DOCSLIB.ORG

Aggressive Blood Pressure Control in General Practice (ABC-GP) Study: Can the New Targets Be Reached?

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Aggressive Blood Pressure Control in General Practice (ABC-GP) Study: Can the New Targets Be Reached? Journal of Human Hypertension (2003) 17, 767–773 & 2003 Nature Publishing Group All rights reserved 0950-9240/03 $25.00 www.nature.com/jhh ORIGINAL ARTICLE Aggressive blood pressure control in general practice (ABC-GP) study: can the new targets be reached? GS Stergiou1, AK Karotsis2, A Symeonidis2 and VA Vassilopoulou1 1Hypertension Center, Third University Department of Medicine, Sotiria Hospital, Athens, Greece; 2Greek Association of General Practitioners (ELEGEIA), Greece Based on outcome trials, guidelines for hypertension Factors associated with uncontrolled systolic BP were management recommend lower blood pressure (BP) diabetes, age 460 years and triple antihypertensive goals using an individualized treatment strategy (IND) therapy at baseline. A faster BP reduction was achieved and referral to a specialist of patients uncontrolled after during the first 3 months using the STEP strategy, but at 6 months of treatment. This study aimed to evaluate the the cost of using more drugs (combination therapy in performance of General Practitioners (GPs) in reaching 68/59% for STEP/IND, P ¼ 0.06). At 6 months similar rates the recommended BP goals using the IND, or a stepwise of control were achieved with the two strategies. In treatment strategy (STEP) as used in the outcome trials. conclusion, in primary care the diastolic BP goal can be Trained GPs were randomized to reach the BP goals reached within 6 months in the majority of patients, within 6 months using the IND or a STEP strategy in whereas systolic BP remains uncontrolled in 50% of the untreated or treated uncontrolled hypertensives. In all, cases. The IND should be the recommended treatment 24 GPs recruited 528 patients of whom 443 were strategy, but further investigation is required on the analysed (mean age 65 7 9 years, 42% men, 70% treated, reasons for treatment failure and the optimal strategy for STEP/IND 12/12 GPs, 231/211 patients). After 6 months, its improvement. 83% of the patients had reached the diastolic BP goal, Journal of Human Hypertension (2003) 17, 767–773. whereas only 51% the systolic (Po0.0001 for difference). doi:10.1038/sj.jhh.1001610 Keywords: blood pressure control; systolic blood pressure; individualized treatment; stepwise treatment; primary care Introduction consider referral of patients to a hypertension specialist.7 One of the major issues in hypertension manage- Virtually all the recent outcome trials in hyperten- ment is the low level of blood pressure (BP) control 1 sion, which showed the benefits of more aggressive in the population. Surveys in several countries antihypertensive drug treatment5,6 or compared new have shown poor hypertension control with only 6– vs old antihypertensive drug classes,8–13 have used a 27% of hypertensive patients having a BP of o140/ 2–4 strict stepwise add-on treatment strategy (STEP). In 90 mmHg. On the other hand, recent outcome contrast, the JNC-VI,1 the ISH-WHO,7 the British14 studies have shown additional benefits in cardio- and the Canadian Hypertension Society,15 all recom- vascular protection by aggressive lowering of BP in 5,6 mend the use of an individualized treatment strategy hypertensive subjects. The Joint National Com- (IND), which allows for substitution of drugs that mittee on Prevention, Detection, Evaluation and 1 seem to be ineffective in individual patients. It could Treatment of High Blood Pressure (JNC-VI) and the be argued that BP control may be achieved faster International Society of Hypertension-World Health 7 using the STEP compared to using the IND strategy. Organization (ISH-WHO) recommended lower BP However, more drugs may be needed using the STEP goals to be reached in clinical practice. According to strategy because it allows for substitution only in the the ISH-WHO guidelines, if control of BP has not presence of adverse reactions. been reached within 6 months, the physician should The present study was designed (a) to evaluate the performance of General Practitioners (GPs) in reach- Correspondence: Dr GS Stergiou, Hypertension Center, Third ing the recommended BP goals in primary care and University Department of Medicine, Sotiria Hospital, 152 Meso- (b) to test the hypothesis that the IND strategy may gion Avenue, Athens 11527, Greece. be inferior in achieving BP control within 6 months, E-mail: [email protected] compared to a strict STEP strategy as used in the Received 14 March 2003; revised 5 June 2003; accepted 10 June 2003 outcome studies. Blood pressure control GS Stergiou et al 768 Subjects and methods With either of the treatment strategies, all drugs were given in a single morning dose. Physicians and patients Clinic BP was measured always by the same GPs GPs employed in primary care in rural areas of for each patient using validated fully automated Greece were invited to participate in the study and oscillometric devices (Omron HEM-705CP, Omron to recruit subjects with essential hypertension, men Healthcare GmbH, Hamburg; bladder size 12 Â 16 and women, aged 30–80 years. Untreated hyperten- 23 cm or 14 Â 28 cm where appropriate). Triplicate sives with systolic BPX150 mmHg and/or diastolic measurements were taken at trough (before drug X95 mmHg on three clinic visits 1–2 weeks apart intake) after 5 min sitting rest and with 1 min (two visits in subjects with systolic BP 180– between readings. Measurements were taken always 200 mmHg and/or diastolic 105–115 mmHg) were on the same arm for each patient and were printed included, as well as treated hypertensives on stable by the device. The average of all the measurements antihypertensive drug treatment (X4 weeks), with of each visit was used for decision-making regarding systolic BPX140 mmHg and/or diastolic X90 mmHg study inclusion and treatment titration. on two clinic visits. Criteria for exclusion were: BP4200/115 mmHg on two succeeding visits during the study, subjects on triple full-dose antihyperten- Analysis sive therapy, heart or renal failure, coronary heart disease, major haematological or pulmonary disease Patients with missing follow-up data at both 6 and 9 or any other clinically significant illness based upon months were excluded from the analysis. One-way recent medical history and unwillingness to parti- analysis of variance (ANOVA) and Student’s t-tests cipate in the study. The study protocol was were performed for the comparison of multiple or approved by the Quality Assurance Committee of two mean values respectively. Comparison of fre- the Greek Association of General Practitioners. quencies was performed using w2 tests. Bonferroni’s Patients gave informed consent for study participa- correction for multiple comparisons was applied tion. where appropriate. Univariate correlations were performed between uncontrolled hypertension at 6 months and several demographic characteristics, Methods cardiovascular risk factors, baseline BP and anti- hypertensive treatment. Variables with a significant GPs were trained in hypertension management univariate association with uncontrolled hyperten- according to the ISH-WHO guidelines7 and were sion were considered in a logistic regression randomized (using computer generated random analysis using a forward stepwise selection algo- numbers) to achieve in their patients the new BP rithm in order to identify independent predictors of goals recommended by the ISH-WHO (systolic/ uncontrolled hypertension. In the multivariable diastolic BP o140/90 mmHg in subjects aged 465 procedure, the presence of uncontrolled hyperten- years and o130/85 mmHg in those o65 years and in sion at 6 months was used as the end point and all diabetic hypertensives irrespectively of their age) continuous variables were considered categorically using either the recommended IND strategy1,7 or an by the application of clinically and statistically angiotensin-converting enzyme (ACE) inhibitor- appropriate cutoff points. Comparisons and correla- based STEP strategy. All GPs were trained by a tions were performed separately for systolic and hypertension specialist (GS) and two GP tutors (AK diastolic BP. A probability value Po0.05 was and AS) in two 3-h sessions; one in the study considered statistically significant. protocol and a second in the BP goals and the treatment strategy (IND or STEP strategy according to randomization). The STEP strategy protocol included the follow- Results ing steps: step 1, medium dose ACE inhibitor Physicians and patients fosinopril 20 mg o.d.; step 2, add-on low dose thiazide diuretic chlorthalidone 12.5 mg o.d.; step A total of 24 GPs recruited 528 hypertensive subjects 3, increase dose of chlorthalidone to 25 mg o.d.; step (median number of recruited patients per GP was 20, 4, add-on calcium antagonist amlodipine or felodi- range 9–47) of whom 85 (16%) were excluded pine 5 mg, or lacidipine 4 mg, or diltiazem 200 mg because of missing follow-up data at 6 and 9 o.d.; step 5, increase dose of calcium antagonist months. Data from 443 subjects were included in (amlodipine or felodipine 10 mg, or lacidipine 6 mg, the final analysis. There was no difference between or diltiazem 300 mg o.d.); step 6, add-on antiadre- analysed and excluded subjects in regard to age, sex, nergic drug, for example, b-blocker or a1 blocker or proportion of diabetics and baseline BP. Baseline centrally acting agent. characteristics of study participants are presented in GPs were asked to intensify drug treatment at 2–5 Table 1. According to the ISH-WHO guidelines,7 weeks intervals and to provide data on clinic BP and 51% of patients should reach a BP goal of o130/ antihypertensive treatment at 3, 6 and 9 months. 85 mmHg and 49% o140/90 mmHg. In 49 patients Journal of Human Hypertension Blood pressure control GS Stergiou et al 769 (11%) follow-up data were available at 6 but not at 9 100% 9 13 months and in 33 (7%) at 9 but not at 6 months. 20 24 80% 29 47 60% 44 Number BP control and drug treatment 48 of drugs 3+ There was a large reduction in both systolic 40% 7 62 2 (22.9 21.0 mmHg, 95% CI 20.9, 25.1, Po0.0001) 1 7 20% 40 36 and diastolic BP (8.5 11.5 mmHg, 95% CI 7.4, 9.7, Proportion of patients 28 Po0.0001) at 3 months (Figure 1).
Load more

Recommended publications
  • Response of the Greek Government to the Report of the European
    CPT/Inf (2019) 5 Response of the Greek Government to the report of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) on its visit to Greece from 10 to 19 April 2018 The Greek Government has requested the publication of this response. The CPT’s report on the April 2018 visit to Greece is set out in document CPT/Inf (2019) 4. Strasbourg, 19 February 2019 Table of contents Response of the Ministry of Health ……………………………………………..................... 3 Response of the Ministry of Justice, Transparency and Human Rights ………………..... 8 Response of the Ministry of Citizen Protection.……………………………………………. 13 Response of the Ministry for Migration Policy……………………………………………… 38 3 HELLENIC REPUBLIC MINISTRY OF HEALTH REPORT TO THE GREEK GOVERNMENT ON THE VISIT TO GREECE CARRIED OUT BY THE EUROPEAN COMMITTEE FOR THE PREVENTION OF TORTURE AND INHUMAN OR DEGRADING TREATMENT OR PUNISHMENT (CPT) FROM 10 TO 19 APRIL 2018 Comments of the Ministry of Health Regarding cooperation and the obligation of national authorities to assist the work of CPT (paragraph 7): The Ministry of Health and the Department of Mental Health have made every possible effort to facilitate the delegation’s visit within their competence and provide the information requested so far in a timely and accurate manner. We apologize for any inconvenience caused by poor cooperation between the ministries due to Easter holiday season at the time of the particular visit and would like to assure the Committee that every effort will be made on our part to avoid such an unfortunate occurrence in the future.
    [Show full text]
  • Genetics of the Peloponnesean Populations and the Theory of Extinction of the Medieval Peloponnesean Greeks
    European Journal of Human Genetics (2017) 25, 637–645 Official journal of The European Society of Human Genetics www.nature.com/ejhg ARTICLE Genetics of the peloponnesean populations and the theory of extinction of the medieval peloponnesean Greeks George Stamatoyannopoulos*,1, Aritra Bose2, Athanasios Teodosiadis3, Fotis Tsetsos2, Anna Plantinga4, Nikoletta Psatha5, Nikos Zogas6, Evangelia Yannaki6, Pierre Zalloua7, Kenneth K Kidd8, Brian L Browning4,9, John Stamatoyannopoulos3,10, Peristera Paschou11 and Petros Drineas2 Peloponnese has been one of the cradles of the Classical European civilization and an important contributor to the ancient European history. It has also been the subject of a controversy about the ancestry of its population. In a theory hotly debated by scholars for over 170 years, the German historian Jacob Philipp Fallmerayer proposed that the medieval Peloponneseans were totally extinguished by Slavic and Avar invaders and replaced by Slavic settlers during the 6th century CE. Here we use 2.5 million single-nucleotide polymorphisms to investigate the genetic structure of Peloponnesean populations in a sample of 241 individuals originating from all districts of the peninsula and to examine predictions of the theory of replacement of the medieval Peloponneseans by Slavs. We find considerable heterogeneity of Peloponnesean populations exemplified by genetically distinct subpopulations and by gene flow gradients within Peloponnese. By principal component analysis (PCA) and ADMIXTURE analysis the Peloponneseans are clearly distinguishable from the populations of the Slavic homeland and are very similar to Sicilians and Italians. Using a novel method of quantitative analysis of ADMIXTURE output we find that the Slavic ancestry of Peloponnesean subpopulations ranges from 0.2 to 14.4%.
    [Show full text]
  • Early Mycenaean Arkadia: Space and Place(S) of an Inland and Mountainous Region
    Early Mycenaean Arkadia: Space and Place(s) of an Inland and Mountainous Region Eleni Salavoura1 Abstract: The concept of space is an abstract and sometimes a conventional term, but places – where people dwell, (inter)act and gain experiences – contribute decisively to the formation of the main characteristics and the identity of its residents. Arkadia, in the heart of the Peloponnese, is a landlocked country with small valleys and basins surrounded by high mountains, which, according to the ancient literature, offered to its inhabitants a hard and laborious life. Its rough terrain made Arkadia always a less attractive area for archaeological investigation. However, due to its position in the centre of the Peloponnese, Arkadia is an inevitable passage for anyone moving along or across the peninsula. The long life of small and medium-sized agrarian communities undoubtedly owes more to their foundation at crossroads connecting the inland with the Peloponnesian coast, than to their potential for economic growth based on the resources of the land. However, sites such as Analipsis, on its east-southeastern borders, the cemetery at Palaiokastro and the ash altar on Mount Lykaion, both in the southwest part of Arkadia, indicate that the area had a Bronze Age past, and raise many new questions. In this paper, I discuss the role of Arkadia in early Mycenaean times based on settlement patterns and excavation data, and I investigate the relation of these inland communities with high-ranking central places. In other words, this is an attempt to set place(s) into space, supporting the idea that the central region of the Peloponnese was a separated, but not isolated part of it, comprising regions that are also diversified among themselves.
    [Show full text]
  • Kleonai, the Corinth-Argos Road, And
    HESPERIA 78 (2OO9) KLEONAI, THE CORINTH- Pages ioj-163 ARGOS ROAD, AND THE "AXIS OF HISTORY" ABSTRACT The ancient roadfrom Corinth to Argos via the Longopotamos passwas one of the most important and longest-used natural routes through the north- eastern Peloponnese. The author proposes to identity the exact route of the road as it passed through Kleonaian territoryby combining the evidence of ancient testimonia, the identification of ancient roadside features, the ac- counts of early travelers,and autopsy.The act of tracing the road serves to emphasizethe prominentposition of the city Kleonaion this interstateroute, which had significant consequences both for its own history and for that of neighboring states. INTRODUCTION Much of the historyof the polis of Kleonaiwas shapedby its location on a numberof majorroutes from the Isthmus and Corinth into the Peloponnese.1The most importantof thesewas a majorartery for north- south travel;from the city of Kleonai,the immediatedestinations of this roadwere Corinthto the north and Argos to the south.It is in connec- tion with its roadsthat Kleonaiis most often mentionedin the ancient sources,and likewise,modern topographical studies of the areahave fo- cusedon definingthe coursesof these routes,particularly that of the main 1. The initial fieldworkfor this Culturefor grantingit. In particular, anonymousreaders and the editors studywas primarilyconducted as I thank prior ephors Elisavet Spathari of Hesperia,were of invaluableassis- part of a one-person surveyof visible and AlexanderMantis for their in- tance. I owe particulargratitude to remainsin Kleonaianterritory under terest in the projectat Kleonai,and Bruce Stiver and John Luchin for their the auspicesof the American School the guardsand residentsof Archaia assistancewith the illustrations.
    [Show full text]
  • Victoria G. Karelias Collection of Traditional Greek Costumes Lyceum Club of Greek Women of Kalamata
    University of Rhode Island DigitalCommons@URI Textiles, Fashion Merchandising and Design Faculty Publications Textiles, Fashion Merchandising and Design 2020 Victoria G. Karelias Collection of Traditional Greek Costumes Lyceum Club of Greek Women of Kalamata Linda Welters University of Rhode Island, [email protected] Follow this and additional works at: https://digitalcommons.uri.edu/tmd_facpubs The University of Rhode Island Faculty have made this article openly available. Please let us know how Open Access to this research benefits you. This is a pre-publication author manuscript of the final, published article. Terms of Use This article is made available under the terms and conditions applicable towards Open Access Policy Articles, as set forth in our Terms of Use. Citation/Publisher Attribution Linda Welters (2020) Victoria G. Karelias Collection of Greek Traditional Costumes, Fashion Theory, 24:1, 93-102, DOI: 10.1080/1362704X.2018.1430888 Available at: https://doi.org/10.1080/1362704X.2018.1430888 This Review is brought to you for free and open access by the Textiles, Fashion Merchandising and Design at DigitalCommons@URI. It has been accepted for inclusion in Textiles, Fashion Merchandising and Design Faculty Publications by an authorized administrator of DigitalCommons@URI. For more information, please contact [email protected]. Exhibition Review Victoria G. Karelias Collection of Traditional Greek Costumes Lyceum Club of Greek Women of Kalamata 64 Stadiou, Kalamata, Greece Reviewed by Linda Welters Take one passionate collector, one derelict building, add a visionary team of collaborators, and the result is a remarkable museum of traditional Greek dress. It opened its doors on October 11, 2016 in the city of Kalamata in the southwestern Peloponnese.
    [Show full text]
  • The HELLENIC OPEN BUSSINES ADMINISTRATION Journal
    The HELLENIC OPEN BUSSINES ADMINISTRATION Journal Volume 2 - 2016, No 1 - Author Reprint Edited by: Dimitrios A. Giannias , Professor HELLENIC OPEN UNIVERSITY ISSN: 2407-9332 Athens 2016 Publisher: D. Giannias 1 The HELLENIC OPEN BUSINESS ADMINISTRATION Journal Volume 2 - 2016, No 1 The HELLENIC OPEN BUSINESS ADMINISTRATION Journal Publisher: D. Giannias / Athens 2016 ISSN: 2407-9332 www.hoba.gr 3 The HELLENIC OPEN BUSINESS ADMINISTRATION Journal The HELLENIC OPEN BUSINESS ADMINISTRATION JOURNAL AIMS AND SCOPE The HELLENIC OPEN BUSINESS ADMINISTRATION Journal is published two times a year and focuses on applied and theoretical research in business Administration and economics. Editor: Dimitrios A. Giannias, HELLENIC OPEN UNIVERSITY, Greece Associate Editors: Athanassios Mihiotis, HELLENIC OPEN UNIVERSITY, Greece Eleni Sfakianaki, HELLENIC OPEN UNIVERSITY, Greece Editorial Advisory Board: o M. Suat AKSOY, ERCIYES UNIVERSITY KAYSERI, Turkey o Charalambos Anthopoulos, HELLENIC OPEN UNIVERSITY, Greece o Christina Beneki, TECHNOLOGICAL EDUCATIONAL INSTITUTE OF IONIAN ISLANDS, Greece o George Blanas, TECHNOLOGICAL EDUCATIONAL INSTITUTE OF THESSALY, Greece o Chepurko Yuri, KUBAN STATE UNIVERSITY, Russia o Tuncay Çelik, ERCIYES UNIVERSITY KAYSERI, Turkey o Vida ČIULEVIČIENE, ALEKSANDRAS STULGINSKIS UNIVERSITY, Lithuania 5 The HELLENIC OPEN BUSINESS ADMINISTRATION Journal o Bruno Eeckels, LES ROCHES INTERNATIONAL SCHOOL OF HOTEL MANAGEMENT, Switzerland o Figus Alessandro, LINK CAMPUS UNIVERSITY & UNIVERSITY OF GENOVA, Italy o George Filis, UNIVERSITY
    [Show full text]
  • Flood Risk Perception and Adaptation Capacity
    Flood risk perception and adaptation capacity: a contribution to the socio-hydrology debate Sven Fuchs, Konstantinos Karagiorgos, Kyriaki Kitikidou, Fotios Maris, Spyridon Paparrizos, Thomas Thaler To cite this version: Sven Fuchs, Konstantinos Karagiorgos, Kyriaki Kitikidou, Fotios Maris, Spyridon Paparrizos, et al.. Flood risk perception and adaptation capacity: a contribution to the socio-hydrology debate. Hydrology and Earth System Sciences, European Geosciences Union, 2017, 21 (6), pp.3183-3198. 10.5194/hess-21-3183-2017. hal-03226100 HAL Id: hal-03226100 https://hal.archives-ouvertes.fr/hal-03226100 Submitted on 16 May 2021 HAL is a multi-disciplinary open access L’archive ouverte pluridisciplinaire HAL, est archive for the deposit and dissemination of sci- destinée au dépôt et à la diffusion de documents entific research documents, whether they are pub- scientifiques de niveau recherche, publiés ou non, lished or not. The documents may come from émanant des établissements d’enseignement et de teaching and research institutions in France or recherche français ou étrangers, des laboratoires abroad, or from public or private research centers. publics ou privés. Hydrol. Earth Syst. Sci., 21, 3183–3198, 2017 https://doi.org/10.5194/hess-21-3183-2017 © Author(s) 2017. This work is distributed under the Creative Commons Attribution 3.0 License. Flood risk perception and adaptation capacity: a contribution to the socio-hydrology debate Sven Fuchs1, Konstantinos Karagiorgos1, Kyriaki Kitikidou2, Fotios Maris3, Spyridon Paparrizos4,a, and
    [Show full text]
  • List of Designated Points of Import in Greece
    List of Designated Points of Import for Food in Greece 1. Port of Pireus . Warehouse PCDC, Pireus Consolidation and Distribution Center, N.Ikonio, Perama Attikis . Warehouse C4, Pireus Port Authority SA, N.Ikonio, Perama Attikis . Warehouse C3 and C5 of Pireus Port Organisation SA, Keratsini Attikis CA: Regional Center for Plant Protection, Quality and Phytosanitary Control of Attiki tel: (+30) 2104002850 / 2104326819/ 2104000219 Fax: (+30) 2104009997 email: [email protected] 2 Athens International Airport “Eleftherios Venizelos” Building 26A, Athens International Airport, Spata Attikis CA: Regional Center for Plant Protection, Quality and Phytosanitary Control of Attiki tel: (+30) 2103538456 / 2104002850 / 2104326819/ 2104000219 Fax: (+30) 2103538457, 2104009997 email: [email protected] / [email protected] 3 Athens Customs of Athens, Metamorfosi Attikis CA: Regional Center for Plant Protection, Quality and Phytosanitary Control of Attiki tel: (+30) 2104002850 / 2104326819/ 2104000219 Fax: (+30) 2104009997 email: [email protected] 4 Port of Thessaloniki APENTOMOTIRIO, 26th Octovriou, Gate 12, p.c.54627, Organismos Limena Thessalonikis CA: Regional Center for Plant Protection, Quality and Phytosanitary Control of Thessaloniki tel: (+30) 2310547749 Fax: (+30) 2310476663 / 2310547749 email: [email protected] 5 Thessaloniki International Airport “Makedonia” Thermi, Thessaloniki CA: Regional Center for Plant Protection, Quality and Phytosanitary Control of Thessaloniki tel: (+30) 2310547749 Fax: (+30) 2310476663 / 2310547749 email:
    [Show full text]
  • National Park of East Macedonia - Thrace
    Magazine MAY - AUGUST 2014 NATIONAL PARK OF EAST MACEDONIA - THRACE 1. May 22, 2014 - World Fish Migration Day (WFMD) 2. Compilation of a Layman’s Guide to Identifying Species in the National Park of Eastern Macedonia-Thrace (NPEMT) 3. Smartphone applications for navigating in the National Park of Eastern Macedonia-Thrace 4.Events for World Environment Day 2014 5. Cleaning up of the Heron 7. Third National colony at Porto Lagos Heron Census 8. Ringing and 6. Mass fish death in census of the white Lake Vistonida stork in NPEMT 1 Compilation of a Layman’s Smartphone applications for 3 Events for World May 22, 2014 - World Fish Guide to Identifying Species navigating in the National Park Environment Day 2014 Migration Day (WFMD) 2 in the National Park of Eastern of Eastern Macedonia-Thrace 4 On the occasion of World Environment Day, which is celebrated on June 5th every year, the Management Body organized ac- May 24th has been designated World Fish Migration Day to Macedonia-Thrace (NPEMT) The Nestos Delta-Vistonida-Ismarida Management Body in the tions to provide information and raise public awareness on en- raise awareness on the problems facing fish populations that context of the project “Developing tourism and handling visitors The Nestos Delta-Vistonida-Ismarida Management Body has vironmental issues. become trapped because of hu- in the protected area of the National Park of Eastern Macedonia created a Layman’s Guide to Identifying Species in the National The main events were the man interventions, like dams, and Thrace”, carried out through the “Protection and Conserva- Park of Eastern Macedonia-Thrace in the context of the project youth fests held under the which prevent fish from migrat- tion of Biodiversity in NPEMT” action incorporated in the Opera- “Support for Protected Areas Management Bodies 2012” – auspices of the Xanthi Mu- ing for reproductive purposes.
    [Show full text]
  • TAP Thriving Land Brochure EN
    THRIVING LAND Supporting Agri-food Education CONTENTS 01 THE “THRIVING LAND” PROJECT 04 02 STRUCTURE 05 2.1 Theoretical approach 05 2.2 Practical implementation 06 03 IMPLEMENTING ENTITIES 06 04 SELECTION CRITERIA FOR BENEFICIARIES 07 05 AGRICULTURAL PRODUCTS THE PROJECT FOCUSES ON 07 5.1 Beekeeping, Production & Commercial Development of Honey and Bee Products 08 5.1.1 Beekeeping 08 Regional Units of Drama and Kavala 08 Regional Unit of Pella 08 Regional Units of Florina and Kastoria 09 5.1.2 Production & Commercial Development of Honey and Bee Products 09 5.2 Production of Olive Oil & Development of Origin Identity for Olive Oil/Table Olives 10 Regional Unit of Evros 10 5.3 Cultivation & Promotion of Medicinal and Aromatic Plants 10 Regional Unit of Rodopi 11 Regional Unit of Thessaloniki 11 Regional Unit of Kozani 12 5.4 Cultivation of Beans 12 Regional Unit of Kastoria 12 5.5 Cultivation of Fruit Trees 13 Regional Units of Pella and Kozani 13 5.6 Cultivation of Sugar Cane & Production of Petimezi 13 Regional Unit of Xanthi 13 5.7 Development of Origin Identity for Greek Pepper Varieties 14 Regional Units of Pella and Florina 14 5.8 Tools for the Development of Sheep-and-Goats & Cattle Farming 16 Regional Units of Kozani, Florina, Serres and Thessaloniki 16 5.8.1 Sheep-and-Goats Farming 16 5.8.2 Cattle Farming 17 06 IMPLEMENTATION TIMELINE 18 07 BRIEF PROFILE OF IMPLEMENTING ENTITIES 19 04 01 THE “THRIVING LAND” PROJECT THRIVING LAND is a project that supports Agri-food Education, implemented with funding from the Trans Adriatic Pipeline TAP (Pipeline of Good Energy) in all three Regions of Northern Greece traversed by the pipeline, in the context of TAP’s Social and Environmental Investment (SEI) programme, in collaboration with the Bodossaki Foundation.
    [Show full text]
  • DKV Stations, Sorted by City
    You drive, we care. GR - Diesel & Services Griechenland / Ellás / Greece Sortiert nach Ort Sorted by city » For help, call me! DKV ASSIST - 24h International Free Call* 00800 365 24 365 In case of difficulties concerning the number 00800 please dial the relevant emergency number of the country: Bei unerwarteten Schwierigkeiten mit der Rufnummer 00800, wählen Sie bitte die Notrufnummer des Landes: Andorra / Andorra Latvia / Lettland » +34 934 6311 81 » +370 5249 1109 Austria / Österreich Liechtenstein / Liechtenstein » +43 362 2723 03 » +39 047 2275 160 Belarus / Weißrussland Lithuania / Litauen » 8 820 0071 0365 (national) » +370 5249 1109 » +7 495 1815 306 Luxembourg / Luxemburg Belgium / Belgien » +32 112 5221 1 » +32 112 5221 1 North Macedonia / Nordmazedonien Bosnia-Herzegovina / Bosnien-Herzegowina » +386 2616 5826 » +386 2616 5826 Moldova / Moldawien Bulgaria / Bulgarien » +386 2616 5826 » +359 2804 3805 Montenegro / Montenegro Croatia / Kroatien » +386 2616 5826 » +386 2616 5826 Netherlands / Niederlande Czech Republic / Tschechische Republik » +49 221 8277 9234 » +420 2215 8665 5 Norway / Norwegen Denmark / Dänemark » +47 221 0170 0 » +45 757 2774 0 Poland / Polen Estonia / Estland » +48 618 3198 82 » +370 5249 1109 Portugal / Portugal Finland / Finnland » +34 934 6311 81 » +358 9622 2631 Romania / Rumänien France / Frankreich » +40 264 2079 24 » +33 130 5256 91 Russia / Russland Germany / Deutschland » 8 800 7070 365 (national) » +49 221 8277 564 » +7 495 1815 306 Great Britain / Großbritannien Serbia / Serbien » 0 800 1975 520
    [Show full text]
  • The Politics of Public Burial in Roman Greece (C
    CONTEsTED BONEs: THE POLITIcs OF PUbLIc bURIaL IN ROMaN GREEcE (C. 200 BC – 200 AD)* Abstract: Intra-urban burial had always been a rare honour in Greek culture. Nonetheless by the high point of the Roman Empire tombs could be seen in public spaces in most Greek cities. Some were of heroes believed to have died long ago. Others belonged to recently deceased benefactors. This article explores the role that both types of monument played in defining and shaping relations of power within the Roman period polis. Much can be gained from looking at the two in conjunction. It is argued that increasing evidence for both types of monument under the Empire means that both types of monument did indeed become more numerous at this time. The case is made that many supposedly heroic graves were ‘invented’ not many generations before they were described by our best source for them, Pausanias, and that local elites were a driving force behind this phenomenon as they tried to draw political capital from familial connections, real or fictive, to the illustrious dead. The parallel increase in public tombs for recent benefactors suggests an attempt on the part of the same class to appropriate the heroic associations of these purportedly ancient burials. INTRODUCTiON A remarkable feature of the cities of Greece under the Roman Empire is the extent to which the world of the dead encroached on that of the liv- ing. While the graves of ordinary citizens were typically clustered in cemetery areas outside the city limits, tomb monuments and cenotaphs for more illustrious individuals could be seen in prominent locations in public spaces, such as agoras, streets and gymnasia — spaces that would have been alive with the hustle and bustle of daily life.
    [Show full text]