the intensive group. Furthermore, the standard group had significantly more deaths and hospitalisations due to CVD. CPAP usage can be improved by both intensive and standard patient support. However, the patients who received intensive CPAP support had significantly better ESS, BDI and SF-36 scores, and lower cardiovascular morbidity and mortality, suggesting that an intensive programme could be worthwhile.
    The European respiratory journal. 07/2014;
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    ABSTRACT: The prevalence of Primary biliary cirrhosis varies in different geographic areas. This might reflect genetic or environmental risk factors. We aimed to define Primary biliary cirrhosis prevalence and incidence, describe patient's spatial distribution, generate prediction maps and detect any possible routing pattern of time-spatial appearance of the disease in Crete, Greece. From 1990-2010, 245 Primary biliary cirrhosis patients diagnosed and followed up at the Gastroenterology Dept of the University Hospital and the District Hospitals of the island, were contacted and 222 were included in the time-spatial analysis. To map their spatial distribution per 5-year periods, geospatial models were applied in Gis-ArcMap 9.3 software. Kriging Interpolation methods were used to generate prediction maps for the disease in Crete. Areas of high and low probability of disease occurrence were estimated through multi-criteria modeling. The disease route was defined by Arc map's toolbox. Prevalence was found to be 365 cases per million, with a mean incidence of 20.88 (range 3.79-35.99). Prediction map estimates from 1.22 to 11 patients per 50 km(2) all over Crete. Areas of high risk of disease occurrence are located in the Eastern part, while low risk in the Western part of the island DISCUSSION: Prevalence and incidence of Primary biliary cirrhosis in Crete are among the higher published in Europe. Given the homogeneous and stable study population and the geopolitics of the island, the heterogeneity in the time-spatial distribution and the route of disease appearance strongly suggest a role for environmental causative agents. This article is protected by copyright. All rights reserved.
    Liver international: official journal of the International Association for the Study of the Liver 02/2014; · 3.87 Impact Factor
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    ABSTRACT: Significant positive effects, particularly on psychological state in patients who completed the follow-up pulmonary rehabilitation programs, are indicated by a large number of studies. Yet, a remarkable proportion of selected patients drop out from these programs. In this study, we investigated existing differences on psychological variables among COPD patients who complete and those who drop out from pulmonary rehabilitation programs. The study included 144 patients, 43 (29.9%) of whom did not complete the program. SCL-90 was used for the assessment of psychological symptoms. On the SCL-90-R scale 55.6% of patients had abnormal findings. Patients who discontinued the program had higher rates of depression and somatization compared to those who completed it. Regarding the psychopathology scales of SCL-90R, we found that patients who discontinued the program showed higher levels of psychopathology on the scales of somatization, depression, paranoid ideation, and psychotism compared to those who completed the program. The final regression model showed that patients with low educational status and psychotism were more likely to leave the program. In conclusion, psychopathology contributes to patients dropping out from a COPD rehabilitation program; thus, psychological assessment prior to inclusion in rehabilitation programs may reduce dropouts.
    BioMed research international. 01/2014; 2014:401326.
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    ABSTRACT: Macrophages are a major cellular component of the innate immune system, and play an important role in the recognition of microbes, particulates, and immunogens and to the regulation of inflammatory responses. In the lung, macrophages react with soluble proteins that bind microbial products in order to remove pathogens and particles and to maintain the sterility of the airway tract. Chronic obstructive pulmonary disease and asthma are both obstructive airway diseases that involve chronic inflammation of the respiratory tract which contributes to disease progression. In the case of COPD, there is increasing evidence that lung macrophages orchestrate inflammation through the release of chemokines that attract neutrophils, monocytes and T cells and the release of several proteases. On the other hand, in asthma, it seems that alveolar macrophages are inappropriately activated and are implicated in the development and progression of the disease. In this review we summarize the current basic and clinical research studies which highlight the role of macrophages in asthma and COPD.
    Cytokine 09/2013; · 2.52 Impact Factor
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    ABSTRACT: Growth factors mediate various cellular responses to environmental stimuli. Specifically, exposure of lung epithelium to oxidative stress induced by cigarette smoke stimulates aberrant epidermal growth factor receptor (ERBB) family activation. This study's objective was to evaluate the expression of ERBB1-4 receptors in the lung tissue of smokers with or without chronic obstructive pulmonary disease (COPD). ERBBs expression was measured by microarray analysis in lung tissue samples from five patients with COPD and five non-COPD smokers, and by quantitative real-time PCR in additional 20 patients with COPD (GOLD stage II), 15 non-COPD smokers and 10 nonsmoker controls. Microarray data analysis revealed that ERBB receptors expression was elevated in patients with COPD compared to non-COPD smokers, ranging from 1·62- to 2·45-fold, (P < 0·01). Real-time qPCR verified that patients with COPD had higher ERBB1-3 expression levels compared with non-COPD smokers (PERBB1 < 0·001; PERBB2 = 0·003; PERBB3 = 0·003) and nonsmokers (PERBB1 = 0·019; PERBB2 = 0·005; PERBB3 = 0·011). On the other hand, ERBB4 mRNA levels gradually increased from nonsmokers (0·74 ± 0·19) to non-COPD smokers (1·11 ± 0·05) to patients with COPD (1·57 ± 0·28) and were correlated with the degree of airflow obstruction (PFEV1 < 0·001). These data suggest that ERBB1-3 overexpression is not related only to smoking exposure but probably to epithelial remodelling and mucociliary system distortion, characterizing COPD. Additionally, the inverse correlation of ERBB4 with FEV1 exhibits a possible link between ERBB4 and COPD severity.
    European Journal of Clinical Investigation 09/2013; · 3.37 Impact Factor
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    ABSTRACT: Background: Chronic Obstructive Pulmonary Disease (COPD) is characterized by airway obstruction. Although several studies have focused on the presence of anxiety and depression in COPD [1, 2, 3] few have focused on gender. The purpose of this study was to assess differences regarding anxiety and depression between female and male patients with COPD. Materials and methods: In a sample of 147 outpatients with COPD (33 women and 114 men) without known comorbidity from mental illness, we administered the BDI (Beck Depression Inventory) questionnaire [1,3,4], as well as the Spielberger Trait Anxiety Scale (STAI) [1,3,4]. We noted the subjects’ demographics and their FEV1%. Results: Women were not different vs men regarding disease duration, education and age (t test p>0.05). Men showed lower FEV1% compared to women (40.74±20.21 vs 52.22±22.43) (t-test p<0.05). Compared to men, women with COPD had higher anxiety (39.8 vs 44.5, t test p<0.05) and depression scores (13.7 vs 1.0, t test p<0.05). Forty-eight % of men demonstrated depression compared to 65.6% of women (BDI score>9, Chi-Square p<0.05) and 28.6% of them exhibited anxiety (STAI score>43) versus 33.7% of women (STAI>45, Chi-Square p<0.05). Age and FV1% showed no correlation with any of the psychological scales’ scores (p> 0.05) while a positive correlation was noted between anxiety and depression (p> 0.05). Conclusions: Female patients with COPD showed higher psychopathologic symptoms regarding anxiety and depression compared to male patients.
    3rd International Congress on Neurobiology, Psychopharmacology and Treatment Guidance; 06/2013
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    ABSTRACT: Chronic Obstructive Pulmonary Disease (COPD) is mainly related to smoking habit and is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Worldwide and in Greece, COPD constitutes a major epidemiological issue. Incidence of depression and anxiety is high in the COPD population. Most studies on depression and anxiety in COPD deal with factors that are positively correlated with both of these comorbidities. The aim of our study was to assess whether two variables, sense of coherence (SOC) and perception of family support (FS), are negatively correlated with depressive and anxiety symptoms in outpatients with COPD. According to Aaron Antonovsky, sense of coherence refers to the ability of individuals to make sense of and manage events. Studies in other diseases suggest that sense of family support has a significant impact on the course and outcome of the disease, yet a limited number of reports across literature addresses the role of family support in COPD patients. In our present study one hundred twenty two (98 men and 24 women) outpatients with pure COPD were included. Age and years of education were recorded. Severity of COPD was assessed with spirometry before and after bronchodilation. All patients replied to self- administered questionnaires on depression (Beck Depression Inventory, BDI), anxiety (Spielberger State-Trait Anxiety Scale, STAI), family support (Family Support Scale, FSS-13) and sense of coherence (Sense of Coherence Scale, SOC). According to our results the mean BDI depression score was 11.65 (SD 7.35), mean trait anxiety score was 40.69 (SD 11.19), mean SOC score was 54.62 (SD 7.40) and mean FS score was 64.58 (SD 11.63). Women patients had higher anxiety scores and lower sense of family support compared to men. Significant negative correlations were evidenced between depression and sense of coherence as well as between anxiety and family support. Step-wise multiple linear regression analysis verified the results and quantified the aforementioned correlations. Notably, raising scores in sense of family support by one point reduces anxiety scores by 0.14 points, and increasing sense of coherence scores by one point reduces depression scores by 0.21 points. In sum, our study confirms the presence of high levels of anxiety and depressive symptoms in COPD patients, with females being in a more disadvantaged position as they tend to have higher levels of both. Sense of coherence and family support are both protective psychological factors against the risk of developing anxiety and depressive symptoms in these patients.
    Psychiatrikē = Psychiatriki. 04/2013; 24(2):109-16.
  • 21st European Congress of Psychiatry; 04/2013
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    ABSTRACT: We examined whether the Cretan cohort of the Seven Countries Study (SCS) is representative for the entire population in the island using cancer mortality registries. The analysis was carried out on the Cretan cohort of the SCS cancer mortality data and a similar cancer registry for the general population during a 51-year follow-up (1960-2011). Information about the causes of mortality was obtained from official death certificates and classified according to the International Classification of Diseases, 9th Revision (ICD-9). Two time-series models of mortalities from cancer, using data from the Cretan cohort and the Hellenic Statistical Office (EL. STAT), were developed using Matlab software. The existence of long-term memory in the data was tested by rescaled range analysis (Hurst-Mandelbrot). State-space reconstruction was applied to identify the simplest system that was able to re-create the present time-series. In the cohort, cancer mortalities accounted for 18.9% of total mortalities. The EL.STAT time-series analysis generated mean V statistics (95%CI) of 0.69815 (0.398-0.999) and 0.677143 (0.301-0.897) for the general population and the seven countries cohort, respectively. The embedding dimension for the EL.STAT data was equal to 1 for the general population and for the Cretan cohort (m=1). The exponent H values for the two time-series were almost equal. In the two time-series the proposed time delay of cancer mortalities was 2. The Cretan cohort of the SCS and the entire population of the island followed similar patterns of cancer mortality over time.
    Oncology letters 03/2013; 5(3):964-968. · 0.24 Impact Factor
  • 01/2013: pages 15-40; , ISBN: 978-1-62081-848-0
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    ABSTRACT: The presence of anxiety and depressive symptoms in COPD patients has been acknowledged for many years. The preponderance of recent studies supports the utility of pulmonary rehabilitation programs to reduce the levels of depression and anxiety in these patients. The aim of this study is to investigate possible changes in levels of anxiety and depression among patients enrolled in a pulmonary rehabilitation program, along with the role of disease severity in these changes. In 101 COPD patients, who attended a pulmonary rehabilitation program, levels of trait anxiety (STAI) and depressive symptoms (BDI) were assessed at the beginning and at the end of the program. Age, sex, level of education in years and stage of disease severity were recorded. Our study included 80 male and 21 female patients. Mean age and mean education level were 64.1 ± 8.1 and 11.3 ± 4.1 years, respectively. Regarding COPD staging, 11 patients suffered from mild, 16 from moderate, 47 from severe and 27 from very severe COPD. Significant decreases in anxiety (from 39.7 to 34.0, p < 0.001) and depression rates (from 10.7 to 6.3, p < 0.001) were observed. A statistically significant reduction in anxiety and depression was revealed (p < 0.05)at all stages of COPD. Pulmonary rehabilitation programs should be offered to all COPD patients irrespective of disease severity, since they all lead to improvement in anxiety and depressive symptoms.
    Multidisciplinary respiratory medicine 01/2013; 8(1):41. · 0.05 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease is a public health problem that results in high morbidity, disability and mortality. Comorbidities are highly prevalent in COPD patients because of aging, common risk factors and pathways, rising mortality, and disability. In this review article we present the most prevalent co-morbidities in COPD patients, we face the issue of multimorbidity and discuss the practical management approach relevant to chest physicians and general practitioners. Issues on comorbidities management according to general guidelines as well as their implications for COPD are raised. The aim is to give clinicians an easy update with specific recommendations for each comorbidity. The implications of several medications used for comorbidities in COPD in terms of benefits, concerns, medication preference, medication avoidance and contraindications are also discussed.
    Current drug targets 12/2012; · 3.93 Impact Factor
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    ABSTRACT: Σκοπός: Η παρούσα μελέτη στοχεύει στην αποτύπωση της επιδημιολογίας των ΙΦΕΝ σε γενετικά ομοιογενή πληθυσμό στο Νομό Ηρακλείου. Υλικό και Μέθοδος: Η παρούσα συγχρονική μελέτη διεξήχθη στο Πανεπιστημιακό Νοσοκομείο Ηρακλείου (ΠΑΓΝΗ) και χρησιμοποίησε δείγμα ασθενών του εξωτερικού ιατρείου του νοσοκομείου (38 ασθενείς με ελκώδη κολίτιδα και 79 με νόσο Crohn). Εφαρμόστηκαν μέθοδοι χωρικών clusters, με βάση τον ακριβή τόπο κατοικίας (στο Arcmap 10). Εφαρμόστηκε χωρική παρεμβολή (kriging interpolation) για την εκτίμηση του αριθμού των ασθενών με ΙΦΕΝ σε περιοχές όπου δεν είχαμε δείγμα. Τέλος, εφαρμόστηκε χωρική παλινδρόμηση (spatial binary regression) για τη συσχέτιση με στοιχεία ραδιενέργειας. Αποτελέσματα: Οι περισσότεροι ασθενείς κατοικούν στο Δ.Ηρακλείου, νέας Αλικαρνασσού, Αρκαλοχωρίου και Καστελλίου. Αναμένεται όμως υψηλότερος αριθμός περιστατικών στο Βόρειο και νότιο-ανατολικό τμήμα του Νομού για τη νόσο Crohn, ενώ στο Βόρειο-ανατολικό για την ελκώδη. Υπολογίζεται ότι θα βρεθούν, >18 περιστατικά ελκώδους κολίτιδας ανά 50km2 στο Δ.Γουβών και Χερσονήσου ενώ αντίστοιχη εικόνα παρουσιάζεται και για τη νόσο Crohn στο Δ.Μοιρών και Γόρτυνας. Η συνυπάρχουσα πάθηση (pvalue<0,001), το οικογενειακό ιστορικό ΙΦΕΝ και καρκίνου (pvalue<0,001) επηρεάζουν τις νόσους. Η ραδιενέργεια παρουσιάζει τιμές από 5-6,5 Mr/hr στα βόρειο-ανατολικά του Νομού, στο Δ.Μοιρών και Γόρτυνας. Όσο αυξάνονται τα επίπεδα ραδιενέργειας τόσο αυξάνονται και οι πιθανότητες εμφάνισης ελκώδους κολίτιδα (OR= 1,7; 95%CI=1,028- 2,489; pvalue<0,001) και νόσου Crohn (OR= 2,2; 95%CI=1,372-4,027; pvalue<0,001). Συμπεράσματα: Η χωρική στατιστική αποτελεί μια σύγχρονη και αξιόπιστη μέθοδο μελέτης της επιδημιολογίας ασθενειών καθώς και εξομάλυνσης πιθανών σφαλμάτων μελετών στα πλαίσια της Δημόσιας Υγείας. Περαιτέρω μελέτη θα διεξαχθεί στη Περιφέρεια Κρήτης με τη πλήρη καταγραφή των ασθενών.
    3rd Panhellenic Forum of Public Health; 12/2012
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    ABSTRACT: Background and aim: The prevalence of primary biliary cirrhosis (PBC) varies in different geographic areas. Variation within regions over time may reflect environmental risk factors. We aimed to describe the spatial distribution of Cretan PBC patients, generate prediction maps and detect a possible routing pattern of time-spatial appearance of the disease in Crete. Methods: To identify the 222 PBC patients’ route per 5year periods from 1990-2010, time-spatial methods were applied in Gis–ArcMap 19 software, using place of birth and/or place of residence. Kriging Interpolation methods were used to generate prediction maps for PBC in Crete. Areas of present risk and future risk were estimated through multicritiria modelling and five buffer zones were entered in the method; Mayo risk score, piecemeal necrosis, fibrosis Ishak stage, population per municipality and patients’ spatial distribution. Results: The areas with present and future risk for PBC are shown in figure 1. Eight through the 10 municipalities with the greatest PBC rates over time are represented in the East part of Crete. According to PBC’s route line it is predicted that within the next 5 years new cases are expected to be diagnosed in the West and South-West part of Crete (fig 2). There is a trend towards increasing PBC cases over time in Crete
    EASL Conference 2012; 11/2012
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    ABSTRACT: BACKGROUND: Tobacco and alcohol use during adolescence have potential long term health consequences and a possibility of future addiction. METHODS: This cross sectional study took place in 2007 among a convenience sample of 981 adolescents from public elementary and high schools in Eastern Crete, Greece. Following parental consent, an anonymous structured questionnaire including information on personal and family use of alcohol and tobacco was distributed. RESULTS: Among the entire study population, cigarette experimentation was found to be associated with current alcohol use, with an Adjusted Odds Ratio (aOR) of 38.8; (95%C.I: 5.33-58.2) and with having a smoker in the immediate family (aOR 10.3; 95%C.I: 3.14-34.0). Among the subset of elementary school children, cigarette smoking was strongly associated with current alcohol use aOR 9.7; (95%C.I: 2.12-44.3), while the association between smoking experimentation and sibling and parental alcohol use was statistically significant within the entire population (however not among elementary students) with an aOR of 2.76 (95%C.I: 1.24-6.15) and aOR 3.66, (95%C.I: 1.97-6.81) respectively. The elementary child's gender was not found to be associated with cigarette experimentation among this study population. CONCLUSIONS: Strong associations were found between alcohol use and tobacco experimentation. The potential parental influence on consequent adolescent tobacco and alcohol use was also noted. Potential community based interventions, if launched in Greece, should take the role of the Greek family into account.
    Tobacco Induced Diseases 09/2012; 10(1):15.
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    ABSTRACT: Health status provides valuable information, complementary to spirometry and improvement of health status has become an important treatment goal in COPD management. We compared the usefulness and validity of the COPD Assessment Test (CAT) and the Clinical COPD Questionnaire (CCQ), two simple questionnaires, in comparison with the St. George Respiratory Questionnaire (SGRQ). We administered the CAT, CCQ and SGRQ in patients with COPD stage I-IV during three visits. Spirometry, 6 MWT, MRC scale, BODE index, and patients perspectives on questionnaires were recorded in all visits. Standard Error of Measurement (SEM) was used to calculate the Minimal Clinical Important Difference (MCID) of all questionnaires. We enrolled 90 COPD patients. Cronbach's alpha for both CAT and CCQ was high (0.86 and 0.89, respectively). Patients with severe COPD reported worse health status compared to milder subgroups. CAT and CCQ correlated significantly (rho =0.64, p < 0.01) and both with the SGRQ (rho = 0.65; CAT and rho = 0.77; CCQ, p < 0.01). Both questionnaires exhibited a weak correlation with lung function (rho = -0.35;CAT and rho = -0.41; CCQ, p < 0.01). Their reproducibility was high; CAT: ICC = 0.94 (CI 0.92-0.96), total CCQ ICC = 0.95 (0.92-0.96) and SGRQ = 0.97 (CI 0.95-0.98). The MCID calculated using the SEM method showed results similar to previous studies of 3.76 for the CAT, 0.41 for the CCQ and 4.84 for SGRQ. Patients suggested both CAT and CCQ as easier tools than SGRQ in terms of complexity and time considerations. More than half of patients preferred CCQ instead of CAT. The CAT and CCQ have similar psychometric properties with a slight advantage for CCQ based mainly on patients' preference and are both valid and reliable questionnaires to assess health status in COPD patients.
    BMC Pulmonary Medicine 05/2012; 12:20. · 2.76 Impact Factor
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    British Journal of General Practice 02/2012; 62(595):107-8. · 1.83 Impact Factor
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    ABSTRACT: Aim: Misdiagnosis of Chronic Obstructive Pulmonary Disease (COPD) in primary health care appears to be common. The objective of this exploratory case study was to describe the selfreported level of knowledge regarding COPD among primary healthcare physicians, before and after a two day intensive educational course. Method: Nine primary health care physicians, eight serving different rural areas of the island of Crete and one in the wider area of Athens (Greece), were invited to a two day educational course on COPD. Questionnaires were used to stratify the level of physicians’ knowledge before and after the course. Utility and suitability of this educational experience was also assessed at the end of the course. Results: Topics such as the ability to perform spirometry and the management of smokers in primary care achieved the greater median score variation before and after course [from 2.0 to 5.0 (P=0.010) and from 3.0 to 6.0 (P=0.011), respectively]. There was a statistical significant difference between the median scores in pre- and post-course responses indicating an immediate positive impact due to the course. Conclusion: These preliminary results showed that a brief and intensive educational course among primary health care physicians, could have a benefit in improving their level of knowledge regarding COPD. Key words: education, primary care, COPD, exploration
    Healthmed 01/2012; 6:781-6. · 0.44 Impact Factor
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    ABSTRACT: Although the prevalence of obstructive sleep apnea/hypopnea syndrome (OSAHS) is high in patients with acute coronary syndromes (ACS), there is little knowledge about the persistence of OSAHS in ACS patients after the acute event. We aimed to assess the prevalence and time course of OSAHS in patients with ACS during and after the acute cardiac event. Fifty-two patients with first-ever ACS, underwent attended overnight polysomnography (PSG) in our sleep center on the third day after the acute event. In patients with an apnea hypopnea index (AHI) > 10/h, we performed a follow up PSG 1 and 6 months later. Twenty-eight patients (54%) had an AHI > 10/h. There was a significant decrease in AHI 1 month after the acute event (13.9 vs. 19.7, p = 0.001), confirming the diagnosis of OSAHS in 22 of 28 patients (79%). At 6-month follow-up, the AHI had decreased further (7.5 vs. 19.7, p < 0.05), and at that time only 6 of the 28 patients (21%) were diagnosed as having OSAHS. Twelve of the 16 current smokers stopped smoking after the acute event. We have demonstrated a high prevalence of OSAHS in ACS patients, which did not persist 6 months later, indicating that, to some degree, OSAHS may be transient and related with the acute phase of the underlying disease or the reduction in the deleterious smoking habit.
    Journal of clinical sleep medicine: JCSM: official publication of the American Academy of Sleep Medicine 01/2012; 8(1):21-6. · 2.93 Impact Factor

Publication Stats

899 Citations
203.16 Total Impact Points

Institutions

  • 2002–2014
    • University of Crete
      • • Division of Social Medicine
      • • Department of Thoracic Medicine
      • • Department of General Surgery
      • • Department of Preventive Medicine and Nutrition
      Retimo, Crete, Greece
  • 2011–2013
    • Νοσοκομείο Σωτηρία
      Athínai, Attica, Greece
  • 2002–2013
    • University Hospital of Heraklion
      • Department of Gastroenterology
      Irákleio, Attica, Greece
  • 2012
    • University of Groningen
      • Department of General Practice
      Groningen, Province of Groningen, Netherlands
  • 2004
    • University of Miami Miller School of Medicine
      • Division of Hospital Medicine
      Miami, FL, United States