OBJECTIVE To investigate health-related quality of life (HRQoL) in individuals with rheumatoid arthritis (RA) and identify the factors that influence it. METHOD A cross-sectional study was conducted at the "Asklepieion" General Hospital of Voula from December 2021 to December 2022. The study comprised 110 patients diagnosed with RA. Data collection was conducted using the short version of the SF-12 questionnaire. Data were collected using a convenience sampling approach. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 26.0. RESULTS The mean score for the "physical health" subscale was 54.8 +/- 23.5, while the mean score for the "mental health" subscale was 53.7 +/- 24.2. These scores indicated a moderate quality of life. A statistically significant correlation was found between the "physical health" and "mental health" subscales, with the highest values observed in younger participants and those with a shorter disease duration, a higher level of education, and those who were married and or partnered. No significant statistical correlation was observed between the HRQoL subscales and patients' gender. The coefficient of determination of the model (Radj(2)) was 0.952, with the independent variables "Rheumatoid arthritis duration (years)", "Age" and "Education" explaining 95.2% of the variation in the dependent variable "SF-12 - physical health". Also, the Radj(2) was 0.953, with the independent variables "Rheumatoid arthritis duration (years)", "Age" and "Education" explaining 95.3% of variation in the dependent variable "SF-12 mental health". CONCLUSIONS The present study highlighted the importance of socio-demographic characteristics to the HRQoL of individuals with RA. Healthcare providers should consider these characteristics, in conjunction with the overall impact of the disease, to enhance the quality of life of people suffering from RA.
OBJECTIVE To investigate the self-reported risk of restless legs syndrome (RLS) in the population of Alonnisos and explore its correlation with demographic, dietary, cognitive and behavioral factors. METHOD This cross-sectional epidemiological study involves 236 adult permanent residents of Alonnisos (115 men and 121 women), a number that represents approximately 10% of the local population, making the sample representative of the island's general population. Participants completed questionnaires assessing RLS risk, adherence to the Mediterranean Diet (MedDiet Score), cognitive function (general practitioner assessment of cognition), work ability (Work Ability Index), as well as demographic data. Statistical analysis was performed using GraphPad Prism software, with a significance level set at p<0.05. RESULTS Of the 236 participants, 15.32% were found to be at high risk for RLS. A significant correlation was observed between RLS risk and younger age and lower body mass index (BMI). No statistically significant differences were found in relation to smoking habits, dietary adherence, cognitive function, work ability, or dementia risk. CONCLUSIONS The high proportion of individuals at riskfor RLS in the population of Alonnisos, combined with limited access to healthcare services, highlights the need to strengthen primary health care and develop health promotion programs for remote islands. The findings of this study may contribute to the design of targeted interventions for improving health in similar isolated populations.
In the late 18th and early 19th centuries, Jean Nicolas Corvisart (1755-1821) played a pivotal role in initiating major advances in cardiology, preparing the ground for the emergence of clinical medicine in the 19th century. The rise of the anatomoclinical method at the Paris School of Medicine decisively contributed to the establishment of cardiology as a distinct medical specialty. Clinical examination techniques were expanded through the reintroduction of percussion, promoted by Corvisart, and auscultation with the stethoscope, invented by Ren & eacute;-Th & eacute;ophile-Hyacinthe Laennec (1781-1826).
OBJECTIVE To assess the extent of regional disparities in public primary health care (PHC), focusing on services provided by PHC units owned by regional health authorities (RHAs). METHOD The research was based on the development of resource allocation indicators that highlighted variations between PHC units and hospitals and among RHAs. All data were freely accessible and related to the number of visits to PHC units and hospitals, key RHA's financial figures, staffing of PHC units, and the catchment population per region. RESULTS In an environment of declining visits to public PHC, a tendency for PHC facilities to attract more emergencies than in the past was identified. At the same time, in specific geographical areas, hospitals were found to absorb proportionately more cases, that is, about half of the total. Strong regional disparities were identified among RHAs, starting with their size in terms of the number of visits to PHC units. Two RHAs deviated significantly from the others in terms of medical and nursing staff indicators. Service utilization and productivity also differed significantly, creating the basis for variations in efficiency. At the financial level, additional inequalities were identified, with some RHAs accumulating higher-value assets, more regular income, and more government grants than others. CONCLUSIONS Regional disparities/inequalities in Greek public PHC extend across the entire spectrum of resource allocation. Balance is impossible to achieve through market self-regulation; therefore, the reallocation of resources is assigned to health policy. This process should consider standard indicators of asset and human resource density, service utilization, labor productivity, and efficiency.
The quality of healthcare services is a fundamental priority for modern healthcare systems, with leadership playing a crucial role in shaping a culture of quality and enhancing patient safety. Approaches such as transformational leadership, empowerment-based leadership, and participative management have been shown to positively influence service outcomes. Leaders who focus on strengthening patient safety, fostering a positive organizational culture, and promoting innovation contribute significantly to the sustainability of healthcare systems. The aim of the present article is to analyze the role of leadership behavior in improving healthcare services, focusing on three key dimensions: leadership and patient safety, leadership and organizational culture, and leadership and innovation in healthcare services. The management of the continuous education of healthcare leaders and the integration of technological solutions for monitoring and managing patient safety are future challenges. Leadership executives who promote collaboration, innovation, and continuous education play a decisive role in shaping a positive work environment.
The most common methods of data collection in qualitative research are interviews, focus groups, observation, and Delphi methodology. Interviews are used to explore in depth individuals' opinions, experiences, feelings, perceptions, beliefs, and motivations regarding specific issues. Interviews are divided into structured, semi-structured and unstructured, with semi-structured interviews being used more often. Focus groups are a common method of data collection in qualitative research, in which a group of individuals discuss a specific research topic under the supervision, organization and guidance of a coordinator or, in other words, a facilitator. Focus groups are used to extract information in a collective form and find the interpretations behind this information. In addition, focus groups are used to gain an in-depth understanding of participants' views, experiences, and beliefs at an overall level. Observation in qualitative research usually refers to the observation of individuals (and or events) and is the systematic observation of individuals (and or events) to investigate their behaviors and interactions in their natural environment. Observation is divided into (a) direct observation in which the researcher observes the studied subjects without interacting with them in the study area and (b) participatory observation in which the researcher observes the studied subjects on the one hand and interacts with them in the study area on the other, i.e. acts as both an observer and a participant. The Delphi methodology is a method of agreement or, in other words, consensus and aims to find a general agreement of the views of a group of experts on a particular topic. In particular, it is used in research to solve problems, create research hypotheses and set priorities, while the way agreement is determined may vary from study to study depending on the research subject.
OBJECTIVE To explore the diagnostic value of DNA methylation biomarkers for primary hepatocellular carcinoma (HCC) and their predictive value for chemotherapy sensitivity. METHOD A total of 54 primary HCC patients were enrolled and divided into a hypomethylation group (n=27) and a hypermethylation group (n=27), and 19 matched adjacent normal samples were collected as a control study. The relationship between the clinicopathological features of HCC patients and DNA methylation was analyzed using the Cox regression model. The relationship between the methylation status of HTATIP2 and UCHL1 and the overall survival of HCC patients was analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic prediction ability of methylation markers for HCC and their predictive performance for chemotherapy sensitivity. RESULTS Hypermethylation of HTATIP2 was associated with longer overall survival, while hypermethylation of UCHL1 was associated with shorter overall survival (p<0.05). The ROC curve was used to evaluate the diagnostic prediction ability of methylation markers for HCC, and among them, HTATIP2 showed the highest sensitivity and specificity. CONCLUSIONS The DNA methylation markers HTATIP2 and UCHL1 are of great value for the early diagnosis of primary HCC and the assessment of chemotherapy sensitivity.
Allergic rhinitis (AR) is one of the most common chronic conditions worldwide, with a significant prevalence in Greece as well. Despite its frequency, it is often underdiagnosed and undertreated. It burdens both patients and the healthcare system, as many individuals resort to self-medication, which is often ineffective. Diagnosis of AR is primarily based on typical symptoms and their duration. Classification according to the ARIA guidelines supports management by distinguishing between intermittent or persistent forms and mild or moderate-to-severe intensity. Although a phenotypic approach can offer greater precision, it is not essential in primary health care (PHC). Treatment involves allergen avoidance, pharmacotherapy (mainly intranasal corticosteroids and antihistamines), and, when indicated, specific immunotherapy. Patient adherence to treatment is generally low, which complicates disease control. Supportive measures, such as nasal irrigation, can help alleviate symptoms. Monitoring treatment response is done using the Visual Analog Scale. The Greek ARIA group aims to bridge the gap between international guidelines and Greek clinical practice, promoting shared care pathways and algorithms to improve management. A key strategic goal is to strengthen the role of PHC and general practitioners in the holistic and effective management of AR.
OBJECTIVE Documentation of the experiences of patients who visited the emergency department (ED) of a general hospital in Attica. METHOD A cross-sectional study was conducted using a convenience sample of 350 adult patients and or accompanying persons who visited the ED of "Georgios Gennimatas" General Hospital of Athens, Greece, on general on-call duty days. Data were collected from October 2022 to September 2023 through a structured questionnaire. The questionnaires were completed in the physical presence of the principal investigator, who remained in the ED area throughout the data collection period. RESULTS A total of 53.7% of participants rated their experience in the ED positively, 37.7% rated it as moderate, and 8.6% rated it negatively. The quality of care was assessed as good to very good by 76% of respondents, while 3.7% characterized it as poor. Information provided by healthcare professionals received high ratings from 97.3% of participants. Communication was considered good/very good by 61.8%, moderate by 31.1%, and poor by 7.1%. Additionally, 72.6% of participants reported feeling respected and that their dignity was preserved throughout their stay. Statistically significant associations revealed that patients who experienced better communication with healthcare professionals reported more positive experiences in the ED. Similarly, those who rated the quality of care higher also reported more favorable experiences. Moreover, patients who had better communication with healthcare professionals stated that they received higher quality care, while better information provision was also associated with improved perceived care quality in the ED. CONCLUSIONS The quality of communication between patients and healthcare professionals, along with perceived care, are critical factors contributing to a positive patient experience in the ED. Mere provision of information is insufficient without supportive and empathetic communication. Further investigation into interpersonal communication and the quality of care in the ED may enhance understanding of the factors that influence patient experience.
OBJECTIVE The comparative assessment of the five regional university general hospitals of the Greek National Health System (NHS), based on performance indicators (PIs), for the period 2016-2023. METHOD Data on hospital activity and financial performance for the sampled hospitals were retrieved from the Ministry of Health (MoH), for the period 2016-2023, and a series of indicators were produced. RESULTS For three consecutive years-2020, 2021 and 2022-the total number of hospitalized patients in the sampled hospitals was lower than in 2019. For two consecutive years (2020 and 2021), the total number of hospitalization days in the sampled hospitals was also fewer than those in 2019.The mean pharmaceutical cost per hospitalized patient, the mean cost of hospitalization day and the total mean cost per hospitalized patient, showed a significant increase during the first two years of the pandemic compared to 2019. CONCLUSIONSThe results indicate that the pandemic had a significant impact on the efficiency of the sampled hospitals, particularly in the first two years. Hospitals appeared to handle fewer cases while experiencing an increase in cost indicators.
Long-term care (LTC) is a cornerstone of health systems, providing support to individuals with chronic illnesses, dis-abilities, or age-related difficulties. As a crucial component of post-hospital care, it aims to enhance the quality of life of beneficiaries through both formal and informal services. In Greece, LTC encompasses home-based services, insti-tutional and community-based structures, addressing needs such as nursing care, rehabilitation, and social integra-tion. Informal caregivers, primarily family members, offer essential support but often face psychological, financial, and educational challenges. Necessary measures include financial incentives, legal facilitations, training programs, mental well-being support, and respite care services. Special attention must be given to women, who constitute the majority of informal caregivers and bear a disproportionate burden, underscoring the need for social equity in care-giving responsibilities. The implementation of comprehensive policies that integrate formal and informal care is vital for ensuring high-quality care, supporting caregivers, and maintaining the sustainability of health systems.
OBJECTIVE To record the causes and characteristics of attendance at health services of the populations of two areas in the regional unit of Heraklion in Crete. METHOD The study design employed a retrospective cohort study approach. The research was conducted in two rural-type primary health care (PHC) centers located within the prefecture of Heraklion. The sample comprised 3,783 individuals who visited the emergency departments of these two PHC centers during the period spanning August to October 2020. The data was sourced from the comprehensive records maintained by these centres. Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS), version 26.0. Frequency distributions were generated for patients and visitors in the health care. The Chi-square method was used to determine the frequency of grouped causes according to the ICPC-2 classification system. RESULTS The majority of attendees and visitors were over the age of 65. The month with the highest attendance was August. In October, there was an increase in visits from people under the age of 18. The main reason for attendance at both health centers for the entire period of the study was based on ICPC-2, procedures. During October, the frequency of occurrence as reasons for attendance for symptoms-complaints and infections (p<0.05) increased, while the frequency of attendance for injuries (p<0.05) decreased compared to the two other months of the study. CONCLUSIONS PHC centres play a substantial and highly effective role in providing care to residents. However, certain improvements are necessary to enhance their overall quality.
OBJECTIVE To evaluate the effect of seasons on prevalence of bloodstream infections (BSI) and the multiple antibiotic resistance (MAR) index. METHOD A one-year retrospective review of laboratory records of 1,131 non-repetitive blood cultures was undertaken. The patients consisted of 624 males and 507 females with age range of one day to 100 years. The BACT/ALERT (R) 3D automated blood culture system was used to detect BSI. Identification and susceptibility tests of significant microbial isolates were performed using standard techniques. RESULTS Patients who were less than one year old (p<0.0001), from orthopedic ward (p<0.0001) and their BSI were detected in the month of June (p=0.0371) had higher prevalence of BSIs. Patients were 1.5 times more likely to have BSI in the rainy season compared with the dry season (odds ratio [OR]=1.533 95% confidence interval [CI]=1.179, 1.993; p=0.0017). Klebsiella pneumoniae was the most prevalent etiologic agent of BSI, and was more likely to be recovered in the rainy season (p=0.0003). Coagulase negative Staphylococci, Staphylococcus aureus and Escherichia coli were the predominant cause of BSI in the dry season. The MAR index of isolates recovered during the rainy season (0.61 +/- 0.21) was higher (p=0.0024) than that of isolates from the dry season (0.50 +/- 0.29). Isolates recovered during the rainy season were four times more likely to have MAR index >0.2 than their counterparts recovered during the dry season (OR=4.13,95% CI=2.240, 8.326; p<0.0001). CONCLUSIONS An overall prevalence of BSI of 28.74% was observed. The BSI and MAR index were higher in the rainy season compared to the dry season. The data presented will be useful in the epidemiology and management of BSI.
The purpose of this report is to describe the clinical presentation of multiple myeloma with CRAB (hyperCalcemia, Renal impairment, Anemia, Bone lesion) manifestations and emphasize the importance of a multimodal evaluation. A 51-year-old male presented with complaints of fatigue, excessive sleepiness, chronic back pain, and pain in the right lower rib. Physical examination revealed pale conjunctiva, while vital signs were within normal limits. Laboratory findings showed normochromic normocytic anemia (hemoglobin [Hb] 11.4 g/dL), elevated urea (57 mg/dL) and creatinine (2.06 mg/dL), hypercalcemia (2.5 mmoL/L), as well as proteinuria and hematuria. Non-contrast thoracic computed tomography (CT) demonstrated multiple lytic lesions in the scapula, sternum, ribs, and spine, whereas abdominal CT revealed lytic lesions and osteopenia in the lumbosacral and pelvic bones. Immunological testing detected elevated free light chain kappa (329.88 mg/L) with a kappa/ lambda ratio of 117.40. Bone marrow aspiration showed 90.5% plasmocyte dominance with immunohistochemistry positive for CD38, CD56, CD138, and kappa. Serum protein electrophoresis revealed an M-spike characteristic of multiple myeloma. In conclusion, this case illustrates that multiple myeloma may present with nonspecific symptoms, but diagnosis is established through a combination of laboratory, radiological, immunological, and histopathological evaluations. A multimodal approach is crucial for early detection and prevention of more severe organ complications.
OBJECTIVE To investigate a possible relationship between preterm birth (PTB) prevention via pessary insertion and fetal heart rate variability (HRV), term of birth, neonatal biometry, and Apgar score in women with a short cervix (ShC). METHOD A total of 64 patients with threatened preterm delivery and ShC between 22 and 30 weeks of gestation were enrolled in the study.Thirty patients treated with acute tocolysis, chronic use of nifedipine, progesterone, and cervical pessary insertion were included in group I.Thirty-four pregnant women treated with acute, and chronic tocolytics and progesterone were included in group II. All patients included in the study had no personal history of spontaneous miscarriages or PTB. HRV parameters were obtained from an RR-interval time series recorded from the maternal abdominal wall fetal non-invasive electrocardiography (FNI-ECG).The study protocol also included several parameters: term at birth, neonatal body weight, body length, head circumference, and Apgar score. RESULTS The data on fetal HRV, term at birth, neonatal anthropometry, and Apgar score revealed certain regularities.The mean gestational term at birth was significantly higher in group I. This fact demonstrated that pessary was a useful part of the therapeutic strategy in patients with threatened PTB. The prolongation of pregnancy until the stage of fetal complete development reflected the statistically significant difference of neonatal biometry variables and a tendency to a statistically significant difference in Apgar score between the representatives of groups Iand II.The logistic regression model with term of birth showed the relationship with Apgar score and the pessary insertion. CONCLUSIONS Pessary was an efficient supplement to tocolytics and progesterone in women with threatened PTB. The insertion of pessary contributed to pregnancy prolongation.
OBJECTIVE To explore the impact of job demands, job resources, work-life balance, and supervisor-resident relationship quality on burnout syndrome among medical residents in Indonesia. METHOD This cross-sectional study was conducted between March and July 2024. Data were collected from 938 medical residents across 16 universities in Indonesia. Data collection was carried out online using a Google Form-based questionnaire that had previously undergone validity and reliability testing. RESULTSThe study identified several factors influencing the risk of burnout among medical residents in Indonesia. Red tape was significantly associated with an increased risk of burnout (odds ratio [OR]: 1.40; 95% confidence interval [CI]: 1.07-1.83; p=0.0163). On the other hand, autonomy in work 1 (OR: 0.76; 95% CI: 0.57-0.99; p=0.0466) and autonomy in work 2 (OR: 0.68; 95% CI: 0.51-0.89; p=0.0060) were associated with a reduced risk of burnout. Furthermore, supervisor support (OR: 0.71; 95% CI: 0.54-0.93; p=0.0117), colleague support (OR: 0.55; 95% CI: 0.42-0.72; p<0.0001), and flexible work schedules (OR: 0.53; 95% CI: 0.41-0.70; p<0.0001) were also associated with a reduced risk of burnout. CONCLUSIONS This study highlighted the impact of job demands, job resources, work-life balance, and supervisor-resident relationships on burnout syndrome among medical residents in Indonesia.
OBJECTIVE To explore the role of sociological factors in patients' quality of life and healthcare evaluation. METHOD A written survey was used as the research tool, consisting of 24 questions for patients and five questions on medical data completed by oncologists. The research was conducted in oncology departments in Split, Dubrovnik, and Zadar. The sample included 191 patients undergoing active treatment, most of whom were retired and from working-class backgrounds. RESULTS The majority of patients were diagnosed with breast, gastrointestinal and lung cancer (70.8%), often in advanced stages. Chemotherapy was the predominant treatment modality (56.0%). The most frequently reported feelings after diagnosis were surprise (53.4%), shock (50.3%), stress (46.0%) and fear (45.5%). Emotional support was mainly provided by spouses (35.1%) and children (24.1%). Notably, 71.2% of patients did not seek help from mental health professionals. Most patients reported spending their leisure time reading or watching television (80.1%) and walking (76.9%), while participation in other physical activities was limited. In terms of socio-economic indicators, the majority reported an average material status (84.7%) and perceived their quality of life as normal (82.2%). Most lived in their own home (81.7%), had children (83.8%) and reported a stable family structure (62.8%). CONCLUSIONS This study provided valuable insights into the broader context of cancer care, highlighting the significant influence of social and emotional factors on patient well-being. It underscored the need to strengthen support systems and develop more tailored interventions that address not only the medical but also the psychosocial and economic dimensions of living with cancer.
A 37-year-old woman with Fitzpatrick skin type IV presented for wound healing evaluation following a fractional CO2 laser procedure. She experienced erythema, slight edema, and stinging on the face post-procedure.The patient had no history of chronic skin disease, keloids, or sensitivities to topical ingredients. Physical examination revealed mild to moderate erythema without signs of infection. The patient received wound care using topical therapy with panthenol, madecassoside, and thermal spring water in cream, gel, and serum, against a control with panthenol moisturizer. Clinical evaluation using VISIA (R) camera system found that the treatment side resolved erythema and edema faster than the control side. Although there were short-lived eruptions of acneiform nature, no serious side effects occurred, and there was increased patient satisfaction with the intervention products. In conclusion, topical formulation with panthenol, madecassoside, and thermal spring water was effective for wound healing after fractional CO2 laser treatment and was comparable to usual moisturizers regarding increased patient satisfaction.
Choledochal cyst, a congenital condition in infants and children, is characterized by dilatation of the bile ducts, which manifests as jaundice, abdominal mass and abdominal pain. Choledochal cysts can lead to complications such as cirrhosis and portal hypertension. Therefore, early detection is necessary. A case of a two-year-six-month-old boy with type I choledochal cyst who underwent choledochal cyst excision at six months of age was reported. Two years later, the patient presented with esophageal variceal bleeding, splenomegaly, and hypersplenism. Severe stenosis of the main portal was observed on computed tomography (CT) angiography, along with abnormalities and thickening of the portal branch. Esophagoduodenoscopic examination showed grade II esophageal varices. The patient was diagnosed with portal hypertension secondary to the choledochal cyst. A late consequence of choledochal cysts is portal hypertension. The long-term risk of liver fibrosis and portal hypertension needs to be taken into consideration. Improving the prognosis of children with choledochal cysts requires timely preventive care.
OBJECTIVE Tau o assess whether acute respiratory rehabilitation in patients with pneumonia caused by SARS-CoV-2 reduces the length of hospitalization. METHOD A total of 57 patients (34 men, 23 women) participated in a respiratory rehabilitation program. The monitored parameters included symptom duration before hospitalization, the date of the SARS-CoV-2 test, hospitalization date, rehabilitation initiation date, length of hospitalization, rehabilitation duration, oxygen therapy or use of continuous positive airway pressure (CPAP), heart rate, blood pressure, oxygen saturation, respiratory rate, modified Borg dyspnea scale, and fatigue levels before and after rehabilitation. RESULTS Symptoms before hospitalization lasted from 2 to 21 days (mean: 6.1 +/- 3.4 days). Rehabilitation was initiated, on average, 7.74 +/- 4.76 days after hospitalization. Rehabilitation duration ranged from 1 to 10 days (mean: 4.16 +/- 2.1 days, median:4 days). Total hospitalization length varied from 4 to 20 days. Statistical analysis revealed that longer symptom duration before hospitalization was significantly associated with a longer hospital stay and delayed rehabilitation initiation but did not correlate with the total rehabilitation duration. Half of the patients, 28 (49.12%), experienced symptoms for up to one week prior to hospitalization and initiated rehabilitation within the first week of their hospital stay. CONCLUSIONS The study did not provide clear evidence that acute respiratory rehabilitation directly reduces the length of hospitalization in patients with SARS-CoV-2 pneumonia. Although delayed rehabilitation initiation was linked to longer hospitalization, no direct impact on the total length of hospitalization was found. Further studies are needed to definitively determine the relationship between respiratory rehabilitation and hospitalization outcomes in COVID-19 patients. This study underscores the complexity of recovery from COVID-19 pneumonia and the need for more focused research in the field of respiratory rehabilitation for these patients.
